30818 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 405, 410, 413, 414, 415,

424, and 485

[HCFA–1006–P]

RIN 0938–AI52

Medicare Program; Revisions to

Payment Policies Under the Physician

Fee Schedule for Calendar Year 1999

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Proposed rule.

SUMMARY: This proposed rule would

make several policy changes affecting

Medicare Part B payment. The changes

that relate to physician services include:

resource-based practice expense relative

value units, medical direction rules for

anesthesia services, and payment for

abnormal Pap smears. Also, we would

rebase the Medicare Economic Index

from a 1989 base year to a 1996 base

year. Under the law, we are required to

develop a resource-based system for

determining practice expense relative

value units. The Balanced Budget Act of

1997 (BBA 1997) delayed, for 1 year,

implementation of the resource-based

practice expense relative value units

until January 1, 1999. Also, BBA 1997

revised our payment policy for

nonphysician practitioners, for

outpatient rehabilitation services, and

for drugs and biologicals not paid on a

cost or prospective payment basis. In

addition, BBA 1997 permits certain

physicians and practitioners to opt out

of Medicare and furnish covered

services to Medicare beneficiaries

through private contracts. In addition,

since we established the physician fee

schedule on January 1, 1992, our

experience indicates that some of our

Part B payment policies need to be

reconsidered. This proposed rule is

intended to correct inequities in

physician payment and solicits public

comments on specific proposed policy

changes.

DATES: Comments on the proposed

resource-based practice expense policy

will be considered if we receive them at

the appropriate address, as provided

below, no later than 5 p.m. on

September 3, 1998. Comments on all

other issues will be considered if we

receive them at the appropriate address,

as provided below, no later than 5 p.m.

on August 4, 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–

1006–P, P.O. Box 26688, Baltimore, MD

21207–0488.

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

Because of staffing and resource

limitations, we cannot accept comments

by facsimile (FAX) transmission. In

commenting, please refer to file code

HCFA–1006–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

Register containing this document, send

your request to: New Orders,

Superintendent of Documents, P.O. Box

371954, Pittsburgh, PA 15250–7954.

Specify the date of the issue requested

and enclose a check or money order

payable to the Superintendent of

Documents, or enclose your Visa or

Master Card number and expiration

date. Credit card orders can also be

placed by calling the order desk at (202)

512–1800 or by faxing to (202) 512–

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

an alternative, you can view and

photocopy the Federal Register

document at most libraries designated

as Federal Depository Libraries and at

many other public and academic

libraries throughout the country that

receive the Federal Register.

This Federal Register document is

also available from the Federal Register

online database through GPO Access, a

service of the U.S. Government Printing

Office. Free public access is available on

a Wide Area Information Server (WAIS)

through the Internet and via

asynchronous dial-in. Internet users can

access the database by using the World

Wide Web; the Superintendent of

Documents home page address is http:/

/www.access.gpo.gov/suldocs/, by

using local WAIS client software, or by

telnet to swais.access.gpo.gov, then

login as guest (no password required).

Dial-in users should use

communications software and modem

to call 202–512–1661; type swais, then

login as guest (no password required).

FOR FURTHER INFORMATION CONTACT:

Roberta Epps, (410) 786–4503 (for issues

related to outpatient rehabilitation

services, nurse practitioners, clinical

nurse specialists, and certified nursemidwives).

Stephen Heffler, (410) 786–1211 (for

issues related to the Medicare Economic

Index).

Anita Heygster, (410) 786–4486 (for

issues related to private contracts).

Jim Menas, (410) 786–4507 (for issues

related to Pap smears and medical

direction for anesthesia services).

Robert Niemann, (410) 786–4569 (for

issues related to the drugs and

biologicals policy).

Regina Walker-Wren, (410) 786–9160

(for issues related to physician

assistants).

Stanley Weintraub, (410) 786–4498

(for issues related to practice expense

relative value units and all other issues).

SUPPLEMENTARY INFORMATION: To assist

readers in referencing sections

contained in this preamble, we are

providing the following table of

contents. Some of the issues discussed

in this preamble affect the payment

policies but do not require changes to

the regulations in the Code of Federal

Regulations. Information on the

regulation’s impact appears throughout

the preamble and not exclusively in part

V.

Table of Contents

I. Background

A. Legislative History

B. Published Changes to the Fee Schedule

II. Specific Proposals for Calendar Year 1999

A. Resource-Based Practice Expense

Relative Value Units

1. Current Practice Expense Relative Value

Unit System

2. Criticism of Current Practice Expense

Relative Value Unit System

3. Resource-Based Practice Expense

Legislation

4. Originally Proposed Methodology for

Developing Resource-Based Practice

Expense Relative Value Units

5. Balanced Budget Act of 1997 Provisions

Pertaining to Resource-Based Practice

Expense Relative Value Units

6. HCFA Response to BBA 1997

Requirements

7. Summary of General Input from the

Medical Community and Comments

from the October 1997 Notice with

Comment Period

8. Issues Considered in Developing New

Practice Expense RVUs

9. Alternative Practice Expense

Methodologies Considered

10. Description of the Proposed

Methodology for Developing Practice

Expense Relative Value Units

a. Overview

b. Data Sources

c. Practice Expense Cost Pools

d. Cost Allocation Methodology
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30819

