32290 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 416 and 488

[HCFA–1885–P]

RIN 0938–AH81

Medicare Program; Update of

Ratesetting Methodology, Payment

Rates, Payment Policies, and the List

of Covered Surgical Procedures for

Ambulatory Surgical Centers Effective

October 1, 1998

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Proposed rule.

SUMMARY: In this rule we propose to—

• Update the criteria for determining

which surgical procedures can be

appropriately and safely performed in

an ambulatory surgical center (ASC);

• Make additions to and deletions

from the current list of Medicare

covered ASC procedures based on the

revised criteria;

• Rebase the ASC payment rates

using cost, charge, and utilization data

collected by a 1994 survey of ASCs;

• Refine the ratesetting methodology

that was implemented by a final notice

published on February 8, 1990 in the

Federal Register;

• Require that ASC payment,

coverage, and wage index updates be

implemented annually on January 1

rather than having these updates occur

randomly throughout the year;

• Reduce regulatory burden; and

• Make several technical policy

changes.

This proposed rule implements

requirements of section 1833(i)(1) and

(2) of the Social Security Act.

DATES: Comments will be considered if

we receive them at the appropriate

address, as provided below, no later

than 5 p.m. on August 11, 1998.

ADDRESSES: Mail written comments (1

original and 3 copies) to the following

address: Health Care Financing

Administration, Department of Health

and Human Services, Attention: HCFA–

1885-P, P.O. Box 26688, Baltimore, MD

21207–5178.

If you prefer, you may deliver your

written comments (1 original and 3

copies) to one of the following

addresses:

Room 309–G, Hubert H. Humphrey

Building, 200 Independence Avenue,

SW., Washington, DC 20201, or

Room C5–09–26, 7500 Security

Boulevard, Baltimore, MD 21244–

1850.

FOR FURTHER INFORMATION CONTACT: Joan

H. Sanow, (410) 786–5723.

SUPPLEMENTARY INFORMATION: Because of

staffing and resource limitations, we

cannot accept comments by facsimile

(FAX) transmission. In commenting,

please refer to file code HCFA–1885–P.

Comments received timely will be

available for public inspection as they

are received, generally beginning

approximately 3 weeks after publication

of a document, in Room 309–G of the

Department’s offices at 200

Independence Avenue, SW.,

Washington, DC, on Monday through

Friday of each week from 8:30 a.m. to

5 p.m. (phone: (202) 690–7890).

Copies: To order copies of the Federal

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your request to: New Orders,

Superintendent of Documents, P.O. Box

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Table of Contents

I. Background

A. Legislative History

B. Published Changes to ASC List

C. Published Changes to ASC Payment

Rates

D. Payment Rate for Extracorporeal Shock

Wave Lithotripsy

E. ASC Town Meeting (July 1996)

F. Revisions to the Conditions for Coverage

of ASCs

II. Comments

III. Provisions of the Proposed Regulations

A. Basis and Scope (proposed § 416.1)

B. Definitions (§ 416.2)

C. Basic requirements (proposed § 416.3

and § 416.4)

D. Additions to/Deletions from the ASC list

1. Revision of 42 CFR 416.65

2. Eliminate Numeric Thresholds

3. Formation of Advisory Group

4. Proposed Additions to the ASC List

a. Additions Suggested by Commenters

b. Proposed Additions Resulting from

Changes to CPT

c. Proposed Additions Resulting from

Ambulatory Payment Classification

(APC) Groupings

5. Proposed Deletions and Exclusions from

the ASC List

a. Procedures Excluded For Reasons of

Safety, Reasonableness and Medical

Necessity

b. Unlisted procedures

c. Exclusion of Office-Based Procedures

d. Suggested Additions Not Accepted

e. Procedures Deleted Because of CPT

Coding Changes

f. Procedures Recommended by

Commenter for Deletion

6. Comments on the ASC List

E. Ratesetting Methodology

1. Current method

2. Proposed ratesetting method—

Determine a per-procedure cost for every

reported CPT code at the individual

facility level

a. Use 1994 Survey Data

b. Audit Representative Sample of

Facilities

c. Adjust Audited Surveys

d. Standardize Unaudited Costs and

Charges

e. Calculate Facility-Specific Cost-toCharge Ratio

5f. Convert Each Procedure Charge to a

Procedure Cost

g. Remove Intraocular Lens (IOL) Costs

from Four Lens Insertion Procedures

h. Calculate Facility Specific Portion of

Procedure Cost Attributable to Labor

Expenses

i. Deflation by Wage Index Value

j. Adjust Reported Costs for Inflation to

Offset Fiscal Year Differences Among

Facilities

3. Proposed ratesetting method:—

Determine the median per-procedure

cost, across all facilities, for each

reported CPT code

a. Weights

b. Determination of weighted, trimmed

median per procedure cost across all

facilities

4. Proposed ratesetting method:—Establish

procedure groupings

a. Current Classification System

b. Proposed Ambulatory Payment

Classification System

5. Proposed ratesetting methodology:—

Determine a standard payment rate for

the procedures within each group

a. Setting rates based on ASC survey data

b. Setting Rates for Procedures with

Limited Medicare Volume or Aberrant

Cost Data
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32291

c. Payment rate for CPT code 67027,

Implantation of intravitreal drug delivery

system

6. Payment Policy Indicators

7. Comments on proposed ambulatory

payment classification groups, payment

policy indicators and payment rates

8. Carrier adjustment of base rates to

determine payment amounts

9. Using Resource Costing to Determine

Procedure Costs

We are disappointed by our lack of

success in the 1994 ASC survey in

gathering usable resource cost data. Our

inability to establish weights and base

ASC payment rates on the resource cost

data that we did collect is particularly

frustrating in light of the fact that we

expect, beginning January 1, 1999, to

make payments to physicians under the

Medicare physicians’ fee schedule that

are determined in part on the basis of

resource-based practice expense relative

units. We have been closely monitoring

the development of the resource-based

practice expense relative value units

under the physicians’ fee schedule and

the ratesetting method for the hospital

outpatient prospective payment system,

which is also scheduled for

implementation effective January 1,

1999. When we rebase ASC payment

rates following the next ASC survey, we

are committed to reexamining the

resource-based practice expense relative

value units established under the

Medicare physicians’ fee schedule and

the weights developed under the

hospital outpatient prospective payment

system for their applicability to ASC

ratesetting in order to advance towards

our goal of setting rates in a manner that

is consistent across different sites of

service.

F. Scope of ASC Services (§ 416.21)

1. ASC Services

2. Venous Access Portals are ASC Facility

Services

3. Acquisition of corneal tissue is an ASC

service

4. Outside the Scope of ASC Services

G. Basis for Payment (§ 416.30)

1. Hospital outpatient department (HOPD)

2. ASCs Operated by a Hospital

3. Medicare approved ASCs

H. Extracorporeal Shock Wave Lithotripsy

(ESWL)

1. Background

2. Comments

I. Schedule and Publication of Updates

1. Update of ASC list

2. Update of ASC Payment Rates

J. Technical Changes to 42 CFR Part 416

1. ASC payment rates

2. ASC survey

K. Explanation and Use of Addenda

IV. Collection of Information Requirements

V. Regulatory Impact Analysis

A. Rebased payment rates

1. Impact on ASCs

B. Additions to/Deletions from the ASC list

C. Impact of Technical Changes

D. Impact on Hospitals and Small Rural

Hospitals

SUPPLEMENTARY INFORMATION:

I. Background

A. Legislative History

Section 1832(a)(2)(F)(i) of the Social

Security Act (the Act) provides that

benefits under the Medicare

Supplementary Medical Insurance

program (Part B) include payment for

facility services furnished in connection

with surgical procedures specified by

the Secretary and performed in an

ambulatory surgical center (ASC).

The Secretary is to review and update

the list of ASC procedures biennially.

To participate in the Medicare

program as an ASC, a facility must meet

the standards specified under section

1832(a)(2)(F)(i) of the Act and 42 CFR

416.25, which sets forth general

conditions and requirements for ASCs.

Generally, there are two primary

elements in the total cost of performing

a surgical procedure: the cost of the

physician’s professional services for

performing the procedure, and the cost

of services furnished by the facility

where the procedure is performed (for

example, surgical supplies and

equipment and nursing services).

Section 1833(i)(2)(A) of the Act

addresses what the ASC facility fee is

intended to represent and how the

amount of the Medicare payment for

ASC facility services is to be

determined. It requires us to review and

update ASC payment amounts annually.

The ASC payment rate is to be a

standard overhead amount established

on the basis of our estimate of a fair fee

that takes into account the costs

incurred by ASCs generally in providing

facility services in connection with

performing a specific procedure. The

Report of the Conference Committee

accompanying section 934 of the

Omnibus Budget Reconciliation Act of

1980 (Public Law 96–499), which

enacted the ASC benefit in December

1980, states, ‘‘This overhead factor is

expected to be calculated on a

prospective basis * * * utilizing sample

survey and similar techniques to

establish reasonable estimated overhead

allowances for each of the listed

procedures which take account of

volume (within reasonable limits).’’ (See

H.R. Rep. No 1479, 96th Cong., 2nd

Sess. 134 (1980).)

In order to estimate the amount of

those reasonable allowances, we are

required by section 1833(i)(2)(A)(i) of

the Act to survey the actual audited

costs incurred by a representative

sample of facilities in connection with

a representative sample of procedures.

This survey is to be conducted every

five years, beginning no later than

January 1, 1995.

Because payment for ASC facility

services is subject to the usual Medicare

Part B deductible and coinsurance

requirements, Medicare pays

participating ASCs 80 percent of the

prospectively-determined rate, adjusted

for regional wage variations.

Section 1833(i)(2)(A)(ii) requires that

the ASC payment rates result in

substantially lower Medicare

expenditures than would have been

paid if the same procedure had been

performed on an inpatient basis in a

hospital. Section 1833(i)(2)(A)(iii)

requires that payment for insertion of an

intraocular lens (IOL) include an

allowance for the IOL that is reasonable

and related to the cost of acquiring the

class of lens involved.

Under section 1833(i)(3)(A), the

aggregate payment to hospital outpatient

departments for covered ASC

procedures is equal to the lesser of the

following amounts:

• The amount paid for the same

services that would be paid to the

hospital under section 1833(a)(2)(B)

(that is, the lower of the hospital’s

reasonable costs or customary charges

less deductibles and coinsurance).

• The amount determined under

section 1833(i)(3)(B)(i) based on a blend

of the lower of the hospital’s reasonable

costs or customary charges, less

deductibles and coinsurance, and the

amount that would be paid to a freestanding ASC in the same area for the

same procedures.

Under section 1833(i)(3)(B)(i), the

blend amount for a cost reporting period

is the sum of the hospital cost

proportion and the ASC cost proportion.

Under section 1833(i)(3)(B)(ii), the

hospital cost proportion and the ASC

cost proportion for portions of cost

reporting periods beginning on or after

January 1, 1991 are 42 and 58 percent,

respectively. Section 4521 of the

Balanced Budget Act of 1997 (BBA

1997) (Public Law 105–33) amended

section 1833(i)(3)(B)(i)(II) of the Act to

eliminate the formula-driven

overpayment (FDO) for ASC procedures.

Section 13531 of the Omnibus Budget

Reconciliation Act of 1993 (OBRA 1993)

(Public Law 103–66), prohibited the

Secretary from providing for any

inflation update in the payment

amounts for ASCs determined under

section 1833(i)(2)(A) of the Act for fiscal

years (FYs) 1994 and 1995. Section

13533 of OBRA 1993 established $150

as the amount of payment allowed for

an IOL inserted during or subsequent to

cataract surgery in an ASC on or after
32292 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

January 1, 1994, and before January 1,

1999.

Section 141(a)(1) of the Social

Security Act Amendments of 1994

(SSAA 1994) (Public Law 103–432)

amended section 1833(i)(2)(A)(i) of the

Act to require that a quinquennial

survey of ASCs be taken beginning not

later than January 1, 1995.

Section 141(a)(2) of SSAA 1994 added

section 1833(i)(2)(C) to the Act to

provide that, beginning with FY 1996,

there be an adjustment for inflation

during fiscal years when the Secretary

does not update ASC rates based on

actual audited costs determined by

surveying a representative sample of

facilities. Section 1833(i)(2)(C) of the

Act provides that ASC payment rates are

to increased by the percentage increase

in the consumer price index for urban

consumers (CPI–U), as estimated by the

Secretary for the 12-month period

ending with the midpoint of the year

involved, beginning with FY 1996.

Section 141(a)(3) of SSAA 1994

amended section 1833(i)(1) of the Act to

require the Secretary to consult with

appropriate trade and professional

organizations in specifying the

procedures that constitute the ASC list.

Section 141(b) of SSAA 1994 requires

the Secretary to establish a process for

reviewing the appropriateness of the

payment amount provided under

section 1833(i)(2)(A)(iii) of the Act for

IOLs with respect to a class of newtechnology IOLs. That process is the

subject of a separate notice of proposed

rulemaking entitled ‘‘Adjustment in

Payment Amounts for New Technology

Intraocular Lenses’’ (BPD–831–P)

published in the Federal Register on

September 9, 1997 at 62 FR 46698.

Section 4555 of BBA 1997 amended

section 1833(i)(2)(C) of the Act to limit

the annual adjustment of ASC payment

rates provided for in that paragraph to

the CPI–U increase reduced by 2.0

percentage points (but not below zero)

for fiscal years 1998 through 2002.

B. Published Changes to ASC List

We published a final notice in the

Federal Register on February 8, 1990

(55 FR 4526) in which we implemented

a new ratesetting methodology that

increased the number of ASC payment

groups from four to the current eight

groups. We assigned a new payment rate

to each of the nearly 1500 current

procedural technology (CPT) codes on

the ASC list at that time, and we revised

the ASC list to be consistent with CPT

coding changes effected by The

American Medical Association in 1988

and 1989.

Federal Register notices adding codes

to and deleting codes from the ASC list

were subsequently published as follows:

• December 31, 1991 notice with

comment period (56 FR 67666) in which

we added approximately 900 CPT codes

to the ASC list, including CPT code

50590, Extracorporeal shock wave

lithotripsy (ESWL).

• January 26, 1995 final notice with

comment period (60 FR 5185) in which

we updated the ASC list to reflect CPT

changes that had occurred during the

interval since publication of the

December 31, 1991 notice. We deleted

five codes from the ASC list on the basis

of modified quantitative criteria that we

adopted to determine whether or not a

procedures should be retained on the

list. We added nearly 30 codes that met

our numeric criteria of adding to the list

procedures performed at least 20

percent of the time on a hospital

inpatient basis but no more than 50

percent of the time in a physician’s

office, based on national claims history

data. We solicited public comment on

certain additions to and deletions from

the ASC list and the payment rates

assigned to the additions. We respond to

those comments in this notice.

C. Published Changes to ASC Payment

Rates

In a final notice published in the

Federal Register on February 8, 1990

(55 FR 4526), we explained the new

ASC ratesetting methodology and

increased the number of ASC payment

groups from four to the current eight

groups on the basis of ASC survey data

collected in 1986. The rates that

Medicare paid for services furnished on

or after March 12, 1990 under the new

eight-group payment methodology were

published in a separate notice with

comment period in the same February 8,

1990 Federal Register (55 FR 4577).

Subsequent updates of the ASC

payment rates are as follows:

• July 5, 1990 Federal Register notice

with comment period (55 FR 27690)

increased payment rates by a CPI–U

factor of 4.21 percent;

• December 31, 1991 Federal Register

notice with comment period (56 FR

67666) increased payment rates by a

CPI–U factor of 5.1 percent and added

a ninth payment group for ESWL;

• October 1, 1992 Federal Register

notice with comment period (57 FR

45544) increased payment rates by a

CPI–U factor of 3.5 percent;

• September 26, 1995 Federal

Register notice (60 FR 49619) increased

payment rates by a CPI–U factor of 3.2

percent;

• October 1, 1996 Federal Register

notice (61 FR 51295) increased payment

rates by a CPI–U factor of 2.6 percent;

• February 19, 1998 Federal Register

notice (62 FR 8462) Increased payments

rates by 0.6 percent effective for services

furnished on or after October 1,1997.

The ASC payment rates implemented by

this notice, which are currently in

effect, are:

Group 1—$314 ......... Group 5—$678.

Group 2—$422 ......... Group 6—$789 (639

+ 150 for IOL).

Group 3—$482 ......... Group 7—$941.

Group 4—$595 ......... Group 8—$928 (778

+ 150 for IOL).

There is no payment rate shown for

group 9 because of the decision in

American Lithotripsy Society v.

Sullivan, 785 F. Supp. 1034 (D.D.C.

1992) that prohibits payment for these

services under the ASC benefit at this

time. Payment for ESWL as an ASC

service is discussed below.

D. Payment Rate for Extracorporeal

Shock Wave Lithotripsy

In the Federal Register published

December 7, 1990, (55 FR 50590), we

published a notice proposing additions

to and deletions from the ASC list. We

solicited comments on our proposal to

add CPT code 50590, Lithotripsy,

extracorporeal shock wave, to the ASC

list and on the Group 7 payment rate of

$812 that we proposed as the ASC

facility fee for the procedure. We also

requested detailed information on

facility charges and costs associated

with providing ESWL services to help

us evaluate the appropriateness of the

proposed payment rate.

In the final notice with comment

period published December 31, 1991 in

the Federal Register (56 FR 67666), we

established a payment rate for ESWL as

new ASC payment group 9. We set the

group 9 rate at $1,150, effective for

services furnished on or after January

30, 1992. On January 30, 1992, the

American Lithotripsy Society filed a

complaint and motion to enjoin

enforcement and implementation of the

December 31, 1991 notice insofar as it

concerned ESWL. In American

Lithotripsy Society v. Louis W. Sullivan,

M.D., et al, 785 F. Supp. 1034 (D.D.C.

1992), the American Lithotripsy Society

challenged HCFA’s determination that

ESWL is a surgical procedure under the

ASC benefit and the amount payable for

ESWL services in an ASC. The plaintiff

alleged that the $1,150 rate was not

based on an estimate of a ‘‘fair fee’’ that

took into account costs incurred by

ASCs performing such services as

required by section 1833(i)(2)(A) of the
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32293

Act and that the rate was not supported

by the administrative record.

On March 12, 1992, the United States

District Court for the District of

Columbia held that HCFA’s decision to

classify ESWL as a surgical procedure

was rationally justified. However, it

remanded the final notice setting a rate

for lithotripsy to the Secretary for

further consideration and stayed the

regulation, insofar as it related to ESWL,

pending remand. On remand, the

Secretary is required to publish all

material information that is relevant to

the setting of the ESWL rate, receive

comments, and publish a final notice in

accordance with the applicable statutes

and regulations.

To comply with the court order,

Medicare ceased paying an ASC facility

fee for ESWL services furnished in

Medicare approved ASCs and resumed

making payment on a reasonable cost

basis for ESWL furnished in a hospital

outpatient setting. On October 1, 1993,

we published a proposed notice with

comment period in the Federal Register

(58 FR 51355) in which we proposed a

revised ASC payment rate of $1,000,

based on further consideration of the

data and methodology that we used to

determine the rate. We explained in

detail in the October 1, 1993 notice how

we arrived at the proposed rate, and we

solicited information on ESWL costs,

charges, and utilization to enable us to

further evaluate the appropriateness of

the assumptions that we used to

develop the proposed rate. The

information submitted during the public

comment period persuaded us to defer

publication of a final notice and

implementation of an ASC facility fee

for ESWL, pending completion of the

1994 ASC survey that was about to be

conducted. In this notice of proposed

rulemaking we respond to the

comments that were submitted timely

following publication of the October 1,

1993 notice, and we propose an ASC

payment rate for ESWL services that we

have determined in accordance with the

ratesetting methodology that is also

proposed in this notice. In accordance

with applicable statutes and regulations,

this notice of proposed rulemaking

includes all material information that is

relevant to the setting of ASC payment

rates, which includes a payment rate for

ESWL. Publication of this notice of

proposed rulemaking is followed by a

60-day public comment period. When

the comment period closes, and

following review of all comments

submitted timely, we shall publish a

final notice to implement rebased ASC

payment rates for procedures on the

ASC list, including ESWL.

E. ASC Town Meeting (July 1996)

Many of the policy changes proposed

in this notice had their genesis in

discussions and comments that

emanated from an ASC ‘‘Town Meeting’’

that was held at the central office of the

Health Care Financing Administration

on July 25–26, 1996. The purpose of the

Town Meeting was to give

representatives of professional and trade

associations and other parties with an

interest in ASCs an opportunity to come

together with HCFA staff to exchange

information and ideas regarding

Medicare ASC policy. More than 100

people from across the country

attended, including physicians, nurses,

ASC administrators, and representatives

of independent and chain facilities,

State licensing and certification

agencies, and numerous professional

societies and ASC trade associations.

From the Town Meeting, we gained a

greater understanding of some of the

immediate and long-term issues and

concerns facing ASC staff and partners,

and we received numerous suggestions

and recommendations on ways to

strengthen the ASC benefit on behalf of

Medicare beneficiaries.

The first day’s meetings focussed on

performance outcome measures for

ASCs and conditions for coverage of

ASCs. The second day of the meeting

focussed on the criteria HCFA uses to

determine which procedures should be

placed on the ASC list and the method

HCFA uses to set ASC payment rates.

Following the Town Meeting, we

received 79 written comments

reiterating concerns and suggestions

that were raised during the meeting

itself.

Virtually every commenter submitted

a critique of a grouping system that we

presented at the meeting as a possible

alternative to the current eight ASC

payment groups. We had distributed to

participants a listing of CPT surgical

codes arranged in ‘‘Ambulatory Patient

Groups’’ (APGs). These groups were

developed by 3M Health Information

Systems with the support of HCFA. The

list was taken from The Ambulatory

Patient Groups Definitions Manual,

Version 2.0. Only groups of CPT codes

were shown; no payment rates or

procedure costs were given. We were

primarily interested in whether or not

participants found the groups to be

clinically homogeneous as well as

consistent in terms of resource costs.

Commenters were unanimous in

disagreeing with the internal

consistency of numerous APG groups

across most body systems. The

commenters’ examples and reasons for

taking issue with the homogeneity of the

APGs prompted us to re-examine the

groups. We did so, which resulted in the

revision and reclassification of most of

the groups. The product of that exercise

is the ambulatory payment classification

(APC) system that we propose in this

notice as the basis for ASC ratesetting.

F. Revisions to the Conditions for

Coverage of ASCs

The standards and conditions for

coverage of an ASC currently found in

subpart C of 42 CFR part 416 are being

revised and are the subject of a separate

notice currently under development.

II. Comments

In the final notice with comment

period published January 26, 1995 in

the Federal Register (60 FR 5185), we

solicited comments on certain changes

to the ASC list that we had not included

in the proposed notice published on

December 14, 1993 (58 FR 65357).

Specifically, we asked for comments on

our deletion from the ASC list of any

codes that had been deleted in CPT

1994, and we asked for comments about

our deletion from the ASC list of CPT

code 36522 Photopheresis,

extracorporeal. We received 9 comments

supporting the deletion of CPT code

36522 from the ASC list and no

comments disagreeing with our

decision. We received no comments

regarding the other deletions from the

ASC list.

We also requested comments on the

addition of, and assignment of payment

groups for, certain CPT codes that were

not proposed in the December 14, 1993

Federal Register. We have limited our

response to comments that were

submitted timely regarding the specified

codes.

We specifically solicited comments

on the addition to the ASC list of certain

codes that were added to CPT 1994 as

well as the appropriateness of the

payment groups to which we assigned

those codes. No commenters disagreed

with adding the codes to the ASC list.

However, commenters indicated that

they believed the payment rate assigned

to the following CPT codes was too low:

19125

19126

29804

31235

31238

31239

31248

31249

31251

31266

31269

31271

31280

31281
32294 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

31282

31283

31284

31286

31287

31288

43216

43259

44394

45339

56309

56316

56317

56351

56356

64421

66172

Response: As a consequence of the

following codes being deleted from CPT

in 1995, we excluded them from the

ASC list: 31248, 31249, 31251, 31266,

31269, 31271, 31280, 31281, 31282,

31283, 31284, 31286. CPT code 64421 is

one of the codes that we are proposing

in this notice to delete from the ASC list

(section III.D). For all but four of the

remaining codes, consistent with

commenters’ recommendations, the

payment rates that we propose in this

notice using the revised ratesetting

methodology and 1994 survey data are

higher than what we proposed in the

January 26, 1995 Federal Register.

However, the same revised ratesetting

methodology and 1994 survey data

result in payment rates for CPT codes

19125 (APC 197), 19126 (APC 197),

43259 (APC 449), and 66172 (APC 652)

that are lower than the rates we

proposed in the January 26, 1995

Federal Register, which is at variance

with commenters’ recommendations.

We welcome comments on the rebased

rates that are proposed as payments for

all of these codes, but request that

arguments for changes in payment rates

be supported by data regarding direct

costs (supplies, equipment, labor, time)

relative to other procedures in the same

APC group that would justify a change

in either the APC group assignment or

the payment rate determined for the

code.

III. Provisions of the Proposed

Regulations

Many of the changes that we are

proposing to make in 42 CFR part 416,

Ambulatory Surgical Services, were

stimulated by our commitment to assist

in the President and Vice President’s

continuing drive to reinvent government

and government regulations and to

reform the Federal government’s

regulatory process. The reorganization

of 42 CFR part 416 represents an effort

to balance a reduction in regulatory

requirements with adequate assurances

that the ambulatory surgical services

that we are purchasing for Medicare

beneficiaries are of the highest quality

and consistent with our commitment to

work in partnership with the rest of the

health care community to institute

better, more common sense ways of

operating that are in the best interests of

Medicare beneficiaries. An outline of

the reorganization that we propose to

make to part 416 in this notice follows:

Current organization Citation Proposed organization Citation

Subpart A—General Provisions and Definitions: Subpart A—Definitions and General Provisions

and Requirements:

Basis and Scope ............................................ 416.1 ......................... Basis and Scope ............................................... 416.1

Definitions ....................................................... 416.2 ......................... Definitions .......................................................... 416.2

Subpart B—General Conditions and Requirements:

Basic requirements ........................................ 416.25 ....................... Basic requirements ............................................... 416.3

Qualifying for an agreement .......................... 416.26

Deemed Compliance .............................. 416.26(a) ................... Currently addressed in 42 CFR 488 ..................... 42 CFR 488

Survey of ASCs ...................................... 416.26(b) ................... Currently addressed in 42 CFR 488 ..................... 42 CFR 488

Acceptance of the ASC .......................... 416.26(c) ................... Replaced by 416.3(h) and (i) ................................ 416.3(h), (i)

Filing of agreement ................................. 416.26(d) ................... Replaced by 416.3(h) and (i) ................................ 416.3(h), (i)

Acceptance; Appeal Rights ..................... 416.26(e)–(f) .............. Replaced by 416.3 (h) and (i) ............................... 416.3(h), (i)

Terms of agreement with HCFA .................... 416.30(a)–(e) ............. Moves to Basic requirements ............................... 416.3

ASC operated by a hospital ........................... 416.30(f) .................... Moved to ‘‘Definitions’’ and ‘‘Basis for payment’’ 416.2 & 416.30

Additional provisions ...................................... 416.30(g) ................... Deleted .................................................................. N.A.

Termination of agreement .............................. 416.35 ....................... Termination of participation, including billing privileges.416.4

Subpart C—Specific Conditions for Coverage: ............................... Subpart D—Specific Conditions of Coverage:

Compliance with State licensure law ............. 416.40 ....................... Basic Requirements .......................................... 416.3

Conditions for Coverage ................................ 416.41–416.49 .......... Proposed Subpart D .......................................... 416.41–416.49

Subpart D—Scope of Benefits: Subpart B—Scope of Benefits:

General rules .................................................. 416.60 ....................... General rules ..................................................... 416.20

Scope of facility services ............................... 416.61 ....................... Scope of ASC Services ..................................... 416.21

Covered surgical procedures ......................... 416.65 ....................... ASC List ............................................................. 416.22

Performance of listed surgical procedures on

an inpatient hospital basis.

416.75 ....................... Performance of procedures on the ASC list in a

hospital inpatient setting.

416.23

Subpart E—Payment for Facility Services: Subpart C—Payment for Facility Services:

Basis for payment .......................................... 416.120 ..................... Basis for payment .............................................. 416.30

ASC facility services payment rate ................ 416.125 ..................... ASC payment rates ........................................... 416.31

Publication of revised payment methodologies.416.130 ..................... Publication of revised payment rates ................ 416.32

Surveys .......................................................... 416.140 ..................... Surveys .............................................................. 416.33

Beneficiary appeals ........................................ 416.150 ..................... Beneficiary appeals ........................................... 416.34

A. Basis and Scope (Proposed § 416.1)

Most of the changes in this section are

of a technical nature. In § 416.1(a)(1) we

propose to revise the description of the

ASC benefit to make it more consistent

with section 1832(a)(2)(F)(i) of the Act.

We further propose to add the statutory

basis for the conditions for coverage of

ASCs as new § 416.1(a)(2). And, we

have deleted the reference to ‘‘a hospital

outpatient department’’ in new

paragraph § 416.1(a)(3) because the

content of part 416 of the Code of

Federal Regulations pertains exclusively

to ASCs under the benefit provided in

section 1832(a)(2)(F)(i) of the Act. The
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current § 416.1(a)(3) would become new

§ 416.1(a)(4).

In § 416.1(b), which defines the scope

of the regulation, we propose to reorder

paragraphs (1), (2), and (3) to parallel

the reorganization of 42 CFR part 416.

We are reorganizing the regulations to

make them simpler, more

understandable, less prescriptive, less

process-oriented, and more focussed on

patient-centered outcomes. Section

416.1(b)(1) applies to renamed subpart

B, which describes the scope of the ASC

benefit, including the scope of ASC

services and the criteria that HCFA uses

to determine those procedures for which

Medicare pays an ASC facility fee.

Section 416.1(b)(2) applies to new

subpart C, which sets forth the manner

in which Medicare determines and

makes payments for ASC services.

Section 416.1(b)(3) refers to new subpart

D, to which we propose to move the

conditions for coverage of a Medicare

approved ASC. Revisions to the

conditions for coverage that an ASC

must meet in order to be certified for

participation in Medicare are the subject

of a separate notice of proposed

rulemaking currently under

development entitled ‘‘Conditions for

Coverage of Ambulatory Surgical

Centers’’ (HCFA–1887–P). In the

reorganized part 416, there is no subpart

E.

B. Definitions (§ 416.2)

We propose to update and clarify the

definition of several basic terms as they

are used in 42 CFR part 416. Rather than

being generic, these definitions are

specific to Medicare approved ASCs and

the implementation of the Medicare

ASC benefit.

When section 934 of the Omnibus

Reconciliation Act of 1980 added to the

benefits available under Part B of

Medicare facility services associated

with certain surgical procedures

provided in an ASC, the Act did not

define an ASC other than to imply that

it was a facility that is different from a

hospital outpatient department, a

physician’s office, and a rural primary

care hospital. Therefore, in order to

implement the benefit, we must identify

ASCs in order to be able to distinguish

them from other types of facilities.

Otherwise, we would not know if

Medicare payments for ASC facility

services under section 1832(a)(2)(F)

were being made properly, in

accordance with the statute and with

Medicare rules and regulations.

The definition of an ASC that is

currently found at § 416.2 became

effective following publication on

August 5, 1982 of the final rule (47 FR

34082) that implemented the ASC

benefit initially. Since 1982, ASCs as a

type of facility have evolved

significantly. In 1982 there were

approximately 40 ASCs in existence. By

the end of 1997, the number of

Medicare-approved ASCs exceeded

2400. We have found the 1982

definition of an ASC to be so broad and

general that it is increasingly difficult

for us to make a definitive

determination whether a facility is an

ASC for the purposes of Medicare

approval. This is especially true in the

health care delivery system of the late

1990s, which is in a state of dynamic

and constant reformation. Therefore, we

have revised the definition of an ASC in

§ 416.2 to be more specific in

distinguishing ASCs from other

categories of facilities.

The first important criterion in

distinguishing ASCs is to recognize that,

for Medicare purposes, an ASC is a

supplier of health care services. It is not

a Medicare provider, as that term is

defined by statute and regulation.

A second criterion critical to

understanding how HCFA defines ASCs

for purposes of entitlement to Medicare

payment is that an ASC is an entity that

is separate and must be distinguishable

from any other entity or type of facility.

We define ‘‘separate’’ as meaning totally

separate with respect to licensure,

accreditation, governance, professional

supervision, administrative functions,

clinical services, recordkeeping,

financial and accounting systems, and

national identifier or supplier number.

The word ‘‘separate’’ does not

necessarily refer to the actual physical

space the ASC occupies. An ASC may

be physically located within the space

of another entity and still be considered

separate for Medicare payment purposes

within this definition.

If a facility that considers itself an

‘‘ASC’’ were to bill Medicare for

services using a hospital’s identification

number, Medicare could not pay the

facility under the benefit established in

the Act at section 1832(a)(2)(F). Though

a facility may be called an ‘‘ASC’’ and

may be located in a separate building or

at a site removed from a hospital’s

campus, Medicare does not consider the

facility to be an ASC unless the facility

has its own license and accreditation,

governing board, system for professional

supervision, clinical services, and

administrative functions, and its own

Medicare billing and identification

number.

Similarly, Medicare cannot pay an

ASC facility fee for procedures

performed in a suite, treatment room,

office or clinic unless the site has been

approved by Medicare as an ASC in

accordance with the regulations.

We recognize that this requirement

that an ASC be a separate entity may be

onerous to ASCs that are owned by a

large health system seeking to share

services or to consolidate with other

member entities. The statutory

requirement for setting ASC payment

rates is at the heart of our requirement

that an ASC be an entity or facility that

is separate from any other entity or

facility and that its administrative,

fiscal, clinical, and patient care services

be clearly distinguishable from those of

any other entity or facility in every

respect. In order for us to determine by

survey what costs ASCs incur to furnish

facility services in connection with

performing a specific surgical

procedure, we at HCFA and the ASC

administrators must be able to

distinguish costs and charges as they

emanate strictly from the ASC. If costs

incurred by the ASC are commingled

with another entity’s activities, it will be

difficult for the ASC to isolate the

portion of costs properly attributable

only to the ASC, and therefore difficult

for us to be assured that the data we are

using to determine payment rates are

truly reflective of ASC costs alone, and

not the costs or services of another

entity, such as other hospital outpatient

services or the functioning of a clinic or

physician’s office.

We have added a definition of

‘‘hospital operated ASC’’ to § 416.2 both

to clarify what we mean by ‘‘hospital

operated ASC’’ and to distinguish a

‘‘hospital operated ASC’’ from a hospital

outpatient department that furnishes

surgical services.

In order to be considered a Medicare

approved ASC, the entity’s function and

purpose must be to supply facility

services, as opposed to physician or

practitioner services, in connection with

performing certain surgical procedures.

We define such services as ASC

services, and under the benefit

established at section 1832(a)(2)(F) of

the Act, Medicare pays a prospectively

determined fee for ASC services.

Section 416.21 of the revised regulation

proposed in this notice lists the types of

services that fall within the scope of

ASC services. They include but are not

limited to nursing and technician

services, supplies, drugs and

biologicals, surgical dressings,

housekeeping services, and use of the

facility. We emphasize that the

professional services of physicians and

other practitioners do not fall within the

scope of ASC facility services, and the

ASC facility fee does not include

payment for the professional services of

physicians and other practitioners.

Medicare pays an ASC facility fee

only for procedures on the ASC list.
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HCFA determines which procedures

will constitute the ASC list on the basis

of certain criteria related to the safety,

appropriateness, and effectiveness of

performing the procedure in an ASC

setting. The criteria that HCFA used as

the standard for determining a

procedure’s suitability for the ASC list

in this notice are proposed in § 416.22.

The procedures for which a Medicare

participating ASC furnishes services

and for which Medicare makes payment

of an ASC facility fee are of a nature that

does not require Medicare patients to be

admitted to a hospital as inpatients

either to have the procedure performed

or to recover from the procedure. By

‘‘hospital,’’ we mean an institution that

meets the definition of ‘‘hospital’’ in

section 1861(e) of the Act.

Within the framework of the

definition of an ASC that we are

proposing in § 416.2, Medicare would

not consider an entity devoted

exclusively to furnishing services such

as clinical laboratory services,

chemotherapy, radiation treatment,

cardiac catheterization, dialysis

services, magnetic resonance imaging,

or other diagnostic tests, to be an ASC

because these are not services that are

necessary to enable surgical procedures

to be performed. However, an entity that

meets the conditions for coverage as an

ASC could also be recognized and paid

by Medicare as a non-physician supplier

of radiology services, as an independent

diagnostic testing facility (IDTF), or as a

supplier of durable medical equipment,

prosthetics, and orthotics as long as it

supplied these services in accordance

with the statute and Medicare payment

rules and regulations.

C. Basic Requirements (Proposed § 416.3

and § 416.4)

We propose to renumber § 416.25 as

§ 416.3. Paragraph (a) does not change.

We have moved current § 416.40 to

become new paragraph (b) in § 416.3, to

reinforce the fundamental importance of

State licensure as a basic requirement

for an ASC wanting to qualify for

participation and billing privileges in

the Medicare program.

We have also moved §§ 416.30(a)

through 416.30(e) to proposed § 416.3,

Basic Requirements. By incorporating

these provisions directly into the

regulations at § 416.3, we emphasize

their significance as binding

requirements with which ASCs wishing

to participate and have billing privileges

in the Medicare program must agree to

comply.

Section 416.3(h) replaces current

§ 416.26(a) and § 416.26(b) by crossreferencing part 488, ‘‘Survey,

Certification, and Enforcement

Procedures’’ and establishes compliance

with the regulations in that part that

pertain to suppliers generally and to

ASCs in particular as a basic

requirement for ASCs to participate in

Medicare. In order to make this link, we

propose to add ASCs to the definition of

‘‘supplier’’ found in § 488.1.

Proposed § 416.3(i) replaces

§ 416.25(b). An ASC can satisfy the

requirement that it have an agreement to

abide by the Medicare laws and

regulations by possessing a Form

HCFA–855, ‘‘Medicare Health Care

Provider/Supplier Enrollment

Application’’ that has been validated by

HCFA.

We are proposing one technical

change in § 416.3(g). This change

requires ASCs to accept the Medicareapproved amount as full payment for all

items and services covered under Part B

of Medicare that it furnishes to

Medicare beneficiaries. ASCs must agree

to accept assignment for all facility

services furnished in connection with

procedures on the ASC list. We are

proposing to extend the ASC’s

assignment acceptance to include all

items and services that the ASC

supplies to a beneficiary, whether those

items and services are considered ASC

facility services as listed in § 416.21(a)

or are items and services for which

payment may be made under other

provisions of Medicare, Part B, such as

those listed in § 416.21(b).

Proposed § 416.4 basically restates the

provisions of § 416.35 yet revises the

language to reflect our proposed

substitution of the ‘‘Medicare Health

Care Provider/Supplier Enrollment

Application’’ (Form HCFA 855) for the

‘‘Health Insurance Benefits Agreement—

(Agreement with Ambulatory Surgical

Center Pursuant to Section 1832(a)(2)(F)

of the Social Security Act)’’ (Form

HCFA 370). Since May 1996, HCFA has

required all ASCs with an interest in

participating and obtaining billing

privileges in Medicare to complete Form

HCFA 855. The certification statement

that is a part of the Form HCFA 855

includes a provision that the applicant

is familiar with and agrees to abide by

the Medicare laws and regulations that

apply to its provider/supplier type. In

42 CFR part 416, we have expanded the

list of basic requirements for ASCs to

include all of the provisions that are

currently listed in the Form HCFA 370.

We have also added to § 416.3 the

provision that an ASC, in order to

participate and to have billing privileges

in Medicare, must have in effect a Form

HCFA 855 that has been validated by

HCFA. Given these changes, we propose

to discontinue use of Form HCFA–370

for ASCs seeking to participate and to

obtain billing privileges in Medicare

beginning on the effective date of the

final rule that implements the proposals

contained in this notice. For ASCs

whose agreement with HCFA consists of

a Form HCFA 370 that has been duly

executed in accordance with the

provisions currently found in §§ 416.26

and 416.30, the Form HCFA 370 and the

ASC’s agreement with HCFA remain in

effect until such time as the ASC

completes a Form HCFA–855 that is

validated by HCFA. We invite

comments on our proposal to retire the

Form HCFA 370 and replace it with a

validated Form HCFA 855.

Revisions to the ASC conditions for

coverage are the subject of a separate

notice entitled ‘‘Conditions for Coverage

of Ambulatory Surgical Centers’’

(HCFA–1887–P) that is currently being

developed. Pending publication of that

notice of proposed rulemaking, we

propose to move the conditions for

coverage found currently in sections

§ 416.41 through § 416.49 to subpart D,

which we propose to rename ‘‘Specific

Conditions for Coverage.’’

D. Additions to/Deletions From the ASC

List

Section 934 of the Omnibus

Reconciliation Act of 1980 amended

sections 1832(a)(2) and 1833 of the Act

to authorize the Secretary to specify, in

consultation with appropriate medical

organizations, surgical procedures that,

although appropriately performed in an

inpatient hospital setting, can also be

performed safely on an ambulatory basis

in an ASC, a hospital outpatient

department, or a rural primary care

hospital. The report accompanying the

legislation explained that the Congress

intended procedures currently

performed on an ambulatory basis in a

physician’s office, which do not

generally require the more elaborate

facilities of an ASC, not be included in

the list of covered procedures (H.R. Rep.

No. 1167, 96th Cong. 2d Sess. 390,

reprinted in the 1980 U.S.C.C.A.N 5526,

5753). In a final rule published August

5, 1982 in the Federal Register (47 FR

34082), we established regulations

which included criteria for specifying

which surgical procedures were to be

included for purposes of implementing

the ASC facility benefit. These criteria

are found at 42 CFR 416.65, and include

both general and specific standards. The

general standards in § 416.65(a) define

ASC procedures as—

• Commonly performed on an

inpatient basis but may be safely

performed in an ASC;

• Not of a type that are commonly

performed or that may be safely

performed in physicians’ offices;
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32297

• Requiring a dedicated operating

room or suite and generally requiring a

post-operative recovery room or shortterm (not overnight) convalescent room;

and,

• Not otherwise excluded from

Medicare coverage.

The specific standards in § 416.65(b)

limit ASC procedures to those that do

not generally exceed 90 minutes

operating time, a total of 4 hours

recovery or convalescent time, and, if

anesthesia is required, the anesthesia

must be local or regional anesthesia or

general anesthesia of not more than 90

minutes duration. Section 416.65(c)

excludes from the ASC list procedures

that generally result in extensive blood

loss, that require major or prolonged

invasion of body cavities, that directly

involve major blood vessels, or that are

generally emergency or life-threatening

in nature.

In April 1987, we adopted numerical

criteria as a tool for identifying

procedures that were commonly

performed either in a hospital inpatient

setting or in a physician’s office.

Collectively, commenters responding to

a notice published in the Federal

Register on February 16, 1984 (49 FR

6023) had recommended that virtually

every surgical CPT code be included on

the ASC list. Consulting with other

specialist physicians and medical

organizations as appropriate, our

medical staff reviewed the

recommended additions to the list to

determine which code or series of codes

were appropriately performed on an

ambulatory basis within the framework

of the regulatory criteria in § 416.65.

However, when we arrayed the

proposed procedures by the site where

they were most frequently performed

according to our claims payment data

files (1984 Part B Medicare Data

(BMAD)), we found that many codes

were not commonly performed on an

inpatient basis or were performed in a

physician’s office a majority of the time,

contrary to our regulations. Therefore,

we decided that if a procedure was

performed on an inpatient basis 20

percent of the time or less, or in a

physician’s office 50 percent of the time

or more, it should be excluded from the

ASC list. (See Federal Register of April

21, 1987, (52 FR 13176).) At the time,

we believed that these utilization

thresholds best reflected the legislative

objectives of moving procedures from

the more expensive hospital inpatient

setting to the less expensive ASC setting

without encouraging the migration of

procedures from the less expensive

physician’s office setting to the ASC. We

applied these place of service tests not

only to codes proposed for addition to

the ASC list, but also to the codes that

were currently on the list, to delete

codes that did not meet the 20/50 site

of service thresholds.

The trend towards performing surgery

on an ambulatory or outpatient basis

grew steadily, and by 1995, we

discovered that a number of procedures

that were on the ASC list at the time fell

short of the 20/50 threshold even

though the procedures were obviously

appropriate to the ASC setting. The

most notable of these was cataract

extraction with intraocular lens

insertion, very few cases of which were

being performed on an inpatient basis

by the early 1990’s. We were also

excluding from the ASC list certain

newer procedures, such as CPT code

66825, Repositioning of intraocular lens

prosthesis, requiring an incision

(separate procedure), that from their

inception were almost never performed

on a hospital inpatient basis but that

were certainly appropriate for the ASC

setting. And, strict adherence to the

same 20/50 thresholds both to add and

remove procedures did not provide

latitude for minor fluctuations in

utilization settings or errors that could

occur in the site-of-service data drawn

from the National Claims History File

that we were using, replacing BMAD

data, for analysis. In an effort to avoid

these anomalies but still retain a

relatively objective standard for

determining which procedures should

comprise the ASC list, we adopted in

the last revision of the list, which was

published in the Federal Register on

January 26, 1995 (60 FR 5185), a

modified standard for deleting

procedures already on the ASC list. We

deleted from the list only those

procedures whose combined inpatient,

hospital outpatient, and ASC site-ofservice volume was less than 46 percent

of the procedure’s total volume, and that

were performed 50 percent of the time

or more in a physician’s office or 10

percent of the time or less in an

inpatient hospital setting. We retained

the 20/50 standard to determine which

procedures should be added to the ASC

list.

The applicability and appropriateness

of the standards HCFA uses to specify

procedures that constitute the ASC list

were the subject of lengthy discussion at

the July 1996 ASC Town Meeting. The

comments of those attending the Town

Meeting, as well as written comments

received following the meeting,

repeatedly characterized the 20/50

numerical thresholds as simplistic,

arbitrary, artificial, and outdated and

urged us to ‘‘modernize’’ the standards

by which we select procedures for the

ASC list. Similarly, most commenters

characterized the 90 minute limit on

surgery and the four hour limit on

recovery as obsolete, outdated, arbitrary

and without medical significance and

blind to the numerous technical

advances in surgery and the

development of short-acting anesthesia

which have radically altered surgical

practices since the early 1980’s when

those criteria were established.

Commenters urged us to supplement or

preferably replace quantitative

thresholds with qualitative

considerations that recognize the

capabilities of modern ASCs. Some

commenters took the position that the

list be abandoned altogether; others

recommended leaving the choice of

where a surgical procedure is to be

performed to those best able to

determine which setting is most

appropriate, namely, the physician, in

consultation with the patient, and the

anesthesiologist. Commenters argued

that eliminating the list would allow

Medicare beneficiaries who are

medically unstable and for whom an

office would not be a safe setting for

even very simple surgery to have access

to an ASC as an alternative to the

hospital. Conversely, an ASC could be

an appropriate alternative to the

hospital for more complex procedures

for beneficiaries who are healthy. At

least one commenter suggested that the

ASC list include any procedure which

we would recognize as appropriate in a

hospital outpatient setting.

The statute prevents us from

eliminating the ASC list. However, in

response to discussions at the Town

Meeting, written comments submitted

after the Town Meeting, and the

growing consensus expressed by the

ASC community in comments we

received following publication in the

Federal Register of proposed notices on

December 7, 1990 (55 FR 50590) and

December 14, 1993 (58 FR 65367), we

propose to modify our approach to

selecting the procedures for which

Medicare pays an ASC facility fee.

1. Revision of 42 CFR 416.65

The intent of the revision to § 416.65

is to render the regulation less

prescriptive in defining the kinds of

procedures that are appropriate for the

ASC list while allowing it to still remain

within the constraints imposed by the

statute. The changes to 42 CFR 416.65

that we are proposing are based on

certain basic premises. First, we

continue to focus on procedures that fall

within the surgical range (10000

through 69999) of the HCFA Common

Procedure Coding System (HCPCS) or

the American Medical Association

(AMA) Physicians’ Current Procedural
32298 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

Terminology (CPT). (The AMA’s CPT

terminology and coding is included,

with permission, in the HCPCS system.

For surgical procedures, the codes are

the same.) Second, we limit ASC

procedures to those surgical procedures

that require the kind of supplies,

equipment, physical environment,

staffing, and health and safety protocols

that are typical of a hospital setting and

required of an ASC, including a

dedicated operating room or suite or

procedure room that is equipped,

staffed, and maintained solely for the

performance of surgical procedures, and

a designated recovery room or area that

is equipped, staffed, and maintained

solely for the use of post-operative

patients. However, while necessitating

the resources and set-up typical of a

hospital surgical department, ASC

procedures must not be those for which

patients are expected to be admitted to

the hospital on an inpatient basis due to

the severity or risks inherent in the

procedure or to the need for inpatient

post-operative care before the patient

can be safely discharged to recuperate at

home. Finally, the ASC list must not

include procedures that are excluded

from Medicare coverage by statute.

We propose to remove the references

to ‘‘commonly performed’’ found in

§ 416.65(a) and the time limits on

operating, anesthesia, and recovery time

that are currently spelled out in

§ 416.65(b)(1) and (2). With the

ambulatory payment classification

(APC) system, we can rely on clinical

homogeneity at least as much as site of

service patterns in determining which

procedures are appropriate for the ASC

list. Precisely because the APC groups

are clinically coherent, as a general rule

we did not split up APC groups by

including some procedures from an APC

group on the ASC list while excluding

from the list other procedures in the

same APC group. We either regarded all

of the procedures in an APC as

appropriate for the ASC list or none of

the procedures in an APC as appropriate

for the ASC list.

We propose to retain the specific

standards found at § 416.65(b)(3), and

we shall continue to exclude from the

ASC list procedures that generally result

in extensive blood loss, require major or

prolonged invasion of body cavities,

directly involve major blood vessels, or

are generally emergent or lifethreatening in nature. Because of the

risks inherent in procedures that

involve these characteristics, any of

which suggests that the well-being of

the patient could be in jeopardy, we are

excluding such procedures from the

ASC list because performing them in an

ambulatory setting violates the statutory

safety standard of the Act

(1833(i)(1)(A)). One of our reasons for

revising 42 CFR Part 416 is to highlight

that procedures with any of the

characteristics listed in proposed

§ 416.22(b) are, by their nature, unsafe

and inappropriate in an ASC setting and

are therefore not reasonable and not

medically necessary when performed in

an ASC setting. Procedures with these

characteristics are excluded from the

ASC list and payment of a Medicare

ASC facility fee for services furnished in

connection with such procedures is not

allowed.

Conversely, we discuss below in

greater detail, procedures that do not

satisfy the criteria in proposed

§§ 416.22(a)(1), 416.22(a)(2), or

416.22(a)(3) are excluded from the ASC

list because such procedures do not

require the generally more elaborate and

costly services and resources that

characterize Medicare approved ASCs.

We solicit comments on the

reasonableness and validity of the

criteria that we are proposing as the

basis for excluding procedures from the

ASC list. We solicit comments on the

reasonableness and validity of the

changes to § 416.65 of the regulations,

which we propose to incorporate in

proposed § 416.22. We also solicit

comments regarding the appropriateness

of all the codes on the ASC list in

Addendum B. Specifically, we welcome

comments regarding any procedure in

Addendum B that should be excluded

from the ASC list because it is not safe

outside a hospital inpatient setting or

any procedure in Addendum B that can

be safely and effectively performed in

an office setting without the more

elaborate services typical of an ASC.

Comments should be framed within the

context of the revised criteria proposed

in proposed § 416.22.

2. Eliminate Numeric Thresholds

Although the 20/50 numeric

thresholds for adding procedures to the

ASC list and the 46/10/50 threshold for

keeping procedures on the list were not

a part of the regulations, they have been

the basis of our policy for determining

whether a procedure belonged on the

ASC list. However, beginning with this

notice, we propose to discontinue using

site-of-service as the principal

determinant of which procedures to add

to or delete from the ASC list. Instead,

we regard site-of-service data as but one

of several factors, such as the criteria

proposed in proposed § 416.22, to be

taken into account in determining

whether or not a procedure should be

on the ASC list.

By adhering to the principle of

keeping APC groups intact, we included

on the ASC list or excluded from the list

all of the procedures in a clinically

homogeneous APC, notwithstanding

anomalous site of service data for

individual procedures within the

groups.

3. Formation of Advisory Group

A number of commenters, both during

and subsequent to the ASC Town

Meeting, urged the creation of an

advisory committee or council to work

with HCFA on keeping the ASC list upto-date. One commenter suggested

adding a review of the ASC list to the

annual CPT/Relative Value Update

Committee (RUC) process. We are

deferring a decision on the creation of

an advisory committee pending

implementation of the provisions that

are proposed in this notice and until we

can investigate further the possibility of

utilizing an existing group, such as the

RUC or the Medicare Carriers Medical

Directors Workgroup, whose members

might give us timely advice regarding

procedures that are appropriate in an

ASC setting. In the meantime, we

propose to continue relying on

consultations with professional and

medical societies and trade associations;

on correspondence and comments from

these groups, from individual members

of the ASC community, and from the

public generally; as well as on the

judgement of our medical advisors to

determine the appropriateness of

procedures for the ASC list both within

the context of the criteria we have

proposed in renumbered § 416.22 and

the composition of APC groups.

4. Proposed Additions to the ASC List

We propose to add 422 CPT codes to

the ASC list, consistent with the

standards we propose in the new

§ 416.22. In applying the principles

proposed in § 416.22 for the purpose of

specifying additions to the ASC list, we

recognized that an ASC might be

appropriate for some procedures

shifting from an inpatient to an

outpatient setting for the patient who is

generally healthy and is capable, but

that an ASC would be a questionable

setting for those procedures among the

greater Medicare population whose

health is more likely to be compromised

by age or disability. Overall, based on

the advice of our medical advisors and

on the written comments we have

received from ASC administrators,

physicians, professional societies, and

trade associations since the January 26,

1995 update of ASC procedures, we

have determined that the procedure

codes we are proposing to add to the

ASC list could be safely performed in an

ASC on the general Medicare
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32299

population in at least a significant

number of cases.

One commenter expressed

apprehension that expanding the ASC

list could result in edicts from HCFA or

other purchasers of health care that once

added to the ASC list, a procedure must

be performed in an ASC, without taking

into account the individual patient’s

condition or the suitability of an ASC

for a particular procedure. We recognize

that for individuals with certain medical

conditions, no procedure on the ASC

list may be safely performed except on

an inpatient basis. Therefore, we

emphasize that the choice of operating

site remains ultimately a matter for the

professional judgement of the patient’s

physician, in consultation with the

patient and, often, the anesthesiologist,

irrespective of whether a procedure is

on the ASC list. Section 416.23 in the

proposed regulations reinforces this

point.

All of the proposed additions to the

ASC list are designated in Addendum

A, along with the ambulatory payment

classification (APC) group proposed for

each. We invite and encourage

comments on the appropriateness of

these additions to the ASC list in light

of the criteria in § 416.22.

a. Additions Suggested by Commenters

Of the 422 additions to the ASC list

that we are proposing, the following 52

codes were specifically suggested by the

ASC community in correspondence and

comments that we have received since

the publication of the last Federal

Register update of the list on January

26, 1995 (60 FR 5185). We invite

comments on the appropriateness for

the ASC list of the procedures identified

by these CPT codes:

15822 43244 56353 67110

15823 43249 56355 67145

15824 43761 57288 67208

15825 45330 62287 67210

15826 49568 62298 67228

26608 50080 63244 67900

29848 50081 65436 68810

33222 51715 65855 68811

35875 52601 66761 68815

36862 52647 66762 68830

37731 52648 66825

40720 55859 67028

42415 57288 67101

43205 62287 67105

b. Proposed Additions Resulting From

Changes to CPT

The CPT is updated annually, and

occasionally new codes added to CPT

affect the ASC list. The following

procedures were added to the ASC list

because they were added to the CPT,

usually to replace a deleted code. We

are requesting comments on the

appropriateness of adding to the ASC

list the codes new to CPT in 1995 that

are indicated below, which we were

unable to include in the Federal

Register notice published on January 26,

1995 (60 FR 5185). We are also

requesting comments on the

appropriateness of adding to the ASC

list codes new to CPT in 1996, 1997,

and 1998, which are indicated below.

New CPT codes added effective January

1, 1995: 31254; 31255; 31256; 31267;

31276; 57522

New CPT codes added effective January

1, 1996: 19290; 19291; 22103; 22328;

43249; 56301; 56302; 56343; 56344;

62350; 62351; 62360; 62361; 62362;

62365; 62367; 62368

New CPT codes effective January 1,

1997: 15756; 15757; 15758; 26551;

26553; 26554; 68810; 68811; 68815

New 1998 CPT codes: We are proposing

to add to the ASC list the following

HCPCS codes that were new in 1998:

29860; 29861; 29863; 29891; 29892;

29893; 52282; 53850; 53852; 56318;

56318; 56346; 59871; 67027; G0104;

G0105

c. Proposed Additions Resulting From

Ambulatory Payment Classification

(APC) Groupings

We have determined that the

remaining codes that we are proposing

to add to the ASC list are consistent

with the criteria in § 416.22, and we

believe that they would be safe,

appropriate, and effective if performed

in an ASC setting.

5. Proposed Deletions and Exclusions

From the ASC List

a. Procedures Excluded for Reasons of

Safety, Reasonableness and Medical

Necessity

There are a total of 2,361 CPT codes

in the surgical range that are not on the

revised ASC list proposed in this notice.

Of these 2,361 procedures, 203 are

codes that we are proposing to delete

from the current ASC list because they

are not safe or otherwise reasonable and

necessary in an ASC setting. The

proposed deletions are flagged in

Addendum A.

b. Unlisted Procedures

In most surgical categories, CPT

includes codes for unlisted procedures.

Because codes for ‘‘unlisted’’

procedures, by definition, contradict the

statutory mandate for an ASC list, and

because there is no way of knowing in

advance whether a procedure for which

there is no appropriate description in

CPT is consistent with our standards for

the ASC list, we are continuing our

policy of excluding those codes from the

ASC list.

c. Exclusion of Office-Based Procedures

Some comments made during and

after the ASC Town Meeting supported

expansion of the ASC list to allow

Medicare payment of an ASC facility fee

for procedures that are ordinarily

performed in an office setting but that

require the more extensive resources

typical of an ASC to accommodate the

special health needs of a patient. We

considered the effect of expanding the

ASC list to include procedures that are

ordinarily performed safely and

appropriately in a physician’s office or

a physician’s clinic or treatment room.

Our 1994 ASC survey did not capture

charge information on office-based

procedures, but we had the benefit of

hospital outpatient claims data and

practice expense data compiled for the

Medicare physician fee schedule (see

the proposed rule in the Federal

Register published June 18, 1997, 62 FR

33158, entitled ‘‘Revisions to Payment

Policies Under the Physician Fee

Schedule, Other Part B Payment Policies

and Establishment of the Clinical

Psychologist Fee Schedule for Calendar

Year 1998’’). We theorized that we

would not encourage office-based

procedures to migrate to the ASC setting

by paying the ASC instead of the

physician the amount allowed for inoffice practice expenses in connection

with an office-based procedure on the

few occasions when a patient needed a

more intensive level of support because

of individual health considerations.

Relating payment to the costs intrinsic

to performing the procedure would also

move closer towards achieving a level

playing field where payments are based

on the service, rather than on the site

where the service is furnished.

In the final analysis, we have decided

that we would not, at this time, propose

to add to the ASC list 340 HCPCS codes

that describe procedures that can be

performed safely and effectively in a

physician’s office, clinic or treatment

room and for which the more elaborate

facility services of an ASC are not

required. Further, we propose to remove

63 codes that are currently on the ASC

list which, we have determined, fail to

meet the criteria in § 416.22(a), i.e. these

procedures do not require surgical

facilities, they are not services of the

kind that are typically provided in a

hospital inpatient setting, or do they do

not require a dedicated operating room

or room for post-operative recovery.

Including procedures that are officebased on the ASC list might be

construed as running counter to

Congressional intent expressed in the

conference report cited above. Also,

paying ASC facility fees of $5 or $10
32300 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

appeared administratively frivolous.

Finally, office-based procedures are

readily identifiable precisely because

they do not satisfy the ASC-appropriate

standards that we are proposing in

§ 416.22. Therefore, we are continuing,

at this time, our policy of not including

office-based procedures on the ASC list.

However, we do not rule out the

possibility of a future change of policy

on this point after we have had an

opportunity to evaluate the impact of

incorporating resource-based practice

expense relative value units (PE RVUs)

into the Medicare Physician Fee

Schedule and of implementing a

prospective payment system for hospital

outpatient surgical services, each of

which is scheduled to occur in 1999.

We have given an ASC payment

policy indicator ‘‘5’’ to the 403 CPT

codes that we consider to be officebased procedures to indicate that no

payment for expenses incurred to

perform these office-based procedures is

allowed other than the Medicare

payment to the physician performing

the procedure. An ASC payment policy

indicator ‘‘5’’ precludes additional

payment if these procedures are

performed in an ASC. Refer to section

III.E. of this notice for a more detailed

discussion of the ASC payment policy

indicators.

d. Suggested Additions Not Accepted

The following procedures have been

suggested by the ASC community for

addition to the list since publication of

the last Federal Register update of the

list on January 26, 1995 (60 FR 5185),

but we propose to exclude them from

the ASC list for the reasons given.

19240—Mastectomy, modified

radical. (This procedure can result in

extensive blood loss; admission to a

hospital on an inpatient basis to recover

from the procedure is appropriate.)

21356 & 21366—Repair heel bone

fracture; 31225— Removal of upper jaw;

33212 & 33213—Insertion or

replacement of pacemaker pulse

generators; 37201— Transcatheter

therapy, infusion for thrombolysis;

41130— Partial removal of tongue;

41153—Tongue, mouth, neck surgery;

51840 & 51841—Anterior

vesicourethropexies; 51845--Abdominovaginal vesical neck suspension;

54430—Revision of penis; 56308—

Laparoscopy, surgical and vaginal

hysterectomy; 63030—Laminotomy

(hemilaminectomy), with

decompression of nerve root(s). (These

procedures require admission to a

hospital on an inpatient basis in order

to have the procedure performed or in

order to recover from the procedure.)

33216, 33217, & 33218—Insertion/

replacement of electrodes and repair of

pacemaker electrodes; 35475 & 35476—

Transluminal balloon angioplasties;

56340, 56341 & 56342—Laparoscopy,

surgical cholecystectomies. (These

procedures directly involve major blood

vessels, and with respect to the

Medicare population in particular, the

latter procedures would necessitate

admission to a hospital on an inpatient

basis to perform or to recover from the

procedure.) One professional society

takes the position that laparoscopic

cholecystectomy should only be

performed in a setting that is equipped

and prepared to switch intra-operatively

to an open procedure in the event

problems arise during the laparoscopic

procedures.

e. Procedures Deleted Because of CPT

Coding Changes

The CPT is updated annually, and

occasionally, the deletions affect the

ASC list. The following is a list of

procedures that were deleted from the

ASC list because they were deleted from

the CPT.

Deleted effective April 1, 1995: 25005;

25317; 25318; 26527; 31245; 31246;

31247; 31248; 31249; 31251; 31261;

31262; 31264; 31266; 31269; 31271;

31280; 31281; 31282; 31283; 31284;

31286; 31659; 36840; 36845; 45180;

52650

Deleted effective March 31, 1996: 28236;

63750; 63780; 67109

Deleted effective April 1, 1997: 15755;

20960; 20971; 25330; 25331; 26522;

26557; 26558; 26559; 42880; 56360;

56361; 68825

None of the procedures deleted from

CPT 1998 were on the ASC list.

f. Procedures Recommended by

Commenter for Deletion

One correspondent suggested that we

remove several codes from the ASC list

because they describe procedures that

may not be safely and effectively

performed in the ASC setting. Our

medical staff concurs with the opinion

of the correspondent, and the following

codes are among those we are proposing

to exclude from the ASC list: 15756;

15757; 15758.

6. Comments on the ASC List

We propose to add 422 procedures to

the ASC list and to delete 203

procedures from the ASC list, consistent

with the standards discussed previously

in this notice. The net effect of these

changes would expand the ASC list

from 2280 CPT codes to 2499 CPT

codes.

We solicit comments on whether we

have made appropriate determinations

regarding the following:

• Procedures that are excluded from

the ASC list because they involve one or

more of the criteria in proposed

§ 416.22(b) and are not, as a

consequence, safely performed in an

ASC. (These procedures are listed in

Addendum A with an ASC payment

policy indicator of ‘‘3.’’);

• Procedures that are not on the ASC

list because they do not satisfy one or

more of the criteria in proposed

§ 416.22(a). (These procedures are listed

in Addendum A with an ASC payment

policy indicator of ‘‘5.’’);

• Procedures that are prepared as the

ASC list for which Medicare should not

be paying an ASC facility fee because

the procedures are not consistent with

the criteria in § 416.22. (The proposed

ASC list is presented as Addendum B.)

We also solicit comments on 203

codes that we are proposing to delete

from the current ASC list and the 422

codes that we are proposing to add to

the ASC list. (See Addendum A.) We

ask that all comments regarding the

appropriateness of procedures for the

ASC list be framed within the context of

the revised criteria proposed in renumbered § 416.22.

E. Ratesetting Methodology

1. Current method

There are currently eight payment

levels under the Medicare ASC benefit.

Based on its cost, each of the 2280 CPT

codes on the ASC list is paid one of

eight prospectively determined payment

rates. Collectively, all of the codes that

are paid a particular rate constitute a

payment group. (A ninth payment rate

for extracorporeal shock wave

lithotripsy (ESWL) was established in a

notice published December 31, 1991 in

the Federal Register (56 FR 67666).

Medicare stopped paying for ESWL as

an ASC service beginning in March

1992 under the provisions of a court

stay, which is discussed in section III.H.

of this notice.) The method by which

the current eight ASC payment levels or

rates were calculated is explained in the

Federal Register that was published on

February 8, 1990 (55 FR 4526). The

steps involved in the 1990 ratesetting

methodology which based rates on ASC

facility overhead expenses and

procedure-specific charges reported in

the 1986 ASC Survey are summarized as

follows:

• Adjust reported costs and charges

on the basis of audit findings, eliminate

incorrectly reported survey data, and

adjust costs that exceed allowable

limits;
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32301

• Inflate per procedure charges across

all facilities using the consumer price

index for all urban consumers (CPI–U);

• Using the hospital prospective

payment system wage index, neutralize

the effect of regional wage differences

across all facilities by deflating that

portion of per-procedure charges

attributable on average to labor costs

(34.45 percent);

• Identify the median charge for each

procedure (CPT code) across all

facilities, weighting individual

procedure charges in each facility by the

total number of times the procedure was

performed multiplied by the facility’s

ratio of Medicare patients to total

number of patients;

• Calculate the median Medicare

cost-to-charge ratio for audited facilities

and adjust the weighted median charge

for each procedure (CPT code) by the

cost-to-charge ratio (0.776) to calculate a

cost value;

• Form groups at $75 intervals and

set the payment rate for each group at

the weighted median cost of the

procedures in the group;

• Incorporate as part of the ASC

facility fee for intraocular lens (IOL)

insertion procedures an allowance for

the lens. (Section 13533 of the Omnibus

Budget Reconciliation Act of 1993

(OBRA 93) (Public Law 103–66),

enacted on August 10, 1993, requires

that the payment for an IOL furnished

by an ASC be equal to $150 for the

period beginning January 1, 1994

through December 31, 1998).

Both the current and proposed ASC

ratesetting methodology consist of four

major components: (I) Determine a perprocedure cost for every reported CPT

code at the individual facility level; (II)

Determine a per-procedure cost for

every reported CPT code across all

facilities; (III) Group procedures, and

(IV) Determine a standard payment rate

that is generally a fair fee for all the

procedures within each group. The

standard payment rate arrived at in the

final step becomes the Medicare ASC

facility fee or payment rate.

In developing the payment rates

proposed in this notice, we have

retained the same basic methodology

that is explained in the final notice

published in the Federal Register on

February 8, 1990 (52 FR 4526) and

outlined above. We have introduced a

few refinements that we believe enable

us to measure more precisely the costs

incurred by ASCs individually and

collectively to perform procedures on

the ASC list. The most notable

modification of the current ratesetting

methodology that we are proposing

affects the third component of the

ratesetting process: We propose to adopt

a different approach to grouping

procedures, using an ambulatory

payment classification system (APCS),

instead of creating groups based on $75

cost increments. The following steps

explain how we arrived at the ASC

payment rates that are proposed in this

notice.

2. Proposed Ratesetting Method

Determine a per-procedure cost for

every reported CPT code at the

individual facility level:

a. Use 1994 Survey Data

Data on facility overhead expenses

and procedure specific charges that

were collected in 1994 via the Medicare

Ambulatory Surgical Center Payment

Rate Survey are the basis for the

payment rates proposed in this notice.

Part I of the survey instrument, ‘‘General

Information and Charge Schedules’’

(Form HCFA–452A), was mailed in July

1992 to all ASCs that were Medicare

participating at that time (1,396) for the

purpose of gathering demographic data

to serve as the frame for selecting a

representative sample of ASCs that

would be asked to complete a more

comprehensive cost survey in 1994. One

thousand one hundred forty-three ASCs

completed and returned Part I of the

ASC survey. In establishing the sample

of facilities to complete Part II of the

ASC survey, we excluded facilities that

had been in operation for less than two

years, facilities that performed fewer

than 250 procedures during the 12-

month survey period, and facilities

whose most recently completed fiscal

year exceeded or was less than 12

months. The remaining 832 ASCs were

stratified into four categories based on

reported procedure volume: high,

medium, and low procedure volume,

and eye specialty facilities. Eye

specialty facilities were defined as any

facility where procedures in the CPT

range between 65000 and 68900 (Eye

and Ocular Adnexa) comprised 50

percent or more of total surgical volume.

We used these strata because we found

them most likely to result in a sample

of facilities that would be representative

of the universe of Medicare

participating ASCs that completed Part

I of the survey in terms of type and

volume of procedures typically

performed and costs incurred to furnish

facility services in connection with

those procedures.

Available resources for data entry

required us to limit the size of the

sample to approximately 300 facilities.

In accordance with generally recognized

statistical conventions, 320 facilities

were randomly selected. In March 1994,

we mailed the Medicare Ambulatory

Surgical Center Payment Rate Survey,

Part II—Facility Overhead and

Procedure Specific Costs (Form HCFA–

452B) to the survey sample. Facilities

were initially required to complete

Form HCFA–452B by May 31, 1994, but

because a large number of facilities

experienced difficulties in meeting the

deadline, we complied with most

requests to extend the due date.

Part II of the survey gathered

information from each ASC’s most

recently completed 12-month fiscal

year. Most facilities reported calendar

year 1993 data, with a few facilities

reporting data from other fiscal years.

The survey yielded a data set of

procedure-specific information for 1516

of the nearly 2250 CPT codes that were

on the ASC list as of December 31, 1993,

including the number of times each

procedure was performed on Medicare

and on non-Medicare patients and the

charge billed on average to all patients,

both Medicare and non-Medicare, for

each surgical CPT code. The survey also

collected data on operating room time

for high volume procedures on the ASC

list and aggregate utilization and

charges for procedures performed that

were not on the ASC list. In addition,

the survey elicited facility overhead

costs for plant and property, equipment,

supplies, contractual labor, employee

labor, owner’s compensation, bad debt,

and general administrative costs. We

asked ASCs to report the costs they

incurred to procure intraocular lenses

and to purchase ‘‘non-routine’’ supplies,

e.g., any supply whose net unit cost

exceeded $100. Information regarding

any relationship between the ASC and

other organizations or entities and the

ASC’s financial statement for the fiscal

period reported in the survey were also

solicited. Part II of the ASC survey

included a section intended to capture

procedure specific statistical and

resource cost data for 29 CPT codes,

including time allocations, staffing

patterns and labor costs, supply costs,

and medical equipment costs.

b. Audit Representative Sample of

Facilities

In accordance with the statutory

requirement at section 1833(i)(2)(A)(i)

that we set rates in such a way as to take

into account actual audited facility

costs, and in order to validate the

accuracy and reasonableness of survey

responses, we conducted a nationwide

audit of a sample of the ASCs that

completed Part II of the survey. One

hundred ASCs, 25 from each sampling

stratum (high utilization, medium

utilization, low utilization, and eye

specialty), were randomly selected for

audit in accordance with standard
32302 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

statistical sampling procedures. The

nationwide audit was conducted from

November 1994 through January 1995

by Medicare fiscal intermediaries.

Although ASC claims are processed by

Medicare carriers, we believe

intermediaries’ familiarity and

experience with Medicare audits better

equipped them to carry out this task. In

addition, the Office of Inspector General

(OIG) conducted an audit of the home

offices of the two principal ASC chain

organizations with facilities included in

the sample. We instructed the auditors

to determine reasonable facility costs in

accordance with Medicare payment

principles.

Of the 320 facilities randomly

selected to complete Part II of the

Medicare ASC survey, 16 were

exempted from completing the survey

because of termination of Medicare

participation or change in ownership

prior to receipt of the survey form;

inability to identify and properly

allocate facility operating costs as a

separate and distinct entity; or,

incomplete records due to facility

damage. In addition, we excluded nine

other surveys from consideration in

setting the rates proposed in this notice

for the following various reasons: The

audits revealed four facilities to have

incorrectly reported their charge and

utilization information; one form could

not be accounted for and the facility did

not have a copy to resubmit; two

facilities reported data for less than a 12

month period; and, two facilities were

unable to capture charge data from their

record keeping systems in the manner

requested.

c. Adjust Audited Surveys

We accepted the auditors’ findings,

which resulted in net adjustments that

reduced reported aggregate costs by 9

percent and increased reported

aggregate charges by 3 percent. The

major cost reductions occurred in the

areas of general administrative expenses

and bad debts. We then made two

additional adjustments to audited

adjusted wage and administrative cost

data, as follows.

After an analysis of audited

contractual labor expenses, employee

salaries and fringe benefits, and owner’s

compensation, we set a maximum

compensation limit for each staffing

category to eliminate unreasonable, and

therefore unallowable, labor expenses

from our determination of facility costs.

(Because payment for the professional

services of physicians and certified

registered nurse anesthetists is made

under other provisions of Medicare, Part

B, the cost of these services is excluded

from determining ASC facility costs.)

• We calculated the hourly wages for

administrative and medical staff, taking

into account fringe benefits and paid

leave, using audited 1994 survey data.

In calculating hourly pay rates for each

staff category, we excluded data

reported as owner’s compensation

because the reported hourly rates of

owner’s compensation were excessively

high relative to the hourly pay for nonowners in the same positions.

• We selected the 75th percentile as

the maximum allowable hourly wage

rate in each staffing category. We

considered using higher levels (80th or

90th percentile) as a cap, but we found

the wage rates above the 75th percentile

to be too erratic. We found the wage

rates at the 75th percentile to be

consistent and reasonable across all staff

categories.

• We adjusted audited hourly wage

rates that exceeded the 75th percentile

of each staffing category to the

maximum allowable hourly wage rate

and recalculated labor costs by

multiplying the adjusted hourly wage

rate by the number of reported paid

hours.

We believe that this approach is an

improvement over the current

methodology because it adjusts

unreasonable labor costs for all

categories of staffing, not just

administrator and medical director pay;

it takes actual compensated hours into

account rather than using full-time

equivalents (FTEs); and, we base the

maximum allowable factor on the 75th

percentile of labor costs rather than on

an average. Table 1 shows the limits

applied to ASC labor expenses.

TABLE 1.—HOURLY WAGE CAPS AT 75TH PERCENTILE

Staff category

Number of

observations

Median

hourly wage

Approx. annual salary

75th percentile hourly wage

Approx. annual salary

Administrator ............................................................................................. 66 35.39 $73,611 45.23 $94,078

Director/Manager ...................................................................................... 87 24.13 50,190 31.53 65,582

Supervisors ............................................................................................... 52 21.41 44,533 26.07 54,226

Clerical ...................................................................................................... 116 11.33 23,566 13.24 27,539

Nurse ........................................................................................................ 117 19.53 40,622 23.60 49,088

Medical Technician ................................................................................... 92 13.31 27,685 16.60 34,528

Other Medical ........................................................................................... 49 10.99 22,859 15.61 32,469

Other Non-medical .................................................................................... 83 11.94 24,865 15.65 32,552

In addition to making adjustments to

unreasonable labor costs, we excluded

from our calculation of facility costs

those expenses reported in the 96

audited surveys for services which are

not allowable under Medicare Part B

principles of payment. Examples of

costs that were not allowed include

expenses for advertising, employee

morale, gifts and memorials,

entertainment, and parties.

d. Standardize Unaudited Costs and

Charges

For the 96 audited surveys, aggregated

audit adjusted expenses, including our

adjustments for unreasonable labor and

administrative costs, were 12 percent

lower than reported overhead costs. To

standardize the costs of the 199

unaudited facilities with those of the 96

audited facilities, we adjusted each

category of overhead expense (plant and

property, equipment, supplies, IOL,

contractual labor, employee, owner’s

compensation, bad debts, and other

expenses) in the unaudited surveys by

the percent of difference between

reported and audit adjusted data in each

category of overhead expense for the 96

audited surveys. To standardize

unaudited charges, we determined the

percent of difference between

aggregated reported charges and

aggregated audited charges for the 96

audited surveys. We increased perprocedure charges in each of the 199

unaudited surveys by the 3.07 percent

of difference between reported and

audit adjusted aggregate charges.
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32303

e. Calculate Facility-Specific Cost-toCharge Ratio

When we rebased ASC payment rates

using 1986 data, we used a median costto-charge ratio based on data from 90

audited surveys. At that time, we

considered using a facility-specific costto-charge ratio that would have taken

into account the differences in the

relationship between charges and cost

that exist among facilities, but we

elected not to do so because the data

from unaudited 1986 surveys were

seriously deficient. Because most of

those earlier deficiencies have been

ameliorated in the 1994 survey

database, we are revising our ratesetting

methodology to use a facility-specific

cost-to-charge ratio.

• For each of the 295 surveys, we

summed costs reported for plant and

property, equipment, supplies,

contractual labor, salaries, owner’s

compensation, bad debts, and

miscellaneous other administrative

expenses to calculate total net adjusted

costs. Note that we exclude costs

incurred by ASCs to furnish intraocular

lenses (IOLs) from the calculation of the

facility specific cost-to-charge ratio.

Otherwise, the cost of an IOL would be

spread across all procedures rather than

being allocated specifically to the four

procedures that require IOLs. We treat

IOL costs separately, as we explain

below.

• For each of the 295 surveys, we

calculated total net adjusted procedure

charges, including charges both for

procedures on the ASC list and for

procedures performed at the ASC that

were not on the ASC list.

• We divided each facility’s total net

adjusted costs by the facility’s total net

adjusted charges to determine the ratio

of the facility’s overall costs to its

charges.

f. Convert Each Procedure Charge to a

Procedure Cost

We multiplied the net adjusted charge

reported for each CPT code by the

facility-specific cost-to-charge ratio in

order to convert every net adjusted perprocedure charge to a per-procedure

cost value. We believe that using a

facility specific cost-to-charge ratio to

arrive at per-procedure costs is a

distinct improvement over the current

methodology of using a median facility

cost-to-charge ratio across all facilities

because the facility specific ratio takes

into account facility variations (single

vs. multi-specialty, small vs. large,

single vs. multiple ownership, etc.)

which may affect the relationship

between facility costs and charges.

g. Remove Intraocular Lens (IOL) Costs

From Four Lens Insertion Procedures

Section 4063(b) of the Omnibus

Budget and Reconciliation Act of 1987

(OBRA 1987) (Public Law 100–203)

amended section 1833(i)(2)(A) of the

Act to mandate that HCFA include

payment for an IOL furnished by an

ASC for insertion during or subsequent

to cataract surgery as part of the ASC

facility fee rather than paying for the

prosthetic lens separately, in addition to

the facility fee. The payment amount

must be reasonable and related to the

cost of acquiring the class of IOL

involved.

Section 4151(c)(3) of the Omnibus

Budget Reconciliation Act of 1990

(OBRA 1990) (Public Law 101–508)

froze the IOL payment amount at $200

for the period beginning November 5,

1990 and ending December 31, 1992,

and we continued the $200 IOL

allowance from January 1, 1993 through

December 31, 1993. Therefore, Medicare

payments to ASCs performing IOL

insertion procedures in calendar year

1993, the survey period for most

facilities completing the 1994 ASC

survey, included a $200 allowance for

the IOL.

Section 13533 of the Omnibus Budget

and Reconciliation Act of 1993 (OBRA

1993) (Public Law 103–66) mandated

that, notwithstanding section

1833(i)(2)(A)(iii) of the Act, payment for

an IOL furnished by an ASC must be

equal to $150 beginning January 1, 1994

through December 31, 1998.

Although the statute at section

1833(i)(2)(A)(iii) defines IOLs as an ASC

facility service and mandates that the

ASC facility fee for lens insertion

procedures include payment for the IOL

that is reasonable and related to the cost

of acquiring the class of lens involved,

amendments to the statute have

mandated a specific dollar amount that

Medicare is to pay for the IOL,

irrespective of the costs incurred by

ASCs generally to furnish the IOL.

Because IOLs are considered a facility

service, ASCs do not bill for them

separately. Rather, the charge for an IOL

is included within the procedure charge

for CPT codes 66983, 66984, 66985, and

66986. After we converted procedure

charges to procedure costs, we

subtracted the IOL cost from the

procedure cost for each of the four lens

insertion codes before we neutralized

per-procedure costs for regional wage

variations, adjusted procedure costs for

inflation, and grouped procedures in

order to set payment rates. The amount

that we subtracted is a facility-specific

mean IOL cost based on data collected

in the 1994 survey regarding the

quantity and models of IOLs purchased

and the total amount paid for each

model net of all discounts, rebates, and

credits. If we did not subtract the IOL

cost from the procedure cost of the lens

insertion procedures at this juncture,

Medicare would be recognizing IOL

costs twice: once as part of the rebased

payment rate for the procedure, and

again through the mandated IOL

allowance that is to be added onto the

payment rates set for CPT codes 66983,

66984, 66985, and 66986. Note that the

payment rate of $863 determined for

CPT codes 66983, 66984, 66985 and

66986 (APC 668) includes a $150 IOL

allowance.

Rates for lens insertion procedures

beginning January 1, 1999. The 1994

survey data reveal that the current IOL

allowance of $150 is neither reasonable

nor related to the cost of acquiring the

lens, but rather, represents an

overpayment by Medicare and a lost

opportunity for beneficiary and program

savings. The 1994 ASC survey data

show that ASCs were acquiring IOLs in

1993 for substantially less than the $200

that Medicare was paying ASCs for IOLs

at that time. Based on survey data

reported by 215 ASCs (72 audited and

143 standardized by increasing IOL

costs by 1.93 percent) that purchased

197,289 lenses, the weighted mean lens

cost was $100, and the weighted median

cost was $97 (weighted by frequency).

Of the 215 ASCs on which these

findings are based, 76 are eye specialty

facilities. For eye specialty ASCs alone,

the weighted mean IOL cost was $82,

and the weighted median IOL cost was

$70. Table 2 shows that even inflating

1993 IOL costs to 1998 dollars, ASCs

can still acquire IOLs on average well

below the $150 allowance mandated by

Congress through December 31, 1998.

TABLE 2.—1994 ASC SURVEY: INTRAOCULAR LENS (IOL) COST INFLATED TO 1998 DOLLARS

CY 1993

dollars

CPI–U inflation factorCY 1998

dollars

Mean Cost, weight by frequency ............................................................................................................. $100 1.14915 $115

Median Cost, weight by frequency ........................................................................................................... 97 1.14915 108
32304 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

TABLE 2.—1994 ASC SURVEY: INTRAOCULAR LENS (IOL) COST INFLATED TO 1998 DOLLARS—Continued

CY 1993

dollars

CPI–U inflation factorCY 1998

dollars

Medicare IOL allowance ........................................................................................................................... 200 NA 150

(Based on 1994 ASC survey reported by 215 ASCs that purchased 197,289 lenses).

Prior to expiration of the $150 IOL

allowance on December 31, 1998, we

shall propose a revised payment rate for

the four lens insertion procedures in

APC 668 in order to be consistent with

section 1833(i)(2)(A)(iii) of the statute,

which states that lens insertion

procedures are to include an IOL

allowance that is reasonable and related

to the cost of the lens involved. In

rebasing the payment rates for the four

lens insertion procedures, we expect to

follow the basic ratesetting methodology

proposed in this notice, with one

difference: We would neutralize the

charge-converted per procedure cost

determined for CPT codes 66983, 66984,

66985, and 66986 to offset the effect of

regional wage variations, and then, we

would add the facility-specific mean

IOL cost to the procedure cost for these

codes. The resulting cost for the four

lens insertion codes would be adjusted

for inflation, and the payment rate for

APC 668 would be recalculated. IOL

costs would then be subject to interim

year annual adjustments for inflation

because they would be packaged within

the facility fee for lens insertion

procedures. Under the current payment

method, the fixed add-on IOL allowance

in payment group 6 and payment group

8 is not subject to an annual adjustment

for inflation.

We solicit comments on this approach

to rebasing the payment rate for IOL

insertion procedures for services

furnished beginning on January 1, 1999.

h. Calculate Facility Specific Portion of

Procedure Cost Attributable to Labor

Expenses

Having converted per procedure

charges to cost values and subtracted

IOL costs from CPT codes 66983, 66984,

66985, and 66986, we determined for

the 295 audited and standardized

surveys the percentage of facility costs

attributable to labor.

• We summed each facility’s

expenses for contractual personnel,

employee salaries and fringe benefits,

and owner’s compensation (laborrelated costs);

• We summed each facility’s net total

costs including plant and property,

equipment, supplies, contractual labor,

employee salaries and fringe benefits,

owner’s compensation, bad debts, and

miscellaneous other administrative

expenses.

• We divided each facility’s total

labor-related costs by its net total costs

to determine the percentage of the

facility’s costs related to labor.

• We multiplied each facility’s perprocedure cost by the facility’s

percentage of labor-related costs to

apportion each procedure cost into

labor-related and non-labor related

components.

Under the current ratesetting

methodology, as explained in the final

notice published in the Federal Register

on February 8, 1990 (55 FR 4526), we

use an average of the labor-related

percentage for all facilities based on

1986 survey data to determine the

portion of procedure charges

attributable to labor costs. Using 1994

survey data to determine as precisely as

possible costs incurred by a facility to

perform an individual surgical

procedure, we reasoned that a facility

specific labor-related percentage would

be a more sensitive gauge of variations

in hiring practices, staffing patterns, and

employee expenses that influence ASC

procedure costs than a national average

which, by definition, flattens these

variations. Therefore, to capture the

influence on per procedure costs of

individual facility staffing patterns and

practices, we calculated a facility

specific labor-related percentage

preliminary to deflating per procedure

costs to offset variations in labor costs

that are the result of broader regional

demographic differences. However, we

shall continue the current method of

calculating actual payment amounts for

ASC facility services using an average

labor-related factor to adjust rates for

regional wage differences, which is

consistent with the Congressional intent

that Medicare pay ASCs a prospectively

determined standard overhead fee.

Using 1994 audited survey data, we

found that, on average, the percentage of

facility costs attributable to labor

expenses (contractual personnel,

employee salaries and fringe benefits,

and owner’s compensation) is 37.66

percent, a slight increase over the 34.45

percent labor-related factor based on

1986 data that carriers use currently to

adjust base rates for regional wage

differences.

i. Deflation by Wage Index Value

In order to remove variations in ASC

per procedure costs that could be due

solely to geographical differences in

labor costs, we neutralized or deflated

the portion of each ASC’s per procedure

costs attributable to labor expenses.

• We calculated a facility-specific

percentage of overall costs attributable

to labor expenses as explained in

section 2-h, above.

• We multiplied each facility’s perprocedure cost (see section 2-f, above)

by the facility’s percentage of laborrelated costs to determine the laborrelated portion of the procedure cost.

• We divided the labor-related

portion by the wage index value

applicable to the ASC’s location.

• We added the deflated labor-related

portion of the procedure’s cost to its

nonlabor-related portion to arrive at a

per procedure cost that is not influenced

by geographic wage variations.

As part of the ratesetting methodology

explained in the final notice published

in the February 8, 1990 Federal Register

(55 FR 4526), we state as a matter of

policy our intention to use the most

recent Medicare hospital inpatient

prospective payment system (PPS) wage

index values both to determine ASC

base payment rates and to calculate

payment amounts for individual claims

for ASC facility services. Therefore, the

updated ASC base rates published in the

February 8, 1990 notice reflect the fiscal

year (FY) 1990 hospital inpatient PPS

wage index that was effective for

hospital discharges beginning October 1,

1989. We also included wage index

values for rural counties deemed urban

under sections 1886(d)(8)(B) and

1886(d)(8)(C) of the Act.

In the Federal Register published

December 31, 1991 (56 FR 67666), we

announced that we would continue to

use the most recently updated hospital

inpatient PPS wage index values for

urban areas and rural areas to calculate

ASC payment amounts; that we would

limit recognition of reclassified wage

index values resulting from

reclassifications approved by the

Medicare Geographic Classification

Review Board (MGCRB) under section

1886(d)(10) of the Act to rural counties

deemed urban under section

1886(d)(8)(B) of the Act; and, that we

would annually update ASC payment
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32305

rates concurrently with the annual

update of the hospital inpatient PPS

wage index.

Use of pre-reclassification wage index

values. Both the method of setting ASC

payment rates and the method of

calculating payment amounts for

individual claims for ASC facility

services proposed in this notice include

a wage index adjustment to offset the

effects of geographic wage differences.

In this notice, we propose to continue

using the most recent index that HCFA

has determined from hospital wage and

salary data collected from hospital cost

reports. However, we propose to use

wage index values that are calculated

from wage and salary data before HCFA

makes certain adjustments. That is, the

wage index that we propose to use to

adjust ASC payment rates reflects

neither the effects of hospitals being

redesignated or reclassified from one

area to another under the provisions of

sections 1886(d)(8)(B), 1886(d)(8)(C),

and 1886(d)(10) of the Act, nor the

requirement stated in sections 4410 (a)

and (b) of the Balanced Budget Act of

1997 (Pub. L. 105–33) that the wage

index for an urban hospital not be lower

than the Statewide rural wage index. We

believe this ‘‘pre-classification// prefloor’’ wage index more directly reflects

salary and wage levels for health care

personnel within a given geographic

area than does a wage index that is the

result of a series of hospital-specific

adjustments.

A description of how HCFA

determines the FY 1998 prereclassification//pre-floor wage index

values for urban and rural areas that we

used to determine the rebased rates that

are proposed in this notice and that

carriers will use to calculate wageadjusted payments to individual ASCs

is in the Federal Register published on

August 29, 1997 (62 FR 45985).

For the same reason that we are using

pre-reclassification// pre-floor wage

index values, we propose to eliminate

special wage index designations for

ASCs in rural counties deemed urban

under section 1886(d)(8)(B) of the Act.

The counties affected by this proposed

change of policy are listed in Table 3.

We propose to have carriers use the

wage index value for the geographic

area in which the facility is located

rather than a reclassified wage index

value when they calculate Medicare

facility fees for ASCs in these

designated counties. We solicit

comments from ASCs located in these

areas if they believe they will be

adversely affected by our no longer

providing an ASC-specific wage index

value for counties deemed urban under

section 1886(d)(8)(B) of the Act.

There is precedent for our decision to

use pre-reclassification hospital

inpatient PPS wage index values: We

use pre-reclassification wage index

values to determine allowable costs and

Medicare payment limits for skilled

nursing facilities (SNFs) and home

health agencies (HHAs). We further

reason that because the decisions of the

MGCRB apply solely to individual

hospitals, and because there is no

mechanism by which we can link ASCs

with individual hospitals, prereclassification// pre-floor wage index

values adequately measure wage and

wage-related costs for short-term, acute

care hospitals located within the labor

market areas defined by the Office of

Management and Budget (OMB) upon

which we base our definition of

geographic areas. OMB updates the

definitions of metropolitan areas (MAs)

each June, adding new areas that qualify

as MAs and cities that qualify as central

areas for MAs, keeping the definitions of

these geographic areas current. We also

include in our definition of hospital

labor market areas the New England

County Metropolitan Areas (NECMAs),

as defined by OMB and the special

reclassification of Stanly County, North

Carolina (a rural county) as part of the

Charlotte-Gastonia-Rock Hill, North

Carolina-South Carolina MSA ( a large

urban area) under section 4408 of the

BBA of 1997.

If the FY 1998 hospital inpatient PPS

wage index is updated prior to

publication of the final rule

implementing the provisions of this

notice, we shall recalculate all

procedure costs and payment rates

accordingly. The final rebased ASC rates

may therefore vary somewhat from the

rates proposed in this notice as a result

of our using pre-reclassification//prefloor hospital inpatient PPS wage index

values that are more current at the time

of publication of the final notice.

During the time between

implementation of the final rates

proposed in this notice and the next

cycle of ratesetting to rebase rates using

newer survey data, we shall freeze the

base rates other than to adjust them for

inflation in accordance with section

1833(i)(2)(C) of the Act, as amended by

section 4555 of BBA 1997. That is, we

do not intend to reset the base rates

during these interim years to reflect the

annual update of the wage index,

although carriers will continue to

calculate payment amounts to facilities

using the most currently available wage

index values, as they do currently.

We note that one consequence of our

proposal to move all ASC updates to a

calendar year cycle is a three-month

delay in applying to the calculation of

ASC facility fees the hospital inpatient

PPS wage index values, which are

updated on a fiscal year basis every

October 1. We believe that the

advantages of consolidating the updates

of ASC rates, the ASC list, and wage

index values to be effective every

January 1, concurrent with the update of

the Medicare Physician Fee Schedule,

the Physicians’ Current Procedural

Terminology, and the Health Care

Financing Administration (HCFA)

Common Procedure Coding System

(HCPCS), far outweigh any

disadvantages that might result from

delaying for three months

implementation of the most recent wage

index. We solicit comments on this

point and on the other modifications we

propose to make with respect to our

policy for adjusting ASC payment rates

to offset the effects of geographic wage

differences.

TABLE 3.—COUNTIES THAT WILL NO

LONGER BE DEEMED URBAN UNDER

SECTION 1886(D)(8)(B) OF THE ACT

TO CALCULATE ASC PAYMENTS

County

Barry, MI

Cass, MI

Caswell, NC

Christian, IL

Harnett, NC

Henry, IN

Indian River, FL

Ionia, MI

Jefferson, KS

Jefferson, WI

Lawrence, PA

Lincoln, WV

Macoupin, IL

Marshall, AL

Mason, IL

Morrow, OH

Owen, IN

Preble, OH

Shiawassee, MI

Tuscola, MI

Van Wert, OH

Walworth, WI

j. Adjust Reported Costs for Inflation to

Offset Fiscal Year Differences Among

Facilities

The most recently completed 12-

month fiscal period for the majority of

ASCs that submitted the 1994 survey

coincided with calendar year 1993, but

there were some surveys with data

reported for a 12-month period ending

on a date other than December 31, 1993.

(The earliest beginning date for a survey

period was January 1, 1992; the latest

ending date for a survey period was

June 30, 1994.) Therefore, both to ensure

comparability in our cost assumptions

and to express procedure costs in

equivalent dollars, we inflated the cost
32306 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

amount established for every procedure

at the facility level from the midpoint of

the facility’s reporting period to a

common end period using the

Consumer Price Index—All Items

(Urban). We used July 1, 1998, the

midpoint of the calendar year during

which the rates in this notice are

proposed for implementation, as the

common end period. Table 4 shows the

factors we used to express procedure

costs in dollar levels projected for July

1, 1998. The only difference between

using the factors in this table to adjust

procedure costs for actual and projected

changes resulting from inflation and the

factors that we used to inflate the 1986

base rates is that the factors used here

are sensitive to quarterly rather than just

annual inflationary trends.

TABLE 4.—FACTORS TO INFLATE AMBULATORY SURGICAL CENTER PER PROCEDURE COSTS TO JULY 1, 1998 DOLLARS

USING CPI-ALL ITEMS, URBAN

Survey year starts Survey mid-point Survey year ends

Factor

needed to

adjust to

common

end period

(7/1/98)

Jan–1–92 ................................................... Jul–1–92 ................................................... Dec–31–92 ............................................... 1.18268

Feb–1–92 .................................................. Aug–1–92 ................................................. Jan–31–93 ................................................ 1.17961

Mar–1–92 .................................................. Sep–1–92 ................................................. Feb–28–93 ................................................ 1.17653

Apr–1–92 ................................................... Oct–1–92 .................................................. Mar–31–93 ................................................ 1.17347

May–1–92 .................................................. Nov–1–92 ................................................. Apr–30–93 ................................................ 1.17043

Jun–1–92 ................................................... Dec–1–92 ................................................. May–31–93 ............................................... 1.16748

Jul–1–92 .................................................... Jan–1–93 .................................................. Jun–30–93 ................................................ 1.16466

Aug–1–92 .................................................. Feb–1–93 .................................................. Jul–31–93 ................................................. 1.16198

Sep–1–92 .................................................. Mar–1–93 .................................................. Aug–31–93 ............................................... 1.15936

Oct–1–92 ................................................... Apr–1–93 .................................................. Sep–30–93 ............................................... 1.15676

Nov–1–92 .................................................. May–1–93 ................................................. Oct–31–93 ................................................ 1.15417

Dec–1–92 .................................................. Jun–1–93 .................................................. Nov–30–93 ............................................... 1.15163

Jan–1–93 ................................................... Jul–1–93 ................................................... Dec–31–93 ............................................... 1.14915

Feb–1–93 .................................................. Aug–1–93 ................................................. Jan–31–94 ................................................ 1.14674

Mar–1–93 .................................................. Sep–1–93 ................................................. Feb–28–94 ................................................ 1.14439

Apr–1–93 ................................................... Oct–1–93 .................................................. Mar–31–94 ................................................ 1.14208

May–1–93 .................................................. Nov–1–93 ................................................. Apr–30–94 ................................................ 1.13982

Jun–1–93 ................................................... Dec–1–93 ................................................. May–31–94 ............................................... 1.13751

Jul–1–93 .................................................... Jan–1–94 .................................................. Jun–30–94 ................................................ 1.13505

Source: DRI/McGraw-Hill, 4th Qtr1996;@USSIM/TRENDLONG1196@CISSIM/CONTROL964.

3. Proposed Ratesetting Method

Determine the median per-procedure

cost, across all facilities, for each

reported CPT code.

a. Weights

In the 1986 ASC survey, we collected

data on the total number of times a

specific procedure, as defined by a CPT

code, was performed in the facility. To

determine Medicare utilization, the

1986 survey asked for a total count of

Medicare patients served by the ASC

during the survey period. The number

of times specific procedures were

performed on Medicare patients was not

identified. Therefore, the only way to

weight 1986 survey data by Medicare

utilization was to apply a facilityspecific ratio of Medicare patients to all

patients served during the survey period

to the total number of times a specific

procedure was performed. As a result,

cost data for procedures with high

Medicare utilization, such as cataract

extraction, were weighted the same as

cost data for procedures that were

performed only rarely for Medicare

beneficiaries.

In the 1994 ASC survey, to obtain a

more accurate measure of Medicare

utilization, we not only collected

information on how many times a

procedure on the ASC list was

performed during the survey period, but

also, how many times the patient was a

Medicare beneficiary when the

procedure was performed. Having this

utilization information available for

each CPT code enables us to weight

1994 survey data with greater precision

than we could with the 1986 survey

data. After we adjust and then convert

per procedure charges to per procedure

costs, we use the procedure’s total

volume as a weighting factor to

determine the median per procedure

cost across all facilities that reported

charge and utilization data for the

procedure. Then, as we explain in a

later section, after we assign procedures

to payment groups, we use the

procedure’s Medicare volume as a

weighting factor to determine the

median cost of all the procedures in the

group. This final median cost becomes

the payment rate for all the procedures

in the group.

b. Determination of Weighted, Trimmed

Median Per Procedure Cost Across All

Facilities

To determine the median cost of a

procedure across all the facilities where

it was performed, we arrayed each

facility’s net, wage-neutral, inflation

adjusted cost for the procedure in

descending order of cost, weighted by

the number of times the procedure was

performed in the facility for all patients,

both Medicare and non-Medicare. After

trimming observations above the 90th

and below the 10th percentile, to

remove costs that were aberrant

extremes, we determined the median

cost for the procedure code. We

repeated this process for every

procedure on the ASC list for which

utilization was reported in the 1994

survey to arrive at a weighted median

procedure cost for the 1516 CPT codes

in the survey data set.

Because Medicare volume for most

procedures is but a fraction of total

utilization, we believe that weighting by

total volume gives us a truer per

procedure median cost across all ASCs

than weighting by Medicare volume

alone. Weighting by total volume

expands our data set by pulling in
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32307

1Health Information Systems, 3M Health Care.

The Ambulatory Patient Groups Definitions

Manual, Version 2.0. Wallingford, Connecticut,

1995.

procedures for which no Medicare

volume was reported. Use of the median

rather the mean procedure cost further

minimizes the effect of individual

facility cost extremes.

Having established a weighted

median procedure cost that represents

costs incurred by ASCs generally to

perform the procedure based on audited

and standardized 1994 survey data, we

proceed to the final step in the

ratesetting process, which is grouping

procedures for the purpose of

calculating prospective ASC payment

rates.

4. Proposed Ratesetting Method

Establish procedure groupings.

a. Current Classification System

When we rebased ASC payment rates

using 1986 survey data, we expanded

from four to eight payment rates or

levels, as explained in the February 8,

1990 Federal Register (55 FR 4539). (We

explain elsewhere in this notice that a

ninth payment level was established

effective January 30, 1992 to

accommodate payment for CPT code

50590, extracorporeal shock wave

lithotripsy, but that payments of an ASC

facility fee for this procedure were

suspended following the issuance of a

court stay on March 10, 1992.) We

currently group codes by assigning each

procedure, depending on its cost, to the

appropriate level within a series of

predetermined $75 intervals. The only

factor roughly common to all

procedures within the six currently

active non-IOL ASC payment groups is

the approximate cost of performing the

procedure based on 1986 survey data

and/or our estimate of that cost when

data are lacking.

b. Proposed Ambulatory Payment

Classification System

We propose to replace the current

method of grouping procedures on the

ASC list with a classification system

that takes factors such as time, type of

surgery, and body system into account,

in addition to the costs incurred by

facilities in connection with performing

the procedure. Addendum B lists the

resulting ambulatory payment

classification system (APCS) groups that

are the basis for determining the

payment rates for ASC facility services

that we are proposing in this notice.

Although the genesis of these groups

was in the ambulatory patient groups

(APGs) that were developed by 3M

Health Care under a HCFA grant, the

APC groups are not the same as APGs,

and Medicare regulations and policy

governing payments to ASCs using these

groups do not necessarily follow the 3M

APG model.1

The APC groups are the result of

intensive work on the part of HCFA staff

and medical advisors who started with

the 3M APGs but then reorganized the

groups on the basis of several factors.

First, we had a data set of 1516 CPT

codes with cost and utilization

information from 295 ASCs that was

collected through the 1994 ASC survey.

In addition, we had comments from 79

correspondents, including ASC

administrators, State agencies,

professional organizations and societies,

trade associations, and physicians

following the July 1996 Medicare ASC

Town Meeting in Baltimore, that were

virtually unanimous in questioning the

internal consistency of a number of the

3M APG groups. (We had circulated

3M’s Version 2.0 significant procedure

APGs at the ASC Town Meeting,

without any costs or rates attached, and

asked for comments on the homogeneity

of the groups.) A number of commenters

suggested regrouping codes, and they

supported their recommendations on

the basis of the time required to perform

procedures in the new groups and the

costs associated with supplies and

equipment needed to perform the

procedures. Of particular concern were

the grouping of gastrointestinal

endoscopies, arthroscopies, a number of

urinary tract procedures, and groups

where diagnostic and therapeutic

surgical procedures were put in the

same APG. In cases where our data

supported a recommendation, we

modified a payment group accordingly.

If we did not make a recommended

change, it was because our data did not

support the change, or because the

change was inconsistent with our

standards for determining procedures

that are safe and appropriate in an ASC.

Once we began shifting codes from one

group to another, we found that other

groups were affected, so we ended up

reviewing and modifying virtually every

grouping of surgical procedure codes.

To classify procedures with limited or

aberrant ASC survey data, we relied on

the medical judgement of our staff

physicians in conjunction with 1993

hospital outpatient department claims

data and physician practice expense

relative value units (RVU) from the

Medicare physician fee schedule. We

also took into account Medicare

utilization patterns based on 1995

physician claims site-of-service data to

aid in determining levels of procedure

complexity.

By adding clinical consistency to cost

as a determinant for classifying surgical

procedures for ratesetting purposes, we

propose to expand from eight to 105 the

number of ASC payment groups. Our

lowest payment rate would drop to $53

(APC #207, Closed Treatment Fracture

Finger/Toe/Trunk), and our highest

payment rate would increase to $2,107

(APC #527, Lithotripsy). We believe this

classification system rectifies distortions

that have developed under the current

ASC groups which have resulted in

underpayments for a number of

procedures and overpayments for some

others.

Using groups that are characterized by

homogeneous clinical characteristics as

well as costs enables us to set rates more

accurately for new procedures that are

appropriate and safe in an ASC but for

which we have minimal data or for

infrequently performed procedures for

which cost data are questionable or nonexistent.

Following the ASC Town Meeting,

some commenters urged a ratesetting

method for ASCs that would promote

equitable reimbursement for procedures

across all settings. At least one

commenter stated that Medicare

payment policy ought to be neutral as to

site of service. In fact, one of the reasons

that we have devoted so much attention

to developing the APC surgical groups

for ASC ratesetting is in anticipation of

using them as part of the prospective

payment system that is to be

implemented on January 1, 1999 for

hospital outpatient department services.

It is our intent to keep the APC surgical

groups comparable for ASCs and

hospital outpatient departments

(HOPDs). Currently under development

is the HOPD prospective payment

system, which contains as one of its

elements APC surgical groups that

parallel the APC surgical groups we are

proposing for ASCs. In order to keep the

groups comparable in the two settings,

we propose to review comments on the

composition of the APC groups that are

submitted during the public comment

period following publication of both

this ASC notice and the HOPD notice.

We further propose to coordinate any

adjustments to the composition of the

APC surgical groups that may result

from our analysis of both sets of

comments to ensure that the final APC

surgical groups not only reflect and take

into account both sets of comments, but

also remain comparable for ASCs and

HOPDs to the maximum extent possible

within the constraints imposed by

statutory and regulatory requirements.
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Every CPT code within the surgical

range of 1998 Physicians’ Current

Procedural Terminology is accounted

for in Addendum A either in an APC

group or in a non-payment category. We

propose to expand the list of Medicare

covered procedures from 2280 to 2499,

which includes the addition of 422

procedures and the deletion of 203

procedures currently on the list,

consistent with the standards discussed

in section II.A. of this notice. We move

to the final step in determining

prospective payment rates for

procedures on the ASC list.

5. Proposed Ratesetting Methodology

Determine a standard payment rate for

the procedures within each group.

a. Setting Rates Based on ASC Survey

Data

Having classified procedures that are

safe and appropriate in an ASC setting

into 105 payment groups, we arrayed

the procedures within each group in

descending order of facility-specific

procedure cost, weighted by each

facility’s procedure-specific Medicare

volume, to determine the median cost of

procedures in that APC. Weighting by

the number of times the procedures

were performed on Medicare patients

gives recognition to the relative

importance of each facility in furnishing

procedures covered by the Medicare

program. The derived median cost

determined the payment rate for the

group.

b. Setting Rates for Procedures With

Limited Medicare Volume or Aberrant

Cost Data

When we determined individual

procedure costs (see section III.E.2,

above), we eliminated information on

costs, charges, and utilization from the

ASC survey database for 345 CPT codes

that were reported by fewer than 3

facilities and 199 CPT codes for which

there was no reported Medicare volume.

We also lacked 1994 survey data for the

422 proposed additions to the ASC list.

After procedures had been assigned to

APC groups (section III.E.4, above), we

found 6 surgical APCs comprised

entirely of codes for which we had no

reported ASC survey data. In addition,

there were 43 APCs with fewer than 200

Medicare cases across all procedures in

the group. (We determined that using

the median cost of fewer than 200

Medicare cases to set payment rates for

these 43 APCs failed to represent

adequately the majority of procedures

within the group and did not result in

a reasonable group payment rate.) We

also identified 15 APCs with Medicare

volume greater than 200 cases for which

we did not rely on reported ASC data

to determine a payment rate because we

believed that reported procedure

charges for codes in these groups were

based more on historical ASC payment

rates than on the cost of performing the

procedure. We also questioned the

reliability of the data reported for

procedures within these groups when

we found in the majority of cases that

the per procedure costs of simple

procedures were higher than the costs

determined for similar but more

complex procedures.

In order to set a payment rate for the

64 APC groups for which we had little

or no Medicare volume or reliable cost

data, we calculated a relative value

factor for each of the 41 surgical APC

groups for which we did have reliable

data, which we extrapolated as a

standard against which to compare and

rank the 64 data deficient APC groups.

To calculate the relative value factors,

we divided the payment rate already set

for each of the 41 APCs with adequate

ASC survey data (see section III.E.5.a,

above) by 504, the median rate of those

41 groups. We used the relative value

factors as a gauge to compare the datadeficient groups with the 41 groups

with data in terms of the type and

duration of surgery, supply and

equipment costs, and clinical labor

requirements characteristic of each

group. We reasoned that we could infer

a relative value factor for each of the

data-deficient groups on the basis of

these comparisons. Using this analysis,

combined with the expertise of our staff

physicians, the comments we received

following the 1996 ASC Town Meeting,

and our analysis of other data sources,

such as 1993 hospital outpatient claims

data and relative value units established

under the Medicare Physician Fee

Schedule, we estimated relative value

factors for the 64 ASC data-deficient

APC groups. The relative value factors

for procedures on the ASC list are

shown in Addendum A and Addendum

C.

We then multiplied the relative value

factor estimated for each data-deficient

group by 504 to determine a payment

rate for each of the 64 data-deficient

APC groups. We viewed 504 as the most

reasonable value to use as a conversion

factor to set ASC payment rates for the

data-deficient APCs because 504 was

the median rate of the APC groups that

had the highest ASC Medicare volume

and for which we had substantive 1994

survey data.

Using this approach, we determined

payment rates for 1058 CPT codes (42

percent of the 2499 codes proposed for

the ASC list) for which we had little or

no cost data. Of the 43 APCs that had

fewer than 200 Medicare cases, nearly

half were assigned a higher payment

rate than would have been the case if we

had relied on the limited ASC data that

were available as the basis for the

payment rate. In the case of two groups

with more than 200 Medicare cases, one

of which consisted of corneal transplant

procedures, we increased the payment

rate because the data-referenced costs

were too low.

c. Payment Rate for CPT Code 67027,

Implantation of Intravitreal Drug

Delivery System

This is a new 1998 CPT code that we

are proposing to add to the ASC list.

Because it is new, we have no cost data

in connection with this code. We ask for

comments on which of the APC groups

proposed for ophthalmic procedures

(APC groups 649, 651, 652, 667, 668,

670, 676, 677, 683, 684, or 690) this

procedure code would be most

appropriately assigned both in terms of

its clinical characteristics and resource

costs. We request that commenters

support their suggestions with

information and data that elucidates the

clinical characteristics and resource

costs of this procedure relative to other

procedures in the various APC groups

for eye surgery.

6. Payment Policy Indicators

We have developed a set of payment

policy indicators to assist ASCs and

fiscal contractors in determining

whether Medicare allows payment to an

ASC for a particular procedure, item or

service. Addendum A shows a payment

indicator for every 1998 HCPCS code.

ASC payment policy indicators are

intended to supplement, not replace, the

correct coding initiative (CCI) edits that

carriers already apply to claims for ASC

services. (The CCI edits identify code

pairs which, when billed together,

represent either unbundling (the

reporting of a comprehensive procedure

and its component procedures) or

mutually exclusive procedures

(procedures which by definition cannot

occur during the same operative

session.)) The ASC payment policy

indicators are defined as follows:

a. We use ‘‘1’’ to designate a

procedure for which Medicare pays

Medicare approved ASCs a

prospectively determined ASC facility

fee for ASC services. Collectively, the

CPT codes with an ASC payment

indicator of ‘‘1’’ make up the ASC list.

(See Addendum B.) Medicare allows

payment of an ASC facility fee only for

codes with an ASC payment policy

indicator of ‘‘1.’’

b. We use ‘‘2’’ to indicate a procedure,

item, or service for which Medicare
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does not allow a separate payment when

the procedure, item, or service is

furnished at a Medicare approved ASC.

If the procedure, item, or service is

covered, payment is always packaged

into and subsumed within payment(s)

made for other services not specified.

Some codes with a ‘‘2’’ indicator

describe items or services that fall

within the scope of ASC facility

services, whose costs are taken into

account within the ASC facility fee.

Examples of these include CPT code

36000, Introduction of needle or

intracatheter; or, CPT code 81002,

Urinalysis, by dip stick or tablet reagent;

or, alphanumeric HCPCS code V2632,

Posterior chamber intraocular lens.

When these services are furnished at an

ASC, payment for them is included as

part of the ASC facility fee.

c. We use ‘‘3’’ to indicate a procedure,

item or service that is excluded from the

ASC list because it is not reasonable, not

necessary, and not appropriate in an

ASC setting. We have assigned an ASC

payment policy indicator of ‘‘3’’ to

procedures that our medical advisors

consider to be unsafe in an ASC based

on the criteria in § 416.22(b), and to CPT

codes that are for unlisted procedures.

d. Codes with an ASC payment policy

indicator ‘‘4’’ are not valid for Medicare

purposes, although Medicare recognizes

a 90-day grace period during which the

code may be used. If Medicare covers

the service, another code is to be used

to bill for it. Codes with an ASC

payment policy indicator ‘‘4’’ are

assigned a procedure status code of ‘‘G’’

on the Medicare Physician’s Fee

Schedule.

e. We use ‘‘5’’ to indicate a procedure,

item, or service that is safely and

appropriately performed or furnished in

a physician’s office or clinic. We

consider procedures with an ASC

payment policy indicator ‘‘5’’ to be

office-based because they do not

generally require the more elaborate

facility services of an ASC and they do

not satisfy the criteria proposed in

§ 416.22(a). Procedures with an ASC

payment policy indicator ‘‘5’’ are not

considered to be on the ASC list.

Medicare takes into account and pays

for the costs incurred to perform these

procedures under the Physician Fee

Schedule. If a procedure with an ASC

payment policy indicator ‘‘5’’ were

performed at an ASC and the ASC billed

Medicare for the procedure, payment

would be denied. The denial would be

based on two factors: first, the

procedure is not on the ASC list, and

secondly, because the procedure is

designated as an office-based procedure,

Medicare payment for the procedure is

made in full to the physician as

determined by the physician’s fee

schedule. Any payment in addition to

what Medicare pays the physician

under the Medicare Physician Fee

Schedule for procedures with an ASC

payment policy indicator ‘‘5’’ is

redundant and is not allowed. After any

applicable deductible and copayment

amounts are satisfied, we consider the

beneficiary’s obligation for a procedure

with an ASC payment policy indicator

‘‘5’’ to be met in full by Medicare’s

payment to the physician.

If a procedure code with an ASC

payment policy indicator ‘‘5’’ is subject

to the site-of-service differential under

the Medicare Physician Fee Schedule,

the site-of-service practice expense

reduction is not applied if the procedure

is performed in an ASC because we do

not consider the procedure to be on the

ASC list and because we regard the ASC

as a surrogate physician’s office with

respect to these procedures.

f. We use ASC payment policy

indicator ‘‘6’’ to indicate that a

procedure, item or service either falls

outside the scope of ASC facility

services as proposed in § 416.21(b) or

that the procedure, item or service is

one to which the concepts of an ASC

facility fee or the ASC benefit are not

relevant and do not apply. In the latter

case, the procedure, item or service is

outside the realm of ASC facility

services and would never, by definition,

be furnished by an ASC, e.g., clinical

laboratory tests, maternity care and

delivery, emergent procedures, or

physician evaluation and management.

In the former case, although the ASC

facility fee for a surgical procedure on

the ASC list does not include payment

for the cost of items, procedures, or

services that have an ASC payment

policy indicator ‘‘6’’, if these

procedures, items, or services are

covered and are reasonable and

necessary, Medicare could allow a

separate payment under another Part B

benefit as long as Medicare recognizes

and approves the entity as a supplier of

the item or service. For example, we do

not consider prosthetic implants, except

IOLs, to fall within the scope of ASC

facility services. But if an entity that is

approved by Medicare as an ASC is also

approved as a supplier of prosthetic

implants, Medicare allows payment to

the entity for a prosthetic implant in

accordance with the prosthetic fee

schedule in addition to payment of an

ASC facility fee for services furnished

by the entity in connection with a

procedure on the ASC list that is

performed to insert the prosthetic

implant. See section III.F for further

discussion of items and services that fall

outside the scope of ASC services.

g. We use ‘‘7’’ to indicate a procedure

to which special coverage instructions

apply, such as CPT code 11950,

Subcutaneous injection of ‘‘filling’’

material, (e.g. collagen); 1 cc or less,

about which carriers must make a

determination of reasonableness and

medical necessity. If a surgical

procedure with an ASC payment policy

indicator ‘‘7’’ is performed in a

Medicare approved ASC and a claim for

ASC services is submitted, payment

depends on whether the carrier

determines that the procedure is

reasonable and necessary. If the carrier

determines that the procedure was

reasonable and necessary, an ASC

payment rate is given and the procedure

would be considered to be on the ASC

list for the purposes of the specific

claim. Procedures with a status

indicator ‘‘R’’ under the Medicare

Physicians’ Fee Schedule automatically

receive an ASC payment policy

indicator of ‘‘7.’’

h. We have reserved payment policy

indicator ‘‘8’’ for future use.

i. We use ‘‘9’’ to indicate a procedure,

item or service that is not covered by

Medicare and for which Medicare never

makes payment. ASC payment policy

indicator ‘‘9’’ corresponds to procedure

status codes ‘‘I’’, ‘‘N’’, and ‘‘E’’ under

the Medicare Physician Fee Schedule.

(Status code ‘‘I’’ is used to indicate

codes that are not valid for Medicare

purposes with no grace billing period

allowed; status code ‘‘N’’ is used to

indicate codes that describe a

noncovered service; status code ‘‘E’’ is

used to indicate codes that are excluded

from the Medicare Physician Fee

Schedule by regulation.)

7. Comments on Proposed Ambulatory

Payment Classification Groups, Payment

Policy Indicators and Payment Rates

Addendum A lists all 1998 HCPCS

codes in numeric order by code and

includes an ASC payment policy

indicator for each code and, where

applicable, a notation as to whether or

not the code is proposed for addition to

or deletion from the ASC list.

Addendum B presents the ASC list by

APC group. Addendum C is a list of 105

surgical APC groups with their

respective titles, ASC relative values,

and ASC payment rates. We solicit

comments on the payment rates, APC

grouping, and payment policy

indicators proposed in these tables.

However, we request that commenters

who question the appropriateness of the

rate or APC assignment proposed for a

particular procedure support their

argument with specific details related to

intra-operative time, staffing

requirements, and costs incurred by the
32310 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

facility to furnish disposable and nondisposable supplies, pharmaceuticals,

instrumentation, and equipment in

connection with the procedure and that

procedures more closely related in

terms of cost be identified. We also

solicit comments on the changes to the

ASC ratesetting methodology that are

proposed in this section.

8. Carrier Adjustment of Base Rates to

Determine Payment Amounts

The payment rates proposed in this

notice are standard base rates that have

been adjusted to remove the effects of

regional wage variations. When carriers

process claims for ASC facility services,

they adjust the base rates to reflect the

wage index value applicable to the area

in which the ASC is located. The

Medicare payment for ASC facility

services is equal to 80 percent of the

wage-adjusted standard payment rate.

Beneficiaries are responsible for a 20

percent copayment for ASC facility

services once their deductible is

satisfied. Below are some examples of

how carriers adjust the ASC base rates

to calculate facility fees.

Example 1

The following is an example of how

to determine the wage adjusted payment

rate for CPT code 28230, Tenotomy,

open, flexor; foot, single or multiple

(separate procedure) performed at an

ASC located in Denver, Colorado. The

procedure is in APC group 271, Level I

foot musculoskeletal procedures. The

base rate for the procedure is $510. The

ASC wage index value for Denver,

Colorado is 1.0386. The labor related

portion of the base rate is $192 ($510 x

37.66 percent); the non-labor related

portion of the base rate is $318 ($510 x

62.34 percent).

Wage Adjusted Rate:

= ($192 x 1.0386) + $318

= $199 + $318

= $517

Example 2

The following is an example of how

to determine payment for CPT code

66984, Extracapsular cataract removal

with insertion of intraocular lens

prosthesis (one stage procedure),

manual or mechanical technique (e.g,

irrigation and aspiration or

phacoemulsification). The procedure is

in APC group 668, Cataract procedures

with IOL insert. The base rate for the

procedure is $863, which includes a

$150 IOL allowance. Because IOLs are

not subject to adjustment for labor costs,

the IOL allowance ($150) must be

subtracted from the composite payment

rate before applying the wage index

adjustment. The ASC wage index value

for Denver, Colorado is 1.0386. The

labor related portion subject to wage

index adjustment is 37.66 percent of the

base rate from which the IOL allowance

has been deducted.

Wage Adjusted Rate:

= [{($863–150) × .3766} × 1.0386] +

[{863–150} × .6234]

= [($713 × .3766) × 1.0386] + [$713 ×

.6234]

= ($269 × 1.0386) + $444

= $279 + $444

= $723

Composite Adjusted Rate:

= $723 + $150

= $873

9. Using Resource Costing to Determine

Procedure Costs

Resource costing involves the

measurement of all the direct and

indirect costs involved in the

performance of a specific procedure.

Direct costs include all activities,

materials, and equipment that are

traceable to a specific procedure.

Indirect costs, such as rent, utilities, and

insurance, cannot be directly traced to

a specific procedure. Rather, a factor

such as units or time is used to allocate

indirect costs uniformly at the

individual procedure level.

We introduced the collection of

resource cost data in the 1994 ASC

survey primarily in response to industry

recommendations that we do so on the

grounds that procedure-specific cost

studies measure facility resource

expenditures more accurately and

reliably than using a cost-to-charge ratio

to convert procedure charges into a

proxy for procedure costs. Part II of the

1994 ASC survey collected procedure

specific statistical and resource cost

data for the following 29 ASC

procedures.

1. 14060 Adjacent tissue transfer or

rearrangement, eyelids, nose, ears and/

or lips; defect 10 sq cm or less.

2. 19120 Excision of cyst,

fibroadenoma, or other benign or

malignant tumor aberrant breast tissue,

duct lesion or nipple lesion (except

19140), male or female, one or more

lesions.

3. 28285 Hammertoe operation; one

toe (e.g., interphalangeal fusion,

filleting, phalangectomy).

4. 28292 Hallux valgus (bunion)

correction, with or without

sesamoidectomy; Keller, McBride or

Mayo type procedure.

5. 29881 Arthroscopy, knee, surgical;

with meniscectomy (medial or lateral

including any menuiscal shaving).

6. 43235 Upper gastrointestinal

endoscopy including esophagus,

stomach, and either the duodenum and/

or jejunum as appropriate; complex

diagnostic.

7. 43239 Upper gastrointestinal

endoscopy including esophagus,

stomach, and either the duodenum and/

or jejunum as appropriate; for biopsy

and/or collection of specimen by

brushing or washing.

8. 45378 Colonoscopy, fiberoptic,

beyond splenic flexure; diagnostic

procedure.

9. 45380 Colonoscopy, fiberoptic,

beyond splenic flexure; for biopsy and/

or collection of specimen by brushing or

washing.

10. 45385 Colonoscopy, fiberoptic,

beyond splenic flexure; with removal of

polypoid lesion(s).

11. 49505 Repair inguinal hernia, age

5 or over.

12. 50590 Lithotripsy, extracorporeal

shock wave.

13. 52000 Cystourethroscopy

(separate procedure).

14. 55700 Biopsy, prostate; needle or

punch, single or multiple, any

approach.

15. 56350 Hysteroscopy, diagnostic

(separate procedure).

16. 58120 Dilation and curettage,

diagnostic and/or therapeutic

(nonobstetrical).

17. 62278 Injection of anesthetic

substance (including narcotics),

diagnostic or therapeutic; lumbar or

caudal epidural, single.

18. 62289 Injection of substance other

than anesthetic, contrast, or neurolytic

solutions; lumbar or caudal epidural

(separate procedure).

19. 64721 Neuroplasty and/or

transposition; median nerve at carpal

tunnel.

20. 65730 Keratoplasty (corneal

transplant); penetrating (except in

aphakia).

21. 66170 Fistulization of sclera for

glaucoma; trabeculectomy ab externo.

22. 66821 Discission of secondary

membranous cataract (opacified

posterior lens capsule and/or anterior

hyaloid); laser surgery (e.g.. YAG laser)

(one or more stages).

23. 66984 Extracapsular cataract

removal with insertion of intraocular

lens prosthesis (one stage procedure),

manual or phacoemulsification

technique (e.g., irrigation and aspiration

or phacoemulsification).

24. 66985 Insertion of intraocular lens

prosthesis (secondary implant), not

associated with concurrent cataract

removal.

25. 66986 Exchange of intraocular

lens.

26. 67010 Removal of vitreous,

anterior approach (open sky technique

or limbal incision); subtotal removal

with mechanical vitrectomy.
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27. 67036 Vitrectomy, mechanical,

pars plana approach.

28. 67107 Repair of retinal

detachment, one or more sessions;

scleral buckling (such as lamellar

excision, imbrication or encircling

procedure), with or without implant,

may include procedures 67101, 67105.

29. 67904 Repair of blepharoptosis;

(tarso) levator resection or advancement,

external approach.

We selected these procedures because

they are either high volume ASC

procedures (such as 66984, 66821,

52000) or they are procedures that

include an unusual cost or service (such

as 67036, 65730, 50590). We asked

facilities to report typical resource

utilization and cost information

regarding time allocations, staffing

patterns and labor costs, supply costs,

and equipment costs on a procedurespecific, single case basis. In order to

calculate an overall per procedure cost

based on the resource cost data reported

in the 1994 ASC survey, we first

calculated a facility-specific procedure

cost for each of the 29 CPT codes

targeted in the 1994 ASC survey. We

then determined the median procedure

cost across all facilities, weighted by

total volume. We also looked at

weighting by Medicare volume. We

used the same wage index values and

inflation factors to adjust resource based

cost data that we used to convert

procedure charges to costs, as explained

in the preceding sections.

Step a—To remove the effect of

geographical wage differences, we

divided indirect and direct labor-related

procedure costs by the preclassification/pre-floor hospital

inpatient prospective payment system

wage index value applicable to the

facility’s location.

Step b—We calculated an overhead

factor by which to step down indirect

overhead costs to a single procedure

level. To determine this factor, we

summed the costs reported by a facility

for its plant and property; office

equipment; medical equipment other

than procedure specific equipment;

office and housekeeping supplies; wages

and fringe benefits for administrators,

directors, managers, supervisors,

clerical, and other non-medical

personnel; bad debt; and general

administrative overhead such as taxes,

insurance, and interest. We divided the

facility’s aggregated overhead expenses

by the total number of procedures

performed at the facility during the

survey period. The resulting figure

represents the amount of indirect

overhead costs apportioned to each

surgical case performed in the ASC.

Step c—We summed the costs

incurred by the facility to furnish the

disposable and reusable supplies,

pharmaceuticals, equipment, and labor

that it typically furnishes in connection

with the procedure (direct costs).

Step d—We added the facility’s

procedure-specific direct costs (Step c)

to the facility’s indirect cost allocation

(Step b).

Step e—We inflated the facility’s

procedure cost to July 1998 using the

appropriate inflation factor.

Step f—To ascertain what it costs

ASCs generally to perform the target

procedures, based on audited direct and

indirect costs, we determined the

median cost across all facilities,

weighted by total volume.

Analysis of Resource-Based Procedure

Cost Methodology: We found that for 11

of the 29 target procedures for which we

collected resource cost data, the per

procedure cost was lower using resource

costing than it was using a cost-tocharge ratio conversion, whereas for 18

of the 29 target procedures, the per

procedure cost was higher using

resource-based costing. Variations in

procedure costs between the two

methods were extreme, and for only 11

procedures was the resource-based cost

within 20% of the cost-to-charge

converted cost.

In seeking an explanation for the lack

of consistency between resource costing

and cost-to-charge conversion as a

descriptor of procedure cost, we found

resource cost data to be irretrievably

flawed. We attribute the flaws in the

resource cost data in part to the fact that

the 1994 survey was our first attempt to

capture resource costs. In spite of our

efforts at clarity and several sessions in

1994 during which we met with ASC

representatives to answer questions

about the survey, the data reported

indicate that our instructions were

either misinterpreted or misunderstood

altogether. In addition, we attribute the

highly variable resource cost data to

ASCs’ lack of familiarity with the new

survey form and to inconsistencies

among ASC recordkeeping systems.

Our intent was for each facility to

furnish a catalog or inventory of the

direct resources it typically expends to

perform each of the 29 target

procedures. But in many instances the

use of disposable and reusable supplies

and pieces of equipment for the same

procedure were reported inconsistently

across facilities. Equipment required to

perform a procedure was not listed or

information reported about the useful

life of equipment or its purchase price

was not given, making it impossible to

prorate the full cost of equipment to a

single case. The unit cost of numerous

items and services was omitted

altogether or ASCs misinterpreted unit

supply cost as the full cost of a single

item or service, instead of prorating the

full cost of an item or service to a single

case. ASCs provided incomplete sets of

resource cost data, e.g., labor costs for a

procedure would be reported without

the corresponding supply costs. Entries

were illegible on several forms.

Because of the many problems

encountered with reported resource cost

data, we used only the audited data

from the 96 facilities to compute

resource cost. However, in many cases

even audited surveys lacked direct

resource cost data reported in the

manner requested. Although we did

consult resource cost data in our

analysis of procedure costs and in

assigning CPT codes to APC groups, we

believe that shortcomings inherent in

our resource cost data base and the

limitation of cost data to only 29 codes

preclude our relying on resource costing

as a basis for setting payment rates at

this time. Therefore, we have based the

rates proposed in this notice on the

methodology explained previously.

We are disappointed by our lack of

success in the 1994 ASC survey in

gathering usable resource cost data. Our

inability to establish weights and base

ASC payment rates on the resource cost

data that we did collect is particularly

frustrating in light of the fact that we

expect, beginning January 1, 1999, to

make payments to physicians under the

Medicare physicians’ fee schedule that

are determined in part on the basis of

resource-based practice expense relative

units. We have been closely monitoring

the development of the resource-based

practice expense relative value units

under the physicians’ fee schedule and

the ratesetting method for the hospital

outpatient prospective payment system,

which is also scheduled for

implementation effective January 1,

1999. When we rebase ASC payment

rates following the next ASC survey, we

are committed to reexamining the

resource-based practice expense relative

value units established under the

Medicare physicians’ fee schedule and

the weights developed under the

hospital outpatient prospective payment

system for their applicability to ASC

ratesetting in order to advance towards

our goal of setting rates in a manner that

is consistent across different sites of

service.

F. Scope of ASC Services (§ 416.21)

We are proposing to renumber

§ 416.61 to become § 416.21, and to

clarify those items and services that we

consider to fall within the scope of

facility services for which payment is
32312 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

made as part of the ASC facility fee. In

addition, this section of the regulation

lists the types of items and services that

are considered to fall outside the scope

of ASC facility services, for which

payment is not included in the ASC

facility fee but for which payment could

be made under other provisions of

Medicare Part B. Recurring questions

have prompted these changes, such as

inquiries as to whether or not ASC

facility services include fixation devices

and orthopedic pins, fluoroscopy used

to assist the surgeon’s field of vision

during surgery, electrocardiograms, the

costs of procuring tissue for implant,

and prosthetic implants.

1. ASC Services

We continue to consider the following

to be ASC facility services: the services

of nurses, technicians, and other staff

involved in patient care; the patient’s

use of the facility, including but not

limited to its operating room, recovery

room, waiting room, rest rooms, locker

area; administrative, recordkeeping, and

housekeeping items and services that

constitute indirect overhead expenses,

including but not limited to employees

and contracted services related to

scheduling, admitting, discharging, and

billing patients, to maintenance,

utilities, laundry, debt service, plant

and property costs, and insurance; and,

intraocular lenses that are defined by

the statute specifically as an ASC

facility service. In addition, ASC

services include medical and other

health services such as surgical

supplies, medical equipment, drugs,

biologicals, and pharmaceuticals;

materials for anesthesia, including the

anesthetic itself and any equipment and

supplies necessary to administer and

monitor anesthesia; and, splints, casts,

pins, wires, and other supplies used to

reduce fractures and dislocations.

Current section 416.61(a)(4) states that

facility services include ‘‘diagnostic or

therapeutic services or items directly

related to the provision of a surgical

procedure.’’ Section 416.61(b)lists as

‘‘excluded services’’, among other

things, ‘‘X-ray or diagnostic procedures

(other than those directly related to

performance of the surgical procedure).

. . .’’ We have had a number of inquiries

as to which diagnostic or therapeutic

services are considered within the scope

of ASC facility services and which are

not. From a payment perspective the

distinction is important, to determine if

the diagnostic and therapeutic services

can be paid for separately, in addition

to the facility fee. In an effort to clarify

the distinction, we have revised the

regulation, and we propose to adopt the

following policy. We assume that when

the descriptor for a CPT code includes

explicit reference to some kind of

imaging, guidance, or other diagnostic

test, the cost, and therefore the ASC

payment rate that we have derived for

that procedure, include the imaging,

guidance, or other diagnostic test, and

those services are considered to be

within the scope of ASC services. An

example of such a procedure is CPT

code 56362, Laparoscopy with guided

transhepatic cholangiography; without

biopsy. In the case of a procedure such

as this, because the imaging is explicitly

integral to and inseparable from the

surgical procedure, it is considered

within the scope of service and no

separate payment is allowed for the

imaging.

When the descriptor for a CPT code

specifies ‘‘with or without’’ some kind

of imaging, guidance, or other

diagnostic test, we assume that the cost,

and therefore the ASC payment rate that

we have derived for that procedure, do

not include the imaging, guidance, or

other diagnostic test, and those services

are considered to fall outside the scope

of ASC facility services. Therefore, the

ASC facility fee for the procedure would

not include payment for costs incurred

to furnish this type of monitoring. There

are other procedures, such as CPT code

36533, Insertion of implantable venous

access port, with or without

subcutaneous reservoir, where the

physician may or may not elect to use

some type of imaging such as a

fluoroscope to assist in placing the

device. In such cases, we assume that

the cost, and therefore the ASC payment

rate for the procedure, do not include

the imaging or guidance. In the case of

these procedures, the imaging,

guidance, or other diagnostic test is

considered to fall outside the scope of

ASC facility services, and the ASC

facility fee does not include payment for

the costs incurred to furnish these

services.

Payment for the costs incurred by an

ASC to perform any tests granted

waived status under the Clinical

Laboratory Improvement Amendments

of 1988 (CLIA) as part of preparing a

patient for surgery on the day of surgery

is included in the ASC facility fee for

the surgical procedure, and no separate

payment for these tests is allowed. If an

entity that is approved by Medicare as

an ASC also wants to be paid by

Medicare for diagnostic laboratory

services, other than tests granted waived

status under CLIA, that entity must meet

the laboratory requirements spelled out

in 42 CFR Part 493. In this case, the

entity would be considered a certified

laboratory billing Medicare for certified

laboratory services, not as a Medicare

approved ASC billing Medicare for ASC

facility services. Classification as a

certified laboratory or classification as a

Medicare approved ASC is, for Medicare

billing purposes mutually exclusive.

2. Venous Access Portals Are ASC

Facility Services

In 1992 we began receiving

communications informing us that the

cost of certain models of implantable

venous access ports that ASCs were

furnishing in connection with CPT

36533, Insertion of implantable venous

access port with or without

subcutaneous reservoir, exceeded the

total facility fee for the surgical implant

procedure. Following a review of cost

data available at the time, we instructed

carriers to pay the acquisition cost of an

implantable venous access port (HCPCS

code A4300) as a temporary add-on to

the ASC facility fee for CPT code 36533,

even though the port is considered a

supply, the cost of which would

ordinarily be packaged in the ASC

facility fee.

In this notice, we propose to place

CPT code 36533 in APC 368. The

payment rate proposed for CPT code

36533 includes an allowance for the

cost incurred by an ASC to furnish

A4300, Implantable access catheter

(venous, arterial, epidural, or

peritoneal), external access, or A4301,

Implantable access total system;

catheter, port/reservoir (venous, arterial

or epidural), percutaneous access.

Beginning on the effective date of the

implementation of the rates and

ratesetting methodology proposed in

this notice, Medicare will cease to make

a separate payment for implantable

access catheters and/or ports furnished

in connection with CPT code 36533

when the procedure is performed in an

ASC. Alphanumeric codes A4300 and

A4301 have a payment indicator ‘‘2,’’

because the costs incurred to furnish

these items, which are considered

supplies, in connection with performing

CPT code 36533 are considered to be

within the scope of ASC services for

which Medicare makes payment of an

ASC facility fee.

We solicit comments on the adequacy

of the payment rate for CPT code 36533

to offset the costs incurred to furnish the

vascular access portal.

3. Acquisition of Corneal Tissue is an

ASC Service

In 1992, ASC administrators and

medical staff also pointed out a growing

disparity between the payment amount

established for corneal transplant

procedures (CPT codes 65710, 65730,

65750, and 65755) and the costs ASCs

were incurring to furnish corneal tissue,

e.g., the charges imposed by eye banks
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32313

and organ procurement organizations

for processing, preserving and shipping

corneal tissue. A review of the data that

were the basis for setting the payment

rates for corneal transplant procedures

indicated that corneal tissue

procurement costs had either not been

reported or else had been imprecisely

identified, and these costs did not

appear to be reflected in the ASC

payment rates established for corneal

transplant surgery. Therefore, we

instructed carriers to pay corneal tissue

acquisition costs (HCPCS code V2785),

subject to the usual copayment and

deductible requirements, as an add-on

to either the ASC facility fee or the

supplying physician’s fee for corneal

transplant surgery performed in an ASC.

The additional payment had to be

supported by an invoice from an eye

bank or organ procurement organization

showing the actual cost of acquiring the

corneal tissue.

In this notice, we propose to group

corneal transplant procedures in APC

670. The payment rate for the

procedures in APC 670 takes into

account the costs of acquiring corneal

tissue. Therefore, Medicare will cease to

make a separate payment for corneal

tissue procurement costs incurred in

connection with CPT codes 65710,

65730, 65750, and 65755 when these

procedures are performed in an ASC,

beginning on the effective date of

implementation of the rates and

ratesetting methodology proposed in

this notice. Alphanumeric code V2785

(Processing, preserving and transporting

corneal tissue) has a payment indicator

‘‘2,’’ because the costs incurred for this

service are considered to be within the

scope of ASC services for which

payment is made as part of the ASC

facility fee.

We solicit comments on the adequacy

of the payment rate for the procedures

in APC 670 to offset the costs incurred

to procure corneal tissue in connection

with performing corneal transplant

surgery.

4. Outside the Scope of ASC Services

Historically, certain items and

services that may be furnished in

connection with surgery performed at

an ASC have not been considered to fall

within the scope of ASC services

because payment for these items and

services could be made under other

provisions of Medicare Part B. None of

the following is considered to be an

ASC service, and Medicare does not

include payment for these services in

the ASC facility fee: Physicians’

services, the services of certified

registered nurse anesthetists, prosthetic

devices and implants, durable medical

equipment and supplies, artificial limbs,

or braces.

As discussed above, diagnostic

imaging services and other diagnostic

tests are not considered to be ASC

services and are not paid for as part of

the ASC facility fee except when they

are considered an integral and

inseparable part of a surgical procedure

by explicit reference or by universal

agreement that they are standard

medical practice as in the case of

amniocentesis.

G. Basis for Payment (§ 416.30)

When an ASC furnishes services in

connection with a procedure on the

ASC list, Medicare pays a prospectively

determined standard fee for those

services. Section 416.22 of the ASC

regulations proposed in this rule

pertains to how we determine which

procedures are safe, effective,

appropriate, reasonable and necessary

in an ASC and are therefore included in

the ASC list. Section 416.21 of the

proposed ASC regulations lists the

services that are paid for within the ASC

facility fee as well as describing services

that might be furnished in connection

with an ASC procedure but for which

payment is not included in the ASC

facility fee. Section 416.30 of the

proposed ASC regulation is intended to

delineate the differing bases by which

Medicare can make payment for services

furnished in connection with surgical

procedures on the ASC list. Because of

the manner in which the statute is

written, the type of setting determines

the basis for Medicare payment for

services that are furnished in

connection with procedures on the ASC

list.

1. Hospital Outpatient Department

(HOPD)

Section 1833(i)(3) of the Act provides

that payment for services furnished in a

hospital outpatient department in

connection with procedures on the ASC

list is to be based in the aggregate on a

comparison between two amounts. The

payment is to be the lesser of the

following:

• The amount for services that would

be paid to the hospital under section

1833(a)(2)(B) of the Act (that is, the

lower of the hospital’s reasonable costs

or customary charges for the services,

reduced by deductibles and

coinsurance).

• An amount based on a blend of—

The amount that would be paid to the

hospital for the services under section

1833(a)(2)(B) of the Act reduced by

deductibles and coinsurance (called the

hospital-specific amount); and

—The amount paid to a Medicare

approved ASC for the same procedure

in the same geographic area in

accordance with 1833(i)(2)(A) of the

Act, which is equal to 80 percent of

the standard overhead amount net of

deductibles (the ASC amount). Under

1833(i)(3)(B)(ii) of the Act, the

hospital specific amount and the ASC

amount for portions of cost reporting

periods beginning on or after January

1, 1991 are 42 and 58 percent,

respectively.

Section 4523(a) of the Balanced

Budget Act of 1997 (Pub. L. 105–33)

requires that, beginning in 1999, the

amount of Medicare payment for

covered HOPD services shall be

determined in accordance with a

prospective payment system. This

HOPD prospective payment system will

replace the blended payment

methodology for ASC procedures

performed in an HOPD setting. It is not

within the scope of this notice to

describe or discuss the specific

provisions of the hospital outpatient

prospective payment system. However,

consistent with our commitment to

move toward a more unified, less

fragmented approach to Medicare

payment for surgical services performed

on an ambulatory basis, we anticipate

that there will be common elements in

the Medicare ratesetting method and

payment structure for surgical

procedures performed in either an ASC,

or in a hospital outpatient setting under

the HOPD prospective payment system.

These common elements include the

principle of packaging payment for a

range of services within a single

payment rate; application of a multiple

procedure discount; adjustment of base

payment rates to take into account the

effects of regional wage differences; and

use of the same system of classifying or

grouping surgical procedures for

ratesetting purposes, e.g., the

ambulatory payment classification

system (APCS) which we discuss

elsewhere in this notice. (Even though

we expect to use a common grouping

system to determine payment rates for

both ASCs and hospital outpatient

departments, note that we base ASC

payment rates on cost and charge

information taken from the 1994 ASC

survey and that we will base hospital

outpatient payment rates on data taken

from 1996 Medicare claims for hospital

outpatient services, on the most recently

available hospital Medicare cost report

information, and on projected Medicare

expenditures in HOPDS in 1999.)

2. ASCs Operated by a Hospital

Our 1992 ASC survey revealed that

hospital operated ASCs comprised only

3.1 percent of the 1081 ASCs from
32314 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

2U.S. Department of Health and Human Services,

Health Care Financing Administration, Medicare

Ambulatory Surgical Center Payment Rate Survey—

1992: Part I, General Information Summary of Data.

Baltimore: July 1994.

which we received completed surveys.2

We propose to add an expanded

definition of ‘‘hospital-operated ASC’’ to

§ 416.2 to eliminate some of the

confusion in terminology that seems to

occur when distinguishing among ASCs,

hospital outpatient departments,

hospital affiliated ASCs, provider-based

ASCs, etc. The term ‘‘hospital operated

ASC’’ was coined originally simply to

identify those ambulatory surgical

centers that were already in existence in

1982 as part of a hospital and that

wanted the option of participating in

and being paid under the new ASC

benefit rather than continuing to be paid

on a reasonable cost basis as part of the

hospital. In the August 5, 1982 Federal

Register, we stated that if a hospital

elected to have its ASC paid for

ambulatory surgical services under the

ASC benefit, that ASC would be subject

to the same rules and regulations that

apply to all ASCs approved under 42

CFR part 416, in addition to certain

other restrictions directly related to the

ASC’s being owned and operated by a

hospital. A hospital outpatient

department providing ambulatory

surgery would not be eligible to be paid

as an ASC. (See 47 FR 34085.)

The regulations that apply solely to

hospital operated ASCs are found in

§ 416.2 and § 416.30 of the revised ASC

regulations that are proposed in this

notice. We propose to continue the

requirement that once an ASC operated

by a hospital elects to participate in

Medicare as an ASC rather than as a part

of the hospital, that ASC will not have

the option of reverting to be a

component of the hospital unless HCFA

determines there is good cause for it to

do so. Costs for a hospital-operated ASC

must be treated as a non-reimbursable

cost center on the hospital’s cost report.

We also propose to delete the

requirement that a hospital operated

ASC’s agreement to participate as an

ASC be made effective on the first day

of the next Medicare cost reporting

period of the hospital (42 CFR

416.30(f)(1)). We do not believe this

would compromise either the interests

of beneficiaries or the integrity of the

Medicare program. This requirement

imposes certain burdens, such as

instances where a hospital’s cost

reporting period does not begin until

many months after its ASC opens for

business. We invite comments on

whether this requirement is superfluous

and should therefore be removed from

the regulations.

3. Medicare Approved ASCs

The statute at 1832(a)(2)(f) authorizes

Medicare to pay ASCs a prospectively

determined fee for facility services

furnished in connection with surgical

procedures on the ASC list. Since 1982,

HCFA has defined facility services as

items and services which would

otherwise be covered under Medicare if

furnished on an inpatient or outpatient

basis in a hospital in connection with

the ASC covered procedure, excluding

items and services for which payment

may be made under other provisions of

Medicare Part B. (See the Federal

Register dated August 5, 1982 (47 FR

34097).) It is these items and services,

e.g., the items and services that would

be covered under Medicare if they were

furnished on an inpatient or outpatient

basis in a hospital in connection with a

surgical procedure, for which we make

payment as part of the ASC facility fee,

and any service for which we include

payment in the ASC facility fee is

considered an ASC service. As a matter

of policy, we have generally not

included, as part of the ASC facility fee,

payment for items and services

explicitly identified in the Act as a

Medicare Part B benefit for which

separate payment is made, although we

have made a few exceptions. In

summary, we exclude from the

Medicare definition of an ASC facility

service any item or service for which

payment is not included in the ASC

facility fee or any procedure not on the

ASC list, even if the item, service or

procedure is furnished at the ASC in

connection with a procedure that is on

the ASC list. Section 416.21 of the

proposed ASC regulations distinguishes

between services for which payment is

included in the ASC facility fee and

services for which payment is not

included in the ASC facility fee.

We have received numerous inquiries

from ASCs asking how Medicare pays

for certain services that they furnish to

Medicare beneficiaries in connection

with a procedure on the ASC list when

Medicare does not include payment for

those services as part of the ASC facility

fee. We have added § 416.30(d)(2) to

emphasize that excluding payment for

certain services and procedures from the

ASC facility fee does not preclude

payment to the ASC for those services

and procedures, presupposing they are

covered and reasonable and necessary,

under other provisions of Medicare Part

B. Examples of the kinds of services

furnished at an ASC in connection with

an ASC procedure, for which payment

is not included in the Medicare ASC

facility fee, are the professional services

of physicians and certified registered

nurse anesthetists, prosthetic implants,

or certain diagnostic X-ray and imaging

services and other diagnostic tests such

as ultra sound. ASCs have asked us how

they can recoup the costs they incur to

furnish facility services (e.g., those

expenses embodied in the technical

component (TC) established for

diagnostic X-ray and other diagnostic

tests under the Medicare physicians’ fee

schedule) for diagnostic

electrocardiograms or fluoroscopy or

ultrasound diagnostic procedures. As

discussed in Section III.F, when

diagnostic X-rays, imaging, or other

diagnostic tests are explicitly referenced

in a CPT code descriptor, they are

considered integral to the surgery and

are therefore paid for within the ASC

facility fee. Otherwise, in order to be

paid separately for services that are

furnished in connection with

procedures on the ASC list that are not

ASC services, the Medicare

participating ASC must also be

recognized and obtain Medicare

approval and billing privileges as a

supplier of these other services.

One example of the multiple

Medicare payment modalities that could

affect how an ASC is paid by Medicare

is the manner in which Medicare would

pay for transperineal ultrasound guided

seed implants for prostate cancer

performed at a Medicare approved ASC.

There is a surgical component to this

treatment, CPT code 55859,

Transperineal placement of needles or

catheters into prostate for interstitial

radioelement application, with or

without cystoscopy. We are proposing

to add this procedure to the ASC list in

APC group 523. Once the surgical

procedure is added to the ASC list,

Medicare would allow payment to an

ASC for facility services furnished in

connection with CPT code 55859. If

cystoscopy services were required, and

the relevant cystoscopy codes were on

the ASC list, Medicare would allow an

ASC facility fee for the cystoscopy

procedure(s), subject to the multiple

procedure payment rules found in

proposed § 416.30(d)(4). The other

procedures and services performed to

furnish this treatment fall within the

radiology range (70000–79999) of CPT.

Since radiology procedures are not

included on the ASC list, there is no

basis for Medicare to make payment to

an ASC for brachytherapy services.

However, if the facility were to obtain

supplier numbers from its carrier

indicating that the carrier recognizes the

facility both as a non-physician supplier

of radiology services and as a

freestanding radiation therapy center,

the facility should be able to bill for and
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32315

be paid the technical component for

brachytherapy services within the

radiology range under the Medicare

physicians’ fee schedule.

Similarly, if a Medicare approved

ASC were to furnish diagnostic X-ray

and other diagnostic tests in connection

with performing a procedure on the

ASC list, such as visualizing the preoperative placement of needle

localization wires, and if payment for

those services is not otherwise included

in the ASC facility fee as signified by an

ASC payment policy indicator ‘‘2,’’ the

facility could be paid the technical

component provided for those services

under the Medicare physicians’ fee

schedule as long as it meets the

requirements for independent

diagnostic testing facilities (IDTFs). The

regulations at 42 CFR 410.32 and 42

CFR 410.33 published in the October 31,

1997 Federal Register (63 FR 59098)

and implemented January 1, 1998

explain the IDTF requirements.

A Medicare approved ASC that is also

approved as a supplier of durable

medical equipment (DME), prosthetics,

and orthotics can be paid the allowed

Medicare fee schedule amount when it

furnishes these items. We believe that

many ASCs are not aware that Medicare

payment for prosthetic implants in

particular is separate from the ASC

facility fee. Prosthetics and durable

medical equipment are coded using

alphanumeric HCPCS codes; the codes

for prosthetic implants begin with code

L8500. Claims for prosthetic implants

are processed by local carriers; claims

for orthotics and DME are processed by

durable medical equipment regional

carriers (DMERCs). ASCs wishing to be

recognized as a supplier of prosthetics,

orthotics, and/or durable medical

equipment should contact the National

Supplier Clearinghouse (NSC), Palmetto

Government Benefit Administrators,

P.O. Box 100141/300 Arbor Lake Drive,

Columbia, South Carolina 29202–3143,

FAX 317–841–4600, to obtain further

information and an application.

As we explained in section III.D

above, we propose to establish that

procedures with any of the criteria in

§ 416.22(b) are not safe and appropriate

in an ASC. We have determined that

such procedures are not reasonable and

medically necessary when performed in

an ASC. Therefore, we propose to add

§ 416.30(d)(3) to the ASC regulations to

clarify that denials for such procedures,

designated by ASC payment policy

indicator ‘‘3,’’ are based on the

exclusion contained in section

1862(a)(1)(A) of the Act, and contained

in § 411.15(k)(1); that is, the services

‘‘are not reasonable and necessary for

the diagnosis and treatment of illness or

injury or to improve the functioning of

a malformed body member.’’

Beneficiaries are protected from liability

for claims denied on this basis by the

limitation on liability provision of

section 1879 of the Act.

If an ASC facility fee is denied for a

procedure because the procedure is not

reasonable and necessary in an ASC,

logic dictates that payment be denied

for any other services furnished in

connection with that procedure because

those other services would also have to

be considered not reasonable and

necessary. Therefore, as a matter of

policy, we propose to instruct carriers to

deny payment for physicians’ services,

including anesthesiologists, or certified

registered nurse anesthetist (CRNA)

services, prosthetic implants, imaging

services, etc., when such services are

furnished at an ASC in connection with

a surgical procedure that is excluded

from the ASC list.

H. Extracorporeal Shock Wave

Lithotripsy (ESWL)

1. Background

On December 31, 1991 we published

a final notice with comment period in

the Federal Register (56 FR 67666) in

which we added CPT code 50590,

Lithotripsy, extracorporeal shock wave

(ESWL), to the list of ASC covered

procedures. We set the payment rate for

ESWL at $1,150 on the basis of a

procedure cost matrix model. A new

payment group 9 was created solely for

ESWL. Payment of a facility fee for

ESWL as an ASC covered procedure was

effective for services furnished

beginning January 30, 1992.

On January 30, 1992 the American

Lithotripsy Society (ALS) filed a

complaint and motion to preliminarily

enjoin enforcement and implementation

of the December 31, 1991 notice insofar

as it concerned ESWL. In American

Lithotripsy Society v. Louis W. Sullivan,

M.D., et al. 85 F. Supp. 1034 (D.D.C.

1992), the plaintiff challenged HCFA’s

determination that ESWL is a surgical

procedure under the ASC benefit and

the amount payable for the services in

an ASC setting. The plaintiff alleged

that the $1,150 rate was not based on an

estimate of ‘‘a fair fee’’ which took into

account costs incurred by ASCs

performing such services as required by

section 1833(i)(2)(a) of the Act and that

the rate was not supported by the

administrative record.

On March 12, 1992, the United States

District Court for the District of

Columbia held that HCFA’s decision to

classify ESWL as a surgical procedure

was reasonable. However, it remanded

the rate-setting issue in the December

31, 1991 notice to the Secretary for

further consideration and stayed the

regulation, insofar as it related to

lithotripsy, pending remand. On

remand, the Secretary is required to

publish all material information that is

relevant to the setting of the ESWL rate,

receive comments, and publish a final

notice in accordance with the applicable

statutes and regulations.

On March 19, 1992 we asked our

regional offices to instruct carriers and

intermediaries to cease payments to

Medicare participating ASCs for ESWL

services and to resume calculation of

payments for ESWL services furnished

in a hospital outpatient setting on a

reasonable cost basis.

On October 1, 1993, we published a

proposed notice in the Federal Register

(58 FR 51355) in which we proposed an

ASC payment rate of $1,000 for ESWL

along with the data and the

methodology used to determine that

rate, in accordance with the court’s

remand. The public comment period

that was to end on November 30, 1993

was extended to December 30, 1993.

(See Federal Register (58 FR 62128)

dated November 24, 1993.)

We received timely 141 comments

about the October 1, 1993 proposed

notice. Commenters included certified

renal lithotripsy specialists; physicians,

nurses, administrators, and attorneys

representing urology and lithotripsy

specialty clinics and centers; hospitals;

physician clinics and group practices;

mobile lithotripsy suppliers; ambulatory

surgical centers; a regional multihospital cooperative stone treatment

service; and, professional societies and

trade associations. Six commenters

submitted information on ESWL costs,

charges, and utilization following the

format that we requested. In addition,

ALS submitted in support of its

comments a study entitled Proposed

Payment for Extracorporeal Shock Wave

Lithotripsy Services Furnished by

Ambulatory Surgical Centers that was

prepared by The Moore Group of

Washington, D.C.

We have been considering the

information contained in the comments

that were submitted during the public

comment period. Virtually every

commenter objected to our proposed

$1,000 ESWL payment rate, the

methodology and cost model that we

used to set the rate, and the assumptions

upon which we based the ratesetting

methodology and cost model, stating

that we had failed to take into account,

as required by the statute, the costs

incurred by facilities to furnish ESWL

services. The comments raised enough

question about the appropriateness of

certain of the assumptions upon which
32316 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

we had based the payment rate

proposed in the October 1, 1993 Federal

Register to cause us to defer setting a

final ESWL rate until we had completed

our survey of ASCs that we had already

scheduled to begin in March 1994. That

survey, entitled ‘‘The Medicare

Ambulatory Surgical Center Payment

Rate Survey—1994, Part II: Facility

Overhead and Procedure Specific

Costs,’’ is described elsewhere in this

notice. We made a point of including

CPT code 50590 in the list of codes for

which we solicited charge, utilization,

and resource cost data, even though

payment of a Medicare ASC facility fee

for ESWL had been under remand since

March 12, 1992.

The ASC payment rate that we

propose in this notice for ESWL (CPT

code 50590) supersedes the rate we

proposed in the October 1, 1993 Federal

Register. We followed the ratesetting

methodology that is the subject of this

notice to determine the ASC payment

rate for ESWL. In addition to reviewing

information on ESWL submitted in the

1994 ASC survey, we also took into

consideration the cost data and

comments submitted during the public

comment period following publication

of the October 1, 1993 Federal Register.

All material information that is relevant

to setting the rate for every ASC covered

procedure contained in this notice,

including but not limited to ESWL, is

published herein, with the exception of

our 1994 ASC survey data, which we

explain how to obtain separately. Our

response to comments received timely

and the final notice published in

accordance with applicable statutes and

regulations will therefore address the

rate set for ESWL services within the

context of the other proposals contained

in this notice.

Below is our response to the

comments that were submitted timely

following publication of the October 1,

1993 proposed notice.

2. Comments

Comment: The American Lithotripsy

Society (ALS) commented that it

continues to disagree with classifying

ESWL as a surgical procedure and that

it believes that ESWL does not belong

on the ASC list.

Response: We do not agree with the

position taken by ALS on this point. We

believe that ESWL is a procedure that is

appropriate for the ASC list in light of

the criteria we are proposing in this

notice (proposed 42 CFR 416.22). We

explained our reasoning for considering

ESWL appropriate for the ASC list in

the final notice with comment period

published December 31, 1991 in the

Federal Register (56 FR 67673), and the

federal district court found that we had

rationally justified and properly noticed

our decision to classify ESWL as a

surgical procedure (American

Lithotripsy Society v. Sullivan, 785 F.

Supp. 1034, 1037 (D.D.C. 1992). We

therefore propose to retain ESWL on the

ASC list in APC group 527.

Comment: Every commenter objected

to the $1,000 payment rate that we

proposed for ESWL services furnished

in a Medicare participating ASC as

being inadequate, unfair, and far below

the actual cost of providing ESWL

services. One commenter charged that

HCFA was using the rate-setting process

as a device to eliminate what HCFA

viewed as underutilized facilities. Other

commenters predicted that Medicare

beneficiaries would be denied access to

the ease and convenience of ESWL

treatment of kidney stones if we were to

implement a $1,000 ASC facility fee for

ESWL because ESWL suppliers could

not afford to treat Medicare patients for

this amount. Another commenter

complained that HCFA’s proposed

facility fee would deprive lithotripsy

facilities of a substantial portion of the

lithotripsy market and adversely affect

the hospitals, physicians, and others

who had invested substantially in ESWL

facilities with the expectation that

overhead costs would be fully

reimbursed by a Medicare payment rate

based on actual costs.

Most commenters also challenged the

cost model matrix and the assumptions

underlying the model that we used to

calculate the $1,000 payment rate

proposed in the October 1, 1993 Federal

Register. One commenter attributed our

proposed rate to an ‘‘impractically high

utilization rate’’ combined with ‘‘an

unrealistically low estimate’’ of the

costs involved in performing an ESWL

treatment. Commenters claimed that we

ignored information submitted by the

actual providers of ESWL services,

relying instead on outdated studies and

obsolete information from 1985, 1986,

and 1987 when lithotripsy was first

introduced and furnished primarily on

an inpatient basis, or substituting our

own judgment of what the facility fee

should be without considering survey

data that revealed the actual costs of

performing the procedure, as required

by the statute. In particular, commenters

challenged our assumptions about

optimal utilization levels and the

number of procedures that could be

performed in one day (too high); capital

costs (understated); fixed costs

(attributable to our understatement of

the staff required to provide ESWL

services in addition to pre-and posttreatment care and to be in compliance

with state regulatory requirements); our

allowance for supplies (too low,

especially for the disposable electrodes);

and, our allowance for indirect

overhead costs (unrealistically low,

especially because lithotripsy centers

perform only one procedure, which

prevents them from offsetting losses

from ESWL by performing other more

lucrative procedures).

Every commenter urged us to review

or revise the proposed rate to bring it

more in line with actual expenses,

which they asserted ranged from $1,911

to as much as $3,674, as validated by

urologists and actual providers of ESWL

services. Many commenters

recommended that we adopt as the basis

for a Medicare payment amount for

ESWL services the findings and data

contained in a report prepared by The

Moore Group at the behest of The

American Lithotripsy Society (ALS) and

its counsel, Dyer, Ellis, Joseph & Mills.

One commenter said the ALS survey

and The Moore Group report would no

longer allow HCFA to use the lack of

cost data as a rationale for relying on the

cost model contained in the October 1,

1993 proposed notice. The same

commenter said that if HCFA was

unwilling to use the ALS survey data as

the basis for setting an ESWL rate,

HCFA should not adopt a payment rate

until it conducted its own survey of

providers to determine a fair fee based

on the costs derived from that survey.

This commenter urged HCFA, as a last

resort, to hold a formal hearing before

implementing its proposed rate if HCFA

would not adopt the ALS survey data or

collect its own survey data.

The report prepared by The Moore

Group for ALS is entitled ‘‘Proposed

Payment for Extracorporeal Shock Wave

Lithotripsy Services Furnished by

Ambulatory Surgical Centers’’ and is

based on the results of a survey

conducted by ALS. (This report was

prepared for Dyer, Ellis, Joseph & Mills,

600 New Hampshire Avenue, NW.,

Washington, DC 20037, telephone (202)

944–3000 by Lois A. Ehle, The Moore

Group, 1212 New York Avenue, Suite

475, Washington DC 20005, telephone

(202) 789–0045.) ALS sent the survey

(‘‘American Lithotripsy Society Shock

Wave Lithotripsy Survey’’) to its

membership. In addition, according to

the introduction to the report, Dornier

Medical Systems and Siemens Medical

Systems, lithotripter manufacturers,

sent the ALS survey to users of their

equipment. Counsel for ALS collected

survey responses and forwarded them to

The Moore Group, which analyzed the

responses and prepared the report. The

report is based on information

submitted by 105 of the 110 providers

that returned a completed survey
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32317

representing approximately one third of

the providers that received the survey.

The report is dated December 15, 1993,

and it was enclosed with comments

submitted by ALS during the extended

public comment period following

publication of the October 1, 1993

proposed notice.

The Moore Group report concluded

that HCFA’s cost matrix model

understated the capital, fixed, and

variable costs associated with ESWL

services with the result that HCFA’s

proposed payment rate of $1,000

understated by 43 percent the $2,326

average cost incurred by ESWL

providers based on analysis of the ASL

survey responses.

Response: The information submitted

by commenters to the October 1, 1993

proposed notice has convinced us to

defer implementing a $1,000 ASC

facility fee for ESWL services. We

considered adopting as an interim

payment rate the average cost per

treatment arrived at by The Moore

Group ($2,326), but we ultimately

decided not to do so for several reasons.

Our principal reservation was related to

the fact that of the 49 fixed lithotripter

sites responding to the ALS survey, only

five were actually identified as

‘‘Medicare approved’’ ambulatory

surgical centers (ASCs), and only 30 of

the 437 mobile sites for which data were

reported were identified as ASCs. Our

charge is to set rates for ambulatory

surgical centers, as defined in the

statute at Section 1832(a)(2)(F) and in

regulations at 42 CFR part 416, and

those rates, as so many commenters

pointed out, are to take into account the

costs incurred by ASCs generally in

providing services in connection with

procedures on the ASC list. While the

ALS survey points to costs incurred by

lithotripsy suppliers generally,

including fixed and mobile sites and

hospitals and ‘‘freestanding’’ centers, we

could not isolate the ALS survey data as

contained in The Moore Group report to

costs incurred solely by ASCs.

One commenter said that if we were

unwilling to use the Moore Survey, we

should then, at the very least, conduct

our own survey of providers to

determine a fair fee for ESWL rather

than implement the payment rate based

on the cost model proposed in the

October 1, 1993 Federal Register. As it

happened, we had scheduled a survey

of ASC costs, charges, and utilization

generally for early 1994, our first such

survey since 1986. Therefore, we

decided to follow the commenter’s

recommendation, and we included

ESWL services as a part of the Medicare

ASC survey that went out in March

1994, the data from which are the

foundation for the rebased payment

rates proposed in this notice. We

followed the ratesetting methodology

explained in this notice and, taking into

account the comments submitted

following publication of the October 1,

1993 proposed notice as well as

information submitted through our 1994

survey, we determined a payment rate

of $2,107 (APC 527) for ESWL services

furnished by a Medicare participating

ASC.

We believe this is a reasonable

payment amount because it

approximates the average per procedure

costs reported in comments to the

October 1, 1993 proposed notice,

including The Moore Group study of the

ALS survey results, and costs derived

from the 1994 Medicare survey of ASCs;

and, it takes into account costs incurred

by fixed as well as mobile lithotripsy

delivery systems. It implicitly

acknowledges the utilization levels

pronounced as typical by commenters

and The Moore Group and rewards

facilities that maintain or exceed those

utilization levels while serving as an

incentive to facilities with lower

utilization to improve their volume.

Further attesting to the reasonableness

and reliability of the payment rate

proposed in this notice is the fact that

it was determined in accordance with a

systematic, data-oriented,

comprehensive ratesetting methodology

applied to more than 2400 surgical

procedures rather than on the basis of

an interim ratesetting methodology that

was developed to fill an immediate need

resulting from a lack in 1991–92 of

current, reliable, disinterested data on

lithotripsy costs.

Comment: One commenter wondered

why we accepted cost data from ASCs

to revise payment rates in February

1990 (55 FR 4526), and from payers like

Blue Cross/Blue Shield and lithotripter

manufacturers to support the cost model

we proposed in the October 1, 1993

Federal Register (58 FR 51355), but

refused to consider data submitted by

lithotripsy providers.

Response: We did consider the data

submitted by commenters following

publication in the Federal Register of

our proposed notice in October 1, 1993

(58 FR 51355), and our analysis of those

comments resulted in our not

implementing the October 1, 1993

proposed rate of $1,000 pending

completion of the 1994 Medicare ASC

survey. In some cases such as the matter

of ESWL treatment time and general

ESWL utilization levels, we have

reversed our earlier proposals on the

basis of information and data submitted

by commenters.

Comment: One commenter stated that,

in order to be considered a ‘‘fair fee,’’

the average cost of ESWL services

reported by The Moore Group ($2,326)

would have to be increased to offset

three additional costs: payment for preand post-treatment services provided by

a host hospital or ASC when ESWL is

furnished by a mobile lithotripter;

payment to offset bad debt; and,

payment to provide a reasonable return

on equity capital.

Response: We disagree. Our reading of

the report indicates that the ALS survey

and The Moore Group study took such

costs into account in the calculation of

an average per treatment cost. The data

reported in the 1994 Medicare ASC

survey would have reflected pre- and

post-operative costs and bad debt.

Medicare policy precludes payment

allowances to provide a return on equity

capital for facilities paid by a

prospective payment system because it

diminishes the incentive for efficient

operation (47 FR 34082, 34089)

Comment: One commenter criticized

our use of the CPI-U All Items Index as

a measure of the effect of inflation on

health care costs and our applying that

factor to historical data to produce an

estimate of current costs.

Response: We see no compelling

argument to depart from the rationale

we gave in the February 8, 1990 Federal

Register (55 FR 4537), in which we

implemented the eight payment rates

that were rebased using 1986 survey

data, for using the consumer price index

for all urban consumers, all items index.

The fact that 141(a)(1)(B)of SSAA 1994

mandated that we use the CPI-U to

update ASC rates during years when we

do not rebase rates using survey data

makes it difficult to justify switching to

a different inflationary adjustment

during years when we rebase rates.

Comment: One conclusion of The

Moore Group report is that HCFA’s cost

matrix model overstates the maximum

amount of time a lithotripter can be

used each year and the number of

treatments that can be reasonably

performed each year. Numerous

commenters echoed the sentiment that

basing the ESWL payment rate on a

utilization level of performing 1,000

procedures annually or an average of

four treatments per day was

unreasonable and impractically high.

One commenter noted that treatment

volume is determined more by the

number of patients with kidney stone

disease than on the availability of

‘‘efficient’’ equipment. Another

commenter wrote that most ASCs

wishing to provide lithotripsy services

will utilize a mobile lithotripter unit

because few ASCs will ever have the
32318 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

volume necessary to keep a lithotripter

busy at maximum possible utilization.

Commenters reported annual utilization

levels ranging from as few as 65

treatments to as many as 1,200

treatments, and daily utilization of no

more than two procedures per day to

five or six a day if the ‘‘day’’ were

extended into the evening hours. The

Moore Group report indicated that an

average of seven hours was required

from patient pre-admission until

discharge, which was cited by other

commenters as the reason why it was

unrealistic to expect more than two

treatments to be performed in one day.

The Moore Group study also indicated

that 42 of the 105 providers that

returned ALS surveys performed

between 400 and 700 procedures per

year, accounting for 44 percent of the

total cases reported by respondents to

the ASL survey, with an average annual

treatment level of 519. One commenter

asserted that no facility actually does

1,000 cases per year. Another conceded

that while six patients could indeed be

treated in the course of a single day,

factors important to quality care might

be sacrificed. One commenter said that

five to six treatments could easily be

furnished in a single day, but that the

length of the day would have to be

extended beyond eight hours. Most

commenters favored approximately 500

treatments annually as a more realistic

utilization level based on their own

experience. Two commenters observed

that the rapid diffusion of ESWL in the

1980’s had resulted in market saturation

so that each lithotripter has a smaller

number of patients to serve, and another

commenter noted that with more than

300 lithotripters in operation, demand

per machine would naturally be lower.

The same commenter further objected to

HCFA’s basing its utilization standard

for ESWL services that are furnished

predominantly in outpatient settings on

a 1985 Blue Cross/Blue Shield study of

six investigational lithotripters that

were involved in the FDA approval

process and that furnished treatments

strictly on an inpatient basis.

Response: Based on the comments we

received and data reported in the 1994

Medicare survey of ASCs, we agree that

in the early 1990’s, most lithotripsy

providers were probably performing

only half to two-thirds of the number of

treatments we assumed as an efficient

annual utilization level when we

proposed a payment rate of $1,000 in

the October 1, 1993 Federal Register.

The payment rate that we are proposing

in this notice for APC group 527 is more

compatible with utilization levels

reported by commenters and suggested

by 1994 ASC survey data. However, we

emphasize that HCFA has a fiduciary

responsibility to the Medicare program

and its beneficiaries that compels us to

promote and reinforce the efficient use

of shrinking resources. We cannot

condone paying for per treatment costs

that are inflated by idle or underutilized

equipment which is the result of

redundancy. We believe that the rate we

propose in this notice for ESWL services

is reasonable and that it allows

generously for volume levels declared

by the industry to be standard without

encouraging further proliferation of

ESWL services in a market that is

acknowledged to be at the saturation

level.

Comment: Most commenters

indicated that our estimate of 30 or 45

minutes to an hour as the amount of

time required to administer ESWL and

disintegrate the stone(s) was too low.

While the Moore Group report shows a

mean treatment time of 113 minutes,

most other commenters indicated that

80 to 90 minutes was typically required

for the actual ESWL treatment. Several

commenters noted that, contrary to our

supposition, treatments using newer

lithotripters actually require more time

than did the older generation of

lithotripters because the newer

lithotripters require a greater number of

lower voltage shocks to be administered,

depending upon the patient’s heart rate.

Response: We agree that the length of

time required to administer an ESWL

treatment generally exceeds the 30 to 60

minutes we suggested in the October 1,

1993 notice. The information submitted

by commenters, further supported by

data collected in the 1994 Medicare

ASC survey, indicates a mean treatment

time of 82 to 113 minutes with a median

treatment time of 89 to 110 minutes.

Comment: Several commenters stated

that HCFA’s cost matrix model does not

include the cost of cystoscopy or any

stent placements.

Response: We stated in the October 1,

1993 notice that the costs associated

with the cystoscope procedure that

frequently accompanies ESWL (CPT

code 52332, Cystourethroscopy, with

insertion of indwelling ureteral stent

(e.g., Gibbons or double-J type) were not

included in the cost model for ESWL.

When this procedure is performed in

conjunction with ESWL (CPT code

50590), the ASC submits a claim for

both procedures. In accordance with

Medicare payment policy when

multiple procedures are performed in an

ASC, Medicare pays the full usual and

customary facility fee for the procedure

with the highest payment rate (CPT

code 50590 in this case) and 50 percent

of the usual and customary facility fee

for the procedure(s) with a lower

payment rate (CPT code 52332 in this

case). The payment rate we are

proposing in this notice for CPT code

52332 (APC 523) is $504.

Comment: Several commenters

disagreed with our estimate of 16

percent Medicare utilization and

suggested annual Medicare procedure

volume ranging between 12 percent and

45 percent, the latter volume occurring

in an area with a high retirement

population.

Response: Our 1994 survey data

indicate that Medicare beneficiaries

account for 16.5 percent of total volume

for ESWL services furnish in an ASC

setting.

Comment: A few commenters wrote

that HCFA’s study fails to account for

the special staffing, travel, and set-up

costs incurred when a mobile unit is

used to furnish ESWL services.

Response: Our October 1, 1993 cost

model may not have fully recognized

costs unique to mobile ESWL services.

However, based on data submitted in

the 1994 Medicare ASC survey, we

believe that the payment rate we are

proposing in this notice does take

mobile unit costs into account.

Comment: One commenter stated that

an increase in the number of mobile

ESWL units threatens the continued

viability of provider based facilities.

Another commenter wrote that volume

at a free-standing lithotripsy center is

expected to decrease due to

implementation of a mobile unit in a

neighboring state.

Response: We recognize that an

increase in the number of mobile ESWL

units could reduce patient volume at

fixed ESWL sites. We do not have

current data to indicate the ratio of

mobile to fixed ESWL units nationally

or by state or region nor can we evaluate

the extent to which increased numbers

of mobile units represent redundancy in

areas with existing adequate ESWL

services or are a response to a demand

for ESWL services in underserved or

remote areas.

Comment: One commenter disagreed

with our proposal that ASC facility

payment be denied for bilateral ESWL

renal treatment, preferring that the

decision be left to the treating urologist

who is in the best position to weigh the

risks to his/her patients of performing

one or multiple ESWL treatments in

cases where there are small

symptomatic stones in both kidneys.

Response: In the absence of medical

evidence arguing otherwise, we propose

to withdraw our October 1, 1993

proposal to deny payment for bilateral

ESWL renal treatment.
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32319

Comment: Three commenters

addressed our proposal to enlist the

medical directors for Medicare carriers

and intermediaries to develop

procedure protocols and to define the

indications for ESWL treatment. The

commenter asserted that indications and

contraindications for treating patients

with ESWL are already well established

in the urological and lithotripsy

literature. One commenter urged that

experienced urologists who have an

established reputation for clinical

expertise in urology and lithotripsy be

enlisted if general guidelines for ESWL

are to be developed. One commenter

wrote that a five percent re-treatment

rate doesn’t suggest abuse of a type that

would justify creation of indicators in

the first place.

Response: In the absence of support

from the provider community and

having no evidence that ESWL is being

performed excessively or is medically

unnecessary for Medicare beneficiaries

with kidney stones, we propose to defer

our October 1, 1993 proposal to sponsor

the development of procedure protocols

and indicators of ESWL treatment.

Comment: A few commenters said it

was not fair to base ESWL costs on a

multi-specialty ASC that can spread

overhead costs over many different

procedures whereas ESWL is most often

provided in single-service fixed-site or

mobile units. Another commenter noted

that the costs of providing ESWL in a

free-standing ambulatory care facility

cannot be deferred to other areas or

services as they can in a full service

hospital. Two commenters stated that

HCFA, by asking for data on costs,

charges and utilization for ESWL

performed on an outpatient basis, was

failing to differentiate between freestanding and hospital-based facilities,

each of which furnishes ESWL services

on an outpatient basis, but each of

which may have very different

operational costs. One commenter said

that HCFA should consider

implementing different overhead

amounts and payment rates for different

classes of centers because costs differ

depending on whether ESWL treatment

is furnished at a fixed lithotripsy center

site, by a mobile unit, or by a multispecialty ASC.

Response: We specifically requested

data for outpatient ESWL services,

whether furnished by a hospital, by a

freestanding ESWL facility, by an ASC,

or by a mobile unit, to distinguish these

from inpatient ESWL services.