11. Comments of the American Medical

Association Regarding the Use of the

Socioeconomic Monitoring System

Survey Data to Construct Practice

Expense Relative Value Units

12. Other Methodological Issues

a. Professional and Technical Component

Services

b. Practice Expenses per Hour Adjustments

and Specialty Crosswalks

c. Time Associated with the Work Relative

Value Units

13. Other Practice Expense Policies

a. Site-of-Service Payment Differential

b. Additional Relative Value Units for

Additional Office-Based Expenses for

Certain Procedure Codes

c. Anesthesia Services

14. Refinement

a. Issues Involved in Refinement

b. Example of the Process for Reviewing

and Commenting on Practice Expense

Relative Value Units

c. Information on Accessing Data Files on

HCFA’s Homepage

15. Reductions in Practice Expense

Relative Value Units for Multiple

Procedures

16. Transition

17. Proposed Regulation Revisions

18. Response to GAO Recommendations

B. Medical Direction for Anesthesia

Services

C. Separate Payment for Physician

Interpretation of an Abnormal

Papanicolaou Smear

D. Rebasing and Revising the Medicare

Economic Index

1. Background

a. History

b. Use of Current Data

2. Rebasing and Revising Expense

Categories

a. American Medical Association

Socioeconomic Monitoring System

Survey

b. Employment Cost Index Survey

c. Asset and Expenditure Survey

d. Current Population Survey

e. Medical Economics Continuing Survey

3. Selection of Price Proxies

a. Background

b. Expense Categories

(1) Physician’s Time

(2) Nonphysician Employee Compensation

(3) Office Expense

(4) Medical Materials and Supplies

(5) Professional Liability Insurance

(6) Medical Equipment

(7) Other Professional Expenses

4. Summary of Changes

III. Implementation of the Balanced Budget

Act of 1997

A. Payment for Drugs and Biologicals

B. Private Contracting with Medicare

Beneficiaries

C. Payment for Outpatient Rehabilitation

Services

1. Overview of Policies Before BBA 1997

a. Coverage

b. Providers of Outpatient Rehabilitation

Services

c. Payment for Services

(1) Reasonable Cost-Based Payments

(2) Fee Schedule Payments

d. Financial Limitation

2. BBA Provisions Affecting Payment for

Outpatient Rehabilitation Services

a. Reasonable Cost-Based Payments

b. Prospective Payment System for

Outpatient Rehabilitation Services

(1) Overview

(2) Services Furnished by Skilled Nursing

Facilities

(3) Services Furnished by Home Health

Agencies

(4) Services Furnished by Comprehensive

Outpatient Rehabilitation Facilities

(5) Site-of-Service Differential

(6) Mandatory Assignment

3. Uniform Procedure Codes for Outpatient

Rehabilitation Services

4. Financial Limitation

5. Qualified Therapists

6. Plan of Treatment

D. Payment for Services of Certain

Nonphysician Practitioners and Services

Furnished Incident to their Professional

Services

1. Coverage and Payment for Nurse

Practitioner Services Before BBA 1997

2. Coverage and Payment for Nurse

Practitioner Services Subsequent to BBA

1997

3. Coverage and Payment for Clinical Nurse

Specialist Services Before BBA 1997

4. Coverage and Payment for Clinical Nurse

Specialist Services Subsequent to BBA

1997

5. Coverage and Payment for Certified

Nurse-Midwife Services

6. Coverage and Payment for Physician

Assistant Services Before BBA 1997

7. Coverage and Payment for Physician

Assistant Services Subsequent to BBA

1997

IV. Collection of Information Requirements

V. Response to Comments

VI. Regulatory Impact Analysis

A. Regulatory Flexibility Act

B. Resource-Based Practice Expense

Relative Value Units

C. Medical Direction for Anesthesia

Services

D. Separate Payment for Physician

Interpretation of an Abnormal

Papanicolaou Smear

E. Rebasing and Revising the Medicare

Economic Index

F. Payment for Nurse Midwives’ Services

F. Payment for Drugs and Biologicals

G. BBA 1997 Provisions Included in This

Proposed Rule

1. Payment for Services of Certain

Nonphysician Practitioners and Services

Furnished Incident to Their Professional

Services

2. Payment for Outpatient Rehabilitation

Services

3. Payment for Drugs and Biologicals

4. Private Contracting with Medicare

Beneficiaries

H. Impact on Beneficiaries

Addendum A—Description of Clinical

Practice Expert Panel Data and

Methodology

Addendum B—Technical Description of the

Proposed Methodology for Developing

Practice Expense Relative Value Units

Addendum C—Relative Value Units (RVUs)

and Related Information

In addition, because of the many

organizations and terms to which we refer by

acronym in this proposed rule, we are listing

these acronyms and their corresponding

terms in alphabetical order below:

AANA—American Association of Nurse

Anesthetists

ABC—Activity based costing

ABN—Advance Beneficiary Notice

AHE—Average Hourly Earnings

AMA—American Medical Association

ASA—American Society of Anesthesiologists

AWP—Average Wholesale Price

BBA—Balanced Budget Act of 1997

BLS—Bureau of Labor Statistics

CF—Conversion factor

CFR—Code of Federal Regulations

CMSAs—Consolidated Metropolitan

Statistical Areas

CORF—Comprehensive outpatient

rehabilitation facility

CPEPs—Clinical Practice Expert Panels

CPI—Consumer Price Index

CPI–U—Consumer Price Index for All Urban

Consumers

CPS—Current Population Survey

CPT—[Physicians’] Current Procedural

Terminology [4th Edition, 1997,

copyrighted by the American Medical

Association]

CRNA—Certified Registered Nurse

Anesthetist

DME—Durable medical equipment

DMEPOS—Durable medical equipment,

prosthetics, orthotics, and supplies

DRG—Diagnosis-related group

EAC—Estimated Acquisition Cost

ECI—Employment Cost Index

ES–202—Data—Bureau of Labor Statistics

from State unemployment insurance

agencies

ESRD—End-stage renal disease

FDA—Food and Drug Administration

FMR—Fair market rental

GAAP—Generally accepted accounting

principles

GAF—Geographic adjustment factor

GPCI—Geographic practice cost index

HCFA—Health Care Financing

Administration

HCPCS—HCFA Common Procedure Coding

System

HHS—[Department of] Health and Human

Services

HMO—Health maintenance organization

HUD—[Department of] Housing and Urban

Development

MEDPAC—Medicare Payment Advisory

Commission

MEI—Medicare Economic Index

MGMA—Medical Group Management

Association

MSA—Metropolitan Statistical Area

NAIC—National Association of Insurance

Commissioners

NPI—National provider identifier

OBRA—Omnibus Budget Reconciliation Act

OTIP—Occupational therapist in

independent practice

PC—Professional component

PMSA—Primary Metropolitan Statistical

Area

PPI—Producer Price Index

PPS—Prospective payment system

PTIP—Physical therapist in independent

practice

RUC—[AMA’s Specialty Society] Relative

[Value] Update Committee
30820 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

RVU—Relative value unit

SMS—Socioeconomic Monitoring System

SNF—Skilled nursing facility

TC—Technical component

TEFRA—Tax Equity and Fiscal

Responsibility Act

UPIN—Uniform provider identifier number

I. Background

A. Legislative History

Since January 1, 1992, Medicare has

paid for physician services under

section 1848 of the Social Security Act

(the Act), ‘‘Payment for Physicians’

Services.’’ This section contains three

major elements: (1) A fee schedule for

the payment of physician services; (2) a

sustainable growth rate for the rates of

increase in Medicare expenditures for

physician services; and (3) limits on the

amounts that nonparticipating

physicians can charge beneficiaries. The

Act requires that payments under the

fee schedule be based on national

uniform relative value units (RVUs)

based on the resources used in

furnishing a service. Section 1848(c) of

the Act requires that national RVUs be

established for physician work, practice

expense, and malpractice expense.

Section 1848(c)(2)(B)(ii)(II) of the Act

provides that adjustments in RVUs

because of changes resulting from a

review of those RVUs may not cause

total physician fee schedule payments

to differ by more than $20 million from

what they would have been had the

adjustments not been made. If this

tolerance is exceeded, we must make

adjustments to the conversion factors

(CFs) to preserve budget neutrality.

B. Published Changes to the Fee

Schedule

We published a final rule on

November 25, 1991 (56 FR 59502) to

implement section 1848 of the Act by

establishing a fee schedule for physician

services furnished on or after January 1,

1992. In the November 1991 final rule

(56 FR 59511), we stated our intention

to update RVUs for new and revised

codes in the American Medical

Association’s (AMA’s) Physicians’

Current Procedural Terminology (CPT)

through an ‘‘interim RVU’’ process

every year. The updates to the RVUs

and fee schedule policies follow:

• November 25, 1992, as a final notice

with comment period on new and

revised RVUs only (57 FR 55914).

• December 2, 1993, as a final rule

with comment period (58 FR 63626) to

revise the refinement process used to

establish physician work RVUs and to

revise payment policies for specific

physician services and supplies. (We

solicited comments on new and revised

RVUs only.)

• December 8, 1994, as a final rule

with comment period (59 FR 63410) to

revise the geographic adjustment factor

(GAF) values, fee schedule payment

areas, and payment policies for specific

physician services. The final rule also

discussed the process for periodic

review and adjustment of RVUs not less

frequently than every 5 years as

required by section 1848(c)(2)(B)(i) of

the Act.

• December 8, 1995, as a final rule

with comment period (60 FR 63124) to

revise various policies affecting

payment for physician services

including Medicare payment for

physician services in teaching settings,

the RVUs for certain existing procedure

codes, and to establish interim RVUs for

new and revised procedure codes. The

rule also included the final revised 1996

geographic practice cost indices (GPCIs).

• November 22, 1996, as a final rule

with comment period (61 FR 59490) to

revise the policy for payment for

diagnostic services, transportation in

connection with furnishing diagnostic

tests, changes in geographic payment

areas (localities), and changes in the

procedure status codes for a variety of

services.