Based on the comments we received,

we acknowledge that ‘‘outpatient’’

ESWL services can be furnished in a

variety of forms. The rate we propose in

this notice does not distinguish among

the various possible types of ESWL

service delivery settings partly because

we do not have data to support a

correlation between the cost of ESWL

services with the type of site that

furnishes those services and partly

because our responsibility is to set a

facility payment rate for ESWL services

furnished by Medicare participating

ASCs. The statute does not include a

separate benefit for suppliers of ESWL

services.

We are not aware of any mobile

lithotripters that have been certified as

a Medicare participating ASC. Rather,

mobile lithotripters are, as a rule,

contracted by ASCs or by hospitals,

clinics, or other entities to furnish a

lithotripter and the actual lithotripsy

treatment by arrangement to a patient of

the ‘‘host’’ entity. The most efficient

utilization of mobile lithotripters seems

to result when pre-operative patient

preparation and post-operative recovery

services are furnished by the host entity,

freeing the lithotripter conveyance for

the next patient. The unusual capital

costs of ESWL are reflected in its being

assigned to a dedicated APC group, but

the fact that ESWL services can be

furnished in virtually any type of setting

as a consequence of the lithotripter’s

mobility makes it impossible to lump all

lithotripsy suppliers together as a

‘‘class’’ of ASCs. Further, in the absence

of data to support that ESWL costs are

a direct function of the type of facility

where the treatment is furnished, we

believe that our proposed rate is fair and

reasonable and takes into account the

costs incurred by ASCs generally to

furnish ESWL services, either directly or

by arrangement.

We believe that the argument can just

as well be made that single specialty

ESWL providers, because they focus on

only one type of procedure, can defray

costs by increasing volume and by being

more efficient than other providers that

furnish ESWL only on an irregular basis.

If sufficient volume cannot be generated

due to the increase in patient access to

lithotripsy services, as one commenter

observed to be the case, the supply of

lithotripters combined with their

mobility may exceed the demand for

single specialty, fixed ESWL suppliers

in high saturation areas. We noted above

our determination to avoid establishing

Medicare payment policy that

stimulates redundant services, which in

turn typically result in inflated per

procedure costs.

Comment: One commenter asked how

payment for CPT code 52337—

Cystourethroscopy, with ureteroscopy

and/or pyeloscopy (includes dilation of

the ureter and/or pyeloureteral junction

by any method); with lithotripsy

(ureteral catheterization is included)

would be affected by the proposed

ESWL payment scheme.

Response: Based on the ratesetting

methodology proposed in this notice,

CPT code 52337 is in APC group 524.

The payment rate proposed for that

group is $1,131.

Comment: Capital and operating

expenses vary significantly from region

to region and cannot be reasonably

represented with broad based

adjustment factors. Do HCFA/Medicare

geographic adjustment guidelines take

variations in capital and operating

expenses into account?

Response: No. The adjustment to ASC

payment rates that Medicare makes to

offset geographic differences applies

only to differences in labor costs.

I. Schedule and Publication of Updates

Section 1833(i)(1) of the Act requires

that the ASC list be reviewed and

updated at least biennially, and section

1833(i)(2) requires that ASC payment

rates be updated annually. Section

141(a)(1)(B) of SSAA 1994 added

paragraph (C) to section 1833(i)(2),

requiring that ASC payment rates be

increased by the percentage increase in

the consumer price index for all urban

consumers (U.S. city average) (CPI–U),

beginning in fiscal year 1996, during

years when the rates are not updated in

accordance with survey data. In the

Federal Register notice published on

December 31, 1991 (56 FR 67666), we

tied ASC rate updates with the annual

update of the PPS wage index and we

said that we would coordinate rate

updates with the ASC list update. In

subsequent years, we have succeeded in

implementing ASC rate updates

resulting from a CPI–U adjustment to

coincide with implementation of the

annual update of the PPS wage index,

but we have been less successful in

coordinating the rate updates with the

list updates, in part because the ASC list

updates have tended to be more closely

related to the calendar year revisions of

CPT than to PPS wage index changes.

1. Update of ASC List

There are two ways in which HCFA

updates the ASC list. First, we modify

the list to reflect the annual changes

made to CPT and alphanumeric HCPCS

codes. For example, if the American

Medical Association (AMA) deletes

from CPT a code that has been on the

ASC list, we remove the code from the

ASC list. In some cases, AMA modifies

the descriptors of CPT codes or creates

a new code to replace a deleted code.

We have always incorporated these

changes into the ASC list. In order to

make the CPT changes in as timely a

manner as possible, we have instructed
32320 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

carriers directly to modify the ASC list

to conform with the CPT changes

without first publishing a notice in the

Federal Register to announce what the

changes will be. We have felt justified

in by-passing the Federal Register

because the annual CPT changes have

been more editorial than substantive.

And we eventually list these changes in

the next Federal Register notice that is

published on the subject of the ASC list.

When we review the ASC list against

the standards for determining whether

or not procedures are appropriate for the

ASC setting or to determine if a code

describing an altogether new procedure

should be added to the ASC list, we go

through the Federal Register notice and

comment process to furnish an

opportunity for public comment on

additions to or deletions from the list

that we propose to make. We also

incorporate into these notices

recommendations for change that we

receive between updates to the list.

We propose to replace § 416.65(c) in

the current ASC regulations with new

§ 416.22(c). In the revised regulation, we

make explicit our intention not to

publish in the Federal Register prior

notice of changes made to the ASC list

to reflect the annual changes made to

CPT. We also indicate that we will go

through the standard notice and

comment process in the Federal

Register when procedures are added to

or deleted from the list in accordance

with the standards in paragraphs (a) and

(b) of § 416.22.

We further propose, as a matter of

policy, to update the ASC list on a

calendar year basis, to coincide with the

annual updates of the HCPCS and the

Medicare physicians’ fee schedule.

2. Update of ASC Payment Rates

We propose to replace the current

section § 416.130 with revised § 416.32.

We clarify that when ASC payment rates

are updated solely by a CPI–U factor to

comply with 1833(i)(2)(C), we intend

only to publish a notice that announces

the new CPI–U adjusted rates, without

a formal comment period. When HCFA

rebases the ASC payment rates to reflect

data collected through the quinquennial

survey of ASCs required under

1833(i)(2)(A)(i) of the Act, we will go

through a full notice and comment or

rulemaking cycle, depending on

whether or not changes to the

regulations are to be proposed.

As with the updates of the ASC list,

we further propose as a matter of policy

to update the ASC payment rates on a

calendar year basis to coincide with the

annual updates of the HCPCS and the

Medicare physicians’ fee schedule. This

represents a departure from our current

policy of implementing rate updates on

October 1 to coincide with the annual

update of the hospital inpatient

prospective payment system (PPS) wage

index. We believe that the improved

efficiency and reduced paperwork

resulting from coordinating all of the

ASC updates—the list, payment rates,

and wage index— to coincide with the

annual CPT update outweighs any

disadvantages that might result from

postponing for three months

implementation of revised PPS wage

index values.

J. Technical Changes to 42 CFR Part 416

1. ASC Payment Rates

We have rewritten, reorganized, and

renumbered § 416.125 to create new

§ 416.31. This revised section

summarizes the characteristics of ASC

payment rates, e.g., they are

prospectively determined; they take into

account the per procedure costs of

providing services by ASCs generally;

they are based on audited survey data;

they are updated annually by a CPI–U

factor during years when they are not

rebased using survey data; and, they

must result in substantially less being

paid by Medicare than would have been

paid if the procedures on the ASC list

were performed on a hospital inpatient

basis.

2. ASC Survey

The purpose of the ASC survey is to

furnish HCFA with data on the costs

incurred by ASCs to furnish facility

services in connection with procedures

on the ASC list. HCFA uses these data

for the purpose of setting ASC payment

rates. The SSAA 1994 amended section

1833(i)(2)(A) to require that ASC costs,

which are to be the basis of the standard

ASC fees determined by HCFA, be

determined by a survey of a

representative sample of procedures and

facilities that is taken every five years.

The 1994 Amendments also make it a

requirement that these costs be audited.

We have revised § 416.140 to include

these new requirements and we have

renumbered this section as § 416.33.

We issued the last ASC survey on

March 15, 1994, and the rates that are

proposed in this notice are based on the

data reported in that survey which were

subsequently verified by audit. The

1994 survey was entitled ‘‘Medicare

Ambulatory Surgical Center Payment

Rate Survey—1994: II. Facility

Overhead and Procedure Specific Costs’’

(Form HCFA–452B, OMB No. 0938–

0434, expired March 1997). The next

ASC survey must be taken in 1999.

Because the survey form that we used in

1994 has expired, we have to have

HCFA Form 452 reinstated and

approved by the Office of Management

and Budget (OMB) before we can survey

ASCs in 1999. HCFA Form 452 is being

revised, and decisions regarding survey

format and content for the 1999 ASC

survey are pending. We expect to

consult representatives of the ASC

industry for assistance in revising HCFA

Form 452 before it is submitted to OMB

for reinstatement and approval.

In § 416.33, we propose to extend the

time period allowed for completion of

the survey from 60 to 90 days, with the

option of an additional 30-day extension

if the facility can demonstrate good

cause for not completing the survey

within the allotted 90 days.

K. Explanation and Use of Addenda

The addenda on the following pages

present in schematic form the updated

ASC payment rates, additions to and

deletions from the ASC list, payment

policy indicators, and ambulatory

payment classification (APC) groups

that are proposed in this notice.

Addendum A—Proposed Ambulatory

Surgical Center (ASC) Payment Status

by HCPCS Code and Related

Information

This addendum is a list of the 1998

HCPCS codes:

1. CPT/HCPCS code. This column is

a list of the 1998 CPT and alphanumeric

HCPCS codes. With the exception of the

surgical CPT codes, most of the codes in

Addendum A show only a payment

policy indicator.

2. Payment Policy Indicator (PPI).

This indicator shows whether the CPT/

HCPCS code is on the ASC list and

whether it is paid for as part of the ASC

facility fee, or separately payable if the

service is covered, or not payable as an

ASC service.

1=Procedure on ASC list. Codes with

this indicator are procedures for which

Medicare pays ASCs a prospectively

determined facility fee. The codes with

this indicator constitute the list of ASC

covered procedures (ASC list).

2=Bundled service/no separate

payment. Payment for covered services

is always bundled into payment for

other services not specified. Medicare

does not make separate payment when

these services are furnished in an ASC.

Payment is already included within the

ASC facility fee or submitted within

payment(s) made for or the services.

3=Excluded from ASC list. Codes

with this indicator are for a procedure,

item or service that is excluded from the

list of ASC covered procedures because

it is not reasonable, not necessary, not

appropriate or not safe in an ASC
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setting. Medicare does not pay an ASC

facility fee for these codes.

4=Invalid code/90-day grace period.

Codes with this indicator are not valid

for Medicare purposes. Medicare

recognizes a 90-day grace period

following designation of the code as

invalid, during which the code may be

used, pending full implementation of

the specified replacement code. ASCs

and hospital outpatient departments are

to use another code to bill for these

services.

5=Office-based procedure. No

payment is allowed for ASC facility

services. If this procedure is performed

in an ASC, the ASC is considered a

physician’s office, and the physician’s

fee constitutes payment in full.

6=Separate payment when furnished

by an ASC. Codes with this indicator are

for items or services that fall outside the

scope of ASC facility services or that are

unrelated to or do not apply to the ASC

benefit. Medicare does not include

payment for the item or service in the

ASC facility fee. However, if this item

or service is supplied at an ASC in

connection with a surgical procedure on

the ASC list, Medicare could make

separate payment under other sections

of Medicare Part B in accordance with

applicable coverage and payment

provisions and requirements.

7=ASC restricted coverage procedure.

Special coverage instructions apply. The

APC group shown signifies the payment

rate to be paid in the event the carrier

determines that the procedure or service

is reasonable and necessary.

8=Reserved for future use.

9=Medicare does not allow payment

for the item or service.

3. Description of Code. This is an

abbreviated version of the narrative

description of the code. Note: All CPT

codes and descriptors are copyrighted

by the American Medical Association.

CPT–4 codes including both long and

short descriptor shall be used in

accordance with the HCFA/AMA

agreement. Any other use violates the

AMA copyright.

4. Current payment group. If

applicable, this column gives the ASC

payment group to which the code is

currently assigned.

5. Current Payment Rate. If

applicable, this column gives the

current ASC payment rate.

6. Proposed APC group. This is the

payment group to which the code would

be assigned under the proposed

ambulatory payment classification

(APC) system.

7. Proposed Payment Rate. Where

applicable, this is the ASC payment rate

proposed for the code.

8. Relative Value Factor. Indicates the

relationship between the payment rate

assigned to the code and the median

payment rate ($504) determined for the

41 surgical APC groups that are priced

on the basis of 1994 ASC survey data.

9. Add/Delete. ‘‘Add’’ indicates that

the code is proposed for addition to the

ASC list. ‘‘Delete’’ indicates that the

code is currently on the ASC list and

that we propose to delete it from the

ASC list.

Addendum B—Proposed Ambulatory

Surgical Center (ASC) List by

Ambulatory Payment Classification

(APC) Groups and Related Information

This addendum lists CPT codes on

the ASC list in order of ambulatory

payment classification (APC) group and

gives the long descriptor of each CPT/

HCPC code on the ASC list.

Note: All CPT codes and descriptors are

copyrighted by the American Medical

Association. CPT–4 codes including both

long and short descriptor shall be used in

accordance with the HCFA/AMA agreement.

Any other use violates the AMA copyright.

Addendum C—List of APC Groups and

Related Information

This addendum lists in numeric order

the number and title of the APC groups

used as the basis for setting the ASC

payment rates proposed in this notice.

The proposed ASC payment rate and

relative value factor for each APC group

are shown.

Addendum D—Ambulatory Surgical

Center (ASC) Wage Index

IV. Collection of Information

Requirements

Under the Paperwork Reduction Act

of 1995 (PRA), agencies are required to

provide a 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

requires that we solicit comment on the

following issues:

• Whether the information collection

is necessary and useful to carry out the

proper functions of the agency;

• The accuracy of the agency’s

estimate of the information collection

burden;

• The quality, utility, and clarity of

the information to be collected; and

• Recommendations to minimize the

information collection burden on the

affected public, including automated

collection techniques.

Therefore, we are soliciting public

comment on each of these issues for the

information collection requirements

discussed below.

The information collection

requirements and associated burden as

summarized below are subject to the

PRA:

Section 416.4 Termination of

participation, including billing

privileges

In summary, an ASC that wishes to

terminate its participation and billing

privileges in Medicare must send HCFA

written notice of its intent. The notice

must state the intended date of

termination which must be the first day

of a calendar month. Furthermore, the

ASC must give prompt notice of the date

and effect of termination to the public,

through publication in local

newspapers, after HCFA has approved

or set a termination date.

The burden for this requirement

involves sending the written intent to

terminate notice to HCFA and

publishing the required third party

disclosure notice in a local newspaper.

The table below indicates the annual

number of responses for the regulation

section in this proposed rule containing

information collection requirements, the

average burden per response in minutes

or hours, and the total annual burden

hours.

ESTIMATED ANNUAL BURDEN CHART

CFR sections

Annual number of responses

Average burden per responseAnnual burden

hours

416.4 (written notice) ............................................................................................... 25 10 minutes .......................... 4.2

416.4 (publication) ................................................................................................... 25 30 minutes .......................... 12.5

Total Hours ....................................................................................................... ........................ ........................................ 17
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Section 416.33(b)(1) Surveys

In summary, § 416.33(b)(1) requires

ASCs to maintain adequate financial

and facility records to allow accurate

completion of the report specified in

subparagarph (b)(2) of this section in the

event they are selected to participate in

the quinquennial ASC survey as a

member of the representative sample of

facilities.

Under 5 CFR 1320.3(b)(2), the burden

associated with the time, effort and

financial resources necessary to comply

with a collection of information that

would be incurred by persons in the

normal course of business will be

excluded from an information

collection. The burden in connection

with such types of collection activities

can be disregarded if it can be

demonstrated that such collection

activities are usual and customary. Each

of the collection requirements

referenced above is of the type that are

usual and customary in the conduct of

commercial business. Thus, we believe

the burden to be exempt for these

requirements.

Section 416.33(b)(2) Surveys

In summary, § 416.33(b)(2) requires

ASCs to submit within 90 days of a

request, from HCFA, ASC survey data.

HCFA issued the last ASC survey in

1994, ‘‘Medicare Ambulatory Surgical

Center Payment Rate Survey—1994: II.

Facility Overhead and Procedure

Specific Costs,’’ Form HCFA–452B,

OMB No. 0938–0434, expired March

1997. Form HCFA 452 is being revised,

and decisions regarding survey format

and content for the 1999 ASC survey are

pending. We expect to consult

representatives of the ASC industry for

assistance in revising Form HCFA 452

before it is submitted to OMB for

approval. In addition, HCFA will

publish a separate Federal Register

notice soliciting public comments for

the ASC Survey.

We have submitted a copy of this

proposed rule to OMB for its review of

the information collection requirements

described above. These requirements are

not effective until they have been

approved by OMB.

If you comment on any of these

information collection and

recordkeeping requirements, please mail

copies directly to the following: Office

of Information and Regulatory Affairs,

Office of Management and Budget,

Room 10235, New Executive Office

Building, Washington, DC 20503, Attn.:

Allison Eydt, HCFA Desk Officer.

V. Regulatory Impact Analysis

We have examined the impacts of this

proposed rule under Executive Order

(E.O.) 12866, the Unfunded Mandates

Act of 1995, and the Regulatory

Flexibility Act. E.O. 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 (RIA) must be prepared for

major rules with economically

significant effects ($100 million or more

annually). The Unfunded Mandates

Reform Act of 1995 also requires (in

section 202) that agencies prepare an

assessment of anticipated costs and

benefits before proposing any rule that

may result in an annual expenditure by

State, local, or tribal governments, in the

aggregate, or by the private sector, of

$100 million.

The Actuarial and Health Cost

Analysis Group of HCFA’s Office of

Strategic Planning estimates that the

rebased ASC payment rates proposed in

this notice reduce Medicare payments to

ASCs by two percent from current

spending levels, in the aggregate.

Actuarial estimates of the modest

savings to Medicare that are the result

of the regrouping and repricing of the

ASC list proposed in this notice are as

follows:

PROJECTED MEDICARE SAVINGS

[In millions]*

FY 1998 ............................................ $¥20

FY 1999 ............................................ ¥20

FY 2000 ............................................ ¥20

FY 2001 ............................................ ¥20

FY 2002 ............................................ ¥20

FY 2003 ............................................ ¥20

* Rounded to the nearest $10 million.

The Balanced Budget Act of 1997 is

considered in the estimate, including

the prospective payment system for

hospital outpatient services to be

implemented on January 1, 1999, the

formula-driven overpayment

elimination effective October 1, 1997,

and the ASC update reduced by two

percentage points for each of the fiscal

years 1998 through 2002.

This proposed rule has no

consequential effect on State, local, or

tribal governments, and, based on the

actuarial estimates shown above, we

believe the private sector costs of this

rule fall below the economic thresholds

established by E.O. 12866 and by the

Unfunded Mandates Act of 1995.

Because this notice is not an

economically significant regulatory

action under either E.O. 12866 or the

Unfunded Mandates Act of 1995, a

regulatory impact analysis is not

required.

Consistent with the provisions of the

Regulatory Flexibility Act, we analyze

options for regulatory relief for small

businesses and other small entities. We

generally prepare a regulatory flexibility

analysis that is consistent with the

Regulatory Flexibility Act (RFA) (5

U.S.C. 601 through 612) unless we

certify that a notice will not have a

significant economic impact on a

substantial number of small entities.

The regulatory flexibility analysis is to

include a justification of why action is

being taken, the kinds and number of

small entities the proposed rule will

affect, and an explanation of any

considered meaningful options that

achieve the objectives and would lessen

any significant adverse economic

impact on the small entities. For

purposes of the RFA, we consider ASCs

to be small entities. In addition, section

1102(b) of the Social Security Act

requires us to prepare a regulatory

impact analysis if a notice may have a

significant impact on the operations of

a substantial number of small rural

hospitals. For purposes of section

1102(b) of the Act, we define a small

rural hospital as a hospital that is

located outside of a Metropolitan

Statistical Area and has fewer than 50

beds.

We believe that the rebased rates

proposed in this notice will affect

revenues of most Medicare approved

ASCs that furnish services to Medicare

beneficiaries and, to a lesser extent,

revenues of hospitals that perform

procedures on the ASC list on an

outpatient basis. We have therefore

prepared the following regulatory

flexibility analysis which, together with

the rest of this preamble, meets all three

assessment requirements under the

RFA. We will have explained the

rationale for and purposes of the rule,

analyzed alternatives, and presented the

measures we propose to minimize the

burden on small entities.

A. Rebased Payment Rates

This notice implements section

1833(i)(2)(A)(i) of the Act, which

mandates that payment amounts for

ASC facility services take into account

costs incurred by ASCs generally to

furnish services in connection with

procedures on the ASC list, as

determined by a survey of the actual

audited costs incurred by ASCs taken

not later than January 1, 1995 and every

five years thereafter.

1. Impact on ASCs

In the aggregate, based on actuarial

estimates, we expect the revised rates
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32323

proposed in this notice to result in a two

percent reduction in Medicare outlays

for ASC facility services. Given the

negligible magnitude of this reduction,

we can say that the effect of rebasing the

ASC rates and revising the ASC list is

virtually budget neutral when viewed in

the aggregate. This outcome is

attributable primarily to the lower

payment rate determined for the two

procedures with the highest ASC

volume: CPT codes 66984 and 66821.

These two procedures alone account for

approximately 46 percent of ASC

Medicare volume, which helps offset

the effect of increased expenditures that

will result from higher payment rates for

procedures such as hernia repair,

hammertoe and bunion correction

surgery, arthoscopic procedures, and

from the addition of extracorporeal

shock wave lithotripsy (ESWL) to the

ASC list.

However, the change in payment rate

for virtually every procedure on the

ASC list—with some procedures

receiving a lower rate and others

receiving a higher rate than they do

currently—could affect the Medicare

revenues of individual ASCs, depending

on factors such as patient volume and

case mix and the type of procedures

performed. Of the 295 facilities whose

1994 survey responses are the basis for

the rates proposed in this notice, 54 (18

percent) reported that more than 60

percent their total volume in a 12-month

period comprised of some combination

of CPT codes in the range between

66820 and 66986 cataract procedures.

For most of those facilities, Medicare

utilization exceeded fifty percent, and

for 16 facilities, Medicare utilization

exceeded seventy-five percent. The rates

proposed in this CPT range represent,

overall, a drop of about eleven percent

from current payment rates for cataractrelated procedures. The rate we propose

for CPT code 66984, the highest volume

ASC procedure representing 35 percent

of all ASC Medicare volume in 1996,

decreases by 8 percent. The rate for CPT

code 66821, the second highest volume

ASC procedure representing 11 percent

of all ASC Medicare volume in 1996,

decreases by 35 percent. Obviously

facilities that specialize in these two

cataract-related procedures are going to

be affected more dramatically by the

proposed rebased rates than are

facilities where the volume of these

procedures is lower.

The rates that we propose in this

notice for certain high volume

gastrointestinal and urinary tract

endoscopies are also lower than current

rates for the same procedures, such as

CPT code 43239 (22 percent decrease),

CPT code 45378 (16 percent decrease)

and CPT code 52000 (32 percent

decrease). As a group, endoscopies are

second only to CPT codes 66984 and

66821 with respect to Medicare

utilization of ASCs. Of the 295 facilities

whose 1994 survey responses are the

basis for the rates proposed in this

notice, 17 (6 percent) reported that more

than 60 percent of their total volume in

a 12-month period comprised some

combination of CPT codes

encompassing gastrointestinal

endoscopies. However, in only one of

those 17 facilities did Medicare

utilization exceed fifty percent, and for

11 facilities, Medicare utilization was

less than thirty-five percent.

Not all of the rebased rates proposed

in this notice are reductions of current

rates. The rebased rates proposed for

arthroscopic surgery, for some

gynecological procedures, for certain

podiatric procedures, for carpal tunnel

release, for hernia repair, and for certain

eye procedures involving the cornea and

the retina are higher than the current

rates for those procedures. Facilities

where those procedures are now being

performed will, upon implementation of

the rebased rates, be paid a facility fee

that more closely approximates the cost

of doing the surgery and that should

allow the facility a reasonable return, as

will facilities performing procedures for

which the rebased rates are lower than

current ASC payment.

Some smaller, single specialty ASCs

may experience some decrease in

Medicare payment upon

implementation of the rebased rates

proposed in this notice, especially if

their annual total volume of cases is less

than 1000, if the proportion of Medicare

beneficiaries that they serve greatly

exceeds the 34 percent average ASC

Medicare volume, or if they perform a

case mix of procedures whose rebased

rates are all lower than current rates.

Congress does not provide us with tools

such as a ‘‘hold-harmless’’ clause or a

transition period for implementation of

rebased rates that could serve to deflect

some of the adverse effects of lower

payment rates. However, judging from

the 1994 survey data, even though

efficient ASCs may experience a

fractional reduction in profits, we do

not think that they will suddenly be

faced with serious financial reverses as

a result of the rates proposed in this

notice. That is because the rebased rates

proposed in this notice are closer to

costs based on verified data reported by

ASCs than are the current rates, which

are based on data collected in 1986.

We emphasize that the rates proposed

in this notice have been determined in

accordance with audited cost, charge,

and utilization data reported by a

representative sample of ASCs, as we

explained in detail earlier in this notice.

To summarize the process we used to

establish the payment rates proposed in

this notice using audit adjusted 1994

survey data—

Step 1—We standardized the original

reported CPT code charges and facility

overhead costs of the 199 unaudited

facilities by the percent of difference

between audited and original reported

data of the 96 audited facilities.

Step 2—We determined each facility’s

cost-to-charge ratio by dividing the

facility’s total costs by its total charges.

Step 3—We converted each procedure

charge to a procedure cost by

multiplying each facility’s procedure

charge by the facility’s cost-to-charge

ratio.

Step 4—Because the facilities’ IOL

costs were imbedded in the calculated

procedure cost for IOL insertion

procedures (CPT codes 66983, 66984,

66985, and 66986), we reduced those

procedure costs by the facility specific

average IOL cost to offset the carrier’s

addition of the $150 allowance for the

IOL.

Step 5—To remove the effects of area

wage differences, we neutralized the

cost of each procedure by dividing the

facility-specific labor-related portion of

procedure cost by the hospital inpatient

prospective payment system prereclassification//pre-floor wage index

value applicable to the facility’s

location. We then added the wage

adjusted labor-related portion of

procedure cost back to the nonlaborrelated portion.

Step 6—We applied an inflation

adjustment based on the CPI–U to each

procedure cost in order to account for

historical and projected price changes

occurring between the midpoint of the

facility’s fiscal period represented in our

data base and the midpoint of the 12-

month period to which the new rates

would apply (July 1, 1998).

Step 7—We grouped the procedure

codes into APCs based on clinical and

cost similarities.

Step 8—For the 41 APCs with

sufficient ASC survey cost data, we

calculated the median procedure cost

for all Medicare cases within the group

to determine the group payment rate.

Step 9—We designated the median of

the payment rates for the 41 APCs with

sufficient ASC survey cost date as a

conversion factor 504.

Step 10—We assigned a value to each

of the remaining 64 APCs for which we

had inadequate ASC survey data based

on an estimate of each APC group’s

relative similarity to or deviation from

the 41 APCs for which we had sufficient

survey data.
32324 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

Step 11—We multiplied the relative

value of each of the 64 groups by a

conversion factor of 504 to determine

the group payment rate.

By using survey data reported by

ASCs that was checked and verified by

audit, we have determined ASC

payment rates that are generally lower

than current ASC payment rates. In one

sense, the lower proposed payment rates

are a tribute to the efficiency and

success of ASCs generally in holding the

line on facility costs. Lower rates reflect

lower costs that are the result of

improved technology, efficiency, and

experience. The fact remains that

regardless of the method we used to

calculate payment rates, whether we

used dollar intervals to group codes like

the current methodology or APC groups

or an individual per procedure fee

schedule or weighted or unweighted

medians or means, the relationship of

the resulting rates relative to current

rates remained the same: rates for high

volume cataract-related procedures and

gastrointestinal endoscopies were lower

and rates for less frequently performed

arthroscopies and various other general

surgical procedures went up.

Another explanation for the lower

rebased rates could rest with the fact

that the current eight ASC payment

rates are based on data that were

collected in 1986, which generally

reflected 1984–85 cost and charge

experience. We used 1986 survey data,

adjusted for inflation, to rebase ASC

payment rates effective for services

furnished beginning on March 12, 1990.

Between March 1990 and October 1996,

we adjusted the ASC payment rates five

times resulting in an across the board

increase of approximately 20 percentage

points for procedures in groups 1, 2, 3,

4, 5, and 7. (The rates for groups 6 and

8, which are limited to intraocular lens

(IOL) insertion procedures for which the

IOL allowance was prescribed by

statute, increased by only 7.5 percent

during that time due to the statutory

reduction in the IOL allowance from

$200 to $150 effective January 1, 1994.)

We did not rebase the 1990 rates, or take

into account variations in cost resulting

from changes in technology. The current

eight ASC rates are therefore the result

of across-the-board flat increases for

inflation dating back to 1990 that do not

reflect upward or downward changes in

costs associated with individual

procedures over the same period.

B. Additions to/Deletions From the ASC

List

The addition of outpatient procedures

that were previously kept off the list

will give ASCs an opportunity to

increase volume and utilization as well

as expand their revenue sources. The

addition of a payment rate for ESWL

will allow payment to ASCs for this

procedure and make it available for

Medicare beneficiaries in an ASC

setting.

The procedures that are being

removed from the ASC list are not high

volume procedures, and we do not

expect their deletion from the ASC list

to have any significant impact, negative

or positive.

C. Impact of Technical Changes

Most of the technical changes

proposed in this notice—extending to

90 days the period for completing the

ASC survey; implementing all ASC

updates on a calendar year basis;

rearranging and reorganizing part 416 of

the Code of Federal Regulations; adding

payment policy indicators; clarifying

that procedures excluded from the ASC

list are not reasonable and necessary in

an ASC—are intended to streamline the

ASC benefit and reduce ambiguity to the

advantage of beneficiaries and ASCs

alike without compromising beneficiary

safety and positive surgical outcomes.

D. Impact on Hospitals and Small Rural

Hospitals

Section 1833(i)(3)(A) of the Act

mandates the method of determining

payments to hospitals for ASC-approved

procedures performed in an outpatient

setting. Congress believed some

comparability should exist in the

amount of payment to hospitals and

ASCs for similar procedures. Congress

recognized, however, that hospitals

have certain overhead costs that ASCs

do not and allowed for those costs by

establishing a blended payment

methodology. For ASC procedures

performed in an outpatient setting,

hospitals are paid based on the lower of

their aggregate costs, aggregate charges,

or a blend of 58 percent of the

applicable wage-adjusted ASC rate and

42 percent of the lower of the hospital’s

aggregate costs or charges. According to

statistics from the Office of the Actuary

within HCFA, 12 percent of Medicare

payments to hospitals by intermediaries

is attributable to services furnished in

conjunction with ASC-covered

procedures performed on an outpatient

basis.

While an ASC rate change may not

keep pace with actual hospital cost

increases, we would recognize cost

increases to the extent that the blended

payment methodology includes

aggregate hospital costs. The weight of

the ASC portion of the blended payment

amount, which would reflect the new

ASC rates, is offset to a degree when

hospital costs significantly exceed the

ASC rate. Another element that could

mitigate the effect of the rebased ASC

rates on hospital outpatient payments is

the application of the lowest payment

screen in determining payments.

Applying the lowest of costs, charges, or

a blend can result in some hospitals

being paid entirely on the basis of a

hospital’s costs or charges. In those

instances, changes in the ASC rates will

have no effect on hospital payments.

The number of Medicare beneficiaries a

hospital serves and its case-mix

variation influence the total impact of

the new ASC rates on Medicare

payments to hospitals. Based on these

factors, we do not believe that the

provisions of this notice will have a

significant impact on a substantial

number of small rural hospitals.

Moreover, the impact of rebased ASC

rates on hospital outpatient payments

will be eliminated upon implementation

of a prospective payment system for

hospital outpatient services in January

1999.

In accordance with the provisions of

Executive Order 12866, this proposed

rule was reviewed by the Office of

Management and Budget.

List of Subjects

42 CFR Part 416

Health facilities, Kidney diseases,

Medicare, Reporting and recordkeeping

requirements.

42 CFR Part 488

Administrative practice and

procedure, Health facilities, Medicare,

Reporting and recordkeeping

requirements.

42 CFR chapter IV would be amended

as set forth below:

PART 416—AMBULATORY SURGICAL

SERVICES

A. Part 416 is amended as set forth

below:

1. The authority citation for part 416

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh).

2. The heading of subpart A is revised

and § 416.1 is revised to read as follows:

Subpart A—Definitions and General

Provisions and Requirements

§ 416.1 Basis and scope.

(a) Statutory basis. (1) Section

1832(a)(2)(F) of the Act provides for

Medicare Part B payment for facility

services furnished by an ambulatory

surgical center (ASC) in connection

with surgical procedures specified by
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32325

the Secretary under section

1833(i)(1)(A) of the Act.

(2) Section 1832(a)(2)(F)(i) of the Act

provides that an ASC, in order to

receive Medicare payment, must meet

health, safety, and other standards

specified by the Secretary in regulations

and must also agree to accept

assignment and to accept as payment in

full for facility services furnished in

connection with surgical procedures

specified by the Secretary under section

1883(i)(1)(A) of the Act the payment

amount determined under section

1833(i)(2)(A).

(3) Section 1833(i)(1)(A) of the Act

requires the Secretary to specify the

surgical procedures that can be

performed safely on an ambulatory basis

in an ASC.

(4) Section 1833(i)(2)(A) and (3)

specify the amounts to be paid for

facility services furnished in connection

with the specified surgical procedures

when they are performed, respectively,

in an ASC or in a hospital outpatient

department.

(b) Scope. This part sets forth—

(1) The scope of ASC facility services

and the criteria for determining the

procedures for which Medicare pays

ASCs a facility fee;

(2) The manner by which Medicare

determines payment amounts for ASC

facility services; and

(3) The conditions that an ASC must

meet in order to participate in the

Medicare program.

3. Section 416.2 is revised to read as

follows:

416.2 Definitions

As used in this part:

An Ambulatory Surgical Center or

ASC means a supplier that—

(1) Has its own National Identifier

under Medicare;

(2) Is a separate entity with respect to

its licensure, accreditation, governance,

professional supervision, administrative

functions, clinical services, record

keeping, and financial and accounting

systems;

(3) Has as its sole purpose the

furnishing of services in connection

with surgical procedures that do not

require inpatient hospitalization; and

(4) Meets the conditions and

requirements set forth in all subparts of

this part.

ASC list means the list of procedures

that HCFA specifies can be safely and

appropriately performed in an ASC, for

which Medicare allows payment of an

ASC facility fee in accordance with the

provisions of this part.

ASC services means services that a

Medicare approved ASC furnishes in

connection with procedures on the ASC

list and for which Medicare pays a

prospectively-determined ASC facility

fee.

Hospital-operated ASC means an ASC

that is owned and operated by a hospital

but that is a separate entity with respect

to its licensure, accreditation,

governance, professional supervision,

administrative functions, clinical

services, recordkeeping, and financial

and accounting systems. A hospitaloperated ASC must meet all the

conditions and requirements set forth in

subparts A, B, C and D of this part.

4. Section 416.25 is redesignated as

§ 416.3 and is transferred to subpart A

and is revised to read as follows:

§ 416.3 Basic Requirements

Participation as an ASC, including

billing privileges, is limited to facilities

that meet the following conditions:

(a) Meet the definition in § 416.2.

(b) Have State licensure in States

where licensure is required.

(c) Meet the conditions for coverage

specified in subpart D of this part and

report promptly to HCFA any failure to

do so.

(d) Charge the beneficiary or any other

person on the beneficiary’s behalf only

the applicable deductible and

coinsurance amounts for services for

which the beneficiary—

(1) Is entitled to have payment made

on his or her behalf under this part; or

(2) Would have been so entitled if the

ASC had filed a request for payment in

accordance with § 410.165 of this

chapter.

(e) Refund as promptly as possible

any money incorrectly collected from

beneficiaries or from someone on their

behalf. As used in this section, money

incorrectly collected means sums

collected in excess of those specified in

paragraph (d) of this section. It includes

amounts collected for a period of time

when the beneficiary was believed not

to be entitled to Medicare benefits if—

(1) The beneficiary is later determined

to have been entitled to Medicare

benefits; and

(2) The beneficiary’s entitlement

period falls within the time the ASC’s

agreement with HCFA is in effect.

(f) Furnish to HCFA, if requested,

information necessary to establish

payment rates as specified in subpart C,

and in the form and manner that HCFA

requires;

(g) Accept assignment for all items

and services that it furnishes to

Medicare beneficiaries for which

payment may be made under Medicare

Part B in connection with procedures on

the ASC list. For purposes of this

section, assignment means an

assignment under § 424.55 of this

chapter of the right to receive payment

under Medicare Part B and payment

under § 424.64 of this chapter (when an

individual dies before assigning the

claim).

(h) Are in compliance with ASC

requirements set forth in Part 488—

Survey, Certification, and Enforcement

Procedures.

(i) Have in effect a validated Medicare

health care provider/supplier

enrollment application.

5. Section 416. 4 is added to subpart

A to read as follows:

§ 416.4 Termination of participation,

including billing privileges.

(a) Termination by the ASC—(1)

Notice to HCFA. An ASC that wishes to

terminate its participation and billing

privileges in Medicare must send HCFA

written notice of its intent.

(2) Date of termination. The notice

must state the intended date of

termination, which must be the first day

of a calendar month.

(i) If the notice does not specify a

date, or the date is not acceptable to

HCFA, HCFA may set a date that will

not be more than 6 months from the

date on the ASC’s notice of intent.

(ii) HCFA may accept a termination

date that is less than 6 months after the

date on the ASC’s notice if it determines

that to do so would not unduly disrupt

services to the community or otherwise

interfere with the effective and efficient

administration of the Medicare program.

(3) Voluntary termination. If an ASC

ceases to furnish services to the

community, that shall be deemed to be

a voluntary termination of the

agreement by the ASC, effective on the

last day of business with Medicare

beneficiaries.

(b) Termination by HCFA. (1) Cause

for termination. HCFA may terminate an

ASC’s participation, including its billing

privileges, if it determines that the

ASC—

(i) No longer meets the conditions for

coverage as specified under subpart D of

this part; or

(ii) Is not in substantial compliance

with the provisions and the

requirements of subparts A, B, and C of

this part, or other applicable regulations

of subchapter B of this chapter, or any

applicable provisions of title XVIII of

the Act.

(2) Notice of termination. HCFA sends

notice of termination to the ASC at least

15 days before the effective date stated

in the notice.

(3) Appeal by the ASC. An ASC may

appeal the termination of its

participation, including its billing

privileges, in accordance with the

provisions set forth in part 498 of this

chapter.
32326 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

(c) Effect of termination. Payment is

not available for ASC services furnished

on or after the effective date of

termination.

(d) Notice to the public. Prompt notice

of the date and effect of termination is

given to the public, through publication

in local newspapers by—

(1) The ASC, after HCFA has

approved or set a termination date; or

(2) HCFA, when it has terminated the

ASC’s participation, including its billing

privileges.

(e) Conditions for reinstatement after

termination by HCFA. When HCFA

terminates an ASC’s participation in

Medicare, which includes terminating

its billing privileges, the ASC may not

file another application to participate in

the Medicare program as an ASC unless

HCFA—

(1) Finds that the reason for the prior

termination has been removed; and

(2) Is assured that the reason for the

termination will not recur.

6. Subpart B is revised; subpart D is

removed; subpart C is redesignated as

subpart D, and § 416.40 is removed; and

subpart E is redesignated as subpart C

and revised. The revised subparts B and

C read as follows:

Subpart B—Scope of Benefits

§ 416.20 General rules.

The services for which payment is

made under this part are facility

services furnished to Medicare

beneficiaries by a participating ASC in

connection with procedures on the ASC

list as specified by HCFA in accordance

with § 416.22.

§ 416.21 Scope of ASC services.

(a) Included services. ASC services

include but are not limited to:

(1) Nursing, technician, and related

services.

(2) Use of the facility where the

surgical procedures are performed.

(3) Items and services directly related

and integral to the pre-operative

preparation of patients upon their

admission to the ASC for surgery, to the

performance of a surgical procedure(s),

and to the post-operative and/or postanesthesia care of patients prior to their

discharge from the ASC. This includes,

but is not limited to, any laboratory

testing performed under a Clinical

Laboratory Improvement Amendments

of 1988 (CLIA) certificate of waiver;

drugs and biologicals; medical and

surgical supplies and equipment;

surgical dressings; splints, casts and

other devices used for reduction of

fractures and dislocations; and, imaging

services or other diagnostic tests integral

to a surgical procedure.

(4) Administrative, recordkeeping,

and housekeeping items and services.

(5) Materials, including supplies and

equipment, for the administration and

monitoring of anesthesia.

(6) Intra-ocular lenses (IOLs).

(b) Excluded services. ASC services

do not include certain items and

services for which payment may be

made under other provisions of this

chapter, such as physician services,

diagnostic X-ray services and other

diagnostic tests (other than those

integral to the performance of a surgical

procedure), diagnostic laboratory tests,

X-ray therapy and other radiation

therapy, prosthetic devices (except

IOLs), ambulance services, leg, arm,

back and neck braces, artificial limbs,

and durable medical equipment for use

in the patient’s home. In addition, ASC

services do not include anesthetist

services furnished on or after January 1,

1989.

§ 416.22 ASC list.

The ASC list consists of those

procedures that HCFA, in consultation

with appropriate trade and professional

associations, specifies as being

appropriately and safely performed in

an ASC. Paragraphs (a) and (b) of this

section list the criteria HCFA uses to

determine if a procedure is to be placed

on the ASC list. Medicare payment of an

ASC facility fee is not allowed for ASC

services furnished in connection with

procedures excluded from the ASC list

in accordance with the criteria in

paragraph (b) of this section. The ASC

list is published in accordance with

paragraph (c) of this section.

(a) Procedures on the ASC list.

Procedures on the ASC list are those

surgical and other medical procedures

that generally—

(1) Require surgical facilities and

services of the kind that are typically

provided in a hospital inpatient setting;

(2) Would not be expected to

necessitate admission as an inpatient to

a hospital either to perform the

procedure or to recover from the

procedure post-operatively;

(3) Require a dedicated operating

room (or suite) or procedure room and

a room for post-operative recovery; and

(4) Are not otherwise excluded under

§ 411.15 of this chapter, or paragraph (b)

of this section.

(b) Procedures excluded from the ASC

list. A procedure with any of the

following characteristics is not

considered safe or appropriate in an

ASC setting. A procedure with any of

these characteristics is not reasonable or

medically necessary in an ASC setting.

Payment of an ASC facility fee for

procedures excluded from the ASC list

in accordance with any of the following

characteristics is not allowed. A

procedure is excluded from the ASC list

if it—

(1) Generally results in extensive

blood loss;

(2) Requires major or prolonged

invasion of body cavities;

(3) Directly involves major blood

vessels;

(4) Is generally emergent or lifethreatening in nature; or

(5) Requires admission to a hospital

on an inpatient basis in order to have

the procedure performed or to recover

from the procedure.

(c) Publication of ASC list. HCFA

publishes the ASC list in the Federal

Register as appropriate.

(1) HCFA automatically revises the

ASC list to ensure that it conforms

timely with coding changes resulting

from the annual update of the Health

Care Financing Administration

Common Procedure Coding System

(HCPCS). The effective date of changes

to the ASC list resulting from HCPCS

coding changes are concurrent with the

effective date of the HCPCS revision.

HCFA announces these conforming

changes in the first Federal Register

notice published thereafter, either in

accordance with paragraph (c)(2) of this

section or in accordance with § 416.32.

(2) When HCFA adds procedures to or

deletes procedures from the ASC list in

accordance with the criteria in

paragraphs (a) and (b) of this section,

HCFA publishes a notice in the Federal

Register explaining the rationale for the

proposed changes and soliciting public

comments on both the proposed

changes and the payment rates proposed

for procedures under consideration for

addition to the list. After reviewing

public comments, HCFA publishes a

notice in the Federal Register to

establish the final revisions to the ASC

list.

§ 416.23 Performance of procedures on

the ASC list in a hospital inpatient setting.

The fact that a procedure is on the

ASC list does not preclude its coverage

in a hospital inpatient setting.

Subpart C—Payment for Facility

Services

§ 416.30 Basis for payment.

The basis for payment for facility

services depends upon the type of entity

at which the services are furnished.

(a) Physician’s office. Payment is in

accordance with part 414 of this

chapter.

(b) Hospital outpatient department.

Payment is in accordance with part 413

of this chapter.
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32327

(c) Hospital-operated ASC. (1) The

ASC participates and is paid only as an

ASC without the option of converting to

or being paid as a hospital outpatient

department, unless HCFA first

determines there is good cause to do

otherwise.

(2) Costs for the ASC are treated as a

nonreimbursable cost center on the

hospital’s cost report.

(d) ASC—General rule. Payment is

based on a prospectively determined

rate.

(1) This rate includes payment for the

cost of ASC services such as supplies,

nursing services, equipment, etc., as

specified in § 416.21. The ASC payment

rate for insertion of an intraocular lens

(IOL) during or subsequent to cataract

removal includes an amount for the IOL

that is reasonable and related to the cost

of acquiring the lens.

(2) The ASC payment rate does not

include payment for certain medical

and other health services that are

covered but that may be billed and paid

for separately under part 410 of this

chapter, such as physician services, Xray services or other diagnostic tests not

integral to the performance of a surgical

procedure, or prosthetic implants (other

than IOLs).

(3) Because procedures excluded from

the ASC list on the basis of the

standards in § 416.22(b) are not

‘‘reasonable and necessary,’’ Medicare

does not allow payment of an ASC

facility fee for those procedures. (See

§ 411.15(k)(1) of this chapter.)

(e) Single and multiple surgical

procedures. (1) If one procedure on the

ASC list is performed in a single

operative session, payment of the ASC

facility fee is based on the prospectively

determined rate for that one procedure.

(2) If more than one surgical

procedure is furnished in a single

operative session, payment is based

on—

(i) The full rate for the procedure with

the highest prospectively determined

rate; and

(ii) One half of the prospectively

determined rate for each of the other

procedures.

(f) Deductibles and coinsurance. Part

B deductible and coinsurance amounts

apply as specified in § 410.152 (a) and

(i) of this chapter.

§ 416.31 ASC payment rates.

(a) The payment rate for a procedure

on the ASC list is based on a standard

prospectively determined per procedure

overhead amount.

(1) The standard overhead amount

represents HCFA’s estimate of a fair perprocedure fee that takes into account the

costs incurred by an ASC generally in

providing facility services in connection

with the performance of the procedure.

(2) HCFA surveys ASCs as described

in § 416.33 to determine the costs

incurred by ASCs generally in providing

ASC services in connection with the

performance of procedures on the ASC

list.

(3) HCFA conducts an audit of a

randomly-selected sample of the

surveys submitted in accordance with

the requirements in § 416.33 to ensure

that the costs from which it derives ASC

payment rates are reported accurately

and in a manner consistent with

Medicare principles of reasonable cost

reimbursement.

(b) The ASC payment rate must result

in substantially less being paid under

the program than would have been paid

if the procedures had been performed

on an inpatient basis in a hospital.

(c) In setting ASC payment rates,

HCFA may adopt reasonable

classifications of facilities and may

establish different rates for different

types of surgical procedures.

(d) For the years when HCFA does not

rebase ASC payment rates using survey

data collected in accordance with

§ 416.33, HCFA updates the existing

ASC payment rates by the percentage

increase in the consumer price index for

all urban consumers (U.S. city average)

as estimated for the 12-month period

ending with the midpoint of the year

involved.

§ 416.32 Publication of revised payment

rates.

Once implemented, ASC payment

rates remain in effect until HCFA

publishes a notice in the Federal

Register to change the rates.

(a) When HCFA rebases ASC payment

rates using survey data collected in

accordance with § 416.33, HCFA

publishes a notice in the Federal

Register describing the method it

followed to rebase the rates and

soliciting public comments on both the

proposed new rates and the ratesetting

method. After reviewing public

comments, HCFA publishes a final

notice in the Federal Register to

establish the new, rebased rates.

(b) During years when HCFA updates

ASC payment rates using a consumer

price index factor as described in

§ 416.31(d), HCFA publishes a notice in

the Federal Register to announce the

updated rates.

§ 416.33 Surveys.

(a) Timing, purpose, and procedures.

(1) Beginning not later than January 1,

1995 and every 5 years thereafter, HCFA

conducts a survey of ASCs based upon

a representative sample of procedures

and facilities to collect data for the

purpose of rebasing ASC payment rates.

(2) HCFA notifies ASCs by mail of

their selection to participate in the ASC

survey and of the form and content of

the report the ASCs must submit.

(3) If the facility does not submit an

adequate report in response to HCFA’s

survey request, HCFA may terminate the

ASC’s Medicare billing privileges and

its participation in the Medicare

program.

(4) ASCs have 90 days within which

to complete and submit the survey.

HCFA may grant a 30-day postponement

of the due date for the survey report if

it determines that the facility has

demonstrated good cause for the delay.

(b) Requirements for ASCs. ASCs

must—

(1) Maintain adequate financial and

facility records to allow accurate

completion of the report specified in

paragraph (b)(2) of this section in the

event they are selected to participate in

the quinquennial ASC survey as a

member of the representative sample of

facilities.

(2) Within 90 days of a request from

HCFA for survey data submit, in the

form and detail specified by HCFA, a

report of—

(i) Their operations, including the

allowable costs actually incurred for the

period and the actual number and a list

of surgical procedures performed during

the period; and

(ii) Their customary charges for each

surgical procedure performed during the

period.

§ 416.34 Beneficiary appeals.

A beneficiary (or ASC as his or her

assignee) may request a hearing by a

carrier (subject to the limitations and

conditions set forth in part 405, subpart

H of this chapter) if the beneficiary or

the ASC—

(a) Is dissatisfied with a carrier’s

denial of a request for payment made on

his or her behalf by an ASC;

(b) Is dissatisfied with the amount of

payment; or

(c) Believes the request for payment is

not being acted upon with reasonable

promptness.

PART 488—SURVEY, CERTIFICATION,

AND ENFORCEMENT PROCEDURES

B. Part 488 is amended as set forth

below:

1. The authority citation for part 488

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh).

2. In § 488.1 the definition of

‘‘supplier’’ is revised to read as follows:
32328

§ 488.1 Definitions.

* * * * *

Supplier means any of the following:

Independent laboratory; portable X-ray

services; physical therapist in

independent practice; ESRD facility;

rural health clinic; Federally qualified

health center; chiropractor; or

ambulatory surgical center.

* * * * *

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance; and Program No. 93.774,

Medicare—Supplementary Medical

Insurance Program)

Dated: March 20, 1998.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing

Administration.

Approved: April 28, 1998.

Donna E. Shalala,

Secretary.

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

00100 2 Anesth, skin surgery ......................................................................... ................ ................ ................ ................ ................

00102 2 Anesth, repair of cleft lip ................................................................... ................ ................ ................ ................ ................

00103 2 Anesth, blepharoplasty ..................................................................... ................ ................ ................ ................ ................

00104 2 Anesth for electroshock .................................................................... ................ ................ ................ ................ ................

00120 2 Anesthesia for ear surgery ............................................................... ................ ................ ................ ................ ................

00124 2 Anesthesia for ear exam ................................................................... ................ ................ ................ ................ ................

00126 2 Anesth, tympanotomy ....................................................................... ................ ................ ................ ................ ................

00140 2 Anesth, procedures on eye ............................................................... ................ ................ ................ ................ ................

00142 2 Anesthesia for lens surgery .............................................................. ................ ................ ................ ................ ................

00144 2 Anesth, corneal transplant ................................................................ ................ ................ ................ ................ ................

00145 2 Anesth, vitrectomy ............................................................................ ................ ................ ................ ................ ................

00147 2 Anesth, iridectomy ............................................................................ ................ ................ ................ ................ ................

00148 2 Anesthesia for eye exam .................................................................. ................ ................ ................ ................ ................

00160 2 Anesth, nose, sinus surgery ............................................................. ................ ................ ................ ................ ................

00162 2 Anesth, nose, sinus surgery ............................................................. ................ ................ ................ ................ ................

00164 2 Anesth, biopsy of nose ..................................................................... ................ ................ ................ ................ ................

00170 2 Anesth, procedure on mouth ............................................................ ................ ................ ................ ................ ................

00172 2 Anesth, cleft palate repair ................................................................. ................ ................ ................ ................ ................

00174 2 Anesth, pharyngeal surgery .............................................................. ................ ................ ................ ................ ................

00176 2 Anesth, pharyngeal surgery .............................................................. ................ ................ ................ ................ ................

00190 2 Anesth, facial bone surgery .............................................................. ................ ................ ................ ................ ................

00192 2 Anesth, facial bone surgery .............................................................. ................ ................ ................ ................ ................

00210 2 Anesth, open head surgery .............................................................. ................ ................ ................ ................ ................

00212 2 Anesth, skull drainage ...................................................................... ................ ................ ................ ................ ................

00214 2 Anesth, skull drainage ...................................................................... ................ ................ ................ ................ ................

00215 2 Anesth, skull fracture ........................................................................ ................ ................ ................ ................ ................

00216 2 Anesth, head vessel surgery ............................................................ ................ ................ ................ ................ ................

00218 2 Anesth, special head surgery ........................................................... ................ ................ ................ ................ ................

00220 2 Anesth, spinal fluid shunt .................................................................. ................ ................ ................ ................ ................

00222 2 Anesth, head nerve surgery ............................................................. ................ ................ ................ ................ ................

00300 2 Anesth, skin surgery, neck ............................................................... ................ ................ ................ ................ ................

00320 2 Anesth, neck organ surgery .............................................................. ................ ................ ................ ................ ................

00322 2 Anesth, biopsy of thyroid .................................................................. ................ ................ ................ ................ ................

00350 2 Anesth, neck vessel surgery ............................................................. ................ ................ ................ ................ ................

00352 2 Anesth, neck vessel surgery ............................................................. ................ ................ ................ ................ ................

00400 2 Anesth, chest skin surgery ............................................................... ................ ................ ................ ................ ................

00402 2 Anesth, surgery of breast ................................................................. ................ ................ ................ ................ ................

00404 2 Anesth, surgery of breast ................................................................. ................ ................ ................ ................ ................

00406 2 Anesth, surgery of breast ................................................................. ................ ................ ................ ................ ................

00410 2 Anesth, correct heart rhythm ............................................................ ................ ................ ................ ................ ................

00420 2 Anesth, skin surgery, back ............................................................... ................ ................ ................ ................ ................

00450 2 Anesth, surgery of shoulder .............................................................. ................ ................ ................ ................ ................

00452 2 Anesth, surgery of shoulder .............................................................. ................ ................ ................ ................ ................

00454 2 Anesth, collar bone biopsy ............................................................... ................ ................ ................ ................ ................

00470 2 Anesth, removal of rib ....................................................................... ................ ................ ................ ................ ................

00472 2 Anesth, chest wall repair .................................................................. ................ ................ ................ ................ ................

00474 2 Anesth, surgery of rib(s) ................................................................... ................ ................ ................ ................ ................

00500 2 Anesth, esophageal surgery ............................................................. ................ ................ ................ ................ ................

00520 2 Anesth, chest procedure ................................................................... ................ ................ ................ ................ ................

00522 2 Anesth, chest lining biopsy ............................................................... ................ ................ ................ ................ ................

00524 2 Anesth, chest drainage ..................................................................... ................ ................ ................ ................ ................

00528 2 Anesth, chest partition view .............................................................. ................ ................ ................ ................ ................

00530 2 Anesth, pacemaker insertion ............................................................ ................ ................ ................ ................ ................

00532 2 Anesth, vascular access ................................................................... ................ ................ ................ ................ ................

00534 2 Anesth, cardioverter/defib ................................................................. ................ ................ ................ ................ ................

00540 2 Anesth, chest surgery ....................................................................... ................ ................ ................ ................ ................

00542 2 Anesth, release of lung ..................................................................... ................ ................ ................ ................ ................

00544 2 Anesth, chest lining removal ............................................................. ................ ................ ................ ................ ................

00546 2 Anesth, lung, chest wall surg ............................................................ ................ ................ ................ ................ ................

00548 2 Anesth, trachea, bronchi surg ........................................................... ................ ................ ................ ................ ................

00560 2 Anesth, open heart surgery .............................................................. ................ ................ ................ ................ ................

00562 2 Anesth, open heart surgery .............................................................. ................ ................ ................ ................ ................

00580 2 Anesth, heart/lung transplant ............................................................ ................ ................ ................ ................ ................

00600 2 Anesth, spine, cord surgery .............................................................. ................ ................ ................ ................ ................
32329

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

00604 2 Anesth, surgery of vertebra .............................................................. ................ ................ ................ ................ ................

00620 2 Anesth, spine, cord surgery .............................................................. ................ ................ ................ ................ ................

00622 2 Anesth, removal of nerves ................................................................ ................ ................ ................ ................ ................

00630 2 Anesth, spine, cord surgery .............................................................. ................ ................ ................ ................ ................

00632 2 Anesth, removal of nerves ................................................................ ................ ................ ................ ................ ................

00634 2 Anesth for chemonucleolysis ............................................................ ................ ................ ................ ................ ................

00670 2 Anesth, spine, cord surgery .............................................................. ................ ................ ................ ................ ................

00700 2 Anesth, abdominal wall surg ............................................................. ................ ................ ................ ................ ................

00702 2 Anesth, for liver biopsy ..................................................................... ................ ................ ................ ................ ................

00730 2 Anesth, abdominal wall surg ............................................................. ................ ................ ................ ................ ................

00740 2 Anesth, gi visualization ..................................................................... ................ ................ ................ ................ ................

00750 2 Anesth, repair of hernia .................................................................... ................ ................ ................ ................ ................

00752 2 Anesth, repair of hernia .................................................................... ................ ................ ................ ................ ................

00754 2 Anesth, repair of hernia .................................................................... ................ ................ ................ ................ ................

00756 2 Anesth, repair of hernia .................................................................... ................ ................ ................ ................ ................

00770 2 Anesth, blood vessel repair .............................................................. ................ ................ ................ ................ ................

00790 2 Anesth, surg upper abdomen ........................................................... ................ ................ ................ ................ ................

00792 2 Anesth, part liver removal ................................................................. ................ ................ ................ ................ ................

00794 2 Anesth, pancreas removal ................................................................ ................ ................ ................ ................ ................

00796 2 Anesth, for liver transplant ................................................................ ................ ................ ................ ................ ................

00800 2 Anesth, abdominal wall surg ............................................................. ................ ................ ................ ................ ................

00802 2 Anesth, fat layer removal .................................................................. ................ ................ ................ ................ ................

00810 2 Anesth, intestine endoscopy ............................................................. ................ ................ ................ ................ ................

00820 2 Anesth, abdominal wall surg ............................................................. ................ ................ ................ ................ ................

00830 2 Anesth, repair of hernia .................................................................... ................ ................ ................ ................ ................

00832 2 Anesth, repair of hernia .................................................................... ................ ................ ................ ................ ................

00840 2 Anesth, surg lower abdomen ............................................................ ................ ................ ................ ................ ................

00842 2 Anesth, amniocentesis ...................................................................... ................ ................ ................ ................ ................

00844 2 Anesth, pelvis surgery ...................................................................... ................ ................ ................ ................ ................

00846 2 Anesth, hysterectomy ....................................................................... ................ ................ ................ ................ ................

00848 2 Anesth, pelvic organ surg ................................................................. ................ ................ ................ ................ ................

00850 2 Anesth, cesarean section ................................................................. ................ ................ ................ ................ ................

00855 2 Anesth, hysterectomy ....................................................................... ................ ................ ................ ................ ................

00857 2 Analgesia, labor & c-section ............................................................. ................ ................ ................ ................ ................

00860 2 Anesth, surgery of abdomen ............................................................ ................ ................ ................ ................ ................

00862 2 Anesth, kidney, ureter surg ............................................................... ................ ................ ................ ................ ................

00864 2 Anesth, removal of bladder ............................................................... ................ ................ ................ ................ ................

00865 2 Anesth, removal of prostate .............................................................. ................ ................ ................ ................ ................

00866 2 Anesth, removal of adrenal ............................................................... ................ ................ ................ ................ ................

00868 2 Anesth, kidney transplant ................................................................. ................ ................ ................ ................ ................

00870 2 Anesth, bladder stone surg ............................................................... ................ ................ ................ ................ ................

00872 2 Anesth, kidney stone destruct .......................................................... ................ ................ ................ ................ ................

00873 2 Anesth, kidney stone destruct .......................................................... ................ ................ ................ ................ ................

00880 2 Anesth, abdomen vessel surg .......................................................... ................ ................ ................ ................ ................

00882 2 Anesth, major vein ligation ............................................................... ................ ................ ................ ................ ................

00884 2 Anesth, major vein revision .............................................................. ................ ................ ................ ................ ................

00900 2 Anesth, perineal procedure ............................................................... ................ ................ ................ ................ ................

00902 2 Anesth, anorectal surgery ................................................................. ................ ................ ................ ................ ................

00904 2 Anesth, perineal surgery ................................................................... ................ ................ ................ ................ ................

00906 2 Anesth, removal of vulva .................................................................. ................ ................ ................ ................ ................

00908 2 Anesth, removal of prostate .............................................................. ................ ................ ................ ................ ................

00910 2 Anesth, bladder surgery .................................................................... ................ ................ ................ ................ ................

00912 2 Anesth, bladder tumor surg .............................................................. ................ ................ ................ ................ ................

00914 2 Anesth, removal of prostate .............................................................. ................ ................ ................ ................ ................

00916 2 Anesth, bleeding control ................................................................... ................ ................ ................ ................ ................

00918 2 Anesth, stone removal ...................................................................... ................ ................ ................ ................ ................

00920 2 Anesth, genitalia surgery .................................................................. ................ ................ ................ ................ ................

00922 2 Anesth, sperm duct surgery .............................................................. ................ ................ ................ ................ ................

00924 2 Anesth, testis exploration .................................................................. ................ ................ ................ ................ ................

00926 2 Anesth, removal of testis .................................................................. ................ ................ ................ ................ ................

00928 2 Anesth, removal of testis .................................................................. ................ ................ ................ ................ ................

00930 2 Anesth, testis suspension ................................................................. ................ ................ ................ ................ ................

00932 2 Anesth, amputation of penis ............................................................. ................ ................ ................ ................ ................

00934 2 Anesth, penis, nodes removal .......................................................... ................ ................ ................ ................ ................

00936 2 Anesth, penis, nodes removal .......................................................... ................ ................ ................ ................ ................

00938 2 Anesth, insert penis device ............................................................... ................ ................ ................ ................ ................

00940 2 Anesth, vaginal procedures .............................................................. ................ ................ ................ ................ ................

00942 2 Anesth, surgery on vagina ................................................................ ................ ................ ................ ................ ................

00944 2 Anesth, vaginal hysterectomy ........................................................... ................ ................ ................ ................ ................

00946 2 Anesth, vaginal delivery .................................................................... ................ ................ ................ ................ ................

00948 2 Anesth, repair of cervix ..................................................................... ................ ................ ................ ................ ................

00950 2 Anesth, vaginal endoscopy ............................................................... ................ ................ ................ ................ ................

00952 2 Anesth, uterine endoscopy ............................................................... ................ ................ ................ ................ ................

00955 2 Analgesia, vaginal delivery ............................................................... ................ ................ ................ ................ ................
32330

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

01000 2 Anesth, skin surgery, pelvis .............................................................. ................ ................ ................ ................ ................

01110 2 Anesth, skin surgery, pelvis .............................................................. ................ ................ ................ ................ ................

01120 2 Anesth, pelvis surgery ...................................................................... ................ ................ ................ ................ ................

01130 2 Anesth, body cast procedure ............................................................ ................ ................ ................ ................ ................

01140 2 Anesth, amputation at pelvis ............................................................ ................ ................ ................ ................ ................

01150 2 Anesth, pelvic tumor surgery ............................................................ ................ ................ ................ ................ ................

01160 2 Anesth, pelvis procedure .................................................................. ................ ................ ................ ................ ................

01170 2 Anesth, pelvis surgery ...................................................................... ................ ................ ................ ................ ................

01180 2 Anesth, pelvis nerve removal ........................................................... ................ ................ ................ ................ ................

01190 2 Anesth, pelvis nerve removal ........................................................... ................ ................ ................ ................ ................

01200 2 Anesth, hip joint procedure ............................................................... ................ ................ ................ ................ ................

01202 2 Anesth, arthroscopy of hip ................................................................ ................ ................ ................ ................ ................

01210 2 Anesth, hip joint surgery ................................................................... ................ ................ ................ ................ ................

01212 2 Anesth, hip disarticulation ................................................................. ................ ................ ................ ................ ................

01214 2 Anesth, replacement of hip ............................................................... ................ ................ ................ ................ ................

01220 2 Anesth, procedure on femur ............................................................. ................ ................ ................ ................ ................

01230 2 Anesth, surgery of femur .................................................................. ................ ................ ................ ................ ................

01232 2 Anesth, amputation of femur ............................................................ ................ ................ ................ ................ ................

01234 2 Anesth, radical femur surg ................................................................ ................ ................ ................ ................ ................

01240 2 Anesth, upper leg skin surg .............................................................. ................ ................ ................ ................ ................

01250 2 Anesth, upper leg surgery ................................................................ ................ ................ ................ ................ ................

01260 2 Anesth, upper leg veins surg ............................................................ ................ ................ ................ ................ ................

01270 2 Anesth, thigh arteries surg ................................................................ ................ ................ ................ ................ ................

01272 2 Anesth, femoral artery surg .............................................................. ................ ................ ................ ................ ................

01274 2 Anesth, femoral embolectomy .......................................................... ................ ................ ................ ................ ................

01300 2 Anesth, skin surgery, knee ............................................................... ................ ................ ................ ................ ................

01320 2 Anesth, knee area surgery ............................................................... ................ ................ ................ ................ ................

01340 2 Anesth, knee area procedure ........................................................... ................ ................ ................ ................ ................

01360 2 Anesth, knee area surgery ............................................................... ................ ................ ................ ................ ................

01380 2 Anesth, knee joint procedure ............................................................ ................ ................ ................ ................ ................

01382 2 Anesth, knee arthroscopy ................................................................. ................ ................ ................ ................ ................

01390 2 Anesth, knee area procedure ........................................................... ................ ................ ................ ................ ................

01392 2 Anesth, knee area surgery ............................................................... ................ ................ ................ ................ ................

01400 2 Anesth, knee joint surgery ................................................................ ................ ................ ................ ................ ................

01402 2 Anesth, replacement of knee ............................................................ ................ ................ ................ ................ ................

01404 2 Anesth, amputation at knee .............................................................. ................ ................ ................ ................ ................

01420 2 Anesth, knee joint casting ................................................................. ................ ................ ................ ................ ................

01430 2 Anesth, knee veins surgery .............................................................. ................ ................ ................ ................ ................

01432 2 Anesth, knee vessel surg ................................................................. ................ ................ ................ ................ ................

01440 2 Anesth, knee arteries surg ................................................................ ................ ................ ................ ................ ................

01442 2 Anesth, knee artery surg .................................................................. ................ ................ ................ ................ ................

01444 2 Anesth, knee artery repair ................................................................ ................ ................ ................ ................ ................

01460 2 Anesth, lower leg skin surg .............................................................. ................ ................ ................ ................ ................

01462 2 Anesth, lower leg procedure ............................................................. ................ ................ ................ ................ ................

01464 2 Anesth, ankle arthroscopy ................................................................ ................ ................ ................ ................ ................

01470 2 Anesth, lower leg surgery ................................................................. ................ ................ ................ ................ ................

01472 2 Anesth, achilles tendon surg ............................................................ ................ ................ ................ ................ ................

01474 2 Anesth, lower leg surgery ................................................................. ................ ................ ................ ................ ................

01480 2 Anesth, lower leg bone surg ............................................................. ................ ................ ................ ................ ................

01482 2 Anesth, radical leg surgery ............................................................... ................ ................ ................ ................ ................

01484 2 Anesth, lower leg revision ................................................................. ................ ................ ................ ................ ................

01486 2 Anesth, ankle replacement ............................................................... ................ ................ ................ ................ ................

01490 2 Anesth, lower leg casting .................................................................. ................ ................ ................ ................ ................

01500 2 Anesth, leg arteries surg ................................................................... ................ ................ ................ ................ ................

01502 2 Anesth, lowerleg embolectomy ......................................................... ................ ................ ................ ................ ................

01520 2 Anesth, lower leg vein surg .............................................................. ................ ................ ................ ................ ................

01522 2 Anesth, lower leg vein surg .............................................................. ................ ................ ................ ................ ................

01600 2 Anesth, shoulder skin surg ............................................................... ................ ................ ................ ................ ................

01610 2 Anesth, surgery of shoulder .............................................................. ................ ................ ................ ................ ................

01620 2 Anesth, shoulder procedure .............................................................. ................ ................ ................ ................ ................

01622 2 Anesth, shoulder arthroscopy ........................................................... ................ ................ ................ ................ ................

01630 2 Anesth, surgery of shoulder .............................................................. ................ ................ ................ ................ ................

01632 2 Anesth, surgery of shoulder .............................................................. ................ ................ ................ ................ ................

01634 2 Anesth, shoulder joint amput ............................................................ ................ ................ ................ ................ ................

01636 2 Anesth, forequarter amput ................................................................ ................ ................ ................ ................ ................

01638 2 Anesth, shoulder replacement .......................................................... ................ ................ ................ ................ ................

01650 2 Anesth, shoulder artery surg ............................................................ ................ ................ ................ ................ ................

01652 2 Anesth, shoulder vessel surg ........................................................... ................ ................ ................ ................ ................

01654 2 Anesth, shoulder vessel surg ........................................................... ................ ................ ................ ................ ................

01656 2 Anesth, arm-leg vessel surg ............................................................. ................ ................ ................ ................ ................

01670 2 Anesth, shoulder vein surg ............................................................... ................ ................ ................ ................ ................

01680 2 Anesth, shoulder casting .................................................................. ................ ................ ................ ................ ................

01682 2 Anesth, airplane cast ........................................................................ ................ ................ ................ ................ ................

01700 2 Anesth, elbow area skin surg ........................................................... ................ ................ ................ ................ ................
32331

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

01710 2 Anesth, elbow area surgery .............................................................. ................ ................ ................ ................ ................

01712 2 Anesth, upperarm tendon surg ......................................................... ................ ................ ................ ................ ................

01714 2 Anesth, upperarm tendon surg ......................................................... ................ ................ ................ ................ ................

01716 2 Anesth, biceps tendon repair ............................................................ ................ ................ ................ ................ ................

01730 2 Anesth, upperarm procedure ............................................................ ................ ................ ................ ................ ................

01732 2 Anesth, elbow arthroscopy ............................................................... ................ ................ ................ ................ ................

01740 2 Anesth, upper arm surgery ............................................................... ................ ................ ................ ................ ................

01742 2 Anesth, humerus surgery .................................................................. ................ ................ ................ ................ ................

01744 2 Anesth, humerus repair .................................................................... ................ ................ ................ ................ ................

01756 2 Anesth, radical humerus surg ........................................................... ................ ................ ................ ................ ................

01758 2 Anesth, humeral lesion surg ............................................................. ................ ................ ................ ................ ................

01760 2 Anesth, elbow replacement .............................................................. ................ ................ ................ ................ ................

01770 2 Anesth, upperarm artery surg ........................................................... ................ ................ ................ ................ ................

01772 2 Anesth, upperarm embolectomy ....................................................... ................ ................ ................ ................ ................

01780 2 Anesth, upper arm vein surg ............................................................ ................ ................ ................ ................ ................

01782 2 Anesth, upperarm vein repair ........................................................... ................ ................ ................ ................ ................

01784 2 Anesth, av fistula repair .................................................................... ................ ................ ................ ................ ................

01800 2 Anesth, lower arm skin surg ............................................................. ................ ................ ................ ................ ................

01810 2 Anesth, lower arm surgery ................................................................ ................ ................ ................ ................ ................

01820 2 Anesth, lower arm procedure ........................................................... ................ ................ ................ ................ ................

01830 2 Anesth, lower arm surgery ................................................................ ................ ................ ................ ................ ................

01832 2 Anesth, wrist replacement ................................................................ ................ ................ ................ ................ ................

01840 2 Anesth, lowerarm artery surg ........................................................... ................ ................ ................ ................ ................

01842 2 Anesth, lowerarm embolectomy ....................................................... ................ ................ ................ ................ ................

01844 2 Anesth, vascular shunt surg ............................................................. ................ ................ ................ ................ ................

01850 2 Anesth, lower arm vein surg ............................................................. ................ ................ ................ ................ ................

01852 2 Anesth, lowerarm vein repair ............................................................ ................ ................ ................ ................ ................

01860 2 Anesth, lower arm casting ................................................................ ................ ................ ................ ................ ................

01900 2 Anesth, uterus/tube inject ................................................................. ................ ................ ................ ................ ................

01902 2 Anesth, burr holes, skull ................................................................... ................ ................ ................ ................ ................

01904 2 Anesth, skull x-ray inject ................................................................... ................ ................ ................ ................ ................

01906 2 Anesth, lumbar myelography ............................................................ ................ ................ ................ ................ ................

01908 2 Anesth, cervical myelography ........................................................... ................ ................ ................ ................ ................

01910 2 Anesth, skull myelography ................................................................ ................ ................ ................ ................ ................

01912 2 Anesth, lumbar discography ............................................................. ................ ................ ................ ................ ................

01914 2 Anesth, cervical discography ............................................................ ................ ................ ................ ................ ................

01916 2 Anesth, head arteriogram ................................................................. ................ ................ ................ ................ ................

01918 2 Anesth, limb arteriogram ................................................................... ................ ................ ................ ................ ................

01920 2 Anesth, catheterize heart .................................................................. ................ ................ ................ ................ ................

01921 2 Anesth, vessel surgery ..................................................................... ................ ................ ................ ................ ................

01922 2 Anesth, cat or MRI scan ................................................................... ................ ................ ................ ................ ................

01990 6 Support for organ donor ................................................................... ................ ................ ................ ................ ................

01995 2 Regional anesthesia, limb ................................................................. ................ ................ ................ ................ ................

01996 2 Manage daily drug therapy ............................................................... ................ ................ ................ ................ ................

01999 3 Unlisted anesth procedure ................................................................ ................ ................ ................ ................ ................

10040 5 Acne surgery of skin abscess ........................................................... ................ ................ ................ ................ ................

10060 5 Drainage of skin abscess ................................................................. ................ ................ ................ ................ ................

10061 5 Drainage of skin abscess ................................................................. ................ ................ ................ ................ ................

10080 5 Drainage of pilonidal cyst ................................................................. ................ ................ ................ ................ ................

10081 5 Drainage of pilonidal cyst ................................................................. ................ ................ ................ ................ ................

10120 5 Remove foreign body ........................................................................ ................ ................ ................ ................ ................

10121 1 Remove foreign body ........................................................................ ................ ................ 163 $449 0.89 Add.

10140 5 Drainage of hematoma/fluid .............................................................. ................ ................ ................ ................ ................

10160 5 Puncture drainage of lesion .............................................................. ................ ................ ................ ................ ................

10180 5 Complex drainage, wound ................................................................ 2 $422 ................ ................ ................ Delete.

11000 5 Debride infected skin ........................................................................ ................ ................ ................ ................ ................

11001 5 Debride infect skin add ..................................................................... ................ ................ ................ ................ ................

11010 1 Debride skin, fx ................................................................................. ................ ................ 163 $449 0.89 Add.

11011 1 Debride skin/muscle, fx ..................................................................... ................ ................ 163 $449 0.89 Add.

11012 1 Debride skin/muscle/bone, fx ............................................................ ................ ................ 163 $449 0.89 Add.

11040 5 Debride skin partial ........................................................................... ................ ................ ................ ................ ................

11041 5 Debride skin full ................................................................................ ................ ................ ................ ................ ................

11042 5 Debride skin/tissue ............................................................................ 2 $422 ................ ................ ................ Delete.

11043 1 Debride tissue/muscle ....................................................................... 2 $422 162 $187 0.37

11044 1 Debride tissue/muscle/bone .............................................................. 2 $422 162 $187 0.37

11055 5 Trim skin lesion ................................................................................. ................ ................ ................ ................ ................

11056 5 Trim 2 to 4 skin lesions .................................................................... ................ ................ ................ ................ ................

11057 5 Trim over 4 skin lesions .................................................................... ................ ................ ................ ................ ................

11100 5 Biopsy of skin lesion ......................................................................... ................ ................ ................ ................ ................

11101 5 Biopsy, each added lesion ................................................................ ................ ................ ................ ................ ................

11200 5 Removal of skin tags ........................................................................ ................ ................ ................ ................ ................

11201 5 Removal of added skin tags ............................................................. ................ ................ ................ ................ ................

11300 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11301 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................
32332

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

11302 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11303 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11305 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11306 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11307 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11308 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11310 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11311 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11312 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11313 5 Shave skin lesion .............................................................................. ................ ................ ................ ................ ................

11400 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11401 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11402 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11403 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11404 1 Removal of skin lesion ...................................................................... 1 $314 162 $187 0.37

11406 1 Removal of skin lesion ...................................................................... 2 $422 163 $449 0.89

11420 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11421 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11422 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11423 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11424 1 Removal of skin lesion ...................................................................... 2 $422 162 $187 0.37

11426 1 Removal of skin lesion ...................................................................... 2 $422 163 $449 0.89

11440 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11441 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11442 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11443 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11444 1 Removal of skin lesion ...................................................................... 1 $314 162 $187 0.37

11446 1 Removal of skin lesion ...................................................................... 2 $422 163 $449 0.89

11450 1 Removal, sweat gland lesion ............................................................ 2 $422 163 $449 0.89

11451 1 Removal, sweat gland lesion ............................................................ 2 $422 163 $449 0.89

11462 1 Removal, sweat gland lesion ............................................................ 2 $422 163 $449 0.89

11463 1 Removal, sweat gland lesion ............................................................ 2 $422 163 $449 0.89

11470 1 Removal, sweat gland lesion ............................................................ 2 $422 163 $449 0.89

11471 1 Removal, sweat gland lesion ............................................................ 2 $422 163 $449 0.89

11600 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11601 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11602 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11603 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11604 1 Removal of skin lesion ...................................................................... 2 $422 162 $187 0.37

11606 1 Removal of skin lesion ...................................................................... 2 $422 163 $449 0.89

11620 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11621 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11622 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11623 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11624 1 Removal of skin lesion ...................................................................... 2 $422 163 $449 0.89

11626 1 Removal of skin lesion ...................................................................... 2 $422 163 $449 0.89

11640 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11641 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11642 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11643 5 Removal of skin lesion ...................................................................... ................ ................ ................ ................ ................

11644 1 Removal of skin lesion ...................................................................... 2 $422 163 $449 0.89

11646 1 Removal of skin lesion ...................................................................... 2 $422 163 $449 0.89

11719 5 Trim nail(s) ........................................................................................ ................ ................ ................ ................ ................

11720 5 Debride nail, 1-5 ............................................................................... ................ ................ ................ ................ ................

11721 5 Debride nail, 6 or more ..................................................................... ................ ................ ................ ................ ................

11730 5 Removal of nail plate ........................................................................ ................ ................ ................ ................ ................

11731 5 Removal of second nail plate ........................................................... ................ ................ ................ ................ ................

11732 5 Remove additional nail plate ............................................................ ................ ................ ................ ................ ................

11740 5 Drain blood from under nail .............................................................. ................ ................ ................ ................ ................

11750 5 Removal of nail bed .......................................................................... ................ ................ ................ ................ ................

11752 1 Remove nail bed/finger tip ................................................................ ................ ................ 163 $449 0.89 Add.

11755 5 Biopsy, nail unit ................................................................................. ................ ................ ................ ................ ................

11760 1 Reconstruction of nail bed ................................................................ ................ ................ 181 $150 0.30 Add.

11762 1 Reconstruction of nail bed ................................................................ ................ ................ 181 $150 0.30 Add.

11765 5 Excision of nail fold, toe .................................................................... ................ ................ ................ ................ ................

11770 1 Removal of pilonidal lesion ............................................................... 3 $482 162 $187 0.37

11771 1 Removal of pilonidal lesion ............................................................... 3 $482 163 $449 0.89

11772 1 Removal of pilonidal lesion ............................................................... 3 $482 163 $449 0.89

11900 5 Injection into skin lesions .................................................................. ................ ................ ................ ................ ................

11901 5 Add.ed skin lesions injection ............................................................ ................ ................ ................ ................ ................

11920 7 Correct skin color defects ................................................................. ................ ................ 181 $150 0.30 Add.

11921 7 Correct skin color defects ................................................................. ................ ................ 181 $150 0.30 Add.

11922 7 Correct skin color defects ................................................................. ................ ................ 181 $150 0.30 Add.

11950 7 Therapy for contour defects .............................................................. ................ ................ 181 $150 0.30 Add.
32333

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

11951 7 Therapy for contour defects .............................................................. ................ ................ 181 $150 0.30 Add.

11952 7 Therapy for contour defects .............................................................. ................ ................ 181 $150 0.30 Add.

11954 7 Therapy for contour defects .............................................................. ................ ................ 181 $150 0.30 Add.

11960 1 Insert tissue expander(s) .................................................................. 2 $422 183 $465 0.92

11970 1 Replace tissue expander .................................................................. 3 $482 183 $465 0.92

11971 1 Remove tissue expander(s) .............................................................. 1 $314 163 $449 0.89

11975 9 Insert contraceptive cap .................................................................... ................ ................ ................ ................ ................

11976 5 Removal of contraceptive cap .......................................................... ................ ................ ................ ................ ................

11977 9 Removal/reinsert contra cap ............................................................. ................ ................ ................ ................ ................

12001 1 Repair superficial wound(s) .............................................................. ................ ................ 181 $150 0.30 Add.

12002 1 Repair superficial wound(s) .............................................................. ................ ................ 181 $150 0.30 Add.

12004 1 Repair superficial wound(s) .............................................................. ................ ................ 181 $150 0.30 Add.

12005 1 Repair superficial wound(s) .............................................................. 2 $422 181 $150 0.30

12006 1 Repair superficial wound(s) .............................................................. 2 $422 181 $150 0.30

12007 1 Repair superficial wound(s) .............................................................. 2 $422 181 $150 0.30

12011 1 Repair superficial wound(s) .............................................................. ................ ................ 181 $150 0.30 Add.

12013 1 Repair superficial wound(s) .............................................................. ................ ................ 181 $150 0.30 Add.

12014 1 Repair superficial wound(s) .............................................................. ................ ................ 181 $150 0.30 Add.

12015 1 Repair superficial wound(s) .............................................................. ................ ................ 181 $150 0.30 Add.

12016 1 Repair superficial wound(s) .............................................................. 2 $422 181 $150 0.30

12017 1 Repair superficial wound(s) .............................................................. 2 $422 181 $150 0.30

12018 1 Repair superficial wound(s) .............................................................. 2 $422 181 $150 0.30

12020 1 Closure of split wound ...................................................................... 1 $314 181 $150 0.30

12021 1 Closure of split wound ...................................................................... 1 $314 181 $150 0.30

12031 1 Layer closure of wound(s) ................................................................ ................ ................ 181 $150 0.30 Add.

12032 1 Layer closure of wound(s) ................................................................ ................ ................ 181 $150 0.30 Add.

12034 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12035 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12036 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12037 1 Layer closure of wound(s) ................................................................ 2 $422 183 $465 0.92

12041 1 Layer closure of wound(s) ................................................................ ................ ................ 181 $150 0.30 Add.

12042 1 Layer closure of wound(s) ................................................................ ................ ................ 181 $150 0.30 Add.

12044 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12045 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12046 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12047 1 Layer closure of wound(s) ................................................................ 2 $422 183 $465 0.92

12051 1 Layer closure of wound(s) ................................................................ ................ ................ 181 $150 0.30 Add.

12052 1 Layer closure of wound(s) ................................................................ ................ ................ 181 $150 0.30 Add.

12053 1 Layer closure of wound(s) ................................................................ ................ ................ 181 $150 0.30 Add.

12054 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12055 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12056 1 Layer closure of wound(s) ................................................................ 2 $422 181 $150 0.30

12057 1 Layer closure of wound(s) ................................................................ 2 $422 183 $465 0.92

13100 1 Repair of wound or lesion ................................................................. 2 $422 182 $383 0.76

13101 1 Repair of wound or lesion ................................................................. 3 $482 182 $383 0.76

13120 1 Repair of wound or lesion ................................................................. 2 $422 182 $383 0.76

13121 1 Repair of wound or lesion ................................................................. 3 $482 182 $383 0.76

13131 1 Repair of wound or lesion ................................................................. 2 $422 182 $383 0.76

13132 1 Repair of wound or lesion ................................................................. 3 $482 182 $383 0.76

13150 1 Repair of wound or lesion ................................................................. 3 $482 182 $383 0.76

13151 1 Repair of wound or lesion ................................................................. 3 $482 182 $383 0.76

13152 1 Repair of wound or lesion ................................................................. 3 $482 182 $383 0.76

13160 1 Late closure of wound ...................................................................... 2 $422 182 $383 0.76

13300 1 Repair of wound or lesion ................................................................. 4 $595 182 $383 0.76

14000 1 Skin tissue rearrangement ................................................................ 2 $422 183 $465 0.92

14001 1 Skin tissue rearrangement ................................................................ 3 $482 183 $465 0.92

14020 1 Skin tissue rearrangement ................................................................ 3 $482 183 $465 0.92

14021 1 Skin tissue rearrangement ................................................................ 3 $482 183 $465 0.92

14040 1 Skin tissue rearrangement ................................................................ 2 $422 183 $465 0.92

14041 1 Skin tissue rearrangement ................................................................ 3 $482 183 $465 0.92

14060 1 Skin tissue rearrangement ................................................................ 3 $482 183 $465 0.92

14061 1 Skin tissue rearrangement ................................................................ 3 $482 183 $465 0.92

14300 1 Skin tissue rearrangement ................................................................ 4 $595 183 $465 0.92

14350 1 Skin tissue rearrangement ................................................................ 3 $482 183 $465 0.92

15000 1 Skin graft procedure ......................................................................... 2 $422 183 $465 0.92

15050 1 Skin pinch graft procedure ................................................................ 2 $422 183 $465 0.92

15100 1 Skin split graft procedure .................................................................. 2 $422 183 $465 0.92

15101 1 Skin split graft procedure .................................................................. 3 $482 183 $465 0.92

15120 1 Skin split graft procedure .................................................................. 2 $422 183 $465 0.92

15121 1 Skin split graft procedure .................................................................. 3 $482 183 $465 0.92

15200 1 Skin full graft procedure .................................................................... 3 $482 183 $465 0.92

15201 1 Skin full graft procedure .................................................................... 2 $422 183 $465 0.92

15220 1 Skin full graft procedure .................................................................... 2 $422 183 $465 0.92

15221 1 Skin full graft procedure .................................................................... 2 $422 183 $465 0.92
32334

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

15240 1 Skin full graft procedure .................................................................... 3 $482 183 $465 0.92

15241 1 Skin full graft procedure .................................................................... 3 $482 183 $465 0.92

15260 1 Skin full graft procedure .................................................................... 2 $422 183 $465 0.92

15261 1 Skin full graft procedure .................................................................... 2 $422 183 $465 0.92

15350 1 Skin homograft procedure ................................................................ 2 $422 183 $465 0.92

15400 1 Skin heterograft procedure ............................................................... 2 $422 183 $465 0.92

15570 1 Form skin pedicle flap ....................................................................... 3 $482 183 $465 0.92

15572 1 Form skin pedicle flap ....................................................................... 3 $482 183 $465 0.92

15574 1 Form skin pedicle flap ....................................................................... 3 $482 183 $465 0.92

15576 1 Form skin pedicle flap ....................................................................... 3 $482 183 $465 0.92

15580 1 Attach skin pedicle graft ................................................................... 3 $482 183 $465 0.92

15600 1 Skin graft procedure ......................................................................... 3 $482 183 $465 0.92

15610 1 Skin graft procedure ......................................................................... 3 $482 183 $465 0.92

15620 1 Skin graft procedure ......................................................................... 4 $595 183 $465 0.92

15625 1 Skin graft procedure ......................................................................... 3 $482 183 $465 0.92

15630 1 Skin graft procedure ......................................................................... 3 $482 183 $465 0.92

15650 1 Transfer skin pedicle flap .................................................................. 5 $678 183 $465 0.92

15732 1 Muscle-skin graft, head/neck ............................................................ 3 $482 184 $565 1.12

15734 1 Muscle-skin graft, trunk ..................................................................... 3 $482 184 $565 1.12

15736 1 Muscle-skin graft, arm ...................................................................... 3 $482 184 $565 1.12

15738 1 Muscle-skin graft, leg ........................................................................ 3 $482 184 $565 1.12

15740 1 Island pedicle flap graft ..................................................................... 2 $422 184 $565 1.12

15750 1 Neurovascular pedicle graft .............................................................. 2 $422 184 $565 1.12

15756 3 Free muscle flap, microvasc ............................................................. 3 $482 ................ ................ ................ Delete.

15757 3 Free skin flap, microvasc .................................................................. 3 $482 ................ ................ ................ Delete.

15758 3 Free fascial flap, microvasc .............................................................. 3 $482 ................ ................ ................ Delete.

15760 1 Composite skin graft ......................................................................... 2 $422 184 $565 1.12

15770 1 Derma-fat-fascia graft ....................................................................... 3 $482 184 $565 1.12

15775 7 Hair transplant punch grafts ............................................................. ................ ................ 183 $465 0.92 Add.

15776 7 Hair transplant punch grafts ............................................................. ................ ................ 183 $465 0.92 Add.

15780 1 Abrasion treatment of skin ................................................................ ................ ................ 163 $449 0.89 Add.

15781 1 Abrasion treatment of skin ................................................................ ................ ................ 163 $449 0.89 Add.

15782 1 Abrasion treatment of skin ................................................................ ................ ................ 163 $449 0.89 Add.

15783 5 Abrasion treatment of skin ................................................................ ................ ................ ................ ................ ................

15786 5 Abrasion treatment of lesion ............................................................. ................ ................ ................ ................ ................

15787 5 Abrasion, added skin lesions ............................................................ ................ ................ ................ ................ ................

15788 5 Chemical peel, face, epiderm ........................................................... ................ ................ ................ ................ ................

15789 5 Chemical peel, face, dermal ............................................................. ................ ................ ................ ................ ................

15792 5 Chemical peel, nonfacial ................................................................... ................ ................ ................ ................ ................

15793 5 Chemical peel, nonfacial ................................................................... ................ ................ ................ ................ ................

15810 5 Salabrasion ....................................................................................... ................ ................ ................ ................ ................

15811 1 Salabrasion ....................................................................................... ................ ................ 163 $449 0.89 Add.

15819 1 Plastic surgery, neck ......................................................................... ................ ................ 183 $465 0.92 Add.

15820 1 Revision of lower eyelid .................................................................... ................ ................ 183 $465 0.92 Add.

15821 1 Revision of lower eyelid .................................................................... ................ ................ 183 $465 0.92 Add.

15822 1 Revision of upper eyelid ................................................................... ................ ................ 183 $465 0.92 Add.

15823 1 Revision of upper eyelid ................................................................... ................ ................ 183 $465 0.92 Add.

15824 7 Removal of forehead wrinkles .......................................................... ................ ................ 184 $565 1.12 Add.

15825 7 Removal of neck wrinkles ................................................................. ................ ................ 183 $465 0.92 Add.

15826 7 Removal of brow wrinkles ................................................................. ................ ................ 184 $565 1.12 Add.

15828 7 Removal of face wrinkles .................................................................. ................ ................ 184 $565 1.12 Add.

15829 7 Removal of skin wrinkles .................................................................. ................ ................ 183 $465 0.92 Add.

15831 1 Excise excessive skin tissue ............................................................ ................ ................ 184 $565 1.12 Add.

15832 1 Excise excessive skin tissue ............................................................ ................ ................ 184 $565 1.12 Add.

15833 1 Excise excessive skin tissue ............................................................ ................ ................ 184 $565 1.12 Add.

15834 1 Excise excessive skin tissue ............................................................ ................ ................ 184 $565 1.12 Add.

15835 1 Excise excessive skin tissue ............................................................ ................ ................ 183 $465 0.92 Add.

15836 1 Excise excessive skin tissue ............................................................ ................ ................ 184 $565 1.12 Add.

15837 1 Excise excessive skin tissue ............................................................ ................ ................ 184 $565 1.12 Add.

15838 1 Excise excessive skin tissue ............................................................ ................ ................ 163 $449 0.89 Add.

15839 1 Excise excessive skin tissue ............................................................ ................ ................ 184 $565 1.12 Add.

15840 1 Graft for face nerve palsy ................................................................. 4 $595 184 $565 1.12

15841 1 Graft for face nerve palsy ................................................................. 4 $595 184 $565 1.12

15842 1 Graft for face nerve palsy ................................................................. 4 $595 184 $565 1.12

15845 1 Skin and muscle repair, face ............................................................ 4 $595 184 $565 1.12

15850 5 Removal of sutures ........................................................................... ................ ................ ................ ................ ................

15851 5 Removal of sutures ........................................................................... ................ ................ ................ ................ ................

15852 5 Dressing change,not for burn ........................................................... ................ ................ ................ ................ ................

15860 1 Test for blood flow in graft ................................................................ ................ ................ 181 $150 0.30 Add.

15876 7 Suction assisted lipectomy ............................................................... ................ ................ 184 $565 1.12 Add.

15877 7 Suction assisted lipectomy ............................................................... ................ ................ 184 $565 1.12 Add.

15878 7 Suction assisted lipectomy ............................................................... ................ ................ 184 $565 1.12 Add.

15879 7 Suction assisted lipectomy ............................................................... ................ ................ 184 $565 1.12 Add.

15920 1 Removal of tail bone ulcer ................................................................ 3 $482 163 $449 0.89
32335

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

15922 1 Removal of tail bone ulcer ................................................................ 4 $595 184 $565 1.12

15931 1 Remove sacrum pressure sore ........................................................ 3 $482 163 $449 0.89

15933 1 Remove sacrum pressure sore ........................................................ 3 $482 163 $449 0.89

15934 1 Remove sacrum pressure sore ........................................................ 3 $482 184 $565 1.12

15935 1 Remove sacrum pressure sore ........................................................ 4 $595 184 $565 1.12

15936 1 Remove sacrum pressure sore ........................................................ 4 $595 184 $565 1.12

15937 1 Remove sacrum pressure sore ........................................................ 4 $595 184 $565 1.12

15940 1 Removal of pressure sore ................................................................ 3 $482 163 $449 0.89

15941 1 Removal of pressure sore ................................................................ 3 $482 163 $449 0.89

15944 1 Removal of pressure sore ................................................................ 3 $482 184 $565 1.12

15945 1 Removal of pressure sore ................................................................ 4 $595 184 $565 1.12

15946 1 Removal of pressure sore ................................................................ 4 $595 184 $565 1.12

15950 1 Remove thigh pressure sore ............................................................ 3 $482 163 $449 0.89

15951 1 Remove thigh pressure sore ............................................................ 4 $595 163 $449 0.89

15952 1 Remove thigh pressure sore ............................................................ 3 $482 184 $565 1.12

15953 1 Remove thigh pressure sore ............................................................ 4 $595 184 $565 1.12

15956 1 Remove thigh pressure sore ............................................................ 3 $482 184 $565 1.12

15958 1 Remove thigh pressure sore ............................................................ 4 $595 184 $565 1.12

15999 3 Removal of pressure sore ................................................................ ................ ................ ................ ................ ................

16000 5 Initial treatment of burn(s) ................................................................. ................ ................ ................ ................ ................

16010 1 Treatment of burn(s) ......................................................................... ................ ................ 152 $213 0.42 Add.

16015 1 Treatment of burn(s) ......................................................................... 2 $422 152 $213 0.42

16020 5 Treatment of burn(s) ......................................................................... ................ ................ ................ ................ ................

16025 5 Treatment of burn(s) ......................................................................... ................ ................ ................ ................ ................

16030 5 Treatment of burn(s) ......................................................................... 1 $314 ................ ................ ................ Delete.

16035 1 Incision of burn scab ......................................................................... 2 $422 162 $187 0.37

16040 1 Burn wound excision ......................................................................... ................ ................ 162 $187 0.37 Add.

16041 1 Burn wound excision ......................................................................... ................ ................ 162 $187 0.37 Add.

16042 1 Burn wound excision ......................................................................... ................ ................ 162 $187 0.37 Add.

17000 5 Destroy benign/premal lesion ........................................................... ................ ................ ................ ................ ................

17003 5 Destroy 2-14 lesions ......................................................................... ................ ................ ................ ................ ................

17004 5 Destroy 15 & more lesions ............................................................... ................ ................ ................ ................ ................

17106 1 Destruction of skin lesions ................................................................ ................ ................ 152 $213 0.42 Add.

17107 1 Destruction of skin lesions ................................................................ ................ ................ 152 $213 0.42 Add.

17108 1 Destruction of skin lesions ................................................................ ................ ................ 152 $213 0.42 Add.

17110 5 Destruct lesion, 1-14 ......................................................................... ................ ................ ................ ................ ................

17111 5 Destruct lesion, 15 or more .............................................................. ................ ................ ................ ................ ................

17250 5 Chemical cautery, tissue ................................................................... ................ ................ ................ ................ ................

17260 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17261 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17262 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17263 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17264 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17266 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17270 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17271 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17272 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17273 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17274 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17276 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17280 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17281 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17282 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17283 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17284 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17286 5 Destruction of skin lesions ................................................................ ................ ................ ................ ................ ................

17304 1 Chemosurgery of skin lesion ............................................................ ................ ................ 162 $187 0.37 Add.

17305 1 2nd stage chemosurgery .................................................................. ................ ................ 162 $187 0.37 Add.

17306 1 3rd stage chemosurgery ................................................................... ................ ................ 162 $187 0.37 Add.

17307 1 Followup skin lesion therapy ............................................................ ................ ................ 162 $187 0.37 Add.

17310 1 Extensive skin chemosurgery ........................................................... ................ ................ 162 $187 0.37 Add.

17340 5 Cryotherapy of skin ........................................................................... ................ ................ ................ ................ ................

17360 5 Skin peel therapy .............................................................................. ................ ................ ................ ................ ................

17380 5 Hair removal by electrolysis .............................................................. ................ ................ ................ ................ ................

17999 3 Skin tissue procedure ....................................................................... ................ ................ ................ ................ ................

19000 5 Drainage of breast lesion .................................................................. ................ ................ ................ ................ ................

19001 5 Drain added breast lesion ................................................................. ................ ................ ................ ................ ................

19020 1 Incision of breast lesion .................................................................... 2 $422 132 $162 0.32

19030 2 Injection for breast x-ray ................................................................... ................ ................ ................ ................ ................

19100 1 Biopsy of breast ................................................................................ 1 $314 122 $186 0.37

19101 1 Biopsy of breast ................................................................................ 2 $422 197 $411 0.81

19110 1 Nipple exploration ............................................................................. 2 $422 197 $411 0.81

19112 1 Excise breast duct fistula .................................................................. 3 $482 197 $411 0.81

19120 1 Removal of breast lesion .................................................................. 3 $482 197 $411 0.81
32336

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

19125 1 Excision, breast lesion ...................................................................... 3 $482 197 $411 0.81

19126 1 Excision, add’l breast lesion ............................................................. 3 $482 197 $411 0.81

19140 1 Removal of breast tissue .................................................................. 4 $595 197 $411 0.81

19160 1 Removal of breast tissue .................................................................. 3 $482 198 $596 1.18

19162 1 Remove breast tissue, nodes ........................................................... 7 $941 198 $596 1.18

19180 1 Removal of breast ............................................................................. 4 $595 198 $596 1.18

19182 1 Removal of breast ............................................................................. 4 $595 198 $596 1.18

19200 3 Removal of breast ............................................................................. ................ ................ ................ ................ ................

19220 3 Removal of breast ............................................................................. ................ ................ ................ ................ ................

19240 3 Removal of breast ............................................................................. ................ ................ ................ ................ ................

19260 3 Removal of chest wall lesion ............................................................ 5 $678 ................ ................ ................ Delete.

19271 3 Revision of chest wall ....................................................................... ................ ................ ................ ................ ................

19272 3 Extensive chest wall surgery ............................................................ ................ ................ ................ ................ ................

19290 1 Place needle wire, breast ................................................................. 1 $314 197 $411 0.81

19291 1 Place needle wire, breast ................................................................. 1 $314 197 $411 0.81

19316 1 Suspension of breast ........................................................................ ................ ................ 198 $596 1.18 Add.

19318 1 Reduction of large breast ................................................................. 4 $595 198 $596 1.18

19324 1 Enlarge breast ................................................................................... ................ ................ 198 $596 1.18 Add.

19325 1 Enlarge breast with implant .............................................................. ................ ................ 198 $596 1.18 Add.

19328 1 Removal of breast implant ................................................................ 1 $314 198 $596 1.18

19330 1 Removal of implant material ............................................................. 1 $314 198 $596 1.18

19340 1 Immediate breast prosthesis ............................................................. 2 $422 198 $596 1.18

19342 1 Delayed breast prosthesis ................................................................ 3 $482 198 $596 1.18

19350 1 Breast reconstruction ........................................................................ 4 $595 198 $596 1.18

19355 1 Correct inverted nipple(s) ................................................................. ................ ................ 198 $596 1.18 Add.

19357 1 Breast reconstruction ........................................................................ 5 $678 198 $596 1.18

19361 3 Breast reconstruction ........................................................................ ................ ................ ................ ................ ................

19364 3 Breast reconstruction ........................................................................ 5 $678 ................ ................ ................ Delete.

19366 1 Breast reconstruction ........................................................................ 5 $678 198 $596 1.18

19367 3 Breast reconstruction ........................................................................ ................ ................ ................ ................ ................

19368 3 Breast reconstruction ........................................................................ ................ ................ ................ ................ ................

19369 3 Breast reconstruction ........................................................................ ................ ................ ................ ................ ................

19370 1 Surgery of breast capsule ................................................................. 4 $595 198 $596 1.18

19371 1 Removal of breast capsule ............................................................... 4 $595 198 $596 1.18

19380 1 Revise breast reconstruction ............................................................ 5 $678 198 $596 1.18

19396 1 Design custom breast implant .......................................................... ................ ................ 197 $411 0.81 Add.

19499 3 Breast surgery procedure ................................................................. ................ ................ ................ ................ ................

20000 5 Incision of abscess ........................................................................... ................ ................ ................ ................ ................

20005 1 Incision of deep abscess .................................................................. 2 $422 251 $504 1.00

20100 3 Explore wound, neck ........................................................................ ................ ................ ................ ................ ................

20101 3 Explore wound, chest ....................................................................... ................ ................ ................ ................ ................

20102 3 Explore wound, abdomen ................................................................. ................ ................ ................ ................ ................

20103 3 Explore wound, extremity ................................................................. ................ ................ ................ ................ ................

20150 3 Excise epiphyseal bar ....................................................................... ................ ................ ................ ................ ................

20200 1 Muscle biopsy ................................................................................... 2 $422 162 $187 0.37

20205 1 Deep muscle biopsy ......................................................................... 3 $482 162 $187 0.37

20206 1 Needle biopsy, muscle ...................................................................... 1 $314 122 $186 0.37

20220 1 Bone biopsy, trocar/needle ............................................................... 1 $314 162 $187 0.37

20225 1 Bone biopsy, trocar/needle ............................................................... 2 $422 162 $187 0.37

20240 1 Bone biopsy, excisional .................................................................... 2 $422 163 $449 0.89

20245 1 Bone biopsy, excisional .................................................................... 3 $482 163 $449 0.89

20250 1 Open bone biopsy ............................................................................. 3 $482 251 $504 1.00

20251 1 Open bone biopsy ............................................................................. 3 $482 251 $504 1.00

20500 1 Injection of sinus tract ....................................................................... ................ ................ 181 $150 0.30 Add.

20501 2 Inject sinus tract for x-ray ................................................................. ................ ................ ................ ................ ................

20520 5 Removal of foreign body ................................................................... ................ ................ ................ ................ ................

20525 1 Removal of foreign body ................................................................... 3 $482 163 $449 0.89

20550 5 Inj tendon/ligament/cyst .................................................................... ................ ................ ................ ................ ................

20600 5 Drain/inject joint/bursa ...................................................................... ................ ................ ................ ................ ................

20605 5 Drain/inject joint/bursa ...................................................................... ................ ................ ................ ................ ................

20610 5 Drain/inject joint/bursa ...................................................................... ................ ................ ................ ................ ................

20615 5 Treatment of bone cyst ..................................................................... ................ ................ ................ ................ ................

20650 1 Insert and remove bone pin .............................................................. 3 $482 251 $504 1.00

20660 3 Apply, remove fixation device ........................................................... 2 $422 ................ ................ ................ Delete.

20661 3 Application of head brace ................................................................. 3 $482 ................ ................ ................ Delete.

20662 3 Application of pelvis brace ................................................................ 3 $482 ................ ................ ................ Delete.

20663 3 Application of thigh brace ................................................................. 3 $482 ................ ................ ................ Delete.

20664 3 Halo brace application ...................................................................... ................ ................ ................ ................ ................

20665 5 Removal of fixation device ................................................................ 1 $314 ................ ................ ................ Delete.

20670 1 Removal of support implant .............................................................. 1 $314 162 $187 0.37

20680 1 Removal of support implant .............................................................. 3 $482 163 $449 0.89

20690 1 Apply bone fixation device ................................................................ 2 $422 252 $574 1.14

20692 1 Apply bone fixation device ................................................................ ................ ................ 252 $574 1.14 Add.

20693 1 Adjust bone fixation device ............................................................... ................ ................ 251 $504 1.00 Add.
32337

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

20694 1 Remove bone fixation device ........................................................... 1 $314 251 $504 1.00

20802 3 Replantation, arm, complete ............................................................. ................ ................ ................ ................ ................

20805 3 Replant forearm, complete ............................................................... ................ ................ ................ ................ ................

20808 3 Replantation, hand, complete ........................................................... ................ ................ ................ ................ ................

20816 3 Replantation digit, complete ............................................................. ................ ................ ................ ................ ................

20822 3 Replantation digit, complete ............................................................. ................ ................ ................ ................ ................

20824 3 Replantation thumb, complete .......................................................... ................ ................ ................ ................ ................

20827 3 Replantation thumb, complete .......................................................... ................ ................ ................ ................ ................

20838 3 Replantation, foot, complete ............................................................. ................ ................ ................ ................ ................

20900 1 Removal of bone for graft ................................................................. 3 $482 252 $574 1.14

20902 1 Removal of bone for graft ................................................................. 4 $595 252 $574 1.14

20910 1 Remove cartilage for graft ................................................................ 3 $482 183 $465 0.92

20912 1 Remove cartilage for graft ................................................................ 3 $482 183 $465 0.92

20920 1 Removal of fascia for graft ............................................................... 4 $595 183 $465 0.92

20922 1 Removal of fascia for graft ............................................................... 3 $482 183 $465 0.92

20924 1 Removal of tendon for graft .............................................................. 4 $595 252 $574 1.14

20926 1 Removal of tissue for graft ............................................................... 4 $595 183 $465 0.92

20930 3 Spinal bone allograft ......................................................................... ................ ................ ................ ................ ................

20931 3 Spinal bone allograft ......................................................................... ................ ................ ................ ................ ................

20936 3 Spinal bone autograft ........................................................................ ................ ................ ................ ................ ................

20937 3 Spinal bone autograft ........................................................................ ................ ................ ................ ................ ................

20938 3 Spinal bone autograft ........................................................................ ................ ................ ................ ................ ................

20950 1 Record fluid pressure,muscle ........................................................... ................ ................ 132 $162 0.32 Add.

20955 3 Fibula bone graft, microvasc ............................................................ 4 $595 ................ ................ ................ Delete.

20956 3 Iliac bone graft, microvasc ................................................................ ................ ................ ................ ................ ................

20957 3 Mt bone graft, microvasc .................................................................. ................ ................ ................ ................ ................

20962 3 Other bone graft, microvasc ............................................................. 4 $595 ................ ................ ................ Delete.

20969 3 Bone/skin graft, microvasc ................................................................ 4 $595 ................ ................ ................ Delete.

20970 3 Bone/skin graft, iliac crest ................................................................. 4 $595 ................ ................ ................ Delete.

20972 3 Bone-skin graft, metatarsal ............................................................... 4 $595 ................ ................ ................ Delete.

20973 3 Bone-skin graft, great toe ................................................................. 4 $595 ................ ................ ................ Delete.

20974 6 Electrical bone stimulation ................................................................ ................ ................ ................ ................ ................

20975 1 Electrical bone stimulation ................................................................ 2 $422 251 $504 1.00

20999 3 Musculoskeletal surgery ................................................................... ................ ................ ................ ................ ................

21010 1 Incision of jaw joint ........................................................................... 2 $422 232 $814 1.62

21015 1 Resection of facial tumor .................................................................. ................ ................ 231 $437 0.87 Add.

21025 1 Excision of bone, lower jaw .............................................................. 2 $422 231 $437 0.87

21026 1 Excision of facial bone(s) .................................................................. 2 $422 231 $437 0.87

21029 1 Contour of face bone lesion ............................................................. ................ ................ 231 $437 0.87 Add.

21030 1 Removal of face bone lesion ............................................................ ................ ................ 231 $437 0.87 Add.

21031 1 Remove exostosis, mandible ............................................................ ................ ................ 231 $437 0.87 Add.

21032 1 Remove exostosis, maxilla ............................................................... ................ ................ 231 $437 0.87 Add.

21034 1 Removal of face bone lesion ............................................................ 3 $482 232 $814 1.62

21040 1 Removal of jaw bone lesion ............................................................. 2 $422 231 $437 0.87

21041 1 Removal of jaw bone lesion ............................................................. 2 $422 231 $437 0.87

21044 1 Removal of jaw bone lesion ............................................................. 2 $422 232 $814 1.62

21045 3 Extensive jaw surgery ....................................................................... ................ ................ ................ ................ ................

21050 1 Removal of jaw joint ......................................................................... 3 $482 232 $814 1.62

21060 1 Remove jaw joint cartilage ................................................................ 2 $422 232 $814 1.62

21070 1 Remove coronoid process ................................................................ 3 $482 232 $814 1.62

21076 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21077 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21079 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21080 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21081 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21082 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21083 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21084 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21085 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21086 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21087 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21088 6 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21089 3 Prepare face/oral prosthesis ............................................................. ................ ................ ................ ................ ................

21100 1 Maxillofacial fixation .......................................................................... 2 $422 231 $437 0.87

21110 1 Interdental fixation ............................................................................. ................ ................ 231 $437 0.87 Add.

21116 2 Injection, jaw joint x-ray .................................................................... ................ ................ ................ ................ ................

21120 1 Reconstruction of chin ...................................................................... ................ ................ 231 $437 0.87 Add.

21121 1 Reconstruction of chin ...................................................................... ................ ................ 232 $814 1.62 Add.

21122 1 Reconstruction of chin ...................................................................... ................ ................ 232 $814 1.62 Add.

21123 1 Reconstruction of chin ...................................................................... ................ ................ 232 $814 1.62 Add.

21125 1 Augmentation lower jaw bone .......................................................... ................ ................ 231 $437 0.87 Add.

21127 1 Augmentation lower jaw bone .......................................................... ................ ................ 232 $814 1.62 Add.

21137 3 Reduction of forehead ...................................................................... ................ ................ ................ ................ ................

21138 3 Reduction of forehead ...................................................................... ................ ................ ................ ................ ................
32338

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

21139 3 Reduction of forehead ...................................................................... ................ ................ ................ ................ ................

21141 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21142 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21143 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21145 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21146 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21147 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21150 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21151 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21154 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21155 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21159 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21160 3 Reconstruct midface, lefort ............................................................... ................ ................ ................ ................ ................

21172 3 Reconstruct orbit/forehead ................................................................ ................ ................ ................ ................ ................

21175 3 Reconstruct orbit/forehead ................................................................ ................ ................ ................ ................ ................

21179 3 Reconstruct entire forehead ............................................................. ................ ................ ................ ................ ................

21180 3 Reconstruct entire forehead ............................................................. ................ ................ ................ ................ ................

21181 1 Contour cranial bone lesion .............................................................. ................ ................ 232 $814 1.62 Add.

21182 3 Reconstruct cranial bone .................................................................. ................ ................ ................ ................ ................

21183 3 Reconstruct cranial bone .................................................................. ................ ................ ................ ................ ................

21184 3 Reconstruct cranial bone .................................................................. ................ ................ ................ ................ ................

21188 3 Reconstruction of midface ................................................................ ................ ................ ................ ................ ................

21193 3 Reconstruct lower jaw bone ............................................................. ................ ................ ................ ................ ................

21194 3 Reconstruct lower jaw bone ............................................................. ................ ................ ................ ................ ................

21195 3 Reconstruct lower jaw bone ............................................................. ................ ................ ................ ................ ................

21196 3 Reconstruct lower jaw bone ............................................................. ................ ................ ................ ................ ................

21198 3 Reconstruct lower jaw bone ............................................................. ................ ................ ................ ................ ................

21206 1 Reconstruct upper jaw bone ............................................................. 5 $678 232 $814 1.62

21208 1 Augmentation of facial bones ........................................................... 7 $941 232 $814 1.62

21209 1 Reduction of facial bones ................................................................. 5 $678 232 $814 1.62

21210 1 Face bone graft ................................................................................. 7 $941 232 $814 1.62

21215 1 Lower jaw bone graft ........................................................................ 7 $941 232 $814 1.62

21230 1 Rib cartilage graft .............................................................................. 7 $941 232 $814 1.62

21235 1 Ear cartilage graft ............................................................................. 7 $941 232 $814 1.62

21240 1 Reconstruction of jaw joint ................................................................ 4 $595 232 $814 1.62

21242 1 Reconstruction of jaw joint ................................................................ 5 $678 232 $814 1.62

21243 1 Reconstruction of jaw joint ................................................................ 5 $678 218 $730 1.45

21244 1 Reconstruction of lower jaw .............................................................. 7 $941 232 $814 1.62

21245 1 Reconstruction of jaw ....................................................................... 7 $941 232 $814 1.62

21246 1 Reconstruction of jaw ....................................................................... 7 $941 232 $814 1.62

21247 3 Reconstruct lower jaw bone ............................................................. ................ ................ ................ ................ ................

21248 1 Reconstruction of jaw ....................................................................... 7 $941 232 $814 1.62

21249 1 Reconstruction of jaw ....................................................................... 7 $941 232 $814 1.62

21255 3 Reconstruct lower jaw bone ............................................................. ................ ................ ................ ................ ................

21256 3 Reconstruction of orbit ...................................................................... ................ ................ ................ ................ ................

21260 1 Revise eye sockets ........................................................................... ................ ................ 232 $814 1.62 Add.

21261 3 Revise eye sockets ........................................................................... ................ ................ ................ ................ ................

21263 3 Revise eye sockets ........................................................................... ................ ................ ................ ................ ................

21267 1 Revise eye sockets ........................................................................... 7 $941 232 $814 1.62

21268 3 Revise eye sockets ........................................................................... ................ ................ ................ ................ ................

21270 1 Augmentation cheek bone ................................................................ 5 $678 232 $814 1.62

21275 1 Revision orbitofacial bones ............................................................... 7 $941 232 $814 1.62

21280 1 Revision of eyelid .............................................................................. 5 $678 231 $437 0.87

21282 1 Revision of eyelid .............................................................................. 5 $678 231 $437 0.87

21295 1 Revision of jaw muscle/bone ............................................................ ................ ................ 231 $437 0.87 Add.

21296 1 Revision of jaw muscle/bone ............................................................ ................ ................ 231 $437 0.87 Add.

21299 3 Cranio/maxillofacial surgery .............................................................. ................ ................ ................ ................ ................

21300 1 Treatment of skull fracture ................................................................ 2 $422 231 $437 0.87

21310 1 Treatment of nose fracture ............................................................... 2 $422 231 $437 0.87

21315 1 Treatment of nose fracture ............................................................... 2 $422 231 $437 0.87

21320 1 Treatment of nose fracture ............................................................... 2 $422 231 $437 0.87

21325 1 Repair of nose fracture ..................................................................... 4 $595 231 $437 0.87

21330 1 Repair of nose fracture ..................................................................... 5 $678 232 $814 1.62

21335 1 Repair of nose fracture ..................................................................... 7 $941 232 $814 1.62

21336 1 Repair nasal septal fracture .............................................................. ................ ................ 216 $580 1.15 Add.

21337 1 Repair nasal septal fracture .............................................................. 2 $422 231 $437 0.87

21338 1 Repair nasoethmoid fracture ............................................................ 4 $595 232 $814 1.62

21339 1 Repair nasoethmoid fracture ............................................................ 5 $678 232 $814 1.62

21340 1 Repair of nose fracture ..................................................................... 4 $595 232 $814 1.62

21343 1 Repair of sinus fracture .................................................................... 5 $678 232 $814 1.62

21344 3 Repair of sinus fracture .................................................................... ................ ................ ................ ................ ................

21345 1 Repair of nose/jaw fracture ............................................................... ................ ................ 232 $814 1.62 Add.

21346 3 Repair of nose/jaw fracture ............................................................... ................ ................ ................ ................ ................

21347 3 Repair of nose/jaw fracture ............................................................... ................ ................ ................ ................ ................
32339

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

21348 3 Repair of nose/jaw fracture ............................................................... ................ ................ ................ ................ ................

21355 1 Repair cheek bone fracture .............................................................. 3 $482 231 $437 0.87

21356 3 Repair cheek bone fracture .............................................................. ................ ................ ................ ................ ................

21360 3 Repair cheek bone fracture .............................................................. 4 $595 ................ ................ ................ Delete.

21365 3 Repair cheek bone fracture .............................................................. 5 $678 ................ ................ ................ Delete.

21366 3 Repair cheek bone fracture .............................................................. ................ ................ ................ ................ ................

21385 3 Repair eye socket fracture ................................................................ 5 $678 ................ ................ ................ Delete.

21386 3 Repair eye socket fracture ................................................................ 5 $678 ................ ................ ................ Delete.

21387 3 Repair eye socket fracture ................................................................ 5 $678 ................ ................ ................ Delete.

21390 3 Repair eye socket fracture ................................................................ 7 $941 ................ ................ ................ Delete.

21395 3 Repair eye socket fracture ................................................................ 7 $941 ................ ................ ................ Delete.

21400 1 Treat eye socket fracture .................................................................. 2 $422 231 $437 0.87

21401 1 Repair eye socket fracture ................................................................ 3 $482 231 $437 0.87

21406 3 Repair eye socket fracture ................................................................ 4 $595 ................ ................ ................ Delete.

21407 3 Repair eye socket fracture ................................................................ 5 $678 ................ ................ ................ Delete.

21408 3 Repair eye socket fracture ................................................................ ................ ................ ................ ................ ................

21421 1 Treat mouth roof fracture .................................................................. 4 $595 232 $814 1.62

21422 3 Repair mouth roof fracture ................................................................ 5 $678 ................ ................ ................ Delete.

21423 3 Repair mouth roof fracture ................................................................ ................ ................ ................ ................ ................

21431 3 Treat craniofacial fracture ................................................................. ................ ................ ................ ................ ................

21432 3 Repair craniofacial fracture ............................................................... ................ ................ ................ ................ ................

21433 3 Repair craniofacial fracture ............................................................... ................ ................ ................ ................ ................

21435 3 Repair craniofacial fracture ............................................................... ................ ................ ................ ................ ................

21436 3 Repair craniofacial fracture ............................................................... ................ ................ ................ ................ ................

21440 1 Repair dental ridge fracture .............................................................. 3 $482 231 $437 0.87

21445 1 Repair dental ridge fracture .............................................................. 4 $595 232 $814 1.62

21450 1 Treat lower jaw fracture .................................................................... 3 $482 232 $814 1.62

21451 1 Treat lower jaw fracture .................................................................... 4 $595 231 $437 0.87

21452 1 Treat lower jaw fracture .................................................................... 2 $422 232 $814 1.62

21453 1 Treat lower jaw fracture .................................................................... 3 $482 232 $814 1.62

21454 1 Treat lower jaw fracture .................................................................... 5 $678 232 $814 1.62

21461 1 Repair lower jaw fracture .................................................................. 4 $595 232 $814 1.62

21462 1 Repair lower jaw fracture .................................................................. 5 $678 232 $814 1.62

21465 1 Repair lower jaw fracture .................................................................. 4 $595 232 $814 1.62

21470 3 Repair lower jaw fracture .................................................................. 5 $678 ................ ................ ................ Delete.

21480 1 Reset dislocated jaw ......................................................................... 1 $314 231 $437 0.87

21485 1 Reset dislocated jaw ......................................................................... 2 $422 231 $437 0.87

21490 1 Repair dislocated jaw ........................................................................ 3 $482 232 $814 1.62

21493 1 Treat hyoid bone fracture ................................................................. 3 $482 231 $437 0.87

21494 1 Repair hyoid bone fracture ............................................................... 4 $595 231 $437 0.87

21495 3 Repair hyoid bone fracture ............................................................... 4 $595 ................ ................ ................ Delete.

21497 1 Interdental wiring ............................................................................... 2 $422 231 $437 0.87

21499 3 Head surgery procedure ................................................................... ................ ................ ................ ................ ................

21501 1 Drain neck/chest lesion ..................................................................... 2 $422 132 $162 0.32

21502 1 Drain chest lesion ............................................................................. 2 $422 252 $574 1.14

21510 3 Drainage of bone lesion .................................................................... 3 $482 ................ ................ ................ Delete.

21550 5 Biopsy of neck/chest ......................................................................... 1 $314 ................ ................ ................ Delete.

21555 1 Remove lesion neck/chest ................................................................ 2 $422 163 $449 0.89

21556 1 Remove lesion neck/chest ................................................................ 2 $422 163 $449 0.89

21557 3 Remove tumor, neck or chest .......................................................... ................ ................ ................ ................ ................

21600 1 Partial removal of rib ......................................................................... 2 $422 252 $574 1.14

21610 1 Partial removal of rib ......................................................................... 2 $422 252 $574 1.14

21615 3 Removal of rib ................................................................................... ................ ................ ................ ................ ................

21616 3 Removal of rib and nerves ............................................................... ................ ................ ................ ................ ................

21620 3 Partial removal of sternum ................................................................ 2 $422 ................ ................ ................ Delete.

21627 3 Sternal debridement .......................................................................... ................ ................ ................ ................ ................

21630 3 Extensive sternum surgery ............................................................... ................ ................ ................ ................ ................

21632 3 Extensive sternum surgery ............................................................... ................ ................ ................ ................ ................

21700 1 Revision of neck muscle ................................................................... 2 $422 132 $162 0.32

21705 3 Revision of neck muscle/rib .............................................................. ................ ................ ................ ................ ................

21720 1 Revision of neck muscle ................................................................... 3 $482 132 $162 0.32

21725 1 Revision of neck muscle ................................................................... 3 $482 132 $162 0.32

21740 3 Reconstruction of sternum ................................................................ ................ ................ ................ ................ ................

21750 3 Repair of sternum separation ........................................................... ................ ................ ................ ................ ................

21800 1 Treatment of rib fracture ................................................................... 1 $314 207 $53 0.11

21805 1 Treatment of rib fracture ................................................................... 2 $422 216 $580 1.15

21810 3 Treatment of rib fracture(s) ............................................................... 2 $422 ................ ................ ................ Delete.

21820 1 Treat sternum fracture ...................................................................... 1 $314 207 $53 0.11

21825 3 Repair sternum fracture .................................................................... ................ ................ ................ ................ ................

21899 3 Neck/chest surgery procedure .......................................................... ................ ................ ................ ................ ................

21920 5 Biopsy soft tissue of back ................................................................. 1 $314 ................ ................ ................ Delete.

21925 1 Biopsy soft tissue of back ................................................................. 2 $422 163 $449 0.89

21930 1 Remove lesion, back or flank ........................................................... 2 $422 163 $449 0.89

21935 1 Remove tumor of back ..................................................................... 3 $482 163 $449 0.89
32340

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

22100 3 Remove part of neck vertebra .......................................................... 3 $482 ................ ................ ................ Delete.

22101 3 Remove part, thorax vertebra ........................................................... 3 $482 ................ ................ ................ Delete.

22102 3 Remove part, lumbar vertebra .......................................................... 3 $482 ................ ................ ................ Delete.

22103 3 Remove extra spine segment ........................................................... 3 $482 ................ ................ ................ Delete.

22110 3 Remove part of neck vertebra .......................................................... ................ ................ ................ ................ ................

22112 3 Remove part, thorax vertebra ........................................................... ................ ................ ................ ................ ................

22114 3 Remove part, lumbar vertebra .......................................................... ................ ................ ................ ................ ................

22116 3 Remove extra spine segment ........................................................... ................ ................ ................ ................ ................

22210 3 Revision of neck spine ...................................................................... ................ ................ ................ ................ ................

22212 3 Revision of thorax spine ................................................................... ................ ................ ................ ................ ................

22214 3 Revision of lumbar spine .................................................................. ................ ................ ................ ................ ................

22216 3 Revise, extra spine segment ............................................................ ................ ................ ................ ................ ................

22220 3 Revision of neck spine ...................................................................... ................ ................ ................ ................ ................

22222 3 Revision of thorax spine ................................................................... ................ ................ ................ ................ ................

22224 3 Revision of lumbar spine .................................................................. ................ ................ ................ ................ ................

22226 3 Revise, extra spine segment ............................................................ ................ ................ ................ ................ ................

22305 1 Treat spine process fracture ............................................................. 1 $314 207 $53 0.11

22310 1 Treat spine fracture ........................................................................... 1 $314 207 $53 0.11

22315 1 Treat spine fracture ........................................................................... 2 $422 207 $53 0.11

22325 3 Repair of spine fracture .................................................................... 3 $482 ................ ................ ................ Delete.

22326 3 Repair neck spine fracture ................................................................ 3 $482 ................ ................ ................ Delete.

22327 3 Repair thorax spine fracture ............................................................. 3 $482 ................ ................ ................ Delete.

22328 3 Repair each add spine fx .................................................................. 3 $482 ................ ................ ................ Delete.

22505 1 Manipulation of spine ........................................................................ 2 $422 210 $397 0.79

22548 3 Neck spine fusion ............................................................................. ................ ................ ................ ................ ................

22554 3 Neck spine fusion ............................................................................. ................ ................ ................ ................ ................

22556 3 Thorax spine fusion .......................................................................... ................ ................ ................ ................ ................

22558 3 Lumbar spine fusion ......................................................................... ................ ................ ................ ................ ................

22585 3 Add.itional spinal fusion .................................................................... ................ ................ ................ ................ ................

22590 3 Spine & skull spinal fusion ................................................................ ................ ................ ................ ................ ................

22595 3 Neck spinal fusion ............................................................................. ................ ................ ................ ................ ................

22600 3 Neck spine fusion ............................................................................. ................ ................ ................ ................ ................

22610 3 Thorax spine fusion .......................................................................... ................ ................ ................ ................ ................

22612 3 Lumbar spine fusion ......................................................................... ................ ................ ................ ................ ................

22614 3 Spine fusion, extra segment ............................................................. ................ ................ ................ ................ ................

22630 3 Lumbar spine fusion ......................................................................... ................ ................ ................ ................ ................

22632 3 Spine fusion, extra segment ............................................................. ................ ................ ................ ................ ................

22800 3 Fusion of spine ................................................................................. ................ ................ ................ ................ ................

22802 3 Fusion of spine ................................................................................. ................ ................ ................ ................ ................

22804 3 Fusion of spine ................................................................................. ................ ................ ................ ................ ................

22808 3 Fusion of spine ................................................................................. ................ ................ ................ ................ ................

22810 3 Fusion of spine ................................................................................. ................ ................ ................ ................ ................

22812 3 Fusion of spine ................................................................................. ................ ................ ................ ................ ................

22818 3 Kyphectomy, 1-2 segments .............................................................. ................ ................ ................ ................ ................

22819 3 Kyphectomy, 3 & more segment ...................................................... ................ ................ ................ ................ ................

22830 3 Exploration of spinal fusion ............................................................... ................ ................ ................ ................ ................

22840 3 Insert spine fixation device ............................................................... ................ ................ ................ ................ ................

22841 3 Insert spine fixation device ............................................................... ................ ................ ................ ................ ................

22842 3 Insert spine fixation device ............................................................... ................ ................ ................ ................ ................

22843 3 Insert spine fixation device ............................................................... ................ ................ ................ ................ ................

22844 3 Insert spine fixation device ............................................................... ................ ................ ................ ................ ................

22845 3 Insert spine fixation device ............................................................... ................ ................ ................ ................ ................

22846 3 Insert spine fixation device ............................................................... ................ ................ ................ ................ ................

22847 3 Insert spine fixation device ............................................................... ................ ................ ................ ................ ................

22848 3 Insert pelvic fixationdevice ................................................................ ................ ................ ................ ................ ................

22849 3 Reinsert spinal fixation ...................................................................... ................ ................ ................ ................ ................

22850 3 Remove spine fixation device ........................................................... ................ ................ ................ ................ ................

22851 3 Apply spine prosth device ................................................................. ................ ................ ................ ................ ................

22852 3 Remove spine fixation device ........................................................... ................ ................ ................ ................ ................

22855 3 Remove spine fixation device ........................................................... ................ ................ ................ ................ ................

22899 3 Spine surgery procedure .................................................................. ................ ................ ................ ................ ................

22900 1 Remove abdominal wall lesion ......................................................... 4 $595 163 $449 0.89

22999 3 Abdomen surgery procedure ............................................................ ................ ................ ................ ................ ................

23000 1 Removal of calcium deposits ............................................................ 2 $422 162 $187 0.37

23020 1 Release shoulder joint ...................................................................... 2 $422 253 $775 1.54

23030 1 Drain shoulder lesion ........................................................................ 1 $314 132 $162 0.32

23031 1 Drain shoulder bursa ........................................................................ ................ ................ 132 $162 0.32 Add.

23035 3 Drain shoulder bone lesion ............................................................... 3 $482 ................ ................ ................ Delete.

23040 1 Exploratory shoulder surgery ............................................................ 3 $482 252 $574 1.14

23044 1 Exploratory shoulder surgery ............................................................ 4 $595 252 $574 1.14

23065 5 Biopsy shoulder tissues .................................................................... 1 $314 ................ ................ ................ Delete.

23066 1 Biopsy shoulder tissues .................................................................... 2 $422 163 $449 0.89

23075 1 Removal of shoulder lesion .............................................................. 2 $422 162 $187 0.37

23076 1 Removal of shoulder lesion .............................................................. 2 $422 163 $449 0.89
32341

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

23077 1 Remove tumor of shoulder ............................................................... 3 $482 163 $449 0.89

23100 1 Biopsy of shoulder joint .................................................................... 2 $422 251 $504 1.00

23101 1 Shoulder joint surgery ....................................................................... 7 $941 252 $574 1.14

23105 1 Remove shoulder joint lining ............................................................ 4 $595 252 $574 1.14

23106 1 Incision of collarbone joint ................................................................ 4 $595 252 $574 1.14

23107 1 Explore, treat shoulder joint .............................................................. 4 $595 252 $574 1.14

23120 1 Partial removal, collar bone .............................................................. 5 $678 253 $775 1.54

23125 3 Removal of collarbone ...................................................................... 5 $678 ................ ................ ................ Delete.

23130 1 Partial removal,shoulderbone ........................................................... 5 $678 253 $775 1.54

23140 1 Removal of bone lesion .................................................................... 4 $595 251 $504 1.00

23145 1 Removal of bone lesion .................................................................... 5 $678 252 $574 1.14

23146 1 Removal of bone lesion .................................................................... 5 $678 252 $574 1.14

23150 1 Removal of humerus lesion .............................................................. 4 $595 252 $574 1.14

23155 1 Removal of humerus lesion .............................................................. 5 $678 252 $574 1.14

23156 1 Removal of humerus lesion .............................................................. 5 $678 252 $574 1.14

23170 1 Remove collarbone lesion ................................................................ 2 $422 252 $574 1.14

23172 1 Remove shoulder blade lesion ......................................................... 2 $422 252 $574 1.14

23174 1 Remove humerus lesion ................................................................... 2 $422 252 $574 1.14

23180 1 Remove collar bone lesion ............................................................... 4 $595 252 $574 1.14

23182 1 Remove shoulder blade lesion ......................................................... 4 $595 252 $574 1.14

23184 1 Remove humerus lesion ................................................................... 4 $595 252 $574 1.14

23190 1 Partial removal of scapula ................................................................ 4 $595 252 $574 1.14

23195 3 Removal of head of humerus ........................................................... 5 $678 ................ ................ ................ Delete.

23200 3 Removal of collar bone ..................................................................... ................ ................ ................ ................ ................

23210 3 Removal of shoulderblade ................................................................ ................ ................ ................ ................ ................

23220 3 Partial removal of humerus ............................................................... ................ ................ ................ ................ ................

23221 3 Partial removal of humerus ............................................................... ................ ................ ................ ................ ................

23222 3 Partial removal of humerus ............................................................... ................ ................ ................ ................ ................

23330 1 Remove shoulder foreign body ......................................................... 1 $314 163 $449 0.89

23331 1 Remove shoulder foreign body ......................................................... 1 $314 163 $449 0.89

23332 3 Remove shoulder foreign body ......................................................... ................ ................ ................ ................ ................

23350 2 Injection for shoulder x-ray ............................................................... ................ ................ ................ ................ ................

23395 3 Muscle transfer, shoulder/arm .......................................................... 5 $678 ................ ................ ................ Delete.

23397 3 Muscle transfers ................................................................................ 7 $941 ................ ................ ................ Delete.

23400 3 Fixation of shoulder blade ................................................................ 7 $941 ................ ................ ................ Delete.

23405 1 Incision of tendon & muscle ............................................................. 2 $422 252 $574 1.14

23406 1 Incise tendon(s) & muscle(s) ............................................................ 2 $422 252 $574 1.14

23410 1 Repair of tendon(s) ........................................................................... 5 $678 254 $1,110 2.20

23412 1 Repair of tendon(s) ........................................................................... 7 $941 254 $1,110 2.20

23415 1 Release of shoulder ligament ........................................................... 5 $678 253 $775 1.54

23420 1 Repair of shoulder ............................................................................ 7 $941 254 $1,110 2.20

23430 1 Repair biceps tendon ........................................................................ 4 $595 254 $1,110 2.20

23440 3 Removal/transplant tendon ............................................................... 4 $595 ................ ................ ................ Delete.

23450 1 Repair shoulder capsule ................................................................... 5 $678 254 $1,110 2.20

23455 1 Repair shoulder capsule ................................................................... 7 $941 254 $1,110 2.20

23460 1 Repair shoulder capsule ................................................................... 5 $678 254 $1,110 2.20

23462 1 Repair shoulder capsule ................................................................... 7 $941 254 $1,110 2.20

23465 1 Repair shoulder capsule ................................................................... 5 $678 254 $1,110 2.20

23466 1 Repair shoulder capsule ................................................................... 7 $941 254 $1,110 2.20

23470 3 Reconstruct shoulder joint ................................................................ ................ ................ ................ ................ ................

23472 3 Reconstruct shoulder joint ................................................................ ................ ................ ................ ................ ................

23480 1 Revision of collarbone ...................................................................... 4 $595 253 $775 1.54

23485 1 Revision of collar bone ..................................................................... 7 $941 253 $775 1.54

23490 1 Reinforce clavicle .............................................................................. 3 $482 253 $775 1.54

23491 1 Reinforce shoulder bones ................................................................. 3 $482 253 $775 1.54

23500 1 Treat clavicle fracture ....................................................................... 1 $314 207 $53 0.11

23505 1 Treat clavicle fracture ....................................................................... 1 $314 207 $53 0.11

23515 1 Repair clavicle fracture ..................................................................... 3 $482 216 $580 1.15

23520 1 Treat clavicle dislocation ................................................................... 1 $314 207 $53 0.11

23525 1 Treat clavicle dislocation ................................................................... 1 $314 207 $53 0.11

23530 1 Repair clavicle dislocation ................................................................ 3 $482 216 $580 1.15

23532 1 Repair clavicle dislocation ................................................................ 4 $595 216 $580 1.15

23540 1 Treat clavicle dislocation ................................................................... 1 $314 207 $53 0.11

23545 1 Treat clavicle dislocation ................................................................... 1 $314 207 $53 0.11

23550 1 Repair clavicle dislocation ................................................................ 3 $482 216 $580 1.15

23552 1 Repair clavicle dislocation ................................................................ 4 $595 216 $580 1.15

23570 1 Treat shoulderblade fracture ............................................................. 1 $314 207 $53 0.11

23575 1 Treat shoulderblade fracture ............................................................. 1 $314 207 $53 0.11

23585 1 Repair scapula fracture ..................................................................... 3 $482 216 $580 1.15

23600 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14

23605 1 Treat humerus fracture ..................................................................... 2 $422 209 $71 0.14

23615 1 Repair humerus fracture ................................................................... 4 $595 216 $580 1.15

23616 1 Repair humerus fracture ................................................................... 4 $595 216 $580 1.15

23620 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14
32342

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

23625 1 Treat humerus fracture ..................................................................... 2 $422 209 $71 0.14

23630 1 Repair humerus fracture ................................................................... 5 $678 216 $580 1.15

23650 1 Treat shoulder dislocation ................................................................. 1 $314 207 $53 0.11

23655 1 Treat shoulder dislocation ................................................................. 1 $314 210 $397 0.79

23660 1 Repair shoulder dislocation .............................................................. 3 $482 216 $580 1.15

23665 1 Treat dislocation/fracture .................................................................. 2 $422 209 $71 0.14

23670 1 Repair dislocation/fracture ................................................................ 3 $482 216 $580 1.15

23675 1 Treat dislocation/fracture .................................................................. 2 $422 209 $71 0.14

23680 1 Repair dislocation/fracture ................................................................ 3 $482 216 $580 1.15

23700 1 Fixation of shoulder .......................................................................... 1 $314 210 $397 0.79

23800 1 Fusion of shoulder joint .................................................................... 4 $595 253 $775 1.54

23802 1 Fusion of shoulder joint .................................................................... 7 $941 253 $775 1.54

23900 3 Amputation of arm & girdle ............................................................... ................ ................ ................ ................ ................

23920 3 Amputation at shoulder joint ............................................................. ................ ................ ................ ................ ................

23921 1 Amputation follow-up surgery ........................................................... 3 $482 183 $465 0.92

23929 3 Shoulder surgery procedure ............................................................. ................ ................ ................ ................ ................

23930 1 Drainage of arm lesion ..................................................................... 1 $314 132 $162 0.32

23931 1 Drainage of arm bursa ...................................................................... 2 $422 132 $162 0.32

23935 1 Drain arm/elbow bone lesion ............................................................ 2 $422 251 $504 1.00

24000 1 Exploratory elbow surgery ................................................................ 4 $595 252 $574 1.14

24006 1 Release elbow joint ........................................................................... ................ ................ 252 $574 1.14 Add.

24065 5 Biopsy arm/elbow soft tissue ............................................................ 1 $314 ................ ................ ................ Delete.

24066 1 Biopsy arm/elbow soft tissue ............................................................ 2 $422 163 $449 0.89

24075 1 Remove arm/elbow lesion ................................................................ 2 $422 162 $187 0.37

24076 1 Remove arm/elbow lesion ................................................................ 2 $422 163 $449 0.89

24077 1 Remove tumor of arm/elbow ............................................................ 3 $482 163 $449 0.89

24100 1 Biopsy elbow joint lining ................................................................... 1 $314 251 $504 1.00

24101 1 Explore/treat elbow joint ................................................................... 4 $595 252 $574 1.14

24102 1 Remove elbow joint lining ................................................................. 4 $595 252 $574 1.14

24105 1 Removal of elbow bursa ................................................................... 3 $482 251 $504 1.00

24110 1 Remove humerus lesion ................................................................... 2 $422 251 $504 1.00

24115 1 Remove/graft bone lesion ................................................................. 3 $482 252 $574 1.14

24116 1 Remove/graft bone lesion ................................................................. 3 $482 252 $574 1.14

24120 1 Remove elbow lesion ........................................................................ 3 $482 251 $504 1.00

24125 1 Remove/graft bone lesion ................................................................. 3 $482 252 $574 1.14

24126 1 Remove/graft bone lesion ................................................................. 3 $482 252 $574 1.14

24130 1 Removal of head of radius ............................................................... 3 $482 252 $574 1.14

24134 1 Removal of arm bone lesion ............................................................. 2 $422 252 $574 1.14

24136 1 Remove radius bone lesion .............................................................. 2 $422 252 $574 1.14

24138 1 Remove elbow bone lesion .............................................................. 2 $422 252 $574 1.14

24140 1 Partial removal of arm bone ............................................................. 3 $482 252 $574 1.14

24145 1 Partial removal of radius ................................................................... 3 $482 252 $574 1.14

24147 1 Partial removal of elbow ................................................................... 2 $422 252 $574 1.14

24149 3 Radical resection of elbow ................................................................ ................ ................ ................ ................ ................

24150 3 Extensive humerus surgery .............................................................. 3 $482 ................ ................ ................ Delete.

24151 3 Extensive humerus surgery .............................................................. 4 $595 ................ ................ ................ Delete.

24152 3 Extensive radius surgery .................................................................. 3 $482 ................ ................ ................ Delete.

24153 3 Extensive radius surgery .................................................................. 4 $595 ................ ................ ................ Delete.

24155 1 Removal of elbow joint ..................................................................... 3 $482 253 $775 1.54

24160 1 Remove elbow joint implant .............................................................. 2 $422 252 $574 1.14

24164 1 Remove radius head implant ............................................................ 3 $482 252 $574 1.14

24200 5 Removal of arm foreign body ........................................................... ................ ................ ................ ................ ................

24201 1 Removal of arm foreign body ........................................................... 2 $422 163 $449 0.89

24220 2 Injection for elbow x-ray .................................................................... ................ ................ ................ ................ ................

24301 1 Muscle/tendon transfer ..................................................................... 4 $595 252 $574 1.14

24305 1 Arm tendon lengthening .................................................................... ................ ................ 252 $574 1.14 Add.

24310 1 Revision of arm tendon ..................................................................... 3 $482 251 $504 1.00

24320 1 Repair of arm tendon ........................................................................ 3 $482 253 $775 1.54

24330 1 Revision of arm muscles .................................................................. 3 $482 253 $775 1.54

24331 1 Revision of arm muscles .................................................................. 3 $482 253 $775 1.54

24340 1 Repair of biceps tendon .................................................................... 3 $482 253 $775 1.54

24341 1 Repair tendon/muscle arm ................................................................ ................ ................ 253 $775 1.54 Add.

24342 1 Repair of ruptured tendon ................................................................. 3 $482 253 $775 1.54

24350 1 Repair of tennis elbow ...................................................................... 3 $482 252 $574 1.14

24351 1 Repair of tennis elbow ...................................................................... 3 $482 252 $574 1.14

24352 1 Repair of tennis elbow ...................................................................... 3 $482 252 $574 1.14

24354 1 Repair of tennis elbow ...................................................................... 3 $482 252 $574 1.14

24356 1 Revision of tennis elbow ................................................................... 3 $482 252 $574 1.14

24360 1 Reconstruct elbow joint ..................................................................... 5 $678 217 $695 1.38

24361 1 Reconstruct elbow joint ..................................................................... 5 $678 218 $730 1.45

24362 1 Reconstruct elbow joint ..................................................................... 5 $678 218 $730 1.45

24363 1 Replace elbow joint ........................................................................... 7 $941 218 $730 1.45

24365 1 Reconstruct head of radius ............................................................... 5 $678 217 $695 1.38

24366 1 Reconstruct head of radius ............................................................... 5 $678 218 $730 1.45
32343

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

24400 1 Revision of humerus ......................................................................... 4 $595 252 $574 1.14

24410 1 Revision of humerus ......................................................................... 4 $595 252 $574 1.14

24420 1 Revision of humerus ......................................................................... 3 $482 253 $775 1.54

24430 1 Repair of humerus ............................................................................ 3 $482 253 $775 1.54

24435 1 Repair humerus with graft ................................................................ 4 $595 253 $775 1.54

24470 1 Revision of elbow joint ...................................................................... 3 $482 253 $775 1.54

24495 1 Decompression of forearm ............................................................... 2 $422 252 $574 1.14

24498 1 Reinforce humerus ............................................................................ 3 $482 253 $775 1.54

24500 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14

24505 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14

24515 1 Repair humerus fracture ................................................................... 4 $595 216 $580 1.15

24516 1 Repair humerus fracture ................................................................... 4 $595 216 $580 1.15

24530 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14

24535 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14

24538 1 Treat humerus fracture ..................................................................... 2 $422 216 $580 1.15

24545 1 Repair humerus fracture ................................................................... 4 $595 216 $580 1.15

24546 1 Repair humerus fracture ................................................................... 5 $678 216 $580 1.15

24560 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14

24565 1 Treat humerus fracture ..................................................................... 2 $422 209 $71 0.14

24566 1 Treat humerus fracture ..................................................................... 2 $422 216 $580 1.15

24575 1 Repair humerus fracture ................................................................... 3 $482 216 $580 1.15

24576 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14

24577 1 Treat humerus fracture ..................................................................... 1 $314 209 $71 0.14

24579 1 Repair humerus fracture ................................................................... 3 $482 216 $580 1.15

24582 1 Treat humerus fracture ..................................................................... 2 $422 216 $580 1.15

24586 1 Repair elbow fracture ........................................................................ 4 $595 216 $580 1.15

24587 1 Repair elbow fracture ........................................................................ 5 $678 216 $580 1.15

24600 1 Treat elbow dislocation ..................................................................... 1 $314 209 $71 0.14

24605 1 Treat elbow dislocation ..................................................................... 2 $422 210 $397 0.79

24615 1 Repair elbow dislocation ................................................................... 3 $482 216 $580 1.15

24620 1 Treat elbow fracture .......................................................................... 2 $422 209 $71 0.14

24635 1 Repair elbow fracture ........................................................................ 3 $482 216 $580 1.15

24640 1 Treat elbow dislocation ..................................................................... ................ ................ 209 $71 0.14 Add.

24650 1 Treat radius fracture ......................................................................... ................ ................ 209 $71 0.14 Add.

24655 1 Treat radius fracture ......................................................................... 1 $314 209 $71 0.14

24665 1 Repair radius fracture ....................................................................... 4 $595 216 $580 1.15

24666 1 Repair radius fracture ....................................................................... 4 $595 216 $580 1.15

24670 1 Treatment of ulna fracture ................................................................ 1 $314 209 $71 0.14

24675 1 Treatment of ulna fracture ................................................................ 1 $314 209 $71 0.14

24685 1 Repair ulna fracture .......................................................................... 3 $482 216 $580 1.15

24800 1 Fusion of elbow joint ......................................................................... 4 $595 253 $775 1.54

24802 1 Fusion/graft of elbow joint ................................................................. 5 $678 253 $775 1.54

24900 3 Amputation of upper arm .................................................................. ................ ................ ................ ................ ................

24920 3 Amputation of upper arm .................................................................. ................ ................ ................ ................ ................

24925 1 Amputation follow-up surgery ........................................................... 3 $482 251 $504 1.00

24930 3 Amputation follow-up surgery ........................................................... ................ ................ ................ ................ ................

24931 3 Amputate upper arm & implant ......................................................... ................ ................ ................ ................ ................

24935 3 Revision of amputation ..................................................................... ................ ................ ................ ................ ................

24940 3 Revision of upper arm ...................................................................... ................ ................ ................ ................ ................

24999 3 Upper arm/elbow surgery ................................................................. ................ ................ ................ ................ ................

25000 1 Incision of tendon sheath .................................................................. 3 $482 251 $504 1.00

25020 1 Decompression of forearm ............................................................... 3 $482 251 $504 1.00

25023 1 Decompression of forearm ............................................................... 3 $482 252 $574 1.14

25028 1 Drainage of forearm lesion ............................................................... 1 $314 251 $504 1.00

25031 1 Drainage of forearm bursa ................................................................ 2 $422 251 $504 1.00

25035 1 Treat forearm bone lesion ................................................................ 2 $422 251 $504 1.00

25040 1 Explore/treat wrist joint ..................................................................... 5 $678 252 $574 1.14

25065 5 Biopsy forearm soft tissues .............................................................. 1 $314 ................ ................ ................ Delete.

25066 1 Biopsy forearm soft tissues .............................................................. 2 $422 163 $449 0.89

25075 1 Removal of forearm lesion ................................................................ 2 $422 162 $187 0.37

25076 1 Removal of forearm lesion ................................................................ 3 $482 163 $449 0.89

25077 1 Remove tumor, forearm/wrist ........................................................... 3 $482 163 $449 0.89

25085 1 Incision of wrist capsule .................................................................... 3 $482 251 $504 1.00

25100 1 Biopsy of wrist joint ........................................................................... 2 $422 251 $504 1.00

25101 1 Explore/treat wrist joint ..................................................................... 3 $482 252 $574 1.14

25105 1 Remove wrist joint lining ................................................................... 4 $595 252 $574 1.14

25107 1 Remove wrist joint cartilage .............................................................. 3 $482 252 $574 1.14

25110 1 Remove wrist tendon lesion ............................................................. 3 $482 251 $504 1.00

25111 1 Remove wrist tendon lesion ............................................................. 3 $482 261 $494 0.98

25112 1 Reremove wrist tendon lesion .......................................................... 4 $595 261 $494 0.98

25115 1 Remove wrist/forearm lesion ............................................................ 4 $595 251 $504 1.00

25116 1 Remove wrist/forearm lesion ............................................................ 4 $595 251 $504 1.00

25118 1 Excise wrist tendon sheath ............................................................... 2 $422 252 $574 1.14

25119 1 Partial removal of ulna ...................................................................... 3 $482 252 $574 1.14
32344

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

25120 1 Removal of forearm lesion ................................................................ 3 $482 252 $574 1.14

25125 1 Remove/graft forearm lesion ............................................................ 3 $482 252 $574 1.14

25126 1 Remove/graft forearm lesion ............................................................ 3 $482 252 $574 1.14

25130 1 Removal of wrist lesion ..................................................................... 3 $482 252 $574 1.14

25135 1 Remove & graft wrist lesion .............................................................. 3 $482 252 $574 1.14

25136 1 Remove & graft wrist lesion .............................................................. 3 $482 252 $574 1.14

25145 1 Remove forearm bone lesion ........................................................... 2 $422 252 $574 1.14

25150 1 Partial removal of ulna ...................................................................... 2 $422 252 $574 1.14

25151 1 Partial removal of radius ................................................................... 2 $422 252 $574 1.14

25170 3 Extensive forearm surgery ................................................................ 3 $482 ................ ................ ................ Delete.

25210 1 Removal of wrist bone ...................................................................... 3 $482 262 $543 1.08

25215 1 Removal of wrist bones .................................................................... 4 $595 262 $543 1.08

25230 1 Partial removal of radius ................................................................... 4 $595 252 $574 1.14

25240 1 Partial removal of ulna ...................................................................... 4 $595 252 $574 1.14

25246 2 Injection for wrist x-ray ...................................................................... ................ ................ ................ ................ ................

25248 1 Remove forearm foreign body .......................................................... 2 $422 251 $504 1.00

25250 1 Removal of wrist prosthesis .............................................................. 1 $314 252 $574 1.14

25251 1 Removal of wrist prosthesis .............................................................. 1 $314 252 $574 1.14

25260 1 Repair forearm tendon/muscle ......................................................... 4 $595 252 $574 1.14

25263 1 Repair forearm tendon/muscle ......................................................... 2 $422 252 $574 1.14

25265 1 Repair forearm tendon/muscle ......................................................... 3 $482 252 $574 1.14

25270 1 Repair forearm tendon/muscle ......................................................... 4 $595 252 $574 1.14

25272 1 Repair forearm tendon/muscle ......................................................... 3 $482 252 $574 1.14

25274 1 Repair forearm tendon/muscle ......................................................... 4 $595 252 $574 1.14

25280 1 Revise wrist/forearm tendon ............................................................. 4 $595 252 $574 1.14

25290 1 Incise wrist/forearm tendon ............................................................... 3 $482 252 $574 1.14

25295 1 Release wrist/forearm tendon ........................................................... 3 $482 251 $504 1.00

25300 1 Fusion of tendons at wrist ................................................................ 3 $482 252 $574 1.14

25301 1 Fusion of tendons at wrist ................................................................ 3 $482 252 $574 1.14

25310 1 Transplant forearm tendon ............................................................... 3 $482 253 $775 1.54

25312 1 Transplant forearm tendon ............................................................... 4 $595 253 $775 1.54

25315 1 Revise palsy hand tendon(s) ............................................................ 3 $482 253 $775 1.54

25316 1 Revise palsy hand tendon(s) ............................................................ 3 $482 253 $775 1.54

25320 1 Repair/revise wrist joint ..................................................................... 3 $482 253 $775 1.54

25332 1 Revise wrist joint ............................................................................... 5 $678 217 $695 1.38

25335 1 Realignment of hand ......................................................................... 3 $482 253 $775 1.54

25337 1 Reconstruct ulna/radioulnar .............................................................. ................ ................ 253 $775 1.54 Add.

25350 1 Revision of radius ............................................................................. 3 $482 253 $775 1.54

25355 1 Revision of radius ............................................................................. 3 $482 253 $775 1.54

25360 1 Revision of ulna ................................................................................ 3 $482 252 $574 1.14

25365 1 Revise radius & ulna ......................................................................... 3 $482 252 $574 1.14

25370 1 Revise radius or ulna ........................................................................ 3 $482 253 $775 1.54

25375 1 Revise radius & ulna ......................................................................... 4 $595 253 $775 1.54

25390 3 Shorten radius/ulna ........................................................................... 3 $482 ................ ................ ................ Delete.

25391 3 Lengthen radius/ulna ........................................................................ 4 $595 ................ ................ ................ Delete.

25392 3 Shorten radius & ulna ....................................................................... 3 $482 ................ ................ ................ Delete.

25393 3 Lengthen radius & ulna ..................................................................... 4 $595 ................ ................ ................ Delete.

25400 1 Repair radius or ulna ........................................................................ 3 $482 252 $574 1.14

25405 3 Repair/graft radius or ulna ................................................................ 4 $595 ................ ................ ................ Delete.

25415 1 Repair radius & ulna ......................................................................... 3 $482 252 $574 1.14

25420 3 Repair/graft radius & ulna ................................................................. 4 $595 ................ ................ ................ Delete.

25425 1 Repair/graft radius or ulna ................................................................ 3 $482 253 $775 1.54

25426 1 Repair/graft radius & ulna ................................................................. 4 $595 253 $775 1.54

25440 1 Repair/graft wrist bone ...................................................................... 4 $595 253 $775 1.54

25441 1 Reconstruct wrist joint ....................................................................... 5 $678 218 $730 1.45

25442 1 Reconstruct wrist joint ....................................................................... 5 $678 218 $730 1.45

25443 1 Reconstruct wrist joint ....................................................................... 5 $678 218 $730 1.45

25444 1 Reconstruct wrist joint ....................................................................... 5 $678 218 $730 1.45

25445 1 Reconstruct wrist joint ....................................................................... 5 $678 218 $730 1.45

25446 1 Wrist replacement ............................................................................. 7 $941 218 $730 1.45

25447 1 Repair wrist joint(s) ........................................................................... 5 $678 217 $695 1.38

25449 1 Remove wrist joint implant ................................................................ 5 $678 217 $695 1.38

25450 1 Revision of wrist joint ........................................................................ 3 $482 253 $775 1.54

25455 1 Revision of wrist joint ........................................................................ 3 $482 253 $775 1.54

25490 1 Reinforce radius ................................................................................ 3 $482 253 $775 1.54

25491 1 Reinforce ulna ................................................................................... 3 $482 253 $775 1.54

25492 1 Reinforce radius and ulna ................................................................. 3 $482 253 $775 1.54

25500 1 Treat fracture of radius ..................................................................... ................ ................ 209 $71 0.14 Add.

25505 1 Treat fracture of radius ..................................................................... 1 $314 209 $71 0.14

25515 1 Repair fracture of radius ................................................................... 3 $482 216 $580 1.15

25520 1 Repair fracture of radius ................................................................... 1 $314 209 $71 0.14

25525 1 Repair fracture of radius ................................................................... 4 $595 216 $580 1.15

25526 1 Repair fracture of radius ................................................................... 5 $678 216 $580 1.15

25530 1 Treat fracture of ulna ........................................................................ ................ ................ 209 $71 0.14 Add.
32345

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

25535 1 Treat fracture of ulna ........................................................................ 1 $314 209 $71 0.14

25545 1 Repair fracture of ulna ...................................................................... 3 $482 216 $580 1.15

25560 1 Treat fracture radius & ulna .............................................................. ................ ................ 209 $71 0.14 Add.

25565 1 Treat fracture radius & ulna .............................................................. 2 $422 209 $71 0.14

25574 1 Treat fracture radius & ulna .............................................................. 3 $482 216 $580 1.15

25575 1 Repair fracture radius/ulna ............................................................... 3 $482 216 $580 1.15

25600 1 Treat fracture radius/ulna .................................................................. ................ ................ 209 $71 0.14 Add.

25605 1 Treat fracture radius/ulna .................................................................. 3 $482 209 $71 0.14

25611 1 Repair fracture radius/ulna ............................................................... 3 $482 216 $580 1.15

25620 1 Repair fracture radius/ulna ............................................................... 5 $678 216 $580 1.15

25622 1 Treat wrist bone fracture ................................................................... ................ ................ 209 $71 0.14 Add.

25624 1 Treat wrist bone fracture ................................................................... 2 $422 209 $71 0.14

25628 1 Repair wrist bone fracture ................................................................ 3 $482 216 $580 1.15

25630 1 Treat wrist bone fracture ................................................................... ................ ................ 209 $71 0.14 Add.

25635 1 Treat wrist bone fracture ................................................................... 1 $314 209 $71 0.14

25645 1 Repair wrist bone fracture ................................................................ 3 $482 216 $580 1.15

25650 1 Repair wrist bone fracture ................................................................ ................ ................ 209 $71 0.14 Add.

25660 1 Treat wrist dislocation ....................................................................... 1 $314 209 $71 0.14

25670 1 Repair wrist dislocation ..................................................................... 3 $482 216 $580 1.15

25675 1 Treat wrist dislocation ....................................................................... 1 $314 209 $71 0.14

25676 1 Repair wrist dislocation ..................................................................... 2 $422 216 $580 1.15

25680 1 Treat wrist fracture ............................................................................ 2 $422 209 $71 0.14

25685 1 Repair wrist fracture .......................................................................... 3 $482 216 $580 1.15

25690 1 Treat wrist dislocation ....................................................................... 1 $314 209 $71 0.14

25695 1 Repair wrist dislocation ..................................................................... 2 $422 216 $580 1.15

25800 1 Fusion of wrist joint ........................................................................... 4 $595 253 $775 1.54

25805 1 Fusion/graft of wrist joint ................................................................... 5 $678 253 $775 1.54

25810 1 Fusion/graft of wrist joint ................................................................... 5 $678 253 $775 1.54

25820 1 Fusion of hand bones ....................................................................... 4 $595 261 $494 0.98

25825 1 Fusion hand bones with graft ........................................................... 5 $678 262 $543 1.08

25830 1 Fusion radioulnar jnt/ulna ................................................................. ................ ................ 253 $775 1.54 Add.

25900 3 Amputation of forearm ...................................................................... ................ ................ ................ ................ ................

25905 3 Amputation of forearm ...................................................................... ................ ................ ................ ................ ................

25907 1 Amputation follow-up surgery ........................................................... 3 $482 251 $504 1.00

25909 3 Amputation follow-up surgery ........................................................... ................ ................ ................ ................ ................

25915 3 Amputation of forearm ...................................................................... ................ ................ ................ ................ ................

25920 3 Amputate hand at wrist ..................................................................... ................ ................ ................ ................ ................

25922 1 Amputate hand at wrist ..................................................................... 3 $482 251 $504 1.00

25924 3 Amputation follow-up surgery ........................................................... ................ ................ ................ ................ ................

25927 3 Amputation of hand ........................................................................... ................ ................ ................ ................ ................

25929 1 Amputation follow-up surgery ........................................................... 3 $482 183 $465 0.92

25931 3 Amputation follow-up surgery ........................................................... ................ ................ ................ ................ ................

25999 3 Forearm or wrist surgery .................................................................. ................ ................ ................ ................ ................

26010 5 Drainage of finger abscess ............................................................... ................ ................ ................ ................ ................

26011 5 Drainage of finger abscess ............................................................... 1 $314 ................ ................ ................ Delete.

26020 1 Drain hand tendon sheath ................................................................ 2 $422 261 $494 0.98

26025 1 Drainage of palm bursa .................................................................... 1 $314 261 $494 0.98

26030 1 Drainage of palm bursa(s) ................................................................ 2 $422 261 $494 0.98

26034 1 Treat hand bone lesion ..................................................................... 2 $422 261 $494 0.98

26035 1 Decompress fingers/hand ................................................................. 4 $595 261 $494 0.98

26037 1 Decompress fingers/hand ................................................................. 4 $595 261 $494 0.98

26040 1 Release palm contracture ................................................................. 4 $595 262 $543 1.08

26045 1 Release palm contracture ................................................................. 3 $482 262 $543 1.08

26055 1 Incise finger tendon sheath .............................................................. 2 $422 261 $494 0.98

26060 1 Incision of finger tendon ................................................................... 2 $422 261 $494 0.98

26070 1 Explore/treat hand joint ..................................................................... 2 $422 261 $494 0.98

26075 1 Explore/treat finger joint .................................................................... 4 $595 261 $494 0.98

26080 1 Explore/treat finger joint .................................................................... 4 $595 261 $494 0.98

26100 1 Biopsy hand joint lining ..................................................................... 2 $422 261 $494 0.98

26105 1 Biopsy finger joint lining .................................................................... 1 $314 261 $494 0.98

26110 1 Biopsy finger joint lining .................................................................... 1 $314 261 $494 0.98

26115 1 Removal of hand lesion .................................................................... 2 $422 163 $449 0.89

26116 1 Removal of hand lesion .................................................................... 2 $422 163 $449 0.89

26117 1 Remove tumor, hand/finger .............................................................. 3 $482 163 $449 0.89

26121 1 Release palm contracture ................................................................. 4 $595 262 $543 1.08

26123 1 Release palm contracture ................................................................. 4 $595 262 $543 1.08

26125 1 Release palm contracture ................................................................. 4 $595 262 $543 1.08

26130 1 Remove wrist joint lining ................................................................... 3 $482 261 $494 0.98

26135 1 Revise finger joint, each ................................................................... 4 $595 262 $543 1.08

26140 1 Revise finger joint, each ................................................................... 2 $422 261 $494 0.98

26145 1 Tendon excision, palm/finger ............................................................ 3 $482 261 $494 0.98

26160 1 Remove tendon sheath lesion .......................................................... 3 $482 261 $494 0.98

26170 1 Removal of palm tendon, each ......................................................... 3 $482 261 $494 0.98

26180 1 Removal of finger tendon ................................................................. 3 $482 261 $494 0.98
32346

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

26185 1 Remove finger bone ......................................................................... ................ ................ 261 $494 0.98 Add.

26200 1 Remove hand bone lesion ................................................................ 2 $422 261 $494 0.98

26205 1 Remove/graft bone lesion ................................................................. 3 $482 262 $543 1.08

26210 1 Removal of finger lesion ................................................................... 2 $422 261 $494 0.98

26215 1 Remove/graft finger lesion ................................................................ 3 $482 261 $494 0.98

26230 1 Partial removal of hand bone ........................................................... 7 $941 261 $494 0.98

26235 1 Partial removal, finger bone .............................................................. 3 $482 261 $494 0.98

26236 1 Partial removal, finger bone .............................................................. 3 $482 261 $494 0.98

26250 1 Extensive hand surgery .................................................................... 3 $482 261 $494 0.98

26255 1 Extensive hand surgery .................................................................... 3 $482 262 $543 1.08

26260 1 Extensive finger surgery ................................................................... 3 $482 261 $494 0.98

26261 1 Extensive finger surgery ................................................................... 3 $482 261 $494 0.98

26262 1 Partial removal of finger .................................................................... 2 $422 261 $494 0.98

26320 1 Removal of implant from hand ......................................................... 2 $422 163 $449 0.89

26350 1 Repair finger/hand tendon ................................................................ 1 $314 262 $543 1.08

26352 1 Repair/graft hand tendon .................................................................. 4 $595 262 $543 1.08

26356 1 Repair finger/hand tendon ................................................................ 4 $595 262 $543 1.08

26357 1 Repair finger/hand tendon ................................................................ 4 $595 262 $543 1.08

26358 1 Repair/graft hand tendon .................................................................. 4 $595 262 $543 1.08

26370 1 Repair finger/hand tendon ................................................................ 4 $595 262 $543 1.08

26372 1 Repair/graft hand tendon .................................................................. 4 $595 262 $543 1.08

26373 1 Repair finger/hand tendon ................................................................ 3 $482 262 $543 1.08

26390 1 Revise hand/finger tendon ................................................................ 4 $595 262 $543 1.08

26392 1 Repair/graft hand tendon .................................................................. 3 $482 262 $543 1.08

26410 1 Repair hand tendon .......................................................................... 3 $482 261 $494 0.98

26412 1 Repair/graft hand tendon .................................................................. 3 $482 262 $543 1.08

26415 1 Excision, hand/finger tendon ............................................................ 4 $595 262 $543 1.08

26416 1 Graft hand or finger tendon .............................................................. 3 $482 262 $543 1.08

26418 1 Repair finger tendon ......................................................................... 4 $595 261 $494 0.98

26420 1 Repair/graft finger tendon ................................................................. 4 $595 262 $543 1.08

26426 1 Repair finger/hand tendon ................................................................ 3 $482 262 $543 1.08

26428 1 Repair/graft finger tendon ................................................................. 3 $482 262 $543 1.08

26432 1 Repair finger tendon ......................................................................... 3 $482 261 $494 0.98

26433 1 Repair finger tendon ......................................................................... 3 $482 261 $494 0.98

26434 1 Repair/graft finger tendon ................................................................. 3 $482 262 $543 1.08

26437 1 Realignment of tendons .................................................................... 3 $482 261 $494 0.98

26440 1 Release palm/finger tendon .............................................................. 3 $482 261 $494 0.98

26442 1 Release palm & finger tendon .......................................................... 3 $482 262 $543 1.08

26445 1 Release hand/finger tendon .............................................................. 3 $482 261 $494 0.98

26449 1 Release forearm/hand tendon .......................................................... 3 $482 262 $543 1.08

26450 1 Incision of palm tendon ..................................................................... 3 $482 261 $494 0.98

26455 1 Incision of finger tendon ................................................................... 3 $482 261 $494 0.98

26460 1 Incise hand/finger tendon ................................................................. 3 $482 261 $494 0.98

26471 1 Fusion of finger tendons ................................................................... 2 $422 261 $494 0.98

26474 1 Fusion of finger tendons ................................................................... 2 $422 261 $494 0.98

26476 1 Tendon lengthening .......................................................................... 1 $314 261 $494 0.98

26477 1 Tendon shortening ............................................................................ 1 $314 261 $494 0.98

26478 1 Lengthening of hand tendon ............................................................. 1 $314 261 $494 0.98

26479 1 Shortening of hand tendon ............................................................... 1 $314 261 $494 0.98

26480 1 Transplant hand tendon .................................................................... 3 $482 262 $543 1.08

26483 1 Transplant/graft hand tendon ............................................................ 3 $482 262 $543 1.08

26485 1 Transplant palm tendon .................................................................... 2 $422 262 $543 1.08

26489 1 Transplant/graft palm tendon ............................................................ 3 $482 262 $543 1.08

26490 1 Revise thumb tendon ........................................................................ 3 $482 262 $543 1.08

26492 1 Tendon transfer with graft ................................................................. 3 $482 262 $543 1.08

26494 1 Hand tendon/muscle transfer ............................................................ 3 $482 262 $543 1.08

26496 1 Revise thumb tendon ........................................................................ 3 $482 262 $543 1.08

26497 1 Finger tendon transfer ...................................................................... 3 $482 262 $543 1.08

26498 1 Finger tendon transfer ...................................................................... 4 $595 262 $543 1.08

26499 1 Revision of finger .............................................................................. 3 $482 262 $543 1.08

26500 1 Hand tendon reconstruction .............................................................. 4 $595 261 $494 0.98

26502 1 Hand tendon reconstruction .............................................................. 4 $595 262 $543 1.08

26504 1 Hand tendon reconstruction .............................................................. 4 $595 262 $543 1.08

26508 1 Release thumb contracture ............................................................... 3 $482 261 $494 0.98

26510 1 Thumb tendon transfer ..................................................................... 3 $482 262 $543 1.08

26516 1 Fusion of knuckle joint ...................................................................... 1 $314 262 $543 1.08

26517 1 Fusion of knuckle joints .................................................................... 3 $482 262 $543 1.08

26518 1 Fusion of knuckle joints .................................................................... 3 $482 262 $543 1.08

26520 1 Release knuckle contracture ............................................................ 3 $482 261 $494 0.98

26525 1 Release finger contracture ................................................................ 3 $482 261 $494 0.98

26530 1 Revise knuckle joint .......................................................................... 3 $482 217 $695 1.38

26531 1 Revise knuckle with implant ............................................................. 7 $941 218 $730 1.45

26535 1 Revise finger joint ............................................................................. 5 $678 217 $695 1.38

26536 1 Revise/implant finger joint ................................................................. 5 $678 218 $730 1.45
32347

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

26540 1 Repair hand joint ............................................................................... 4 $595 261 $494 0.98

26541 1 Repair hand joint with graft ............................................................... 7 $941 262 $543 1.08

26542 1 Repair hand joint with graft ............................................................... 4 $595 261 $494 0.98

26545 1 Reconstruct finger joint ..................................................................... 4 $595 262 $543 1.08

26546 1 Repair non-union hand ..................................................................... ................ ................ 262 $543 1.08 Add.

26548 1 Reconstruct finger joint ..................................................................... 4 $595 262 $543 1.08

26550 1 Construct thumb replacement ........................................................... 2 $422 262 $543 1.08

26551 3 Great toe-hand transfer .................................................................... 4 $595 ................ ................ ................ Delete.

26553 3 Single toe-hand transfer ................................................................... 2 $422 ................ ................ ................ Delete.

26554 3 Double toe-hand transfer .................................................................. 2 $422 ................ ................ ................ Delete.

26555 1 Positional change of finger ............................................................... 3 $482 262 $543 1.08

26556 3 Toe joint transfer ............................................................................... ................ ................ ................ ................ ................

26560 1 Repair of web finger ......................................................................... 2 $422 261 $494 0.98

26561 1 Repair of web finger ......................................................................... 3 $482 262 $543 1.08

26562 1 Repair of web finger ......................................................................... 4 $595 262 $543 1.08

26565 1 Correct metacarpal flaw .................................................................... 5 $678 262 $543 1.08

26567 1 Correct finger deformity .................................................................... 5 $678 262 $543 1.08

26568 1 Lengthen metacarpal/finger .............................................................. 3 $482 262 $543 1.08

26580 1 Repair hand deformity ...................................................................... 5 $678 262 $543 1.08

26585 1 Repair finger deformity ..................................................................... 5 $678 262 $543 1.08

26587 1 Reconstruct extra finger .................................................................... 5 $678 261 $494 0.98

26590 1 Repair finger deformity ..................................................................... 5 $678 262 $543 1.08

26591 1 Repair muscles of hand .................................................................... 3 $482 262 $543 1.08

26593 1 Release muscles of hand ................................................................. 3 $482 261 $494 0.98

26596 1 Excision constricting tissue ............................................................... 2 $422 262 $543 1.08

26597 1 Release of scar contracture .............................................................. 3 $482 262 $543 1.08

26600 1 Treat metacarpal fracture ................................................................. ................ ................ 209 $71 0.14 Add.

26605 1 Treat metacarpal fracture ................................................................. 2 $422 209 $71 0.14

26607 1 Treat metacarpal fracture ................................................................. 2 $422 209 $71 0.14

26608 1 Treat metacarpal fracture ................................................................. ................ ................ 216 $580 1.15 Add.

26615 1 Repair metacarpal fracture ............................................................... 4 $595 216 $580 1.15

26641 1 Treat thumb dislocation .................................................................... ................ ................ 209 $71 0.14 Add.

26645 1 Treat thumb fracture ......................................................................... 1 $314 209 $71 0.14

26650 1 Repair thumb fracture ....................................................................... 2 $422 216 $580 1.15

26665 1 Repair thumb fracture ....................................................................... 4 $595 216 $580 1.15

26670 1 Treat hand dislocation ...................................................................... ................ ................ 209 $71 0.14 Add.

26675 1 Treat hand dislocation ...................................................................... 2 $422 210 $397 0.79

26676 1 Pin hand dislocation .......................................................................... 2 $422 216 $580 1.15

26685 1 Repair hand dislocation .................................................................... 3 $482 216 $580 1.15

26686 1 Repair hand dislocation .................................................................... 3 $482 216 $580 1.15

26700 1 Treat knuckle dislocation .................................................................. ................ ................ 207 $53 0.11 Add.

26705 1 Treat knuckle dislocation .................................................................. 2 $422 210 $397 0.79

26706 1 Pin knuckle dislocation ..................................................................... 2 $422 209 $71 0.14

26715 1 Repair knuckle dislocation ................................................................ 4 $595 216 $580 1.15

26720 1 Treat finger fracture, each ................................................................ ................ ................ 207 $53 0.11 Add.

26725 1 Treat finger fracture, each ................................................................ ................ ................ 207 $53 0.11 Add.

26727 1 Treat finger fracture, each ................................................................ 7 $941 216 $580 1.15

26735 1 Repair finger fracture, each .............................................................. 4 $595 216 $580 1.15

26740 1 Treat finger fracture, each ................................................................ ................ ................ 207 $53 0.11 Add.

26742 1 Treat finger fracture, each ................................................................ 2 $422 209 $71 0.14

26746 1 Repair finger fracture, each .............................................................. 5 $678 216 $580 1.15

26750 1 Treat finger fracture, each ................................................................ ................ ................ 207 $53 0.11 Add.

26755 1 Treat finger fracture, each ................................................................ ................ ................ 207 $53 0.11 Add.

26756 1 Pin finger fracture, each ................................................................... 2 $422 216 $580 1.15

26765 1 Repair finger fracture, each .............................................................. 4 $595 216 $580 1.15

26770 1 Treat finger dislocation ..................................................................... ................ ................ 207 $53 0.11 Add.

26775 1 Treat finger dislocation ..................................................................... ................ ................ 210 $397 0.79 Add.

26776 1 Pin finger dislocation ......................................................................... 2 $422 216 $580 1.15

26785 1 Repair finger dislocation ................................................................... 2 $422 216 $580 1.15

26820 1 Thumb fusion with graft .................................................................... 5 $678 262 $543 1.08

26841 1 Fusion of thumb ................................................................................ 4 $595 262 $543 1.08

26842 1 Thumb fusion with graft .................................................................... 4 $595 262 $543 1.08

26843 1 Fusion of hand joint .......................................................................... 3 $482 262 $543 1.08

26844 1 Fusion/graft of hand joint .................................................................. 3 $482 262 $543 1.08

26850 1 Fusion of knuckle .............................................................................. 4 $595 262 $543 1.08

26852 1 Fusion of knuckle with graft .............................................................. 4 $595 262 $543 1.08

26860 1 Fusion of finger joint ......................................................................... 3 $482 262 $543 1.08

26861 1 Fusion of finger joint,added .............................................................. 2 $422 262 $543 1.08

26862 1 Fusion/graft of finger joint ................................................................. 4 $595 262 $543 1.08

26863 1 Fuse/graft added joint ....................................................................... 3 $482 262 $543 1.08

26910 1 Amputate metacarpal bone ............................................................... 3 $482 262 $543 1.08

26951 1 Amputation of finger/thumb ............................................................... 2 $422 261 $494 0.98

26952 1 Amputation of finger/thumb ............................................................... 4 $595 261 $494 0.98

26989 3 Hand/finger surgery .......................................................................... ................ ................ ................ ................ ................
32348

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

26990 1 Drainage of pelvis lesion .................................................................. 1 $314 251 $504 1.00

26991 1 Drainage of pelvis bursa ................................................................... 1 $314 251 $504 1.00

26992 3 Drainage of bone lesion .................................................................... 2 $422 ................ ................ ................ Delete.

27000 1 Incision of hip tendon ........................................................................ 2 $422 251 $504 1.00

27001 1 Incision of hip tendon ........................................................................ 3 $482 252 $574 1.14

27003 1 Incision of hip tendon ........................................................................ 3 $482 252 $574 1.14

27005 3 Incision of hip tendon ........................................................................ ................ ................ ................ ................ ................

27006 3 Incision of hip tendons ...................................................................... ................ ................ ................ ................ ................

27025 3 Incision of hip/thigh fascia ................................................................ ................ ................ ................ ................ ................

27030 3 Drainage of hip joint .......................................................................... 3 $482 ................ ................ ................ Delete.