• October 31, 1997, as a final rule

with comment period (62 FR 59048) to

revise the geographic practice cost index

(GPCI), physician supervision of

diagnostic tests, establishment of

independent diagnostic testing facilities,

the methodology used to develop

reasonable compensation equivalent

limits, payment to participating and

nonparticipating suppliers, global

surgical services, caloric vestibular

testing, and clinical consultations. The

final rule also implemented certain

provisions of the Balanced Budget Act

of 1997 (BBA 1997) (Public Law 105–

33), enacted on August 5, 1997, and

implemented the RVUs for certain

existing procedure codes and

established interim RVUs for new and

revised procedure codes.

This proposed rule would affect the

regulations set forth at 42 CFR part 405,

which consists of regulations on Federal

health insurance for the aged and

disabled; part 410, which consists of

regulations on supplementary medical

insurance benefits; part 414, which

consists of regulations on the payment

for Part B medical and other health

services; part 415, which pertains to

services furnished by physicians in

providers, supervising physicians in

teaching settings, and residents in

certain settings; part 424, which

pertains to the conditions for Medicare

payment; and part 485, which pertains

to conditions of participation:

specialized providers.

II. Specific Proposals for Calendar Year

1999

A. Resource-Based Practice Expense

Relative Value Units

1. Current Practice Expense Relative

Value Unit System

The Act details the types of services

that are paid under the physician fee

schedule. These include physician

services, services and supplies incident

to a physician service, diagnostic x-ray

tests, diagnostic laboratory tests

(excluding clinical laboratory tests), and

x-ray, radium, and radioactive isotope

therapy. BBA 1997 added other services

such as certain preventive services.

While some of these services do not

have work RVUs, all of the services have

practice expense and malpractice

expense RVUs. (Physician anesthesia

services are included under the

physician fee schedule but are paid

under a different payment methodology

that uses a separate CF and allowable

base and time units. Physician

anesthesia services do not have practice

expense and malpractice expense

RVUs.) Payments for practice expense

RVUs account for approximately 41

percent of total physician fee schedule

payments.

In most cases, the current practice

expense RVUs are calculated based on

a statutory formula. They are derived

from the product of ‘‘base allowed

charges’’ and service-specific practice

expense percentages. The base allowed

charge is the national allowed charge for

the service furnished during 1991. The

service-specific practice expense

percentage is a weighted average of the

practice expense percentages of the

specialties performing the service.

For services furnished beginning with

calendar year 1994 and whose practice

expense RVUs exceed 1994 work RVUs

and are performed in the office setting

less than 75 percent of the time, practice

expense RVUs in each of 1994, 1995,

and 1996 were reduced by 25 percent of

the amount they exceed the 1994 work

RVUs. (Before 1998, practice expense

RVUs were not reduced to less than 128

percent of 1994 work RVUs.)

For services furnished beginning with

calendar year 1998 whose practice

expense RVUs (determined for 1998)

exceeded 110 percent of the work RVUs

and which were provided less than 75

percent of the time in an office setting,

the 1998 practice expense RVUs were

reduced to a number equal to 110

percent of the work RVUs. This

limitation did not apply to services that

had a proposed resource-based practice

expense RVU in the June 18, 1997

proposed rule (62 FR 33158), which was
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30821

an increase from its 1997 practice

expense RVU. For office visit procedure

codes performed beginning calendar

year 1998, the practice expense RVUs

were increased by a uniform percentage

to equal the aggregate decrease in the

practice expense RVUs for other

services.

2. Criticism of Current Practice Expense

Relative Value Unit System

A common criticism of the current

practice expense RVU system is that for

many services the RVUs, which are

based on charges under the reasonable

charge system, are not based directly on

the resources involved with furnishing

the service. Rather, the charge-based

nature of the current fee schedule

practice expense retains historical

charge patterns that existed before the

implementation of the physician fee

schedule on January 1, 1992. Those

charge patterns favor procedures and

tests performed in hospitals rather than

evaluation and management services

and other office-based services.

For example, a primary care physician

would have to bill CPT code 99213

(level 3 office visit, established patient)

approximately 80 times to collect the

same amount of practice expense

payments as a cardiac surgeon would

for performing one coronary artery

bypass graft with three coronary venous

grafts (CPT code 33512), although the

practice expenses the surgeon typically

incurs for the cardiac surgery are

primarily related to the pre- and

postoperative services furnished in the

office, administrative costs, and

overhead. The costs for clinical staff,

medical supplies, and medical

equipment furnished to hospital

patients are included in the diagnosisrelated group (DRG) payment made to

the hospital as required by section

1862(a)(14).

In their 1993 annual report to the

Congress, the Physician Payment

Review Commission recommended that

the Congress revise the practice expense

component of the physician fee

schedule so that it is resource-based.

They further recommended that we

collect data regarding the direct cost

incurred in delivering each service and

that a formula-based approach be used

to allocate indirect costs. This

recommendation was instrumental in

the Congress’ legislating the resourcebased practice expense component.

3. Resource-Based Practice Expense

Legislation

Section 121 of the Social Security Act

Amendments of 1994 (Public Law 103–

432), enacted on October 31, 1994,

requires us to develop a methodology

for a resource-based system for

determining practice expense RVUs for

each physician service. In developing

the methodology, we must consider the

staff, equipment, and supplies used in

providing medical and surgical services

in various settings. The legislation

required the new payment methodology

to be effective for services furnished in

1998.

The legislation specifically requires

that, in implementing the new system of

practice expense RVUs, we must apply

the same budget-neutrality provisions

that we apply to other adjustments

under the physician fee schedule.

Before publication of the final rule in

October 1997, section 4505 of the BBA

1997 delayed initial implementation of

resource-based practice expense RVUs

until 1999. It also required that we do

the following:

• Use, to the maximum extent

practicable, generally accepted cost

accounting principles that recognize all

staff, equipment, supplies, and

expenses, not solely those that can be

linked to specific procedures.

• Consult with organizations

representing physicians regarding

methodology and data to be used.

• Develop a refinement method to be

used during the transition.

• Consider impact projections that

compare new proposed payment

amounts to data on actual physician

practice expenses.

4. Originally Proposed Methodology for

Developing Resource-Based Practice

Expense Relative Value Units

To implement the October 1994

legislation, we published a proposed

rule on June 18, 1997 (62 FR 33158). In

the proposed rule, we established a

framework in which practice expenses

were divided into direct and indirect

costs. Direct costs are those costs that

can be directly attributed to providing a

service, such as the cost of a nurse’s

time (salary), medical supplies and

equipment, administrative costs of

billing, record maintenance, and the

scheduling of office patients. Direct

costs also include the physician’s costs

of office staff time for scheduling

appointments and billing and collection

activities associated with a medical

procedure furnished in a hospital.

Indirect costs cannot be directly

attributed to a specific service, and

include costs such as rent, utilities,

office equipment and supplies, and

accounting and legal fees. The

allocation of indirect costs to specific

products or services is a classic

accounting problem. The indirect costs

are difficult to relate directly to a

specific service because they are

incurred by the practice as a whole.

The June 1997 proposed rule (62 FR

33172) described the following

methodology for calculating the

proposed direct practice expense RVUs.

• We calculated the total pool of

practice expense RVUs for 1995 and

divided it into direct and indirect

practice expense pools using the

American Medical Association’s

(AMA’s) Socioeconomic Monitoring

System (SMS) survey data and our 1995

national claims history data. The

national distribution of direct and

indirect practice expense RVUs was 55

percent direct practice expense RVUs

and 45 percent indirect practice expense

RVUs.