27033 1 Exploration of hip joint ...................................................................... 3 $482 253 $775 1.54

27035 3 Denervation of hip joint ..................................................................... 4 $595 ................ ................ ................ Delete.

27036 3 Excision of hip joint/muscle .............................................................. ................ ................ ................ ................ ................

27040 1 Biopsy of soft tissues ........................................................................ 1 $314 162 $187 0.37

27041 1 Biopsy of soft tissues ........................................................................ 2 $422 163 $449 0.89

27047 1 Remove hip/pelvis lesion .................................................................. 2 $422 163 $449 0.89

27048 1 Remove hip/pelvis lesion .................................................................. 3 $482 163 $449 0.89

27049 1 Remove tumor, hip/pelvis ................................................................. 3 $482 163 $449 0.89

27050 1 Biopsy of sacroiliac joint ................................................................... 3 $482 251 $504 1.00

27052 1 Biopsy of hip joint ............................................................................. 3 $482 251 $504 1.00

27054 3 Removal of hip joint lining ................................................................ ................ ................ ................ ................ ................

27060 1 Removal of ischial bursa .................................................................. 5 $678 251 $504 1.00

27062 1 Remove femur lesion/bursa .............................................................. 5 $678 251 $504 1.00

27065 1 Removal of hip bone lesion .............................................................. 5 $678 251 $504 1.00

27066 1 Removal of hip bone lesion .............................................................. 5 $678 252 $574 1.14

27067 1 Remove/graft hip bone lesion ........................................................... ................ ................ 252 $574 1.14 Add.

27070 3 Partial removal of hip bone ............................................................... ................ ................ ................ ................ ................

27071 3 Partial removal of hip bone ............................................................... ................ ................ ................ ................ ................

27075 3 Extensive hip surgery ....................................................................... ................ ................ ................ ................ ................

27076 3 Extensive hip surgery ....................................................................... ................ ................ ................ ................ ................

27077 3 Extensive hip surgery ....................................................................... ................ ................ ................ ................ ................

27078 3 Extensive hip surgery ....................................................................... ................ ................ ................ ................ ................

27079 3 Extensive hip surgery ....................................................................... ................ ................ ................ ................ ................

27080 1 Removal of tail bone ......................................................................... 2 $422 252 $574 1.14

27086 1 Remove hip foreign body .................................................................. 1 $314 251 $504 1.00

27087 1 Remove hip foreign body .................................................................. 3 $482 251 $504 1.00

27090 3 Removal of hip prosthesis ................................................................ ................ ................ ................ ................ ................

27091 3 Removal of hip prosthesis ................................................................ ................ ................ ................ ................ ................

27093 2 Injection for hip x-ray ........................................................................ ................ ................ ................ ................ ................

27095 2 Injection for hip x-ray ........................................................................ ................ ................ ................ ................ ................

27097 1 Revision of hip tendon ...................................................................... 3 $482 252 $574 1.14

27098 1 Transfer tendon to pelvis .................................................................. 3 $482 252 $574 1.14

27100 1 Transfer of abdominal muscle .......................................................... 4 $595 253 $775 1.54

27105 1 Transfer of spinal muscle ................................................................. 4 $595 253 $775 1.54

27110 1 Transfer of iliopsoas muscle ............................................................. 4 $595 253 $775 1.54

27111 1 Transfer of iliopsoas muscle ............................................................. 4 $595 253 $775 1.54

27120 3 Reconstruction of hip socket ............................................................ ................ ................ ................ ................ ................

27122 3 Reconstruction of hip socket ............................................................ ................ ................ ................ ................ ................

27125 3 Partial hip replacement ..................................................................... ................ ................ ................ ................ ................

27130 3 Total hip replacement ....................................................................... ................ ................ ................ ................ ................

27132 3 Total hip replacement ....................................................................... ................ ................ ................ ................ ................

27134 3 Revise hip joint replacement ............................................................ ................ ................ ................ ................ ................

27137 3 Revise hip joint replacement ............................................................ ................ ................ ................ ................ ................

27138 3 Revise hip joint replacement ............................................................ ................ ................ ................ ................ ................

27140 3 Transplant of femur ridge ................................................................. ................ ................ ................ ................ ................

27146 3 Incision of hip bone ........................................................................... ................ ................ ................ ................ ................

27147 3 Revision of hip bone ......................................................................... ................ ................ ................ ................ ................

27151 3 Incision of hip bones ......................................................................... ................ ................ ................ ................ ................

27156 3 Revision of hip bones ....................................................................... ................ ................ ................ ................ ................

27158 3 Revision of pelvis .............................................................................. ................ ................ ................ ................ ................

27161 3 Incision of neck of femur .................................................................. ................ ................ ................ ................ ................

27165 3 Incision/fixation of femur ................................................................... ................ ................ ................ ................ ................

27170 3 Repair/graft femur head/neck ........................................................... ................ ................ ................ ................ ................

27175 3 Treat slipped epiphysis ..................................................................... ................ ................ ................ ................ ................

27176 3 Treat slipped epiphysis ..................................................................... ................ ................ ................ ................ ................

27177 3 Repair slipped epiphysis ................................................................... ................ ................ ................ ................ ................

27178 3 Repair slipped epiphysis ................................................................... ................ ................ ................ ................ ................

27179 3 Revise head/neck of femur ............................................................... ................ ................ ................ ................ ................

27181 3 Repair slipped epiphysis ................................................................... ................ ................ ................ ................ ................

27185 3 Revision of femur epiphysis .............................................................. ................ ................ ................ ................ ................

27187 3 Reinforce hip bones .......................................................................... ................ ................ ................ ................ ................

27193 1 Treat pelvic ring fracture ................................................................... 1 $314 209 $71 0.14

27194 1 Treat pelvic ring fracture ................................................................... 2 $422 210 $397 0.79

27200 1 Treat tail bone fracture ..................................................................... ................ ................ 207 $53 0.11 Add.
32349

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

27202 1 Repair tail bone fracture ................................................................... 2 $422 216 $580 1.15

27215 3 Pelvic fracture(s) treatment ............................................................... ................ ................ ................ ................ ................

27216 3 Treat pelvic ring fracture ................................................................... ................ ................ ................ ................ ................

27217 3 Treat pelvic ring fracture ................................................................... ................ ................ ................ ................ ................

27218 3 Treat pelvic ring fracture ................................................................... ................ ................ ................ ................ ................

27220 1 Treat hip socket fracture ................................................................... ................ ................ 209 $71 0.14 Add.

27222 3 Treat hip socket fracture ................................................................... ................ ................ ................ ................ ................

27226 3 Treat hip wall fracture ....................................................................... ................ ................ ................ ................ ................

27227 3 Treat hip fracture(s) .......................................................................... ................ ................ ................ ................ ................

27228 3 Treat hip fracture(s) .......................................................................... ................ ................ ................ ................ ................

27230 1 Treat fracture of thigh ....................................................................... 1 $314 209 $71 0.14

27232 3 Treat fracture of thigh ....................................................................... ................ ................ ................ ................ ................

27235 3 Repair of thigh fracture ..................................................................... ................ ................ ................ ................ ................

27236 3 Repair of thigh fracture ..................................................................... ................ ................ ................ ................ ................

27238 1 Treatment of thigh fracture ............................................................... 1 $314 209 $71 0.14

27240 3 Treatment of thigh fracture ............................................................... ................ ................ ................ ................ ................

27244 3 Repair of thigh fracture ..................................................................... ................ ................ ................ ................ ................

27245 3 Repair of thigh fracture ..................................................................... ................ ................ ................ ................ ................

27246 1 Treatment of thigh fracture ............................................................... 1 $314 209 $71 0.14

27248 3 Repair of thigh fracture ..................................................................... ................ ................ ................ ................ ................

27250 1 Treat hip dislocation .......................................................................... 1 $314 209 $71 0.14

27252 1 Treat hip dislocation .......................................................................... 2 $422 210 $397 0.79

27253 3 Repair of hip dislocation ................................................................... ................ ................ ................ ................ ................

27254 3 Repair of hip dislocation ................................................................... ................ ................ ................ ................ ................

27256 1 Treatment of hip dislocation ............................................................. ................ ................ 209 $71 0.14 Add.

27257 1 Treatment of hip dislocation ............................................................. ................ ................ 210 $397 0.79 Add.

27258 3 Repair of hip dislocation ................................................................... ................ ................ ................ ................ ................

27259 3 Repair of hip dislocation ................................................................... ................ ................ ................ ................ ................

27265 1 Treatment of hip dislocation ............................................................. 1 $314 209 $71 0.14

27266 1 Treatment of hip dislocation ............................................................. 2 $422 217 $695 1.38

27275 1 Manipulation of hip joint .................................................................... 2 $422 210 $397 0.79

27280 3 Fusion of sacroiliac joint ................................................................... ................ ................ ................ ................ ................

27282 3 Fusion of pubic bones ...................................................................... ................ ................ ................ ................ ................

27284 3 Fusion of hip joint ............................................................................. ................ ................ ................ ................ ................

27286 3 Fusion of hip joint ............................................................................. ................ ................ ................ ................ ................

27290 3 Amputation of leg at hip .................................................................... ................ ................ ................ ................ ................

27295 3 Amputation of leg at hip .................................................................... ................ ................ ................ ................ ................

27299 3 Pelvis/hip joint surgery ...................................................................... ................ ................ ................ ................ ................

27301 1 Drain thigh/knee lesion ..................................................................... 3 $482 132 $162 0.32

27303 3 Drainage of bone lesion .................................................................... 2 $422 ................ ................ ................ Delete.

27305 1 Incise thigh tendon & fascia ............................................................. 2 $422 251 $504 1.00

27306 1 Incision of thigh tendon ..................................................................... 3 $482 251 $504 1.00

27307 1 Incision of thigh tendons ................................................................... 3 $482 251 $504 1.00

27310 1 Exploration of knee joint ................................................................... 4 $595 252 $574 1.14

27315 1 Partial removal, thigh nerve .............................................................. 2 $422 631 $600 1.19

27320 1 Partial removal, thigh nerve .............................................................. 2 $422 631 $600 1.19

27323 1 Biopsy thigh soft tissues ................................................................... 1 $314 162 $187 0.37

27324 1 Biopsy thigh soft tissues ................................................................... 1 $314 163 $449 0.89

27327 1 Removal of thigh lesion .................................................................... 2 $422 163 $449 0.89

27328 1 Removal of thigh lesion .................................................................... 3 $482 163 $449 0.89

27329 1 Remove tumor, thigh/knee ................................................................ ................ ................ 163 $449 0.89 Add.

27330 1 Biopsy knee joint lining ..................................................................... 4 $595 252 $574 1.14

27331 1 Explore/treat knee joint ..................................................................... 4 $595 252 $574 1.14

27332 1 Removal of knee cartilage ................................................................ 4 $595 252 $574 1.14

27333 1 Removal of knee cartilage ................................................................ 4 $595 252 $574 1.14

27334 1 Remove knee joint lining .................................................................. 4 $595 252 $574 1.14

27335 1 Remove knee joint lining .................................................................. 4 $595 252 $574 1.14

27340 1 Removal of kneecap bursa ............................................................... 3 $482 251 $504 1.00

27345 1 Removal of knee cyst ....................................................................... 4 $595 251 $504 1.00

27350 1 Removal of kneecap ......................................................................... 4 $595 252 $574 1.14

27355 1 Remove femur lesion ........................................................................ 3 $482 252 $574 1.14

27356 1 Remove femur lesion/graft ................................................................ 4 $595 252 $574 1.14

27357 1 Remove femur lesion/graft ................................................................ ................ ................ 252 $574 1.14 Add.

27358 1 Remove femur lesion/fixation ........................................................... ................ ................ 252 $574 1.14 Add.

27360 1 Partial removal leg bone(s) ............................................................... 5 $678 252 $574 1.14

27365 3 Extensive leg surgery ....................................................................... ................ ................ ................ ................ ................

27370 2 Injection for knee x-ray ..................................................................... ................ ................ ................ ................ ................

27372 1 Removal of foreign body ................................................................... 7 $941 163 $449 0.89

27380 1 Repair of kneecap tendon ................................................................ 1 $314 251 $504 1.00

27381 1 Repair/graft kneecap tendon ............................................................ 3 $482 251 $504 1.00

27385 1 Repair of thigh muscle ...................................................................... 3 $482 251 $504 1.00

27386 1 Repair/graft of thigh muscle .............................................................. 3 $482 251 $504 1.00

27390 1 Incision of thigh tendon ..................................................................... 1 $314 251 $504 1.00

27391 1 Incision of thigh tendons ................................................................... 2 $422 251 $504 1.00
32350

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

27392 1 Incision of thigh tendons ................................................................... 3 $482 251 $504 1.00

27393 1 Lengthening of thigh tendon ............................................................. 2 $422 252 $574 1.14

27394 1 Lengthening of thigh tendons ........................................................... 3 $482 252 $574 1.14

27395 1 Lengthening of thigh tendons ........................................................... 3 $482 253 $775 1.54

27396 1 Transplant of thigh tendon ................................................................ 3 $482 252 $574 1.14

27397 1 Transplants of thigh tendons ............................................................ 3 $482 253 $775 1.54

27400 1 Revise thigh muscles/tendons .......................................................... 3 $482 253 $775 1.54

27403 1 Repair of knee cartilage .................................................................... 4 $595 252 $574 1.14

27405 1 Repair of knee ligament .................................................................... 4 $595 253 $775 1.54

27407 1 Repair of knee ligament .................................................................... 4 $595 253 $775 1.54

27409 1 Repair of knee ligaments .................................................................. 4 $595 253 $775 1.54

27418 1 Repair degenerated kneecap ........................................................... 3 $482 253 $775 1.54

27420 1 Revision of unstable kneecap ........................................................... 3 $482 253 $775 1.54

27422 1 Revision of unstable kneecap ........................................................... 7 $941 253 $775 1.54

27424 1 Revision/removal of kneecap ............................................................ 3 $482 253 $775 1.54

27425 1 Lateral retinacular release ................................................................ 7 $941 252 $574 1.14

27427 1 Reconstruction, knee ........................................................................ 3 $482 254 $1,110 2.20

27428 1 Reconstruction, knee ........................................................................ 4 $595 254 $1,110 2.20

27429 1 Reconstruction, knee ........................................................................ 4 $595 254 $1,110 2.20

27430 1 Revision of thigh muscles ................................................................. 4 $595 253 $775 1.54

27435 1 Incision of knee joint ......................................................................... 4 $595 253 $775 1.54

27437 1 Revise kneecap ................................................................................ 4 $595 217 $695 1.38

27438 1 Revise kneecap with implant ............................................................ 5 $678 218 $730 1.45

27440 1 Revision of knee joint ....................................................................... 5 $678 217 $695 1.38

27441 1 Revision of knee joint ....................................................................... 5 $678 217 $695 1.38

27442 1 Revision of knee joint ....................................................................... 5 $678 217 $695 1.38

27443 1 Revision of knee joint ....................................................................... 5 $678 217 $695 1.38

27445 3 Revision of knee joint ....................................................................... ................ ................ ................ ................ ................

27446 3 Revision of knee joint ....................................................................... ................ ................ ................ ................ ................

27447 3 Total knee replacement .................................................................... ................ ................ ................ ................ ................

27448 3 Incision of thigh ................................................................................. ................ ................ ................ ................ ................

27450 3 Incision of thigh ................................................................................. ................ ................ ................ ................ ................

27454 3 Realignment of thigh bone ................................................................ ................ ................ ................ ................ ................

27455 3 Realignment of knee ......................................................................... ................ ................ ................ ................ ................

27457 3 Realignment of knee ......................................................................... ................ ................ ................ ................ ................

27465 3 Shortening of thigh bone .................................................................. ................ ................ ................ ................ ................

27466 3 Lengthening of thigh bone ................................................................ ................ ................ ................ ................ ................

27468 3 Shorten/lengthen thighs .................................................................... ................ ................ ................ ................ ................

27470 3 Repair of thigh .................................................................................. ................ ................ ................ ................ ................

27472 3 Repair/graft of thigh .......................................................................... ................ ................ ................ ................ ................

27475 3 Surgery to stop leg growth ............................................................... ................ ................ ................ ................ ................

27477 3 Surgery to stop leg growth ............................................................... ................ ................ ................ ................ ................

27479 3 Surgery to stop leg growth ............................................................... ................ ................ ................ ................ ................

27485 3 Surgery to stop leg growth ............................................................... ................ ................ ................ ................ ................

27486 3 Revise knee joint replace ................................................................. ................ ................ ................ ................ ................

27487 3 Revise knee joint replace ................................................................. ................ ................ ................ ................ ................

27488 3 Removal of knee prosthesis ............................................................. ................ ................ ................ ................ ................

27495 3 Reinforce thigh .................................................................................. ................ ................ ................ ................ ................

27496 1 Decompression of thigh/knee ........................................................... ................ ................ 251 $504 1.00 Add.

27497 1 Decompression of thigh/knee ........................................................... ................ ................ 251 $504 1.00 Add.

27498 1 Decompression of thigh/knee ........................................................... ................ ................ 251 $504 1.00 Add.

27499 1 Decompression of thigh/knee ........................................................... ................ ................ 251 $504 1.00 Add.

27500 1 Treatment of thigh fracture ............................................................... 1 $314 209 $71 0.14

27501 1 Treatment of thigh fracture ............................................................... 2 $422 209 $71 0.14

27502 1 Treatment of thigh fracture ............................................................... 2 $422 209 $71 0.14

27503 1 Treatment of thigh fracture ............................................................... 3 $482 209 $71 0.14

27506 3 Repair of thigh fracture ..................................................................... ................ ................ ................ ................ ................

27507 3 Treatment of thigh fracture ............................................................... 4 $595 ................ ................ ................ Delete.

27508 1 Treatment of thigh fracture ............................................................... 1 $314 209 $71 0.14

27509 1 Treatment of thigh fracture ............................................................... 3 $482 216 $580 1.15

27510 1 Treatment of thigh fracture ............................................................... 1 $314 209 $71 0.14

27511 3 Treatment of thigh fracture ............................................................... 4 $595 ................ ................ ................ Delete.

27513 3 Treatment of thigh fracture ............................................................... 5 $678 ................ ................ ................ Delete.

27514 3 Repair of thigh fracture ..................................................................... ................ ................ ................ ................ ................

27516 1 Repair of thigh growth plate ............................................................. 1 $314 209 $71 0.14

27517 1 Repair of thigh growth plate ............................................................. 1 $314 209 $71 0.14

27519 3 Repair of thigh growth plate ............................................................. ................ ................ ................ ................ ................

27520 1 Treat kneecap fracture ...................................................................... 1 $314 209 $71 0.14

27524 3 Repair of kneecap fracture ............................................................... 3 $482 ................ ................ ................ Delete.

27530 1 Treatment of knee fracture ............................................................... 1 $314 209 $71 0.14

27532 1 Treatment of knee fracture ............................................................... 1 $314 209 $71 0.14

27535 3 Treatment of knee fracture ............................................................... 3 $482 ................ ................ ................ Delete.

27536 3 Repair of knee fracture ..................................................................... ................ ................ ................ ................ ................

27538 1 Treat knee fracture(s) ....................................................................... 1 $314 209 $71 0.14
32351

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

27540 3 Repair of knee fracture ..................................................................... ................ ................ ................ ................ ................

27550 1 Treat knee dislocation ....................................................................... 1 $314 209 $71 0.14

27552 1 Treat knee dislocation ....................................................................... 1 $314 210 $397 0.79

27556 1 Repair of knee dislocation ................................................................ ................ ................ 216 $580 1.15 Add.

27557 3 Repair of knee dislocation ................................................................ ................ ................ ................ ................ ................

27558 3 Repair of knee dislocation ................................................................ ................ ................ ................ ................ ................

27560 1 Treat kneecap dislocation ................................................................. 1 $314 209 $71 0.14

27562 1 Treat kneecap dislocation ................................................................. 1 $314 210 $397 0.79

27566 1 Repair kneecap dislocation ............................................................... 2 $422 216 $580 1.15

27570 1 Fixation of knee joint ......................................................................... 1 $314 210 $397 0.79

27580 3 Fusion of knee .................................................................................. ................ ................ ................ ................ ................

27590 3 Amputate leg at thigh ........................................................................ ................ ................ ................ ................ ................

27591 3 Amputate leg at thigh ........................................................................ ................ ................ ................ ................ ................

27592 3 Amputate leg at thigh ........................................................................ ................ ................ ................ ................ ................

27594 1 Amputation follow-up surgery ........................................................... ................ ................ 251 $504 1.00 Add.

27596 3 Amputation follow-up surgery ........................................................... ................ ................ ................ ................ ................

27598 3 Amputate lower leg at knee .............................................................. ................ ................ ................ ................ ................

27599 3 Leg surgery procedure ...................................................................... ................ ................ ................ ................ ................

27600 1 Decompression of lower leg ............................................................. ................ ................ 251 $504 1.00 Add.

27601 1 Decompression of lower leg ............................................................. ................ ................ 251 $504 1.00 Add.

27602 1 Decompression of lower leg ............................................................. ................ ................ 251 $504 1.00 Add.

27603 1 Drain lower leg lesion ....................................................................... 2 $422 132 $162 0.32

27604 1 Drain lower leg bursa ........................................................................ 2 $422 251 $504 1.00

27605 1 Incision of achilles tendon ................................................................ 1 $314 271 $510 1.01

27606 1 Incision of achilles tendon ................................................................ 1 $314 251 $504 1.00

27607 1 Treat lower leg bone lesion .............................................................. 2 $422 251 $504 1.00

27610 1 Explore/treat ankle joint .................................................................... 2 $422 252 $574 1.14

27612 1 Exploration of ankle joint .................................................................. 3 $482 252 $574 1.14

27613 5 Biopsy lower leg soft tissue .............................................................. 1 $314 ................ ................ ................ Delete.

27614 1 Biopsy lower leg soft tissue .............................................................. 2 $422 163 $449 0.89

27615 1 Remove tumor, lower leg .................................................................. 3 $482 216 $580 1.15

27618 1 Remove lower leg lesion .................................................................. 2 $422 163 $449 0.89

27619 1 Remove lower leg lesion .................................................................. 3 $482 163 $449 0.89

27620 1 Explore, treat ankle joint ................................................................... 4 $595 252 $574 1.14

27625 1 Remove ankle joint lining .................................................................. 4 $595 252 $574 1.14

27626 1 Remove ankle joint lining .................................................................. 4 $595 252 $574 1.14

27630 1 Removal of tendon lesion ................................................................. 3 $482 251 $504 1.00

27635 1 Remove lower leg bone lesion ......................................................... 3 $482 252 $574 1.14

27637 1 Remove/graft leg bone lesion ........................................................... 3 $482 252 $574 1.14

27638 1 Remove/graft leg bone lesion ........................................................... 3 $482 252 $574 1.14

27640 1 Partial removal of tibia ...................................................................... 2 $422 253 $775 1.54

27641 1 Partial removal of fibula .................................................................... 2 $422 252 $574 1.14

27645 3 Extensive lower leg surgery .............................................................. ................ ................ ................ ................ ................

27646 3 Extensive lower leg surgery .............................................................. ................ ................ ................ ................ ................

27647 1 Extensive ankle/heel surgery ............................................................ ................ ................ 253 $775 1.54 Add.

27648 2 Injection for ankle x-ray .................................................................... ................ ................ ................ ................ ................

27650 1 Repair achilles tendon ...................................................................... 3 $482 253 $775 1.54

27652 1 Repair/graft achilles tendon .............................................................. 3 $482 253 $775 1.54

27654 1 Repair of achilles tendon .................................................................. 3 $482 253 $775 1.54

27656 1 Repair leg fascia defect .................................................................... 2 $422 251 $504 1.00

27658 1 Repair of leg tendon, each ............................................................... 1 $314 251 $504 1.00

27659 1 Repair of leg tendon, each ............................................................... 2 $422 251 $504 1.00

27664 1 Repair of leg tendon, each ............................................................... 2 $422 251 $504 1.00

27665 1 Repair of leg tendon, each ............................................................... 2 $422 252 $574 1.14

27675 1 Repair lower leg tendons .................................................................. 2 $422 251 $504 1.00

27676 1 Repair lower leg tendons .................................................................. 3 $482 252 $574 1.14

27680 1 Release of lower leg tendon ............................................................. 3 $482 252 $574 1.14

27681 1 Release of lower leg tendons ........................................................... 2 $422 252 $574 1.14

27685 1 Revision of lower leg tendon ............................................................ 3 $482 252 $574 1.14

27686 1 Revise lower leg tendons ................................................................. 3 $482 252 $574 1.14

27687 1 Revision of calf tendon ..................................................................... 3 $482 252 $574 1.14

27690 1 Revise lower leg tendon ................................................................... 4 $595 253 $775 1.54

27691 1 Revise lower leg tendon ................................................................... 4 $595 253 $775 1.54

27692 1 Revise additional leg tendon ............................................................ 3 $482 253 $775 1.54

27695 1 Repair of ankle ligament ................................................................... 2 $422 252 $574 1.14

27696 1 Repair of ankle ligaments ................................................................. 2 $422 252 $574 1.14

27698 1 Repair of ankle ligament ................................................................... 2 $422 252 $574 1.14

27700 1 Revision of ankle joint ....................................................................... 5 $678 217 $695 1.38

27702 3 Reconstruct ankle joint ..................................................................... ................ ................ ................ ................ ................

27703 3 Reconstruction, ankle joint ................................................................ ................ ................ ................ ................ ................

27704 1 Removal of ankle implant ................................................................. 2 $422 251 $504 1.00

27705 1 Incision of tibia .................................................................................. 2 $422 253 $775 1.54

27707 1 Incision of fibula ................................................................................ 2 $422 251 $504 1.00

27709 1 Incision of tibia & fibula ..................................................................... 2 $422 252 $574 1.14
32352

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

27712 3 Realignment of lower leg .................................................................. ................ ................ ................ ................ ................

27715 3 Revision of lower leg ........................................................................ 4 $595 ................ ................ ................ Delete.

27720 3 Repair of tibia .................................................................................... ................ ................ ................ ................ ................

27722 3 Repair/graft of tibia ........................................................................... ................ ................ ................ ................ ................

27724 3 Repair/graft of tibia ........................................................................... ................ ................ ................ ................ ................

27725 3 Repair of lower leg ............................................................................ ................ ................ ................ ................ ................

27727 3 Repair of lower leg ............................................................................ ................ ................ ................ ................ ................

27730 1 Repair of tibia epiphysis ................................................................... 2 $422 252 $574 1.14

27732 1 Repair of fibula epiphysis ................................................................. 2 $422 252 $574 1.14

27734 1 Repair lower leg epiphyses .............................................................. 2 $422 252 $574 1.14

27740 1 Repair of leg epiphyses .................................................................... 2 $422 252 $574 1.14

27742 1 Repair of leg epiphyses .................................................................... 2 $422 253 $775 1.54

27745 1 Reinforce tibia ................................................................................... 3 $482 253 $775 1.54

27750 1 Treatment of tibia fracture ................................................................ 1 $314 209 $71 0.14

27752 1 Treatment of tibia fracture ................................................................ 1 $314 209 $71 0.14

27756 1 Repair of tibia fracture ...................................................................... 3 $482 216 $580 1.15

27758 1 Repair of tibia fracture ...................................................................... 4 $595 216 $580 1.15

27759 1 Repair of tibia fracture ...................................................................... 4 $595 216 $580 1.15

27760 1 Treatment of ankle fracture .............................................................. 1 $314 209 $71 0.14

27762 1 Treatment of ankle fracture .............................................................. 1 $314 209 $71 0.14

27766 1 Repair of ankle fracture .................................................................... 3 $482 216 $580 1.15

27780 1 Treatment of fibula fracture .............................................................. 1 $314 209 $71 0.14

27781 1 Treatment of fibula fracture .............................................................. 1 $314 209 $71 0.14

27784 1 Repair of fibula fracture .................................................................... 3 $482 216 $580 1.15

27786 1 Treatment of ankle fracture .............................................................. 1 $314 209 $71 0.14

27788 1 Treatment of ankle fracture .............................................................. 1 $314 209 $71 0.14

27792 1 Repair of ankle fracture .................................................................... 3 $482 216 $580 1.15

27808 1 Treatment of ankle fracture .............................................................. 1 $314 209 $71 0.14

27810 1 Treatment of ankle fracture .............................................................. 1 $314 209 $71 0.14

27814 1 Repair of ankle fracture .................................................................... 3 $482 216 $580 1.15

27816 1 Treatment of ankle fracture .............................................................. 1 $314 209 $71 0.14

27818 1 Treatment of ankle fracture .............................................................. 1 $314 209 $71 0.14

27822 1 Repair of ankle fracture .................................................................... 3 $482 216 $580 1.15

27823 1 Repair of ankle fracture .................................................................... 3 $482 216 $580 1.15

27824 1 Treat lower leg fracture ..................................................................... 1 $314 209 $71 0.14

27825 1 Treat lower leg fracture ..................................................................... 2 $422 209 $71 0.14

27826 1 Treat lower leg fracture ..................................................................... 3 $482 216 $580 1.15

27827 1 Treat lower leg fracture ..................................................................... 3 $482 216 $580 1.15

27828 1 Treat lower leg fracture ..................................................................... 4 $595 216 $580 1.15

27829 1 Treat lower leg joint .......................................................................... 2 $422 216 $580 1.15

27830 1 Treat lower leg dislocation ................................................................ 1 $314 209 $71 0.14

27831 1 Treat lower leg dislocation ................................................................ 1 $314 210 $397 0.79

27832 1 Repair lower leg dislocation .............................................................. 2 $422 216 $580 1.15

27840 1 Treat ankle dislocation ...................................................................... 1 $314 209 $71 0.14

27842 1 Treat ankle dislocation ...................................................................... 1 $314 210 $397 0.79

27846 1 Repair ankle dislocation .................................................................... 3 $482 216 $580 1.15

27848 1 Repair ankle dislocation .................................................................... 3 $482 216 $580 1.15

27860 1 Fixation of ankle joint ........................................................................ 1 $314 210 $397 0.79

27870 1 Fusion of ankle joint .......................................................................... 4 $595 253 $775 1.54

27871 1 Fusion of tibiofibular joint .................................................................. 4 $595 253 $775 1.54

27880 3 Amputation of lower leg .................................................................... ................ ................ ................ ................ ................

27881 3 Amputation of lower leg .................................................................... ................ ................ ................ ................ ................

27882 3 Amputation of lower leg .................................................................... ................ ................ ................ ................ ................

27884 1 Amputation follow-up surgery ........................................................... 3 $482 251 $504 1.00

27886 3 Amputation follow-up surgery ........................................................... ................ ................ ................ ................ ................

27888 3 Amputation of foot at ankle ............................................................... ................ ................ ................ ................ ................

27889 1 Amputation of foot at ankle ............................................................... ................ ................ 252 $574 1.14 Add.

27892 1 Decompression of leg ....................................................................... ................ ................ 251 $504 1.00 Add.

27893 1 Decompression of leg ....................................................................... ................ ................ 251 $504 1.00 Add.

27894 1 Decompression of leg ....................................................................... ................ ................ 251 $504 1.00 Add.

27899 3 Leg/ankle surgery procedure ............................................................ ................ ................ ................ ................ ................

28001 1 Drainage of bursa of foot .................................................................. ................ ................ 132 $162 0.32 Add.

28002 1 Treatment of foot infection ................................................................ 3 $482 251 $504 1.00

28003 1 Treatment of foot infection ................................................................ 3 $482 251 $504 1.00

28005 1 Treat foot bone lesion ....................................................................... 3 $482 271 $510 1.01

28008 1 Incision of foot fascia ........................................................................ 3 $482 271 $510 1.01

28010 1 Incision of toe tendon ....................................................................... ................ ................ 271 $510 1.01 Add.

28011 1 Incision of toe tendons ...................................................................... ................ ................ 271 $510 1.01 Add.

28020 1 Exploration of a foot joint .................................................................. 2 $422 271 $510 1.01

28022 1 Exploration of a foot joint .................................................................. ................ ................ 271 $510 1.01 Add.

28024 1 Exploration of a toe joint ................................................................... ................ ................ 271 $510 1.01 Add.

28030 1 Removal of foot nerve ...................................................................... 4 $595 631 $600 1.19

28035 1 Decompression of tibia nerve ........................................................... 4 $595 631 $600 1.19

28043 1 Excision of foot lesion ....................................................................... 2 $422 162 $187 0.37
32353

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

28045 1 Excision of foot lesion ....................................................................... 3 $482 271 $510 1.01

28046 1 Resection of tumor, foot ................................................................... 3 $482 271 $510 1.01

28050 1 Biopsy of foot joint lining ................................................................... 2 $422 271 $510 1.01

28052 1 Biopsy of foot joint lining ................................................................... ................ ................ 271 $510 1.01 Add.

28054 1 Biopsy of toe joint lining .................................................................... 2 $422 271 $510 1.01

28060 1 Partial removal foot fascia ................................................................ 2 $422 272 $546 1.08

28062 1 Removal of foot fascia ...................................................................... 3 $482 272 $546 1.08

28070 1 Removal of foot joint lining ............................................................... 3 $482 272 $546 1.08

28072 1 Removal of foot joint lining ............................................................... 3 $482 272 $546 1.08

28080 1 Removal of foot lesion ...................................................................... 3 $482 271 $510 1.01

28086 1 Excise foot tendon sheath ................................................................ 2 $422 271 $510 1.01

28088 1 Excise foot tendon sheath ................................................................ 2 $422 271 $510 1.01

28090 1 Removal of foot lesion ...................................................................... 3 $482 271 $510 1.01

28092 1 Removal of toe lesions ..................................................................... 3 $482 271 $510 1.01

28100 1 Removal of ankle/heel lesion ............................................................ 2 $422 271 $510 1.01

28102 1 Remove/graft foot lesion ................................................................... 3 $482 272 $546 1.08

28103 1 Remove/graft foot lesion ................................................................... 3 $482 272 $546 1.08

28104 1 Removal of foot lesion ...................................................................... 2 $422 271 $510 1.01

28106 1 Remove/graft foot lesion ................................................................... 3 $482 272 $546 1.08

28107 1 Remove/graft foot lesion ................................................................... 3 $482 272 $546 1.08

28108 1 Removal of toe lesions ..................................................................... ................ ................ 271 $510 1.01 Add.

28110 1 Part removal of metatarsal ............................................................... 3 $482 276 $680 1.35

28111 1 Part removal of metatarsal ............................................................... 3 $482 271 $510 1.01

28112 1 Part removal of metatarsal ............................................................... 3 $482 271 $510 1.01

28113 1 Part removal of metatarsal ............................................................... 3 $482 271 $510 1.01

28114 1 Removal of metatarsal heads ........................................................... 3 $482 271 $510 1.01

28116 1 Revision of foot ................................................................................. 3 $482 271 $510 1.01

28118 1 Removal of heel bone ....................................................................... 4 $595 271 $510 1.01

28119 1 Removal of heel spur ........................................................................ 4 $595 271 $510 1.01

28120 1 Part removal of ankle/heel ................................................................ 7 $941 271 $510 1.01

28122 1 Partial removal of foot bone ............................................................. 3 $482 271 $510 1.01

28124 1 Partial removal of toe ........................................................................ ................ ................ 271 $510 1.01 Add.

28126 1 Partial removal of toe ........................................................................ ................ ................ 271 $510 1.01 Add.

28130 1 Removal of ankle bone ..................................................................... 3 $482 271 $510 1.01

28140 1 Removal of metatarsal ...................................................................... 3 $482 271 $510 1.01

28150 1 Removal of toe .................................................................................. 3 $482 271 $510 1.01

28153 1 Partial removal of toe ........................................................................ ................ ................ 271 $510 1.01 Add.

28160 1 Partial removal of toe ........................................................................ ................ ................ 271 $510 1.01 Add.

28171 1 Extensive foot surgery ...................................................................... 3 $482 271 $510 1.01

28173 1 Extensive foot surgery ...................................................................... 3 $482 271 $510 1.01

28175 1 Extensive foot surgery ...................................................................... 3 $482 271 $510 1.01

28190 5 Removal of foot foreign body ........................................................... ................ ................ ................ ................ ................

28192 1 Removal of foot foreign body ........................................................... 2 $422 163 $449 0.89

28193 1 Removal of foot foreign body ........................................................... 4 $595 163 $449 0.89

28200 1 Repair of foot tendon ........................................................................ 3 $482 271 $510 1.01

28202 1 Repair/graft of foot tendon ................................................................ 3 $482 272 $546 1.08

28208 1 Repair of foot tendon ........................................................................ 3 $482 271 $510 1.01

28210 1 Repair/graft of foot tendon ................................................................ 3 $482 271 $510 1.01

28220 1 Release of foot tendon ..................................................................... ................ ................ 271 $510 1.01 Add.

28222 1 Release of foot tendons .................................................................... 1 $314 271 $510 1.01

28225 1 Release of foot tendon ..................................................................... 1 $314 271 $510 1.01

28226 1 Release of foot tendons .................................................................... 1 $314 271 $510 1.01

28230 1 Incision of foot tendon(s) .................................................................. ................ ................ 271 $510 1.01 Add.

28232 1 Incision of toe tendon ....................................................................... ................ ................ 271 $510 1.01 Add.

28234 1 Incision of foot tendon ...................................................................... ................ ................ 271 $510 1.01 Add.

28238 1 Revision of foot tendon ..................................................................... 3 $482 272 $546 1.08

28240 1 Release of big toe ............................................................................. 2 $422 271 $510 1.01

28250 1 Revision of foot fascia ...................................................................... 3 $482 272 $546 1.08

28260 1 Release of midfoot joint .................................................................... 3 $482 272 $546 1.08

28261 1 Revision of foot tendon ..................................................................... 3 $482 272 $546 1.08

28262 1 Revision of foot and ankle ................................................................ 4 $595 272 $546 1.08

28264 1 Release of midfoot joint .................................................................... 1 $314 272 $546 1.08

28270 1 Release of foot contracture .............................................................. ................ ................ 271 $510 1.01 Add.

28272 1 Release of toe joint, each ................................................................. ................ ................ 271 $510 1.01 Add.

28280 1 Fusion of toes ................................................................................... 2 $422 271 $510 1.01

28285 1 Repair of hammertoe ........................................................................ 3 $482 271 $510 1.01

28286 1 Repair of hammertoe ........................................................................ 4 $595 271 $510 1.01

28288 1 Partial removal of foot bone ............................................................. 3 $482 272 $546 1.08

28290 1 Correction of bunion ......................................................................... 2 $422 276 $680 1.35

28292 1 Correction of bunion ......................................................................... 2 $422 276 $680 1.35

28293 1 Correction of bunion ......................................................................... 3 $482 276 $680 1.35

28294 1 Correction of bunion ......................................................................... 3 $482 276 $680 1.35

28296 1 Correction of bunion ......................................................................... 3 $482 276 $680 1.35

28297 1 Correction of bunion ......................................................................... 3 $482 276 $680 1.35
32354

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

28298 1 Correction of bunion ......................................................................... 3 $482 276 $680 1.35

28299 1 Correction of bunion ......................................................................... 5 $678 276 $680 1.35

28300 1 Incision of heel bone ......................................................................... 2 $422 272 $546 1.08

28302 1 Incision of ankle bone ....................................................................... 2 $422 272 $546 1.08

28304 1 Incision of midfoot bones .................................................................. 2 $422 272 $546 1.08

28305 1 Incise/graft midfoot bones ................................................................. 3 $482 272 $546 1.08

28306 1 Incision of metatarsal ........................................................................ 4 $595 272 $546 1.08

28307 1 Incision of metatarsal ........................................................................ 4 $595 272 $546 1.08

28308 1 Incision of metatarsal ........................................................................ 2 $422 272 $546 1.08

28309 1 Incision of metatarsals ...................................................................... 4 $595 272 $546 1.08

28310 1 Revision of big toe ............................................................................ 3 $482 271 $510 1.01

28312 1 Revision of toe .................................................................................. 3 $482 271 $510 1.01

28313 1 Repair deformity of toe ..................................................................... 2 $422 271 $510 1.01

28315 1 Removal of sesamoid bone .............................................................. 4 $595 271 $510 1.01

28320 1 Repair of foot bones ......................................................................... 4 $595 272 $546 1.08

28322 1 Repair of metatarsals ........................................................................ 4 $595 272 $546 1.08

28340 1 Resect enlarged toe tissue ............................................................... 4 $595 271 $510 1.01

28341 1 Resect enlarged toe .......................................................................... 4 $595 271 $510 1.01

28344 1 Repair extra toe(s) ............................................................................ 4 $595 272 $546 1.08

28345 1 Repair webbed toe(s) ....................................................................... 4 $595 272 $546 1.08

28360 1 Reconstruct cleft foot ........................................................................ ................ ................ 272 $546 1.08 Add.

28400 1 Treatment of heel fracture ................................................................ 1 $314 209 $71 0.14

28405 1 Treatment of heel fracture ................................................................ 2 $422 209 $71 0.14

28406 1 Treatment of heel fracture ................................................................ 2 $422 216 $580 1.15

28415 1 Repair of heel fracture ...................................................................... 3 $482 216 $580 1.15

28420 1 Repair/graft heel fracture .................................................................. 4 $595 216 $580 1.15

28430 1 Treatment of ankle fracture .............................................................. ................ ................ 209 $71 0.14 Add.

28435 1 Treatment of ankle fracture .............................................................. 2 $422 209 $71 0.14

28436 1 Treatment of ankle fracture .............................................................. 2 $422 216 $580 1.15

28445 1 Repair of ankle fracture .................................................................... 3 $482 216 $580 1.15

28450 1 Treat midfoot fracture, each ............................................................. ................ ................ 209 $71 0.14 Add.

28455 1 Treat midfoot fracture, each ............................................................. ................ ................ 209 $71 0.14 Add.

28456 1 Repair midfoot fracture ..................................................................... 2 $422 216 $580 1.15

28465 1 Repair midfoot fracture,each ............................................................ 3 $482 216 $580 1.15

28470 1 Treat metatarsal fracture .................................................................. ................ ................ 209 $71 0.14 Add.

28475 1 Treat metatarsal fracture .................................................................. ................ ................ 209 $71 0.14 Add.

28476 1 Repair metatarsal fracture ................................................................ 2 $422 216 $580 1.15

28485 1 Repair metatarsal fracture ................................................................ 4 $595 216 $580 1.15

28490 1 Treat big toe fracture ........................................................................ ................ ................ 207 $53 0.11 Add.

28495 1 Treat big toe fracture ........................................................................ ................ ................ 207 $53 0.11 Add.

28496 1 Repair big toe fracture ...................................................................... 2 $422 216 $580 1.15

28505 1 Repair big toe fracture ...................................................................... 3 $482 216 $580 1.15

28510 1 Treatment of toe fracture .................................................................. ................ ................ 207 $53 0.11 Add.

28515 1 Treatment of toe fracture .................................................................. ................ ................ 207 $53 0.11 Add.

28525 1 Repair of toe fracture ........................................................................ 3 $482 216 $580 1.15

28530 1 Treat sesamoid bone fracture ........................................................... ................ ................ 209 $71 0.14 Add.

28531 1 Treat sesamoid bone fracture ........................................................... ................ ................ 216 $580 1.15 Add.

28540 1 Treat foot dislocation ........................................................................ ................ ................ 209 $71 0.14 Add.

28545 1 Treat foot dislocation ........................................................................ 1 $314 210 $397 0.79

28546 1 Treat foot dislocation ........................................................................ 2 $422 216 $580 1.15

28555 1 Repair foot dislocation ...................................................................... 2 $422 216 $580 1.15

28570 1 Treat foot dislocation ........................................................................ ................ ................ 209 $71 0.14 Add.

28575 1 Treat foot dislocation ........................................................................ 1 $314 210 $397 0.79

28576 1 Treat foot dislocation ........................................................................ 3 $482 216 $580 1.15

28585 1 Repair foot dislocation ...................................................................... 3 $482 216 $580 1.15

28600 1 Treat foot dislocation ........................................................................ ................ ................ 209 $71 0.14 Add.

28605 1 Treat foot dislocation ........................................................................ 1 $314 210 $397 0.79

28606 1 Treat foot dislocation ........................................................................ 2 $422 216 $580 1.15

28615 1 Repair foot dislocation ...................................................................... 3 $482 216 $580 1.15

28630 1 Treat toe dislocation ......................................................................... ................ ................ 207 $53 0.11 Add.

28635 1 Treat toe dislocation ......................................................................... 1 $314 210 $397 0.79

28636 1 Treat toe dislocation ......................................................................... 3 $482 216 $580 1.15

28645 1 Repair toe dislocation ....................................................................... 3 $482 216 $580 1.15

28660 1 Treat toe dislocation ......................................................................... ................ ................ 207 $53 0.11 Add.

28665 1 Treat toe dislocation ......................................................................... 1 $314 210 $397 0.79

28666 1 Treat toe dislocation ......................................................................... 3 $482 216 $580 1.15

28675 1 Repair of toe dislocation ................................................................... 3 $482 216 $580 1.15

28705 1 Fusion of foot bones ......................................................................... 4 $595 272 $546 1.08

28715 1 Fusion of foot bones ......................................................................... 4 $595 272 $546 1.08

28725 1 Fusion of foot bones ......................................................................... 4 $595 272 $546 1.08

28730 1 Fusion of foot bones ......................................................................... 4 $595 272 $546 1.08

28735 1 Fusion of foot bones ......................................................................... 4 $595 272 $546 1.08

28737 1 Revision of foot bones ...................................................................... 5 $678 271 $510 1.01

28740 1 Fusion of foot bones ......................................................................... 4 $595 272 $546 1.08
32355

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

28750 1 Fusion of big toe joint ....................................................................... 4 $595 271 $510 1.01

28755 1 Fusion of big toe joint ....................................................................... 4 $595 271 $510 1.01

28760 1 Fusion of big toe joint ....................................................................... 4 $595 272 $546 1.08

28800 3 Amputation of midfoot ....................................................................... ................ ................ ................ ................ ................

28805 3 Amputation thru metatarsal ............................................................... ................ ................ ................ ................ ................

28810 1 Amputation toe & metatarsal ............................................................ 2 $422 271 $510 1.01

28820 1 Amputation of toe .............................................................................. 2 $422 271 $510 1.01

28825 1 Partial amputation of toe ................................................................... 2 $422 271 $510 1.01

28899 3 Foot/toes surgery procedure ............................................................. ................ ................ ................ ................ ................

29000 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29010 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29015 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29020 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29025 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29035 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29040 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29044 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29046 5 Application of body cast .................................................................... ................ ................ ................ ................ ................

29049 5 Application of figure eight ................................................................. ................ ................ ................ ................ ................

29055 5 Application of shoulder cast .............................................................. ................ ................ ................ ................ ................

29058 5 Application of shoulder cast .............................................................. ................ ................ ................ ................ ................

29065 5 Application of long arm cast ............................................................. ................ ................ ................ ................ ................

29075 5 Application of forearm cast ............................................................... ................ ................ ................ ................ ................

29085 5 Apply hand/wrist cast ........................................................................ ................ ................ ................ ................ ................

29105 5 Apply long arm splint ........................................................................ ................ ................ ................ ................ ................

29125 5 Apply forearm splint .......................................................................... ................ ................ ................ ................ ................

29126 5 Apply forearm splint .......................................................................... ................ ................ ................ ................ ................

29130 5 Application of finger splint ................................................................. ................ ................ ................ ................ ................

29131 5 Application of finger splint ................................................................. ................ ................ ................ ................ ................

29200 5 Strapping of chest ............................................................................. ................ ................ ................ ................ ................

29220 5 Strapping of low back ....................................................................... ................ ................ ................ ................ ................

29240 5 Strapping of shoulder ........................................................................ ................ ................ ................ ................ ................

29260 5 Strapping of elbow or wrist ............................................................... ................ ................ ................ ................ ................

29280 5 Strapping of hand or finger ............................................................... ................ ................ ................ ................ ................

29305 5 Application of hip cast ....................................................................... ................ ................ ................ ................ ................

29325 5 Application of hip casts ..................................................................... ................ ................ ................ ................ ................

29345 5 Application of long leg cast ............................................................... ................ ................ ................ ................ ................

29355 5 Application of long leg cast ............................................................... ................ ................ ................ ................ ................

29358 5 Apply long leg cast brace ................................................................. ................ ................ ................ ................ ................

29365 5 Application of long leg cast ............................................................... ................ ................ ................ ................ ................

29405 5 Apply short leg cast .......................................................................... ................ ................ ................ ................ ................

29425 5 Apply short leg cast .......................................................................... ................ ................ ................ ................ ................

29435 5 Apply short leg cast .......................................................................... ................ ................ ................ ................ ................

29440 5 Add.ition of walker to cast ................................................................ ................ ................ ................ ................ ................

29445 5 Apply rigid leg cast ........................................................................... ................ ................ ................ ................ ................

29450 5 Application of leg cast ....................................................................... ................ ................ ................ ................ ................

29505 5 Application long leg splint ................................................................. ................ ................ ................ ................ ................

29515 5 Application lower leg splint ............................................................... ................ ................ ................ ................ ................

29520 5 Strapping of hip ................................................................................. ................ ................ ................ ................ ................

29530 5 Strapping of knee .............................................................................. ................ ................ ................ ................ ................

29540 5 Strapping of ankle ............................................................................. ................ ................ ................ ................ ................

29550 5 Strapping of toes ............................................................................... ................ ................ ................ ................ ................

29580 5 Application of paste boot .................................................................. ................ ................ ................ ................ ................

29590 5 Application of foot splint .................................................................... ................ ................ ................ ................ ................

29700 5 Removal/revision of cast ................................................................... ................ ................ ................ ................ ................

29705 5 Removal/revision of cast ................................................................... ................ ................ ................ ................ ................

29710 5 Removal/revision of cast ................................................................... ................ ................ ................ ................ ................

29715 5 Removal/revision of cast ................................................................... ................ ................ ................ ................ ................

29720 5 Repair of body cast ........................................................................... ................ ................ ................ ................ ................

29730 5 Windowing of cast ............................................................................. ................ ................ ................ ................ ................

29740 5 Wedging of cast ................................................................................ ................ ................ ................ ................ ................

29750 5 Wedging of clubfoot cast .................................................................. ................ ................ ................ ................ ................

29799 3 Casting/strapping procedure ............................................................. ................ ................ ................ ................ ................

29800 1 Jaw arthroscopy/surgery ................................................................... ................ ................ 280 $675 1.34 Add.

29804 1 Jaw arthroscopy/surgery ................................................................... 3 $482 281 $807 1.60

29815 1 Shoulder arthroscopy ........................................................................ 3 $482 280 $675 1.34

29819 1 Shoulder arthroscopy/surgery ........................................................... 3 $482 281 $807 1.60

29820 1 Shoulder arthroscopy/surgery ........................................................... 3 $482 281 $807 1.60

29821 1 Shoulder arthroscopy/surgery ........................................................... 3 $482 281 $807 1.60

29822 1 Shoulder arthroscopy/surgery ........................................................... 3 $482 281 $807 1.60

29823 1 Shoulder arthroscopy/surgery ........................................................... 3 $482 281 $807 1.60

29825 1 Shoulder arthroscopy/surgery ........................................................... 3 $482 281 $807 1.60

29826 1 Shoulder arthroscopy/surgery ........................................................... 3 $482 281 $807 1.60

29830 1 Elbow arthroscopy ............................................................................ 3 $482 280 $675 1.34
32356

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

29834 1 Elbow arthroscopy/surgery ............................................................... 3 $482 281 $807 1.60

29835 1 Elbow arthroscopy/surgery ............................................................... 3 $482 281 $807 1.60

29836 1 Elbow arthroscopy/surgery ............................................................... 3 $482 281 $807 1.60

29837 1 Elbow arthroscopy/surgery ............................................................... 3 $482 281 $807 1.60

29838 1 Elbow arthroscopy/surgery ............................................................... 3 $482 281 $807 1.60

29840 1 Wrist arthroscopy .............................................................................. 3 $482 280 $675 1.34

29843 1 Wrist arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29844 1 Wrist arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29845 1 Wrist arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29846 1 Wrist arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29847 1 Wrist arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29848 1 Wrist arthroscopy/surgery ................................................................. ................ ................ 281 $807 1.60 Add.

29850 1 Knee arthroscopy/surgery ................................................................. 4 $595 286 $1,110 2.20

29851 1 Knee arthroscopy/surgery ................................................................. 4 $595 286 $1,110 2.20

29855 1 Tibial arthroscopy/surgery ................................................................. 4 $595 286 $1,110 2.20

29856 1 Tibial arthroscopy/surgery ................................................................. 4 $595 286 $1,110 2.20

29860 1 Hip arthroscopy, dx ........................................................................... ................ ................ 281 $807 1.60 Add.

29861 1 Hip arthroscopy/surgery .................................................................... ................ ................ 281 $807 1.60 Add.

29862 1 Hip arthroscopy/surgery .................................................................... ................ ................ 281 $807 1.60 Add.

29863 1 Hip arthroscopy/surgery .................................................................... ................ ................ 281 $807 1.60 Add.

29870 1 Knee arthroscopy, diagnostic ........................................................... 3 $482 280 $675 1.34

29871 1 Knee arthroscopy/drainage ............................................................... 3 $482 282 $860 1.71

29874 1 Knee arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29875 1 Knee arthroscopy/surgery ................................................................. 4 $595 281 $807 1.60

29876 1 Knee arthroscopy/surgery ................................................................. 4 $595 282 $860 1.71

29877 1 Knee arthroscopy/surgery ................................................................. 4 $595 281 $807 1.60

29879 1 Knee arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29880 1 Knee arthroscopy/surgery ................................................................. 4 $595 281 $807 1.60

29881 1 Knee arthroscopy/surgery ................................................................. 4 $595 281 $807 1.60

29882 1 Knee arthroscopy/surgery ................................................................. 3 $482 282 $860 1.71

29883 1 Knee arthroscopy/surgery ................................................................. 3 $482 282 $860 1.71

29884 1 Knee arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29885 1 Knee arthroscopy/surgery ................................................................. 3 $482 282 $860 1.71

29886 1 Knee arthroscopy/surgery ................................................................. 3 $482 281 $807 1.60

29887 1 Knee arthroscopy/surgery ................................................................. 3 $482 282 $860 1.71

29888 1 Knee arthroscopy/surgery ................................................................. 3 $482 286 $1,110 2.20

29889 1 Knee arthroscopy/surgery ................................................................. 3 $482 286 $1,110 2.20

29891 1 Ankle arthroscopy/surgery ................................................................ ................ ................ 282 $860 1.71 Add.

29892 1 Ankle arthroscopy/surgery ................................................................ ................ ................ 286 $1,110 2.20 Add.

29893 1 Scope, plantar fasciotomy ................................................................ ................ ................ 271 $510 1.01 Add.

29894 1 Ankle arthroscopy/surgery ................................................................ 3 $482 281 $807 1.60

29895 1 Ankle arthroscopy/surgery ................................................................ 3 $482 281 $807 1.60

29897 1 Ankle arthroscopy/surgery ................................................................ 3 $482 281 $807 1.60

29898 1 Ankle arthroscopy/surgery ................................................................ 3 $482 281 $807 1.60

29909 3 Arthroscopy of joint ........................................................................... ................ ................ ................ ................ ................

30000 5 Drainage of nose lesion .................................................................... ................ ................ ................ ................ ................

30020 5 Drainage of nose lesion .................................................................... ................ ................ ................ ................ ................

30100 5 Intranasal biopsy ............................................................................... ................ ................ ................ ................ ................

30110 5 Removal of nose polyp(s) ................................................................. ................ ................ ................ ................ ................

30115 1 Removal of nose polyp(s) ................................................................. 2 $422 313 $537 1.07

30117 5 Removal of intranasal lesion ............................................................ 3 $482 ................ ................ ................ Delete.

30118 1 Removal of intranasal lesion ............................................................ 3 $482 313 $537 1.07

30120 1 Revision of nose ............................................................................... 1 $314 313 $537 1.07

30124 5 Removal of nose lesion .................................................................... 1 $314 ................ ................ ................ Delete.

30125 1 Removal of nose lesion .................................................................... 2 $422 313 $537 1.07

30130 1 Removal of turbinate bones .............................................................. 3 $482 313 $537 1.07

30140 1 Removal of turbinate bones .............................................................. 2 $422 313 $537 1.07

30150 1 Partial removal of nose ..................................................................... 3 $482 313 $537 1.07

30160 1 Removal of nose ............................................................................... 4 $595 313 $537 1.07

30200 2 Injection treatment of nose ............................................................... ................ ................ ................ ................ ................

30210 5 Nasal sinus therapy .......................................................................... ................ ................ ................ ................ ................

30220 5 Insert nasal septal button ................................................................. ................ ................ ................ ................ ................

30300 5 Remove nasal foreign body .............................................................. ................ ................ ................ ................ ................

30310 1 Remove nasal foreign body .............................................................. 1 $314 313 $537 1.07

30320 1 Remove nasal foreign body .............................................................. 2 $422 313 $537 1.07

30400 7 Reconstruction of nose ..................................................................... 4 $595 314 $946 1.88

30410 7 Reconstruction of nose ..................................................................... 5 $678 314 $946 1.88

30420 7 Reconstruction of nose ..................................................................... 5 $678 314 $946 1.88

30430 7 Revision of nose ............................................................................... 3 $482 313 $537 1.07

30435 7 Revision of nose ............................................................................... 5 $678 314 $946 1.88

30450 7 Revision of nose ............................................................................... 7 $941 314 $946 1.88

30460 1 Revision of nose ............................................................................... ................ ................ 314 $946 1.88 Add.

30462 1 Revision of nose ............................................................................... ................ ................ 314 $946 1.88 Add.

30520 1 Repair of nasal septum ..................................................................... 4 $595 313 $537 1.07
32357

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

30540 1 Repair nasal defect ........................................................................... 5 $678 313 $537 1.07

30545 1 Repair nasal defect ........................................................................... ................ ................ 314 $946 1.88 Add.

30560 5 Release of nasal adhesions ............................................................. 2 $422 ................ ................ ................ Delete.

30580 1 Repair upper jaw fistula .................................................................... 4 $595 313 $537 1.07

30600 1 Repair mouth/nose fistula ................................................................. 4 $595 313 $537 1.07

30620 1 Intranasal reconstruction ................................................................... 7 $941 313 $537 1.07

30630 1 Repair nasal septum defect .............................................................. 7 $941 313 $537 1.07

30801 1 Cauterization inner nose ................................................................... 1 $314 312 $233 0.46

30802 1 Cauterization inner nose ................................................................... 1 $314 312 $233 0.46

30901 1 Control of nosebleed ......................................................................... ................ ................ 318 $77 0.15 Add.

30903 1 Control of nosebleed ......................................................................... 1 $314 318 $77 0.15

30905 1 Control of nosebleed ......................................................................... 1 $314 318 $77 0.15

30906 1 Repeat control of nosebleed ............................................................. 1 $314 318 $77 0.15

30915 1 Ligation nasal sinus artery ................................................................ 2 $422 367 $682 1.35

30920 1 Ligation upper jaw artery .................................................................. 3 $482 367 $682 1.35

30930 1 Therapy fracture of nose .................................................................. ................ ................ 312 $233 0.46 Add.

30999 3 Nasal surgery procedure .................................................................. ................ ................ ................ ................ ................

31000 5 Irrigation maxillary sinus ................................................................... ................ ................ ................ ................ ................

31002 5 Irrigation sphenoid sinus ................................................................... ................ ................ ................ ................ ................

31020 1 Exploration maxillary sinus ............................................................... 2 $422 313 $537 1.07

31030 1 Exploration maxillary sinus ............................................................... 3 $482 313 $537 1.07

31032 1 Explore sinus,remove polyps ............................................................ 4 $595 313 $537 1.07

31040 1 Exploration behind upper jaw ........................................................... ................ ................ 314 $946 1.88 Add.

31050 1 Exploration sphenoid sinus ............................................................... 2 $422 313 $537 1.07

31051 1 Sphenoid sinus surgery .................................................................... 4 $595 313 $537 1.07

31070 1 Exploration of frontal sinus ............................................................... 2 $422 313 $537 1.07

31075 1 Exploration of frontal sinus ............................................................... 4 $595 314 $946 1.88

31080 1 Removal of frontal sinus ................................................................... 4 $595 314 $946 1.88

31081 1 Removal of frontal sinus ................................................................... ................ ................ 314 $946 1.88 Add.

31084 1 Removal of frontal sinus ................................................................... 4 $595 314 $946 1.88

31085 1 Removal of frontal sinus ................................................................... ................ ................ 314 $946 1.88 Add.

31086 1 Removal of frontal sinus ................................................................... 4 $595 314 $946 1.88

31087 1 Removal of frontal sinus ................................................................... ................ ................ 314 $946 1.88 Add.

31090 1 Exploration of sinuses ....................................................................... 5 $678 314 $946 1.88

31200 1 Removal of ethmoid sinus ................................................................ 2 $422 313 $537 1.07

31201 1 Removal of ethmoid sinus ................................................................ 5 $678 314 $946 1.88

31205 1 Removal of ethmoid sinus ................................................................ 3 $482 314 $946 1.88

31225 3 Removal of upper jaw ....................................................................... ................ ................ ................ ................ ................

31230 3 Removal of upper jaw ....................................................................... ................ ................ ................ ................ ................

31231 5 Nasal endoscopy, dx ........................................................................ ................ ................ ................ ................ ................

31233 1 Nasal/sinus endoscopy, dx ............................................................... 2 $422 332 $423 0.84

31235 1 Nasal/sinus endoscopy, dx ............................................................... 1 $314 332 $423 0.84

31237 1 Nasal/sinus endoscopy, surg ............................................................ 2 $422 332 $423 0.84

31238 1 Nasal/sinus endoscopy, surg ............................................................ 1 $314 332 $423 0.84

31239 1 Nasal/sinus endoscopy, surg ............................................................ 4 $595 333 $653 1.30

31240 1 Nasal/sinus endoscopy, surg ............................................................ 2 $422 332 $423 0.84

31254 1 Revision of ethmoid sinus ................................................................. 3 $482 333 $653 1.30

31255 1 Removal of ethmoid sinus ................................................................ 5 $678 333 $653 1.30

31256 1 Exploration maxillary sinus ............................................................... 3 $482 333 $653 1.30

31267 1 Endoscopy, maxillary sinus .............................................................. 3 $482 333 $653 1.30

31276 1 Sinus surgical endoscopy ................................................................. 3 $482 333 $653 1.30

31287 1 Nasal/sinus endoscopy, surg ............................................................ 3 $482 333 $653 1.30

31288 1 Nasal/sinus endoscopy, surg ............................................................ 3 $482 333 $653 1.30

31290 3 Nasal/sinus endoscopy, surg ............................................................ ................ ................ ................ ................ ................

31291 3 Nasal/sinus endoscopy, surg ............................................................ ................ ................ ................ ................ ................

31292 3 Nasal/sinus endoscopy, surg ............................................................ ................ ................ ................ ................ ................

31293 3 Nasal/sinus endoscopy, surg ............................................................ ................ ................ ................ ................ ................

31294 3 Nasal/sinus endoscopy, surg ............................................................ ................ ................ ................ ................ ................

31299 3 Sinus surgery procedure ................................................................... ................ ................ ................ ................ ................

31300 1 Removal of larynx lesion .................................................................. 5 $678 314 $946 1.88

31320 1 Diagnostic incision larynx ................................................................. 2 $422 313 $537 1.07

31360 3 Removal of larynx ............................................................................. ................ ................ ................ ................ ................

31365 3 Removal of larynx ............................................................................. ................ ................ ................ ................ ................

31367 3 Partial removal of larynx ................................................................... ................ ................ ................ ................ ................

31368 3 Partial removal of larynx ................................................................... ................ ................ ................ ................ ................

31370 3 Partial removal of larynx ................................................................... ................ ................ ................ ................ ................

31375 3 Partial removal of larynx ................................................................... ................ ................ ................ ................ ................

31380 3 Partial removal of larynx ................................................................... ................ ................ ................ ................ ................

31382 3 Partial removal of larynx ................................................................... ................ ................ ................ ................ ................

31390 3 Removal of larynx & pharynx ........................................................... ................ ................ ................ ................ ................

31395 3 Reconstruct larynx & pharynx ........................................................... ................ ................ ................ ................ ................

31400 1 Revision of larynx ............................................................................. ................ ................ 314 $946 1.88 Add.

31420 1 Removal of epiglottis ........................................................................ ................ ................ 314 $946 1.88 Add.

31500 3 Insert emergency airway ................................................................... ................ ................ ................ ................ ................
32358

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

31502 1 Change of windpipe airway .............................................................. ................ ................ 470 $119 0.24 Add.

31505 5 Diagnostic laryngoscopy ................................................................... ................ ................ ................ ................ ................

31510 1 Laryngoscopy with biopsy ................................................................. 2 $422 332 $423 0.84

31511 1 Remove foreign body, larynx ............................................................ 2 $422 332 $423 0.84

31512 1 Removal of larynx lesion .................................................................. 2 $422 332 $423 0.84

31513 1 Injection into vocal cord .................................................................... 2 $422 332 $423 0.84

31515 1 Laryngoscopy for aspiration .............................................................. 1 $314 332 $423 0.84

31520 1 Diagnostic laryngoscopy ................................................................... ................ ................ 332 $423 0.84 Add.

31525 1 Diagnostic laryngoscopy ................................................................... 1 $314 332 $423 0.84

31526 1 Diagnostic laryngoscopy ................................................................... 2 $422 332 $423 0.84

31527 1 Laryngoscopy for treatment .............................................................. 1 $314 333 $653 1.30

31528 1 Laryngoscopy and dilatation ............................................................. 2 $422 332 $423 0.84

31529 1 Laryngoscopy and dilatation ............................................................. 2 $422 332 $423 0.84

31530 1 Operative laryngoscopy .................................................................... 2 $422 333 $653 1.30

31531 1 Operative laryngoscopy .................................................................... 3 $482 333 $653 1.30

31535 1 Operative laryngoscopy .................................................................... 2 $422 333 $653 1.30

31536 1 Operative laryngoscopy .................................................................... 3 $482 333 $653 1.30

31540 1 Operative laryngoscopy .................................................................... 3 $482 333 $653 1.30

31541 1 Operative laryngoscopy .................................................................... 4 $595 333 $653 1.30

31560 1 Operative laryngoscopy .................................................................... 5 $678 333 $653 1.30

31561 1 Operative laryngoscopy .................................................................... 5 $678 333 $653 1.30

31570 1 Laryngoscopy with injection .............................................................. 2 $422 333 $653 1.30

31571 1 Laryngoscopy with injection .............................................................. 2 $422 333 $653 1.30

31575 5 Diagnostic laryngoscopy ................................................................... ................ ................ ................ ................ ................

31576 1 Laryngoscopy with biopsy ................................................................. 2 $422 332 $423 0.84

31577 1 Remove foreign body, larynx ............................................................ 2 $422 332 $423 0.84

31578 1 Removal of larynx lesion .................................................................. 2 $422 332 $423 0.84

31579 5 Diagnostic laryngoscopy ................................................................... ................ ................ ................ ................ ................

31580 3 Revision of larynx ............................................................................. 5 $678 ................ ................ ................ Delete.

31582 3 Revision of larynx ............................................................................. 5 $678 ................ ................ ................ Delete.

31584 3 Repair of larynx fracture ................................................................... 4 $595 ................ ................ ................ Delete.

31585 1 Repair of larynx fracture ................................................................... 1 $314 207 $53 0.11

31586 1 Repair of larynx fracture ................................................................... 2 $422 209 $71 0.14

31587 3 Revision of larynx ............................................................................. ................ ................ ................ ................ ................

31588 1 Revision of larynx ............................................................................. 5 $678 314 $946 1.88

31590 1 Reinnervate larynx ............................................................................ 5 $678 314 $946 1.88

31595 1 Larynx nerve surgery ........................................................................ 2 $422 313 $537 1.07

31599 3 Larynx surgery procedure ................................................................. ................ ................ ................ ................ ................

31600 3 Incision of windpipe .......................................................................... 2 $422 ................ ................ ................ Delete.

31601 3 Incision of windpipe .......................................................................... ................ ................ ................ ................ ................

31603 3 Incision of windpipe .......................................................................... ................ ................ ................ ................ ................

31605 3 Incision of windpipe .......................................................................... ................ ................ ................ ................ ................

31610 3 Incision of windpipe .......................................................................... ................ ................ ................ ................ ................

31611 1 Surgery/speech prosthesis ............................................................... 3 $482 313 $537 1.07

31612 1 Puncture/clear windpipe .................................................................... 1 $314 312 $233 0.46

31613 1 Repair windpipe opening .................................................................. 2 $422 313 $537 1.07

31614 1 Repair windpipe opening .................................................................. 2 $422 313 $537 1.07

31615 1 Visualization of windpipe .................................................................. 1 $314 336 $407 0.81

31622 1 Diagnostic bronchoscopy .................................................................. 1 $314 336 $407 0.81

31625 1 Bronchoscopy with biopsy ................................................................ 2 $422 336 $407 0.81

31628 1 Bronchoscopy with biopsy ................................................................ 2 $422 336 $407 0.81

31629 1 Bronchoscopy with biopsy ................................................................ 2 $422 336 $407 0.81

31630 1 Bronchoscopy with repair ................................................................. 2 $422 336 $407 0.81

31631 1 Bronchoscopy with dilation ............................................................... 2 $422 336 $407 0.81

31635 1 Remove foreign body, airway ........................................................... 2 $422 336 $407 0.81

31640 1 Bronchoscopy & remove lesion ........................................................ 2 $422 336 $407 0.81

31641 1 Bronchoscopy, treat blockage .......................................................... 2 $422 336 $407 0.81

31645 1 Bronchoscopy, clear airways ............................................................ 1 $314 336 $407 0.81

31646 1 Bronchoscopy,reclear airways .......................................................... 1 $314 336 $407 0.81

31656 2 Bronchoscopy,inject for xray ............................................................. 1 $314 ................ ................ ................ Delete.

31700 1 Insertion of airway catheter .............................................................. 1 $314 332 $423 0.84

31708 2 Instill airway contrast dye ................................................................. ................ ................ ................ ................ ................

31710 2 Insertion of airway catheter .............................................................. 1 $314 ................ ................ ................ Delete.

31715 2 Injection for bronchus x-ray .............................................................. 1 $314 ................ ................ ................ Delete.

31717 1 Bronchial brush biopsy ..................................................................... 1 $314 332 $423 0.84

31720 1 Clearance of airways ........................................................................ 1 $314 332 $423 0.84

31725 3 Clearance of airways ........................................................................ ................ ................ ................ ................ ................

31730 1 Intro windpipe wire/tube .................................................................... 1 $314 332 $423 0.84

31750 1 Repair of windpipe ............................................................................ 5 $678 314 $946 1.88

31755 1 Repair of windpipe ............................................................................ 2 $422 314 $946 1.88

31760 3 Repair of windpipe ............................................................................ ................ ................ ................ ................ ................

31766 3 Reconstruction of windpipe ............................................................... ................ ................ ................ ................ ................

31770 3 Repair/graft of bronchus ................................................................... ................ ................ ................ ................ ................

31775 3 Reconstruct bronchus ....................................................................... ................ ................ ................ ................ ................
32359

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

31780 3 Reconstruct windpipe ........................................................................ ................ ................ ................ ................ ................

31781 3 Reconstruct windpipe ........................................................................ ................ ................ ................ ................ ................

31785 3 Remove windpipe lesion ................................................................... 4 $595 ................ ................ ................ Delete.

31786 3 Remove windpipe lesion ................................................................... ................ ................ ................ ................ ................

31800 3 Repair of windpipe injury .................................................................. 2 $422 ................ ................ ................ Delete.

31805 3 Repair of windpipe injury .................................................................. ................ ................ ................ ................ ................

31820 1 Closure of windpipe lesion ................................................................ 1 $314 313 $537 1.07

31825 1 Repair of windpipe defect ................................................................. 2 $422 313 $537 1.07

31830 1 Revise windpipe scar ........................................................................ 2 $422 313 $537 1.07

31899 3 Airways surgical procedure ............................................................... ................ ................ ................ ................ ................

32000 1 Drainage of chest .............................................................................. 1 $314 320 $126 0.25

32002 3 Treatment of collapsed lung ............................................................. 2 $422 ................ ................ ................ Delete.

32005 3 Treat lung lining chemically .............................................................. 2 $422 ................ ................ ................ Delete.

32020 3 Insertion of chest tube ...................................................................... 2 $422 ................ ................ ................ Delete.

32035 3 Exploration of chest .......................................................................... ................ ................ ................ ................ ................

32036 3 Exploration of chest .......................................................................... ................ ................ ................ ................ ................

32095 3 Biopsy through chest wall ................................................................. ................ ................ ................ ................ ................

32100 3 Exploration/biopsy of chest ............................................................... ................ ................ ................ ................ ................

32110 3 Explore/repair chest .......................................................................... ................ ................ ................ ................ ................

32120 3 Re-exploration of chest ..................................................................... ................ ................ ................ ................ ................

32124 3 Explore chest, free adhesions .......................................................... ................ ................ ................ ................ ................

32140 3 Removal of lung lesion(s) ................................................................. ................ ................ ................ ................ ................

32141 3 Remove/treat lung lesions ................................................................ ................ ................ ................ ................ ................

32150 3 Removal of lung lesion(s) ................................................................. ................ ................ ................ ................ ................

32151 3 Remove lung foreign body ................................................................ ................ ................ ................ ................ ................

32160 3 Open chest heart massage .............................................................. ................ ................ ................ ................ ................

32200 3 Open drainage, lung lesion ............................................................... ................ ................ ................ ................ ................

32201 3 Percut drainage, lung lesion ............................................................. ................ ................ ................ ................ ................

32215 3 Treat chest lining .............................................................................. ................ ................ ................ ................ ................

32220 3 Release of lung ................................................................................. ................ ................ ................ ................ ................

32225 3 Partial release of lung ....................................................................... ................ ................ ................ ................ ................

32310 3 Removal of chest lining .................................................................... ................ ................ ................ ................ ................

32320 3 Free/remove chest lining .................................................................. ................ ................ ................ ................ ................

32400 1 Needle biopsy chest lining ................................................................ 1 $314 122 $186 0.37

32402 3 Open biopsy chest lining .................................................................. ................ ................ ................ ................ ................

32405 1 Biopsy, lung or mediastinum ............................................................ 1 $314 122 $186 0.37

32420 1 Puncture/clear lung ........................................................................... 1 $314 320 $126 0.25

32440 3 Removal of lung ................................................................................ ................ ................ ................ ................ ................

32442 3 Sleeve pneumonectomy ................................................................... ................ ................ ................ ................ ................

32445 3 Removal of lung ................................................................................ ................ ................ ................ ................ ................

32480 3 Partial removal of lung ...................................................................... ................ ................ ................ ................ ................

32482 3 Bilobectomy ....................................................................................... ................ ................ ................ ................ ................

32484 3 Segmentectomy ................................................................................ ................ ................ ................ ................ ................

32486 3 Sleeve lobectomy .............................................................................. ................ ................ ................ ................ ................

32488 3 Completion pneumonectomy ............................................................ ................ ................ ................ ................ ................

32491 3 Lung volume reduction ..................................................................... ................ ................ ................ ................ ................

32500 3 Partial removal of lung ...................................................................... ................ ................ ................ ................ ................

32501 3 Repair bronchus (add-on) ................................................................. ................ ................ ................ ................ ................

32520 3 Remove lung & revise chest ............................................................. ................ ................ ................ ................ ................

32522 3 Remove lung & revise chest ............................................................. ................ ................ ................ ................ ................

32525 3 Remove lung & revise chest ............................................................. ................ ................ ................ ................ ................

32540 3 Removal of lung lesion ..................................................................... ................ ................ ................ ................ ................

32601 3 Thoracoscopy, diagnostic ................................................................. ................ ................ ................ ................ ................

32602 3 Thoracoscopy, diagnostic ................................................................. ................ ................ ................ ................ ................

32603 3 Thoracoscopy, diagnostic ................................................................. ................ ................ ................ ................ ................

32604 3 Thoracoscopy, diagnostic ................................................................. ................ ................ ................ ................ ................

32605 3 Thoracoscopy, diagnostic ................................................................. ................ ................ ................ ................ ................

32606 3 Thoracoscopy, diagnostic ................................................................. ................ ................ ................ ................ ................

32650 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32651 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32652 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32653 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32654 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32655 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32656 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32657 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32658 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32659 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32660 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32661 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32662 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32663 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32664 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................

32665 3 Thoracoscopy, surgical ..................................................................... ................ ................ ................ ................ ................
32360

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

32800 3 Repair lung hernia ............................................................................ ................ ................ ................ ................ ................

32810 3 Close chest after drainage ................................................................ ................ ................ ................ ................ ................

32815 3 Close bronchial fistula ....................................................................... ................ ................ ................ ................ ................

32820 3 Reconstruct injured chest ................................................................. ................ ................ ................ ................ ................

32850 9 Donor pneumonectomy ..................................................................... ................ ................ ................ ................ ................

32851 3 Lung transplant, single ...................................................................... ................ ................ ................ ................ ................

32852 3 Lung transplant w/bypass ................................................................. ................ ................ ................ ................ ................

32853 3 Lung transplant, double .................................................................... ................ ................ ................ ................ ................

32854 3 Lung transplant w/bypass ................................................................. ................ ................ ................ ................ ................

32900 3 Removal of rib(s) .............................................................................. ................ ................ ................ ................ ................

32905 3 Revise & repair chest wall ................................................................ ................ ................ ................ ................ ................

32906 3 Revise & repair chest wall ................................................................ ................ ................ ................ ................ ................

32940 3 Revision of lung ................................................................................ ................ ................ ................ ................ ................

32960 1 Therapeutic pneumothorax ............................................................... ................ ................ 320 $126 0.25 Add.

32999 3 Chest surgery procedure .................................................................. ................ ................ ................ ................ ................

33010 1 Drainage of heart sac ....................................................................... 2 $422 320 $126 0.25

33011 1 Repeat drainage of heart sac ........................................................... 2 $422 320 $126 0.25

33015 3 Incision of heart sac .......................................................................... ................ ................ ................ ................ ................

33020 3 Incision of heart sac .......................................................................... ................ ................ ................ ................ ................

33025 3 Incision of heart sac .......................................................................... ................ ................ ................ ................ ................

33030 3 Partial removal of heart sac .............................................................. ................ ................ ................ ................ ................

33031 3 Partial removal of heart sac .............................................................. ................ ................ ................ ................ ................

33050 3 Removal of heart sac lesion ............................................................. ................ ................ ................ ................ ................

33120 3 Removal of heart lesion .................................................................... ................ ................ ................ ................ ................

33130 3 Removal of heart lesion .................................................................... ................ ................ ................ ................ ................

33200 3 Insertion of heart pacemaker ............................................................ ................ ................ ................ ................ ................

33201 3 Insertion of heart pacemaker ............................................................ ................ ................ ................ ................ ................

33206 3 Insertion of heart pacemaker ............................................................ ................ ................ ................ ................ ................

33207 3 Insertion of heart pacemaker ............................................................ ................ ................ ................ ................ ................

33208 3 Insertion of heart pacemaker ............................................................ ................ ................ ................ ................ ................

33210 3 Insertion of heart electrode ............................................................... ................ ................ ................ ................ ................

33211 3 Insertion of heart electrode ............................................................... ................ ................ ................ ................ ................

33212 3 Insertion of pulse generator .............................................................. ................ ................ ................ ................ ................

33213 3 Insertion of pulse generator .............................................................. ................ ................ ................ ................ ................

33214 3 Upgrade of pacemaker system ......................................................... ................ ................ ................ ................ ................

33216 3 Revision implanted electrode ............................................................ ................ ................ ................ ................ ................

33217 3 Insert/revise electrode ....................................................................... ................ ................ ................ ................ ................

33218 3 Repair pacemaker electrodes ........................................................... ................ ................ ................ ................ ................

33220 3 Repair pacemaker electrode ............................................................. ................ ................ ................ ................ ................

33222 1 Pacemaker aicd pocket .................................................................... ................ ................ 360 $397 0.79 Add.

33223 1 Pacemaker aicd pocket .................................................................... ................ ................ 360 $397 0.79 Add.

33233 3 Removal of pacemaker system ........................................................ ................ ................ ................ ................ ................

33234 3 Removal of pacemaker system ........................................................ ................ ................ ................ ................ ................

33235 3 Removal pacemaker electrode ......................................................... ................ ................ ................ ................ ................

33236 3 Remove electrode/thoracotomy ........................................................ ................ ................ ................ ................ ................

33237 3 Remove electrode/thoracotomy ........................................................ ................ ................ ................ ................ ................

33238 3 Remove electrode/thoracotomy ........................................................ ................ ................ ................ ................ ................

33240 3 Insert/replace pulse gener ................................................................ ................ ................ ................ ................ ................

33241 3 Remove pulse generator only ........................................................... ................ ................ ................ ................ ................

33242 3 Repair pulse generator/leads ............................................................ ................ ................ ................ ................ ................

33243 3 Remove generator/thoracotomy ....................................................... ................ ................ ................ ................ ................

33244 3 Remove generator ............................................................................ ................ ................ ................ ................ ................

33245 3 Implant heart defibrillator .................................................................. ................ ................ ................ ................ ................

33246 3 Implant heart defibrillator .................................................................. ................ ................ ................ ................ ................

33247 3 Insert/replace leads ........................................................................... ................ ................ ................ ................ ................

33249 3 Insert/replace leads/gener ................................................................ ................ ................ ................ ................ ................

33250 3 Ablate heart dysrhythm focus ........................................................... ................ ................ ................ ................ ................

33251 3 Ablate heart dysrhythm focus ........................................................... ................ ................ ................ ................ ................

33253 3 Reconstruct atria ............................................................................... ................ ................ ................ ................ ................

33261 3 Ablate heart dysrhythm focus ........................................................... ................ ................ ................ ................ ................

33300 3 Repair of heart wound ...................................................................... ................ ................ ................ ................ ................

33305 3 Repair of heart wound ...................................................................... ................ ................ ................ ................ ................

33310 3 Exploratory heart surgery ................................................................. ................ ................ ................ ................ ................

33315 3 Exploratory heart surgery ................................................................. ................ ................ ................ ................ ................

33320 3 Repair major blood vessel(s) ............................................................ ................ ................ ................ ................ ................

33321 3 Repair major vessel .......................................................................... ................ ................ ................ ................ ................

33322 3 Repair major blood vessel(s) ............................................................ ................ ................ ................ ................ ................

33330 3 Insert major vessel graft ................................................................... ................ ................ ................ ................ ................

33332 3 Insert major vessel graft ................................................................... ................ ................ ................ ................ ................

33335 3 Insert major vessel graft ................................................................... ................ ................ ................ ................ ................

33400 3 Repair of aortic valve ........................................................................ ................ ................ ................ ................ ................

33401 3 Valvuloplasty, open ........................................................................... ................ ................ ................ ................ ................

33403 3 Valvuloplasty, w/cp bypass ............................................................... ................ ................ ................ ................ ................

33404 3 Prepare heart-aorta conduit .............................................................. ................ ................ ................ ................ ................
32361

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

33405 3 Replacement of aortic valve ............................................................. ................ ................ ................ ................ ................

33406 3 Replacement, aortic valve ................................................................ ................ ................ ................ ................ ................

33411 3 Replacement of aortic valve ............................................................. ................ ................ ................ ................ ................

33412 3 Replacement of aortic valve ............................................................. ................ ................ ................ ................ ................

33413 3 Replacement, aortic valve ................................................................ ................ ................ ................ ................ ................

33414 3 Repair, aortic valve ........................................................................... ................ ................ ................ ................ ................

33415 3 Revision, subvalvular tissue ............................................................. ................ ................ ................ ................ ................

33416 3 Revise ventricle muscle .................................................................... ................ ................ ................ ................ ................

33417 3 Repair of aortic valve ........................................................................ ................ ................ ................ ................ ................

33420 3 Revision of mitral valve ..................................................................... ................ ................ ................ ................ ................

33422 3 Revision of mitral valve ..................................................................... ................ ................ ................ ................ ................

33425 3 Repair of mitral valve ........................................................................ ................ ................ ................ ................ ................

33426 3 Repair of mitral valve ........................................................................ ................ ................ ................ ................ ................

33427 3 Repair of mitral valve ........................................................................ ................ ................ ................ ................ ................

33430 3 Replacement of mitral valve ............................................................. ................ ................ ................ ................ ................

33460 3 Revision of tricuspid valve ................................................................ ................ ................ ................ ................ ................

33463 3 Valvuloplasty, tricuspid ..................................................................... ................ ................ ................ ................ ................

33464 3 Valvuloplasty, tricuspid ..................................................................... ................ ................ ................ ................ ................

33465 3 Replace tricuspid valve ..................................................................... ................ ................ ................ ................ ................

33468 3 Revision of tricuspid valve ................................................................ ................ ................ ................ ................ ................

33470 3 Revision of pulmonary valve ............................................................. ................ ................ ................ ................ ................

33471 3 Valvotomy, pulmonary valve ............................................................. ................ ................ ................ ................ ................

33472 3 Revision of pulmonary valve ............................................................. ................ ................ ................ ................ ................

33474 3 Revision of pulmonary valve ............................................................. ................ ................ ................ ................ ................

33475 3 Replacement, pulmonary valve ........................................................ ................ ................ ................ ................ ................

33476 3 Revision of heart chamber ................................................................ ................ ................ ................ ................ ................

33478 3 Revision of heart chamber ................................................................ ................ ................ ................ ................ ................

33496 3 Repair, prosth valve clot ................................................................... ................ ................ ................ ................ ................

33500 3 Repair heart vessel fistula ................................................................ ................ ................ ................ ................ ................

33501 3 Repair heart vessel fistula ................................................................ ................ ................ ................ ................ ................

33502 3 Coronary artery correction ................................................................ ................ ................ ................ ................ ................

33503 3 Coronary artery graft ......................................................................... ................ ................ ................ ................ ................

33504 3 Coronary artery graft ......................................................................... ................ ................ ................ ................ ................

33505 3 Repair artery w/tunnel ....................................................................... ................ ................ ................ ................ ................

33506 3 Repair artery, translocation ............................................................... ................ ................ ................ ................ ................

33510 3 CABG, vein, single ............................................................................ ................ ................ ................ ................ ................

33511 3 CABG, vein, two ............................................................................... ................ ................ ................ ................ ................

33512 3 CABG, vein, three ............................................................................. ................ ................ ................ ................ ................

33513 3 CABG, vein, four ............................................................................... ................ ................ ................ ................ ................

33514 3 CABG, vein, five ............................................................................... ................ ................ ................ ................ ................

33516 3 CABG, vein, six+ ............................................................................... ................ ................ ................ ................ ................

33517 3 CABG, artery-vein, single ................................................................. ................ ................ ................ ................ ................

33518 3 CABG, artery-vein, two ..................................................................... ................ ................ ................ ................ ................

33519 3 CABG, artery-vein, three .................................................................. ................ ................ ................ ................ ................

33521 3 CABG, artery-vein, four .................................................................... ................ ................ ................ ................ ................

33522 3 CABG, artery-vein, five ..................................................................... ................ ................ ................ ................ ................

33523 3 CABG, artery-vein, six+ .................................................................... ................ ................ ................ ................ ................

33530 3 Coronary artery, bypass/reop ........................................................... ................ ................ ................ ................ ................

33533 3 CABG, arterial, single ....................................................................... ................ ................ ................ ................ ................

33534 3 CABG, arterial, two ........................................................................... ................ ................ ................ ................ ................

33535 3 CABG, arterial, three ........................................................................ ................ ................ ................ ................ ................

33536 3 CABG, arterial, four+ ........................................................................ ................ ................ ................ ................ ................

33542 3 Removal of heart lesion .................................................................... ................ ................ ................ ................ ................

33545 3 Repair of heart damage .................................................................... ................ ................ ................ ................ ................

33572 3 Open coronary endarterectomy ........................................................ ................ ................ ................ ................ ................

33600 3 Closure of valve ................................................................................ ................ ................ ................ ................ ................

33602 3 Closure of valve ................................................................................ ................ ................ ................ ................ ................

33606 3 Anastomosis/artery-aorta .................................................................. ................ ................ ................ ................ ................

33608 3 Repair anomaly w/conduit ................................................................ ................ ................ ................ ................ ................

33610 3 Repair by enlargement ..................................................................... ................ ................ ................ ................ ................

33611 3 Repair double ventricle ..................................................................... ................ ................ ................ ................ ................

33612 3 Repair double ventricle ..................................................................... ................ ................ ................ ................ ................

33615 3 Repair (simple fontan) ...................................................................... ................ ................ ................ ................ ................

33617 3 Repair by modified fontan ................................................................. ................ ................ ................ ................ ................

33619 3 Repair single ventricle ...................................................................... ................ ................ ................ ................ ................

33641 3 Repair heart septum defect .............................................................. ................ ................ ................ ................ ................

33645 3 Revision of heart veins ..................................................................... ................ ................ ................ ................ ................

33647 3 Repair heart septum defects ............................................................ ................ ................ ................ ................ ................

33660 3 Repair of heart defects ..................................................................... ................ ................ ................ ................ ................

33665 3 Repair of heart defects ..................................................................... ................ ................ ................ ................ ................

33670 3 Repair of heart chambers ................................................................. ................ ................ ................ ................ ................

33681 3 Repair heart septum defect .............................................................. ................ ................ ................ ................ ................

33684 3 Repair heart septum defect .............................................................. ................ ................ ................ ................ ................

33688 3 Repair heart septum defect .............................................................. ................ ................ ................ ................ ................
32362

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

33690 3 Reinforce pulmonary artery .............................................................. ................ ................ ................ ................ ................

33692 3 Repair of heart defects ..................................................................... ................ ................ ................ ................ ................

33694 3 Repair of heart defects ..................................................................... ................ ................ ................ ................ ................

33697 3 Repair of heart defects ..................................................................... ................ ................ ................ ................ ................

33702 3 Repair of heart defects ..................................................................... ................ ................ ................ ................ ................

33710 3 Repair of heart defects ..................................................................... ................ ................ ................ ................ ................

33720 3 Repair of heart defect ....................................................................... ................ ................ ................ ................ ................

33722 3 Repair of heart defect ....................................................................... ................ ................ ................ ................ ................

33730 3 Repair heart-vein defect(s) ............................................................... ................ ................ ................ ................ ................

33732 3 Repair heart-vein defect ................................................................... ................ ................ ................ ................ ................

33735 3 Revision of heart chamber ................................................................ ................ ................ ................ ................ ................

33736 3 Revision of heart chamber ................................................................ ................ ................ ................ ................ ................

33737 3 Revision of heart chamber ................................................................ ................ ................ ................ ................ ................

33750 3 Major vessel shunt ............................................................................ ................ ................ ................ ................ ................

33755 3 Major vessel shunt ............................................................................ ................ ................ ................ ................ ................

33762 3 Major vessel shunt ............................................................................ ................ ................ ................ ................ ................

33764 3 Major vessel shunt & graft ................................................................ ................ ................ ................ ................ ................

33766 3 Major vessel shunt ............................................................................ ................ ................ ................ ................ ................

33767 3 Atrial septectomy/septostomy ........................................................... ................ ................ ................ ................ ................

33770 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33771 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33774 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33775 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33776 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33777 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33778 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33779 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33780 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33781 3 Repair great vessels defect .............................................................. ................ ................ ................ ................ ................

33786 3 Repair arterial trunk .......................................................................... ................ ................ ................ ................ ................

33788 3 Revision of pulmonary artery ............................................................ ................ ................ ................ ................ ................

33800 3 Aortic suspension .............................................................................. ................ ................ ................ ................ ................

33802 3 Repair vessel defect ......................................................................... ................ ................ ................ ................ ................

33803 3 Repair vessel defect ......................................................................... ................ ................ ................ ................ ................

33813 3 Repair septal defect .......................................................................... ................ ................ ................ ................ ................

33814 3 Repair septal defect .......................................................................... ................ ................ ................ ................ ................

33820 3 Revise major vessel .......................................................................... ................ ................ ................ ................ ................

33822 3 Revise major vessel .......................................................................... ................ ................ ................ ................ ................

33824 3 Revise major vessel .......................................................................... ................ ................ ................ ................ ................

33840 3 Remove aorta constriction ................................................................ ................ ................ ................ ................ ................

33845 3 Remove aorta constriction ................................................................ ................ ................ ................ ................ ................

33851 3 Remove aorta constriction ................................................................ ................ ................ ................ ................ ................

33852 3 Repair septal defect .......................................................................... ................ ................ ................ ................ ................

33853 3 Repair septal defect .......................................................................... ................ ................ ................ ................ ................

33860 3 Ascending aorta graft ........................................................................ ................ ................ ................ ................ ................

33861 3 Ascending aorta graft ........................................................................ ................ ................ ................ ................ ................

33863 3 Ascending aorta graft ........................................................................ ................ ................ ................ ................ ................

33870 3 Transverse aortic arch graft .............................................................. ................ ................ ................ ................ ................

33875 3 Thoracic aorta graft ........................................................................... ................ ................ ................ ................ ................

33877 3 Thoracoabdominal graft .................................................................... ................ ................ ................ ................ ................

33910 3 Remove lung artery emboli ............................................................... ................ ................ ................ ................ ................

33915 3 Remove lung artery emboli ............................................................... ................ ................ ................ ................ ................

33916 3 Surgery of great vessel ..................................................................... ................ ................ ................ ................ ................

33917 3 Repair pulmonary artery ................................................................... ................ ................ ................ ................ ................

33918 3 Repair pulmonary atresia .................................................................. ................ ................ ................ ................ ................

33919 3 Repair pulmonary atresia .................................................................. ................ ................ ................ ................ ................

33920 3 Repair pulmonary atresia .................................................................. ................ ................ ................ ................ ................

33922 3 Transect pulmonary artery ................................................................ ................ ................ ................ ................ ................

33924 3 Remove pulmonary shunt ................................................................. ................ ................ ................ ................ ................

33930 9 Removal of donor heart/lung ............................................................ ................ ................ ................ ................ ................

33935 3 Transplantation, heart/lung ............................................................... ................ ................ ................ ................ ................

33940 9 Removal of donor heart .................................................................... ................ ................ ................ ................ ................

33945 3 Transplantation of heart .................................................................... ................ ................ ................ ................ ................

33960 3 External circulation assist ................................................................. ................ ................ ................ ................ ................

33961 3 External circulation assist ................................................................. ................ ................ ................ ................ ................

33970 3 Aortic circulation assist ..................................................................... ................ ................ ................ ................ ................

33971 3 Aortic circulation assist ..................................................................... ................ ................ ................ ................ ................

33973 3 Insert balloon device ......................................................................... ................ ................ ................ ................ ................

33974 3 Remove intra-aortic balloon .............................................................. ................ ................ ................ ................ ................

33975 3 Implant ventricular device ................................................................. ................ ................ ................ ................ ................

33976 3 Implant ventricular device ................................................................. ................ ................ ................ ................ ................

33977 3 Remove ventricular device ............................................................... ................ ................ ................ ................ ................

33978 3 Remove ventricular device ............................................................... ................ ................ ................ ................ ................

33999 3 Cardiac surgery procedure ............................................................... ................ ................ ................ ................ ................
32363

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

34001 3 Removal of artery clot ....................................................................... ................ ................ ................ ................ ................

34051 3 Removal of artery clot ....................................................................... ................ ................ ................ ................ ................

34101 3 Removal of artery clot ....................................................................... 3 $482 ................ ................ ................ Delete.

34111 3 Removal of arm artery clot ............................................................... ................ ................ ................ ................ ................

34151 3 Removal of artery clot ....................................................................... ................ ................ ................ ................ ................

34201 3 Removal of artery clot ....................................................................... ................ ................ ................ ................ ................

34203 3 Removal of leg artery clot ................................................................. ................ ................ ................ ................ ................

34401 3 Removal of vein clot ......................................................................... ................ ................ ................ ................ ................

34421 3 Removal of vein clot ......................................................................... ................ ................ ................ ................ ................

34451 3 Removal of vein clot ......................................................................... ................ ................ ................ ................ ................

34471 3 Removal of vein clot ......................................................................... ................ ................ ................ ................ ................

34490 3 Removal of vein clot ......................................................................... ................ ................ ................ ................ ................

34501 3 Repair valve, femoral vein ................................................................ ................ ................ ................ ................ ................

34502 3 Reconstruct, vena cava .................................................................... ................ ................ ................ ................ ................

34510 3 Transposition of vein valve ............................................................... ................ ................ ................ ................ ................

34520 3 Cross-over vein graft ........................................................................ ................ ................ ................ ................ ................

34530 3 Leg vein fusion .................................................................................. ................ ................ ................ ................ ................

35001 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35002 3 Repair artery rupture, neck ............................................................... ................ ................ ................ ................ ................

35005 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35011 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35013 3 Repair artery rupture, arm ................................................................ ................ ................ ................ ................ ................

35021 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35022 3 Repair artery rupture, chest .............................................................. ................ ................ ................ ................ ................

35045 3 Repair defect of arm artery ............................................................... ................ ................ ................ ................ ................

35081 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35082 3 Repair artery rupture, aorta .............................................................. ................ ................ ................ ................ ................

35091 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35092 3 Repair artery rupture, aorta .............................................................. ................ ................ ................ ................ ................

35102 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35103 3 Repair artery rupture, groin .............................................................. ................ ................ ................ ................ ................

35111 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35112 3 Repair artery rupture,spleen ............................................................. ................ ................ ................ ................ ................

35121 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35122 3 Repair artery rupture, belly ............................................................... ................ ................ ................ ................ ................

35131 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35132 3 Repair artery rupture, groin .............................................................. ................ ................ ................ ................ ................

35141 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35142 3 Repair artery rupture, thigh ............................................................... ................ ................ ................ ................ ................

35151 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35152 3 Repair artery rupture, knee ............................................................... ................ ................ ................ ................ ................

35161 3 Repair defect of artery ...................................................................... ................ ................ ................ ................ ................

35162 3 Repair artery rupture ......................................................................... ................ ................ ................ ................ ................

35180 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35182 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35184 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35188 1 Repair blood vessel lesion ................................................................ ................ ................ 368 $841 1.67 Add.

35189 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35190 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35201 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35206 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35207 1 Repair blood vessel lesion ................................................................ ................ ................ 368 $841 1.67 Add.

35211 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35216 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35221 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35226 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35231 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35236 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35241 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35246 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35251 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35256 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35261 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35266 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35271 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35276 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35281 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35286 3 Repair blood vessel lesion ................................................................ ................ ................ ................ ................ ................

35301 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35311 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35321 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35331 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35341 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35351 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................
32364

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

35355 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35361 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35363 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35371 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35372 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35381 3 Rechanneling of artery ...................................................................... ................ ................ ................ ................ ................

35390 3 Reoperation, carotid .......................................................................... ................ ................ ................ ................ ................

35400 3 Angioscopy ........................................................................................ ................ ................ ................ ................ ................

35450 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35452 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35454 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35456 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35458 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35459 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35460 3 Repair venous blockage ................................................................... ................ ................ ................ ................ ................

35470 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35471 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35472 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35473 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35474 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35475 3 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

35476 3 Repair venous blockage ................................................................... ................ ................ ................ ................ ................

35480 3 Atherectomy, open ............................................................................ ................ ................ ................ ................ ................

35481 3 Atherectomy, open ............................................................................ ................ ................ ................ ................ ................

35482 3 Atherectomy, open ............................................................................ ................ ................ ................ ................ ................

35483 3 Atherectomy, open ............................................................................ ................ ................ ................ ................ ................

35484 3 Atherectomy, open ............................................................................ ................ ................ ................ ................ ................

35485 3 Atherectomy, open ............................................................................ ................ ................ ................ ................ ................

35490 3 Atherectomy, percutaneous .............................................................. ................ ................ ................ ................ ................

35491 3 Atherectomy, percutaneous .............................................................. ................ ................ ................ ................ ................

35492 3 Atherectomy, percutaneous .............................................................. ................ ................ ................ ................ ................

35493 3 Atherectomy, percutaneous .............................................................. ................ ................ ................ ................ ................

35494 3 Atherectomy, percutaneous .............................................................. ................ ................ ................ ................ ................

35495 3 Atherectomy, percutaneous .............................................................. ................ ................ ................ ................ ................

35501 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35506 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35507 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35508 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35509 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35511 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35515 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35516 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35518 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35521 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35526 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35531 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35533 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35536 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35541 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35546 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35548 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35549 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35551 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35556 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35558 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35560 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35563 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35565 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35566 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35571 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35582 3 Vein bypass graft .............................................................................. ................ ................ ................ ................ ................

35583 3 Vein bypass graft .............................................................................. ................ ................ ................ ................ ................

35585 3 Vein bypass graft .............................................................................. ................ ................ ................ ................ ................

35587 3 Vein bypass graft .............................................................................. ................ ................ ................ ................ ................

35601 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35606 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35612 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35616 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35621 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35623 3 Bypass graft, not vein ....................................................................... ................ ................ ................ ................ ................

35626 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35631 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35636 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35641 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................
32365

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

35642 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35645 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35646 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35650 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35651 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35654 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35656 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35661 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35663 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35665 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35666 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35671 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35681 3 Artery bypass graft ............................................................................ ................ ................ ................ ................ ................

35691 3 Arterial transposition ......................................................................... ................ ................ ................ ................ ................

35693 3 Arterial transposition ......................................................................... ................ ................ ................ ................ ................

35694 3 Arterial transposition ......................................................................... ................ ................ ................ ................ ................

35695 3 Arterial transposition ......................................................................... ................ ................ ................ ................ ................

35700 3 Reoperation, bypass graft ................................................................. ................ ................ ................ ................ ................

35701 3 Exploration, carotid artery ................................................................. ................ ................ ................ ................ ................

35721 3 Exploration, femoral artery ................................................................ ................ ................ ................ ................ ................

35741 3 Exploration popliteal artery ............................................................... ................ ................ ................ ................ ................

35761 3 Exploration of artery/vein .................................................................. ................ ................ ................ ................ ................

35800 3 Explore neck vessels ........................................................................ ................ ................ ................ ................ ................

35820 3 Explore chest vessels ....................................................................... ................ ................ ................ ................ ................

35840 3 Explore abdominal vessels ............................................................... ................ ................ ................ ................ ................

35860 3 Explore limb vessels ......................................................................... ................ ................ ................ ................ ................

35870 3 Repair vessel graft defect ................................................................. ................ ................ ................ ................ ................

35875 1 Removal of clot in graft ..................................................................... ................ ................ 368 $841 1.67 Add.

35876 1 Removal of clot in graft ..................................................................... ................ ................ 368 $841 1.67 Add.

35901 3 Excision, graft, neck .......................................................................... ................ ................ ................ ................ ................

35903 3 Excision, graft, extremity ................................................................... ................ ................ ................ ................ ................

35905 3 Excision, graft, thorax ....................................................................... ................ ................ ................ ................ ................

35907 3 Excision, graft, abdomen .................................................................. ................ ................ ................ ................ ................

36000 2 Place needle in vein ......................................................................... ................ ................ ................ ................ ................

36005 2 Injection, venography ........................................................................ ................ ................ ................ ................ ................

36010 3 Place catheter in vein ....................................................................... ................ ................ ................ ................ ................

36011 2 Place catheter in vein ....................................................................... ................ ................ ................ ................ ................

36012 2 Place catheter in vein ....................................................................... ................ ................ ................ ................ ................

36013 3 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36014 3 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36015 3 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36100 2 Establish access to artery ................................................................. ................ ................ ................ ................ ................

36120 2 Establish access to artery ................................................................. ................ ................ ................ ................ ................

36140 2 Establish access to artery ................................................................. ................ ................ ................ ................ ................

36145 2 Artery to vein shunt ........................................................................... ................ ................ ................ ................ ................

36160 2 Establish access to aorta .................................................................. ................ ................ ................ ................ ................

36200 2 Place catheter in aorta ...................................................................... ................ ................ ................ ................ ................

36215 2 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36216 2 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36217 2 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36218 2 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36245 2 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36246 2 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36247 2 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36248 2 Place catheter in artery ..................................................................... ................ ................ ................ ................ ................

36260 1 Insertion of infusion pump ................................................................ ................ ................ 368 $841 1.67 Add.

36261 1 Revision of infusion pump ................................................................ 2 $422 360 $397 0.79

36262 1 Removal of infusion pump ................................................................ 1 $314 360 $397 0.79

36299 3 Vessel injection procedure ................................................................ ................ ................ ................ ................ ................

36400 2 Drawing blood ................................................................................... ................ ................ ................ ................ ................

36405 2 Drawing blood ................................................................................... ................ ................ ................ ................ ................

36406 2 Drawing blood ................................................................................... ................ ................ ................ ................ ................

36410 2 Drawing blood ................................................................................... ................ ................ ................ ................ ................

36415 9 Drawing blood ................................................................................... ................ ................ ................ ................ ................

36420 2 Establish access to vein ................................................................... ................ ................ ................ ................ ................

36425 2 Establish access to vein ................................................................... ................ ................ ................ ................ ................

36430 6 Blood transfusion service .................................................................. ................ ................ ................ ................ ................

36440 6 Blood transfusion service .................................................................. ................ ................ ................ ................ ................

36450 6 Exchange transfusion service ........................................................... ................ ................ ................ ................ ................

36455 6 Exchange transfusion service ........................................................... ................ ................ ................ ................ ................

36460 6 Transfusion service, fetal .................................................................. ................ ................ ................ ................ ................

36468 5 Injection(s); spider veins ................................................................... ................ ................ ................ ................ ................

36469 5 Injection(s); spider veins ................................................................... ................ ................ ................ ................ ................

36470 5 Injection therapy of vein .................................................................... ................ ................ ................ ................ ................
32366

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

36471 5 Injection therapy of veins .................................................................. ................ ................ ................ ................ ................

36481 2 Insertion of catheter, vein ................................................................. ................ ................ ................ ................ ................

36488 1 Insertion of catheter, vein ................................................................. ................ ................ 346 $195 0.39 Add.

36489 1 Insertion of catheter, vein ................................................................. 1 $314 346 $195 0.39

36490 1 Insertion of catheter, vein ................................................................. ................ ................ 346 $195 0.39 Add.

36491 1 Insertion of catheter, vein ................................................................. 1 $314 346 $195 0.39

36493 1 Repositioning of cvc .......................................................................... ................ ................ 346 $195 0.39 Add.

36500 3 Insertion of catheter, vein ................................................................. ................ ................ ................ ................ ................

36510 3 Insertion of catheter, vein ................................................................. ................ ................ ................ ................ ................

36520 6 Plasma and/or cell exchange ........................................................... ................ ................ ................ ................ ................

36522 6 Photopheresis ................................................................................... ................ ................ ................ ................ ................

36530 7 Insertion of infusion pump ................................................................ 3 $482 368 $841 1.67

36531 7 Revision of infusion pump ................................................................ 2 $422 360 $397 0.79

36532 7 Removal of infusion pump ................................................................ 1 $314 360 $397 0.79

36533 1 Insertion of access port .................................................................... 3 $482 368 $841 1.67

36534 1 Revision of access port .................................................................... 2 $422 360 $397 0.79

36535 1 Removal of access port .................................................................... 1 $314 360 $397 0.79

36600 2 Withdrawal of arterial blood .............................................................. ................ ................ ................ ................ ................

36620 3 Insertion catheter, artery ................................................................... ................ ................ ................ ................ ................

36625 3 Insertion catheter, artery ................................................................... ................ ................ ................ ................ ................

36640 1 Insertion catheter, artery ................................................................... 1 $314 346 $195 0.39

36660 3 Insertion catheter, artery ................................................................... ................ ................ ................ ................ ................

36680 6 Insert needle, bone cavity ................................................................. ................ ................ ................ ................ ................

36800 1 Insertion of cannula .......................................................................... 3 $482 368 $841 1.67

36810 1 Insertion of cannula .......................................................................... 3 $482 368 $841 1.67

36815 1 Insertion of cannula .......................................................................... 3 $482 368 $841 1.67

36821 1 Artery-vein fusion .............................................................................. 3 $482 368 $841 1.67

36822 3 Insertion of cannula(s) ...................................................................... ................ ................ ................ ................ ................

36825 1 Artery-vein graft ................................................................................ 4 $595 368 $841 1.67

36830 1 Artery-vein graft ................................................................................ 4 $595 368 $841 1.67

36832 1 Revise artery-vein fistula .................................................................. 4 $595 368 $841 1.67

36834 3 Repair A-V aneurysm ....................................................................... ................ ................ ................ ................ ................

36835 1 Artery to vein shunt ........................................................................... 4 $595 368 $841 1.67

36860 1 Cannula declotting ............................................................................ 2 $422 368 $841 1.67

36861 1 Cannula declotting ............................................................................ 3 $482 368 $841 1.67

37140 3 Revision of circulation ....................................................................... ................ ................ ................ ................ ................

37145 3 Revision of circulation ....................................................................... ................ ................ ................ ................ ................

37160 3 Revision of circulation ....................................................................... ................ ................ ................ ................ ................

37180 3 Revision of circulation ....................................................................... ................ ................ ................ ................ ................

37181 3 Splice spleen/kidney veins ................................................................ ................ ................ ................ ................ ................

37195 3 Thrombolytic therapy, stroke ............................................................ ................ ................ ................ ................ ................

37200 3 Transcatheter biopsy ........................................................................ ................ ................ ................ ................ ................

37201 3 Transcatheter therapy infuse ............................................................ ................ ................ ................ ................ ................

37202 3 Transcatheter therapy infuse ............................................................ ................ ................ ................ ................ ................

37203 3 Transcatheter retrieval ...................................................................... ................ ................ ................ ................ ................

37204 3 Transcatheter occlusion .................................................................... ................ ................ ................ ................ ................

37205 3 Transcatheter stent ........................................................................... ................ ................ ................ ................ ................

37206 3 Transcatheter stent ........................................................................... ................ ................ ................ ................ ................

37207 3 Transcatheter stent ........................................................................... ................ ................ ................ ................ ................

37208 3 Transcatheter stent ........................................................................... ................ ................ ................ ................ ................

37209 3 Exchange arterial catheter ................................................................ ................ ................ ................ ................ ................

37250 3 Intravascular us ................................................................................. ................ ................ ................ ................ ................

37251 3 Intravascular us ................................................................................. ................ ................ ................ ................ ................

37565 3 Ligation of neck vein ......................................................................... ................ ................ ................ ................ ................

37600 3 Ligation of neck artery ...................................................................... ................ ................ ................ ................ ................

37605 3 Ligation of neck artery ...................................................................... ................ ................ ................ ................ ................

37606 3 Ligation of neck artery ...................................................................... ................ ................ ................ ................ ................

37607 1 Ligation of fistula ............................................................................... ................ ................ 368 $841 1.67 Add.

37609 1 Temporal artery procedure ............................................................... 2 $422 162 $187 0.37

37615 3 Ligation of neck artery ...................................................................... ................ ................ ................ ................ ................

37616 3 Ligation of chest artery ..................................................................... ................ ................ ................ ................ ................

37617 3 Ligation of abdomen artery ............................................................... ................ ................ ................ ................ ................

37618 1 Ligation of extremity artery ............................................................... ................ ................ 367 $682 1.35 Add.

37620 3 Revision of major vein ...................................................................... ................ ................ ................ ................ ................

37650 1 Revision of major vein ...................................................................... ................ ................ 367 $682 1.35 Add.

37660 3 Revision of major vein ...................................................................... ................ ................ ................ ................ ................

37700 1 Revise leg vein ................................................................................. 2 $422 367 $682 1.35

37720 1 Removal of leg vein .......................................................................... 3 $482 367 $682 1.35

37730 1 Removal of leg veins ........................................................................ 3 $482 367 $682 1.35

37735 1 Removal of leg veins/lesion .............................................................. 3 $482 367 $682 1.35

37760 1 Revision of leg veins ......................................................................... 3 $482 367 $682 1.35

37780 1 Revision of leg vein .......................................................................... 3 $482 367 $682 1.35

37785 1 Revise secondary varicosity ............................................................. 3 $482 367 $682 1.35

37788 3 Revascularization, penis ................................................................... ................ ................ ................ ................ ................
32367

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

37790 1 Penile venous occlusion ................................................................... ................ ................ 537 $1,221 2.42 Add.

37799 3 Vascular surgery procedure .............................................................. ................ ................ ................ ................ ................

38100 3 Removal of spleen, total ................................................................... ................ ................ ................ ................ ................

38101 3 Removal of spleen, partial ................................................................ ................ ................ ................ ................ ................

38102 3 Removal of spleen, total ................................................................... ................ ................ ................ ................ ................

38115 3 Repair of ruptured spleen ................................................................. ................ ................ ................ ................ ................

38200 2 Injection for spleen x-ray .................................................................. ................ ................ ................ ................ ................

38230 6 Bone marrow collection .................................................................... ................ ................ ................ ................ ................

38231 6 Stem cell collection ........................................................................... ................ ................ ................ ................ ................

38240 3 Bone marrow/stem transplant ........................................................... ................ ................ ................ ................ ................

38241 3 Bone marrow/stem transplant ........................................................... ................ ................ ................ ................ ................

38300 1 Drainage lymph node lesion ............................................................. 1 $314 132 $162 0.32

38305 1 Drainage lymph node lesion ............................................................. 2 $422 132 $162 0.32

38308 1 Incision of lymph channels ............................................................... 2 $422 396 $440 0.87

38380 3 Thoracic duct procedure ................................................................... ................ ................ ................ ................ ................

38381 3 Thoracic duct procedure ................................................................... ................ ................ ................ ................ ................

38382 3 Thoracic duct procedure ................................................................... ................ ................ ................ ................ ................

38500 1 Biopsy/removal, lymph node(s) ........................................................ 2 $422 396 $440 0.87

38505 1 Needle biopsy, lymph node(s) .......................................................... 1 $314 122 $186 0.37

38510 1 Biopsy/removal, lymph node(s) ........................................................ 2 $422 396 $440 0.87

38520 1 Biopsy/removal, lymph node(s) ........................................................ 2 $422 396 $440 0.87

38525 1 Biopsy/removal, lymph node(s) ........................................................ 2 $422 396 $440 0.87

38530 1 Biopsy/removal, lymph node(s) ........................................................ 2 $422 396 $440 0.87

38542 1 Explore deep node(s), neck .............................................................. 2 $422 397 $630 1.25

38550 1 Removal neck/armpit lesion .............................................................. 3 $482 396 $440 0.87

38555 1 Removal neck/armpit lesion .............................................................. 4 $595 397 $630 1.25

38562 3 Removal, pelvic lymph nodes ........................................................... ................ ................ ................ ................ ................

38564 3 Removal, abdomen lymph nodes ..................................................... ................ ................ ................ ................ ................

38700 3 Removal of lymph nodes, neck ........................................................ 2 $422 ................ ................ ................ Delete.

38720 3 Removal of lymph nodes, neck ........................................................ ................ ................ ................ ................ ................

38724 3 Removal of lymph nodes, neck ........................................................ ................ ................ ................ ................ ................

38740 1 Remove armpit lymph nodes ............................................................ 2 $422 397 $630 1.25

38745 1 Remove armpits lymph nodes .......................................................... 4 $595 397 $630 1.25

38746 3 Remove thoracic lymph nodes ......................................................... ................ ................ ................ ................ ................

38747 3 Remove abdominal lymph nodes ..................................................... ................ ................ ................ ................ ................

38760 1 Remove groin lymph nodes .............................................................. 2 $422 397 $630 1.25

38765 3 Remove groin lymph nodes .............................................................. ................ ................ ................ ................ ................

38770 3 Remove pelvis lymph nodes ............................................................. ................ ................ ................ ................ ................

38780 3 Remove abdomen lymph nodes ....................................................... ................ ................ ................ ................ ................

38790 2 Injection for lymphatic xray ............................................................... 1 $314 ................ ................ ................ Delete.

38794 2 Access thoracic lymph duct .............................................................. ................ ................ ................ ................ ................

38999 3 Blood/lymph system procedure ........................................................ ................ ................ ................ ................ ................

39000 3 Exploration of chest .......................................................................... ................ ................ ................ ................ ................

39010 3 Exploration of chest .......................................................................... ................ ................ ................ ................ ................

39200 3 Removal chest lesion ........................................................................ ................ ................ ................ ................ ................

39220 3 Removal chest lesion ........................................................................ ................ ................ ................ ................ ................

39400 3 Visualization of chest ........................................................................ ................ ................ ................ ................ ................

39499 3 Chest procedure ............................................................................... ................ ................ ................ ................ ................

39501 3 Repair diaphragm laceration ............................................................. ................ ................ ................ ................ ................

39502 3 Repair paraesophageal hernia ......................................................... ................ ................ ................ ................ ................

39503 3 Repair of diaphragm hernia .............................................................. ................ ................ ................ ................ ................

39520 3 Repair of diaphragm hernia .............................................................. ................ ................ ................ ................ ................

39530 3 Repair of diaphragm hernia .............................................................. ................ ................ ................ ................ ................

39531 3 Repair of diaphragm hernia .............................................................. ................ ................ ................ ................ ................

39540 3 Repair of diaphragm hernia .............................................................. ................ ................ ................ ................ ................

39541 3 Repair of diaphragm hernia .............................................................. ................ ................ ................ ................ ................

39545 3 Revision of diaphragm ...................................................................... ................ ................ ................ ................ ................

39599 3 Diaphragm surgery procedure .......................................................... ................ ................ ................ ................ ................

40490 5 Biopsy of lip ...................................................................................... ................ ................ ................ ................ ................

40500 1 Partial excision of lip ......................................................................... 2 $422 313 $537 1.07

40510 1 Partial excision of lip ......................................................................... 2 $422 313 $537 1.07

40520 1 Partial excision of lip ......................................................................... 2 $422 313 $537 1.07

40525 1 Reconstruct lip with flap .................................................................... 2 $422 313 $537 1.07

40527 1 Reconstruct lip with flap .................................................................... 2 $422 313 $537 1.07

40530 1 Partial removal of lip ......................................................................... 2 $422 313 $537 1.07

40650 1 Repair lip ........................................................................................... 3 $482 313 $537 1.07

40652 1 Repair lip ........................................................................................... 3 $482 313 $537 1.07

40654 1 Repair lip ........................................................................................... 3 $482 313 $537 1.07

40700 1 Repair cleft lip/nasal ......................................................................... ................ ................ 314 $946 1.88 Add.

40701 1 Repair cleft lip/nasal ......................................................................... ................ ................ 314 $946 1.88 Add.

40702 1 Repair cleft lip/nasal ......................................................................... ................ ................ 314 $946 1.88 Add.

40720 1 Repair cleft lip/nasal ......................................................................... ................ ................ 314 $946 1.88 Add.

40761 1 Repair cleft lip/nasal ......................................................................... ................ ................ 314 $946 1.88 Add.

40799 3 Lip surgery procedure ....................................................................... ................ ................ ................ ................ ................
32368

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

40800 5 Drainage of mouth lesion .................................................................. ................ ................ ................ ................ ................

40801 5 Drainage of mouth lesion .................................................................. 2 $422 ................ ................ ................ Delete.

40804 5 Removal foreign body, mouth ........................................................... ................ ................ ................ ................ ................

40805 5 Removal foreign body, mouth ........................................................... 2 $422 ................ ................ ................ Delete.

40806 5 Incision of lip fold .............................................................................. 1 $314 ................ ................ ................ Delete.

40808 5 Biopsy of mouth lesion ..................................................................... ................ ................ ................ ................ ................

40810 5 Excision of mouth lesion ................................................................... ................ ................ ................ ................ ................

40812 5 Excise/repair mouth lesion ................................................................ ................ ................ ................ ................ ................

40814 1 Excise/repair mouth lesion ................................................................ 2 $422 313 $537 1.07

40816 1 Excision of mouth lesion ................................................................... 2 $422 313 $537 1.07

40818 1 Excise oral mucosa for graft ............................................................. 1 $314 313 $537 1.07

40819 1 Excise lip or cheek fold ..................................................................... 1 $314 313 $537 1.07

40820 5 Treatment of mouth lesion ................................................................ 1 $314 ................ ................ ................ Delete.

40830 1 Repair mouth laceration .................................................................... ................ ................ 312 $233 0.46 Add.

40831 1 Repair mouth laceration .................................................................... 1 $314 312 $233 0.46

40840 7 Reconstruction of mouth ................................................................... 2 $422 313 $537 1.07

40842 7 Reconstruction of mouth ................................................................... 3 $482 313 $537 1.07

40843 7 Reconstruction of mouth ................................................................... 3 $482 314 $946 1.88

40844 7 Reconstruction of mouth ................................................................... 5 $678 314 $946 1.88

40845 7 Reconstruction of mouth ................................................................... 5 $678 314 $946 1.88

40899 3 Mouth surgery procedure .................................................................. ................ ................ ................ ................ ................

41000 5 Drainage of mouth lesion .................................................................. 1 $314 ................ ................ ................ Delete.

41005 5 Drainage of mouth lesion .................................................................. 1 $314 ................ ................ ................ Delete.

41006 1 Drainage of mouth lesion .................................................................. 1 $314 313 $537 1.07

41007 1 Drainage of mouth lesion .................................................................. 1 $314 313 $537 1.07

41008 1 Drainage of mouth lesion .................................................................. 1 $314 313 $537 1.07

41009 1 Drainage of mouth lesion .................................................................. 1 $314 313 $537 1.07

41010 1 Incision of tongue fold ....................................................................... 1 $314 313 $537 1.07

41015 1 Drainage of mouth lesion .................................................................. 1 $314 313 $537 1.07

41016 1 Drainage of mouth lesion .................................................................. 1 $314 313 $537 1.07

41017 1 Drainage of mouth lesion .................................................................. 1 $314 313 $537 1.07

41018 1 Drainage of mouth lesion .................................................................. 1 $314 313 $537 1.07

41100 5 Biopsy of tongue ............................................................................... ................ ................ ................ ................ ................

41105 5 Biopsy of tongue ............................................................................... 2 $422 ................ ................ ................ Delete.

41108 5 Biopsy of floor of mouth .................................................................... ................ ................ ................ ................ ................

41110 5 Excision of tongue lesion .................................................................. 1 $314 ................ ................ ................ Delete.

41112 1 Excision of tongue lesion .................................................................. 2 $422 313 $537 1.07

41113 1 Excision of tongue lesion .................................................................. 2 $422 313 $537 1.07

41114 1 Excision of tongue lesion .................................................................. 2 $422 313 $537 1.07

41115 5 Excision of tongue fold ..................................................................... 1 $314 ................ ................ ................ Delete.

41116 1 Excision of mouth lesion ................................................................... 1 $314 313 $537 1.07

41120 1 Partial removal of tongue .................................................................. 5 $678 313 $537 1.07

41130 3 Partial removal of tongue .................................................................. ................ ................ ................ ................ ................

41135 3 Tongue and neck surgery ................................................................. ................ ................ ................ ................ ................

41140 3 Removal of tongue ............................................................................ ................ ................ ................ ................ ................

41145 3 Tongue removal; neck surgery ......................................................... ................ ................ ................ ................ ................

41150 3 Tongue, mouth, jaw surgery ............................................................. ................ ................ ................ ................ ................

41153 3 Tongue, mouth, neck surgery ........................................................... ................ ................ ................ ................ ................

41155 3 Tongue, jaw, & neck surgery ............................................................ ................ ................ ................ ................ ................

41250 1 Repair tongue laceration ................................................................... 2 $422 312 $233 0.46

41251 1 Repair tongue laceration ................................................................... 2 $422 312 $233 0.46

41252 1 Repair tongue laceration ................................................................... 2 $422 312 $233 0.46

41500 1 Fixation of tongue ............................................................................. 1 $314 312 $233 0.46

41510 1 Tongue to lip surgery ........................................................................ 1 $314 312 $233 0.46

41520 1 Reconstruction, tongue fold .............................................................. 2 $422 313 $537 1.07

41599 3 Tongue and mouth surgery .............................................................. ................ ................ ................ ................ ................

41800 1 Drainage of gum lesion ..................................................................... 1 $314 312 $233 0.46

41805 5 Removal foreign body, gum .............................................................. 1 $314 ................ ................ ................ Delete.

41806 5 Removal foreign body, jawbone ....................................................... 1 $314 ................ ................ ................ Delete.

41820 5 Excision, gum, each quadrant .......................................................... ................ ................ ................ ................ ................

41821 5 Excision of gum flap ......................................................................... ................ ................ ................ ................ ................

41822 7 Excision of gum lesion ...................................................................... ................ ................ 231 $437 0.87 Add.

41823 7 Excision of gum lesion ...................................................................... ................ ................ 231 $437 0.87 Add.

41825 5 Excision of gum lesion ...................................................................... ................ ................ ................ ................ ................

41826 5 Excision of gum lesion ...................................................................... ................ ................ ................ ................ ................

41827 1 Excision of gum lesion ...................................................................... 2 $422 313 $537 1.07

41828 5 Excision of gum lesion ...................................................................... ................ ................ ................ ................ ................

41830 5 Removal of gum tissue ..................................................................... ................ ................ ................ ................ ................

41850 5 Treatment of gum lesion ................................................................... ................ ................ ................ ................ ................

41870 5 Gum graft .......................................................................................... ................ ................ ................ ................ ................

41872 5 Repair gum ....................................................................................... ................ ................ ................ ................ ................

41874 5 Repair tooth socket ........................................................................... ................ ................ ................ ................ ................

41899 3 Dental surgery procedure ................................................................. ................ ................ ................ ................ ................

42000 5 Drainage mouth roof lesion .............................................................. 2 $422 ................ ................ ................ Delete.
32369

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

42100 5 Biopsy roof of mouth ......................................................................... ................ ................ ................ ................ ................

42104 5 Excision lesion, mouth roof ............................................................... 2 $422 ................ ................ ................ Delete.

42106 5 Excision lesion, mouth roof ............................................................... 2 $422 ................ ................ ................ Delete.

42107 1 Excision lesion, mouth roof ............................................................... 2 $422 313 $537 1.07

42120 1 Remove palate/lesion ....................................................................... 4 $595 313 $537 1.07

42140 5 Excision of uvula ............................................................................... 2 $422 ................ ................ ................ Delete.

42145 3 Repair, palate, pharynx/uvula ........................................................... 5 $678 ................ ................ ................ Delete.

42160 5 Treatment mouth roof lesion ............................................................. 1 $314 ................ ................ ................ Delete.

42180 1 Repair palate ..................................................................................... 1 $314 313 $537 1.07

42182 1 Repair palate ..................................................................................... 2 $422 313 $537 1.07

42200 1 Reconstruct cleft palate .................................................................... 5 $678 313 $537 1.07

42205 1 Reconstruct cleft palate .................................................................... 5 $678 313 $537 1.07

42210 1 Reconstruct cleft palate .................................................................... 5 $678 314 $946 1.88

42215 1 Reconstruct cleft palate .................................................................... 7 $941 313 $537 1.07

42220 1 Reconstruct cleft palate .................................................................... 5 $678 313 $537 1.07

42225 1 Reconstruct cleft palate .................................................................... 5 $678 314 $946 1.88

42226 1 Lengthening of palate ....................................................................... ................ ................ 314 $946 1.88 Add.

42227 1 Lengthening of palate ....................................................................... ................ ................ 314 $946 1.88 Add.

42235 1 Repair palate ..................................................................................... 5 $678 313 $537 1.07

42260 1 Repair nose to lip fistula ................................................................... 4 $595 313 $537 1.07

42280 5 Preparation, palate mold ................................................................... ................ ................ ................ ................ ................

42281 5 Insertion, palate prosthesis ............................................................... 3 $482 ................ ................ ................ Delete.

42299 3 Palate/uvula surgery ......................................................................... ................ ................ ................ ................ ................

42300 1 Drainage of salivary gland ................................................................ 1 $314 312 $233 0.46

42305 1 Drainage of salivary gland ................................................................ 2 $422 312 $233 0.46

42310 1 Drainage of salivary gland ................................................................ 1 $314 312 $233 0.46

42320 1 Drainage of salivary gland ................................................................ 1 $314 312 $233 0.46

42325 1 Create salivary cyst drain ................................................................. 2 $422 313 $537 1.07

42326 1 Create salivary cyst drain ................................................................. ................ ................ 313 $537 1.07 Add.

42330 5 Removal of salivary stone ................................................................ ................ ................ ................ ................ ................

42335 5 Removal of salivary stone ................................................................ 3 $482 ................ ................ ................ Delete.

42340 1 Removal of salivary stone ................................................................ 2 $422 313 $537 1.07

42400 1 Biopsy of salivary gland .................................................................... ................ ................ 122 $186 0.37 Add.

42405 1 Biopsy of salivary gland .................................................................... 2 $422 312 $233 0.46

42408 1 Excision of salivary cyst .................................................................... 3 $482 313 $537 1.07

42409 1 Drainage of salivary cyst .................................................................. 3 $482 313 $537 1.07

42410 1 Excise parotid gland/lesion ............................................................... 3 $482 313 $537 1.07

42415 1 Excise parotid gland/lesion ............................................................... ................ ................ 314 $946 1.88 Add.

42420 1 Excise parotid gland/lesion ............................................................... 7 $941 314 $946 1.88

42425 1 Excise parotid gland/lesion ............................................................... 7 $941 314 $946 1.88

42426 3 Excise parotid gland/lesion ............................................................... ................ ................ ................ ................ ................

42440 1 Excision submaxillary gland .............................................................. 3 $482 313 $537 1.07

42450 1 Excision sublingual gland ................................................................. 2 $422 313 $537 1.07

42500 1 Repair salivary duct .......................................................................... 3 $482 313 $537 1.07

42505 1 Repair salivary duct .......................................................................... 4 $595 313 $537 1.07

42507 1 Parotid duct diversion ....................................................................... 3 $482 313 $537 1.07

42508 1 Parotid duct diversion ....................................................................... 4 $595 313 $537 1.07

42509 1 Parotid duct diversion ....................................................................... 4 $595 314 $946 1.88

42510 1 Parotid duct diversion ....................................................................... 4 $595 313 $537 1.07

42550 2 Injection for salivary x-ray ................................................................. ................ ................ ................ ................ ................

42600 1 Closure of salivary fistula .................................................................. 1 $314 313 $537 1.07

42650 5 Dilation of salivary duct ..................................................................... ................ ................ ................ ................ ................

42660 5 Dilation of salivary duct ..................................................................... ................ ................ ................ ................ ................

42665 5 Ligation of salivary duct .................................................................... ................ ................ ................ ................ ................

42699 3 Salivary surgery procedure ............................................................... ................ ................ ................ ................ ................

42700 1 Drainage of tonsil abscess ............................................................... 1 $314 312 $233 0.46

42720 1 Drainage of throat abscess ............................................................... 1 $314 312 $233 0.46

42725 1 Drainage of throat abscess ............................................................... 2 $422 313 $537 1.07

42800 1 Biopsy of throat ................................................................................. ................ ................ 312 $233 0.46 Add.

42802 1 Biopsy of throat ................................................................................. 1 $314 312 $233 0.46

42804 1 Biopsy of upper nose/throat .............................................................. 1 $314 312 $233 0.46

42806 1 Biopsy of upper nose/throat .............................................................. 2 $422 312 $233 0.46

42808 1 Excise pharynx lesion ....................................................................... 2 $422 312 $233 0.46

42809 5 Remove pharynx foreign body .......................................................... ................ ................ ................ ................ ................

42810 1 Excision of neck cyst ........................................................................ 3 $482 313 $537 1.07

42815 1 Excision of neck cyst ........................................................................ 5 $678 313 $537 1.07

42820 1 Remove tonsils and adenoids .......................................................... ................ ................ 319 $648 1.29 Add.

42821 1 Remove tonsils and adenoids .......................................................... 5 $678 319 $648 1.29

42825 1 Removal of tonsils ............................................................................ ................ ................ 319 $648 1.29 Add.

42826 1 Removal of tonsils ............................................................................ 4 $595 319 $648 1.29

42830 1 Removal of adenoids ........................................................................ ................ ................ 319 $648 1.29 Add.

42831 1 Removal of adenoids ........................................................................ 4 $595 319 $648 1.29

42835 1 Removal of adenoids ........................................................................ ................ ................ 319 $648 1.29 Add.

42836 1 Removal of adenoids ........................................................................ 4 $595 319 $648 1.29
32370

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

42842 1 Extensive surgery of throat ............................................................... ................ ................ 314 $946 1.88 Add.

42844 1 Extensive surgery of throat ............................................................... ................ ................ 314 $946 1.88 Add.

42845 3 Extensive surgery of throat ............................................................... ................ ................ ................ ................ ................

42860 1 Excision of tonsil tags ....................................................................... 3 $482 319 $648 1.29

42870 1 Excision of lingual tonsil ................................................................... 3 $482 319 $648 1.29

42890 1 Partial removal of pharynx ................................................................ ................ ................ 314 $946 1.88 Add.

42892 1 Revision of pharyngeal walls ............................................................ ................ ................ 314 $946 1.88 Add.

42894 3 Revision of pharyngeal walls ............................................................ ................ ................ ................ ................ ................

42900 1 Repair throat wound ......................................................................... 1 $314 313 $537 1.07

42950 1 Reconstruction of throat .................................................................... 2 $422 313 $537 1.07

42953 3 Repair throat, esophagus ................................................................. ................ ................ ................ ................ ................

42955 1 Surgical opening of throat ................................................................. 2 $422 313 $537 1.07

42960 1 Control throat bleeding ..................................................................... 1 $314 318 $77 0.15

42961 3 Control throat bleeding ..................................................................... ................ ................ ................ ................ ................

42962 1 Control throat bleeding ..................................................................... 2 $422 313 $537 1.07

42970 1 Control nose/throat bleeding ............................................................. ................ ................ 318 $77 0.15 Add.

42971 3 Control nose/throat bleeding ............................................................. ................ ................ ................ ................ ................

42972 1 Control nose/throat bleeding ............................................................. ................ ................ 313 $537 1.07 Add.

42999 3 Throat surgery procedure ................................................................. ................ ................ ................ ................ ................

43020 1 Incision of esophagus ....................................................................... ................ ................ 313 $537 1.07 Add.

43030 1 Throat muscle surgery ...................................................................... ................ ................ 313 $537 1.07 Add.

43045 3 Incision of esophagus ....................................................................... ................ ................ ................ ................ ................

43100 3 Excision of esophagus lesion ........................................................... ................ ................ ................ ................ ................

43101 3 Excision of esophagus lesion ........................................................... ................ ................ ................ ................ ................

43107 3 Removal of esophagus ..................................................................... ................ ................ ................ ................ ................

43108 3 Removal of esophagus ..................................................................... ................ ................ ................ ................ ................

43112 3 Removal of esophagus ..................................................................... ................ ................ ................ ................ ................

43113 3 Removal of esophagus ..................................................................... ................ ................ ................ ................ ................

43116 3 Partial removal of esophagus ........................................................... ................ ................ ................ ................ ................

43117 3 Partial removal of esophagus ........................................................... ................ ................ ................ ................ ................

43118 3 Partial removal of esophagus ........................................................... ................ ................ ................ ................ ................

43121 3 Partial removal of esophagus ........................................................... ................ ................ ................ ................ ................

43122 3 Parital removal of esophagus ........................................................... ................ ................ ................ ................ ................

43123 3 Partial removal of esophagus ........................................................... ................ ................ ................ ................ ................

43124 3 Removal of esophagus ..................................................................... ................ ................ ................ ................ ................

43130 3 Removal of esophagus pouch .......................................................... ................ ................ ................ ................ ................

43135 3 Removal of esophagus pouch .......................................................... ................ ................ ................ ................ ................

43200 1 Esophagus endoscopy ...................................................................... 1 $314 417 $327 0.65

43202 1 Esophagus endoscopy, biopsy ......................................................... 1 $314 417 $327 0.65

43204 1 Esophagus endoscopy & inject ........................................................ 1 $314 407 $302 0.60

43205 1 Esophagus endoscopy/ligation ......................................................... ................ ................ 407 $302 0.60 Add.

43215 1 Esophagus endoscopy ...................................................................... 1 $314 407 $302 0.60

43216 1 Esophagus endoscopy/lesion ........................................................... 1 $314 407 $302 0.60

43217 1 Esophagus endoscopy ...................................................................... 1 $314 407 $302 0.60

43219 1 Esophagus endoscopy ...................................................................... 1 $314 449 $415 0.82

43220 1 Esophagus endoscopy, dilation ........................................................ 1 $314 407 $302 0.60

43226 1 Esophagus endoscopy, dilation ........................................................ 1 $314 407 $302 0.60

43227 1 Esophagus endoscopy, repair .......................................................... 2 $422 407 $302 0.60

43228 1 Esophagus endoscopy, ablation ....................................................... 2 $422 449 $415 0.82

43234 1 Upper GI endoscopy, exam .............................................................. 1 $314 417 $327 0.65

43235 1 Upper gi endoscopy, diagnosis ........................................................ 1 $314 417 $327 0.65

43239 1 Upper GI endoscopy, biopsy ............................................................ 2 $422 417 $327 0.65

43241 1 Upper GI endoscopy with tube ......................................................... 2 $422 418 $348 0.69

43243 1 Upper GI endoscopy & inject. ........................................................... 2 $422 418 $348 0.69

43244 1 Upper GI endoscopy/ligation ............................................................ ................ ................ 418 $348 0.69 Add.

43245 1 Operative upper GI endoscopy ......................................................... 2 $422 418 $348 0.69

43246 1 Place gastrostomy tube .................................................................... 2 $422 418 $348 0.69

43247 1 Operative upper GI endoscopy ......................................................... 2 $422 418 $348 0.69

43248 1 Upper GI endoscopy/guidewire ........................................................ 2 $422 418 $348 0.69

43249 1 Esophagus endoscopy, dilation ........................................................ 2 $422 418 $348 0.69

43250 1 Upper GI endoscopy/tumor ............................................................... 2 $422 418 $348 0.69

43251 1 Operative upper GI endoscopy ......................................................... 2 $422 418 $348 0.69

43255 1 Operative upper GI endoscopy ......................................................... 2 $422 418 $348 0.69

43258 1 Operative upper GI endoscopy ......................................................... 3 $482 449 $415 0.82

43259 1 Endoscopic ultrasound exam ............................................................ 3 $482 449 $415 0.82

43260 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43261 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43262 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43263 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43264 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43265 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43267 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43268 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43269 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94
32371

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

43271 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 456 $473 0.94

43272 1 Endoscopy, bile duct/pancreas ......................................................... 2 $422 449 $415 0.82

43300 3 Repair of esophagus ......................................................................... ................ ................ ................ ................ ................

43305 3 Repair esophagus and fistula ........................................................... ................ ................ ................ ................ ................

43310 3 Repair of esophagus ......................................................................... ................ ................ ................ ................ ................

43312 3 Repair esophagus and fistula ........................................................... ................ ................ ................ ................ ................

43320 3 Fuse esophagus & stomach ............................................................. ................ ................ ................ ................ ................

43324 3 Revise esophagus & stomach .......................................................... ................ ................ ................ ................ ................

43325 3 Revise esophagus & stomach .......................................................... ................ ................ ................ ................ ................

43326 3 Revise esophagus & stomach .......................................................... ................ ................ ................ ................ ................

43330 3 Repair of esophagus ......................................................................... ................ ................ ................ ................ ................

43331 3 Repair of esophagus ......................................................................... ................ ................ ................ ................ ................

43340 3 Fuse esophagus & intestine ............................................................. ................ ................ ................ ................ ................

43341 3 Fuse esophagus & intestine ............................................................. ................ ................ ................ ................ ................

43350 3 Surgical opening, esophagus ........................................................... ................ ................ ................ ................ ................

43351 3 Surgical opening, esophagus ........................................................... ................ ................ ................ ................ ................

43352 3 Surgical opening, esophagus ........................................................... ................ ................ ................ ................ ................

43360 3 Gastrointestinal repair ....................................................................... ................ ................ ................ ................ ................

43361 3 Gastrointestinal repair ....................................................................... ................ ................ ................ ................ ................

43400 3 Ligate esophagus veins .................................................................... ................ ................ ................ ................ ................

43401 3 Esophagus surgery for veins ............................................................ ................ ................ ................ ................ ................

43405 3 Ligate/staple esophagus ................................................................... ................ ................ ................ ................ ................

43410 3 Repair esophagus wound ................................................................. ................ ................ ................ ................ ................

43415 3 Repair esophagus wound ................................................................. ................ ................ ................ ................ ................

43420 3 Repair esophagus opening ............................................................... ................ ................ ................ ................ ................

43425 3 Repair esophagus opening ............................................................... ................ ................ ................ ................ ................

43450 1 Dilate esophagus .............................................................................. 1 $314 406 $187 0.37

43453 1 Dilate esophagus .............................................................................. 1 $314 406 $187 0.37

43456 1 Dilate esophagus .............................................................................. 2 $422 406 $187 0.37

43458 1 Dilation of esophagus ....................................................................... 2 $422 406 $187 0.37

43460 3 Pressure treatment esophagus ......................................................... ................ ................ ................ ................ ................

43496 3 Free jejunum flap, microvasc ............................................................ ................ ................ ................ ................ ................

43499 3 Esophagus surgery procedure .......................................................... ................ ................ ................ ................ ................

43500 3 Surgical opening of stomach ............................................................ ................ ................ ................ ................ ................

43501 3 Surgical repair of stomach ................................................................ ................ ................ ................ ................ ................

43502 3 Surgical repair of stomach ................................................................ ................ ................ ................ ................ ................

43510 3 Surgical opening of stomach ............................................................ ................ ................ ................ ................ ................

43520 3 Incision of pyloric muscle .................................................................. ................ ................ ................ ................ ................

43600 1 Biopsy of stomach ............................................................................ 1 $314 417 $327 0.65

43605 3 Biopsy of stomach ............................................................................ ................ ................ ................ ................ ................

43610 3 Excision of stomach lesion ............................................................... ................ ................ ................ ................ ................

43611 3 Excision of stomach lesion ............................................................... ................ ................ ................ ................ ................

43620 3 Removal of stomach ......................................................................... ................ ................ ................ ................ ................

43621 3 Removal of stomach ......................................................................... ................ ................ ................ ................ ................

43622 3 Removal of stomach ......................................................................... ................ ................ ................ ................ ................

43631 3 Removal of stomach, partial ............................................................. ................ ................ ................ ................ ................

43632 3 Removal stomach, partial ................................................................. ................ ................ ................ ................ ................

43633 3 Removal stomach, partial ................................................................. ................ ................ ................ ................ ................

43634 3 Removal stomach, partial ................................................................. ................ ................ ................ ................ ................

43635 3 Partial removal of stomach ............................................................... ................ ................ ................ ................ ................

43638 3 Partial removal of stomach ............................................................... ................ ................ ................ ................ ................

43639 3 Removal stomach, partial ................................................................. ................ ................ ................ ................ ................

43640 3 Vagotomy & pylorus repair ............................................................... ................ ................ ................ ................ ................

43641 3 Vagotomy & pylorus repair ............................................................... ................ ................ ................ ................ ................

43750 1 Place gastrostomy tube .................................................................... 2 $422 418 $348 0.69

43760 1 Change gastrostomy tube ................................................................. 1 $314 470 $119 0.24

43761 1 Reposition gastrostomy tube ............................................................ ................ ................ 470 $119 0.24 Add.

43800 3 Reconstruction of pylorus ................................................................. ................ ................ ................ ................ ................

43810 3 Fusion of stomach and bowel ........................................................... ................ ................ ................ ................ ................

43820 3 Fusion of stomach and bowel ........................................................... ................ ................ ................ ................ ................

43825 3 Fusion of stomach and bowel ........................................................... ................ ................ ................ ................ ................

43830 3 Place gastrostomy tube .................................................................... ................ ................ ................ ................ ................

43831 3 Place gastrostomy tube .................................................................... ................ ................ ................ ................ ................

43832 3 Place gastrostomy tube .................................................................... ................ ................ ................ ................ ................

43840 3 Repair of stomach lesion .................................................................. ................ ................ ................ ................ ................

43842 3 Gastroplasty for obesity .................................................................... ................ ................ ................ ................ ................

43843 3 Gastroplasty for obesity .................................................................... ................ ................ ................ ................ ................

43846 3 Gastric bypass for obesity ................................................................ ................ ................ ................ ................ ................

43847 3 Gastric bypass for obesity ................................................................ ................ ................ ................ ................ ................

43848 3 Revision gastroplasty ........................................................................ ................ ................ ................ ................ ................

43850 3 Revise stomach-bowel fusion ........................................................... ................ ................ ................ ................ ................

43855 3 Revise stomach-bowel fusion ........................................................... ................ ................ ................ ................ ................

43860 3 Revise stomach-bowel fusion ........................................................... ................ ................ ................ ................ ................

43865 3 Revise stomach-bowel fusion ........................................................... ................ ................ ................ ................ ................
32372

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

43870 1 Repair stomach opening ................................................................... 1 $314 182 $383 0.76

43880 3 Repair stomach-bowel fistula ............................................................ ................ ................ ................ ................ ................

43999 3 Stomach surgery procedure ............................................................. ................ ................ ................ ................ ................

44005 3 Freeing of bowel adhesion ............................................................... ................ ................ ................ ................ ................

44010 3 Incision of small bowel ...................................................................... ................ ................ ................ ................ ................

44015 3 Insert needle catheter,bowel ............................................................. ................ ................ ................ ................ ................

44020 3 Exploration of small bowel ................................................................ ................ ................ ................ ................ ................

44021 3 Decompress small bowel .................................................................. ................ ................ ................ ................ ................

44025 3 Incision of large bowel ...................................................................... ................ ................ ................ ................ ................

44050 3 Reduce bowel obstruction ................................................................ ................ ................ ................ ................ ................

44055 3 Correct malrotation of bowel ............................................................. ................ ................ ................ ................ ................

44100 1 Biopsy of bowel ................................................................................. 1 $314 417 $327 0.65

44110 3 Excision of bowel lesion(s) ............................................................... ................ ................ ................ ................ ................

44111 3 Excision of bowel lesion(s) ............................................................... ................ ................ ................ ................ ................

44120 3 Removal of small intestine ................................................................ ................ ................ ................ ................ ................

44121 3 Removal of small intestine ................................................................ ................ ................ ................ ................ ................

44125 3 Removal of small intestine ................................................................ ................ ................ ................ ................ ................

44130 3 Bowel to bowel fusion ....................................................................... ................ ................ ................ ................ ................

44139 3 Mobilization of colon ......................................................................... ................ ................ ................ ................ ................

44140 3 Partial removal of colon .................................................................... ................ ................ ................ ................ ................

44141 3 Partial removal of colon .................................................................... ................ ................ ................ ................ ................

44143 3 Partial removal of colon .................................................................... ................ ................ ................ ................ ................

44144 3 Partial removal of colon .................................................................... ................ ................ ................ ................ ................

44145 3 Partial removal of colon .................................................................... ................ ................ ................ ................ ................

44146 3 Partial removal of colon .................................................................... ................ ................ ................ ................ ................

44147 3 Partial removal of colon .................................................................... ................ ................ ................ ................ ................

44150 3 Removal of colon .............................................................................. ................ ................ ................ ................ ................

44151 3 Removal of colon/ileostomy .............................................................. ................ ................ ................ ................ ................

44152 3 Removal of colon/ileostomy .............................................................. ................ ................ ................ ................ ................

44153 3 Removal of colon/ileostomy .............................................................. ................ ................ ................ ................ ................

44155 3 Removal of colon .............................................................................. ................ ................ ................ ................ ................

44156 3 Removal of colon/ileostomy .............................................................. ................ ................ ................ ................ ................

44160 3 Removal of colon .............................................................................. ................ ................ ................ ................ ................

44300 3 Open bowel to skin ........................................................................... ................ ................ ................ ................ ................

44310 3 Ileostomy/jejunostomy ....................................................................... ................ ................ ................ ................ ................

44312 1 Revision of ileostomy ........................................................................ 1 $314 183 $465 0.92

44314 3 Revision of ileostomy ........................................................................ ................ ................ ................ ................ ................

44316 3 Devise bowel pouch .......................................................................... ................ ................ ................ ................ ................

44320 3 Colostomy ......................................................................................... ................ ................ ................ ................ ................

44322 3 Colostomy with biopsies ................................................................... ................ ................ ................ ................ ................

44340 1 Revision of colostomy ....................................................................... 3 $482 183 $465 0.92

44345 3 Revision of colostomy ....................................................................... 4 $595 ................ ................ ................ Delete.

44346 3 Revision of colostomy ....................................................................... 4 $595 ................ ................ ................ Delete.

44360 1 Small bowel endoscopy .................................................................... 2 $422 419 $364 0.72

44361 1 Small bowel endoscopy,biopsy ......................................................... 2 $422 419 $364 0.72

44363 1 Small bowel endoscopy .................................................................... 2 $422 419 $364 0.72

44364 1 Small bowel endoscopy .................................................................... 2 $422 419 $364 0.72

44365 1 Small bowel endoscopy .................................................................... 2 $422 419 $364 0.72

44366 1 Small bowel endoscopy .................................................................... 2 $422 419 $364 0.72

44369 1 Small bowel endoscopy .................................................................... 2 $422 449 $415 0.82

44372 1 Small bowel endoscopy .................................................................... 2 $422 419 $364 0.72

44373 1 Small bowel endoscopy .................................................................... 2 $422 419 $364 0.72

44376 1 Small bowel endoscopy .................................................................... ................ ................ 419 $364 0.72 Add.

44377 1 Small bowel endoscopy .................................................................... ................ ................ 419 $364 0.72 Add.

44378 1 Small bowel endoscopy .................................................................... ................ ................ 419 $364 0.72 Add.

44380 1 Small bowel endoscopy .................................................................... 1 $314 426 $354 0.70

44382 1 Small bowel endoscopy .................................................................... 1 $314 426 $354 0.70

44385 1 Endoscopy of bowel pouch ............................................................... 1 $314 426 $354 0.70

44386 1 Endoscopy,bowel pouch,biopsy ........................................................ 1 $314 426 $354 0.70

44388 1 Colon endoscopy .............................................................................. 1 $314 426 $354 0.70

44389 1 Colonoscopy with biopsy .................................................................. 1 $314 426 $354 0.70

44390 1 Colonoscopy for foreign body ........................................................... 1 $314 427 $405 0.80

44391 1 Colonoscopy for bleeding ................................................................. 1 $314 427 $405 0.80

44392 1 Colonoscopy & polypectomy ............................................................ 1 $314 427 $405 0.80

44393 1 Colonoscopy, lesion removal ............................................................ 1 $314 449 $415 0.82

44394 1 Colonoscopy w/snare ........................................................................ 1 $314 427 $405 0.80

44500 3 Intro, gastrointestinal tube ................................................................ ................ ................ ................ ................ ................

44602 3 Suture, small intestine ...................................................................... ................ ................ ................ ................ ................

44603 3 Suture, small intestine ...................................................................... ................ ................ ................ ................ ................

44604 3 Suture, large intestine ....................................................................... ................ ................ ................ ................ ................

44605 3 Repair of bowel lesion ...................................................................... ................ ................ ................ ................ ................

44615 3 Intestinal stricturoplasty .................................................................... ................ ................ ................ ................ ................

44620 3 Repair bowel opening ....................................................................... ................ ................ ................ ................ ................

44625 3 Repair bowel opening ....................................................................... ................ ................ ................ ................ ................
32373

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

44626 3 Repair bowel opening ....................................................................... ................ ................ ................ ................ ................

44640 3 Repair bowel-skin fistula ................................................................... ................ ................ ................ ................ ................

44650 3 Repair bowel fistula .......................................................................... ................ ................ ................ ................ ................

44660 3 Repair bowel-bladder fistula ............................................................. ................ ................ ................ ................ ................

44661 3 Repair bowel-bladder fistula ............................................................. ................ ................ ................ ................ ................

44680 3 Surgical revision, intestine ................................................................ ................ ................ ................ ................ ................

44700 3 Suspend bowel w/prosthesis ............................................................ ................ ................ ................ ................ ................

44799 3 Intestine surgery procedure .............................................................. ................ ................ ................ ................ ................

44800 3 Excision of bowel pouch ................................................................... ................ ................ ................ ................ ................

44820 3 Excision of mesentery lesion ............................................................ ................ ................ ................ ................ ................

44850 3 Repair of mesentery ......................................................................... ................ ................ ................ ................ ................

44899 3 Bowel surgery procedure .................................................................. ................ ................ ................ ................ ................

44900 3 Drain, app abscess, open ................................................................. ................ ................ ................ ................ ................

44901 3 Drain, app abscess, perc .................................................................. ................ ................ ................ ................ ................

44950 3 Appendectomy .................................................................................. ................ ................ ................ ................ ................

44955 3 Appendectomy .................................................................................. ................ ................ ................ ................ ................

44960 3 Appendectomy .................................................................................. ................ ................ ................ ................ ................

45000 1 Drainage of pelvic abscess ............................................................... 1 $314 452 $301 0.60

45005 1 Drainage of rectal abscess ............................................................... 2 $422 452 $301 0.60

45020 1 Drainage of rectal abscess ............................................................... 2 $422 452 $301 0.60

45100 1 Biopsy of rectum ............................................................................... 1 $314 452 $301 0.60

45108 1 Removal of anorectal lesion ............................................................. 2 $422 453 $631 1.25

45110 3 Removal of rectum ............................................................................ ................ ................ ................ ................ ................

45111 3 Partial removal of rectum .................................................................. ................ ................ ................ ................ ................

45112 3 Removal of rectum ............................................................................ ................ ................ ................ ................ ................

45113 3 Partial proctectomy ........................................................................... ................ ................ ................ ................ ................

45114 3 Partial removal of rectum .................................................................. ................ ................ ................ ................ ................

45116 3 Partial removal of rectum .................................................................. ................ ................ ................ ................ ................

45119 3 Remove, rectum w/reservoir ............................................................. ................ ................ ................ ................ ................

45120 3 Removal of rectum ............................................................................ ................ ................ ................ ................ ................

45121 3 Removal of rectum and colon ........................................................... ................ ................ ................ ................ ................

45123 3 Partial proctectomy ........................................................................... ................ ................ ................ ................ ................

45130 3 Excision of rectal prolapse ................................................................ ................ ................ ................ ................ ................

45135 3 Excision of rectal prolapse ................................................................ ................ ................ ................ ................ ................

45150 1 Excision of rectal stricture ................................................................. 2 $422 453 $631 1.25

45160 1 Excision of rectal lesion .................................................................... ................ ................ 453 $631 1.25 Add.

45170 1 Excision of rectal lesion .................................................................... 2 $422 453 $631 1.25

45190 1 Destruction, rectal tumor ................................................................... ................ ................ 453 $631 1.25 Add.

45300 1 Proctosigmoidoscopy ........................................................................ ................ ................ 446 $175 0.35 Add.

45303 1 Proctosigmoidoscopy ........................................................................ ................ ................ 447 $210 0.42 Add.

45305 1 Proctosigmoidoscopy; biopsy ........................................................... 1 $314 446 $175 0.35

45307 1 Proctosigmoidoscopy ........................................................................ 1 $314 447 $210 0.42

45308 1 Proctosigmoidoscopy ........................................................................ 1 $314 447 $210 0.42

45309 1 Proctosigmoidoscopy ........................................................................ 1 $314 447 $210 0.42

45315 1 Proctosigmoidoscopy ........................................................................ 1 $314 447 $210 0.42

45317 1 Proctosigmoidoscopy ........................................................................ 1 $314 447 $210 0.42

45320 1 Proctosigmoidoscopy ........................................................................ 1 $314 447 $210 0.42

45321 1 Proctosigmoidoscopy ........................................................................ 1 $314 447 $210 0.42

45330 1 Sigmoidoscopy, diagnostic ............................................................... ................ ................ 446 $175 0.35 Add.

45331 1 Sigmoidoscopy and biopsy ............................................................... 1 $314 446 $175 0.35

45332 1 Sigmoidoscopy .................................................................................. 1 $314 448 $225 0.45

45333 1 Sigmoidoscopy & polypectomy ......................................................... 1 $314 448 $225 0.45

45334 1 Sigmoidoscopy for bleeding .............................................................. 1 $314 448 $225 0.45

45337 1 Sigmoidoscopy, decompression ....................................................... 1 $314 448 $225 0.45

45338 1 Sigmoidoscopy .................................................................................. 1 $314 448 $225 0.45

45339 1 Sigmoidoscopy .................................................................................. 1 $314 449 $415 0.82

45355 1 Surgical colonoscopy ........................................................................ 1 $314 427 $405 0.80

45378 1 Diagnostic colonoscopy .................................................................... 2 $422 426 $354 0.70

45379 1 Colonoscopy ..................................................................................... 2 $422 427 $405 0.80

45380 1 Colonoscopy and biopsy ................................................................... 2 $422 426 $354 0.70

45382 1 Colonoscopy,control bleeding ........................................................... 2 $422 427 $405 0.80

45383 1 Colonoscopy, lesion removal ............................................................ 2 $422 449 $415 0.82

45384 1 Colonoscopy ..................................................................................... 2 $422 427 $405 0.80

45385 1 Colonoscopy, lesion removal ............................................................ 2 $422 427 $405 0.80

45500 1 Repair of rectum ............................................................................... 2 $422 453 $631 1.25

45505 1 Repair of rectum ............................................................................... 2 $422 453 $631 1.25

45520 2 Treatment of rectal prolapse ............................................................. ................ ................ ................ ................ ................

45540 3 Correct rectal prolapse ..................................................................... ................ ................ ................ ................ ................

45541 3 Correct rectal prolapse ..................................................................... ................ ................ ................ ................ ................

45550 3 Repair rectum;remove sigmoid ......................................................... ................ ................ ................ ................ ................

45560 1 Repair of rectocele ............................................................................ 2 $422 453 $631 1.25

45562 3 Exploration/repair of rectum .............................................................. ................ ................ ................ ................ ................

45563 3 Exploration/repair of rectum .............................................................. ................ ................ ................ ................ ................

45800 3 Repair rectumbladder fistula ............................................................. ................ ................ ................ ................ ................
32374

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

45805 3 Repair fistula; colostomy ................................................................... ................ ................ ................ ................ ................

45820 3 Repair rectourethral fistula ................................................................ ................ ................ ................ ................ ................

45825 3 Repair fistula; colostomy ................................................................... ................ ................ ................ ................ ................

45900 1 Reduction of rectal prolapse ............................................................. 1 $314 452 $301 0.60

45905 1 Dilation of anal sphincter .................................................................. 1 $314 452 $301 0.60

45910 1 Dilation of rectal narrowing ............................................................... 1 $314 452 $301 0.60

45915 1 Remove rectal obstruction ................................................................ 1 $314 452 $301 0.60

45999 3 Rectum surgery procedure ............................................................... ................ ................ ................ ................ ................

46030 1 Removal of rectal marker ................................................................. 1 $314 452 $301 0.60

46040 1 Incision of rectal abscess ................................................................. 3 $482 452 $301 0.60

46045 1 Incision of rectal abscess ................................................................. 2 $422 453 $631 1.25

46050 1 Incision of anal abscess ................................................................... 1 $314 452 $301 0.60

46060 1 Incision of rectal abscess ................................................................. 2 $422 453 $631 1.25

46070 5 Incision of anal septum ..................................................................... ................ ................ ................ ................ ................

46080 1 Incision of anal sphincter .................................................................. 3 $482 452 $301 0.60

46083 5 Incise external hemorrhoid ............................................................... ................ ................ ................ ................ ................

46200 1 Removal of anal fissure .................................................................... 2 $422 453 $631 1.25

46210 1 Removal of anal crypt ....................................................................... 2 $422 452 $301 0.60

46211 1 Removal of anal crypts ..................................................................... 2 $422 453 $631 1.25

46220 5 Removal of anal tab .......................................................................... 1 $314 ................ ................ ................ Delete.

46221 5 Ligation of hemorrhoid(s) .................................................................. ................ ................ ................ ................ ................

46230 5 Removal of anal tabs ........................................................................ ................ ................ ................ ................ ................

46250 1 Hemorrhoidectomy ............................................................................ 3 $482 453 $631 1.25

46255 1 Hemorrhoidectomy ............................................................................ 3 $482 453 $631 1.25

46257 1 Remove hemorrhoids & fissure ........................................................ 3 $482 453 $631 1.25

46258 1 Remove hemorrhoids & fistula ......................................................... 3 $482 453 $631 1.25

46260 1 Hemorrhoidectomy ............................................................................ 3 $482 453 $631 1.25

46261 1 Remove hemorrhoids & fissure ........................................................ 4 $595 453 $631 1.25

46262 1 Remove hemorrhoids & fistula ......................................................... 4 $595 453 $631 1.25

46270 1 Removal of anal fistula ..................................................................... 3 $482 453 $631 1.25

46275 1 Removal of anal fistula ..................................................................... 3 $482 453 $631 1.25

46280 1 Removal of anal fistula ..................................................................... 4 $595 453 $631 1.25

46285 1 Removal of anal fistula ..................................................................... 1 $314 453 $631 1.25

46288 1 Repair anal fistula ............................................................................. ................ ................ 453 $631 1.25 Add.

46320 5 Removal of hemorrhoid clot .............................................................. ................ ................ ................ ................ ................

46500 5 Injection into hemorrhoids ................................................................. ................ ................ ................ ................ ................

46600 5 Diagnostic anoscopy ......................................................................... ................ ................ ................ ................ ................

46604 1 Anoscopy and dilation ....................................................................... ................ ................ 437 $150 0.30 Add.

46606 5 Anoscopy and biopsy ........................................................................ ................ ................ ................ ................ ................

46608 1 Anoscopy;remove foreign body ........................................................ 1 $314 437 $150 0.30

46610 1 Anoscopy; remove lesion .................................................................. 1 $314 437 $150 0.30

46611 1 Anoscopy .......................................................................................... 1 $314 437 $150 0.30

46612 1 Anoscopy; remove lesions ................................................................ 1 $314 437 $150 0.30

46614 1 Anoscopy; control bleeding ............................................................... ................ ................ 437 $150 0.30 Add.

46615 1 Anoscopy .......................................................................................... ................ ................ 437 $150 0.30 Add.

46700 1 Repair of anal stricture ..................................................................... 3 $482 453 $631 1.25

46705 3 Repair of anal stricture ..................................................................... ................ ................ ................ ................ ................

46715 3 Repair of anovaginal fistula .............................................................. ................ ................ ................ ................ ................

46716 3 Repair of anovaginal fistula .............................................................. ................ ................ ................ ................ ................

46730 3 Construction of absent anus ............................................................. ................ ................ ................ ................ ................

46735 3 Construction of absent anus ............................................................. ................ ................ ................ ................ ................

46740 3 Construction of absent anus ............................................................. ................ ................ ................ ................ ................

46742 3 Repair, imperforated anus ................................................................ ................ ................ ................ ................ ................

46744 3 Repair, cloacal anomaly ................................................................... ................ ................ ................ ................ ................

46746 3 Repair, cloacal anomaly ................................................................... ................ ................ ................ ................ ................

46748 3 Repair, cloacal anomaly ................................................................... ................ ................ ................ ................ ................

46750 1 Repair of anal sphincter .................................................................... 3 $482 453 $631 1.25

46751 3 Repair of anal sphincter .................................................................... ................ ................ ................ ................ ................

46753 1 Reconstruction of anus ..................................................................... 3 $482 453 $631 1.25

46754 1 Removal of suture from anus ........................................................... 2 $422 452 $301 0.60

46760 1 Repair of anal sphincter .................................................................... 2 $422 453 $631 1.25

46761 1 Repair of anal sphincter .................................................................... ................ ................ 453 $631 1.25 Add.

46762 1 Implant artificial sphincter ................................................................. ................ ................ 453 $631 1.25 Add.

46900 1 Destruction, anal lesion(s) ................................................................ ................ ................ 152 $213 0.42 Add.

46910 1 Destruction, anal lesion(s) ................................................................ ................ ................ 152 $213 0.42 Add.

46916 1 Cryosurgery, anal lesion(s) ............................................................... ................ ................ 152 $213 0.42 Add.

46917 1 Laser surgery, anal lesion(s) ............................................................ ................ ................ 152 $213 0.42 Add.

46922 1 Excision of anal lesion(s) .................................................................. 1 $314 152 $213 0.42

46924 1 Destruction, anal lesion(s) ................................................................ 1 $314 152 $213 0.42

46934 5 Destruction of hemorrhoids ............................................................... ................ ................ ................ ................ ................

46935 5 Destruction of hemorrhoids ............................................................... ................ ................ ................ ................ ................

46936 5 Destruction of hemorrhoids ............................................................... ................ ................ ................ ................ ................

46937 1 Cryotherapy of rectal lesion .............................................................. 2 $422 453 $631 1.25

46938 1 Cryotherapy of rectal lesion .............................................................. 2 $422 453 $631 1.25
32375

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

46940 5 Treatment of anal fissure .................................................................. ................ ................ ................ ................ ................

46942 5 Treatment of anal fissure .................................................................. ................ ................ ................ ................ ................

46945 5 Ligation of hemorrhoids .................................................................... ................ ................ ................ ................ ................

46946 5 Ligation of hemorrhoids .................................................................... ................ ................ ................ ................ ................

46999 3 Anus surgery procedure ................................................................... ................ ................ ................ ................ ................

47000 1 Needle biopsy of liver ....................................................................... 1 $314 122 $186 0.37

47001 3 Needle biopsy, liver .......................................................................... ................ ................ ................ ................ ................

47010 3 Open drainage, liver lesion ............................................................... ................ ................ ................ ................ ................

47011 3 Percut drain, liver lesion ................................................................... ................ ................ ................ ................ ................

47015 3 Inject/aspirate liver cyst .................................................................... ................ ................ ................ ................ ................

47100 3 Wedge biopsy of liver ....................................................................... ................ ................ ................ ................ ................

47120 3 Partial removal of liver ...................................................................... ................ ................ ................ ................ ................

47122 3 Extensive removal of liver ................................................................. ................ ................ ................ ................ ................

47125 3 Partial removal of liver ...................................................................... ................ ................ ................ ................ ................

47130 3 Partial removal of liver ...................................................................... ................ ................ ................ ................ ................

47133 9 Removal of donor liver ...................................................................... ................ ................ ................ ................ ................

47134 3 Partial removal, donor liver ............................................................... ................ ................ ................ ................ ................

47135 3 Transplantation of liver ..................................................................... ................ ................ ................ ................ ................

47136 3 Transplantation of liver ..................................................................... ................ ................ ................ ................ ................

47300 3 Surgery for liver lesion ...................................................................... ................ ................ ................ ................ ................

47350 3 Repair liver wound ............................................................................ ................ ................ ................ ................ ................

47360 3 Repair liver wound ............................................................................ ................ ................ ................ ................ ................

47361 3 Repair liver wound ............................................................................ ................ ................ ................ ................ ................

47362 3 Repair liver wound ............................................................................ ................ ................ ................ ................ ................

47399 3 Liver surgery procedure .................................................................... ................ ................ ................ ................ ................

47400 3 Incision of liver duct .......................................................................... ................ ................ ................ ................ ................

47420 3 Incision of bile duct ........................................................................... ................ ................ ................ ................ ................

47425 3 Incision of bile duct ........................................................................... ................ ................ ................ ................ ................

47460 3 Incise bile duct sphincter .................................................................. ................ ................ ................ ................ ................

47480 3 Incision of gallbladder ....................................................................... ................ ................ ................ ................ ................

47490 3 Incision of gallbladder ....................................................................... ................ ................ ................ ................ ................

47500 2 Injection for liver x-rays ..................................................................... ................ ................ ................ ................ ................

47505 2 Injection for liver x-rays ..................................................................... ................ ................ ................ ................ ................

47510 1 Insert catheter, bile duct ................................................................... 2 $422 458 $473 0.94

47511 1 Insert bile duct drain ......................................................................... ................ ................ 458 $473 0.94 Add.

47525 1 Change bile duct catheter ................................................................. 1 $314 470 $119 0.24

47530 1 Revise, reinsert bile tube .................................................................. 1 $314 470 $119 0.24

47550 3 Bile duct endoscopy .......................................................................... ................ ................ ................ ................ ................

47552 1 Biliary endoscopy, thru skin .............................................................. 2 $422 458 $473 0.94

47553 1 Biliary endoscopy, thru skin .............................................................. 3 $482 458 $473 0.94

47554 1 Biliary endoscopy, thru skin .............................................................. 3 $482 458 $473 0.94

47555 1 Biliary endoscopy, thru skin .............................................................. 3 $482 458 $473 0.94

47556 1 Biliary endoscopy, thru skin .............................................................. ................ ................ 458 $473 0.94 Add.

47600 3 Removal of gallbladder ..................................................................... ................ ................ ................ ................ ................

47605 3 Removal of gallbladder ..................................................................... ................ ................ ................ ................ ................

47610 3 Removal of gallbladder ..................................................................... ................ ................ ................ ................ ................

47612 3 Removal of gallbladder ..................................................................... ................ ................ ................ ................ ................

47620 3 Removal of gallbladder ..................................................................... ................ ................ ................ ................ ................

47630 1 Remove bile duct stone .................................................................... 3 $482 458 $473 0.94

47700 3 Exploration of bile ducts ................................................................... ................ ................ ................ ................ ................

47701 3 Bile duct revision ............................................................................... ................ ................ ................ ................ ................

47711 3 Excision of bile duct tumor ............................................................... ................ ................ ................ ................ ................

47712 3 Excision of bile duct tumor ............................................................... ................ ................ ................ ................ ................

47715 3 Excision of bile duct cyst .................................................................. ................ ................ ................ ................ ................

47716 3 Fusion of bile duct cyst ..................................................................... ................ ................ ................ ................ ................

47720 3 Fuse gallbladder & bowel ................................................................. ................ ................ ................ ................ ................

47721 3 Fuse upper gi structures ................................................................... ................ ................ ................ ................ ................

47740 3 Fuse gallbladder & bowel ................................................................. ................ ................ ................ ................ ................

47741 3 Fuse gallbladder & bowel ................................................................. ................ ................ ................ ................ ................

47760 3 Fuse bile ducts and bowel ................................................................ ................ ................ ................ ................ ................

47765 3 Fuse liver ducts & bowel .................................................................. ................ ................ ................ ................ ................

47780 3 Fuse bile ducts and bowel ................................................................ ................ ................ ................ ................ ................

47785 3 Fuse bile ducts and bowel ................................................................ ................ ................ ................ ................ ................

47800 3 Reconstruction of bile ducts ............................................................. ................ ................ ................ ................ ................

47801 3 Placement, bile duct support ............................................................ ................ ................ ................ ................ ................

47802 3 Fuse liver duct & intestine ................................................................ ................ ................ ................ ................ ................

47900 3 Suture bile duct injury ....................................................................... ................ ................ ................ ................ ................

47999 3 Bile tract surgery procedure ............................................................. ................ ................ ................ ................ ................

48000 3 Drainage of abdomen ....................................................................... ................ ................ ................ ................ ................

48001 3 Placement of drain, pancreas ........................................................... ................ ................ ................ ................ ................

48005 3 Resect/debride pancreas .................................................................. ................ ................ ................ ................ ................

48020 3 Removal of pancreatic stone ............................................................ ................ ................ ................ ................ ................

48100 3 Biopsy of pancreas ........................................................................... ................ ................ ................ ................ ................

48102 1 Needle biopsy, pancreas .................................................................. 1 $314 122 $186 0.37
32376

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

48120 3 Removal of pancreas lesion ............................................................. ................ ................ ................ ................ ................

48140 3 Partial removal of pancreas .............................................................. ................ ................ ................ ................ ................

48145 3 Partial removal of pancreas .............................................................. ................ ................ ................ ................ ................

48146 3 Pancreatectomy ................................................................................ ................ ................ ................ ................ ................

48148 3 Removal of pancreatic duct .............................................................. ................ ................ ................ ................ ................

48150 3 Partial removal of pancreas .............................................................. ................ ................ ................ ................ ................

48152 3 Pancreatectomy ................................................................................ ................ ................ ................ ................ ................

48153 3 Pancreatectomy ................................................................................ ................ ................ ................ ................ ................

48154 3 Pancreatectomy ................................................................................ ................ ................ ................ ................ ................

48155 3 Removal of pancreas ........................................................................ ................ ................ ................ ................ ................

48160 9 Pancreas removal, transplant ........................................................... ................ ................ ................ ................ ................

48180 3 Fuse pancreas and bowel ................................................................ ................ ................ ................ ................ ................

48400 3 Injection, intraoperative ..................................................................... ................ ................ ................ ................ ................

48500 3 Surgery of pancreas cyst .................................................................. ................ ................ ................ ................ ................

48510 3 Drain pancreatic pseudocyst ............................................................ ................ ................ ................ ................ ................

48511 3 Drain pancreatic pseudocyst ............................................................ ................ ................ ................ ................ ................

48520 3 Fuse pancreas cyst and bowel ......................................................... ................ ................ ................ ................ ................

48540 3 Fuse pancreas cyst and bowel ......................................................... ................ ................ ................ ................ ................

48545 3 Pancreatorrhaphy .............................................................................. ................ ................ ................ ................ ................

48547 3 Duodenal exclusion ........................................................................... ................ ................ ................ ................ ................

48550 9 Donor pancreatectomy ...................................................................... ................ ................ ................ ................ ................

48554 9 Transplantallograft pancreas ............................................................ ................ ................ ................ ................ ................

48556 3 Removal, allograft pancreas ............................................................. ................ ................ ................ ................ ................

48999 3 Pancreas surgery procedure ............................................................ ................ ................ ................ ................ ................

49000 3 Exploration of abdomen .................................................................... 4 $595 ................ ................ ................ Delete.

49002 3 Reopening of abdomen .................................................................... ................ ................ ................ ................ ................

49010 3 Exploration behind abdomen ............................................................ ................ ................ ................ ................ ................

49020 3 Drain abdominal abscess ................................................................. ................ ................ ................ ................ ................

49021 3 Drain abdominal abscess ................................................................. ................ ................ ................ ................ ................

49040 3 Open drainage abdom abscess ........................................................ ................ ................ ................ ................ ................

49041 3 Percut drain abdom abscess ............................................................ ................ ................ ................ ................ ................

49060 3 Open drain retroper abscess ............................................................ ................ ................ ................ ................ ................

49061 3 Percutdrain retroper abscess ............................................................ ................ ................ ................ ................ ................

49062 3 Drain to peritoneal cavity .................................................................. ................ ................ ................ ................ ................

49080 1 Puncture, peritoneal cavity ............................................................... 2 $422 320 $126 0.25

49081 1 Removal of abdominal fluid .............................................................. 2 $422 320 $126 0.25

49085 1 Remove abdomen foreign body ....................................................... 2 $422 459 $611 1.21

49180 1 Biopsy, abdominal mass ................................................................... 1 $314 122 $186 0.37

49200 3 Removal of abdominal lesion ........................................................... ................ ................ ................ ................ ................

49201 3 Removal of abdominal lesion ........................................................... ................ ................ ................ ................ ................

49215 3 Excise sacral spine tumor ................................................................. ................ ................ ................ ................ ................

49220 3 Multiple surgery, abdomen ............................................................... ................ ................ ................ ................ ................

49250 1 Excision of umbilicus ........................................................................ 4 $595 459 $611 1.21

49255 3 Removal of omentum ........................................................................ ................ ................ ................ ................ ................

49400 2 Air injection into abdomen ................................................................ 1 $314 ................ ................ ................ Delete.

49420 1 Insert abdominal drain ...................................................................... 1 $314 459 $611 1.21

49421 1 Insert abdominal drain ...................................................................... 1 $314 459 $611 1.21

49422 1 Remove perm cannula/catheter ........................................................ ................ ................ 470 $119 0.24 Add.

49423 3 Exchange drainage cath ................................................................... ................ ................ ................ ................ ................

49424 2 Assess cyst, contrast inj ................................................................... ................ ................ ................ ................ ................

49425 3 Insert abdomen-venous drain ........................................................... 2 $422 ................ ................ ................ Delete.

49426 1 Revise abdomen-venous shunt ........................................................ 2 $422 459 $611 1.21

49427 2 Injection, abdominal shunt ................................................................ ................ ................ ................ ................ ................

49428 3 Ligation of shunt ............................................................................... ................ ................ ................ ................ ................

49429 1 Removal of shunt .............................................................................. ................ ................ 470 $119 0.24 Add.

49495 1 Repair inguinal hernia, init ................................................................ ................ ................ 466 $739 1.47 Add.

49496 1 Repair inguinal hernia, init ................................................................ ................ ................ 466 $739 1.47 Add.

49500 1 Repair inguinal hernia ....................................................................... ................ ................ 466 $739 1.47 Add.

49501 1 Repair inguinal hernia, init ................................................................ ................ ................ 466 $739 1.47 Add.

49505 1 Repair inguinal hernia ....................................................................... 4 $595 466 $739 1.47

49507 1 Repair, inguinal hernia ...................................................................... ................ ................ 466 $739 1.47 Add.

49520 1 Rerepair inguinal hernia .................................................................... 7 $941 466 $739 1.47

49521 1 Repair inguinal hernia, rec ................................................................ ................ ................ 466 $739 1.47 Add.

49525 1 Repair inguinal hernia ....................................................................... 4 $595 466 $739 1.47

49540 1 Repair lumbar hernia ........................................................................ 2 $422 466 $739 1.47

49550 1 Repair femoral hernia ....................................................................... 5 $678 466 $739 1.47

49553 1 Repair femoral hernia, init ................................................................ ................ ................ 466 $739 1.47 Add.

49555 1 Repair femoral hernia ....................................................................... 5 $678 466 $739 1.47

49557 1 Repair femoral hernia, recur ............................................................. ................ ................ 466 $739 1.47 Add.

49560 1 Repair abdominal hernia ................................................................... 4 $595 466 $739 1.47

49561 1 Repair incisional hernia .................................................................... ................ ................ 466 $739 1.47 Add.

49565 1 Rerepair abdominal hernia ............................................................... 4 $595 466 $739 1.47

49566 1 Repair incisional hernia .................................................................... ................ ................ 466 $739 1.47 Add.

49568 1 Hernia repair w/mesh ........................................................................ ................ ................ 466 $739 1.47 Add.
32377

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

49570 1 Repair epigastric hernia .................................................................... 4 $595 466 $739 1.47

49572 1 Repair, epigastric hernia ................................................................... ................ ................ 466 $739 1.47 Add.

49580 1 Repair umbilical hernia ..................................................................... ................ ................ 466 $739 1.47 Add.

49582 1 Repair umbilical hernia ..................................................................... ................ ................ 466 $739 1.47 Add.

49585 1 Repair umbilical hernia ..................................................................... 4 $595 466 $739 1.47

49587 1 Repair umbilical hernia ..................................................................... ................ ................ 466 $739 1.47 Add.

49590 1 Repair abdominal hernia ................................................................... 3 $482 466 $739 1.47

49600 1 Repair umbilical lesion ...................................................................... ................ ................ 466 $739 1.47 Add.

49605 3 Repair umbilical lesion ...................................................................... ................ ................ ................ ................ ................

49606 3 Repair umbilical lesion ...................................................................... ................ ................ ................ ................ ................

49610 3 Repair umbilical lesion ...................................................................... ................ ................ ................ ................ ................

49611 3 Repair umbilical lesion ...................................................................... ................ ................ ................ ................ ................

49900 3 Repair of abdominal wall .................................................................. ................ ................ ................ ................ ................

49905 3 Omental flap ...................................................................................... ................ ................ ................ ................ ................

49906 3 Free omental flap, microvasc ........................................................... ................ ................ ................ ................ ................

49999 3 Abdomen surgery procedure ............................................................ ................ ................ ................ ................ ................

50010 3 Exploration of kidney ........................................................................ ................ ................ ................ ................ ................

50020 3 Open drain renal abscess ................................................................. 2 $422 ................ ................ ................ Delete.

50021 3 Percut drain renal abscess ............................................................... ................ ................ ................ ................ ................

50040 3 Drainage of kidney ............................................................................ 3 $482 ................ ................ ................ Delete.

50045 3 Exploration of kidney ........................................................................ ................ ................ ................ ................ ................

50060 3 Removal of kidney stone .................................................................. ................ ................ ................ ................ ................

50065 3 Incision of kidney .............................................................................. ................ ................ ................ ................ ................

50070 3 Incision of kidney .............................................................................. ................ ................ ................ ................ ................

50075 3 Removal of kidney stone .................................................................. ................ ................ ................ ................ ................

50080 3 Removal of kidney stone .................................................................. ................ ................ ................ ................ ................

50081 3 Removal of kidney stone .................................................................. ................ ................ ................ ................ ................

50100 3 Revise kidney blood vessels ............................................................ ................ ................ ................ ................ ................

50120 3 Exploration of kidney ........................................................................ ................ ................ ................ ................ ................

50125 3 Explore and drain kidney .................................................................. ................ ................ ................ ................ ................

50130 3 Removal of kidney stone .................................................................. ................ ................ ................ ................ ................

50135 3 Exploration of kidney ........................................................................ ................ ................ ................ ................ ................

50200 1 Biopsy of kidney ................................................................................ 1 $314 122 $186 0.37

50205 3 Biopsy of kidney ................................................................................ ................ ................ ................ ................ ................

50220 3 Removal of kidney ............................................................................ ................ ................ ................ ................ ................

50225 3 Removal of kidney ............................................................................ ................ ................ ................ ................ ................

50230 3 Removal of kidney ............................................................................ ................ ................ ................ ................ ................

50234 3 Removal of kidney & ureter .............................................................. ................ ................ ................ ................ ................

50236 3 Removal of kidney & ureter .............................................................. ................ ................ ................ ................ ................

50240 3 Partial removal of kidney .................................................................. ................ ................ ................ ................ ................

50280 3 Removal of kidney lesion .................................................................. ................ ................ ................ ................ ................

50290 3 Removal of kidney lesion .................................................................. ................ ................ ................ ................ ................

50300 9 Removal of donor kidney .................................................................. ................ ................ ................ ................ ................

50320 3 Removal of donor kidney .................................................................. ................ ................ ................ ................ ................

50340 3 Removal of kidney ............................................................................ ................ ................ ................ ................ ................

50360 3 Transplantation of kidney .................................................................. ................ ................ ................ ................ ................

50365 3 Transplantation of kidney .................................................................. ................ ................ ................ ................ ................

50370 3 Remove transplanted kidney ............................................................ ................ ................ ................ ................ ................

50380 3 Reimplantation of kidney .................................................................. ................ ................ ................ ................ ................

50390 1 Drainage of kidney lesion ................................................................. 1 $314 122 $186 0.37

50392 2 Insert kidney drain ............................................................................ 1 $314 ................ ................ ................ Delete.

50393 2 Insert ureteral tube ............................................................................ 1 $314 ................ ................ ................ Delete.

50394 2 Injection for kidney x-ray ................................................................... ................ ................ ................ ................ ................

50395 2 Create passage to kidney ................................................................. 1 $314 ................ ................ ................ Delete.

50396 6 Measure kidney pressure ................................................................. 1 $314 ................ ................ ................ Delete.

50398 1 Change kidney tube .......................................................................... 1 $314 521 $212 0.42

50400 3 Revision of kidney/ureter .................................................................. ................ ................ ................ ................ ................

50405 3 Revision of kidney/ureter .................................................................. ................ ................ ................ ................ ................

50500 3 Repair of kidney wound .................................................................... ................ ................ ................ ................ ................

50520 3 Close kidney-skin fistula ................................................................... 1 $314 ................ ................ ................ Delete.

50525 3 Repair renal-abdomen fistula ............................................................ ................ ................ ................ ................ ................

50526 3 Repair renal-abdomen fistula ............................................................ ................ ................ ................ ................ ................

50540 3 Revision of horseshoe kidney ........................................................... ................ ................ ................ ................ ................

50551 1 Kidney endoscopy ............................................................................. 1 $314 522 $393 0.78

50553 1 Kidney endoscopy ............................................................................. 1 $314 522 $393 0.78

50555 1 Kidney endoscopy & biopsy ............................................................. 1 $314 522 $393 0.78

50557 1 Kidney endoscopy & treatment ......................................................... 1 $314 522 $393 0.78

50559 1 Renal endoscopy; radiotracer ........................................................... 1 $314 522 $393 0.78

50561 1 Kidney endoscopy & treatment ......................................................... 1 $314 522 $393 0.78

50570 3 Kidney endoscopy ............................................................................. 1 $314 ................ ................ ................ Delete.

50572 3 Kidney endoscopy ............................................................................. 1 $314 ................ ................ ................ Delete.

50574 3 Kidney endoscopy & biopsy ............................................................. 1 $314 ................ ................ ................ Delete.

50575 3 Kidney endoscopy ............................................................................. ................ ................ ................ ................ ................

50576 3 Kidney endoscopy & treatment ......................................................... 1 $314 ................ ................ ................ Delete.
32378

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

50578 3 Renal endoscopy; radiotracer ........................................................... 1 $314 ................ ................ ................ Delete.

50580 3 Kidney endoscopy & treatment ......................................................... 1 $314 ................ ................ ................ Delete.

50590 1 Fragmenting of kidney stone ............................................................ 9 ................ 527 $2,107 4.18

50600 3 Exploration of ureter ......................................................................... ................ ................ ................ ................ ................

50605 3 Insert ureteral support ....................................................................... ................ ................ ................ ................ ................

50610 3 Removal of ureter stone ................................................................... ................ ................ ................ ................ ................

50620 3 Removal of ureter stone ................................................................... ................ ................ ................ ................ ................

50630 3 Removal of ureter stone ................................................................... ................ ................ ................ ................ ................

50650 3 Removal of ureter ............................................................................. ................ ................ ................ ................ ................

50660 3 Removal of ureter ............................................................................. ................ ................ ................ ................ ................

50684 2 Injection for ureter x-ray .................................................................... 1 $314 ................ ................ ................ Delete.

50686 6 Measure ureter pressure .................................................................. ................ ................ ................ ................ ................

50688 1 Change of ureter tube ....................................................................... 1 $314 470 $119 0.24

50690 2 Injection for ureter x-ray .................................................................... 1 $314 ................ ................ ................ Delete.

50700 3 Revision of ureter .............................................................................. ................ ................ ................ ................ ................

50715 3 Release of ureter .............................................................................. ................ ................ ................ ................ ................

50722 3 Release of ureter .............................................................................. ................ ................ ................ ................ ................

50725 3 Release/revise ureter ........................................................................ ................ ................ ................ ................ ................

50727 3 Revise ureter ..................................................................................... ................ ................ ................ ................ ................

50728 3 Revise ureter ..................................................................................... ................ ................ ................ ................ ................

50740 3 Fusion of ureter & kidney ................................................................. ................ ................ ................ ................ ................

50750 3 Fusion of ureter & kidney ................................................................. ................ ................ ................ ................ ................

50760 3 Fusion of ureters ............................................................................... ................ ................ ................ ................ ................

50770 3 Splicing of ureters ............................................................................. ................ ................ ................ ................ ................

50780 3 Reimplant ureter in bladder .............................................................. ................ ................ ................ ................ ................

50782 3 Reimplant ureter in bladder .............................................................. ................ ................ ................ ................ ................

50783 3 Reimplant ureter in bladder .............................................................. ................ ................ ................ ................ ................

50785 3 Reimplant ureter in bladder .............................................................. ................ ................ ................ ................ ................

50800 3 Implant ureter in bowel ..................................................................... ................ ................ ................ ................ ................

50810 3 Fusion of ureter & bowel .................................................................. ................ ................ ................ ................ ................

50815 3 Urine shunt to bowel ......................................................................... ................ ................ ................ ................ ................

50820 3 Construct bowel bladder ................................................................... ................ ................ ................ ................ ................

50825 3 Construct bowel bladder ................................................................... ................ ................ ................ ................ ................

50830 3 Revise urine flow .............................................................................. ................ ................ ................ ................ ................

50840 3 Replace ureter by bowel ................................................................... ................ ................ ................ ................ ................

50845 3 Appendico-vesicostomy .................................................................... ................ ................ ................ ................ ................

50860 3 Transplant ureter to skin ................................................................... ................ ................ ................ ................ ................

50900 3 Repair of ureter ................................................................................. ................ ................ ................ ................ ................

50920 3 Closure ureter/skin fistula ................................................................. ................ ................ ................ ................ ................

50930 3 Closure ureter/bowel fistula .............................................................. ................ ................ ................ ................ ................

50940 3 Release of ureter .............................................................................. ................ ................ ................ ................ ................

50951 1 Endoscopy of ureter .......................................................................... 1 $314 523 $504 1.00

50953 1 Endoscopy of ureter .......................................................................... 1 $314 523 $504 1.00

50955 1 Ureter endoscopy & biopsy .............................................................. 1 $314 523 $504 1.00

50957 1 Ureter endoscopy & treatment .......................................................... 1 $314 523 $504 1.00

50959 1 Ureter endoscopy & tracer ................................................................ 1 $314 523 $504 1.00

50961 1 Ureter endoscopy & treatment .......................................................... 1 $314 523 $504 1.00

50970 3 Ureter endoscopy .............................................................................. 1 $314 ................ ................ ................ Delete.

50972 3 Ureter endoscopy & catheter ............................................................ 1 $314 ................ ................ ................ Delete.

50974 3 Ureter endoscopy & biopsy .............................................................. 1 $314 ................ ................ ................ Delete.

50976 3 Ureter endoscopy & treatment .......................................................... 1 $314 ................ ................ ................ Delete.

50978 3 Ureter endoscopy & tracer ................................................................ 1 $314 ................ ................ ................ Delete.

50980 3 Ureter endoscopy & treatment .......................................................... 1 $314 ................ ................ ................ Delete.

51000 5 Drainage of bladder .......................................................................... ................ ................ ................ ................ ................

51005 5 Drainage of bladder .......................................................................... 1 $314 ................ ................ ................ Delete.

51010 5 Drainage of bladder .......................................................................... 1 $314 ................ ................ ................ Delete.

51020 1 Incise & treat bladder ........................................................................ 4 $595 523 $504 1.00

51030 1 Incise & treat bladder ........................................................................ 4 $595 523 $504 1.00

51040 1 Incise & drain bladder ....................................................................... 4 $595 523 $504 1.00

51045 1 Incise bladder, drain ureter ............................................................... 4 $595 523 $504 1.00

51050 1 Removal of bladder stone ................................................................. ................ ................ 523 $504 1.00 Add.

51060 3 Removal of ureter stone ................................................................... ................ ................ ................ ................ ................

51065 1 Removal of ureter stone ................................................................... ................ ................ 523 $504 1.00 Add.

51080 1 Drainage of bladder abscess ............................................................ ................ ................ 132 $162 0.32 Add.

51500 1 Removal of bladder cyst ................................................................... 4 $595 466 $739 1.47

51520 1 Removal of bladder lesion ................................................................ ................ ................ 523 $504 1.00 Add.

51525 3 Removal of bladder lesion ................................................................ ................ ................ ................ ................ ................

51530 3 Removal of bladder lesion ................................................................ ................ ................ ................ ................ ................

51535 3 Repair of ureter lesion ...................................................................... ................ ................ ................ ................ ................

51550 3 Partial removal of bladder ................................................................. ................ ................ ................ ................ ................

51555 3 Partial removal of bladder ................................................................. ................ ................ ................ ................ ................

51565 3 Revise bladder & ureter(s) ................................................................ ................ ................ ................ ................ ................

51570 3 Removal of bladder ........................................................................... ................ ................ ................ ................ ................

51575 3 Removal of bladder & nodes ............................................................ ................ ................ ................ ................ ................
32379

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

51580 3 Remove bladder; revise tract ............................................................ ................ ................ ................ ................ ................

51585 3 Removal of bladder & nodes ............................................................ ................ ................ ................ ................ ................

51590 3 Remove bladder; revise tract ............................................................ ................ ................ ................ ................ ................

51595 3 Remove bladder; revise tract ............................................................ ................ ................ ................ ................ ................

51596 3 Remove bladder, create pouch ........................................................ ................ ................ ................ ................ ................

51597 3 Removal of pelvic structures ............................................................ ................ ................ ................ ................ ................

51600 2 Injection for bladder x-ray ................................................................. 1 $314 ................ ................ ................ Delete.

51605 2 Preparation for bladder xray ............................................................. 1 $314 ................ ................ ................ Delete.

51610 2 Injection for bladder x-ray ................................................................. 1 $314 ................ ................ ................ Delete.

51700 5 Irrigation of bladder ........................................................................... ................ ................ ................ ................ ................

51705 1 Change of bladder tube .................................................................... ................ ................ 470 $119 0.24 Add.

51710 1 Change of bladder tube .................................................................... 1 $314 470 $119 0.24

51715 1 Endoscopic injection/implant ............................................................. ................ ................ 531 $418 0.83 Add.

51720 5 Treatment of bladder lesion .............................................................. ................ ................ ................ ................ ................

51725 6 Simple cystometrogram .................................................................... 1 $314 ................ ................ ................ Delete.

51726 6 Complex cystometrogram ................................................................. 1 $314 ................ ................ ................ Delete.

51736 6 Urine flow measurement ................................................................... ................ ................ ................ ................ ................

51741 6 Electro-uroflowmetry, first ................................................................. ................ ................ ................ ................ ................

51772 6 Urethra pressure profile .................................................................... 1 $314 ................ ................ ................ Delete.

51784 6 Anal/urinary muscle study ................................................................. ................ ................ ................ ................ ................

51785 6 Anal/urinary muscle study ................................................................. 1 $314 ................ ................ ................ Delete.

51792 6 Urinary reflex study ........................................................................... ................ ................ ................ ................ ................

51795 6 Urine voiding pressure study ............................................................ ................ ................ ................ ................ ................

51797 6 Intraabdominal pressure test ............................................................ ................ ................ ................ ................ ................

51800 3 Revision of bladder/urethra ............................................................... ................ ................ ................ ................ ................

51820 3 Revision of urinary tract .................................................................... ................ ................ ................ ................ ................

51840 3 Attach bladder/urethra ...................................................................... ................ ................ ................ ................ ................

51841 3 Attach bladder/urethra ...................................................................... ................ ................ ................ ................ ................

51845 3 Repair bladder neck .......................................................................... ................ ................ ................ ................ ................

51860 3 Repair of bladder wound .................................................................. ................ ................ ................ ................ ................

51865 3 Repair of bladder wound .................................................................. 4 $595 ................ ................ ................ Delete.

51880 1 Repair of bladder opening ................................................................ 1 $314 523 $504 1.00

51900 3 Repair bladder/vagina lesion ............................................................ 4 $595 ................ ................ ................ Delete.

51920 3 Close bladder-uterus fistula .............................................................. 3 $482 ................ ................ ................ Delete.

51925 3 Hysterectomy/bladder repair ............................................................. ................ ................ ................ ................ ................

51940 3 Correction of bladder defect ............................................................. ................ ................ ................ ................ ................

51960 3 Revision of bladder & bowel ............................................................. ................ ................ ................ ................ ................

51980 3 Construct bladder opening ................................................................ ................ ................ ................ ................ ................

52000 1 Cystoscopy ........................................................................................ 1 $314 521 $212 0.42

52005 1 Cystoscopy & ureter catheter ........................................................... 2 $422 522 $393 0.78

52007 1 Cystoscopy and biopsy ..................................................................... 2 $422 522 $393 0.78

52010 1 Cystoscopy & duct catheter .............................................................. 2 $422 522 $393 0.78

52204 1 Cystoscopy ........................................................................................ 2 $422 522 $393 0.78

52214 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52224 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52234 1 Cystoscopy and treatment ................................................................ 2 $422 523 $504 1.00

52235 1 Cystoscopy and treatment ................................................................ 3 $482 523 $504 1.00

52240 1 Cystoscopy and treatment ................................................................ 3 $482 523 $504 1.00

52250 1 Cystoscopy & radiotracer .................................................................. 4 $595 523 $504 1.00

52260 1 Cystoscopy & treatment .................................................................... 2 $422 522 $393 0.78

52265 1 Cystoscopy & treatment .................................................................... ................ ................ 521 $212 0.42 Add.

52270 1 Cystoscopy & revise urethra ............................................................. 2 $422 522 $393 0.78

52275 1 Cystoscopy & revise urethra ............................................................. 2 $422 522 $393 0.78

52276 1 Cystoscopy and treatment ................................................................ 3 $482 522 $393 0.78

52277 1 Cystoscopy and treatment ................................................................ 2 $422 523 $504 1.00

52281 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52282 1 Cystoscopy, implant stent ................................................................. ................ ................ 523 $504 1.00 Add.

52283 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52285 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52290 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52300 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52301 1 Cystoscopy and treatment ................................................................ ................ ................ 522 $393 0.78 Add.

52305 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52310 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52315 1 Cystoscopy and treatment ................................................................ 2 $422 522 $393 0.78

52317 1 Remove bladder stone ...................................................................... 1 $314 523 $504 1.00

52318 1 Remove bladder stone ...................................................................... 2 $422 523 $504 1.00

52320 1 Cystoscopy and treatment ................................................................ 5 $678 523 $504 1.00

52325 1 Cystoscopy, stone removal ............................................................... 4 $595 523 $504 1.00

52327 1 Cystoscopy, inject material ............................................................... ................ ................ 522 $393 0.78 Add.

52330 1 Cystoscopy and treatment ................................................................ 2 $422 523 $504 1.00

52332 1 Cystoscopy and treatment ................................................................ 2 $422 523 $504 1.00

52334 1 Create passage to kidney ................................................................. 3 $482 523 $504 1.00

52335 1 Endoscopy of urinary tract ................................................................ 3 $482 523 $504 1.00
32380

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

52336 1 Cystoscopy, stone removal ............................................................... 4 $595 523 $504 1.00

52337 1 Cystoscopy, stone removal ............................................................... 4 $595 524 $1,131 2.24

52338 1 Cystoscopy and treatment ................................................................ 4 $595 523 $504 1.00

52339 1 Cystoscopy and treatment ................................................................ ................ ................ 523 $504 1.00 Add.

52340 1 Cystoscopy and treatment ................................................................ 3 $482 523 $504 1.00

52450 1 Incision of prostate ............................................................................ 3 $482 523 $504 1.00

52500 1 Revision of bladder neck .................................................................. 3 $482 523 $504 1.00

52510 1 Dilation prostatic urethra ................................................................... ................ ................ 522 $393 0.78 Add.

52601 1 Prostatectomy (TURP) ...................................................................... 4 $595 524 $1,131 2.24

52606 1 Control postop bleeding .................................................................... 1 $314 523 $504 1.00

52612 1 Prostatectomy, first stage ................................................................. 2 $422 524 $1,131 2.24

52614 1 Prostatectomy, second stage ........................................................... 1 $314 524 $1,131 2.24

52620 1 Remove residual prostate ................................................................. 1 $314 524 $1,131 2.24

52630 1 Remove prostate regrowth ............................................................... 2 $422 524 $1,131 2.24

52640 1 Relieve bladder contracture .............................................................. 2 $422 523 $504 1.00

52647 1 Laser surgery of prostate .................................................................. ................ ................ 524 $1,131 2.24 Add.

52648 1 Laser surgery of prostate .................................................................. ................ ................ 524 $1,131 2.24 Add.

52700 1 Drainage of prostate abscess ........................................................... 2 $422 523 $504 1.00

53000 1 Incision of urethra ............................................................................. 1 $314 531 $418 0.83

53010 1 Incision of urethra ............................................................................. 1 $314 531 $418 0.83

53020 1 Incision of urethra ............................................................................. 1 $314 531 $418 0.83

53025 1 Incision of urethra ............................................................................. ................ ................ 531 $418 0.83 Add.

53040 1 Drainage of urethra abscess ............................................................ 2 $422 531 $418 0.83

53060 1 Drainage of urethra abscess ............................................................ ................ ................ 531 $418 0.83 Add.

53080 1 Drainage of urinary leakage ............................................................. ................ ................ 531 $418 0.83 Add.

53085 3 Drainage of urinary leakage ............................................................. ................ ................ ................ ................ ................

53200 1 Biopsy of urethra ............................................................................... 1 $314 531 $418 0.83

53210 1 Removal of urethra ........................................................................... 5 $678 532 $644 1.28

53215 1 Removal of urethra ........................................................................... 5 $678 532 $644 1.28

53220 1 Treatment of urethra lesion .............................................................. 2 $422 532 $644 1.28

53230 1 Removal of urethra lesion ................................................................. 2 $422 532 $644 1.28

53235 1 Removal of urethra lesion ................................................................. 3 $482 532 $644 1.28

53240 1 Surgery for urethra pouch ................................................................. 2 $422 532 $644 1.28

53250 1 Removal of urethra gland ................................................................. 2 $422 531 $418 0.83

53260 1 Treatment of urethra lesion .............................................................. 2 $422 531 $418 0.83

53265 1 Treatment of urethra lesion .............................................................. 2 $422 531 $418 0.83

53270 1 Removal of urethra gland ................................................................. ................ ................ 531 $418 0.83 Add.

53275 1 Repair of urethra defect .................................................................... 2 $422 531 $418 0.83

53400 1 Revise urethra, 1st stage .................................................................. 3 $482 532 $644 1.28

53405 1 Revise urethra, 2nd stage ................................................................ 2 $422 532 $644 1.28

53410 1 Reconstruction of urethra ................................................................. 2 $422 532 $644 1.28

53415 3 Reconstruction of urethra ................................................................. ................ ................ ................ ................ ................

53420 1 Reconstruct urethra, stage 1 ............................................................ 3 $482 532 $644 1.28

53425 1 Reconstruct urethra, stage 2 ............................................................ 2 $422 532 $644 1.28

53430 1 Reconstruction of urethra ................................................................. 2 $422 532 $644 1.28

53440 1 Correct bladder function ................................................................... 2 $422 538 $1,221 2.42

53442 1 Remove perineal prosthesis ............................................................. 1 $314 531 $418 0.83

53443 3 Reconstruction of urethra ................................................................. ................ ................ ................ ................ ................

53445 1 Correct urine flow control .................................................................. ................ ................ 538 $1,221 2.42 Add.

53447 1 Remove artificial sphincter ................................................................ 1 $314 532 $644 1.28

53449 1 Correct artificial sphincter ................................................................. 1 $314 532 $644 1.28

53450 1 Revision of urethra ............................................................................ 1 $314 532 $644 1.28

53460 1 Revision of urethra ............................................................................ 1 $314 532 $644 1.28

53502 1 Repair of urethra injury ..................................................................... 2 $422 531 $418 0.83

53505 1 Repair of urethra injury ..................................................................... 2 $422 531 $418 0.83

53510 1 Repair of urethra injury ..................................................................... 2 $422 531 $418 0.83

53515 1 Repair of urethra injury ..................................................................... 2 $422 532 $644 1.28

53520 1 Repair of urethra defect .................................................................... 2 $422 532 $644 1.28

53600 5 Dilate urethra stricture ...................................................................... ................ ................ ................ ................ ................

53601 5 Dilate urethra stricture ...................................................................... ................ ................ ................ ................ ................

53605 1 Dilate urethra stricture ...................................................................... 2 $422 522 $393 0.78

53620 5 Dilate urethra stricture ...................................................................... ................ ................ ................ ................ ................

53621 5 Dilate urethra stricture ...................................................................... ................ ................ ................ ................ ................

53660 5 Dilation of urethra ............................................................................. ................ ................ ................ ................ ................

53661 5 Dilation of urethra ............................................................................. ................ ................ ................ ................ ................

53665 1 Dilation of urethra ............................................................................. 1 $314 531 $418 0.83

53670 5 Insert urinary catheter ....................................................................... ................ ................ ................ ................ ................

53675 5 Insert urinary catheter ....................................................................... ................ ................ ................ ................ ................

53850 1 Prostatic microwave thermotx ........................................................... ................ ................ 524 $1,131 2.24 Add.

53852 1 Prostatic rf thermotx .......................................................................... ................ ................ 524 $1,131 2.24 Add.

53899 3 Urology surgery procedure ............................................................... ................ ................ ................ ................ ................

54000 1 Slitting of prepuce ............................................................................. ................ ................ 531 $418 0.83 Add.

54001 1 Slitting of prepuce ............................................................................. 2 $422 531 $418 0.83

54015 1 Drain penis lesion ............................................................................. 4 $595 132 $162 0.32
32381

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

54050 1 Destruction, penis lesion(s) .............................................................. ................ ................ 152 $213 0.42 Add.

54055 1 Destruction, penis lesion(s) .............................................................. ................ ................ 152 $213 0.42 Add.

54056 1 Cryosurgery, penis lesion(s) ............................................................. ................ ................ 152 $213 0.42 Add.

54057 1 Laser surg, penis lesion(s) ............................................................... 1 $314 152 $213 0.42

54060 1 Excision of penis lesion(s) ................................................................ 1 $314 152 $213 0.42

54065 1 Destruction, penis lesion(s) .............................................................. 1 $314 152 $213 0.42

54100 1 Biopsy of penis ................................................................................. 1 $314 162 $187 0.37

54105 1 Biopsy of penis ................................................................................. 1 $314 162 $187 0.37

54110 1 Treatment of penis lesion ................................................................. 2 $422 537 $1,221 2.42

54111 1 Treat penis lesion, graft .................................................................... ................ ................ 537 $1,221 2.42 Add.

54112 1 Treat penis lesion, graft .................................................................... ................ ................ 537 $1,221 2.42 Add.

54115 1 Treatment of penis lesion ................................................................. 1 $314 132 $162 0.32

54120 1 Partial removal of penis .................................................................... 2 $422 537 $1,221 2.42

54125 3 Removal of penis .............................................................................. 2 $422 ................ ................ ................ Delete.

54130 3 Remove penis & nodes .................................................................... ................ ................ ................ ................ ................

54135 3 Remove penis & nodes .................................................................... ................ ................ ................ ................ ................

54150 1 Circumcision ...................................................................................... ................ ................ 536 $459 0.91 Add.

54152 1 Circumcision ...................................................................................... 1 $314 536 $459 0.91

54160 1 Circumcision ...................................................................................... ................ ................ 536 $459 0.91 Add.

54161 1 Circumcision ...................................................................................... 2 $422 536 $459 0.91

54200 5 Treatment of penis lesion ................................................................. ................ ................ ................ ................ ................

54205 1 Treatment of penis lesion ................................................................. 4 $595 537 $1,221 2.42

54220 5 Treatment of penis lesion ................................................................. 1 $314 ................ ................ ................ Delete.

54230 2 Prepare penis study .......................................................................... ................ ................ ................ ................ ................

54231 5 Dynamic cavernosometry ................................................................. ................ ................ ................ ................ ................

54235 5 Penile injection .................................................................................. ................ ................ ................ ................ ................

54240 6 Penis study ....................................................................................... ................ ................ ................ ................ ................

54250 6 Penis study ....................................................................................... ................ ................ ................ ................ ................

54300 1 Revision of penis .............................................................................. 3 $482 537 $1,221 2.42

54304 1 Revision of penis .............................................................................. ................ ................ 537 $1,221 2.42 Add.

54308 1 Reconstruction of urethra ................................................................. ................ ................ 537 $1,221 2.42 Add.

54312 1 Reconstruction of urethra ................................................................. ................ ................ 537 $1,221 2.42 Add.

54316 1 Reconstruction of urethra ................................................................. ................ ................ 537 $1,221 2.42 Add.

54318 1 Reconstruction of urethra ................................................................. ................ ................ 537 $1,221 2.42 Add.

54322 1 Reconstruction of urethra ................................................................. ................ ................ 537 $1,221 2.42 Add.

54324 1 Reconstruction of urethra ................................................................. ................ ................ 537 $1,221 2.42 Add.

54326 1 Reconstruction of urethra ................................................................. ................ ................ 537 $1,221 2.42 Add.

54328 1 Revise penis, urethra ........................................................................ ................ ................ 537 $1,221 2.42 Add.

54332 3 Revise penis, urethra ........................................................................ ................ ................ ................ ................ ................

54336 3 Revise penis, urethra ........................................................................ ................ ................ ................ ................ ................

54340 1 Secondary urethral surgery .............................................................. ................ ................ 537 $1,221 2.42 Add.

54344 1 Secondary urethral surgery .............................................................. ................ ................ 537 $1,221 2.42 Add.

54348 1 Secondary urethral surgery .............................................................. ................ ................ 537 $1,221 2.42 Add.

54352 1 Reconstruct urethra, penis ................................................................ ................ ................ 537 $1,221 2.42 Add.

54360 1 Penis plastic surgery ......................................................................... 3 $482 537 $1,221 2.42

54380 1 Repair penis ...................................................................................... ................ ................ 537 $1,221 2.42 Add.

54385 1 Repair penis ...................................................................................... ................ ................ 537 $1,221 2.42 Add.

54390 3 Repair penis and bladder ................................................................. ................ ................ ................ ................ ................

54400 1 Insert semi-rigid prosthesis ............................................................... ................ ................ 538 $1,221 2.42 Add.

54401 1 Insert self-contd prosthesis ............................................................... ................ ................ 538 $1,221 2.42 Add.

54402 1 Remove penis prosthesis ................................................................. ................ ................ 537 $1,221 2.42 Add.

54405 1 Insert multi-comp prosthesis ............................................................. ................ ................ 538 $1,221 2.42 Add.

54407 1 Remove multi-comp prosthesis ........................................................ ................ ................ 537 $1,221 2.42 Add.

54409 1 Revise penis prosthesis .................................................................... ................ ................ 537 $1,221 2.42 Add.

54420 1 Revision of penis .............................................................................. 4 $595 537 $1,221 2.42

54430 3 Revision of penis .............................................................................. ................ ................ ................ ................ ................

54435 1 Revision of penis .............................................................................. 4 $595 537 $1,221 2.42

54440 1 Repair of penis .................................................................................. 4 $595 537 $1,221 2.42

54450 5 Preputial stretching ........................................................................... 1 $314 ................ ................ ................ Delete.

54500 1 Biopsy of testis .................................................................................. 1 $314 122 $186 0.37

54505 1 Biopsy of testis .................................................................................. 1 $314 546 $523 1.04

54510 1 Removal of testis lesion .................................................................... 2 $422 546 $523 1.04

54520 1 Removal of testis .............................................................................. 3 $482 546 $523 1.04

54530 1 Removal of testis .............................................................................. 4 $595 546 $523 1.04

54535 3 Extensive testis surgery .................................................................... ................ ................ ................ ................ ................

54550 1 Exploration for testis ......................................................................... 4 $595 546 $523 1.04

54560 3 Exploration for testis ......................................................................... ................ ................ ................ ................ ................

54600 1 Reduce testis torsion ........................................................................ 4 $595 546 $523 1.04

54620 1 Suspension of testis .......................................................................... 3 $482 546 $523 1.04

54640 1 Suspension of testis .......................................................................... 4 $595 546 $523 1.04

54650 3 Orchiopexy (Fowler-Stephens) ......................................................... ................ ................ ................ ................ ................

54660 1 Revision of testis ............................................................................... 2 $422 546 $523 1.04

54670 1 Repair testis injury ............................................................................ 3 $482 546 $523 1.04

54680 1 Relocation of testis(es) ..................................................................... 3 $482 546 $523 1.04
32382

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

54700 1 Drainage of scrotum ......................................................................... 2 $422 546 $523 1.04

54800 1 Biopsy of epididymis ......................................................................... 1 $314 122 $186 0.37

54820 1 Exploration of epididymis .................................................................. 1 $314 546 $523 1.04

54830 1 Remove epididymis lesion ................................................................ 3 $482 546 $523 1.04

54840 1 Remove epididymis lesion ................................................................ 4 $595 546 $523 1.04

54860 1 Removal of epididymis ...................................................................... 3 $482 546 $523 1.04

54861 1 Removal of epididymis ...................................................................... 4 $595 546 $523 1.04

54900 1 Fusion of spermatic ducts ................................................................. 4 $595 546 $523 1.04

54901 1 Fusion of spermatic ducts ................................................................. 4 $595 546 $523 1.04

55000 5 Drainage of hydrocele ....................................................................... ................ ................ ................ ................ ................

55040 1 Removal of hydrocele ....................................................................... 3 $482 466 $739 1.47

55041 1 Removal of hydroceles ..................................................................... 5 $678 466 $739 1.47

55060 1 Repair of hydrocele ........................................................................... 4 $595 546 $523 1.04

55100 1 Drainage of scrotum abscess ........................................................... 1 $314 132 $162 0.32

55110 1 Explore scrotum ................................................................................ 2 $422 546 $523 1.04

55120 1 Removal of scrotum lesion ............................................................... 2 $422 546 $523 1.04

55150 1 Removal of scrotum .......................................................................... 1 $314 546 $523 1.04

55175 1 Revision of scrotum .......................................................................... 1 $314 546 $523 1.04

55180 1 Revision of scrotum .......................................................................... 2 $422 546 $523 1.04

55200 1 Incision of sperm duct ....................................................................... 2 $422 546 $523 1.04

55250 1 Removal of sperm duct(s) ................................................................ ................ ................ 546 $523 1.04 Add.

55300 2 Preparation,sperm duct x-ray ........................................................... ................ ................ ................ ................ ................

55400 1 Repair of sperm duct ........................................................................ 1 $314 546 $523 1.04

55450 1 Ligation of sperm duct ...................................................................... ................ ................ 546 $523 1.04 Add.

55500 1 Removal of hydrocele ....................................................................... 3 $482 546 $523 1.04

55520 1 Removal of sperm cord lesion .......................................................... 4 $595 546 $523 1.04

55530 1 Revise spermatic cord veins ............................................................. 4 $595 546 $523 1.04

55535 1 Revise spermatic cord veins ............................................................. 4 $595 546 $523 1.04

55540 1 Revise hernia & sperm veins ............................................................ 5 $678 546 $523 1.04

55600 3 Incise sperm duct pouch ................................................................... 1 $314 ................ ................ ................ Delete.

55605 3 Incise sperm duct pouch ................................................................... 1 $314 ................ ................ ................ Delete.

55650 3 Remove sperm duct pouch ............................................................... 1 $314 ................ ................ ................ Delete.

55680 1 Remove sperm pouch lesion ............................................................ 1 $314 546 $523 1.04

55700 1 Biopsy of prostate ............................................................................. 2 $422 547 $265 0.53

55705 1 Biopsy of prostate ............................................................................. 2 $422 547 $265 0.53

55720 1 Drainage of prostate abscess ........................................................... 1 $314 523 $504 1.00

55725 1 Drainage of prostate abscess ........................................................... ................ ................ 523 $504 1.00 Add.

55801 3 Removal of prostate .......................................................................... ................ ................ ................ ................ ................

55810 3 Extensive prostate surgery ............................................................... ................ ................ ................ ................ ................

55812 3 Extensive prostate surgery ............................................................... ................ ................ ................ ................ ................

55815 3 Extensive prostate surgery ............................................................... ................ ................ ................ ................ ................

55821 3 Removal of prostate .......................................................................... ................ ................ ................ ................ ................

55831 3 Removal of prostate .......................................................................... ................ ................ ................ ................ ................

55840 3 Extensive prostate surgery ............................................................... ................ ................ ................ ................ ................

55842 3 Extensive prostate surgery ............................................................... ................ ................ ................ ................ ................

55845 3 Extensive prostate surgery ............................................................... ................ ................ ................ ................ ................

55859 1 Percut/needle insert, pros ................................................................. ................ ................ 523 $504 1.00 Add.

55860 3 Surgical exposure, prostate .............................................................. ................ ................ ................ ................ ................

55862 3 Extensive prostate surgery ............................................................... ................ ................ ................ ................ ................

55865 3 Extensive prostate surgery ............................................................... ................ ................ ................ ................ ................

55870 6 Electroejaculation .............................................................................. ................ ................ ................ ................ ................

55899 3 Genital surgery procedure ................................................................ ................ ................ ................ ................ ................

55970 9 Sex transformation, M to F ............................................................... ................ ................ ................ ................ ................

55980 9 Sex transformation, F to M ............................................................... ................ ................ ................ ................ ................

56300 1 Laparoscopy; diagnostic ................................................................... 3 $482 551 $831 1.65

56301 1 Laparoscopy; tubal cautery ............................................................... 3 $482 551 $831 1.65

56302 1 Laparoscopy; tubal block .................................................................. 3 $482 551 $831 1.65

56303 1 Laparoscopy; excise lesions ............................................................. 5 $678 551 $831 1.65

56304 1 Laparoscopy; lysis ............................................................................ 5 $678 551 $831 1.65

56305 1 Laparoscopy; biopsy ......................................................................... 4 $595 551 $831 1.65

56306 1 Laparoscopy; aspiration .................................................................... 4 $595 551 $831 1.65

56307 1 Laparoscopy; remove adnexa .......................................................... 5 $678 552 $1,383 2.74

56308 3 Laparoscopy; hysterectomy .............................................................. ................ ................ ................ ................ ................

56309 1 Laparoscopy; remove myoma .......................................................... 5 $678 552 $1,383 2.74

56310 3 Laparoscopic enterolysis .................................................................. ................ ................ ................ ................ ................

56311 1 Laparoscopic lymph node biop ......................................................... ................ ................ 552 $1,383 2.74 Add.

56312 1 Laparoscopic lymphadenectomy ...................................................... ................ ................ 552 $1,383 2.74 Add.

56313 1 Laparoscopic lymphadenectomy ...................................................... ................ ................ 552 $1,383 2.74 Add.

56314 3 Lapar; drain lymphocele ................................................................... ................ ................ ................ ................ ................

56315 3 Laparoscopic appendectomy ............................................................ ................ ................ ................ ................ ................

56316 1 Laparoscopic hernia repair ............................................................... 4 $595 552 $1,383 2.74

56317 1 Laparoscopic hernia repair ............................................................... 7 $941 552 $1,383 2.74

56318 1 Laparoscopic orchiectomy ................................................................ ................ ................ 552 $1,383 2.74 Add.

56320 1 Laparoscopy, spermatic veins .......................................................... ................ ................ 552 $1,383 2.74 Add.
32383

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

56322 3 Laparoscopy, vagus nerves .............................................................. ................ ................ ................ ................ ................

56323 3 Laparoscopy, vagus nerves .............................................................. ................ ................ ................ ................ ................

56324 3 Laparoscopy, cholecystoenter .......................................................... ................ ................ ................ ................ ................

56340 3 Laparoscopic cholecystectomy ......................................................... ................ ................ ................ ................ ................

56341 3 Laparoscopic cholecystectomy ......................................................... ................ ................ ................ ................ ................

56342 3 Laparoscopic cholecystectomy ......................................................... ................ ................ ................ ................ ................

56343 1 Laparoscopic salpingostomy ............................................................. 5 $678 552 $1,383 2.74

56344 1 Laparoscopic fimbrioplasty ............................................................... 5 $678 552 $1,383 2.74

56345 3 Laparoscopic splenectomy ............................................................... ................ ................ ................ ................ ................

56346 1 Laparoscopic gastrostomy ................................................................ ................ ................ 551 $831 1.65 Add.

56347 3 Laparoscopic jejunostomy ................................................................ ................ ................ ................ ................ ................

56348 3 Laparo; resect intestine .................................................................... ................ ................ ................ ................ ................

56349 3 Laparoscopy; fundoplasty ................................................................. ................ ................ ................ ................ ................

56350 1 Hysteroscopy; diagnostic .................................................................. 1 $314 562 $481 0.95

56351 1 Hysteroscopy; biopsy ........................................................................ 3 $482 550 $610 1.21

56352 1 Hysteroscopy; lysis ........................................................................... 2 $422 550 $610 1.21

56353 1 Hysteroscopy; resect septum ........................................................... ................ ................ 550 $610 1.21 Add.

56354 1 Hysteroscopy; remove myoma ......................................................... 3 $482 550 $610 1.21

56355 1 Hysteroscopy; remove impact .......................................................... ................ ................ 550 $610 1.21 Add.

56356 1 Hysteroscopy; ablation ...................................................................... 4 $595 550 $610 1.21

56362 1 Laparoscopy w/cholangio ................................................................. 3 $482 552 $1,383 2.74

56363 1 Laparoscopy w/biopsy ...................................................................... 3 $482 552 $1,383 2.74

56399 3 Laparoscopy procedure .................................................................... ................ ................ ................ ................ ................

56405 5 I & D of vulva/perineum .................................................................... 2 $422 ................ ................ ................ Delete.

56420 5 Drainage of gland abscess ............................................................... ................ ................ ................ ................ ................

56440 1 Surgery for vulva lesion .................................................................... 2 $422 562 $481 0.95

56441 5 Lysis of labial lesion(s) ..................................................................... 1 $314 ................ ................ ................ Delete.

56501 1 Destruction, vulva lesion(s) ............................................................... ................ ................ 152 $213 0.42 Add.

56515 1 Destruction, vulva lesion(s) ............................................................... 3 $482 152 $213 0.42

56605 5 Biopsy of vulva/perineum .................................................................. 1 $314 ................ ................ ................ Delete.

56606 5 Biopsy of vulva/perineum .................................................................. ................ ................ ................ ................ ................

56620 1 Partial removal of vulva .................................................................... 5 $678 563 $601 1.19

56625 1 Complete removal of vulva ............................................................... 7 $941 563 $601 1.19

56630 3 Extensive vulva surgery .................................................................... ................ ................ ................ ................ ................

56631 3 Extensive vulva surgery .................................................................... ................ ................ ................ ................ ................

56632 3 Extensive vulva surgery .................................................................... ................ ................ ................ ................ ................

56633 3 Extensive vulva surgery .................................................................... ................ ................ ................ ................ ................

56634 3 Extensive vulva surgery .................................................................... ................ ................ ................ ................ ................

56637 3 Extensive vulva surgery .................................................................... ................ ................ ................ ................ ................

56640 3 Extensive vulva surgery .................................................................... ................ ................ ................ ................ ................

56700 1 Partial removal of hymen .................................................................. 1 $314 562 $481 0.95

56720 1 Incision of hymen .............................................................................. 1 $314 562 $481 0.95

56740 1 Remove vagina gland lesion ............................................................ 3 $482 562 $481 0.95

56800 1 Repair of vagina ................................................................................ 3 $482 562 $481 0.95

56805 3 Repair clitoris .................................................................................... ................ ................ ................ ................ ................

56810 1 Repair of perineum ........................................................................... 5 $678 562 $481 0.95

57000 1 Exploration of vagina ........................................................................ 1 $314 562 $481 0.95

57010 1 Drainage of pelvic abscess ............................................................... 2 $422 562 $481 0.95

57020 1 Drainage of pelvic fluid ..................................................................... 2 $422 562 $481 0.95

57061 5 Destruction vagina lesion(s) ............................................................. ................ ................ ................ ................ ................

57065 1 Destruction vagina lesion(s) ............................................................. 1 $314 562 $481 0.95

57100 5 Biopsy of vagina ............................................................................... ................ ................ ................ ................ ................

57105 1 Biopsy of vagina ............................................................................... 2 $422 562 $481 0.95

57108 3 Partial removal of vagina .................................................................. ................ ................ ................ ................ ................

57110 3 Removal of vagina ............................................................................ ................ ................ ................ ................ ................

57120 3 Closure of vagina .............................................................................. ................ ................ ................ ................ ................

57130 1 Remove vagina lesion ...................................................................... 2 $422 562 $481 0.95

57135 1 Remove vagina lesion ...................................................................... 2 $422 562 $481 0.95

57150 5 Treat vagina infection ....................................................................... ................ ................ ................ ................ ................

57160 5 Insertion of pessary/device ............................................................... ................ ................ ................ ................ ................

57170 5 Fitting of diaphragm/cap ................................................................... ................ ................ ................ ................ ................

57180 5 Treat vaginal bleeding ...................................................................... 1 $314 ................ ................ ................ Delete.

57200 1 Repair of vagina ................................................................................ 1 $314 562 $481 0.95

57210 1 Repair vagina/perineum .................................................................... 2 $422 562 $481 0.95

57220 1 Revision of urethra ............................................................................ 3 $482 563 $601 1.19

57230 1 Repair of urethral lesion ................................................................... 3 $482 562 $481 0.95

57240 1 Repair bladder & vagina ................................................................... 5 $678 563 $601 1.19

57250 1 Repair rectum & vagina .................................................................... 5 $678 563 $601 1.19

57260 1 Repair of vagina ................................................................................ 5 $678 563 $601 1.19

57265 1 Extensive repair of vagina ................................................................ 7 $941 563 $601 1.19

57268 1 Repair of bowel bulge ....................................................................... 3 $482 563 $601 1.19

57270 3 Repair of bowel pouch ...................................................................... ................ ................ ................ ................ ................

57280 3 Suspension of vagina ....................................................................... ................ ................ ................ ................ ................

57282 3 Repair of vaginal prolapse ................................................................ ................ ................ ................ ................ ................
32384

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

57284 1 Repair paravaginal defect ................................................................. ................ ................ 563 $601 1.19 Add.

57288 1 Repair bladder defect ....................................................................... ................ ................ 563 $601 1.19 Add.

57289 1 Repair bladder & vagina ................................................................... ................ ................ 563 $601 1.19 Add.

57291 1 Construction of vagina ...................................................................... ................ ................ 563 $601 1.19 Add.

57292 3 Construct vagina with graft ............................................................... ................ ................ ................ ................ ................

57300 1 Repair rectum-vagina fistula ............................................................. 3 $482 563 $601 1.19

57305 3 Repair rectum-vagina fistula ............................................................. ................ ................ ................ ................ ................

57307 3 Fistula repair & colostomy ................................................................ ................ ................ ................ ................ ................

57308 3 Fistula repair, transperine ................................................................. ................ ................ ................ ................ ................

57310 3 Repair urethrovaginal lesion ............................................................. 3 $482 ................ ................ ................ Delete.

57311 3 Repair urethrovaginal lesion ............................................................. 4 $595 ................ ................ ................ Delete.

57320 3 Repair bladder-vagina lesion ............................................................ 3 $482 ................ ................ ................ Delete.

57330 3 Repair bladder-vagina lesion ............................................................ ................ ................ ................ ................ ................

57335 3 Repair vagina .................................................................................... ................ ................ ................ ................ ................

57400 1 Dilation of vagina .............................................................................. 2 $422 562 $481 0.95

57410 1 Pelvic examination ............................................................................ 2 $422 562 $481 0.95

57415 1 Removal vaginal foreign body .......................................................... ................ ................ 562 $481 0.95 Add.

57452 5 Examination of vagina ...................................................................... ................ ................ ................ ................ ................

57454 5 Vagina examination & biopsy ........................................................... ................ ................ ................ ................ ................

57460 1 Cervix excision .................................................................................. ................ ................ 562 $481 0.95 Add.

57500 5 Biopsy of cervix ................................................................................. ................ ................ ................ ................ ................

57505 5 Endocervical curettage ..................................................................... ................ ................ ................ ................ ................

57510 5 Cauterization of cervix ...................................................................... ................ ................ ................ ................ ................

57511 5 Cryocautery of cervix ........................................................................ ................ ................ ................ ................ ................

57513 5 Laser surgery of cervix ..................................................................... 2 $422 ................ ................ ................ Delete.

57520 1 Conization of cervix .......................................................................... 2 $422 563 $601 1.19

57522 1 Conization of cervix .......................................................................... 2 $422 563 $601 1.19

57530 1 Removal of cervix ............................................................................. 3 $482 563 $601 1.19

57531 3 Removal of cervix, radical ................................................................ ................ ................ ................ ................ ................

57540 3 Removal of residual cervix ............................................................... ................ ................ ................ ................ ................

57545 3 Remove cervix, repair pelvis ............................................................. ................ ................ ................ ................ ................

57550 1 Removal of residual cervix ............................................................... 3 $482 563 $601 1.19

57555 1 Remove cervix, repair vagina ........................................................... ................ ................ 563 $601 1.19 Add.

57556 1 Remove cervix, repair bowel ............................................................ ................ ................ 563 $601 1.19 Add.

57700 1 Revision of cervix .............................................................................. 1 $314 562 $481 0.95

57720 1 Revision of cervix .............................................................................. 3 $482 562 $481 0.95

57800 5 Dilation of cervical canal ................................................................... 1 $314 ................ ................ ................ Delete.

57820 1 D&c of residual cervix ....................................................................... 3 $482 567 $458 0.91

58100 5 Biopsy of uterus lining ...................................................................... ................ ................ ................ ................ ................

58120 1 Dilation and curettage (D&C) ............................................................ 2 $422 567 $458 0.91

58140 3 Removal of uterus lesion .................................................................. ................ ................ ................ ................ ................

58145 1 Removal of uterus lesion .................................................................. 5 $678 563 $601 1.19

58150 3 Total hysterectomy ............................................................................ ................ ................ ................ ................ ................

58152 3 Total hysterectomy ............................................................................ ................ ................ ................ ................ ................

58180 3 Partial hysterectomy ......................................................................... ................ ................ ................ ................ ................

58200 3 Extensive hysterectomy .................................................................... ................ ................ ................ ................ ................

58210 3 Extensive hysterectomy .................................................................... ................ ................ ................ ................ ................

58240 3 Removal of pelvis contents ............................................................... ................ ................ ................ ................ ................

58260 3 Vaginal hysterectomy ........................................................................ ................ ................ ................ ................ ................

58262 3 Vaginal hysterectomy ........................................................................ ................ ................ ................ ................ ................

58263 3 Vaginal hysterectomy ........................................................................ ................ ................ ................ ................ ................

58267 3 Hysterectomy & vagina repair .......................................................... ................ ................ ................ ................ ................

58270 3 Hysterectomy & vagina repair .......................................................... ................ ................ ................ ................ ................

58275 3 Hysterectomy, revise vagina ............................................................. ................ ................ ................ ................ ................

58280 3 Hysterectomy, revise vagina ............................................................. ................ ................ ................ ................ ................

58285 3 Extensive hysterectomy .................................................................... ................ ................ ................ ................ ................

58300 9 Insert intrauterine device .................................................................. ................ ................ ................ ................ ................

58301 5 Remove intrauterine device .............................................................. ................ ................ ................ ................ ................

58321 6 Artificial insemination ........................................................................ ................ ................ ................ ................ ................

58322 6 Artificial insemination ........................................................................ ................ ................ ................ ................ ................

58323 6 Sperm washing ................................................................................. ................ ................ ................ ................ ................

58340 2 Catheter for hysterography ............................................................... ................ ................ ................ ................ ................

58345 1 Reopen fallopian tube ....................................................................... ................ ................ 562 $481 0.95 Add.

58350 1 Reopen fallopian tube ....................................................................... ................ ................ 562 $481 0.95 Add.

58400 3 Suspension of uterus ........................................................................ ................ ................ ................ ................ ................

58410 3 Suspension of uterus ........................................................................ ................ ................ ................ ................ ................

58520 3 Repair of ruptured uterus .................................................................. ................ ................ ................ ................ ................

58540 3 Revision of uterus ............................................................................. ................ ................ ................ ................ ................

58600 3 Division of fallopian tube ................................................................... ................ ................ ................ ................ ................

58605 3 Division of fallopian tube ................................................................... ................ ................ ................ ................ ................

58611 3 Ligate oviduct(s) ................................................................................ ................ ................ ................ ................ ................

58615 3 Occlude fallopian tube(s) .................................................................. ................ ................ ................ ................ ................

58700 3 Removal of fallopian tube ................................................................. ................ ................ ................ ................ ................

58720 3 Removal of ovary/tube(s) .................................................................. ................ ................ ................ ................ ................
32385

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

58740 3 Revise fallopian tube(s) .................................................................... ................ ................ ................ ................ ................

58750 3 Repair oviduct ................................................................................... ................ ................ ................ ................ ................

58752 3 Revise ovarian tube(s) ...................................................................... ................ ................ ................ ................ ................

58760 3 Remove tubal obstruction ................................................................. ................ ................ ................ ................ ................

58770 3 Create new tubal opening ................................................................. ................ ................ ................ ................ ................

58800 1 Drainage of ovarian cyst(s) ............................................................... 3 $482 563 $601 1.19

58805 3 Drainage of ovarian cyst(s) ............................................................... ................ ................ ................ ................ ................

58820 1 Open drain ovary abscess ................................................................ 3 $482 563 $601 1.19

58822 3 Percut drain ovary abscess .............................................................. ................ ................ ................ ................ ................

58823 3 Percut drain pelvic abscess .............................................................. ................ ................ ................ ................ ................

58825 3 Transposition, ovary(s) ..................................................................... ................ ................ ................ ................ ................

58900 3 Biopsy of ovary(s) ............................................................................. 3 $482 ................ ................ ................ Delete.

58920 3 Partial removal of ovary(s) ................................................................ ................ ................ ................ ................ ................

58925 3 Removal of ovarian cyst(s) ............................................................... ................ ................ ................ ................ ................

58940 3 Removal of ovary(s) .......................................................................... ................ ................ ................ ................ ................

58943 3 Removal of ovary(s) .......................................................................... ................ ................ ................ ................ ................

58950 3 Resect ovarian malignancy ............................................................... ................ ................ ................ ................ ................

58951 3 Resect ovarian malignancy ............................................................... ................ ................ ................ ................ ................

58952 3 Resect ovarian malignancy ............................................................... ................ ................ ................ ................ ................

58960 3 Exploration of abdomen .................................................................... ................ ................ ................ ................ ................

58970 1 Retrieval of oocyte ............................................................................ ................ ................ 562 $481 0.95 Add.

58974 6 Transfer of embryo ........................................................................... ................ ................ ................ ................ ................

58976 6 Transfer of embryo ........................................................................... ................ ................ ................ ................ ................

58999 3 Genital surgery procedure ................................................................ ................ ................ ................ ................ ................

59000 6 Amniocentesis ................................................................................... ................ ................ ................ ................ ................

59012 6 Fetal cord puncture, prenatal ............................................................ ................ ................ ................ ................ ................

59015 6 Chorion biopsy .................................................................................. ................ ................ ................ ................ ................

59020 6 Fetal contract stress test .................................................................. ................ ................ ................ ................ ................

59025 6 Fetal non-stress test ......................................................................... ................ ................ ................ ................ ................

59030 6 Fetal scalp blood sample .................................................................. ................ ................ ................ ................ ................

59050 6 Fetal monitor w/report ....................................................................... ................ ................ ................ ................ ................

59051 6 Fetal monitor/interpret only ............................................................... ................ ................ ................ ................ ................

59100 3 Remove uterus lesion ....................................................................... ................ ................ ................ ................ ................

59120 3 Treat ectopic pregnancy ................................................................... ................ ................ ................ ................ ................

59121 3 Treat ectopic pregnancy ................................................................... ................ ................ ................ ................ ................

59130 3 Treat ectopic pregnancy ................................................................... ................ ................ ................ ................ ................

59135 3 Treat ectopic pregnancy ................................................................... ................ ................ ................ ................ ................

59136 3 Treat ectopic pregnancy ................................................................... ................ ................ ................ ................ ................

59140 3 Treat ectopic pregnancy ................................................................... ................ ................ ................ ................ ................

59150 3 Treat ectopic pregnancy ................................................................... ................ ................ ................ ................ ................

59151 3 Treat ectopic pregnancy ................................................................... ................ ................ ................ ................ ................

59160 1 D&C after delivery ............................................................................. ................ ................ 567 $458 0.91 Add.

59200 6 Insert cervical dilator ......................................................................... ................ ................ ................ ................ ................

59300 1 Episiotomy or vaginal repair ............................................................. ................ ................ 562 $481 0.95 Add.

59320 1 Revision of cervix .............................................................................. ................ ................ 562 $481 0.95 Add.

59325 3 Revision of cervix .............................................................................. ................ ................ ................ ................ ................

59350 3 Repair of uterus ................................................................................ ................ ................ ................ ................ ................

59400 6 Obstetrical care ................................................................................. ................ ................ ................ ................ ................

59409 6 Obstetrical care ................................................................................. ................ ................ ................ ................ ................

59410 6 Obstetrical care ................................................................................. ................ ................ ................ ................ ................

59412 6 Antepartum manipulation .................................................................. ................ ................ ................ ................ ................

59414 6 Deliver placenta ................................................................................ ................ ................ ................ ................ ................

59425 6 Antepartum care only ........................................................................ ................ ................ ................ ................ ................

59426 6 Antepartum care only ........................................................................ ................ ................ ................ ................ ................

59430 6 Care after delivery ............................................................................ ................ ................ ................ ................ ................

59510 6 Cesarean delivery ............................................................................. ................ ................ ................ ................ ................

59514 3 Cesarean delivery only ..................................................................... ................ ................ ................ ................ ................

59515 6 Cesarean delivery ............................................................................. ................ ................ ................ ................ ................

59525 3 Remove uterus after cesarean ......................................................... ................ ................ ................ ................ ................

59610 3 Vbac delivery .................................................................................... ................ ................ ................ ................ ................

59612 6 Vbac delivery only ............................................................................. ................ ................ ................ ................ ................

59614 6 Vbac care after delivery .................................................................... ................ ................ ................ ................ ................

59618 6 Attempted vbac delivery ................................................................... ................ ................ ................ ................ ................

59620 3 Attempted vbac delivery only ............................................................ ................ ................ ................ ................ ................

59622 6 Attempted vbac after care ................................................................ ................ ................ ................ ................ ................

59812 1 Treatment of miscarriage .................................................................. ................ ................ 587 $503 1.00 Add.

59820 1 Care of miscarriage .......................................................................... ................ ................ 587 $503 1.00 Add.

59821 1 Treatment of miscarriage .................................................................. ................ ................ 587 $503 1.00 Add.

59830 3 Treat uterus infection ........................................................................ ................ ................ ................ ................ ................

59840 1 Abortion ............................................................................................. ................ ................ 586 $448 0.89 Add.

59841 1 Abortion ............................................................................................. ................ ................ 586 $448 0.89 Add.

59850 3 Abortion ............................................................................................. ................ ................ ................ ................ ................

59851 3 Abortion ............................................................................................. ................ ................ ................ ................ ................

59852 3 Abortion ............................................................................................. ................ ................ ................ ................ ................
32386

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

59855 3 Abortion ............................................................................................. ................ ................ ................ ................ ................

59856 3 Abortion ............................................................................................. ................ ................ ................ ................ ................

59857 3 Abortion ............................................................................................. ................ ................ ................ ................ ................

59866 3 Abortion ............................................................................................. ................ ................ ................ ................ ................

59870 1 Evacuate mole of uterus ................................................................... ................ ................ 587 $503 1.00 Add.

59871 1 Remove cerclage suture ................................................................... ................ ................ 562 $481 0.95 Add.

59899 3 Maternity care procedure .................................................................. ................ ................ ................ ................ ................

60000 1 Drain thyroid/tongue cyst .................................................................. 1 $314 312 $233 0.46

60001 5 Aspirate/inject thyroid cyst ................................................................ ................ ................ ................ ................ ................

60100 1 Biopsy of thyroid ............................................................................... ................ ................ 122 $186 0.37 Add.

60200 1 Remove thyroid lesion ...................................................................... 2 $422 397 $630 1.25

60210 1 Partial excision thyroid ...................................................................... ................ ................ 397 $630 1.25 Add.

60212 3 Parital thyroid excision ...................................................................... ................ ................ ................ ................ ................

60220 1 Partial removal of thyroid .................................................................. 2 $422 397 $630 1.25

60225 1 Partial removal of thyroid .................................................................. 3 $482 397 $630 1.25

60240 1 Removal of thyroid ............................................................................ ................ ................ 397 $630 1.25 Add.

60252 3 Removal of thyroid ............................................................................ ................ ................ ................ ................ ................

60254 3 Extensive thyroid surgery ................................................................. ................ ................ ................ ................ ................

60260 3 Repeat thyroid surgery ..................................................................... ................ ................ ................ ................ ................

60270 3 Removal of thyroid ............................................................................ ................ ................ ................ ................ ................

60271 3 Removal of thyroid ............................................................................ ................ ................ ................ ................ ................

60280 1 Remove thyroid duct lesion .............................................................. 4 $595 397 $630 1.25

60281 1 Remove thyroid duct lesion .............................................................. 4 $595 397 $630 1.25

60500 3 Explore parathyroid glands ............................................................... ................ ................ ................ ................ ................

60502 3 Re-explore parathyroids .................................................................... ................ ................ ................ ................ ................

60505 3 Explore parathyroid glands ............................................................... ................ ................ ................ ................ ................

60512 3 Autotransplant, parathyroid ............................................................... ................ ................ ................ ................ ................

60520 3 Removal of thymus gland ................................................................. ................ ................ ................ ................ ................

60521 3 Removal of thymus gland ................................................................. ................ ................ ................ ................ ................

60522 3 Removal of thymus gland ................................................................. ................ ................ ................ ................ ................

60540 3 Explore adrenal gland ....................................................................... ................ ................ ................ ................ ................

60545 3 Explore adrenal gland ....................................................................... ................ ................ ................ ................ ................

60600 3 Remove carotid body lesion ............................................................. ................ ................ ................ ................ ................

60605 3 Remove carotid body lesion ............................................................. ................ ................ ................ ................ ................

60699 3 Endocrine surgery procedure ........................................................... ................ ................ ................ ................ ................

61000 1 Remove cranial cavity fluid ............................................................... ................ ................ 602 $241 0.48 Add.

61001 1 Remove cranial cavity fluid ............................................................... ................ ................ 602 $241 0.48 Add.

61020 1 Remove brain cavity fluid ................................................................. 1 $314 602 $241 0.48

61026 1 Injection into brain canal ................................................................... 1 $314 602 $241 0.48

61050 1 Remove brain canal fluid .................................................................. 1 $314 602 $241 0.48

61055 1 Injection into brain canal ................................................................... 1 $314 602 $241 0.48

61070 1 Brain canal shunt procedure ............................................................. 1 $314 602 $241 0.48

61105 3 Drill skull for examination .................................................................. ................ ................ ................ ................ ................

61106 3 Drill skull for exam/surgery ............................................................... ................ ................ ................ ................ ................

61107 3 Drill skull for implantation .................................................................. ................ ................ ................ ................ ................

61108 3 Drill skull for drainage ....................................................................... ................ ................ ................ ................ ................

61120 3 Pierce skull for examination .............................................................. ................ ................ ................ ................ ................

61130 3 Pierce skull, exam/surgery ................................................................ ................ ................ ................ ................ ................

61140 3 Pierce skull for biopsy ....................................................................... ................ ................ ................ ................ ................

61150 3 Pierce skull for drainage ................................................................... ................ ................ ................ ................ ................

61151 3 Pierce skull for drainage ................................................................... ................ ................ ................ ................ ................

61154 3 Pierce skull, remove clot ................................................................... ................ ................ ................ ................ ................

61156 3 Pierce skull for drainage ................................................................... ................ ................ ................ ................ ................

61210 3 Pierce skull; implant device .............................................................. ................ ................ ................ ................ ................

61215 1 Insert brain-fluid device ..................................................................... 3 $482 618 $841 1.67

61250 3 Pierce skull & explore ....................................................................... ................ ................ ................ ................ ................

61253 3 Pierce skull & explore ....................................................................... ................ ................ ................ ................ ................

61304 3 Open skull for exploration ................................................................. ................ ................ ................ ................ ................

61305 3 Open skull for exploration ................................................................. ................ ................ ................ ................ ................

61312 3 Open skull for drainage .................................................................... ................ ................ ................ ................ ................

61313 3 Open skull for drainage .................................................................... ................ ................ ................ ................ ................

61314 3 Open skull for drainage .................................................................... ................ ................ ................ ................ ................

61315 3 Open skull for drainage .................................................................... ................ ................ ................ ................ ................

61320 3 Open skull for drainage .................................................................... ................ ................ ................ ................ ................

61321 3 Open skull for drainage .................................................................... ................ ................ ................ ................ ................

61330 3 Decompress eye socket ................................................................... ................ ................ ................ ................ ................

61332 3 Explore/biopsy eye socket ................................................................ ................ ................ ................ ................ ................

61333 3 Explore orbit; remove lesion ............................................................. ................ ................ ................ ................ ................

61334 3 Explore orbit; remove object ............................................................. ................ ................ ................ ................ ................

61340 3 Relieve cranial pressure ................................................................... ................ ................ ................ ................ ................

61343 3 Incise skull, pressure relief ............................................................... ................ ................ ................ ................ ................

61345 3 Relieve cranial pressure ................................................................... ................ ................ ................ ................ ................

61440 3 Incise skull for surgery ...................................................................... ................ ................ ................ ................ ................

61450 3 Incise skull for surgery ...................................................................... ................ ................ ................ ................ ................
32387

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

61458 3 Incise skull for brain wound .............................................................. ................ ................ ................ ................ ................

61460 3 Incise skull for surgery ...................................................................... ................ ................ ................ ................ ................

61470 3 Incise skull for surgery ...................................................................... ................ ................ ................ ................ ................

61480 3 Incise skull for surgery ...................................................................... ................ ................ ................ ................ ................

61490 3 Incise skull for surgery ...................................................................... ................ ................ ................ ................ ................

61500 3 Removal of skull lesion ..................................................................... ................ ................ ................ ................ ................

61501 3 Remove infected skull bone ............................................................. ................ ................ ................ ................ ................

61510 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61512 3 Remove brain lining lesion ............................................................... ................ ................ ................ ................ ................

61514 3 Removal of brain abscess ................................................................ ................ ................ ................ ................ ................

61516 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61518 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61519 3 Remove brain lining lesion ............................................................... ................ ................ ................ ................ ................

61520 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61521 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61522 3 Removal of brain abscess ................................................................ ................ ................ ................ ................ ................

61524 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61526 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61530 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61531 3 Implant brain electrodes ................................................................... ................ ................ ................ ................ ................

61533 3 Implant brain electrodes ................................................................... ................ ................ ................ ................ ................

61534 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61535 3 Remove brain electrodes .................................................................. ................ ................ ................ ................ ................

61536 3 Removal of brain lesion .................................................................... ................ ................ ................ ................ ................

61538 3 Removal of brain tissue .................................................................... ................ ................ ................ ................ ................

61539 3 Removal of brain tissue .................................................................... ................ ................ ................ ................ ................

61541 3 Incision of brain tissue ...................................................................... ................ ................ ................ ................ ................

61542 3 Removal of brain tissue .................................................................... ................ ................ ................ ................ ................

61543 3 Removal of brain tissue .................................................................... ................ ................ ................ ................ ................

61544 3 Remove & treat brain lesion ............................................................. ................ ................ ................ ................ ................

61545 3 Excision of brain tumor ..................................................................... ................ ................ ................ ................ ................

61546 3 Removal of pituitary gland ................................................................ ................ ................ ................ ................ ................

61548 3 Removal of pituitary gland ................................................................ ................ ................ ................ ................ ................

61550 3 Release of skull seams ..................................................................... ................ ................ ................ ................ ................

61552 3 Release of skull seams ..................................................................... ................ ................ ................ ................ ................

61556 3 Incise skull/sutures ............................................................................ ................ ................ ................ ................ ................

61557 3 Incise skull/sutures ............................................................................ ................ ................ ................ ................ ................

61558 3 Excision of skull/sutures ................................................................... ................ ................ ................ ................ ................

61559 3 Excision of skull/sutures ................................................................... ................ ................ ................ ................ ................

61563 3 Excision of skull tumor ...................................................................... ................ ................ ................ ................ ................

61564 3 Excision of skull tumor ...................................................................... ................ ................ ................ ................ ................

61570 3 Remove brain foreign body .............................................................. ................ ................ ................ ................ ................

61571 3 Incise skull for brain wound .............................................................. ................ ................ ................ ................ ................

61575 3 Skull base/brainstem surgery ........................................................... ................ ................ ................ ................ ................

61576 3 Skull base/brainstem surgery ........................................................... ................ ................ ................ ................ ................

61580 3 Craniofacial approach, skull .............................................................. ................ ................ ................ ................ ................

61581 3 Craniofacial approach, skull .............................................................. ................ ................ ................ ................ ................

61582 3 Craniofacial approach, skull .............................................................. ................ ................ ................ ................ ................

61583 3 Craniofacial approach, skull .............................................................. ................ ................ ................ ................ ................

61584 3 Orbitocranial approach/skull ............................................................. ................ ................ ................ ................ ................

61585 3 Orbitocranial approach/skull ............................................................. ................ ................ ................ ................ ................

61586 3 Resect nasopharnyx, skull ................................................................ ................ ................ ................ ................ ................

61590 3 Infratemporal approach/skull ............................................................. ................ ................ ................ ................ ................

61591 3 Infratemporal approach/skull ............................................................. ................ ................ ................ ................ ................

61592 3 Orbitocranial approach/skull ............................................................. ................ ................ ................ ................ ................

61595 3 Transtemporal approach/skull ........................................................... ................ ................ ................ ................ ................

61596 3 Transcochlear approach/skull ........................................................... ................ ................ ................ ................ ................

61597 3 Transcondylar approach/skull ........................................................... ................ ................ ................ ................ ................

61598 3 Transpetrosal approach/skull ............................................................ ................ ................ ................ ................ ................

61600 3 Resect/excise cranial lesion ............................................................. ................ ................ ................ ................ ................

61601 3 Resect/excise cranial lesion ............................................................. ................ ................ ................ ................ ................

61605 3 Resect/excise cranial lesion ............................................................. ................ ................ ................ ................ ................

61606 3 Resect/excise cranial lesion ............................................................. ................ ................ ................ ................ ................

61607 3 Resect/excise cranial lesion ............................................................. ................ ................ ................ ................ ................

61608 3 Resect/excise cranial lesion ............................................................. ................ ................ ................ ................ ................

61609 3 Transect, artery, sinus ...................................................................... ................ ................ ................ ................ ................

61610 3 Transect, artery, sinus ...................................................................... ................ ................ ................ ................ ................

61611 3 Transect, artery, sinus ...................................................................... ................ ................ ................ ................ ................

61612 3 Transect, artery, sinus ...................................................................... ................ ................ ................ ................ ................

61613 3 Remove aneurysm, sinus ................................................................. ................ ................ ................ ................ ................

61615 3 Resect/excise lesion, skull ................................................................ ................ ................ ................ ................ ................

61616 3 Resect/excise lesion, skull ................................................................ ................ ................ ................ ................ ................

61618 3 Repair dura ....................................................................................... ................ ................ ................ ................ ................

61619 3 Repair dura ....................................................................................... ................ ................ ................ ................ ................
32388

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

61624 3 Occlusion/embolization cath ............................................................. ................ ................ ................ ................ ................

61626 3 Occlusion/embolization cath ............................................................. ................ ................ ................ ................ ................

61680 3 Intracranial vessel surgery ................................................................ ................ ................ ................ ................ ................

61682 3 Intracranial vessel surgery ................................................................ ................ ................ ................ ................ ................

61684 3 Intracranial vessel surgery ................................................................ ................ ................ ................ ................ ................

61686 3 Intracranial vessel surgery ................................................................ ................ ................ ................ ................ ................

61690 3 Intracranial vessel surgery ................................................................ ................ ................ ................ ................ ................

61692 3 Intracranial vessel surgery ................................................................ ................ ................ ................ ................ ................

61700 3 Inner skull vessel surgery ................................................................. ................ ................ ................ ................ ................

61702 3 Inner skull vessel surgery ................................................................. ................ ................ ................ ................ ................

61703 3 Clamp neck artery ............................................................................. ................ ................ ................ ................ ................

61705 3 Revise circulation to head ................................................................ ................ ................ ................ ................ ................

61708 3 Revise circulation to head ................................................................ ................ ................ ................ ................ ................

61710 3 Revise circulation to head ................................................................ ................ ................ ................ ................ ................

61711 3 Fusion of skull arteries ...................................................................... ................ ................ ................ ................ ................

61712 3 Skull or spine microsurgery .............................................................. ................ ................ ................ ................ ................

61720 3 Incise skull/brain surgery .................................................................. ................ ................ ................ ................ ................

61735 3 Incise skull/brain surgery .................................................................. ................ ................ ................ ................ ................

61750 3 Incise skull; brain biopsy ................................................................... ................ ................ ................ ................ ................

61751 3 Brain biopsy with cat scan ................................................................ ................ ................ ................ ................ ................

61760 3 Implant brain electrodes ................................................................... ................ ................ ................ ................ ................

61770 3 Incise skull for treatment ................................................................... ................ ................ ................ ................ ................

61790 1 Treat trigeminal nerve ....................................................................... 3 $482 631 $600 1.19

61791 3 Treat trigeminal tract ......................................................................... 3 $482 ................ ................ ................ Delete.

61793 3 Focus radiation beam ....................................................................... ................ ................ ................ ................ ................

61795 3 Brain surgery using computer ........................................................... ................ ................ ................ ................ ................

61850 3 Implant neuroelectrodes ................................................................... ................ ................ ................ ................ ................

61855 3 Implant neuroelectrodes ................................................................... ................ ................ ................ ................ ................

61860 3 Implant neuroelectrodes ................................................................... ................ ................ ................ ................ ................

61865 3 Implant neuroelectrodes ................................................................... ................ ................ ................ ................ ................

61870 3 Implant neuroelectrodes ................................................................... ................ ................ ................ ................ ................

61875 3 Implant neuroelectrodes ................................................................... ................ ................ ................ ................ ................

61880 3 Revise/remove neuroelectrode ......................................................... ................ ................ ................ ................ ................

61885 1 Implant neuroreceiver ....................................................................... 2 $422 618 $841 1.67

61888 3 Revise/remove neuroreceiver ........................................................... 1 $314 ................ ................ ................ Delete.

62000 3 Repair of skull fracture ...................................................................... ................ ................ ................ ................ ................

62005 3 Repair of skull fracture ...................................................................... ................ ................ ................ ................ ................

62010 3 Treatment of head injury ................................................................... ................ ................ ................ ................ ................

62100 3 Repair brain fluid leakage ................................................................. ................ ................ ................ ................ ................

62115 3 Reduction of skull defect .................................................................. ................ ................ ................ ................ ................

62116 3 Reduction of skull defect .................................................................. ................ ................ ................ ................ ................

62117 3 Reduction of skull defect .................................................................. ................ ................ ................ ................ ................

62120 3 Repair skull cavity lesion .................................................................. ................ ................ ................ ................ ................

62121 3 Incise skull repair .............................................................................. ................ ................ ................ ................ ................

62140 3 Repair of skull defect ........................................................................ ................ ................ ................ ................ ................

62141 3 Repair of skull defect ........................................................................ ................ ................ ................ ................ ................

62142 3 Remove skull plate/flap ..................................................................... ................ ................ ................ ................ ................

62143 3 Replace skull plate/flap ..................................................................... ................ ................ ................ ................ ................

62145 3 Repair of skull & brain ...................................................................... ................ ................ ................ ................ ................

62146 3 Repair of skull with graft ................................................................... ................ ................ ................ ................ ................

62147 3 Repair of skull with graft ................................................................... ................ ................ ................ ................ ................

62180 3 Establish brain cavity shunt .............................................................. ................ ................ ................ ................ ................

62190 3 Establish brain cavity shunt .............................................................. ................ ................ ................ ................ ................

62192 3 Establish brain cavity shunt .............................................................. ................ ................ ................ ................ ................

62194 1 Replace/irrigate catheter ................................................................... 1 $314 602 $241 0.48

62200 3 Establish brain cavity shunt .............................................................. ................ ................ ................ ................ ................

62201 3 Establish brain cavity shunt .............................................................. ................ ................ ................ ................ ................

62220 3 Establish brain cavity shunt .............................................................. ................ ................ ................ ................ ................

62223 3 Establish brain cavity shunt .............................................................. ................ ................ ................ ................ ................

62225 1 Replace/irrigate catheter ................................................................... 1 $314 602 $241 0.48

62230 1 Replace/revise brain shunt ............................................................... 2 $422 617 $391 0.78

62256 3 Remove brain cavity shunt ............................................................... 2 $422 ................ ................ ................ Delete.

62258 3 Replace brain cavity shunt ............................................................... ................ ................ ................ ................ ................

62268 1 Drain spinal cord cyst ....................................................................... 1 $314 602 $241 0.48

62269 1 Needle biopsy spinal cord ................................................................ 1 $314 122 $186 0.37

62270 1 Spinal fluid tap, diagnostic ................................................................ 1 $314 600 $101 0.20

62272 1 Drain spinal fluid ............................................................................... 1 $314 600 $101 0.20

62273 1 Treat lumbar spine lesion ................................................................. 1 $314 602 $241 0.48

62274 1 Inject spinal anesthetic ..................................................................... 1 $314 602 $241 0.48

62275 1 Inject spinal anesthetic ..................................................................... 1 $314 602 $241 0.48

62276 1 Inject spinal anesthetic ..................................................................... 1 $314 602 $241 0.48

62277 1 Inject spinal anesthetic ..................................................................... 1 $314 602 $241 0.48

62278 1 Inject spinal anesthetic ..................................................................... 1 $314 602 $241 0.48

62279 1 Inject spinal anesthetic ..................................................................... 1 $314 602 $241 0.48
32389

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

62280 1 Treat spinal cord lesion .................................................................... 1 $314 602 $241 0.48

62281 1 Treat spinal cord lesion .................................................................... ................ ................ 602 $241 0.48 Add.

62282 1 Treat spinal canal lesion ................................................................... 1 $314 602 $241 0.48

62284 2 Injection for myelogram .................................................................... ................ ................ ................ ................ ................

62287 1 Percutaneous diskectomy ................................................................. ................ ................ 631 $600 1.19 Add.

62288 1 Injection into spinal canal ................................................................. 1 $314 602 $241 0.48

62289 1 Injection into spinal canal ................................................................. 1 $314 602 $241 0.48

62290 2 Inject for spine disk x-ray .................................................................. ................ ................ ................ ................ ................

62291 2 Inject for spine disk x-ray .................................................................. ................ ................ ................ ................ ................

62292 1 Injection into disk lesion .................................................................... ................ ................ 602 $241 0.48 Add.

62294 1 Injection into spinal artery ................................................................. 3 $482 602 $241 0.48

62298 1 Injection into spinal canal ................................................................. ................ ................ 602 $241 0.48 Add.

62350 1 Implant spinal catheter ...................................................................... 2 $422 617 $391 0.78

62351 3 Implant spinal catheter ...................................................................... 2 $422 ................ ................ ................ Delete.

62355 1 Remove spinal canal catheter .......................................................... ................ ................ 617 $391 0.78 Add.

62360 1 Insert spine infusion device .............................................................. 2 $422 618 $841 1.67

62361 1 Implant spine infusion pump ............................................................. 2 $422 618 $841 1.67

62362 1 Implant spine infusion pump ............................................................. 2 $422 618 $841 1.67

62365 1 Remove spine infusion device .......................................................... 2 $422 617 $391 0.78

62367 6 Analyze spine infusion pump ............................................................ 2 $422 ................ ................ ................ Delete.

62368 6 Analyze spine infusion pump ............................................................ 2 $422 ................ ................ ................ Delete.

63001 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63003 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63005 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63011 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63012 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63015 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63016 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63017 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63020 3 Neck spine disk surgery ................................................................... ................ ................ ................ ................ ................

63030 3 Low back disk surgery ...................................................................... ................ ................ ................ ................ ................

63035 3 Added spinal disk surgery ................................................................ ................ ................ ................ ................ ................

63040 3 Neck spine disk surgery ................................................................... ................ ................ ................ ................ ................

63042 3 Low back disk surgery ...................................................................... ................ ................ ................ ................ ................

63045 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63046 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63047 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63048 3 Removal of spinal lamina ................................................................. ................ ................ ................ ................ ................

63055 3 Decompress spinal cord ................................................................... ................ ................ ................ ................ ................

63056 3 Decompress spinal cord ................................................................... ................ ................ ................ ................ ................

63057 3 Decompress spinal cord ................................................................... ................ ................ ................ ................ ................

63064 3 Decompress spinal cord ................................................................... ................ ................ ................ ................ ................

63066 3 Decompress spinal cord ................................................................... ................ ................ ................ ................ ................

63075 3 Neck spine disk surgery ................................................................... ................ ................ ................ ................ ................

63076 3 Neck spine disk surgery ................................................................... ................ ................ ................ ................ ................

63077 3 Spine disk surgery, thorax ................................................................ ................ ................ ................ ................ ................

63078 3 Spine disk surgery, thorax ................................................................ ................ ................ ................ ................ ................

63081 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63082 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63085 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63086 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63087 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63088 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63090 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63091 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63170 3 Incise spinal cord tract(s) .................................................................. ................ ................ ................ ................ ................

63172 3 Drainage of spinal cyst ..................................................................... ................ ................ ................ ................ ................

63173 3 Drainage of spinal cyst ..................................................................... ................ ................ ................ ................ ................

63180 3 Revise spinal cord ligaments ............................................................ ................ ................ ................ ................ ................

63182 3 Revise spinal cord ligaments ............................................................ ................ ................ ................ ................ ................

63185 3 Incise spinal column/nerves .............................................................. ................ ................ ................ ................ ................

63190 3 Incise spinal column/nerves .............................................................. ................ ................ ................ ................ ................

63191 3 Incise spinal column/nerves .............................................................. ................ ................ ................ ................ ................

63194 3 Incise spinal column & cord .............................................................. ................ ................ ................ ................ ................

63195 3 Incise spinal column & cord .............................................................. ................ ................ ................ ................ ................

63196 3 Incise spinal column & cord .............................................................. ................ ................ ................ ................ ................

63197 3 Incise spinal column & cord .............................................................. ................ ................ ................ ................ ................

63198 3 Incise spinal column & cord .............................................................. ................ ................ ................ ................ ................

63199 3 Incise spinal column & cord .............................................................. ................ ................ ................ ................ ................

63200 3 Release of spinal cord ...................................................................... ................ ................ ................ ................ ................

63250 3 Revise spinal cord vessels ............................................................... ................ ................ ................ ................ ................

63251 3 Revise spinal cord vessels ............................................................... ................ ................ ................ ................ ................

63252 3 Revise spinal cord vessels ............................................................... ................ ................ ................ ................ ................

63265 3 Excise intraspinal lesion ................................................................... ................ ................ ................ ................ ................
32390

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

63266 3 Excise intraspinal lesion ................................................................... ................ ................ ................ ................ ................

63267 3 Excise intraspinal lesion ................................................................... ................ ................ ................ ................ ................

63268 3 Excise intraspinal lesion ................................................................... ................ ................ ................ ................ ................

63270 3 Excise intraspinal lesion ................................................................... ................ ................ ................ ................ ................

63271 3 Excise intraspinal lesion ................................................................... ................ ................ ................ ................ ................

63272 3 Excise intraspinal lesion ................................................................... ................ ................ ................ ................ ................

63273 3 Excise intraspinal lesion ................................................................... ................ ................ ................ ................ ................

63275 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63276 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63277 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63278 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63280 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63281 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63282 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63283 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63285 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63286 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63287 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63290 3 Biopsy/excise spinal tumor ............................................................... ................ ................ ................ ................ ................

63300 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63301 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63302 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63303 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63304 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63305 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63306 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63307 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63308 3 Removal of vertebral body ................................................................ ................ ................ ................ ................ ................

63600 1 Remove spinal cord lesion ............................................................... 2 $422 631 $600 1.19

63610 1 Stimulation of spinal cord ................................................................. 1 $314 631 $600 1.19

63615 1 Remove lesion of spinal cord ........................................................... ................ ................ 631 $600 1.19 Add.

63650 1 Implant neuroelectrodes ................................................................... 2 $422 616 $391 0.78

63655 3 Implant neuroelectrodes ................................................................... ................ ................ ................ ................ ................

63660 1 Revise/remove neuroelectrode ......................................................... 1 $314 617 $391 0.78

63685 1 Implant neuroreceiver ....................................................................... 2 $422 618 $841 1.67

63688 1 Revise/remove neuroreceiver ........................................................... 1 $314 617 $391 0.78

63690 6 Analysis of neuroreceiver ................................................................. ................ ................ ................ ................ ................

63691 6 Analysis of neuroreceiver ................................................................. ................ ................ ................ ................ ................

63700 3 Repair of spinal herniation ................................................................ ................ ................ ................ ................ ................

63702 3 Repair of spinal herniation ................................................................ ................ ................ ................ ................ ................

63704 3 Repair of spinal herniation ................................................................ ................ ................ ................ ................ ................

63706 3 Repair of spinal herniation ................................................................ ................ ................ ................ ................ ................

63707 3 Repair spinal fluid leakage ............................................................... ................ ................ ................ ................ ................

63709 3 Repair spinal fluid leakage ............................................................... ................ ................ ................ ................ ................

63710 3 Graft repair of spine defect ............................................................... ................ ................ ................ ................ ................

63740 3 Install spinal shunt ............................................................................ ................ ................ ................ ................ ................

63741 3 Install spinal shunt ............................................................................ ................ ................ ................ ................ ................

63744 1 Revision of spinal shunt .................................................................... 3 $482 617 $391 0.78

63746 1 Removal of spinal shunt ................................................................... 2 $422 617 $391 0.78

64400 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64402 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64405 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64408 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64410 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64412 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64413 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64415 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64417 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64418 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64420 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64421 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64425 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64430 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64435 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64440 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64441 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64442 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64443 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64445 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64450 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64505 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64508 5 Injection for nerve block .................................................................... ................ ................ ................ ................ ................

64510 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64520 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.
32391

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

64530 5 Injection for nerve block .................................................................... 1 $314 ................ ................ ................ Delete.

64550 6 Apply neurostimulator ....................................................................... ................ ................ ................ ................ ................

64553 1 Implant neuroelectrodes ................................................................... ................ ................ 616 $391 0.78 Add.

64555 1 Implant neuroelectrodes ................................................................... ................ ................ 616 $391 0.78 Add.

64560 1 Implant neuroelectrodes ................................................................... ................ ................ 616 $391 0.78 Add.

64565 1 Implant neuroelectrodes ................................................................... ................ ................ 616 $391 0.78 Add.

64573 1 Implant neuroelectrodes ................................................................... ................ ................ 616 $391 0.78 Add.

64575 1 Implant neuroelectrodes ................................................................... 1 $314 616 $391 0.78

64577 1 Implant neuroelectrodes ................................................................... ................ ................ 616 $391 0.78 Add.

64580 1 Implant neuroelectrodes ................................................................... ................ ................ 616 $391 0.78 Add.

64585 1 Revise/remove neuroelectrode ......................................................... ................ ................ 617 $391 0.78 Add.

64590 1 Implant neuroreceiver ....................................................................... 2 $422 618 $841 1.67

64595 1 Revise/remove neuroreceiver ........................................................... 1 $314 617 $391 0.78

64600 5 Injection treatment of nerve .............................................................. 1 $314 ................ ................ ................ Delete.

64605 5 Injection treatment of nerve .............................................................. 1 $314 ................ ................ ................ Delete.

64610 5 Injection treatment of nerve .............................................................. 1 $314 ................ ................ ................ Delete.

64612 5 Destroy nerve, face muscle .............................................................. ................ ................ ................ ................ ................

64613 5 Destroy nerve, spine muscle ............................................................ ................ ................ ................ ................ ................

64620 5 Injection treatment of nerve .............................................................. 1 $314 ................ ................ ................ Delete.

64622 5 Injection treatment of nerve .............................................................. 1 $314 ................ ................ ................ Delete.

64623 5 Injection treatment of nerve .............................................................. 1 $314 ................ ................ ................ Delete.

64630 5 Injection treatment of nerve .............................................................. 2 $422 ................ ................ ................ Delete.

64640 5 Injection treatment of nerve .............................................................. ................ ................ ................ ................ ................

64680 5 Injection treatment of nerve .............................................................. 2 $422 ................ ................ ................ Delete.

64702 1 Revise finger/toe nerve ..................................................................... 1 $314 631 $600 1.19

64704 1 Revise hand/foot nerve ..................................................................... 1 $314 631 $600 1.19

64708 1 Revise arm/leg nerve ........................................................................ 2 $422 631 $600 1.19

64712 1 Revision of sciatic nerve ................................................................... 2 $422 631 $600 1.19

64713 1 Revision of arm nerve(s) .................................................................. 2 $422 631 $600 1.19

64714 1 Revise low back nerve(s) ................................................................. 2 $422 631 $600 1.19

64716 1 Revision of cranial nerve .................................................................. 3 $482 631 $600 1.19

64718 1 Revise ulnar nerve at elbow ............................................................. 2 $422 631 $600 1.19

64719 1 Revise ulnar nerve at wrist ............................................................... 2 $422 631 $600 1.19

64721 1 Carpal tunnel surgery ....................................................................... 2 $422 631 $600 1.19

64722 1 Relieve pressure on nerve(s) ........................................................... 1 $314 631 $600 1.19

64726 1 Release foot/toe nerve ...................................................................... 1 $314 631 $600 1.19

64727 1 Internal nerve revision ...................................................................... 1 $314 631 $600 1.19

64732 1 Incision of brow nerve ....................................................................... 2 $422 631 $600 1.19

64734 1 Incision of cheek nerve ..................................................................... 2 $422 631 $600 1.19

64736 1 Incision of chin nerve ........................................................................ 2 $422 631 $600 1.19

64738 1 Incision of jaw nerve ......................................................................... 2 $422 631 $600 1.19

64740 1 Incision of tongue nerve ................................................................... 2 $422 631 $600 1.19

64742 1 Incision of facial nerve ...................................................................... 2 $422 631 $600 1.19

64744 1 Incise nerve, back of head ............................................................... 2 $422 631 $600 1.19

64746 1 Incise diaphragm nerve .................................................................... 2 $422 631 $600 1.19

64752 3 Incision of vagus nerve ..................................................................... ................ ................ ................ ................ ................

64755 3 Incision of stomach nerves ............................................................... ................ ................ ................ ................ ................

64760 3 Incision of vagus nerve ..................................................................... ................ ................ ................ ................ ................

64761 1 Incision of pelvis nerve ..................................................................... ................ ................ 631 $600 1.19 Add.

64763 3 Incise hip/thigh nerve ........................................................................ ................ ................ ................ ................ ................

64766 3 Incise hip/thigh nerve ........................................................................ ................ ................ ................ ................ ................

64771 1 Sever cranial nerve ........................................................................... 2 $422 631 $600 1.19

64772 1 Incision of spinal nerve ..................................................................... 2 $422 631 $600 1.19

64774 1 Remove skin nerve lesion ................................................................ 2 $422 631 $600 1.19

64776 1 Remove digit nerve lesion ................................................................ 3 $482 631 $600 1.19

64778 1 Add.ed digit nerve surgery ................................................................ 2 $422 631 $600 1.19

64782 1 Remove limb nerve lesion ................................................................ 3 $482 631 $600 1.19

64783 1 Add.ed limb nerve surgery ................................................................ 2 $422 631 $600 1.19

64784 1 Remove nerve lesion ........................................................................ 3 $482 631 $600 1.19

64786 1 Remove sciatic nerve lesion ............................................................. 3 $482 632 $666 1.32

64787 1 Implant nerve end ............................................................................. 2 $422 631 $600 1.19

64788 1 Remove skin nerve lesion ................................................................ 3 $482 631 $600 1.19

64790 1 Removal of nerve lesion ................................................................... 3 $482 631 $600 1.19

64792 1 Removal of nerve lesion ................................................................... 3 $482 632 $666 1.32

64795 1 Biopsy of nerve ................................................................................. 2 $422 631 $600 1.19

64802 3 Remove sympathetic nerves ............................................................ 2 $422 ................ ................ ................ Delete.

64804 3 Remove sympathetic nerves ............................................................ ................ ................ ................ ................ ................

64809 3 Remove sympathetic nerves ............................................................ ................ ................ ................ ................ ................

64818 3 Remove sympathetic nerves ............................................................ ................ ................ ................ ................ ................

64820 3 Remove sympathetic nerves ............................................................ ................ ................ ................ ................ ................

64830 1 Microrepair of nerve .......................................................................... 5 $678 631 $600 1.19

64831 1 Repair of digit nerve ......................................................................... 4 $595 632 $666 1.32

64832 1 Repair additional nerve ..................................................................... 1 $314 632 $666 1.32

64834 1 Repair of hand or foot nerve ............................................................ 2 $422 632 $666 1.32
32392

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

64835 1 Repair of hand or foot nerve ............................................................ 3 $482 632 $666 1.32

64836 1 Repair of hand or foot nerve ............................................................ 3 $482 632 $666 1.32

64837 1 Repair additional nerve ..................................................................... 1 $314 632 $666 1.32

64840 1 Repair of leg nerve ........................................................................... 2 $422 632 $666 1.32

64856 1 Repair/transpose nerve ..................................................................... 2 $422 632 $666 1.32

64857 1 Repair arm/leg nerve ........................................................................ 2 $422 632 $666 1.32

64858 1 Repair sciatic nerve .......................................................................... 2 $422 632 $666 1.32

64859 1 Add.itional nerve surgery .................................................................. 1 $314 632 $666 1.32

64861 1 Repair of arm nerves ........................................................................ 3 $482 632 $666 1.32

64862 1 Repair of low back nerves ................................................................ 3 $482 632 $666 1.32

64864 1 Repair of facial nerve ........................................................................ 3 $482 632 $666 1.32

64865 1 Repair of facial nerve ........................................................................ 4 $595 632 $666 1.32

64866 3 Fusion of facial/other nerve .............................................................. ................ ................ ................ ................ ................

64868 3 Fusion of facial/other nerve .............................................................. ................ ................ ................ ................ ................

64870 1 Fusion of facial/other nerve .............................................................. 4 $595 632 $666 1.32

64872 1 Subsequent repair of nerve .............................................................. 2 $422 632 $666 1.32

64874 1 Repair & revise nerve ....................................................................... 3 $482 632 $666 1.32

64876 1 Repair nerve; shorten bone .............................................................. 3 $482 632 $666 1.32

64885 1 Nerve graft, head or neck ................................................................. ................ ................ 632 $666 1.32 Add.

64886 1 Nerve graft, head or neck ................................................................. ................ ................ 632 $666 1.32 Add.

64890 1 Nerve graft, hand or foot .................................................................. 2 $422 632 $666 1.32

64891 1 Nerve graft, hand or foot .................................................................. 2 $422 632 $666 1.32

64892 1 Nerve graft, arm or leg ..................................................................... 2 $422 632 $666 1.32

64893 1 Nerve graft, arm or leg ..................................................................... 2 $422 632 $666 1.32

64895 1 Nerve graft, hand or foot .................................................................. 3 $482 632 $666 1.32

64896 1 Nerve graft, hand or foot .................................................................. 3 $482 632 $666 1.32

64897 1 Nerve graft, arm or leg ..................................................................... 3 $482 632 $666 1.32

64898 1 Nerve graft, arm or leg ..................................................................... 3 $482 632 $666 1.32

64901 1 Add.itional nerve graft ....................................................................... 2 $422 632 $666 1.32

64902 1 Add.itional nerve graft ....................................................................... 2 $422 632 $666 1.32

64905 1 Nerve pedicle transfer ....................................................................... 2 $422 632 $666 1.32

64907 1 Nerve pedicle transfer ....................................................................... 1 $314 632 $666 1.32

64999 3 Nervous system surgery ................................................................... ................ ................ ................ ................ ................

65091 1 Revise eye ........................................................................................ 3 $482 684 $491 0.97

65093 1 Revise eye with implant .................................................................... 3 $482 684 $491 0.97

65101 1 Removal of eye ................................................................................. 3 $482 684 $491 0.97

65103 1 Remove eye/insert implant ............................................................... 3 $482 684 $491 0.97

65105 1 Remove eye/attach implant .............................................................. 4 $595 684 $491 0.97

65110 3 Removal of eye ................................................................................. 5 $678 ................ ................ ................ Delete.

65112 3 Remove eye, revise socket .............................................................. 7 $941 ................ ................ ................ Delete.

65114 3 Remove eye, revise socket .............................................................. 7 $941 ................ ................ ................ Delete.

65125 5 Revise ocular implant ....................................................................... ................ ................ ................ ................ ................

65130 1 Insert ocular implant ......................................................................... 3 $482 684 $491 0.97

65135 1 Insert ocular implant ......................................................................... 2 $422 684 $491 0.97

65140 1 Attach ocular implant ........................................................................ 3 $482 684 $491 0.97

65150 1 Revise ocular implant ....................................................................... 2 $422 684 $491 0.97

65155 1 Reinsert ocular implant ..................................................................... 3 $482 684 $491 0.97

65175 1 Removal of ocular implant ................................................................ 1 $314 683 $317 0.63

65205 5 Remove foreign body from eye ........................................................ ................ ................ ................ ................ ................

65210 5 Remove foreign body from eye ........................................................ ................ ................ ................ ................ ................

65220 5 Remove foreign body from eye ........................................................ ................ ................ ................ ................ ................

65222 5 Remove foreign body from eye ........................................................ ................ ................ ................ ................ ................

65235 1 Remove foreign body from eye ........................................................ 2 $422 652 $415 0.82

65260 1 Remove foreign body from eye ........................................................ 3 $482 676 $336 0.67

65265 1 Remove foreign body from eye ........................................................ 4 $595 676 $336 0.67

65270 1 Repair of eye wound ......................................................................... 2 $422 183 $465 0.92

65272 1 Repair of eye wound ......................................................................... 2 $422 651 $297 0.59

65273 3 Repair of eye wound ......................................................................... ................ ................ ................ ................ ................

65275 1 Repair of eye wound ......................................................................... 4 $595 651 $297 0.59

65280 1 Repair of eye wound ......................................................................... 4 $595 652 $415 0.82

65285 1 Repair of eye wound ......................................................................... 4 $595 652 $415 0.82

65286 1 Repair of eye wound ......................................................................... ................ ................ 651 $297 0.59 Add.

65290 1 Repair of eye socket wound ............................................................. 3 $482 677 $523 1.04

65400 1 Removal of eye lesion ...................................................................... 1 $314 652 $415 0.82

65410 1 Biopsy of cornea ............................................................................... 2 $422 683 $317 0.63

65420 1 Removal of eye lesion ...................................................................... 2 $422 651 $297 0.59

65426 1 Removal of eye lesion ...................................................................... 5 $678 652 $415 0.82

65430 5 Corneal smear .................................................................................. ................ ................ ................ ................ ................

65435 5 Curette/treat cornea .......................................................................... ................ ................ ................ ................ ................

65436 1 Curette/treat cornea .......................................................................... ................ ................ 651 $297 0.59 Add.

65450 1 Treatment of corneal lesion .............................................................. ................ ................ 651 $297 0.59 Add.

65600 5 Revision of cornea ............................................................................ ................ ................ ................ ................ ................

65710 1 Corneal transplant ............................................................................. 7 $941 670 $1,648 3.27

65730 1 Corneal transplant ............................................................................. 7 $941 670 $1,648 3.27
32393

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

65750 1 Corneal transplant ............................................................................. 7 $941 670 $1,648 3.27

65755 1 Corneal transplant ............................................................................. 7 $941 670 $1,648 3.27

65760 9 Revision of cornea ............................................................................ ................ ................ ................ ................ ................

65765 9 Revision of cornea ............................................................................ ................ ................ ................ ................ ................

65767 9 Corneal tissue transplant .................................................................. ................ ................ ................ ................ ................

65770 1 Revise cornea with implant ............................................................... 7 $941 652 $415 0.82

65771 9 Radial keratotomy ............................................................................. ................ ................ ................ ................ ................

65772 1 Correction of astigmatism ................................................................. ................ ................ 651 $297 0.59 Add.

65775 1 Correction of astigmatism ................................................................. ................ ................ 652 $415 0.82 Add.

65800 1 Drainage of eye ................................................................................ 1 $314 683 $317 0.63

65805 1 Drainage of eye ................................................................................ 1 $314 683 $317 0.63

65810 1 Drainage of eye ................................................................................ 3 $482 651 $297 0.59

65815 1 Drainage of eye ................................................................................ 2 $422 651 $297 0.59

65820 1 Relieve inner eye pressure ............................................................... ................ ................ 651 $297 0.59 Add.

65850 1 Incision of eye ................................................................................... 4 $595 652 $415 0.82

65855 1 Laser surgery of eye ......................................................................... ................ ................ 649 $274 0.54 Add.

65860 1 Incise inner eye adhesions ............................................................... ................ ................ 649 $274 0.54 Add.

65865 1 Incise inner eye adhesions ............................................................... 1 $314 652 $415 0.82

65870 1 Incise inner eye adhesions ............................................................... 4 $595 652 $415 0.82

65875 1 Incise inner eye adhesions ............................................................... 4 $595 652 $415 0.82

65880 1 Incise inner eye adhesions ............................................................... 4 $595 652 $415 0.82

65900 1 Remove eye lesion ........................................................................... 5 $678 652 $415 0.82

65920 1 Remove implant from eye ................................................................. 7 $941 652 $415 0.82

65930 1 Remove blood clot from eye ............................................................. 5 $678 652 $415 0.82

66020 1 Injection treatment of eye ................................................................. 1 $314 683 $317 0.63

66030 1 Injection treatment of eye ................................................................. 1 $314 683 $317 0.63

66130 1 Remove eye lesion ........................................................................... 7 $941 651 $297 0.59

66150 1 Glaucoma surgery ............................................................................. 4 $595 652 $415 0.82

66155 1 Glaucoma surgery ............................................................................. 4 $595 652 $415 0.82

66160 1 Glaucoma surgery ............................................................................. 2 $422 652 $415 0.82

66165 1 Glaucoma surgery ............................................................................. 4 $595 652 $415 0.82

66170 1 Glaucoma surgery ............................................................................. 4 $595 652 $415 0.82

66172 1 Incision of eye ................................................................................... 4 $595 652 $415 0.82

66180 1 Implant eye shunt ............................................................................. 5 $678 652 $415 0.82

66185 1 Revise eye shunt .............................................................................. 2 $422 652 $415 0.82

66220 1 Repair eye lesion .............................................................................. 3 $482 676 $336 0.67

66225 1 Repair/graft eye lesion ...................................................................... 4 $595 652 $415 0.82

66250 1 Follow-up surgery of eye .................................................................. 2 $422 652 $415 0.82

66500 1 Incision of iris .................................................................................... 1 $314 651 $297 0.59

66505 1 Incision of iris .................................................................................... 1 $314 651 $297 0.59

66600 1 Remove iris and lesion ..................................................................... 3 $482 651 $297 0.59

66605 1 Removal of iris .................................................................................. 3 $482 652 $415 0.82

66625 1 Removal of iris .................................................................................. 3 $482 651 $297 0.59

66630 1 Removal of iris .................................................................................. 3 $482 651 $297 0.59

66635 1 Removal of iris .................................................................................. 3 $482 652 $415 0.82

66680 1 Repair iris & ciliary body ................................................................... 3 $482 652 $415 0.82

66682 1 Repair iris and ciliary body ............................................................... 2 $422 652 $415 0.82

66700 1 Destruction, ciliary body .................................................................... 2 $422 651 $297 0.59

66710 1 Destruction, ciliary body .................................................................... 2 $422 651 $297 0.59

66720 1 Destruction, ciliary body .................................................................... 2 $422 651 $297 0.59

66740 1 Destruction, ciliary body .................................................................... 2 $422 652 $415 0.82

66761 1 Revision of iris .................................................................................. ................ ................ 649 $274 0.54 Add.

66762 1 Revision of iris .................................................................................. ................ ................ 649 $274 0.54 Add.

66770 1 Removal of inner eye lesion ............................................................. ................ ................ 649 $274 0.54 Add.

66820 1 Incision, secondary cataract ............................................................. ................ ................ 651 $297 0.59 Add.

66821 1 After cataract laser surgery .............................................................. 2 $422 649 $274 0.54

66825 1 Reposition intraocular lens ............................................................... ................ ................ 651 $297 0.59 Add.

66830 1 Removal of lens lesion ..................................................................... 4 $595 652 $415 0.82

66840 1 Removal of lens material .................................................................. 4 $595 667 $661 1.31

66850 1 Removal of lens material .................................................................. 7 $941 667 $661 1.31

66852 1 Removal of lens material .................................................................. 4 $595 667 $661 1.31

66920 1 Extraction of lens .............................................................................. 4 $595 667 $661 1.31

66930 1 Extraction of lens .............................................................................. 5 $678 667 $661 1.31

66940 1 Extraction of lens .............................................................................. 5 $678 667 $661 1.31

66983 1 Remove cataract, insert lens ............................................................ 8 $928 668 $863 1.71

66984 1 Remove cataract, insert lens ............................................................ 8 $928 668 $863 1.71

66985 1 Insert lens prosthesis ........................................................................ 6 $789 668 $863 1.71

66986 1 Exchange lens prosthesis ................................................................. 6 $789 668 $863 1.71

66999 3 Eye surgery procedure ..................................................................... ................ ................ ................ ................ ................

67005 1 Partial removal of eye fluid ............................................................... 4 $595 676 $336 0.67

67010 1 Partial removal of eye fluid ............................................................... 4 $595 676 $336 0.67

67015 1 Release of eye fluid .......................................................................... 1 $314 676 $336 0.67

67025 1 Replace eye fluid .............................................................................. 1 $314 683 $317 0.63

67027 1 Implant eye drug system .................................................................. ................ ................ ................ ................ ................ Add.
32394

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

67028 5 Injection eye drug ............................................................................. ................ ................ ................ ................ ................

67030 1 Incise inner eye strands .................................................................... 1 $314 676 $336 0.67

67031 1 Laser surgery, eye strands ............................................................... 2 $422 649 $274 0.54

67036 1 Removal of inner eye fluid ................................................................ 4 $595 690 $983 1.95

67038 1 Strip retinal membrane ..................................................................... 5 $678 690 $983 1.95

67039 1 Laser treatment of retina .................................................................. 7 $941 690 $983 1.95

67040 1 Laser treatment of retina .................................................................. 7 $941 690 $983 1.95

67101 1 Repair, detached retina .................................................................... ................ ................ 676 $336 0.67 Add.

67105 5 Repair, detached retina .................................................................... ................ ................ ................ ................ ................

67107 1 Repair detached retina ..................................................................... 5 $678 690 $983 1.95

67108 1 Repair detached retina ..................................................................... 7 $941 690 $983 1.95

67110 1 Repair detached retina ..................................................................... ................ ................ 676 $336 0.67 Add.

67112 1 Re-repair detached retina ................................................................. 7 $941 690 $983 1.95

67115 1 Release, encircling material .............................................................. 2 $422 676 $336 0.67

67120 1 Remove eye implant material ........................................................... 2 $422 676 $336 0.67

67121 1 Remove eye implant material ........................................................... 2 $422 676 $336 0.67

67141 1 Treatment of retina ........................................................................... 2 $422 676 $336 0.67

67145 5 Treatment of retina ........................................................................... ................ ................ ................ ................ ................

67208 1 Treatment of retinal lesion ................................................................ ................ ................ 676 $336 0.67 Add.

67210 5 Treatment of retinal lesion ................................................................ ................ ................ ................ ................ ................

67218 1 Treatment of retinal lesion ................................................................ 5 $678 676 $336 0.67

67227 1 Treatment of retinal lesion ................................................................ 1 $314 676 $336 0.67

67228 5 Treatment of retinal lesion ................................................................ ................ ................ ................ ................ ................

67250 1 Reinforce eye wall ............................................................................ 3 $482 684 $491 0.97

67255 1 Reinforce/graft eye wall .................................................................... 3 $482 684 $491 0.97

67299 3 Eye surgery procedure ..................................................................... ................ ................ ................ ................ ................

67311 1 Revise eye muscle ............................................................................ 3 $482 677 $523 1.04

67312 1 Revise two eye muscles ................................................................... 4 $595 677 $523 1.04

67314 1 Revise eye muscle ............................................................................ 4 $595 677 $523 1.04

67316 1 Revise two eye muscles ................................................................... 4 $595 677 $523 1.04

67318 1 Revise eye muscle(s) ....................................................................... 4 $595 677 $523 1.04

67320 1 Revise eye muscle(s) ....................................................................... 4 $595 677 $523 1.04

67331 1 Eye surgery follow-up ....................................................................... 4 $595 677 $523 1.04

67332 1 Rerevise eye muscles ....................................................................... 4 $595 677 $523 1.04

67334 1 Revise eye muscle w/suture ............................................................. ................ ................ 677 $523 1.04 Add.

67335 1 Eye suture during surgery ................................................................ ................ ................ 677 $523 1.04 Add.

67340 1 Revise eye muscle ............................................................................ 4 $595 677 $523 1.04

67343 1 Release eye tissue ........................................................................... ................ ................ 677 $523 1.04 Add.

67345 5 Destroy nerve of eye muscle ............................................................ ................ ................ ................ ................ ................

67350 1 Biopsy eye muscle ............................................................................ 1 $314 162 $187 0.37

67399 3 Eye muscle surgery procedure ......................................................... ................ ................ ................ ................ ................

67400 1 Explore/biopsy eye socket ................................................................ 3 $482 684 $491 0.97

67405 1 Explore/drain eye socket .................................................................. 4 $595 684 $491 0.97

67412 1 Explore/treat eye socket ................................................................... 5 $678 684 $491 0.97

67413 1 Explore/treat eye socket ................................................................... 5 $678 684 $491 0.97

67414 3 Explore/decompress eye socke ........................................................ ................ ................ ................ ................ ................

67415 1 Aspiration orbital contents ................................................................ 1 $314 122 $186 0.37

67420 1 Explore/treat eye socket ................................................................... 5 $678 232 $814 1.62

67430 1 Explore/treat eye socket ................................................................... 5 $678 232 $814 1.62

67440 1 Explore/drain eye socket .................................................................. 5 $678 232 $814 1.62

67445 3 Explore/decompress eye socke ........................................................ ................ ................ ................ ................ ................

67450 1 Explore/biopsy eye socket ................................................................ 5 $678 232 $814 1.62

67500 5 Inject/treat eye socket ....................................................................... ................ ................ ................ ................ ................

67505 5 Inject/treat eye socket ....................................................................... ................ ................ ................ ................ ................

67515 5 Inject/treat eye socket ....................................................................... ................ ................ ................ ................ ................

67550 1 Insert eye socket implant .................................................................. 4 $595 684 $491 0.97

67560 1 Revise eye socket implant ................................................................ 2 $422 684 $491 0.97

67570 3 Decompress optic nerve ................................................................... ................ ................ ................ ................ ................

67599 3 Orbit surgery procedure .................................................................... ................ ................ ................ ................ ................

67700 5 Drainage of eyelid abscess .............................................................. ................ ................ ................ ................ ................

67710 5 Incision of eyelid ............................................................................... ................ ................ ................ ................ ................

67715 1 Incision of eyelid fold ........................................................................ 1 $314 683 $317 0.63

67800 5 Remove eyelid lesion ........................................................................ ................ ................ ................ ................ ................

67801 5 Remove eyelid lesions ...................................................................... ................ ................ ................ ................ ................

67805 5 Remove eyelid lesions ...................................................................... ................ ................ ................ ................ ................

67808 1 Remove eyelid lesion(s) ................................................................... 2 $422 684 $491 0.97

67810 5 Biopsy of eyelid ................................................................................. ................ ................ ................ ................ ................

67820 5 Revise eyelashes .............................................................................. ................ ................ ................ ................ ................

67825 5 Revise eyelashes .............................................................................. ................ ................ ................ ................ ................

67830 1 Revise eyelashes .............................................................................. 2 $422 683 $317 0.63

67835 1 Revise eyelashes .............................................................................. 2 $422 684 $491 0.97

67840 5 Remove eyelid lesion ........................................................................ ................ ................ ................ ................ ................

67850 5 Treat eyelid lesion ............................................................................. ................ ................ ................ ................ ................

67875 5 Closure of eyelid by suture ............................................................... ................ ................ ................ ................ ................
32395

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

67880 1 Revision of eyelid .............................................................................. 3 $482 683 $317 0.63

67882 1 Revision of eyelid .............................................................................. 3 $482 684 $491 0.97

67900 1 Repair brow defect ............................................................................ ................ ................ 684 $491 0.97 Add.

67901 1 Repair eyelid defect .......................................................................... 5 $678 684 $491 0.97

67902 1 Repair eyelid defect .......................................................................... 5 $678 684 $491 0.97

67903 1 Repair eyelid defect .......................................................................... 4 $595 684 $491 0.97

67904 1 Repair eyelid defect .......................................................................... 4 $595 684 $491 0.97

67906 1 Repair eyelid defect .......................................................................... 5 $678 684 $491 0.97

67908 1 Repair eyelid defect .......................................................................... 4 $595 684 $491 0.97

67909 1 Revise eyelid defect .......................................................................... 4 $595 684 $491 0.97

67911 1 Revise eyelid defect .......................................................................... 3 $482 684 $491 0.97

67914 1 Repair eyelid defect .......................................................................... 3 $482 684 $491 0.97

67915 5 Repair eyelid defect .......................................................................... ................ ................ ................ ................ ................

67916 1 Repair eyelid defect .......................................................................... 4 $595 684 $491 0.97

67917 1 Repair eyelid defect .......................................................................... 4 $595 684 $491 0.97

67921 1 Repair eyelid defect .......................................................................... 3 $482 684 $491 0.97

67922 5 Repair eyelid defect .......................................................................... ................ ................ ................ ................ ................

67923 1 Repair eyelid defect .......................................................................... 4 $595 684 $491 0.97

67924 1 Repair eyelid defect .......................................................................... 4 $595 684 $491 0.97

67930 5 Repair eyelid wound ......................................................................... ................ ................ ................ ................ ................

67935 1 Repair eyelid wound ......................................................................... 2 $422 683 $317 0.63

67938 5 Remove eyelid foreign body ............................................................. ................ ................ ................ ................ ................

67950 1 Revision of eyelid .............................................................................. 2 $422 684 $491 0.97

67961 1 Revision of eyelid .............................................................................. 3 $482 684 $491 0.97

67966 1 Revision of eyelid .............................................................................. 3 $482 684 $491 0.97

67971 1 Reconstruction of eyelid ................................................................... 3 $482 684 $491 0.97

67973 1 Reconstruction of eyelid ................................................................... 3 $482 684 $491 0.97

67974 1 Reconstruction of eyelid ................................................................... 3 $482 684 $491 0.97

67975 1 Reconstruction of eyelid ................................................................... 3 $482 684 $491 0.97

67999 3 Revision of eyelid .............................................................................. ................ ................ ................ ................ ................

68020 5 Incise/drain eyelid lining .................................................................... ................ ................ ................ ................ ................

68040 5 Treatment of eyelid lesions ............................................................... ................ ................ ................ ................ ................

68100 1 Biopsy of eyelid lining ....................................................................... ................ ................ 162 $187 0.37 Add.

68110 1 Remove eyelid lining lesion .............................................................. ................ ................ 162 $187 0.37 Add.

68115 1 Remove eyelid lining lesion .............................................................. ................ ................ 162 $187 0.37 Add.

68130 1 Remove eyelid lining lesion .............................................................. 2 $422 652 $415 0.82

68135 1 Remove eyelid lining lesion .............................................................. ................ ................ 162 $187 0.37 Add.

68200 5 Treat eyelid by injection .................................................................... ................ ................ ................ ................ ................

68320 1 Revise/graft eyelid lining ................................................................... 4 $595 684 $491 0.97

68325 1 Revise/graft eyelid lining ................................................................... 4 $595 684 $491 0.97

68326 1 Revise/graft eyelid lining ................................................................... 4 $595 684 $491 0.97

68328 1 Revise/graft eyelid lining ................................................................... 4 $595 684 $491 0.97

68330 1 Revise eyelid lining ........................................................................... 4 $595 652 $415 0.82

68335 1 Revise/graft eyelid lining ................................................................... 4 $595 684 $491 0.97

68340 1 Separate eyelid adhesions ............................................................... 4 $595 684 $491 0.97

68360 1 Revise eyelid lining ........................................................................... 2 $422 652 $415 0.82

68362 1 Revise eyelid lining ........................................................................... 2 $422 652 $415 0.82

68399 3 Eyelid lining surgery .......................................................................... ................ ................ ................ ................ ................

68400 5 Incise/drain tear gland ...................................................................... ................ ................ ................ ................ ................

68420 5 Incise/drain tear sac .......................................................................... ................ ................ ................ ................ ................

68440 5 Incise tear duct opening ................................................................... ................ ................ ................ ................ ................

68500 1 Removal of tear gland ...................................................................... 3 $482 684 $491 0.97

68505 1 Partial removal tear gland ................................................................. 3 $482 684 $491 0.97

68510 1 Biopsy of tear gland .......................................................................... 1 $314 683 $317 0.63

68520 1 Removal of tear sac .......................................................................... 3 $482 684 $491 0.97

68525 1 Biopsy of tear sac ............................................................................. 1 $314 683 $317 0.63

68530 5 Clearance of tear duct ...................................................................... ................ ................ ................ ................ ................

68540 1 Remove tear gland lesion ................................................................. 3 $482 684 $491 0.97

68550 1 Remove tear gland lesion ................................................................. 3 $482 684 $491 0.97

68700 1 Repair tear ducts .............................................................................. 2 $422 684 $491 0.97

68705 5 Revise tear duct opening .................................................................. ................ ................ ................ ................ ................

68720 1 Create tear sac drain ........................................................................ 4 $595 684 $491 0.97

68745 1 Create tear duct drain ....................................................................... 4 $595 684 $491 0.97

68750 1 Create tear duct drain ....................................................................... 4 $595 684 $491 0.97

68760 5 Close tear duct opening .................................................................... ................ ................ ................ ................ ................

68761 5 Close tear duct opening .................................................................... ................ ................ ................ ................ ................

68770 1 Close tear system fistula .................................................................. ................ ................ 684 $491 0.97 Add.

68801 5 Dilate tear duct opening .................................................................... ................ ................ ................ ................ ................

68810 1 Probe nasolacrimal duct ................................................................... 1 $314 683 $317 0.63

68811 1 Probe nasolacrimal duct ................................................................... 2 $422 684 $491 0.97

68815 1 Probe nasolacrimal duct ................................................................... 2 $422 684 $491 0.97

68840 5 Explore/irrigate tear ducts ................................................................. ................ ................ ................ ................ ................

68850 2 Injection for tear sac x-ray ................................................................ ................ ................ ................ ................ ................

68899 3 Tear duct system surgery ................................................................. ................ ................ ................ ................ ................
32396

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

69000 5 Drain external ear lesion ................................................................... ................ ................ ................ ................ ................

69005 5 Drain external ear lesion ................................................................... ................ ................ ................ ................ ................

69020 5 Drain outer ear canal lesion ............................................................. ................ ................ ................ ................ ................

69090 9 Pierce earlobes ................................................................................. ................ ................ ................ ................ ................

69100 5 Biopsy of external ear ....................................................................... ................ ................ ................ ................ ................

69105 5 Biopsy of external ear canal ............................................................. ................ ................ ................ ................ ................

69110 1 Partial removal external ear .............................................................. 1 $314 163 $449 0.89

69120 1 Removal of external ear ................................................................... 2 $422 313 $537 1.07

69140 1 Remove ear canal lesion(s) .............................................................. 2 $422 313 $537 1.07

69145 1 Remove ear canal lesion(s) .............................................................. 2 $422 163 $449 0.89

69150 1 Extensive ear canal surgery ............................................................. 3 $482 314 $946 1.88

69155 3 Extensive ear/neck surgery .............................................................. ................ ................ ................ ................ ................

69200 5 Clear outer ear canal ........................................................................ ................ ................ ................ ................ ................

69205 1 Clear outer ear canal ........................................................................ 1 $314 163 $449 0.89

69210 5 Remove impacted ear wax ............................................................... ................ ................ ................ ................ ................

69220 5 Clean out mastoid cavity .................................................................. ................ ................ ................ ................ ................

69222 5 Clean out mastoid cavity .................................................................. ................ ................ ................ ................ ................

69300 7 Revise external ear ........................................................................... ................ ................ 313 $537 1.07 Add.

69310 1 Rebuild outer ear canal .................................................................... 3 $482 314 $946 1.88

69320 1 Rebuild outer ear canal .................................................................... 7 $941 314 $946 1.88

69399 3 Outer ear surgery procedure ............................................................ ................ ................ ................ ................ ................

69400 5 Inflate middle ear canal .................................................................... ................ ................ ................ ................ ................

69401 5 Inflate middle ear canal .................................................................... ................ ................ ................ ................ ................

69405 5 Catheterize middle ear canal ............................................................ ................ ................ ................ ................ ................

69410 5 Inset middle ear baffle ...................................................................... ................ ................ ................ ................ ................

69420 5 Incision of eardrum ........................................................................... ................ ................ ................ ................ ................

69421 1 Incision of eardrum ........................................................................... 3 $482 312 $233 0.46

69424 5 Remove ventilating tube ................................................................... 1 $314 ................ ................ ................ Delete.

69433 1 Create eardrum opening ................................................................... ................ ................ 312 $233 0.46 Add.

69436 1 Create eardrum opening ................................................................... 3 $482 312 $233 0.46

69440 1 Exploration of middle ear .................................................................. 3 $482 313 $537 1.07

69450 1 Eardrum revision ............................................................................... 1 $314 313 $537 1.07

69501 1 Mastoidectomy .................................................................................. 7 $941 314 $946 1.88

69502 1 Mastoidectomy .................................................................................. 7 $941 314 $946 1.88

69505 1 Remove mastoid structures .............................................................. 7 $941 314 $946 1.88

69511 1 Extensive mastoid surgery ................................................................ 7 $941 314 $946 1.88

69530 1 Extensive mastoid surgery ................................................................ 7 $941 314 $946 1.88

69535 3 Remove part of temporal bone ......................................................... ................ ................ ................ ................ ................

69540 5 Remove ear lesion ............................................................................ ................ ................ ................ ................ ................

69550 1 Remove ear lesion ............................................................................ 5 $678 314 $946 1.88

69552 1 Remove ear lesion ............................................................................ 7 $941 314 $946 1.88

69554 3 Remove ear lesion ............................................................................ ................ ................ ................ ................ ................

69601 1 Mastoid surgery revision ................................................................... 7 $941 314 $946 1.88

69602 1 Mastoid surgery revision ................................................................... 7 $941 314 $946 1.88

69603 1 Mastoid surgery revision ................................................................... 7 $941 314 $946 1.88

69604 1 Mastoid surgery revision ................................................................... 7 $941 314 $946 1.88

69605 1 Mastoid surgery revision ................................................................... 7 $941 314 $946 1.88

69610 5 Repair of eardrum ............................................................................. ................ ................ ................ ................ ................

69620 1 Repair of eardrum ............................................................................. 2 $422 313 $537 1.07

69631 1 Repair eardrum structures ................................................................ 5 $678 314 $946 1.88

69632 1 Rebuild eardrum structures .............................................................. 5 $678 314 $946 1.88

69633 1 Rebuild eardrum structures .............................................................. 5 $678 314 $946 1.88

69635 1 Repair eardrum structures ................................................................ 7 $941 314 $946 1.88

69636 1 Rebuild eardrum structures .............................................................. 7 $941 314 $946 1.88

69637 1 Rebuild eardrum structures .............................................................. 7 $941 314 $946 1.88

69641 1 Revise middle ear & mastoid ............................................................ 7 $941 314 $946 1.88

69642 1 Revise middle ear & mastoid ............................................................ 7 $941 314 $946 1.88

69643 1 Revise middle ear & mastoid ............................................................ 7 $941 314 $946 1.88

69644 1 Revise middle ear & mastoid ............................................................ 7 $941 314 $946 1.88

69645 1 Revise middle ear & mastoid ............................................................ 7 $941 314 $946 1.88

69646 1 Revise middle ear & mastoid ............................................................ 7 $941 314 $946 1.88

69650 1 Release middle ear bone .................................................................. 7 $941 314 $946 1.88

69660 1 Revise middle ear bone .................................................................... 5 $678 314 $946 1.88

69661 1 Revise middle ear bone .................................................................... 5 $678 314 $946 1.88

69662 1 Revise middle ear bone .................................................................... 5 $678 314 $946 1.88

69666 1 Repair middle ear structures ............................................................ 4 $595 314 $946 1.88

69667 1 Repair middle ear structures ............................................................ 4 $595 314 $946 1.88

69670 1 Remove mastoid air cells ................................................................. 3 $482 314 $946 1.88

69676 1 Remove middle ear nerve ................................................................ 3 $482 314 $946 1.88

69700 1 Close mastoid fistula ......................................................................... 3 $482 314 $946 1.88

69710 9 Implant/replace hearing aid .............................................................. 3 $482 ................ ................ ................ Delete.

69711 1 Remove/repair hearing aid ............................................................... 1 $314 314 $946 1.88

69720 1 Release facial nerve ......................................................................... 5 $678 314 $946 1.88

69725 1 Release facial nerve ......................................................................... 5 $678 314 $946 1.88
32397

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

69740 1 Repair facial nerve ............................................................................ 5 $678 314 $946 1.88

69745 1 Repair facial nerve ............................................................................ 5 $678 314 $946 1.88

69799 3 Middle ear surgery procedure ........................................................... ................ ................ ................ ................ ................

69801 1 Incise inner ear ................................................................................. 5 $678 314 $946 1.88

69802 1 Incise inner ear ................................................................................. 7 $941 314 $946 1.88

69805 1 Explore inner ear .............................................................................. 7 $941 314 $946 1.88

69806 1 Explore inner ear .............................................................................. 7 $941 314 $946 1.88

69820 1 Establish inner ear window ............................................................... 5 $678 314 $946 1.88

69840 1 Revise inner ear window .................................................................. 5 $678 314 $946 1.88

69905 1 Remove inner ear ............................................................................. 7 $941 314 $946 1.88

69910 1 Remove inner ear & mastoid ............................................................ 7 $941 314 $946 1.88

69915 1 Incise inner ear nerve ....................................................................... 7 $941 314 $946 1.88

69930 1 Implant cochlear device .................................................................... 7 $941 317 $962 1.91

69949 3 Inner ear surgery procedure ............................................................. ................ ................ ................ ................ ................

69950 3 Incise inner ear nerve ....................................................................... ................ ................ ................ ................ ................

69955 3 Release facial nerve ......................................................................... ................ ................ ................ ................ ................

69960 3 Release inner ear canal .................................................................... ................ ................ ................ ................ ................

69970 3 Remove inner ear lesion ................................................................... ................ ................ ................ ................ ................

69979 3 Temporal bone surgery ..................................................................... ................ ................ ................ ................ ................

70010 6 Contrast x-ray of brain ...................................................................... ................ ................ ................ ................ ................

70015 6 Contrast x-ray of brain ...................................................................... ................ ................ ................ ................ ................

70030 6 X-ray eye for foreign body ................................................................ ................ ................ ................ ................ ................

70100 6 X-ray exam of jaw ............................................................................. ................ ................ ................ ................ ................

70110 6 X-ray exam of jaw ............................................................................. ................ ................ ................ ................ ................

70120 6 X-ray exam of mastoids .................................................................... ................ ................ ................ ................ ................

70130 6 X-ray exam of mastoids .................................................................... ................ ................ ................ ................ ................

70134 6 X-ray exam of middle ear ................................................................. ................ ................ ................ ................ ................

70140 6 X-ray exam of facial bones ............................................................... ................ ................ ................ ................ ................

70150 6 X-ray exam of facial bones ............................................................... ................ ................ ................ ................ ................

70160 6 X-ray exam of nasal bones ............................................................... ................ ................ ................ ................ ................

70170 6 X-ray exam of tear duct .................................................................... ................ ................ ................ ................ ................

70190 6 X-ray exam of eye sockets ............................................................... ................ ................ ................ ................ ................

70200 6 X-ray exam of eye sockets ............................................................... ................ ................ ................ ................ ................

70210 6 X-ray exam of sinuses ...................................................................... ................ ................ ................ ................ ................

70220 6 X-ray exam of sinuses ...................................................................... ................ ................ ................ ................ ................

70240 6 X-ray exam pituitary saddle .............................................................. ................ ................ ................ ................ ................

70250 6 X-ray exam of skull ........................................................................... ................ ................ ................ ................ ................

70260 6 X-ray exam of skull ........................................................................... ................ ................ ................ ................ ................

70300 6 X-ray exam of teeth .......................................................................... ................ ................ ................ ................ ................

70310 6 X-ray exam of teeth .......................................................................... ................ ................ ................ ................ ................

70320 6 Full mouth x-ray of teeth ................................................................... ................ ................ ................ ................ ................

70328 6 X-ray exam of jaw joint ..................................................................... ................ ................ ................ ................ ................

70330 6 X-ray exam of jaw joints ................................................................... ................ ................ ................ ................ ................

70332 6 X-ray exam of jaw joint ..................................................................... ................ ................ ................ ................ ................

70336 6 Magnetic image jaw joint .................................................................. ................ ................ ................ ................ ................

70350 6 X-ray head for orthodontia ................................................................ ................ ................ ................ ................ ................

70355 6 Panoramic x-ray of jaws ................................................................... ................ ................ ................ ................ ................

70360 6 X-ray exam of neck ........................................................................... ................ ................ ................ ................ ................

70370 6 Throat x-ray & fluoroscopy ............................................................... ................ ................ ................ ................ ................

70371 6 Speech evaluation, complex ............................................................. ................ ................ ................ ................ ................

70373 6 Contrast x-ray of larynx .................................................................... ................ ................ ................ ................ ................

70380 6 X-ray exam of salivary gland ............................................................ ................ ................ ................ ................ ................

70390 6 X-ray exam of salivary duct .............................................................. ................ ................ ................ ................ ................

70450 6 CAT scan of head or brain ............................................................... ................ ................ ................ ................ ................

70460 6 Contrast CAT scan of head .............................................................. ................ ................ ................ ................ ................

70470 6 Contrast CAT scans of head ............................................................ ................ ................ ................ ................ ................

70480 6 CAT scan of skull .............................................................................. ................ ................ ................ ................ ................

70481 6 Contrast CAT scan of skull ............................................................... ................ ................ ................ ................ ................

70482 6 Contrast CAT scans of skull ............................................................. ................ ................ ................ ................ ................

70486 6 CAT scan of face, jaw ...................................................................... ................ ................ ................ ................ ................

70487 6 Contrast CAT scan, face/jaw ............................................................ ................ ................ ................ ................ ................

70488 6 Contrast CAT scans face/jaw ........................................................... ................ ................ ................ ................ ................

70490 6 CAT scan of neck tissue ................................................................... ................ ................ ................ ................ ................

70491 6 Contrast CAT of neck tissue ............................................................. ................ ................ ................ ................ ................

70492 6 Contrast CAT of neck tissue ............................................................. ................ ................ ................ ................ ................

70540 6 Magnetic image, face, neck .............................................................. ................ ................ ................ ................ ................

70541 6 Magnetic image, head (MRA) ........................................................... ................ ................ ................ ................ ................

70551 6 Magnetic image, brain (MRI) ............................................................ ................ ................ ................ ................ ................

70552 6 Magnetic image, brain (MRI) ............................................................ ................ ................ ................ ................ ................

70553 6 Magnetic image, brain ...................................................................... ................ ................ ................ ................ ................

71010 6 Chest x-ray ........................................................................................ ................ ................ ................ ................ ................

71015 6 X-ray exam of chest .......................................................................... ................ ................ ................ ................ ................

71020 6 Chest x-ray ........................................................................................ ................ ................ ................ ................ ................

71021 6 Chest x-ray ........................................................................................ ................ ................ ................ ................ ................
32398

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

71022 6 Chest x-ray ........................................................................................ ................ ................ ................ ................ ................

71023 6 Chest x-ray and fluoroscopy ............................................................. ................ ................ ................ ................ ................

71030 6 Chest x-ray ........................................................................................ ................ ................ ................ ................ ................

71034 6 Chest x-ray & fluoroscopy ................................................................ ................ ................ ................ ................ ................

71035 6 Chest x-ray ........................................................................................ ................ ................ ................ ................ ................

71036 6 X-ray guidance for biopsy ................................................................. ................ ................ ................ ................ ................

71038 6 X-ray guidance for biopsy ................................................................. ................ ................ ................ ................ ................

71040 6 Contrast x-ray of bronchi .................................................................. ................ ................ ................ ................ ................

71060 6 Contrast x-ray of bronchi .................................................................. ................ ................ ................ ................ ................

71090 6 X-ray & pacemaker insertion ............................................................ ................ ................ ................ ................ ................

71100 6 X-ray exam of ribs ............................................................................ ................ ................ ................ ................ ................

71101 6 X-ray exam of ribs, chest .................................................................. ................ ................ ................ ................ ................

71110 6 X-ray exam of ribs ............................................................................ ................ ................ ................ ................ ................

71111 6 X-ray exam of ribs, chest .................................................................. ................ ................ ................ ................ ................

71120 6 X-ray exam of breastbone ................................................................ ................ ................ ................ ................ ................

71130 6 X-ray exam of breastbone ................................................................ ................ ................ ................ ................ ................

71250 6 Cat scan of chest .............................................................................. ................ ................ ................ ................ ................

71260 6 Contrast CAT scan of chest ............................................................. ................ ................ ................ ................ ................

71270 6 Contrast CAT scans of chest ............................................................ ................ ................ ................ ................ ................

71550 6 Magnetic image, chest ...................................................................... ................ ................ ................ ................ ................

71555 9 Magnetic imaging/chest (MRA) ......................................................... ................ ................ ................ ................ ................

72010 6 X-ray exam of spine .......................................................................... ................ ................ ................ ................ ................

72020 6 X-ray exam of spine .......................................................................... ................ ................ ................ ................ ................

72040 6 X-ray exam of neck spine ................................................................. ................ ................ ................ ................ ................

72050 6 X-ray exam of neck spine ................................................................. ................ ................ ................ ................ ................

72052 6 X-ray exam of neck spine ................................................................. ................ ................ ................ ................ ................

72069 6 X-ray exam of trunk spine ................................................................ ................ ................ ................ ................ ................

72070 6 X-ray exam of thorax spine .............................................................. ................ ................ ................ ................ ................

72072 6 X-ray exam of thoracic spine ............................................................ ................ ................ ................ ................ ................

72074 6 X-ray exam of thoracic spine ............................................................ ................ ................ ................ ................ ................

72080 6 X-ray exam of trunk spine ................................................................ ................ ................ ................ ................ ................

72090 6 X-ray exam of trunk spine ................................................................ ................ ................ ................ ................ ................

72100 6 X-ray exam of lower spine ................................................................ ................ ................ ................ ................ ................

72110 6 X-ray exam of lower spine ................................................................ ................ ................ ................ ................ ................

72114 6 X-ray exam of lower spine ................................................................ ................ ................ ................ ................ ................

72120 6 X-ray exam of lower spine ................................................................ ................ ................ ................ ................ ................

72125 6 CAT scan of neck spine ................................................................... ................ ................ ................ ................ ................

72126 6 Contrast CAT scan of neck .............................................................. ................ ................ ................ ................ ................

72127 6 Contrast CAT scans of neck ............................................................. ................ ................ ................ ................ ................

72128 6 CAT scan of thorax spine ................................................................. ................ ................ ................ ................ ................

72129 6 Contrast CAT scan of thorax ............................................................ ................ ................ ................ ................ ................

72130 6 Contrast CAT scans of thorax .......................................................... ................ ................ ................ ................ ................

72131 6 CAT scan of lower spine .................................................................. ................ ................ ................ ................ ................

72132 6 Contrast CAT of lower spine ............................................................ ................ ................ ................ ................ ................

72133 6 Contrast CAT scans, low spine ........................................................ ................ ................ ................ ................ ................

72141 6 Magnetic image, neck spine ............................................................. ................ ................ ................ ................ ................

72142 6 Magnetic image, neck spine ............................................................. ................ ................ ................ ................ ................

72146 6 Magnetic image, chest spine ............................................................ ................ ................ ................ ................ ................

72147 6 Magnetic image, chest spine ............................................................ ................ ................ ................ ................ ................

72148 6 Magnetic image, lumbar spine .......................................................... ................ ................ ................ ................ ................

72149 6 Magnetic image, lumbar spine .......................................................... ................ ................ ................ ................ ................

72156 6 Magnetic image, neck spine ............................................................. ................ ................ ................ ................ ................

72157 6 Magnetic image, chest spine ............................................................ ................ ................ ................ ................ ................

72158 6 Magnetic image, lumbar spine .......................................................... ................ ................ ................ ................ ................

72159 9 Magnetic imaging/spine (MRA) ......................................................... ................ ................ ................ ................ ................

72170 6 X-ray exam of pelvis ......................................................................... ................ ................ ................ ................ ................

72190 6 X-ray exam of pelvis ......................................................................... ................ ................ ................ ................ ................

72192 6 CAT scan of pelvis ............................................................................ ................ ................ ................ ................ ................

72193 6 Contrast CAT scan of pelvis ............................................................. ................ ................ ................ ................ ................

72194 6 Contrast CAT scans of pelvis ........................................................... ................ ................ ................ ................ ................

72196 6 Magnetic image, pelvis ..................................................................... ................ ................ ................ ................ ................

72198 9 Magnetic imaging/pelvis(MRA) ......................................................... ................ ................ ................ ................ ................

72200 6 X-ray exam sacroiliac joints .............................................................. ................ ................ ................ ................ ................

72202 6 X-ray exam sacroiliac joints .............................................................. ................ ................ ................ ................ ................

72220 6 X-ray exam of tailbone ...................................................................... ................ ................ ................ ................ ................

72240 6 Contrast x-ray of neck spine ............................................................. ................ ................ ................ ................ ................

72255 6 Contrast x-ray thorax spine .............................................................. ................ ................ ................ ................ ................

72265 6 Contrast x-ray lower spine ................................................................ ................ ................ ................ ................ ................

72270 6 Contrast x-ray of spine ..................................................................... ................ ................ ................ ................ ................

72285 6 X-ray of neck spine disk ................................................................... ................ ................ ................ ................ ................

72295 6 X-ray of lower spine disk .................................................................. ................ ................ ................ ................ ................

73000 6 X-ray exam of collarbone .................................................................. ................ ................ ................ ................ ................

73010 6 X-ray exam of shoulder blade .......................................................... ................ ................ ................ ................ ................

73020 6 X-ray exam of shoulder .................................................................... ................ ................ ................ ................ ................
32399

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

73030 6 X-ray exam of shoulder .................................................................... ................ ................ ................ ................ ................

73040 6 Contrast x-ray of shoulder ................................................................ ................ ................ ................ ................ ................

73050 6 X-ray exam of shoulders ................................................................... ................ ................ ................ ................ ................

73060 6 X-ray exam of humerus .................................................................... ................ ................ ................ ................ ................

73070 6 X-ray exam of elbow ......................................................................... ................ ................ ................ ................ ................

73080 6 X-ray exam of elbow ......................................................................... ................ ................ ................ ................ ................

73085 6 Contrast x-ray of elbow ..................................................................... ................ ................ ................ ................ ................

73090 6 X-ray exam of forearm ...................................................................... ................ ................ ................ ................ ................

73092 6 X-ray exam of arm, infant ................................................................. ................ ................ ................ ................ ................

73100 6 X-ray exam of wrist ........................................................................... ................ ................ ................ ................ ................

73110 6 X-ray exam of wrist ........................................................................... ................ ................ ................ ................ ................

73115 6 Contrast x-ray of wrist ....................................................................... ................ ................ ................ ................ ................

73120 6 X-ray exam of hand .......................................................................... ................ ................ ................ ................ ................

73130 6 X-ray exam of hand .......................................................................... ................ ................ ................ ................ ................

73140 6 X-ray exam of finger(s) ..................................................................... ................ ................ ................ ................ ................

73200 6 CAT scan of arm ............................................................................... ................ ................ ................ ................ ................

73201 6 Contrast CAT scan of arm ................................................................ ................ ................ ................ ................ ................

73202 6 Contrast CAT scans of arm .............................................................. ................ ................ ................ ................ ................

73220 6 Magnetic image, arm, hand .............................................................. ................ ................ ................ ................ ................

73221 6 Magnetic image, joint of arm ............................................................ ................ ................ ................ ................ ................

73225 9 Magnetic imaging/upper (MRA) ........................................................ ................ ................ ................ ................ ................

73500 6 X-ray exam of hip ............................................................................. ................ ................ ................ ................ ................

73510 6 X-ray exam of hip ............................................................................. ................ ................ ................ ................ ................

73520 6 X-ray exam of hips ............................................................................ ................ ................ ................ ................ ................

73525 6 Contrast x-ray of hip ......................................................................... ................ ................ ................ ................ ................

73530 6 X-ray exam of hip ............................................................................. ................ ................ ................ ................ ................

73540 6 X-ray exam of pelvis & hips .............................................................. ................ ................ ................ ................ ................

73550 6 X-ray exam of thigh .......................................................................... ................ ................ ................ ................ ................

73560 6 X-ray exam of knee .......................................................................... ................ ................ ................ ................ ................

73562 6 X-ray exam of knee .......................................................................... ................ ................ ................ ................ ................

73564 6 X-ray exam of knee .......................................................................... ................ ................ ................ ................ ................

73565 6 X-ray exam of knee .......................................................................... ................ ................ ................ ................ ................

73580 6 Contrast x-ray of knee joint .............................................................. ................ ................ ................ ................ ................

73590 6 X-ray exam of lower leg .................................................................... ................ ................ ................ ................ ................

73592 6 X-ray exam of leg, infant .................................................................. ................ ................ ................ ................ ................

73600 6 X-ray exam of ankle .......................................................................... ................ ................ ................ ................ ................

73610 6 X-ray exam of ankle .......................................................................... ................ ................ ................ ................ ................

73615 6 Contrast x-ray of ankle ..................................................................... ................ ................ ................ ................ ................

73620 6 X-ray exam of foot ............................................................................ ................ ................ ................ ................ ................

73630 6 X-ray exam of foot ............................................................................ ................ ................ ................ ................ ................

73650 6 X-ray exam of heel ........................................................................... ................ ................ ................ ................ ................

73660 6 X-ray exam of toe(s) ......................................................................... ................ ................ ................ ................ ................

73700 6 CAT scan of leg ................................................................................ ................ ................ ................ ................ ................

73701 6 Contrast CAT scan of leg ................................................................. ................ ................ ................ ................ ................

73702 6 Contrast CAT scans of leg ............................................................... ................ ................ ................ ................ ................

73720 6 Magnetic image, leg, foot ................................................................. ................ ................ ................ ................ ................

73721 6 Magnetic image, joint of leg .............................................................. ................ ................ ................ ................ ................

73725 6 Magnetic imaging/lower (MRA) ......................................................... ................ ................ ................ ................ ................

74000 6 X-ray exam of abdomen ................................................................... ................ ................ ................ ................ ................

74010 6 X-ray exam of abdomen ................................................................... ................ ................ ................ ................ ................

74020 6 X-ray exam of abdomen ................................................................... ................ ................ ................ ................ ................

74022 6 X-ray exam series, abdomen ............................................................ ................ ................ ................ ................ ................

74150 6 CAT scan of abdomen ...................................................................... ................ ................ ................ ................ ................

74160 6 Contrast CAT scan of abdomen ....................................................... ................ ................ ................ ................ ................

74170 6 Contrast CAT scans, abdomen ........................................................ ................ ................ ................ ................ ................

74181 6 Magnetic image,abdomen (MRI) ...................................................... ................ ................ ................ ................ ................

74185 9 Magnetic image/abdomen (MRA) ..................................................... ................ ................ ................ ................ ................

74190 6 X-ray exam of peritoneum ................................................................ ................ ................ ................ ................ ................

74210 6 Contrast xray exam of throat ............................................................ ................ ................ ................ ................ ................

74220 6 Contrast xray exam, esophagus ....................................................... ................ ................ ................ ................ ................

74230 6 Cinema xray throat/esophagus ......................................................... ................ ................ ................ ................ ................

74235 6 Remove esophagus obstruction ....................................................... ................ ................ ................ ................ ................

74240 6 X-ray exam upper GI tract ................................................................ ................ ................ ................ ................ ................

74241 6 X-ray exam upper GI tract ................................................................ ................ ................ ................ ................ ................

74245 6 X-ray exam upper GI tract ................................................................ ................ ................ ................ ................ ................

74246 6 Contrast xray upper GI tract ............................................................. ................ ................ ................ ................ ................

74247 6 Contrast xray upper GI tract ............................................................. ................ ................ ................ ................ ................

74249 6 Contrast xray upper GI tract ............................................................. ................ ................ ................ ................ ................

74250 6 X-ray exam of small bowel ............................................................... ................ ................ ................ ................ ................

74251 6 X-ray exam of small bowel ............................................................... ................ ................ ................ ................ ................

74260 6 X-ray exam of small bowel ............................................................... ................ ................ ................ ................ ................

74270 6 Contrast x-ray exam of colon ........................................................... ................ ................ ................ ................ ................

74280 6 Contrast x-ray exam of colon ........................................................... ................ ................ ................ ................ ................

74283 6 Contrast x-ray exam of colon ........................................................... ................ ................ ................ ................ ................
32400

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

74290 6 Contrast x-ray, gallbladder ................................................................ ................ ................ ................ ................ ................

74291 6 Contrast x-rays, gallbladder .............................................................. ................ ................ ................ ................ ................

74300 6 X-ray bile ducts, pancreas ................................................................ ................ ................ ................ ................ ................

74301 6 Add.itional x-rays at surgery ............................................................. ................ ................ ................ ................ ................

74305 6 X-ray bile ducts, pancreas ................................................................ ................ ................ ................ ................ ................

74320 6 Contrast x-ray of bile ducts ............................................................... ................ ................ ................ ................ ................

74327 6 X-ray for bile stone removal ............................................................. ................ ................ ................ ................ ................

74328 6 Xray for bile duct endoscopy ............................................................ ................ ................ ................ ................ ................

74329 6 X-ray for pancreas endoscopy .......................................................... ................ ................ ................ ................ ................

74330 6 Xray,bile/pancreas endoscopy .......................................................... ................ ................ ................ ................ ................

74340 6 X-ray guide for GI tube ..................................................................... ................ ................ ................ ................ ................

74350 6 X-ray guide, stomach tube ................................................................ ................ ................ ................ ................ ................

74355 6 X-ray guide, intestinal tube ............................................................... ................ ................ ................ ................ ................

74360 6 X-ray guide, GI dilation ..................................................................... ................ ................ ................ ................ ................

74363 6 X-ray, bile duct dilation ..................................................................... ................ ................ ................ ................ ................

74400 6 Contrast x-ray urinary tract ............................................................... ................ ................ ................ ................ ................

74405 6 Contrast x-ray urinary tract ............................................................... ................ ................ ................ ................ ................

74410 6 Contrast x-ray urinary tract ............................................................... ................ ................ ................ ................ ................

74415 6 Contrast x-ray urinary tract ............................................................... ................ ................ ................ ................ ................

74420 6 Contrast x-ray urinary tract ............................................................... ................ ................ ................ ................ ................

74425 6 Contrast x-ray urinary tract ............................................................... ................ ................ ................ ................ ................

74430 6 Contrast x-ray of bladder .................................................................. ................ ................ ................ ................ ................

74440 6 Xray exam male genital tract ............................................................ ................ ................ ................ ................ ................

74445 6 X-ray exam of penis .......................................................................... ................ ................ ................ ................ ................

74450 6 X-ray exam urethra/bladder .............................................................. ................ ................ ................ ................ ................

74455 6 X-ray exam urethra/bladder .............................................................. ................ ................ ................ ................ ................

74470 6 X-ray exam of kidney lesion ............................................................. ................ ................ ................ ................ ................

74475 6 Xray control catheter insert ............................................................... ................ ................ ................ ................ ................

74480 6 Xray control catheter insert ............................................................... ................ ................ ................ ................ ................

74485 6 X-ray guide, GU dilation ................................................................... ................ ................ ................ ................ ................

74710 6 X-ray measurement of pelvis ............................................................ ................ ................ ................ ................ ................

74740 6 X-ray female genital tract .................................................................. ................ ................ ................ ................ ................

74742 6 X-ray fallopian tube ........................................................................... ................ ................ ................ ................ ................

74775 6 X-ray exam of perineum ................................................................... ................ ................ ................ ................ ................

75552 6 Magnetic image, myocardium ........................................................... ................ ................ ................ ................ ................

75553 6 Magnetic image, myocardium ........................................................... ................ ................ ................ ................ ................

75554 6 Cardiac MRI/function ........................................................................ ................ ................ ................ ................ ................

75555 6 Cardiac MRI/limited study ................................................................. ................ ................ ................ ................ ................

75556 9 Cardiac MRI/flow mapping ................................................................ ................ ................ ................ ................ ................

75600 6 Contrast x-ray exam of aorta ............................................................ ................ ................ ................ ................ ................

75605 6 Contrast x-ray exam of aorta ............................................................ ................ ................ ................ ................ ................

75625 6 Contrast x-ray exam of aorta ............................................................ ................ ................ ................ ................ ................

75630 6 X-ray aorta, leg arteries .................................................................... ................ ................ ................ ................ ................

75650 6 Artery x-rays, head & neck ............................................................... ................ ................ ................ ................ ................

75658 6 X-ray exam of arm arteries ............................................................... ................ ................ ................ ................ ................

75660 6 Artery x-rays, head & neck ............................................................... ................ ................ ................ ................ ................

75662 6 Artery x-rays, head & neck ............................................................... ................ ................ ................ ................ ................

75665 6 Artery x-rays, head & neck ............................................................... ................ ................ ................ ................ ................

75671 6 Artery x-rays, head & neck ............................................................... ................ ................ ................ ................ ................

5676 6 Artery x-rays, neck ............................................................................ ................ ................ ................ ................ ................

75680 6 Artery x-rays, neck ............................................................................ ................ ................ ................ ................ ................

75685 6 Artery x-rays, spine ........................................................................... ................ ................ ................ ................ ................

75705 6 Artery x-rays, spine ........................................................................... ................ ................ ................ ................ ................

75710 6 Artery x-rays, arm/leg ....................................................................... ................ ................ ................ ................ ................

75716 6 Artery x-rays, arms/legs .................................................................... ................ ................ ................ ................ ................

75722 6 Artery x-rays, kidney ......................................................................... ................ ................ ................ ................ ................

75724 6 Artery x-rays, kidneys ....................................................................... ................ ................ ................ ................ ................

75726 6 Artery x-rays, abdomen .................................................................... ................ ................ ................ ................ ................

75731 6 Artery x-rays, adrenal gland ............................................................. ................ ................ ................ ................ ................

75733 6 Artery x-rays,adrenal glands ............................................................. ................ ................ ................ ................ ................

75736 6 Artery x-rays, pelvis .......................................................................... ................ ................ ................ ................ ................

75741 6 Artery x-rays, lung ............................................................................. ................ ................ ................ ................ ................

75743 6 Artery x-rays, lungs ........................................................................... ................ ................ ................ ................ ................

75746 6 Artery x-rays, lung ............................................................................. ................ ................ ................ ................ ................

75756 6 Artery x-rays, chest ........................................................................... ................ ................ ................ ................ ................

75774 6 Artery x-ray, each vessel .................................................................. ................ ................ ................ ................ ................

75790 6 Visualize A-V shunt ........................................................................... ................ ................ ................ ................ ................

75801 6 Lymph vessel x-ray, arm/leg ............................................................. ................ ................ ................ ................ ................

75803 6 Lymph vessel x-ray, arms/legs ......................................................... ................ ................ ................ ................ ................

75805 6 Lymph vessel x-ray, trunk ................................................................. ................ ................ ................ ................ ................

75807 6 Lymph vessel x-ray, trunk ................................................................. ................ ................ ................ ................ ................

75809 6 Nonvascular shunt, x-ray .................................................................. ................ ................ ................ ................ ................

75810 6 Vein x-ray, spleen/liver ..................................................................... ................ ................ ................ ................ ................

75820 6 Vein x-ray, arm/leg ............................................................................ ................ ................ ................ ................ ................
32401

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

75822 6 Vein x-ray, arms/legs ........................................................................ ................ ................ ................ ................ ................

75825 6 Vein x-ray, trunk ................................................................................ ................ ................ ................ ................ ................

75827 6 Vein x-ray, chest ............................................................................... ................ ................ ................ ................ ................

75831 6 Vein x-ray, kidney ............................................................................. ................ ................ ................ ................ ................

75833 6 Vein x-ray, kidneys ........................................................................... ................ ................ ................ ................ ................

75840 6 Vein x-ray, adrenal gland .................................................................. ................ ................ ................ ................ ................

75842 6 Vein x-ray, adrenal glands ................................................................ ................ ................ ................ ................ ................

75860 6 Vein x-ray, neck ................................................................................ ................ ................ ................ ................ ................

75870 6 Vein x-ray, skull ................................................................................ ................ ................ ................ ................ ................

75872 6 Vein x-ray, skull ................................................................................ ................ ................ ................ ................ ................

75880 6 Vein x-ray, eye socket ...................................................................... ................ ................ ................ ................ ................

75885 6 Vein x-ray, liver ................................................................................. ................ ................ ................ ................ ................

75887 6 Vein x-ray, liver ................................................................................. ................ ................ ................ ................ ................

75889 6 Vein x-ray, liver ................................................................................. ................ ................ ................ ................ ................

75891 6 Vein x-ray, liver ................................................................................. ................ ................ ................ ................ ................

75893 6 Venous sampling by catheter ........................................................... ................ ................ ................ ................ ................

75894 6 Xrays, transcatheter therapy ............................................................. ................ ................ ................ ................ ................

75896 6 Xrays, transcatheter therapy ............................................................. ................ ................ ................ ................ ................

75898 6 Follow-up angiogram ........................................................................ ................ ................ ................ ................ ................

75900 6 Arterial catheter exchange ................................................................ ................ ................ ................ ................ ................

75940 6 X-ray placement, vein filter ............................................................... ................ ................ ................ ................ ................

75945 6 Intravascular us ................................................................................. ................ ................ ................ ................ ................

75946 6 Intravascular us ................................................................................. ................ ................ ................ ................ ................

75960 6 Transcatheter intro, stent .................................................................. ................ ................ ................ ................ ................

75961 6 Retrieval, broken catheter ................................................................. ................ ................ ................ ................ ................

75962 6 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

75964 6 Repair artery blockage, each ............................................................ ................ ................ ................ ................ ................

75966 6 Repair arterial blockage .................................................................... ................ ................ ................ ................ ................

75968 6 Repair artery blockage, each ............................................................ ................ ................ ................ ................ ................

75970 6 Vascular biopsy ................................................................................. ................ ................ ................ ................ ................

75978 6 Repair venous blockage ................................................................... ................ ................ ................ ................ ................

75980 6 Contrast xray exam bile duct ............................................................ ................ ................ ................ ................ ................

75982 6 Contrast xray exam bile duct ............................................................ ................ ................ ................ ................ ................

75984 6 Xray control catheter change ............................................................ ................ ................ ................ ................ ................

75989 6 Abscess drainage under x-ray .......................................................... ................ ................ ................ ................ ................

75992 6 Atherectomy, x-ray exam .................................................................. ................ ................ ................ ................ ................

75993 6 Atherectomy, x-ray exam .................................................................. ................ ................ ................ ................ ................

75994 6 Atherectomy, x-ray exam .................................................................. ................ ................ ................ ................ ................

75995 6 Atherectomy, x-ray exam .................................................................. ................ ................ ................ ................ ................

75996 6 Atherectomy, x-ray exam .................................................................. ................ ................ ................ ................ ................

76000 6 Fluoroscope examination .................................................................. ................ ................ ................ ................ ................

76001 6 Fluoroscope exam, extensive ........................................................... ................ ................ ................ ................ ................

76003 6 Needle localization by x-ray .............................................................. ................ ................ ................ ................ ................

76010 6 X-ray, nose to rectum ....................................................................... ................ ................ ................ ................ ................

76020 6 X-rays for bone age .......................................................................... ................ ................ ................ ................ ................

76040 6 X-rays, bone evaluation .................................................................... ................ ................ ................ ................ ................

76061 6 X-rays, bone survey .......................................................................... ................ ................ ................ ................ ................

76062 6 X-rays, bone survey .......................................................................... ................ ................ ................ ................ ................

76065 6 X-rays, bone evaluation .................................................................... ................ ................ ................ ................ ................

76066 6 Joint(s) survey, single film ................................................................ ................ ................ ................ ................ ................

76070 6 CT scan, bone density study ............................................................ ................ ................ ................ ................ ................

76075 6 Dual energy x-ray study .................................................................... ................ ................ ................ ................ ................

76076 6 Dual energy x-ray study .................................................................... ................ ................ ................ ................ ................

76078 6 Photodensitometry ............................................................................ ................ ................ ................ ................ ................

76080 6 X-ray exam of fistula ......................................................................... ................ ................ ................ ................ ................

76086 6 X-ray of mammary duct .................................................................... ................ ................ ................ ................ ................

76088 6 X-ray of mammary ducts .................................................................. ................ ................ ................ ................ ................

76090 6 Mammogram, one breast .................................................................. ................ ................ ................ ................ ................

76091 6 Mammogram, both breasts ............................................................... ................ ................ ................ ................ ................

76092 9 Mamm0gram, screening ................................................................... ................ ................ ................ ................ ................

76093 6 Magnetic image, breast .................................................................... ................ ................ ................ ................ ................

76094 6 Magnetic image, both breasts .......................................................... ................ ................ ................ ................ ................

76095 6 Stereotactic breast biopsy ................................................................ ................ ................ ................ ................ ................

76096 6 X-ray of needle wire, breast ............................................................. ................ ................ ................ ................ ................

76098 6 X-ray exam, breast specimen ........................................................... ................ ................ ................ ................ ................

76100 6 X-ray exam of body section .............................................................. ................ ................ ................ ................ ................

76101 6 Complex body section x-ray ............................................................. ................ ................ ................ ................ ................

76102 6 Complex body section x-rays ........................................................... ................ ................ ................ ................ ................

76120 6 Cinematic x-rays ............................................................................... ................ ................ ................ ................ ................

76125 6 Cinematic x-rays ............................................................................... ................ ................ ................ ................ ................

76140 9 X-ray consultation ............................................................................. ................ ................ ................ ................ ................

76150 6 X-ray exam, dry process ................................................................... ................ ................ ................ ................ ................

76350 6 Special x-ray contrast study ............................................................. ................ ................ ................ ................ ................

76355 6 CAT scan for localization .................................................................. ................ ................ ................ ................ ................
32402

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

76360 6 CAT scan for needle biopsy ............................................................. ................ ................ ................ ................ ................

76365 6 CAT scan for cyst aspiration ............................................................ ................ ................ ................ ................ ................

76370 6 CAT scan for therapy guide .............................................................. ................ ................ ................ ................ ................

76375 6 3d/holograph reconstr add-on ........................................................... ................ ................ ................ ................ ................

76380 6 CAT scan follow-up study ................................................................. ................ ................ ................ ................ ................

76390 6 Mr spectroscopy ................................................................................ ................ ................ ................ ................ ................

76400 6 Magnetic image, bone marrow ......................................................... ................ ................ ................ ................ ................

76499 6 Radiographic procedure .................................................................... ................ ................ ................ ................ ................

76506 6 Echo exam of head ........................................................................... ................ ................ ................ ................ ................

76511 6 Echo exam of eye ............................................................................. ................ ................ ................ ................ ................

76512 6 Echo exam of eye ............................................................................. ................ ................ ................ ................ ................

76513 6 Echo exam of eye, water bath .......................................................... ................ ................ ................ ................ ................

76516 6 Echo exam of eye ............................................................................. ................ ................ ................ ................ ................

76519 6 Echo exam of eye ............................................................................. ................ ................ ................ ................ ................

76529 6 Echo exam of eye ............................................................................. ................ ................ ................ ................ ................

76536 6 Echo exam of head and neck ........................................................... ................ ................ ................ ................ ................

76604 6 Echo exam of chest .......................................................................... ................ ................ ................ ................ ................

76645 6 Echo exam of breast ......................................................................... ................ ................ ................ ................ ................

76700 6 Echo exam of abdomen .................................................................... ................ ................ ................ ................ ................

76705 6 Echo exam of abdomen .................................................................... ................ ................ ................ ................ ................

76770 6 Echo exam abdomen back wall ........................................................ ................ ................ ................ ................ ................

76775 6 Echo exam abdomen back wall ........................................................ ................ ................ ................ ................ ................

76778 6 Echo exam kidney transplant ........................................................... ................ ................ ................ ................ ................

76800 6 Echo exam spinal canal .................................................................... ................ ................ ................ ................ ................

76805 6 Echo exam of pregnant uterus ......................................................... ................ ................ ................ ................ ................

76810 6 Echo exam of pregnant uterus ......................................................... ................ ................ ................ ................ ................

76815 6 Echo exam of pregnant uterus ......................................................... ................ ................ ................ ................ ................

76816 6 Echo exam followup or repeat .......................................................... ................ ................ ................ ................ ................

76818 6 Fetal biophysical profile .................................................................... ................ ................ ................ ................ ................

76825 6 Echo exam of fetal heart .................................................................. ................ ................ ................ ................ ................

76826 6 Echo exam of fetal heart .................................................................. ................ ................ ................ ................ ................

76827 6 Echo exam of fetal heart .................................................................. ................ ................ ................ ................ ................

76828 6 Echo exam of fetal heart .................................................................. ................ ................ ................ ................ ................

76830 6 Echo exam, transvaginal .................................................................. ................ ................ ................ ................ ................

76831 6 Echo exam, uterus ............................................................................ ................ ................ ................ ................ ................

76856 6 Echo exam of pelvis ......................................................................... ................ ................ ................ ................ ................

76857 6 Echo exam of pelvis ......................................................................... ................ ................ ................ ................ ................

76870 6 Echo exam of scrotum ...................................................................... ................ ................ ................ ................ ................

76872 6 Echo exam, transrectal ..................................................................... ................ ................ ................ ................ ................

76880 6 Echo exam of extremity .................................................................... ................ ................ ................ ................ ................

76885 6 Echo exam, infant hips ..................................................................... ................ ................ ................ ................ ................

76886 6 Echo exam, infant hips ..................................................................... ................ ................ ................ ................ ................

76930 6 Echo guide for heart sac tap ............................................................ ................ ................ ................ ................ ................

76932 6 Echo guide for heart biopsy .............................................................. ................ ................ ................ ................ ................

76934 6 Echo guide for chest tap ................................................................... ................ ................ ................ ................ ................

76936 6 Echo guide for artery repair .............................................................. ................ ................ ................ ................ ................

76938 6 Echo exam for drainage ................................................................... ................ ................ ................ ................ ................

76941 6 Echo guide for transfusion ................................................................ ................ ................ ................ ................ ................

76942 6 Echo guide for biopsy ....................................................................... ................ ................ ................ ................ ................

76945 6 Echo guide, villus sampling .............................................................. ................ ................ ................ ................ ................

76946 6 Echo guide for amniocentesis .......................................................... ................ ................ ................ ................ ................

76948 6 Echo guide, ova aspiration ............................................................... ................ ................ ................ ................ ................

76950 6 Echo guidance radiotherapy ............................................................. ................ ................ ................ ................ ................

76960 6 Echo guidance radiotherapy ............................................................. ................ ................ ................ ................ ................

76965 6 Echo guidance radiotherapy ............................................................. ................ ................ ................ ................ ................

76970 6 Ultrasound exam follow-up ............................................................... ................ ................ ................ ................ ................

76975 6 GI endoscopic ultrasound ................................................................. ................ ................ ................ ................ ................

76986 6 Echo exam at surgery ....................................................................... ................ ................ ................ ................ ................

76999 6 Echo examination procedure ............................................................ ................ ................ ................ ................ ................

77261 6 Radiation therapy planning ............................................................... ................ ................ ................ ................ ................

77262 6 Radiation therapy planning ............................................................... ................ ................ ................ ................ ................

77263 6 Radiation therapy planning ............................................................... ................ ................ ................ ................ ................

77280 6 Set radiation therapy field ................................................................. ................ ................ ................ ................ ................

77285 6 Set radiation therapy field ................................................................. ................ ................ ................ ................ ................

77290 6 Set radiation therapy field ................................................................. ................ ................ ................ ................ ................

77295 6 Set radiation therapy field ................................................................. ................ ................ ................ ................ ................

77299 6 Radiation therapy planning ............................................................... ................ ................ ................ ................ ................

77300 6 Radiation therapy dose plan ............................................................. ................ ................ ................ ................ ................

77305 6 Radiation therapy dose plan ............................................................. ................ ................ ................ ................ ................

77310 6 Radiation therapy dose plan ............................................................. ................ ................ ................ ................ ................

77315 6 Radiation therapy dose plan ............................................................. ................ ................ ................ ................ ................

77321 6 Radiation therapy port plan .............................................................. ................ ................ ................ ................ ................

77326 6 Radiation therapy dose plan ............................................................. ................ ................ ................ ................ ................

77327 6 Radiation therapy dose plan ............................................................. ................ ................ ................ ................ ................
32403

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

77328 6 Radiation therapy dose plan ............................................................. ................ ................ ................ ................ ................

77331 6 Special radiation dosimetry ............................................................... ................ ................ ................ ................ ................

77332 6 Radiation treatment aid(s) ................................................................ ................ ................ ................ ................ ................

77333 6 Radiation treatment aid(s) ................................................................ ................ ................ ................ ................ ................

77334 6 Radiation treatment aid(s) ................................................................ ................ ................ ................ ................ ................

77336 6 Radiation physics consu ................................................................... ................ ................ ................ ................ ................

77370 6 Radiation physics consult ................................................................. ................ ................ ................ ................ ................

77399 6 External radiation dosimetry ............................................................. ................ ................ ................ ................ ................

77401 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77402 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77403 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77404 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77406 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77407 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77408 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77409 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77411 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77412 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77413 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77414 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77416 6 Radiation treatment delivery ............................................................. ................ ................ ................ ................ ................

77417 6 Radiology port film(s) ........................................................................ ................ ................ ................ ................ ................

77419 6 Weekly radiation therapy .................................................................. ................ ................ ................ ................ ................

77420 6 Weekly radiation therapy .................................................................. ................ ................ ................ ................ ................

77425 6 Weekly radiation therapy .................................................................. ................ ................ ................ ................ ................

77430 6 Weekly radiation therapy .................................................................. ................ ................ ................ ................ ................

77431 6 Radiation therapy management ........................................................ ................ ................ ................ ................ ................

77432 6 Stereotactic radiation trmt ................................................................. ................ ................ ................ ................ ................

77470 6 Special radiation treatment ............................................................... ................ ................ ................ ................ ................

77499 6 Radiation therapy management ........................................................ ................ ................ ................ ................ ................

77600 6 Hyperthermia treatment .................................................................... ................ ................ ................ ................ ................

77605 6 Hyperthermia treatment .................................................................... ................ ................ ................ ................ ................

77610 6 Hyperthermia treatment .................................................................... ................ ................ ................ ................ ................

77615 6 Hyperthermia treatment .................................................................... ................ ................ ................ ................ ................

77620 6 Hyperthermia treatment .................................................................... ................ ................ ................ ................ ................

77750 6 Infuse radioactive materials .............................................................. ................ ................ ................ ................ ................

77761 6 Radioelement application .................................................................. ................ ................ ................ ................ ................

77762 6 Radioelement application .................................................................. ................ ................ ................ ................ ................

77763 6 Radioelement application .................................................................. ................ ................ ................ ................ ................

77776 6 Radioelement application .................................................................. ................ ................ ................ ................ ................

77777 6 Radioelement application .................................................................. ................ ................ ................ ................ ................

77778 6 Radioelement application .................................................................. ................ ................ ................ ................ ................

77781 6 High intensity brachytherapy ............................................................ ................ ................ ................ ................ ................

77782 6 High intensity brachytherapy ............................................................ ................ ................ ................ ................ ................

77783 6 High intensity brachytherapy ............................................................ ................ ................ ................ ................ ................

77784 6 High intensity brachytherapy ............................................................ ................ ................ ................ ................ ................

77789 6 Radioelement application .................................................................. ................ ................ ................ ................ ................

77790 6 Radioelement handling ..................................................................... ................ ................ ................ ................ ................

77799 6 Radium/radioisotope therapy ............................................................ ................ ................ ................ ................ ................

78000 6 Thyroid, single uptake ....................................................................... ................ ................ ................ ................ ................

78001 6 Thyroid, multiple uptakes .................................................................. ................ ................ ................ ................ ................

78003 6 Thyroid suppress/stimul .................................................................... ................ ................ ................ ................ ................

78006 6 Thyroid, imaging with uptake ............................................................ ................ ................ ................ ................ ................

78007 6 Thyroid, image, mult uptakes ........................................................... ................ ................ ................ ................ ................

78010 6 Thyroid imaging ................................................................................ ................ ................ ................ ................ ................

78011 6 Thyroid imaging with flow ................................................................. ................ ................ ................ ................ ................

78015 6 Thyroid met imaging ......................................................................... ................ ................ ................ ................ ................

78016 6 Thyroid met imaging/studies ............................................................. ................ ................ ................ ................ ................

78017 6 Thyroid met imaging, mult ................................................................ ................ ................ ................ ................ ................

78018 6 Thyroid, met imaging, body .............................................................. ................ ................ ................ ................ ................

78070 6 Parathyroid nuclear imaging ............................................................. ................ ................ ................ ................ ................

78075 6 Adrenal nuclear imaging ................................................................... ................ ................ ................ ................ ................

78099 6 Endocrine nuclear procedure ............................................................ ................ ................ ................ ................ ................

78102 6 Bone marrow imaging, ltd ................................................................. ................ ................ ................ ................ ................

78103 6 Bone marrow imaging, mult .............................................................. ................ ................ ................ ................ ................

78104 6 Bone marrow imaging, body ............................................................. ................ ................ ................ ................ ................

78110 6 Plasma volume, single ...................................................................... ................ ................ ................ ................ ................

78111 6 Plasma volume, multiple ................................................................... ................ ................ ................ ................ ................

78120 6 Red cell mass, single ........................................................................ ................ ................ ................ ................ ................

78121 6 Red cell mass, multiple ..................................................................... ................ ................ ................ ................ ................

78122 6 Blood volume .................................................................................... ................ ................ ................ ................ ................

78130 6 Red cell survival study ...................................................................... ................ ................ ................ ................ ................

78135 6 Red cell survival kinetics .................................................................. ................ ................ ................ ................ ................

78140 6 Red cell sequestration ...................................................................... ................ ................ ................ ................ ................
32404

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

78160 6 Plasma iron turnover ......................................................................... ................ ................ ................ ................ ................

78162 6 Iron absorption exam ........................................................................ ................ ................ ................ ................ ................

78170 6 Red cell iron utilization ...................................................................... ................ ................ ................ ................ ................

78172 6 Total body iron estimation ................................................................ ................ ................ ................ ................ ................

78185 6 Spleen imaging ................................................................................. ................ ................ ................ ................ ................

78190 6 Platelet survival, kinetics ................................................................... ................ ................ ................ ................ ................

78191 6 Platelet survival ................................................................................. ................ ................ ................ ................ ................

78195 6 Lymph system imaging ..................................................................... ................ ................ ................ ................ ................

78199 6 Blood/lymph nuclear exam ............................................................... ................ ................ ................ ................ ................

78201 6 Liver imaging ..................................................................................... ................ ................ ................ ................ ................

78202 6 Liver imaging with flow ..................................................................... ................ ................ ................ ................ ................

78205 6 Liver imaging (3D) ............................................................................ ................ ................ ................ ................ ................

78215 6 Liver and spleen imaging .................................................................. ................ ................ ................ ................ ................

78216 6 Liver & spleen image, flow ............................................................... ................ ................ ................ ................ ................

78220 6 Liver function study ........................................................................... ................ ................ ................ ................ ................

78223 6 Hepatobiliary imaging ....................................................................... ................ ................ ................ ................ ................

78230 6 Salivary gland imaging ...................................................................... ................ ................ ................ ................ ................

78231 6 Serial salivary imaging ...................................................................... ................ ................ ................ ................ ................

78232 6 Salivary gland function exam ............................................................ ................ ................ ................ ................ ................

78258 6 Esophageal motility study ................................................................. ................ ................ ................ ................ ................

78261 6 Gastric mucosa imaging ................................................................... ................ ................ ................ ................ ................

78262 6 Gastroesophageal reflux exam ......................................................... ................ ................ ................ ................ ................

78264 6 Gastric emptying study ..................................................................... ................ ................ ................ ................ ................

78270 6 Vit B-12 absorption exam ................................................................. ................ ................ ................ ................ ................

78271 6 Vit B-12 absorp exam, IF .................................................................. ................ ................ ................ ................ ................

78272 6 Vit B-12 absorp, combined ............................................................... ................ ................ ................ ................ ................

78278 6 Acute GI blood loss imaging ............................................................. ................ ................ ................ ................ ................

78282 6 GI protein loss exam ......................................................................... ................ ................ ................ ................ ................

78290 6 Meckel’s divert exam ........................................................................ ................ ................ ................ ................ ................

78291 6 Leveen/shunt patency exam ............................................................. ................ ................ ................ ................ ................

78299 6 GI nuclear procedure ........................................................................ ................ ................ ................ ................ ................

78300 6 Bone imaging, limited area ............................................................... ................ ................ ................ ................ ................

78305 6 Bone imaging, multiple areas ........................................................... ................ ................ ................ ................ ................

78306 6 Bone imaging, whole body ............................................................... ................ ................ ................ ................ ................

78315 6 Bone imaging, 3 phase ..................................................................... ................ ................ ................ ................ ................

78320 6 Bone imaging (3D) ............................................................................ ................ ................ ................ ................ ................

78350 6 Bone mineral, single photon ............................................................. ................ ................ ................ ................ ................

78351 9 Bone mineral, dual photon ................................................................ ................ ................ ................ ................ ................

78399 6 Musculoskeletal nuclear exam .......................................................... ................ ................ ................ ................ ................

78414 6 Non-imaging heart function ............................................................... ................ ................ ................ ................ ................

78428 6 Cardiac shunt imaging ...................................................................... ................ ................ ................ ................ ................

78445 6 Vascular flow imaging ....................................................................... ................ ................ ................ ................ ................

78455 6 Venous thrombosis study ................................................................. ................ ................ ................ ................ ................

78457 6 Venous thrombosis imaging ............................................................. ................ ................ ................ ................ ................

78458 6 Ven thrombosis images, bilat ........................................................... ................ ................ ................ ................ ................

78459 9 Heart muscle imaging (PET) ............................................................. ................ ................ ................ ................ ................

78460 6 Heart muscle blood single ................................................................ ................ ................ ................ ................ ................

78461 6 Heart muscle blood multiple ............................................................. ................ ................ ................ ................ ................

78464 6 Heart image (3D) single .................................................................... ................ ................ ................ ................ ................

78465 6 Heart image (3D) multiple ................................................................. ................ ................ ................ ................ ................

78466 6 Heart infarct image ........................................................................... ................ ................ ................ ................ ................

78468 6 Heart infarct image, EF ..................................................................... ................ ................ ................ ................ ................

78469 6 Heart infarct image (3D) ................................................................... ................ ................ ................ ................ ................

78472 6 Gated heart, resting .......................................................................... ................ ................ ................ ................ ................

78473 6 Gated heart, multiple ........................................................................ ................ ................ ................ ................ ................

78478 6 Heart wall motion (add-on) ............................................................... ................ ................ ................ ................ ................

78480 6 Heart function, (add-on) .................................................................... ................ ................ ................ ................ ................

78481 6 Heart first pass single ....................................................................... ................ ................ ................ ................ ................

78483 6 Heart first pass multiple .................................................................... ................ ................ ................ ................ ................

78491 9 Heart image (pet) single ................................................................... ................ ................ ................ ................ ................