• The underpinning for the proposed

direct components of the practice

expense RVUs was the data reported by

the Clinical Practice Expert Panels

(CPEPs) for clinical and administrative

labor, medical supplies, and medical

equipment inputs. There were 15

CPEPs, corresponding to the major

medical specialties, which were made

up of nominees from all major specialty

societies. (A description of the CPEPs is

contained in the June 1997 proposed

rule (62 FR 33161).) (See Addendum A

for a detailed description of the CPEP

process.)

• These data were edited to apply

Medicare payment policy rules to

ensure that the reported data were

consistent with our national hospital

and physician payment policies. The

primary adjustment was the removal of

direct inputs recorded for clinical labor

staff, medical equipment, and medical

supplies furnished to hospital patients.

Other adjustments were made for the

professional component of a service, the

technical component of a service, and

the combined service, for codes that

have an indicator of ZZZ under the

physician fee schedule, and for certain

allergy and immunotherapy codes

performed on a per-test, per-dose, or

per-vial basis.

• We believed that the relative

relationships of the staff time estimates

within the individual CPEPs were

generally correct but that the absolute

time estimates needed normalization.

We placed the codes from the different

CPEPs on the same scale using a

normalization process that we call

‘‘linking.’’ Specifically, linking shifted

an entire CPEP’s data relative to other

CPEPs’ data, based on the relationship

of the values assigned across panels for

codes that had been assigned to

multiple CPEPs. We separately linked

clinical and administrative labor costs.

Statistically, the linking was done using

regression methods.
30822 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

• After the data were edited and

linked, our physicians and clinical staff

analyzed the direct practice expense

RVUs to determine if there were

unexplainable variations in the

underlying CPEP data. This review

resulted in the application of two

general reasonableness rules. First, a

decision was made to cap the

administrative time of several categories

of service (services without a global

period and procedures subject to global

periods with zero follow-up days) at the

administrative time assigned to CPT

code 99213 (midlevel office visits).

Second, we decided to cap the

nonphysician clinical staff time at 1.5

times the physician time, in minutes, for

performing the procedure. Additional

more specific rules were applied to

certain supplies and supply costs and

for certain codes, such as

psychotherapy, physical therapy,

chemotherapy, and nerve block codes.

• The aggregate percentage shares

across all specialties of labor and

medical supplies and equipment from

the CPEP data were scaled to the

percentage shares of these categories

from the AMA’s SMS survey data. The

CPEP expenses for labor, medical

supplies, and medical equipment were

adjusted by scaling factors of 1.21, 1.06,

and 0.39 respectively.

• The direct practice expense dollar

amounts were converted into direct

practice expense RVUs. An adjustment

factor of 0.65 was used to convert the

aggregate direct practice expense dollars

to the available Medicare direct practice

expense dollars.

• Aggregate indirect practice expense

RVUs were allocated to individual

codes based on the code-specific sum of

the direct practice expense, the

malpractice expense, and the physician

work RVU.

• The direct and the indirect practice

expense RVUs per code were combined

to produce a single practice expense

RVU per code.

Other practice expense proposals in

the June 1997 proposed rule (62 FR

33160) included:

• Replacement of the current site-ofservice differential policy that

systematically reduces the practice

expense RVUs by 50 percent for certain

procedures with a policy that would

generally identify two different levels

(office or nonoffice) of practice expense

RVUs for each procedure code

depending on the site of service.

• Elimination of the current policy

that allows additional practice expense

RVUs for supplies that are used incident

to a physician service but were not the

type of routine supplies included in the

current practice expense RVUs for

specific services. These supplies were

included in the CPEP data for the

specific procedure code.

• Reduction of the practice expenses

for multiple nonsurgical services

performed at the same time as an

evaluation and management service.

The June 1997 proposed rule

provided for a 60-day comment period

ending on August 18, 1997.

5. Balanced Budget Act of 1997

Provisions Pertaining to Resource-Based

Practice Expense Relative Value Units

On August 5, 1997, the President

signed into law the Balanced Budget Act

of 1997 (BBA 1997). Section 4505(a) of

BBA 1997 delayed the effective date of

the resource-based practice expense

RVU system until January 1, 1999. In

addition, BBA 1997 provided for the

following revisions in the requirements

to change from a charge-based practice

expense RVU system to a resource-based

method.

Instead of paying for all services

entirely under a resource-based system

in 1999, section 4505(b) of BBA 1997

provided for a 4-year transition period.

The practice expense RVUs for the year

1999 will be the product of 75 percent

of the previous year’s RVUs (1998) and

25 percent of the resource-based RVUs.

For the year 2000, the percentages will

be 50 percent charge-based and 50

percent resource-based. For the year

2001, the percentages will be 25 percent

charge-based and 75 percent resourcebased. For subsequent years, the RVUs

will be totally resource-based.

Section 4505(c) of BBA 1997 required

the Comptroller General to review and

evaluate our proposed rule and report to

the Congress by February 1998. The

review was required to include an

analysis of (1) the adequacy of the data

used in preparing the rule, (2) categories

of allowable costs, (3) methods for

allocating direct and indirect expenses,

(4) the potential impact of the rule on

beneficiary access to services, and (5)

any other matters related to the

appropriateness of resource-based

methodology for practice expenses. The

Comptroller General was also to consult

with representatives of physician

organizations with respect to matters of

both data and methodology.

Section 4505(e) of BBA 1997 provided

that, for 1998, the practice expense

RVUs be adjusted for certain services in

anticipation of the implementation of

resource-based practice expenses

beginning in 1999. Practice expense

RVUs for office visits were increased.

For other services whose practice

expense RVUs (determined for 1998)

exceeded 110 percent of the work RVUs

and which were provided less than 75

percent of the time in an office setting,

the 1998 practice expense RVUs were

reduced to a number equal to 110

percent of the work RVUs. This

limitation did not apply to services that

had a proposed resource-based practice

expense RVU in the June 1997 proposed

rule that was an increase from its 1997

practice expense RVU. The total of the

reductions was less than the statutory

maximum of $390 million. The

procedure codes affected and the final

RVUs for 1998 were published in the

October 31, 1997 final rule (62 FR

59103).

Section 4505(d)(2) of BBA 1997

required that the Secretary transmit a

report to the Congress by March 1, 1998,

including a presentation of data to be

used in developing the practice expense

RVUs and an explanation of the

methodology. A report was submitted to

the Congress in early March 1998.

Section 4505(d)(3) requires that a

proposed rule be published by May 1,

1998, with a 90-day comment period.

For the transition to begin on January 1,

1999, a final rule must be published by

October 31, 1998.

BBA 1997 also required that we

develop new resource-based practice

expense RVUs. In developing these new

practice expense RVUs, section

4505(d)(1) required us to: (1) Utilize, to

the maximum extent practicable,

generally accepted accounting

principles that recognize all staff,

equipment, supplies, and expenses, not

just those that can be tied to specific

procedures, and use actual data on

equipment utilization and other key

assumptions; (2) consult with

organizations representing physicians

regarding the methodology and data to

be used; and (3) develop a refinement

process to be used during each of the 4

years of the transition period.

6. HCFA Response to BBA 1997

Requirements

BBA 1997 required us to develop new

resource-based RVUs and to consult

with physician organizations regarding

methodology and data. To meet the BBA

1997 requirements and to promote input

as we developed new RVUs, we have

sought and will continue to encourage

maximum input from those affected by

this initiative. The following is a

summary of activities we have

undertaken.

• Validation Panel Meetings.

We hosted 17 medical specialty

panels that were charged with

validating the CPEP direct cost data for

the high-volume CPT codes for each

specialty. All the major medical

specialty societies were represented,

including nonphysician organizations.
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30823

Each panel, consisting of about 12 to 15

members, was made up of the

appropriate specialists, two general

surgeons, two primary care physicians,

and two Medicare carrier medical

directors. The panel members reviewed

and, if they believed necessary, revised

the clinical and administrative times

and the supplies and equipment

involved for each code. Consensus

within panels was reached on about 200

codes.