78492 9 Heart image (pet) multiple ................................................................ ................ ................ ................ ................ ................

78499 6 Cardiovascular nuclear exam ........................................................... ................ ................ ................ ................ ................

78580 6 Lung perfusion imaging .................................................................... ................ ................ ................ ................ ................

78584 6 Lung V/Q image single breath .......................................................... ................ ................ ................ ................ ................

78585 6 Lung V/Q imaging ............................................................................. ................ ................ ................ ................ ................

78586 6 Aerosol lung image, single ............................................................... ................ ................ ................ ................ ................

78587 6 Aerosol lung image, multiple ............................................................ ................ ................ ................ ................ ................

78591 6 Vent image, 1 breath, 1 proj ............................................................. ................ ................ ................ ................ ................

78593 6 Vent image, 1 proj, gas .................................................................... ................ ................ ................ ................ ................

78594 6 Vent image, mult proj, gas ................................................................ ................ ................ ................ ................ ................

78596 6 Lung differential function ................................................................... ................ ................ ................ ................ ................

78599 6 Respiratory nuclear exam ................................................................. ................ ................ ................ ................ ................

78600 6 Brain imaging, ltd static .................................................................... ................ ................ ................ ................ ................

78601 6 Brain ltd imaging & flow .................................................................... ................ ................ ................ ................ ................
32405

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

78605 6 Brain imaging, complete ................................................................... ................ ................ ................ ................ ................

78606 6 Brain imaging comp & flow ............................................................... ................ ................ ................ ................ ................

78607 6 Brain imaging (3D) ............................................................................ ................ ................ ................ ................ ................

78608 9 Brain imaging (PET) ......................................................................... ................ ................ ................ ................ ................

78609 9 Brain imaging (PET) ......................................................................... ................ ................ ................ ................ ................

78610 6 Brain flow imaging only ..................................................................... ................ ................ ................ ................ ................

78615 6 Cerebral blood flow imaging ............................................................. ................ ................ ................ ................ ................

78630 6 Cerebrospinal fluid scan ................................................................... ................ ................ ................ ................ ................

78635 6 CSF ventriculography ....................................................................... ................ ................ ................ ................ ................

78645 6 CSF shunt evaluation ....................................................................... ................ ................ ................ ................ ................

78647 6 Cerebrospinal fluid scan ................................................................... ................ ................ ................ ................ ................

78650 6 CSF leakage imaging ....................................................................... ................ ................ ................ ................ ................

78660 6 Nuclear exam of tear flow ................................................................. ................ ................ ................ ................ ................

78699 6 Nervous system nuclear exam ......................................................... ................ ................ ................ ................ ................

78700 6 Kidney imaging, static ....................................................................... ................ ................ ................ ................ ................

78701 6 Kidney imaging with flow .................................................................. ................ ................ ................ ................ ................

78704 6 Imaging renogram ............................................................................. ................ ................ ................ ................ ................

78707 6 Kidney flow & function image ........................................................... ................ ................ ................ ................ ................

78708 6 Kidney flow & function image ........................................................... ................ ................ ................ ................ ................

78709 6 Kidney flow & function image ........................................................... ................ ................ ................ ................ ................

78710 6 Kidney imaging (3D) ......................................................................... ................ ................ ................ ................ ................

78715 6 Renal vascular flow exam ................................................................. ................ ................ ................ ................ ................

78725 6 Kidney function study ........................................................................ ................ ................ ................ ................ ................

78730 6 Urinary bladder retention .................................................................. ................ ................ ................ ................ ................

78740 6 Ureteral reflux study .......................................................................... ................ ................ ................ ................ ................

78760 6 Testicular imaging ............................................................................. ................ ................ ................ ................ ................

78761 6 Testicular imaging & flow .................................................................. ................ ................ ................ ................ ................

78799 6 Genitourinary nuclear exam .............................................................. ................ ................ ................ ................ ................

78800 6 Tumor imaging, limited area ............................................................. ................ ................ ................ ................ ................

78801 6 Tumor imaging, mult areas ............................................................... ................ ................ ................ ................ ................

78802 6 Tumor imaging, whole body ............................................................. ................ ................ ................ ................ ................

78803 6 Tumor imaging (3D) .......................................................................... ................ ................ ................ ................ ................

78805 6 Abscess imaging, ltd area ................................................................ ................ ................ ................ ................ ................

78806 6 Abscess imaging, whole body .......................................................... ................ ................ ................ ................ ................

78807 6 Nuclear localization/abscess ............................................................. ................ ................ ................ ................ ................

78810 9 Tumor imaging (PET) ....................................................................... ................ ................ ................ ................ ................

78890 6 Nuclear medicine data proc .............................................................. ................ ................ ................ ................ ................

78891 6 Nuclear med data proc ..................................................................... ................ ................ ................ ................ ................

78990 9 Provide diag radionuclide(s) ............................................................. ................ ................ ................ ................ ................

78999 6 Nuclear diagnostic exam .................................................................. ................ ................ ................ ................ ................

79000 6 Intial hyperthyroid therapy ................................................................ ................ ................ ................ ................ ................

79001 6 Repeat hyperthyroid therapy ............................................................ ................ ................ ................ ................ ................

79020 6 Thyroid ablation ................................................................................ ................ ................ ................ ................ ................

79030 6 Thyroid ablation, carcinoma .............................................................. ................ ................ ................ ................ ................

79035 6 Thyroid metastatic therapy ............................................................... ................ ................ ................ ................ ................

79100 6 Hematopoetic nuclear therapy .......................................................... ................ ................ ................ ................ ................

79200 6 Intracavitary nuc treatment ............................................................... ................ ................ ................ ................ ................

79300 6 Interstitial nuclear therapy ................................................................. ................ ................ ................ ................ ................

79400 6 Nonhemato nuclear therapy ............................................................. ................ ................ ................ ................ ................

79420 6 Intravascular nuc therapy ................................................................. ................ ................ ................ ................ ................

79440 6 Nuclear joint therapy ......................................................................... ................ ................ ................ ................ ................

79900 6 Provide ther radiopharm(s) ............................................................... ................ ................ ................ ................ ................

79999 6 Nuclear medicine therapy ................................................................. ................ ................ ................ ................ ................

80049 6 Metabolic panel, basic ...................................................................... ................ ................ ................ ................ ................

80050 9 General health panel ........................................................................ ................ ................ ................ ................ ................

80051 6 Electrolyte panel ............................................................................... ................ ................ ................ ................ ................

80054 6 Comprehen metabolic panel ............................................................. ................ ................ ................ ................ ................

80055 9 Obstetric panel .................................................................................. ................ ................ ................ ................ ................

80058 6 Hepatic function panel ...................................................................... ................ ................ ................ ................ ................

80059 6 Hepatitis panel .................................................................................. ................ ................ ................ ................ ................

80061 2 Lipid panel ......................................................................................... ................ ................ ................ ................ ................

80072 6 Arthritis panel .................................................................................... ................ ................ ................ ................ ................

80090 6 Torch antibody panel ........................................................................ ................ ................ ................ ................ ................

80091 6 Thyroid panel .................................................................................... ................ ................ ................ ................ ................

80092 6 Thyroid panel w/TSH ........................................................................ ................ ................ ................ ................ ................

80100 6 Drug screen ...................................................................................... ................ ................ ................ ................ ................

80101 6 Drug screen ...................................................................................... ................ ................ ................ ................ ................

80102 6 Drug confirmation .............................................................................. ................ ................ ................ ................ ................

80103 6 Drug analysis, tissue prep ................................................................ ................ ................ ................ ................ ................

80150 6 Assay of amikacin ............................................................................. ................ ................ ................ ................ ................

80152 6 Assay of amitriptyline ........................................................................ ................ ................ ................ ................ ................

80154 6 Assay of benzodiazepines ................................................................ ................ ................ ................ ................ ................

80156 6 Assay carbamazepine ....................................................................... ................ ................ ................ ................ ................

80158 6 Assay of cyclosporine ....................................................................... ................ ................ ................ ................ ................
32406

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

80160 6 Assay of desipramine ....................................................................... ................ ................ ................ ................ ................

80162 6 Assay for digoxin .............................................................................. ................ ................ ................ ................ ................

80164 6 Assay, dipropylacetic acid ................................................................ ................ ................ ................ ................ ................

80166 6 Assay of doxepin .............................................................................. ................ ................ ................ ................ ................

80168 6 Assay of ethosuximide ...................................................................... ................ ................ ................ ................ ................

80170 6 Gentamicin ........................................................................................ ................ ................ ................ ................ ................

80172 6 Assay for gold ................................................................................... ................ ................ ................ ................ ................

80174 6 Assay of imipramine ......................................................................... ................ ................ ................ ................ ................

80176 6 Assay for lidocaine ............................................................................ ................ ................ ................ ................ ................

80178 6 Assay for lithium ............................................................................... ................ ................ ................ ................ ................

80182 6 Assay for nortriptyline ....................................................................... ................ ................ ................ ................ ................

80184 6 Assay for phenobarbital .................................................................... ................ ................ ................ ................ ................

80185 6 Assay for phenytoin .......................................................................... ................ ................ ................ ................ ................

80186 6 Assay for phenytoin, free .................................................................. ................ ................ ................ ................ ................

80188 6 Assay for primidone .......................................................................... ................ ................ ................ ................ ................

80190 6 Assay for procainamide .................................................................... ................ ................ ................ ................ ................

80192 6 Assay for procainamide .................................................................... ................ ................ ................ ................ ................

80194 6 Assay for quinidine ........................................................................... ................ ................ ................ ................ ................

80196 6 Assay for salicylate ........................................................................... ................ ................ ................ ................ ................

80197 6 Assay for tacrolimus ......................................................................... ................ ................ ................ ................ ................

80198 6 Assay for theophylline ....................................................................... ................ ................ ................ ................ ................

80200 6 Assay for tobramycin ........................................................................ ................ ................ ................ ................ ................

80201 6 Assay for topiramate ......................................................................... ................ ................ ................ ................ ................

80202 6 Assay for vancomycin ....................................................................... ................ ................ ................ ................ ................

80299 6 Quantitative assay, drug ................................................................... ................ ................ ................ ................ ................

80400 6 Acth stimulation panel ....................................................................... ................ ................ ................ ................ ................

80402 6 Acth stimulation panel ....................................................................... ................ ................ ................ ................ ................

80406 6 Acth stimulation panel ....................................................................... ................ ................ ................ ................ ................

80408 6 Aldosterone suppression eval ........................................................... ................ ................ ................ ................ ................

80410 6 Calcitonin stimul panel ...................................................................... ................ ................ ................ ................ ................

80412 6 CRH stimulation panel ...................................................................... ................ ................ ................ ................ ................

80414 6 Testosterone response ..................................................................... ................ ................ ................ ................ ................

80415 6 Estradiol response panel .................................................................. ................ ................ ................ ................ ................

80416 6 Renin stimulation panel .................................................................... ................ ................ ................ ................ ................

80417 6 Renin stimulation panel .................................................................... ................ ................ ................ ................ ................

80418 6 Pituitary evaluation panel .................................................................. ................ ................ ................ ................ ................

80420 6 Dexamethasone panel ...................................................................... ................ ................ ................ ................ ................

80422 6 Glucagon tolerance panel ................................................................. ................ ................ ................ ................ ................

80424 6 Glucagon tolerance panel ................................................................. ................ ................ ................ ................ ................

80426 6 Gonadotropin hormone panel ........................................................... ................ ................ ................ ................ ................

80428 6 Growth hormone panel ..................................................................... ................ ................ ................ ................ ................

80430 6 Growth hormone panel ..................................................................... ................ ................ ................ ................ ................

80432 6 Insulin suppression panel ................................................................. ................ ................ ................ ................ ................

80434 6 Insulin tolerance panel ...................................................................... ................ ................ ................ ................ ................

80435 6 Insulin tolerance panel ...................................................................... ................ ................ ................ ................ ................

80436 6 Metyrapone panel ............................................................................. ................ ................ ................ ................ ................

80438 6 TRH stimulation panel ...................................................................... ................ ................ ................ ................ ................

80439 6 TRH stimulation panel ...................................................................... ................ ................ ................ ................ ................

80440 6 TRH stimulation panel ...................................................................... ................ ................ ................ ................ ................

80500 6 Lab pathology consultation ............................................................... ................ ................ ................ ................ ................

80502 6 Lab pathology consultation ............................................................... ................ ................ ................ ................ ................

81000 6 Urinalysis, nonauto, w/scope ............................................................ ................ ................ ................ ................ ................

81001 6 Urinalysis, auto, w/scope .................................................................. ................ ................ ................ ................ ................

81002 2 Urinalysis nonauto w/o scope ........................................................... ................ ................ ................ ................ ................

81003 6 Urinalysis, auto, w/o scope ............................................................... ................ ................ ................ ................ ................

81005 6 Urinalysis ........................................................................................... ................ ................ ................ ................ ................

81007 6 Urine screen for bacteria .................................................................. ................ ................ ................ ................ ................

81015 6 Microscopic exam of urine ................................................................ ................ ................ ................ ................ ................

81020 6 Urinalysis, glass test ......................................................................... ................ ................ ................ ................ ................

81025 2 Urine pregnancy test ......................................................................... ................ ................ ................ ................ ................

81050 6 Urinalysis, volume measure .............................................................. ................ ................ ................ ................ ................

81099 6 Urinalysis test procedure .................................................................. ................ ................ ................ ................ ................

82000 6 Assay blood acetaldehyde ................................................................ ................ ................ ................ ................ ................

82003 6 Assay acetaminophen ....................................................................... ................ ................ ................ ................ ................

82009 6 Test for acetone/ketones .................................................................. ................ ................ ................ ................ ................

82010 6 Acetone assay .................................................................................. ................ ................ ................ ................ ................

82013 6 Acetylcholinesterase assay ............................................................... ................ ................ ................ ................ ................

82024 6 ACTH ................................................................................................ ................ ................ ................ ................ ................

82030 6 ADP & AMP ...................................................................................... ................ ................ ................ ................ ................

82040 6 Assay serum albumin ....................................................................... ................ ................ ................ ................ ................

82042 6 Assay urine albumin ......................................................................... ................ ................ ................ ................ ................

82043 6 Microalbumin, quantitative ................................................................ ................ ................ ................ ................ ................

82044 2 Microalbumin, semiquant .................................................................. ................ ................ ................ ................ ................

82055 6 Assay ethanol ................................................................................... ................ ................ ................ ................ ................
32407

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

82075 6 Assay breath ethanol ........................................................................ ................ ................ ................ ................ ................

82085 6 Assay of aldolase .............................................................................. ................ ................ ................ ................ ................

82088 6 Aldosterone ....................................................................................... ................ ................ ................ ................ ................

82101 6 Assay of urine alkaloids .................................................................... ................ ................ ................ ................ ................

82103 6 Alpha-1-antitrypsin, total ................................................................... ................ ................ ................ ................ ................

82104 6 Alpha-1-antitrypsin, pheno ................................................................ ................ ................ ................ ................ ................

82105 6 Alpha-fetoprotein, serum ................................................................... ................ ................ ................ ................ ................

82106 6 Alpha-fetoprotein; amniotic ............................................................... ................ ................ ................ ................ ................

82108 6 Assay, aluminum ............................................................................... ................ ................ ................ ................ ................

82128 6 Test for amino acids ......................................................................... ................ ................ ................ ................ ................

82130 6 Amino acids analysis ........................................................................ ................ ................ ................ ................ ................

82131 6 Amino acids ...................................................................................... ................ ................ ................ ................ ................

82135 6 Assay, aminolevulinic acid ................................................................ ................ ................ ................ ................ ................

82140 6 Assay of ammonia ............................................................................ ................ ................ ................ ................ ................

82143 6 Amniotic fluid scan ............................................................................ ................ ................ ................ ................ ................

82145 6 Assay of amphetamines ................................................................... ................ ................ ................ ................ ................

82150 6 Assay of amylase .............................................................................. ................ ................ ................ ................ ................

82154 6 Androstanediol glucuronide .............................................................. ................ ................ ................ ................ ................

82157 6 Assay of androstenedione ................................................................ ................ ................ ................ ................ ................

82160 6 Androsterone assay .......................................................................... ................ ................ ................ ................ ................

82163 6 Assay of angiotensin II ..................................................................... ................ ................ ................ ................ ................

82164 6 Angiotensin I enzyme test ................................................................ ................ ................ ................ ................ ................

82172 6 Apolipoprotein ................................................................................... ................ ................ ................ ................ ................

82175 6 Assay of arsenic ............................................................................... ................ ................ ................ ................ ................

82180 6 Assay of ascorbic acid ...................................................................... ................ ................ ................ ................ ................

82190 6 Atomic absorption ............................................................................. ................ ................ ................ ................ ................

82205 6 Assay of barbiturates ........................................................................ ................ ................ ................ ................ ................

82232 6 Beta-2 protein ................................................................................... ................ ................ ................ ................ ................

82239 6 Bile acids, total .................................................................................. ................ ................ ................ ................ ................

82240 6 Bile acids, cholylglycine .................................................................... ................ ................ ................ ................ ................

82250 6 Assay bilirubin ................................................................................... ................ ................ ................ ................ ................

82251 6 Assay bilirubin ................................................................................... ................ ................ ................ ................ ................

82252 6 Fecal bilirubin test ............................................................................. ................ ................ ................ ................ ................

82270 2 Test feces for blood .......................................................................... ................ ................ ................ ................ ................

82273 2 Test for blood, other source ............................................................. ................ ................ ................ ................ ................

82286 6 Assay of bradykinin ........................................................................... ................ ................ ................ ................ ................

82300 6 Assay cadmium ................................................................................. ................ ................ ................ ................ ................

82306 6 Assay of vitamin D ............................................................................ ................ ................ ................ ................ ................

82307 6 Assay of vitamin D ............................................................................ ................ ................ ................ ................ ................

82308 6 Assay of calcitonin ............................................................................ ................ ................ ................ ................ ................

82310 6 Assay calcium ................................................................................... ................ ................ ................ ................ ................

82330 6 Assay calcium ................................................................................... ................ ................ ................ ................ ................

82331 6 Calcium infusion test ......................................................................... ................ ................ ................ ................ ................

82340 6 Assay calcium in urine ...................................................................... ................ ................ ................ ................ ................

82355 6 Calculus (stone) analysis .................................................................. ................ ................ ................ ................ ................

82360 6 Calculus (stone) assay ..................................................................... ................ ................ ................ ................ ................

82365 6 Calculus (stone) assay ..................................................................... ................ ................ ................ ................ ................

82370 6 X-ray assay, calculus (stone) ........................................................... ................ ................ ................ ................ ................

82374 6 Assay blood carbon dioxide .............................................................. ................ ................ ................ ................ ................

82375 6 Assay blood carbon monoxide ......................................................... ................ ................ ................ ................ ................

82376 6 Test for carbon monoxide ................................................................. ................ ................ ................ ................ ................

82378 6 Carcinoembryonic antigen ................................................................ ................ ................ ................ ................ ................

82380 6 Assay carotene ................................................................................. ................ ................ ................ ................ ................

82382 6 Assay urine catecholamines ............................................................. ................ ................ ................ ................ ................

82383 6 Assay blood catecholamines ............................................................ ................ ................ ................ ................ ................

82384 6 Assay three catecholamines ............................................................. ................ ................ ................ ................ ................

82387 6 Cathepsin-D ...................................................................................... ................ ................ ................ ................ ................

82390 6 Assay ceruloplasmin ......................................................................... ................ ................ ................ ................ ................

82397 6 Chemiluminescent assay .................................................................. ................ ................ ................ ................ ................

82415 6 Assay chloramphenicol ..................................................................... ................ ................ ................ ................ ................

82435 6 Assay blood chloride ......................................................................... ................ ................ ................ ................ ................

82436 6 Assay urine chloride ......................................................................... ................ ................ ................ ................ ................

82438 6 Assay other fluid chlorides ................................................................ ................ ................ ................ ................ ................

82441 6 Test for chlorohydrocarbons ............................................................. ................ ................ ................ ................ ................

82465 2 Assay serum cholesterol ................................................................... ................ ................ ................ ................ ................

82480 6 Assay serum cholinesterase ............................................................. ................ ................ ................ ................ ................

82482 6 Assay rbc cholinesterase .................................................................. ................ ................ ................ ................ ................

82485 6 Assay chondroitin sulfate .................................................................. ................ ................ ................ ................ ................

82486 6 Gas/liquid chromatography ............................................................... ................ ................ ................ ................ ................

82487 6 Paper chromatography ..................................................................... ................ ................ ................ ................ ................

82488 6 Paper chromatography ..................................................................... ................ ................ ................ ................ ................

82489 6 Thin layer chromatography ............................................................... ................ ................ ................ ................ ................

82491 6 Chromotography, quantitative ........................................................... ................ ................ ................ ................ ................

82495 6 Assay chromium ............................................................................... ................ ................ ................ ................ ................
32408

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

82507 6 Assay citrate ..................................................................................... ................ ................ ................ ................ ................

82520 6 Assay for cocaine ............................................................................. ................ ................ ................ ................ ................

82523 6 Collagen crosslinks ........................................................................... ................ ................ ................ ................ ................

82525 6 Assay copper .................................................................................... ................ ................ ................ ................ ................

82528 6 Assay corticosterone ......................................................................... ................ ................ ................ ................ ................

82530 6 Cortisol, free ...................................................................................... ................ ................ ................ ................ ................

82533 6 Total cortisol ...................................................................................... ................ ................ ................ ................ ................

82540 6 Assay creatine .................................................................................. ................ ................ ................ ................ ................

82550 6 Assay CK (CPK) ............................................................................... ................ ................ ................ ................ ................

82552 6 Assay CPK in blood .......................................................................... ................ ................ ................ ................ ................

82553 6 Creatine, MB fraction ........................................................................ ................ ................ ................ ................ ................

82554 6 Creatine, isoforms ............................................................................. ................ ................ ................ ................ ................

82565 6 Assay creatinine ................................................................................ ................ ................ ................ ................ ................

82570 6 Assay urine creatinine ...................................................................... ................ ................ ................ ................ ................

82575 6 Creatinine clearance test .................................................................. ................ ................ ................ ................ ................

82585 6 Assay cryofibrinogen ......................................................................... ................ ................ ................ ................ ................

82595 6 Assay cryoglobulin ............................................................................ ................ ................ ................ ................ ................

82600 6 Assay cyanide ................................................................................... ................ ................ ................ ................ ................

82607 6 Vitamin B-12 ..................................................................................... ................ ................ ................ ................ ................

82608 6 B-12 binding capacity ....................................................................... ................ ................ ................ ................ ................

82615 6 Test for urine cystines ...................................................................... ................ ................ ................ ................ ................

82626 6 Dehydroepiandrosterone ................................................................... ................ ................ ................ ................ ................

82627 6 Dehydroepiandrosterone ................................................................... ................ ................ ................ ................ ................

82633 6 Desoxycorticosterone ........................................................................ ................ ................ ................ ................ ................

82634 6 Deoxycortisol ..................................................................................... ................ ................ ................ ................ ................

82638 6 Assay dibucaine number .................................................................. ................ ................ ................ ................ ................

82646 6 Assay of dihydrocodeinone ............................................................... ................ ................ ................ ................ ................

82649 6 Assay of dihydromorphinone ............................................................ ................ ................ ................ ................ ................

82651 6 Dihydrotestosterone assay ............................................................... ................ ................ ................ ................ ................

82652 6 Assay, dihydroxyvitamin D ................................................................ ................ ................ ................ ................ ................

82654 6 Assay of dimethadione ..................................................................... ................ ................ ................ ................ ................

82664 6 Electrophoretic test ........................................................................... ................ ................ ................ ................ ................

82666 6 Epiandrosterone assay ..................................................................... ................ ................ ................ ................ ................

82668 6 Erythropoietin .................................................................................... ................ ................ ................ ................ ................

82670 6 Estradiol ............................................................................................ ................ ................ ................ ................ ................

82671 6 Estrogens assay ............................................................................... ................ ................ ................ ................ ................

82672 6 Estrogen assay ................................................................................. ................ ................ ................ ................ ................

82677 6 Estriol ................................................................................................ ................ ................ ................ ................ ................

82679 6 Estrone .............................................................................................. ................ ................ ................ ................ ................

82690 6 Ethchlorvynol ..................................................................................... ................ ................ ................ ................ ................

82693 6 Ethylene glycol .................................................................................. ................ ................ ................ ................ ................

82696 6 Etiocholanolone ................................................................................. ................ ................ ................ ................ ................

82705 6 Fats/lipids, feces, qualitativ ............................................................... ................ ................ ................ ................ ................

82710 6 Fats/lipids, feces, quantitati .............................................................. ................ ................ ................ ................ ................

82715 6 Fecal fat assay .................................................................................. ................ ................ ................ ................ ................

82725 6 Assay blood fatty acids ..................................................................... ................ ................ ................ ................ ................

82728 6 Assay ferritin ..................................................................................... ................ ................ ................ ................ ................

82735 6 Assay fluoride ................................................................................... ................ ................ ................ ................ ................

82742 6 Assay of flurazepam ......................................................................... ................ ................ ................ ................ ................

82746 6 Blood folic acid serum ...................................................................... ................ ................ ................ ................ ................

82747 6 Folic acid, RBC ................................................................................. ................ ................ ................ ................ ................

82757 6 Assay semen fructose ...................................................................... ................ ................ ................ ................ ................

82759 6 RBC galactokinase assay ................................................................. ................ ................ ................ ................ ................

82760 6 Assay galactose ................................................................................ ................ ................ ................ ................ ................

82775 6 Assay galactose transferase ............................................................. ................ ................ ................ ................ ................

82776 6 Galactose transferase test ................................................................ ................ ................ ................ ................ ................

82784 6 Assay gammaglobulin IgM ................................................................ ................ ................ ................ ................ ................

82785 6 Assay, gammaglobulin IgE ............................................................... ................ ................ ................ ................ ................

82787 6 IgG1, 2, 3 and 4 ................................................................................ ................ ................ ................ ................ ................

82800 6 Blood pH ........................................................................................... ................ ................ ................ ................ ................

82803 6 Blood gases: pH, pO2 & pCO2 ........................................................ ................ ................ ................ ................ ................

82805 6 Blood gases W/02 saturation ............................................................ ................ ................ ................ ................ ................

82810 6 Blood gases, O2 sat only ................................................................. ................ ................ ................ ................ ................

82820 6 Hemoglobin-oxygen affinity ............................................................... ................ ................ ................ ................ ................

82926 6 Assay gastric acid ............................................................................. ................ ................ ................ ................ ................

82928 6 Assay gastric acid ............................................................................. ................ ................ ................ ................ ................

82938 6 Gastrin test ........................................................................................ ................ ................ ................ ................ ................

82941 6 Assay of gastrin ................................................................................ ................ ................ ................ ................ ................

82943 6 Assay of glucagon ............................................................................ ................ ................ ................ ................ ................

82946 6 Glucagon tolerance test .................................................................... ................ ................ ................ ................ ................

82947 2 Assay quantitative, glucose .............................................................. ................ ................ ................ ................ ................

82948 6 Reagent strip/blood glucose ............................................................. ................ ................ ................ ................ ................

82950 2 Glucose test ...................................................................................... ................ ................ ................ ................ ................

82951 2 Glucose tolerance test (GTT) ........................................................... ................ ................ ................ ................ ................
32409

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

82952 2 GTT-added samples ......................................................................... ................ ................ ................ ................ ................

82953 6 Glucose-tolbutamide test .................................................................. ................ ................ ................ ................ ................

82955 6 Assay G6PD enzyme ........................................................................ ................ ................ ................ ................ ................

82960 6 Test for G6PD enzyme ..................................................................... ................ ................ ................ ................ ................

82962 2 Glucose blood test ............................................................................ ................ ................ ................ ................ ................

82963 6 Glucosidase assay ............................................................................ ................ ................ ................ ................ ................

82965 6 Assay GDH enzyme ......................................................................... ................ ................ ................ ................ ................

82975 6 Assay glutamine ................................................................................ ................ ................ ................ ................ ................

82977 6 Assay of GGT ................................................................................... ................ ................ ................ ................ ................

82978 6 Glutathione assay ............................................................................. ................ ................ ................ ................ ................

82979 6 Assay RBC glutathione enzyme ....................................................... ................ ................ ................ ................ ................

82980 6 Assay of glutethimide ........................................................................ ................ ................ ................ ................ ................

82985 6 Glycated protein ................................................................................ ................ ................ ................ ................ ................

83001 6 Gonadotropin (FSH) .......................................................................... ................ ................ ................ ................ ................

83002 6 Gonadotropin (LH) ............................................................................ ................ ................ ................ ................ ................

83003 6 Assay growth hormone (HGH) ......................................................... ................ ................ ................ ................ ................

83008 6 Assay guanosine ............................................................................... ................ ................ ................ ................ ................

83010 6 Quant assay haptoglobin .................................................................. ................ ................ ................ ................ ................

83012 6 Assay haptoglobins ........................................................................... ................ ................ ................ ................ ................

83015 6 Heavy metal screen .......................................................................... ................ ................ ................ ................ ................

83018 6 Quantitative screen, metals .............................................................. ................ ................ ................ ................ ................

83019 6 Breath isotope test ............................................................................ ................ ................ ................ ................ ................

83020 6 Assay hemoglobin ............................................................................. ................ ................ ................ ................ ................

83026 2 Hemoglobin, copper sulfate .............................................................. ................ ................ ................ ................ ................

83030 6 Fetal hemoglobin assay .................................................................... ................ ................ ................ ................ ................

83033 6 Fetal fecal hemoglobin assay ........................................................... ................ ................ ................ ................ ................

83036 6 Glycated hemoglobin test ................................................................. ................ ................ ................ ................ ................

83045 6 Blood methemoglobin test ................................................................ ................ ................ ................ ................ ................

83050 6 Blood methemoglobin assay ............................................................. ................ ................ ................ ................ ................

83051 6 Assay plasma hemoglobin ................................................................ ................ ................ ................ ................ ................

83055 6 Blood sulfhemoglobin test ................................................................. ................ ................ ................ ................ ................

83060 6 Blood sulfhemoglobin assay ............................................................. ................ ................ ................ ................ ................

83065 6 Hemoglobin heat assay .................................................................... ................ ................ ................ ................ ................

83068 6 Hemoglobin stability screen .............................................................. ................ ................ ................ ................ ................

83069 6 Assay urine hemoglobin ................................................................... ................ ................ ................ ................ ................

83070 6 Qualt assay hemosiderin .................................................................. ................ ................ ................ ................ ................

83071 6 Quant assay of hemosiderin ............................................................. ................ ................ ................ ................ ................

83088 6 Assay histamine ................................................................................ ................ ................ ................ ................ ................

83150 6 Assay for HVA .................................................................................. ................ ................ ................ ................ ................

83491 6 Assay of corticosteroids .................................................................... ................ ................ ................ ................ ................

83497 6 Assay 5-HIAA .................................................................................... ................ ................ ................ ................ ................

83498 6 Assay of progesterone ...................................................................... ................ ................ ................ ................ ................

83499 6 Assay of progesterone ...................................................................... ................ ................ ................ ................ ................

83500 6 Assay free hydroxyproline ................................................................ ................ ................ ................ ................ ................

83505 6 Assay total hydroxyproline ................................................................ ................ ................ ................ ................ ................

83516 6 Immunoassay, non antibody ............................................................. ................ ................ ................ ................ ................

83518 6 Immunoassay, dipstick ...................................................................... ................ ................ ................ ................ ................

83519 6 Immunoassay nonantibody ............................................................... ................ ................ ................ ................ ................

83520 6 Immunoassay, RIA ............................................................................ ................ ................ ................ ................ ................

83525 6 Assay of insulin ................................................................................. ................ ................ ................ ................ ................

83527 6 Assay of insulin ................................................................................. ................ ................ ................ ................ ................

83528 6 Assay intrinsic factor ......................................................................... ................ ................ ................ ................ ................

83540 6 Assay iron ......................................................................................... ................ ................ ................ ................ ................

83550 6 Iron binding test ................................................................................ ................ ................ ................ ................ ................

83570 6 Assay IDH enzyme ........................................................................... ................ ................ ................ ................ ................

83582 6 Assay ketogenic steroids .................................................................. ................ ................ ................ ................ ................

83586 6 Assay 17-(17-KS)ketosteroids .......................................................... ................ ................ ................ ................ ................

83593 6 Fractionation ketosteroids ................................................................. ................ ................ ................ ................ ................

83605 6 Lactic acid assay .............................................................................. ................ ................ ................ ................ ................

83615 6 Lactate (LD) (LDH) enzyme .............................................................. ................ ................ ................ ................ ................

83625 6 Assay LDH enzymes ........................................................................ ................ ................ ................ ................ ................

83632 6 Placental lactogen ............................................................................. ................ ................ ................ ................ ................

83633 6 Test urine for lactose ........................................................................ ................ ................ ................ ................ ................

83634 6 Assay urine for lactose ..................................................................... ................ ................ ................ ................ ................

83655 6 Assay for lead ................................................................................... ................ ................ ................ ................ ................

83661 6 Assay L/S ratio .................................................................................. ................ ................ ................ ................ ................

83662 6 L/S ratio, foam stability ..................................................................... ................ ................ ................ ................ ................

83670 6 Assay LAP enzyme ........................................................................... ................ ................ ................ ................ ................

83690 6 Assay lipase ...................................................................................... ................ ................ ................ ................ ................

83715 6 Assay blood lipoproteins ................................................................... ................ ................ ................ ................ ................

83717 6 Assay blood lipoproteins ................................................................... ................ ................ ................ ................ ................

83718 2 Blood lipoprotein assay ..................................................................... ................ ................ ................ ................ ................

83719 6 Blood lipoprotein assay ..................................................................... ................ ................ ................ ................ ................

83721 6 Blood lipoprotein assay ..................................................................... ................ ................ ................ ................ ................
32410

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

83727 6 LRH hormone assay ......................................................................... ................ ................ ................ ................ ................

83735 6 Assay magnesium ............................................................................. ................ ................ ................ ................ ................

83775 6 Assay of md enzyme ........................................................................ ................ ................ ................ ................ ................

83785 6 Assay of manganese ........................................................................ ................ ................ ................ ................ ................

83805 6 Assay of meprobamate ..................................................................... ................ ................ ................ ................ ................

83825 6 Assay mercury .................................................................................. ................ ................ ................ ................ ................

83835 6 Assay metanephrines ....................................................................... ................ ................ ................ ................ ................

83840 6 Assay methadone ............................................................................. ................ ................ ................ ................ ................

83857 6 Assay methemalbumin ...................................................................... ................ ................ ................ ................ ................

83858 6 Assay methsuximide ......................................................................... ................ ................ ................ ................ ................

83864 6 Mucopolysaccharides ........................................................................ ................ ................ ................ ................ ................

83866 6 Mucopolysaccharides screen ............................................................ ................ ................ ................ ................ ................

83872 6 Assay synovial fluid mucin ................................................................ ................ ................ ................ ................ ................

83873 6 Assay, CSF protein ........................................................................... ................ ................ ................ ................ ................

83874 6 Myoglobin .......................................................................................... ................ ................ ................ ................ ................

83883 6 Nephelometry, not specified ............................................................. ................ ................ ................ ................ ................

83885 6 Assay for nickel ................................................................................. ................ ................ ................ ................ ................

83887 6 Assay nicotine ................................................................................... ................ ................ ................ ................ ................

83890 6 Molecular diagnostics ....................................................................... ................ ................ ................ ................ ................

83892 6 Molecular diagnostics ....................................................................... ................ ................ ................ ................ ................

83894 6 Molecular diagnostics ....................................................................... ................ ................ ................ ................ ................

83896 6 Molecular diagnostics ....................................................................... ................ ................ ................ ................ ................

83898 6 Molecular diagnostics ....................................................................... ................ ................ ................ ................ ................

83902 6 Molecular diagnostics ....................................................................... ................ ................ ................ ................ ................

83912 6 Genetic examination ......................................................................... ................ ................ ................ ................ ................

83915 6 Assay nucleotidase ........................................................................... ................ ................ ................ ................ ................

83916 6 Oligoclonal bands ............................................................................. ................ ................ ................ ................ ................

83918 6 Assay organic acids .......................................................................... ................ ................ ................ ................ ................

83925 6 Opiates .............................................................................................. ................ ................ ................ ................ ................

83930 6 Assay blood osmolality ..................................................................... ................ ................ ................ ................ ................

83935 6 Assay urine osmolality ...................................................................... ................ ................ ................ ................ ................

83937 6 Assay for osteocalcin ........................................................................ ................ ................ ................ ................ ................

83945 6 Assay oxalate .................................................................................... ................ ................ ................ ................ ................

83970 6 Assay of parathormone ..................................................................... ................ ................ ................ ................ ................

83986 2 Assay body fluid acidity .................................................................... ................ ................ ................ ................ ................

83992 6 Assay for phencyclidine .................................................................... ................ ................ ................ ................ ................

84022 6 Assay of phenothiazine ..................................................................... ................ ................ ................ ................ ................

84030 6 Assay blood PKU .............................................................................. ................ ................ ................ ................ ................

84035 6 Assay phenylketones ........................................................................ ................ ................ ................ ................ ................

84060 6 Assay acid phosphatase ................................................................... ................ ................ ................ ................ ................

84061 6 Phosphatase, forensic exam ............................................................ ................ ................ ................ ................ ................

84066 6 Assay prostate phosphatase ............................................................ ................ ................ ................ ................ ................

84075 6 Assay alkaline phosphatase ............................................................. ................ ................ ................ ................ ................

84078 6 Assay alkaline phosphatase ............................................................. ................ ................ ................ ................ ................

84080 6 Assay alkaline phosphatases ........................................................... ................ ................ ................ ................ ................

84081 6 Amniotic fluid enzyme test ................................................................ ................ ................ ................ ................ ................

84085 6 Assay RBC PG6D enzyme ............................................................... ................ ................ ................ ................ ................

84087 6 Assay phosphohexose enzymes ...................................................... ................ ................ ................ ................ ................

84100 6 Assay phosphorus ............................................................................ ................ ................ ................ ................ ................

84105 6 Assay urine phosphorus ................................................................... ................ ................ ................ ................ ................

84106 6 Test for porphobilinogen ................................................................... ................ ................ ................ ................ ................

84110 6 Assay porphobilinogen ...................................................................... ................ ................ ................ ................ ................

84119 6 Test urine for porphyrins ................................................................... ................ ................ ................ ................ ................

84120 6 Assay urine porphyrins ..................................................................... ................ ................ ................ ................ ................

84126 6 Assay feces porphyrins ..................................................................... ................ ................ ................ ................ ................

84127 6 Porphyrins, feces .............................................................................. ................ ................ ................ ................ ................

84132 6 Assay serum potassium .................................................................... ................ ................ ................ ................ ................

84133 6 Assay urine potassium ...................................................................... ................ ................ ................ ................ ................

84134 6 Prealbumin ........................................................................................ ................ ................ ................ ................ ................

84135 6 Assay pregnanediol .......................................................................... ................ ................ ................ ................ ................

84138 6 Assay pregnanetriol .......................................................................... ................ ................ ................ ................ ................

84140 6 Assay for pregnenolone .................................................................... ................ ................ ................ ................ ................

84143 6 Assay/17-hydroxypregnenolone ........................................................ ................ ................ ................ ................ ................

84144 6 Assay progesterone .......................................................................... ................ ................ ................ ................ ................

84146 6 Assay for prolactin ............................................................................ ................ ................ ................ ................ ................

84150 6 Assay of prostaglandin ..................................................................... ................ ................ ................ ................ ................

84153 6 Prostate specific antigen ................................................................... ................ ................ ................ ................ ................

84155 6 Assay protein .................................................................................... ................ ................ ................ ................ ................

84160 6 Assay serum protein ......................................................................... ................ ................ ................ ................ ................

84165 6 Assay serum proteins ....................................................................... ................ ................ ................ ................ ................

84181 6 Western blot test ............................................................................... ................ ................ ................ ................ ................

84182 6 Protein, western blot test .................................................................. ................ ................ ................ ................ ................

84202 6 Assay RBC protoporphyrin ............................................................... ................ ................ ................ ................ ................

84203 6 Test RBC protoporphyrin .................................................................. ................ ................ ................ ................ ................
32411

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

84206 6 Assay of proinsulin ............................................................................ ................ ................ ................ ................ ................

84207 6 Assay vitamin B–6 ............................................................................ ................ ................ ................ ................ ................

84210 6 Assay pyruvate ................................................................................. ................ ................ ................ ................ ................

84220 6 Assay pyruvate kinase ...................................................................... ................ ................ ................ ................ ................

84228 6 Assay quinine .................................................................................... ................ ................ ................ ................ ................

84233 6 Assay estrogen ................................................................................. ................ ................ ................ ................ ................

84234 6 Assay progesterone .......................................................................... ................ ................ ................ ................ ................

84235 6 Assay endocrine hormone ................................................................ ................ ................ ................ ................ ................

84238 6 Assay non-endocrine receptor .......................................................... ................ ................ ................ ................ ................

84244 6 Assay of renin ................................................................................... ................ ................ ................ ................ ................

84252 6 Assay vitamin B–2 ............................................................................ ................ ................ ................ ................ ................

84255 6 Assay selenium ................................................................................. ................ ................ ................ ................ ................

84260 6 Assay serotonin ................................................................................ ................ ................ ................ ................ ................

84270 6 Sex hormone globulin (SHBG) ......................................................... ................ ................ ................ ................ ................

84275 6 Assay sialic acid ............................................................................... ................ ................ ................ ................ ................

84285 6 Assay silica ....................................................................................... ................ ................ ................ ................ ................

84295 6 Assay serum sodium ........................................................................ ................ ................ ................ ................ ................

84300 6 Assay urine sodium .......................................................................... ................ ................ ................ ................ ................

84305 6 Somatomedin .................................................................................... ................ ................ ................ ................ ................

84307 6 Somatostatin ..................................................................................... ................ ................ ................ ................ ................

84311 6 Spectrophotometry ............................................................................ ................ ................ ................ ................ ................

84315 6 Body fluid specific gravity ................................................................. ................ ................ ................ ................ ................

84375 6 Chromatogram assay, sugars ........................................................... ................ ................ ................ ................ ................

84392 6 Assay urine sulfate ........................................................................... ................ ................ ................ ................ ................

84402 6 Testosterone ..................................................................................... ................ ................ ................ ................ ................

84403 6 Assay total testosterone ................................................................... ................ ................ ................ ................ ................

84425 6 Assay vitamin B-1 ............................................................................. ................ ................ ................ ................ ................

84430 6 Assay thiocyanate ............................................................................. ................ ................ ................ ................ ................

84432 6 Thyroglobulin ..................................................................................... ................ ................ ................ ................ ................

84436 6 Assay, total thyroxine ........................................................................ ................ ................ ................ ................ ................

84437 6 Assay neonatal thyroxine .................................................................. ................ ................ ................ ................ ................

84439 6 Assay, free thyroxine ........................................................................ ................ ................ ................ ................ ................

84442 6 Thyroid activity (TBG) assay ............................................................. ................ ................ ................ ................ ................

84443 6 Assay thyroid stim hormone ............................................................. ................ ................ ................ ................ ................

84445 6 Thyroid immunoglobulins TSI ........................................................... ................ ................ ................ ................ ................

84446 6 Assay vitamin E ................................................................................ ................ ................ ................ ................ ................

84449 6 Assay for transcortin ......................................................................... ................ ................ ................ ................ ................

84450 6 Transferase (AST) (SGOT) ............................................................... ................ ................ ................ ................ ................

84460 6 Alanine amino (ALT) (SGPT) ............................................................ ................ ................ ................ ................ ................

84466 6 Transferrin ......................................................................................... ................ ................ ................ ................ ................

84478 2 Assay triglycerides ............................................................................ ................ ................ ................ ................ ................

84479 6 Assay thyroid (t-3 or t-4) ................................................................... ................ ................ ................ ................ ................

84480 6 Assay triiodothyronine (t-3) ............................................................... ................ ................ ................ ................ ................

84481 6 Free assay (FT-3) ............................................................................. ................ ................ ................ ................ ................

84482 6 T3 reverse ......................................................................................... ................ ................ ................ ................ ................

84484 6 Troponin, quant ................................................................................. ................ ................ ................ ................ ................

84485 6 Assay duodenal fluid trypsin ............................................................. ................ ................ ................ ................ ................

84488 6 Test feces for trypsin ........................................................................ ................ ................ ................ ................ ................

84490 6 Assay feces for trypsin ..................................................................... ................ ................ ................ ................ ................

84510 6 Assay tyrosine ................................................................................... ................ ................ ................ ................ ................

84512 6 Troponin, qual ................................................................................... ................ ................ ................ ................ ................

84520 6 Assay urea nitrogen .......................................................................... ................ ................ ................ ................ ................

84525 6 Urea nitrogen semi-quant ................................................................. ................ ................ ................ ................ ................

84540 6 Assay urine urea-N ........................................................................... ................ ................ ................ ................ ................

84545 6 Urea-N clearance test ....................................................................... ................ ................ ................ ................ ................

84550 6 Assay blood uric acid ........................................................................ ................ ................ ................ ................ ................

84560 6 Assay urine uric acid ........................................................................ ................ ................ ................ ................ ................

84577 6 Assay feces urobilinogen .................................................................. ................ ................ ................ ................ ................

84578 6 Test urine urobilinogen ..................................................................... ................ ................ ................ ................ ................

84580 6 Assay urine urobilinogen .................................................................. ................ ................ ................ ................ ................

84583 6 Assay urine urobilinogen .................................................................. ................ ................ ................ ................ ................

84585 6 Assay urine VMA .............................................................................. ................ ................ ................ ................ ................

84586 6 VIP assay .......................................................................................... ................ ................ ................ ................ ................

84588 6 Assay vasopressin ............................................................................ ................ ................ ................ ................ ................

84590 6 Assay vitamin-A ................................................................................ ................ ................ ................ ................ ................

84597 6 Assay vitamin-K ................................................................................ ................ ................ ................ ................ ................

84600 6 Assay for volatiles ............................................................................. ................ ................ ................ ................ ................

84620 6 Xylose tolerance test ........................................................................ ................ ................ ................ ................ ................

84630 6 Assay zinc ......................................................................................... ................ ................ ................ ................ ................

84681 6 Assay C-peptide ................................................................................ ................ ................ ................ ................ ................

84702 6 Chorionic gonadotropin test .............................................................. ................ ................ ................ ................ ................

84703 6 Chorionic gonadotropin assay .......................................................... ................ ................ ................ ................ ................

84830 2 Ovulation tests .................................................................................. ................ ................ ................ ................ ................

84999 6 Clinical chemistry test ....................................................................... ................ ................ ................ ................ ................
32412

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

85002 6 Bleeding time test ............................................................................. ................ ................ ................ ................ ................

85007 6 Differential WBC count ..................................................................... ................ ................ ................ ................ ................

85008 6 Nondifferential WBC count ............................................................... ................ ................ ................ ................ ................

85009 6 Differential WBC count ..................................................................... ................ ................ ................ ................ ................

85013 2 Hematocrit ......................................................................................... ................ ................ ................ ................ ................

85014 2 Hematocrit ......................................................................................... ................ ................ ................ ................ ................

85018 2 Hemoglobin ....................................................................................... ................ ................ ................ ................ ................

85021 6 Automated hemogram ...................................................................... ................ ................ ................ ................ ................

85022 6 Automated hemogram ...................................................................... ................ ................ ................ ................ ................

85023 6 Automated hemogram ...................................................................... ................ ................ ................ ................ ................

85024 6 Automated hemogram ...................................................................... ................ ................ ................ ................ ................

85025 6 Automated hemogram ...................................................................... ................ ................ ................ ................ ................

85027 6 Automated hemogram ...................................................................... ................ ................ ................ ................ ................

85029 6 Automated hemogram ...................................................................... ................ ................ ................ ................ ................

85030 6 Automated hemogram ...................................................................... ................ ................ ................ ................ ................

85031 6 Manual hemogram, complete cbc .................................................... ................ ................ ................ ................ ................

85041 6 Red blood cell (RBC) count .............................................................. ................ ................ ................ ................ ................

85044 6 Reticulocyte count ............................................................................. ................ ................ ................ ................ ................

85045 6 Reticulocyte count ............................................................................. ................ ................ ................ ................ ................

85048 6 White blood cell (WBC) count .......................................................... ................ ................ ................ ................ ................

85060 6 Blood smear interpretation ................................................................ ................ ................ ................ ................ ................

85095 6 Bone marrow aspiration .................................................................... ................ ................ ................ ................ ................

85097 6 Bone marrow interpretation .............................................................. ................ ................ ................ ................ ................

85102 6 Bone marrow biopsy ......................................................................... ................ ................ ................ ................ ................

85130 6 Chromogenic substrate assay .......................................................... ................ ................ ................ ................ ................

85170 6 Blood clot retraction .......................................................................... ................ ................ ................ ................ ................

85175 6 Blood clot lysis time .......................................................................... ................ ................ ................ ................ ................

85210 6 Blood clot factor II test ...................................................................... ................ ................ ................ ................ ................

85220 6 Blood clot factor V test ..................................................................... ................ ................ ................ ................ ................

85230 6 Blood clot factor VII test ................................................................... ................ ................ ................ ................ ................

85240 6 Blood clot factor VIII test .................................................................. ................ ................ ................ ................ ................

85244 6 Blood clot factor VIII test .................................................................. ................ ................ ................ ................ ................

85245 6 Blood clot factor VIII test .................................................................. ................ ................ ................ ................ ................

85246 6 Blood clot factor VIII test .................................................................. ................ ................ ................ ................ ................

85247 6 Blood clot factor VIII test .................................................................. ................ ................ ................ ................ ................

85250 6 Blood clot factor IX test .................................................................... ................ ................ ................ ................ ................

85260 6 Blood clot factor X test ..................................................................... ................ ................ ................ ................ ................

85270 6 Blood clot factor XI test .................................................................... ................ ................ ................ ................ ................

85280 6 Blood clot factor XII test ................................................................... ................ ................ ................ ................ ................

85290 6 Blood clot factor XIII test .................................................................. ................ ................ ................ ................ ................

85291 6 Blood clot factor XIII test .................................................................. ................ ................ ................ ................ ................

85292 6 Blood clot factor assay ..................................................................... ................ ................ ................ ................ ................

85293 6 Blood clot factor assay ..................................................................... ................ ................ ................ ................ ................

85300 6 Antithrombin III test ........................................................................... ................ ................ ................ ................ ................

85301 6 Antithrombin III test ........................................................................... ................ ................ ................ ................ ................

85302 6 Blood clot inhibitor antigen ............................................................... ................ ................ ................ ................ ................

85303 6 Blood clot inhibitor test ..................................................................... ................ ................ ................ ................ ................

85305 6 Blood clot inhibitor assay .................................................................. ................ ................ ................ ................ ................

85306 6 Blood clot inhibitor test ..................................................................... ................ ................ ................ ................ ................

85335 6 Factor inhibitor test ........................................................................... ................ ................ ................ ................ ................

85337 6 Thrombomodulin ............................................................................... ................ ................ ................ ................ ................

85345 6 Coagulation time ............................................................................... ................ ................ ................ ................ ................

85347 6 Coagulation time ............................................................................... ................ ................ ................ ................ ................

85348 6 Coagulation time ............................................................................... ................ ................ ................ ................ ................

85360 6 Euglobulin lysis ................................................................................. ................ ................ ................ ................ ................

85362 6 Fibrin degradation products .............................................................. ................ ................ ................ ................ ................

85366 6 Fibrinogen test .................................................................................. ................ ................ ................ ................ ................

85370 6 Fibrinogen test .................................................................................. ................ ................ ................ ................ ................

85378 6 Fibrin degradation ............................................................................. ................ ................ ................ ................ ................

85379 6 Fibrin degradation ............................................................................. ................ ................ ................ ................ ................

85384 6 Fibrinogen ......................................................................................... ................ ................ ................ ................ ................

85385 6 Fibrinogen ......................................................................................... ................ ................ ................ ................ ................

85390 6 Fibrinolysins screen .......................................................................... ................ ................ ................ ................ ................

85400 6 Fibrinolytic plasmin ........................................................................... ................ ................ ................ ................ ................

85410 6 Fibrinolytic antiplasmin ...................................................................... ................ ................ ................ ................ ................

85415 6 Fibrinolytic plasminogen ................................................................... ................ ................ ................ ................ ................

85420 6 Fibrinolytic plasminogen ................................................................... ................ ................ ................ ................ ................

85421 6 Fibrinolytic plasminogen ................................................................... ................ ................ ................ ................ ................

85441 6 Heinz bodies; direct .......................................................................... ................ ................ ................ ................ ................

85445 6 Heinz bodies; induced ...................................................................... ................ ................ ................ ................ ................

85460 6 Hemoglobin, fetal .............................................................................. ................ ................ ................ ................ ................

85461 6 Hemoglobin, fetal .............................................................................. ................ ................ ................ ................ ................

85475 6 Hemolysin ......................................................................................... ................ ................ ................ ................ ................

85520 6 Heparin assay ................................................................................... ................ ................ ................ ................ ................
32413

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

85525 6 Heparin .............................................................................................. ................ ................ ................ ................ ................

85530 6 Heparin-protamine tolerance ............................................................ ................ ................ ................ ................ ................

85535 6 Iron stain, blood cells ........................................................................ ................ ................ ................ ................ ................

85540 6 Wbc alkaline phosphatase ................................................................ ................ ................ ................ ................ ................

85547 6 RBC mechanical fragility ................................................................... ................ ................ ................ ................ ................

85549 6 Muramidase ...................................................................................... ................ ................ ................ ................ ................

85555 6 RBC osmotic fragility ........................................................................ ................ ................ ................ ................ ................

85557 6 RBC osmotic fragility ........................................................................ ................ ................ ................ ................ ................

85576 6 Blood platelet aggregation ................................................................ ................ ................ ................ ................ ................

85585 6 Blood platelet estimation ................................................................... ................ ................ ................ ................ ................

85590 6 Platelet manual count ....................................................................... ................ ................ ................ ................ ................

85595 6 Platelet count, automated ................................................................. ................ ................ ................ ................ ................

85597 6 Platelet neutralization ........................................................................ ................ ................ ................ ................ ................

85610 6 Prothrombin time ............................................................................... ................ ................ ................ ................ ................

85611 6 Prothrombin test ................................................................................ ................ ................ ................ ................ ................

85612 6 Viper venom prothrombin time ......................................................... ................ ................ ................ ................ ................

85613 6 Russell viper venom, diluted ............................................................. ................ ................ ................ ................ ................

85635 6 Reptilase test .................................................................................... ................ ................ ................ ................ ................

85651 2 Rbc sed rate, nonauto ...................................................................... ................ ................ ................ ................ ................

85652 6 Rbc sed rate, auto ............................................................................ ................ ................ ................ ................ ................

85660 6 RBC sickle cell test ........................................................................... ................ ................ ................ ................ ................

85670 6 Thrombin time, plasma ..................................................................... ................ ................ ................ ................ ................

85675 6 Thrombin time, titer ........................................................................... ................ ................ ................ ................ ................

85705 6 Thromboplastin inhibition .................................................................. ................ ................ ................ ................ ................

85730 6 Thromboplastin time, partial ............................................................. ................ ................ ................ ................ ................

85732 6 Thromboplastin time, partial ............................................................. ................ ................ ................ ................ ................

85810 6 Blood viscosity examination .............................................................. ................ ................ ................ ................ ................

85999 6 Hematology procedure ...................................................................... ................ ................ ................ ................ ................

86000 6 Agglutinins; febrile ............................................................................. ................ ................ ................ ................ ................

86003 6 Allergen specific IgE ......................................................................... ................ ................ ................ ................ ................

86005 6 Allergen specific IgE ......................................................................... ................ ................ ................ ................ ................

86021 6 WBC antibody identification .............................................................. ................ ................ ................ ................ ................

86022 6 Platelet antibodies ............................................................................. ................ ................ ................ ................ ................

86023 6 Immunoglobulin assay ...................................................................... ................ ................ ................ ................ ................

86038 6 Antinuclear antibodies ....................................................................... ................ ................ ................ ................ ................

86039 6 Antinuclear antibodies (ANA) ............................................................ ................ ................ ................ ................ ................

86060 6 Antistreptolysin O titer ....................................................................... ................ ................ ................ ................ ................

86063 6 Antistreptolysin O screen .................................................................. ................ ................ ................ ................ ................

86077 6 Physician blood bank service ........................................................... ................ ................ ................ ................ ................

86078 6 Physician blood bank service ........................................................... ................ ................ ................ ................ ................

86079 6 Physician blood bank service ........................................................... ................ ................ ................ ................ ................

86140 6 C-reactive protein .............................................................................. ................ ................ ................ ................ ................

86147 6 Cardiolipin antibody .......................................................................... ................ ................ ................ ................ ................

86148 6 Phospholipid antibody ....................................................................... ................ ................ ................ ................ ................

86155 6 Chemotaxis assay ............................................................................. ................ ................ ................ ................ ................

86156 6 Cold agglutinin screen ...................................................................... ................ ................ ................ ................ ................

86157 6 Cold agglutinin, titer .......................................................................... ................ ................ ................ ................ ................

86160 6 Complement, antigen ........................................................................ ................ ................ ................ ................ ................

86161 6 Complement/function activity ............................................................ ................ ................ ................ ................ ................

86162 6 Complement, total (CH50) ................................................................ ................ ................ ................ ................ ................

86171 6 Complement fixation, each ............................................................... ................ ................ ................ ................ ................

86185 6 Counterimmunoelectrophoresis ........................................................ ................ ................ ................ ................ ................

86215 6 Deoxyribonuclease, antibody ............................................................ ................ ................ ................ ................ ................

86225 6 DNA antibody .................................................................................... ................ ................ ................ ................ ................

86226 6 DNA antibody, single strand ............................................................. ................ ................ ................ ................ ................

86235 6 Nuclear antigen antibody .................................................................. ................ ................ ................ ................ ................

86243 6 Fc receptor ........................................................................................ ................ ................ ................ ................ ................

86255 6 Fluorescent antibody; screen ............................................................ ................ ................ ................ ................ ................

86256 6 Fluorescent antibody; titer ................................................................ ................ ................ ................ ................ ................

86277 6 Growth hormone antibody ................................................................ ................ ................ ................ ................ ................

86280 6 Hemagglutination inhibition ............................................................... ................ ................ ................ ................ ................

86308 6 Heterophile antibodies ...................................................................... ................ ................ ................ ................ ................

86309 6 Heterophile antibodies ...................................................................... ................ ................ ................ ................ ................

86310 6 Heterophile antibodies ...................................................................... ................ ................ ................ ................ ................

86316 6 Immunoassay, tumor antigen ........................................................... ................ ................ ................ ................ ................

86317 6 Immunoassay, infectious agent ........................................................ ................ ................ ................ ................ ................

86318 2 Immunoassay, infectious agent ........................................................ ................ ................ ................ ................ ................

86320 6 Serum immunoelectrophoresis ......................................................... ................ ................ ................ ................ ................

86325 6 Other immunoelectrophoresis ........................................................... ................ ................ ................ ................ ................

86327 6 Immunoelectrophoresis assay .......................................................... ................ ................ ................ ................ ................

86329 6 Immunodiffusion ................................................................................ ................ ................ ................ ................ ................

86331 6 Immunodiffusion ouchterlony ............................................................ ................ ................ ................ ................ ................

86332 6 Immune complex assay .................................................................... ................ ................ ................ ................ ................

86334 6 Immunofixation procedure ................................................................ ................ ................ ................ ................ ................
32414

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

86337 6 Insulin antibodies .............................................................................. ................ ................ ................ ................ ................

86340 6 Intrinsic factor antibody ..................................................................... ................ ................ ................ ................ ................

86341 6 Islet cell antibody .............................................................................. ................ ................ ................ ................ ................

86343 6 Leukocyte histamine release ............................................................ ................ ................ ................ ................ ................

86344 6 Leukocyte phagocytosis .................................................................... ................ ................ ................ ................ ................

86353 6 Lymphocyte transformation ............................................................... ................ ................ ................ ................ ................

86359 6 T cells, total count ............................................................................. ................ ................ ................ ................ ................

86360 6 T cell absolute count/ratio ................................................................. ................ ................ ................ ................ ................

86361 6 T cell absolute count ......................................................................... ................ ................ ................ ................ ................

86376 6 Microsomal antibody ......................................................................... ................ ................ ................ ................ ................

86378 6 Migration inhibitory factor .................................................................. ................ ................ ................ ................ ................

86382 6 Neutralization test, viral .................................................................... ................ ................ ................ ................ ................

86384 6 Nitroblue tetrazolium dye .................................................................. ................ ................ ................ ................ ................

86403 6 Particle agglutination test .................................................................. ................ ................ ................ ................ ................

86406 6 Particle agglutination test .................................................................. ................ ................ ................ ................ ................

86430 6 Rheumatoid factor test ...................................................................... ................ ................ ................ ................ ................

86431 6 Rheumatoid factor, quant ................................................................. ................ ................ ................ ................ ................

86485 6 Skin test, candida ............................................................................. ................ ................ ................ ................ ................

86490 6 Coccidioidomycosis skin test ............................................................ ................ ................ ................ ................ ................

86510 6 Histoplasmosis skin test ................................................................... ................ ................ ................ ................ ................

86580 6 TB intradermal test ........................................................................... ................ ................ ................ ................ ................

86585 6 TB tine test ........................................................................................ ................ ................ ................ ................ ................

86586 6 Skin test, unlisted .............................................................................. ................ ................ ................ ................ ................

86588 2 Streptocollus, direct screen .............................................................. ................ ................ ................ ................ ................

86590 6 Streptokinase, antibody .................................................................... ................ ................ ................ ................ ................

86592 6 Blood serology, qualitative ................................................................ ................ ................ ................ ................ ................

86593 6 Blood serology, quantitative .............................................................. ................ ................ ................ ................ ................

86602 6 Antinomyces antibody ....................................................................... ................ ................ ................ ................ ................

86603 6 Adenovirus, antibody ........................................................................ ................ ................ ................ ................ ................

86606 6 Aspergillus antibody .......................................................................... ................ ................ ................ ................ ................

86609 6 Bacterium, antibody .......................................................................... ................ ................ ................ ................ ................

86612 6 Blastomyces, antibody ...................................................................... ................ ................ ................ ................ ................

86615 6 Bordetella antibody ........................................................................... ................ ................ ................ ................ ................

86617 6 Lyme disease antibody ..................................................................... ................ ................ ................ ................ ................

86618 6 Lyme disease antibody ..................................................................... ................ ................ ................ ................ ................

86619 6 Borrelia antibody ............................................................................... ................ ................ ................ ................ ................

86622 6 Brucella, antibody ............................................................................. ................ ................ ................ ................ ................

86625 6 Campylobacter, antibody .................................................................. ................ ................ ................ ................ ................

86628 6 Candida, antibody ............................................................................. ................ ................ ................ ................ ................

86631 6 Chlamydia, antibody ......................................................................... ................ ................ ................ ................ ................

86632 6 Chlamydia, IgM, antibody ................................................................. ................ ................ ................ ................ ................

86635 6 Coccidioides, antibody ...................................................................... ................ ................ ................ ................ ................

86638 6 Q fever antibody ............................................................................... ................ ................ ................ ................ ................

86641 6 Cryptococcus antibody ...................................................................... ................ ................ ................ ................ ................

86644 6 CMV antibody ................................................................................... ................ ................ ................ ................ ................

86645 6 CMV antibody, IgM ........................................................................... ................ ................ ................ ................ ................

86648 6 Diphtheria antibody ........................................................................... ................ ................ ................ ................ ................

86651 6 Encephalitis antibody ........................................................................ ................ ................ ................ ................ ................

86652 6 Encephalitis antibody ........................................................................ ................ ................ ................ ................ ................

86653 6 Encephalitis, antibody ....................................................................... ................ ................ ................ ................ ................

86654 6 Encephalitis, antibody ....................................................................... ................ ................ ................ ................ ................

86658 6 Enterovirus, antibody ........................................................................ ................ ................ ................ ................ ................

86663 6 Epstein-barr antibody ........................................................................ ................ ................ ................ ................ ................

86664 6 Epstein-barr antibody ........................................................................ ................ ................ ................ ................ ................

86665 6 Epstein-barr, antibody ....................................................................... ................ ................ ................ ................ ................

86668 6 Francisella tularensis ........................................................................ ................ ................ ................ ................ ................

86671 6 Fungus, antibody .............................................................................. ................ ................ ................ ................ ................

86674 6 Giardia lamblia .................................................................................. ................ ................ ................ ................ ................

86677 6 Helicobacter pylori ............................................................................ ................ ................ ................ ................ ................

86682 6 Helminth, antibody ............................................................................ ................ ................ ................ ................ ................

86684 6 Hemophilus influenza ........................................................................ ................ ................ ................ ................ ................

86687 6 HTLV–I .............................................................................................. ................ ................ ................ ................ ................

86688 6 HTLV–II ............................................................................................. ................ ................ ................ ................ ................

86689 6 HTLV/HIV confirmatory test .............................................................. ................ ................ ................ ................ ................

86692 6 Hepatitis, delta agent ........................................................................ ................ ................ ................ ................ ................

86694 6 Herpes simplex test .......................................................................... ................ ................ ................ ................ ................

86695 6 Herpes simplex test .......................................................................... ................ ................ ................ ................ ................

86698 6 Histoplasma ...................................................................................... ................ ................ ................ ................ ................

86701 6 HIV–1 ................................................................................................ ................ ................ ................ ................ ................

86702 6 HIV–2 ................................................................................................ ................ ................ ................ ................ ................

86703 6 HIV–1/HIV–2, single assay ............................................................... ................ ................ ................ ................ ................

86704 6 Hep b core ab test, igg & m ............................................................. ................ ................ ................ ................ ................

86705 6 Hep b core ab test, igm .................................................................... ................ ................ ................ ................ ................

86706 6 Hepatitis b surface ab test ................................................................ ................ ................ ................ ................ ................
32415

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

86707 6 Hepatitis be ab test ........................................................................... ................ ................ ................ ................ ................

86708 6 Hep a ab test, igg & m ..................................................................... ................ ................ ................ ................ ................

86709 6 Hep a ab test, igm ............................................................................ ................ ................ ................ ................ ................

86710 6 Influenza virus ................................................................................... ................ ................ ................ ................ ................

86713 6 Legionella .......................................................................................... ................ ................ ................ ................ ................

86717 6 Leishmania ........................................................................................ ................ ................ ................ ................ ................

86720 6 Leptospira ......................................................................................... ................ ................ ................ ................ ................

86723 6 Listeria monocytogenes .................................................................... ................ ................ ................ ................ ................

86727 6 Lymph choriomeningitis .................................................................... ................ ................ ................ ................ ................

86729 6 Lympho venereum ............................................................................ ................ ................ ................ ................ ................

86732 6 Mucormycosis ................................................................................... ................ ................ ................ ................ ................

86735 6 Mumps .............................................................................................. ................ ................ ................ ................ ................

86738 6 Mycoplasma ...................................................................................... ................ ................ ................ ................ ................

86741 6 Neisseria meningitidis ....................................................................... ................ ................ ................ ................ ................

86744 6 Nocardia ............................................................................................ ................ ................ ................ ................ ................

86747 6 Parvovirus ......................................................................................... ................ ................ ................ ................ ................

86750 6 Malaria .............................................................................................. ................ ................ ................ ................ ................

86753 6 Protozoa, not elsewhere ................................................................... ................ ................ ................ ................ ................

86756 6 Respiratory virus ............................................................................... ................ ................ ................ ................ ................

86759 6 Rotavirus ........................................................................................... ................ ................ ................ ................ ................

86762 6 Rubella .............................................................................................. ................ ................ ................ ................ ................

86765 6 Rubeola ............................................................................................. ................ ................ ................ ................ ................

86768 6 Salmonella ........................................................................................ ................ ................ ................ ................ ................

86771 6 Shigella ............................................................................................. ................ ................ ................ ................ ................

86774 6 Tetanus ............................................................................................. ................ ................ ................ ................ ................

86777 6 Toxoplasma ....................................................................................... ................ ................ ................ ................ ................

86778 6 Toxoplasma, IgM .............................................................................. ................ ................ ................ ................ ................

86781 6 Treponema pallidum confirm ............................................................ ................ ................ ................ ................ ................

86784 6 Trichinella .......................................................................................... ................ ................ ................ ................ ................

86787 6 Varicella-zoster ................................................................................. ................ ................ ................ ................ ................

86790 6 Virus, not specified ........................................................................... ................ ................ ................ ................ ................

86793 6 Yersinia ............................................................................................. ................ ................ ................ ................ ................

86800 6 Thyroglobulin antibody ...................................................................... ................ ................ ................ ................ ................

86803 6 Hepatitis c ab test ............................................................................. ................ ................ ................ ................ ................

86804 6 Hep c ab test, confirm ...................................................................... ................ ................ ................ ................ ................

86805 6 Lymphocytotoxicity assay ................................................................. ................ ................ ................ ................ ................

86806 6 Lymphocytotoxicity assay ................................................................. ................ ................ ................ ................ ................

86807 6 Cytotoxic antibody screening ............................................................ ................ ................ ................ ................ ................

86808 6 Cytotoxic antibody screening ............................................................ ................ ................ ................ ................ ................

86812 6 HLA typing, A, B, or C ...................................................................... ................ ................ ................ ................ ................

86813 6 HLA typing, A, B, or C ...................................................................... ................ ................ ................ ................ ................

86816 6 HLA typing, DR/DQ ........................................................................... ................ ................ ................ ................ ................

86817 6 HLA typing, DR/DQ ........................................................................... ................ ................ ................ ................ ................

86821 6 Lymphocyte culture, mixed ............................................................... ................ ................ ................ ................ ................

86822 6 Lymphocyte culture, primed .............................................................. ................ ................ ................ ................ ................

86849 6 Immunology procedure ..................................................................... ................ ................ ................ ................ ................

86850 6 RBC antibody screen ........................................................................ ................ ................ ................ ................ ................

86860 6 RBC antibody elution ........................................................................ ................ ................ ................ ................ ................

86870 6 RBC antibody identification ............................................................... ................ ................ ................ ................ ................

86880 6 Coombs test ...................................................................................... ................ ................ ................ ................ ................

86885 6 Coombs test ...................................................................................... ................ ................ ................ ................ ................

86886 6 Coombs test ...................................................................................... ................ ................ ................ ................ ................

86890 6 Autologous blood process ................................................................ ................ ................ ................ ................ ................

86891 6 Autologous blood, op salvage .......................................................... ................ ................ ................ ................ ................

86900 6 Blood typing, ABO ............................................................................ ................ ................ ................ ................ ................

86901 6 Blood typing, Rh (D) ......................................................................... ................ ................ ................ ................ ................

86903 6 Blood typing, antigen screen ............................................................ ................ ................ ................ ................ ................

86904 6 Blood typing, patient serum .............................................................. ................ ................ ................ ................ ................

86905 6 Blood typing, RBC antigens .............................................................. ................ ................ ................ ................ ................

86906 6 Blood typing, Rh phenotype ............................................................. ................ ................ ................ ................ ................

86910 9 Blood typing, paternity test ............................................................... ................ ................ ................ ................ ................

86911 9 Blood typing, antigen system ............................................................ ................ ................ ................ ................ ................

86915 6 Bone marrow ..................................................................................... ................ ................ ................ ................ ................

86920 6 Compatibility test ............................................................................... ................ ................ ................ ................ ................

86921 6 Compatibility test ............................................................................... ................ ................ ................ ................ ................

86922 6 Compatibility test ............................................................................... ................ ................ ................ ................ ................

86927 6 Plasma, fresh frozen ......................................................................... ................ ................ ................ ................ ................

86930 6 Frozen blood prep ............................................................................. ................ ................ ................ ................ ................

86931 6 Frozen blood thaw ............................................................................ ................ ................ ................ ................ ................

86932 6 Frozen blood, freeze/thaw ................................................................ ................ ................ ................ ................ ................

86940 6 Hemolysins/agglutinins auto ............................................................. ................ ................ ................ ................ ................

86941 6 Hemolysins/agglutinins ..................................................................... ................ ................ ................ ................ ................

86945 6 Blood product/irradiation ................................................................... ................ ................ ................ ................ ................

86950 6 Leukacyte transfusion ....................................................................... ................ ................ ................ ................ ................
32416

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

86965 6 Pooling blood platelets ...................................................................... ................ ................ ................ ................ ................

86970 6 RBC pretreatment ............................................................................. ................ ................ ................ ................ ................

86971 6 RBC pretreatment ............................................................................. ................ ................ ................ ................ ................

86972 6 RBC pretreatment ............................................................................. ................ ................ ................ ................ ................

86975 6 RBC pretreatment, serum ................................................................. ................ ................ ................ ................ ................

86976 6 RBC pretreatment, serum ................................................................. ................ ................ ................ ................ ................

86977 6 RBC pretreatment, serum ................................................................. ................ ................ ................ ................ ................

86978 6 RBC pretreatment, serum ................................................................. ................ ................ ................ ................ ................

86985 6 Split blood or products ...................................................................... ................ ................ ................ ................ ................

86999 6 Transfusion procedure ...................................................................... ................ ................ ................ ................ ................

87001 6 Small animal inoculation ................................................................... ................ ................ ................ ................ ................

87003 6 Small animal inoculation ................................................................... ................ ................ ................ ................ ................

87015 6 Specimen concentration ................................................................... ................ ................ ................ ................ ................

87040 6 Blood culture for bacteria .................................................................. ................ ................ ................ ................ ................

87045 6 Stool culture for bacteria ................................................................... ................ ................ ................ ................ ................

87060 6 Nose/throat culture,bacteria .............................................................. ................ ................ ................ ................ ................

87070 6 Culture specimen, bacteria ............................................................... ................ ................ ................ ................ ................

87072 2 Culture of specimen by kit ................................................................ ................ ................ ................ ................ ................

87075 6 Culture specimen, bacteria ............................................................... ................ ................ ................ ................ ................

87076 6 Bacteria identification ........................................................................ ................ ................ ................ ................ ................

87081 6 Bacteria culture screen ..................................................................... ................ ................ ................ ................ ................

87082 6 Culture of specimen by kit ................................................................ ................ ................ ................ ................ ................

87083 6 Culture of specimen by kit ................................................................ ................ ................ ................ ................ ................

87084 6 Culture of specimen by kit ................................................................ ................ ................ ................ ................ ................

87085 6 Culture of specimen by kit ................................................................ ................ ................ ................ ................ ................

87086 6 Urine culture, colony count ............................................................... ................ ................ ................ ................ ................

87087 6 Urine bacteria culture ........................................................................ ................ ................ ................ ................ ................

87088 6 Urine bacteria culture ........................................................................ ................ ................ ................ ................ ................

87101 6 Skin fungus culture ........................................................................... ................ ................ ................ ................ ................

87102 6 Fungus isolation culture .................................................................... ................ ................ ................ ................ ................

87103 6 Blood fungus culture ......................................................................... ................ ................ ................ ................ ................

87106 6 Fungus identification ......................................................................... ................ ................ ................ ................ ................

87109 6 Mycoplasma culture .......................................................................... ................ ................ ................ ................ ................

87110 6 Culture, chlamydia ............................................................................ ................ ................ ................ ................ ................

87116 6 Mycobacteria culture ......................................................................... ................ ................ ................ ................ ................

87117 6 Mycobacteria culture ......................................................................... ................ ................ ................ ................ ................

87118 6 Mycobacteria identification ................................................................ ................ ................ ................ ................ ................

87140 6 Culture typing, fluorescent ................................................................ ................ ................ ................ ................ ................

87143 6 Culture typing, GLC method ............................................................. ................ ................ ................ ................ ................

87145 6 Culture typing, phage method .......................................................... ................ ................ ................ ................ ................

87147 6 Culture typing, serologic ................................................................... ................ ................ ................ ................ ................

87151 6 Culture typing, serologic ................................................................... ................ ................ ................ ................ ................

87155 6 Culture typing, precipitin ................................................................... ................ ................ ................ ................ ................

87158 6 Culture typing, added method .......................................................... ................ ................ ................ ................ ................

87163 6 Special microbiology culture ............................................................. ................ ................ ................ ................ ................

87164 6 Dark field examination ...................................................................... ................ ................ ................ ................ ................

87166 6 Dark field examination ...................................................................... ................ ................ ................ ................ ................

87174 6 Endotoxin, bacterial .......................................................................... ................ ................ ................ ................ ................

87175 6 Assay, endotoxin, bacterial ............................................................... ................ ................ ................ ................ ................

87176 6 Endotoxin, bacterial .......................................................................... ................ ................ ................ ................ ................

87177 6 Ova and parasites smears ................................................................ ................ ................ ................ ................ ................

87181 6 Antibiotic sensitivity, each ................................................................. ................ ................ ................ ................ ................

87184 6 Antibiotic sensitivity, each ................................................................. ................ ................ ................ ................ ................

87186 6 Antibiotic sensitivity, MIC .................................................................. ................ ................ ................ ................ ................

87187 6 Antibiotic sensitivity, MBC ................................................................. ................ ................ ................ ................ ................

87188 6 Antibiotic sensitivity, each ................................................................. ................ ................ ................ ................ ................

87190 6 TB antibiotic sensitivity ..................................................................... ................ ................ ................ ................ ................

87192 6 Antibiotic sensitivity, each ................................................................. ................ ................ ................ ................ ................

87197 6 Bactericidal level, serum ................................................................... ................ ................ ................ ................ ................

87205 6 Smear, stain & interpret .................................................................... ................ ................ ................ ................ ................

87206 6 Smear, stain & interpret .................................................................... ................ ................ ................ ................ ................

87207 6 Smear, stain & interpret .................................................................... ................ ................ ................ ................ ................

87208 6 Smear, stain & interpret .................................................................... ................ ................ ................ ................ ................

87210 6 Smear, stain & interpret .................................................................... ................ ................ ................ ................ ................

87211 6 Smear, stain & interpret .................................................................... ................ ................ ................ ................ ................

87220 6 Tissue exam for fungi ....................................................................... ................ ................ ................ ................ ................

87230 6 Assay, toxin or antitoxin .................................................................... ................ ................ ................ ................ ................

87250 6 Virus inoculation for test ................................................................... ................ ................ ................ ................ ................

87252 6 Virus inoculation for test ................................................................... ................ ................ ................ ................ ................

87253 6 Virus inoculation for test ................................................................... ................ ................ ................ ................ ................

87260 6 Adenovirus ag, dfa ............................................................................ ................ ................ ................ ................ ................

87265 6 Pertussis ag, dfa ............................................................................... ................ ................ ................ ................ ................

87270 6 Chylmd trach ag, dfa ........................................................................ ................ ................ ................ ................ ................

87272 6 Cryptosporidum ag, dfa .................................................................... ................ ................ ................ ................ ................
32417

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

87274 6 Herpes simplex ag, dfa ..................................................................... ................ ................ ................ ................ ................

87276 6 Influenza ag, dfa ............................................................................... ................ ................ ................ ................ ................

87278 6 Legion pneumo ag, dfa ..................................................................... ................ ................ ................ ................ ................

87280 6 Resp syncytial ag, dfa ...................................................................... ................ ................ ................ ................ ................

87285 6 Trepon pallidum ag, dfa .................................................................... ................ ................ ................ ................ ................

87290 6 Varicella ag, dfa ................................................................................ ................ ................ ................ ................ ................

87299 6 Ag detection nos, dfa ........................................................................ ................ ................ ................ ................ ................

87301 6 Adenovirus ag, eia ............................................................................ ................ ................ ................ ................ ................

87320 6 Chylmd trach ag, eia ......................................................................... ................ ................ ................ ................ ................

87324 6 Clostridium ag, eia ............................................................................ ................ ................ ................ ................ ................

87328 6 Cryptospor ag, eia ............................................................................ ................ ................ ................ ................ ................

87332 6 Cytomegalovirus ag, eia ................................................................... ................ ................ ................ ................ ................

87335 6 E coli 0157 ag, eia ............................................................................ ................ ................ ................ ................ ................

87340 6 Hepatitis b surface ag, eia ................................................................ ................ ................ ................ ................ ................

87350 6 Hepatitis b ag, eia ............................................................................. ................ ................ ................ ................ ................

87380 6 Hepatitis delta ag, eia ....................................................................... ................ ................ ................ ................ ................

87385 6 Histoplasma capsul ag, eia ............................................................... ................ ................ ................ ................ ................

87390 6 Hiv-1 ag, eia ...................................................................................... ................ ................ ................ ................ ................

87391 6 Hiv-2 ag, eia ...................................................................................... ................ ................ ................ ................ ................

87420 6 Resp syncytial ag, eia ....................................................................... ................ ................ ................ ................ ................

87425 6 Rotavirus ag, eia ............................................................................... ................ ................ ................ ................ ................

87430 6 Strep a ag, eia .................................................................................. ................ ................ ................ ................ ................

87449 6 Ag detect nos, eia, mult .................................................................... ................ ................ ................ ................ ................

87450 6 Ag detect nos, eia, single ................................................................. ................ ................ ................ ................ ................

87470 6 Bartonella, dna, dir probe ................................................................. ................ ................ ................ ................ ................

87471 6 Bartonella, dna, amp probe .............................................................. ................ ................ ................ ................ ................

87472 6 Bartonella, dna, quant ....................................................................... ................ ................ ................ ................ ................

87475 6 Lyme dis, dna, dir probe ................................................................... ................ ................ ................ ................ ................

87476 6 Lyme dis, dna, amp probe ................................................................ ................ ................ ................ ................ ................

87477 6 Lyme dis, dna, quant ........................................................................ ................ ................ ................ ................ ................

87480 6 Candida, dna, dir probe .................................................................... ................ ................ ................ ................ ................

87481 6 Candida, dna, amp probe ................................................................. ................ ................ ................ ................ ................

87482 6 Candida, dna, quant ......................................................................... ................ ................ ................ ................ ................

87485 6 Chylmd pneum, dna, dir probe ......................................................... ................ ................ ................ ................ ................

87486 6 Chylmd pneum, dna, amp probe ...................................................... ................ ................ ................ ................ ................

87487 6 Chylmd pneum, dna, quant .............................................................. ................ ................ ................ ................ ................

87490 6 Chylmd trach, dna, dir probe ............................................................ ................ ................ ................ ................ ................

87491 6 Chylmd trach, dna, amp probe ......................................................... ................ ................ ................ ................ ................

87492 6 Chylmd trach, dna, quant ................................................................. ................ ................ ................ ................ ................

87495 6 Cytomeg, dna, dir probe ................................................................... ................ ................ ................ ................ ................

87496 6 Cytomeg, dna, amp probe ................................................................ ................ ................ ................ ................ ................

87497 6 Cytomeg, dna, quant ........................................................................ ................ ................ ................ ................ ................

87510 6 Gardner vag, dna, dir probe ............................................................. ................ ................ ................ ................ ................

87511 6 Gardner vag, dna, amp probe .......................................................... ................ ................ ................ ................ ................

87512 6 Gardner vag, dna, quant ................................................................... ................ ................ ................ ................ ................

87515 6 Hepatitis b, dna, dir probe ................................................................ ................ ................ ................ ................ ................

87516 6 Hepatitis b, dna, amp probe ............................................................. ................ ................ ................ ................ ................

87517 6 Hepatitis b, dna, quant ...................................................................... ................ ................ ................ ................ ................

87520 6 Hepatitis c, rna, dir probe ................................................................. ................ ................ ................ ................ ................

87521 6 Hepatitis c, rna, amp probe .............................................................. ................ ................ ................ ................ ................

87522 6 Hepatitis c, rna, quant ....................................................................... ................ ................ ................ ................ ................

87525 6 Hepatitis g, dna, dir probe ................................................................ ................ ................ ................ ................ ................

87526 6 Hepatitis g, dna, amp probe ............................................................. ................ ................ ................ ................ ................

87527 6 Hepatitis g, dna, quant ...................................................................... ................ ................ ................ ................ ................

87528 6 Hsv, dna, dir probe ........................................................................... ................ ................ ................ ................ ................

87529 6 Hsv, dna, amp probe ........................................................................ ................ ................ ................ ................ ................

87530 6 Hsv, dna, quant ................................................................................. ................ ................ ................ ................ ................

87531 6 Hhv-6, dna, dir probe ........................................................................ ................ ................ ................ ................ ................

87532 6 Hhv-6, dna, amp probe ..................................................................... ................ ................ ................ ................ ................

87533 6 Hhv-6, dna, quant ............................................................................. ................ ................ ................ ................ ................

87534 6 Hiv-1, dna, dir probe ......................................................................... ................ ................ ................ ................ ................

87535 6 Hiv-1, dna, amp probe ...................................................................... ................ ................ ................ ................ ................

87536 6 Hiv-1, dna, quant .............................................................................. ................ ................ ................ ................ ................

87537 6 Hiv-2, dna, dir probe ......................................................................... ................ ................ ................ ................ ................

87538 6 Hiv-2, dna, amp probe ...................................................................... ................ ................ ................ ................ ................

87539 6 Hiv-2, dna, quant .............................................................................. ................ ................ ................ ................ ................

87540 6 Legion pneumo, dna, dir prob .......................................................... ................ ................ ................ ................ ................

87541 6 Legion pneumo, dna, amp prob ....................................................... ................ ................ ................ ................ ................

87542 6 Legion pneumo, dna, quant .............................................................. ................ ................ ................ ................ ................

87550 6 Mycobacteria, dna, dir probe ............................................................ ................ ................ ................ ................ ................

87551 6 Mycobacteria, dna, amp probe ......................................................... ................ ................ ................ ................ ................

87552 6 Mycobacteria, dna, quant ................................................................. ................ ................ ................ ................ ................

87555 6 M.tuberculo, dna, dir probe ............................................................... ................ ................ ................ ................ ................

87556 6 M.tuberculo, dna, amp probe ............................................................ ................ ................ ................ ................ ................
32418

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

87557 6 M.tuberculo, dna, quant .................................................................... ................ ................ ................ ................ ................

87560 6 M.avium-intra, dna, dir prob .............................................................. ................ ................ ................ ................ ................

87561 6 M.avium-intra, dna, amp prob ........................................................... ................ ................ ................ ................ ................

87562 6 M.avium-intra, dna, quant ................................................................. ................ ................ ................ ................ ................

87580 6 M.pneumon, dna, dir probe .............................................................. ................ ................ ................ ................ ................

87581 6 M.pneumon, dna, amp probe ........................................................... ................ ................ ................ ................ ................

87582 6 M.pneumon, dna, quant .................................................................... ................ ................ ................ ................ ................

87590 6 N.gonorrhoeae, dna, dir prob ........................................................... ................ ................ ................ ................ ................

87591 6 N.gonorrhoeae, dna, amp prob ........................................................ ................ ................ ................ ................ ................

87592 6 N.gonorrhoeae, dna, quant ............................................................... ................ ................ ................ ................ ................

87620 6 Hpv, dna, dir probe ........................................................................... ................ ................ ................ ................ ................

87621 6 Hpv, dna, amp probe ........................................................................ ................ ................ ................ ................ ................

87622 6 Hpv, dna, quant ................................................................................ ................ ................ ................ ................ ................

87650 6 Strep a, dna, dir probe ...................................................................... ................ ................ ................ ................ ................

87651 6 Strep a, dna, amp probe ................................................................... ................ ................ ................ ................ ................

87652 6 Strep a, dna, quant ........................................................................... ................ ................ ................ ................ ................

87797 6 Detect agent nos, dna, dir ................................................................ ................ ................ ................ ................ ................

87798 6 Detect agent nos, dna, amp ............................................................. ................ ................ ................ ................ ................

87799 6 Detect agent nos, dna, quant ........................................................... ................ ................ ................ ................ ................

87810 6 Chylmd trach assay w/optic .............................................................. ................ ................ ................ ................ ................

87850 6 N. gonorrhoeae assay w/optic .......................................................... ................ ................ ................ ................ ................

87880 6 Strep a assay w/optic ....................................................................... ................ ................ ................ ................ ................

87899 6 Agent nos assay w/optic ................................................................... ................ ................ ................ ................ ................

87999 6 Microbiology procedure ..................................................................... ................ ................ ................ ................ ................

88000 9 Autopsy (necropsy), gross ................................................................ ................ ................ ................ ................ ................

88005 9 Autopsy (necropsy), gross ................................................................ ................ ................ ................ ................ ................

88007 9 Autopsy (necropsy), gross ................................................................ ................ ................ ................ ................ ................

88012 9 Autopsy (necropsy), gross ................................................................ ................ ................ ................ ................ ................

88014 9 Autopsy (necropsy), gross ................................................................ ................ ................ ................ ................ ................

88016 9 Autopsy (necropsy), gross ................................................................ ................ ................ ................ ................ ................

88020 9 Autopsy (necropsy), complete .......................................................... ................ ................ ................ ................ ................

88025 9 Autopsy (necropsy), complete .......................................................... ................ ................ ................ ................ ................

88027 9 Autopsy (necropsy), complete .......................................................... ................ ................ ................ ................ ................

88028 9 Autopsy (necropsy), complete .......................................................... ................ ................ ................ ................ ................

88029 9 Autopsy (necropsy), complete .......................................................... ................ ................ ................ ................ ................

88036 9 Limited autopsy ................................................................................. ................ ................ ................ ................ ................

88037 9 Limited autopsy ................................................................................. ................ ................ ................ ................ ................

88040 9 Forensic autopsy (necropsy) ............................................................ ................ ................ ................ ................ ................

88045 9 Coroner’s autopsy (necropsy) ........................................................... ................ ................ ................ ................ ................

88099 9 Necropsy (autopsy) procedure ......................................................... ................ ................ ................ ................ ................

88104 6 Cytopathology, fluids ......................................................................... ................ ................ ................ ................ ................

88106 6 Cytopathology, fluids ......................................................................... ................ ................ ................ ................ ................

88107 6 Cytopathology, fluids ......................................................................... ................ ................ ................ ................ ................

88108 6 Cytopath, concentrate tech ............................................................... ................ ................ ................ ................ ................

88125 6 Forensic cytopathology ..................................................................... ................ ................ ................ ................ ................

88130 6 Sex chromatin identification .............................................................. ................ ................ ................ ................ ................

88140 6 Sex chromatin identification .............................................................. ................ ................ ................ ................ ................

88141 6 Cytopath cerv/vag interpret ............................................................... ................ ................ ................ ................ ................

88142 6 Cytopath cerv/vag thin layer ............................................................. ................ ................ ................ ................ ................

88150 6 Cytopath cerv/vag ............................................................................. ................ ................ ................ ................ ................

88152 6 Cytopath cerv/vag auto ..................................................................... ................ ................ ................ ................ ................

88155 6 Cytopath cerv/vag index ................................................................... ................ ................ ................ ................ ................

88156 6 Cytopath cerv/vag tbs ....................................................................... ................ ................ ................ ................ ................

88158 6 Cytopath cerv/vag tbs auto ............................................................... ................ ................ ................ ................ ................

88160 6 Cytopath smear, other source .......................................................... ................ ................ ................ ................ ................

88161 6 Cytopath smear, other source .......................................................... ................ ................ ................ ................ ................

88162 6 Cytopath smear, other source .......................................................... ................ ................ ................ ................ ................

88170 6 Fine needle aspiration ...................................................................... ................ ................ ................ ................ ................

88171 6 Fine needle aspiration ...................................................................... ................ ................ ................ ................ ................

88172 6 Evaluation of smear .......................................................................... ................ ................ ................ ................ ................

88173 6 Interpretation of smear ...................................................................... ................ ................ ................ ................ ................

88180 6 Cell marker study .............................................................................. ................ ................ ................ ................ ................

88182 6 Cell marker study .............................................................................. ................ ................ ................ ................ ................

88199 6 Cytopathology procedure .................................................................. ................ ................ ................ ................ ................

88230 6 Tissue culture, lymphocyte ............................................................... ................ ................ ................ ................ ................

88233 6 Tissue culture, skin/biopsy ................................................................ ................ ................ ................ ................ ................

88235 6 Tissue culture, placenta .................................................................... ................ ................ ................ ................ ................

88237 6 Tissue culture, bone marrow ............................................................ ................ ................ ................ ................ ................

88239 6 Tissue culture, other ......................................................................... ................ ................ ................ ................ ................

88245 6 Chromosome analysis ...................................................................... ................ ................ ................ ................ ................

88248 6 Chromosome analysis ...................................................................... ................ ................ ................ ................ ................

88250 6 Chromosome analysis ...................................................................... ................ ................ ................ ................ ................

88260 6 Chromosome analysis: 5 cells .......................................................... ................ ................ ................ ................ ................

88261 6 Chromosome analysis: 5 cells .......................................................... ................ ................ ................ ................ ................
32419

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

88262 6 Chromosome count: 15–20 cells ...................................................... ................ ................ ................ ................ ................

88263 6 Chromosome analysis: 45 cells ........................................................ ................ ................ ................ ................ ................

88267 6 Chromosome analysis: placenta ....................................................... ................ ................ ................ ................ ................

88269 6 Chromosome analysis: amniotic ....................................................... ................ ................ ................ ................ ................

88280 6 Chromosome karyotype study .......................................................... ................ ................ ................ ................ ................

88283 6 Chromosome banding study ............................................................. ................ ................ ................ ................ ................

88285 6 Chromosome count: additional ......................................................... ................ ................ ................ ................ ................

88289 6 Chromosome study: additional ......................................................... ................ ................ ................ ................ ................

88299 6 Cytogenetic study ............................................................................. ................ ................ ................ ................ ................

88300 6 Surg path, gross ............................................................................... ................ ................ ................ ................ ................

88302 6 Tissue exam by pathologist .............................................................. ................ ................ ................ ................ ................

88304 6 Tissue exam by pathologist .............................................................. ................ ................ ................ ................ ................

88305 6 Tissue exam by pathologist .............................................................. ................ ................ ................ ................ ................

88307 6 Tissue exam by pathologist .............................................................. ................ ................ ................ ................ ................

88309 6 Tissue exam by pathologist .............................................................. ................ ................ ................ ................ ................

88311 6 Decalcify tissue ................................................................................. ................ ................ ................ ................ ................

88312 6 Special stains .................................................................................... ................ ................ ................ ................ ................

88313 6 Special stains .................................................................................... ................ ................ ................ ................ ................

88314 6 Histochemical stain ........................................................................... ................ ................ ................ ................ ................

88318 6 Chemical histochemistry ................................................................... ................ ................ ................ ................ ................

88319 6 Enzyme histochemistry ..................................................................... ................ ................ ................ ................ ................

88321 6 Microslide consultation ...................................................................... ................ ................ ................ ................ ................

88323 6 Microslide consultation ...................................................................... ................ ................ ................ ................ ................

88325 6 Comprehensive review of data ......................................................... ................ ................ ................ ................ ................

88329 6 Pathology consult in surgery ............................................................ ................ ................ ................ ................ ................

88331 6 Pathology consult in surgery ............................................................ ................ ................ ................ ................ ................

88332 6 Pathology consult in surgery ............................................................ ................ ................ ................ ................ ................

88342 6 Immunocytochemistry ....................................................................... ................ ................ ................ ................ ................

88346 6 Immunofluorescent study .................................................................. ................ ................ ................ ................ ................

88347 6 Immunofluorescent study .................................................................. ................ ................ ................ ................ ................

88348 6 Electron microscopy .......................................................................... ................ ................ ................ ................ ................

88349 6 Scanning electron microscopy .......................................................... ................ ................ ................ ................ ................

88355 6 Analysis, skeletal muscle .................................................................. ................ ................ ................ ................ ................

88356 6 Analysis, nerve .................................................................................. ................ ................ ................ ................ ................

88358 6 Analysis, tumor ................................................................................. ................ ................ ................ ................ ................

88362 6 Nerve teasing preparations ............................................................... ................ ................ ................ ................ ................

88365 6 Tissue hybridization .......................................................................... ................ ................ ................ ................ ................

88371 6 Protein, western blot tissue .............................................................. ................ ................ ................ ................ ................

88372 6 Protein analysis w/probe ................................................................... ................ ................ ................ ................ ................

88399 6 Surgical pathology procedure ........................................................... ................ ................ ................ ................ ................

89050 6 Body fluid cell count .......................................................................... ................ ................ ................ ................ ................

89051 6 Body fluid cell count .......................................................................... ................ ................ ................ ................ ................

89060 6 Exam, synovial fluid crystals ............................................................. ................ ................ ................ ................ ................

89100 6 Sample intestinal contents ................................................................ ................ ................ ................ ................ ................

89105 6 Sample intestinal contents ................................................................ ................ ................ ................ ................ ................

89125 6 Specimen fat stain ............................................................................ ................ ................ ................ ................ ................

89130 6 Sample stomach contents ................................................................ ................ ................ ................ ................ ................

89132 6 Sample stomach contents ................................................................ ................ ................ ................ ................ ................

89135 6 Sample stomach contents ................................................................ ................ ................ ................ ................ ................

89136 6 Sample stomach contents ................................................................ ................ ................ ................ ................ ................

89140 6 Sample stomach contents ................................................................ ................ ................ ................ ................ ................

89141 6 Sample stomach contents ................................................................ ................ ................ ................ ................ ................

89160 6 Exam feces for meat fibers ............................................................... ................ ................ ................ ................ ................

89190 6 Nasal smear for eosinophils ............................................................. ................ ................ ................ ................ ................

89250 6 Fertilization of oocyte ........................................................................ ................ ................ ................ ................ ................

89251 6 Culture oocyte w/embryos ................................................................ ................ ................ ................ ................ ................

89252 6 Assist oocyte fertilization .................................................................. ................ ................ ................ ................ ................

89253 6 Embryo hatching ............................................................................... ................ ................ ................ ................ ................

89254 6 Oocyte identification .......................................................................... ................ ................ ................ ................ ................

89255 6 Prepare embryo for transfer ............................................................. ................ ................ ................ ................ ................

89256 6 Prepare cryopreserved embryo ........................................................ ................ ................ ................ ................ ................

89257 6 Sperm identification .......................................................................... ................ ................ ................ ................ ................

89258 6 Cryopreservation, embryo ................................................................. ................ ................ ................ ................ ................

89259 6 Cryopreservation, sperm ................................................................... ................ ................ ................ ................ ................

89260 6 Sperm isolation, simple ..................................................................... ................ ................ ................ ................ ................

89261 6 Sperm isolation, complex .................................................................. ................ ................ ................ ................ ................

89300 6 Semen analysis ................................................................................. ................ ................ ................ ................ ................

89310 6 Semen analysis ................................................................................. ................ ................ ................ ................ ................

89320 6 Semen analysis ................................................................................. ................ ................ ................ ................ ................

89325 6 Sperm antibody test .......................................................................... ................ ................ ................ ................ ................

89329 6 Sperm evaluation test ....................................................................... ................ ................ ................ ................ ................

89330 6 Evaluation, cervical mucus ............................................................... ................ ................ ................ ................ ................

89350 6 Sputum specimen collection ............................................................. ................ ................ ................ ................ ................

89355 6 Exam feces for starch ....................................................................... ................ ................ ................ ................ ................
32420

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

89360 6 Collect sweat for test ........................................................................ ................ ................ ................ ................ ................

89365 6 Water load test .................................................................................. ................ ................ ................ ................ ................

89399 6 Pathology lab procedure ................................................................... ................ ................ ................ ................ ................

90700 9 DTaP immunization ........................................................................... ................ ................ ................ ................ ................

90701 9 DTP immunization ............................................................................. ................ ................ ................ ................ ................

90702 9 DT immunization ............................................................................... ................ ................ ................ ................ ................

90703 9 Tetanus immunization ....................................................................... ................ ................ ................ ................ ................

90704 9 Mumps immunization ........................................................................ ................ ................ ................ ................ ................

90705 9 Measles immunization ...................................................................... ................ ................ ................ ................ ................

90706 9 Rubella immunization ........................................................................ ................ ................ ................ ................ ................

90707 9 MMR virus immunization .................................................................. ................ ................ ................ ................ ................

90708 9 Measles-rubella immunization .......................................................... ................ ................ ................ ................ ................

90709 9 Rubella & mumps immunization ....................................................... ................ ................ ................ ................ ................

90710 9 Combined vaccine ............................................................................ ................ ................ ................ ................ ................

90711 9 Combined vaccine ............................................................................ ................ ................ ................ ................ ................

90712 9 Oral poliovirus immunization ............................................................. ................ ................ ................ ................ ................

90713 9 Poliomyelitis immunization ................................................................ ................ ................ ................ ................ ................

90714 9 Typhoid immunization ....................................................................... ................ ................ ................ ................ ................

90716 9 Chicken pox vaccine ......................................................................... ................ ................ ................ ................ ................

90717 9 Yellow fever immunization ................................................................ ................ ................ ................ ................ ................

90718 9 Td immunization ................................................................................ ................ ................ ................ ................ ................

90719 9 Diphtheria immunization ................................................................... ................ ................ ................ ................ ................

90720 9 DTP/HIB vaccine ............................................................................... ................ ................ ................ ................ ................

90721 9 Dtap/hib vaccine ............................................................................... ................ ................ ................ ................ ................

90724 6 Influenza immunization ..................................................................... ................ ................ ................ ................ ................

90725 9 Cholera immunization ....................................................................... ................ ................ ................ ................ ................

90726 9 Rabies immunization ......................................................................... ................ ................ ................ ................ ................

90727 9 Plague immunization ......................................................................... ................ ................ ................ ................ ................

90728 9 BCG immunization ............................................................................ ................ ................ ................ ................ ................

90730 9 Hepatitis A vaccine ........................................................................... ................ ................ ................ ................ ................

90732 6 Pneumococcal immunization ............................................................ ................ ................ ................ ................ ................

90733 9 Meningococcal immunization ............................................................ ................ ................ ................ ................ ................

90735 9 Encephalitis virus vaccine ................................................................. ................ ................ ................ ................ ................

90737 9 Influenza B immunization .................................................................. ................ ................ ................ ................ ................

90741 9 Passive immunization, ISG ............................................................... ................ ................ ................ ................ ................

90742 9 Special passive immunization ........................................................... ................ ................ ................ ................ ................

90744 6 Hepatitis B vaccine, under 11 ........................................................... ................ ................ ................ ................ ................

90745 6 Hepatitis B vaccine, 11–19 ............................................................... ................ ................ ................ ................ ................

90746 6 Hepatitis B vaccine, over 20 ............................................................. ................ ................ ................ ................ ................

90747 6 Hepatitis B vaccine, ill pat ................................................................ ................ ................ ................ ................ ................

90748 6 Hepatitis b/hib vaccine ...................................................................... ................ ................ ................ ................ ................

90749 6 Immunization procedure ................................................................... ................ ................ ................ ................ ................

90780 6 IV infusion therapy, 1 hour ............................................................... ................ ................ ................ ................ ................

90781 6 IV infusion, additional hour ............................................................... ................ ................ ................ ................ ................

90782 6 Injection (SC)/(IM) ............................................................................. ................ ................ ................ ................ ................

90783 6 Injection (IA) ...................................................................................... ................ ................ ................ ................ ................

90784 6 Injection (IV) ...................................................................................... ................ ................ ................ ................ ................

90788 6 Injection of antibiotic ......................................................................... ................ ................ ................ ................ ................

90799 6 Therapeutic/diag injection ................................................................. ................ ................ ................ ................ ................

90801 6 Psy dx interview ................................................................................ ................ ................ ................ ................ ................

90802 6 Intac psy dx interview ....................................................................... ................ ................ ................ ................ ................

90804 6 Psytx, office (20–30) ......................................................................... ................ ................ ................ ................ ................

90805 6 Psytx, office (20–30) w/e&m ............................................................. ................ ................ ................ ................ ................

90806 6 Psytx, office (45–50) ......................................................................... ................ ................ ................ ................ ................

90807 6 Psytx, office (45–50) w/e&m ............................................................. ................ ................ ................ ................ ................

90808 6 Psytx, office (75–80) ......................................................................... ................ ................ ................ ................ ................

90809 6 Psytx, office (75–80) w/e&m ............................................................. ................ ................ ................ ................ ................

90810 6 Intac psytx, office (20–30) ................................................................ ................ ................ ................ ................ ................

90811 6 Intac psytx, off 20–30 w/e&m ........................................................... ................ ................ ................ ................ ................

90812 6 Intac psytx, office (45–50) ................................................................ ................ ................ ................ ................ ................

90813 6 Intac psytx, off 45–50 w/e&m ........................................................... ................ ................ ................ ................ ................

90814 6 Intac psytx, office (75–80) ................................................................ ................ ................ ................ ................ ................

90815 6 Intac psytx, off 75–80 w/e&m ........................................................... ................ ................ ................ ................ ................

90816 6 Psytx, hosp (20–30) .......................................................................... ................ ................ ................ ................ ................

90817 6 Psytx, hosp (20–30) w/e&m .............................................................. ................ ................ ................ ................ ................

90818 6 Psytx, hosp (45–50) .......................................................................... ................ ................ ................ ................ ................

90819 6 Psytx, hosp (45–50) w/e&m .............................................................. ................ ................ ................ ................ ................

90821 6 Psytx, hosp (75–80) .......................................................................... ................ ................ ................ ................ ................

90822 6 Psytx, hosp (75–80) w/e&m .............................................................. ................ ................ ................ ................ ................

90823 6 Intac psytx, hosp (20–30) ................................................................. ................ ................ ................ ................ ................

90824 6 Intac psytx, hsp 20–30 w/e&m ......................................................... ................ ................ ................ ................ ................

90826 6 Intac psytx, hosp (45–50) ................................................................. ................ ................ ................ ................ ................

90827 6 Intac psytx, hsp 45–50 w/e&m ......................................................... ................ ................ ................ ................ ................

90828 6 Intac psytx, hosp (75–80) ................................................................. ................ ................ ................ ................ ................
32421

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

90829 6 Intac psytx, hsp 75–80 w/e&m ......................................................... ................ ................ ................ ................ ................

90845 6 Psychoanalysis ................................................................................. ................ ................ ................ ................ ................

90846 6 Family psytx w/o patient ................................................................... ................ ................ ................ ................ ................

90847 6 Family psytx w/patient ...................................................................... ................ ................ ................ ................ ................

90849 6 Multiple family group psytx ............................................................... ................ ................ ................ ................ ................

90853 6 Group psychotherapy ........................................................................ ................ ................ ................ ................ ................

90857 6 Intac group psytx .............................................................................. ................ ................ ................ ................ ................

90862 6 Medication management ................................................................... ................ ................ ................ ................ ................

90865 6 Narcosynthesis .................................................................................. ................ ................ ................ ................ ................

90870 6 Electroconvulsive therapy ................................................................. ................ ................ ................ ................ ................

90871 6 Electroconvulsive therapy ................................................................. ................ ................ ................ ................ ................

90875 9 Psychophysiological therapy ............................................................. ................ ................ ................ ................ ................

90876 9 Psychophysiological therapy ............................................................. ................ ................ ................ ................ ................

90880 6 Hypnotherapy .................................................................................... ................ ................ ................ ................ ................

90882 9 Environmental manipulation .............................................................. ................ ................ ................ ................ ................

90885 6 Psy evaluation of records ................................................................. ................ ................ ................ ................ ................

90887 6 Consultation with family .................................................................... ................ ................ ................ ................ ................

90889 6 Preparation of report ......................................................................... ................ ................ ................ ................ ................

90899 6 Psychiatric service/therapy ............................................................... ................ ................ ................ ................ ................

90901 6 Biofeedback, any method ................................................................. ................ ................ ................ ................ ................

90911 6 Biofeedback peri/uro/rectal ............................................................... ................ ................ ................ ................ ................

90918 6 ESRD related services, month ......................................................... ................ ................ ................ ................ ................

90919 6 ESRD related services, month ......................................................... ................ ................ ................ ................ ................

90920 6 ESRD related services, month ......................................................... ................ ................ ................ ................ ................

90921 6 ESRD related services, month ......................................................... ................ ................ ................ ................ ................

90922 6 ESRD related services, day .............................................................. ................ ................ ................ ................ ................

90923 6 Esrd related services, day ................................................................ ................ ................ ................ ................ ................

90924 6 Esrd related services, day ................................................................ ................ ................ ................ ................ ................

90925 6 Esrd related services, day ................................................................ ................ ................ ................ ................ ................

90935 6 Hemodialysis, one evaluation ........................................................... ................ ................ ................ ................ ................

90937 6 Hemodialysis, repeated eval. ............................................................ ................ ................ ................ ................ ................

90945 6 Dialysis, one evaluation .................................................................... ................ ................ ................ ................ ................

90947 6 Dialysis, repeated eval. ..................................................................... ................ ................ ................ ................ ................

90989 6 Dialysis training/complete ................................................................. ................ ................ ................ ................ ................

90993 6 Dialysis training/incomplete .............................................................. ................ ................ ................ ................ ................

90997 6 Hemoperfusion .................................................................................. ................ ................ ................ ................ ................

90999 6 Dialysis procedure ............................................................................ ................ ................ ................ ................ ................

91000 6 Esophageal intubation ...................................................................... ................ ................ ................ ................ ................

91010 6 Esophagus motility study .................................................................. ................ ................ ................ ................ ................

91011 6 Esophagus motility study .................................................................. ................ ................ ................ ................ ................

91012 6 Esophagus motility study .................................................................. ................ ................ ................ ................ ................

91020 6 Gastric motility .................................................................................. ................ ................ ................ ................ ................

91030 6 Acid perfusion of esophagus ............................................................ ................ ................ ................ ................ ................

91032 6 Esophagus, acid reflux test .............................................................. ................ ................ ................ ................ ................

91033 6 Prolonged acid reflux test ................................................................. ................ ................ ................ ................ ................

91052 6 Gastric analysis test .......................................................................... ................ ................ ................ ................ ................

91055 6 Gastric intubation for smear ............................................................. ................ ................ ................ ................ ................

91060 6 Gastric saline load test ..................................................................... ................ ................ ................ ................ ................

91065 6 Breath hydrogen test ........................................................................ ................ ................ ................ ................ ................

91100 6 Pass intestine bleeding tube ............................................................. ................ ................ ................ ................ ................

91105 6 Gastric intubation treatment .............................................................. ................ ................ ................ ................ ................

91122 6 Anal pressure record ........................................................................ ................ ................ ................ ................ ................

91299 6 Gastroenterology procedure ............................................................. ................ ................ ................ ................ ................

92002 6 Eye exam, new patient ..................................................................... ................ ................ ................ ................ ................

92004 6 Eye exam, new patient ..................................................................... ................ ................ ................ ................ ................

92012 6 Eye exam established pt .................................................................. ................ ................ ................ ................ ................

92014 6 Eye exam & treatment ...................................................................... ................ ................ ................ ................ ................

92015 9 Refraction .......................................................................................... ................ ................ ................ ................ ................

92018 6 New eye exam & treatment .............................................................. ................ ................ ................ ................ ................

92019 6 Eye exam & treatment ...................................................................... ................ ................ ................ ................ ................

92020 6 Special eye evaluation ...................................................................... ................ ................ ................ ................ ................

92060 6 Special eye evaluation ...................................................................... ................ ................ ................ ................ ................

92065 6 Orthoptic/pleoptic training ................................................................. ................ ................ ................ ................ ................

92070 6 Fitting of contact lens ........................................................................ ................ ................ ................ ................ ................

92081 6 Visual field examination(s) ................................................................ ................ ................ ................ ................ ................

92082 6 Visual field examination(s) ................................................................ ................ ................ ................ ................ ................

92083 6 Visual field examination(s) ................................................................ ................ ................ ................ ................ ................

92100 6 Serial tonometry exam(s) .................................................................. ................ ................ ................ ................ ................

92120 6 Tonography & eye evaluation ........................................................... ................ ................ ................ ................ ................

92130 6 Water provocation tonography .......................................................... ................ ................ ................ ................ ................

92140 6 Glaucoma provocative tests ............................................................. ................ ................ ................ ................ ................

92225 6 Special eye exam, initial ................................................................... ................ ................ ................ ................ ................

92226 6 Special eye exam, subsequent ......................................................... ................ ................ ................ ................ ................

92230 6 Eye exam with photos ...................................................................... ................ ................ ................ ................ ................
32422

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

92235 6 Eye exam with photos ...................................................................... ................ ................ ................ ................ ................

92240 6 Icg angiography ................................................................................ ................ ................ ................ ................ ................

92250 6 Eye exam with photos ...................................................................... ................ ................ ................ ................ ................

92260 6 Ophthalmoscopy/dynamometry ........................................................ ................ ................ ................ ................ ................

92265 6 Eye muscle evaluation ...................................................................... ................ ................ ................ ................ ................

92270 6 Electro-oculography .......................................................................... ................ ................ ................ ................ ................

92275 6 Electroretinography ........................................................................... ................ ................ ................ ................ ................

92283 6 Color vision examination ................................................................... ................ ................ ................ ................ ................

92284 6 Dark adaptation eye exam ................................................................ ................ ................ ................ ................ ................

92285 6 Eye photography ............................................................................... ................ ................ ................ ................ ................

92286 6 Internal eye photography .................................................................. ................ ................ ................ ................ ................

92287 6 Internal eye photography .................................................................. ................ ................ ................ ................ ................

92310 9 Contact lens fitting ............................................................................ ................ ................ ................ ................ ................

92311 6 Contact lens fitting ............................................................................ ................ ................ ................ ................ ................

92312 6 Contact lens fitting ............................................................................ ................ ................ ................ ................ ................

92313 6 Contact lens fitting ............................................................................ ................ ................ ................ ................ ................

92314 9 Prescription of contact lens .............................................................. ................ ................ ................ ................ ................

92315 6 Prescription of contact lens .............................................................. ................ ................ ................ ................ ................

92316 6 Prescription of contact lens .............................................................. ................ ................ ................ ................ ................

92317 6 Prescription of contact lens .............................................................. ................ ................ ................ ................ ................

92325 6 Modification of contact lens .............................................................. ................ ................ ................ ................ ................

92326 6 Replacement of contact lens ............................................................ ................ ................ ................ ................ ................

92330 6 Fitting of artificial eye ........................................................................ ................ ................ ................ ................ ................

92335 6 Fitting of artificial eye ........................................................................ ................ ................ ................ ................ ................

92340 9 Fitting of spectacles .......................................................................... ................ ................ ................ ................ ................

92341 9 Fitting of spectacles .......................................................................... ................ ................ ................ ................ ................

92342 9 Fitting of spectacles .......................................................................... ................ ................ ................ ................ ................

92352 6 Special spectacles fitting .................................................................. ................ ................ ................ ................ ................

92353 6 Special spectacles fitting .................................................................. ................ ................ ................ ................ ................

92354 6 Special spectacles fitting .................................................................. ................ ................ ................ ................ ................

92355 6 Special spectacles fitting .................................................................. ................ ................ ................ ................ ................

92358 6 Eye prosthesis service ...................................................................... ................ ................ ................ ................ ................

92370 9 Repair & adjust spectacles ............................................................... ................ ................ ................ ................ ................

92371 6 Repair & adjust spectacles ............................................................... ................ ................ ................ ................ ................

92390 9 Supply of spectacles ......................................................................... ................ ................ ................ ................ ................

92391 9 Supply of contact lenses ................................................................... ................ ................ ................ ................ ................

92392 9 Supply of low vision aids .................................................................. ................ ................ ................ ................ ................

92393 9 Supply of artificial eye ....................................................................... ................ ................ ................ ................ ................

92395 9 Supply of spectacles ......................................................................... ................ ................ ................ ................ ................

92396 9 Supply of contact lenses ................................................................... ................ ................ ................ ................ ................

92499 6 Eye service or procedure .................................................................. ................ ................ ................ ................ ................

92502 6 Ear and throat examination .............................................................. ................ ................ ................ ................ ................

92504 6 Ear microscopy examination ............................................................. ................ ................ ................ ................ ................

92506 6 Speech & hearing evaluation ............................................................ ................ ................ ................ ................ ................

92507 6 Speech/hearing therapy .................................................................... ................ ................ ................ ................ ................

92508 6 Speech/hearing therapy .................................................................... ................ ................ ................ ................ ................

92510 6 Rehab for ear implant ....................................................................... ................ ................ ................ ................ ................

92511 6 Nasopharyngoscopy ......................................................................... ................ ................ ................ ................ ................

92512 6 Nasal function studies ....................................................................... ................ ................ ................ ................ ................

92516 6 Facial nerve function test .................................................................. ................ ................ ................ ................ ................

92520 6 Laryngeal function studies ................................................................ ................ ................ ................ ................ ................

92525 6 Oral function evaluation .................................................................... ................ ................ ................ ................ ................

92526 6 Oral function therapy ........................................................................ ................ ................ ................ ................ ................

92531 6 Spontaneous nystagmus study ......................................................... ................ ................ ................ ................ ................

92532 6 Positional nystagmus study .............................................................. ................ ................ ................ ................ ................

92533 6 Caloric vestibular test ....................................................................... ................ ................ ................ ................ ................

92534 6 Optokinetic nystagmus ...................................................................... ................ ................ ................ ................ ................

92541 6 Spontaneous nystagmus test ........................................................... ................ ................ ................ ................ ................

92542 6 Positional nystagmus test ................................................................. ................ ................ ................ ................ ................

92543 6 Caloric vestibular test ....................................................................... ................ ................ ................ ................ ................

92544 6 Optokinetic nystagmus test ............................................................... ................ ................ ................ ................ ................

92545 6 Oscillating tracking test ..................................................................... ................ ................ ................ ................ ................

92546 6 Sinusoidal rotational test ................................................................... ................ ................ ................ ................ ................

92547 6 Supplemental electrical test .............................................................. ................ ................ ................ ................ ................

92548 6 Posturography ................................................................................... ................ ................ ................ ................ ................

92551 9 Pure tone hearing test, air ................................................................ ................ ................ ................ ................ ................

92552 6 Pure tone audiometry, air ................................................................. ................ ................ ................ ................ ................

92553 6 Audiometry, air & bone ..................................................................... ................ ................ ................ ................ ................

92555 6 Speech threshold audiometry ........................................................... ................ ................ ................ ................ ................

92556 6 Speech audiometry, complete .......................................................... ................ ................ ................ ................ ................

92557 6 Comprehensive hearing test ............................................................. ................ ................ ................ ................ ................

92559 9 Group audiometric testing ................................................................. ................ ................ ................ ................ ................

92560 9 Bekesy audiometry, screen .............................................................. ................ ................ ................ ................ ................

92561 6 Bekesy audiometry, diagnosis .......................................................... ................ ................ ................ ................ ................
32423

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

92562 6 Loudness balance test ...................................................................... ................ ................ ................ ................ ................

92563 6 Tone decay hearing test ................................................................... ................ ................ ................ ................ ................

92564 6 Sisi hearing test ................................................................................ ................ ................ ................ ................ ................

92565 6 Stenger test, pure tone ..................................................................... ................ ................ ................ ................ ................

92567 6 Tympanometry .................................................................................. ................ ................ ................ ................ ................

92568 6 Acoustic reflex testing ....................................................................... ................ ................ ................ ................ ................

92569 6 Acoustic reflex decay test ................................................................. ................ ................ ................ ................ ................

92571 6 Filtered speech hearing test ............................................................. ................ ................ ................ ................ ................

92572 6 Staggered spondaic word test .......................................................... ................ ................ ................ ................ ................

92573 6 Lombard test ..................................................................................... ................ ................ ................ ................ ................

92575 6 Sensorineural acuity test .................................................................. ................ ................ ................ ................ ................

92576 6 Synthetic sentence test ..................................................................... ................ ................ ................ ................ ................

92577 6 Stenger test, speech ......................................................................... ................ ................ ................ ................ ................

92579 6 Visual audiometry (vra) ..................................................................... ................ ................ ................ ................ ................

92582 6 Conditioning play audiometry ........................................................... ................ ................ ................ ................ ................

92583 6 Select picture audiometry ................................................................. ................ ................ ................ ................ ................

92584 6 Electrocochleography ........................................................................ ................ ................ ................ ................ ................

92585 6 Auditory evoked potential ................................................................. ................ ................ ................ ................ ................

92587 6 Evoked auditory test ......................................................................... ................ ................ ................ ................ ................

92588 6 Evoked auditory test ......................................................................... ................ ................ ................ ................ ................

92589 6 Auditory function test(s) .................................................................... ................ ................ ................ ................ ................

92590 9 Hearing aid exam, one ear ............................................................... ................ ................ ................ ................ ................

92591 9 Hearing aid exam, both ears ............................................................ ................ ................ ................ ................ ................

92592 9 Hearing aid check, one ear .............................................................. ................ ................ ................ ................ ................

92593 9 Hearing aid check, both ears ............................................................ ................ ................ ................ ................ ................

92594 9 Electro hearing aid test,one .............................................................. ................ ................ ................ ................ ................

92595 9 Electro hearingaid test,both .............................................................. ................ ................ ................ ................ ................

92596 6 Ear protector evaluation .................................................................... ................ ................ ................ ................ ................

92597 6 Oral speech device eval ................................................................... ................ ................ ................ ................ ................

92598 6 Modify oral speech device ................................................................ ................ ................ ................ ................ ................

92599 6 ENT procedure/service ..................................................................... ................ ................ ................ ................ ................

92950 6 Heart/lung resuscitation(CPR ........................................................... ................ ................ ................ ................ ................

92953 6 Temporary external pacing ............................................................... ................ ................ ................ ................ ................

92960 6 Heart electroconversion .................................................................... ................ ................ ................ ................ ................

92970 6 Cardioassist, internal ........................................................................ ................ ................ ................ ................ ................

92971 6 Cardioassist, external ....................................................................... ................ ................ ................ ................ ................

92975 6 Dissolve clot, heart vessel ................................................................ ................ ................ ................ ................ ................

92977 6 Dissolve clot, heart vessel ................................................................ ................ ................ ................ ................ ................

92978 6 Intravas us, heart (add-on) ............................................................... ................ ................ ................ ................ ................

92979 6 Intravas us, heart (add-on) ............................................................... ................ ................ ................ ................ ................

92980 6 Insert intracoronary stent .................................................................. ................ ................ ................ ................ ................

92981 6 Insert intracoronary stent .................................................................. ................ ................ ................ ................ ................

92982 6 Coronary artery dilation .................................................................... ................ ................ ................ ................ ................

92984 6 Coronary artery dilation .................................................................... ................ ................ ................ ................ ................

92986 6 Revision of aortic valve ..................................................................... ................ ................ ................ ................ ................

92987 6 Revision of mitral valve ..................................................................... ................ ................ ................ ................ ................

92990 6 Revision of pulmonary valve ............................................................. ................ ................ ................ ................ ................

92992 6 Revision of heart chamber ................................................................ ................ ................ ................ ................ ................

92993 6 Revision of heart chamber ................................................................ ................ ................ ................ ................ ................

92995 6 Coronary atherectomy ...................................................................... ................ ................ ................ ................ ................

92996 6 Coronary atherectomy ...................................................................... ................ ................ ................ ................ ................

92997 6 Pul art balloon repair, perc ............................................................... ................ ................ ................ ................ ................

92998 6 Pul art balloon repair, perc ............................................................... ................ ................ ................ ................ ................

93000 6 Electrocardiogram, complete ............................................................ ................ ................ ................ ................ ................

93005 6 Electrocardiogram, tracing ................................................................ ................ ................ ................ ................ ................

93010 6 Electrocardiogram report .................................................................. ................ ................ ................ ................ ................

93012 6 Transmission of ecg .......................................................................... ................ ................ ................ ................ ................

93014 6 Report on transmitted ecg ................................................................ ................ ................ ................ ................ ................

93015 6 Cardiovascular stress test ................................................................ ................ ................ ................ ................ ................

93016 6 Cardiovascular stress test ................................................................ ................ ................ ................ ................ ................

93017 6 Cardiovascular stress test ................................................................ ................ ................ ................ ................ ................

93018 6 Cardiovascular stress test ................................................................ ................ ................ ................ ................ ................

93024 6 Cardiac drug stress test .................................................................... ................ ................ ................ ................ ................

93040 6 Rhythm ECG with report ................................................................... ................ ................ ................ ................ ................

93041 6 Rhythm ECG, tracing ........................................................................ ................ ................ ................ ................ ................

93042 6 Rhythm ECG, report ......................................................................... ................ ................ ................ ................ ................

93224 6 ECG monitor/report, 24 hrs .............................................................. ................ ................ ................ ................ ................

93225 6 ECG monitor/record, 24 hrs .............................................................. ................ ................ ................ ................ ................

93226 6 ECG monitor/report, 24 hrs .............................................................. ................ ................ ................ ................ ................

93227 6 ECG monitor/review, 24 hrs ............................................................. ................ ................ ................ ................ ................

93230 6 ECG monitor/report, 24 hrs .............................................................. ................ ................ ................ ................ ................

93231 6 Ecg monitor/record, 24 hrs ............................................................... ................ ................ ................ ................ ................

93232 6 ECG monitor/report, 24 hrs .............................................................. ................ ................ ................ ................ ................

93233 6 ECG monitor/review, 24 hrs ............................................................. ................ ................ ................ ................ ................
32424

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

93235 6 ECG monitor/report, 24 hrs .............................................................. ................ ................ ................ ................ ................

93236 6 ECG monitor/report, 24 hrs .............................................................. ................ ................ ................ ................ ................

93237 6 ECG monitor/review, 24 hrs ............................................................. ................ ................ ................ ................ ................

93268 6 ECG record/review ............................................................................ ................ ................ ................ ................ ................

93270 6 ECG recording .................................................................................. ................ ................ ................ ................ ................

93271 6 Ecg/monitoring and anaylysis ........................................................... ................ ................ ................ ................ ................

93272 6 Ecg/review, interpret only ................................................................. ................ ................ ................ ................ ................

93278 6 ECG/signal-averaged ........................................................................ ................ ................ ................ ................ ................

93303 6 Echo transthoracic ............................................................................ ................ ................ ................ ................ ................

93304 6 Echo transthoracic ............................................................................ ................ ................ ................ ................ ................

93307 6 Echo exam of heart .......................................................................... ................ ................ ................ ................ ................

93308 6 Echo exam of heart .......................................................................... ................ ................ ................ ................ ................

93312 6 Echo transesophageal ...................................................................... ................ ................ ................ ................ ................

93313 6 Echo transesophageal ...................................................................... ................ ................ ................ ................ ................

93314 6 Echo transesophageal ...................................................................... ................ ................ ................ ................ ................

93315 6 Echo transesophageal ...................................................................... ................ ................ ................ ................ ................

93316 6 Echo transesophageal ...................................................................... ................ ................ ................ ................ ................

93317 6 Echo transesophageal ...................................................................... ................ ................ ................ ................ ................

93320 6 Doppler echo exam, heart ................................................................ ................ ................ ................ ................ ................

93321 6 Doppler echo exam, heart ................................................................ ................ ................ ................ ................ ................

93325 6 Doppler color flow ............................................................................. ................ ................ ................ ................ ................

93350 6 Echo transthoracic ............................................................................ ................ ................ ................ ................ ................

93501 6 Right heart catheterization ................................................................ ................ ................ ................ ................ ................

93503 6 Insert/place heart catheter ................................................................ ................ ................ ................ ................ ................

93505 6 Biopsy of heart lining ........................................................................ ................ ................ ................ ................ ................

93508 6 Cath placement, angiography ........................................................... ................ ................ ................ ................ ................

93510 6 Left heart catheterization .................................................................. ................ ................ ................ ................ ................

93511 6 Left heart catheterization .................................................................. ................ ................ ................ ................ ................

93514 6 Left heart catheterization .................................................................. ................ ................ ................ ................ ................

93524 6 Left heart catheterization .................................................................. ................ ................ ................ ................ ................

93526 6 Rt & Lt heart catheters ..................................................................... ................ ................ ................ ................ ................

93527 6 Rt & Lt heart catheters ..................................................................... ................ ................ ................ ................ ................

93528 6 Rt & Lt heart catheters ..................................................................... ................ ................ ................ ................ ................

93529 6 Rt, Lt heart catheterization ............................................................... ................ ................ ................ ................ ................

93530 6 Rt heart cath, congenital ................................................................... ................ ................ ................ ................ ................

93531 6 R & l heart cath, congenital .............................................................. ................ ................ ................ ................ ................

93532 6 R & l heart cath, congenital .............................................................. ................ ................ ................ ................ ................

93533 6 R & l heart cath, congenital .............................................................. ................ ................ ................ ................ ................

93536 6 Insert circulation assi ........................................................................ ................ ................ ................ ................ ................

93539 6 Injection, cardiac cath ....................................................................... ................ ................ ................ ................ ................

93540 6 Injection, cardiac cath ....................................................................... ................ ................ ................ ................ ................

93541 6 Injection for lung angiogram ............................................................. ................ ................ ................ ................ ................

93542 6 Injection for heart x-rays ................................................................... ................ ................ ................ ................ ................

93543 6 Injection for heart x-rays ................................................................... ................ ................ ................ ................ ................

93544 6 Injection for aortography ................................................................... ................ ................ ................ ................ ................

93545 6 Injection for coronary xrays .............................................................. ................ ................ ................ ................ ................

93555 6 Imaging, cardiac cath ........................................................................ ................ ................ ................ ................ ................

93556 6 Imaging, cardiac cath ........................................................................ ................ ................ ................ ................ ................

93561 6 Cardiac output measurement ........................................................... ................ ................ ................ ................ ................

93562 6 Cardiac output measurement ........................................................... ................ ................ ................ ................ ................

93600 6 Bundle of His recording .................................................................... ................ ................ ................ ................ ................

93602 6 Intra-atrial recording .......................................................................... ................ ................ ................ ................ ................

93603 6 Right ventricular recording ................................................................ ................ ................ ................ ................ ................

93607 6 Right ventricular recording ................................................................ ................ ................ ................ ................ ................

93609 6 Mapping of tachycardia ..................................................................... ................ ................ ................ ................ ................

93610 6 Intra-atrial pacing .............................................................................. ................ ................ ................ ................ ................

93612 6 Intraventricular pacing ....................................................................... ................ ................ ................ ................ ................

93615 6 Esophageal recording ....................................................................... ................ ................ ................ ................ ................

93616 6 Esophageal recording ....................................................................... ................ ................ ................ ................ ................

93618 6 Heart rhythm pacing ......................................................................... ................ ................ ................ ................ ................

93619 6 Electrophysiology evaluation ............................................................ ................ ................ ................ ................ ................

93620 6 Electrophysiology evaluation ............................................................ ................ ................ ................ ................ ................

93621 6 Electrophysiology evaluation ............................................................ ................ ................ ................ ................ ................

93622 6 Electrophysiology evaluation ............................................................ ................ ................ ................ ................ ................

93623 6 Stimulation, pacing heart .................................................................. ................ ................ ................ ................ ................

93624 6 Electrophysiologic study ................................................................... ................ ................ ................ ................ ................

93631 6 Heart pacing, mapping ...................................................................... ................ ................ ................ ................ ................

93640 6 Evaluation heart device .................................................................... ................ ................ ................ ................ ................

93641 6 Electrophysiology evaluation ............................................................ ................ ................ ................ ................ ................

93642 6 Electrophysiology evaluation ............................................................ ................ ................ ................ ................ ................

93650 6 Ablate heart dysrhythm focus ........................................................... ................ ................ ................ ................ ................

93651 6 Ablate heart dysrhythm focus ........................................................... ................ ................ ................ ................ ................

93652 6 Ablate heart dysrhythm focus ........................................................... ................ ................ ................ ................ ................

93660 6 Tilt table evaluation ........................................................................... ................ ................ ................ ................ ................
32425

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

93720 6 Total body plethysmography ............................................................. ................ ................ ................ ................ ................

93721 6 Plethysmography tracing .................................................................. ................ ................ ................ ................ ................

93722 6 Plethysmography report .................................................................... ................ ................ ................ ................ ................

93724 6 Analyze pacemaker system .............................................................. ................ ................ ................ ................ ................

93731 6 Analyze pacemaker system .............................................................. ................ ................ ................ ................ ................

93732 6 Analyze pacemaker system .............................................................. ................ ................ ................ ................ ................

93733 6 Telephone analysis, pacemaker ....................................................... ................ ................ ................ ................ ................

93734 6 Analyze pacemaker system .............................................................. ................ ................ ................ ................ ................

93735 6 Analyze pacemaker system .............................................................. ................ ................ ................ ................ ................

93736 6 Telephone analysis, pacemaker ....................................................... ................ ................ ................ ................ ................

93737 6 Analyze cardio/defibrillator ................................................................ ................ ................ ................ ................ ................

93738 6 Analyze cardio/defibrillator ................................................................ ................ ................ ................ ................ ................

93740 6 Temperature gradient studies ........................................................... ................ ................ ................ ................ ................

93760 9 Cephalic thermogram ........................................................................ ................ ................ ................ ................ ................

93762 9 Peripheral thermogram ..................................................................... ................ ................ ................ ................ ................

93770 6 Measure venous pressure ................................................................ ................ ................ ................ ................ ................

93784 9 Ambulatory BP monitoring ................................................................ ................ ................ ................ ................ ................

93786 9 Ambulatory BP recording .................................................................. ................ ................ ................ ................ ................

93788 9 Ambulatory BP analysis .................................................................... ................ ................ ................ ................ ................

93790 9 Review/report BP recording .............................................................. ................ ................ ................ ................ ................

93797 6 Cardiac rehab ................................................................................... ................ ................ ................ ................ ................

93798 6 Cardiac rehab/monitor ...................................................................... ................ ................ ................ ................ ................

93799 6 Cardiovascular procedure ................................................................. ................ ................ ................ ................ ................

93875 6 Extracranial study ............................................................................. ................ ................ ................ ................ ................

93880 6 Extracranial study ............................................................................. ................ ................ ................ ................ ................

93882 6 Extracranial study ............................................................................. ................ ................ ................ ................ ................

93886 6 Intracranial study ............................................................................... ................ ................ ................ ................ ................

93888 6 Intracranial study ............................................................................... ................ ................ ................ ................ ................

93922 6 Extremity study ................................................................................. ................ ................ ................ ................ ................

93923 6 Extremity study ................................................................................. ................ ................ ................ ................ ................

93924 6 Extremity study ................................................................................. ................ ................ ................ ................ ................

93925 6 Lower extremity study ....................................................................... ................ ................ ................ ................ ................

93926 6 Lower extremity study ....................................................................... ................ ................ ................ ................ ................

93930 6 Upper extremity study ....................................................................... ................ ................ ................ ................ ................

93931 6 Upper extremity study ....................................................................... ................ ................ ................ ................ ................

93965 6 Extremity study ................................................................................. ................ ................ ................ ................ ................

93970 6 Extremity study ................................................................................. ................ ................ ................ ................ ................

93971 6 Extremity study ................................................................................. ................ ................ ................ ................ ................

93975 6 Vascular study .................................................................................. ................ ................ ................ ................ ................

93976 6 Vascular study .................................................................................. ................ ................ ................ ................ ................

93978 6 Vascular study .................................................................................. ................ ................ ................ ................ ................

93979 6 Vascular study .................................................................................. ................ ................ ................ ................ ................

93980 6 Penile vascular study ........................................................................ ................ ................ ................ ................ ................

93981 6 Penile vascular study ........................................................................ ................ ................ ................ ................ ................

93990 6 Doppler flow testing .......................................................................... ................ ................ ................ ................ ................

94010 6 Breathing capacity test ..................................................................... ................ ................ ................ ................ ................

94060 6 Evaluation of wheezing ..................................................................... ................ ................ ................ ................ ................

94070 6 Evaluation of wheezing ..................................................................... ................ ................ ................ ................ ................

94150 6 Vital capacity test .............................................................................. ................ ................ ................ ................ ................

94200 6 Lung function test (MBC/MVV) ......................................................... ................ ................ ................ ................ ................

94240 6 Residual lung capacity ...................................................................... ................ ................ ................ ................ ................

94250 6 Expired gas collection ....................................................................... ................ ................ ................ ................ ................

94260 6 Thoracic gas volume ......................................................................... ................ ................ ................ ................ ................

94350 6 Lung nitrogen washout curve ........................................................... ................ ................ ................ ................ ................

94360 6 Measure airflow resistance ............................................................... ................ ................ ................ ................ ................

94370 6 Breath airway closing volume ........................................................... ................ ................ ................ ................ ................

94375 6 Respiratory flow volume loop ........................................................... ................ ................ ................ ................ ................

94400 6 CO2 breathing response curve ......................................................... ................ ................ ................ ................ ................

94450 6 Hypoxia response curve ................................................................... ................ ................ ................ ................ ................

94620 6 Pulmonary stress testing .................................................................. ................ ................ ................ ................ ................

94640 6 Airway inhalation treatment .............................................................. ................ ................ ................ ................ ................

94642 6 Aerosol inhalation treatment ............................................................. ................ ................ ................ ................ ................

94650 6 Pressure breathing (IPPB) ................................................................ ................ ................ ................ ................ ................

94651 6 Pressure breathing (IPPB) ................................................................ ................ ................ ................ ................ ................

94652 6 Pressure breathing (IPPB) ................................................................ ................ ................ ................ ................ ................

94656 6 Initial ventilator mgmt ........................................................................ ................ ................ ................ ................ ................

94657 6 Cont. ventilator .................................................................................. ................ ................ ................ ................ ................

94660 6 Pos airway pressure, CPAP ............................................................. ................ ................ ................ ................ ................

94662 6 Neg pressure ventilation,cnp ............................................................ ................ ................ ................ ................ ................

94664 6 Aerosol or vapor inhalations ............................................................. ................ ................ ................ ................ ................

94665 6 Aerosol or vapor inhalations ............................................................. ................ ................ ................ ................ ................

94667 6 Chest wall manipulation .................................................................... ................ ................ ................ ................ ................

94668 6 Chest wall manipulation .................................................................... ................ ................ ................ ................ ................

94680 6 Exhaled air analysis: O2 ................................................................... ................ ................ ................ ................ ................
32426

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

94681 6 Exhaled air analysis: O2,CO2 .......................................................... ................ ................ ................ ................ ................

94690 6 Exhaled air analysis .......................................................................... ................ ................ ................ ................ ................

94720 6 Monoxide diffusing capacity .............................................................. ................ ................ ................ ................ ................

94725 6 Membrane diffusion capacity ............................................................ ................ ................ ................ ................ ................

94750 6 Pulmonary compliance study ............................................................ ................ ................ ................ ................ ................

94760 6 Measure blood oxygen level ............................................................. ................ ................ ................ ................ ................

94761 6 Measure blood oxygen level ............................................................. ................ ................ ................ ................ ................

94762 6 Measure blood oxygen level ............................................................. ................ ................ ................ ................ ................

94770 6 Exhaled carbon dioxide test ............................................................. ................ ................ ................ ................ ................

94772 6 Breath recording, infant .................................................................... ................ ................ ................ ................ ................

94799 6 Pulmonary service/procedure ........................................................... ................ ................ ................ ................ ................

95004 6 Allergy skin tests ............................................................................... ................ ................ ................ ................ ................

95010 6 Sensitivity skin tests .......................................................................... ................ ................ ................ ................ ................

95015 6 Sensitivity skin tests .......................................................................... ................ ................ ................ ................ ................

95024 6 Allergy skin tests ............................................................................... ................ ................ ................ ................ ................

95027 6 Skin end point titration ...................................................................... ................ ................ ................ ................ ................

95028 6 Allergy skin tests ............................................................................... ................ ................ ................ ................ ................

95044 6 Allergy patch tests ............................................................................ ................ ................ ................ ................ ................

95052 6 Photo patch test ................................................................................ ................ ................ ................ ................ ................

95056 6 Photosensitivity tests ........................................................................ ................ ................ ................ ................ ................

95060 6 Eye allergy tests ............................................................................... ................ ................ ................ ................ ................

95065 6 Nose allergy test ............................................................................... ................ ................ ................ ................ ................

95070 6 Bronchial allergy tests ....................................................................... ................ ................ ................ ................ ................

95071 6 Bronchial allergy tests ....................................................................... ................ ................ ................ ................ ................

95075 6 Ingestion challenge test .................................................................... ................ ................ ................ ................ ................

95078 6 Provocative testing ............................................................................ ................ ................ ................ ................ ................

95115 6 Immunotherapy, one injection ........................................................... ................ ................ ................ ................ ................

95117 6 Immunotherapy injections ................................................................. ................ ................ ................ ................ ................

95120 9 Immunotherapy, one injection ........................................................... ................ ................ ................ ................ ................

95125 9 Immunotherapy, many antigens ....................................................... ................ ................ ................ ................ ................

95130 9 Immunotherapy, insect venom .......................................................... ................ ................ ................ ................ ................

95131 9 Immunotherapy, insect venoms ........................................................ ................ ................ ................ ................ ................

95132 9 Immunotherapy, insect venoms ........................................................ ................ ................ ................ ................ ................

95133 9 Immunotherapy, insect venoms ........................................................ ................ ................ ................ ................ ................

95134 9 Immunotherapy, insect venoms ........................................................ ................ ................ ................ ................ ................

95144 6 Antigen therapy services .................................................................. ................ ................ ................ ................ ................

95145 6 Antigen therapy services .................................................................. ................ ................ ................ ................ ................

95146 6 Antigen therapy services .................................................................. ................ ................ ................ ................ ................

95147 6 Antigen therapy services .................................................................. ................ ................ ................ ................ ................

95148 6 Antigen therapy services .................................................................. ................ ................ ................ ................ ................

95149 6 Antigen therapy services .................................................................. ................ ................ ................ ................ ................

95165 6 Antigen therapy services .................................................................. ................ ................ ................ ................ ................

95170 6 Antigen therapy services .................................................................. ................ ................ ................ ................ ................

95180 6 Rapid desensitization ........................................................................ ................ ................ ................ ................ ................

95199 6 Allergy immunology services ............................................................ ................ ................ ................ ................ ................

95805 6 Multiple sleep latency test ................................................................ ................ ................ ................ ................ ................

95806 6 Sleep study, unattended ................................................................... ................ ................ ................ ................ ................

95807 6 Sleep study, attended ....................................................................... ................ ................ ................ ................ ................

95808 6 Polysomnography, 1-3 ...................................................................... ................ ................ ................ ................ ................

95810 6 Polysomnography, 4 or more ........................................................... ................ ................ ................ ................ ................

95811 6 Polysomnography w/cpap ................................................................. ................ ................ ................ ................ ................

95812 6 Electroencephalogram (EEG) ........................................................... ................ ................ ................ ................ ................

95813 6 Electroencephalogram (EEG) ........................................................... ................ ................ ................ ................ ................

95816 6 Electroencephalogram (EEG) ........................................................... ................ ................ ................ ................ ................

95819 6 Electroencephalogram (EEG) ........................................................... ................ ................ ................ ................ ................

95822 6 Sleep electroencephalogram ............................................................ ................ ................ ................ ................ ................

95824 6 Electroencephalography ................................................................... ................ ................ ................ ................ ................

95827 6 Night electroencephalogram ............................................................. ................ ................ ................ ................ ................

95829 6 Surgery electrocorticogram ............................................................... ................ ................ ................ ................ ................

95830 6 Insert electrodes for EEG ................................................................. ................ ................ ................ ................ ................

95831 6 Limb muscle testing, manual ............................................................ ................ ................ ................ ................ ................

95832 6 Hand muscle testing, manual ........................................................... ................ ................ ................ ................ ................

95833 6 Body muscle testing, manual ............................................................ ................ ................ ................ ................ ................

95834 6 Body muscle testing, manual ............................................................ ................ ................ ................ ................ ................

95851 6 Range of motion measurements ...................................................... ................ ................ ................ ................ ................

95852 6 Range of motion measurements ...................................................... ................ ................ ................ ................ ................

95857 6 Tensilon test ...................................................................................... ................ ................ ................ ................ ................

95858 6 Tensilon test & myogram .................................................................. ................ ................ ................ ................ ................

95860 6 Muscle test, one limb ........................................................................ ................ ................ ................ ................ ................

95861 6 Muscle test, two limbs ...................................................................... ................ ................ ................ ................ ................

95863 6 Muscle test, 3 limbs .......................................................................... ................ ................ ................ ................ ................

95864 6 Muscle test, 4 limbs .......................................................................... ................ ................ ................ ................ ................

95867 6 Muscle test, head or neck ................................................................ ................ ................ ................ ................ ................

95868 6 Muscle test, head or neck ................................................................ ................ ................ ................ ................ ................
32427

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

95869 6 Muscle test, thor paraspinal .............................................................. ................ ................ ................ ................ ................

95870 6 Muscle test, non-paraspinal .............................................................. ................ ................ ................ ................ ................

95872 6 Muscle test, one fiber ....................................................................... ................ ................ ................ ................ ................

95875 6 Limb exercise test ............................................................................. ................ ................ ................ ................ ................

95900 6 Motor nerve conduction test ............................................................. ................ ................ ................ ................ ................

95903 6 Motor nerve conduction test ............................................................. ................ ................ ................ ................ ................

95904 6 Sense nerve conduction test ............................................................ ................ ................ ................ ................ ................

95920 6 Intraoperative nerve testing .............................................................. ................ ................ ................ ................ ................

95921 6 Autonomic nervous func test ............................................................ ................ ................ ................ ................ ................

95922 6 Autonomic nervous func test ............................................................ ................ ................ ................ ................ ................

95923 6 Autonomic nervous func test ............................................................ ................ ................ ................ ................ ................

95925 6 Somatosensory testing ..................................................................... ................ ................ ................ ................ ................

95926 6 Somatosensory testing ..................................................................... ................ ................ ................ ................ ................

95927 6 Somatosensory testing ..................................................................... ................ ................ ................ ................ ................

95930 6 Visual evoked potential test .............................................................. ................ ................ ................ ................ ................

95933 6 Blink reflex test ................................................................................. ................ ................ ................ ................ ................

95934 6 ‘h’ reflex test ...................................................................................... ................ ................ ................ ................ ................

95936 6 ‘h’ reflex test ...................................................................................... ................ ................ ................ ................ ................

95937 6 Neuromuscular junction test ............................................................. ................ ................ ................ ................ ................

95950 6 Ambulatory eeg monitoring ............................................................... ................ ................ ................ ................ ................

95951 6 EEG monitoring/videorecord ............................................................. ................ ................ ................ ................ ................

95953 6 EEG monitoring/computer ................................................................. ................ ................ ................ ................ ................

95954 6 EEG monitoring/giving drugs ............................................................ ................ ................ ................ ................ ................

95955 6 EEG during surgery .......................................................................... ................ ................ ................ ................ ................

95956 6 EEG monitoring/cable/radio .............................................................. ................ ................ ................ ................ ................

95957 6 EEG digital analysis .......................................................................... ................ ................ ................ ................ ................

95958 6 EEG monitoring/function test ............................................................ ................ ................ ................ ................ ................

95961 6 Electrode stimulation, brain .............................................................. ................ ................ ................ ................ ................

95962 6 Electrode stimulation, brain .............................................................. ................ ................ ................ ................ ................

95999 6 Neurological procedure ..................................................................... ................ ................ ................ ................ ................

96100 6 Psychological testing ........................................................................ ................ ................ ................ ................ ................

96105 6 Assessment of aphasia ..................................................................... ................ ................ ................ ................ ................

96110 6 Developmental test, lim .................................................................... ................ ................ ................ ................ ................

96111 6 Developmental test, extend .............................................................. ................ ................ ................ ................ ................

96115 6 Neurobehavior status exam .............................................................. ................ ................ ................ ................ ................

96117 6 Neuropsych test battery .................................................................... ................ ................ ................ ................ ................

96400 6 Chemotherapy, (SC)/(IM) .................................................................. ................ ................ ................ ................ ................

96405 6 Intralesional chemo admin ................................................................ ................ ................ ................ ................ ................

96406 6 Intralesional chemo admin ................................................................ ................ ................ ................ ................ ................

96408 6 Chemotherapy, push technique ........................................................ ................ ................ ................ ................ ................

96410 6 Chemotherapy, infusion method ....................................................... ................ ................ ................ ................ ................

96412 6 Chemotherapy, infusion method ....................................................... ................ ................ ................ ................ ................

96414 6 Chemotherapy, infusion method ....................................................... ................ ................ ................ ................ ................

96420 6 Chemotherapy, push technique ........................................................ ................ ................ ................ ................ ................

96422 6 Chemotherapy, infusion method ....................................................... ................ ................ ................ ................ ................

96423 6 Chemotherapy, infusion method ....................................................... ................ ................ ................ ................ ................

96425 6 Chemotherapy, infusion method ....................................................... ................ ................ ................ ................ ................

96440 6 Chemotherapy, intracavitary ............................................................. ................ ................ ................ ................ ................

96445 6 Chemotherapy, intracavitary ............................................................. ................ ................ ................ ................ ................

96450 6 Chemotherapy, into CNS .................................................................. ................ ................ ................ ................ ................

96520 6 Pump refilling, maintenance ............................................................. ................ ................ ................ ................ ................

96530 6 Pump refilling, maintenance ............................................................. ................ ................ ................ ................ ................

96542 6 Chemotherapy injection .................................................................... ................ ................ ................ ................ ................

96545 6 Provide chemotherapy agent ............................................................ ................ ................ ................ ................ ................

96549 6 Chemotherapy, unspecified .............................................................. ................ ................ ................ ................ ................

96900 6 Ultraviolet light therapy ..................................................................... ................ ................ ................ ................ ................

96902 6 Trichogram ........................................................................................ ................ ................ ................ ................ ................

96910 6 Photochemotherapy with UV–B ........................................................ ................ ................ ................ ................ ................

96912 6 Photochemotherapy with UV–A ........................................................ ................ ................ ................ ................ ................

96913 6 Photochemotherapy, UV–A or B ...................................................... ................ ................ ................ ................ ................

96999 6 Dermatological procedure ................................................................. ................ ................ ................ ................ ................

97001 6 Pt evaluation ..................................................................................... ................ ................ ................ ................ ................

97002 6 Pt re-evaluation ................................................................................. ................ ................ ................ ................ ................

97003 6 Ot evaluation ..................................................................................... ................ ................ ................ ................ ................

97004 6 Ot re-evaluation ................................................................................ ................ ................ ................ ................ ................

97010 6 Hot or cold packs therapy ................................................................. ................ ................ ................ ................ ................

97012 6 Mechanical traction therapy .............................................................. ................ ................ ................ ................ ................

97014 6 Electric stimulation therapy ............................................................... ................ ................ ................ ................ ................

97016 6 Vasopneumatic device therapy ......................................................... ................ ................ ................ ................ ................

97018 6 Paraffin bath therapy ........................................................................ ................ ................ ................ ................ ................

97020 6 Microwave therapy ............................................................................ ................ ................ ................ ................ ................

97022 6 Whirlpool therapy .............................................................................. ................ ................ ................ ................ ................

97024 6 Diathermy treatment ......................................................................... ................ ................ ................ ................ ................

97026 6 Infrared therapy ................................................................................. ................ ................ ................ ................ ................
32428

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

97028 6 Ultraviolet therapy ............................................................................. ................ ................ ................ ................ ................

97032 6 Electrical stimulation ......................................................................... ................ ................ ................ ................ ................

97033 6 Electric current therapy ..................................................................... ................ ................ ................ ................ ................

97034 6 Contrast bath therapy ....................................................................... ................ ................ ................ ................ ................

97035 6 Ultrasound therapy ............................................................................ ................ ................ ................ ................ ................

97036 6 Hydrotherapy ..................................................................................... ................ ................ ................ ................ ................

97039 6 Physical therapy treatment ............................................................... ................ ................ ................ ................ ................

97110 6 Therapeutic exercises ....................................................................... ................ ................ ................ ................ ................

97112 6 Neuromuscular reeducation .............................................................. ................ ................ ................ ................ ................

97113 6 Aquatic therapy/exercises ................................................................. ................ ................ ................ ................ ................

97116 6 Gait training therapy ......................................................................... ................ ................ ................ ................ ................

97122 6 Manual traction therapy .................................................................... ................ ................ ................ ................ ................

97124 6 Massage therapy .............................................................................. ................ ................ ................ ................ ................

97139 6 Physical medicine procedure ............................................................ ................ ................ ................ ................ ................

97150 6 Group therapeutic procedures .......................................................... ................ ................ ................ ................ ................

97250 6 Myofascial release ............................................................................ ................ ................ ................ ................ ................

97260 6 Regional manipulation ...................................................................... ................ ................ ................ ................ ................

97261 6 Supplemental manipulations ............................................................. ................ ................ ................ ................ ................

97265 6 Joint mobilization .............................................................................. ................ ................ ................ ................ ................

97504 6 Orthotic training ................................................................................. ................ ................ ................ ................ ................

97520 6 Prosthetic training ............................................................................. ................ ................ ................ ................ ................

97530 6 Therapeutic activities ........................................................................ ................ ................ ................ ................ ................

97535 6 Self care mngment training ............................................................... ................ ................ ................ ................ ................

97537 6 Community/work reintegration .......................................................... ................ ................ ................ ................ ................

97542 6 Wheelchair mngement training ......................................................... ................ ................ ................ ................ ................

97545 6 Work hardening ................................................................................. ................ ................ ................ ................ ................

97546 6 Work hardening ................................................................................. ................ ................ ................ ................ ................

97703 6 Prosthetic checkout ........................................................................... ................ ................ ................ ................ ................

97750 6 Physical performance test ................................................................ ................ ................ ................ ................ ................

97770 6 Cognitive skills development ............................................................ ................ ................ ................ ................ ................

97780 9 Acupuncture w/o stim ....................................................................... ................ ................ ................ ................ ................

97781 9 Acupuncture w/stim ........................................................................... ................ ................ ................ ................ ................

97799 6 Physical medicine procedure ............................................................ ................ ................ ................ ................ ................

98925 6 Osteopathic manipulation ................................................................. ................ ................ ................ ................ ................

98926 6 Osteopathic manipulation ................................................................. ................ ................ ................ ................ ................

98927 6 Osteopathic manipulation ................................................................. ................ ................ ................ ................ ................

98928 6 Osteopathic manipulation ................................................................. ................ ................ ................ ................ ................

98929 6 Osteopathic manipulation ................................................................. ................ ................ ................ ................ ................

98940 6 Chiropractic manipulation ................................................................. ................ ................ ................ ................ ................

98941 6 Chiropractic manipulation ................................................................. ................ ................ ................ ................ ................

98942 6 Chiropractic manipulation ................................................................. ................ ................ ................ ................ ................

98943 9 Chiropractic manipulation ................................................................. ................ ................ ................ ................ ................

99000 6 Specimen handling ........................................................................... ................ ................ ................ ................ ................

99001 6 Specimen handling ........................................................................... ................ ................ ................ ................ ................

99002 6 Device handling ................................................................................ ................ ................ ................ ................ ................

99024 6 Post-op follow-up visit ....................................................................... ................ ................ ................ ................ ................

99025 6 Initial surgical evaluation ................................................................... ................ ................ ................ ................ ................

99050 6 Medical services after hrs ................................................................. ................ ................ ................ ................ ................

99052 6 Medical services at night .................................................................. ................ ................ ................ ................ ................

99054 6 Medical services,unusual hrs ............................................................ ................ ................ ................ ................ ................

99056 6 Non-office medical services .............................................................. ................ ................ ................ ................ ................

99058 6 Office emergency care ...................................................................... ................ ................ ................ ................ ................

99070 6 Special supplies ................................................................................ ................ ................ ................ ................ ................

99071 6 Patient education materials .............................................................. ................ ................ ................ ................ ................

99075 9 Medical testimony ............................................................................. ................ ................ ................ ................ ................

99078 6 Group health education .................................................................... ................ ................ ................ ................ ................

99080 6 Special reports or forms ................................................................... ................ ................ ................ ................ ................

99082 6 Unusual physician travel ................................................................... ................ ................ ................ ................ ................

99090 6 Computer data analysis .................................................................... ................ ................ ................ ................ ................

99100 6 Special anesthesia service ............................................................... ................ ................ ................ ................ ................

99116 6 Anesthesia with hypothermia ............................................................ ................ ................ ................ ................ ................

99135 6 Special anesthesia procedure .......................................................... ................ ................ ................ ................ ................

99140 6 Emergency anesthesia ..................................................................... ................ ................ ................ ................ ................

99141 6 Sedation, iv/im or inhalant ................................................................ ................ ................ ................ ................ ................

99142 6 Sedation, oral/rectal/nasal ................................................................ ................ ................ ................ ................ ................

99175 6 Induction of vomiting ......................................................................... ................ ................ ................ ................ ................

99183 6 Hyperbaric oxygen therapy ............................................................... ................ ................ ................ ................ ................

99185 6 Regional hypothermia ....................................................................... ................ ................ ................ ................ ................

99186 6 Total body hypothermia .................................................................... ................ ................ ................ ................ ................

99190 6 Special pump services ...................................................................... ................ ................ ................ ................ ................

99191 6 Special pump services ...................................................................... ................ ................ ................ ................ ................

99192 6 Special pump services ...................................................................... ................ ................ ................ ................ ................

99195 6 Phlebotomy ....................................................................................... ................ ................ ................ ................ ................

99199 6 Special service or report ................................................................... ................ ................ ................ ................ ................
32429

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

99201 6 Office/outpatient visit, new ................................................................ ................ ................ ................ ................ ................

99202 6 Office/outpatient visit, new ................................................................ ................ ................ ................ ................ ................

99203 6 Office/outpatient visit, new ................................................................ ................ ................ ................ ................ ................

99204 6 Office/outpatient visit, new ................................................................ ................ ................ ................ ................ ................

99205 6 Office/outpatient visit, new ................................................................ ................ ................ ................ ................ ................

99211 6 Office/outpatient visit, est .................................................................. ................ ................ ................ ................ ................

99212 6 Office/outpatient visit, est .................................................................. ................ ................ ................ ................ ................

99213 6 Office/outpatient visit, est .................................................................. ................ ................ ................ ................ ................

99214 6 Office/outpatient visit, est .................................................................. ................ ................ ................ ................ ................

99215 6 Office/outpatient visit, est .................................................................. ................ ................ ................ ................ ................

99217 6 Observation care discharge .............................................................. ................ ................ ................ ................ ................

99218 6 Observation care ............................................................................... ................ ................ ................ ................ ................

99219 6 Observation care ............................................................................... ................ ................ ................ ................ ................

99220 6 Observation care ............................................................................... ................ ................ ................ ................ ................

99221 6 Initial hospital care ............................................................................ ................ ................ ................ ................ ................

99222 6 Initial hospital care ............................................................................ ................ ................ ................ ................ ................

99223 6 Initial hospital care ............................................................................ ................ ................ ................ ................ ................

99231 6 Subsequent hospital care ................................................................. ................ ................ ................ ................ ................

99232 6 Subsequent hospital care ................................................................. ................ ................ ................ ................ ................

99233 6 Subsequent hospital care ................................................................. ................ ................ ................ ................ ................

99234 6 Observ/hosp same date .................................................................... ................ ................ ................ ................ ................

99235 6 Observ/hosp same date .................................................................... ................ ................ ................ ................ ................

99236 6 Observ/hosp same date .................................................................... ................ ................ ................ ................ ................

99238 6 Hospital discharge day ..................................................................... ................ ................ ................ ................ ................

99239 6 Hospital discharge day ..................................................................... ................ ................ ................ ................ ................

99241 6 Office consultation ............................................................................ ................ ................ ................ ................ ................

99242 6 Office consultation ............................................................................ ................ ................ ................ ................ ................

99243 6 Office consultation ............................................................................ ................ ................ ................ ................ ................

99244 6 Office consultation ............................................................................ ................ ................ ................ ................ ................

99245 6 Office consultation ............................................................................ ................ ................ ................ ................ ................

99251 6 Initial inpatient consult ...................................................................... ................ ................ ................ ................ ................

99252 6 Initial inpatient consult ...................................................................... ................ ................ ................ ................ ................

99253 6 Initial inpatient consult ...................................................................... ................ ................ ................ ................ ................

99254 6 Initial inpatient consult ...................................................................... ................ ................ ................ ................ ................

99255 6 Initial inpatient consult ...................................................................... ................ ................ ................ ................ ................

99261 6 Follow-up inpatient consult ............................................................... ................ ................ ................ ................ ................

99262 6 Follow-up inpatient consult ............................................................... ................ ................ ................ ................ ................

99263 6 Follow-up inpatient consult ............................................................... ................ ................ ................ ................ ................

99271 6 Confirmatory consultation ................................................................. ................ ................ ................ ................ ................

99272 6 Confirmatory consultation ................................................................. ................ ................ ................ ................ ................

99273 6 Confirmatory consultation ................................................................. ................ ................ ................ ................ ................

99274 6 Confirmatory consultation ................................................................. ................ ................ ................ ................ ................

99275 6 Confirmatory consultation ................................................................. ................ ................ ................ ................ ................

99281 6 Emergency dept visit ........................................................................ ................ ................ ................ ................ ................

99282 6 Emergency dept visit ........................................................................ ................ ................ ................ ................ ................

99283 6 Emergency dept visit ........................................................................ ................ ................ ................ ................ ................

99284 6 Emergency dept visit ........................................................................ ................ ................ ................ ................ ................

99285 6 Emergency dept visit ........................................................................ ................ ................ ................ ................ ................

99288 6 Direct advanced life support ............................................................. ................ ................ ................ ................ ................

99291 6 Critical care, first hour ....................................................................... ................ ................ ................ ................ ................

99292 6 Critical care, addl 30 min .................................................................. ................ ................ ................ ................ ................

99295 6 Neonatal critical care ........................................................................ ................ ................ ................ ................ ................

99296 6 Neonatal critical care ........................................................................ ................ ................ ................ ................ ................

99297 6 Neonatal critical care ........................................................................ ................ ................ ................ ................ ................

99301 6 Nursing facility care .......................................................................... ................ ................ ................ ................ ................

99302 6 Nursing facility care .......................................................................... ................ ................ ................ ................ ................

99303 6 Nursing facility care .......................................................................... ................ ................ ................ ................ ................

99311 6 Nursing facility care, subseq ............................................................. ................ ................ ................ ................ ................

99312 6 Nursing facility care, subseq ............................................................. ................ ................ ................ ................ ................

99313 6 Nursing facility care, subseq ............................................................. ................ ................ ................ ................ ................

99315 6 Nursing fac discharge day ................................................................ ................ ................ ................ ................ ................

99316 6 Nursing fac discharge day ................................................................ ................ ................ ................ ................ ................

99321 6 Rest home visit, new patient ............................................................ ................ ................ ................ ................ ................

99322 6 Rest home visit, new patient ............................................................ ................ ................ ................ ................ ................

99323 6 Rest home visit, new patient ............................................................ ................ ................ ................ ................ ................

99331 6 Rest home visit, estab pat ................................................................ ................ ................ ................ ................ ................

99332 6 Rest home visit, estab pat ................................................................ ................ ................ ................ ................ ................

99333 6 Rest home visit, estab pat ................................................................ ................ ................ ................ ................ ................

99341 6 Home visit, new patient .................................................................... ................ ................ ................ ................ ................

99342 6 Home visit, new patient .................................................................... ................ ................ ................ ................ ................

99343 6 Home visit, new patient .................................................................... ................ ................ ................ ................ ................

99344 6 Home visit, new patient .................................................................... ................ ................ ................ ................ ................

99345 6 Home visit, new patient .................................................................... ................ ................ ................ ................ ................

99347 6 Home visit, estab patient .................................................................. ................ ................ ................ ................ ................
32430

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

99348 6 Home visit, estab patient .................................................................. ................ ................ ................ ................ ................

99349 6 Home visit, estab patient .................................................................. ................ ................ ................ ................ ................

99350 6 Home visit, estab patient .................................................................. ................ ................ ................ ................ ................

99354 6 Prolonged service, office .................................................................. ................ ................ ................ ................ ................

99355 6 Prolonged service, office .................................................................. ................ ................ ................ ................ ................

99356 6 Prolonged service, inpatient ............................................................. ................ ................ ................ ................ ................

99357 6 Prolonged service, inpatient ............................................................. ................ ................ ................ ................ ................

99358 6 Prolonged serv, w/o contact ............................................................. ................ ................ ................ ................ ................

99359 6 Prolonged serv, w/o contact ............................................................. ................ ................ ................ ................ ................

99360 6 Physician standby services ............................................................... ................ ................ ................ ................ ................

99361 6 Physician/team conference ............................................................... ................ ................ ................ ................ ................

99362 6 Physician/team conference ............................................................... ................ ................ ................ ................ ................

99371 6 Physician phone consultation ........................................................... ................ ................ ................ ................ ................

99372 6 Physician phone consultation ........................................................... ................ ................ ................ ................ ................

99373 6 Physician phone consultation ........................................................... ................ ................ ................ ................ ................

99374 6 Home health care supervision .......................................................... ................ ................ ................ ................ ................

99375 6 Home health care supervision .......................................................... ................ ................ ................ ................ ................

99377 6 Hospice care supervision .................................................................. ................ ................ ................ ................ ................

99378 6 Hospice care supervision .................................................................. ................ ................ ................ ................ ................

99379 6 Nursing fac care supervision ............................................................ ................ ................ ................ ................ ................

99380 6 Nursing fac care supervision ............................................................ ................ ................ ................ ................ ................

99381 9 Preventive visit, new, infant .............................................................. ................ ................ ................ ................ ................

99382 9 Preventive visit, new, age 1–4 .......................................................... ................ ................ ................ ................ ................

99383 9 Preventive visit, new, age 5–11 ........................................................ ................ ................ ................ ................ ................

99384 9 Preventive visit, new, 12–17 ............................................................. ................ ................ ................ ................ ................

99385 9 Preventive visit, new, 18–39 ............................................................. ................ ................ ................ ................ ................

99386 9 Preventive visit, new, 40–64 ............................................................. ................ ................ ................ ................ ................

99387 9 Preventive visit, new, 65 & over ....................................................... ................ ................ ................ ................ ................

99391 9 Preventive visit, est, infant ................................................................ ................ ................ ................ ................ ................

99392 9 Preventive visit, est, age 1–4 ........................................................... ................ ................ ................ ................ ................

99393 9 Preventive visit, est, age 5–11 ......................................................... ................ ................ ................ ................ ................

99394 9 Preventive visit, est, 12–17 ............................................................... ................ ................ ................ ................ ................

99395 9 Preventive visit, est, 18–39 ............................................................... ................ ................ ................ ................ ................

99396 9 Preventive visit, est, 40–64 ............................................................... ................ ................ ................ ................ ................

99397 9 Preventive visit, est, 65 & over ......................................................... ................ ................ ................ ................ ................

99401 9 Preventive counseling, indiv ............................................................. ................ ................ ................ ................ ................

99402 9 Preventive counseling, indiv ............................................................. ................ ................ ................ ................ ................

99403 9 Preventive counseling, indiv ............................................................. ................ ................ ................ ................ ................

99404 9 Preventive counseling, indiv ............................................................. ................ ................ ................ ................ ................

99411 9 Preventive counseling, group ........................................................... ................ ................ ................ ................ ................

99412 9 Preventive counseling, group ........................................................... ................ ................ ................ ................ ................

99420 9 Health risk assessment test .............................................................. ................ ................ ................ ................ ................

99429 9 Unlisted preventive service ............................................................... ................ ................ ................ ................ ................

99431 6 Initial care, normal newborn ............................................................. ................ ................ ................ ................ ................

99432 6 Newborn care not in hospital ............................................................ ................ ................ ................ ................ ................

99433 6 Normal newborn care,hospital .......................................................... ................ ................ ................ ................ ................

99435 6 Hospital NB discharge day ............................................................... ................ ................ ................ ................ ................

99436 6 Attendance, birth ............................................................................... ................ ................ ................ ................ ................

99440 6 Newborn resuscitation ...................................................................... ................ ................ ................ ................ ................

99450 9 Life/disability evaluation .................................................................... ................ ................ ................ ................ ................

99455 6 Disability examination ....................................................................... ................ ................ ................ ................ ................

99456 6 Disability examination ....................................................................... ................ ................ ................ ................ ................

99499 6 Unlisted E/M service ......................................................................... ................ ................ ................ ................ ................

A0021 9 Outside state ambulance serv .......................................................... ................ ................ ................ ................ ................

A0030 6 Air ambulance service ...................................................................... ................ ................ ................ ................ ................

A0040 6 Helicopter ambulance service ........................................................... ................ ................ ................ ................ ................

A0050 6 Water amb service emergency ......................................................... ................ ................ ................ ................ ................

A0080 9 Noninterest escort in non er ............................................................. ................ ................ ................ ................ ................

A0090 9 Interest escort in non er .................................................................... ................ ................ ................ ................ ................

A0100 9 Nonemergency transport taxi ............................................................ ................ ................ ................ ................ ................

A0110 9 Nonemergency transport bus ........................................................... ................ ................ ................ ................ ................

A0120 9 Noner transport mini-bus .................................................................. ................ ................ ................ ................ ................

A0130 9 Noner transport wheelch van ............................................................ ................ ................ ................ ................ ................

A0140 9 Nonemergency transport air ............................................................. ................ ................ ................ ................ ................

A0160 9 Noner transport case worker ............................................................ ................ ................ ................ ................ ................

A0170 9 Noner transport parking fees ............................................................ ................ ................ ................ ................ ................

A0180 9 Noner transport lodgng recip ............................................................ ................ ................ ................ ................ ................

A0190 9 Noner transport meals recip ............................................................. ................ ................ ................ ................ ................

A0200 9 Noner transport lodgng escrt ............................................................ ................ ................ ................ ................ ................

A0210 9 Noner transport meals escort ........................................................... ................ ................ ................ ................ ................

A0225 6 Neonatal emergency transport ......................................................... ................ ................ ................ ................ ................

A0300 6 Ambulance basic non-emer all ......................................................... ................ ................ ................ ................ ................

A0302 6 Ambulance basic emergeny all ......................................................... ................ ................ ................ ................ ................

A0304 6 Amb adv non-er no serv all .............................................................. ................ ................ ................ ................ ................
32431

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

A0306 6 Amb adv non-er spec serv all ........................................................... ................ ................ ................ ................ ................

A0308 6 Amb adv er no spec serv all ............................................................. ................ ................ ................ ................ ................

A0310 6 Amb adv er spec serv all .................................................................. ................ ................ ................ ................ ................

A0320 6 Amb basic non-er + supplies ............................................................ ................ ................ ................ ................ ................

A0322 6 Amb basic emerg + supplies ............................................................ ................ ................ ................ ................ ................

A0324 6 Adv non-er serv sep mileage ............................................................ ................ ................ ................ ................ ................

A0326 6 Adv non-er no serv sep mile ............................................................. ................ ................ ................ ................ ................

A0328 6 Adv er no serv sep mileage .............................................................. ................ ................ ................ ................ ................

A0330 6 Adv er spec serv sep mile ................................................................ ................ ................ ................ ................ ................

A0340 6 Amb basic non-er + mileage ............................................................. ................ ................ ................ ................ ................

A0342 6 Ambul basic emer + mileage ............................................................ ................ ................ ................ ................ ................

A0344 6 Amb adv non-er no serv +mile ......................................................... ................ ................ ................ ................ ................

A0346 6 Amb adv non-er serv + mile ............................................................. ................ ................ ................ ................ ................

A0348 6 Adv emer no spec serv + mile .......................................................... ................ ................ ................ ................ ................

A0350 6 Adv emer spec serv + mileage ......................................................... ................ ................ ................ ................ ................

A0360 6 Basic non-er sep mile & supp .......................................................... ................ ................ ................ ................ ................

A0362 6 Basic emer sep mile & supply .......................................................... ................ ................ ................ ................ ................

A0364 6 Adv non-er no serv sep mi&su ......................................................... ................ ................ ................ ................ ................

A0366 6 Adv non-er serv sep mil&supp ......................................................... ................ ................ ................ ................ ................

A0368 6 Adv er no serv sep mile&supp ......................................................... ................ ................ ................ ................ ................

A0370 6 Adv er spec serv sep mi&supp ......................................................... ................ ................ ................ ................ ................

A0380 6 Basic life support mileage ................................................................. ................ ................ ................ ................ ................

A0382 6 Basic support routine suppls ............................................................ ................ ................ ................ ................ ................

A0384 6 Bls defibrillation supplies .................................................................. ................ ................ ................ ................ ................

A0390 6 Advanced life support mileag ........................................................... ................ ................ ................ ................ ................

A0392 6 Als defibrillation supplies .................................................................. ................ ................ ................ ................ ................

A0394 6 Als IV drug therapy supplies ............................................................. ................ ................ ................ ................ ................

A0396 6 Als esophageal intub suppls ............................................................. ................ ................ ................ ................ ................

A0398 6 Als routine disposble suppls ............................................................. ................ ................ ................ ................ ................

A0420 6 Ambulance waiting 1⁄2 hr ................................................................... ................ ................ ................ ................ ................

A0422 6 Ambulance 02 life sustaining ............................................................ ................ ................ ................ ................ ................

A0424 6 Extra ambulance attendant ............................................................... ................ ................ ................ ................ ................

A0888 9 Noncovered ambulance mileage ...................................................... ................ ................ ................ ................ ................

A0999 6 Unlisted ambulance service .............................................................. ................ ................ ................ ................ ................

A4206 2 1 CC sterile syringe&needle ............................................................. ................ ................ ................ ................ ................

A4207 2 2 CC sterile syringe&needle ............................................................. ................ ................ ................ ................ ................

A4208 2 3 CC sterile syringe&needle ............................................................. ................ ................ ................ ................ ................

A4209 2 5+ CC sterile syringe&needle ........................................................... ................ ................ ................ ................ ................

A4210 9 Nonneedle injection device ............................................................... ................ ................ ................ ................ ................

A4211 2 Supp for self-adm injections ............................................................. ................ ................ ................ ................ ................

A4212 2 Non coring needle or stylet ............................................................... ................ ................ ................ ................ ................

A4213 2 20+ CC syringe only ......................................................................... ................ ................ ................ ................ ................

A4214 2 30 CC sterile water/saline ................................................................. ................ ................ ................ ................ ................

A4215 2 Sterile needle .................................................................................... ................ ................ ................ ................ ................

A4220 2 Infusion pump refill kit ....................................................................... ................ ................ ................ ................ ................

A4221 2 Maint drug infus cath per wk ............................................................ ................ ................ ................ ................ ................

A4222 2 Drug infusion pump supplies ............................................................ ................ ................ ................ ................ ................

A4230 9 Infus insulin pump non needl ............................................................ ................ ................ ................ ................ ................

A4231 9 Infusion insulin pump needle ............................................................ ................ ................ ................ ................ ................

A4232 9 Syringe w/needle insulin 3cc ............................................................ ................ ................ ................ ................ ................

A4244 2 Alcohol or peroxide per pint .............................................................. ................ ................ ................ ................ ................

A4245 2 Alcohol wipes per box ....................................................................... ................ ................ ................ ................ ................

A4246 2 Betadine/phisohex solution ............................................................... ................ ................ ................ ................ ................

A4247 2 Betadine/iodine swabs/wipes ............................................................ ................ ................ ................ ................ ................

A4250 9 Urine reagent strips/tablets ............................................................... ................ ................ ................ ................ ................

A4253 2 Blood glucose/reagent strips ............................................................ ................ ................ ................ ................ ................

A4254 2 Battery for glucose monitor ............................................................... ................ ................ ................ ................ ................

A4255 2 Glucose monitor platforms ................................................................ ................ ................ ................ ................ ................

A4256 2 Calibrator solution/chips .................................................................... ................ ................ ................ ................ ................

A4258 2 Lancet device each ........................................................................... ................ ................ ................ ................ ................

A4259 2 Lancets per box ................................................................................ ................ ................ ................ ................ ................

A4260 9 Levonorgestrel implant ...................................................................... ................ ................ ................ ................ ................

A4262 2 Temporary tear duct plug ................................................................. ................ ................ ................ ................ ................

A4263 2 Permanent tear duct plug ................................................................. ................ ................ ................ ................ ................

A4265 2 Paraffin .............................................................................................. ................ ................ ................ ................ ................

A4270 2 Disposable endoscope sheath .......................................................... ................ ................ ................ ................ ................

A4300 2 Cath impl vasc access portal ............................................................ ................ ................ ................ ................ ................

A4301 2 Implantable access syst perc ........................................................... ................ ................ ................ ................ ................

A4305 2 Drug delivery system >=50 ML ......................................................... ................ ................ ................ ................ ................

A4306 2 Drug delivery system <=5 ML ........................................................... ................ ................ ................ ................ ................

A4310 6 Insert tray w/o bag/cath .................................................................... ................ ................ ................ ................ ................

A4311 6 Catheter w/o bag 2-way latex ........................................................... ................ ................ ................ ................ ................

A4312 6 Cath w/o bag 2-way silicone ............................................................. ................ ................ ................ ................ ................

A4313 6 Catheter w/bag 3-way ....................................................................... ................ ................ ................ ................ ................
32432

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

A4314 6 Cath w/drainage 2-way latex ............................................................ ................ ................ ................ ................ ................

A4315 6 Cath w/drainage 2-way silcne ........................................................... ................ ................ ................ ................ ................

A4316 6 Cath w/drainage 3-way ..................................................................... ................ ................ ................ ................ ................

A4320 6 Irrigation tray ..................................................................................... ................ ................ ................ ................ ................

A4321 6 Cath therapeutic irrig agent .............................................................. ................ ................ ................ ................ ................

A4322 6 Irrigation syringe ............................................................................... ................ ................ ................ ................ ................

A4323 6 Saline irrigation solution .................................................................... ................ ................ ................ ................ ................

A4326 6 Male external catheter ...................................................................... ................ ................ ................ ................ ................

A4327 6 Fem urinary collect dev cup ............................................................. ................ ................ ................ ................ ................

A4328 6 Fem urinary collect pouch ................................................................ ................ ................ ................ ................ ................