• Cross Specialty Panel.

Although the October validation

panels were able to reach consensus on

many high-volume procedures within

specific specialties, we were concerned

that there was not a uniform or

consistent scale applied to labor inputs

across specialties. Therefore, in

December, we convened a multiple

specialty panel of 37 panelists,

including physicians, nonphysicians,

and administrators nominated by the

specialty societies.

We expected the panel to help us

achieve consistency across panels on

resource inputs, such as insurance

billing and transcription times, and to

standardize the clinical staff types for

similar classes of services, whether they

be registered nurses, medical assistants,

licensed practical nurses, or a mix of

these staff types. The results of the cross

specialty panel were generally

unsuccessful. While the panel did

provide the arena for panelists to

furnish explanations of times for

activities that we believed to be

excessive, the panelists were generally

reluctant to make any major

modifications in the times or staff they

had assigned to their own services. The

panelists could not agree to any rules

that would aid us in standardizing the

data.

The panelists did recommend that we

explore an option that treats billing and

insurance activities as indirect costs.

Many panelists also suggested that we

proceed cautiously and try to minimize

the magnitude of redistribution.

• Indirect Cost Symposium.

We convened a meeting on November

21, 1997 on indirect practice expenses

to provide a forum for participants to

discuss their preferred methodology for

allocating indirect costs. We asked those

organizations that commented on our

proposed indirect cost methodology to

make a formal presentation of their

views. All major medical specialty

groups were invited to attend and join

in the discussion.

Some groups endorsed the

methodology we proposed in the June

1997 proposed rule (62 FR 33172) with

some modifications. One modification

recommended was to eliminate

malpractice RVUs as a factor in

allocating indirect costs. It was noted,

even by some advocates for other

allocation methods, that our proposed

methodology embodied traditional

accounting methods for allocating

indirect costs.

Only two major alternatives to our

proposed methodology were presented.

The first, the Activity Based Costing

(ABC) method, was described as a

cutting edge approach to determining

the cost of individual products (CPT

codes). Under the ABC method, the total

costs of a practice are collected and

assigned to discrete processes or

activities. These costs are then assigned

to products to which they are related.

The ABC method was developed for

industries in which direct labor (the

traditional cost accounting method for

allocating indirect costs) is not the

dominant factor in the production of the

good or service. This method is in the

early developmental stages in medical

practice use.

The second alternative methodology

presented was the physician work RVU

method of allocating indirect practice

expenses. This method would allocate

indirect costs using only the physician

work RVUs. However, there did not

appear to be much support for this

methodology at the meeting. It would,

for example, penalize physician

practices that have proportionately

higher equipment costs.

• October 31, 1997 Notice with

Comment Period

• To inform all interested parties of

our plans to issue a new proposed rule

and to request additional data from the

medical community to assist us in

meeting BBA 1997 requirements, on

October 31, 1997, we published a notice

(62 FR 59267).

In that notice, we requested that

physicians, physician organizations, or

others provide us with the following

information:

• Generally accepted cost accounting

principles—We specifically requested

information on the following: (1)

Aspects of the cost accounting

methodology used in the June 1997

proposed rule that were not consistent

with the statutory guidance; and (2)

complete copies of studies of resourcebased practice expense RVUs, including

any underlying surveys supporting

these studies, performed by physicians

or physician groups or their contractors

or consultants, including pertinent

details about the survey.

• Equipment utilization—We

specifically requested complete copies

of any studies or other data showing the

actual utilization of equipment by

physician practices, including pertinent

details about the survey, such as

response rates, sampling design,

methodology, directions, and

definitions.

• Other assumptions—We

specifically requested information

regarding the useful life of equipment,

the amount and percentage of direct

practice costs versus the amount and

percentage of indirect costs by specialty,

and practice expense values for sites for

which values were not proposed in the

June 1997 proposed rule (62 FR 33158).

• Use of physician-employed staff in

hospitals and other facility settings—We

specifically requested comments and

information about the extent to which a

physician employee, such as a

registered nurse, accompanies the

physician to the hospital, ambulatory

surgical center, or other facilities to

provide services, such as acting as an

assistant at surgery or serving as a scrub

nurse. We asked for names of specific

facilities so that we might contact them

in order to more fully understand the

nature of the relationships.

• Refinement process—We requested

comments on how this refinement

process would operate including

assigning practice expense RVUs to new

codes, who would be involved in the

refinement process, and how all of the

users of the physician fee schedule

would have access to the process.

• Review of New Methodology by

KPMG Peat Marwick LLP—Under

contract #500–97–0402, we requested

that KPMG Peat Marwick LLP review

the practice expense per hour

methodology. They concluded that the

methodology follows reasonable cost

accounting principles. They made this

determination based on an examination

of the available data sources and a

consideration of the cost and feasibility

of acquiring additional nationally

representative data. As a future

consideration, they recommended

sample validation of our cost allocation

bases.

7. Summary of General Input From the

Medical Community and Comments

From the October 1997 Notice With

Comment Period

Some physicians, such as primary

care physicians, expressed satisfaction

that the proposed methodology was

generally sound. In addition, the AMA

was supportive of our panel process for

direct expenses and offered many

helpful comments. However, many

surgeons and medical specialties argued

that we should discard our current

practice expense data, and develop

payments that reflect their ‘‘actual

costs.’’
30824 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

Both in written comments and in our

meetings with the medical community,

we received much feedback on our

methodology for indirect practice

expense. However, there was no

consensus regarding methods for

allocating indirect costs to individual

procedure codes.

In addition, we received 56 specific

comments from individuals, major

organizations, and physician specialty

groups on our October 1997 notice. The

comments are summarized by the

following categories:

• Generally Accepted Accounting

Principles.

Some of the groups expected to

experience an increase in payment

under the June 1997 proposed rule

thought our approach satisfied the

current statutory mandate that we

utilize generally accepted accounting

principles (GAAP). Those physician

groups that expected to experience a

decrease in payments based on the

methodology described in the June 1997

proposed rule said the approach in the

proposed rule was inconsistent with

GAAP. They argued that GAAP requires

us to use actual practice expense data

and said the data from the CPEPs and

validation panels were based on

erroneous assumptions, or were

unverified approximations. At least five

commenters supported using the

activity-based accounting approach.

• Equipment utilization.

Some groups furnished equipmentspecific utilization levels for a few

services. Generally, the equipment and

utilization levels were not based on

representative surveys of physicians

performing the service. Some

suggestions were as follows:

Percent

Electroencephalography equipment.26

Electromyography ....................... 36.5

Nerve Conduction Velocity ......... 36.5

Cystoscope ................................. 5

Loop electrode excision procedure.1

Colposcope ................................. 1.6

YAG laser ................................... 12

ARGON laser .............................. 5 to 6.4

Fundus camera ........................... 31.3

Spirometry and Ancillary Equipment.10 to 17

Bronchoscopy ............................. 5 to 10

• Useful Life.

We did not receive specific comments

on suggested useful lives for specific

medical equipment, which is an

important factor in estimating

equipment costs.

• Direct and Indirect Costs.

Some commenters pointed out that

not all clinical labor can be classified as

direct costs. Tasks such as ordering

supplies and attending meetings or

continuing education classes should be

captured as indirect costs. Some groups,

including one primary care group, said

that billing costs should be an indirect

expense, while others supported

maintaining them as direct costs. Many

groups supported an allocation process

in which indirect costs are assigned

based on a specialty’s specific indirect

cost percentage. Only one group

specifically objected to this approach.