A4329 6 External catheter start set ................................................................. ................ ................ ................ ................ ................

A4330 6 Stool collection pouch ....................................................................... ................ ................ ................ ................ ................

A4335 6 Incontinence supply .......................................................................... ................ ................ ................ ................ ................

A4338 6 Indwelling catheter latex ................................................................... ................ ................ ................ ................ ................

A4340 6 Indwelling catheter special ................................................................ ................ ................ ................ ................ ................

A4344 6 Cath indw foley 2 way silicn ............................................................. ................ ................ ................ ................ ................

A4346 6 Cath indw foley 3 way ...................................................................... ................ ................ ................ ................ ................

A4347 6 Male external catheter ...................................................................... ................ ................ ................ ................ ................

A4351 6 Straight tip urine catheter ................................................................. ................ ................ ................ ................ ................

A4352 6 Coude tip urinary catheter ................................................................ ................ ................ ................ ................ ................

A4353 6 Intermittent urinary cath .................................................................... ................ ................ ................ ................ ................

A4354 6 Cath insertion tray w/bag .................................................................. ................ ................ ................ ................ ................

A4355 6 Bladder irrigation tubing .................................................................... ................ ................ ................ ................ ................

A4356 6 Ext ureth clmp or compr dvc ............................................................. ................ ................ ................ ................ ................

A4357 6 Bedside drainage bag ....................................................................... ................ ................ ................ ................ ................

A4358 6 Urinary leg bag ................................................................................. ................ ................ ................ ................ ................

A4359 6 Urinary suspensory w/o leg b ........................................................... ................ ................ ................ ................ ................

A4361 6 Ostomy face plate ............................................................................. ................ ................ ................ ................ ................

A4362 6 Solid skin barrier ............................................................................... ................ ................ ................ ................ ................

A4363 6 Liquid skin barrier ............................................................................. ................ ................ ................ ................ ................

A4364 6 Ostomy/cath adhesive ...................................................................... ................ ................ ................ ................ ................

A4365 6 Ostomy adhesive remover wipe ....................................................... ................ ................ ................ ................ ................

A4367 6 Ostomy belt ....................................................................................... ................ ................ ................ ................ ................

A4368 6 Ostomy filter ...................................................................................... ................ ................ ................ ................ ................

A4397 6 Irrigation supply sleeve ..................................................................... ................ ................ ................ ................ ................

A4398 6 Ostomy irrigation bag ........................................................................ ................ ................ ................ ................ ................

A4399 6 Ostomy irrig cone/cath w brs ............................................................ ................ ................ ................ ................ ................

A4400 6 Ostomy irrigation set ......................................................................... ................ ................ ................ ................ ................

A4402 6 Lubricant per ounce .......................................................................... ................ ................ ................ ................ ................

A4404 6 Ostomy ring each .............................................................................. ................ ................ ................ ................ ................

A4421 6 Ostomy supply misc .......................................................................... ................ ................ ................ ................ ................

A4454 6 Tape all types all sizes ..................................................................... ................ ................ ................ ................ ................

A4455 6 Adhesive remover per ounce ............................................................ ................ ................ ................ ................ ................

A4460 6 Elastic compression bandage ........................................................... ................ ................ ................ ................ ................

A4462 6 Abdmnl drssng holder/binder ............................................................ ................ ................ ................ ................ ................

A4465 6 Non-elastic extremity binder ............................................................. ................ ................ ................ ................ ................

A4470 6 Gravlee jet washer ............................................................................ ................ ................ ................ ................ ................

A4480 6 Vabra aspirator ................................................................................. ................ ................ ................ ................ ................

A4481 6 Tracheostoma filter ........................................................................... ................ ................ ................ ................ ................

A4490 9 Above knee surgical stocking ........................................................... ................ ................ ................ ................ ................

A4495 9 Thigh length surg stocking ................................................................ ................ ................ ................ ................ ................

A4500 9 Below knee surgical stocking ........................................................... ................ ................ ................ ................ ................

A4510 9 Full length surg stocking ................................................................... ................ ................ ................ ................ ................

A4550 2 Surgical trays .................................................................................... ................ ................ ................ ................ ................

A4554 9 Disposable underpads ...................................................................... ................ ................ ................ ................ ................

A4556 2 Electrodes ......................................................................................... ................ ................ ................ ................ ................

A4557 2 Lead wires ......................................................................................... ................ ................ ................ ................ ................

A4558 2 Conductive paste or gel .................................................................... ................ ................ ................ ................ ................

A4560 2 Pessary ............................................................................................. ................ ................ ................ ................ ................

A4565 2 Slings ................................................................................................ ................ ................ ................ ................ ................

A4570 2 Splint ................................................................................................. ................ ................ ................ ................ ................

A4572 2 Rib belt .............................................................................................. ................ ................ ................ ................ ................

A4575 9 Hyperbaric o2 chamber disps ........................................................... ................ ................ ................ ................ ................

A4580 2 Cast supplies (plaster) ...................................................................... ................ ................ ................ ................ ................

A4590 2 Special casting material .................................................................... ................ ................ ................ ................ ................

A4595 6 TENS suppl 2 lead per month .......................................................... ................ ................ ................ ................ ................

A4611 6 Heavy duty battery ............................................................................ ................ ................ ................ ................ ................

A4612 6 Battery cables ................................................................................... ................ ................ ................ ................ ................

A4613 6 Battery charger ................................................................................. ................ ................ ................ ................ ................

A4615 2 Cannula nasal ................................................................................... ................ ................ ................ ................ ................

A4616 2 Tubing (oxygen) per foot .................................................................. ................ ................ ................ ................ ................

A4617 2 Mouth piece ...................................................................................... ................ ................ ................ ................ ................

A4618 2 Breathing circuits .............................................................................. ................ ................ ................ ................ ................

A4619 2 Face tent ........................................................................................... ................ ................ ................ ................ ................
32433

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

A4620 2 Variable concentration mask ............................................................ ................ ................ ................ ................ ................

A4621 2 Tracheotomy mask or collar ............................................................. ................ ................ ................ ................ ................

A4622 2 Tracheostomy or larngectomy .......................................................... ................ ................ ................ ................ ................

A4623 2 Tracheostomy inner cannula ............................................................ ................ ................ ................ ................ ................

A4624 2 Tracheal suction tube ....................................................................... ................ ................ ................ ................ ................

A4625 2 Trach care kit for new trach .............................................................. ................ ................ ................ ................ ................

A4626 2 Tracheostomy cleaning brush ........................................................... ................ ................ ................ ................ ................

A4627 9 Spacer bag/reservoir ......................................................................... ................ ................ ................ ................ ................

A4628 2 Oropharyngeal suction cath .............................................................. ................ ................ ................ ................ ................

A4629 2 Tracheostomy care kit ...................................................................... ................ ................ ................ ................ ................

A4630 6 Repl bat t.e.n.s. own by pt ................................................................ ................ ................ ................ ................ ................

A4631 6 Wheelchair battery ............................................................................ ................ ................ ................ ................ ................

A4635 6 Underarm crutch pad ........................................................................ ................ ................ ................ ................ ................

A4636 6 Handgrip for cane etc ....................................................................... ................ ................ ................ ................ ................

A4637 6 Repl tip cane/crutch/walker ............................................................... ................ ................ ................ ................ ................

A4640 6 Alternating pressure pad ................................................................... ................ ................ ................ ................ ................

A4641 9 Diagnostic imaging agent ................................................................. ................ ................ ................ ................ ................

A4642 9 Satumomab pendetide per dose ...................................................... ................ ................ ................ ................ ................

A4643 9 High dose contrast MRI .................................................................... ................ ................ ................ ................ ................

A4644 9 Contrast 100–199 MGs iodine .......................................................... ................ ................ ................ ................ ................

A4645 9 Contrast 200–299 MGs iodine .......................................................... ................ ................ ................ ................ ................

A4646 9 Contrast 300–399 MGs iodine .......................................................... ................ ................ ................ ................ ................

A4647 2 Supp- paramagnetic contr mat ......................................................... ................ ................ ................ ................ ................

A4649 2 Surgical supplies ............................................................................... ................ ................ ................ ................ ................

A4650 2 Supp esrd centrifuge ......................................................................... ................ ................ ................ ................ ................

A4655 6 Esrd syringe/needle .......................................................................... ................ ................ ................ ................ ................

A4660 6 Esrd blood pressure device .............................................................. ................ ................ ................ ................ ................

A4663 6 Esrd blood pressure cuff ................................................................... ................ ................ ................ ................ ................

A4670 9 Auto blood pressure monitor ............................................................ ................ ................ ................ ................ ................

A4680 6 Activated carbon filters ..................................................................... ................ ................ ................ ................ ................

A4690 6 Dialyzers ........................................................................................... ................ ................ ................ ................ ................

A4700 6 Standard dialysate solution ............................................................... ................ ................ ................ ................ ................

A4705 6 Bicarb dialysate solution ................................................................... ................ ................ ................ ................ ................

A4712 6 Sterile water ...................................................................................... ................ ................ ................ ................ ................

A4714 6 Treated water for dialysis ................................................................. ................ ................ ................ ................ ................

A4730 6 Fistula cannulation set dial ............................................................... ................ ................ ................ ................ ................

A4735 6 Local/topical anesthetics ................................................................... ................ ................ ................ ................ ................

A4740 6 Esrd shunt accessory ....................................................................... ................ ................ ................ ................ ................

A4750 2 Arterial or venous tubing ................................................................... ................ ................ ................ ................ ................

A4755 2 Arterial and venous tubing ................................................................ ................ ................ ................ ................ ................

A4760 6 Standard testing solution .................................................................. ................ ................ ................ ................ ................

A4765 6 Dialysate concentrate ....................................................................... ................ ................ ................ ................ ................

A4770 2 Blood testing supplies ....................................................................... ................ ................ ................ ................ ................

A4771 2 Blood clotting time tube .................................................................... ................ ................ ................ ................ ................

A4772 2 Dextrostick/glucose strips ................................................................. ................ ................ ................ ................ ................

A4773 2 Hemostix ........................................................................................... ................ ................ ................ ................ ................

A4774 2 Ammonia test paper .......................................................................... ................ ................ ................ ................ ................

A4780 6 Esrd sterilizing agent ........................................................................ ................ ................ ................ ................ ................

A4790 6 Esrd cleansing agents ...................................................................... ................ ................ ................ ................ ................

A4800 6 Heparin/antidote dialysis ................................................................... ................ ................ ................ ................ ................

A4820 6 Supplies hemodialysis kit .................................................................. ................ ................ ................ ................ ................

A4850 6 Rubber tipped hemostats .................................................................. ................ ................ ................ ................ ................

A4860 2 Disposable catheter caps ................................................................. ................ ................ ................ ................ ................

A4870 6 Plumbing/electrical work ................................................................... ................ ................ ................ ................ ................

A4880 6 Water storage tanks .......................................................................... ................ ................ ................ ................ ................

A4890 6 Contracts/repair/maintenance ........................................................... ................ ................ ................ ................ ................

A4900 6 Capd supply kit ................................................................................. ................ ................ ................ ................ ................

A4901 6 Ccpd supply kit ................................................................................. ................ ................ ................ ................ ................

A4905 6 Ipd supply kit ..................................................................................... ................ ................ ................ ................ ................

A4910 6 Esrd nonmedical supplies ................................................................. ................ ................ ................ ................ ................

A4912 2 Gomco drain bottle ........................................................................... ................ ................ ................ ................ ................

A4913 6 Esrd supply ....................................................................................... ................ ................ ................ ................ ................

A4914 2 Preparation kit ................................................................................... ................ ................ ................ ................ ................

A4918 2 Venous pressure clamp .................................................................... ................ ................ ................ ................ ................

A4919 6 Supp dialysis dialyzer holde ............................................................. ................ ................ ................ ................ ................

A4920 2 Harvard pressure clamp ................................................................... ................ ................ ................ ................ ................

A4921 2 Measuring cylinder ............................................................................ ................ ................ ................ ................ ................

A4927 2 Gloves ............................................................................................... ................ ................ ................ ................ ................

A5051 6 Pouch clsd w barr attached .............................................................. ................ ................ ................ ................ ................

A5052 6 Clsd ostomy pouch w/o barr ............................................................. ................ ................ ................ ................ ................

A5053 6 Clsd ostomy pouch faceplate ........................................................... ................ ................ ................ ................ ................

A5054 6 Clsd ostomy pouch w/flange ............................................................. ................ ................ ................ ................ ................

A5055 6 Stoma cap ......................................................................................... ................ ................ ................ ................ ................

A5061 6 Pouch drainable w barrier at ............................................................ ................ ................ ................ ................ ................
32434

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

A5062 6 Drnble ostomy pouch w/o barr ......................................................... ................ ................ ................ ................ ................

A5063 6 Drain ostomy pouch w/flange ........................................................... ................ ................ ................ ................ ................

A5064 9 Drain ostomy pouch w/fceplte .......................................................... ................ ................ ................ ................ ................

A5065 9 Drain ostomy pouch on fcplte ........................................................... ................ ................ ................ ................ ................

A5071 6 Urinary pouch w/barrier .................................................................... ................ ................ ................ ................ ................

A5072 6 Urinary pouch w/o barrier ................................................................. ................ ................ ................ ................ ................

A5073 6 Urinary pouch on barr w/flng ............................................................ ................ ................ ................ ................ ................

A5074 9 Urinary pouch w/faceplate ................................................................ ................ ................ ................ ................ ................

A5075 9 Urinary pouch on faceplate ............................................................... ................ ................ ................ ................ ................

A5081 6 Continent stoma plug ........................................................................ ................ ................ ................ ................ ................

A5082 6 Continent stoma catheter .................................................................. ................ ................ ................ ................ ................

A5093 6 Ostomy accessory convex inse ........................................................ ................ ................ ................ ................ ................

A5102 6 Bedside drain btl w/wo tube ............................................................. ................ ................ ................ ................ ................

A5105 6 Urinary suspensory ........................................................................... ................ ................ ................ ................ ................

A5112 6 Urinary leg bag ................................................................................. ................ ................ ................ ................ ................

A5113 6 Latex leg strap .................................................................................. ................ ................ ................ ................ ................

A5114 6 Foam/fabric leg strap ........................................................................ ................ ................ ................ ................ ................

A5119 2 Skin barrier wipes box pr 50 ............................................................. ................ ................ ................ ................ ................

A5121 2 Solid skin barrier 6x6 ........................................................................ ................ ................ ................ ................ ................

A5122 2 Solid skin barrier 8x8 ........................................................................ ................ ................ ................ ................ ................

A5123 2 Skin barrier with flange ..................................................................... ................ ................ ................ ................ ................

A5126 2 Adhesive disc/foam pad .................................................................... ................ ................ ................ ................ ................

A5131 2 Appliance cleaner ............................................................................. ................ ................ ................ ................ ................

A5149 2 Incontinence/ostomy supply .............................................................. ................ ................ ................ ................ ................

A5500 6 Diab shoe for density insert .............................................................. ................ ................ ................ ................ ................

A5501 6 Diabetic custom molded shoe .......................................................... ................ ................ ................ ................ ................

A5502 6 Diabetic shoe density insert .............................................................. ................ ................ ................ ................ ................

A5503 6 Diabetic shoe w/roller/rockr .............................................................. ................ ................ ................ ................ ................

A5504 6 Diabetic shoe with wedge ................................................................. ................ ................ ................ ................ ................

A5505 6 Diab shoe w/metatarsal bar .............................................................. ................ ................ ................ ................ ................

A5506 6 Diabetic shoe w/off set heel ............................................................. ................ ................ ................ ................ ................

A5507 6 Modification diabetic shoe ................................................................ ................ ................ ................ ................ ................

A6020 2 Collagen dressing cover ea .............................................................. ................ ................ ................ ................ ................

A6025 9 Silicone gel sheet, each .................................................................... ................ ................ ................ ................ ................

A6154 2 Wound pouch each ........................................................................... ................ ................ ................ ................ ................

A6196 2 Alginate dressing <=16 sq in ............................................................ ................ ................ ................ ................ ................

A6197 2 Alginate drsg >16 <=48 sq in ........................................................... ................ ................ ................ ................ ................

A6198 2 alginate dressing >48 sq in ............................................................... ................ ................ ................ ................ ................

A6199 2 Alginate drsg wound filler ................................................................. ................ ................ ................ ................ ................

A6203 2 Composite drsg <= 16 sq in ............................................................. ................ ................ ................ ................ ................

A6204 2 Composite drsg >16 <=48 sq in ....................................................... ................ ................ ................ ................ ................

A6205 2 Composite drsg > 48 sq in ............................................................... ................ ................ ................ ................ ................

A6206 2 Contact layer <= 16 sq in ................................................................. ................ ................ ................ ................ ................

A6207 2 Contact layer >16<= 48 sq in ........................................................... ................ ................ ................ ................ ................

A6208 2 Contact layer > 48 sq in ................................................................... ................ ................ ................ ................ ................

A6209 2 Foam drsg <=16 sq in w/o bdr ......................................................... ................ ................ ................ ................ ................

A6210 2 Foam drg >16<=48 sq in w/o b ........................................................ ................ ................ ................ ................ ................

A6211 2 Foam drg > 48 sq in w/o brdr ........................................................... ................ ................ ................ ................ ................

A6212 2 Foam drg <=16 sq in w/border ......................................................... ................ ................ ................ ................ ................

A6213 2 Foam drg ≤16<=48 sq in w/bdr ........................................................ ................ ................ ................ ................ ................

A6214 2 Foam drg ≤ 48 sq in w/border .......................................................... ................ ................ ................ ................ ................

A6215 2 Foam dressing wound filler ............................................................... ................ ................ ................ ................ ................

A6216 2 Non-sterile gauze<=16 sq in ............................................................. ................ ................ ................ ................ ................

A6217 2 Non-sterile gauze>16<=48 sq ........................................................... ................ ................ ................ ................ ................

A6218 2 Non-sterile gauze > 48 sq in ............................................................ ................ ................ ................ ................ ................

A6219 2 Gauze >= 16 sq in w/border ............................................................. ................ ................ ................ ................ ................

A6220 2 Gauze >16 <=48 sq in w/bordr ......................................................... ................ ................ ................ ................ ................

A6221 2 Gauze > 48 sq in w/border ............................................................... ................ ................ ................ ................ ................

A6222 2 Gauze <=16 in no w/sal w/o b .......................................................... ................ ................ ................ ................ ................

A6223 2 Gauze >16<=48 no w/sal w/o b ........................................................ ................ ................ ................ ................ ................

A6224 2 Gauze > 48 in no w/sal w/o b ........................................................... ................ ................ ................ ................ ................

A6228 2 Gauze <= 16 sq in water/sal ............................................................ ................ ................ ................ ................ ................

A6229 2 Gauze >16 <=48 sq in watr/sal ........................................................ ................ ................ ................ ................ ................

A6230 2 Gauze ≤ 48 sq in water/salne ........................................................... ................ ................ ................ ................ ................

A6234 2 Hydrocolld drg ≤=16 w/o bdr ............................................................ ................ ................ ................ ................ ................

A6235 2 Hydrocolld drg >16 ≤=48 w/o b ........................................................ ................ ................ ................ ................ ................

A6236 2 Hydrocolld drg > 48 in w/o b ............................................................ ................ ................ ................ ................ ................

A6237 2 Hydrocolld drg <=16 in w/bdr ........................................................... ................ ................ ................ ................ ................

A6238 2 Hydrocolld drg >16 <=48 w/bdr ........................................................ ................ ................ ................ ................ ................

A6239 2 Hydrocolld drg > 48 in w/bdr ............................................................ ................ ................ ................ ................ ................

A6240 2 Hydrocolld drg filler paste ................................................................. ................ ................ ................ ................ ................

A6241 2 Hydrocolloid drg filler dry .................................................................. ................ ................ ................ ................ ................

A6242 2 Hydrogel drg <=16 in w/o bdr ........................................................... ................ ................ ................ ................ ................

A6243 2 Hydrogel drg >16<=48 w/o bdr ......................................................... ................ ................ ................ ................ ................
32435

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

A6244 2 Hydrogel drg >48 in w/o bdr ............................................................. ................ ................ ................ ................ ................

A6245 2 Hydrogel drg <= 16 in w/bdr ............................................................. ................ ................ ................ ................ ................

A6246 2 Hydrogel drg >16<=48 in w/b ........................................................... ................ ................ ................ ................ ................

A6247 2 Hydrogel drg > 48 sq in w/b ............................................................. ................ ................ ................ ................ ................

A6248 2 Hydrogel drsg gel filler ...................................................................... ................ ................ ................ ................ ................

A6250 2 Skin seal protect moisturizr .............................................................. ................ ................ ................ ................ ................

A6251 2 Absorpt drg <=16 sq in w/o b ........................................................... ................ ................ ................ ................ ................

A6252 2 Absorpt drg >16 <=48 w/o bdr .......................................................... ................ ................ ................ ................ ................

A6253 2 Absorpt drg > 48 sq in w/o b ............................................................ ................ ................ ................ ................ ................

A6254 2 Absorpt drg <=16 sq in w/bdr ........................................................... ................ ................ ................ ................ ................

A6255 2 Absorpt drg >16<=48 in w/bdr .......................................................... ................ ................ ................ ................ ................

A6256 2 Absorpt drg > 48 sq in w/bdr ............................................................ ................ ................ ................ ................ ................

A6257 2 Transparent film <= 16 sq in ............................................................. ................ ................ ................ ................ ................

A6258 2 Transparent film >16<=48 in ............................................................. ................ ................ ................ ................ ................

A6259 2 Transparent film > 48 sq in ............................................................... ................ ................ ................ ................ ................

A6260 2 Wound cleanser any type/size .......................................................... ................ ................ ................ ................ ................

A6261 2 Wound filler gel/paste /oz ................................................................. ................ ................ ................ ................ ................

A6262 2 Wound filler dry form / gram ............................................................. ................ ................ ................ ................ ................

A6263 2 Non-sterile elastic gauze/yd .............................................................. ................ ................ ................ ................ ................

A6264 2 Non-sterile no elastic gauze ............................................................. ................ ................ ................ ................ ................

A6265 2 Tape per 18 sq inches ...................................................................... ................ ................ ................ ................ ................

A6266 2 Impreg gauze no h20/sal/yard .......................................................... ................ ................ ................ ................ ................

A6402 2 Sterile gauze <= 16 sq in ................................................................. ................ ................ ................ ................ ................

A6403 2 Sterile gauze >16 <= 48 sq in .......................................................... ................ ................ ................ ................ ................

A6404 2 Sterile gauze > 48 sq in .................................................................... ................ ................ ................ ................ ................

A6405 2 Sterile elastic gauze /yd .................................................................... ................ ................ ................ ................ ................

A6406 2 Sterile non-elastic gauze/yd .............................................................. ................ ................ ................ ................ ................

A9150 9 Misc/exper non-prescript dru ............................................................ ................ ................ ................ ................ ................

A9160 9 Podiatrist non-covered servi ............................................................. ................ ................ ................ ................ ................

A9170 9 Chiropractor non-covered ser ........................................................... ................ ................ ................ ................ ................

A9190 9 Misc/expe personal comfort i ............................................................ ................ ................ ................ ................ ................

A9270 9 Non-covered item or service ............................................................. ................ ................ ................ ................ ................

A9300 9 Exercise equipment .......................................................................... ................ ................ ................ ................ ................

A9500 9 Technetium TC 99m sestamibi ......................................................... ................ ................ ................ ................ ................

A9502 6 Technetium TC99M tetrofosmin ....................................................... ................ ................ ................ ................ ................

A9503 9 Technetium TC 99m medronate ....................................................... ................ ................ ................ ................ ................

A9505 9 Thallous chloride TL 201/mci ............................................................ ................ ................ ................ ................ ................

A9600 6 Strontium-89 chloride ........................................................................ ................ ................ ................ ................ ................

B4034 6 Enter feed supkit syr by day ............................................................. ................ ................ ................ ................ ................

B4035 6 Enteral feed supp pump per d .......................................................... ................ ................ ................ ................ ................

B4036 6 Enteral feed sup kit grav by .............................................................. ................ ................ ................ ................ ................

B4081 6 Enteral ng tubing w/ stylet ................................................................ ................ ................ ................ ................ ................

B4082 6 Enteral ng tubing w/o stylet .............................................................. ................ ................ ................ ................ ................

B4083 6 Enteral stomach tube levine ............................................................. ................ ................ ................ ................ ................

B4084 6 Gastrostomy/jejunostomy tubi ........................................................... ................ ................ ................ ................ ................

B4085 6 Gastrostomy tube w/ring each .......................................................... ................ ................ ................ ................ ................

B4150 6 Enteral formulae category i ............................................................... ................ ................ ................ ................ ................

B4151 6 Enteral formulae category i- ............................................................. ................ ................ ................ ................ ................

B4152 6 Enteral formulae category ii .............................................................. ................ ................ ................ ................ ................

B4153 6 Enteral formulae category ii .............................................................. ................ ................ ................ ................ ................

B4154 6 Enteral formulae category IV ............................................................ ................ ................ ................ ................ ................

B4155 6 Enteral formulae category v .............................................................. ................ ................ ................ ................ ................

B4156 6 Enteral formulae category vi ............................................................. ................ ................ ................ ................ ................

B4164 6 Parenteral 50% dextrose solu .......................................................... ................ ................ ................ ................ ................

B4168 6 Parenteral sol amino acid 3. ............................................................. ................ ................ ................ ................ ................

B4172 6 Parenteral sol amino acid 5. ............................................................. ................ ................ ................ ................ ................

B4176 6 Parenteral sol amino acid 7- ............................................................. ................ ................ ................ ................ ................

B4178 6 Parenteral sol amino acid > .............................................................. ................ ................ ................ ................ ................

B4180 6 Parenteral sol carb > 50% ................................................................ ................ ................ ................ ................ ................

B4184 6 Parenteral sol lipids 10% .................................................................. ................ ................ ................ ................ ................

B4186 6 Parenteral sol lipids 20% .................................................................. ................ ................ ................ ................ ................

B4189 6 Parenteral sol amino acid & ............................................................. ................ ................ ................ ................ ................

B4193 6 Parenteral sol 52–73 gm prot ........................................................... ................ ................ ................ ................ ................

B4197 6 Parenteral sol 74–100 gm pro .......................................................... ................ ................ ................ ................ ................

B4199 6 Parenteral sol ≤ 100gm prote ........................................................... ................ ................ ................ ................ ................

B4216 6 Parenteral nutrition additiv ................................................................ ................ ................ ................ ................ ................

B4220 6 Parenteral supply kit premix ............................................................. ................ ................ ................ ................ ................

B4222 6 Parenteral supply kit homemi ........................................................... ................ ................ ................ ................ ................

B4224 6 Parenteral administration ki .............................................................. ................ ................ ................ ................ ................

B5000 6 Parenteral sol renal-amirosy ............................................................. ................ ................ ................ ................ ................

B5100 6 Parenteral sol hepatic-fream ............................................................. ................ ................ ................ ................ ................

B5200 6 Parenteral sol stres-brnch c .............................................................. ................ ................ ................ ................ ................

B9000 6 Enter infusion pump w/o alrm ........................................................... ................ ................ ................ ................ ................

B9002 6 Enteral infusion pump w/ ala ............................................................ ................ ................ ................ ................ ................
32436

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

B9004 6 Parenteral infus pump portab ........................................................... ................ ................ ................ ................ ................

B9006 6 Parenteral infus pump statio ............................................................. ................ ................ ................ ................ ................

B9998 6 Enteral supp not otherwise c ............................................................ ................ ................ ................ ................ ................

B9999 6 Parenteral supp not othrws c ............................................................ ................ ................ ................ ................ ................

D0120 9 Periodic oral evaluation .................................................................... ................ ................ ................ ................ ................

D0140 9 Limit oral eval problm focus .............................................................. ................ ................ ................ ................ ................

D0150 6 Comprehensve oral evaluation ......................................................... ................ ................ ................ ................ ................

D0160 9 Extensv oral eval prob focus ............................................................ ................ ................ ................ ................ ................

D0210 9 Intraor complete film series .............................................................. ................ ................ ................ ................ ................

D0220 9 Intraoral periapical first f ................................................................... ................ ................ ................ ................ ................

D0230 9 Intraoral periapical ea add ................................................................ ................ ................ ................ ................ ................

D0240 6 Intraoral occlusal film ........................................................................ ................ ................ ................ ................ ................

D0250 6 Extraoral first film .............................................................................. ................ ................ ................ ................ ................

D0260 6 Extraoral ea additional film ............................................................... ................ ................ ................ ................ ................

D0270 6 Dental bitewing single film ................................................................ ................ ................ ................ ................ ................

D0272 6 Dental bitewings two films ................................................................ ................ ................ ................ ................ ................

D0274 6 Dental bitewings four films ................................................................ ................ ................ ................ ................ ................

D0290 9 Dental film skull/facial bon ................................................................ ................ ................ ................ ................ ................

D0310 9 Dental saliography ............................................................................ ................ ................ ................ ................ ................

D0320 9 Dental tmj arthrogram incl i .............................................................. ................ ................ ................ ................ ................

D0321 9 Dental other tmj films ........................................................................ ................ ................ ................ ................ ................

D0322 9 Dental tomographic survey ............................................................... ................ ................ ................ ................ ................

D0330 9 Dental panoramic film ....................................................................... ................ ................ ................ ................ ................

D0340 9 Dental cephalometric film ................................................................. ................ ................ ................ ................ ................

D0415 9 Bacteriologic study ............................................................................ ................ ................ ................ ................ ................

D0425 9 Caries susceptibility test ................................................................... ................ ................ ................ ................ ................

D0460 6 Pulp vitality test ................................................................................. ................ ................ ................ ................ ................

D0470 9 Diagnostic casts ................................................................................ ................ ................ ................ ................ ................

D0471 6 Diagnostic photographs .................................................................... ................ ................ ................ ................ ................

D0501 6 Histopathologic examinations ........................................................... ................ ................ ................ ................ ................

D0502 6 Other oral pathology procedu ........................................................... ................ ................ ................ ................ ................

D0999 6 Unspecified diagnostic proce ............................................................ ................ ................ ................ ................ ................

D1110 9 Dental prophylaxis adult ................................................................... ................ ................ ................ ................ ................

D1120 9 Dental prophylaxis child .................................................................... ................ ................ ................ ................ ................

D1201 9 Topical fluor w prophy child .............................................................. ................ ................ ................ ................ ................

D1203 9 Topical fluor w/o prophy chi .............................................................. ................ ................ ................ ................ ................

D1204 9 Topical fluor w/o prophy adu ............................................................ ................ ................ ................ ................ ................

D1205 9 Topical fluoride w/ prophy a ............................................................. ................ ................ ................ ................ ................

D1310 9 Nutri counsel-control caries .............................................................. ................ ................ ................ ................ ................

D1320 9 Tobacco counseling .......................................................................... ................ ................ ................ ................ ................

D1330 9 Oral hygiene instruction .................................................................... ................ ................ ................ ................ ................

D1351 9 Dental sealant per tooth ................................................................... ................ ................ ................ ................ ................

D1510 6 Space maintainer fxd unilat .............................................................. ................ ................ ................ ................ ................

D1515 6 Fixed bilat space maintainer ............................................................. ................ ................ ................ ................ ................

D1520 6 Remove unilat space maintain ......................................................... ................ ................ ................ ................ ................

D1525 6 Remove bilat space maintain ........................................................... ................ ................ ................ ................ ................

D1550 6 Recement space maintainer ............................................................. ................ ................ ................ ................ ................

D2110 9 Amalgam one surface primary .......................................................... ................ ................ ................ ................ ................

D2120 9 Amalgam two surfaces primary ........................................................ ................ ................ ................ ................ ................

D2130 9 Amalgam three surfaces prima ......................................................... ................ ................ ................ ................ ................

D2131 9 Amalgam four/more surf prima ......................................................... ................ ................ ................ ................ ................

D2140 9 Amalgam one surface permanen ..................................................... ................ ................ ................ ................ ................

D2150 9 Amalgam two surfaces permane ...................................................... ................ ................ ................ ................ ................

D2160 9 Amalgam three surfaces perma ....................................................... ................ ................ ................ ................ ................

D2161 9 Amalgam 4 or ≤ surfaces perm ........................................................ ................ ................ ................ ................ ................

D2210 9 Silcate cement per restorat ............................................................... ................ ................ ................ ................ ................

D2330 9 Resin one surface-anterior ............................................................... ................ ................ ................ ................ ................

D2331 9 Resin two surfaces-anterior .............................................................. ................ ................ ................ ................ ................

D2332 9 Resin three surfaces-anterio ............................................................. ................ ................ ................ ................ ................

D2335 9 Resin 4/≤ surf or w incis an .............................................................. ................ ................ ................ ................ ................

D2336 9 Composite resin crown ..................................................................... ................ ................ ................ ................ ................

D2380 9 Resin one surf poster primar ............................................................ ................ ................ ................ ................ ................

D2381 9 Resin two surf poster primar ............................................................. ................ ................ ................ ................ ................

D2382 9 Resin three/more surf post p ............................................................ ................ ................ ................ ................ ................

D2385 9 Resin one surf poster perman .......................................................... ................ ................ ................ ................ ................

D2386 9 Resin two surf poster perman .......................................................... ................ ................ ................ ................ ................

D2387 9 Resin three/more surf post p ............................................................ ................ ................ ................ ................ ................

D2410 9 Dental gold foil one surface .............................................................. ................ ................ ................ ................ ................

D2420 9 Dental gold foil two surface .............................................................. ................ ................ ................ ................ ................

D2430 9 Dental gold foil three surfa ............................................................... ................ ................ ................ ................ ................

D2510 9 Dental inlay metalic 1 surf ................................................................ ................ ................ ................ ................ ................

D2520 9 Dental inlay metallic 2 surf ............................................................... ................ ................ ................ ................ ................

D2530 9 Dental inlay metl 3/more sur ............................................................. ................ ................ ................ ................ ................

D2543 9 Dental onlay metallic 3 surf .............................................................. ................ ................ ................ ................ ................
32437

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

D2544 9 Dental onlay metl 4/more sur ........................................................... ................ ................ ................ ................ ................

D2610 9 Inlay porcelain/ceramic 1 su ............................................................. ................ ................ ................ ................ ................

D2620 9 Inlay porcelain/ceramic 2 su ............................................................. ................ ................ ................ ................ ................

D2630 9 Dental onlay porc 3/more sur ........................................................... ................ ................ ................ ................ ................

D2642 9 Dental onlay porcelin 2 surf .............................................................. ................ ................ ................ ................ ................

D2643 9 Dental onlay porcelin 3 surf .............................................................. ................ ................ ................ ................ ................

D2644 9 Dental onlay porc 4/more sur ........................................................... ................ ................ ................ ................ ................

D2650 9 Inlay composite/resin one su ............................................................ ................ ................ ................ ................ ................

D2651 9 Inlay composite/resin two su ............................................................ ................ ................ ................ ................ ................

D2652 9 Dental inlay resin 3/mre sur .............................................................. ................ ................ ................ ................ ................

D2662 9 Dental onlay resin 2 surface ............................................................. ................ ................ ................ ................ ................

D2663 9 Dental onlay resin 3 surface ............................................................. ................ ................ ................ ................ ................

D2664 9 Dental onlay resin 4/mre sur ............................................................ ................ ................ ................ ................ ................

D2710 9 Crown resin laboratory ...................................................................... ................ ................ ................ ................ ................

D2720 9 Crown resin w/high noble me ........................................................... ................ ................ ................ ................ ................

D2721 9 Crown resin w/base metal ................................................................ ................ ................ ................ ................ ................

D2722 9 Crown resin w/noble metal ............................................................... ................ ................ ................ ................ ................

D2740 9 Crown porcelain/ceramic subs .......................................................... ................ ................ ................ ................ ................

D2750 9 Crown porcelain w/h noble m ........................................................... ................ ................ ................ ................ ................

D2751 9 Crown porcelain fused base m ......................................................... ................ ................ ................ ................ ................

D2752 9 Crown porcelain w/noble met ........................................................... ................ ................ ................ ................ ................

D2790 9 Crown full cast high noble m ............................................................ ................ ................ ................ ................ ................

D2791 9 Crown full cast base metal ............................................................... ................ ................ ................ ................ ................

D2792 9 Crown full cast noble metal .............................................................. ................ ................ ................ ................ ................

D2810 9 Crown 3⁄4 cast metallic ...................................................................... ................ ................ ................ ................ ................

D2910 9 Dental recement inlay ....................................................................... ................ ................ ................ ................ ................

D2920 9 Dental recement crown ..................................................................... ................ ................ ................ ................ ................

D2930 9 Prefab stnlss steel crwn pri .............................................................. ................ ................ ................ ................ ................

D2931 9 Prefab stnlss steel crown pe ............................................................ ................ ................ ................ ................ ................

D2932 9 Prefabricated resin crown ................................................................. ................ ................ ................ ................ ................

D2933 9 Prefab stainless steel crown ............................................................. ................ ................ ................ ................ ................

D2940 9 Dental sedative filling ........................................................................ ................ ................ ................ ................ ................

D2950 9 Core build-up incl any pins ............................................................... ................ ................ ................ ................ ................

D2951 9 Tooth pin retention ............................................................................ ................ ................ ................ ................ ................

D2952 9 Post and core cast + crown .............................................................. ................ ................ ................ ................ ................

D2954 9 Prefab post/core + crown .................................................................. ................ ................ ................ ................ ................

D2955 9 Post removal ..................................................................................... ................ ................ ................ ................ ................

D2960 9 Laminate labial veneer ...................................................................... ................ ................ ................ ................ ................

D2961 9 Lab labial veneer resin ..................................................................... ................ ................ ................ ................ ................

D2962 9 Lab labial veneer porcelain ............................................................... ................ ................ ................ ................ ................

D2970 6 Temporary-fractured tooth ................................................................ ................ ................ ................ ................ ................

D2980 9 Crown repair ..................................................................................... ................ ................ ................ ................ ................

D2999 6 Dental unspec restorative pr ............................................................. ................ ................ ................ ................ ................

D3110 9 Pulp cap direct .................................................................................. ................ ................ ................ ................ ................

D3120 9 Pulp cap indirect ............................................................................... ................ ................ ................ ................ ................

D3220 9 Therapeutic pulpotomy ..................................................................... ................ ................ ................ ................ ................

D3230 9 Pulpal therapy anterior prim ............................................................. ................ ................ ................ ................ ................

D3240 9 Pulpal therapy posterior pri ............................................................... ................ ................ ................ ................ ................

D3310 9 Anterior .............................................................................................. ................ ................ ................ ................ ................

D3320 9 Root canal therapy 2 canals ............................................................. ................ ................ ................ ................ ................

D3330 9 Root canal therapy 3 canals ............................................................. ................ ................ ................ ................ ................

D3346 9 Retreat root canal anterior ................................................................ ................ ................ ................ ................ ................

D3347 9 Retreat root canal bicuspid ............................................................... ................ ................ ................ ................ ................

D3348 9 Retreat root canal molar ................................................................... ................ ................ ................ ................ ................

D3351 9 Apexification/recalc initial .................................................................. ................ ................ ................ ................ ................

D3352 9 Apexification/recalc interim ............................................................... ................ ................ ................ ................ ................

D3353 9 Apexification/recalc final ................................................................... ................ ................ ................ ................ ................

D3410 9 Apicoect/perirad surg anter ............................................................... ................ ................ ................ ................ ................

D3421 9 Root surgery bicuspid ....................................................................... ................ ................ ................ ................ ................

D3425 9 Root surgery molar ........................................................................... ................ ................ ................ ................ ................

D3426 9 Root surgery ea add root .................................................................. ................ ................ ................ ................ ................

D3430 9 Retrograde filling ............................................................................... ................ ................ ................ ................ ................

D3450 9 Root amputation ................................................................................ ................ ................ ................ ................ ................

D3460 6 Endodontic endosseous implan ........................................................ ................ ................ ................ ................ ................

D3470 9 Intentional replantation ...................................................................... ................ ................ ................ ................ ................

D3910 9 Isolation-tooth w rubb dam ............................................................... ................ ................ ................ ................ ................

D3920 9 Tooth splitting .................................................................................... ................ ................ ................ ................ ................

D3950 9 Canal prep/fitting of dowel ................................................................ ................ ................ ................ ................ ................

D3960 9 Bleaching of discolored tooth ........................................................... ................ ................ ................ ................ ................

D3999 6 Endodontic procedure ....................................................................... ................ ................ ................ ................ ................

D4210 9 Gingivectomy/plasty per quad .......................................................... ................ ................ ................ ................ ................

D4211 9 Gingivectomy/plasty per tooth .......................................................... ................ ................ ................ ................ ................

D4220 9 Gingival curettage per quadr ............................................................ ................ ................ ................ ................ ................

D4240 9 Gingival flap proc w/planin ................................................................ ................ ................ ................ ................ ................
32438

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

D4249 9 Crown lengthen hard tissue .............................................................. ................ ................ ................ ................ ................

D4250 6 Mucogingival surg per quadra .......................................................... ................ ................ ................ ................ ................

D4260 6 Osseous surgery per quadrant ......................................................... ................ ................ ................ ................ ................

D4263 6 Bone replce graft first site ................................................................. ................ ................ ................ ................ ................

D4264 6 Bone replce graft each add .............................................................. ................ ................ ................ ................ ................

D4266 9 Guided tiss regen resorble ............................................................... ................ ................ ................ ................ ................

D4267 9 Guided tiss regen nonresorb ............................................................ ................ ................ ................ ................ ................

D4270 6 Pedicle soft tissue graft pr ................................................................ ................ ................ ................ ................ ................

D4271 6 Free soft tissue graft proc ................................................................. ................ ................ ................ ................ ................

D4273 6 Subepithelial tissue graft ................................................................... ................ ................ ................ ................ ................

D4274 9 Distal/proximal wedge proc ............................................................... ................ ................ ................ ................ ................

D4320 9 Provision splnt intracoronal ............................................................... ................ ................ ................ ................ ................

D4321 9 Provisional splint extracoro ............................................................... ................ ................ ................ ................ ................

D4341 9 Periodontal scaling & root ................................................................. ................ ................ ................ ................ ................

D4355 6 Full mouth debridement .................................................................... ................ ................ ................ ................ ................

D4381 6 Localized chemo delivery ................................................................. ................ ................ ................ ................ ................

D4910 9 Periodontal maint procedures ........................................................... ................ ................ ................ ................ ................

D4920 9 Unscheduled dressing change ......................................................... ................ ................ ................ ................ ................

D4999 9 Unspecified periodontal proc ............................................................ ................ ................ ................ ................ ................

D5110 9 Dentures complete maxillary ............................................................ ................ ................ ................ ................ ................

D5120 9 Dentures complete mandible ............................................................ ................ ................ ................ ................ ................

D5130 9 Dentures immediat maxillary ............................................................ ................ ................ ................ ................ ................

D5140 9 Dentures immediat mandible ............................................................ ................ ................ ................ ................ ................

D5211 9 Dentures maxill part resin ................................................................. ................ ................ ................ ................ ................

D5212 9 Dentures mand part resin ................................................................. ................ ................ ................ ................ ................

D5213 9 Dentures maxill part metal ................................................................ ................ ................ ................ ................ ................

D5214 9 Dentures mandibl part metal ............................................................ ................ ................ ................ ................ ................

D5281 9 Removable partial denture ................................................................ ................ ................ ................ ................ ................

D5410 9 Dentures adjust cmplt maxil ............................................................. ................ ................ ................ ................ ................

D5411 9 Dentures adjust cmplt mand ............................................................. ................ ................ ................ ................ ................

D5421 9 Dentures adjust part maxill ............................................................... ................ ................ ................ ................ ................

D5422 9 Dentures adjust part mandbl ............................................................ ................ ................ ................ ................ ................

D5510 9 Dentur repr broken compl bas .......................................................... ................ ................ ................ ................ ................

D5520 9 Replace denture teeth complt ........................................................... ................ ................ ................ ................ ................

D5610 9 Dentures repair resin base ............................................................... ................ ................ ................ ................ ................

D5620 9 Rep part denture cast frame ............................................................. ................ ................ ................ ................ ................

D5630 9 Rep partial denture clasp .................................................................. ................ ................ ................ ................ ................

D5640 9 Replace part denture teeth ............................................................... ................ ................ ................ ................ ................

D5650 9 Add. tooth to partial denture ............................................................. ................ ................ ................ ................ ................

D5660 9 Add. clasp to partial denture ............................................................. ................ ................ ................ ................ ................

D5710 9 Dentures rebase cmplt maxil ............................................................ ................ ................ ................ ................ ................

D5711 9 Dentures rebase cmplt mand ........................................................... ................ ................ ................ ................ ................

D5720 9 Dentures rebase part maxill .............................................................. ................ ................ ................ ................ ................

D5721 9 Dentures rebase part mandbl ........................................................... ................ ................ ................ ................ ................

D5730 9 Denture reln cmplt maxil ch .............................................................. ................ ................ ................ ................ ................

D5731 9 Denture reln cmplt mand chr ............................................................ ................ ................ ................ ................ ................

D5740 9 Denture reln part maxil chr ............................................................... ................ ................ ................ ................ ................

D5741 9 Denture reln part mand chr .............................................................. ................ ................ ................ ................ ................

D5750 9 Denture reln cmplt max lab .............................................................. ................ ................ ................ ................ ................

D5751 9 Denture reln cmplt mand lab ............................................................ ................ ................ ................ ................ ................

D5760 9 Denture reln part maxil lab ............................................................... ................ ................ ................ ................ ................

D5761 9 Denture reln part mand lab ............................................................... ................ ................ ................ ................ ................

D5810 9 Denture interm cmplt maxill .............................................................. ................ ................ ................ ................ ................

D5811 9 Denture interm cmplt mandbl ........................................................... ................ ................ ................ ................ ................

D5820 9 Denture interm part maxill ................................................................ ................ ................ ................ ................ ................

D5821 9 Denture interm part mandbl .............................................................. ................ ................ ................ ................ ................

D5850 9 Denture tiss conditn maxill ................................................................ ................ ................ ................ ................ ................

D5851 9 Denture tiss condtin mandbl ............................................................. ................ ................ ................ ................ ................

D5860 9 Overdenture complete ...................................................................... ................ ................ ................ ................ ................

D5861 9 Overdenture partial ........................................................................... ................ ................ ................ ................ ................

D5862 9 Precision attachment ........................................................................ ................ ................ ................ ................ ................

D5899 9 Removable prosthodontic proc ......................................................... ................ ................ ................ ................ ................

D5911 6 Facial moulage sectional .................................................................. ................ ................ ................ ................ ................

D5912 6 Facial moulage complete .................................................................. ................ ................ ................ ................ ................

D5913 9 Nasal prosthesis ............................................................................... ................ ................ ................ ................ ................

D5914 9 Auricular prosthesis .......................................................................... ................ ................ ................ ................ ................

D5915 9 Orbital prosthesis .............................................................................. ................ ................ ................ ................ ................

D5916 9 Ocular prosthesis .............................................................................. ................ ................ ................ ................ ................

D5919 9 Facial prosthesis ............................................................................... ................ ................ ................ ................ ................

D5922 9 Nasal septal prosthesis ..................................................................... ................ ................ ................ ................ ................

D5923 9 Ocular prosthesis interim .................................................................. ................ ................ ................ ................ ................

D5924 9 Cranial prosthesis ............................................................................. ................ ................ ................ ................ ................

D5925 9 Facial augmentation implant ............................................................. ................ ................ ................ ................ ................

D5926 9 Replacement nasal prosthesis .......................................................... ................ ................ ................ ................ ................
32439

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

D5927 9 Auricular replacement ....................................................................... ................ ................ ................ ................ ................

D5928 9 Orbital replacement ........................................................................... ................ ................ ................ ................ ................

D5929 9 Facial replacement ............................................................................ ................ ................ ................ ................ ................

D5931 9 Surgical obturator .............................................................................. ................ ................ ................ ................ ................

D5932 9 Postsurgical obturator ....................................................................... ................ ................ ................ ................ ................

D5933 9 Refitting of obturator ......................................................................... ................ ................ ................ ................ ................

D5934 9 Mandibular flange prosthesis ............................................................ ................ ................ ................ ................ ................

D5935 9 Mandibular denture prosth ................................................................ ................ ................ ................ ................ ................

D5936 9 Temp obturator prosthesis ................................................................ ................ ................ ................ ................ ................

D5937 9 Trismus appliance ............................................................................. ................ ................ ................ ................ ................

D5951 6 Feeding aid ....................................................................................... ................ ................ ................ ................ ................

D5952 9 Pediatric speech aid ......................................................................... ................ ................ ................ ................ ................

D5953 9 Adult speech aid ............................................................................... ................ ................ ................ ................ ................

D5954 9 Superimposed prosthesis ................................................................. ................ ................ ................ ................ ................

D5955 9 Palatal lift prosthesis ......................................................................... ................ ................ ................ ................ ................

D5958 9 Intraoral con def inter plt ................................................................... ................ ................ ................ ................ ................

D5959 9 Intraoral con def mod palat ............................................................... ................ ................ ................ ................ ................

D5960 9 Modify speech aid prosthesis ........................................................... ................ ................ ................ ................ ................

D5982 9 Surgical stent .................................................................................... ................ ................ ................ ................ ................

D5983 6 Radiation applicator .......................................................................... ................ ................ ................ ................ ................

D5984 6 Radiation shield ................................................................................ ................ ................ ................ ................ ................

D5985 6 Radiation cone locator ...................................................................... ................ ................ ................ ................ ................

D5986 9 Fluoride applicator ............................................................................ ................ ................ ................ ................ ................

D5987 6 Commissure splint ............................................................................ ................ ................ ................ ................ ................

D5988 9 Surgical splint .................................................................................... ................ ................ ................ ................ ................

D5999 9 Maxillofacial prosthesis ..................................................................... ................ ................ ................ ................ ................

D6010 9 Odontics endosteal implant .............................................................. ................ ................ ................ ................ ................

D6020 9 Odontics abutment placement .......................................................... ................ ................ ................ ................ ................

D6040 9 Odontics eposteal implant ................................................................ ................ ................ ................ ................ ................

D6050 9 Odontics transosteal implnt .............................................................. ................ ................ ................ ................ ................

D6055 9 Implant connecting bar ..................................................................... ................ ................ ................ ................ ................

D6080 9 Implant maintenance ......................................................................... ................ ................ ................ ................ ................

D6090 9 Repair implant ................................................................................... ................ ................ ................ ................ ................

D6095 9 Odontics repr abutment .................................................................... ................ ................ ................ ................ ................

D6100 9 Removal of implant ........................................................................... ................ ................ ................ ................ ................

D6199 9 Implant procedure ............................................................................. ................ ................ ................ ................ ................

D6210 9 Prosthodont high noble metal ........................................................... ................ ................ ................ ................ ................

D6211 9 Bridge base metal cast ..................................................................... ................ ................ ................ ................ ................

D6212 9 Bridge noble metal cast .................................................................... ................ ................ ................ ................ ................

D6240 9 Bridge porcelain high noble .............................................................. ................ ................ ................ ................ ................

D6241 9 Bridge porcelain base metal ............................................................. ................ ................ ................ ................ ................

D6242 9 Bridge porcelain nobel metal ............................................................ ................ ................ ................ ................ ................

D6250 9 Bridge resin w/high noble ................................................................. ................ ................ ................ ................ ................

D6251 9 Bridge resin base metal .................................................................... ................ ................ ................ ................ ................

D6252 9 Bridge resin w/noble metal ............................................................... ................ ................ ................ ................ ................

D6520 9 Dental retainer two surfaces ............................................................. ................ ................ ................ ................ ................

D6530 9 Retainer metallic 3+ surface ............................................................. ................ ................ ................ ................ ................

D6543 9 Dental retainr onlay 3 surf ................................................................ ................ ................ ................ ................ ................

D6544 9 Dental retainr onlay 4/more .............................................................. ................ ................ ................ ................ ................

D6545 9 Dental retainr cast metl ..................................................................... ................ ................ ................ ................ ................

D6720 9 Retain crown resin w hi nble ............................................................ ................ ................ ................ ................ ................

D6721 9 Crown resin w/base metal ................................................................ ................ ................ ................ ................ ................

D6722 9 Crown resin w/noble metal ............................................................... ................ ................ ................ ................ ................

D6750 9 Crown porcelain high noble .............................................................. ................ ................ ................ ................ ................

D6751 9 Crown porcelain base metal ............................................................. ................ ................ ................ ................ ................

D6752 9 Crown porcelain noble metal ............................................................ ................ ................ ................ ................ ................

D6780 9 Crown 3⁄4 high noble metal ............................................................... ................ ................ ................ ................ ................

D6790 9 Crown full high noble metal .............................................................. ................ ................ ................ ................ ................

D6791 9 Crown full base metal cast ............................................................... ................ ................ ................ ................ ................

D6792 9 Crown full noble metal cast .............................................................. ................ ................ ................ ................ ................

D6920 6 Dental connector bar ........................................................................ ................ ................ ................ ................ ................

D6930 9 Dental recement bridge .................................................................... ................ ................ ................ ................ ................

D6940 9 Stress breaker ................................................................................... ................ ................ ................ ................ ................

D6950 9 Precision attachment ........................................................................ ................ ................ ................ ................ ................

D6970 9 Post & core plus retainer .................................................................. ................ ................ ................ ................ ................

D6971 9 Cast post bridge retainer .................................................................. ................ ................ ................ ................ ................

D6972 9 Prefab post & core plus reta ............................................................. ................ ................ ................ ................ ................

D6973 9 Core build up for retainer .................................................................. ................ ................ ................ ................ ................

D6975 9 Coping metal ..................................................................................... ................ ................ ................ ................ ................

D6980 9 Bridge repair ..................................................................................... ................ ................ ................ ................ ................

D6999 9 Fixed prosthodontic proc .................................................................. ................ ................ ................ ................ ................

D7110 6 Oral surgery single tooth .................................................................. ................ ................ ................ ................ ................

D7120 6 Each add tooth extraction ................................................................. ................ ................ ................ ................ ................

D7130 6 Tooth root removal ............................................................................ ................ ................ ................ ................ ................
32440

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

D7210 6 Rem imp tooth w mucoper flp .......................................................... ................ ................ ................ ................ ................

D7220 6 Impact tooth remov soft tiss ............................................................. ................ ................ ................ ................ ................

D7230 6 Impact tooth remov part bony ........................................................... ................ ................ ................ ................ ................

D7240 6 Impact tooth remov comp bony ........................................................ ................ ................ ................ ................ ................

D7241 6 Impact tooth rem bony w/comp ........................................................ ................ ................ ................ ................ ................

D7250 6 Tooth root removal ............................................................................ ................ ................ ................ ................ ................

D7260 6 Oral antral fistula closure .................................................................. ................ ................ ................ ................ ................

D7270 9 Tooth reimplantation ......................................................................... ................ ................ ................ ................ ................

D7272 9 Tooth transplantation ........................................................................ ................ ................ ................ ................ ................

D7280 9 Exposure impact tooth orthod ........................................................... ................ ................ ................ ................ ................

D7281 9 Exposure tooth aid eruption .............................................................. ................ ................ ................ ................ ................

D7285 9 Biopsy of oral tissue hard ................................................................. ................ ................ ................ ................ ................

D7286 9 Biopsy of oral tissue soft .................................................................. ................ ................ ................ ................ ................

D7290 9 Repositioning of teeth ....................................................................... ................ ................ ................ ................ ................

D7291 6 Transseptal fiberotomy ..................................................................... ................ ................ ................ ................ ................

D7310 9 Alveoplasty w/ extraction .................................................................. ................ ................ ................ ................ ................

D7320 9 Alveoplasty w/o extraction ................................................................ ................ ................ ................ ................ ................

D7340 9 Vestibuloplasty ridge extens ............................................................. ................ ................ ................ ................ ................

D7350 9 Vestibuloplasty exten graft ................................................................ ................ ................ ................ ................ ................

D7410 9 Rad exc lesion up to 1.25 cm ........................................................... ................ ................ ................ ................ ................

D7420 9 Lesion > 1.25 cm .............................................................................. ................ ................ ................ ................ ................

D7430 9 Exc benign tumor to 1.25 cm ........................................................... ................ ................ ................ ................ ................

D7431 9 Benign tumor exc > 1.25 cm ............................................................ ................ ................ ................ ................ ................

D7440 9 Malig tumor exc to 1.25 cm .............................................................. ................ ................ ................ ................ ................

D7441 9 Malig tumor > 1.25 cm ...................................................................... ................ ................ ................ ................ ................

D7450 9 Rem odontogen cyst to 1.25cm ........................................................ ................ ................ ................ ................ ................

D7451 9 Rem odontogen cyst > 1.25 cm ....................................................... ................ ................ ................ ................ ................

D7460 9 Rem nonodonto cyst to 1.25cm ........................................................ ................ ................ ................ ................ ................

D7461 9 Rem nonodonto cyst > 1.25 cm ....................................................... ................ ................ ................ ................ ................

D7465 9 Lesion destruction ............................................................................. ................ ................ ................ ................ ................

D7470 9 Rem exostosis maxilla/mandib ......................................................... ................ ................ ................ ................ ................

D7480 9 Partial ostectomy .............................................................................. ................ ................ ................ ................ ................

D7490 9 Mandible resection ............................................................................ ................ ................ ................ ................ ................

D7510 9 I&d absc intraoral soft tiss ................................................................ ................ ................ ................ ................ ................

D7520 9 I&d abscess extraoral ....................................................................... ................ ................ ................ ................ ................

D7530 9 Removal fb skin/areolar tiss ............................................................. ................ ................ ................ ................ ................

D7540 9 Removal of fb reaction ...................................................................... ................ ................ ................ ................ ................

D7550 9 Removal of sloughed off bone .......................................................... ................ ................ ................ ................ ................

D7560 9 Maxillary sinusotomy ......................................................................... ................ ................ ................ ................ ................

D7610 9 Maxilla open reduct simple ............................................................... ................ ................ ................ ................ ................

D7620 9 Clsd reduct simpl maxilla fx .............................................................. ................ ................ ................ ................ ................

D7630 9 Open red simpl mandible fx .............................................................. ................ ................ ................ ................ ................

D7640 9 Clsd red simpl mandible fx ............................................................... ................ ................ ................ ................ ................

D7650 9 Open red simp malar/zygom fx ......................................................... ................ ................ ................ ................ ................

D7660 9 Clsd red simp malar/zygom fx .......................................................... ................ ................ ................ ................ ................

D7670 9 Open red simple alveolus fx ............................................................. ................ ................ ................ ................ ................

D7680 9 Reduct simple facial bone fx ............................................................ ................ ................ ................ ................ ................

D7710 9 Maxilla open reduct compound ......................................................... ................ ................ ................ ................ ................

D7720 9 Clsd reduct compd maxilla fx ........................................................... ................ ................ ................ ................ ................

D7730 9 Open reduct compd mandble fx ....................................................... ................ ................ ................ ................ ................

D7740 9 Clsd reduct compd mandble fx ......................................................... ................ ................ ................ ................ ................

D7750 9 Open red comp malar/zygma fx ....................................................... ................ ................ ................ ................ ................

D7760 9 Clsd red comp malar/zygma fx ......................................................... ................ ................ ................ ................ ................

D7770 9 Open reduc compd alveolus fx ......................................................... ................ ................ ................ ................ ................

D7780 9 Reduct compnd facial bone fx .......................................................... ................ ................ ................ ................ ................

D7810 9 Tmj open reduct-dislocation .............................................................. ................ ................ ................ ................ ................

D7820 9 Closed tmp manipulation .................................................................. ................ ................ ................ ................ ................

D7830 9 Tmj manipulation under anest .......................................................... ................ ................ ................ ................ ................

D7840 9 Removal of tmj condyle .................................................................... ................ ................ ................ ................ ................

D7850 9 Tmj meniscectomy ............................................................................ ................ ................ ................ ................ ................

D7852 9 Tmj repair of joint disc ...................................................................... ................ ................ ................ ................ ................

D7854 9 Tmj excisn of joint membrane .......................................................... ................ ................ ................ ................ ................

D7856 9 Tmj cutting of a muscle .................................................................... ................ ................ ................ ................ ................

D7858 9 Tmj reconstruction ............................................................................ ................ ................ ................ ................ ................

D7860 9 Tmj cutting into joint .......................................................................... ................ ................ ................ ................ ................

D7865 9 Tmj reshaping components .............................................................. ................ ................ ................ ................ ................

D7870 9 Tmj aspiration joint fluid .................................................................... ................ ................ ................ ................ ................

D7872 9 Tmj diagnostic arthroscopy ............................................................... ................ ................ ................ ................ ................

D7873 9 Tmj arthroscopy lysis adhesn ........................................................... ................ ................ ................ ................ ................

D7874 9 Tmj arthroscopy disc reposit ............................................................. ................ ................ ................ ................ ................

D7875 9 Tmj arthroscopy synovectomy .......................................................... ................ ................ ................ ................ ................

D7876 9 Tmj arthroscopy discectomy ............................................................. ................ ................ ................ ................ ................

D7877 9 Tmj arthroscopy debridement ........................................................... ................ ................ ................ ................ ................

D7880 9 Occlusal orthotic appliance ............................................................... ................ ................ ................ ................ ................
32441

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

D7899 9 Tmj unspecified therapy .................................................................... ................ ................ ................ ................ ................

D7910 9 Dent sutur recent wnd to 5cm .......................................................... ................ ................ ................ ................ ................

D7911 9 Dental suture wound to 5 cm ........................................................... ................ ................ ................ ................ ................

D7912 9 Suture complicate wnd > 5 cm ......................................................... ................ ................ ................ ................ ................

D7920 9 Dental skin graft ................................................................................ ................ ................ ................ ................ ................

D7940 6 Reshaping bone orthognathic ........................................................... ................ ................ ................ ................ ................

D7941 9 Bone cutting ramus closed ............................................................... ................ ................ ................ ................ ................

D7942 9 Bone cutting ramus open .................................................................. ................ ................ ................ ................ ................

D7943 9 Cutting ramus open w/graft .............................................................. ................ ................ ................ ................ ................

D7944 9 Bone cutting segmented ................................................................... ................ ................ ................ ................ ................

D7945 9 Bone cutting body mandible ............................................................. ................ ................ ................ ................ ................

D7946 9 Reconstruction maxilla total .............................................................. ................ ................ ................ ................ ................

D7947 9 Reconstruct maxilla segment ............................................................ ................ ................ ................ ................ ................

D7948 9 Reconstruct midface no graft ............................................................ ................ ................ ................ ................ ................

D7949 9 Reconstruct midface w/graft ............................................................. ................ ................ ................ ................ ................

D7950 9 Mandible graft ................................................................................... ................ ................ ................ ................ ................

D7955 9 Repair maxillofacial defects .............................................................. ................ ................ ................ ................ ................

D7960 9 Frenulectomy/frenulotomy ................................................................. ................ ................ ................ ................ ................

D7970 9 Excision hyperplastic tissue .............................................................. ................ ................ ................ ................ ................

D7971 9 Excision pericoronal gingiva ............................................................. ................ ................ ................ ................ ................

D7980 9 Sialolithotomy .................................................................................... ................ ................ ................ ................ ................

D7981 9 Excision of salivary gland ................................................................. ................ ................ ................ ................ ................

D7982 9 Sialodochoplasty ............................................................................... ................ ................ ................ ................ ................

D7983 9 Closure of salivary fistula .................................................................. ................ ................ ................ ................ ................

D7990 9 Emergency tracheotomy ................................................................... ................ ................ ................ ................ ................

D7991 9 Dental coronoidectomy ..................................................................... ................ ................ ................ ................ ................

D7995 9 Synthetic graft facial bones .............................................................. ................ ................ ................ ................ ................

D7996 9 Implant mandible for augment .......................................................... ................ ................ ................ ................ ................

D7999 9 Oral surgery procedure ..................................................................... ................ ................ ................ ................ ................

D8010 9 Limited dental tx primary .................................................................. ................ ................ ................ ................ ................

D8020 9 Limited dental tx transition ................................................................ ................ ................ ................ ................ ................

D8030 9 Limited dental tx adolescent ............................................................. ................ ................ ................ ................ ................

D8040 9 Limited dental tx adult ....................................................................... ................ ................ ................ ................ ................

D8050 9 Intercep dental tx primary ................................................................. ................ ................ ................ ................ ................

D8060 9 Intercep dental tx transitn ................................................................. ................ ................ ................ ................ ................

D8070 9 Compre dental tx transition ............................................................... ................ ................ ................ ................ ................

D8080 9 Compre dental tx adolescent ............................................................ ................ ................ ................ ................ ................

D8090 9 Compre dental tx adult ..................................................................... ................ ................ ................ ................ ................

D8210 9 Orthodontic rem appliance tx ............................................................ ................ ................ ................ ................ ................

D8220 9 Fixed appliance therapy habt ........................................................... ................ ................ ................ ................ ................

D8660 9 Preorthodontic tx visit ....................................................................... ................ ................ ................ ................ ................

D8670 9 Periodic orthodontc tx visit ................................................................ ................ ................ ................ ................ ................

D8680 9 Orthodontic retention ........................................................................ ................ ................ ................ ................ ................

D8690 9 Orthodontic treatment ....................................................................... ................ ................ ................ ................ ................

D8999 9 Orthodontic procedure ...................................................................... ................ ................ ................ ................ ................

D9110 6 Tx dental pain minor proc ................................................................. ................ ................ ................ ................ ................

D9210 9 Dent anesthesia w/o surgery ............................................................ ................ ................ ................ ................ ................

D9211 9 Regional block anesthesia ................................................................ ................ ................ ................ ................ ................

D9212 9 Trigeminal block anesthesia ............................................................. ................ ................ ................ ................ ................

D9215 9 Local anesthesia ............................................................................... ................ ................ ................ ................ ................

D9220 9 General anesthesia ........................................................................... ................ ................ ................ ................ ................

D9221 9 General anesthesia ea ad 15m ........................................................ ................ ................ ................ ................ ................

D9230 6 Analgesia .......................................................................................... ................ ................ ................ ................ ................

D9240 9 Intravenous sedation ......................................................................... ................ ................ ................ ................ ................

D9310 9 Dental consultation ........................................................................... ................ ................ ................ ................ ................

D9410 9 Dental house call .............................................................................. ................ ................ ................ ................ ................

D9420 9 Hospital call ....................................................................................... ................ ................ ................ ................ ................

D9430 9 Office visit during hours .................................................................... ................ ................ ................ ................ ................

D9440 9 Office visit after hours ....................................................................... ................ ................ ................ ................ ................

D9610 9 Dent therapeutic drug inject .............................................................. ................ ................ ................ ................ ................

D9630 6 Other drugs/medicaments ................................................................. ................ ................ ................ ................ ................

D9910 9 Dent appl desensitizing med ............................................................ ................ ................ ................ ................ ................

D9920 9 Behavior management ...................................................................... ................ ................ ................ ................ ................

D9930 6 Treatment of complications ............................................................... ................ ................ ................ ................ ................

D9940 6 Dental occlusal guard ....................................................................... ................ ................ ................ ................ ................

D9941 9 Fabrication athletic guard ................................................................. ................ ................ ................ ................ ................

D9950 6 Occlusion analysis ............................................................................ ................ ................ ................ ................ ................

D9951 6 Limited occlusal adjustment .............................................................. ................ ................ ................ ................ ................

D9952 6 Complete occlusal adjustment .......................................................... ................ ................ ................ ................ ................

D9970 9 Enamel microabrasion ...................................................................... ................ ................ ................ ................ ................

D9999 9 Adjunctive procedure ........................................................................ ................ ................ ................ ................ ................

E0100 6 Cane adjust/fixed with tip .................................................................. ................ ................ ................ ................ ................

E0105 6 Cane adjust/fixed quad/3 pro ............................................................ ................ ................ ................ ................ ................

E0110 6 Crutch forearm pair ........................................................................... ................ ................ ................ ................ ................
32442

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

E0111 6 Crutch forearm each ......................................................................... ................ ................ ................ ................ ................

E0112 6 Crutch underarm pair wood .............................................................. ................ ................ ................ ................ ................

E0113 6 Crutch underarm each wood ............................................................ ................ ................ ................ ................ ................

E0114 6 Crutch underarm pair no wood ......................................................... ................ ................ ................ ................ ................

E0116 6 Crutch underarm each no wood ....................................................... ................ ................ ................ ................ ................

E0130 6 Walker rigid adjust/fixed ht ............................................................... ................ ................ ................ ................ ................

E0135 6 Walker folding adjust/fixed ................................................................ ................ ................ ................ ................ ................

E0141 6 Rigid walker wheeled wo seat .......................................................... ................ ................ ................ ................ ................

E0142 6 Walker rigid wheeled with se ............................................................ ................ ................ ................ ................ ................

E0143 6 Walker folding wheeled w/o s ........................................................... ................ ................ ................ ................ ................

E0145 6 Walker whled seat/crutch att ............................................................ ................ ................ ................ ................ ................

E0146 6 Folding walker wheels w seat ........................................................... ................ ................ ................ ................ ................

E0147 6 Walker variable wheel resist ............................................................. ................ ................ ................ ................ ................

E0153 6 Forearm crutch platform atta ............................................................ ................ ................ ................ ................ ................

E0154 6 Walker platform attachment .............................................................. ................ ................ ................ ................ ................

E0155 6 Walker rigd pick-up/wheel at ............................................................ ................ ................ ................ ................ ................

E0156 6 Walker seat attachment .................................................................... ................ ................ ................ ................ ................

E0157 6 Walker crutch attachment ................................................................. ................ ................ ................ ................ ................

E0158 6 Walker leg extensions ....................................................................... ................ ................ ................ ................ ................

E0159 6 Brake for wheeled walker ................................................................. ................ ................ ................ ................ ................

E0160 6 Sitz type bath or equipment .............................................................. ................ ................ ................ ................ ................

E0161 6 Sitz bath/equipment w/faucet ............................................................ ................ ................ ................ ................ ................

E0162 6 Sitz bath chair ................................................................................... ................ ................ ................ ................ ................

E0163 6 Commode chair stationry fxd ............................................................ ................ ................ ................ ................ ................

E0164 6 Commode chair mobile fixed a ......................................................... ................ ................ ................ ................ ................

E0165 6 Commode chair stationry det ............................................................ ................ ................ ................ ................ ................

E0166 6 Commode chair mobile detach ......................................................... ................ ................ ................ ................ ................

E0167 6 Commode chair pail or pan .............................................................. ................ ................ ................ ................ ................

E0175 6 Commode chair foot rest .................................................................. ................ ................ ................ ................ ................

E0176 6 Air pressre pad/cushion nonp ........................................................... ................ ................ ................ ................ ................

E0177 6 Water press pad/cushion nonp ......................................................... ................ ................ ................ ................ ................

E0178 6 Gel pressre pad/cushion nonp .......................................................... ................ ................ ................ ................ ................

E0179 6 Dry pressre pad/cushion nonp .......................................................... ................ ................ ................ ................ ................

E0180 6 Press pad alternating w pump .......................................................... ................ ................ ................ ................ ................

E0181 6 Press pad alternating w/ pum ........................................................... ................ ................ ................ ................ ................

E0182 6 Pressure pad alternating pum .......................................................... ................ ................ ................ ................ ................

E0184 6 Dry pressure mattress ...................................................................... ................ ................ ................ ................ ................

E0185 6 Gel pressure mattress pad ............................................................... ................ ................ ................ ................ ................

E0186 6 Air pressure mattress ........................................................................ ................ ................ ................ ................ ................

E0187 6 Water pressure mattress .................................................................. ................ ................ ................ ................ ................

E0188 6 Synthetic sheepskin pad ................................................................... ................ ................ ................ ................ ................

E0189 6 Lambswool sheepskin pad ............................................................... ................ ................ ................ ................ ................

E0191 6 Protector heel or elbow ..................................................................... ................ ................ ................ ................ ................

E0192 6 Pad wheelchr low press/posit ........................................................... ................ ................ ................ ................ ................

E0193 6 Powered air flotation bed .................................................................. ................ ................ ................ ................ ................

E0194 6 Air fluidized bed ................................................................................ ................ ................ ................ ................ ................

E0196 6 Gel pressure mattress ...................................................................... ................ ................ ................ ................ ................

E0197 6 Air pressure pad for mattres ............................................................. ................ ................ ................ ................ ................

E0198 6 Water pressure pad for mattr ........................................................... ................ ................ ................ ................ ................

E0199 6 Dry pressure pad for mattres ............................................................ ................ ................ ................ ................ ................

E0200 6 Heat lamp without stand ................................................................... ................ ................ ................ ................ ................

E0202 6 Phototherapy light w/ photom ........................................................... ................ ................ ................ ................ ................

E0205 6 Heat lamp with stand ........................................................................ ................ ................ ................ ................ ................

E0210 6 Electric heat pad standard ................................................................ ................ ................ ................ ................ ................

E0215 6 Electric heat pad moist ..................................................................... ................ ................ ................ ................ ................

E0217 6 Water circ heat pad w pump ............................................................. ................ ................ ................ ................ ................

E0218 6 Water circ cold pad w pump ............................................................. ................ ................ ................ ................ ................

E0220 6 Hot water bottle ................................................................................. ................ ................ ................ ................ ................

E0225 6 Hydrocollator unit .............................................................................. ................ ................ ................ ................ ................

E0230 6 Ice cap or collar ................................................................................ ................ ................ ................ ................ ................

E0235 6 Paraffin bath unit portable ................................................................ ................ ................ ................ ................ ................

E0236 6 Pump for water circulating p ............................................................. ................ ................ ................ ................ ................

E0238 6 Heat pad non-electric moist .............................................................. ................ ................ ................ ................ ................

E0239 6 Hydrocollator unit portable ................................................................ ................ ................ ................ ................ ................

E0241 6 Bath tub wall rail ............................................................................... ................ ................ ................ ................ ................

E0242 6 Bath tub rail floor .............................................................................. ................ ................ ................ ................ ................

E0243 6 Toilet rail ........................................................................................... ................ ................ ................ ................ ................

E0244 6 Toilet seat raised .............................................................................. ................ ................ ................ ................ ................

E0245 6 Tub stool or bench ............................................................................ ................ ................ ................ ................ ................

E0246 6 Transfer tub rail attachment .............................................................. ................ ................ ................ ................ ................

E0249 6 Pad water circulating heat u ............................................................. ................ ................ ................ ................ ................

E0250 6 Hosp bed fixed ht w/ mattres ............................................................ ................ ................ ................ ................ ................

E0251 6 Hosp bed fixd ht w/o mattres ............................................................ ................ ................ ................ ................ ................

E0255 6 Hospital bed var ht w/ mattr ............................................................. ................ ................ ................ ................ ................
32443

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

E0256 6 Hospital bed var ht w/o matt ............................................................. ................ ................ ................ ................ ................

E0260 6 Hosp bed semi-electr w/ matt ........................................................... ................ ................ ................ ................ ................

E0261 6 Hosp bed semi-electr w/o mat .......................................................... ................ ................ ................ ................ ................

E0265 6 Hosp bed total electr w/ mat ............................................................. ................ ................ ................ ................ ................

E0266 6 Hosp bed total elec w/o matt ............................................................ ................ ................ ................ ................ ................

E0270 6 Hospital bed institutional t ................................................................. ................ ................ ................ ................ ................

E0271 6 Mattress innerspring ......................................................................... ................ ................ ................ ................ ................

E0272 6 Mattress foam rubber ........................................................................ ................ ................ ................ ................ ................

E0273 6 Bed board ......................................................................................... ................ ................ ................ ................ ................

E0274 6 Over-bed table .................................................................................. ................ ................ ................ ................ ................

E0275 6 Bed pan standard ............................................................................. ................ ................ ................ ................ ................

E0276 6 Bed pan fracture ............................................................................... ................ ................ ................ ................ ................

E0277 6 Powered pres-redu air mattrs ........................................................... ................ ................ ................ ................ ................

E0280 6 Bed cradle ......................................................................................... ................ ................ ................ ................ ................

E0290 6 Hosp bed fx ht w/o rails w/m ............................................................ ................ ................ ................ ................ ................

E0291 6 Hosp bed fx ht w/o rail w/o ............................................................... ................ ................ ................ ................ ................

E0292 6 Hosp bed var ht w/o rail w/o ............................................................. ................ ................ ................ ................ ................

E0293 6 Hosp bed var ht w/o rail w/ ............................................................... ................ ................ ................ ................ ................

E0294 6 Hosp bed semi-elect w/ mattr ........................................................... ................ ................ ................ ................ ................

E0295 6 Hosp bed semi-elect w/o matt .......................................................... ................ ................ ................ ................ ................

E0296 6 Hosp bed total elect w/ matt ............................................................. ................ ................ ................ ................ ................

E0297 6 Hosp bed total elect w/o mat ............................................................ ................ ................ ................ ................ ................

E0305 6 Rails bed side half length ................................................................. ................ ................ ................ ................ ................

E0310 6 Rails bed side full length .................................................................. ................ ................ ................ ................ ................

E0315 6 Bed accessory brd/tbl/supprt ............................................................ ................ ................ ................ ................ ................

E0325 6 Urinal male jug-type .......................................................................... ................ ................ ................ ................ ................

E0326 6 Urinal female jug-type ....................................................................... ................ ................ ................ ................ ................

E0350 6 Control unit bowel system ................................................................ ................ ................ ................ ................ ................

E0352 6 Disposable pack w/bowel syst .......................................................... ................ ................ ................ ................ ................

E0370 6 Air elevator for heel .......................................................................... ................ ................ ................ ................ ................

E0371 6 Nonpower mattress overlay .............................................................. ................ ................ ................ ................ ................

E0372 6 Powered air mattress overlay ........................................................... ................ ................ ................ ................ ................

E0373 6 Nonpowered pressure mattress ........................................................ ................ ................ ................ ................ ................

E0424 6 Stationary compressed gas 02 ......................................................... ................ ................ ................ ................ ................

E0425 6 Gas system stationary compre ......................................................... ................ ................ ................ ................ ................

E0430 6 Oxygen system gas portable ............................................................ ................ ................ ................ ................ ................

E0431 6 Portable gaseous 02 ......................................................................... ................ ................ ................ ................ ................

E0434 6 Portable liquid 02 .............................................................................. ................ ................ ................ ................ ................

E0435 6 Oxygen system liquid portabl ........................................................... ................ ................ ................ ................ ................

E0439 6 Stationary liquid 02 ........................................................................... ................ ................ ................ ................ ................

E0440 6 Oxygen system liquid station ............................................................ ................ ................ ................ ................ ................

E0441 6 Oxygen contents gas per/unit ........................................................... ................ ................ ................ ................ ................

E0442 6 Oxygen contents liq per/unit ............................................................. ................ ................ ................ ................ ................

E0443 6 Port 02 contents gas/unit .................................................................. ................ ................ ................ ................ ................

E0444 6 Port 02 contents liq/unit .................................................................... ................ ................ ................ ................ ................

E0450 6 Volume vent stationary/porta ............................................................ ................ ................ ................ ................ ................

E0452 6 Intermit assis device w cpap ............................................................. ................ ................ ................ ................ ................

E0453 6 Ventilator 12 hrs/less per d ............................................................... ................ ................ ................ ................ ................

E0455 6 Oxygen tent excl croup/ped t ............................................................ ................ ................ ................ ................ ................

E0457 6 Chest shell ........................................................................................ ................ ................ ................ ................ ................

E0459 6 Chest wrap ........................................................................................ ................ ................ ................ ................ ................

E0460 6 Neg press vent portabl/statn ............................................................. ................ ................ ................ ................ ................

E0462 6 Rocking bed w/ or w/o side r ............................................................ ................ ................ ................ ................ ................

E0480 6 Percussor elect/pneum home m ....................................................... ................ ................ ................ ................ ................

E0500 6 Ippb all types ..................................................................................... ................ ................ ................ ................ ................

E0550 6 Humidif extens supple w ippb ........................................................... ................ ................ ................ ................ ................

E0555 6 Humidifier for use w/ regula .............................................................. ................ ................ ................ ................ ................

E0560 6 Humidifier supplemental w/ i ............................................................. ................ ................ ................ ................ ................

E0565 6 Compressor air power source .......................................................... ................ ................ ................ ................ ................

E0570 6 Nebulizer with compression .............................................................. ................ ................ ................ ................ ................

E0575 6 Nebulizer ultrasonic .......................................................................... ................ ................ ................ ................ ................

E0580 6 Nebulizer for use w/ regulat .............................................................. ................ ................ ................ ................ ................

E0585 6 Nebulizer w/ compressor & he ......................................................... ................ ................ ................ ................ ................

E0600 6 Suction pump portab hom modl ....................................................... ................ ................ ................ ................ ................

E0601 6 Cont airway pressure device ............................................................ ................ ................ ................ ................ ................

E0605 6 Vaporizer room type ......................................................................... ................ ................ ................ ................ ................

E0606 6 Drainage board postural ................................................................... ................ ................ ................ ................ ................

E0607 6 Blood glucose monitor home ............................................................ ................ ................ ................ ................ ................

E0608 6 Apnea monitor ................................................................................... ................ ................ ................ ................ ................

E0609 6 Blood gluc mon w/special fea ........................................................... ................ ................ ................ ................ ................

E0610 6 Pacemaker monitr audible/vis ........................................................... ................ ................ ................ ................ ................

E0615 6 Pacemaker monitr digital/vis ............................................................. ................ ................ ................ ................ ................

E0621 6 Patient lift sling or seat ..................................................................... ................ ................ ................ ................ ................

E0625 6 Patient lift bathroom or toi ................................................................ ................ ................ ................ ................ ................
32444

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

E0627 6 Seat lift incorp lift-chair ..................................................................... ................ ................ ................ ................ ................

E0628 6 Seat lift for pt furn-electr ................................................................... ................ ................ ................ ................ ................

E0629 6 Seat lift for pt furn-non-el .................................................................. ................ ................ ................ ................ ................

E0630 6 Patient lift hydraulic ........................................................................... ................ ................ ................ ................ ................

E0635 6 Patient lift electric .............................................................................. ................ ................ ................ ................ ................

E0650 6 Pneuma compresor non-segment .................................................... ................ ................ ................ ................ ................

E0651 6 Pneum compressor segmental ......................................................... ................ ................ ................ ................ ................

E0652 6 Pneum compres w/cal pressure ....................................................... ................ ................ ................ ................ ................

E0655 6 Pneumatic appliance half arm .......................................................... ................ ................ ................ ................ ................

E0660 6 Pneumatic appliance full leg ............................................................. ................ ................ ................ ................ ................

E0665 6 Pneumatic appliance full arm ........................................................... ................ ................ ................ ................ ................

E0666 6 Pneumatic appliance half leg ............................................................ ................ ................ ................ ................ ................

E0667 6 Seg pneumatic appl full leg .............................................................. ................ ................ ................ ................ ................

E0668 6 Seg pneumatic appl full arm ............................................................. ................ ................ ................ ................ ................

E0669 6 Seg pneumatic appli half leg ............................................................ ................ ................ ................ ................ ................

E0671 6 Pressure pneum appl full leg ............................................................ ................ ................ ................ ................ ................

E0672 6 Pressure pneum appl full arm .......................................................... ................ ................ ................ ................ ................

E0673 6 Pressure pneum appl half leg ........................................................... ................ ................ ................ ................ ................

E0690 6 Ultraviolet cabinet ............................................................................. ................ ................ ................ ................ ................

E0700 6 Safety equipment .............................................................................. ................ ................ ................ ................ ................

E0710 6 Restraints any type ........................................................................... ................ ................ ................ ................ ................

E0720 6 Tens two lead ................................................................................... ................ ................ ................ ................ ................

E0730 6 Tens four lead ................................................................................... ................ ................ ................ ................ ................

E0731 6 Conductive garment for tens/ ........................................................... ................ ................ ................ ................ ................

E0740 6 Incontinence treatment systm ........................................................... ................ ................ ................ ................ ................

E0744 6 Neuromuscular stim for scoli ............................................................ ................ ................ ................ ................ ................

E0745 6 Neuromuscular stim for shock .......................................................... ................ ................ ................ ................ ................

E0746 6 Electromyograph biofeedback .......................................................... ................ ................ ................ ................ ................

E0747 6 Elec osteogen stim not spine ........................................................... ................ ................ ................ ................ ................

E0748 6 Elec osteogen stim spinal ................................................................. ................ ................ ................ ................ ................

E0749 6 Elec osteogen stim implanted ........................................................... ................ ................ ................ ................ ................

E0751 6 Pulse generator or receiver .............................................................. ................ ................ ................ ................ ................

E0753 6 Neurostimul electrodes/leads ............................................................ ................ ................ ................ ................ ................

E0755 6 Electronic salivary reflex s ................................................................ ................ ................ ................ ................ ................

E0760 6 Osteogen ultrasound stimltor ............................................................ ................ ................ ................ ................ ................

E0776 6 Iv pole ............................................................................................... ................ ................ ................ ................ ................

E0781 6 External ambulatory infus pu ............................................................ ................ ................ ................ ................ ................

E0782 6 Non-programble infusion pump ........................................................ ................ ................ ................ ................ ................

E0783 6 Programmable infusion pump ........................................................... ................ ................ ................ ................ ................

E0784 6 Ext amb infusn pump insulin ............................................................ ................ ................ ................ ................ ................

E0791 6 Parenteral infusion pump sta ............................................................ ................ ................ ................ ................ ................

E0840 6 Tract frame attach headboard .......................................................... ................ ................ ................ ................ ................

E0850 6 Traction stand free standing ............................................................. ................ ................ ................ ................ ................

E0855 6 Cervical traction equipment .............................................................. ................ ................ ................ ................ ................

E0860 6 Tract equip cervical tract .................................................................. ................ ................ ................ ................ ................

E0870 6 Tract frame attach footboard ............................................................ ................ ................ ................ ................ ................

E0880 6 Trac stand free stand extrem ........................................................... ................ ................ ................ ................ ................

E0890 6 Traction frame attach pelvic ............................................................. ................ ................ ................ ................ ................

E0900 6 Trac stand free stand pelvic ............................................................. ................ ................ ................ ................ ................

E0910 6 Trapeze bar attached to bed ............................................................ ................ ................ ................ ................ ................

E0920 6 Fracture frame attached to b ............................................................ ................ ................ ................ ................ ................

E0930 6 Fracture frame free standing ............................................................ ................ ................ ................ ................ ................

E0935 6 Exercise device passive moti ........................................................... ................ ................ ................ ................ ................

E0940 6 Trapeze bar free standing ................................................................ ................ ................ ................ ................ ................

E0941 6 Gravity assisted traction de .............................................................. ................ ................ ................ ................ ................

E0942 6 Cervical head harness/halter ............................................................ ................ ................ ................ ................ ................

E0943 6 Cervical pillow ................................................................................... ................ ................ ................ ................ ................

E0944 6 Pelvic belt/harness/boot .................................................................... ................ ................ ................ ................ ................

E0945 6 Belt/harness extremity ...................................................................... ................ ................ ................ ................ ................

E0946 6 Fracture frame dual w cross ............................................................. ................ ................ ................ ................ ................

E0947 6 Fracture frame attachmnts pe .......................................................... ................ ................ ................ ................ ................

E0948 6 Fracture frame attachmnts ce ........................................................... ................ ................ ................ ................ ................

E0950 6 Tray ................................................................................................... ................ ................ ................ ................ ................

E0951 6 Loop heel .......................................................................................... ................ ................ ................ ................ ................

E0952 6 Loop tie ............................................................................................. ................ ................ ................ ................ ................

E0953 6 Pneumatic tire ................................................................................... ................ ................ ................ ................ ................

E0954 6 Wheelchair semi-pneumatic ca ......................................................... ................ ................ ................ ................ ................

E0958 6 Whlchr att- conv 1 arm drive ............................................................ ................ ................ ................ ................ ................

E0959 6 Amputee adapter .............................................................................. ................ ................ ................ ................ ................

E0961 6 Wheelchair brake extension ............................................................. ................ ................ ................ ................ ................

E0962 6 Wheelchair 1 inch cushion ................................................................ ................ ................ ................ ................ ................

E0963 6 Wheelchair 2 inch cushion ................................................................ ................ ................ ................ ................ ................

E0964 6 Wheelchair 3 inch cushion ................................................................ ................ ................ ................ ................ ................

E0965 6 Wheelchair 4 inch cushion ................................................................ ................ ................ ................ ................ ................
32445

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

E0966 6 Wheelchair head rest extensi ........................................................... ................ ................ ................ ................ ................

E0967 6 Wheelchair hand rims ....................................................................... ................ ................ ................ ................ ................

E0968 6 Wheelchair commode seat ............................................................... ................ ................ ................ ................ ................

E0969 6 Wheelchair narrowing device ............................................................ ................ ................ ................ ................ ................

E0970 6 Wheelchair no. 2 footplates .............................................................. ................ ................ ................ ................ ................

E0971 6 Wheelchair anti-tipping devi .............................................................. ................ ................ ................ ................ ................

E0972 6 Transfer board or device .................................................................. ................ ................ ................ ................ ................

E0973 6 Wheelchair adjustabl height .............................................................. ................ ................ ................ ................ ................

E0974 6 Wheelchair grade-aid ........................................................................ ................ ................ ................ ................ ................

E0975 6 Wheelchair reinforced seat u ............................................................ ................ ................ ................ ................ ................

E0976 6 Wheelchair reinforced back u ........................................................... ................ ................ ................ ................ ................

E0977 6 Wheelchair wedge cushion ............................................................... ................ ................ ................ ................ ................

E0978 6 Wheelchair belt w/airplane b ............................................................ ................ ................ ................ ................ ................

E0979 6 Wheelchair belt with velcro ............................................................... ................ ................ ................ ................ ................

E0980 6 Wheelchair safety vest ...................................................................... ................ ................ ................ ................ ................

E0990 6 Whellchair elevating leg res .............................................................. ................ ................ ................ ................ ................

E0991 6 Wheelchair upholstry seat ................................................................ ................ ................ ................ ................ ................

E0992 6 Wheelchair solid seat insert .............................................................. ................ ................ ................ ................ ................

E0993 6 Wheelchair back upholstery .............................................................. ................ ................ ................ ................ ................

E0994 6 Wheelchair arm rest .......................................................................... ................ ................ ................ ................ ................

E0995 6 Wheelchair calf rest .......................................................................... ................ ................ ................ ................ ................

E0996 6 Wheelchair tire solid ......................................................................... ................ ................ ................ ................ ................

E0997 6 Wheelchair caster w/ a fork .............................................................. ................ ................ ................ ................ ................

E0998 6 Wheelchair caster w/o a fork ............................................................ ................ ................ ................ ................ ................

E0999 6 Wheelchr pneumatic tire w/wh .......................................................... ................ ................ ................ ................ ................

E1000 6 Wheelchair tire pneumatic ca ........................................................... ................ ................ ................ ................ ................

E1001 6 Wheelchair wheel .............................................................................. ................ ................ ................ ................ ................

E1031 6 Rollabout chair with casters .............................................................. ................ ................ ................ ................ ................

E1050 6 Whelchr fxd full length arms ............................................................. ................ ................ ................ ................ ................

E1060 6 Wheelchair detachable arms ............................................................ ................ ................ ................ ................ ................

E1065 6 Wheelchair power attachment .......................................................... ................ ................ ................ ................ ................

E1066 6 Wheelchair battery charger ............................................................... ................ ................ ................ ................ ................

E1069 6 Wheelchair deep cycle batter ........................................................... ................ ................ ................ ................ ................

E1070 6 Wheelchair detachable foot r ............................................................ ................ ................ ................ ................ ................

E1083 6 Hemi-wheelchair fixed arms ............................................................. ................ ................ ................ ................ ................

E1084 6 Hemi-wheelchair detachable a ......................................................... ................ ................ ................ ................ ................

E1085 6 Hemi-wheelchair fixed arms ............................................................. ................ ................ ................ ................ ................

E1086 6 Hemi-wheelchair detachable a ......................................................... ................ ................ ................ ................ ................

E1087 6 Wheelchair lightwt fixed arm ............................................................. ................ ................ ................ ................ ................

E1088 6 Wheelchair lightweight det a ............................................................. ................ ................ ................ ................ ................

E1089 6 Wheelchair lightwt fixed arm ............................................................. ................ ................ ................ ................ ................

E1090 6 Wheelchair lightweight det a ............................................................. ................ ................ ................ ................ ................

E1091 6 Wheelchair youth .............................................................................. ................ ................ ................ ................ ................

E1092 6 Wheelchair wide w/ leg rests ............................................................ ................ ................ ................ ................ ................

E1093 6 Wheelchair wide w/ foot rest ............................................................. ................ ................ ................ ................ ................

E1100 6 Whchr s-recl fxd arm leg res ............................................................ ................ ................ ................ ................ ................

E1110 6 Wheelchair semi-recl detach ............................................................ ................ ................ ................ ................ ................

E1130 6 Whlchr stand fxd arm ft rest ............................................................. ................ ................ ................ ................ ................

E1140 6 Wheelchair standard detach a .......................................................... ................ ................ ................ ................ ................

E1150 6 Wheelchair standard w/ leg r ............................................................ ................ ................ ................ ................ ................

E1160 6 Wheelchair fixed arms ...................................................................... ................ ................ ................ ................ ................

E1170 6 Whlchr ampu fxd arm leg rest .......................................................... ................ ................ ................ ................ ................

E1171 6 Wheelchair amputee w/o leg r .......................................................... ................ ................ ................ ................ ................

E1172 6 Wheelchair amputee detach ar ......................................................... ................ ................ ................ ................ ................

E1180 6 Wheelchair amputee w/ foot r ........................................................... ................ ................ ................ ................ ................

E1190 6 Wheelchair amputee w/ leg re .......................................................... ................ ................ ................ ................ ................

E1195 6 Wheelchair amputee heavy dut ........................................................ ................ ................ ................ ................ ................

E1200 6 Wheelchair amputee fixed arm ......................................................... ................ ................ ................ ................ ................

E1210 6 Whlchr moto ful arm leg rest ............................................................ ................ ................ ................ ................ ................

E1211 6 Wheelchair motorized w/ det ............................................................ ................ ................ ................ ................ ................

E1212 6 Wheelchair motorized w full .............................................................. ................ ................ ................ ................ ................

E1213 6 Wheelchair motorized w/ det ............................................................ ................ ................ ................ ................ ................

E1220 6 Whlchr special size/constrc .............................................................. ................ ................ ................ ................ ................

E1221 6 Wheelchair spec size w foot ............................................................. ................ ................ ................ ................ ................

E1222 6 Wheelchair spec size w/ leg ............................................................. ................ ................ ................ ................ ................

E1223 6 Wheelchair spec size w foot ............................................................. ................ ................ ................ ................ ................

E1224 6 Wheelchair spec size w/ leg ............................................................. ................ ................ ................ ................ ................

E1225 6 Wheelchair spec sz semi-recl ........................................................... ................ ................ ................ ................ ................

E1226 6 Wheelchair spec sz full-recl .............................................................. ................ ................ ................ ................ ................

E1227 6 Wheelchair spec sz spec ht a .......................................................... ................ ................ ................ ................ ................

E1228 6 Wheelchair spec sz spec ht b .......................................................... ................ ................ ................ ................ ................

E1230 6 Power operated vehicle .................................................................... ................ ................ ................ ................ ................

E1240 6 Whchr litwt det arm leg rest .............................................................. ................ ................ ................ ................ ................

E1250 6 Wheelchair lightwt fixed arm ............................................................. ................ ................ ................ ................ ................
32446

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

E1260 6 Wheelchair lightwt foot rest .............................................................. ................ ................ ................ ................ ................

E1270 6 Wheelchair lightweight leg r .............................................................. ................ ................ ................ ................ ................

E1280 6 Whchr h-duty det arm leg res ........................................................... ................ ................ ................ ................ ................

E1285 6 Wheelchair heavy duty fixed ............................................................. ................ ................ ................ ................ ................

E1290 6 Wheelchair hvy duty detach a .......................................................... ................ ................ ................ ................ ................

E1295 6 Wheelchair heavy duty fixed ............................................................. ................ ................ ................ ................ ................

E1296 6 Wheelchair special seat heig ............................................................ ................ ................ ................ ................ ................

E1297 6 Wheelchair special seat dept ............................................................ ................ ................ ................ ................ ................

E1298 6 Wheelchair spec seat depth/w .......................................................... ................ ................ ................ ................ ................

E1300 6 Whirlpool portable ............................................................................. ................ ................ ................ ................ ................

E1310 6 Whirlpool non-portable ...................................................................... ................ ................ ................ ................ ................

E1340 6 Repair for DME, per 15 min .............................................................. ................ ................ ................ ................ ................

E1353 6 Oxygen supplies regulator ................................................................ ................ ................ ................ ................ ................

E1355 6 Oxygen supplies stand/rack .............................................................. ................ ................ ................ ................ ................

E1372 6 Oxy suppl heater for nebuliz ............................................................. ................ ................ ................ ................ ................

E1375 6 Oxygen suppl nebulizer porta ........................................................... ................ ................ ................ ................ ................

E1377 6 Oxygen concentrator to 244 c .......................................................... ................ ................ ................ ................ ................

E1378 6 Oxygen concentrator to 488 c .......................................................... ................ ................ ................ ................ ................

E1379 6 Oxygen concentrator to 732 c .......................................................... ................ ................ ................ ................ ................

E1380 6 Oxygen concentrator to 976 c .......................................................... ................ ................ ................ ................ ................

E1381 6 Oxygen concentrat to 1220 cu ......................................................... ................ ................ ................ ................ ................

E1382 6 Oxygen concentrat to 1464 cu ......................................................... ................ ................ ................ ................ ................

E1383 6 Oxygen concentrat to 1708 cu ......................................................... ................ ................ ................ ................ ................

E1384 6 Oxygen concentrat to 1952 cu ......................................................... ................ ................ ................ ................ ................

E1385 6 Oxygen concentrator >1952 c .......................................................... ................ ................ ................ ................ ................

E1399 6 Durable medical equipment mi ......................................................... ................ ................ ................ ................ ................

E1400 6 Oxygen concentrator < 2 lite ............................................................ ................ ................ ................ ................ ................

E1401 6 Oxygen concentrator 2–3 lite ............................................................ ................ ................ ................ ................ ................

E1402 6 Oxygen concentrator 3–4 lite ............................................................ ................ ................ ................ ................ ................

E1403 6 Oxygen concentrator 4–5 lite ............................................................ ................ ................ ................ ................ ................

E1404 6 Oxygen concentrator >5 lite .............................................................. ................ ................ ................ ................ ................

E1405 6 O2/water vapor enrich w/heat ........................................................... ................ ................ ................ ................ ................

E1406 6 O2/water vapor enrich w/o he .......................................................... ................ ................ ................ ................ ................

E1510 6 Kidney dialysate delivry sys .............................................................. ................ ................ ................ ................ ................

E1520 6 Heparin infusion pump for di ............................................................ ................ ................ ................ ................ ................

E1530 6 Air bubble detector for dial ............................................................... ................ ................ ................ ................ ................

E1540 6 Pressure alarm for dialysis ............................................................... ................ ................ ................ ................ ................

E1550 6 Bath conductivity meter .................................................................... ................ ................ ................ ................ ................

E1560 6 Blood leak detector for dial ............................................................... ................ ................ ................ ................ ................

E1570 6 Adjustable chair for esrd pt ............................................................... ................ ................ ................ ................ ................

E1575 6 Transducer protector/fluid b .............................................................. ................ ................ ................ ................ ................

E1580 6 Unipuncture control system .............................................................. ................ ................ ................ ................ ................

E1590 6 Hemodialysis machine ...................................................................... ................ ................ ................ ................ ................

E1592 6 Auto interm peritoneal dialy .............................................................. ................ ................ ................ ................ ................

E1594 6 Cycler dialysis machine .................................................................... ................ ................ ................ ................ ................

E1600 6 Deliv/install equip for dial .................................................................. ................ ................ ................ ................ ................

E1610 6 Reverse osmosis water purifi ........................................................... ................ ................ ................ ................ ................

E1615 6 Deionizer water purification .............................................................. ................ ................ ................ ................ ................

E1620 6 Blood pump for dialysis .................................................................... ................ ................ ................ ................ ................

E1625 6 Water softening system .................................................................... ................ ................ ................ ................ ................

E1630 6 Reciprocating peritoneal dia ............................................................. ................ ................ ................ ................ ................

E1632 6 Wearable artificial kidney .................................................................. ................ ................ ................ ................ ................

E1635 6 Compact travel hemodialyzer ........................................................... ................ ................ ................ ................ ................

E1636 6 Sorbent cartridges for dialy ............................................................... ................ ................ ................ ................ ................

E1640 6 Replacement components for d ........................................................ ................ ................ ................ ................ ................

E1699 6 Dialysis equipment unspecifi ............................................................ ................ ................ ................ ................ ................

E1700 6 Jaw motion rehab system ................................................................. ................ ................ ................ ................ ................

E1701 6 Repl cushions for jaw motion ........................................................... ................ ................ ................ ................ ................

E1702 6 Repl measr scales jaw motion .......................................................... ................ ................ ................ ................ ................

E1800 6 Adjust elbow ext/flex device ............................................................. ................ ................ ................ ................ ................

E1805 6 Adjust wrist ext/flex device ............................................................... ................ ................ ................ ................ ................

E1810 6 Adjust knee ext/flex device ............................................................... ................ ................ ................ ................ ................

E1815 6 Adjust ankle ext/flex device .............................................................. ................ ................ ................ ................ ................

E1820 6 Soft interface material ....................................................................... ................ ................ ................ ................ ................

E1825 6 Adjust finger ext/flex devc ................................................................. ................ ................ ................ ................ ................

E1830 6 Adjust toe ext/flex device .................................................................. ................ ................ ................ ................ ................

G0001 2 Drawing blood for specimen ............................................................. ................ ................ ................ ................ ................

G0002 2 Temporary urinary catheter .............................................................. ................ ................ ................ ................ ................

G0004 2 ECG transm phys review & int ......................................................... ................ ................ ................ ................ ................

G0005 2 ECG 24 hour recording ..................................................................... ................ ................ ................ ................ ................

G0006 2 ECG transmission & analysis ........................................................... ................ ................ ................ ................ ................

G0007 2 ECG phy review & interpret .............................................................. ................ ................ ................ ................ ................

G0008 6 Admin influenza virus vac ................................................................. ................ ................ ................ ................ ................

G0009 6 Admin pneumococcal vaccine .......................................................... ................ ................ ................ ................ ................
32447

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

G0010 6 Admin hepatitis b vaccine ................................................................. ................ ................ ................ ................ ................

G0015 2 Post symptom ECG tracing .............................................................. ................ ................ ................ ................ ................

G0016 2 Post symptom ECG md review ......................................................... ................ ................ ................ ................ ................

G0025 2 Collagen skin test kit ......................................................................... ................ ................ ................ ................ ................

G0026 6 Fecal leukocyte examination ............................................................ ................ ................ ................ ................ ................

G0027 6 Semen analysis ................................................................................. ................ ................ ................ ................ ................

G0030 6 PET imaging prev PET single .......................................................... ................ ................ ................ ................ ................

G0031 6 PET imaging prev PET multple ........................................................ ................ ................ ................ ................ ................

G0032 6 PET follow SPECT 78464 singl ........................................................ ................ ................ ................ ................ ................

G0033 6 PET follow SPECT 78464 mult ......................................................... ................ ................ ................ ................ ................

G0034 6 PET follow SPECT 76865 singl ........................................................ ................ ................ ................ ................ ................

G0035 6 PET follow SPECT 78465 mult ......................................................... ................ ................ ................ ................ ................

G0036 6 PET follow cornry angio sing ............................................................ ................ ................ ................ ................ ................

G0037 6 PET follow cornry angio mult ............................................................ ................ ................ ................ ................ ................

G0038 6 PET follow myocard perf sing ........................................................... ................ ................ ................ ................ ................

G0039 6 PET follow myocard perf mult ........................................................... ................ ................ ................ ................ ................

G0040 6 PET follow stress echo singl ............................................................. ................ ................ ................ ................ ................

G0041 6 PET follow stress echo mult ............................................................. ................ ................ ................ ................ ................

G0042 6 PET follow ventriculogm sing ........................................................... ................ ................ ................ ................ ................

G0043 6 PET follow ventriculogm mult ........................................................... ................ ................ ................ ................ ................

G0044 6 PET following rest ECG singl ........................................................... ................ ................ ................ ................ ................

G0045 6 PET following rest ECG mult ............................................................ ................ ................ ................ ................ ................

G0046 6 PET follow stress ECG singl ............................................................. ................ ................ ................ ................ ................

G0047 6 PET follow stress ECG mult ............................................................. ................ ................ ................ ................ ................

G0050 6 Residual urine by ultrasound ............................................................ ................ ................ ................ ................ ................

G0101 6 CA screen; pelvic/breast exam ......................................................... ................ ................ ................ ................ ................

G0104 1 CA screen; flexi sigmoidscope ......................................................... ................ ................ 446 $175 0.35 Add.

G0105 1 Colorectal scrn; hi risk ind ................................................................ ................ ................ 426 $354 0.70 Add.

G0106 6 Colon CA screen; barium enema ..................................................... ................ ................ ................ ................ ................

G0107 6 CA screen; fecal blood test .............................................................. ................ ................ ................ ................ ................

G0110 6 Nett pulm-rehab educ; ind ................................................................ ................ ................ ................ ................ ................

G0111 6 Nett pulm-rehab educ; group ............................................................ ................ ................ ................ ................ ................

G0112 6 Nett; nutrition guid, initial .................................................................. ................ ................ ................ ................ ................

G0113 6 Nett; nutrition guid,subseqnt ............................................................. ................ ................ ................ ................ ................

G0114 6 Nett; psychosocial consult ................................................................ ................ ................ ................ ................ ................

G0115 6 Nett; psychological testing ................................................................ ................ ................ ................ ................ ................

G0116 6 Nett; psychosocial counsel ............................................................... ................ ................ ................ ................ ................

G0120 6 Colon ca scrn; barium enema .......................................................... ................ ................ ................ ................ ................

G0121 9 Colon ca scrn; barium enema .......................................................... ................ ................ ................ ................ ................

G0122 9 Colon ca scrn; barium enema .......................................................... ................ ................ ................ ................ ................

J0120 9 Tetracyclin injection .......................................................................... ................ ................ ................ ................ ................

J0150 9 Injection adenosine 6 MG ................................................................. ................ ................ ................ ................ ................

J0170 9 Adrenalin epinephrin inject ............................................................... ................ ................ ................ ................ ................

J0190 9 Inj biperiden lactate/5 mg ................................................................. ................ ................ ................ ................ ................

J0205 9 Alglucerase injection ......................................................................... ................ ................ ................ ................ ................

J0207 9 Amifostine ......................................................................................... ................ ................ ................ ................ ................

J0210 9 Methyldopate hcl injection ................................................................ ................ ................ ................ ................ ................

J0256 9 Alpha 1-proteinase 500 MG .............................................................. ................ ................ ................ ................ ................

J0270 9 Alprostadil for injection ...................................................................... ................ ................ ................ ................ ................

J0280 9 Aminophyllin 250 MG inj ................................................................... ................ ................ ................ ................ ................

J0290 9 Ampicillin 500 MG inj ........................................................................ ................ ................ ................ ................ ................

J0295 9 Ampicillin sodium per 1.5 gm ............................................................ ................ ................ ................ ................ ................

J0300 9 Amobarbital 125 MG inj .................................................................... ................ ................ ................ ................ ................

J0330 9 Succinycholine chloride inj ................................................................ ................ ................ ................ ................ ................

J0340 9 Nandrolon phenpropionate inj ........................................................... ................ ................ ................ ................ ................

J0350 9 Injection anistreplase 30 u ................................................................ ................ ................ ................ ................ ................

J0360 9 Hydralazine hcl injection ................................................................... ................ ................ ................ ................ ................

J0380 9 Inj metaraminol bitartrate .................................................................. ................ ................ ................ ................ ................

J0390 9 Chloroquine injection ........................................................................ ................ ................ ................ ................ ................

J0400 9 Inj trimethaphan camsylate ............................................................... ................ ................ ................ ................ ................

J0460 9 Atropine sulfate injection ................................................................... ................ ................ ................ ................ ................

J0470 9 Dimecaprol injection .......................................................................... ................ ................ ................ ................ ................

J0475 9 Baclofen 10 MG injection .................................................................. ................ ................ ................ ................ ................

J0500 9 Dicyclomine injection ........................................................................ ................ ................ ................ ................ ................

J0510 9 Benzquinamide injection ................................................................... ................ ................ ................ ................ ................

J0515 9 Inj benztropine mesylate ................................................................... ................ ................ ................ ................ ................

J0520 9 Bethanechol chloride inject ............................................................... ................ ................ ................ ................ ................

J0530 9 Penicillin g benzathine inj ................................................................. ................ ................ ................ ................ ................

J0540 9 Penicillin g benzathine inj ................................................................. ................ ................ ................ ................ ................

J0550 9 Penicillin g benzathine inj ................................................................. ................ ................ ................ ................ ................

J0560 9 Penicillin g benzathine inj ................................................................. ................ ................ ................ ................ ................

J0570 9 Penicillin g benzathine inj ................................................................. ................ ................ ................ ................ ................

J0580 9 Penicillin g benzathine inj ................................................................. ................ ................ ................ ................ ................

J0585 9 Botulinum toxin a per unit ................................................................. ................ ................ ................ ................ ................
32448

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

J0590 9 Ethylnorepinephrine hcl inj ................................................................ ................ ................ ................ ................ ................

J0600 9 Edetate calcium disodium inj ............................................................ ................ ................ ................ ................ ................

J0610 9 Calcium gluconate injection .............................................................. ................ ................ ................ ................ ................

J0620 9 Calcium glycer & lact/10 ML ............................................................. ................ ................ ................ ................ ................

J0630 9 Calcitonin salmon injection ............................................................... ................ ................ ................ ................ ................

J0635 9 Calcitriol injection .............................................................................. ................ ................ ................ ................ ................

J0640 9 Leucovorin calcium injection ............................................................. ................ ................ ................ ................ ................

J0670 9 Inj mepivacaine HCL/10 ml ............................................................... ................ ................ ................ ................ ................

J0690 9 Cefazolin sodium injection ................................................................ ................ ................ ................ ................ ................

J0694 9 Cefoxitin sodium injection ................................................................. ................ ................ ................ ................ ................

J0695 9 Cefonocid sodium injection ............................................................... ................ ................ ................ ................ ................

J0696 9 Ceftriaxone sodium injection ............................................................. ................ ................ ................ ................ ................

J0697 9 Sterile cefuroxime injection ............................................................... ................ ................ ................ ................ ................

J0698 9 Cefotaxime sodium injection ............................................................. ................ ................ ................ ................ ................

J0702 9 Betamethasone acet&sod phosp ...................................................... ................ ................ ................ ................ ................

J0704 9 Betamethasone sod phosp/4 MG ..................................................... ................ ................ ................ ................ ................

J0710 9 Cephapirin sodium injection .............................................................. ................ ................ ................ ................ ................

J0713 9 Inj ceftazidime per 500 mg ............................................................... ................ ................ ................ ................ ................

J0715 9 Ceftizoxime sodium / 500 MG .......................................................... ................ ................ ................ ................ ................

J0720 9 Chloramphenicol sodium injec .......................................................... ................ ................ ................ ................ ................

J0725 9 Chorionic gonadotropin/1000u .......................................................... ................ ................ ................ ................ ................

J0730 9 Chlorpheniramin maleate inj ............................................................. ................ ................ ................ ................ ................

J0735 9 Clonidine hydrochloride .................................................................... ................ ................ ................ ................ ................

J0740 9 Cidofovir injection .............................................................................. ................ ................ ................ ................ ................

J0743 9 Cilastatin sodium injection ................................................................ ................ ................ ................ ................ ................

J0745 9 Inj codeine phosphate /30 MG ......................................................... ................ ................ ................ ................ ................

J0760 9 Colchicine injection ........................................................................... ................ ................ ................ ................ ................

J0770 9 Colistimethate sodium inj .................................................................. ................ ................ ................ ................ ................

J0780 9 Prochlorperazine injection ................................................................. ................ ................ ................ ................ ................

J0800 9 Corticotropin injection ....................................................................... ................ ................ ................ ................ ................

J0810 9 Cortisone injection ............................................................................ ................ ................ ................ ................ ................

J0835 9 Inj cosyntropin per 0.25 MG ............................................................. ................ ................ ................ ................ ................

J0850 9 Cytomegalovirus imm IV /vial ........................................................... ................ ................ ................ ................ ................

J0895 9 Deferoxamine mesylate inj ............................................................... ................ ................ ................ ................ ................

J0900 9 Testosterone enanthate inj ............................................................... ................ ................ ................ ................ ................

J0945 9 Brompheniramine maleate inj ........................................................... ................ ................ ................ ................ ................

J0970 9 Estradiol valerate injection ................................................................ ................ ................ ................ ................ ................

J1000 9 Depo-estradiol cypionate inj ............................................................. ................ ................ ................ ................ ................

J1020 9 Methylprednisolone 20 MG inj .......................................................... ................ ................ ................ ................ ................

J1030 9 Methylprednisolone 40 MG inj .......................................................... ................ ................ ................ ................ ................

J1040 9 Methylprednisolone 80 MG inj .......................................................... ................ ................ ................ ................ ................

J1050 9 Medroxyprogesterone inj .................................................................. ................ ................ ................ ................ ................

J1055 9 Medrxyprogester acetate inj ............................................................. ................ ................ ................ ................ ................

J1060 9 Testosterone cypionate 1 ML ........................................................... ................ ................ ................ ................ ................

J1070 9 Testosterone cypionat 100 MG ........................................................ ................ ................ ................ ................ ................

J1080 9 Testosterone cypionat 200 MG ........................................................ ................ ................ ................ ................ ................

J1090 9 Testosterone cypionate 50 MG ........................................................ ................ ................ ................ ................ ................

J1095 9 Inj dexamethasone acetate ............................................................... ................ ................ ................ ................ ................

J1100 9 Dexamethosone sodium phos .......................................................... ................ ................ ................ ................ ................

J1110 9 Inj dihydroergotamine mesylt ............................................................ ................ ................ ................ ................ ................

J1120 9 Acetazolamid sodium injectio ........................................................... ................ ................ ................ ................ ................

J1160 9 Digoxin injection ................................................................................ ................ ................ ................ ................ ................

J1165 9 Phenytoin sodium injection ............................................................... ................ ................ ................ ................ ................

J1170 9 Hydromorphone injection .................................................................. ................ ................ ................ ................ ................

J1180 9 Dyphylline injection ........................................................................... ................ ................ ................ ................ ................

J1190 9 Dexrazoxane HCl injection ............................................................... ................ ................ ................ ................ ................

J1200 9 Diphenhydramine hcl injectio ............................................................ ................ ................ ................ ................ ................

J1205 9 Chlorothiazide sodium inj .................................................................. ................ ................ ................ ................ ................

J1212 9 Dimethyl sulfoxide 50% 50 ML ......................................................... ................ ................ ................ ................ ................

J1230 9 Methadone injection .......................................................................... ................ ................ ................ ................ ................

J1240 9 Dimenhydrinate injection ................................................................... ................ ................ ................ ................ ................

J1245 9 Dipyridamole injection ....................................................................... ................ ................ ................ ................ ................

J1250 9 Inj dobutamine HCL/250 mg ............................................................. ................ ................ ................ ................ ................

J1320 9 Amitriptyline injection ........................................................................ ................ ................ ................ ................ ................

J1325 9 Epoprostenol injection ....................................................................... ................ ................ ................ ................ ................

J1330 9 Ergonovine maleate injection ............................................................ ................ ................ ................ ................ ................

J1362 9 Erythromycin glucep / 250 MG ......................................................... ................ ................ ................ ................ ................

J1364 9 Erythro lactobionate /500 MG ........................................................... ................ ................ ................ ................ ................

J1380 9 Estradiol valerate 10 MG inj ............................................................. ................ ................ ................ ................ ................

J1390 9 Estradiol valerate 20 MG inj ............................................................. ................ ................ ................ ................ ................

J1410 9 Inj estrogen conjugate 25 MG .......................................................... ................ ................ ................ ................ ................

J1435 9 Injection estrone per 1 MG ............................................................... ................ ................ ................ ................ ................

J1436 9 Etidronate disodium inj ..................................................................... ................ ................ ................ ................ ................

J1440 9 Filgrastim 300 mcg injeciton ............................................................. ................ ................ ................ ................ ................
32449

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

J1441 9 Filgrastim 480 mcg injection ............................................................. ................ ................ ................ ................ ................

J1455 9 Foscarnet sodium injection ............................................................... ................ ................ ................ ................ ................

J1460 9 Gamma globulin 1 CC inj .................................................................. ................ ................ ................ ................ ................

J1470 9 Gamma globulin 2 CC inj .................................................................. ................ ................ ................ ................ ................

J1480 9 Gamma globulin 3 CC inj .................................................................. ................ ................ ................ ................ ................

J1490 9 Gamma globulin 4 CC inj .................................................................. ................ ................ ................ ................ ................

J1500 9 Gamma globulin 5 CC inj .................................................................. ................ ................ ................ ................ ................

J1510 9 Gamma globulin 6 CC inj .................................................................. ................ ................ ................ ................ ................

J1520 9 Gamma globulin 7 CC inj .................................................................. ................ ................ ................ ................ ................

J1530 9 Gamma globulin 8 CC inj .................................................................. ................ ................ ................ ................ ................

J1540 9 Gamma globulin 9 CC inj .................................................................. ................ ................ ................ ................ ................

J1550 9 Gamma globulin 10 CC inj ................................................................ ................ ................ ................ ................ ................

J1560 9 Gamma globulin >10 CC inj ............................................................. ................ ................ ................ ................ ................

J1561 9 Immune globulin 500 mg .................................................................. ................ ................ ................ ................ ................

J1562 9 Immune globulin 5 gms .................................................................... ................ ................ ................ ................ ................

J1565 9 RSV-ivig ............................................................................................ ................ ................ ................ ................ ................

J1570 9 Ganciclovir sodium injection ............................................................. ................ ................ ................ ................ ................

J1580 9 Garamycin gentamicin inj ................................................................. ................ ................ ................ ................ ................

J1600 9 Gold sodium thiomaleate inj ............................................................. ................ ................ ................ ................ ................

J1610 9 Glucagon hydrochloride/1 MG .......................................................... ................ ................ ................ ................ ................

J1620 9 Gonadorelin hydroch/ 100 mcg ........................................................ ................ ................ ................ ................ ................

J1626 9 Granisetron HCl injection .................................................................. ................ ................ ................ ................ ................

J1630 9 Haloperidol injection .......................................................................... ................ ................ ................ ................ ................

J1631 9 Haloperidol decanoate inj ................................................................. ................ ................ ................ ................ ................

J1642 9 Inj heparin sodium per 10 u .............................................................. ................ ................ ................ ................ ................

J1644 9 Inj heparin sodium per 1000u ........................................................... ................ ................ ................ ................ ................

J1645 9 Dalteparin sodium ............................................................................. ................ ................ ................ ................ ................

J1650 9 Inj enoxaparin sodium 30 mg ........................................................... ................ ................ ................ ................ ................

J1670 9 Tetanus immune globulin inj ............................................................. ................ ................ ................ ................ ................

J1690 9 Prednisolone tebutate inj .................................................................. ................ ................ ................ ................ ................

J1700 9 Hydrocortisone acetate inj ................................................................ ................ ................ ................ ................ ................

J1710 9 Hydrocortisone sodium ph inj ........................................................... ................ ................ ................ ................ ................

J1720 9 Hydrocortisone sodium succ i ........................................................... ................ ................ ................ ................ ................

J1730 9 Diazoxide injection ............................................................................ ................ ................ ................ ................ ................

J1739 9 Hydroxyprogesterone cap 125 .......................................................... ................ ................ ................ ................ ................

J1741 9 Hydroxyprogesterone cap 250 .......................................................... ................ ................ ................ ................ ................

J1742 9 Ibutilide fumarate injection ................................................................ ................ ................ ................ ................ ................

J1760 9 Iron dextran 2 CC inj ........................................................................ ................ ................ ................ ................ ................

J1770 9 Iron dextran 5 CC inj ........................................................................ ................ ................ ................ ................ ................

J1780 9 Iron dextran 10 CC inj ...................................................................... ................ ................ ................ ................ ................

J1785 9 Injection imiglucerase /unit ............................................................... ................ ................ ................ ................ ................

J1790 9 Droperidol injection ........................................................................... ................ ................ ................ ................ ................

J1800 9 Propranolol injection ......................................................................... ................ ................ ................ ................ ................

J1810 9 Droperidol/fentanyl inj ....................................................................... ................ ................ ................ ................ ................

J1820 9 Insulin injection ................................................................................. ................ ................ ................ ................ ................

J1825 9 Interferon beta-1a ............................................................................. ................ ................ ................ ................ ................

J1830 9 Interferon beta-1b / .25 MG .............................................................. ................ ................ ................ ................ ................

J1840 9 Kanamycin sulfate 500 MG inj .......................................................... ................ ................ ................ ................ ................

J1850 9 Kanamycin sulfate 75 MG inj ............................................................ ................ ................ ................ ................ ................

J1885 9 Ketorolac tromethamine inj ............................................................... ................ ................ ................ ................ ................

J1890 9 Cephalothin sodium injection ............................................................ ................ ................ ................ ................ ................

J1910 9 Kutapressin injection ......................................................................... ................ ................ ................ ................ ................

J1930 9 Propiomazine injection ...................................................................... ................ ................ ................ ................ ................

J1940 9 Furosemide injection ......................................................................... ................ ................ ................ ................ ................

J1950 9 Leuprolide acetate /3.75 MG ............................................................ ................ ................ ................ ................ ................

J1955 9 Inj levocarnitine per 1 gm ................................................................. ................ ................ ................ ................ ................

J1960 9 Levorphanol tartrate inj ..................................................................... ................ ................ ................ ................ ................

J1970 9 Methotrimeprazine injection .............................................................. ................ ................ ................ ................ ................

J1980 9 Hyoscyamine sulfate inj .................................................................... ................ ................ ................ ................ ................

J1990 9 Chlordiazepoxide injection ................................................................ ................ ................ ................ ................ ................

J2000 9 Lidocaine injection ............................................................................ ................ ................ ................ ................ ................

J2010 9 Lincomycin injection .......................................................................... ................ ................ ................ ................ ................

J2060 9 Lorazepam injection .......................................................................... ................ ................ ................ ................ ................

J2150 9 Mannitol injection .............................................................................. ................ ................ ................ ................ ................

J2175 9 Meperidine hydrochl /100 MG .......................................................... ................ ................ ................ ................ ................

J2180 9 Meperidine/promethazine inj ............................................................. ................ ................ ................ ................ ................

J2210 9 Methylergonovin maleate inj ............................................................. ................ ................ ................ ................ ................

J2240 9 Metocurine iodide injection ............................................................... ................ ................ ................ ................ ................

J2250 9 Inj midazolam hydrochloride ............................................................. ................ ................ ................ ................ ................

J2260 9 Inj milrinone lactate/5 ML .................................................................. ................ ................ ................ ................ ................

J2270 9 Morphine sulfate injection ................................................................. ................ ................ ................ ................ ................

J2275 9 Morphine sulfate injection ................................................................. ................ ................ ................ ................ ................

J2300 9 Inj nalbuphine hydrochloride ............................................................. ................ ................ ................ ................ ................

J2310 9 Inj naloxone hydrochloride ................................................................ ................ ................ ................ ................ ................
32450

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

J2320 9 Nandrolone decanoate 50 MG ......................................................... ................ ................ ................ ................ ................

J2321 9 Nandrolone decanoate 100 MG ....................................................... ................ ................ ................ ................ ................

J2322 9 Nandrolone decanoate 200 MG ....................................................... ................ ................ ................ ................ ................

J2330 9 Thiothixene injection ......................................................................... ................ ................ ................ ................ ................

J2350 9 Niacinamide/niacin injection .............................................................. ................ ................ ................ ................ ................

J2360 9 Orphenadrine injection ...................................................................... ................ ................ ................ ................ ................

J2370 9 Phenylephrine hcl injection ............................................................... ................ ................ ................ ................ ................

J2400 9 Chloroprocaine hcl injection .............................................................. ................ ................ ................ ................ ................

J2405 9 Ondansetron hcl injection ................................................................. ................ ................ ................ ................ ................

J2410 9 Oxymorphone hcl injection ............................................................... ................ ................ ................ ................ ................

J2430 9 Pamidronate disodium /30 MG ......................................................... ................ ................ ................ ................ ................

J2440 9 Papaverin hcl injection ...................................................................... ................ ................ ................ ................ ................

J2460 9 Oxytetracycline injection ................................................................... ................ ................ ................ ................ ................

J2480 9 Hydrochlorides of opium inj .............................................................. ................ ................ ................ ................ ................

J2510 9 Penicillin g procaine inj ..................................................................... ................ ................ ................ ................ ................

J2512 9 Inj pentagastrin per 2 ML .................................................................. ................ ................ ................ ................ ................

J2515 9 Pentobarbital sodium inj ................................................................... ................ ................ ................ ................ ................

J2540 9 Penicillin g potassium inj .................................................................. ................ ................ ................ ................ ................

J2545 9 Pentamidine isethionte/300mg .......................................................... ................ ................ ................ ................ ................

J2550 9 Promethazine hcl injection ................................................................ ................ ................ ................ ................ ................

J2560 9 Phenobarbital sodium inj .................................................................. ................ ................ ................ ................ ................

J2590 9 Oxytocin injection .............................................................................. ................ ................ ................ ................ ................

J2597 9 Inj desmopressin acetate .................................................................. ................ ................ ................ ................ ................

J2640 9 Prednisolone sodium ph inj .............................................................. ................ ................ ................ ................ ................

J2650 9 Prednisolone acetate inj ................................................................... ................ ................ ................ ................ ................

J2670 9 Totazoline hcl injection ..................................................................... ................ ................ ................ ................ ................

J2675 9 Inj progesterone per 50 MG ............................................................. ................ ................ ................ ................ ................

J2680 9 Fluphenazine decanoate 25 MG ...................................................... ................ ................ ................ ................ ................

J2690 9 Procainamide hcl injection ................................................................ ................ ................ ................ ................ ................

J2700 9 Oxacillin sodium injection ................................................................. ................ ................ ................ ................ ................

J2710 9 Neostigmine methylslfte inj ............................................................... ................ ................ ................ ................ ................

J2720 9 Inj protamine sulfate/10 MG ............................................................. ................ ................ ................ ................ ................

J2725 9 Inj protirelin per 250 mcg .................................................................. ................ ................ ................ ................ ................

J2730 9 Pralidoxime chloride inj ..................................................................... ................ ................ ................ ................ ................

J2760 9 Phentolaine mesylate inj ................................................................... ................ ................ ................ ................ ................

J2765 9 Metoclopramide hcl injection ............................................................ ................ ................ ................ ................ ................

J2790 9 Rho d immune globulin inj ................................................................ ................ ................ ................ ................ ................

J2800 9 Methocarbamol injection ................................................................... ................ ................ ................ ................ ................

J2810 9 Inj theophylline per 40 MG ............................................................... ................ ................ ................ ................ ................

J2820 9 Sargramostim injection ..................................................................... ................ ................ ................ ................ ................

J2860 9 Secobarbital sodium inj ..................................................................... ................ ................ ................ ................ ................

J2910 9 Aurothioglucose injection .................................................................. ................ ................ ................ ................ ................

J2912 9 Sodium chloride injection .................................................................. ................ ................ ................ ................ ................

J2920 9 Methylprednisolone injection ............................................................. ................ ................ ................ ................ ................

J2930 9 Methylprednisolone injection ............................................................. ................ ................ ................ ................ ................

J2950 9 Promazine hcl injection ..................................................................... ................ ................ ................ ................ ................

J2970 9 Methicillin sodium injection ............................................................... ................ ................ ................ ................ ................

J2995 9 Inj streptokinase /250000 IU ............................................................. ................ ................ ................ ................ ................

J2996 9 Alteplase recombinant inj .................................................................. ................ ................ ................ ................ ................

J3000 9 Streptomycin injection ....................................................................... ................ ................ ................ ................ ................

J3010 9 Fentanyl citrate injection ................................................................... ................ ................ ................ ................ ................

J3030 9 Sumatriptan succinate / 6 MG .......................................................... ................ ................ ................ ................ ................

J3070 9 Pentazocine hcl injection .................................................................. ................ ................ ................ ................ ................

J3080 9 Chlorprothixene injection .................................................................. ................ ................ ................ ................ ................

J3105 9 Terbutaline sulfate inj ........................................................................ ................ ................ ................ ................ ................

J3120 9 Testosterone enanthate inj ............................................................... ................ ................ ................ ................ ................

J3130 9 Testosterone enanthate inj ............................................................... ................ ................ ................ ................ ................

J3140 9 Testosterone suspension inj ............................................................. ................ ................ ................ ................ ................

J3150 9 Testosteron propionate inj ................................................................ ................ ................ ................ ................ ................

J3230 9 Chlorpromazine hcl injection ............................................................. ................ ................ ................ ................ ................

J3240 9 Thyrotropin injection .......................................................................... ................ ................ ................ ................ ................

J3250 9 Trimethobenzamide hcl inj ................................................................ ................ ................ ................ ................ ................

J3260 9 Tobramycin sulfate injection ............................................................. ................ ................ ................ ................ ................

J3265 9 Injection torsemide 10 mg/ml ............................................................ ................ ................ ................ ................ ................

J3270 9 Imipramine hcl injection .................................................................... ................ ................ ................ ................ ................

J3280 9 Thiethylperazine maleate inj ............................................................. ................ ................ ................ ................ ................

J3301 9 Triamcinolone acetonide inj .............................................................. ................ ................ ................ ................ ................

J3302 9 Triamcinolone diacetate inj ............................................................... ................ ................ ................ ................ ................

J3303 9 Triamcinolone hexacetonl inj ............................................................ ................ ................ ................ ................ ................

J3305 9 Inj trimetrexate glucoronate .............................................................. ................ ................ ................ ................ ................

J3310 9 Perphenazine injection ...................................................................... ................ ................ ................ ................ ................

J3320 9 Spectinomycn di-hcl inj ..................................................................... ................ ................ ................ ................ ................

J3350 9 Urea injection .................................................................................... ................ ................ ................ ................ ................

J3360 9 Diazepam injection ............................................................................ ................ ................ ................ ................ ................
32451

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

J3364 9 Urokinase 5000 IU injection .............................................................. ................ ................ ................ ................ ................

J3365 9 Urokinase 250,000 IU inj .................................................................. ................ ................ ................ ................ ................

J3370 2 Vancomycin hcl injection .................................................................. ................ ................ ................ ................ ................

J3390 9 Methoxamine injection ...................................................................... ................ ................ ................ ................ ................

J3400 9 Triflupromazine hcl inj ....................................................................... ................ ................ ................ ................ ................

J3410 9 Hydroxyzine hcl injection .................................................................. ................ ................ ................ ................ ................

J3420 9 Vitamin b12 injection ......................................................................... ................ ................ ................ ................ ................

J3430 9 Vitamin k phytonadione inj ................................................................ ................ ................ ................ ................ ................

J3450 9 Mephentermine sulfate inj ................................................................. ................ ................ ................ ................ ................

J3470 9 Hyaluronidase injection ..................................................................... ................ ................ ................ ................ ................

J3475 9 Inj magnesium sulfate ....................................................................... ................ ................ ................ ................ ................

J3480 9 Inj potassium chloride ....................................................................... ................ ................ ................ ................ ................

J3490 9 Drugs unclassified injection .............................................................. ................ ................ ................ ................ ................

J3520 9 Edetate disodium per 150 mg .......................................................... ................ ................ ................ ................ ................

J3530 9 Nasal vaccine inhalation ................................................................... ................ ................ ................ ................ ................

J3535 9 Metered dose inhaler drug ................................................................ ................ ................ ................ ................ ................

J3570 9 Laetrile amygdalin vit B17 ................................................................ ................ ................ ................ ................ ................

J7030 9 Normal saline solution infus .............................................................. ................ ................ ................ ................ ................

J7040 9 Normal saline solution infus .............................................................. ................ ................ ................ ................ ................

J7042 9 5% dextrose/normal saline ............................................................... ................ ................ ................ ................ ................

J7050 9 Normal saline solution infus .............................................................. ................ ................ ................ ................ ................

J7051 9 Sterile saline/water ............................................................................ ................ ................ ................ ................ ................

J7060 9 5% dextrose/water ............................................................................ ................ ................ ................ ................ ................

J7070 9 D5w infusion ..................................................................................... ................ ................ ................ ................ ................

J7100 9 Dextran 40 infusion ........................................................................... ................ ................ ................ ................ ................

J7110 9 Dextran 75 infusion ........................................................................... ................ ................ ................ ................ ................

J7120 9 Ringers lactate infusion .................................................................... ................ ................ ................ ................ ................

J7130 9 Hypertonic saline solution ................................................................. ................ ................ ................ ................ ................

J7190 6 Factor viii ........................................................................................... ................ ................ ................ ................ ................

J7191 6 Factor VIII (porcine) .......................................................................... ................ ................ ................ ................ ................

J7192 6 Factor viii recombinant ...................................................................... ................ ................ ................ ................ ................

J7194 6 Factor ix complex .............................................................................. ................ ................ ................ ................ ................

J7196 6 Othr hemophilia clot factors .............................................................. ................ ................ ................ ................ ................

J7197 6 Antithrombin iii injection .................................................................... ................ ................ ................ ................ ................

J7300 9 Intraut copper contraceptive ............................................................. ................ ................ ................ ................ ................

J7310 9 Ganciclovir long act implant .............................................................. ................ ................ ................ ................ ................

J7500 6 Azathiop po tab 50mg 100s ea ........................................................ ................ ................ ................ ................ ................

J7501 6 Azathioprine parenteral ..................................................................... ................ ................ ................ ................ ................

J7503 6 Cyclosporine parenteral .................................................................... ................ ................ ................ ................ ................

J7504 6 Lymphocyte immune globulin ........................................................... ................ ................ ................ ................ ................

J7505 6 Monoclonal antibodies ...................................................................... ................ ................ ................ ................ ................

J7506 6 Prednisone oral ................................................................................. ................ ................ ................ ................ ................

J7507 9 Tacrolimus oral per 1 MG ................................................................. ................ ................ ................ ................ ................

J7508 9 Tacrolimus oral per 5 MG ................................................................. ................ ................ ................ ................ ................

J7509 6 Methylprednisolone oral .................................................................... ................ ................ ................ ................ ................

J7510 6 Prednisolone oral per 5 mg .............................................................. ................ ................ ................ ................ ................

J7599 6 Immunosuppressive drug noc ........................................................... ................ ................ ................ ................ ................

J7610 9 Acetylcysteine 10% injection ............................................................ ................ ................ ................ ................ ................

J7615 9 Acetylcysteine 20% injection ............................................................ ................ ................ ................ ................ ................

J7620 9 Albuterol sulfate .083%/ml ................................................................ ................ ................ ................ ................ ................

J7625 9 Albuterol sulfate .5% inj .................................................................... ................ ................ ................ ................ ................

J7627 9 Bitolterolmesylate inhal sol ............................................................... ................ ................ ................ ................ ................

J7630 9 Cromolyn sodium injection ................................................................ ................ ................ ................ ................ ................

J7640 9 Epinephrine injection ......................................................................... ................ ................ ................ ................ ................

J7645 9 Ipratropium bromide .02%/ml ............................................................ ................ ................ ................ ................ ................

J7650 9 Isoetharine hcl .1% inj ...................................................................... ................ ................ ................ ................ ................

J7651 9 Isoetharine hcl .125% inj .................................................................. ................ ................ ................ ................ ................

J7652 9 Isoetharine hcl .167% inj .................................................................. ................ ................ ................ ................ ................

J7653 9 Isoetharine hcl .2%/ inj ..................................................................... ................ ................ ................ ................ ................

J7654 9 Isoetharine hcl .25% inj .................................................................... ................ ................ ................ ................ ................

J7655 9 Isoetharine hcl 1% inj ....................................................................... ................ ................ ................ ................ ................

J7660 9 Isoproterenol hcl .5% inj ................................................................... ................ ................ ................ ................ ................

J7665 9 Isoproterenol hcl 1% inj .................................................................... ................ ................ ................ ................ ................

J7670 9 Metaproterenol sulfate .4% ............................................................... ................ ................ ................ ................ ................

J7672 9 Metaproterenol sulfate .6% ............................................................... ................ ................ ................ ................ ................

J7675 9 Metaproterenol sulfate 5% ................................................................ ................ ................ ................ ................ ................

J7699 9 Inhalation solution for DME .............................................................. ................ ................ ................ ................ ................

J7799 9 Non-inhalation drug for DME ............................................................ ................ ................ ................ ................ ................

J8499 9 Oral prescrip drug non chemo .......................................................... ................ ................ ................ ................ ................

J8530 9 Cyclophosphamide oral 25 MG ........................................................ ................ ................ ................ ................ ................

J8560 9 Etoposide oral 50 MG ....................................................................... ................ ................ ................ ................ ................

J8600 9 Melphalan oral 2 MG ........................................................................ ................ ................ ................ ................ ................

J8610 9 Methotrexate oral 2.5 MG ................................................................. ................ ................ ................ ................ ................

J8999 9 Oral prescription drug chemo ........................................................... ................ ................ ................ ................ ................
32452

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

J9000 9 Doxorubic hcl 10 MG vl chemo ........................................................ ................ ................ ................ ................ ................

J9015 9 Aldesleukin/single use vial ................................................................ ................ ................ ................ ................ ................

J9020 9 Asparaginase injection ...................................................................... ................ ................ ................ ................ ................

J9031 9 Bcg live intravesical vac ................................................................... ................ ................ ................ ................ ................

J9040 9 Bleomycin sulfate injection ............................................................... ................ ................ ................ ................ ................

J9045 9 Carboplatin injection ......................................................................... ................ ................ ................ ................ ................

J9050 9 Carmus bischl nitro inj ...................................................................... ................ ................ ................ ................ ................

J9060 9 Cisplatin 10 MG injection .................................................................. ................ ................ ................ ................ ................

J9062 9 Cisplatin 50 MG injection .................................................................. ................ ................ ................ ................ ................

J9065 9 Inj cladribine per 1 MG ..................................................................... ................ ................ ................ ................ ................

J9070 9 Cyclophosphamide 100 MG inj ......................................................... ................ ................ ................ ................ ................

J9080 9 Cyclophosphamide 200 MG inj ......................................................... ................ ................ ................ ................ ................

J9090 9 Cyclophosphamide 500 MG inj ......................................................... ................ ................ ................ ................ ................

J9091 9 Cyclophosphamide 1.0 grm inj ......................................................... ................ ................ ................ ................ ................

J9092 9 Cyclophosphamide 2.0 grm inj ......................................................... ................ ................ ................ ................ ................

J9093 9 Cyclophosphamide lyophilized .......................................................... ................ ................ ................ ................ ................

J9094 9 Cyclophosphamide lyophilized .......................................................... ................ ................ ................ ................ ................

J9095 9 Cyclophosphamide lyophilized .......................................................... ................ ................ ................ ................ ................

J9096 9 Cyclophosphamide lyophilized .......................................................... ................ ................ ................ ................ ................

J9097 9 Cyclophosphamide lyophilized .......................................................... ................ ................ ................ ................ ................

J9100 9 Cytarabine hcl 100 MG inj ................................................................ ................ ................ ................ ................ ................

J9110 9 Cytarabine hcl 500 MG inj ................................................................ ................ ................ ................ ................ ................

J9120 9 Dactinomycin actinomycin d ............................................................. ................ ................ ................ ................ ................

J9130 9 Dacarbazine 10 MG inj ..................................................................... ................ ................ ................ ................ ................

J9140 9 Dacarbazine 200 MG inj ................................................................... ................ ................ ................ ................ ................

J9150 9 Daunorubicin ..................................................................................... ................ ................ ................ ................ ................

J9165 9 Diethylstilbestrol injection .................................................................. ................ ................ ................ ................ ................

J9170 9 Docetaxel .......................................................................................... ................ ................ ................ ................ ................

J9181 9 Etoposide 10 MG inj ......................................................................... ................ ................ ................ ................ ................

J9182 9 Etoposide 100 MG inj ....................................................................... ................ ................ ................ ................ ................

J9185 9 Fludarabine phosphate inj ................................................................ ................ ................ ................ ................ ................

J9190 9 Fluorouracil injection ......................................................................... ................ ................ ................ ................ ................

J9200 9 Floxuridine injection .......................................................................... ................ ................ ................ ................ ................

J9201 9 Gemcitabine HCl ............................................................................... ................ ................ ................ ................ ................

J9202 9 Goserelin acetate implant ................................................................. ................ ................ ................ ................ ................

J9206 9 Irinotecan injection ............................................................................ ................ ................ ................ ................ ................

J9208 9 Ifosfomide injection ........................................................................... ................ ................ ................ ................ ................

J9209 9 Mesna injection ................................................................................. ................ ................ ................ ................ ................

J9211 9 Idarubicin hcl injection ...................................................................... ................ ................ ................ ................ ................

J9213 9 Interferon alfa-2a inj .......................................................................... ................ ................ ................ ................ ................

J9214 9 Interferon alfa-2b inj .......................................................................... ................ ................ ................ ................ ................

J9215 9 Interferon alfa-n3 inj .......................................................................... ................ ................ ................ ................ ................

J9216 9 Interferon gamma 1-b inj .................................................................. ................ ................ ................ ................ ................

J9217 9 Leuprolide acetate suspnsion ........................................................... ................ ................ ................ ................ ................

J9218 9 Leuprolide acetate injection .............................................................. ................ ................ ................ ................ ................

J9230 9 Mechlorethamine hcl inj .................................................................... ................ ................ ................ ................ ................

J9245 9 Inj melphalan hydrochl 50 MG .......................................................... ................ ................ ................ ................ ................

J9250 9 Methotrexate sodium inj .................................................................... ................ ................ ................ ................ ................

J9260 9 Methotrexate sodium inj .................................................................... ................ ................ ................ ................ ................

J9265 9 Paclitaxel injection ............................................................................ ................ ................ ................ ................ ................

J9266 9 Pegaspargase/singl dose vial ........................................................... ................ ................ ................ ................ ................

J9268 9 Pentostatin injection .......................................................................... ................ ................ ................ ................ ................

J9270 9 Plicamycin (mithramycin) inj ............................................................. ................ ................ ................ ................ ................

J9280 9 Mitomycin 5 MG inj ........................................................................... ................ ................ ................ ................ ................

J9290 9 Mitomycin 20 MG inj ......................................................................... ................ ................ ................ ................ ................

J9291 9 Mitomycin 40 MG inj ......................................................................... ................ ................ ................ ................ ................

J9293 9 Mitoxantrone hydrochl / 5 MG .......................................................... ................ ................ ................ ................ ................

J9320 9 Streptozocin injection ........................................................................ ................ ................ ................ ................ ................

J9340 9 Thiotepa injection .............................................................................. ................ ................ ................ ................ ................

J9350 9 Topotecan ......................................................................................... ................ ................ ................ ................ ................

J9360 9 Vinblastine sulfate inj ........................................................................ ................ ................ ................ ................ ................

J9370 9 Vincristine sulfate 1 MG inj ............................................................... ................ ................ ................ ................ ................

J9375 9 Vincristine sulfate 2 MG inj ............................................................... ................ ................ ................ ................ ................

J9380 9 Vincristine sulfate 5 MG inj ............................................................... ................ ................ ................ ................ ................

J9390 9 Vinorelbine tartrate/10 mg ................................................................ ................ ................ ................ ................ ................

J9600 9 Porfimer sodium ................................................................................ ................ ................ ................ ................ ................

J9999 9 Chemotherapy drug .......................................................................... ................ ................ ................ ................ ................

K0001 6 Standard wheelchair ......................................................................... ................ ................ ................ ................ ................

K0002 6 Stnd hemi (low seat) whlchr ............................................................. ................ ................ ................ ................ ................

K0003 6 Lightweight wheelchair ...................................................................... ................ ................ ................ ................ ................

K0004 6 High strength ltwt whlchr .................................................................. ................ ................ ................ ................ ................

K0005 6 Ultralightweight wheelchair ............................................................... ................ ................ ................ ................ ................

K0006 6 Heavy duty wheelchair ...................................................................... ................ ................ ................ ................ ................

K0007 6 Extra heavy duty wheelchair ............................................................. ................ ................ ................ ................ ................
32453

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

K0008 6 Cstm manual wheelchair/base .......................................................... ................ ................ ................ ................ ................

K0009 6 Other manual wheelchair/base ......................................................... ................ ................ ................ ................ ................

K0010 6 Stnd wt frame power whlchr ............................................................. ................ ................ ................ ................ ................

K0011 6 Stnd wt pwr whlchr w control ............................................................ ................ ................ ................ ................ ................

K0012 6 Ltwt portbl power whlchr ................................................................... ................ ................ ................ ................ ................

K0013 6 Custom power whlchr base .............................................................. ................ ................ ................ ................ ................

K0014 6 Other power whlchr base .................................................................. ................ ................ ................ ................ ................

K0015 6 Detach non-adjus hght armrst .......................................................... ................ ................ ................ ................ ................

K0016 6 Detach adjust armrst cmplete ........................................................... ................ ................ ................ ................ ................

K0017 6 Detach adjust armrest base .............................................................. ................ ................ ................ ................ ................

K0018 6 Detach adjust armrst upper .............................................................. ................ ................ ................ ................ ................

K0019 6 Arm pad each ................................................................................... ................ ................ ................ ................ ................

K0020 6 Fixed adjust armrest pair .................................................................. ................ ................ ................ ................ ................

K0021 6 Anti-tipping device each .................................................................... ................ ................ ................ ................ ................

K0022 6 Reinforced back upholstery .............................................................. ................ ................ ................ ................ ................

K0023 6 Planr back insrt foam w/strp ............................................................. ................ ................ ................ ................ ................

K0024 6 Plnr back insrt foam w/hrdwr ............................................................ ................ ................ ................ ................ ................

K0025 6 Hook-on headrest extension ............................................................. ................ ................ ................ ................ ................

K0026 6 Back upholst lgtwt whlchr ................................................................. ................ ................ ................ ................ ................

K0027 6 Back upholst other whlchr ................................................................ ................ ................ ................ ................ ................

K0028 6 Fully reclining back ........................................................................... ................ ................ ................ ................ ................

K0029 6 Reinforced seat upholstery ............................................................... ................ ................ ................ ................ ................

K0030 6 Solid plnr seat sngl dnsfoam ............................................................ ................ ................ ................ ................ ................

K0031 6 Safety belt/pelvic strap ...................................................................... ................ ................ ................ ................ ................

K0032 6 Seat uphols lgtwt whlchr ................................................................... ................ ................ ................ ................ ................

K0033 6 Seat upholstery other whlchr ............................................................ ................ ................ ................ ................ ................

K0034 6 Heel loop each .................................................................................. ................ ................ ................ ................ ................

K0035 6 Heel loop with ankle strap ................................................................ ................ ................ ................ ................ ................

K0036 6 Toe loop each ................................................................................... ................ ................ ................ ................ ................

K0037 6 High mount flip-up footrest ............................................................... ................ ................ ................ ................ ................

K0038 6 Leg strap each .................................................................................. ................ ................ ................ ................ ................

K0039 6 Leg strap h style each ...................................................................... ................ ................ ................ ................ ................

K0040 6 Adjustable angle footplate ................................................................ ................ ................ ................ ................ ................

K0041 6 Large size footplate each ................................................................. ................ ................ ................ ................ ................

K0042 6 Standard size footplate each ............................................................ ................ ................ ................ ................ ................

K0043 6 Ftrst lower extension tube ................................................................ ................ ................ ................ ................ ................

K0044 6 Ftrst upper hanger bracket ............................................................... ................ ................ ................ ................ ................

K0045 6 Footrest complete assembly ............................................................. ................ ................ ................ ................ ................

K0046 6 Elevat legrst low extension ............................................................... ................ ................ ................ ................ ................

K0047 6 Elevat legrst up hangr brack ............................................................. ................ ................ ................ ................ ................

K0048 6 Elevate legrest complete .................................................................. ................ ................ ................ ................ ................

K0049 6 Calf pad each .................................................................................... ................ ................ ................ ................ ................

K0050 6 Ratchet assembly ............................................................................. ................ ................ ................ ................ ................

K0051 6 Cam relese assem ftrst/lgrst ............................................................. ................ ................ ................ ................ ................

K0052 6 Swingaway detach footrest ............................................................... ................ ................ ................ ................ ................

K0053 6 Elevate footrest articulate ................................................................. ................ ................ ................ ................ ................

K0054 6 Seat wdth 10–12/15/17/20 wc .......................................................... ................ ................ ................ ................ ................

K0055 6 Seat dpth 15/17/18 ltwt wc ............................................................... ................ ................ ................ ................ ................

K0056 6 Seat ht <17 or <=21 ltwt wc ............................................................. ................ ................ ................ ................ ................

K0057 6 Seat wdth 19/20 hvy dty wc ............................................................. ................ ................ ................ ................ ................

K0058 6 Seat dpth 17/18 power wc ................................................................ ................ ................ ................ ................ ................

K0059 6 Plastic coated handrim each ............................................................ ................ ................ ................ ................ ................

K0060 6 Steel handrim each ........................................................................... ................ ................ ................ ................ ................

K0061 6 Aluminum handrim each ................................................................... ................ ................ ................ ................ ................

K0062 6 Handrim 8–10 vert/obliq proj ............................................................ ................ ................ ................ ................ ................

K0063 6 Hndrm 12–16 vert/obliq proj ............................................................. ................ ................ ................ ................ ................

K0064 6 Zero pressure tube flat free .............................................................. ................ ................ ................ ................ ................

K0065 6 Spoke protectors ............................................................................... ................ ................ ................ ................ ................

K0066 6 Solid tire any size each .................................................................... ................ ................ ................ ................ ................

K0067 6 Pneumatic tire any size each ........................................................... ................ ................ ................ ................ ................

K0068 6 Pneumatic tire tube each .................................................................. ................ ................ ................ ................ ................

K0069 6 Rear whl complete solid tire ............................................................. ................ ................ ................ ................ ................

K0070 6 Rear whl compl pneum tire ............................................................... ................ ................ ................ ................ ................

K0071 6 Front castr compl pneum tire ............................................................ ................ ................ ................ ................ ................

K0072 6 Frnt cstr cmpl sem-pneum tir ............................................................ ................ ................ ................ ................ ................

K0073 6 Caster pin lock each ......................................................................... ................ ................ ................ ................ ................

K0074 6 Pneumatic caster tire each ............................................................... ................ ................ ................ ................ ................

K0075 6 Semi-pneumatic caster tire ............................................................... ................ ................ ................ ................ ................

K0076 6 Solid caster tire each ........................................................................ ................ ................ ................ ................ ................

K0077 6 Front caster assem complete ........................................................... ................ ................ ................ ................ ................

K0078 6 Pneumatic caster tire tube ................................................................ ................ ................ ................ ................ ................

K0079 6 Wheel lock extension pair ................................................................. ................ ................ ................ ................ ................

K0080 6 Anti-rollback device pair .................................................................... ................ ................ ................ ................ ................

K0081 6 Wheel lock assembly complete ........................................................ ................ ................ ................ ................ ................
32454

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

K0082 6 22 nf deep cycl acid battery ............................................................. ................ ................ ................ ................ ................

K0083 6 22 nf gel cell battery each ................................................................ ................ ................ ................ ................ ................

K0084 6 Grp 24 deep cycl acid battry ............................................................. ................ ................ ................ ................ ................

K0085 6 Group 24 gel cell battery .................................................................. ................ ................ ................ ................ ................

K0086 6 U–1 lead acid battery each ............................................................... ................ ................ ................ ................ ................

K0087 6 U–1 gel cell battery each .................................................................. ................ ................ ................ ................ ................

K0088 6 Battry chrgr acid/gel cell ................................................................... ................ ................ ................ ................ ................

K0089 6 Battery charger dual mode ............................................................... ................ ................ ................ ................ ................

K0090 6 Rear tire power wheelchair ............................................................... ................ ................ ................ ................ ................

K0091 6 Rear tire tube power whlchr ............................................................. ................ ................ ................ ................ ................

K0092 6 Rear assem cmplt powr whlchr ........................................................ ................ ................ ................ ................ ................

K0093 6 Rear zero pressure tire tube ............................................................. ................ ................ ................ ................ ................

K0094 6 Wheel tire for power base ................................................................ ................ ................ ................ ................ ................

K0095 6 Wheel tire tube each base ................................................................ ................ ................ ................ ................ ................

K0096 6 Wheel assem powr base complt ...................................................... ................ ................ ................ ................ ................

K0097 6 Wheel zero presure tire tube ............................................................ ................ ................ ................ ................ ................

K0098 6 Drive belt power wheelchair ............................................................. ................ ................ ................ ................ ................

K0099 6 Front caster power whelchair ........................................................... ................ ................ ................ ................ ................

K0100 6 Amputee adapter pair ....................................................................... ................ ................ ................ ................ ................

K0101 6 One-arm drive attachment ................................................................ ................ ................ ................ ................ ................

K0102 6 Crutch and cane holder .................................................................... ................ ................ ................ ................ ................

K0103 6 Transfer board < 25′′ ........................................................................ ................ ................ ................ ................ ................

K0104 6 Cylinder tank carrier .......................................................................... ................ ................ ................ ................ ................

K0105 6 Iv hanger ........................................................................................... ................ ................ ................ ................ ................

K0106 6 Arm trough each ............................................................................... ................ ................ ................ ................ ................

K0107 6 Wheelchair tray ................................................................................. ................ ................ ................ ................ ................

K0108 6 Other accessories ............................................................................. ................ ................ ................ ................ ................

K0109 6 Customize whlchr base frame .......................................................... ................ ................ ................ ................ ................

K0112 6 Trunk vest supprt innr frame ............................................................. ................ ................ ................ ................ ................

K0113 6 Trunk vest suprt w/o inr frm .............................................................. ................ ................ ................ ................ ................

K0114 6 Whlchr back suprt inr frame ............................................................. ................ ................ ................ ................ ................

K0115 6 Back module orthotic system ............................................................ ................ ................ ................ ................ ................

K0116 6 Back & seat modul orthot sys ........................................................... ................ ................ ................ ................ ................

K0119 6 Azathioprine oral tab 50 MG ............................................................. ................ ................ ................ ................ ................

K0120 6 Azathioprine prentrl 100 MG ............................................................. ................ ................ ................ ................ ................

K0121 6 Cyclosporine oral 25 MG .................................................................. ................ ................ ................ ................ ................

K0122 6 Cyclosporine prentrl 250 MG ............................................................ ................ ................ ................ ................ ................

K0123 6 Imun/antitymocyt glob 250 MG ......................................................... ................ ................ ................ ................ ................

K0137 6 Skin barrier liquid per oz ................................................................... ................ ................ ................ ................ ................

K0138 6 Skin barrier paste per oz .................................................................. ................ ................ ................ ................ ................

K0139 6 Skin barrier powder per oz ............................................................... ................ ................ ................ ................ ................

K0168 6 Disposable nebulizer set ................................................................... ................ ................ ................ ................ ................

K0169 6 Disposable nebulizer small ............................................................... ................ ................ ................ ................ ................

K0170 6 Non disposable nebulizer set ........................................................... ................ ................ ................ ................ ................

K0171 6 Filtered nebulizer set ........................................................................ ................ ................ ................ ................ ................

K0172 6 Disposable nebulizer unfill ................................................................ ................ ................ ................ ................ ................

K0173 6 Disposable nebulizer prefill ............................................................... ................ ................ ................ ................ ................

K0174 6 Reservoir bottle w nebulizer ............................................................. ................ ................ ................ ................ ................

K0175 6 Disposable corrugated tubing ........................................................... ................ ................ ................ ................ ................

K0176 6 Non dispos corrugated tubing ........................................................... ................ ................ ................ ................ ................

K0177 6 Water collec dev w nebulizer ............................................................ ................ ................ ................ ................ ................

K0178 6 Disposbl filter w compressor ............................................................. ................ ................ ................ ................ ................

K0179 6 Non-dispos filter w/compress ............................................................ ................ ................ ................ ................ ................

K0180 6 Aerosol mask with nebulizer ............................................................. ................ ................ ................ ................ ................

K0181 6 Dome & mouthpiece w/ nebuliz ........................................................ ................ ................ ................ ................ ................

K0182 6 Water distilled w/ nebulizer ............................................................... ................ ................ ................ ................ ................

K0183 6 Nasal application with cpap .............................................................. ................ ................ ................ ................ ................

K0184 6 Nasal pillows/seals pair .................................................................... ................ ................ ................ ................ ................

K0185 6 Headgear with cpap device .............................................................. ................ ................ ................ ................ ................

K0186 6 Chin strap with cpap device ............................................................. ................ ................ ................ ................ ................

K0187 6 Tubing with cpap device ................................................................... ................ ................ ................ ................ ................

K0188 6 Filter disposable with cpap ............................................................... ................ ................ ................ ................ ................

K0189 6 Filter non-disposable w/cpap ............................................................ ................ ................ ................ ................ ................

K0190 6 Disposable canister w/pump ............................................................. ................ ................ ................ ................ ................

K0191 6 Non-disposbl canister w/pump .......................................................... ................ ................ ................ ................ ................

K0192 6 Tubing used w/suction pump ............................................................ ................ ................ ................ ................ ................

K0193 6 Airway pressure dev/w hmdfer ......................................................... ................ ................ ................ ................ ................

K0194 6 Assist device w/humidifier ................................................................. ................ ................ ................ ................ ................

K0195 6 Elevating whlchair leg rests .............................................................. ................ ................ ................ ................ ................

K0268 6 Humidifier with cpap device .............................................................. ................ ................ ................ ................ ................

K0269 6 Aerosol compressor cpap dev .......................................................... ................ ................ ................ ................ ................

K0270 6 Ultrasonic generator w nebul ............................................................ ................ ................ ................ ................ ................

K0277 6 Skin barrier solid 4x4 equiv .............................................................. ................ ................ ................ ................ ................

K0278 6 Skin barrier with flange ..................................................................... ................ ................ ................ ................ ................
32455

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

K0279 6 Skin barrier extended wear ............................................................... ................ ................ ................ ................ ................

K0280 6 Extension drainage tubing ................................................................ ................ ................ ................ ................ ................

K0281 6 Lubricant catheter insertion .............................................................. ................ ................ ................ ................ ................

K0283 6 Saline solution dispenser .................................................................. ................ ................ ................ ................ ................

K0284 6 External infusion pump reuse ........................................................... ................ ................ ................ ................ ................

K0400 6 Skin support attachment each .......................................................... ................ ................ ................ ................ ................

K0401 6 Diabetic deluxe shoe ........................................................................ ................ ................ ................ ................ ................

K0407 6 Urinary cath skin attachment ............................................................ ................ ................ ................ ................ ................

K0408 6 Urinary cath leg strap ....................................................................... ................ ................ ................ ................ ................

K0409 6 Sterile H2O irrigation solut ................................................................ ................ ................ ................ ................ ................

K0410 6 Male ext cath w/adh coating ............................................................. ................ ................ ................ ................ ................

K0411 6 Male ext cath w/adh strip .................................................................. ................ ................ ................ ................ ................

K0412 6 Mycophenolate mofetil 25o mg ......................................................... ................ ................ ................ ................ ................

K0415 6 RX antiemetic drg, oral NOS ............................................................ ................ ................ ................ ................ ................

K0416 6 Rx antiemetic drg, rectal NOS .......................................................... ................ ................ ................ ................ ................

K0417 6 Mech infus pump sht trm drug .......................................................... ................ ................ ................ ................ ................

K0418 6 Oral cyclosporin ................................................................................ ................ ................ ................ ................ ................

K0419 6 Drainable plstic pch w fcplt ............................................................... ................ ................ ................ ................ ................

K0420 6 Drainable rubber pch w fcplt ............................................................. ................ ................ ................ ................ ................

K0421 6 drainable plstic pch w/o fp ................................................................ ................ ................ ................ ................ ................

K0422 6 Drainable rubber pch w/o fp ............................................................. ................ ................ ................ ................ ................

K0423 6 Urinary plstic pouch w fcplt ............................................................... ................ ................ ................ ................ ................

K0424 6 Urinary rubber pouch w fcplt ............................................................. ................ ................ ................ ................ ................

K0425 6 Urinary plstic pouch w/o fp ............................................................... ................ ................ ................ ................ ................

K0426 6 Urinary hvy plstc pch w/o fp ............................................................. ................ ................ ................ ................ ................

K0427 6 Urinary rubber pouch w/o fp ............................................................. ................ ................ ................ ................ ................

K0428 6 Ostomy faceplt/silicone ring .............................................................. ................ ................ ................ ................ ................

K0429 6 Skin barrier solid ext wear ................................................................ ................ ................ ................ ................ ................

K0430 6 Skin barrier w flang ex wear ............................................................. ................ ................ ................ ................ ................

K0431 6 Closed pouch w st wear bar ............................................................. ................ ................ ................ ................ ................

K0432 6 Drainable pch w ex wear bar ............................................................ ................ ................ ................ ................ ................

K0433 6 Drainable pch w st wear bar ............................................................. ................ ................ ................ ................ ................

K0434 6 Drainable pch ex wear convex ......................................................... ................ ................ ................ ................ ................

K0435 6 Urinary pouch w ex wear bar ............................................................ ................ ................ ................ ................ ................

K0436 6 Urinary pouch w st wear bar ............................................................. ................ ................ ................ ................ ................

K0437 6 Urine pch w ex wear bar conv .......................................................... ................ ................ ................ ................ ................

K0438 6 Ostomy pouch liq deodorant ............................................................. ................ ................ ................ ................ ................

K0439 6 Ostomy pouch solid deodorant ......................................................... ................ ................ ................ ................ ................

K0440 6 Nasal prosthesis ............................................................................... ................ ................ ................ ................ ................

K0441 6 Midfacial prosthesis .......................................................................... ................ ................ ................ ................ ................

K0442 6 Orbital prosthesis .............................................................................. ................ ................ ................ ................ ................

K0443 6 Upper facial prosthesis ..................................................................... ................ ................ ................ ................ ................

K0444 6 Hemi-facial prosthesis ....................................................................... ................ ................ ................ ................ ................

K0445 6 Auricular prosthesis .......................................................................... ................ ................ ................ ................ ................

K0446 6 Partial facial prosthesis ..................................................................... ................ ................ ................ ................ ................

K0447 6 Nasal septal prosthesis ..................................................................... ................ ................ ................ ................ ................

K0448 6 Unspec maxillofacial prosth .............................................................. ................ ................ ................ ................ ................

K0449 6 Repair maxillofacial prosth ................................................................ ................ ................ ................ ................ ................

K0450 6 Liq adhes for facial prosth ................................................................ ................ ................ ................ ................ ................

K0451 6 Adhesive remover wipes ................................................................... ................ ................ ................ ................ ................

K0452 6 Wheelchair bearings ......................................................................... ................ ................ ................ ................ ................

K0453 6 Amphotericin B .................................................................................. ................ ................ ................ ................ ................

K0455 6 Pump uninterrupted infusion ............................................................. ................ ................ ................ ................ ................

K0501 6 Aerosol compressor for svneb .......................................................... ................ ................ ................ ................ ................

K0503 6 Acetylcysteine inh sol u d ................................................................. ................ ................ ................ ................ ................

K0504 6 Albuterol inh sol con ......................................................................... ................ ................ ................ ................ ................

K0505 6 Albuterol inh sol u d .......................................................................... ................ ................ ................ ................ ................

K0506 6 Atropine inh sol con .......................................................................... ................ ................ ................ ................ ................

K0507 6 Atropine inh sol u d ........................................................................... ................ ................ ................ ................ ................

K0508 6 Bitolterol mes inh sol con ................................................................. ................ ................ ................ ................ ................

K0509 6 Bitolterol mes inh sol u d .................................................................. ................ ................ ................ ................ ................

K0511 6 Cromolyn sodium inh sol u d ............................................................ ................ ................ ................ ................ ................

K0512 6 Dexamethasone inh sol con ............................................................. ................ ................ ................ ................ ................

K0513 6 Dexamethasone inh sol u d .............................................................. ................ ................ ................ ................ ................

K0514 6 Domase alpha inh sol u d ................................................................. ................ ................ ................ ................ ................

K0515 6 Glycopyrrolate inh sol con ................................................................ ................ ................ ................ ................ ................

K0516 6 Glycopyrrolate inh sol u d ................................................................. ................ ................ ................ ................ ................

K0518 6 Ipratropium brom inh sol u d ............................................................. ................ ................ ................ ................ ................

K0519 6 Isoetharine HCl inh sol con .............................................................. ................ ................ ................ ................ ................

K0520 6 Isoetharine HCl inh sol u d ............................................................... ................ ................ ................ ................ ................

K0521 6 IsoproterenolHCl inh sol con ............................................................ ................ ................ ................ ................ ................

K0522 6 IsoproterenolHCl inh sol u d ............................................................. ................ ................ ................ ................ ................

K0523 6 Metaproterenol inh sol con ............................................................... ................ ................ ................ ................ ................

K0524 6 Metaproterenol inh sol u d ................................................................ ................ ................ ................ ................ ................
32456

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

K0525 6 Terbutaline SO4 inh sol con ............................................................. ................ ................ ................ ................ ................

K0526 6 Terbutaline SO4 inh sol u d .............................................................. ................ ................ ................ ................ ................

K0527 6 Triamcinolone inh sol con ................................................................. ................ ................ ................ ................ ................

K0528 6 Triamcinolone inh sol u d ................................................................. ................ ................ ................ ................ ................

K0529 6 Sterile H20 or nss w lv neb .............................................................. ................ ................ ................ ................ ................

K0530 6 Nebulizer not used w oxygen ........................................................... ................ ................ ................ ................ ................

L0100 6 Cerv craniosten helmet mold ............................................................ ................ ................ ................ ................ ................

L0110 6 Cerv craniostenosis hel non- ............................................................ ................ ................ ................ ................ ................

L0120 6 Cerv flexible non-adjustable ............................................................. ................ ................ ................ ................ ................

L0130 6 Flex thermoplastic collar mo ............................................................. ................ ................ ................ ................ ................

L0140 6 Cervical semi-rigid adjustab .............................................................. ................ ................ ................ ................ ................

L0150 6 Cerv semi-rig adj molded chn ........................................................... ................ ................ ................ ................ ................

L0160 6 Cerv semi-rig wire occ/mand ............................................................ ................ ................ ................ ................ ................

L0170 6 Cervical collar molded to pt .............................................................. ................ ................ ................ ................ ................

L0172 6 Cerv col thermplas foam 2 pi ............................................................ ................ ................ ................ ................ ................

L0174 6 Cerv col foam 2 piece w thor ............................................................ ................ ................ ................ ................ ................

L0180 6 Cer post col occ/man sup adj ........................................................... ................ ................ ................ ................ ................

L0190 6 Cerv collar supp adj cerv ba ............................................................. ................ ................ ................ ................ ................

L0200 6 Cerv col supp adj bar & thor ............................................................. ................ ................ ................ ................ ................

L0210 6 Thoracic rib belt ................................................................................ ................ ................ ................ ................ ................

L0220 6 Thor rib belt custom fabrica .............................................................. ................ ................ ................ ................ ................

L0300 6 TLSO flex surgical support ............................................................... ................ ................ ................ ................ ................

L0310 6 Tlso flexible custom fabrica .............................................................. ................ ................ ................ ................ ................

L0315 6 Tlso flex elas rigid post pa ................................................................ ................ ................ ................ ................ ................

L0317 6 Tlso flex hypext elas post p .............................................................. ................ ................ ................ ................ ................

L0320 6 Tlso a-p contrl w apron frnt .............................................................. ................ ................ ................ ................ ................

L0330 6 Tlso ant-pos-lateral control ............................................................... ................ ................ ................ ................ ................

L0340 6 Tlso a-p-l-rotary with apron ............................................................... ................ ................ ................ ................ ................

L0350 6 Tlso flex compress jacket cu ............................................................ ................ ................ ................ ................ ................

L0360 6 Tlso flex compress jacket mo ........................................................... ................ ................ ................ ................ ................

L0370 6 Tlso a-p-l-rotary hyperexten .............................................................. ................ ................ ................ ................ ................

L0380 6 Tlso a-p-l-rot w/ pos extens .............................................................. ................ ................ ................ ................ ................

L0390 6 Tlso a-p-l control molded .................................................................. ................ ................ ................ ................ ................

L0400 6 Tlso a-p-l w interface mater .............................................................. ................ ................ ................ ................ ................

L0410 6 Tlso a-p-l two piece constr ............................................................... ................ ................ ................ ................ ................

L0420 6 Tlso a-p-l 2 piece w interfa ............................................................... ................ ................ ................ ................ ................

L0430 6 Tlso a-p-l w interface custm ............................................................. ................ ................ ................ ................ ................

L0440 6 Tlso a-p-l overlap frnt cust ................................................................ ................ ................ ................ ................ ................

L0500 6 Lso flex surgical support ................................................................... ................ ................ ................ ................ ................

L0510 6 Lso flexible custom fabricat .............................................................. ................ ................ ................ ................ ................

L0515 6 Lso flex elas w/ rig post pa ............................................................... ................ ................ ................ ................ ................

L0520 6 Lso a-p-l control with apron .............................................................. ................ ................ ................ ................ ................

L0530 6 Lso ant-pos control w apron ............................................................. ................ ................ ................ ................ ................

L0540 6 Lso lumbar flexion a-p-l .................................................................... ................ ................ ................ ................ ................

L0550 6 Lso a-p-l control molded ................................................................... ................ ................ ................ ................ ................

L0560 6 Lso a-p-l w interface ......................................................................... ................ ................ ................ ................ ................

L0565 6 Lso a-p-l control custom ................................................................... ................ ................ ................ ................ ................

L0600 6 Sacroiliac flex surg support .............................................................. ................ ................ ................ ................ ................

L0610 6 Sacroiliac flexible custm fa ............................................................... ................ ................ ................ ................ ................

L0620 6 Sacroiliac semi-rig w apron .............................................................. ................ ................ ................ ................ ................

L0700 6 Ctlso a-p-l control molded ................................................................. ................ ................ ................ ................ ................

L0710 6 Ctlso a-p-l control w/ inter ................................................................. ................ ................ ................ ................ ................

L0810 6 Halo cervical into jckt vest ................................................................ ................ ................ ................ ................ ................

L0820 6 Halo cervical into body jack .............................................................. ................ ................ ................ ................ ................

L0830 6 Halo cerv into milwaukee typ ............................................................ ................ ................ ................ ................ ................

L0860 6 Magnetic resonanc image comp ....................................................... ................ ................ ................ ................ ................

L0900 6 Torso/ptosis support ......................................................................... ................ ................ ................ ................ ................

L0910 6 Torso & ptosis supp custm fa ........................................................... ................ ................ ................ ................ ................

L0920 6 Torso/pendulous abd support ........................................................... ................ ................ ................ ................ ................

L0930 6 Pendulous abdomen supp custm ..................................................... ................ ................ ................ ................ ................

L0940 6 Torso/postsurgical support ................................................................ ................ ................ ................ ................ ................

L0950 6 Post surg support custom fab ........................................................... ................ ................ ................ ................ ................

L0960 6 Post surgical support pads ............................................................... ................ ................ ................ ................ ................

L0970 6 Tlso corset front ................................................................................ ................ ................ ................ ................ ................

L0972 6 Lso corset front ................................................................................. ................ ................ ................ ................ ................

L0974 6 Tlso full corset ................................................................................... ................ ................ ................ ................ ................

L0976 6 Lso full corset .................................................................................... ................ ................ ................ ................ ................

L0978 6 Axillary crutch extension ................................................................... ................ ................ ................ ................ ................

L0980 6 Peroneal straps pair .......................................................................... ................ ................ ................ ................ ................

L0982 6 Stocking supp grips set of f .............................................................. ................ ................ ................ ................ ................

L0984 6 Protective body sock each ................................................................ ................ ................ ................ ................ ................

L0999 6 Add to spinal orthosis NOS .............................................................. ................ ................ ................ ................ ................

L1000 6 Ctlso milwauke initial model ............................................................. ................ ................ ................ ................ ................

L1010 6 Ctlso axilla sling ................................................................................ ................ ................ ................ ................ ................
32457

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L1020 6 Kyphosis pad .................................................................................... ................ ................ ................ ................ ................

L1025 6 Kyphosis pad floating ........................................................................ ................ ................ ................ ................ ................

L1030 6 Lumbar bolster pad ........................................................................... ................ ................ ................ ................ ................

L1040 6 Lumbar or lumbar rib pad ................................................................. ................ ................ ................ ................ ................

L1050 6 Sternal pad ........................................................................................ ................ ................ ................ ................ ................

L1060 6 Thoracic pad ..................................................................................... ................ ................ ................ ................ ................

L1070 6 Trapezius sling .................................................................................. ................ ................ ................ ................ ................

L1080 6 Outrigger ........................................................................................... ................ ................ ................ ................ ................

L1085 6 Outrigger bil w/ vert extens ............................................................... ................ ................ ................ ................ ................

L1090 6 Lumbar sling ..................................................................................... ................ ................ ................ ................ ................

L1100 6 Ring flange plastic/leather ................................................................ ................ ................ ................ ................ ................

L1110 6 Ring flange plas/leather mol ............................................................. ................ ................ ................ ................ ................

L1120 6 Covers for upright each .................................................................... ................ ................ ................ ................ ................

L1200 6 Furnsh initial orthosis only ................................................................ ................ ................ ................ ................ ................

L1210 6 Lateral thoracic extension ................................................................. ................ ................ ................ ................ ................

L1220 6 Anterior thoracic extension ............................................................... ................ ................ ................ ................ ................

L1230 6 Milwaukee type superstructur ........................................................... ................ ................ ................ ................ ................

L1240 6 Lumbar derotation pad ...................................................................... ................ ................ ................ ................ ................

L1250 6 Anterior asis pad ............................................................................... ................ ................ ................ ................ ................

L1260 6 Anterior thoracic derotation ............................................................... ................ ................ ................ ................ ................

L1270 6 Abdominal pad .................................................................................. ................ ................ ................ ................ ................

L1280 6 Rib gusset (elastic) each .................................................................. ................ ................ ................ ................ ................

L1290 6 Lateral trochanteric pad .................................................................... ................ ................ ................ ................ ................

L1300 6 Body jacket mold to patient .............................................................. ................ ................ ................ ................ ................

L1310 6 Post-operative body jacket ............................................................... ................ ................ ................ ................ ................

L1499 6 Spinal orthosis NOS ......................................................................... ................ ................ ................ ................ ................

L1500 6 Thkao mobility frame ........................................................................ ................ ................ ................ ................ ................

L1510 6 Thkao standing frame ....................................................................... ................ ................ ................ ................ ................

L1520 6 Thkao swivel walker .......................................................................... ................ ................ ................ ................ ................

L1600 6 Abduct hip flex frejka w cvr .............................................................. ................ ................ ................ ................ ................

L1610 6 Abduct hip flex frejka covr ................................................................ ................ ................ ................ ................ ................

L1620 6 Abduct hip flex pavlik harne ............................................................. ................ ................ ................ ................ ................

L1630 6 Abduct control hip semi-flex ............................................................. ................ ................ ................ ................ ................

L1640 6 Pelv band/spread bar thigh c ............................................................ ................ ................ ................ ................ ................

L1650 6 HO abduction hip adjustable ............................................................ ................ ................ ................ ................ ................

L1660 6 HO abduction static plastic ............................................................... ................ ................ ................ ................ ................

L1680 6 Pelvic & hip control thigh c ............................................................... ................ ................ ................ ................ ................

L1685 6 Post-op hip abduct custom fa ........................................................... ................ ................ ................ ................ ................

L1686 6 HO post-op hip abduction ................................................................. ................ ................ ................ ................ ................

L1700 6 Leg perthes orth toronto typ ............................................................. ................ ................ ................ ................ ................

L1710 6 Legg perthes orth newington ............................................................ ................ ................ ................ ................ ................

L1720 6 Legg perthes orthosis trilat ............................................................... ................ ................ ................ ................ ................

L1730 6 Legg perthes orth scottish r .............................................................. ................ ................ ................ ................ ................

L1750 6 Legg perthes sling ............................................................................ ................ ................ ................ ................ ................

L1755 6 Legg perthes patten bottom t ........................................................... ................ ................ ................ ................ ................

L1800 6 Knee orthoses elas w stays .............................................................. ................ ................ ................ ................ ................

L1810 6 Ko elastic with joints ......................................................................... ................ ................ ................ ................ ................

L1815 6 Elastic with condylar pads ................................................................ ................ ................ ................ ................ ................

L1820 6 Ko elas w/ condyle pads & jo ........................................................... ................ ................ ................ ................ ................

L1825 6 Ko elastic knee cap .......................................................................... ................ ................ ................ ................ ................

L1830 6 Ko immobilizer canvas longit ............................................................ ................ ................ ................ ................ ................

L1832 6 KO adj jnt pos rigid support .............................................................. ................ ................ ................ ................ ................

L1834 6 Ko w/0 joint rigid molded to .............................................................. ................ ................ ................ ................ ................

L1840 6 Ko derot ant cruciate custom ............................................................ ................ ................ ................ ................ ................

L1843 6 KO single upright custom fit ............................................................. ................ ................ ................ ................ ................

L1844 6 Ko w/adj jt rot cntrl molded ............................................................... ................ ................ ................ ................ ................

L1845 6 Ko w/ adj flex/ext rotat cus ............................................................... ................ ................ ................ ................ ................

L1846 6 Ko w adj flex/ext rotat mold .............................................................. ................ ................ ................ ................ ................

L1850 6 Ko swedish type ................................................................................ ................ ................ ................ ................ ................

L1855 6 Ko plas doub upright jnt mol ............................................................. ................ ................ ................ ................ ................

L1858 6 Ko polycentric pneumatic pad .......................................................... ................ ................ ................ ................ ................

L1860 6 Ko supracondylar socket mold ......................................................... ................ ................ ................ ................ ................

L1870 6 Ko doub upright lacers molde ........................................................... ................ ................ ................ ................ ................

L1880 6 Ko doub upright cuffs/lacers ............................................................. ................ ................ ................ ................ ................

L1885 6 Knee upright w/resistance ................................................................ ................ ................ ................ ................ ................

L1900 6 Afo sprng wir drsflx calf bd ............................................................... ................ ................ ................ ................ ................

L1902 6 Afo ankle gauntlet ............................................................................. ................ ................ ................ ................ ................

L1904 6 Afo molded ankle gauntlet ................................................................ ................ ................ ................ ................ ................

L1906 6 Afo multiligamentus ankle su ............................................................ ................ ................ ................ ................ ................

L1910 6 Afo sing bar clasp attach sh ............................................................. ................ ................ ................ ................ ................

L1920 6 Afo sing upright w/ adjust s .............................................................. ................ ................ ................ ................ ................

L1930 6 Afo plastic ......................................................................................... ................ ................ ................ ................ ................

L1940 6 Afo molded to patient plasti .............................................................. ................ ................ ................ ................ ................

L1945 6 Afo molded plas rig ant tib ................................................................ ................ ................ ................ ................ ................
32458

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L1950 6 Afo spiral molded to pt plas .............................................................. ................ ................ ................ ................ ................

L1960 6 Afo pos solid ank plastic mo ............................................................. ................ ................ ................ ................ ................

L1970 6 Afo plastic molded w/ankle j ............................................................. ................ ................ ................ ................ ................

L1980 6 Afo sing solid stirrup calf .................................................................. ................ ................ ................ ................ ................

L1990 6 Afo doub solid stirrup calf ................................................................. ................ ................ ................ ................ ................

L2000 6 Kafo sing fre stirr thi/calf ................................................................... ................ ................ ................ ................ ................

L2010 6 Kafo sng solid stirrup w/o j ............................................................... ................ ................ ................ ................ ................

L2020 6 Kafo dbl solid stirrup band/ ............................................................... ................ ................ ................ ................ ................

L2030 6 Kafo dbl solid stirrup w/o j ................................................................ ................ ................ ................ ................ ................

L2035 6 KAFO plastic pediatric size ............................................................... ................ ................ ................ ................ ................

L2036 6 Kafo plas doub free knee mol .......................................................... ................ ................ ................ ................ ................

L2037 6 Kafo plas sing free knee mol ............................................................ ................ ................ ................ ................ ................

L2038 6 Kafo w/o joint multi-axis an ............................................................... ................ ................ ................ ................ ................

L2039 6 KAFO, plstic, medlat rotat con .......................................................... ................ ................ ................ ................ ................

L2040 6 Hkafo torsion bil rot straps ................................................................ ................ ................ ................ ................ ................

L2050 6 Hkafo torsion cable hip pelv ............................................................. ................ ................ ................ ................ ................

L2060 6 Hkafo torsion ball bearing j ............................................................... ................ ................ ................ ................ ................

L2070 6 Hkafo torsion unilat rot str ................................................................ ................ ................ ................ ................ ................

L2080 6 Hkafo unilat torsion cable ................................................................. ................ ................ ................ ................ ................

L2090 6 Hkafo unilat torsion ball br ................................................................ ................ ................ ................ ................ ................

L2102 6 Afo tibial fx cast plstr mol ................................................................. ................ ................ ................ ................ ................

L2104 6 Afo tib fx cast synthetic mo .............................................................. ................ ................ ................ ................ ................

L2106 6 Afo tib fx cast plaster mold ............................................................... ................ ................ ................ ................ ................

L2108 6 Afo tib fx cast molded to pt ............................................................... ................ ................ ................ ................ ................

L2112 6 Afo tibial fracture soft ........................................................................ ................ ................ ................ ................ ................

L2114 6 Afo tib fx semi-rigid ........................................................................... ................ ................ ................ ................ ................

L2116 6 Afo tibial fracture rigid ....................................................................... ................ ................ ................ ................ ................

L2122 6 Kafo fem fx cast plaster mol ............................................................. ................ ................ ................ ................ ................

L2124 6 Kafo fem fx cast synthet mol ............................................................ ................ ................ ................ ................ ................

L2126 6 Kafo fem fx cast thermoplas ............................................................. ................ ................ ................ ................ ................

L2128 6 Kafo fem fx cast molded to p ........................................................... ................ ................ ................ ................ ................

L2132 6 Kafo femoral fx cast soft ................................................................... ................ ................ ................ ................ ................

L2134 6 Kafo fem fx cast semi-rigid ............................................................... ................ ................ ................ ................ ................

L2136 6 Kafo femoral fx cast rigid .................................................................. ................ ................ ................ ................ ................

L2180 6 Plas shoe insert w ank joint .............................................................. ................ ................ ................ ................ ................

L2182 6 Drop lock knee .................................................................................. ................ ................ ................ ................ ................

L2184 6 Limited motion knee joint .................................................................. ................ ................ ................ ................ ................

L2186 6 Adj motion knee jnt lerman t ............................................................. ................ ................ ................ ................ ................

L2188 6 Quadrilateral brim ............................................................................. ................ ................ ................ ................ ................

L2190 6 Waist belt .......................................................................................... ................ ................ ................ ................ ................

L2192 6 Pelvic band & belt thigh fla ............................................................... ................ ................ ................ ................ ................

L2200 6 Limited ankle motion ea jnt ............................................................... ................ ................ ................ ................ ................

L2210 6 Dorsiflexion assist each joi ............................................................... ................ ................ ................ ................ ................

L2220 6 Dorsi & plantar flex ass/res .............................................................. ................ ................ ................ ................ ................

L2230 6 Split flat caliper stirr & p ................................................................... ................ ................ ................ ................ ................

L2240 6 Round caliper and plate atta ............................................................ ................ ................ ................ ................ ................

L2250 6 Foot plate molded stirrup at .............................................................. ................ ................ ................ ................ ................

L2260 6 Reinforced solid stirrup ..................................................................... ................ ................ ................ ................ ................

L2265 6 Long tongue stirrup ........................................................................... ................ ................ ................ ................ ................

L2270 6 Varus/valgus strap padded/li ............................................................ ................ ................ ................ ................ ................

L2275 6 Plastic mod low ext pad/line ............................................................. ................ ................ ................ ................ ................

L2280 6 Molded inner boot ............................................................................. ................ ................ ................ ................ ................

L2300 6 Abduction bar jointed adjust ............................................................. ................ ................ ................ ................ ................

L2310 6 Abduction bar-straight ....................................................................... ................ ................ ................ ................ ................

L2320 6 Non-molded lacer .............................................................................. ................ ................ ................ ................ ................

L2330 6 Lacer molded to patient mode .......................................................... ................ ................ ................ ................ ................

L2335 6 Anterior swing band .......................................................................... ................ ................ ................ ................ ................

L2340 6 Pre-tibial shell molded to p ............................................................... ................ ................ ................ ................ ................

L2350 6 Prosthetic type socket molde ............................................................ ................ ................ ................ ................ ................

L2360 6 Extended steel shank ....................................................................... ................ ................ ................ ................ ................

L2370 6 Patten bottom .................................................................................... ................ ................ ................ ................ ................

L2375 6 Torsion ank & half solid sti ............................................................... ................ ................ ................ ................ ................

L2380 6 Torsion straight knee joint ................................................................ ................ ................ ................ ................ ................

L2385 6 Straight knee joint heavy du ............................................................. ................ ................ ................ ................ ................

L2390 6 Offset knee joint each ....................................................................... ................ ................ ................ ................ ................

L2395 6 Offset knee joint heavy duty ............................................................. ................ ................ ................ ................ ................

L2397 6 Suspension sleeve lower ext ............................................................ ................ ................ ................ ................ ................

L2405 6 Knee joint drop lock ea jnt ................................................................ ................ ................ ................ ................ ................

L2415 6 Knee joint cam lock each joi ............................................................. ................ ................ ................ ................ ................

L2425 6 Knee disc/dial lock/adj flex ............................................................... ................ ................ ................ ................ ................

L2430 6 Knee jnt ratchet lock ea jnt ............................................................... ................ ................ ................ ................ ................

L2435 6 Knee joint polycentric joint ................................................................ ................ ................ ................ ................ ................

L2492 6 Knee lift loop drop lock rin ................................................................ ................ ................ ................ ................ ................

L2500 6 Thi/glut/ischia wgt bearing ................................................................ ................ ................ ................ ................ ................
32459

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L2510 6 Th/wght bear quad-lat brim m .......................................................... ................ ................ ................ ................ ................

L2520 6 Th/wght bear quad-lat brim c ............................................................ ................ ................ ................ ................ ................

L2525 6 Th/wght bear nar m-l brim mo .......................................................... ................ ................ ................ ................ ................

L2526 6 Th/wght bear nar m-l brim cu ........................................................... ................ ................ ................ ................ ................

L2530 6 Thigh/wght bear lacer non-mo .......................................................... ................ ................ ................ ................ ................

L2540 6 Thigh/wght bear lacer molded .......................................................... ................ ................ ................ ................ ................

L2550 6 Thigh/wght bear high roll cu ............................................................. ................ ................ ................ ................ ................

L2570 6 Hip clevis type 2 posit jnt .................................................................. ................ ................ ................ ................ ................

L2580 6 Pelvic control pelvic sling .................................................................. ................ ................ ................ ................ ................

L2600 6 Hip clevis/thrust bearing fr ................................................................ ................ ................ ................ ................ ................

L2610 6 Hip clevis/thrust bearing lo ............................................................... ................ ................ ................ ................ ................

L2620 6 Pelvic control hip heavy dut .............................................................. ................ ................ ................ ................ ................

L2622 6 Hip joint adjustable flexion ................................................................ ................ ................ ................ ................ ................

L2624 6 Hip adj flex ext abduct cont .............................................................. ................ ................ ................ ................ ................

L2627 6 Plastic mold recipro hip & c .............................................................. ................ ................ ................ ................ ................

L2628 6 Metal frame recipro hip & ca ............................................................ ................ ................ ................ ................ ................

L2630 6 Pelvic control band & belt u .............................................................. ................ ................ ................ ................ ................

L2640 6 Pelvic control band & belt b .............................................................. ................ ................ ................ ................ ................

L2650 6 Pelv & thor control gluteal ................................................................ ................ ................ ................ ................ ................

L2660 6 Thoracic control thoracic ba ............................................................. ................ ................ ................ ................ ................

L2670 6 Thorac cont paraspinal uprig ............................................................ ................ ................ ................ ................ ................

L2680 6 Thorac cont lat support upri .............................................................. ................ ................ ................ ................ ................

L2750 6 Plating chrome/nickel pr bar ............................................................. ................ ................ ................ ................ ................

L2755 6 Carbon graphite lamination ............................................................... ................ ................ ................ ................ ................

L2760 6 Extension per extension per ............................................................. ................ ................ ................ ................ ................

L2770 6 Low ext orthosis per bar/jnt .............................................................. ................ ................ ................ ................ ................

L2780 6 Non-corrosive finish .......................................................................... ................ ................ ................ ................ ................

L2785 6 Drop lock retainer each .................................................................... ................ ................ ................ ................ ................

L2795 6 Knee control full kneecap ................................................................. ................ ................ ................ ................ ................

L2800 6 Knee cap medial or lateral p ............................................................ ................ ................ ................ ................ ................

L2810 6 Knee control condylar pad ................................................................ ................ ................ ................ ................ ................

L2820 6 Soft interface below knee se ............................................................ ................ ................ ................ ................ ................

L2830 6 Soft interface above knee se ............................................................ ................ ................ ................ ................ ................

L2840 6 Tibial length sock fx or equ .............................................................. ................ ................ ................ ................ ................

L2850 6 Femoral lgth sock fx or equa ............................................................ ................ ................ ................ ................ ................

L2860 6 Torsion mechanism knee/ankle ........................................................ ................ ................ ................ ................ ................

L2999 6 Lower extremity orthosis NOS .......................................................... ................ ................ ................ ................ ................

L3000 6 Ft insert ucb berkeley shell ............................................................... ................ ................ ................ ................ ................

L3001 6 Foot insert remov molded spe .......................................................... ................ ................ ................ ................ ................

L3002 6 Foot insert plastazote or eq .............................................................. ................ ................ ................ ................ ................

L3003 6 Foot insert silicone gel eac ............................................................... ................ ................ ................ ................ ................

L3010 6 Foot longitudinal arch suppo ............................................................ ................ ................ ................ ................ ................

L3020 6 Foot longitud/metatarsal sup ............................................................ ................ ................ ................ ................ ................

L3030 6 Foot arch support remov prem ......................................................... ................ ................ ................ ................ ................

L3040 6 Ft arch suprt premold longit .............................................................. ................ ................ ................ ................ ................

L3050 6 Foot arch supp premold metat ......................................................... ................ ................ ................ ................ ................

L3060 6 Foot arch supp longitud/meta ........................................................... ................ ................ ................ ................ ................

L3070 6 Arch suprt att to sho longit ............................................................... ................ ................ ................ ................ ................

L3080 6 Arch supp att to shoe metata ........................................................... ................ ................ ................ ................ ................

L3090 6 Arch supp att to shoe long/m ........................................................... ................ ................ ................ ................ ................

L3100 6 Hallus-valgus nght dynamic s ........................................................... ................ ................ ................ ................ ................

L3140 6 Abduction rotation bar shoe .............................................................. ................ ................ ................ ................ ................

L3150 6 Abduct rotation bar w/o shoe ............................................................ ................ ................ ................ ................ ................

L3160 6 Shoe styled positioning dev .............................................................. ................ ................ ................ ................ ................

L3170 6 Foot plastic heel stabilizer ................................................................ ................ ................ ................ ................ ................

L3201 6 Oxford w supinat/pronat inf ............................................................... ................ ................ ................ ................ ................

L3202 6 Oxford w/ supinat/pronator c ............................................................ ................ ................ ................ ................ ................

L3203 6 Oxford w/ supinator/pronator ............................................................ ................ ................ ................ ................ ................

L3204 6 Hightop w/ supp/pronator inf ............................................................. ................ ................ ................ ................ ................

L3206 6 Hightop w/ supp/pronator chi ............................................................ ................ ................ ................ ................ ................

L3207 6 Hightop w/ supp/pronator jun ............................................................ ................ ................ ................ ................ ................

L3208 6 Surgical boot each infant .................................................................. ................ ................ ................ ................ ................

L3209 6 Surgical boot each child ................................................................... ................ ................ ................ ................ ................

L3211 6 Surgical boot each junior .................................................................. ................ ................ ................ ................ ................

L3212 6 Benesch boot pair infant ................................................................... ................ ................ ................ ................ ................

L3213 6 Benesch boot pair child .................................................................... ................ ................ ................ ................ ................

L3214 6 Benesch boot pair junior ................................................................... ................ ................ ................ ................ ................

L3215 6 Orthopedic ftwear ladies oxf ............................................................. ................ ................ ................ ................ ................

L3216 6 Orthoped ladies shoes dpth i ............................................................ ................ ................ ................ ................ ................

L3217 6 Ladies shoes hightop depth i ............................................................ ................ ................ ................ ................ ................

L3218 6 Ladies surgical boot each ................................................................. ................ ................ ................ ................ ................

L3219 6 Orthopedic mens shoes oxford ......................................................... ................ ................ ................ ................ ................

L3221 6 Orthopedic mens shoes dpth i .......................................................... ................ ................ ................ ................ ................

L3222 6 Mens shoes hightop depth inl ........................................................... ................ ................ ................ ................ ................
32460

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L3223 6 Mens surgical boot each ................................................................... ................ ................ ................ ................ ................

L3224 6 Woman’s shoe oxford brace ............................................................. ................ ................ ................ ................ ................

L3225 6 Man’s shoe oxford brace .................................................................. ................ ................ ................ ................ ................

L3230 6 Custom shoes depth inlay ................................................................ ................ ................ ................ ................ ................

L3250 6 Custom mold shoe remov prost ....................................................... ................ ................ ................ ................ ................

L3251 6 Shoe molded to pt silicone s ............................................................ ................ ................ ................ ................ ................

L3252 6 Shoe molded plastazote cust ........................................................... ................ ................ ................ ................ ................

L3253 6 Shoe molded plastazote cust ........................................................... ................ ................ ................ ................ ................

L3254 6 Orth foot non-stndard size/w ............................................................ ................ ................ ................ ................ ................

L3255 6 Orth foot non-standard size/ ............................................................. ................ ................ ................ ................ ................

L3257 6 Orth foot add charge split s .............................................................. ................ ................ ................ ................ ................

L3260 6 Ambulatory surgical boot eac ........................................................... ................ ................ ................ ................ ................

L3265 6 Plastazote sandal each ..................................................................... ................ ................ ................ ................ ................

L3300 6 Sho lift taper to metatarsal ............................................................... ................ ................ ................ ................ ................

L3310 6 Shoe lift elev heel/sole neo .............................................................. ................ ................ ................ ................ ................

L3320 6 Shoe lift elev heel/sole cor ............................................................... ................ ................ ................ ................ ................

L3330 6 Lifts elevation metal extens .............................................................. ................ ................ ................ ................ ................

L3332 6 Shoe lifts tapered to one-ha ............................................................. ................ ................ ................ ................ ................

L3334 6 Shoe lifts elevation heel /i ................................................................. ................ ................ ................ ................ ................

L3340 6 Shoe wedge sach ............................................................................. ................ ................ ................ ................ ................

L3350 6 Shoe heel wedge .............................................................................. ................ ................ ................ ................ ................

L3360 6 Shoe sole wedge outside sole .......................................................... ................ ................ ................ ................ ................

L3370 6 Shoe sole wedge between sole ........................................................ ................ ................ ................ ................ ................

L3380 6 Shoe clubfoot wedge ........................................................................ ................ ................ ................ ................ ................

L3390 6 Shoe outflare wedge ......................................................................... ................ ................ ................ ................ ................

L3400 6 Shoe metatarsal bar wedge ro ......................................................... ................ ................ ................ ................ ................

L3410 6 Shoe metatarsal bar between ........................................................... ................ ................ ................ ................ ................

L3420 6 Full sole/heel wedge btween ............................................................ ................ ................ ................ ................ ................

L3430 6 Sho heel count plast reinfor .............................................................. ................ ................ ................ ................ ................

L3440 6 Heel leather reinforced ..................................................................... ................ ................ ................ ................ ................

L3450 6 Shoe heel sach cushion type ........................................................... ................ ................ ................ ................ ................

L3455 6 Shoe heel new leather standa .......................................................... ................ ................ ................ ................ ................

L3460 6 Shoe heel new rubber standar ......................................................... ................ ................ ................ ................ ................

L3465 6 Shoe heel thomas with wedge ......................................................... ................ ................ ................ ................ ................

L3470 6 Shoe heel thomas extend to b ......................................................... ................ ................ ................ ................ ................

L3480 6 Shoe heel pad & depress for ............................................................ ................ ................ ................ ................ ................

L3485 6 Shoe heel pad removable for ........................................................... ................ ................ ................ ................ ................

L3500 6 Shoe misc add insole leather ........................................................... ................ ................ ................ ................ ................

L3510 6 Shoe misc addition insole ru ............................................................ ................ ................ ................ ................ ................

L3520 6 Shoe insole felt cver w/ lea .............................................................. ................ ................ ................ ................ ................

L3530 6 Shoe misc additions sole hal ............................................................ ................ ................ ................ ................ ................

L3540 6 Shoe misc additions sole ful ............................................................. ................ ................ ................ ................ ................

L3550 6 Shoe misc add toe tap standa .......................................................... ................ ................ ................ ................ ................

L3560 6 Shoe misc add toe tap horses .......................................................... ................ ................ ................ ................ ................

L3570 6 Shoe special extension to in ............................................................. ................ ................ ................ ................ ................

L3580 6 Shoe convert instep velcro c ............................................................ ................ ................ ................ ................ ................

L3590 6 Shoe convert firm to soft cn ............................................................. ................ ................ ................ ................ ................

L3595 6 Shoe misc additions march ba ......................................................... ................ ................ ................ ................ ................

L3600 6 Trans shoe calip plate exist .............................................................. ................ ................ ................ ................ ................

L3610 6 Trans shoe caliper plate new ........................................................... ................ ................ ................ ................ ................

L3620 6 Trans shoe solid stirrup exi .............................................................. ................ ................ ................ ................ ................

L3630 6 Trans shoe solid stirrup new ............................................................ ................ ................ ................ ................ ................

L3640 6 Shoe dennis browne splint bo .......................................................... ................ ................ ................ ................ ................

L3649 6 Unlist proc orth shoe modif/ .............................................................. ................ ................ ................ ................ ................

L3650 6 Shlder fig 8 abduct restrain .............................................................. ................ ................ ................ ................ ................

L3660 6 Abduct restrainer canvas&web ......................................................... ................ ................ ................ ................ ................

L3670 6 Acromio/clavicular canvas&we ......................................................... ................ ................ ................ ................ ................

L3700 6 Elbow orthoses elas w stays ............................................................ ................ ................ ................ ................ ................

L3710 6 Elbow elastic with metal joi ............................................................... ................ ................ ................ ................ ................

L3720 6 Forearm/arm cuffs free motio ........................................................... ................ ................ ................ ................ ................

L3730 6 Forearm/arm cuffs ext/flex a ............................................................. ................ ................ ................ ................ ................

L3740 6 Cuffs adj lock w/ active con .............................................................. ................ ................ ................ ................ ................

L3800 6 Whfo short opponen no attach ......................................................... ................ ................ ................ ................ ................

L3805 6 Whfo long opponens no attach ......................................................... ................ ................ ................ ................ ................

L3810 6 Whfo thumb abduction bar ............................................................... ................ ................ ................ ................ ................

L3815 6 Whfo second m.p. abduction a ......................................................... ................ ................ ................ ................ ................

L3820 6 Whfo ip ext asst w/ mp ext s ............................................................ ................ ................ ................ ................ ................

L3825 6 Whfo m.p. extension stop ................................................................. ................ ................ ................ ................ ................

L3830 6 Whfo m.p. extension assist ............................................................... ................ ................ ................ ................ ................

L3835 6 Whfo m.p. spring extension a ........................................................... ................ ................ ................ ................ ................

L3840 6 Whfo spring swivel thumb ................................................................. ................ ................ ................ ................ ................

L3845 6 Whfo thumb ip ext ass w/ mp ........................................................... ................ ................ ................ ................ ................

L3850 6 Action wrist w/ dorsiflex as ............................................................... ................ ................ ................ ................ ................

L3855 6 Whfo adj m.p. flexion contro ............................................................. ................ ................ ................ ................ ................
32461

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L3860 6 Whfo adj m.p. flex ctrl & i. ................................................................ ................ ................ ................ ................ ................

L3890 6 Torsion mechanism wrist/elbo .......................................................... ................ ................ ................ ................ ................

L3900 6 Hinge extension/flex wrist/f ............................................................... ................ ................ ................ ................ ................

L3901 6 Hinge ext/flex wrist finger ................................................................. ................ ................ ................ ................ ................

L3902 6 Whfo ext power compress gas ......................................................... ................ ................ ................ ................ ................

L3904 6 Whfo electric custom fitted ............................................................... ................ ................ ................ ................ ................

L3906 6 Wrist gauntlet molded to pt ............................................................... ................ ................ ................ ................ ................

L3907 6 Whfo wrst gauntlt thmb spica ........................................................... ................ ................ ................ ................ ................

L3908 6 Wrist cock-up non-molded ................................................................ ................ ................ ................ ................ ................

L3910 6 Whfo swanson design ....................................................................... ................ ................ ................ ................ ................

L3912 6 Flex glove w/elastic finger ................................................................ ................ ................ ................ ................ ................

L3914 6 WHO wrist extension cock-up .......................................................... ................ ................ ................ ................ ................

L3916 6 Whfo wrist extens w/ outrigg ............................................................ ................ ................ ................ ................ ................

L3918 6 HFO knuckle bender ......................................................................... ................ ................ ................ ................ ................

L3920 6 Knuckle bender with outrigge ........................................................... ................ ................ ................ ................ ................

L3922 6 Knuckle bend 2 seg to flex j ............................................................. ................ ................ ................ ................ ................

L3924 6 Oppenheimer .................................................................................... ................ ................ ................ ................ ................

L3926 6 Thomas suspension .......................................................................... ................ ................ ................ ................ ................

L3928 6 Finger extension w/ clock sp ............................................................ ................ ................ ................ ................ ................

L3930 6 Finger extension with wrist ............................................................... ................ ................ ................ ................ ................

L3932 6 Safety pin spring wire ....................................................................... ................ ................ ................ ................ ................

L3934 6 Safety pin modified ........................................................................... ................ ................ ................ ................ ................

L3936 6 Palmer ............................................................................................... ................ ................ ................ ................ ................

L3938 6 Dorsal wrist ....................................................................................... ................ ................ ................ ................ ................

L3940 6 Dorsal wrist w/ outrigger at ............................................................... ................ ................ ................ ................ ................

L3942 6 Reverse knuckle bender ................................................................... ................ ................ ................ ................ ................

L3944 6 Reverse knuckle bend w/ outr .......................................................... ................ ................ ................ ................ ................

L3946 6 HFO composite elastic ...................................................................... ................ ................ ................ ................ ................

L3948 6 Finger knuckle bender ...................................................................... ................ ................ ................ ................ ................

L3950 6 Oppenheimer w/ knuckle bend ......................................................... ................ ................ ................ ................ ................

L3952 6 Oppenheimer w/ rev knuckle 2 ......................................................... ................ ................ ................ ................ ................

L3954 6 Spreading hand ................................................................................. ................ ................ ................ ................ ................

L3956 6 Add. joint upper ext orthosis ............................................................. ................ ................ ................ ................ ................

L3960 6 Sewho airplan desig abdu pos ......................................................... ................ ................ ................ ................ ................

L3962 6 Sewho erbs palsey design abd ........................................................ ................ ................ ................ ................ ................

L3963 6 Molded w/ articulating elbow ............................................................ ................ ................ ................ ................ ................

L3964 6 Seo mobile arm sup att to wc ........................................................... ................ ................ ................ ................ ................

L3965 6 Arm supp att to wc rancho ty ............................................................ ................ ................ ................ ................ ................

L3966 6 Mobile arm supports reclinin ............................................................. ................ ................ ................ ................ ................

L3968 6 Friction dampening arm supp ........................................................... ................ ................ ................ ................ ................

L3969 6 Monosuspension arm/hand supp ...................................................... ................ ................ ................ ................ ................

L3970 6 Elevat proximal arm support ............................................................. ................ ................ ................ ................ ................

L3972 6 Offset/lat rocker arm w/ ela .............................................................. ................ ................ ................ ................ ................

L3974 6 Mobile arm support supinator ........................................................... ................ ................ ................ ................ ................

L3980 6 Upp ext fx orthosis humeral .............................................................. ................ ................ ................ ................ ................

L3982 6 Upper ext fx orthosis rad/ul .............................................................. ................ ................ ................ ................ ................

L3984 6 Upper ext fx orthosis wrist ................................................................ ................ ................ ................ ................ ................

L3985 6 Forearm hand fx orth w/ wr h ........................................................... ................ ................ ................ ................ ................

L3986 6 Humeral rad/ulna wrist fx or ............................................................. ................ ................ ................ ................ ................

L3995 6 Sock fracture or equal each ............................................................. ................ ................ ................ ................ ................

L3999 6 Upper limb orthosis NOS .................................................................. ................ ................ ................ ................ ................

L4000 6 Repl girdle milwaukee orth ............................................................... ................ ................ ................ ................ ................

L4010 6 Replace trilateral socket br ............................................................... ................ ................ ................ ................ ................

L4020 6 Replace quadlat socket brim ............................................................ ................ ................ ................ ................ ................

L4030 6 Replace socket brim cust fit ............................................................. ................ ................ ................ ................ ................

L4040 6 Replace molded thigh lacer .............................................................. ................ ................ ................ ................ ................

L4045 6 Replace non-molded thigh lac .......................................................... ................ ................ ................ ................ ................

L4050 6 Replace molded calf lacer ................................................................ ................ ................ ................ ................ ................

L4055 6 Replace non-molded calf lace .......................................................... ................ ................ ................ ................ ................

L4060 6 Replace high roll cuff ........................................................................ ................ ................ ................ ................ ................

L4070 6 Replace prox & dist upright .............................................................. ................ ................ ................ ................ ................

L4080 6 Repl met band kafo-afo prox ............................................................ ................ ................ ................ ................ ................

L4090 6 Repl met band kafo-afo calf/ ............................................................ ................ ................ ................ ................ ................

L4100 6 Repl leath cuff kafo prox th .............................................................. ................ ................ ................ ................ ................

L4110 6 Repl leath cuff kafo-afo cal ............................................................... ................ ................ ................ ................ ................

L4130 6 Replace pretibial shell ....................................................................... ................ ................ ................ ................ ................

L4205 6 Ortho dvc repair per 15 min ............................................................. ................ ................ ................ ................ ................

L4210 6 Orth dev repair/repl minor p ............................................................. ................ ................ ................ ................ ................

L4310 6 Mult-podus/eq orth prep mgmt ......................................................... ................ ................ ................ ................ ................

L4320 6 Low ext mgmt sys ft pos afo ............................................................. ................ ................ ................ ................ ................

L4350 6 Pneumatic ankle cntrl splint .............................................................. ................ ................ ................ ................ ................

L4360 6 Pneumatic walking splint .................................................................. ................ ................ ................ ................ ................

L4370 6 Pneumatic full leg splint .................................................................... ................ ................ ................ ................ ................

L4380 6 Pneumatic knee splint ....................................................................... ................ ................ ................ ................ ................
32462

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L4390 6 Replace multi-podus splint ................................................................ ................ ................ ................ ................ ................

L4392 6 Replace ankle contrac splint ............................................................. ................ ................ ................ ................ ................

L4394 6 Replace foot drop splint .................................................................... ................ ................ ................ ................ ................

L4396 6 Ankle contracture splint .................................................................... ................ ................ ................ ................ ................

L4398 6 Foot drop splint recumbent ............................................................... ................ ................ ................ ................ ................

L5000 6 Sho insert w arch toe filler ................................................................ ................ ................ ................ ................ ................

L5010 6 Mold socket ank hgt w/ toe f ............................................................. ................ ................ ................ ................ ................

L5020 6 Tibial tubercle hgt w/ toe f ................................................................ ................ ................ ................ ................ ................

L5050 6 Ank symes mold sckt sach ft ............................................................ ................ ................ ................ ................ ................

L5060 6 Symes met fr leath socket ar ............................................................ ................ ................ ................ ................ ................

L5100 6 Molded socket shin sach foot ........................................................... ................ ................ ................ ................ ................

L5105 6 Plast socket jts/thgh lacer ................................................................. ................ ................ ................ ................ ................

L5150 6 Mold sckt ext knee shin sach ........................................................... ................ ................ ................ ................ ................

L5160 6 Mold socket bent knee shin s ........................................................... ................ ................ ................ ................ ................

L5200 6 Kne sing axis fric shin sach .............................................................. ................ ................ ................ ................ ................

L5210 6 No knee/ankle joints w/ ft b .............................................................. ................ ................ ................ ................ ................

L5220 6 No knee joint with artic ali ................................................................ ................ ................ ................ ................ ................

L5230 6 Fem focal defic constant fri .............................................................. ................ ................ ................ ................ ................

L5250 6 Hip canad sing axi cons fric ............................................................. ................ ................ ................ ................ ................

L5270 6 Tilt table locking hip sing .................................................................. ................ ................ ................ ................ ................

L5280 6 Hemipelvect canad sing axis ............................................................ ................ ................ ................ ................ ................

L5300 6 Bk sach soft cover & finish ............................................................... ................ ................ ................ ................ ................

L5310 6 Knee disart sach soft cv/fin .............................................................. ................ ................ ................ ................ ................

L5320 6 Ak open end sach soft cv/fin ............................................................ ................ ................ ................ ................ ................

L5330 6 Hip canadian sach sft cv/fin .............................................................. ................ ................ ................ ................ ................

L5340 6 Hemipelvectomy canad cv/fin ........................................................... ................ ................ ................ ................ ................

L5400 6 Postop dress & 1 cast chg bk .......................................................... ................ ................ ................ ................ ................

L5410 6 Postop dsg bk ea add cast ch .......................................................... ................ ................ ................ ................ ................

L5420 6 Postop dsg & 1 cast chg ak/d .......................................................... ................ ................ ................ ................ ................

L5430 6 Postop dsg ak ea add cast ch .......................................................... ................ ................ ................ ................ ................

L5450 6 Postop app non-wgt bear dsg .......................................................... ................ ................ ................ ................ ................

L5460 6 Postop app non-wgt bear dsg .......................................................... ................ ................ ................ ................ ................

L5500 6 Init bk ptb plaster direct .................................................................... ................ ................ ................ ................ ................

L5505 6 Init ak ischal plstr direct .................................................................... ................ ................ ................ ................ ................

L5510 6 Prep BK ptb plaster molded ............................................................. ................ ................ ................ ................ ................

L5520 6 Perp BK ptb thermopls direct ........................................................... ................ ................ ................ ................ ................

L5530 6 Prep BK ptb thermopls molded ........................................................ ................ ................ ................ ................ ................

L5535 6 Prep BK ptb open end socket .......................................................... ................ ................ ................ ................ ................

L5540 6 Prep BK ptb laminated socket .......................................................... ................ ................ ................ ................ ................

L5560 6 Prep AK ischial plast molded ............................................................ ................ ................ ................ ................ ................

L5570 6 Prep AK ischial direct form ............................................................... ................ ................ ................ ................ ................

L5580 6 Prep AK ischial thermo mold ............................................................ ................ ................ ................ ................ ................

L5585 6 Prep AK ischial open end ................................................................. ................ ................ ................ ................ ................

L5590 6 Prep AK ischial laminated ................................................................. ................ ................ ................ ................ ................

L5595 6 Hip disartic sach thermopls .............................................................. ................ ................ ................ ................ ................

L5600 6 Hip disart sach laminat mold ............................................................ ................ ................ ................ ................ ................

L5610 6 Above knee hydracadence ............................................................... ................ ................ ................ ................ ................

L5611 6 Ak 4 bar link w/fric swing .................................................................. ................ ................ ................ ................ ................

L5613 6 Ak 4 bar ling w/hydraul swig ............................................................. ................ ................ ................ ................ ................

L5614 6 4-bar link above knee w/swng .......................................................... ................ ................ ................ ................ ................

L5616 6 Ak univ multiplex sys frict ................................................................. ................ ................ ................ ................ ................

L5617 6 AK/BK self-aligning unit ea ............................................................... ................ ................ ................ ................ ................

L5618 6 Test socket symes ............................................................................ ................ ................ ................ ................ ................

L5620 6 Test socket below knee .................................................................... ................ ................ ................ ................ ................

L5622 6 Test socket knee disarticula ............................................................. ................ ................ ................ ................ ................

L5624 6 Test socket above knee .................................................................... ................ ................ ................ ................ ................

L5626 6 Test socket hip disarticulat ............................................................... ................ ................ ................ ................ ................

L5628 6 Test socket hemipelvectomy ............................................................ ................ ................ ................ ................ ................

L5629 6 Below knee acrylic socket ................................................................ ................ ................ ................ ................ ................

L5630 6 Syme typ expandabl wall sckt .......................................................... ................ ................ ................ ................ ................

L5631 6 Ak/knee disartic acrylic soc .............................................................. ................ ................ ................ ................ ................

L5632 6 Symes type ptb brim design s .......................................................... ................ ................ ................ ................ ................

L5634 6 Symes type poster opening so ......................................................... ................ ................ ................ ................ ................

L5636 6 Symes type medial opening so ........................................................ ................ ................ ................ ................ ................

L5637 6 Below knee total contact ................................................................... ................ ................ ................ ................ ................

L5638 6 Below knee leather socket ................................................................ ................ ................ ................ ................ ................

L5639 6 Below knee wood socket .................................................................. ................ ................ ................ ................ ................

L5640 6 Knee disarticulat leather so .............................................................. ................ ................ ................ ................ ................

L5642 6 Above knee leather socket ............................................................... ................ ................ ................ ................ ................

L5643 6 Hip flex inner socket ext fr ................................................................ ................ ................ ................ ................ ................

L5644 6 Above knee wood socket .................................................................. ................ ................ ................ ................ ................

L5645 6 Ak flexibl inner socket ext ................................................................. ................ ................ ................ ................ ................

L5646 6 Below knee air cushion socke .......................................................... ................ ................ ................ ................ ................

L5647 6 Below knee suction socket ............................................................... ................ ................ ................ ................ ................
32463

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L5648 6 Above knee air cushion socke .......................................................... ................ ................ ................ ................ ................

L5649 6 Isch containmt/narrow m-l so ............................................................ ................ ................ ................ ................ ................

L5650 6 Tot contact ak/knee disart s ............................................................. ................ ................ ................ ................ ................

L5651 6 Ak flex inner socket ext fra ............................................................... ................ ................ ................ ................ ................

L5652 6 Suction susp ak/knee disart .............................................................. ................ ................ ................ ................ ................

L5653 6 Knee disart expand wall sock ........................................................... ................ ................ ................ ................ ................

L5654 6 Socket insert symes .......................................................................... ................ ................ ................ ................ ................

L5655 6 Socket insert below knee .................................................................. ................ ................ ................ ................ ................

L5656 6 Socket insert knee articulat .............................................................. ................ ................ ................ ................ ................

L5658 6 Socket insert above knee ................................................................. ................ ................ ................ ................ ................

L5660 6 Sock insrt syme silicone gel ............................................................. ................ ................ ................ ................ ................

L5661 6 Multi-durometer symes ..................................................................... ................ ................ ................ ................ ................

L5662 6 Socket insert bk silicone ge .............................................................. ................ ................ ................ ................ ................

L5663 6 Sock knee disartic silicone ............................................................... ................ ................ ................ ................ ................

L5664 6 Socket insert ak silicone ge .............................................................. ................ ................ ................ ................ ................

L5665 6 Multi-durometer below knee ............................................................. ................ ................ ................ ................ ................

L5666 6 Below knee cuff suspension ............................................................. ................ ................ ................ ................ ................

L5667 6 Socket insert w lock lower ................................................................ ................ ................ ................ ................ ................

L5668 6 Socket insert w/o lock lower ............................................................. ................ ................ ................ ................ ................

L5669 6 Below knee socket w/o lock ............................................................. ................ ................ ................ ................ ................

L5670 6 Bk molded supracondylar susp ........................................................ ................ ................ ................ ................ ................

L5672 6 Bk removable medial brim sus ......................................................... ................ ................ ................ ................ ................

L5674 6 Bk latex sleeve suspension/e ........................................................... ................ ................ ................ ................ ................

L5675 6 Bk latex sleeve susp/eq hvy ............................................................. ................ ................ ................ ................ ................

L5676 6 Bk knee joints single axis p .............................................................. ................ ................ ................ ................ ................

L5677 6 Bk knee joints polycentric p .............................................................. ................ ................ ................ ................ ................

L5678 6 Bk joint covers pair ........................................................................... ................ ................ ................ ................ ................

L5680 6 Bk thigh lacer non-molded ................................................................ ................ ................ ................ ................ ................

L5682 6 Bk thigh lacer glut/ischia m ............................................................... ................ ................ ................ ................ ................

L5684 6 Bk fork strap ...................................................................................... ................ ................ ................ ................ ................

L5686 6 Bk back check ................................................................................... ................ ................ ................ ................ ................

L5688 6 Bk waist belt webbing ....................................................................... ................ ................ ................ ................ ................

L5690 6 Bk waist belt padded and lin ............................................................ ................ ................ ................ ................ ................

L5692 6 Ak pelvic control belt light ................................................................. ................ ................ ................ ................ ................

L5694 6 Ak pelvic control belt pad/l ................................................................ ................ ................ ................ ................ ................

L5695 6 Ak sleeve susp neoprene/equa ........................................................ ................ ................ ................ ................ ................

L5696 6 Ak/knee disartic pelvic join ............................................................... ................ ................ ................ ................ ................

L5697 6 Ak/knee disartic pelvic band ............................................................. ................ ................ ................ ................ ................

L5698 6 Ak/knee disartic silesian ba .............................................................. ................ ................ ................ ................ ................

L5699 6 Shoulder harness .............................................................................. ................ ................ ................ ................ ................

L5700 6 Replace socket below knee .............................................................. ................ ................ ................ ................ ................

L5701 6 Replace socket above knee ............................................................. ................ ................ ................ ................ ................

L5702 6 Replace socket hip ........................................................................... ................ ................ ................ ................ ................

L5704 6 Custom shape covr below knee ....................................................... ................ ................ ................ ................ ................

L5705 6 Custm shape cover above knee ....................................................... ................ ................ ................ ................ ................

L5706 6 Custm shape cvr knee disart ............................................................ ................ ................ ................ ................ ................

L5707 6 Custm shape cover hip disart ........................................................... ................ ................ ................ ................ ................

L5710 6 Kne-shin exo sng axi mnl loc ........................................................... ................ ................ ................ ................ ................

L5711 6 Knee-shin exo mnl lock ultra ............................................................ ................ ................ ................ ................ ................

L5712 6 Knee-shin exo frict swg & st ............................................................. ................ ................ ................ ................ ................

L5714 6 Knee-shin exo variable frict .............................................................. ................ ................ ................ ................ ................

L5716 6 Knee-shin exo mech stance ph ........................................................ ................ ................ ................ ................ ................

L5718 6 Knee-shin exo frct swg & sta ............................................................ ................ ................ ................ ................ ................

L5722 6 Knee-shin pneum swg frct exo ......................................................... ................ ................ ................ ................ ................

L5724 6 Knee-shin exo fluid swing ph ............................................................ ................ ................ ................ ................ ................

L5726 6 Knee-shin ext jnts fld swg e ............................................................. ................ ................ ................ ................ ................

L5728 6 Knee-shin fluid swg & stance ........................................................... ................ ................ ................ ................ ................

L5780 6 Knee-shin pneum/hydra pneum ........................................................ ................ ................ ................ ................ ................

L5785 6 Exoskeletal bk ultralt mater .............................................................. ................ ................ ................ ................ ................

L5790 6 Exoskeletal ak ultra-light m ............................................................... ................ ................ ................ ................ ................

L5795 6 Exoskel hip ultra-light mate .............................................................. ................ ................ ................ ................ ................

L5810 6 Endoskel knee-shin mnl lock ............................................................ ................ ................ ................ ................ ................

L5811 6 Endo knee-shin mnl lck ultra ............................................................ ................ ................ ................ ................ ................

L5812 6 Endo knee-shin frct swg & st ............................................................ ................ ................ ................ ................ ................

L5814 6 Endo knee-shin hydral swg ph ......................................................... ................ ................ ................ ................ ................

L5816 6 Endo knee-shin polyc mch sta ......................................................... ................ ................ ................ ................ ................

L5818 6 Endo knee-shin frct swg & st ............................................................ ................ ................ ................ ................ ................

L5822 6 Endo knee-shin pneum swg frc ........................................................ ................ ................ ................ ................ ................

L5824 6 Endo knee-shin fluid swing p ............................................................ ................ ................ ................ ................ ................

L5826 6 Pediatric knee joint ........................................................................... ................ ................ ................ ................ ................

L5828 6 Endo knee-shin fluid swg/sta ............................................................ ................ ................ ................ ................ ................

L5830 6 Endo knee-shin pneum/swg pha ...................................................... ................ ................ ................ ................ ................

L5840 6 Multi-axial knee/shin system ............................................................. ................ ................ ................ ................ ................

L5845 6 Knee-shin sys stance flexion ............................................................ ................ ................ ................ ................ ................
32464

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L5846 6 Knee-shin sys microprocessor .......................................................... ................ ................ ................ ................ ................

L5850 6 Endo ak/hip knee extens assi ........................................................... ................ ................ ................ ................ ................

L5855 6 Mech hip extension assist ................................................................ ................ ................ ................ ................ ................

L5910 6 Endo below knee alignable sy .......................................................... ................ ................ ................ ................ ................

L5920 6 Endo ak/hip alignable system ........................................................... ................ ................ ................ ................ ................

L5925 6 Above knee manual lock .................................................................. ................ ................ ................ ................ ................

L5930 6 High activity knee frame ................................................................... ................ ................ ................ ................ ................

L5940 6 Endo bk ultra-light material ............................................................... ................ ................ ................ ................ ................

L5950 6 Endo ak ultra-light material ............................................................... ................ ................ ................ ................ ................

L5960 6 Endo hip ultra-light materia ............................................................... ................ ................ ................ ................ ................

L5962 6 Below knee flex cover system .......................................................... ................ ................ ................ ................ ................

L5964 6 Above knee flex cover system .......................................................... ................ ................ ................ ................ ................

L5966 6 Hip flexible cover system .................................................................. ................ ................ ................ ................ ................

L5970 6 Foot external keel sach foot ............................................................. ................ ................ ................ ................ ................

L5972 6 Flexible keel foot ............................................................................... ................ ................ ................ ................ ................

L5974 6 Foot single axis ankle/foot ................................................................ ................ ................ ................ ................ ................

L5976 6 Energy storing foot ............................................................................ ................ ................ ................ ................ ................

L5978 6 Ft prosth multiaxial ankl/ft ................................................................. ................ ................ ................ ................ ................

L5979 6 Multi-axial ankle/ft prosth .................................................................. ................ ................ ................ ................ ................

L5980 6 Flex foot system ................................................................................ ................ ................ ................ ................ ................

L5981 6 Flex-walk sys low ext prosth ............................................................. ................ ................ ................ ................ ................

L5982 6 Exoskeletal axial rotation u ............................................................... ................ ................ ................ ................ ................

L5984 6 Endoskeletal axial rotation ................................................................ ................ ................ ................ ................ ................

L5985 6 Lwr ext dynamic prosth pylon ........................................................... ................ ................ ................ ................ ................

L5986 6 Multi-axial rotation unit ...................................................................... ................ ................ ................ ................ ................

L5987 6 Shank ft w vert load pylon ................................................................ ................ ................ ................ ................ ................

L5999 6 Lowr extremity prosthes NOS ........................................................... ................ ................ ................ ................ ................

L6000 6 Par hand robin-aids thum rem .......................................................... ................ ................ ................ ................ ................

L6010 6 Hand robin-aids little/ring .................................................................. ................ ................ ................ ................ ................

L6020 6 Part hand robin-aids no fing ............................................................. ................ ................ ................ ................ ................

L6050 6 Wrst MLd sck flx hng tri pad ............................................................. ................ ................ ................ ................ ................

L6055 6 Wrst mold sock w/exp interfa ............................................................ ................ ................ ................ ................ ................

L6100 6 Elb mold sock flex hinge pad ........................................................... ................ ................ ................ ................ ................

L6110 6 Elbow mold sock suspension t ......................................................... ................ ................ ................ ................ ................

L6120 6 Elbow mold doub splt soc ste ........................................................... ................ ................ ................ ................ ................

L6130 6 Elbow stump activated lock h ........................................................... ................ ................ ................ ................ ................

L6200 6 Elbow mold outsid lock hinge ........................................................... ................ ................ ................ ................ ................

L6205 6 Elbow molded w/ expand inter ......................................................... ................ ................ ................ ................ ................

L6250 6 Elbow inter loc elbow forarm ............................................................ ................ ................ ................ ................ ................

L6300 6 Shlder disart int lock elbow ............................................................... ................ ................ ................ ................ ................

L6310 6 Shoulder passive restor comp .......................................................... ................ ................ ................ ................ ................

L6320 6 Shoulder passive restor cap ............................................................. ................ ................ ................ ................ ................

L6350 6 Thoracic intern lock elbow ................................................................ ................ ................ ................ ................ ................

L6360 6 Thoracic passive restor comp ........................................................... ................ ................ ................ ................ ................

L6370 6 Thoracic passive restor cap .............................................................. ................ ................ ................ ................ ................

L6380 6 Postop dsg cast chg wrst/elb ............................................................ ................ ................ ................ ................ ................

L6382 6 Postop dsg cast chg elb dis/ ............................................................ ................ ................ ................ ................ ................

L6384 6 Postop dsg cast chg shlder/t ............................................................ ................ ................ ................ ................ ................

L6386 6 Postop ea cast chg & realign ........................................................... ................ ................ ................ ................ ................

L6388 6 Postop applicat rigid dsg on ............................................................. ................ ................ ................ ................ ................

L6400 6 Below elbow prosth tiss shap ........................................................... ................ ................ ................ ................ ................

L6450 6 Elb disart prosth tiss shap ................................................................ ................ ................ ................ ................ ................

L6500 6 Above elbow prosth tiss shap ........................................................... ................ ................ ................ ................ ................

L6550 6 Shldr disar prosth tiss shap .............................................................. ................ ................ ................ ................ ................

L6570 6 Scap thorac prosth tiss shap ............................................................ ................ ................ ................ ................ ................

L6580 6 Wrist/elbow bowden cable mol ......................................................... ................ ................ ................ ................ ................

L6582 6 Wrist/elbow bowden cbl dir f ............................................................. ................ ................ ................ ................ ................

L6584 6 Elbow fair lead cable molded ........................................................... ................ ................ ................ ................ ................

L6586 6 Elbow fair lead cable dir fo ............................................................... ................ ................ ................ ................ ................

L6588 6 Shdr fair lead cable molded .............................................................. ................ ................ ................ ................ ................

L6590 6 Shdr fair lead cable direct ................................................................. ................ ................ ................ ................ ................

L6600 6 Polycentric hinge pair ....................................................................... ................ ................ ................ ................ ................

L6605 6 Single pivot hinge pair ...................................................................... ................ ................ ................ ................ ................

L6610 6 Flexible metal hinge pair ................................................................... ................ ................ ................ ................ ................

L6615 6 Disconnect locking wrist uni ............................................................. ................ ................ ................ ................ ................

L6616 6 Disconnect insert locking wr ............................................................. ................ ................ ................ ................ ................

L6620 6 Flexion-friction wrist unit ................................................................... ................ ................ ................ ................ ................

L6623 6 Spring-ass rot wrst w/ latch .............................................................. ................ ................ ................ ................ ................

L6625 6 Rotation wrst w/ cable lock ............................................................... ................ ................ ................ ................ ................

L6628 6 Quick disconn hook adapter o .......................................................... ................ ................ ................ ................ ................

L6629 6 Lamination collar w/ couplin ............................................................. ................ ................ ................ ................ ................

L6630 6 Stainless steel any wrist ................................................................... ................ ................ ................ ................ ................

L6632 6 Latex suspension sleeve each ......................................................... ................ ................ ................ ................ ................

L6635 6 Lift assist for elbow ........................................................................... ................ ................ ................ ................ ................
32465

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L6637 6 Nudge control elbow lock ................................................................. ................ ................ ................ ................ ................

L6640 6 Shoulder abduction joint pai ............................................................. ................ ................ ................ ................ ................

L6641 6 Excursion amplifier pulley t ............................................................... ................ ................ ................ ................ ................

L6642 6 Excursion amplifier lever ty ............................................................... ................ ................ ................ ................ ................

L6645 6 Shoulder flexion-abduction j ............................................................. ................ ................ ................ ................ ................

L6650 6 Shoulder universal joint .................................................................... ................ ................ ................ ................ ................

L6655 6 Standard control cable extra ............................................................. ................ ................ ................ ................ ................

L6660 6 Heavy duty control cable .................................................................. ................ ................ ................ ................ ................

L6665 6 Teflon or equal cable lining .............................................................. ................ ................ ................ ................ ................

L6670 6 Hook to hand cable adapter ............................................................. ................ ................ ................ ................ ................

L6672 6 Harness chest/shlder saddle ............................................................ ................ ................ ................ ................ ................

L6675 6 Harness figure of 8 sing con ............................................................ ................ ................ ................ ................ ................

L6676 6 Harness figure of 8 dual con ............................................................ ................ ................ ................ ................ ................

L6680 6 Test sock wrist disart/bel e ............................................................... ................ ................ ................ ................ ................

L6682 6 Test sock elbw disart/above ............................................................. ................ ................ ................ ................ ................

L6684 6 Test socket shldr disart/tho ............................................................... ................ ................ ................ ................ ................

L6686 6 Suction socket ................................................................................... ................ ................ ................ ................ ................

L6687 6 Frame typ socket bel elbow/w .......................................................... ................ ................ ................ ................ ................

L6688 6 Frame typ sock above elb/dis ........................................................... ................ ................ ................ ................ ................

L6689 6 Frame typ socket shoulder di ........................................................... ................ ................ ................ ................ ................

L6690 6 Frame typ sock interscap-tho ........................................................... ................ ................ ................ ................ ................

L6691 6 Removable insert each ..................................................................... ................ ................ ................ ................ ................

L6692 6 Silicone gel insert or equal ............................................................... ................ ................ ................ ................ ................

L6700 6 Terminal device model #3 ................................................................. ................ ................ ................ ................ ................

L6705 6 Terminal device model #5 ................................................................. ................ ................ ................ ................ ................

L6710 6 Terminal device model #5x ............................................................... ................ ................ ................ ................ ................

L6715 6 Terminal device model #5xa ............................................................. ................ ................ ................ ................ ................

L6720 6 Terminal device model #6 ................................................................. ................ ................ ................ ................ ................

L6725 6 Terminal device model #7 ................................................................. ................ ................ ................ ................ ................

L6730 6 Terminal device model #7lo .............................................................. ................ ................ ................ ................ ................

L6735 6 Terminal device model #8 ................................................................. ................ ................ ................ ................ ................

L6740 6 Terminal device model #8x ............................................................... ................ ................ ................ ................ ................

L6745 6 Terminal device model #88x ............................................................. ................ ................ ................ ................ ................

L6750 6 Terminal device model #10p ............................................................. ................ ................ ................ ................ ................

L6755 6 Terminal device model #10x ............................................................. ................ ................ ................ ................ ................

L6765 6 Terminal device model #12p ............................................................. ................ ................ ................ ................ ................

L6770 6 Terminal device model #99x ............................................................. ................ ................ ................ ................ ................

L6775 6 Terminal device model #555 ............................................................. ................ ................ ................ ................ ................

L6780 6 Terminal device model #ss555 ......................................................... ................ ................ ................ ................ ................

L6790 6 Hooks-accu hook or equal ................................................................ ................ ................ ................ ................ ................

L6795 6 Hooks-2 load or equal ...................................................................... ................ ................ ................ ................ ................

L6800 6 Hooks-aprl vc or equal ...................................................................... ................ ................ ................ ................ ................

L6805 6 Modifier wrist flexion unit .................................................................. ................ ................ ................ ................ ................

L6806 6 Trs grip vc or equal ........................................................................... ................ ................ ................ ................ ................

L6807 6 Term device grip 1⁄2 or equal ............................................................ ................ ................ ................ ................ ................

L6808 6 Term device infant or child ............................................................... ................ ................ ................ ................ ................

L6809 6 Trs super sport passive .................................................................... ................ ................ ................ ................ ................

L6810 6 Pincher tool otto bock or eq ............................................................. ................ ................ ................ ................ ................

L6825 6 Hands dorrance vo ........................................................................... ................ ................ ................ ................ ................

L6830 6 Hand aprl vc ...................................................................................... ................ ................ ................ ................ ................

L6835 6 Hand sierra vo .................................................................................. ................ ................ ................ ................ ................

L6840 6 Hand becker imperial ........................................................................ ................ ................ ................ ................ ................

L6845 6 Hand becker lock grip ....................................................................... ................ ................ ................ ................ ................

L6850 6 Term dvc-hand becker plylite ........................................................... ................ ................ ................ ................ ................

L6855 6 Hand robin-aids vo ............................................................................ ................ ................ ................ ................ ................

L6860 6 Hand robin-aids vo soft ..................................................................... ................ ................ ................ ................ ................

L6865 6 Hand passive hand ........................................................................... ................ ................ ................ ................ ................

L6867 6 Hand detroit infant hand ................................................................... ................ ................ ................ ................ ................

L6868 6 Passive inf hand steeper/hos ........................................................... ................ ................ ................ ................ ................

L6870 6 Hand child mitt .................................................................................. ................ ................ ................ ................ ................

L6872 6 Hand nyu child hand ......................................................................... ................ ................ ................ ................ ................

L6873 6 Hand mech inf steeper or equ .......................................................... ................ ................ ................ ................ ................

L6875 6 Hand bock vc .................................................................................... ................ ................ ................ ................ ................

L6880 6 Hand bock vo .................................................................................... ................ ................ ................ ................ ................

L6890 6 Production glove ............................................................................... ................ ................ ................ ................ ................

L6895 6 Custom glove .................................................................................... ................ ................ ................ ................ ................

L6900 6 Hand restorat thumb/1 finger ............................................................ ................ ................ ................ ................ ................

L6905 6 Hand restoration multiple fi ............................................................... ................ ................ ................ ................ ................

L6910 6 Hand restoration no fingers .............................................................. ................ ................ ................ ................ ................

L6915 6 Hand restoration replacmnt g ........................................................... ................ ................ ................ ................ ................

L6920 6 Wrist disarticul switch ctrl ................................................................. ................ ................ ................ ................ ................

L6925 6 Wrist disart myoelectronic c .............................................................. ................ ................ ................ ................ ................

L6930 6 Below elbow switch control ............................................................... ................ ................ ................ ................ ................

L6935 6 Below elbow myoelectronic ct .......................................................... ................ ................ ................ ................ ................
32466

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L6940 6 Elbow disarticulation switch .............................................................. ................ ................ ................ ................ ................

L6945 6 Elbow disart myoelectronic c ............................................................ ................ ................ ................ ................ ................

L6950 6 Above elbow switch control .............................................................. ................ ................ ................ ................ ................

L6955 6 Above elbow myoelectronic ct .......................................................... ................ ................ ................ ................ ................

L6960 6 Shldr disartic switch contro ............................................................... ................ ................ ................ ................ ................

L6965 6 Shldr disartic myoelectronic .............................................................. ................ ................ ................ ................ ................

L6970 6 Interscapular-thor switch ct ............................................................... ................ ................ ................ ................ ................

L6975 6 Interscap-thor myoelectronic ............................................................. ................ ................ ................ ................ ................

L7010 6 Hand otto back steeper/eq sw .......................................................... ................ ................ ................ ................ ................

L7015 6 Hand sys teknik village swit .............................................................. ................ ................ ................ ................ ................

L7020 6 Electronic greifer switch ct ................................................................ ................ ................ ................ ................ ................

L7025 6 Electron hand myoelectronic ............................................................ ................ ................ ................ ................ ................

L7030 6 Hand sys teknik vill myoelec ............................................................. ................ ................ ................ ................ ................

L7035 6 Electron greifer myoelectro ............................................................... ................ ................ ................ ................ ................

L7040 6 Prehensile actuator hosmer s ........................................................... ................ ................ ................ ................ ................

L7045 6 Electron hook child michigan ............................................................ ................ ................ ................ ................ ................

L7170 6 Electronic elbow hosmer swit ........................................................... ................ ................ ................ ................ ................

L7180 6 Electronic elbow utah myoele ........................................................... ................ ................ ................ ................ ................

L7185 6 Electron elbow adolescent sw .......................................................... ................ ................ ................ ................ ................

L7186 6 Electron elbow child switch ............................................................... ................ ................ ................ ................ ................

L7190 6 Elbow adolescent myoelectron ......................................................... ................ ................ ................ ................ ................

L7191 6 Elbow child myoelectronic ct ............................................................ ................ ................ ................ ................ ................

L7260 6 Electron wrist rotator otto .................................................................. ................ ................ ................ ................ ................

L7261 6 Electron wrist rotator utah ................................................................. ................ ................ ................ ................ ................

L7266 6 Servo control steeper or equ ............................................................ ................ ................ ................ ................ ................

L7272 6 Analogue control unb or equa .......................................................... ................ ................ ................ ................ ................

L7274 6 Proportional ctl 12 volt uta ................................................................ ................ ................ ................ ................ ................

L7360 6 Six volt bat otto bock/eq ea .............................................................. ................ ................ ................ ................ ................

L7362 6 Battery chrgr six volt otto .................................................................. ................ ................ ................ ................ ................

L7364 6 Twelve volt battery utah/equ ............................................................. ................ ................ ................ ................ ................

L7366 6 Battery chrgr 12 volt utah/e .............................................................. ................ ................ ................ ................ ................

L7499 6 Upper extremity prosthes NOS ......................................................... ................ ................ ................ ................ ................

L7500 6 Prosthetic dvc repair hourly .............................................................. ................ ................ ................ ................ ................

L7510 6 Prosthetic device repair rep .............................................................. ................ ................ ................ ................ ................

L7520 6 Repair prosthesis per 15 min ........................................................... ................ ................ ................ ................ ................

L7900 6 Vacuum erection system .................................................................. ................ ................ ................ ................ ................

L8000 6 Mastectomy bra ................................................................................ ................ ................ ................ ................ ................

L8010 6 Mastectomy sleeve ........................................................................... ................ ................ ................ ................ ................

L8020 6 Mastectomy form .............................................................................. ................ ................ ................ ................ ................

L8030 6 Breast prosthesis silicone/e .............................................................. ................ ................ ................ ................ ................

L8039 6 Breast prosthesis NOS ..................................................................... ................ ................ ................ ................ ................

L8100 6 Elas suprt stock bk med wgt ............................................................. ................ ................ ................ ................ ................

L8110 6 Elastic supp stocking bk hvy ............................................................ ................ ................ ................ ................ ................

L8120 6 Elastic supp stockng bk surg ............................................................ ................ ................ ................ ................ ................

L8130 6 Elastic supp stocking ak med ........................................................... ................ ................ ................ ................ ................

L8140 6 Elastic supp stocking ak hvy ............................................................ ................ ................ ................ ................ ................

L8150 6 Elastic supp stockng ak surg ............................................................ ................ ................ ................ ................ ................

L8160 6 Supp stocking full lgth med .............................................................. ................ ................ ................ ................ ................

L8170 6 Supp stocking full lgth hvy ................................................................ ................ ................ ................ ................ ................

L8180 6 Supp stocking heavy surg wei .......................................................... ................ ................ ................ ................ ................

L8190 6 Elas stocking leotards med w ........................................................... ................ ................ ................ ................ ................

L8200 6 Elas stocking leotards surg ............................................................... ................ ................ ................ ................ ................

L8210 6 Elastic stocking custom made .......................................................... ................ ................ ................ ................ ................

L8220 6 Elastic stocking lymphedema ........................................................... ................ ................ ................ ................ ................

L8230 6 Elastic stocking garter belt ................................................................ ................ ................ ................ ................ ................

L8239 6 Elastic support NOS ......................................................................... ................ ................ ................ ................ ................

L8300 6 Truss single w/ standard pad ........................................................... ................ ................ ................ ................ ................

L8310 6 Truss double w/ standard pad .......................................................... ................ ................ ................ ................ ................

L8320 6 Truss addition to std pad wa ............................................................ ................ ................ ................ ................ ................

L8330 6 Truss add to std pad scrotal ............................................................. ................ ................ ................ ................ ................

L8400 6 Sheath below knee ........................................................................... ................ ................ ................ ................ ................

L8410 6 Sheath above knee ........................................................................... ................ ................ ................ ................ ................

L8415 6 Sheath upper limb ............................................................................. ................ ................ ................ ................ ................

L8417 6 Pros sheath/sock w gel cushn .......................................................... ................ ................ ................ ................ ................

L8420 6 Sock wool below knee ...................................................................... ................ ................ ................ ................ ................

L8430 6 Sock wool above knee ...................................................................... ................ ................ ................ ................ ................

L8435 6 Sock wool upper limb ....................................................................... ................ ................ ................ ................ ................

L8440 6 Shrinker below knee ......................................................................... ................ ................ ................ ................ ................

L8460 6 Shrinker above knee ......................................................................... ................ ................ ................ ................ ................

L8465 6 Shrinker upper limb ........................................................................... ................ ................ ................ ................ ................

L8470 6 Stump sock single below knee ......................................................... ................ ................ ................ ................ ................

L8480 6 Stump sock single above knee ......................................................... ................ ................ ................ ................ ................

L8485 6 Stump sock fitting uppr limb ............................................................. ................ ................ ................ ................ ................

L8490 6 Air seal suction reten systm ............................................................. ................ ................ ................ ................ ................
32467

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

L8499 6 Unlisted misc prosthetic ser .............................................................. ................ ................ ................ ................ ................

L8500 6 Artificial larynx ................................................................................... ................ ................ ................ ................ ................

L8501 6 Tracheostomy speaking valve .......................................................... ................ ................ ................ ................ ................

L8600 6 Implant breast silicone/eq ................................................................. ................ ................ ................ ................ ................

L8603 6 Collagen imp urinary 2.5 CC ............................................................ ................ ................ ................ ................ ................

L8610 6 Ocular implant ................................................................................... ................ ................ ................ ................ ................

L8612 6 Aqueous shunt prosthesis ................................................................ ................ ................ ................ ................ ................

L8613 6 Ossicular implant .............................................................................. ................ ................ ................ ................ ................

L8614 6 Cochlear device/system .................................................................... ................ ................ ................ ................ ................

L8619 6 Replace cochlear processor ............................................................. ................ ................ ................ ................ ................

L8630 6 Metacarpophalangeal implant ........................................................... ................ ................ ................ ................ ................

L8641 6 Metatarsal joint implant ..................................................................... ................ ................ ................ ................ ................

L8642 6 Hallux implant ................................................................................... ................ ................ ................ ................ ................

L8658 6 Interphalangeal joint implnt ............................................................... ................ ................ ................ ................ ................

L8670 6 Vascular graft, synthetic ................................................................... ................ ................ ................ ................ ................

L8699 6 Prosthetic implant NOS .................................................................... ................ ................ ................ ................ ................

M0064 6 Visit for drug monitoring .................................................................... ................ ................ ................ ................ ................

M0075 9 Cellular therapy ................................................................................. ................ ................ ................ ................ ................

M0076 9 Prolotherapy ...................................................................................... ................ ................ ................ ................ ................

M0100 9 Intragastric hypothermia ................................................................... ................ ................ ................ ................ ................

M0101 4 Foot care hygienic/pm ...................................................................... ................ ................ ................ ................ ................

M0300 9 IV chelationtherapy ........................................................................... ................ ................ ................ ................ ................

M0301 9 Fabric wrapping of aneurysm ........................................................... ................ ................ ................ ................ ................

M0302 9 Assessment of cardiac output .......................................................... ................ ................ ................ ................ ................

P2028 6 Cephalin floculation test .................................................................... ................ ................ ................ ................ ................

P2029 6 Congo red blood test ........................................................................ ................ ................ ................ ................ ................

P2031 9 Hair analysis ..................................................................................... ................ ................ ................ ................ ................

P2033 6 Blood thymol turbidity ....................................................................... ................ ................ ................ ................ ................

P2038 6 Blood mucoprotein ............................................................................ ................ ................ ................ ................ ................

P3000 6 Screen pap by tech w md supv ........................................................ ................ ................ ................ ................ ................

P3001 6 Screening pap smear by phys .......................................................... ................ ................ ................ ................ ................

P7001 9 Culture bacterial urine ....................................................................... ................ ................ ................ ................ ................

P9010 9 Whole blood for transfusion .............................................................. ................ ................ ................ ................ ................

P9011 9 Blood split unit .................................................................................. ................ ................ ................ ................ ................

P9012 9 Cryoprecipitate each unit .................................................................. ................ ................ ................ ................ ................

P9013 9 Unit/s blood fibrinogen ...................................................................... ................ ................ ................ ................ ................

P9014 9 Gamma globulin 1 ML ...................................................................... ................ ................ ................ ................ ................

P9015 9 Rh immune globulin 1 ML ................................................................. ................ ................ ................ ................ ................

P9016 9 Leukocyte poor blood, unit ............................................................... ................ ................ ................ ................ ................

P9017 9 One donor fresh frozn plasma .......................................................... ................ ................ ................ ................ ................

P9018 9 Plasma protein fract, unit .................................................................. ................ ................ ................ ................ ................

P9019 9 Platelet concentrate unit ................................................................... ................ ................ ................ ................ ................

P9020 9 Plaelet rich plasma unit .................................................................... ................ ................ ................ ................ ................

P9021 9 Red blood cells unit .......................................................................... ................ ................ ................ ................ ................

P9022 9 Washed red blood cells unit ............................................................. ................ ................ ................ ................ ................

P9603 6 One-way allow prorated miles .......................................................... ................ ................ ................ ................ ................

P9604 6 One-way allow prorated trip .............................................................. ................ ................ ................ ................ ................

P9610 6 Urine specimen collect singl ............................................................. ................ ................ ................ ................ ................

P9615 6 Urine specimen collect mult .............................................................. ................ ................ ................ ................ ................

Q0034 6 Admin of influenza vaccine ............................................................... ................ ................ ................ ................ ................

Q0035 6 Cardiokymography ............................................................................ ................ ................ ................ ................ ................

Q0068 6 Extracorpeal plasmapheresis ............................................................ ................ ................ ................ ................ ................

Q0081 6 Infusion ther other than che .............................................................. ................ ................ ................ ................ ................

Q0082 6 Activity therapy w/partial h ................................................................ ................ ................ ................ ................ ................

Q0083 6 Chemo by other than infusion .......................................................... ................ ................ ................ ................ ................

Q0084 6 Chemotherapy by infusion ................................................................ ................ ................ ................ ................ ................

Q0085 6 Chemo by both infusion and o ......................................................... ................ ................ ................ ................ ................

Q0086 6 Physical therapy evaluation/ ............................................................. ................ ................ ................ ................ ................

Q0091 6 Obtaining screen pap smear ............................................................ ................ ................ ................ ................ ................

Q0092 6 Set up port xray equipment .............................................................. ................ ................ ................ ................ ................

Q0111 6 Wet mounts/ w preparations ............................................................. ................ ................ ................ ................ ................

Q0112 6 Potassium hydroxide preps .............................................................. ................ ................ ................ ................ ................

Q0113 6 Pinworm examinations ...................................................................... ................ ................ ................ ................ ................

Q0114 6 Fern test ............................................................................................ ................ ................ ................ ................ ................

Q0115 6 Post-coital mucous exam .................................................................. ................ ................ ................ ................ ................

Q0132 6 Dispensing fee DME neb drug ......................................................... ................ ................ ................ ................ ................

Q0136 6 Non esrd epoetin alpha inj ................................................................ ................ ................ ................ ................ ................

Q0144 9 Azithromycin dihydrate, oral ............................................................. ................ ................ ................ ................ ................

Q0156 6 Human albumin 5% .......................................................................... ................ ................ ................ ................ ................

Q0157 6 Human albumin 25% ........................................................................ ................ ................ ................ ................ ................

Q9920 9 Epoetin with hct <= 20 ...................................................................... ................ ................ ................ ................ ................

Q9921 9 Epoetin with hct = 21 ........................................................................ ................ ................ ................ ................ ................

Q9922 9 Epoetin with hct = 22 ........................................................................ ................ ................ ................ ................ ................

Q9923 9 Epoetin with hct = 23 ........................................................................ ................ ................ ................ ................ ................
32468

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

Q9924 9 Epoetin with hct = 24 ........................................................................ ................ ................ ................ ................ ................

Q9925 9 Epoetin with hct = 25 ........................................................................ ................ ................ ................ ................ ................

Q9926 9 Epoetin with hct = 26 ........................................................................ ................ ................ ................ ................ ................

Q9927 9 Epoetin with hct = 27 ........................................................................ ................ ................ ................ ................ ................

Q9928 9 Epoetin with hct = 28 ........................................................................ ................ ................ ................ ................ ................

Q9929 9 Epoetin with hct = 29 ........................................................................ ................ ................ ................ ................ ................

Q9930 9 Epoetin with hct = 30 ........................................................................ ................ ................ ................ ................ ................

Q9931 9 Epoetin with hct = 31 ........................................................................ ................ ................ ................ ................ ................

Q9932 9 Epoetin with hct = 32 ........................................................................ ................ ................ ................ ................ ................

Q9933 9 Epoetin with hct = 33 ........................................................................ ................ ................ ................ ................ ................

Q9934 9 Epoetin with hct = 34 ........................................................................ ................ ................ ................ ................ ................

Q9935 9 Epoetin with hct = 35 ........................................................................ ................ ................ ................ ................ ................

Q9936 9 Epoetin with hct = 36 ........................................................................ ................ ................ ................ ................ ................

Q9937 9 Epoetin with hct = 37 ........................................................................ ................ ................ ................ ................ ................

Q9938 9 Epoetin with hct = 38 ........................................................................ ................ ................ ................ ................ ................

Q9939 9 Epoetin with hct = 39 ........................................................................ ................ ................ ................ ................ ................

Q9940 9 Epoetin with hct ≤= 40 ...................................................................... ................ ................ ................ ................ ................

R0070 6 Transport portable x-ray ................................................................... ................ ................ ................ ................ ................

R0075 6 Transport port x-ray multipl ............................................................... ................ ................ ................ ................ ................

R0076 6 Transport portable EKG .................................................................... ................ ................ ................ ................ ................

V2020 6 Vision svcs frames purchases .......................................................... ................ ................ ................ ................ ................

V2025 9 Eyeglasses delux frames .................................................................. ................ ................ ................ ................ ................

V2100 6 Lens spher single plano 4.00 ........................................................... ................ ................ ................ ................ ................

V2101 6 Single visn sphere 4.12–7.00 ........................................................... ................ ................ ................ ................ ................

V2102 6 Singl visn sphere 7.12–20.00 ........................................................... ................ ................ ................ ................ ................

V2103 6 Spherocylindr 4.00d/12–2.00d .......................................................... ................ ................ ................ ................ ................

V2104 6 Spherocylindr 4.00d/2.12–4d ............................................................ ................ ................ ................ ................ ................

V2105 6 Spherocylinder 4.00d/4.25–6d .......................................................... ................ ................ ................ ................ ................

V2106 6 Spherocylinder 4.00d/>6.00d ............................................................ ................ ................ ................ ................ ................

V2107 6 Spherocylinder 4.25d/12–2d ............................................................. ................ ................ ................ ................ ................

V2108 6 Spherocylinder 4.25d/2.12–4d .......................................................... ................ ................ ................ ................ ................

V2109 6 Spherocylinder 4.25d/4.25–6d .......................................................... ................ ................ ................ ................ ................

V2110 6 Spherocylinder 4.25d/over 6d ........................................................... ................ ................ ................ ................ ................

V2111 6 Spherocylindr 7.25d/.25–2.25 ........................................................... ................ ................ ................ ................ ................

V2112 6 Spherocylindr 7.25d/2.25–4d ............................................................ ................ ................ ................ ................ ................

V2113 6 Spherocylindr 7.25d/4.25–6d ............................................................ ................ ................ ................ ................ ................

V2114 6 Spherocylinder over 12.00d .............................................................. ................ ................ ................ ................ ................

V2115 6 Lens lenticular bifocal ....................................................................... ................ ................ ................ ................ ................

V2116 6 Nonaspheric lens bifocal ................................................................... ................ ................ ................ ................ ................

V2117 6 Aspheric lens bifocal ......................................................................... ................ ................ ................ ................ ................

V2118 6 Lens aniseikonic single ..................................................................... ................ ................ ................ ................ ................

V2199 6 Lens single vision not oth c .............................................................. ................ ................ ................ ................ ................

V2200 6 Lens spher bifoc plano 4.00d ........................................................... ................ ................ ................ ................ ................

V2201 6 Lens sphere bifocal 4.12–7.0 ........................................................... ................ ................ ................ ................ ................

V2202 6 Lens sphere bifocal 7.12–20. ........................................................... ................ ................ ................ ................ ................

V2203 6 Lens sphcyl bifocal 4.00d/.1 ............................................................. ................ ................ ................ ................ ................

V2204 6 Lens sphcy bifocal 4.00d/2.1 ............................................................ ................ ................ ................ ................ ................

V2205 6 Lens sphcy bifocal 4.00d/4.2 ............................................................ ................ ................ ................ ................ ................

V2206 6 Lens sphcy bifocal 4.00d/ove ........................................................... ................ ................ ................ ................ ................

V2207 6 Lens sphcy bifocal 4.25–7d/. ............................................................ ................ ................ ................ ................ ................

V2208 6 Lens sphcy bifocal 4.25–7/2. ............................................................ ................ ................ ................ ................ ................

V2209 6 Lens sphcy bifocal 4.25–7/4. ............................................................ ................ ................ ................ ................ ................

V2210 6 Lens sphcy bifocal 4.25–7/ov ........................................................... ................ ................ ................ ................ ................

V2211 6 Lens sphcy bifo 7.25–12/.25– ........................................................... ................ ................ ................ ................ ................

V2212 6 Lens sphcyl bifo 7.25–12/2.2 ............................................................ ................ ................ ................ ................ ................

V2213 6 Lens sphcyl bifo 7.25–12/4.2 ............................................................ ................ ................ ................ ................ ................

V2214 6 Lens sphcyl bifocal over 12. ............................................................. ................ ................ ................ ................ ................

V2215 6 Lens lenticular bifocal ....................................................................... ................ ................ ................ ................ ................

V2216 6 Lens lenticular nonaspheric .............................................................. ................ ................ ................ ................ ................

V2217 6 Lens lenticular aspheric bif ............................................................... ................ ................ ................ ................ ................

V2218 6 Lens aniseikonic bifocal .................................................................... ................ ................ ................ ................ ................

V2219 6 Lens bifocal seg width over .............................................................. ................ ................ ................ ................ ................

V2220 6 Lens bifocal add over 3.25d ............................................................. ................ ................ ................ ................ ................

V2299 6 Lens bifocal speciality ....................................................................... ................ ................ ................ ................ ................

V2300 6 Lens sphere trifocal 4.00d ................................................................ ................ ................ ................ ................ ................

V2301 6 Lens sphere trifocal 4.12–7. ............................................................. ................ ................ ................ ................ ................

V2302 6 Lens sphere trifocal 7.12–20 ............................................................ ................ ................ ................ ................ ................

V2303 6 Lens sphcy trifocal 4.0/.12– .............................................................. ................ ................ ................ ................ ................

V2304 6 Lens sphcy trifocal 4.0/2.25 .............................................................. ................ ................ ................ ................ ................

V2305 6 Lens sphcy trifocal 4.0/4.25 .............................................................. ................ ................ ................ ................ ................

V2306 6 Lens sphcyl trifocal 4.00/>6 .............................................................. ................ ................ ................ ................ ................

V2307 6 Lens sphcy trifocal 4.25–7/. .............................................................. ................ ................ ................ ................ ................

V2308 6 Lens sphc trifocal 4.25–7/2. .............................................................. ................ ................ ................ ................ ................

V2309 6 Lens sphc trifocal 4.25–7/4. .............................................................. ................ ................ ................ ................ ................
32469

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

2 Codes proposed for additions to or deletions from ASC list.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

V2310 6 Lens sphc trifocal 4.25–7/>6 ............................................................. ................ ................ ................ ................ ................

V2311 6 Lens sphc trifo 7.25–12/.25– ............................................................ ................ ................ ................ ................ ................

V2312 6 Lens sphc trifo 7.25–12/2.25 ............................................................ ................ ................ ................ ................ ................

V2313 6 Lens sphc trifo 7.25–12/4.25 ............................................................ ................ ................ ................ ................ ................

V2314 6 Lens sphcyl trifocal over 12 .............................................................. ................ ................ ................ ................ ................

V2315 6 Lens lenticular trifocal ....................................................................... ................ ................ ................ ................ ................

V2316 6 Lens lenticular nonaspheric .............................................................. ................ ................ ................ ................ ................

V2317 6 Lens lenticular aspheric tri ................................................................ ................ ................ ................ ................ ................

V2318 6 Lens aniseikonic trifocal .................................................................... ................ ................ ................ ................ ................

V2319 6 Lens trifocal seg width > 28 .............................................................. ................ ................ ................ ................ ................

V2320 6 Lens trifocal add over 3.25d ............................................................. ................ ................ ................ ................ ................

V2399 6 Lens trifocal speciality ....................................................................... ................ ................ ................ ................ ................

V2410 6 Lens variab asphericity sing ............................................................. ................ ................ ................ ................ ................

V2430 6 Lens variable asphericity bi .............................................................. ................ ................ ................ ................ ................

V2499 6 Variable asphericity lens ................................................................... ................ ................ ................ ................ ................

V2500 6 Contact lens pmma spherical ........................................................... ................ ................ ................ ................ ................

V2501 6 Cntct lens pmma-toric/prism ............................................................. ................ ................ ................ ................ ................

V2502 6 Contact lens pmma bifocal ............................................................... ................ ................ ................ ................ ................

V2503 6 Cntct lens pmma color vision ............................................................ ................ ................ ................ ................ ................

V2510 6 Cntct gas permeable sphericl ........................................................... ................ ................ ................ ................ ................

V2511 6 Cntct toric prism ballast .................................................................... ................ ................ ................ ................ ................

V2512 6 Cntct lens gas permbl bifocl ............................................................. ................ ................ ................ ................ ................

V2513 6 Contact lens extended wear ............................................................. ................ ................ ................ ................ ................

V2520 6 Contact lens hydrophilic .................................................................... ................ ................ ................ ................ ................

V2521 6 Cntct lens hydrophilic toric ................................................................ ................ ................ ................ ................ ................

V2522 6 Cntct lens hydrophil bifocl ................................................................. ................ ................ ................ ................ ................

V2523 6 Cntct lens hydrophil extend .............................................................. ................ ................ ................ ................ ................

V2530 6 Contact lens gas impermeable ......................................................... ................ ................ ................ ................ ................

V2531 6 Contact lens gas permeable ............................................................. ................ ................ ................ ................ ................

V2599 6 Contact lens/es other type ................................................................ ................ ................ ................ ................ ................

V2600 6 Hand held low vision aids ................................................................. ................ ................ ................ ................ ................

V2610 6 Single lens spectacle mount ............................................................. ................ ................ ................ ................ ................

V2615 6 Telescop/othr compound lens ........................................................... ................ ................ ................ ................ ................

V2623 6 Plastic eye prosth custom ................................................................. ................ ................ ................ ................ ................

V2624 6 Polishing artifical eye ........................................................................ ................ ................ ................ ................ ................

V2625 6 Enlargemnt of eye prosthesis ........................................................... ................ ................ ................ ................ ................

V2626 6 Reduction of eye prosthesis ............................................................. ................ ................ ................ ................ ................

V2627 6 Scleral cover shell ............................................................................. ................ ................ ................ ................ ................

V2628 6 Fabrication & fitting ........................................................................... ................ ................ ................ ................ ................

V2629 6 Prosthetic eye other type .................................................................. ................ ................ ................ ................ ................

V2630 2 Anter chamber intraocul lens ............................................................ ................ ................ ................ ................ ................

V2631 2 Iris support intraoclr lens .................................................................. ................ ................ ................ ................ ................

V2632 2 Post chmbr intraocular lens .............................................................. ................ ................ ................ ................ ................

V2700 6 Balance lens ..................................................................................... ................ ................ ................ ................ ................

V2710 6 Glass/plastic slab off prism ............................................................... ................ ................ ................ ................ ................

V2715 6 Prism lens/es .................................................................................... ................ ................ ................ ................ ................

V2718 6 Fresnell prism press-on lens ............................................................. ................ ................ ................ ................ ................

V2730 6 Special base curve ........................................................................... ................ ................ ................ ................ ................

V2740 6 Rose tint plastic ................................................................................ ................ ................ ................ ................ ................

V2741 6 Non-rose tint plastic .......................................................................... ................ ................ ................ ................ ................

V2742 6 Rose tint glass .................................................................................. ................ ................ ................ ................ ................

V2743 6 Non-rose tint glass ............................................................................ ................ ................ ................ ................ ................

V2744 6 Tint photochromatic lens/es .............................................................. ................ ................ ................ ................ ................

V2750 6 Anti-reflective coating ........................................................................ ................ ................ ................ ................ ................

V2755 6 UV lens/es ......................................................................................... ................ ................ ................ ................ ................

V2760 6 Scratch resistant coating .................................................................. ................ ................ ................ ................ ................

V2770 6 Occluder lens/es ............................................................................... ................ ................ ................ ................ ................

V2780 6 Oversize lens/es ............................................................................... ................ ................ ................ ................ ................

V2781 6 Progressive lens per lens ................................................................. ................ ................ ................ ................ ................

V2785 2 Corneal tissue processing ................................................................ ................ ................ ................ ................ ................

V2799 6 Miscellaneous vision service ............................................................ ................ ................ ................ ................ ................

V5008 9 Hearing screening ............................................................................. ................ ................ ................ ................ ................

V5010 9 Assessment for hearing aid .............................................................. ................ ................ ................ ................ ................

V5011 9 Hearing aid fitting/checking ............................................................... ................ ................ ................ ................ ................

V5014 9 Hearing aid repair/modifying ............................................................. ................ ................ ................ ................ ................

V5020 9 Conformity evaluation ....................................................................... ................ ................ ................ ................ ................

V5030 9 Body-worn hearing aid air ................................................................. ................ ................ ................ ................ ................

V5040 9 Body-worn hearing aid bone ............................................................. ................ ................ ................ ................ ................

V5050 9 Body-worn hearing aid in ear ........................................................... ................ ................ ................ ................ ................

V5060 9 Behind ear hearing aid ..................................................................... ................ ................ ................ ................ ................

V5070 9 Glasses air conduction ..................................................................... ................ ................ ................ ................ ................

V5080 9 Glasses bone conduction ................................................................. ................ ................ ................ ................ ................

V5090 9 Hearing aid dispensing fee ............................................................... ................ ................ ................ ................ ................

V5100 9 Body-worn bilat hearing aid .............................................................. ................ ................ ................ ................ ................
32470 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM A.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) PAYMENT STATUS BY HCPCS CODE AND RELATED

INFORMATION—Continued

CPT 1/

HCPCS

ASC

payment

indicator

Description

Current

payment

group

Current

payment

rate

Proposed

APC

group

Proposed

payment

rate

Relative

value

factor

Add 2/

Delete

V5110 9 Hearing aid dispensing fee ............................................................... ................ ................ ................ ................ ................

V5120 9 Body-worn binaur hearing aid ........................................................... ................ ................ ................ ................ ................

V5130 9 In ear binaural hearing aid ................................................................ ................ ................ ................ ................ ................

V5140 9 Behind ear binaur hearing ai ............................................................ ................ ................ ................ ................ ................

V5150 9 Glasses binaural hearing aid ............................................................ ................ ................ ................ ................ ................

V5160 9 Dispensing fee binaural .................................................................... ................ ................ ................ ................ ................

V5170 9 Within ear cros hearing aid ............................................................... ................ ................ ................ ................ ................

V5180 9 Behind ear cros hearing aid ............................................................. ................ ................ ................ ................ ................

V5190 9 Glasses cros hearing aid .................................................................. ................ ................ ................ ................ ................

V5200 9 Cros hearing aid dispens fee ............................................................ ................ ................ ................ ................ ................

V5210 9 In ear bicros hearing aid ................................................................... ................ ................ ................ ................ ................

V5220 9 Behind ear bicros hearing ai ............................................................. ................ ................ ................ ................ ................

V5230 9 Glasses bicros hearing aid ............................................................... ................ ................ ................ ................ ................

V5240 9 Dispensing fee bicros ....................................................................... ................ ................ ................ ................ ................

V5299 6 Hearing service ................................................................................. ................ ................ ................ ................ ................

V5336 9 Repair communication device ........................................................... ................ ................ ................ ................ ................

V5362 6 Speech screening ............................................................................. ................ ................ ................ ................ ................

V5363 6 Language screening ......................................................................... ................ ................ ................ ................ ................

V5364 6 Dysphagia screening ........................................................................ ................ ................ ................ ................ ................

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION

APC

group

CPT 1/

HCPCS Description

122 ............ 19100 BIOPSY OF BREAST; NEEDLE CORE (SEPARATE PROCEDURE)

122 ............ 20206 BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE

122 ............ 32400 BIOPSY, PLEURA; PERCUTANEOUS NEEDLE

122 ............ 32405 BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE

122 ............ 38505 BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL, INGUINAL, AXILLARY)

122 ............ 42400 BIOPSY OF SALIVARY GLAND; NEEDLE

122 ............ 47000 BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS

122 ............ 48102 BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE

122 ............ 49180 BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS, PERCUTANEOUS NEEDLE

122 ............ 50200 RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE

122 ............ 50390 ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, PERCUTANEOUS

122 ............ 54500 BIOPSY OF TESTIS, NEEDLE (SEPARATE PROCEDURE)

122 ............ 54800 BIOPSY OF EPIDIDYMIS, NEEDLE

122 ............ 60100 BIOPSY THYROID, PERCUTANEOUS CORE NEEDLE

122 ............ 62269 BIOPSY OF SPINAL CORD, PERCUTANEOUS NEEDLE

122 ............ 67415 FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS

132 ............ 19020 MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

132 ............ 20950 MONITORING OF INTERSTITIAL FLUID PRESSURE (INCLUDES INSERTION OF DEVICE, EG, WICK CATHETER TECHNIQUE,

NEEDLE MANOMETER TECHNIQUE) IN DETECTION OF MUSCLE COMPARTMENT SYNDROME

132 ............ 21501 INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX;

132 ............ 21700 DIVISION OF SCALENUS ANTICUS; WITHOUT RESECTION OF CERVICAL RIB

132 ............ 21720 DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITHOUT CAST APPLICATION

132 ............ 21725 DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPEN OPERATION; WITH CAST APPLICATION

132 ............ 23030 INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESS OR HEMATOMA

132 ............ 23031 INCISION AND DRAINAGE, SHOULDER AREA; INFECTED BURSA

132 ............ 23930 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA

132 ............ 23931 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; INFECTED BURSA

132 ............ 27301 INCISION AND DRAINAGE OF DEEP ABSCESS, INFECTED BURSA, OR HEMATOMA, THIGH OR KNEE REGION

132 ............ 27603 INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA

132 ............ 28001 INCISION AND DRAINAGE, INFECTED BURSA, FOOT

132 ............ 38300 DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; SIMPLE

132 ............ 38305 DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; EXTENSIVE

132 ............ 51080 DRAINAGE OF PERIVESICAL OR PREVESICAL SPACE ABSCESS

132 ............ 54015 INCISION AND DRAINAGE OF PENIS, DEEP

132 ............ 54115 REMOVAL FOREIGN BODY FROM DEEP PENILE TISSUE (EG, PLASTIC IMPLANT)

132 ............ 55100 DRAINAGE OF SCROTAL WALL ABSCESS

152 ............ 16010 DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; UNDER ANESTHESIA, SMALL

152 ............ 16015 DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; UNDER ANESTHESIA, MEDIUM OR LARGE, OR WITH MAJOR

DEBRIDEMENT

152 ............ 17106 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); LESS THAN 10 SQ CM

152 ............ 17107 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); 10.0–50.0 SQ CM

152 ............ 17108 DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); OVER 50.0 SQ CM

152 ............ 46900 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CHEMICAL

152 ............ 46910 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
32471

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

152 ............ 46916 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CRYOSURGERY

152 ............ 46917 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY

152 ............ 46922 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION

152 ............ 46924 DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE, ANY METHOD

152 ............ 54050 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CHEMICAL

152 ............ 54055 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION

152 ............ 54056 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CRYOSURGERY

152 ............ 54057 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY

152 ............ 54060 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION

152 ............ 54065 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE, ANY METHOD

152 ............ 56501 DESTRUCTION OF LESION(S), VULVA; SIMPLE, ANY METHOD

152 ............ 56515 DESTRUCTION OF LESION(S), VULVA; EXTENSIVE, ANY METHOD

162 ............ 11043 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE

162 ............ 11044 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE

162 ............ 11404 EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; LESION DIAMETER

3.1 TO 4.0 CM

162 ............ 11424 EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 3.1 TO 4.0 CM

162 ............ 11444 EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;

LESION DIAMETER 3.1 TO 4.0 CM

162 ............ 11604 EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESION DIAMETER 3.1 TO 4.0 CM

162 ............ 11770 EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE

162 ............ 16035 ESCHAROTOMY

162 ............ 16040 EXCISION BURN WOUND, WITHOUT SKIN GRAFTING, EMPLOYING ALLOPLASTIC DRESSING (EG, SYNTHETIC MESH), ANY

ANATOMIC SITE; UP TO ONE PERCENT TOTAL BODY SURFACE AREA

162 ............ 16041 EXCISION BURN WOUND, WITHOUT SKIN GRAFTING, EMPLOYING ALLOPLASTIC DRESSING (EG, SYNTHETIC MESH), ANY

ANATOMIC SITE; GREATER THAN ONE PERCENT AND UP TO NINE PERCENT TOTAL BODY SURFACE AREA

162 ............ 16042 EXCISION BURN WOUND, WITHOUT SKIN GRAFTING, EMPLOYING ALLOPLASTIC DRESSING (EG, SYNTHETIC MESH), ANY

ANATOMIC SITE; EACH ADDITIONAL NINE PERCENT TOTAL BODY SURFACE AREA, OR PART THEREOF

162 ............ 17304 CHEMOSURGERY (MOHS’ MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION

OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE

SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; FIRST STAGE, FRESH TISSUE TECHNIQUE, UP TO 5 SPECIMENS

162 ............ 17305 CHEMOSURGERY (MOHS’ MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION

OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE

SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; SECOND STAGE, FIXED OR FRESH TISSUE, UP TO 5

SPECIMENS

162 ............ 17306 CHEMOSURGERY (MOHS’ MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION

OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE

SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; THIRD STAGE, FIXED OR FRESH TISSUE, UP TO 5 SPECIMENS

162 ............ 17307 CHEMOSURGERY (MOHS’ MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION

OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE

SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; ADDITIONAL STAGE(S), UP TO 5 SPECIMENS, EACH STAGE

162 ............ 17310 CHEMOSURGERY (MOHS’ MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION

OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE

SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION; MORE THAN 5 SPECIMENS, FIXED OR FRESH TISSUE, ANY

STAGE

162 ............ 20200 BIOPSY, MUSCLE; SUPERFICIAL

162 ............ 20205 BIOPSY, MUSCLE; DEEP

162 ............ 20220 BIOPSY, BONE, TROCAR, OR NEEDLE; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS)

162 ............ 20225 BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (VERTEBRAL BODY, FEMUR)

162 ............ 20670 REMOVAL OF IMPLANT; SUPERFICIAL, (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)

162 ............ 23000 REMOVAL OF SUBDELTOID (OR INTRATENDINOUS) CALCAREOUS DEPOSITS, OPEN METHOD

162 ............ 23075 EXCISION, TUMOR, SHOULDER AREA; SUBCUTANEOUS

162 ............ 24075 EXCISION, TUMOR, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS

162 ............ 25075 EXCISION, TUMOR, FOREARM AND/OR WRIST AREA; SUBCUTANEOUS

162 ............ 27040 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; SUPERFICIAL

162 ............ 27323 BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL

162 ............ 28043 EXCISION, TUMOR, FOOT; SUBCUTANEOUS

162 ............ 37609 LIGATION OR BIOPSY, TEMPORAL ARTERY

162 ............ 54100 BIOPSY OF PENIS; CUTANEOUS (SEPARATE PROCEDURE)

162 ............ 54105 BIOPSY OF PENIS; DEEP STRUCTURES

162 ............ 67350 BIOPSY OF EXTRAOCULAR MUSCLE

162 ............ 68100 BIOPSY OF CONJUNCTIVA
32472

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1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

162 ............ 68110 EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM

162 ............ 68115 EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM

162 ............ 68135 DESTRUCTION OF LESION, CONJUNCTIVA

163 ............ 10121 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED

163 ............ 11010 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR DISLOCATION(S); SKIN AND SUBCUTANEOUS TISSUES

163 ............ 11011 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR DISLOCATION(S); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE

163 ............ 11012 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL ASSOCIATED WITH OPEN FRACTURE(S) AND/OR DISLOCATION(S); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE

163 ............ 11406 EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; LESION DIAMETER

OVER 4.0 CM

163 ............ 11426 EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 4.0 CM

163 ............ 11446 EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;

LESION DIAMETER OVER 4.0 CM

163 ............ 11450 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE OR INTERMEDIATE REPAIR

163 ............ 11451 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH COMPLEX REPAIR

163 ............ 11462 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH SIMPLE OR INTERMEDIATE REPAIR

163 ............ 11463 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH COMPLEX REPAIR

163 ............ 11470 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH SIMPLE

OR INTERMEDIATE REPAIR

163 ............ 11471 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH COMPLEX

REPAIR

163 ............ 11606 EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESION DIAMETER OVER 4.0 CM

163 ............ 11624 EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 3.1 TO 4.0 CM

163 ............ 11626 EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 4.0 CM

163 ............ 11644 EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS; LESION DIAMETER 3.1 TO 4.0 CM

163 ............ 11646 EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS; LESION DIAMETER OVER 4.0 CM

163 ............ 11752 EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR PERMANENT REMOVAL; WITH AMPUTATION OF TUFT OF DISTAL PHALANX

163 ............ 11771 EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE

163 ............ 11772 EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED

163 ............ 11971 REMOVAL OF TISSUE EXPANDER(S) WITHOUT INSERTION OF PROSTHESIS

163 ............ 15780 DERMABRASION; TOTAL FACE (EG, FOR ACNE SCARRING, FINE WRINKLING, RHYTIDS, GENERAL KERATOSIS)

163 ............ 15781 DERMABRASION; SEGMENTAL, FACE

163 ............ 15782 DERMABRASION; REGIONAL, OTHER THAN FACE

163 ............ 15811 SALABRASION; OVER 20 SQ CM

163 ............ 15838 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); SUBMENTAL FAT PAD

163 ............ 15920 EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH PRIMARY SUTURE

163 ............ 15931 EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE;

163 ............ 15933 EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY

163 ............ 15940 EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE;

163 ............ 15941 EXCISION, ISCHIAL PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY (ISCHIECTOMY)

163 ............ 15950 EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE;

163 ............ 15951 EXCISION, TROCHANTERIC PRESSURE ULCER, WITH PRIMARY SUTURE; WITH OSTECTOMY

163 ............ 20240 BIOPSY, EXCISIONAL; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS, TROCHANTER OF FEMUR)

163 ............ 20245 BIOPSY, EXCISIONAL; DEEP (EG, HUMERUS, ISCHIUM, FEMUR)

163 ............ 20525 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED

163 ............ 20680 REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)

163 ............ 21555 EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX; SUBCUTANEOUS

163 ............ 21556 EXCISION TUMOR, SOFT TISSUE OF NECK OR THORAX; DEEP, SUBFASCIAL, INTRAMUSCULAR

163 ............ 21925 BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP

163 ............ 21930 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK

163 ............ 21935 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF BACK OR FLANK

163 ............ 22900 EXCISION, ABDOMINAL WALL TUMOR, SUBFASCIAL (EG, DESMOID)

163 ............ 23066 BIOPSY, SOFT TISSUE OF SHOULDER AREA; DEEP

163 ............ 23076 EXCISION, TUMOR, SHOULDER AREA; DEEP, SUBFASCIAL, OR INTRAMUSCULAR

163 ............ 23077 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF SHOULDER AREA

163 ............ 23330 REMOVAL OF FOREIGN BODY, SHOULDER; SUBCUTANEOUS

163 ............ 23331 REMOVAL OF FOREIGN BODY, SHOULDER; DEEP (EG, NEER PROSTHESIS REMOVAL)

163 ............ 24066 BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP

163 ............ 24076 EXCISION, TUMOR, UPPER ARM OR ELBOW AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR

163 ............ 24077 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF UPPER ARM OR ELBOW AREA

163 ............ 24201 REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP

163 ............ 25066 BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; DEEP

163 ............ 25076 EXCISION, TUMOR, FOREARM AND/OR WRIST AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR

163 ............ 25077 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOREARM AND/OR WRIST AREA

163 ............ 26115 EXCISION, TUMOR OR VASCULAR MALFORMATION, HAND OR FINGER; SUBCUTANEOUS

163 ............ 26116 EXCISION, TUMOR OR VASCULAR MALFORMATION, HAND OR FINGER; DEEP, SUBFASCIAL, INTRAMUSCULAR

163 ............ 26117 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FINGER

163 ............ 26320 REMOVAL OF IMPLANT FROM FINGER OR HAND

163 ............ 27041 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; DEEP

163 ............ 27047 EXCISION, TUMOR, PELVIS AND HIP AREA; SUBCUTANEOUS

163 ............ 27048 EXCISION, TUMOR, PELVIS AND HIP AREA; DEEP, SUBFASCIAL, INTRAMUSCULAR
32473

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

163 ............ 27049 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF PELVIS AND HIP AREA

163 ............ 27324 BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; DEEP

163 ............ 27327 EXCISION, TUMOR, THIGH OR KNEE AREA; SUBCUTANEOUS

163 ............ 27328 EXCISION, TUMOR, THIGH OR KNEE AREA; DEEP, SUBFASCIAL, OR INTRAMUSCULAR

163 ............ 27329 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF THIGH OR KNEE AREA

163 ............ 27372 REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA

163 ............ 27614 BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; DEEP

163 ............ 27618 EXCISION, TUMOR, LEG OR ANKLE AREA; SUBCUTANEOUS

163 ............ 27619 EXCISION, TUMOR, LEG OR ANKLE AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR

163 ............ 28192 REMOVAL OF FOREIGN BODY, FOOT; DEEP

163 ............ 28193 REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED

163 ............ 69110 EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR

163 ............ 69145 EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL

163 ............ 69205 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA

181 ............ 11760 REPAIR OF NAIL BED

181 ............ 11762 RECONSTRUCTION OF NAIL BED WITH GRAFT

181 ............ 11920 TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT COLOR DEFECTS OF SKIN, INCLUDING MICROPIGMENTATION; 6.0 SQ CM OR LESS

181 ............ 11921 TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT COLOR DEFECTS OF SKIN, INCLUDING MICROPIGMENTATION; 6.1 TO 20.0 SQ CM

181 ............ 11922 TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUE PIGMENTS TO CORRECT COLOR DEFECTS OF SKIN, INCLUDING MICROPIGMENTATION; EACH ADDITIONAL 20.0 SQ CM

181 ............ 11950 SUBCUTANEOUS INJECTION OF ‘‘FILLING’’ MATERIAL (EG, COLLAGEN); 1 CC OR LESS

181 ............ 11951 SUBCUTANEOUS INJECTION OF ‘‘FILLING’’ MATERIAL (EG, COLLAGEN); 1.1 TO 5.0 CC

181 ............ 11952 SUBCUTANEOUS INJECTION OF ‘‘FILLING’’ MATERIAL (EG, COLLAGEN); 5.1 TO 10.0 CC

181 ............ 11954 SUBCUTANEOUS INJECTION OF ‘‘FILLING’’ MATERIAL (EG, COLLAGEN); OVER 10.0 CC

181 ............ 12001 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES

(INCLUDING HANDS AND FEET); 2.5 CM OR LESS

181 ............ 12002 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES

(INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM

181 ............ 12004 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES

(INCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM

181 ............ 12005 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES

(INCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM

181 ............ 12006 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES

(INCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM

181 ............ 12007 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES

(INCLUDING HANDS AND FEET); OVER 30.0 CM

181 ............ 12011 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM

OR LESS

181 ............ 12013 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO

5.0 CM

181 ............ 12014 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO

7.5 CM

181 ............ 12015 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO

12.5 CM

181 ............ 12016 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 12.6 CM

TO 20.0 CM

181 ............ 12017 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 20.1 CM

TO 30.0 CM

181 ............ 12018 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; OVER

30.0 CM

181 ............ 12020 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE

181 ............ 12021 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING

181 ............ 12031 LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.5 CM

OR LESS

181 ............ 12032 LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM

TO 7.5 CM

181 ............ 12034 LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 7.6 CM

TO 12.5 CM

181 ............ 12035 LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM

TO 20.0 CM

181 ............ 12036 LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 20.1 CM

TO 30.0 CM

181 ............ 12041 LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS

181 ............ 12042 LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM

181 ............ 12044 LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 7.6 CM TO 12.5 CM

181 ............ 12045 LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 12.6 CM TO 20.0 CM

181 ............ 12046 LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 20.1 CM TO 30.0 CM

181 ............ 12051 LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS

181 ............ 12052 LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM

181 ............ 12053 LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO 7.5 CM

181 ............ 12054 LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO 12.5 CM

181 ............ 12055 LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 12.6 CM TO 20.0 CM

181 ............ 12056 LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 20.1 CM TO 30.0 CM
32474

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

181 ............ 15860 INTRAVENOUS INJECTION OF AGENT (EG, FLUORESCEIN) TO TEST BLOOD FLOW IN FLAP OR GRAFT

181 ............ 20500 INJECTION OF SINUS TRACT; THERAPEUTIC (SEPARATE PROCEDURE)

182 ............ 13100 REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM

182 ............ 13101 REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM

182 ............ 13120 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM

182 ............ 13121 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM

182 ............ 13131 REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM TO 2.5

CM

182 ............ 13132 REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM TO 7.5

CM

182 ............ 13150 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.0 CM OR LESS

182 ............ 13151 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM

182 ............ 13152 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM

182 ............ 13160 SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED

182 ............ 13300 REPAIR, UNUSUAL, COMPLICATED, OVER 7.5 CM, ANY AREA

182 ............ 43870 CLOSURE OF GASTROSTOMY, SURGICAL

183 ............ 11960 INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN BREAST, INCLUDING SUBSEQUENT EXPANSION

183 ............ 11970 REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS

183 ............ 12037 LAYER CLOSURE OF WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER

30.0 CM

183 ............ 12047 LAYER CLOSURE OF WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; OVER 30.0 CM

183 ............ 12057 LAYER CLOSURE OF WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; OVER 30.0 CM

183 ............ 14000 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS

183 ............ 14001 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM

183 ............ 14020 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/ OR LEGS; DEFECT 10 SQ CM OR LESS

183 ............ 14021 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/ OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ CM

183 ............ 14040 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA,

HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS

183 ............ 14041 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA,

HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM

183 ............ 14060 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS

183 ............ 14061 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ

CM

183 ............ 14300 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, MORE THAN 30 SQ CM, UNUSUAL OR COMPLICATED, ANY AREA

183 ............ 14350 FILLETED FINGER OR TOE FLAP, INCLUDING PREPARATION OF RECIPIENT SITE

183 ............ 15000 EXCISIONAL PREPARATION OR CREATION OF RECIPIENT SITE BY EXCISION OF ESSENTIALLY INTACT SKIN (INCLUDING

SUBCUTANEOUS TISSUES), SCAR, OR OTHER LESION PRIOR TO REPAIR WITH FREE SKIN GRAFT (LIST AS SEPARATE

SERVICE IN ADDITION TO SKIN GRAFT)

183 ............ 15050 PINCH GRAFT, SINGLE OR MULTIPLE, TO COVER SMALL ULCER, TIP OF DIGIT, OR OTHER MINIMAL OPEN AREA (EXCEPT ON

FACE), UP TO DEFECT SIZE 2 CM DIAMETER

183 ............ 15100 SPLIT GRAFT, TRUNK, SCALP, ARMS, LEGS, HANDS, AND/OR FEET (EXCEPT MULTIPLE DIGITS); 100 SQ CM OR LESS, OR

EACH ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)

183 ............ 15101 SPLIT GRAFT, TRUNK, SCALP, ARMS, LEGS, HANDS, AND/OR FEET (EXCEPT MULTIPLE DIGITS); EACH ADDITIONAL 100 SQ

CM, OR EACH ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF

183 ............ 15120 SPLIT GRAFT, FACE, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, AND/OR MULTIPLE DIGITS; 100 SQ CM OR LESS,

OR EACH ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)

183 ............ 15121 SPLIT GRAFT, FACE, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, AND/OR MULTIPLE DIGITS; EACH ADDITIONAL 100

SQ CM, OR EACH ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF

183 ............ 15200 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; 20 SQ CM OR LESS

183 ............ 15201 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; EACH ADDITIONAL 20 SQ CM

183 ............ 15220 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/OR LEGS; 20 SQ CM OR

LESS

183 ............ 15221 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 20 SQ CM

183 ............ 15240 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,

AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQ CM OR LESS

183 ............ 15241 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,

AXILLAE, GENITALIA, HANDS, AND/OR FEET; EACH ADDITIONAL 20 SQ CM

183 ............ 15260 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS; 20 SQ

CM OR LESS

183 ............ 15261 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS; EACH

ADDITIONAL 20 SQ CM

183 ............ 15350 APPLICATION OF ALLOGRAFT, SKIN

183 ............ 15400 APPLICATION OF XENOGRAFT, SKIN

183 ............ 15570 FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; TRUNK

183 ............ 15572 FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; SCALP, ARMS, OR LEGS

183 ............ 15574 FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,

AXILLAE, GENITALIA, HANDS OR FEET

183 ............ 15576 FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE, EARS, LIPS, OR INTRAORAL

183 ............ 15580 CROSS FINGER FLAP, INCLUDING FREE GRAFT TO DONOR SITE

183 ............ 15600 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT TRUNK

183 ............ 15610 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT SCALP, ARMS, OR LEGS

183 ............ 15620 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT FOREHEAD, CHEEKS, CHIN, NECK, AXILLAE, GENITALIA,

HANDS (EXCEPT 15625), OR FEET

183 ............ 15625 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); SECTION PEDICLE OF CROSS FINGER FLAP
32475

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

183 ............ 15630 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS

183 ............ 15650 TRANSFER, INTERMEDIATE, OF ANY PEDICLE FLAP (EG, ABDOMEN TO WRIST, ‘‘WALKING’’ TUBE), ANY LOCATION

183 ............ 15775 PUNCH GRAFT FOR HAIR TRANSPLANT; 1 TO 15 PUNCH GRAFTS

183 ............ 15776 PUNCH GRAFT FOR HAIR TRANSPLANT; MORE THAN 15 PUNCH GRAFTS

183 ............ 15819 CERVICOPLASTY

183 ............ 15820 BLEPHAROPLASTY, LOWER EYELID;

183 ............ 15821 BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE HERNIATED FAT PAD

183 ............ 15822 BLEPHAROPLASTY, UPPER EYELID;

183 ............ 15823 BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID

183 ............ 15825 RHYTIDECTOMY; NECK WITH PLATYSMAL TIGHTENING (PLATYSMAL FLAP, ‘‘P–FLAP’’)

183 ............ 15829 RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC SYSTEM (SMAS) FLAP

183 ............ 15835 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); BUTTOCK

183 ............ 20910 CARTILAGE GRAFT; COSTOCHONDRAL

183 ............ 20912 CARTILAGE GRAFT; NASAL SEPTUM

183 ............ 20920 FASCIA LATA GRAFT; BY STRIPPER

183 ............ 20922 FASCIA LATA GRAFT; BY INCISION AND AREA EXPOSURE, COMPLEX OR SHEET

183 ............ 20926 TISSUE GRAFTS, OTHER (EG, PARATENON, FAT, DERMIS)

183 ............ 23921 DISARTICULATION OF SHOULDER; SECONDARY CLOSURE OR SCAR REVISION

183 ............ 25929 TRANSMETACARPAL AMPUTATION; SECONDARY CLOSURE OR SCAR REVISION

183 ............ 44312 REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)

183 ............ 44340 REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)

183 ............ 65270 REPAIR OF LACERATION; CONJUNCTIVA, WITH OR WITHOUT NONPERFORATING LACERATION SCLERA, DIRECT CLOSURE

184 ............ 15732 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; HEAD AND NECK (EG, TEMPORALIS, MASSETER,

STERNOCLEIDOMASTOID, LEVATOR SCAPULAE)

184 ............ 15734 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK

184 ............ 15736 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; UPPER EXTREMITY

184 ............ 15738 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; LOWER EXTREMITY

184 ............ 15740 FLAP; ISLAND PEDICLE

184 ............ 15750 FLAP; NEUROVASCULAR PEDICLE

184 ............ 15760 GRAFT; COMPOSITE (EG, FULL THICKNESS OF EXTERNAL EAR OR NASAL ALA), INCLUDING PRIMARY CLOSURE, DONOR

AREA

184 ............ 15770 GRAFT; DERMA–FAT–FASCIA

184 ............ 15824 RHYTIDECTOMY; FOREHEAD

184 ............ 15826 RHYTIDECTOMY; GLABELLAR FROWN LINES

184 ............ 15828 RHYTIDECTOMY; CHEEK, CHIN, AND NECK

184 ............ 15831 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); ABDOMEN (ABDOMINOPLASTY)

184 ............ 15832 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); THIGH

184 ............ 15833 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); LEG

184 ............ 15834 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); HIP

184 ............ 15836 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); ARM

184 ............ 15837 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); FOREARM OR HAND

184 ............ 15839 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); OTHER AREA

184 ............ 15840 GRAFT FOR FACIAL NERVE PARALYSIS; FREE FASCIA GRAFT (INCLUDING OBTAINING FASCIA)

184 ............ 15841 GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE GRAFT (INCLUDING OBTAINING GRAFT)

184 ............ 15842 GRAFT FOR FACIAL NERVE PARALYSIS; FREE MUSCLE GRAFT BY MICROSURGICAL TECHNIQUE

184 ............ 15845 GRAFT FOR FACIAL NERVE PARALYSIS; REGIONAL MUSCLE TRANSFER

184 ............ 15876 SUCTION ASSISTED LIPECTOMY; HEAD AND NECK

184 ............ 15877 SUCTION ASSISTED LIPECTOMY; TRUNK

184 ............ 15878 SUCTION ASSISTED LIPECTOMY; UPPER EXTREMITY

184 ............ 15879 SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY

184 ............ 15922 EXCISION, COCCYGEAL PRESSURE ULCER, WITH COCCYGECTOMY; WITH FLAP CLOSURE

184 ............ 15934 EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;

184 ............ 15935 EXCISION, SACRAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY

184 ............ 15936 EXCISION, SACRAL PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE;

184 ............ 15937 EXCISION, SACRAL PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE; WITH OSTECTOMY

184 ............ 15944 EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE;

184 ............ 15945 EXCISION, ISCHIAL PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY

184 ............ 15946 EXCISION, ISCHIAL PRESSURE ULCER, WITH OSTECTOMY, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE

184 ............ 15952 EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE;

184 ............ 15953 EXCISION, TROCHANTERIC PRESSURE ULCER, WITH SKIN FLAP CLOSURE; WITH OSTECTOMY

184 ............ 15956 EXCISION, TROCHANTERIC PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE;

184 ............ 15958 EXCISION, TROCHANTERIC PRESSURE ULCER, WITH MUSCLE OR MYOCUTANEOUS FLAP CLOSURE; WITH OSTECTOMY

197 ............ 19101 BIOPSY OF BREAST; INCISIONAL

197 ............ 19110 NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARY LACTIFEROUS DUCT OR A PAPILLOMA LACTIFEROUS

DUCT

197 ............ 19112 EXCISION OF LACTIFEROUS DUCT FISTULA

197 ............ 19120 EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19140), MALE OR FEMALE, ONE OR MORE LESIONS

197 ............ 19125 EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER; SINGLE LESION

197 ............ 19126 EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER; EACH ADDITIONAL

LESION SEPARATELY IDENTIFIED BY A RADIOLOGICAL MARKER

197 ............ 19140 MASTECTOMY FOR GYNECOMASTIA

197 ............ 19290 PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST;

197 ............ 19291 PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST; EACH ADDITIONAL LESION

197 ............ 19396 PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT
32476

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

198 ............ 19160 MASTECTOMY, PARTIAL;

198 ............ 19162 MASTECTOMY, PARTIAL; WITH AXILLARY LYMPHADENECTOMY

198 ............ 19180 MASTECTOMY, SIMPLE, COMPLETE

198 ............ 19182 MASTECTOMY, SUBCUTANEOUS

198 ............ 19316 MASTOPEXY

198 ............ 19318 REDUCTION MAMMAPLASTY

198 ............ 19324 MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANT

198 ............ 19325 MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT

198 ............ 19328 REMOVAL OF INTACT MAMMARY IMPLANT

198 ............ 19330 REMOVAL OF MAMMARY IMPLANT MATERIAL

198 ............ 19340 IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION

198 ............ 19342 DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION

198 ............ 19350 NIPPLE/AREOLA RECONSTRUCTION

198 ............ 19355 CORRECTION OF INVERTED NIPPLES

198 ............ 19357 BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUE EXPANDER, INCLUDING SUBSEQUENT EXPANSION

198 ............ 19366 BREAST RECONSTRUCTION WITH OTHER TECHNIQUE

198 ............ 19370 OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST

198 ............ 19371 PERIPROSTHETIC CAPSULECTOMY, BREAST

198 ............ 19380 REVISION OF RECONSTRUCTED BREAST

207 ............ 21800 CLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED, EACH

207 ............ 21820 CLOSED TREATMENT OF STERNUM FRACTURE

207 ............ 22305 CLOSED TREATMENT OF VERTEBRAL PROCESS FRACTURE(S)

207 ............ 22310 CLOSED TREATMENT OF VERTEBRAL BODY FRACTURE(S), WITHOUT MANIPULATION, REQUIRING AND INCLUDING CASTING

OR BRACING

207 ............ 22315 CLOSED TREATMENT OF VERTEBRAL FRACTURE(S) AND/OR DISLOCATION(S) REQUIRING CASTING OR BRACING, WITH AND

INCLUDING CASTING AND/ OR BRACING, WITH OR WITHOUT ANESTHESIA, BY MANIPULATION OR TRACTION

207 ............ 23500 CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITHOUT MANIPULATION

207 ............ 23505 CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH MANIPULATION

207 ............ 23520 CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION

207 ............ 23525 CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH MANIPULATION

207 ............ 23540 CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION

207 ............ 23545 CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITH MANIPULATION

207 ............ 23570 CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION

207 ............ 23575 CLOSED TREATMENT OF SCAPULAR FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION (WITH OR

WITHOUT SHOULDER JOINT INVOLVEMENT)

207 ............ 23650 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; WITHOUT ANESTHESIA

207 ............ 26700 CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT ANESTHESIA

207 ............ 26720 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; WITHOUT

MANIPULATION, EACH

207 ............ 26725 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION, EACH

207 ............ 26740 CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT;

WITHOUT MANIPULATION, EACH

207 ............ 26750 CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITHOUT MANIPULATION, EACH

207 ............ 26755 CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITH MANIPULATION, EACH

207 ............ 26770 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT ANESTHESIA

207 ............ 27200 CLOSED TREATMENT OF COCCYGEAL FRACTURE

207 ............ 28490 CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITHOUT MANIPULATION

207 ............ 28495 CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES; WITH MANIPULATION

207 ............ 28510 CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITHOUT MANIPULATION, EACH

207 ............ 28515 CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITH MANIPULATION, EACH

207 ............ 28630 CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA

207 ............ 28660 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA

207 ............ 31585 TREATMENT OF CLOSED LARYNGEAL FRACTURE; WITHOUT MANIPULATION

209 ............ 23600 CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITHOUT MANIPULATION

209 ............ 23605 CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITH MANIPULATION, WITH

OR WITHOUT SKELETAL TRACTION

209 ............ 23620 CLOSED TREATMENT OF GREATER TUBEROSITY FRACTURE; WITHOUT MANIPULATION

209 ............ 23625 CLOSED TREATMENT OF GREATER TUBEROSITY FRACTURE; WITH MANIPULATION

209 ............ 23665 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER TUBEROSITY, WITH MANIPULATION

209 ............ 23675 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTURE, WITH MANIPULATION

209 ............ 24500 CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION

209 ............ 24505 CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION

209 ............ 24530 CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT

INTERCONDYLAR EXTENSION; WITHOUT MANIPULATION

209 ............ 24535 CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT

INTERCONDYLAR EXTENSION; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION

209 ............ 24560 CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MANIPULATION

209 ............ 24565 CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH MANIPULATION

209 ............ 24576 CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MANIPULATION

209 ............ 24577 CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH MANIPULATION

209 ............ 24600 TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA

209 ............ 24620 CLOSED TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL END OF ULNA

WITH DISLOCATION OF RADIAL HEAD), WITH MANIPULATION
32477

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

209 ............ 24640 CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, ‘‘NURSEMAID ELBOW’’, WITH MANIPULATION

209 ............ 24650 CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT MANIPULATION

209 ............ 24655 CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH MANIPULATION

209 ............ 24670 CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (OLECRANON PROCESS); WITHOUT MANIPULATION

209 ............ 24675 CLOSED TREATMENT OF ULNAR FRACTURE, PROXIMAL END (OLECRANON PROCESS); WITH MANIPULATION

209 ............ 25500 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUT MANIPULATION

209 ............ 25505 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION

209 ............ 25520 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE, WITH DISLOCATION OF DISTAL RADIO-ULNAR JOINT (GALEAZZI FRACTURE/DISLOCATION)

209 ............ 25530 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION

209 ............ 25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION

209 ............ 25560 CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION

209 ............ 25565 CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION

209 ............ 25600 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, WITH OR

WITHOUT FRACTURE OF ULNAR STYLOID; WITHOUT MANIPULATION

209 ............ 25605 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, WITH OR

WITHOUT FRACTURE OF ULNAR STYLOID; WITH MANIPULATION

209 ............ 25622 CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITHOUT MANIPULATION

209 ............ 25624 CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; WITH MANIPULATION

209 ............ 25630 CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)); WITHOUT MANIPULATION, EACH BONE

209 ............ 25635 CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)); WITH MANIPULATION,

EACH BONE

209 ............ 25650 CLOSED TREATMENT OF ULNAR STYLOID FRACTURE

209 ............ 25660 CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES, WITH MANIPULATION

209 ............ 25675 CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH MANIPULATION

209 ............ 25680 CLOSED TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION, WITH MANIPULATION

209 ............ 25690 CLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATION

209 ............ 26600 CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE

209 ............ 26605 CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE

209 ............ 26607 CLOSED TREATMENT OF METACARPAL FRACTURE, WITH MANIPULATION, WITH INTERNAL OR EXTERNAL FIXATION, EACH

BONE

209 ............ 26641 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITH MANIPULATION

209 ............ 26645 CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH MANIPULATION

209 ............ 26670 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE), SINGLE, WITH

MANIPULATION; WITHOUT ANESTHESIA

209 ............ 26706 PERCUTANEOUS SKELETAL FIXATION OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION

209 ............ 26742 CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT; WITH

MANIPULATION, EACH

209 ............ 27193 CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; WITHOUT MANIPULATION

209 ............ 27220 CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITHOUT MANIPULATION

209 ............ 27230 CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; WITHOUT MANIPULATION

209 ............ 27238 CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITHOUT MANIPULATION

209 ............ 27246 CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE, WITHOUT MANIPULATION

209 ............ 27250 CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUT ANESTHESIA

209 ............ 27256 TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICAL), BY ABDUCTION, SPLINT OR TRACTION; WITHOUT ANESTHESIA, WITHOUT MANIPULATION

209 ............ 27265 CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; WITHOUT ANESTHESIA

209 ............ 27500 CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION

209 ............ 27501 CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITHOUT

INTERCONDYLAR EXTENSION, WITHOUT MANIPULATION

209 ............ 27502 CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION

209 ............ 27503 CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR FEMORAL FRACTURE WITH OR WITHOUT

INTERCONDYLAR EXTENSION, WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION

209 ............ 27508 CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITHOUT MANIPULATION

209 ............ 27510 CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITH MANIPULATION

209 ............ 27516 CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION

209 ............ 27517 CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; WITH MANIPULATION, WITH OR WITHOUT SKIN OR

SKELETAL TRACTION

209 ............ 27520 CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION

209 ............ 27530 CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITHOUT MANIPULATION

209 ............ 27532 CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); WITH OR WITHOUT MANIPULATION, WITH SKELETAL

TRACTION

209 ............ 27538 CLOSED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF KNEE, WITH OR WITHOUT MANIPULATION

209 ............ 27550 CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIA

209 ............ 27560 CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA

209 ............ 27750 CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITHOUT MANIPULATION

209 ............ 27752 CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITH MANIPULATION, WITH

OR WITHOUT SKELETAL TRACTION

209 ............ 27760 CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUT MANIPULATION

209 ............ 27762 CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL

TRACTION
32478

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

209 ............ 27780 CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITHOUT MANIPULATION

209 ............ 27781 CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION

209 ............ 27786 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPULATION

209 ............ 27788 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH MANIPULATION

209 ............ 27808 CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, (INCLUDING POTTS); WITHOUT MANIPULATION

209 ............ 27810 CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, (INCLUDING POTTS); WITH MANIPULATION

209 ............ 27816 CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION

209 ............ 27818 CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION

209 ............ 27824 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, PILON OR TIBIAL PLAFOND), WITH OR WITHOUT ANESTHESIA; WITHOUT MANIPULATION

209 ............ 27825 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, PILON OR TIBIAL PLAFOND), WITH OR WITHOUT ANESTHESIA; WITH SKELETAL TRACTION AND/OR REQUIRING MANIPULATION

209 ............ 27830 CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; WITHOUT ANESTHESIA

209 ............ 27840 CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA

209 ............ 28400 CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION

209 ............ 28405 CLOSED TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION

209 ............ 28430 CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION

209 ............ 28435 CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION

209 ............ 28450 TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITHOUT MANIPULATION, EACH

209 ............ 28455 TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITH MANIPULATION, EACH

209 ............ 28470 CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH

209 ............ 28475 CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH

209 ............ 28530 CLOSED TREATMENT OF SESAMOID FRACTURE

209 ............ 28540 CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; WITHOUT ANESTHESIA

209 ............ 28570 CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA

209 ............ 28600 CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; WITHOUT ANESTHESIA

209 ............ 31586 TREATMENT OF CLOSED LARYNGEAL FRACTURE; WITH CLOSED MANIPULATIVE REDUCTION

210 ............ 22505 MANIPULATION OF SPINE REQUIRING ANESTHESIA, ANY REGION

210 ............ 23655 CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING ANESTHESIA

210 ............ 23700 MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION

EXCLUDED)

210 ............ 24605 TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA

210 ............ 26675 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE), SINGLE, WITH

MANIPULATION; REQUIRING ANESTHESIA

210 ............ 26705 CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH MANIPULATION; REQUIRING ANESTHESIA

210 ............ 26775 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; REQUIRING ANESTHESIA

210 ............ 27194 CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION, DIASTASIS OR SUBLUXATION; WITH MANIPULATION, REQUIRING MORE THAN LOCAL ANESTHESIA

210 ............ 27252 CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA

210 ............ 27257 TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICAL), BY ABDUCTION, SPLINT OR TRACTION; WITH MANIPULATION, REQUIRING ANESTHESIA

210 ............ 27275 MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA

210 ............ 27552 CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA

210 ............ 27562 CLOSED TREATMENT OF PATELLAR DISLOCATION; REQUIRING ANESTHESIA

210 ............ 27570 MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION

DEVICES)

210 ............ 27831 CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION; REQUIRING ANESTHESIA

210 ............ 27842 CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING ANESTHESIA, WITH OR WITHOUT PERCUTANEOUS SKELETAL

FIXATION

210 ............ 27860 MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION APPARATUS)

210 ............ 28545 CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL; REQUIRING ANESTHESIA

210 ............ 28575 CLOSED TREATMENT OF TALOTARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA

210 ............ 28605 CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; REQUIRING ANESTHESIA

210 ............ 28635 CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA

210 ............ 28665 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA

216 ............ 21336 OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION

216 ............ 21805 OPEN TREATMENT OF RIB FRACTURE WITHOUT FIXATION, EACH

216 ............ 23515 OPEN TREATMENT OF CLAVICULAR FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 23530 OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;

216 ............ 23532 OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)

216 ............ 23550 OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;

216 ............ 23552 OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)

216 ............ 23585 OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) WITH OR WITHOUT INTERNAL FIXATION

216 ............ 23615 OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, WITH OR WITHOUT INTERNAL

OR EXTERNAL FIXATION, WITH OR WITHOUT REPAIR OF TUBEROSITY(-IES);

216 ............ 23616 OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, WITH OR WITHOUT INTERNAL

OR EXTERNAL FIXATION, WITH OR WITHOUT REPAIR OF TUBEROSITY(-IES); WITH PROXIMAL HUMERAL PROSTHETIC REPLACEMENT

216 ............ 23630 OPEN TREATMENT OF GREATER TUBEROSITY FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 23660 OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION

216 ............ 23670 OPEN TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF GREATER TUBEROSITY, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION
32479

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

216 ............ 23680 OPEN TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTURE, WITH OR WITHOUT

INTERNAL OR EXTERNAL FIXATION

216 ............ 24515 OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE

216 ............ 24516 OPEN TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT

CERCLAGE AND/OR LOCKING SCREWS

216 ............ 24538 PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT INTERCONDYLAR EXTENSION

216 ............ 24545 OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITHOUT INTERCONDYLAR EXTENSION

216 ............ 24546 OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITH INTERCONDYLAR EXTENSION

216 ............ 24566 PERCUTANEOUS SKELETAL FIXATION OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH MANIPULATION

216 ............ 24575 OPEN TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 24579 OPEN TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH OR WITHOUT INTERNAL OR EXTERNAL

FIXATION

216 ............ 24582 PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH MANIPULATION

216 ............ 24586 OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DISTAL HUMERUS

AND PROXIMAL ULNA AND/ OR PROXIMAL RADIUS);

216 ............ 24587 OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DISTAL HUMERUS

AND PROXIMAL ULNA AND/ OR PROXIMAL RADIUS); WITH IMPLANT ARTHROPLASTY

216 ............ 24615 OPEN TREATMENT OF ACUTE OR CHRONIC ELBOW DISLOCATION

216 ............ 24635 OPEN TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL END OF ULNA

WITH DISLOCATION OF RADIAL HEAD), WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 24665 OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, WITH OR WITHOUT INTERNAL FIXATION OR RADIAL HEAD EXCISION;

216 ............ 24666 OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, WITH OR WITHOUT INTERNAL FIXATION OR RADIAL HEAD EXCISION; WITH RADIAL HEAD PROSTHETIC REPLACEMENT

216 ............ 24685 OPEN TREATMENT OF ULNAR FRACTURE PROXIMAL END (OLECRANON PROCESS), WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 25515 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 25525 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, WITH INTERNAL AND/ OR EXTERNAL FIXATION AND CLOSED TREATMENT

OF DISLOCATION OF DISTAL RADIO-ULNAR JOINT (GALEAZZI FRACTURE/DISLOCATION), WITH OR WITHOUT

PERCUTANEOUS SKELETAL FIXATION

216 ............ 25526 OPEN TREATMENT OF RADIAL SHAFT FRACTURE, WITH INTERNAL AND/ OR EXTERNAL FIXATION AND OPEN TREATMENT,

WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION OF DISTAL RADIO-ULNAR JOINT (GALEAZZI FRACTURE/DISLOCATION), INCLUDES REPAIR OF TRIANGULAR CARTILAGE

216 ............ 25545 OPEN TREATMENT OF ULNAR SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 25574 OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL OR EXTERNAL FIXATION; OF RADIUS OR

ULNA

216 ............ 25575 OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL OR EXTERNAL FIXATION; OF RADIUS AND

ULNA

216 ............ 25611 PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, WITH OR WITHOUT FRACTURE OF ULNAR STYLOID, REQUIRING MANIPULATION, WITH OR WITHOUT EXTERNAL

FIXATION

216 ............ 25620 OPEN TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, WITH OR

WITHOUT FRACTURE OF ULNAR STYLOID, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 25628 OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 25645 OPEN TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID (NAVICULAR)), EACH BONE

216 ............ 25670 OPEN TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, ONE OR MORE BONES

216 ............ 25676 OPEN TREATMENT OF DISTAL RADIOULNAR DISLOCATION, ACUTE OR CHRONIC

216 ............ 25685 OPEN TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION

216 ............ 25695 OPEN TREATMENT OF LUNATE DISLOCATION

216 ............ 26608 PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE

216 ............ 26615 OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH

BONE

216 ............ 26650 PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE),

WITH MANIPULATION, WITH OR WITHOUT EXTERNAL FIXATION

216 ............ 26665 OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH OR WITHOUT

INTERNAL OR EXTERNAL FIXATION

216 ............ 26676 PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE),

SINGLE, WITH MANIPULATION

216 ............ 26685 OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE); SINGLE, WITH OR

WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 26686 OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE); COMPLEX, MULTIPLE OR DELAYED REDUCTION

216 ............ 26715 OPEN TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 26727 PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH

216 ............ 26735 OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH OR

WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH

216 ............ 26746 OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT, WITH

OR WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH

216 ............ 26756 PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, EACH
32480

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

216 ............ 26765 OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, WITH OR WITHOUT INTERNAL OR EXTERNAL

FIXATION, EACH

216 ............ 26776 PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION

216 ............ 26785 OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, SINGLE

216 ............ 27202 OPEN TREATMENT OF COCCYGEAL FRACTURE

216 ............ 27509 PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, OR

SUPRACONDYLAR OR TRANSCONDYLAR, WITH OR WITHOUT INTERCONDYLAR EXTENSION, OR DISTAL FEMORAL

EPIPHYSEAL SEPARATION

216 ............ 27556 OPEN TREATMENT OF KNEE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITHOUT PRIMARY LIGAMENTOUS REPAIR OR AUGMENTATION/RECONSTRUCTION

216 ............ 27566 OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUT PARTIAL OR TOTAL PATELLECTOMY

216 ............ 27615 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF LEG OR ANKLE AREA

216 ............ 27756 PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) (EG, PINS OR

SCREWS)

216 ............ 27758 OPEN TREATMENT OF TIBIAL SHAFT FRACTURE, (WITH OR WITHOUT FIBULAR FRACTURE) WITH PLATE/SCREWS, WITH OR

WITHOUT CERCLAGE

216 ............ 27759 OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY IMPLANT,

WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE

216 ............ 27766 OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 27784 OPEN TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 27792 OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), WITH OR WITHOUT INTERNAL OR EXTERNAL

FIXATION

216 ............ 27814 OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 27822 OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, MEDIAL

AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP

216 ............ 27823 OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, MEDIAL

AND/OR LATERAL MALLEOLUS; WITH FIXATION OF POSTERIOR LIP

216 ............ 27826 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTAL TIBIA (EG, PILON OR

TIBIAL PLAFOND), WITH INTERNAL OR EXTERNAL FIXATION; OF FIBULA ONLY

216 ............ 27827 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTAL TIBIA (EG, PILON OR

TIBIAL PLAFOND), WITH INTERNAL OR EXTERNAL FIXATION; OF TIBIA ONLY

216 ............ 27828 OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/ PORTION OF DISTAL TIBIA (EG, PILON OR

TIBIAL PLAFOND), WITH INTERNAL OR EXTERNAL FIXATION; OF BOTH TIBIA AND FIBULA

216 ............ 27829 OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 27832 OPEN TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, OR WITH EXCISION OF PROXIMAL FIBULA

216 ............ 27846 OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXATION; WITHOUT REPAIR

OR INTERNAL FIXATION

216 ............ 27848 OPEN TREATMENT OF ANKLE DISLOCATION, WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXATION; WITH REPAIR OR INTERNAL OR EXTERNAL FIXATION

216 ............ 28406 PERCUTANEOUS SKELETAL FIXATION OF CALCANEAL FRACTURE, WITH MANIPULATION

216 ............ 28415 OPEN TREATMENT OF CALCANEAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION;

216 ............ 28420 OPEN TREATMENT OF CALCANEAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION; WITH PRIMARY ILIAC

OR OTHER AUTOGENOUS BONE GRAFT (INCLUDES OBTAINING GRAFT)

216 ............ 28436 PERCUTANEOUS SKELETAL FIXATION OF TALUS FRACTURE, WITH MANIPULATION

216 ............ 28445 OPEN TREATMENT OF TALUS FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 28456 PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), WITH MANIPULATION, EACH

216 ............ 28465 OPEN TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH

216 ............ 28476 PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH

216 ............ 28485 OPEN TREATMENT OF METATARSAL FRACTURE, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION, EACH

216 ............ 28496 PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH MANIPULATION

216 ............ 28505 OPEN TREATMENT OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 28525 OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, WITH OR WITHOUT INTERNAL OR

EXTERNAL FIXATION, EACH

216 ............ 28531 OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUT INTERNAL FIXATION

216 ............ 28546 PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE DISLOCATION, OTHER THAN TALOTARSAL, WITH MANIPULATION

216 ............ 28555 OPEN TREATMENT OF TARSAL BONE DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 28576 PERCUTANEOUS SKELETAL FIXATION OF TALOTARSAL JOINT DISLOCATION, WITH MANIPULATION

216 ............ 28585 OPEN TREATMENT OF TALOTARSAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 28606 PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPULATION

216 ............ 28615 OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 28636 PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION

216 ............ 28645 OPEN TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

216 ............ 28666 PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION

216 ............ 28675 OPEN TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION

217 ............ 24360 ARTHROPLASTY, ELBOW; WITH MEMBRANE

217 ............ 24365 ARTHROPLASTY, RADIAL HEAD;

217 ............ 25332 ARTHROPLASTY, WRIST, WITH OR WITHOUT INTERPOSITION, WITH OR WITHOUT EXTERNAL OR INTERNAL FIXATION

217 ............ 25447 INTERPOSITION ARTHROPLASTY, INTERCARPAL OR CARPOMETACARPAL JOINTS
32481

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1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

217 ............ 25449 REVISION OF ARTHROPLASTY, INCLUDING REMOVAL OF IMPLANT, WRIST JOINT

217 ............ 26530 ARTHROPLASTY, METACARPOPHALANGEAL JOINT; SINGLE, EACH

217 ............ 26535 ARTHROPLASTY INTERPHALANGEAL JOINT; SINGLE, EACH

217 ............ 27266 CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL ANESTHESIA

217 ............ 27437 ARTHROPLASTY, PATELLA; WITHOUT PROSTHESIS

217 ............ 27440 ARTHROPLASTY, KNEE, TIBIAL PLATEAU;

217 ............ 27441 ARTHROPLASTY, KNEE, TIBIAL PLATEAU; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY

217 ............ 27442 ARTHROPLASTY, KNEE, FEMORAL CONDYLES OR TIBIAL PLATEAUS;

217 ............ 27443 ARTHROPLASTY, KNEE, FEMORAL CONDYLES OR TIBIAL PLATEAUS; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY

217 ............ 27700 ARTHROPLASTY, ANKLE;

218 ............ 21243 ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH PROSTHETIC JOINT REPLACEMENT

218 ............ 24361 ARTHROPLASTY, ELBOW; WITH DISTAL HUMERAL PROSTHETIC REPLACEMENT

218 ............ 24362 ARTHROPLASTY, ELBOW; WITH IMPLANT AND FASCIA LATA LIGAMENT RECONSTRUCTION

218 ............ 24363 ARTHROPLASTY, ELBOW; WITH DISTAL HUMERUS AND PROXIMAL ULNAR PROSTHETIC REPLACEMENT (‘‘TOTAL ELBOW’’)

218 ............ 24366 ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT

218 ............ 25441 ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS

218 ............ 25442 ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL ULNA

218 ............ 25443 ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; SCAPHOID (NAVICULAR)

218 ............ 25444 ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; LUNATE

218 ............ 25445 ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM

218 ............ 25446 ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; DISTAL RADIUS AND PARTIAL OR ENTIRE CARPUS (‘‘TOTAL WRIST’’)

218 ............ 26531 ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, SINGLE, EACH

218 ............ 26536 ARTHROPLASTY INTERPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, SINGLE, EACH

218 ............ 27438 ARTHROPLASTY, PATELLA; WITH PROSTHESIS

231 ............ 21015 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCALP

231 ............ 21025 EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); MANDIBLE

231 ............ 21026 EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS); FACIAL BONE(S)

231 ............ 21029 REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)

231 ............ 21030 EXCISION OF BENIGN TUMOR OR CYST OF FACIAL BONE OTHER THAN MANDIBLE

231 ............ 21031 EXCISION OF TORUS MANDIBULARIS

231 ............ 21032 EXCISION OF MAXILLARY TORUS PALATINUS

231 ............ 21040 EXCISION OF BENIGN CYST OR TUMOR OF MANDIBLE; SIMPLE

231 ............ 21041 EXCISION OF BENIGN CYST OR TUMOR OF MANDIBLE; COMPLEX

231 ............ 21100 APPLICATION OF HALO TYPE APPLIANCE FOR MAXILLOFACIAL FIXATION, INCLUDES REMOVAL (SEPARATE PROCEDURE)

231 ............ 21110 APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONS OTHER THAN FRACTURE OR DISLOCATION, INCLUDES

REMOVAL

231 ............ 21120 GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, PROSTHETIC MATERIAL)

231 ............ 21125 AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL

231 ............ 21280 MEDIAL CANTHOPEXY (SEPARATE PROCEDURE)

231 ............ 21282 LATERAL CANTHOPEXY

231 ............ 21295 REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC HYPERTROPHY);

EXTRAORAL APPROACH

231 ............ 21296 REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC HYPERTROPHY);

INTRAORAL APPROACH

231 ............ 21300 CLOSED TREATMENT OF SKULL FRACTURE WITHOUT OPERATION

231 ............ 21310 CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION

231 ............ 21315 CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT STABILIZATION

231 ............ 21320 CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION

231 ............ 21325 OPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATED

231 ............ 21337 CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION

231 ............ 21355 PERCUTANEOUS TREATMENT OF FRACTURE OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD, WITH

MANIPULATION

231 ............ 21400 CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT ‘‘BLOWOUT’’; WITHOUT MANIPULATION

231 ............ 21401 CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT ‘‘BLOWOUT’’; WITH MANIPULATION

231 ............ 21440 CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE)

231 ............ 21451 CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANIPULATION

231 ............ 21480 CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT

231 ............ 21485 CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; COMPLICATED (EG, RECURRENT REQUIRING INTERMAXILLARY FIXATION OR SPLINTING), INITIAL OR SUBSEQUENT

231 ............ 21493 CLOSED TREATMENT OF HYOID FRACTURE; WITHOUT MANIPULATION

231 ............ 21494 CLOSED TREATMENT OF HYOID FRACTURE; WITH MANIPULATION

231 ............ 21497 INTERDENTAL WIRING, FOR CONDITION OTHER THAN FRACTURE

231 ............ 41822 EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES

231 ............ 41823 EXCISION OF OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES

232 ............ 21010 ARTHROTOMY, TEMPOROMANDIBULAR JOINT

232 ............ 21034 EXCISION OF MALIGNANT TUMOR OF FACIAL BONE OTHER THAN MANDIBLE

232 ............ 21044 EXCISION OF MALIGNANT TUMOR OF MANDIBLE;

232 ............ 21050 CONDYLECTOMY, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)

232 ............ 21060 MENISCECTOMY, PARTIAL OR COMPLETE, TEMPOROMANDIBULAR JOINT (SEPARATE PROCEDURE)

232 ............ 21070 CORONOIDECTOMY (SEPARATE PROCEDURE)

232 ............ 21121 GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE

232 ............ 21122 GENIOPLASTY; SLIDING OSTEOTOMIES, TWO OR MORE OSTEOTOMIES (EG, WEDGE EXCISION OR BONE WEDGE REVERSAL

FOR ASYMMETRICAL CHIN)

232 ............ 21123 GENIOPLASTY; SLIDING, AUGMENTATION WITH INTERPOSITIONAL BONE GRAFTS (INCLUDES OBTAINING AUTOGRAFTS)

232 ............ 21127 AUGMENTATION, MANDIBULAR BODY OR ANGLE; WITH BONE GRAFT, ONLAY OR INTERPOSITIONAL (INCLUDES OBTAINING

AUTOGRAFT)
32482

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1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

232 ............ 21181 RECONSTRUCTION BY CONTOURING OF BENIGN TUMOR OF CRANIAL BONES (EG, FIBROUS DYSPLASIA), EXTRACRANIAL

232 ............ 21206 OSTEOTOMY, MAXILLA, SEGMENTAL (EG, WASSMUND OR SCHUCHARD)

232 ............ 21208 OSTEOPLASTY, FACIAL BONES; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, OR PROSTHETIC IMPLANT)

232 ............ 21209 OSTEOPLASTY, FACIAL BONES; REDUCTION

232 ............ 21210 GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS (INCLUDES OBTAINING GRAFT)

232 ............ 21215 GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT)

232 ............ 21230 GRAFT; RIB CARTILAGE, AUTOGENOUS, TO FACE, CHIN, NOSE OR EAR (INCLUDES OBTAINING GRAFT)

232 ............ 21235 GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)

232 ............ 21240 ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR WITHOUT AUTOGRAFT (INCLUDES OBTAINING GRAFT)

232 ............ 21242 ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH ALLOGRAFT

232 ............ 21244 RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH TRANSOSTEAL BONE PLATE (EG, MANDIBULAR STAPLE BONE PLATE)

232 ............ 21245 RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; PARTIAL

232 ............ 21246 RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; COMPLETE

232 ............ 21248 RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER); PARTIAL

232 ............ 21249 RECONSTRUCTION OF MANDIBLE OR MAXILLA, ENDOSTEAL IMPLANT (EG, BLADE, CYLINDER); COMPLETE

232 ............ 21260 PERIORBITAL OSTEOTOMIES FOR ORBITAL HYPERTELORISM, WITH BONE GRAFTS; EXTRACRANIAL APPROACH

232 ............ 21267 ORBITAL REPOSITIONING, PERIORBITAL OSTEOTOMIES, UNILATERAL, WITH BONE GRAFTS; EXTRACRANIAL APPROACH

232 ............ 21270 MALAR AUGMENTATION, PROSTHETIC MATERIAL

232 ............ 21275 SECONDARY REVISION OF ORBITOCRANIOFACIAL RECONSTRUCTION

232 ............ 21330 OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH INTERNAL AND/OR EXTERNAL SKELETAL FIXATION

232 ............ 21335 OPEN TREATMENT OF NASAL FRACTURE; WITH CONCOMITANT OPEN TREATMENT OF FRACTURED SEPTUM

232 ............ 21338 OPEN TREATMENT OF NASOETHMOID FRACTURE; WITHOUT EXTERNAL FIXATION

232 ............ 21339 OPEN TREATMENT OF NASOETHMOID FRACTURE; WITH EXTERNAL FIXATION

232 ............ 21340 PERCUTANEOUS TREATMENT OF NASOETHMOID COMPLEX FRACTURE, WITH SPLINT, WIRE OR HEADCAP FIXATION, INCLUDING REPAIR OF CANTHAL LIGAMENTS AND/OR THE NASOLACRIMAL APPARATUS

232 ............ 21343 OPEN TREATMENT OF DEPRESSED FRONTAL SINUS FRACTURE

232 ............ 21345 CLOSED TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE), WITH INTERDENTAL WIRE FIXATION OR

FIXATION OF DENTURE OR SPLINT

232 ............ 21421 CLOSED TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE), WITH INTERDENTAL WIRE FIXATION OR FIXATION OF DENTURE OR SPLINT 5116

232 ............ 21445 OPEN TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE (SEPARATE PROCEDURE)

232 ............ 21450 CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITHOUT MANIPULATION

232 ............ 21452 PERCUTANEOUS TREATMENT OF MANDIBULAR FRACTURE, WITH EXTERNAL FIXATION

232 ............ 21453 CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH INTERDENTAL FIXATION

232 ............ 21454 OPEN TREATMENT OF MANDIBULAR FRACTURE WITH EXTERNAL FIXATION

232 ............ 21461 OPEN TREATMENT OF MANDIBULAR FRACTURE; WITHOUT INTERDENTAL FIXATION

232 ............ 21462 OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH INTERDENTAL FIXATION

232 ............ 21465 OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTURE

232 ............ 21490 OPEN TREATMENT OF TEMPOROMANDIBULAR DISLOCATION

232 ............ 67420 ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH REMOVAL OF LESION

232 ............ 67430 ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH REMOVAL OF FOREIGN BODY

232 ............ 67440 ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); WITH DRAINAGE

232 ............ 67450 ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG, KROENLEIN); FOR EXPLORATION, WITH OR WITHOUT BIOPSY

251 ............ 20005 INCISION OF SOFT TISSUE ABSCESS (EG, SECONDARY TO OSTEOMYELITIS); DEEP OR COMPLICATED

251 ............ 20250 BIOPSY, VERTEBRAL BODY, OPEN; THORACIC

251 ............ 20251 BIOPSY, VERTEBRAL BODY, OPEN; LUMBAR OR CERVICAL

251 ............ 20650 INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING REMOVAL (SEPARATE PROCEDURE)

251 ............ 20693 ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, NEW PIN(S) OR WIRE(S) AND/

OR NEW RING(S) OR BAR(S))

251 ............ 20694 REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM

251 ............ 20975 ELECTRICAL STIMULATION TO AID BONE HEALING; INVASIVE (OPERATIVE)

251 ............ 23100 ARTHROTOMY WITH BIOPSY, GLENOHUMERAL JOINT

251 ............ 23140 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA;

251 ............ 23935 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HUMERUS OR ELBOW

251 ............ 24100 ARTHROTOMY, ELBOW; WITH SYNOVIAL BIOPSY ONLY

251 ............ 24105 EXCISION, OLECRANON BURSA

251 ............ 24110 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS;

251 ............ 24120 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR OLECRANON PROCESS;

251 ............ 24310 TENOTOMY, OPEN, ELBOW TO SHOULDER, SINGLE, EACH

251 ............ 24925 AMPUTATION, ARM THROUGH HUMERUS; SECONDARY CLOSURE OR SCAR REVISION

251 ............ 25000 TENDON SHEATH INCISION; AT RADIAL STYLOID (EG, FOR DEQUERVAIN’S DISEASE)

251 ............ 25020 DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST; FLEXOR OR EXTENSOR COMPARTMENT

251 ............ 25028 INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA

251 ............ 25031 INCISION AND DRAINAGE, FOREARM AND/OR WRIST; INFECTED BURSA

251 ............ 25035 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOREARM AND/OR

WRIST

251 ............ 25085 CAPSULOTOMY, WRIST (EG, FOR CONTRACTURE)

251 ............ 25100 ARTHROTOMY, WRIST JOINT; WITH BIOPSY

251 ............ 25110 EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST

251 ............ 25115 RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC,

OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); FLEXORS

251 ............ 25116 RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC,

OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR WITHOUT TRANSPOSITION OF DORSAL

RETINACULUM
32483

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

251 ............ 25248 EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR WRIST

251 ............ 25295 TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON

251 ............ 25907 AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; SECONDARY CLOSURE OR SCAR REVISION

251 ............ 25922 DISARTICULATION THROUGH WRIST; SECONDARY CLOSURE OR SCAR REVISION

251 ............ 26990 INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA

251 ............ 26991 INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; INFECTED BURSA

251 ............ 27000 TENOTOMY, ADDUCTOR OF HIP, SUBCUTANEOUS, CLOSED (SEPARATE PROCEDURE)

251 ............ 27050 ARTHROTOMY, WITH BIOPSY; SACROILIAC JOINT

251 ............ 27052 ARTHROTOMY, WITH BIOPSY; HIP JOINT

251 ............ 27060 EXCISION; ISCHIAL BURSA

251 ............ 27062 EXCISION; TROCHANTERIC BURSA OR CALCIFICATION

251 ............ 27065 EXCISION OF BONE CYST OR BENIGN TUMOR; SUPERFICIAL (WING OF ILIUM, SYMPHYSIS PUBIS, OR GREATER TROCHANTER OF FEMUR) WITH OR WITHOUT AUTOGRAFT

251 ............ 27086 REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS TISSUE

251 ............ 27087 REMOVAL OF FOREIGN BODY, PELVIS OR HIP; DEEP

251 ............ 27305 FASCIOTOMY, ILIOTIBIAL (TENOTOMY), OPEN

251 ............ 27306 TENOTOMY, SUBCUTANEOUS, CLOSED, ADDUCTOR OR HAMSTRING, (SEPARATE PROCEDURE); SINGLE

251 ............ 27307 TENOTOMY, SUBCUTANEOUS, CLOSED, ADDUCTOR OR HAMSTRING, (SEPARATE PROCEDURE); MULTIPLE

251 ............ 27340 EXCISION, PREPATELLAR BURSA

251 ............ 27345 EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (BAKER’S CYST)

251 ............ 27380 SUTURE OF INFRAPATELLAR TENDON; PRIMARY

251 ............ 27381 SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT

251 ............ 27385 SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY

251 ............ 27386 SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR

TENDON GRAFT

251 ............ 27390 TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; SINGLE

251 ............ 27391 TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE, ONE LEG

251 ............ 27392 TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE, BILATERAL

251 ............ 27496 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR EXTENSOR OR ADDUCTOR);

251 ............ 27497 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, ONE COMPARTMENT (FLEXOR OR EXTENSOR OR ADDUCTOR); WITH

DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE

251 ............ 27498 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS;

251 ............ 27499 DECOMPRESSION FASCIOTOMY, THIGH AND/OR KNEE, MULTIPLE COMPARTMENTS; WITH DEBRIDEMENT OF NONVIABLE

MUSCLE AND/OR NERVE

251 ............ 27594 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; SECONDARY CLOSURE OR SCAR REVISION

251 ............ 27600 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY

251 ............ 27601 DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY

251 ............ 27602 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S)

251 ............ 27604 INCISION AND DRAINAGE, LEG OR ANKLE; INFECTED BURSA

251 ............ 27606 TENOTOMY, ACHILLES TENDON, SUBCUTANEOUS (SEPARATE PROCEDURE); GENERAL ANESTHESIA

251 ............ 27607 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), LEG OR ANKLE

251 ............ 27630 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKLE

251 ............ 27656 REPAIR, FASCIAL DEFECT OF LEG

251 ............ 27658 REPAIR OR SUTURE OF FLEXOR TENDON OF LEG; PRIMARY, WITHOUT GRAFT, SINGLE, EACH

251 ............ 27659 REPAIR OR SUTURE OF FLEXOR TENDON OF LEG; SECONDARY WITH OR WITHOUT GRAFT, SINGLE TENDON, EACH

251 ............ 27664 REPAIR OR SUTURE OF EXTENSOR TENDON OF LEG; PRIMARY, WITHOUT GRAFT, SINGLE, EACH

251 ............ 27675 REPAIR FOR DISLOCATING PERONEAL TENDONS; WITHOUT FIBULAR OSTEOTOMY

251 ............ 27704 REMOVAL OF ANKLE IMPLANT

251 ............ 27707 OSTEOTOMY; FIBULA

251 ............ 27884 AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDARY CLOSURE OR SCAR REVISION

251 ............ 27892 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY, WITH DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE

251 ............ 27893 DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY, WITH DEBRIDEMENT OF NONVIABLE MUSCLE

AND/OR NERVE

251 ............ 27894 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S), WITH

DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE

251 ............ 28002 DEEP DISSECTION BELOW FASCIA, FOR DEEP INFECTION OF FOOT, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT;

SINGLE BURSAL SPACE, SPECIFY

251 ............ 28003 DEEP DISSECTION BELOW FASCIA, FOR DEEP INFECTION OF FOOT, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT;

MULTIPLE AREAS

252 ............ 20690 APPLICATION OF A UNIPLANE (PINS OR WIRES IN ONE PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM

252 ............ 20692 APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM

(EG, ILIZAROV, MONTICELLI TYPE)

252 ............ 20900 BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)

252 ............ 20902 BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE

252 ............ 20924 TENDON GRAFT, FROM A DISTANCE (EG, PALMARIS, TOE EXTENSOR, PLANTARIS)

252 ............ 21502 INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX; WITH PARTIAL RIB

OSTECTOMY

252 ............ 21600 EXCISION OF RIB, PARTIAL

252 ............ 21610 COSTOTRANSVERSECTOMY (SEPARATE PROCEDURE)

252 ............ 23040 ARTHROTOMY, GLENOHUMERAL JOINT, FOR INFECTION, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY

252 ............ 23044 ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT, FOR INFECTION, WITH EXPLORATION, DRAINAGE, OR

REMOVAL OF FOREIGN BODY

252 ............ 23101 ARTHROTOMY WITH BIOPSY, OR WITH EXCISION OF TORN CARTILAGE, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT

252 ............ 23105 ARTHROTOMY WITH SYNOVECTOMY; GLENOHUMERAL JOINT
32484

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

252 ............ 23106 ARTHROTOMY WITH SYNOVECTOMY; STERNOCLAVICULAR JOINT

252 ............ 23107 ARTHROTOMY, GLENOHUMERAL JOINT, WITH JOINT EXPLORATION, WITH OR WITHOUT REMOVAL OF LOOSE OR FOREIGN

BODY

252 ............ 23145 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH AUTOGRAFT (INCLUDES

OBTAINING GRAFT)

252 ............ 23146 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CLAVICLE OR SCAPULA; WITH ALLOGRAFT

252 ............ 23150 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS;

252 ............ 23155 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

252 ............ 23156 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH ALLOGRAFT

252 ............ 23170 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), CLAVICLE

252 ............ 23172 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SCAPULA

252 ............ 23174 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HUMERAL HEAD TO SURGICAL NECK

252 ............ 23180 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS), CLAVICLE

252 ............ 23182 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS), SCAPULA

252 ............ 23184 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS), PROXIMAL HUMERUS

252 ............ 23190 OSTECTOMY OF SCAPULA, PARTIAL (EG, SUPERIOR MEDIAL ANGLE)

252 ............ 23405 TENOMYOTOMY, SHOULDER AREA; SINGLE

252 ............ 23406 TENOMYOTOMY, SHOULDER AREA; MULTIPLE THROUGH SAME INCISION

252 ............ 24000 ARTHROTOMY, ELBOW, FOR INFECTION, WITH EXPLORATION, DRAINAGE OR REMOVAL OF FOREIGN BODY

252 ............ 24006 ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR CAPSULAR RELEASE (SEPARATE PROCEDURE)

252 ............ 24101 ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF LOOSE

OR FOREIGN BODY

252 ............ 24102 ARTHROTOMY, ELBOW; WITH SYNOVECTOMY

252 ............ 24115 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH AUTOGRAFT (INCLUDES OBTAINING

GRAFT)

252 ............ 24116 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; WITH ALLOGRAFT

252 ............ 24125 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR OLECRANON PROCESS;

WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

252 ............ 24126 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF HEAD OR NECK OF RADIUS OR OLECRANON PROCESS;

WITH ALLOGRAFT

252 ............ 24130 EXCISION, RADIAL HEAD

252 ............ 24134 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), SHAFT OR DISTAL HUMERUS

252 ............ 24136 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), RADIAL HEAD OR NECK

252 ............ 24138 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), OLECRANON PROCESS

252 ............ 24140 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS), HUMERUS

252 ............ 24145 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS), RADIAL

HEAD OR NECK

252 ............ 24147 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS), OLECRANON PROCESS

252 ............ 24160 IMPLANT REMOVAL; ELBOW JOINT

252 ............ 24164 IMPLANT REMOVAL; RADIAL HEAD

252 ............ 24301 MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW, SINGLE (EXCLUDING 24320–24331)

252 ............ 24305 TENDON LENGTHENING, UPPER ARM OR ELBOW, SINGLE, EACH

252 ............ 24350 FASCIOTOMY, LATERAL OR MEDIAL (EG, ‘‘TENNIS ELBOW’’ OR EPICONDYLITIS);

252 ............ 24351 FASCIOTOMY, LATERAL OR MEDIAL (EG, ‘‘TENNIS ELBOW’’ OR EPICONDYLITIS); WITH EXTENSOR ORIGIN DETACHMENT

252 ............ 24352 FASCIOTOMY, LATERAL OR MEDIAL (EG, ‘‘TENNIS ELBOW’’ OR EPICONDYLITIS); WITH ANNULAR LIGAMENT RESECTION

252 ............ 24354 FASCIOTOMY, LATERAL OR MEDIAL (EG, ‘‘TENNIS ELBOW’’ OR EPICONDYLITIS); WITH STRIPPING

252 ............ 24356 FASCIOTOMY, LATERAL OR MEDIAL (EG, ‘‘TENNIS ELBOW’’ OR EPICONDYLITIS); WITH PARTIAL OSTECTOMY

252 ............ 24400 OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION

252 ............ 24410 MULTIPLE OSTEOTOMIES WITH REALIGNMENT ON INTRAMEDULLARY ROD, HUMERAL SHAFT (SOFIELD TYPE PROCEDURE)

252 ............ 24495 DECOMPRESSION FASCIOTOMY, FOREARM, WITH BRACHIAL ARTERY EXPLORATION

252 ............ 25023 DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST; WITH DEBRIDEMENT OF NONVIABLE MUSCLE AND/OR NERVE

252 ............ 25040 ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY

252 ............ 25101 ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF

LOOSE OR FOREIGN BODY

252 ............ 25105 ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY

252 ............ 25107 ARTHROTOMY, DISTAL RADIOULNAR JOINT FOR REPAIR OF TRIANGULAR CARTILAGE COMPLEX

252 ............ 25118 SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;

252 ............ 25119 SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT; WITH RESECTION OF DISTAL ULNA

252 ............ 25120 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD OR NECK OF RADIUS AND OLECRANON PROCESS);

252 ............ 25125 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD OR NECK OF RADIUS AND OLECRANON PROCESS); WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

252 ............ 25126 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD OR NECK OF RADIUS AND OLECRANON PROCESS); WITH ALLOGRAFT

252 ............ 25130 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES;

252 ............ 25135 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

252 ............ 25136 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF CARPAL BONES; WITH ALLOGRAFT

252 ............ 25145 SEQUESTRECTOMY (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOREARM AND/OR WRIST
32485

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

252 ............ 25150 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); ULNA

252 ............ 25151 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); RADIUS

252 ............ 25230 RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE)

252 ............ 25240 EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH TYPE OR MATCHED RESECTION)

252 ............ 25250 REMOVAL OF WRIST PROSTHESIS; (SEPARATE PROCEDURE)

252 ............ 25251 REMOVAL OF WRIST PROSTHESIS; COMPLICATED, INCLUDING ‘‘TOTAL WRIST’’

252 ............ 25260 REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE

252 ............ 25263 REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE, EACH TENDON OR MUSCLE

252 ............ 25265 REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; SECONDARY, WITH FREE GRAFT (INCLUDES OBTAINING

GRAFT), EACH TENDON OR MUSCLE

252 ............ 25270 REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE

252 ............ 25272 REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; SECONDARY, SINGLE, EACH TENDON OR MUSCLE

252 ............ 25274 REPAIR, TENDON OR MUSCLE, EXTENSOR, SECONDARY, WITH TENDON GRAFT (INCLUDES OBTAINING GRAFT), FOREARM

AND/OR WRIST, EACH TENDON OR MUSCLE

252 ............ 25280 LENGTHENING OR SHORTENING OF FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON

252 ............ 25290 TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON

252 ............ 25300 TENODESIS AT WRIST; FLEXORS OF FINGERS

252 ............ 25301 TENODESIS AT WRIST; EXTENSORS OF FINGERS

252 ............ 25360 OSTEOTOMY; ULNA

252 ............ 25365 OSTEOTOMY; RADIUS AND ULNA

252 ............ 25400 REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)

252 ............ 25415 REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)

252 ............ 27001 TENOTOMY, ADDUCTOR OF HIP, SUBCUTANEOUS, OPEN

252 ............ 27003 TENOTOMY, ADDUCTOR, SUBCUTANEOUS, OPEN, WITH OBTURATOR NEURECTOMY

252 ............ 27066 EXCISION OF BONE CYST OR BENIGN TUMOR; DEEP, WITH OR WITHOUT AUTOGRAFT

252 ............ 27067 EXCISION OF BONE CYST OR BENIGN TUMOR; WITH AUTOGRAFT REQUIRING SEPARATE INCISION

252 ............ 27080 COCCYGECTOMY, PRIMARY

252 ............ 27097 HAMSTRING RECESSION, PROXIMAL

252 ............ 27098 ADDUCTOR TRANSFER TO ISCHIUM

252 ............ 27310 ARTHROTOMY, KNEE, FOR INFECTION, WITH EXPLORATION, DRAINAGE OR REMOVAL OF FOREIGN BODY

252 ............ 27330 ARTHROTOMY, KNEE; WITH SYNOVIAL BIOPSY ONLY

252 ............ 27331 ARTHROTOMY, KNEE; WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF LOOSE OR

FOREIGN BODIES

252 ............ 27332 ARTHROTOMY, KNEE, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY); MEDIAL OR LATERAL

252 ............ 27333 ARTHROTOMY, KNEE, WITH EXCISION OF SEMILUNAR CARTILAGE (MENISCECTOMY); MEDIAL AND LATERAL

252 ............ 27334 ARTHROTOMY, KNEE, WITH SYNOVECTOMY; ANTERIOR OR POSTERIOR

252 ............ 27335 ARTHROTOMY, KNEE, WITH SYNOVECTOMY; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL AREA

252 ............ 27350 PATELLECTOMY OR HEMIPATELLECTOMY

252 ............ 27355 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR;

252 ............ 27356 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH ALLOGRAFT

252 ............ 27357 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH AUTOGRAFT (INCLUDES OBTAINING

GRAFT)

252 ............ 27358 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH INTERNAL FIXATION (LIST IN ADDITION TO

27355, 27356, OR 27357)

252 ............ 27360 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS), FEMUR,

PROXIMAL TIBIA AND/ OR FIBULA

252 ............ 27393 LENGTHENING OF HAMSTRING TENDON; SINGLE

252 ............ 27394 LENGTHENING OF HAMSTRING TENDON; MULTIPLE, ONE LEG

252 ............ 27396 TRANSPLANT, HAMSTRING TENDON TO PATELLA; SINGLE

252 ............ 27403 ARTHROTOMY WITH OPEN MENISCUS REPAIR

252 ............ 27425 LATERAL RETINACULAR RELEASE (ANY METHOD)

252 ............ 27610 ARTHROTOMY, ANKLE, FOR INFECTION, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY

252 ............ 27612 ARTHROTOMY, ANKLE, POSTERIOR CAPSULAR RELEASE, WITH OR WITHOUT ACHILLES TENDON LENGTHENING

252 ............ 27620 ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH OR WITHOUT BIOPSY, WITH OR WITHOUT REMOVAL OF LOOSE OR

FOREIGN BODY

252 ............ 27625 ARTHROTOMY, ANKLE, WITH SYNOVECTOMY;

252 ............ 27626 ARTHROTOMY, ANKLE, WITH SYNOVECTOMY; INCLUDING TENOSYNOVECTOMY

252 ............ 27635 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;

252 ............ 27637 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH AUTOGRAFT (INCLUDES OBTAINING

GRAFT)

252 ............ 27638 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH ALLOGRAFT

252 ............ 27641 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS OR

EXOSTOSIS); FIBULA

252 ............ 27665 REPAIR OR SUTURE OF EXTENSOR TENDON OF LEG; SECONDARY WITH OR WITHOUT GRAFT, SINGLE TENDON, EACH

252 ............ 27676 REPAIR FOR DISLOCATING PERONEAL TENDONS; WITH FIBULAR OSTEOTOMY

252 ............ 27680 TENOLYSIS, INCLUDING TIBIA, FIBULA, AND ANKLE FLEXOR; SINGLE

252 ............ 27681 TENOLYSIS, INCLUDING TIBIA, FIBULA, AND ANKLE FLEXOR; MULTIPLE (THROUGH SAME INCISION), EACH

252 ............ 27685 LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE (SEPARATE PROCEDURE)

252 ............ 27686 LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; MULTIPLE (THROUGH SAME INCISION), EACH

252 ............ 27687 GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)

252 ............ 27695 SUTURE, PRIMARY, TORN, RUPTURED OR SEVERED LIGAMENT, ANKLE; COLLATERAL

252 ............ 27696 SUTURE, PRIMARY, TORN, RUPTURED OR SEVERED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS

252 ............ 27698 SUTURE, SECONDARY REPAIR, TORN, RUPTURED OR SEVERED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCEDURE)

252 ............ 27709 OSTEOTOMY; TIBIA AND FIBULA
32486

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

252 ............ 27730 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL TIBIA

252 ............ 27732 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL FIBULA

252 ............ 27734 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL TIBIA AND FIBULA

252 ............ 27740 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, COMBINED, PROXIMAL AND DISTAL TIBIA AND FIBULA;

252 ............ 27889 ANKLE DISARTICULATION

253 ............ 23020 CAPSULAR CONTRACTURE RELEASE (SEVER TYPE PROCEDURE)

253 ............ 23120 CLAVICULECTOMY; PARTIAL

253 ............ 23130 ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL

253 ............ 23415 CORACOACROMIAL LIGAMENT RELEASE, WITH OR WITHOUT ACROMIOPLASTY

253 ............ 23480 OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION;

253 ............ 23485 OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITH BONE GRAFT FOR NONUNION OR MALUNION (INCLUDES OBTAINING GRAFT AND/OR NECESSARY FIXATION)

253 ............ 23490 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE; CLAVICLE

253 ............ 23491 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE; PROXIMAL HUMERUS AND HUMERAL HEAD

253 ............ 23800 ARTHRODESIS, SHOULDER JOINT; WITH OR WITHOUT LOCAL BONE GRAFT

253 ............ 23802 ARTHRODESIS, SHOULDER JOINT; WITH PRIMARY AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)

253 ............ 24155 RESECTION OF ELBOW JOINT (ARTHRECTOMY)

253 ............ 24320 TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT FREE GRAFT, ELBOW TO SHOULDER, SINGLE (SEDDONBROOKES TYPE PROCEDURE)

253 ............ 24330 FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT);

253 ............ 24331 FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT); WITH EXTENSOR ADVANCEMENT

253 ............ 24340 TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE)

253 ............ 24341 REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECONDARY (EXCLUDES

ROTATOR CUFF)

253 ............ 24342 REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT

253 ............ 24420 OSTEOPLASTY, HUMERUS (EG, SHORTENING OR LENGTHENING) (EXCLUDING 64876)

253 ............ 24430 REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)

253 ............ 24435 REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)

253 ............ 24470 HEMIEPIPHYSEAL ARREST (EG, FOR CUBITUS VARUS OR VALGUS, DISTAL HUMERUS)

253 ............ 24498 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING), WITH OR WITHOUT METHYLMETHACRYLATE, HUMERUS

253 ............ 24800 ARTHRODESIS, ELBOW JOINT; WITH OR WITHOUT LOCAL AUTOGRAFT OR ALLOGRAFT

253 ............ 24802 ARTHRODESIS, ELBOW JOINT; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT OTHER THAN LOCALLY OBTAINED)

253 ............ 25310 TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON

253 ............ 25312 TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; WITH TENDON

GRAFT(S) (INCLUDES OBTAINING GRAFT), EACH TENDON

253 ............ 25315 FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM AND/OR WRIST;

253 ............ 25316 FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANN CONTRACTURE), FOREARM AND/OR WRIST; WITH TENDON(S) TRANSFER

253 ............ 25320 CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, ANY METHOD (EG, CAPSULODESIS, LIGAMENT REPAIR, TENDON TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY, CAPSULOTOMY AND OPEN REDUCTION) FOR CARPAL INSTABILITY

253 ............ 25335 CENTRALIZATION OF WRIST ON ULNA (EG, RADIAL CLUB HAND)

253 ............ 25337 RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR JOINT, SECONDARY BY SOFT

TISSUE STABILIZATION (EG, TENDON TRANSFER, TENDON GRAFT OR WEAVE, OR TENODESIS) WITH OR WITHOUT OPEN

REDUCTION OF DISTAL RADIOULNAR JOINT

253 ............ 25350 OSTEOTOMY, RADIUS; DISTAL THIRD

253 ............ 25355 OSTEOTOMY, RADIUS; MIDDLE OR PROXIMAL THIRD

253 ............ 25370 MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE PROCEDURE); RADIUS OR ULNA

253 ............ 25375 MULTIPLE OSTEOTOMIES, WITH REALIGNMENT ON INTRAMEDULLARY ROD (SOFIELD TYPE PROCEDURE); RADIUS AND

ULNA

253 ............ 25425 REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA

253 ............ 25426 REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS AND ULNA

253 ............ 25440 REPAIR OF NONUNION, SCAPHOID (NAVICULAR) BONE, WITH OR WITHOUT RADIAL STYLOIDECTOMY (INCLUDES OBTAINING

GRAFT AND NECESSARY FIXATION)

253 ............ 25450 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS OR ULNA

253 ............ 25455 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING; DISTAL RADIUS AND ULNA

253 ............ 25490 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE; RADIUS

253 ............ 25491 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE; ULNA

253 ............ 25492 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE; RADIUS

AND ULNA

253 ............ 25800 ARTHRODESIS, WRIST JOINT (INCLUDING RADIOCARPAL AND/OR ULNOCARPAL FUSION); WITHOUT BONE GRAFT

253 ............ 25805 ARTHRODESIS, WRIST JOINT (INCLUDING RADIOCARPAL AND/OR ULNOCARPAL FUSION); WITH SLIDING GRAFT

253 ............ 25810 ARTHRODESIS, WRIST JOINT (INCLUDING RADIOCARPAL AND/OR ULNOCARPAL FUSION); WITH ILIAC OR OTHER

AUTOGRAFT (INCLUDES OBTAINING GRAFT)

253 ............ 25830 DISTAL RADIOULNAR JOINT ARTHRODESIS AND SEGMENTAL RESECTION OF ULNA (EG, SAUVE-KAPANDJI PROCEDURE),

WITH OR WITHOUT BONE GRAFT

253 ............ 27033 ARTHROTOMY, HIP, WITH EXPLORATION OR REMOVAL OF LOOSE OR FOREIGN BODY

253 ............ 27100 TRANSFER EXTERNAL OBLIQUE MUSCLE TO GREATER TROCHANTER INCLUDING FASCIAL OR TENDON EXTENSION (GRAFT)

253 ............ 27105 TRANSFER PARASPINAL MUSCLE TO HIP (INCLUDES FASCIAL OR TENDON EXTENSION GRAFT)

253 ............ 27110 TRANSFER ILIOPSOAS; TO GREATER TROCHANTER

253 ............ 27111 TRANSFER ILIOPSOAS; TO FEMORAL NECK

253 ............ 27395 LENGTHENING OF HAMSTRING TENDON; MULTIPLE, BILATERAL

253 ............ 27397 TRANSPLANT, HAMSTRING TENDON TO PATELLA; MULTIPLE
32487

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

253 ............ 27400 TENDON OR MUSCLE TRANSFER, HAMSTRINGS TO FEMUR (EGGERS TYPE PROCEDURE)

253 ............ 27405 REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL

253 ............ 27407 REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; CRUCIATE

253 ............ 27409 REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; COLLATERAL AND CRUCIATE LIGAMENTS

253 ............ 27418 ANTERIOR TIBIAL TUBERCLEPLASTY (EG, FOR CHONDROMALACIA PATELLAE)

253 ............ 27420 RECONSTRUCTION FOR RECURRENT DISLOCATING PATELLA; (HAUSER TYPE PROCEDURE)

253 ............ 27422 RECONSTRUCTION FOR RECURRENT DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (CAMPBELL, GOLDWAITE TYPE PROCEDURE)

253 ............ 27424 RECONSTRUCTION FOR RECURRENT DISLOCATING PATELLA; WITH PATELLECTOMY

253 ............ 27430 QUADRICEPSPLASTY (BENNETT OR THOMPSON TYPE)

253 ............ 27435 CAPSULOTOMY, KNEE, POSTERIOR CAPSULAR RELEASE

253 ............ 27640 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS OR

EXOSTOSIS); TIBIA

253 ............ 27647 RADICAL RESECTION OF TUMOR, BONE; TALUS OR CALCANEUS

253 ............ 27650 REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;

253 ............ 27652 REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON; WITH GRAFT (INCLUDES OBTAINING GRAFT)

253 ............ 27654 REPAIR, SECONDARY, RUPTURED ACHILLES TENDON, WITH OR WITHOUT GRAFT

253 ............ 27690 TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); SUPERFICIAL (EG, ANTERIOR TIBIAL EXTENSORS INTO MIDFOOT)

253 ............ 27691 TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS,

OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)

253 ............ 27692 TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); EACH ADDITIONAL TENDON

253 ............ 27705 OSTEOTOMY; TIBIA

253 ............ 27742 EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING, COMBINED, PROXIMAL AND DISTAL TIBIA AND FIBULA; AND DISTAL FEMUR

253 ............ 27745 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE, TIBIA

253 ............ 27870 ARTHRODESIS, ANKLE, ANY METHOD

253 ............ 27871 ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL

254 ............ 23410 REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF); ACUTE

254 ............ 23412 REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF); CHRONIC

254 ............ 23420 REPAIR OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES ACROMIOPLASTY)

254 ............ 23430 TENODESIS OF LONG TENDON OF BICEPS

254 ............ 23450 CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE OR MAGNUSON TYPE OPERATION

254 ............ 23455 CAPSULORRHAPHY, ANTERIOR; BANKART TYPE OPERATION WITH OR WITHOUT STAPLING

254 ............ 23460 CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK

254 ............ 23462 CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER

254 ............ 23465 CAPSULORRHAPHY FOR RECURRENT DISLOCATION, POSTERIOR, WITH OR WITHOUT BONE BLOCK

254 ............ 23466 CAPSULORRHAPHY WITH ANY TYPE MULTI-DIRECTIONAL INSTABILITY

254 ............ 27427 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR

254 ............ 27428 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN)