Some physician groups provided

specific direct and indirect cost ratios

based on limited surveys of their

membership.

• Employed Staff.

According to an American Hospital

Association survey, 63 percent of

respondents (from 573 hospitals)

believed that a physician brought staff

to the hospital during the last 6 months

of 1996. Of these respondents, 82

percent said this was not a regular

practice. Therefore, the American

Hospital Association commented it is

not a typical practice in the United

States for physicians to bring their own

staff to a hospital.

Five surgical specialties and

subspecialties—neurosurgery,

ophthalmology, general thoracic

surgery, congenital thoracic surgery, and

adult cardiac surgery—indicated that at

least 50 percent of practices use

employed clinical staff in nonoffice

settings. General surgery indicated that

31 percent of general surgery practices

pay for clinical staff working in

nonoffice settings. The Society of

Thoracic Surgeons stated that they do

not have data on the number of clinical

nurses who work with thoracic surgeons

in hospitals. However, they stated that

a survey of physician assistants shows

that 72 percent of physician assistants

employed in cardiovascular surgery

were employed by solo or group

physician practices.

According to the American Academy

of Ophthalmology, 51 percent of

ophthalmologists bring equipment, such

as keratomes, diamond knives, cataract

trays, and muscle trays to furnish

services to hospital patients.

• Refinement.

Most commenters support using the

AMA’s Specialty Society Relative Value

Update Committee’s (RUC’s) process to

refine the practice expense RVUs.

(Currently the RUC recommends

refinement of the physician work

RVUs.) Of these commenters, many

recommended that the process include

nurses and practice managers, that there

be established rules and procedures for

data collection, survey design, and

response rates, and that the process

allows participation by subspecialties,

such as transplant surgeons and

pediatric surgeons. One commenter

suggested a process using the AMA,

Medical Group Management

Association (MGMA), and HCFA. Some

commenters suggested using a RUC

process only for new codes.

• Transition.

Several commenters stated that the

base year for the transition should be

the 1997 practice expense RVUs and not

the 1998 practice expense RVUs. They

suggested that the 1998 adjustment

required by BBA 1997 is not intended

to be included in the base for purposes

of the practice expense transition. Some

commenters recommended that we

explore using ceilings and floors during

the transition period or use caution so

as to limit the amount of the

redistribution.

• Site-of-Service Differential.

Commenters from the American

Academy of Orthopaedic Surgeons

stated that we need office practice

expense RVUs for musculoskeletal

system surgery codes 25000, 25031,

26040, 26060, 26608, 29815 through

29848, and 29870 through 29898. Some

commenters believe we should develop

practice expense RVUs for all

procedures at all sites and permit office

endoscopy only under very limited and

clearly defined standards.

• Data Quality.

The American College of Surgeons

stated that the CPEP data are based on

erroneous assumptions, educated

guesses, and unverified approximations.

They stated that the data from panels

are unreliable for the administrative

times for chiropractic manipulation,

level 3 office visits, inpatient

consultations, balloon angioplasty, and

clinical times for allergy skin testing.

• Validation.

The AMA stated that we should use

AMA and MGMA data on full time

equivalent staff for each physician to

assess how well various methodological

options account for total labor costs.

The American College of Physicians

suggested we complete an impact

analysis that compares proposed

practice expense payments to actual

practice expenses on a specialty by

specialty basis, as well as sponsoring a

study requiring on-site visits to

practices.

8. Issues Considered in Developing New

Practice Expense RVUs

We faced the following major issues

as we decided whether and how to

modify our original proposal for

physician practice expense RVUs. These

issues arose from many sources: from

concerns about the CPEP data and our
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30825

original proposed methodology, from

the requirements of BBA 1997, from the

findings and recommendations in the

General Accounting Office’s Report to

the Congress on physician practice

expense, and from input we received

from the medical community.

• Purpose.

Our original practice expense

proposal was based on the 1994

legislation, which stated that the new

practice expense methodology must

consider the staff, equipment, and

supplies used in the provision of

various medical and surgical services in

various settings. We interpreted this to

mean that Medicare payments for each

service should be based on the relative

resources typically and reasonably

involved with performing the service.

We believed we could best calculate

these resources by achieving clinical

consensus on the actual inputs it would

typically take to perform a given service.

However, surgeons and some other

specialties contended that the purpose

of a resource-based practice expense

system should be to reimburse them

based on their total current

expenditures for practice costs. Because

the higher paid specialties have more to

spend on their practices as a result of

historic charging practices and

insurance coverage, there is a concern

that adopting such a methodology

would not achieve the desired equity.

The argument made by some outside

groups is that physicians have been

increasingly forced to be more efficient

and, as a result, differences in practice

expenses among specialties reflect

‘‘real’’ costs that should then be

reflected in the new practice expense

RVUs.

With the passage of BBA in August

1997, the statute now requires us to

‘‘utilize, to the maximum extent

practicable, generally accepted cost

accounting principles which recognize

all staff, equipment, supplies, and

expenses, not just those which can be

tied to specific procedures. * * *’’

Therefore, in developing and analyzing

any new alternative methods for

computing practice expense RVUs, we

have evaluated how well each option

recognizes all practice expense costs.

• ‘‘Bottom-up’’ versus ‘‘Top-down’’

Methodology.

In line with our original stated

purpose and the 1994 legislation, our

practice expense methodology

published in the June 1997 proposed

rule (62 FR 33172) used a ‘‘bottom-up’’

approach, which obtained expert panel

estimates of actual inputs—staff times,

supplies, and equipment—for each

procedure and then used these estimates

to build up to the direct practice

expense RVUs. Some groups

complained that some of the published

relative values were too low and favored

using studies that actually measured the

inputs onsite. Unfortunately, if any

reliable data exist at all, they are only

for a few scattered specialties, and it

certainly is not practical for us to

undertake such a task (Medicare pays

physicians for over 7,000 services). We

understand that even the few specialties

that have attempted surveys have had

limited success obtaining complete

practice expense data from even limited

selected practices.

Many of the specialty societies

favored a ‘‘top-down’’ methodology,

which would start our calculations with

their total current expenditures and

then allocate these costs down to the

procedure level by some method.

Several groups supported using an

Activity Based Costing (ABC)

methodology for calculating practice

expenses. The proponents of ABC

maintain that it produces more accurate

costs because it measures the costs of

processes (for example, servicing

patients, scheduling, and billing) as

opposed to traditional costing systems,

which measure resources (for example,

salaries and rent). However, ABC is only

in the experimental stages in medical

practice use, and many difficult

questions about its utility in medical

practices have not been resolved, for

example, its assumption that all medical

practices operate in the same manner.

ABC still requires subjective

estimations, or some other algorithm, to

allocate costs from ‘‘processes’’ to

individual CPT codes.

• Available Data Sources.

Much of the debate about what would

constitute the most accurate practice

expense methodology cannot be

resolved in the short run. There is no

consensus about the best way to

determine the most accurate practice

expense methodology. Furthermore,

there are only limited data sources

available. CPEP data, along with the

modifications made by our subsequent

panels, are the only source of estimates

at the CPT code level of resource inputs

needed to provide each service. AMA’s

SMS survey data are from a national

survey of randomly selected selfemployed physicians that collects

information on practice expense on an

aggregate level, and can be used to

determine overall differences in

expenditures among specialties.

The only other relevant data sources

of which we are presently aware are a

few other surveys of practice expense,

such as those performed by the MGMA,

Medical Economics, and the American

College of Surgeons. Because of

selective sampling and low response

rates of these three surveys, these data

are not representative of the population

of physicians and cannot be used to

derive code-specific RVUs, though the

data might prove useful in validating

general impacts.

• Specialty-Specific Differences.

Our June 1997 proposed rule did not

explicitly recognize specialty-specific

differences. Differences across

specialties were only reflected

implicitly to the extent that more

indirect RVUs would be allocated to

those procedures with the greatest

physician work and direct costs. Under

our June 1997 proposed approach, we

allocated indirect relative values based

on the typical use of resources, that is,

the direct practice expense RVUs, the

physician work RVUs, and the

malpractice RVUs per code.

The specialty groups, along with the

AMA and even some primary care

groups, were almost unanimous in their

view that we should use an approach

that explicitly recognizes specialtyspecific differences in the indirect cost

of practice. It was pointed out, as an

example, that some specialties such as

radiology or ophthalmology would have

much higher indirect equipment costs

than other specialties. The specialty

groups believed that not recognizing

such specialty differences would be

inherently unfair to some specialties.

The AMA staff suggested that we use

their survey data to calculate the

specialty-specific indirect costs.

In developing our options for a new

practice expense methodology, we,

therefore, needed to decide whether we

would maintain specialty-neutral

methods, use specialty differentials to

help allocate only indirect RVUs, or use

specialty-specific data to establish the

total redistributive pools for each

specialty.

• Administrative Costs.

Another decision we had to make as

we developed new practice expense

RVUs was how a new proposal would

treat administrative costs. The June

1997 proposed rule (62 FR 33167)

methodology treated administrative

labor cost as a direct expense, and the

administrative cost RVUs were derived

from the CPEP data. On first reviewing

the raw CPEP inputs for administrative

staff times, it appeared that there were

some problems with the data. First,

some of the suggested administrative

staff times appeared excessively high,

particularly for the billing staff. Second,

there was variation in staff times for the

same CPT code between the different

panels. In the June 1997 proposed rule

(62 FR 33166), we dealt with these

problems through our linking
30826 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

methodology and by capping

administrative times. Both of these

methods were strongly opposed by

many specialty groups, largely because

our adjustments had dramatic effects on

the raw data. For example, the linking

coefficient for thoracic surgery reduced

their administrative inputs by 76

percent. There were also comments

claiming that many administrative

duties are of a general nature that

cannot be fully captured on a codespecific basis.

As a result of these concerns, many

outside groups have suggested that we

treat administrative cost as an indirect

practice expense. The advantages of

adopting this suggestion would be that

we could get around the mentioned data

discrepancies, avoid the controversial

use of linking for administrative labor,

and be more certain that we had

captured all administrative costs. The

main disadvantage would be that it

would greatly increase the percentage of

RVUs that would have to be allocated by

a formula.

• Clinical Costs.

Although the problems were on a

lesser scale, we observed many of the

same difficulties with the raw CPEP

inputs for clinical costs as there were for

the administrative costs discussed

above. There was some lack of

standardization of clinical staff types

between the CPEP panels, and some

staff times appeared excessive. In the

June 1997 proposed rule, these

problems were addressed by linking and

by capping the clinical times; both of

these methods caused considerable

controversy in the medical community.

We had hoped that the validation and

cross-specialty panels would have

resolved the inconsistencies across

specialties, but they were unable to

accomplish this task. It was clear,

therefore, that any new proposal would

still have to address a method of

standardizing the data between the

various specialty panels.

• The General Accounting Office

(GAO) Report to Congress on Physician

Practice Expense.

As already mentioned, BBA 1997

required the GAO to review and

evaluate our June 1997 proposed rule on

a resource-based methodology for

practice expenses. This report was

issued in February 1998 and concluded

that both our use of expert panels to

develop direct cost estimates and our

original allocation methodology for

indirect costs were acceptable options.

However, the GAO raised questions

about the validity of some specifics of

the linking regression model and about

the appropriateness of capping

administrative and clinical labor time

estimates. In addition, the report

suggested that using specialty-specific

indirect expense ratios, based on the

SMS survey data, would be more clearly

consistent with BBA 1997. Also, the

report recommended that we consider

classifying administrative labor costs as

indirect expenses. (See section 18 for a

more detailed discussion of the report’s

recommendations.)

9. Alternative Practice Expense

Methodologies Considered

We carefully considered two

alternative approaches to developing

new practice expense RVUs: the first

maintained the ‘‘bottom-up’’

methodology of our original proposal,

while the second adopted a ‘‘top-down’’

methodology.

• ‘‘Bottom-up’’ Option.

We regard our original ‘‘bottom-up’’

proposal as a viable method of

developing practice expense RVUs. It

clearly fulfilled the requirement of the

Social Security Amendments of 1994,

which states that practice expense

relative values should be based on the

relative practice expense resources

involved in furnishing the service. Both

the GAO and the Physician Payment

Review Commission, as well as many

researchers in the field, supported our

use of expert panels to estimate direct

practice expenses. Therefore, we

developed a method that was similar to

our original proposal.

Like our proposal in the June 1997

proposed rule, this option based its

calculation for all direct inputs on the

data reported by the CPEPs. As before,

both clinical and administrative labor

were linked, and all direct cost

estimates were scaled as in the original

proposed rule. However, in a significant

departure from our original proposal,

the caps on clinical and administrative

staff times were eliminated. For indirect

costs, this option continued not to

recognize a specialty-specific method of

cost allocation to specific procedures. It

did, however, have a different indirect

allocation formula from our original

proposal; under this option, 50 percent

would be allocated on the basis of direct

costs and 50 percent on the basis of

physician time. Of the latter 50 percent,

physician time in the office would get

a weight 50 percent higher than

physician time out of the office. If there

was no physician involvement, as is the

case with technical component services,

the maximum clinical staff time would

be used.

• The ‘‘Top-Down’’ Option.

This option is a departure from our

original proposal and is an effort to

balance the requirements of the 1994

Social Security Amendments with the

1997 BBA requirements. It uses the two

significant sources of actual practice

expense data we have available: the

CPEP data and the AMA’s SMS survey

data. It allocates current aggregate

specialty practice costs to specific

procedures and, thus, can be seen as a

‘‘top-down’’ approach.

This option is based on an

assumption that current aggregate

specialty practice costs are a reasonable

way to establish initial estimates of

relative resource costs of physician

services across specialties. The specialty

practice cost data are derived from the

AMA’s SMS survey data on actual

practice expenses. The survey data are

used to calculate the practice expenses

generated for every hour worked by a

physician. The average practice expense

per hour for the physicians in a given

specialty is then multiplied by the total

number of physician hours worked by

that specialty as reflected in the

Medicare claims data. This determines

the total pool of practice expense

payments for that specialty. We then

allocated this pool to the procedures

performed by that specialty using the

CPEP data (excluding the administrative

staff time associated with specific

procedures) and the physician work

RVUs. We calculated a weighted average

of the practice expense payments for

procedures performed by more than one

specialty.

After much analysis and discussion,

we have decided to propose the ‘‘topdown’’ methodology. We believe the

‘‘top-down’’ methodology is more

responsive than the ‘‘bottom-up’’

approach to both BBA 1997

requirements and to many of the

concerns of the medical community. By

using aggregate specialty practice costs

as the basis for establishing the practice

expense pools, we are recognizing all of

a specialty’s costs, not just those linked

with a specific procedure. By basing the

redistributions of the practice expense

system on physician-reported actual

practice expense data, by using a

specialty-specific allocation method,

and by treating administrative costs as

an indirect expense, we avoid many of

the criticisms leveled at our original

proposal.

We also believe this option is

responsive to the short-term

recommendations in the GAO Report to

Congress on physician practice expense

payments relating to the June 1997

proposed rule’s limits on clinical and

administrative staff time and possible

changes in the linking algorithm. Our

recommended methodology would

make these recommendations moot by

eliminating the limits and linking

algorithm that were part of our previous
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30827

proposal. Finally, based on our

experiences with the validation panels

we held in October and December 1997,

we believe the ‘‘top-down’’ approach

will be less difficult to refine.