254 ............ 27429 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; INTRA-ARTICULAR (OPEN) AND EXTRA-ARTICULAR

261 ............ 25111 EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY

261 ............ 25112 EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT

261 ............ 25820 INTERCARPAL FUSION; WITHOUT BONE GRAFT

261 ............ 26020 DRAINAGE OF TENDON SHEATH, ONE DIGIT AND/OR PALM

261 ............ 26025 DRAINAGE OF PALMAR BURSA; SINGLE, ULNAR OR RADIAL

261 ............ 26030 DRAINAGE OF PALMAR BURSA; MULTIPLE OR COMPLICATED

261 ............ 26034 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), HAND OR FINGER

261 ............ 26035 DECOMPRESSION FINGERS AND/OR HAND, INJECTION INJURY (EG, GREASE GUN)

261 ............ 26037 DECOMPRESSIVE FASCIOTOMY, HAND (EXCLUDES 26035)

261 ............ 26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)

261 ............ 26060 TENOTOMY, PERCUTANEOUS, SINGLE, EACH DIGIT

261 ............ 26070 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY; CARPOMETACARPAL JOINT

261 ............ 26075 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY; METACARPOPHALANGEAL JOINT

261 ............ 26080 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY; INTERPHALANGEAL JOINT, EACH

261 ............ 26100 ARTHROTOMY WITH SYNOVIAL BIOPSY; CARPOMETACARPAL JOINT

261 ............ 26105 ARTHROTOMY WITH SYNOVIAL BIOPSY; METACARPOPHALANGEAL JOINT

261 ............ 26110 ARTHROTOMY WITH SYNOVIAL BIOPSY; INTERPHALANGEAL JOINT, EACH

261 ............ 26130 SYNOVECTOMY, CARPOMETACARPAL JOINT

261 ............ 26140 SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION, EACH INTERPHALANGEAL JOINT

261 ............ 26145 SYNOVECTOMY TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR, PALM OR FINGER, SINGLE, EACH DIGIT

261 ............ 26160 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLION), HAND OR FINGER

261 ............ 26170 EXCISION OF TENDON, PALM, FLEXOR, SINGLE (SEPARATE PROCEDURE), EACH

261 ............ 26180 EXCISION OF TENDON, FINGER, FLEXOR (SEPARATE PROCEDURE)

261 ............ 26185 SESAMOIDECTOMY, THUMB OR FINGER (SEPARATE PROCEDURE)

261 ............ 26200 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL;

261 ............ 26210 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR DISTAL PHALANX OF FINGER;

261 ............ 26215 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL, MIDDLE, OR DISTAL PHALANX OF FINGER;

WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

261 ............ 26230 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); METACARPAL

261 ............ 26235 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); PROXIMAL OR MIDDLE PHALANX OF FINGER
32488

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

261 ............ 26236 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); DISTAL

PHALANX OF FINGER

261 ............ 26250 RADICAL RESECTION (OSTECTOMY) FOR TUMOR, METACARPAL;

261 ............ 26260 RADICAL RESECTION (OSTECTOMY) FOR TUMOR, PROXIMAL OR MIDDLE PHALANX OF FINGER;

261 ............ 26261 RADICAL RESECTION (OSTECTOMY) FOR TUMOR, PROXIMAL OR MIDDLE PHALANX OF FINGER; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

261 ............ 26262 RADICAL RESECTION (OSTECTOMY) FOR TUMOR, DISTAL PHALANX OF FINGER

261 ............ 26410 EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON

261 ............ 26418 EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON

261 ............ 26432 EXTENSOR TENDON REPAIR, DISTAL INSERTION (’’MALLET FINGER’’), CLOSED, SPLINTING WITH OR WITHOUT

PERCUTANEOUS PINNING

261 ............ 26433 EXTENSOR TENDON REPAIR, DISTAL INSERTION (’’MALLET FINGER’’), OPEN, PRIMARY OR SECONDARY REPAIR; WITHOUT

GRAFT

261 ............ 26437 EXTENSOR TENDON REALIGNMENT, HAND

261 ............ 26440 TENOLYSIS, SIMPLE, FLEXOR TENDON; PALM OR FINGER, SINGLE, EACH TENDON

261 ............ 26445 TENOLYSIS, EXTENSOR TENDON, DORSUM OF HAND OR FINGER; EACH TENDON

261 ............ 26450 TENOTOMY, FLEXOR, SINGLE, PALM, OPEN, EACH

261 ............ 26455 TENOTOMY, FLEXOR, SINGLE, FINGER, OPEN, EACH

261 ............ 26460 TENOTOMY, EXTENSOR, HAND OR FINGER, SINGLE, OPEN, EACH

261 ............ 26471 TENODESIS; FOR PROXIMAL INTERPHALANGEAL JOINT STABILIZATION

261 ............ 26474 TENODESIS; FOR DISTAL JOINT STABILIZATION

261 ............ 26476 TENDON LENGTHENING, EXTENSOR, HAND OR FINGER, SINGLE, EACH

261 ............ 26477 TENDON SHORTENING, EXTENSOR, HAND OR FINGER, SINGLE, EACH

261 ............ 26478 TENDON LENGTHENING, FLEXOR, HAND OR FINGER, SINGLE, EACH

261 ............ 26479 TENDON SHORTENING, FLEXOR, HAND OR FINGER, SINGLE, EACH

261 ............ 26500 TENDON PULLEY RECONSTRUCTION; WITH LOCAL TISSUES (SEPARATE PROCEDURE)

261 ............ 26508 THENAR MUSCLE RELEASE FOR THUMB CONTRACTURE

261 ............ 26520 CAPSULECTOMY OR CAPSULOTOMY FOR CONTRACTURE; METACARPOPHALANGEAL JOINT, SINGLE, EACH

261 ............ 26525 CAPSULECTOMY OR CAPSULOTOMY FOR CONTRACTURE; INTERPHALANGEAL JOINT, SINGLE, EACH

261 ............ 26540 REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT

261 ............ 26542 RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH LOCAL TISSUE (EG, ADDUCTOR ADVANCEMENT)

261 ............ 26560 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS

261 ............ 26587 RECONSTRUCTION OF SUPERNUMERARY DIGIT, SOFT TISSUE AND BONE

261 ............ 26593 RELEASE, INTRINSIC MUSCLES OF HAND (SPECIFY)

261 ............ 26951 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING

NEURECTOMIES; WITH DIRECT CLOSURE

261 ............ 26952 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING

NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)

262 ............ 25210 CARPECTOMY; ONE BONE

262 ............ 25215 CARPECTOMY; ALL BONES OF PROXIMAL ROW

262 ............ 25825 INTERCARPAL FUSION; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26040 FASCIOTOMY, PALMAR, FOR DUPUYTREN’S CONTRACTURE; PERCUTANEOUS

262 ............ 26045 FASCIOTOMY, PALMAR, FOR DUPUYTREN’S CONTRACTURE; OPEN, PARTIAL

262 ............ 26121 FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING

(INCLUDES OBTAINING GRAFT)

262 ............ 26123 FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH

OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT);

262 ............ 26125 FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH

OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT);

EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

262 ............ 26135 SYNOVECTOMY, METACARPOPHALANGEAL JOINT INCLUDING INTRINSIC RELEASE AND EXTENSOR HOOD RECONSTRUCTION, EACH DIGIT

262 ............ 26205 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF METACARPAL; WITH AUTOGRAFT (INCLUDES OBTAINING

GRAFT)

262 ............ 26255 RADICAL RESECTION (OSTECTOMY) FOR TUMOR, METACARPAL; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26350 FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, NOT IN ’’NO MAN’S LAND’’; PRIMARY OR SECONDARY WITHOUT FREE

GRAFT, EACH TENDON

262 ............ 26352 FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, NOT IN ’’NO MAN’S LAND’’; SECONDARY WITH FREE GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON

262 ............ 26356 FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, IN ’’NO MAN’S LAND’’; PRIMARY, EACH TENDON

262 ............ 26357 FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, IN ’’NO MAN’S LAND’’; SECONDARY, EACH TENDON

262 ............ 26358 FLEXOR TENDON REPAIR OR ADVANCEMENT, SINGLE, IN ’’NO MAN’S LAND’’; SECONDARY WITH FREE GRAFT (INCLUDES

OBTAINING GRAFT), EACH TENDON

262 ............ 26370 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT SUBLIMIS; PRIMARY

262 ............ 26372 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT SUBLIMIS; SECONDARY WITH FREE GRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26373 PROFUNDUS TENDON REPAIR OR ADVANCEMENT, WITH INTACT SUBLIMIS; SECONDARY WITHOUT FREE GRAFT

262 ............ 26390 FLEXOR TENDON EXCISION, IMPLANTATION OF PLASTIC TUBE OR ROD FOR DELAYED TENDON GRAFT, HAND OR FINGER

62 .............. 26392 REMOVAL OF TUBE OR ROD AND INSERTION OF FLEXOR TENDON GRAFT (INCLUDES OBTAINING GRAFT), HAND OR FINGER

262 ............ 26412 EXTENSOR TENDON REPAIR, DORSUM OF HAND, SINGLE, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON

262 ............ 26415 EXTENSOR TENDON EXCISION, IMPLANTATION OF PLASTIC TUBE OR ROD FOR DELAYED EXTENSOR TENDON GRAFT,

HAND OR FINGER
32489

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

262 ............ 26416 REMOVAL OF TUBE OR ROD AND INSERTION OF EXTENSOR TENDON GRAFT (INCLUDES OBTAINING GRAFT), HAND OR FINGER

262 ............ 26420 EXTENSOR TENDON REPAIR, DORSUM OF FINGER, SINGLE, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDES OBTAINING GRAFT) EACH TENDON

262 ............ 26426 EXTENSOR TENDON REPAIR, CENTRAL SLIP REPAIR, SECONDARY (BOUTONNIERE DEFORMITY); USING LOCAL TISSUES

262 ............ 26428 EXTENSOR TENDON REPAIR, CENTRAL SLIP REPAIR, SECONDARY (BOUTONNIERE DEFORMITY); WITH FREE GRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26434 EXTENSOR TENDON REPAIR, DISTAL INSERTION (’’MALLET FINGER’’), OPEN, PRIMARY OR SECONDARY REPAIR; WITH FREE

GRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26442 TENOLYSIS, SIMPLE, FLEXOR TENDON; PALM AND FINGER, EACH TENDON

262 ............ 26449 TENOLYSIS, COMPLEX, EXTENSOR TENDON, DORSUM OF HAND OR FINGER, INCLUDING HAND AND FOREARM

262 ............ 26480 TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL AREA OR DORSUM OF HAND, SINGLE; WITHOUT FREE GRAFT,

EACH

262 ............ 26483 TENDON TRANSFER OR TRANSPLANT, CARPOMETACARPAL AREA OR DORSUM OF HAND, SINGLE; WITH FREE TENDON

GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON

262 ............ 26485 TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, EACH TENDON; WITHOUT FREE TENDON GRAFT

262 ............ 26489 TENDON TRANSFER OR TRANSPLANT, PALMAR, SINGLE, EACH TENDON; WITH FREE TENDON GRAFT (INCLUDES OBTAINING

GRAFT), EACH TENDON

262 ............ 26490 OPPONENSPLASTY; SUBLIMIS TENDON TRANSFER TYPE

262 ............ 26492 OPPONENSPLASTY; TENDON TRANSFER WITH GRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26494 OPPONENSPLASTY; HYPOTHENAR MUSCLE TRANSFER

262 ............ 26496 OPPONENSPLASTY; OTHER METHODS

262 ............ 26497 TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION; RING AND SMALL FINGER

262 ............ 26498 TENDON TRANSFER TO RESTORE INTRINSIC FUNCTION; ALL FOUR FINGERS

262 ............ 26499 CORRECTION CLAW FINGER, OTHER METHODS

262 ............ 26502 TENDON PULLEY RECONSTRUCTION; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT) (SEPARATE PROCEDURE)

262 ............ 26504 TENDON PULLEY RECONSTRUCTION; WITH TENDON PROSTHESIS (SEPARATE PROCEDURE)

262 ............ 26510 CROSS INTRINSIC TRANSFER

262 ............ 26516 CAPSULODESIS FOR M-P JOINT STABILIZATION; SINGLE DIGIT

262 ............ 26517 CAPSULODESIS FOR M-P JOINT STABILIZATION; TWO DIGITS

262 ............ 26518 CAPSULODESIS FOR M-P JOINT STABILIZATION; THREE OR FOUR DIGITS

262 ............ 26541 RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH TENDON OR FASCIAL GRAFT

(INCLUDES OBTAINING GRAFT)

262 ............ 26545 RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGEAL JOINT, SINGLE, INCLUDING GRAFT, EACH JOINT

262 ............ 26546 REPAIR NON-UNION, METACARPAL OR PHALANX, (INCLUDES OBTAINING BONE GRAFT WITH OR WITHOUT EXTERNAL OR INTERNAL FIXATION)

262 ............ 26548 REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, INTERPHALANGEAL JOINT

262 ............ 26550 POLLICIZATION OF A DIGIT

262 ............ 26555 POSITIONAL CHANGE OF OTHER FINGER

262 ............ 26561 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS AND GRAFTS

262 ............ 26562 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; COMPLEX (EG, INVOLVING BONE, NAILS)

262 ............ 26565 OSTEOTOMY FOR CORRECTION OF DEFORMITY; METACARPAL

262 ............ 26567 OSTEOTOMY FOR CORRECTION OF DEFORMITY; PHALANX OF FINGER

262 ............ 26568 OSTEOPLASTY FOR LENGTHENING OF METACARPAL OR PHALANX

262 ............ 26580 REPAIR CLEFT HAND

262 ............ 26585 REPAIR BIFID DIGIT

262 ............ 26590 REPAIR MACRODACTYLIA

262 ............ 26591 REPAIR, INTRINSIC MUSCLES OF HAND (SPECIFY)

262 ............ 26596 EXCISION OF CONSTRICTING RING OF FINGER, WITH MULTIPLE Z-PLASTIES

262 ............ 26597 RELEASE OF SCAR CONTRACTURE, FLEXOR OR EXTENSOR, WITH SKIN GRAFTS, REARRANGEMENT FLAPS, OR Z-PLASTIES,

HAND AND/OR FINGER

262 ............ 26820 FUSION IN OPPOSITION, THUMB, WITH AUTOGENOUS GRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26841 ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION;

262 ............ 26842 ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES

OBTAINING GRAFT)

262 ............ 26843 ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, OTHER THAN THUMB;

262 ............ 26844 ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, OTHER THAN THUMB; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26850 ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;

262 ............ 26852 ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES

OBTAINING GRAFT)

262 ............ 26860 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;

262 ............ 26861 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; EACH ADDITIONAL INTERPHALANGEAL

JOINT

262 ............ 26862 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

262 ............ 26863 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT), EACH ADDITIONAL JOINT

262 ............ 26910 AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSEOUS

TRANSFER

271 ............ 27605 TENOTOMY, ACHILLES TENDON, SUBCUTANEOUS (SEPARATE PROCEDURE); *LOCAL ANESTHESIA

271 ............ 28005 INCISION, DEEP, WITH OPENING OF BONE CORTEX (EG, FOR OSTEOMYELITIS OR BONE ABSCESS), FOOT

271 ............ 28008 FASCIOTOMY, FOOT AND/OR TOE

271 ............ 28010 TENOTOMY, SUBCUTANEOUS, TOE; SINGLE

271 ............ 28011 TENOTOMY, SUBCUTANEOUS, TOE; MULTIPLE
32490

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

271 ............ 28020 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERTARSAL OR

TARSOMETATARSAL JOINT

271 ............ 28022 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; METATARSOPHALANGEAL

JOINT

271 ............ 28024 ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHALANGEAL JOINT

271 ............ 28045 EXCISION, TUMOR, FOOT; DEEP, SUBFASCIAL, INTRAMUSCULAR

271 ............ 28046 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOOT

271 ............ 28050 ARTHROTOMY FOR SYNOVIAL BIOPSY; INTERTARSAL OR TARSOMETATARSAL JOINT

271 ............ 28052 ARTHROTOMY FOR SYNOVIAL BIOPSY; METATARSOPHALANGEAL JOINT

271 ............ 28054 ARTHROTOMY FOR SYNOVIAL BIOPSY; INTERPHALANGEAL JOINT

271 ............ 28080 EXCISION OF INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH

271 ............ 28086 SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR

271 ............ 28088 SYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR

271 ............ 28090 EXCISION OF LESION OF TENDON OR FIBROUS SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) (CYST OR GANGLION);

FOOT

271 ............ 28092 EXCISION OF LESION OF TENDON OR FIBROUS SHEATH OR CAPSULE (INCLUDING SYNOVECTOMY) (CYST OR GANGLION);

TOES

271 ............ 28100 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;

271 ............ 28104 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL BONES, EXCEPT TALUS OR

CALCANEUS;

271 ............ 28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PHALANGES OF FOOT

271 ............ 28111 OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD

271 ............ 28112 OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)

271 ............ 28113 OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD

271 ............ 28114 OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS, WITH PARTIAL PROXIMAL PHALANGECTOMY, EXCLUDING

FIRST METATARSAL (CLAYTON TYPE PROCEDURE)

271 ............ 28116 OSTECTOMY, EXCISION OF TARSAL COALITION

271 ............ 28118 OSTECTOMY, CALCANEUS;

271 ............ 28119 OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE

271 ............ 28120 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS OR TALAR BOSSING), TALUS OR CALCANEUS

271 ............ 28122 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS OR TARSAL BOSSING), TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS

271 ............ 28124 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS OR DORSAL BOSSING), PHALANX OF TOE

271 ............ 28126 RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, SINGLE TOE, EACH

271 ............ 28130 TALECTOMY (ASTRAGALECTOMY)

271 ............ 28140 METATARSECTOMY

271 ............ 28150 PHALANGECTOMY OF TOE, SINGLE, EACH

271 ............ 28153 RESECTION, HEAD OF PHALANX, TOE

271 ............ 28160 HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, SINGLE, EACH

271 ............ 28171 RADICAL RESECTION OF TUMOR, BONE; TARSAL (EXCEPT TALUS OR CALCANEUS)

271 ............ 28173 RADICAL RESECTION OF TUMOR, BONE; METATARSAL

271 ............ 28175 RADICAL RESECTION OF TUMOR, BONE; PHALANX OF TOE

271 ............ 28200 REPAIR OR SUTURE OF TENDON, FOOT, FLEXOR, SINGLE; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TENDON

271 ............ 28208 REPAIR OR SUTURE OF TENDON, FOOT, EXTENSOR, SINGLE; PRIMARY OR SECONDARY, EACH TENDON

271 ............ 28210 REPAIR OR SUTURE OF TENDON, FOOT, EXTENSOR, SINGLE; SECONDARY WITH FREE GRAFT, EACH TENDON (INCLUDES

OBTAINING GRAFT)

271 ............ 28220 TENOLYSIS, FLEXOR, FOOT; SINGLE

271 ............ 28222 TENOLYSIS, FLEXOR, FOOT; MULTIPLE (THROUGH SAME INCISION)

271 ............ 28225 TENOLYSIS, EXTENSOR, FOOT; SINGLE

271 ............ 28226 TENOLYSIS, EXTENSOR, FOOT; MULTIPLE (THROUGH SAME INCISION)

271 ............ 28230 TENOTOMY, OPEN, FLEXOR; FOOT, SINGLE OR MULTIPLE (SEPARATE PROCEDURE)

271 ............ 28232 TENOTOMY, OPEN, FLEXOR; TOE, SINGLE (SEPARATE PROCEDURE)

271 ............ 28234 TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE

271 ............ 28240 TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE

271 ............ 28270 CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, SINGLE, EACH JOINT (SEPARATE

PROCEDURE)

271 ............ 28272 CAPSULOTOMY; INTERPHALANGEAL JOINT, SINGLE, EACH JOINT (SEPARATE PROCEDURE)

271 ............ 28280 WEBBING OPERATION (CREATE SYNDACTYLISM OF TOES) (KELIKIAN TYPE PROCEDURE)

271 ............ 28285 HAMMERTOE OPERATION, ONE TOE (EG, INTERPHALANGEAL FUSION, FILLETING, PHALANGECTOMY)

271 ............ 28286 COCK-UP FIFTH TOE OPERATION WITH PLASTIC SKIN CLOSURE (RUIZ-MORA TYPE PROCEDURE)

271 ............ 28310 OSTEOTOMY FOR SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX, FIRST TOE (SEPARATE

PROCEDURE)

271 ............ 28312 OSTEOTOMY FOR SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; OTHER PHALANGES, ANY TOE

271 ............ 28313 RECONSTRUCTION, ANGULAR DEFORMITY OF TOE (OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES), SOFT TISSUE

PROCEDURES ONLY

271 ............ 28315 SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)

271 ............ 28340 RECONSTRUCTION, TOE, MACRODACTYLY; SOFT TISSUE RESECTION

271 ............ 28341 RECONSTRUCTION, TOE, MACRODACTYLY; REQUIRING BONE RESECTION

271 ............ 28737 ARTHRODESIS, MIDTARSAL NAVICULAR–CUNEIFORM, WITH TENDON LENGTHENING AND ADVANCEMENT (MILLER TYPE

PROCEDURE)

271 ............ 28750 ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT

271 ............ 28755 ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
32491

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

271 ............ 28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE

271 ............ 28820 AMPUTATION, TOE; METATARSOPHALANGEAL JOINT

271 ............ 28825 AMPUTATION, TOE; INTERPHALANGEAL JOINT

271 ............ 29893 ENDOSCOPIC PLANTAR FASCIOTOMY

272 ............ 28060 FASCIECTOMY, EXCISION OF PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)

272 ............ 28062 FASCIECTOMY, EXCISION OF PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE)

272 ............ 28070 SYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL JOINT, EACH

272 ............ 28072 SYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH

272 ............ 28102 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ILIAC OR OTHER AUTOGRAFT

(INCLUDES OBTAINING GRAFT)

272 ............ 28103 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ALLOGRAFT

272 ............ 28106 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL BONES, EXCEPT TALUS OR

CALCANEUS; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)

272 ............ 28107 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL BONES, EXCEPT TALUS OR

CALCANEUS; WITH ALLOGRAFT

272 ............ 28202 REPAIR OR SUTURE OF TENDON, FOOT, FLEXOR, SINGLE; SECONDARY WITH FREE GRAFT, EACH TENDON (INCLUDES OBTAINING GRAFT)

272 ............ 28238 ADVANCEMENT OF POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY NAVICULAR BONE (KIDNER TYPE PROCEDURE)

272 ............ 28250 DIVISION OF PLANTAR FASCIA AND MUSCLE (‘‘STEINDLER STRIPPING’’) (SEPARATE PROCEDURE)

272 ............ 28260 CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)

272 ............ 28261 CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING

272 ............ 28262 CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND TENDON(S) LENGTHENING

AS FOR RESISTANT CLUBFOOT DEFORMITY

272 ............ 28264 CAPSULOTOMY, MIDTARSAL (HEYMAN TYPE PROCEDURE)

272 ............ 28288 OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, SINGLE, METATARSAL HEAD, FIRST THROUGH FIFTH, EACH

METATARSAL HEAD

272 ............ 28300 OSTEOTOMY; CALCANEUS (DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION

272 ............ 28302 OSTEOTOMY; TALUS

272 ............ 28304 OSTEOTOMY, MIDTARSAL BONES, OTHER THAN CALCANEUS OR TALUS;

272 ............ 28305 OSTEOTOMY, MIDTARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)

(FOWLER TYPE)

272 ............ 28306 OSTEOTOMY, METATARSAL, BASE OR SHAFT, SINGLE, WITH OR WITHOUT LENGTHENING, FOR SHORTENING OR ANGULAR

CORRECTION; FIRST METATARSAL

272 ............ 28307 OSTEOTOMY, METATARSAL, BASE OR SHAFT, SINGLE, WITH OR WITHOUT LENGTHENING, FOR SHORTENING OR ANGULAR

CORRECTION; FIRST METATARSAL WITH AUTOGRAFT

272 ............ 28308 OSTEOTOMY, METATARSAL, BASE OR SHAFT, SINGLE, WITH OR WITHOUT LENGTHENING, FOR SHORTENING OR ANGULAR

CORRECTION; OTHER THAN FIRST METATARSAL

272 ............ 28309 OSTEOTOMY, METATARSALS, MULTIPLE, FOR CAVUS FOOT (SWANSON TYPE PROCEDURE)

272 ............ 28320 REPAIR OF NONUNION OR MALUNION; TARSAL BONES (EG, CALCANEUS, TALUS)

272 ............ 28322 REPAIR OF NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES OBTAINING GRAFT)

272 ............ 28344 RECONSTRUCTION, TOE(S); POLYDACTYLY

272 ............ 28345 RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT SKIN GRAFT(S), EACH WEB

272 ............ 28360 RECONSTRUCTION, CLEFT FOOT

272 ............ 28705 PANTALAR ARTHRODESIS

272 ............ 28715 TRIPLE ARTHRODESIS

272 ............ 28725 SUBTALAR ARTHRODESIS

272 ............ 28730 ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE

272 ............ 28735 ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH OSTEOTOMY AS FOR FLATFOOT

CORRECTION

272 ............ 28740 ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT

272 ............ 28760 ARTHRODESIS, GREAT TOE, INTERPHALANGEAL JOINT, WITH EXTENSOR HALLUCIS LONGUS TRANSFER TO FIRST METATARSAL NECK (JONES TYPE PROCEDURE)

276 ............ 28110 OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCEDURE)

276 ............ 28290 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; SIMPLE EXOSTECTOMY (SILVER TYPE

PROCEDURE)

276 ............ 28292 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; KELLER, MCBRIDE, OR MAYO TYPE PROCEDURE

276 ............ 28293 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; RESECTION OF JOINT WITH IMPLANT

276 ............ 28294 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; WITH TENDON TRANSPLANTS (JOPLIN

TYPE PROCEDURE)

276 ............ 28296 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; WITH METATARSAL OSTEOTOMY (EG,

MITCHELL, CHEVRON, OR CONCENTRIC TYPE PROCEDURES)

276 ............ 28297 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; LAPIDUS TYPE PROCEDURE

276 ............ 28298 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; BY PHALANX OSTEOTOMY

276 ............ 28299 HALLUX VALGUS (BUNION) CORRECTION, WITH OR WITHOUT SESAMOIDECTOMY; BY OTHER METHODS (EG, DOUBLE OSTEOTOMY)

280 ............ 29800 ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)

280 ............ 29815 ARTHROSCOPY, SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)

280 ............ 29830 ARTHROSCOPY, ELBOW, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)

280 ............ 29840 ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)

280 ............ 29870 ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)

281 ............ 29804 ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICAL

281 ............ 29819 ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
32492

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

281 ............ 29820 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL

281 ............ 29821 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE

281 ............ 29822 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED

281 ............ 29823 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE

281 ............ 29825 ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR WITHOUT MANIPULATION

281 ............ 29826 ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY, WITH

OR WITHOUT CORACOACROMIAL RELEASE

281 ............ 29834 ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY

281 ............ 29835 ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL

281 ............ 29836 ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLETE

281 ............ 29837 ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED

281 ............ 29838 ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE

281 ............ 29843 ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE

281 ............ 29844 ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL

281 ............ 29845 ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE

281 ............ 29846 ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR OF TRIANGULAR FIBROCARTILAGE AND/OR JOINT

DEBRIDEMENT

281 ............ 29847 ARTHROSCOPY, WRIST, SURGICAL; INTERNAL FIXATION FOR FRACTURE OR INSTABILITY

281 ............ 29848 ARTHROSCOPY, WRIST, SURGICAL; WITH RELEASE OF TRANSVERSE CARPAL LIGAMENT

281 ............ 29860 ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)

281 ............ 29861 ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY

281 ............ 29862 ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), ABRASION

ARTHROPLASTY, AND/OR RESECTION OF LABRUM

281 ............ 29863 ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY

281 ............ 29874 ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTEOCHONDRITIS

DISSECANS FRAGMENTATION, CHONDRAL FRAGMENTATION)

281 ............ 29875 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE)

281 ............ 29877 ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY)

281 ............ 29879 ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECESSARY) OR MULTIPLE DRILLING

281 ............ 29880 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAVING)

281 ............ 29881 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING)

281 ............ 29884 ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITH OR WITHOUT MANIPULATION (SEPARATE PROCEDURE)

281 ............ 29886 ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION

281 ............ 29894 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN

BODY

281 ............ 29895 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL

281 ............ 29897 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED

281 ............ 29898 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSIVE

282 ............ 29871 ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE

282 ............ 29876 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, TWO OR MORE COMPARTMENTS (EG, MEDIAL OR LATERAL)

282 ............ 29882 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)

282 ............ 29883 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL AND LATERAL)

282 ............ 29885 ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR OSTEOCHONDRITIS DISSECANS WITH BONE GRAFTING, WITH OR WITHOUT INTERNAL FIXATION (INCLUDING DEBRIDEMENT OF BASE OF LESION)

282 ............ 29887 ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION WITH INTERNAL FIXATION

282 ............ 29891 ARTHROSCOPY, ANKLE, SURGICAL; EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, INCLUDING DRILLING

OF THE DEFECT

286 ............ 29850 ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE,

WITH OR WITHOUT MANIPULATION; WITHOUT INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)

286 ............ 29851 ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE,

WITH OR WITHOUT MANIPULATION; WITH INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)

286 ............ 29855 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, WITH OR WITHOUT

INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)

286 ............ 29856 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR WITHOUT INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)

286 ............ 29888 ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION

286 ............ 29889 ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/ AUGMENTATION OR RECONSTRUCTION

286 ............ 29892 ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION, TALAR DOME FRACTURE, OR TIBIAL PLAFOND FRACTURE, WITH OR WITHOUT INTERNAL FIXATION (INCLUDES ARTHROSCOPY)

312 ............ 30801 CAUTERIZATION AND/OR ABLATION, MUCOSA OF TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD, (SEPARATE PROCEDURE); SUPERFICIAL

312 ............ 30802 CAUTERIZATION AND/OR ABLATION, MUCOSA OF TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD, (SEPARATE PROCEDURE); INTRAMURAL

312 ............ 30930 FRACTURE NASAL TURBINATE(S), THERAPEUTIC

312 ............ 31612 TRACHEAL PUNCTURE, PERCUTANEOUS WITH TRANSTRACHEAL ASPIRATION AND/OR INJECTION

312 ............ 40830 CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS

312 ............ 40831 CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM OR COMPLEX

312 ............ 41250 REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS OF TONGUE

312 ............ 41251 REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONE–THIRD OF TONGUE

312 ............ 41252 REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM OR COMPLEX

312 ............ 41500 FIXATION OF TONGUE, MECHANICAL, OTHER THAN SUTURE (EG, K–WIRE)

312 ............ 41510 SUTURE OF TONGUE TO LIP FOR MICROGNATHIA (DOUGLAS TYPE PROCEDURE)

312 ............ 41800 DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES
32493

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

312 ............ 42300 DRAINAGE OF ABSCESS; PAROTID, SIMPLE

312 ............ 42305 DRAINAGE OF ABSCESS; PAROTID, COMPLICATED

312 ............ 42310 DRAINAGE OF ABSCESS; SUBMAXILLARY OR SUBLINGUAL, INTRAORAL

312 ............ 42320 DRAINAGE OF ABSCESS; SUBMAXILLARY, EXTERNAL

312 ............ 42405 BIOPSY OF SALIVARY GLAND; INCISIONAL

312 ............ 42700 INCISION AND DRAINAGE ABSCESS; PERITONSILLAR

312 ............ 42720 INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, INTRAORAL APPROACH

312 ............ 42800 BIOPSY; OROPHARYNX

312 ............ 42802 BIOPSY; HYPOPHARYNX

312 ............ 42804 BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE

312 ............ 42806 BIOPSY; NASOPHARYNX, SURVEY FOR UNKNOWN PRIMARY LESION

312 ............ 42808 EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD

312 ............ 60000 INCISION AND DRAINAGE OF THYROGLOSSAL CYST, INFECTED

312 ............ 69421 MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA

312 ............ 69433 TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), LOCAL OR TOPICAL ANESTHESIA

312 ............ 69436 TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA

313 ............ 30115 EXCISION, NASAL POLYP(S), EXTENSIVE

313 ............ 30118 EXCISION OR DESTRUCTION, ANY METHOD (INCLUDING LASER), INTRANASAL LESION; EXTERNAL APPROACH (LATERAL

RHINOTOMY)

313 ............ 30120 EXCISION OR SURGICAL PLANING OF SKIN OF NOSE FOR RHINOPHYMA

313 ............ 30125 EXCISION DERMOID CYST, NOSE; COMPLEX, UNDER BONE OR CARTILAGE

313 ............ 30130 EXCISION TURBINATE, PARTIAL OR COMPLETE

313 ............ 30140 SUBMUCOUS RESECTION TURBINATE, PARTIAL OR COMPLETE

313 ............ 30150 RHINECTOMY; PARTIAL

313 ............ 30160 RHINECTOMY; TOTAL

313 ............ 30310 REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA

313 ............ 30320 REMOVAL FOREIGN BODY, INTRANASAL; BY LATERAL RHINOTOMY

313 ............ 30430 RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT OF NASAL TIP WORK)

313 ............ 30520 SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT

WITH GRAFT

313 ............ 30540 REPAIR CHOANAL ATRESIA; INTRANASAL

313 ............ 30580 REPAIR FISTULA; OROMAXILLARY (COMBINE WITH 31030 IF ANTROTOMY IS INCLUDED)

313 ............ 30600 REPAIR FISTULA; ORONASAL

313 ............ 30620 SEPTAL OR OTHER INTRANASAL DERMATOPLASTY (DOES NOT INCLUDE OBTAINING GRAFT)

313 ............ 30630 REPAIR NASAL SEPTAL PERFORATIONS

313 ............ 31020 SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL

313 ............ 31030 SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITHOUT REMOVAL OF ANTROCHOANAL POLYPS

313 ............ 31032 SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) WITH REMOVAL OF ANTROCHOANAL POLYPS

313 ............ 31050 SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;

313 ............ 31051 SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY; WITH MUCOSAL STRIPPING OR REMOVAL OF POLYP(S)

313 ............ 31070 SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE (TREPHINE OPERATION)

313 ............ 31200 ETHMOIDECTOMY; INTRANASAL, ANTERIOR

313 ............ 31320 LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); DIAGNOSTIC

313 ............ 31595 SECTION RECURRENT LARYNGEAL NERVE, THERAPEUTIC (SEPARATE PROCEDURE), UNILATERAL

313 ............ 31611 CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND SUBSEQUENT INSERTION OF AN ALARYNGEAL SPEECH PROSTHESIS (EG, VOICE BUTTON, BLOM-SINGER PROSTHESIS)

313 ............ 31613 TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION

313 ............ 31614 TRACHEOSTOMA REVISION; COMPLEX, WITH FLAP ROTATION

313 ............ 31820 SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTIC REPAIR

313 ............ 31825 SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH PLASTIC REPAIR

313 ............ 31830 REVISION OF TRACHEOSTOMY SCAR

313 ............ 40500 VERMILIONECTOMY (LIP SHAVE), WITH MUCOSAL ADVANCEMENT

313 ............ 40510 EXCISION OF LIP; TRANSVERSE WEDGE EXCISION WITH PRIMARY CLOSURE

313 ............ 40520 EXCISION OF LIP; V-EXCISION WITH PRIMARY DIRECT LINEAR CLOSURE

313 ............ 40525 EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER OR FAN)

313 ............ 40527 EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH CROSS LIP FLAP (ABBE-ESTLANDER)

313 ............ 40530 RESECTION OF LIP, MORE THAN ONE-FOURTH, WITHOUT RECONSTRUCTION

313 ............ 40650 REPAIR LIP, FULL THICKNESS; VERMILION ONLY

313 ............ 40652 REPAIR LIP, FULL THICKNESS; UP TO HALF VERTICAL HEIGHT

313 ............ 40654 REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICAL HEIGHT, OR COMPLEX

313 ............ 40814 EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH COMPLEX REPAIR

313 ............ 40816 EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; COMPLEX, WITH EXCISION OF UNDERLYING

MUSCLE

313 ............ 40818 EXCISION OF MUCOSA OF VESTIBULE OF MOUTH AS DONOR GRAFT

313 ............ 40819 EXCISION OF FRENUM, LABIAL OR BUCCAL (FRENUMECTOMY, FRENULECTOMY, FRENECTOMY)

313 ............ 40840 VESTIBULOPLASTY; ANTERIOR

313 ............ 40842 VESTIBULOPLASTY; POSTERIOR, UNILATERAL

313 ............ 41006 INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; SUBLINGUAL,

DEEP, SUPRAMYLOHYOID

313 ............ 41007 INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; SUBMENTAL

SPACE

313 ............ 41008 INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; SUBMANDIBULAR SPACE

313 ............ 41009 INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; MASTICATOR

SPACE
32494

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

313 ............ 41010 INCISION OF LINGUAL FRENUM (FRENOTOMY)

313 ............ 41015 EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBLINGUAL

313 ............ 41016 EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBMENTAL

313 ............ 41017 EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBMANDIBULAR

313 ............ 41018 EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; MASTICATOR SPACE

313 ............ 41112 EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS

313 ............ 41113 EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD

313 ............ 41114 EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL TONGUE FLAP

313 ............ 41116 EXCISION, LESION OF FLOOR OF MOUTH

313 ............ 41120 GLOSSECTOMY; LESS THAN ONE-HALF TONGUE

313 ............ 41520 FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)

313 ............ 41827 EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITH COMPLEX REPAIR

313 ............ 42107 EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE

313 ............ 42120 RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION

313 ............ 42180 REPAIR, LACERATION OF PALATE; UP TO 2 CM

313 ............ 42182 REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX

313 ............ 42200 PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY

313 ............ 42205 PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; SOFT TISSUE ONLY

313 ............ 42215 PALATOPLASTY FOR CLEFT PALATE; MAJOR REVISION

313 ............ 42220 PALATOPLASTY FOR CLEFT PALATE; SECONDARY LENGTHENING PROCEDURE

313 ............ 42235 REPAIR OF ANTERIOR PALATE, INCLUDING VOMER FLAP

313 ............ 42260 REPAIR OF NASOLABIAL FISTULA

313 ............ 42325 FISTULIZATION OF SUBLINGUAL SALIVARY CYST (RANULA);

313 ............ 42326 FISTULIZATION OF SUBLINGUAL SALIVARY CYST (RANULA); WITH PROSTHESIS

313 ............ 42340 SIALOLITHOTOMY; PAROTID, EXTRAORAL OR COMPLICATED INTRAORAL

313 ............ 42408 EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA)

313 ............ 42409 MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA)

313 ............ 42410 EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITHOUT NERVE DISSECTION

313 ............ 42440 EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND

313 ............ 42450 EXCISION OF SUBLINGUAL GLAND

313 ............ 42500 PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE

313 ............ 42505 PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; SECONDARY OR COMPLICATED

313 ............ 42507 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE);

313 ............ 42508 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF ONE SUBMANDIBULAR GLAND

313 ............ 42510 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH LIGATION OF BOTH SUBMANDIBULAR (WHARTON’S) DUCTS

313 ............ 42600 CLOSURE SALIVARY FISTULA

313 ............ 42725 INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL OR PARAPHARYNGEAL, EXTERNAL APPROACH

313 ............ 42810 EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINED TO SKIN AND SUBCUTANEOUS TISSUES

313 ............ 42815 EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR FISTULA, EXTENDING BENEATH SUBCUTANEOUS TISSUES AND/OR INTO

PHARYNX

313 ............ 42900 SUTURE PHARYNX FOR WOUND OR INJURY

313 ............ 42950 PHARYNGOPLASTY (PLASTIC OR RECONSTRUCTIVE OPERATION ON PHARYNX)

313 ............ 42955 PHARYNGOSTOMY (FISTULIZATION OF PHARYNX, EXTERNAL FOR FEEDING)

313 ............ 42962 CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); WITH SECONDARY

SURGICAL INTERVENTION

313 ............ 42972 CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTADENOIDECTOMY); WITH SECONDARY SURGICAL INTERVENTION

313 ............ 43020 ESOPHAGOTOMY, CERVICAL APPROACH, WITH REMOVAL OF FOREIGN BODY

313 ............ 43030 CRICOPHARYNGEAL MYOTOMY

313 ............ 69120 EXCISION EXTERNAL EAR; COMPLETE AMPUTATION

313 ............ 69140 EXCISION EXOSTOSIS(ES), EXTERNAL AUDITORY CANAL

313 ............ 69300 OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION

313 ............ 69440 MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL INCISION

313 ............ 69450 TYMPANOLYSIS, TRANSCANAL

313 ............ 69620 MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)

314 ............ 30400 RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP

314 ............ 30410 RHINOPLASTY, PRIMARY; COMPLETE, EXTERNAL PARTS INCLUDING BONY PYRAMID, LATERAL AND ALAR CARTILAGES,

AND/OR ELEVATION OF NASAL TIP

314 ............ 30420 RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR

314 ............ 30435 RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)

314 ............ 30450 RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)

314 ............ 30460 RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, INCLUDING COLUMELLAR

LENGTHENING; TIP ONLY

314 ............ 30462 RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, INCLUDING COLUMELLAR

LENGTHENING; TIP, SEPTUM, OSTEOTOMIES

314 ............ 30545 REPAIR CHOANAL ATRESIA; TRANSPALATINE

314 ............ 31040 PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH

314 ............ 31075 SINUSOTOMY FRONTAL; TRANSORBITAL, UNILATERAL (FOR MUCOCELE OR OSTEOMA, LYNCH TYPE)

314 ............ 31080 SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT OSTEOPLASTIC FLAP, BROW INCISION (INCLUDES ABLATION)

314 ............ 31081 SINUSOTOMY FRONTAL; OBLITERATIVE, WITHOUT OSTEOPLASTIC FLAP, CORONAL INCISION (INCLUDES ABLATION)

314 ............ 31084 SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION

314 ............ 31085 SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION

314 ............ 31086 SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, BROW INCISION

314 ............ 31087 SINUSOTOMY FRONTAL; NONOBLITERATIVE, WITH OSTEOPLASTIC FLAP, CORONAL INCISION
32495

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

314 ............ 31090 SINUSOTOMY COMBINED, THREE OR MORE SINUSES (UNILATERAL)

314 ............ 31201 ETHMOIDECTOMY; INTRANASAL, TOTAL

314 ............ 31205 ETHMOIDECTOMY; EXTRANASAL, TOTAL

314 ............ 31300 LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); WITH REMOVAL OF TUMOR OR LARYNGOCELE, CORDECTOMY

314 ............ 31400 ARYTENOIDECTOMY OR ARYTENOIDOPEXY, EXTERNAL APPROACH

314 ............ 31420 EPIGLOTTIDECTOMY

314 ............ 31588 LARYNGOPLASTY, NOT OTHERWISE SPECIFIED (EG, FOR BURNS, RECONSTRUCTION AFTER PARTIAL LARYNGECTOMY)

314 ............ 31590 LARYNGEAL REINNERVATION BY NEUROMUSCULAR PEDICLE

314 ............ 31750 TRACHEOPLASTY; CERVICAL

314 ............ 31755 TRACHEOPLASTY; TRACHEOPHARYNGEAL FISTULIZATION, EACH STAGE

314 ............ 40700 PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY, PARTIAL OR COMPLETE, UNILATERAL

314 ............ 40701 PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE STAGE PROCEDURE

314 ............ 40702 PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, ONE OF TWO STAGES

314 ............ 40720 PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; SECONDARY, BY RECREATION OF DEFECT AND RECLOSURE

314 ............ 40761 PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; WITH CROSS LIP PEDICLE FLAP (ABBE-ESTLANDER TYPE), INCLUDING

SECTIONING AND INSERTING OF PEDICLE

314 ............ 40843 VESTIBULOPLASTY; POSTERIOR, BILATERAL

314 ............ 40844 VESTIBULOPLASTY; ENTIRE ARCH

314 ............ 40845 VESTIBULOPLASTY; COMPLEX (INCLUDING RIDGE EXTENSION, MUSCLE REPOSITIONING)

314 ............ 42210 PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT TO ALVEOLAR RIDGE (INCLUDES OBTAINING GRAFT)

314 ............ 42225 PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP

314 ............ 42226 LENGTHENING OF PALATE, AND PHARYNGEAL FLAP

314 ............ 42227 LENGTHENING OF PALATE, WITH ISLAND FLAP

314 ............ 42415 EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE, WITH DISSECTION AND PRESERVATION OF FACIAL

NERVE

314 ............ 42420 EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, WITH DISSECTION AND PRESERVATION OF FACIAL NERVE

314 ............ 42425 EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL, EN BLOC REMOVAL WITH SACRIFICE OF FACIAL NERVE

314 ............ 42509 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF BOTH SUBMANDIBULAR GLANDS

314 ............ 42842 RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; WITHOUT CLOSURE

314 ............ 42844 RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; CLOSURE WITH LOCAL FLAP (EG,

TONGUE, BUCCAL)

314 ............ 42890 LIMITED PHARYNGECTOMY

314 ............ 42892 RESECTION OF LATERAL PHARYNGEAL WALL OR PYRIFORM SINUS, DIRECT CLOSURE BY ADVANCEMENT OF LATERAL AND

POSTERIOR PHARYNGEAL WALLS

314 ............ 69150 RADICAL EXCISION EXTERNAL AUDITORY CANAL LESION; WITHOUT NECK DISSECTION

314 ............ 69310 RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO TRAUMA, INFECTION)

(SEPARATE PROCEDURE)

314 ............ 69320 RECONSTRUCTION EXTERNAL AUDITORY CANAL FOR CONGENITAL ATRESIA, SINGLE STAGE

314 ............ 69501 TRANSMASTOID ANTROTOMY (‘‘SIMPLE’’ MASTOIDECTOMY)

314 ............ 69502 MASTOIDECTOMY; COMPLETE

314 ............ 69505 MASTOIDECTOMY; MODIFIED RADICAL

314 ............ 69511 MASTOIDECTOMY; RADICAL

314 ............ 69530 PETROUS APICECTOMY INCLUDING RADICAL MASTOIDECTOMY

314 ............ 69550 EXCISION AURAL GLOMUS TUMOR; TRANSCANAL

314 ............ 69552 EXCISION AURAL GLOMUS TUMOR; TRANSMASTOID

314 ............ 69601 REVISION MASTOIDECTOMY; RESULTING IN COMPLETE MASTOIDECTOMY

314 ............ 69602 REVISION MASTOIDECTOMY; RESULTING IN MODIFIED RADICAL MASTOIDECTOMY

314 ............ 69603 REVISION MASTOIDECTOMY; RESULTING IN RADICAL MASTOIDECTOMY

314 ............ 69604 REVISION MASTOIDECTOMY; RESULTING IN TYMPANOPLASTY

314 ............ 69605 REVISION MASTOIDECTOMY; WITH APICECTOMY

314 ............ 69631 TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY),

INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION

314 ............ 69632 TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY),

INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION (EG, POSTFENESTRATION)

314 ............ 69633 TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY),

INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS (EG, PARTIAL OSSICULAR REPLACEMENT PROSTHESIS (PORP), TOTAL OSSICULAR REPLACEMENT PROSTHESIS (TORP))

314 ............ 69635 TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION

314 ............ 69636 TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION

314 ............ 69637 TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDING CANALPLASTY, ATTICOTOMY, MIDDLE EAR SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS (EG, PARTIAL OSSICULAR REPLACEMENT PROSTHESIS (PORP), TOTAL OSSICULAR REPLACEMENT PROSTHESIS

(TORP))

314 ............ 69641 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION

314 ............ 69642 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION

314 ............ 69643 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED WALL, WITHOUT OSSICULAR CHAIN RECONSTRUCTION

314 ............ 69644 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED CANAL WALL, WITH OSSICULAR CHAIN RECONSTRUCTION

314 ............ 69645 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); RADICAL OR COMPLETE, WITHOUT OSSICULAR CHAIN RECONSTRUCTION
32496

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

314 ............ 69646 TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); RADICAL OR COMPLETE, WITH OSSICULAR CHAIN RECONSTRUCTION

314 ............ 69650 STAPES MOBILIZATION

314 ............ 69660 STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE OF

FOREIGN MATERIAL;

314 ............ 69661 STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE OF

FOREIGN MATERIAL; WITH FOOTPLATE DRILL OUT

314 ............ 69662 REVISION OF STAPEDECTOMY OR STAPEDOTOMY

314 ............ 69666 REPAIR OVAL WINDOW FISTULA

314 ............ 69667 REPAIR ROUND WINDOW FISTULA

314 ............ 69670 MASTOID OBLITERATION (SEPARATE PROCEDURE)

314 ............ 69676 TYMPANIC NEURECTOMY

314 ............ 69700 CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE PROCEDURE)

314 ............ 69711 REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL BONE

314 ............ 69720 DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; LATERAL TO GENICULATE GANGLION

314 ............ 69725 DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; INCLUDING MEDIAL TO GENICULATE GANGLION

314 ............ 69740 SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION; LATERAL TO GENICULATE

GANGLION

314 ............ 69745 SUTURE FACIAL NERVE, INTRATEMPORAL, WITH OR WITHOUT GRAFT OR DECOMPRESSION; INCLUDING MEDIAL TO GENICULATE GANGLION

314 ............ 69801 LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRUCTIVE PROCEDURES

OR PERFUSION OF VESTIBULOACTIVE DRUGS (SINGLE OR MULTIPLE PERFUSIONS); TRANSCANAL

314 ............ 69802 LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRUCTIVE PROCEDURES

OR PERFUSION OF VESTIBULOACTIVE DRUGS (SINGLE OR MULTIPLE PERFUSIONS); WITH MASTOIDECTOMY

314 ............ 69805 ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT

314 ............ 69806 ENDOLYMPHATIC SAC OPERATION; WITH SHUNT

314 ............ 69820 FENESTRATION SEMICIRCULAR CANAL

314 ............ 69840 REVISION FENESTRATION OPERATION

314 ............ 69905 LABYRINTHECTOMY; TRANSCANAL

314 ............ 69910 LABYRINTHECTOMY; WITH MASTOIDECTOMY

314 ............ 69915 VESTIBULAR NERVE SECTION, TRANSLABYRINTHINE APPROACH

317 ............ 69930 COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY

318 ............ 30901 CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD

318 ............ 30903 CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD

318 ............ 30905 CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERIZATION, ANY METHOD; INITIAL

318 ............ 30906 CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERIZATION, ANY METHOD;

SUBSEQUENT

318 ............ 42960 CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); SIMPLE

318 ............ 42970 CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTADENOIDECTOMY); SIMPLE, WITH

POSTERIOR NASAL PACKS, WITH OR WITHOUT ANTERIOR PACKS AND/OR CAUTERIZATION

319 ............ 42820 TONSILLECTOMY AND ADENOIDECTOMY; UNDER AGE 12

319 ............ 42821 TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER

319 ............ 42825 TONSILLECTOMY, PRIMARY OR SECONDARY; UNDER AGE 12

319 ............ 42826 TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER

319 ............ 42830 ADENOIDECTOMY, PRIMARY; UNDER AGE 12

319 ............ 42831 ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER

319 ............ 42835 ADENOIDECTOMY, SECONDARY; UNDER AGE 12

319 ............ 42836 ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER

319 ............ 42860 EXCISION OF TONSIL TAGS

319 ............ 42870 EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)

320 ............ 32000 THORACENTESIS, PUNCTURE OF PLEURAL CAVITY FOR ASPIRATION, INITIAL OR SUBSEQUENT

320 ............ 32420 PNEUMONOCENTESIS, PUNCTURE OF LUNG FOR ASPIRATION

320 ............ 32960 PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL INJECTION OF AIR

320 ............ 33010 PERICARDIOCENTESIS; INITIAL

320 ............ 33011 PERICARDIOCENTESIS; SUBSEQUENT

320 ............ 49080 PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE (DIAGNOSTIC OR THERAPEUTIC); INITIAL

320 ............ 49081 PERITONEOCENTESIS, ABDOMINAL PARACENTESIS, OR PERITONEAL LAVAGE (DIAGNOSTIC OR THERAPEUTIC); SUBSEQUENT

332 ............ 31233 NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY (VIA INFERIOR MEATUS OR CANINE FOSSA PUNCTURE)

332 ............ 31235 NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF SPHENOIDAL FACE OR

CANNULATION OF OSTIUM)

332 ............ 31237 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)

332 ............ 31238 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF EPISTAXIS

332 ............ 31240 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION

332 ............ 31510 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH BIOPSY

332 ............ 31511 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH REMOVAL OF FOREIGN BODY

332 ............ 31512 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH REMOVAL OF LESION

332 ............ 31513 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH VOCAL CORD INJECTION

332 ............ 31515 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION

332 ............ 31520 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, NEWBORN

332 ............ 31525 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN

332 ............ 31526 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE

332 ............ 31528 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATATION, INITIAL
32497

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

332 ............ 31529 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATATION, SUBSEQUENT

332 ............ 31576 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY

332 ............ 31577 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF FOREIGN BODY

332 ............ 31578 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF LESION

332 ............ 31700 CATHETERIZATION, TRANSGLOTTIC (SEPARATE PROCEDURE)

332 ............ 31717 CATHETERIZATION WITH BRONCHIAL BRUSH BIOPSY

332 ............ 31720 CATHETER ASPIRATION (SEPARATE PROCEDURE); NASOTRACHEAL

332 ............ 31730 TRANSTRACHEAL (PERCUTANEOUS) INTRODUCTION OF NEEDLE WIRE DILATOR/ STENT OR INDWELLING TUBE FOR OXYGEN THERAPY

333 ............ 31239 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY

333 ............ 31254 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, PARTIAL (ANTERIOR)

333 ............ 31255 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL (ANTERIOR AND POSTERIOR)

333 ............ 31256 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY

333 ............ 31267 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY

SINUS

333 ............ 31276 NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL SINUS EXPLORATION, WITH OR WITHOUT REMOVAL OF TISSUE

FROM FRONTAL SINUS

333 ............ 31287 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY

333 ............ 31288 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS

333 ............ 31527 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH INSERTION OF OBTURATOR

333 ............ 31530 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL

333 ............ 31531 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL; WITH OPERATING MICROSCOPE

333 ............ 31535 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY

333 ............ 31536 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE

333 ............ 31540 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/ OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS

333 ............ 31541 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/ OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS;

WITH OPERATING MICROSCOPE

333 ............ 31560 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY

333 ............ 31561 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE

333 ............ 31570 LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC

333 ............ 31571 LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE

336 ............ 31615 TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTOMY INCISION

336 ............ 31622 BRONCHOSCOPY; DIAGNOSTIC, (FLEXIBLE OR RIGID), WITH OR WITHOUT CELL WASHING OR BRUSHING

336 ............ 31625 BRONCHOSCOPY; WITH BIOPSY

336 ............ 31628 BRONCHOSCOPY; WITH TRANSBRONCHIAL LUNG BIOPSY, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE

336 ............ 31629 BRONCHOSCOPY; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY

336 ............ 31630 BRONCHOSCOPY; WITH TRACHEAL OR BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE

336 ............ 31631 BRONCHOSCOPY; WITH TRACHEAL DILATION AND PLACEMENT OF TRACHEAL STENT

336 ............ 31635 BRONCHOSCOPY; WITH REMOVAL OF FOREIGN BODY

336 ............ 31640 BRONCHOSCOPY; WITH EXCISION OF TUMOR

336 ............ 31641 BRONCHOSCOPY; WITH DESTRUCTION OF TUMOR OR RELIEF OF STENOSIS BY ANY METHOD OTHER THAN EXCISION (EG,

LASER)

336 ............ 31645 BRONCHOSCOPY; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL (EG, DRAINAGE OF LUNG ABSCESS)

336 ............ 31646 BRONCHOSCOPY; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, SUBSEQUENT

346 ............ 36488 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL VENOUS

PRESSURE, HYPERALIMENTATION, HEMODIALYSIS, OR CHEMOTHERAPY); PERCUTANEOUS, AGE 2 YEARS OR UNDER

346 ............ 36489 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL VENOUS

PRESSURE, HYPERALIMENTATION, HEMODIALYSIS, OR CHEMOTHERAPY); PERCUTANEOUS, OVER AGE 2

346 ............ 36490 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL VENOUS

PRESSURE, HYPERALIMENTATION, HEMODIALYSIS, OR CHEMOTHERAPY); CUTDOWN, AGE 2 YEARS OR UNDER

346 ............ 36491 PLACEMENT OF CENTRAL VENOUS CATHETER (SUBCLAVIAN, JUGULAR, OR OTHER VEIN) (EG, FOR CENTRAL VENOUS

PRESSURE, HYPERALIMENTATION, HEMODIALYSIS, OR CHEMOTHERAPY); CUTDOWN, OVER AGE 2

346 ............ 36493 REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GUIDANCE

346 ............ 36640 ARTERIAL CATHETERIZATION FOR PROLONGED INFUSION THERAPY (CHEMOTHERAPY), CUTDOWN

360 ............ 33222 REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER

360 ............ 33223 REVISION OR RELOCATION OF SKIN POCKET FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

360 ............ 36261 REVISION OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP

360 ............ 36262 REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP

360 ............ 36531 REVISION OF IMPLANTABLE INTRAVENOUS INFUSION PUMP

360 ............ 36532 REMOVAL OF IMPLANTABLE INTRAVENOUS INFUSION PUMP

360 ............ 36534 REVISION OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR

360 ............ 36535 REMOVAL OF IMPLANTABLE VENOUS ACCESS PORT AND/OR SUBCUTANEOUS RESERVOIR

367 ............ 30915 LIGATION ARTERIES; ETHMOIDAL

367 ............ 30920 LIGATION ARTERIES; INTERNAL MAXILLARY ARTERY, TRANSANTRAL

367 ............ 37618 LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREMITY

367 ............ 37650 LIGATION OF FEMORAL VEIN

367 ............ 37700 LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS

367 ............ 37720 LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS

367 ............ 37730 LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG AND SHORT SAPHENOUS VEINS

367 ............ 37735 LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS WITH RADICAL EXCISION OF

ULCER AND SKIN GRAFT AND/OR INTERRUPTION OF COMMUNICATING VEINS OF LOWER LEG, WITH EXCISION OF DEEP

FASCIA

367 ............ 37760 LIGATION OF PERFORATORS, SUBFASCIAL, RADICAL (LINTON TYPE), WITH OR WITHOUT SKIN GRAFT

367 ............ 37780 LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION (SEPARATE PROCEDURE)
32498

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

367 ............ 37785 LIGATION, DIVISION, AND/OR EXCISION OF RECURRENT OR SECONDARY VARICOSE VEINS (CLUSTERS), ONE LEG

368 ............ 35188 REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; HEAD AND NECK

368 ............ 35207 REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER

368 ............ 35875 THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT;

368 ............ 35876 THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT; WITH REVISION OF ARTERIAL OR VENOUS GRAFT

368 ............ 36260 INSERTION OF IMPLANTABLE INTRA-ARTERIAL INFUSION PUMP (EG, FOR CHEMOTHERAPY OF LIVER)

368 ............ 36530 INSERTION OF IMPLANTABLE INTRAVENOUS INFUSION PUMP

368 ............ 36533 INSERTION OF IMPLANTABLE VENOUS ACCESS PORT, WITH OR WITHOUT SUBCUTANEOUS RESERVOIR

368 ............ 36800 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); VEIN TO VEIN

368 ............ 36810 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL

(SCRIBNER TYPE)

368 ............ 36815 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL

REVISION, OR CLOSURE

368 ............ 36821 ARTERIOVENOUS ANASTOMOSIS, DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)

368 ............ 36825 CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); AUTOGENOUS GRAFT

368 ............ 36830 CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT

368 ............ 36832 REVISION OF AN ARTERIOVENOUS FISTULA, WITH OR WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS

GRAFT (SEPARATE PROCEDURE)

368 ............ 36835 INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE)

368 ............ 36860 CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER

368 ............ 36861 CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER

368 ............ 37607 LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA

396 ............ 38308 LYMPHANGIOTOMY OR OTHER OPERATIONS ON LYMPHATIC CHANNELS

396 ............ 38500 BIOPSY OR EXCISION OF LYMPH NODE(S); SUPERFICIAL (SEPARATE PROCEDURE)

396 ............ 38510 BIOPSY OR EXCISION OF LYMPH NODE(S); DEEP CERVICAL NODE(S)

396 ............ 38520 BIOPSY OR EXCISION OF LYMPH NODE(S); DEEP CERVICAL NODE(S) WITH EXCISION SCALENE FAT PAD

396 ............ 38525 BIOPSY OR EXCISION OF LYMPH NODE(S); DEEP AXILLARY NODE(S)

396 ............ 38530 BIOPSY OR EXCISION OF LYMPH NODE(S); INTERNAL MAMMARY NODE(S) (SEPARATE PROCEDURE)

396 ............ 38550 EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITHOUT DEEP NEUROVASCULAR DISSECTION

397 ............ 38542 DISSECTION, DEEP JUGULAR NODE(S)

397 ............ 38555 EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITH DEEP NEUROVASCULAR DISSECTION

397 ............ 38740 AXILLARY LYMPHADENECTOMY; SUPERFICIAL

397 ............ 38745 AXILLARY LYMPHADENECTOMY; COMPLETE

397 ............ 38760 INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, INCLUDING CLOQUET’S NODE (SEPARATE PROCEDURE)

397 ............ 60200 EXCISION OF CYST OR ADENOMA OF THYROID, OR TRANSECTION OF ISTHMUS

397 ............ 60210 PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY

397 ............ 60220 TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY

397 ............ 60225 TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCLUDING ISTHMUSECTOMY

397 ............ 60240 THYROIDECTOMY, TOTAL OR COMPLETE

397 ............ 60280 EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;

397 ............ 60281 EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS; RECURRENT

406 ............ 43450 DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES

406 ............ 43453 DILATION OF ESOPHAGUS, OVER GUIDE WIRE

406 ............ 43456 DILATION OF ESOPHAGUS, BY BALLOON OR DILATOR, RETROGRADE

406 ............ 43458 DILATION OF ESOPHAGUS WITH BALLOON (30 MM DIAMETER OR LARGER) FOR ACHALASIA

407 ............ 43204 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL VARICES

407 ............ 43205 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BAND LIGATION OF ESOPHAGEAL VARICES

407 ............ 43215 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF FOREIGN BODY

407 ............ 43216 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY

FORCEPS OR BIPOLAR CAUTERY

407 ............ 43217 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

407 ............ 43220 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER)

407 ............ 43226 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION OVER GUIDE WIRE

407 ............ 43227 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD

417 ............ 43200 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR

WASHING (SEPARATE PROCEDURE)

417 ............ 43202 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

417 ............ 43234 UPPER GASTROINTESTINAL ENDOSCOPY, SIMPLE PRIMARY EXAMINATION (EG, WITH SMALL DIAMETER FLEXIBLE ENDOSCOPE) (SEPARATE PROCEDURE)

417 ............ 43235 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING

(SEPARATE PROCEDURE)

417 ............ 43239 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BIOPSY, SINGLE OR MULTIPLE

417 ............ 43600 BIOPSY OF STOMACH; BY CAPSULE, TUBE, PERORAL (ONE OR MORE SPECIMENS)

417 ............ 44100 BIOPSY OF INTESTINE BY CAPSULE, TUBE, PERORAL (ONE OR MORE SPECIMENS)

418 ............ 43241 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH TRANSENDOSCOPIC TUBE OR CATHETER PLACEMENT

418 ............ 43243 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL AND/OR GASTRIC VARICES

418 ............ 43244 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BAND LIGATION OF ESOPHAGEAL AND/OR GASTRIC VARICES
32499

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

418 ............ 43245 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DILATION OF GASTRIC OUTLET FOR OBSTRUCTION, ANY METHOD

418 ............ 43246 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE

418 ............ 43247 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF FOREIGN BODY

418 ............ 43248 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION OF ESOPHAGUS OVER GUIDE WIRE

418 ............ 43249 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)

418 ............ 43250 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY

418 ............ 43251 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

418 ............ 43255 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH CONTROL OF BLEEDING, ANY METHOD

418 ............ 43750 PERCUTANEOUS PLACEMENT OF GASTROSTOMY TUBE

419 ............ 44360 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

419 ............ 44361 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH

BIOPSY, SINGLE OR MULTIPLE

419 ............ 44363 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH

REMOVAL OF FOREIGN BODY

419 ............ 44364 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH

REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

419 ............ 44365 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH

REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY

419 ............ 44366 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH

CONTROL OF BLEEDING, ANY METHOD

419 ............ 44372 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH

PLACEMENT OF PERCUTANEOUS JEJUNOSTOMY TUBE

419 ............ 44373 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH

CONVERSION OF PERCUTANEOUS GASTROSTOMY TUBE TO PERCUTANEOUS JEJUNOSTOMY TUBE

419 ............ 44376 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

419 ............ 44377 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE

419 ............ 44378 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; WITH

CONTROL OF BLEEDING, ANY METHOD

426 ............ 44380 ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING

(SEPARATE PROCEDURE)

426 ............ 44382 ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE

426 ............ 44385 ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

426 ............ 44386 ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; WITH BIOPSY, SINGLE OR MULTIPLE

426 ............ 44388 COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR

WASHING (SEPARATE PROCEDURE)

426 ............ 44389 COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE

426 ............ 45378 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WITH OR WITHOUT COLON DECOMPRESSION (SEPARATE PROCEDURE)

426 ............ 45380 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH BIOPSY, SINGLE OR MULTIPLE

426 ............ G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK

427 ............ 44390 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF FOREIGN BODY

427 ............ 44391 COLONOSCOPY THROUGH STOMA; WITH CONTROL OF BLEEDING, ANY METHOD

427 ............ 44392 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY

427 ............ 44394 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

427 ............ 45355 COLONOSCOPY, RIGID OR FLEXIBLE, TRANSABDOMINAL VIA COLOTOMY, SINGLE OR MULTIPLE

427 ............ 45379 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF FOREIGN BODY

427 ............ 45382 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH CONTROL OF BLEEDING, ANY METHOD

427 ............ 45384 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY

427 ............ 45385 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

437 ............ 46604 ANOSCOPY; WITH DILATION, ANY METHOD

437 ............ 46608 ANOSCOPY; WITH REMOVAL OF FOREIGN BODY

437 ............ 46610 ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY

437 ............ 46611 ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE TECHNIQUE

437 ............ 46612 ANOSCOPY; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT BIOPSY FORCEPS, BIPOLAR

CAUTERY OR SNARE TECHNIQUE

437 ............ 46614 ANOSCOPY; WITH CONTROL OF BLEEDING, ANY METHOD

437 ............ 46615 ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY

FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
32500

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

446 ............ 45300 PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

446 ............ 45305 PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE

446 ............ 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING

(SEPARATE PROCEDURE)

446 ............ 45331 SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

446 ............ G0104 COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY

447 ............ 45303 PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION, ANY METHOD

447 ............ 45307 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY

447 ............ 45308 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY FORCEPS

OR BIPOLAR CAUTERY

447 ............ 45309 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY SNARE TECHNIQUE

447 ............ 45315 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS, OR OTHER LESIONS BY HOT BIOPSY

FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

447 ............ 45317 PROCTOSIGMOIDOSCOPY, RIGID; WITH CONTROL OF BLEEDING, ANY METHOD

447 ............ 45320 PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE (EG, LASER)

447 ............ 45321 PROCTOSIGMOIDOSCOPY, RIGID; WITH DECOMPRESSION OF VOLVULUS

448 ............ 45332 SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY

448 ............ 45333 SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR

BIPOLAR CAUTERY

448 ............ 45334 SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD

448 ............ 45337 SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION OF VOLVULUS, ANY METHOD

448 ............ 45338 SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

449 ............ 43219 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF PLASTIC TUBE OR STENT

449 ............ 43228 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S), NOT AMENABLE TO

REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

449 ............ 43258 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY

HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

449 ............ 43259 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION

449 ............ 43272 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER

LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

449 ............ 44369 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH

ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

449 ............ 44393 COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

449 ............ 45339 SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL

BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

449 ............ 45383 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

452 ............ 45000 TRANSRECTAL DRAINAGE OF PELVIC ABSCESS

452 ............ 45005 INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM

452 ............ 45020 INCISION AND DRAINAGE OF DEEP SUPRALEVATOR, PELVIRECTAL, OR RETRORECTAL ABSCESS

452 ............ 45100 BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)

452 ............ 45900 REDUCTION OF PROCIDENTIA (SEPARATE PROCEDURE) UNDER ANESTHESIA

452 ............ 45905 DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL

452 ............ 45910 DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL

452 ............ 45915 REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA

452 ............ 46030 REMOVAL OF ANAL SETON, OTHER MARKER

452 ............ 46040 INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE)

452 ............ 46050 INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL

452 ............ 46080 SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)

452 ............ 46210 CRYPTECTOMY; SINGLE

452 ............ 46754 REMOVAL OF THIERSCH WIRE OR SUTURE, ANAL CANAL

453 ............ 45108 ANORECTAL MYOMECTOMY

453 ............ 45150 DIVISION OF STRICTURE OF RECTUM

453 ............ 45160 EXCISION OF RECTAL TUMOR BY PROCTOTOMY, TRANSSACRAL OR TRANSCOCCYGEAL APPROACH

453 ............ 45170 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH

453 ............ 45190 DESTRUCTION OF RECTAL TUMOR, ANY METHOD (EG, ELECTRODESICCATION) TRANSANAL APPROACH

453 ............ 45500 PROCTOPLASTY; FOR STENOSIS

453 ............ 45505 PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE

453 ............ 45560 REPAIR OF RECTOCELE (SEPARATE PROCEDURE)

453 ............ 46045 INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL, UNDER ANESTHESIA

453 ............ 46060 INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS, WITH FISTULECTOMY OR FISTULOTOMY, SUBMUSCULAR, WITH OR WITHOUT PLACEMENT OF SETON

453 ............ 46200 FISSURECTOMY, WITH OR WITHOUT SPHINCTEROTOMY

453 ............ 46211 CRYPTECTOMY; MULTIPLE (SEPARATE PROCEDURE)

453 ............ 46250 HEMORRHOIDECTOMY, EXTERNAL, COMPLETE

453 ............ 46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE

453 ............ 46257 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISSURECTOMY

453 ............ 46258 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SIMPLE; WITH FISTULECTOMY, WITH OR WITHOUT FISSURECTOMY
32501

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

453 ............ 46260 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE

453 ............ 46261 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISSURECTOMY

453 ............ 46262 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, COMPLEX OR EXTENSIVE; WITH FISTULECTOMY, WITH OR WITHOUT

FISSURECTOMY

453 ............ 46270 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS

453 ............ 46275 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SUBMUSCULAR

453 ............ 46280 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); COMPLEX OR MULTIPLE, WITH OR WITHOUT

PLACEMENT OF SETON

453 ............ 46285 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); SECOND STAGE

453 ............ 46288 CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP

453 ............ 46700 ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; ADULT

453 ............ 46750 SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT

453 ............ 46753 GRAFT (THIERSCH OPERATION) FOR RECTAL INCONTINENCE AND/OR PROLAPSE

453 ............ 46760 SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; MUSCLE TRANSPLANT

453 ............ 46761 SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; LEVATOR MUSCLE IMBRICATION (PARK POSTERIOR ANAL REPAIR)

453 ............ 46762 SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; IMPLANTATION ARTIFICIAL SPHINCTER

453 ............ 46937 CRYOSURGERY OF RECTAL TUMOR; BENIGN

453 ............ 46938 CRYOSURGERY OF RECTAL TUMOR; MALIGNANT

456 ............ 43260 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF

SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

456 ............ 43261 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MULTIPLE

456 ............ 43262 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY

456 ............ 43263 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PRESSURE MEASUREMENT OF SPHINCTER OF

ODDI (PANCREATIC DUCT OR COMMON BILE DUCT)

456 ............ 43264 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF

STONE(S) FROM BILIARY AND/OR PANCREATIC DUCTS

456 ............ 43265 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE DESTRUCTION,

LITHOTRIPSY OF STONE(S), ANY METHOD

456 ............ 43267 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF

NASOBILIARY OR NASOPANCREATIC DRAINAGE TUBE

456 ............ 43268 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF

TUBE OR STENT INTO BILE OR PANCREATIC DUCT

456 ............ 43269 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF

FOREIGN BODY AND/OR CHANGE OF TUBE OR STENT

456 ............ 43271 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE BALLOON DILATION OF AMPULLA, BILIARY AND/OR PANCREATIC DUCT(S)

458 ............ 47510 INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC CATHETER FOR BILIARY DRAINAGE

458 ............ 47511 INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC STENT FOR INTERNAL AND EXTERNAL BILIARY DRAINAGE

458 ............ 47552 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF

SPECIMEN(S) BY BRUSHING AND/OR WASHING (SEPARATE PROCEDURE)

458 ............ 47553 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH BIOPSY, SINGLE OR MULTIPLE

458 ............ 47554 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH REMOVAL OF STONE(S)

458 ............ 47555 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF BILIARY DUCT STRICTURE(S)

WITHOUT STENT

458 ............ 47556 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT; WITH DILATION OF BILIARY DUCT STRICTURE(S)

WITH STENT

458 ............ 47630 BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS VIA T-TUBE TRACT, BASKET, OR SNARE (EG, BURHENNE TECHNIQUE)

459 ............ 49085 REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY

459 ............ 49250 UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)

459 ............ 49420 INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS; TEMPORARY

459 ............ 49421 INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS; PERMANENT

459 ............ 49426 REVISION OF PERITONEAL-VENOUS SHUNT

466 ............ 49495 REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE

466 ............ 49496 REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH OR WITHOUT HYDROCELECTOMY; INCARCERATED OR

STRANGULATED

466 ............ 49500 REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE

466 ............ 49501 REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5 YEARS, WITH OR WITHOUT HYDROCELECTOMY; INCARCERATED OR STRANGULATED

466 ............ 49505 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE

466 ............ 49507 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED

466 ............ 49520 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE

466 ............ 49521 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED

466 ............ 49525 REPAIR INGUINAL HERNIA, SLIDING, ANY AGE

466 ............ 49540 REPAIR LUMBAR HERNIA

466 ............ 49550 REPAIR INITIAL FEMORAL HERNIA, ANY AGE, REDUCIBLE;

466 ............ 49553 REPAIR INITIAL FEMORAL HERNIA, ANY AGE, REDUCIBLE; INCARCERATED OR STRANGULATED

466 ............ 49555 REPAIR RECURRENT FEMORAL HERNIA; REDUCIBLE

466 ............ 49557 REPAIR RECURRENT FEMORAL HERNIA; INCARCERATED OR STRANGULATED

466 ............ 49560 REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE

466 ............ 49561 REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED

466 ............ 49565 REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE

466 ............ 49566 REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED

466 ............ 49568 IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR INCISIONAL OR VENTRAL HERNIA REPAIR (LIST SEPARATELY IN ADDITION TO CODE FOR THE INCISIONAL OR VENTRAL HERNIA REPAIR)
32502

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

466 ............ 49570 REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE)

466 ............ 49572 REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED

466 ............ 49580 REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; REDUCIBLE

466 ............ 49582 REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; INCARCERATED OR STRANGULATED

466 ............ 49585 REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE

466 ............ 49587 REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATED OR STRANGULATED

466 ............ 49590 REPAIR SPIGELIAN HERNIA

466 ............ 49600 REPAIR OF SMALL OMPHALOCELE, WITH PRIMARY CLOSURE

466 ............ 51500 EXCISION OF URACHAL CYST OR SINUS, WITH OR WITHOUT UMBILICAL HERNIA REPAIR

466 ............ 55040 EXCISION OF HYDROCELE; UNILATERAL

466 ............ 55041 EXCISION OF HYDROCELE; BILATERAL

470 ............ 31502 TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT

470 ............ 43760 CHANGE OF GASTROSTOMY TUBE

470 ............ 43761 REPOSITIONING OF THE GASTRIC FEEDING TUBE THROUGH THE DUODENUM FOR ENTERIC NUTRITION

470 ............ 47525 CHANGE OF PERCUTANEOUS BILIARY DRAINAGE CATHETER

470 ............ 47530 REVISION AND/OR REINSERTION OF TRANSHEPATIC TUBE

470 ............ 49422 REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER

470 ............ 49429 REMOVAL OF PERITONEAL-VENOUS SHUNT

470 ............ 50688 CHANGE OF URETEROSTOMY TUBE

470 ............ 51705 CHANGE OF CYSTOSTOMY TUBE; SIMPLE

470 ............ 51710 CHANGE OF CYSTOSTOMY TUBE; COMPLICATED

521 ............ 50398 CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE

521 ............ 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE)

521 ............ 52265 CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL ANESTHESIA

522 ............ 50551 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;

522 ............ 50553 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH URETERAL CATHETERIZATION, WITH OR

WITHOUT DILATION OF URETER

522 ............ 50555 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BIOPSY

522 ............ 50557 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH FULGURATION AND/OR INCISION, WITH

OR WITHOUT BIOPSY

522 ............ 50559 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH INSERTION OF RADIOACTIVE SUBSTANCE WITH OR WITHOUT BIOPSY AND/OR FULGURATION

522 ............ 50561 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH REMOVAL OF FOREIGN BODY OR CALCULUS

522 ............ 52005 CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;

522 ............ 52007 CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BRUSH BIOPSY OF URETER AND/OR RENAL PELVIS

522 ............ 52010 CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

DUCT RADIOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE

522 ............ 52204 CYSTOURETHROSCOPY, WITH BIOPSY

522 ............ 52214 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF TRIGONE, BLADDER

NECK, PROSTATIC FOSSA, URETHRA, OR PERIURETHRAL GLANDS

522 ............ 52224 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR TREATMENT OF MINOR

(LESS THAN 0.5 CM) LESION(S) WITH OR WITHOUT BIOPSY

522 ............ 52260 CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL OR CONDUCTION (SPINAL)

ANESTHESIA

522 ............ 52270 CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALE

522 ............ 52275 CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE

522 ............ 52276 CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY

522 ............ 52281 CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, WITH OR WITHOUT MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR CYSTOGRAPHY, MALE OR FEMALE

522 ............ 52283 CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE

522 ............ 52285 CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL OF THE FOLLOWING:

URETHRAL MEATOTOMY, URETHRAL DILATION, INTERNAL URETHROTOMY, LYSIS OF URETHROVAGINAL SEPTAL FIBROSIS, LATERAL INCISIONS OF THE BLADDER NECK, AND FULGURATION OF POLYP(S) OF URETHRA, BLADDER NECK, AND/

OR TRIGONE

522 ............ 52290 CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL OR BILATERAL

522 ............ 52300 CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL

522 ............ 52301 CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL

522 ............ 52305 CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE

522 ............ 52310 CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); SIMPLE

522 ............ 52315 CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); COMPLICATED

522 ............ 52327 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC INJECTION OF IMPLANT MATERIAL

522 ............ 52510 TRANSURETHRAL BALLOON DILATION OF THE PROSTATIC URETHRA, ANY METHOD

522 ............ 53605 DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE, GENERAL

OR CONDUCTION (SPINAL) ANESTHESIA
32503

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

523 ............ 50951 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;

523 ............ 50953 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH URETERAL CATHETERIZATION, WITH OR WITHOUT

DILATION OF URETER

523 ............ 50955 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BIOPSY

523 ............ 50957 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH FULGURATION AND/OR INCISION, WITH OR WITHOUT BIOPSY

523 ............ 50959 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH

OR WITHOUT BIOPSY AND/OR FULGURATION (NOT INCLUDING PROVISION OF MATERIAL)

523 ............ 50961 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR

URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH REMOVAL OF FOREIGN BODY OR CALCULUS

523 ............ 51020 CYSTOTOMY OR CYSTOSTOMY; WITH FULGURATION AND/OR INSERTION OF RADIOACTIVE MATERIAL

523 ............ 51030 CYSTOTOMY OR CYSTOSTOMY; WITH CRYOSURGICAL DESTRUCTION OF INTRAVESICAL LESION

523 ............ 51040 CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE

523 ............ 51045 CYSTOTOMY, WITH INSERTION OF URETERAL CATHETER OR STENT (SEPARATE PROCEDURE)

523 ............ 51050 CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK RESECTION

523 ............ 51065 CYSTOTOMY, WITH STONE BASKET EXTRACTION AND/OR ULTRASONIC OR ELECTROHYDRAULIC FRAGMENTATION OF

URETERAL CALCULUS

523 ............ 51520 CYSTOTOMY; FOR SIMPLE EXCISION OF VESICAL NECK (SEPARATE PROCEDURE)

523 ............ 51880 CLOSURE OF CYSTOSTOMY (SEPARATE PROCEDURE)

523 ............ 52234 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF;

SMALL BLADDER TUMOR(S) (0.5 TO 2.0 CM)

523 ............ 52235 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF;

MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM)

523 ............ 52240 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF;

LARGE BLADDER TUMOR(S)

523 ............ 52250 CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH OR WITHOUT BIOPSY OR FULGURATION

523 ............ 52277 CYSTOURETHROSCOPY, WITH RESECTION OF EXTERNAL SPHINCTER (SPHINCTEROTOMY)

523 ............ 52282 CYSTOURETHROSCOPY, WITH INSERTION OF URETHRAL STENT

523 ............ 52317 LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS;

SIMPLE OR SMALL (LESS THAN 2.5 CM)

523 ............ 52318 LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS;

COMPLICATED OR LARGE (OVER 2.5 CM)

523 ............ 52320 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS

523 ............ 52325 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF URETERAL CALCULUS (EG,

ULTRASONIC OR ELECTRO-HYDRAULIC TECHNIQUE)

523 ............ 52330 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHOUT REMOVAL OF

URETERAL CALCULUS

523 ............ 52332 CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)

523 ............ 52334 CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO ESTABLISH A PERCUTANEOUS

NEPHROSTOMY, RETROGRADE

523 ............ 52335 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR

PYELOURETERAL JUNCTION BY ANY METHOD);

523 ............ 52336 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR

PYELOURETERAL JUNCTION BY ANY METHOD); WITH REMOVAL OR MANIPULATION OF CALCULUS (URETERAL CATHETERIZATION IS INCLUDED)

523 ............ 52338 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR

PYELOURETERAL JUNCTION BY ANY METHOD); WITH BIOPSY AND/OR FULGURATION OF LESION

523 ............ 52339 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR

PYELOURETERAL JUNCTION BY ANY METHOD); WITH RESECTION OF TUMOR

523 ............ 52340 CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERIOR URETHRAL VALVES,

OR CONGENITAL OBSTRUCTIVE HYPERTROPHIC MUCOSAL FOLDS

523 ............ 52450 TRANSURETHRAL INCISION OF PROSTATE

523 ............ 52500 TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)

523 ............ 52606 TRANSURETHRAL FULGURATION FOR POSTOPERATIVE BLEEDING OCCURRING AFTER THE USUAL FOLLOW-UP TIME

523 ............ 52640 TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE

523 ............ 52700 TRANSURETHRAL DRAINAGE OF PROSTATIC ABSCESS

523 ............ 55720 PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; SIMPLE

523 ............ 55725 PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; COMPLICATED

523 ............ 55859 TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO PROSTATE FOR INTERSTITIAL RADIOELEMENT APPLICATION, WITH OR WITHOUT CYSTOSCOPY

524 ............ 52337 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR

PYELOURETERAL JUNCTION BY ANY METHOD); WITH LITHOTRIPSY (URETERAL CATHETERIZATION IS INCLUDED)

524 ............ 52601 TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING,

COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)

524 ............ 52612 TRANSURETHRAL RESECTION OF PROSTATE; FIRST STAGE OF TWO-STAGE RESECTION (PARTIAL RESECTION)

524 ............ 52614 TRANSURETHRAL RESECTION OF PROSTATE; SECOND STAGE OF TWO-STAGE RESECTION (RESECTION COMPLETED)

524 ............ 52620 TRANSURETHRAL RESECTION; OF RESIDUAL OBSTRUCTIVE TISSUE AFTER 90 DAYS POSTOPERATIVE

524 ............ 52630 TRANSURETHRAL RESECTION; OF REGROWTH OF OBSTRUCTIVE TISSUE LONGER THAN ONE YEAR POSTOPERATIVE
32504

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

524 ............ 52647 NON-CONTACT LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE

(VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL

URETHROTOMY ARE INCLUDED)

524 ............ 52648 CONTACT LASER VAPORIZATION WITH OR WITHOUT TRANSURETHRAL RESECTION OF PROSTATE, INCLUDING CONTROL OF

POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION

AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)

524 ............ 53850 TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY MICROWAVE THERMOTHERAPY

524 ............ 53852 TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY

527 ............ 50590 LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE

531 ............ 51715 ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLADDER

NECK

531 ............ 53000 URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PENDULOUS URETHRA

531 ............ 53010 URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PERINEAL URETHRA, EXTERNAL

531 ............ 53020 MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT

531 ............ 53025 MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); INFANT

531 ............ 53040 DRAINAGE OF DEEP PERIURETHRAL ABSCESS

531 ............ 53060 DRAINAGE OF SKENE’S GLAND ABSCESS OR CYST

531 ............ 53080 DRAINAGE OF PERINEAL URINARY EXTRAVASATION; UNCOMPLICATED (SEPARATE PROCEDURE)

531 ............ 53200 BIOPSY OF URETHRA

531 ............ 53250 EXCISION OF BULBOURETHRAL GLAND (COWPER’S GLAND)

531 ............ 53260 EXCISION OR FULGURATION; URETHRAL POLYP(S), DISTAL URETHRA

531 ............ 53265 EXCISION OR FULGURATION; URETHRAL CARUNCLE

531 ............ 53270 EXCISION OR FULGURATION; SKENE’S GLANDS

531 ............ 53275 EXCISION OR FULGURATION; URETHRAL PROLAPSE

531 ............ 53442 REMOVAL OF PERINEAL PROSTHESIS INTRODUCED FOR CONTINENCE

531 ............ 53502 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE

531 ............ 53505 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE

531 ............ 53510 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PERINEAL

531 ............ 53665 DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA

531 ............ 54000 SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); NEWBORN

531 ............ 54001 SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN

532 ............ 53210 URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; FEMALE

532 ............ 53215 URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; MALE

532 ............ 53220 EXCISION OR FULGURATION OF CARCINOMA OF URETHRA

532 ............ 53230 EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); FEMALE

532 ............ 53235 EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); MALE

532 ............ 53240 MARSUPIALIZATION OF URETHRAL DIVERTICULUM, MALE OR FEMALE

532 ............ 53400 URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNSEN TYPE)

532 ............ 53405 URETHROPLASTY; SECOND STAGE (FORMATION OF URETHRA), INCLUDING URINARY DIVERSION

532 ............ 53410 URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE ANTERIOR URETHRA

532 ............ 53420 URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS URETHRA; FIRST STAGE

532 ............ 53425 URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS URETHRA; SECOND

STAGE

532 ............ 53430 URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA

532 ............ 53447 REMOVAL, REPAIR, OR REPLACEMENT OF INFLATABLE SPHINCTER INCLUDING PUMP AND/OR RESERVOIR AND/OR CUFF

532 ............ 53449 SURGICAL CORRECTION OF HYDRAULIC ABNORMALITY OF INFLATABLE SPHINCTER DEVICE

532 ............ 53450 URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT

532 ............ 53460 URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRAL SEGMENT (RICHARDSON TYPE PROCEDURE)

532 ............ 53515 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PROSTATOMEMBRANOUS

532 ............ 53520 CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS FISTULA, MALE (SEPARATE PROCEDURE)

536 ............ 54150 CIRCUMCISION, USING CLAMP OR OTHER DEVICE; NEWBORN

536 ............ 54152 CIRCUMCISION, USING CLAMP OR OTHER DEVICE; EXCEPT NEWBORN

536 ............ 54160 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; NEWBORN

536 ............ 54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; EXCEPT NEWBORN

537 ............ 37790 PENILE VENOUS OCCLUSIVE PROCEDURE

537 ............ 54110 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE);

537 ............ 54111 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT TO 5 CM IN LENGTH

537 ............ 54112 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT GREATER THAN 5 CM IN LENGTH

537 ............ 54120 AMPUTATION OF PENIS; PARTIAL

537 ............ 54205 INJECTION PROCEDURE FOR PEYRONIE DISEASE; WITH SURGICAL EXPOSURE OF PLAQUE

537 ............ 54300 PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG, HYPOSPADIAS), WITH OR WITHOUT MOBILIZATION

OF URETHRA

537 ............ 54304 PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE OR FOR FIRST STAGE HYPOSPADIAS REPAIR WITH OR

WITHOUT TRANSPLANTATION OF PREPUCE AND/OR SKIN FLAPS

537 ............ 54308 URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION); LESS THAN 3 CM

537 ............ 54312 URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION); GREATER THAN 3 CM

537 ............ 54316 URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION) WITH FREE SKIN GRAFT

OBTAINED FROM SITE OTHER THAN GENITALIA

537 ............ 54318 URETHROPLASTY FOR THIRD STAGE HYPOSPADIAS REPAIR TO RELEASE PENIS FROM SCROTUM (EG, THIRD STAGE CECIL

REPAIR)

537 ............ 54322 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH SIMPLE MEATAL ADVANCEMENT (EG, MAGPI, V-FLAP)

537 ............ 54324 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY

LOCAL SKIN FLAPS (EG, FLIP-FLAP, PREPUCIAL FLAP)

537 ............ 54326 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY

LOCAL SKIN FLAPS AND MOBILIZATION OF URETHRA
32505

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

537 ............ 54328 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH EXTENSIVE DISSECTION TO CORRECT CHORDEE AND URETHROPLASTY WITH LOCAL SKIN FLAPS, SKIN GRAFT PATCH, AND/OR ISLAND FLAP

537 ............ 54340 REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); BY CLOSURE, INCISION, OR EXCISION,

SIMPLE

537 ............ 54344 REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING MOBILIZATION OF SKIN

FLAPS AND URETHROPLASTY WITH FLAP OR PATCH GRAFT

537 ............ 54348 REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING EXTENSIVE DISSECTION

AND URETHROPLASTY WITH FLAP, PATCH OR TUBED GRAFT (INCLUDES URINARY DIVERSION)

537 ............ 54352 REPAIR OF HYPOSPADIAS CRIPPLE REQUIRING EXTENSIVE DISSECTION AND EXCISION OF PREVIOUSLY CONSTRUCTED

STRUCTURES INCLUDING RE-RELEASE OF CHORDEE AND RECONSTRUCTION OF URETHRA AND PENIS BY USE OF LOCAL

SKIN AS GRAFTS AND ISLAND FLAPS AND SKIN BROUGHT IN AS FLAPS OR GRAFTS

537 ............ 54360 PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION

537 ............ 54380 PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER;

537 ............ 54385 PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH INCONTINENCE

537 ............ 54402 REMOVAL OR REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS

537 ............ 54407 REMOVAL, REPAIR, OR REPLACEMENT OF INFLATABLE (MULTI-COMPONENT) PENILE PROSTHESIS, INCLUDING PUMP AND/

OR RESERVOIR AND/OR CYLINDERS

537 ............ 54409 SURGICAL CORRECTION OF HYDRAULIC ABNORMALITY OF INFLATABLE (MULTI-COMPONENT) PROSTHESIS INCLUDING

PUMP AND/OR RESERVOIR AND/OR CYLINDERS

537 ............ 54420 CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT (PRIAPISM OPERATION), UNILATERAL OR BILATERAL

537 ............ 54435 CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION (EG, BIOPSY NEEDLE, WINTER PROCEDURE, RONGEUR, OR PUNCH)

FOR PRIAPISM

537 ............ 54440 PLASTIC OPERATION OF PENIS FOR INJURY

538 ............ 53440 OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE, WITH OR WITHOUT INTRODUCTION OF PROSTHESIS

538 ............ 53445 OPERATION FOR CORRECTION OF URINARY INCONTINENCE WITH PLACEMENT OF INFLATABLE URETHRAL OR BLADDER

NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP AND/OR RESERVOIR

538 ............ 54400 INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID)

538 ............ 54401 INSERTION OF PENILE PROSTHESIS; INFLATABLE (SELF-CONTAINED)

538 ............ 54405 INSERTION OF INFLATABLE (MULTI-COMPONENT) PENILE PROSTHESIS, INCLUDING PLACEMENT OF PUMP, CYLINDERS,

AND/OR RESERVOIR

546 ............ 54505 BIOPSY OF TESTIS, INCISIONAL (SEPARATE PROCEDURE)

546 ............ 54510 EXCISION OF LOCAL LESION OF TESTIS

546 ............ 54520 ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL

APPROACH

546 ............ 54530 ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH

546 ............ 54550 EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR SCROTAL AREA)

546 ............ 54600 REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS

546 ............ 54620 FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE)

546 ............ 54640 ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR

546 ............ 54660 INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)

546 ............ 54670 SUTURE OR REPAIR OF TESTICULAR INJURY

546 ............ 54680 TRANSPLANTATION OF TESTIS(ES) TO THIGH (BECAUSE OF SCROTAL DESTRUCTION)

546 ............ 54700 INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMATOMA)

546 ............ 54820 EXPLORATION OF EPIDIDYMIS, WITH OR WITHOUT BIOPSY

546 ............ 54830 EXCISION OF LOCAL LESION OF EPIDIDYMIS

546 ............ 54840 EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY

546 ............ 54860 EPIDIDYMECTOMY; UNILATERAL

546 ............ 54861 EPIDIDYMECTOMY; BILATERAL

546 ............ 54900 EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; UNILATERAL

546 ............ 54901 EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; BILATERAL

546 ............ 55060 REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE)

546 ............ 55110 SCROTAL EXPLORATION

546 ............ 55120 REMOVAL OF FOREIGN BODY IN SCROTUM

546 ............ 55150 RESECTION OF SCROTUM

546 ............ 55175 SCROTOPLASTY; SIMPLE

546 ............ 55180 SCROTOPLASTY; COMPLICATED

546 ............ 55200 VASOTOMY, CANNULIZATION WITH OR WITHOUT INCISION OF VAS, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)

546 ............ 55250 VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)

546 ............ 55400 VASOVASOSTOMY, VASOVASORRHAPHY

546 ............ 55450 LIGATION (PERCUTANEOUS) OF VAS DEFERENS, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)

546 ............ 55500 EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL (SEPARATE PROCEDURE)

546 ............ 55520 EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE)

546 ............ 55530 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE PROCEDURE)

546 ............ 55535 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; ABDOMINAL APPROACH

546 ............ 55540 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; WITH HERNIA REPAIR

546 ............ 55680 EXCISION OF MULLERIAN DUCT CYST

547 ............ 55700 BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH

547 ............ 55705 BIOPSY, PROSTATE; INCISIONAL, ANY APPROACH

550 ............ 56351 HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D &

C

550 ............ 56352 HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)

550 ............ 56353 HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTION OF INTRAUTERINE SEPTUM (ANY METHOD)

550 ............ 56354 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA

550 ............ 56355 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY

550 ............ 56356 HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (ANY METHOD)
32506

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

551 ............ 56300 LAPAROSCOPY (PERITONEOSCOPY), DIAGNOSTIC; (SEPARATE PROCEDURE)

551 ............ 56301 LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)

551 ............ 56302 LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR FALOPE RING)

551 ............ 56303 LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD

551 ............ 56304 LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)

551 ............ 56305 LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)

551 ............ 56306 LAPAROSCOPY, SURGICAL; WITH ASPIRATION (SINGLE OR MULTIPLE)

551 ............ 56346 LAPAROSCOPY, SURGICAL; GASTROSTOMY, TEMPORARY (TUBE OR RUBBER OR PLASTIC) (SEPARATE PROCEDURE)

552 ............ 56307 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)

552 ............ 56309 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA (SINGLE OR MULTIPLE)

552 ............ 56311 LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE

552 ............ 56312 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY

552 ............ 56313 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORTIC LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE

552 ............ 56316 LAPAROSCOPY, SURGICAL; REPAIR OF INITIAL INGUINAL HERNIA

552 ............ 56317 LAPAROSCOPY, SURGICAL; REPAIR OF RECURRENT INGUINAL HERNIA

552 ............ 56318 LAPAROSCOPY, SURGICAL; ORCHIECTOMY

552 ............ 56320 LAPAROSCOPY, SURGICAL; WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE

552 ............ 56343 LAPAROSCOPY, SURGICAL; WITH SALPINGOSTOMY (SALPINGONEOSTOMY)

552 ............ 56344 LAPAROSCOPY, SURGICAL; WITH FIMBRIOPLASTY

552 ............ 56362 LAPAROSCOPY WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY; WITHOUT BIOPSY

552 ............ 56363 LAPAROSCOPY WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY; WITH BIOPSY

562 ............ 56350 HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)

562 ............ 56440 MARSUPIALIZATION OF BARTHOLIN’S GLAND CYST

562 ............ 56700 PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING

562 ............ 56720 HYMENOTOMY, SIMPLE INCISION

562 ............ 56740 EXCISION OF BARTHOLIN’S GLAND OR CYST

562 ............ 56800 PLASTIC REPAIR OF INTROITUS

562 ............ 56810 PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)

562 ............ 57000 COLPOTOMY; WITH EXPLORATION

562 ............ 57010 COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS

562 ............ 57020 COLPOCENTESIS (SEPARATE PROCEDURE)

562 ............ 57065 DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE, ANY METHOD

562 ............ 57105 BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE (INCLUDING CYSTS)

562 ............ 57130 EXCISION OF VAGINAL SEPTUM

562 ............ 57135 EXCISION OF VAGINAL CYST OR TUMOR

562 ............ 57200 COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)

562 ............ 57210 COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR PERINEUM (NONOBSTETRICAL)

562 ............ 57230 PLASTIC REPAIR OF URETHROCELE

562 ............ 57400 DILATION OF VAGINA UNDER ANESTHESIA

562 ............ 57410 PELVIC EXAMINATION UNDER ANESTHESIA

562 ............ 57415 REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA

562 ............ 57460 COLPOSCOPY (VAGINOSCOPY); WITH LOOP ELECTRODE EXCISION PROCEDURE OF THE CERVIX

562 ............ 57700 CERCLAGE OF UTERINE CERVIX, NONOBSTETRICAL

562 ............ 57720 TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE CERVIX, VAGINAL APPROACH

562 ............ 58345 TRANSCERVICAL INTRODUCTION OF FALLOPIAN TUBE CATHETER FOR DIAGNOSIS AND/OR RE-ESTABLISHING PATENCY

(ANY METHOD), WITH OR WITHOUT HYSTEROSALPINGOGRAPHY

562 ............ 58350 CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS

562 ............ 58970 FOLLICLE PUNCTURE FOR OOCYTE RETRIEVAL, ANY METHOD

562 ............ 59300 EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING PHYSICIAN

562 ............ 59320 CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL

562 ............ 59871 REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHER THAN LOCAL)

563 ............ 56620 VULVECTOMY SIMPLE; PARTIAL

563 ............ 56625 VULVECTOMY SIMPLE; COMPLETE

563 ............ 57220 PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH (EG, KELLY URETHRAL PLICATION)

563 ............ 57240 ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE

563 ............ 57250 POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY

563 ............ 57260 COMBINED ANTEROPOSTERIOR COLPORRHAPHY;

563 ............ 57265 COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR

563 ............ 57268 REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE)

563 ............ 57284 PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, STRESS URINARY INCONTINENCE, AND/OR INCOMPLETE VAGINAL PROLAPSE)

563 ............ 57288 SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)

563 ............ 57289 PEREYRA PROCEDURE, INCLUDING ANTERIOR COLPORRHAPHY

563 ............ 57291 CONSTRUCTION OF ARTIFICIAL VAGINA; WITHOUT GRAFT

563 ............ 57300 CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH

563 ............ 57520 CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER

563 ............ 57522 CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION

563 ............ 57530 TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX (SEPARATE PROCEDURE)

563 ............ 57550 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH;

563 ............ 57555 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH ANTERIOR AND/OR POSTERIOR REPAIR
32507

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

563 ............ 57556 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH REPAIR OF ENTEROCELE

563 ............ 58145 MYOMECTOMY, EXCISION OF FIBROID TUMOR OF UTERUS, SINGLE OR MULTIPLE (SEPARATE PROCEDURE); VAGINAL APPROACH

563 ............ 58800 DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE); VAGINAL APPROACH

563 ............ 58820 DRAINAGE OF OVARIAN ABSCESS; VAGINAL APPROACH, OPEN

567 ............ 57820 DILATION AND CURETTAGE OF CERVICAL STUMP

567 ............ 58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)

567 ............ 59160 CURRETTAGE, POSTPARTUM

586 ............ 59840 INDUCED ABORTION, BY DILATION AND CURETTAGE

586 ............ 59841 INDUCED ABORTION, BY DILATION AND EVACUATION

587 ............ 59812 TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY

587 ............ 59820 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER

587 ............ 59821 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER

587 ............ 59870 UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE

600 ............ 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC

600 ............ 62272 SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF SPINAL FLUID (BY NEEDLE OR CATHETER)

602 ............ 61000 SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; INITIAL

602 ............ 61001 SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; SUBSEQUENT TAPS

602 ............ 61020 VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULAR CATHETER/RESERVOIR; WITHOUT INJECTION

602 ............ 61026 VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULAR CATHETER/RESERVOIR; WITH INJECTION OF DRUG OR OTHER SUBSTANCE FOR DIAGNOSIS OR TREATMENT

602 ............ 61050 CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITHOUT INJECTION (SEPARATE PROCEDURE)

602 ............ 61055 CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITH INJECTION OF DRUG OR OTHER SUBSTANCE FOR DIAGNOSIS

OR TREATMENT (EG, C1-C2)

602 ............ 61070 PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE

602 ............ 62194 REPLACEMENT OR IRRIGATION, SUBARACHNOID/SUBDURAL CATHETER

602 ............ 62225 REPLACEMENT OR IRRIGATION, VENTRICULAR CATHETER

602 ............ 62268 PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX

602 ............ 62273 INJECTION, LUMBAR EPIDURAL, OF BLOOD OR CLOT PATCH

602 ............ 62274 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS);

SUBARACHNOID OR SUBDURAL, SINGLE

602 ............ 62275 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); EPIDURAL, CERVICAL OR THORACIC, SINGLE

602 ............ 62276 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS);

SUBARACHNOID OR SUBDURAL, DIFFERENTIAL

602 ............ 62277 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS);

SUBARACHNOID OR SUBDURAL, CONTINUOUS

602 ............ 62278 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); EPIDURAL, LUMBAR OR CAUDAL, SINGLE

602 ............ 62279 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); EPIDURAL, LUMBAR OR CAUDAL, CONTINUOUS

602 ............ 62280 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); SUBARACHNOID

602 ............ 62281 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); EPIDURAL, CERVICAL OR THORACIC

602 ............ 62282 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); EPIDURAL, LUMBAR OR CAUDAL

602 ............ 62288 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, ANTISPASMODIC, CONTRAST, OR NEUROLYTIC SOLUTIONS; SUBARACHNOID (SEPARATE PROCEDURE)

602 ............ 62289 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, ANTISPASMODIC, CONTRAST, OR NEUROLYTIC SOLUTIONS; LUMBAR OR CAUDAL EPIDURAL (SEPARATE PROCEDURE)

602 ............ 62292 INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS, INCLUDING DISKOGRAPHY, INTERVERTEBRAL DISK, SINGLE OR MULTIPLE LEVELS, LUMBAR

602 ............ 62294 INJECTION PROCEDURE, ARTERIAL, FOR OCCLUSION OF ARTERIOVENOUS MALFORMATION, SPINAL

602 ............ 62298 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, CONTRAST, OR NEUROLYTIC SOLUTIONS, EPIDURAL, CERVICAL OR

THORACIC (SEPARATE PROCEDURE)

616 ............ 63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; EPIDURAL

616 ............ 64553 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE

616 ............ 64555 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE

616 ............ 64560 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE

616 ............ 64565 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR

616 ............ 64573 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE

616 ............ 64575 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE

616 ............ 64577 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE

616 ............ 64580 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR

617 ............ 62230 REPLACEMENT OR REVISION OF CSF SHUNT, OBSTRUCTED VALVE, OR DISTAL CATHETER IN SHUNT SYSTEM

617 ............ 62350 IMPLANTATION, REVISION OR REPOSITIONING OF INTRATHECAL OR EPIDURAL CATHETER, FOR IMPLANTABLE RESERVOIR

OR IMPLANTABLE INFUSION PUMP; WITHOUT LAMINECTOMY

617 ............ 62355 REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER

617 ............ 62365 REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL OR EPIDURAL INFUSION

617 ............ 63660 REVISION OR REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODES

617 ............ 63688 REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER

617 ............ 63744 REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT

617 ............ 63746 REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT

617 ............ 64585 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODES
32508

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

617 ............ 64595 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER

618 ............ 61215 INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR CONTINUOUS INFUSION SYSTEM FOR CONNECTION TO VENTRICULAR CATHETER

618 ............ 61885 INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT

OR INDUCTIVE COUPLING

618 ............ 62360 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; SUBCUTANEOUS RESERVOIR

618 ............ 62361 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; NON-PROGRAMMABLE

PUMP

618 ............ 62362 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP,

INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING

618 ............ 63685 INCISION AND SUBCUTANEOUS PLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR

INDUCTIVE COUPLING

618 ............ 64590 INCISION AND SUBCUTANEOUS PLACEMENT OF PERIPHERAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING

631 ............ 27315 NEURECTOMY, HAMSTRING MUSCLE

631 ............ 27320 NEURECTOMY, POPLITEAL (GASTROCNEMIUS)

631 ............ 28030 NEURECTOMY OF INTRINSIC MUSCULATURE OF FOOT

631 ............ 28035 TARSAL TUNNEL RELEASE (POSTERIOR TIBIAL NERVE DECOMPRESSION)

631 ............ 61790 CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT (EG, ALCOHOL, THERMAL,

ELECTRICAL, RADIOFREQUENCY); GASSERIAN GANGLION

631 ............ 62287 ASPIRATION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DISK, ANY METHOD, SINGLE OR

MULTIPLE LEVELS, LUMBAR

631 ............ 63600 CREATION OF LESION OF SPINAL CORD BY STEREOTACTIC METHOD, PERCUTANEOUS, ANY MODALITY (INCLUDING STIMULATION AND/OR RECORDING)

631 ............ 63610 STEREOTACTIC STIMULATION OF SPINAL CORD, PERCUTANEOUS, SEPARATE PROCEDURE NOT FOLLOWED BY OTHER

SURGERY

631 ............ 63615 STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION OF LESION, SPINAL CORD

631 ............ 64702 NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT

631 ............ 64704 NEUROPLASTY; NERVE OF HAND OR FOOT

631 ............ 64708 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; OTHER THAN SPECIFIED

631 ............ 64712 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; SCIATIC NERVE

631 ............ 64713 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; BRACHIAL PLEXUS

631 ............ 64714 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; LUMBAR PLEXUS

631 ............ 64716 NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY)

631 ............ 64718 NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW

631 ............ 64719 NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST

631 ............ 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL

631 ............ 64722 DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)

631 ............ 64726 DECOMPRESSION; PLANTAR DIGITAL NERVE

631 ............ 64727 INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR

NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS)

631 ............ 64732 TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE

631 ............ 64734 TRANSECTION OR AVULSION OF; INFRAORBITAL NERVE

631 ............ 64736 TRANSECTION OR AVULSION OF; MENTAL NERVE

631 ............ 64738 TRANSECTION OR AVULSION OF; INFERIOR ALVEOLAR NERVE BY OSTEOTOMY

631 ............ 64740 TRANSECTION OR AVULSION OF; LINGUAL NERVE

631 ............ 64742 TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE

631 ............ 64744 TRANSECTION OR AVULSION OF; GREATER OCCIPITAL NERVE

631 ............ 64746 TRANSECTION OR AVULSION OF; PHRENIC NERVE

631 ............ 64761 TRANSECTION OR AVULSION OF; PUDENDAL NERVE

631 ............ 64771 TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL

631 ............ 64772 TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL

631 ............ 64774 EXCISION OF NEUROMA; CUTANEOUS NERVE, SURGICALLY IDENTIFIABLE

631 ............ 64776 EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME DIGIT

631 ............ 64778 EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY BY THIS NUMBER)

631 ............ 64782 EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE

631 ............ 64783 EXCISION OF NEUROMA; HAND OR FOOT, EACH ADDITIONAL NERVE, EXCEPT SAME DIGIT (LIST SEPARATELY BY THIS NUMBER)

631 ............ 64784 EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC

631 ............ 64787 IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION)

631 ............ 64788 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; CUTANEOUS NERVE

631 ............ 64790 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR PERIPHERAL NERVE

631 ............ 64795 BIOPSY OF NERVE

631 ............ 64830 MICRODISSECTION AND/OR MICROREPAIR OF NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE REPAIR)

632 ............ 64786 EXCISION OF NEUROMA; SCIATIC NERVE

632 ............ 64792 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; EXTENSIVE (INCLUDING MALIGNANT TYPE)

632 ............ 64831 SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE

632 ............ 64832 SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE

632 ............ 64834 SUTURE OF ONE NERVE, HAND OR FOOT; COMMON SENSORY NERVE

632 ............ 64835 SUTURE OF ONE NERVE, HAND OR FOOT; MEDIAN MOTOR THENAR

632 ............ 64836 SUTURE OF ONE NERVE, HAND OR FOOT; ULNAR MOTOR

632 ............ 64837 SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT

632 ............ 64840 SUTURE OF POSTERIOR TIBIAL NERVE

632 ............ 64856 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; INCLUDING TRANSPOSITION
32509

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

632 ............ 64857 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; WITHOUT TRANSPOSITION

632 ............ 64858 SUTURE OF SCIATIC NERVE

632 ............ 64859 SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE

632 ............ 64861 SUTURE OF; BRACHIAL PLEXUS

632 ............ 64862 SUTURE OF; LUMBAR PLEXUS

632 ............ 64864 SUTURE OF FACIAL NERVE; EXTRACRANIAL

632 ............ 64865 SUTURE OF FACIAL NERVE; INFRATEMPORAL, WITH OR WITHOUT GRAFTING

632 ............ 64870 ANASTOMOSIS; FACIAL–PHRENIC

632 ............ 64872 SUTURE OF NERVE; REQUIRING SECONDARY OR DELAYED SUTURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY NEURORRHAPHY)

632 ............ 64874 SUTURE OF NERVE; REQUIRING EXTENSIVE MOBILIZATION, OR TRANSPOSITION OF NERVE (LIST SEPARATELY IN ADDITION

TO CODE FOR NERVE SUTURE)

632 ............ 64876 SUTURE OF NERVE; REQUIRING SHORTENING OF BONE OF EXTREMITY (LIST SEPARATELY IN ADDITION TO CODE FOR

NERVE SUTURE)

632 ............ 64885 NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO 4 CM IN LENGTH

632 ............ 64886 NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE THAN 4 CM LENGTH

632 ............ 64890 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; UP TO 4 CM LENGTH

632 ............ 64891 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; MORE THAN 4 CM LENGTH

632 ............ 64892 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; UP TO 4 CM LENGTH

632 ............ 64893 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; MORE THAN 4 CM LENGTH

632 ............ 64895 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT; UP TO 4 CM LENGTH

632 ............ 64896 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT; MORE THAN 4 CM LENGTH

632 ............ 64897 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG; UP TO 4 CM LENGTH

632 ............ 64898 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG; MORE THAN 4 CM LENGTH

632 ............ 64901 NERVE GRAFT, EACH ADDITIONAL NERVE; SINGLE STRAND

632 ............ 64902 NERVE GRAFT, EACH ADDITIONAL NERVE; MULTIPLE STRANDS (CABLE)

632 ............ 64905 NERVE PEDICLE TRANSFER; FIRST STAGE

632 ............ 64907 NERVE PEDICLE TRANSFER; SECOND STAGE

649 ............ 65855 TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS (DEFINED TREATMENT SERIES)

649 ............ 65860 SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER TECHNIQUE (SEPARATE PROCEDURE)

649 ............ 66761 IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (EG, FOR GLAUCOMA) (ONE OR MORE SESSIONS)

649 ............ 66762 IRIDOPLASTY BY PHOTOCOAGULATION (ONE OR MORE SESSIONS) (EG, FOR IMPROVEMENT OF VISION, FOR WIDENING OF

ANTERIOR CHAMBER ANGLE)

649 ............ 66770 DESTRUCTION OF CYST OR LESION IRIS OR CILIARY BODY (NONEXCISIONAL PROCEDURE)

649 ............ 66821 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR

HYALOID); LASER SURGERY (EG, YAG LASER) (ONE OR MORE STAGES)

649 ............ 67031 SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, MEMBRANES OR OPACITIES, LASER SURGERY

(ONE OR MORE STAGES)

651 ............ 65272 REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITHOUT HOSPITALIZATION

651 ............ 65275 REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITH OR WITHOUT REMOVAL FOREIGN BODY

651 ............ 65286 REPAIR OF LACERATION; APPLICATION OF TISSUE GLUE, WOUNDS OF CORNEA AND/OR SCLERA

651 ............ 65420 EXCISION OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT

651 ............ 65436 REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA)

651 ............ 65450 DESTRUCTION OF LESION OF CORNEA BY CRYOTHERAPY, PHOTOCOAGULATION OR THERMOCAUTERIZATION

651 ............ 65772 CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM

651 ............ 65810 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF VITREOUS AND/OR

DISCISSION OF ANTERIOR HYALOID MEMBRANE, WITH OR WITHOUT AIR INJECTION

651 ............ 65815 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF BLOOD, WITH OR WITHOUT

IRRIGATION AND/OR AIR INJECTION

651 ............ 65820 GONIOTOMY

651 ............ 66130 EXCISION OF LESION, SCLERA

651 ............ 66500 IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); EXCEPT TRANSFIXION

651 ............ 66505 IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); WITH TRANSFIXION AS FOR IRIS BOMBE

651 ............ 66600 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION

651 ............ 66625 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA (SEPARATE PROCEDURE)

651 ............ 66630 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; SECTOR FOR GLAUCOMA (SEPARATE PROCEDURE)

651 ............ 66700 CILIARY BODY DESTRUCTION; DIATHERMY

651 ............ 66710 CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION

651 ............ 66720 CILIARY BODY DESTRUCTION; CRYOTHERAPY

651 ............ 66820 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR

HYALOID); STAB INCISION TECHNIQUE (ZIEGLER OR WHEELER KNIFE)

651 ............ 66825 REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE)

652 ............ 65235 REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER OR LENS

652 ............ 65280 REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL TISSUE

652 ............ 65285 REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, WITH REPOSITION OR RESECTION OF UVEAL TISSUE

652 ............ 65400 EXCISION OF LESION, CORNEA (KERATECTOMY, LAMELLAR, PARTIAL), EXCEPT PTERYGIUM

652 ............ 65426 EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT

652 ............ 65770 KERATOPROSTHESIS

652 ............ 65775 CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM

652 ............ 65850 TRABECULOTOMY AB EXTERNO

652 ............ 65865 SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR

LIQUID) (SEPARATE PROCEDURE); GONIOSYNECHIAE

652 ............ 65870 SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR

LIQUID) (SEPARATE PROCEDURE); ANTERIOR SYNECHIAE, EXCEPT GONIOSYNECHIAE

652 ............ 65875 SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR

LIQUID) (SEPARATE PROCEDURE); POSTERIOR SYNECHIAE
32510

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1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

652 ............ 65880 SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR

LIQUID) (SEPARATE PROCEDURE); CORNEOVITREAL ADHESIONS

652 ............ 65900 REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER EYE

652 ............ 65920 REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT EYE

652 ............ 65930 REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT EYE

652 ............ 66150 FISTULIZATION OF SCLERA FOR GLAUCOMA; TREPHINATION WITH IRIDECTOMY

652 ............ 66155 FISTULIZATION OF SCLERA FOR GLAUCOMA; THERMOCAUTERIZATION WITH IRIDECTOMY

652 ............ 66160 FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IRIDECTOMY

652 ............ 66165 FISTULIZATION OF SCLERA FOR GLAUCOMA; IRIDENCLEISIS OR IRIDOTASIS

652 ............ 66170 FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGERY

652 ............ 66172 FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO WITH SCARRING FROM PREVIOUS OCULAR

SURGERY OR TRAUMA (INCLUDES INJECTION OF ANTIFIBROTIC AGENTS)

652 ............ 66180 AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR (EG, MOLTENO, SCHOCKET, DENVER-KRUPIN)

652 ............ 66185 REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR

652 ............ 66225 REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT

652 ............ 66250 REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR LATE, MAJOR OR MINOR

PROCEDURE

652 ............ 66605 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; WITH CYCLECTOMY

652 ............ 66635 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; OPTICAL (SEPARATE PROCEDURE)

652 ............ 66680 REPAIR OF IRIS, CILIARY BODY (AS FOR IRIDODIALYSIS)

652 ............ 66682 SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITH RETRIEVAL OF SUTURE THROUGH SMALL INCISION (EG,

MCCANNEL SUTURE)

652 ............ 66740 CILIARY BODY DESTRUCTION; CYCLODIALYSIS

652 ............ 66830 REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID)

WITH CORNEO-SCLERAL SECTION, WITH OR WITHOUT IRIDECTOMY (IRIDOCAPSULOTOMY, IRIDOCAPSULECTOMY)

652 ............ 68130 EXCISION OF LESION, CONJUNCTIVA; WITH ADJACENT SCLERA

652 ............ 68330 REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY, WITHOUT GRAFT

652 ............ 68360 CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE PROCEDURE)

652 ............ 68362 CONJUNCTIVAL FLAP; TOTAL (SUCH AS GUNDERSON THIN FLAP OR PURSE STRING FLAP)

667 ............ 66840 REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, ONE OR MORE STAGES

667 ............ 66850 REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG,

PHACOEMULSIFICATION), WITH ASPIRATION

667 ............ 66852 REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH OR WITHOUT VITRECTOMY

667 ............ 66920 REMOVAL OF LENS MATERIAL; INTRACAPSULAR

667 ............ 66930 REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS

667 ............ 66940 REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852)

668 ............ 66983 INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE)

668 ............ 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE),

MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION)

668 ............ 66985 INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL

668 ............ 66986 EXCHANGE OF INTRAOCULAR LENS

670 ............ 65710 KERATOPLASTY (CORNEAL TRANSPLANT); LAMELLAR

670 ............ 65730 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EXCEPT IN APHAKIA)

670 ............ 65750 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN APHAKIA)

670 ............ 65755 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN PSEUDOPHAKIA)

676 ............ 65260 REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, MAGNETIC EXTRACTION, ANTERIOR OR POSTERIOR ROUTE

676 ............ 65265 REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, NONMAGNETIC EXTRACTION

676 ............ 66220 REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT

676 ............ 67005 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL

676 ............ 67010 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); SUBTOTAL REMOVAL WITH

MECHANICAL VITRECTOMY

676 ............ 67015 ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR CHOROIDAL FLUID, PARS PLANA APPROACH (POSTERIOR SCLEROTOMY)

676 ............ 67030 DISCISSION OF VITREOUS STRANDS (WITHOUT REMOVAL), PARS PLANA APPROACH

676 ............ 67101 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; CRYOTHERAPY OR DIATHERMY, WITH OR WITHOUT DRAINAGE OF SUBRETINAL FLUID

676 ............ 67110 REPAIR OF RETINAL DETACHMENT; BY INJECTION OF AIR OR OTHER GAS (EG, PNEUMATIC RETINOPEXY)

676 ............ 67115 RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT)

676 ............ 67120 REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; EXTRAOCULAR

676 ............ 67121 REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; INTRAOCULAR

676 ............ 67141 PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITHOUT DRAINAGE, ONE OR

MORE SESSIONS; CRYOTHERAPY, DIATHERMY

676 ............ 67208 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE OR MORE

SESSIONS; CRYOTHERAPY, DIATHERMY

676 ............ 67218 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE OR MORE

SESSIONS; RADIATION BY IMPLANTATION OF SOURCE (INCLUDES REMOVAL OF SOURCE)

676 ............ 67227 DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE SESSIONS;

CRYOTHERAPY, DIATHERMY

677 ............ 65290 REPAIR OF WOUND, EXTRAOCULAR MUSCLE, TENDON AND/OR TENON’S CAPSULE

677 ............ 67311 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); ONE HORIZONTAL MUSCLE

677 ............ 67312 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); TWO HORIZONTAL MUSCLES
32511

444444444444

1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.

Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

677 ............ 67314 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); ONE VERTICAL MUSCLE (EXCLUDING SUPERIOR OBLIQUE)

677 ............ 67316 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); TWO OR

MORE VERTICAL MUSCLES (EXCLUDING SUPERIOR OBLIQUE)

677 ............ 67318 STRABISMUS SURGERY, ANY PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON), SUPERIOR OBLIQUE MUSCLE

677 ............ 67320 TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR MUSCLE (SPECIFY)

677 ............ 67331 STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT INVOLVE THE

EXTRAOCULAR MUSCLES

677 ............ 67332 STRABISMUS SURGERY ON PATIENT WITH SCARRING OF EXTRAOCULAR MUSCLES (EG, PRIOR OCULAR INJURY, STRABISMUS OR RETINAL DETACHMENT SURGERY) OR RESTRICTIVE MYOPATHY (EG, DYSTHYROID OPHTHALMOPATHY)

677 ............ 67334 STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT MUSCLE RECESSION

677 ............ 67335 PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY, INCLUDING POSTOPERATIVE ADJUSTMENT(S)

OF SUTURE(S) (REPORT IN ADDITION TO CODE FOR SPECIFIC STRABISMUS SURGERY)

677 ............ 67340 STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR MUSCLE(S)

677 ............ 67343 RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE (SEPARATE PROCEDURE)

683 ............ 65175 REMOVAL OF OCULAR IMPLANT

683 ............ 65410 BIOPSY OF CORNEA

683 ............ 65800 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH DIAGNOSTIC ASPIRATION OF AQUEOUS

683 ............ 65805 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH THERAPEUTIC RELEASE OF AQUEOUS

683 ............ 66020 INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE); AIR OR LIQUID

683 ............ 66030 INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE); MEDICATION

683 ............ 67025 INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA OR LIMBAL APPROACH, (FLUID–GAS EXCHANGE), WITH OR WITHOUT

ASPIRATION (SEPARATE PROCEDURE)

683 ............ 67715 CANTHOTOMY (SEPARATE PROCEDURE)

683 ............ 67830 CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN

683 ............ 67880 CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;

683 ............ 67935 SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL CONJUNCTIVA DIRECT CLOSURE; FULL THICKNESS

683 ............ 68510 BIOPSY OF LACRIMAL GLAND

683 ............ 68525 BIOPSY OF LACRIMAL SAC

683 ............ 68810 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION;

684 ............ 65091 EVISCERATION OF OCULAR CONTENTS; WITHOUT IMPLANT

684 ............ 65093 EVISCERATION OF OCULAR CONTENTS; WITH IMPLANT

684 ............ 65101 ENUCLEATION OF EYE; WITHOUT IMPLANT

684 ............ 65103 ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES NOT ATTACHED TO IMPLANT

684 ............ 65105 ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES ATTACHED TO IMPLANT

684 ............ 65130 INSERTION OF OCULAR IMPLANT SECONDARY; AFTER EVISCERATION, IN SCLERAL SHELL

684 ............ 65135 INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES NOT ATTACHED TO IMPLANT

684 ............ 65140 INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES ATTACHED TO IMPLANT

684 ............ 65150 REINSERTION OF OCULAR IMPLANT; WITH OR WITHOUT CONJUNCTIVAL GRAFT

684 ............ 65155 REINSERTION OF OCULAR IMPLANT; WITH USE OF FOREIGN MATERIAL FOR REINFORCEMENT AND/OR ATTACHMENT OF

MUSCLES TO IMPLANT

684 ............ 67250 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT

684 ............ 67255 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT

684 ............ 67400 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); FOR EXPLORATION, WITH OR WITHOUT BIOPSY

684 ............ 67405 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH DRAINAGE ONLY

684 ............ 67412 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF LESION

684 ............ 67413 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF FOREIGN BODY

684 ............ 67550 ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); INSERTION

684 ............ 67560 ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); REMOVAL OR REVISION

684 ............ 67808 EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/OR REQUIRING HOSPITALIZATION, SINGLE OR MULTIPLE

684 ............ 67835 CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN, WITH FREE MUCOUS MEMBRANE GRAFT

684 ............ 67882 CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY; WITH TRANSPOSITION

OF TARSAL PLATE

684 ............ 67900 REPAIR OF BROW PTOSIS (SUPRACILIARY, MID–FOREHEAD OR CORONAL APPROACH)

684 ............ 67901 REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERIAL

684 ............ 67902 REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH FASCIAL SLING (INCLUDES OBTAINING FASCIA)

684 ............ 67903 REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTION OR ADVANCEMENT, INTERNAL APPROACH

684 ............ 67904 REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH

684 ............ 67906 REPAIR OF BLEPHAROPTOSIS; SUPERIOR RECTUS TECHNIQUE WITH FASCIAL SLING (INCLUDES OBTAINING FASCIA)

684 ............ 67908 REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLER’S MUSCLE-LEVATOR RESECTION (EG, FASANELLA-SERVAT

TYPE)

684 ............ 67909 REDUCTION OF OVERCORRECTION OF PTOSIS

684 ............ 67911 CORRECTION OF LID RETRACTION

684 ............ 67914 REPAIR OF ECTROPION; SUTURE

684 ............ 67916 REPAIR OF ECTROPION; BLEPHAROPLASTY, EXCISION TARSAL WEDGE

684 ............ 67917 REPAIR OF ECTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, KUHNT-SZYMANOWSKI OR TARSAL STRIP OPERATIONS)

684 ............ 67921 REPAIR OF ENTROPION; SUTURE

684 ............ 67923 REPAIR OF ENTROPION; BLEPHAROPLASTY, EXCISION TARSAL WEDGE

684 ............ 67924 REPAIR OF ENTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, WHEELER OPERATION)

684 ............ 67950 CANTHOPLASTY (RECONSTRUCTION OF CANTHUS)

684 ............ 67961 EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL THICKNESS, MAY

INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICLE FLAP WITH ADJACENT TISSUE TRANSFER OR REARRANGEMENT;

UP TO ONE-FOURTH OF LID MARGIN
32512 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM B.—PROPOSED AMBULATORY SURGICAL CENTER (ASC) LIST BY AMBULATORY PAYMENT CLASSIFICATION

(APC) GROUPS AND RELATED INFORMATION—Continued

APC

group

CPT 1/

HCPCS Description

684 ............ 67966 EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL THICKNESS, MAY

INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICLE FLAP WITH ADJACENT TISSUE TRANSFER OR REARRANGEMENT;

OVER ONE-FOURTH OF LID MARGIN

684 ............ 67971 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID;

UP TO TWO-THIRDS OF EYELID, ONE STAGE OR FIRST STAGE

684 ............ 67973 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID;

TOTAL EYELID, LOWER, ONE STAGE OR FIRST STAGE

684 ............ 67974 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID;

TOTAL EYELID, UPPER, ONE STAGE OR FIRST STAGE

684 ............ 67975 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID;

SECOND STAGE

684 ............ 68320 CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT

684 ............ 68325 CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT)

684 ............ 68326 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT

684 ............ 68328 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING

GRAFT)

684 ............ 68335 REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA OR BUCCAL MUCOUS MEMBRANE (INCLUDES OBTAINING

GRAFT)

684 ............ 68340 REPAIR OF SYMBLEPHARON; DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OR CONTACT

LENS

684 ............ 68500 EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; TOTAL

684 ............ 68505 EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; PARTIAL

684 ............ 68520 EXCISION OF LACRIMAL SAC (DACRYOCYSTECTOMY)

684 ............ 68540 EXCISION OF LACRIMAL GLAND TUMOR; FRONTAL APPROACH

684 ............ 68550 EXCISION OF LACRIMAL GLAND TUMOR; INVOLVING OSTEOTOMY

684 ............ 68700 PLASTIC REPAIR OF CANALICULI

684 ............ 68720 DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY)

684 ............ 68745 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITHOUT TUBE

684 ............ 68750 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITH INSERTION OF TUBE OR STENT

684 ............ 68770 CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE)

684 ............ 68811 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; REQUIRING GENERAL ANESTHESIA

684 ............ 68815 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF TUBE OR STENT

690 ............ 67036 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;

690 ............ 67038 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH EPIRETINAL MEMBRANE STRIPPING

690 ............ 67039 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL ENDOLASER PHOTOCOAGULATION

690 ............ 67040 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH ENDOLASER PANRETINAL PHOTOCOAGULATION

690 ............ 67107 REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH AS LAMELLAR SCLERAL DISSECTION, IMBRICATION OR ENCIRCLING PROCEDURE), WITH OR WITHOUT IMPLANT, WITH OR WITHOUT CRYOTHERAPY, PHOTOCOAGULATION, AND

DRAINAGE OF SUBRETINAL FLUID

690 ............ 67108 REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY, ANY METHOD, WITH OR WITHOUT AIR OR GAS TAMPONADE, FOCAL

ENDOLASER PHOTOCOAGULATION, CRYOTHERAPY, DRAINAGE OF SUBRETINAL FLUID, SCLERAL BUCKLING, AND/OR REMOVAL OF LENS BY SAME TECHNIQUE

690 ............ 67112 REPAIR OF RETINAL DETACHMENT; BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT HAVING PREVIOUS IPSILATERAL

RETINAL DETACHMENT REPAIR(S) USING SCLERAL BUCKLING OR VITRECTOMY TECHNIQUES

ADDENDUM C.—LIST OF APC GROUPS AND RELATED INFORMATION

APC

group Group title

Proposed ASC

payment

rate

Proposed ASC

relative value

factor

122 ......... level II needle biopsy.aspiration .......................................................................................................... $186 0.37

132 ......... level II incision & drainage .................................................................................................................. $162 0.32

152 ......... level II debridement/destruction .......................................................................................................... $213 0.42

162 ......... level II excision/biopsy ........................................................................................................................ $187 0.37

163 ......... level III excision/biopsy ....................................................................................................................... $449 0.89

181 ......... level I skin repair ................................................................................................................................. $150 0.30

182 ......... level II skin repair ................................................................................................................................ $383 0.76

183 ......... level III skin repair ............................................................................................................................... $465 0.92

184 ......... level IV skin repair ............................................................................................................................... $565 1.12

197 ......... incision/excision breast ....................................................................................................................... $411 0.81

198 ......... breast reconstruction/mastectomy ...................................................................................................... $596 1.18

207 ......... closed treatment fracture finger/toe/trunk ........................................................................................... $53 0.11

209 ......... closed treatment fracture/dislocation/except finger/toe/trunk .............................................................. $71 0.14

210 ......... bone/joint manipulation under anesthesia .......................................................................................... $397 0.79

216 ......... open/percutaneous treatment fracture or dislocation ......................................................................... $580 1.15

217 ......... arthroplasty .......................................................................................................................................... $695 1.38

218 ......... arthroplasty with prosthesis ................................................................................................................. $730 1.45

231 ......... level I skull and facial bone procedures ............................................................................................. $437 0.87

232 ......... level II skull and facial bone procedures ............................................................................................ $814 1.62

251 ......... level I musculoskeletal procedures ..................................................................................................... $504 1.00
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32513

ADDENDUM C.—LIST OF APC GROUPS AND RELATED INFORMATION—Continued

APC

group Group title

Proposed ASC

payment

rate

Proposed ASC

relative value

factor

252 ......... level II musculoskeletal procedures .................................................................................................... $574 1.14

253 ......... level III musculoskeletal procedures ................................................................................................... $775 1.54

254 ......... level IV musculoskeletal procedures ................................................................................................... $1,110 2.20

261 ......... level I hand musculoskeletal procedures ............................................................................................ $494 0.98

262 ......... level II hand musculoskeletal procedures ........................................................................................... $543 1.08

271 ......... level I foot musculoskeletal procedures .............................................................................................. $510 1.01

272 ......... level II foot musculoskeletal procedures ............................................................................................. $546 1.08

279 ......... bunion procedures ............................................................................................................................... $680 1.35

280 ......... diagnostic arthroscopy ........................................................................................................................ $675 1.34

281 ......... level I surgical arthroscopy ................................................................................................................. $807 1.60

282 ......... level II surgical arthroscopy ................................................................................................................ $860 1.71

286 ......... arthroscopy aided procedures ............................................................................................................. $1,110 2.20

312 ......... level II ENT procedures ...................................................................................................................... $233 0.46

313 ......... level III ENT procedures ..................................................................................................................... $537 1.07

314 ......... level IV ENT procedures ..................................................................................................................... $946 1.88

317 ......... implantaton of cochlear device ........................................................................................................... $962 1.91

318 ......... nasal cauterization/packing ................................................................................................................. $77 0.15

319 ......... tonsil/adenoid procedures ................................................................................................................... $648 1.29

320 ......... thoracentesis/lavage procedures ........................................................................................................ $126 0.25

332 ......... level II endoscopy upper airway ......................................................................................................... $423 0.84

333 ......... level III endoscropy upper airway ....................................................................................................... $653 1.30

336 ......... endoscopy lower airway ...................................................................................................................... $407 0.81

346 ......... placement transvenous caths/cutdown ............................................................................................... $195 0.39

360 ......... removal/revision pacemaker/vascular device ..................................................................................... $397 0.79

367 ......... vascular ligation ................................................................................................................................... $682 1.35

368 ......... vascular repair/fistula construction ...................................................................................................... $841 1.67

396 ......... lymph node excisions .......................................................................................................................... $440 0.87

397 ......... thyroid/lymphadenectomy procedures ................................................................................................ $630 1.25

406 ......... esophageal dilation without endoscopy .............................................................................................. $187 0.37

407 ......... esophagoscopy ................................................................................................................................... $302 0.60

417 ......... diagnostic upper GI endoscopy .......................................................................................................... $327 0.65

418 ......... therapeutic upper GI endoscopy ......................................................................................................... $348 0.69

419 ......... small intestine endoscopy ................................................................................................................... $364 0.72

426 ......... diagnostic lower GI endoscopy ........................................................................................................... $354 0.70

427 ......... therapeutic lower GI endoscopy ......................................................................................................... $405 0.80

437 ......... therapeutic anoscopy .......................................................................................................................... $150 0.30

446 ......... diagnostic sigmoidoscopy ................................................................................................................... $175 0.35

447 ......... therapeutic proctosigmoidoscopy ........................................................................................................ $210 0.42

448 ......... therapeutic flexible sigmoidoscopy ..................................................................................................... $225 0.45

449 ......... complex GI endoscopy ........................................................................................................................ $415 0.82

452 ......... level II anal/rectal procedures ............................................................................................................. $301 0.60

453 ......... level III anal/rectal procedures ............................................................................................................ $631 1.25

456 ......... endoscopic retrograde cholangio-pancreatography (ERCP) .............................................................. $473 0.94

458 ......... percutaneous bilary endoscopic procedures ...................................................................................... $473 0.94

459 ......... pentoneal and abdominal procedures ................................................................................................. $611 1.21

466 ......... hemia/hydrocele procedures ............................................................................................................... $739 1.47

470 ......... tube procedures .................................................................................................................................. $119 0.24

521 ......... level I cystourethroscopy and other genitourinary procedures ........................................................... $212 0.42

522 ......... level II cystourethroscopy and other genitourinary procedures .......................................................... $393 0.78

523 ......... level III cystourethroscopy and other genitourinary procedures ......................................................... $504 1.00

524 ......... level IV cystourethroscopy and other genitourinary procedures ........................................................ $1,131 2.24

527 ......... lithotripsy ............................................................................................................................................. $2,107 4.18

531 ......... level I urethral procedures .................................................................................................................. $418 0.83

532 ......... level II urethral procedures ................................................................................................................. $644 1.28

536 ......... circumcision ......................................................................................................................................... $459 0.91

537 ......... penile procedures ................................................................................................................................ $1,221 2.42

538 ......... insertion of penile prosthesis B94 ....................................................................................................... $1,221 2.42

546 ......... testes/epididymis procedures .............................................................................................................. $523 1.04

547 ......... prostate biopsy .................................................................................................................................... $265 0.53

550 ......... surgical hysteroscopy .......................................................................................................................... $610 1.21

551 ......... level I laparoscopy .............................................................................................................................. $831 1.65

552 ......... level II laparoscopy ............................................................................................................................. $1,383 2.74

562 ......... level II female reproductive procedures .............................................................................................. $481 0.95

563 ......... level III female reproductive procedures ............................................................................................. $601 1.19

567 ......... D & C ................................................................................................................................................... $458 0.91

586 ......... therapeutic abortion ............................................................................................................................. $448 0.89

587 ......... spontaneous abortion .......................................................................................................................... $503 1.00
32514 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM C.—LIST OF APC GROUPS AND RELATED INFORMATION—Continued

APC

group Group title

Proposed ASC

payment

rate

Proposed ASC

relative value

factor

600 ......... spinal tap ............................................................................................................................................. $101 0.20

602 ......... level II nervous system injections ....................................................................................................... $241 0.48

616 ......... implantation of neurostimulator electrodes ......................................................................................... $391 0.78

617 ......... revision/removal neurological device .................................................................................................. $391 0.78

618 ......... implantation neurological devices ....................................................................................................... $841 1.67

631 ......... level I nerve procedures ...................................................................................................................... $600 1.19

632 ......... level II nerve procedures ..................................................................................................................... $666 1.32

649 ......... laser eye procedures except retinal .................................................................................................... $274 0.54

651 ......... level I anterior segment eye procedures ............................................................................................ $297 0.59

652 ......... level II anterior segment eye procedures ........................................................................................... $415 0.82

667 ......... cataract procedures ............................................................................................................................. $661 1.31

668 ......... cataract procedures with IOL insert .................................................................................................... $863 1.71

670 ......... corneal transplant B117 ...................................................................................................................... $1,648 3.27

676 ......... posterior segment eye procedures ..................................................................................................... $336 0.67

677 ......... strabismus/muscle procedures ............................................................................................................ $523 1.04

683 ......... level III eye procedure ......................................................................................................................... $317 0.63

684 ......... level IV eye procedure ........................................................................................................................ $491 0.97

690 ......... vitrectomy ............................................................................................................................................ $983 1.95

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS

Urban area

(Constituent counties or county

equivalents)

Wage

index

0040 Abilene, TX .......................... 0.8287

Taylor, TX

0060 Aguadilla, PR ...................... 0.4188

Aguada, PR

Aguadilla, PR

Moca, PR

0080 Akron, OH ........................... 0.9772

Portage, OH

Summit, OH

0120 Albany, GA .......................... 0.7914

Dougherty, GA

Lee, GA

0160 Albany-Schenectady-Troy,

NY ............................................... 0.8480

Albany, NY

Montgomery, NY

Rensselaer, NY

Saratoga, NY

Schenectady, NY

Schoharie, NY

0200 Albuquerque, NM ................ 0.9309

Bernalillo, NM

Sandoval, NM

Valencia, NM

0220 Alexandria, LA ..................... 0.8162

Rapides, LA

0240 Allentown-Bethlehem-Easton, PA ........................................ 1.0086

Carbon, PA

Lehigh, PA

Northampton, PA

0280 Altoona, PA ......................... 0.9137

Blair, PA

0320 Amarillo, TX ......................... 0.9425

Potter, TX

Randall, TX

0380 AK Anchorage, AK .............. 1.2842

Anchorage,

0440 Ann Arbor, MI ...................... 1.1785

Lenawee, MI

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Livingston, MI

Washtenaw, MI

0450 Anniston, AL ........................ 0.8266

Calhoun, AL

0460 Appleton-Oshkosh-Neenah,

WI ................................................ 0.8996

Calumet, WI

Outagamie, WI

Winnebago, WI

0470 Arecibo, PR ......................... 0.4218

Arecibo, PR

Camuy, PR

Hatillo, PR

0480 Asheville, NC ....................... 0.9072

Buncombe, NC

Madison, NC

0500 Athens, GA .......................... 0.9087

Clarke, GA

Madison, GA

Oconee, GA

0520 *Atlanta, GA ........................ 0.9823

Barrow, GA

Bartow, GA

Carroll, GA

Cherokee, GA

Clayton, GA

Cobb, GA

Coweta, GA

DeKalb, GA

Douglas, GA

Fayette, GA

Forsyth, GA

Fulton, GA

Gwinnett, GA

Henry, GA

Newton, GA

Paulding, GA

Pickens, GA

Rockdale, GA

Spalding, GA

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Walton, GA

0560 Atlantic City-Cape May, NJ 1.1155

Atlantic City, NJ

Cape May, NJ

0600 Augusta-Aiken, GA–SC ....... 0.9333

Columbia, GA

McDuffie, GA

Richmond, GA

Aiken, SC

Edgefield, SC

0640 Austin-San Marcos, TX ....... 0.9133

Bastrop, TX

Caldwell, TX

Hays, TX

Travis, TX

Williamson, TX

0680 Bakersfield, CA ................... 1.0014

Kern, CA

0720 *Baltimore, MD .................... 0.9689

Anne Arundel, MD

Baltimore, MD

Baltimore City, MD

Carroll, MD

Harford, MD

Howard, MD

Queen Annes, MD

0733 Bangor, ME ......................... 0.9478

Penobscot, ME

0743 Barnstable-Yarmouth, MA ... 1.4291

Barnstable, MA

0760 Baton Rouge, LA ................. 0.8382

Ascension, LA

East Baton Rouge, LA

Livingston, LA

West Baton Rouge, LA

0840 Beaumont-Port Arthur, TX .. 0.8593

Hardin, TX

Jefferson, TX

Orange, TX

0860 Bellingham, WA ................... 1.1221
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32515

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Whatcom, WA

0870 Benton Harbor, MI ............... 0.8634

Berrien, MI

0875 *Bergen-Passaic, NJ ........... 1.2156

Bergen, NJ

Passaic, NJ

0880 Billings, MT .......................... 0.9783

Yellowstone, MT

0920 Biloxi-Gulfport-Pascagoula,

MS ............................................... 0.8415

Hancock, MS

Harrison, MS

Jackson, MS

0960 Binghamton, NY .................. 0.8914

Broome, NY

Tioga, NY

1000 Birmingham, AL ................... 0.9005

Blount, AL

Jefferson, AL

St. Clair, AL

Shelby, AL

1010 Bismarck, ND ...................... 0.7695

Burleigh, ND

Morton, ND

1020 Bloomington, IN ................... 0.9128

Monroe, IN

1040 Bloomington-Normal, IL ...... 0.8733

McLean, IL

1080 Boise City, ID ...................... 0.8856

Ada, ID

Canyon, ID

1123 *Boston-Worcester Lawrence-Lowell-Brockton, MA–NH .. 1.1506

Bristol, MA

Essex, MA

Middlesex, MA

Norfolk, MA

Plymouth, MA

Suffolk, MA

Worcester, MA

Hillsborough, NH

Merrimack, NH

Rockingham, NH

Strafford, NH

1125 Boulder-Longmont, CO ....... 1.0015

Boulder, CO

1145 Brazoria, TX ........................ 0.9341

Brazoria, TX

1150 Bremerton, WA .................... 1.0999

Kitsap, WA

1240 Brownsville-Harlingen-San

Benito, TX ................................... 0.8740

Cameron, TX

1260 Bryan-College Station, TX .. 0.8571

Brazos, TX

1280 *Buffalo-Niagara Falls, NY .. 0.9272

Erie, NY

Niagara, NY

1303 Burlington, VT ..................... 1.0142

Chittenden, VT

Franklin, VT

Grand Isle, VT

1310 Caguas, PR ......................... 0.4459

Caguas, PR

Cayey, PR

Cidra, PR

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Gurabo, PR

San Lorenzo, PR

1320 Canton-Massillon, OH ......... 0.8961

Carroll, OH

Stark, OH

1350 Casper, WY ......................... 0.9013

Natrona, WY

1360 Cedar Rapids, IA ................. 0.8529

Linn, IA

1400 Champaign-Urbana, IL ........ 0.8824

Champaign, IL

1440 Charleston-North Charleston, SC ........................................ 0.8807

Berkeley, SC

Charleston, SC

Dorchester, SC

1480 Charleston, WV ................... 0.9142

Kanawha, WV

Putnam, WV

1520 *Charlotte-Gastonia-Rock

Hill, NC–SC ................................. 0.9710

Cabarrus, NC

Gaston, NC

Lincoln, NC

Mecklenburg, NC

Rowan, NC

Union, NC

York, SC

1540 Charlottesville, VA ............... 0.9051

Albemarle, VA

Charlottesville City, VA

Fluvanna, VA

Greene, VA

1560 Chattanooga, TN–GA .......... 0.8658

Catoosa, GA

Dade, GA

Walker, GA

Hamilton, TN

Marion, TN

1580 Cheyenne, WY .................... 0.7555

Laramie, WY

1600 *Chicago, IL ......................... 1.0860

Cook, IL

DeKalb, IL

DuPage, IL

Grundy, IL

Kane, IL

Kendall, IL

Lake, IL

McHenry, IL

Will, IL

1620 Chico-Paradise, CA ............. 1.0429

Butte, CA

1640 *Cincinnati, OH–KY–IN ....... 0.9474

Dearborn, IN

Ohio, IN

Boone, KY

Campbell, KY

Gallatin, KY

Grant, KY

Kenton, KY

Pendleton, KY

Brown, OH

Clermont, OH

Hamilton, OH

Warren, OH

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

1660 Clarksville-Hopkinsville, TN–

KY ................................................ 0.7852

Christian, KY

Montgomery, TN

1680 *Cleveland-Lorain-Elyria,

OH ............................................... 0.9804

Ashtabula, OH

Cuyahoga, OH

Geauga, OH

Lake, OH

Lorain, OH

Medina, OH

1720 Colorado Springs, CO ......... 0.9316

El Paso, CO

1740 Columbia, MO ..................... 0.9001

Boone, MO

1760 Columbia, SC ...................... 0.9192

Lexington, SC

Richland, SC

1800 Columbus, GA–AL .............. 0.8288

Russell, AL

Chattanoochee, GA

Harris, GA

Muscogee, GA

1840 *Columbus, OH ................... 0.9793

Delaware, OH

Fairfield, OH

Franklin, OH

Licking, OH

Madison, OH

Pickaway, OH

1880 Corpus Christi, TX ............... 0.8945

Nueces, TX

San Patricio, TX

1900 Cumberland, MD–WV ......... 0.8822

Allegany, MD

Mineral, WV

1920 *Dallas, TX .......................... 0.9703

Collin, TX

Dallas, TX

Denton, TX

Ellis, TX

Henderson, TX

Hunt, TX

Kaufman, TX

Rockwall, TX

1950 Danville, VA ......................... 0.8146

Danville City, VA

Pittsylvania, VA

1960 Davenport-Rock Island-Moline, IA–IL .................................... 0.8405

Scott, IA

Henry, IL

Rock Island, IL

2000 Dayton-Springfield, OH ....... 0.9584

Clark, OH

Greene, OH

Miami, OH

Montgomery, OH

2020 Daytona Beach, FL ............. 0.8375

Flagler, FL

Volusia, FL

2030 Decatur, AL ......................... 0.8286

Lawrence, AL

Morgan, AL

2040 Decatur, IL ........................... 0.7915
32516 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Macon, IL

2080 *Denver, CO ........................ 1.0386

Adams, CO

Arapahoe, CO

Denver, CO

Douglas, CO

Jefferson, CO

2120 Des Moines, IA .................... 0.8837

Dallas, IA

Polk, IA

Warren, IA

2160 *Detroit, MI .......................... 1.0825

Lapeer, MI

Macomb, MI

Monroe, MI

Oakland, MI

St. Clair, MI

Wayne, MI

2180 Dothan, AL .......................... 0.8070

Dale, AL

Houston, AL

2190 Dover, DE ............................ 0.9303

Kent, DE

2200 Dubuque, IA ........................ 0.8088

Dubuque, IA

2240 Duluth-Superior, MN–WI ..... 0.9779

St. Louis, MN

Douglas, WI

2281 Dutchess County, NY .......... 1.0632

Dutchess, NY

2290 Eau Claire, WI ..................... 0.8764

Chippewa, WI

Eau Claire, WI

2320 El Paso, TX ......................... 1.0123

El Paso, TX

2330 Elkhart-Goshen, IN .............. 0.9081

Elkhart, IN

2335 Elmira, NY ........................... 0.8247

Chemung, NY

2340 Enid, OK .............................. 0.7962

Garfield, OK

2360 Erie, PA ............................... 0.8862

Erie, PA

2400 Eugene-Springfield, OR ...... 1.1435

Lane, OR

2440 Evansville-Henderson, IN–

KY ................................................ 0.8641

Posey, IN

Vanderburgh, IN

Warrick, IN

Henderson, KY

2520 Fargo-Moorhead, ND–MN ... 0.8837

Clay, MN

Cass, ND

2560 Fayetteville, NC ................... 0.8734

Cumberland, NC

2580 Fayetteville-Springdale-Rogers, AR ........................................ 0.7461

Benton, AR

Washington, AR

2620 Flagstaff, AZ–UT ................. 0.9115

Coconino, AZ

Kane, UT

2640 Flint, MI ............................... 1.1171

Genesee, MI

2650 Florence, AL ........................ 0.7551

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Colbert, AL

Lauderdale, AL

2655 Florence, SC ....................... 0.8711

Florence, SC

2670 Fort Collins-Loveland, CO ... 1.0248

Larimer, CO

2680 *Ft. Lauderdale, FL ............. 1.0448

Broward, FL

2700 Fort Myers-Cape Coral, FL 0.8788

Lee, FL

2710 Fort Pierce-Port St. Lucie,

FL ................................................ 1.0257

Martin, FL

St. Lucie, FL

2720 Fort Smith, AR–OK ............. 0.7769

Crawford, AR

Sebastian, AR

Sequoyah, OK

2750 Fort Walton Beach, FL ........ 0.8765

Okaloosa, FL

2760 Fort Wayne, IN .................... 0.8901

Adams, IN

Allen, IN

DeKalb, IN

Huntington, IN

Wells, IN

Whitley, IN

2800 *Forth Worth-Arlington, TX .. 0.9979

Hood, TX

Johnson, TX

Parker, TX

Tarrant, TX

2840 Fresno, CA .......................... 1.0607

Fresno, CA

Madera, CA

2880 Gadsden, AL ....................... 0.8815

Etowah, AL

2900 Gainesville, FL .................... 0.9616

Alachua, FL

2920 Galveston-Texas City, TX ... 1.0564

Galveston, TX

2960 Gary, IN ............................... 0.9633

Lake, IN

Porter, IN

2975 Glens Falls, NY ................... 0.8386

Warren, NY

Washington, NY

2980 Goldsboro, NC .................... 0.8443

Wayne, NC

2985 Grand Forks, ND–MN ......... 0.8745

Polk, MN

Grand Forks, ND

2995 Grand Junction, CO ............ 0.9090

Mesa, CO

3000 Grand Rapids-MuskegonHolland, MI .................................. 1.0147

Allegan, MI

Kent, MI

Muskegon, MI

Ottawa, MI

3040 Great Falls, MT ................... 0.8803

Cascade, MT

3060 Greeley, CO ........................ 1.0097

Weld, CO

3080 Green Bay, WI .................... 0.9097

Brown, WI

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

3120 *Greensboro-WinstonSalem-High Point, NC ................. 0.9351

Alamance, NC

Davidson, NC

Davie, NC

Forsyth, NC

Guilford, NC

Randolph, NC

Stokes, NC

Yadkin, NC

3150 Greenville, NC ..................... 0.9064

Pitt, NC

3160 Greenville-Spartanburg-Anderson, SC .................................. 0.9059

Anderson, SC

Cherokee, SC

Greenville, SC

Pickens, SC

Spartanburg, SC

3180 Hagerstown, MD ................. 0.9681

Washington, MD

3200 Hamilton-Middletown, OH ... 0.8767

Butler, OH

3240 Harrisburg-Lebanon-Carlisle, PA ....................................... 1.0187

Cumberland, PA

Dauphin, PA

Lebanon, PA

Perry, PA

3283 *Hartford, CT ....................... 1.2562

Hartford, CT

Litchfield, CT

Middlesex, CT

Tolland, CT

3285 Hattiesburg, MS .................. 0.7192

Forrest, MS

Lamar, MS

3290 Hickory-Morganton-Lenoir,

NC ............................................... 0.8686

Alexander, NC

Burke, NC

Caldwell, NC

Catawba, NC

3320 Honolulu, HI ........................ 1.1816

Honolulu, HI

3350 Houma, LA .......................... 0.7854

Lafourche, LA

Terrebonne, LA

3360 *Houston, TX ....................... 0.9855

Chambers, TX

Fort Bend, TX

Harris, TX

Liberty, TX

Montgomery, TX

Waller, TX

3400 Huntington-Ashland, WV–

KY–OH ........................................ 0.9160

Boyd, KY

Carter, KY

Greenup, KY

Lawrence, OH

Cabell, WV

Wayne, WV

3440 Huntsville, AL ...................... 0.8485

Limestone, AL

Madison, AL
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32517

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

3480 *Indianapolis, IN .................. 0.9848

Boone, IN

Hamilton, IN

Hancock, IN

Hendricks, IN

Johnson, IN

Madison, IN

Marion, IN

Morgan, IN

Shelby, IN

3500 Iowa City, IA ........................ 0.9413

Johnson, IA

3520 Jackson, MI ......................... 0.9052

Jackson, MI

3560 Jackson, MS ........................ 0.7760

Hinds, MS

Madison, MS

Rankin, MS

3580 Jackson, TN ........................ 0.8522

Madison, TN

Chester, TN

3600 Jacksonville, FL ................... 0.8969

Clay, FL

Duval, FL

Nassau, FL

St. Johns, FL

3605 Jacksonville, NC .................. 0.6973

Onslow, NC

3610 Jamestown, NY ................... 0.7552

Chautaqua, NY

3620 Janesville-Beloit, WI ............ 0.8824

Rock, WI

3640 Jersey City, NJ .................... 1.1412

Hudson, NJ

3660 Johnson City-Kingsport-Bristol, TN–VA ................................... 0.9114

Carter, TN

Hawkins, TN

Sullivan, TN

Unicoi, TN

Washington, TN

Bristol City, VA

Scott, VA

Washington, VA

3680 Johnstown, PA .................... 0.8378

Cambria, PA

Somerset, PA

3700 Jonesboro, AR .................... 0.7443

Craighead, AR

3710 Joplin, MO ........................... 0.7510

Jasper, MO

Newton, MO

3720 Kalamazoo-Battlecreek, MI 1.0668

Calhoun, MI

Kalamazoo, MI

Van Buren, MI

3740 Kankakee, IL ....................... 0.8653

Kankakee, IL

3760 *Kansas City, KS–MO ......... 0.9564

Johnson, KS

Leavenworth, KS

Miami, KS

Wyandotte, KS

Cass, MO

Clay, MO

Clinton, MO

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Jackson, MO

Lafayette, MO

Platte, MO

Ray, MO

3800 Kenosha, WI ........................ 0.9196

Kenosha, WI

3810 Killeen-Temple, TX .............. 1.0252

Bell, TX

Coryell, TX

3840 Knoxville, TN ....................... 0.8831

Anderson, TN

Blount, TN

Knox, TN

Loudon, TN

Sevier, TN

Union, TN

3850 Kokomo, IN ......................... 0.8416

Howard, IN

Tipton, IN

3870 La Crosse, WI–MN .............. 0.8749

Houston, MN

La Crosse, WI

3880 Lafayette, LA ....................... 0.8206

Acadia, LA

Lafayette, LA

St. Landry, LA

St. Martin, LA

3920 Lafayette, IN ........................ 0.9174

Clinton, IN

Tippecanoe, IN

3960 Lake Charles, LA ................ 0.7776

Calcasieu, LA

3980 Lakeland-Winter Haven, FL 0.8806

Polk, FL

4000 Lancaster, PA ...................... 0.9481

Lancaster, PA

4040 Lansing-East Lansing, MI ... 1.0088

Clinton, MI

Eaton, MI

Ingham, MI

4080 Laredo, TX .......................... 0.7325

Webb, TX

4100 Las Cruces, NM .................. 0.8646

Dona Ana, NM

4120 *Las Vegas, NV–AZ ............ 1.0592

Mohave, AZ

Clark, NV

Nye, NV

4150 Lawrence, KS ...................... 0.8608

Douglas, KS

4200 Lawton, OK ......................... 0.9045

Comanche, OK

4243 Lewiston-Auburn, ME .......... 0.9536

Androscoggin, ME

4280 Lexington, KY ...................... 0.8390

Bourbon, KY

Clark, KY

Fayette, KY

Jessamine, KY

Madison, KY

Scott, KY

Woodford, KY

4320 Lima, OH ............................. 0.9185

Allen, OH

Eagles, OH

4360 Lincoln, NE .......................... 0.9231

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Lancaster, NE

4400 Little Rock-North Little

Rock, AR ..................................... 0.8490

Faulkner, AR

Laennec, AR

Pulaski, AR

Saline, AR

4420 Longview-Marshall, TX ........ 0.8613

Gregg, TX

Harrison, TX

Upshur, TX

4480 *Los Angeles-Long Beach,

CA ............................................... 1.2232

Los Angeles, CA

4520 Louisville, KY–IN ................. 0.9507

Clark, IN

Floyd, IN

Harrison, IN

Scott, IN

Bullitt, KY

Jefferson, KY

Oldham, KY

4600 Lubbock, TX ........................ 0.8400

Lubbock, TX

4640 Lynchburg, VA ..................... 0.8228

Amherst, VA

Bedford, VA

Bedford City, VA

Campbell, VA

Lynchburg City, VA

4680 Macon, GA .......................... 0.9227

Bibb, GA

Houston, GA

Jones, GA

Peach, GA

Twiggs, GA

4720 Madison, WI ........................ 1.0055

Dane, WI

4800 Mansfield, OH ..................... 0.8639

Crawford, OH

Richland, OH

4840 Mayaguez, PR ..................... 0.4475

Anasco, PR

Cabo Rojo, PR

Hormigueros, PR

Mayaguez, PR

Sabana Grande, PR

San German, PR

4880 McAllen-Edinburg-Mission,

TX ................................................ 0.8371

Hidalgo, TX

4890 Medford-Ashland, OR ......... 1.0354

Jackson, OR

4900 Melbourne-Titusville-Palm

Bay, FL ........................................ 0.8819

Brevard, FL

4920 *Memphis, TN–AR–MS ....... 0.8589

Crittenden, AR

DeSoto, MS

Fayette, TN

Shelby, TN

Tipton, TN

4940 Merced, CA ......................... 1.0947

Merced, CA

5000 *Miami, FL.

Dade, FL 0.9859
32518 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

5015 *Middlesex-SomersetHunterdon, NJ ............................. 1.1059

Hunterdon, NJ

Middlesex, NJ

Somerset, NJ

5080 *Milwaukee-Waukesha, WI 0.9819

Milwaukee, WI

Ozaukee, WI

Washington, WI

Waukesha, WI

5120 *Minneapolis-St. Paul, MN–

WI ................................................ 1.0733

Anoka, MN

Carver, MN

Chisago, MN

Dakota, MN

Hennepin, MN

Isanti, MN

Ramsey, MN

Scott, MN

Sherburne, MN

Washington, MN

Wright, MN

Pierce, WI

St. Croix, WI

5160 Mobile, AL ........................... 0.8455

Baldwin, AL

Mobile, AL

5170 Modesto, CA ....................... 1.0794

Stanislaus, CA

5190 *Monmouth-Ocean, NJ ........ 1.0934

Monmouth, NJ

Ocean, NJ

5200 Monroe, LA .......................... 0.8414

Ouachita, LA

5240 Montgomery, AL .................. 0.7671

Autauga, AL

Elmore, AL

Montgomery, AL

5280 Muncie, IN ........................... 0.9173

Delaware, IN

5330 Myrtle Beach, SC ................ 0.8072

Horry, SC

5345 Naples, FL ........................... 1.0109

Collier, FL

5360 *Nashville, TN ..................... 0.9182

Cheatham, TN

Davidson, TN

Dickson, TN

Robertson, TN

Rutherford TN

Sumner, TN

Williamson, TN

Wilson, TN

5380 *Nassau-Suffolk, NY ........... 1.3807

Nassau, NY

Suffolk, NY

5483 *New Haven-BridgeportStamford-Danbury-Waterbury,

CT.

Fairfield, CT 1.2618

New Haven, CT

5523 New London-Norwich, CT ... 1.2013

New London, CT

5560 *New Orleans, LA ............... 0.9566

Jefferson, LA

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Orleans, LA

Plaquemines, LA

St. Bernard, LA

St. Charles, LA

St. James, LA

St. John Baptist, LA

St. Tammany, LA

5600 *New York, NY .................... 1.4449

Bronx, NY

Kings, NY

New York, NY

Putnam, NY

Queens, NY

Richmond, NY

Rockland, NY

Westchester, NY

5640 *Newark, NJ ........................ 1.1980

Essex, NJ

Morris, NJ

Sussex, NJ

Union, NJ

Warren, NJ

5660 Newburgh, NY–PA .............. 1.1283

Orange, NY

Pike, PA

5720 *Norfolk-Virginia BeachNewport News, VA–NC ............... 0.8316

Currituck, NC

Chesapeake City, VA

Gloucester, VA

Hampton City, VA

Isle of Wight, VA

James City, VA

Mathews, VA

Newport News City, VA

Norfolk City, VA

Poquoson City, VA

Portsmouth City, VA

Suffolk City, VA

Virginia Beach City, VA

Williamsburg City, VA

York, VA

5775 *Oakland, CA ...................... 1.5068

Alameda, CA

Contra Costa, CA

5790 Ocala, FL ............................. 0.9032

Marion, FL

5800 Odessa-Midland, TX ........... 0.8660

Ector, TX

Midland, TX

5880 *Oklahoma City, OK ............ 0.8481

Canadian, OK

Cleveland, OK

Logan, OK

McClain, OK

Oklahoma, OK

Pottawatomie, OK

5910 Olympia, WA ....................... 1.0901

Thurston, WA

5920 Omaha, NE–IA .................... 0.9421

Pottawattamie, IA

Cass, NE

Douglas, NE

Sarpy, NE

Washington, NE

5945 *Orange County, CA ........... 1.1605

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Orange, CA

5960 *Orlando, FL ........................ 0.9397

Lake, FL

Orange, FL

Osceola, FL

Seminole, FL

5990 Owensboro, KY ................... 0.7480

Daviess, KY

6015 Panama City, FL ................. 0.8337

Bay, FL

6020 Parkersburg-Marietta, WV–

OH ............................................... 0.8046

Washington, OH

Wood, WV

6080 Pensacola, FL ..................... 0.8193

Escambia, FL

Santa Rosa, FL

6120 Peoria-Pekin, IL ................... 0.8571

Peoria, IL

Tazewell, IL

Woodford, IL

6160 *Philadelphia, PA–NJ .......... 1.1398

Burlington, NJ

Camden, NJ

Gloucester, NJ

Salem, NJ

Bucks, PA

Chester, PA

Delaware, PA

Montgomery, PA

Philadelphia, PA

6200 *Phoenix-Mesa, AZ ............. 0.9606

Maricopa, AZ

Pinal, AZ

6240 Pine Bluff, AR ...................... 0.7826

Jefferson, AR

6280 *Pittsburgh, PA .................... 0.9725

Allegheny, PA

Beaver, PA

Butler, PA

Fayette, PA

Washington, PA

Westmoreland, PA

6323 Pittsfield, MA ....................... 1.0960

Berkshire, MA

6340 Pocatello, ID ........................ 0.9586

Bannock, ID

6360 Ponce, PR ........................... 0.4589

Guayanilla, PR

Juana Diaz, PR

Penuelas, PR

Ponce, PR

Villalba, PR

Yauco, PR

6403 Portland, ME ....................... 0.9627

Cumberland, ME

Sagadahoc, ME

York, ME

6440 *Portland-Vancouver, OR–

WA ............................................... 1.1344

Clackamas, OR

Columbia, OR

Multnomah, OR

Washington, OR

Yamhill, OR

Clark, WA
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32519

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

6483 Providence-Warwick-Pawtucket, RI ..................................... 1.1049

Bristol, RI

Kent, RI

Newport, RI

Providence, RI

Washington, RI

Statewide, RI

6520 Provo-Orem, UT .................. 1.0073

Utah, UT

6560 Pueblo, CO .......................... 0.8450

Pueblo, CO

6580 Punta Gorda, FL ................. 0.8725

Charlotte, FL

6600 Racine, WI ........................... 0.8934

Racine, WI

6640 Raleigh-Durham-Chapel Hill,

NC ............................................... 0.9818

Chatham, NC

Durham, NC

Franklin, NC

Johnston, NC

Orange, NC

Wake, NC

6660 Rapid City, SD .................... 0.8345

Pennington, SD

6680 Reading, PA ........................ 0.9516

Berks, PA

6690 Redding, CA ........................ 1.1790

Shasta, CA

6720 Reno, NV ............................. 1.0768

Washoe, NV

6740 Richland-Kennewick-Pasco,

WA ............................................... 0.9918

Benton, WA

Franklin, WA

6760 Richmond-Petersburg, VA .. 0.9152

Charles City County, VA

Chesterfield, VA

Colonial Heights City, VA

Dinwiddie, VA

Goochland, VA

Hanover, VA

Henrico, VA

Hopewell City, VA

New Kent, VA

Petersburg City, VA

Powhatan, VA

Prince George, VA

Richmond City, VA

6780 *Riverside-San Bernardino,

CA ............................................... 1.1307

Riverside, CA

San Bernardino, CA

6800 Roanoke, VA ....................... 0.8402

Botetourt, VA

Roanoke, VA

Roanoke City, VA

Salem City, VA

6820 Rochester, MN .................... 1.0502

Olmsted, MN

6840 *Rochester, NY ................... 0.9524

Genesee, NY

Livingston, NY

Monroe, NY

Ontario, NY

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Orleans, NY

Wayne, NY

6880 Rockford, IL ......................... 0.9081

Boone, IL

Ogle, IL

Winnebago, IL

6895 Rocky Mount, NC ................ 0.9029

Edgecombe, NC

Nash, NC

6920 *Sacramento, CA ................ 1.2202

El Dorado, CA

Placer, CA

Sacramento, CA

6960 Saginaw-Bay City-Midland,

MI ................................................ 0.9564

Bay, MI

Midland, MI

Saginaw, MI

6980 St. Cloud, MN ...................... 0.9544

Benton, MN

Stearns, MN

7000 St. Joseph, MO ................... 0.8366

Andrews, MO

Buchanan, MO

7040 *St. Louis, MO–IL ................ 0.9130

Clinton, IL

Jersey, IL

Madison, IL

Monroe, IL

St. Clair, IL

Franklin, MO

Jefferson, MO

Lincoln, MO

St. Charles, MO

St. Louis, MO

St. Louis City, MO

Warren, MO

7080 Salem, OR ........................... 0.9965

Marion, OR

Polk, OR

7120 Salinas, CA ......................... 1.4513

Monterey, CA

7160 *Salt Lake City-Ogden, UT 0.9857

Davis, UT

Salt Lake, UT

Weber, UT

7200 San Angelo, TX ................... 0.7780

Tom Green, TX

7240 *San Antonio, TX ................ 0.8499

Bexar, TX

Comal, TX

Guadalupe, TX

Wilson, TX

7320 *San Diego, CA ................... 1.2193

San Diego, CA

7360 *San Francisco, CA ............. 1.4180

Marin, CA

San Francisco, CA

San Mateo, CA

7400 *San Jose, CA ..................... 1.4332

Santa Clara, CA

7440 *San Juan-Bayamon, PR .... 0.4625

Aguas Buenas, PR

Barceloneta, PR

Bayamon, PR

Canovanas, PR

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Carolina, PR

Catano, PR

Ceiba, PR

Comerio, PR

Corozal, PR

Dorado, PR

Fajardo, PR

Florida, PR

Guaynabo, PR

Humacao, PR

Juncos, PR

Los Piedras, PR

Loiza, PR

Luguillo, PR

Manati, PR

Morovis, PR

Naguabo, PR

Naranjito, PR

Rio Grande, PR

San Juan, PR

Toa Alta, PR

Toa Baja, PR

Trujillo Alto, PR

Vega Alta, PR

Vega Baja, PR

Yabucoa, PR

7460 San Luis ObispoAtascadero-Paso Robles, CA ..... 1.1374

San Luis Obispo, CA

7480 Santa Barbara-Santa MariaLompoc, CA ................................ 1.0688

Santa Barbara, CA

7485 Santa Cruz-Watsonville, CA 1.4187

Santa Cruz, CA

7490 Santa Fe, NM ...................... 1.0332

Los Alamos, NM

Santa Fe, NM

7500 Santa Rosa, CA .................. 1.2815

Sonoma, CA

7510 Sarasota-Bradenton, FL ...... 0.9757

Manatee, FL

Sarasota, FL

7520 Savannah, GA ..................... 0.8638

Bryan, GA

Chatham, GA

Effingham, GA

7560 Scranton-Wilkes-Barre-Hazleton, PA .................................... 0.8539

Columbia, PA

Lackawanna, PA

Luzerne, PA

Wyoming, PA

7600 *Seattle-Bellevue-Everett,

WA ............................................... 1.1339

Island, WA

King, WA

Snohomish, WA

7610 Sharon, PA .......................... 0.8783

Mercer, PA

7620 Sheboygan, WI .................... 0.7862

Sheboygan, WI

7640 Sherman-Denison, TX ......... 0.8499

Grayson, TX

7680 Shreveport-Bossier City, LA 0.9381

Bossier, LA

Caddo, LA
32520 Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

Webster, LA

7720 Sioux City, IA–NE ............... 0.8031

Woodbury, IA

Dakota, NE

7760 Sioux Falls, SD ................... 0.8712

Lincoln, SD

Minnehaha, SD

7800 South Bend, IN .................... 0.9868

St. Joseph, IN

7840 Spokane, WA ...................... 1.0486

Spokane, WA

7880 Springfield, IL ...................... 0.8713

Menard, IL

Sangamon, IL

7920 Springfield, MO ................... 0.7989

Christian, MO

Greene, MO

Webster, MO

8003 Springfield, MA .................... 1.0740

Hampden, MA

Hampshire, MA

8050 State College, PA ................ 0.9635

Centre, PA

8080 Steubenville-Weirton, OH–

WV ............................................... 0.8645

Jefferson, OH

Brooke, WV

Hancock, WV

8120 Stockton-Lodi, CA ............... 1.1496

San Joaquin, CA

8140 Sumter, SC .......................... 0.7842

Sumter, SC

8160 Syracuse, NY ...................... 0.9464

Cayuga, NY

Madison, NY

Onondaga, NY

Oswego, NY

8200 Tacoma, WA ....................... 1.1016

Pierce, WA

8240 Tallahassee, FL ................... 0.8332

Gadsden, FL

Leon, FL

8280 *Tampa-St. PetersburgClearwater, FL ............................. 0.9103

Hernando, FL

Hillsborough, FL

Pasco, FL

Pinellas, FL

8320 Terre Haute, IN ................... 0.8614

Clay, IN

Vermillion, IN

Vigo, IN

8360 Texarkana, AR-Texarkana,

TX ................................................ 0.8664

Miller, AR

Bowie, TX

8400 Toledo, OH .......................... 1.0390

Fulton, OH

Lucas, OH

Wood, OH

8440 Topeka, KS ......................... 0.9438

Shawnee, KS

8480 Trenton, NJ ......................... 1.0380

Mercer, NJ

8520 Tucson, AZ .......................... 0.9180

Pima, AZ

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

8560 Tulsa, OK ............................ 0.8074

Creek, OK

Osage, OK

Rogers, OK

Tulsa, OK

Wagoner, OK

8600 Tuscaloosa, AL ................... 0.8187

Tuscaloosa, AL

8640 Tyler, TX .............................. 0.9567

Smith, TX

8680 Utica-Rome, NY .................. 0.8398

Herkimer, NY

Oneida, NY

8720 Vallejo-Fairfield-Napa, CA ... 1.3754

Napa, CA

Solano, CA

8735 Ventura, CA ......................... 1.0946

Ventura, CA

8750 Victoria, TX .......................... 0.8474

Victoria, TX

8760 Vineland-Millville-Bridgeton,

NJ ................................................ 1.0110

Cumberland, NJ

8780 Visalia-Tulare-Porterville,

CA ............................................... 0.9924

Tulare, CA

8800 Waco, TX ............................ 0.7696

McLennan, TX

8840 *Washington, DC–MD–VA–

WV ............................................... 1.0911

District of Columbia, DC

Calvert, MD

Charles, MD

Frederick, MD

Montgomery, MD

Prince Georges, MD

Alexandria City, VA

Arlington, VA

Clarke, VA

Culpepper, VA

Fairfax, VA

Fairfax City, VA

Falls Church City, VA

Fauquier, VA

Fredericksburg City, VA

King George, VA

Loudoun, VA

Manassas City, VA

Manassas Park City, VA

Prince William, VA

Spotsylvania, VA

Stafford, VA

Warren, VA

Berkeley, WV

Jefferson, WV

8920 Waterloo-Cedar Falls, IA ..... 0.8640

Black Hawk, IA

8940 Wausau, WI ......................... 1.0545

Marathon, WI

8960 West Palm Beach-Boca

Raton, FL .................................... 1.0372

Palm Beach, FL

9000 Wheeling, OH–WV .............. 0.7707

Belmont, OH

Marshall, WV

Ohio, WV

ADDENDUM D.—WAGE INDEX FOR

URBAN AREAS—Continued

Urban area

(Constituent counties or county

equivalents)

Wage

index

9040 Wichita, KS .......................... 0.9403

Butler, KS

Harvey, KS

Sedgwick, KS

9080 Wichita Falls, TX ................. 0.7646

Archer, TX

Wichita, TX

9140 Williamsport, PA .................. 0.8548

Lycoming, PA

9160 Wilmington-Newark, DE–MD 1.1538

New Castle, DE

Cecil, MD

9200 Wilmington, NC ................... 0.9322

New Hanover, NC

Brunswick, NC

9260 Yakima, WA ........................ 1.0102

Yakima, WA

9270 Yolo, CA .............................. 1.1431

Yolo, CA

9280 York, PA .............................. 0.9415

York, PA

9320 Youngstown-Warren, OH .... 0.9937

Columbiana, OH

Mahoning, OH

Trumbull, OH

9340 Yuba City, CA ..................... 1.0324

Sutter, CA

Yuba, CA

9360 Yuma, AZ ............................ 0.9732

Yuma, AZ

*Large Urban Area

WAGE INDEX FOR RURAL AREAS

Nonurban area Wage

index

Alabama .......................................... 0.7260

Alaska ............................................. 1.2302

Arizona ............................................ 0.7989

Arkansas ......................................... 0.6995

California ......................................... 0.9977

Colorado ......................................... 0.8129

Connecticut ..................................... 1.2617

Delaware ......................................... 0.8925

Florida ............................................. 0.8838

Georgia ........................................... 0.7761

Hawaii ............................................. 1.0229

Idaho ............................................... 0.8221

Illinois .............................................. 0.7644

Indiana ............................................ 0.8161

Iowa ................................................ 0.7391

Kansas ............................................ 0.7203

Kentucky ......................................... 0.7772

Louisiana ......................................... 0.7383

Maine .............................................. 0.8468

Maryland ......................................... 0.8617

Massachusetts ................................ 1.0718

Michigan .......................................... 0.8923

Minnesota ....................................... 0.8179

Mississippi ....................................... 0.6911

Missouri ........................................... 0.7205

Montana .......................................... 0.8302

Nebraska ......................................... 0.7401

Nevada ............................................ 0.8914
Federal Register / Vol. 63, No. 113 / Friday, June 12, 1998 / Proposed Rules 32521

WAGE INDEX FOR RURAL AREAS—

Continued

Nonurban area Wage

index

New Hampshire .............................. 0.9717

New Jersey 1 ................................... ..............

New Mexico .................................... 0.8070

New York ........................................ 0.8401

North Carolina ................................. 0.7937

North Dakota ................................... 0.7360

Ohio ................................................ 0.8434

Oklahoma ........................................ 0.7072

Oregon ............................................ 0.9975

Pennsylvania ................................... 0.8421

WAGE INDEX FOR RURAL AREAS—

Continued

Nonurban area Wage

index

Puerto Rico ..................................... 0.3939

Rhode Island 1 ................................ ..............

South Carolina ................................ 0.7921

South Dakota .................................. 0.6983

Tennessee ...................................... 0.7353

Texas .............................................. 0.7404

Utah ................................................ 0.8926

Vermont .......................................... 0.9314

Virginia ............................................ 0.7782

Washington ..................................... 1.0221

WAGE INDEX FOR RURAL AREAS—

Continued

Nonurban area Wage

index

West Virginia ................................... 0.7938

Wisconsin ........................................ 0.8471

Wyoming ......................................... 0.8247

1All counties within the State are classified

urban.

[FR Doc. 98–14835 Filed 6–11–98; 8:45 am]

BILLING CODE 4120–01–P