10. Description of the Proposed

Methodology for Developing Practice

Expense Relative Value Units

(See Addendum B for a detailed

technical description of the proposed

methodology.)

a. Overview. We used actual practice

expense data by specialty to create six

cost pools (administrative labor, clinical

labor, medical supplies, medical

equipment, office supplies, and all

other). We then allocated these cost

pools to individual procedure codes. An

overview of this approach is presented

in Exhibit 1.

Exhibit 1. Overall Allocation Approach

b. Data Sources. We used the 1995

through 1997 AMA’s SMS survey data

to develop the cost pools and the CPEP

data to allocate these cost pools to

procedure codes.

The AMA originally developed the

SMS in 1981. It covers a broad range of

economic and practice characteristics.

The annual SMS survey is designed to

provide representative information on

the population of all non-federal

physicians who spend the greatest

proportion of their time in patient care

activities. The survey is sent to both

office and hospital-based physicians,

but excludes residents. The recipients of

the survey are randomly selected from

the AMA’s physician master file, which

contains current and historical

information on every physician in the

United States, including nonmembers of

the AMA.

The SMS survey consists of three

distinct sections:

• Screening questions to verify the

physician’s self-designated practice

specialty and eligibility for the survey.

• A main questionnaire to collect

information on practice characteristics,

hours worked, volume of services, fees

for selected procedures, income, and

expenses.

• Special topic questions to provide

information on key socioeconomic

issues.

The SMS survey is a computerassisted telephone survey that checks

the consistency of responses during the

survey and automatically skips

questions that are not relevant to the

physician. To prepare the physician, the

AMA mails a practice expense summary

in advance. The physician may

designate a proxy such as a practice

manager or an accountant to answer the

practice expense questions. The AMA

makes vigorous efforts to achieve a high

response rate despite the short field

period of surveys. Each interviewer’s

work is monitored by supervisory staff

for both production and quality. AMA

staff also monitors interviews to ensure

that a high level of quality is maintained

throughout the survey.

The CPEP data were collected from

panels of physicians, practice

administrators, and nonphysicians (for

example, registered nurses) who were

nominated by physician specialty

societies and other groups. There were

15 CPEPs consisting of 180 members

from more than 61 specialties and

subspecialties. Approximately 50

percent of the panelists were

physicians. The CPEPs identified the

direct inputs involved in each physician

service for procedure codes in an office

setting and out-of-office setting. (See

Addendum A for a detailed description

of the CPEP process.)

c. Practice Expense Cost Pools. We

created practice expense cost pools by

physician specialty for clinical labor,

administrative labor, medical supplies,

medical equipment, office supplies, and

all other expenses. There are three steps

in the creation of the cost pools.

Step 1: Use the AMA’s SMS survey

data of actual cost data, by physician

specialty, for 1995 through 1997 to

determine practice expenses per hour by

cost category.

Step 2: Determine the total number of

physician hours, by specialty, spent

treating Medicare patients as reflected

in the Medicare claims data.

Step 3: Calculate the practice expense

pools by specialty and by cost category

using the results from step 1 and step 2.

A short description of each step

follows.

Step 1: Determine practice expenses

per hour by cost category.

Based on the AMA’s SMS survey data

for each physician respondent, we

calculated practice expenses per hour

spent in patient care activities by cost

pool. We made the following

assumptions in this calculation:

• The physician respondent shares

practice expense equally with all other

physician owners in the practice.

• The physician respondent works

the same number of hours as all other

physician owners in the practice.

• For any employee physician in the

practice, the hours spent in patient care

activities are the average hours spent in

patient care activities for employee

physicians in the specialty of the

physician respondent.

Using the above assumptions, the

practice expenses per hour for each

physician respondent’s practice was

calculated as the practice expenses for

the practice divided by the total number
30828 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

of hours spent in patient care activities

by the physicians in the practice. The

practice expenses per hour for the

specialty are an average of the practice

expenses per hour for the respondent

physicians in that specialty.

Step 2: Determine the number of

physician hours spent treating Medicare

patients.

For each specialty, the total number of

physician hours spent treating Medicare

patients was calculated from physician

time data for each procedure code and

the Medicare claims data. The primary

sources for the physician time data are

surveys submitted to the AMA’s RUC

and surveys done by Harvard for the

initial establishment of the work RVUs.

Step 3: Determine the practice

expense pools by specialty and by cost

category.

The practice expense cost pools for

clinical labor, administrative labor,

medical supplies, medical equipment,

office expenses, and all other expenses

are determined by multiplying the

practice expenses per hour for these

categories (calculated in step 1) by the

total physician hours (calculated in step

2).

d. Cost Allocation Methodology

We allocated by specialty each

practice expense cost pool to individual

procedure codes either using the CPEP

data for clinical labor, medical supplies,

and medical equipment, or using a

combination of the CPEP data for

clinical labor, medical supplies, and

medical equipment and the physician

fee schedule work RVUs.

Exhibit 2 depicts our cost allocation

methodology. For each specialty, the six

cost pools and their respective cost

allocation bases are used to determine

costs for each procedure code.

Exhibit 2. Cost Allocation Methodology

Step 4: Allocate the practice expense

pools by specialty to individual

procedures.

For each specialty, we separated the

six practice expense pools (clinical

labor, administrative labor, medical

supplies, medical equipment, office

expenses, and all other expenses)

created in Step 3 into two groups and

used a different allocation basis for each

group. Group one includes clinical

labor, medical supplies, and medical

equipment, and group two includes

administrative labor, office expenses,

and all other expenses.

Group one: clinical labor, medical

supplies, and medical equipment.

We used the CPEP data as the

allocation basis for the group one pools

(clinical labor, medical supplies, and

medical equipment). The CPEP data for

clinical labor were used to allocate the

clinical labor cost pool, the CPEP data

for medical supplies were used to

allocate the medical supplies cost pool,

and the CPEP data for medical

equipment were used to allocate the

medical equipment cost pool.

Group two: administrative, labor,

office expenses, and other expenses.

For the allocation of administrative

labor, office expenses, and other

expenses, a combination of the group

one cost allocations and the physician

fee schedule work RVUs was used to

allocate the cost pools.

Step 5: Weight average allocations for

procedures performed by more than one

specialty.

For procedures performed by more

than one specialty, the final procedure

code allocation was a weighted average

of allocations for the specialties that

perform the procedure, with the weights

being the frequency with which each

specialty performs the procedure on

Medicare patients.

11. Comments of the American Medical

Association Regarding the Use of the

Socioeconomic Monitoring System

Survey Data to Construct Practice

Expense Relative Value Units

At our request, the AMA sent two

tables summarizing practice expense

information by physician specialty.

Additionally, the AMA supplied us

with SMS background information and

comments regarding its use to construct

resource-based practice expense RVUs.

The following are the AMA’s

comments as well as two tables derived

from the SMS data:

The SMS survey is an annual nationally

representative survey of physicians drawn

randomly from the AMA’s Physician

Masterfile (a listing of all member and

nonmember physicians in the United States).

The survey was conducted by an external

contractor—the Rand Corporation was the

survey contractor for the 1995 through 1997

SMS surveys. Unit response rates to SMS

have been roughly 60 percent in recent years,

which is as high or higher than comparable

physician surveys. It is a computer-assisted

telephone survey which allows checks to be

made for the consistency of responses during

the survey and to automatically skip

questions that are not relevant to particular

physicians. On the practice expense

questions, special effort is made to obtain

accurate information. A practice expense

summary is mailed to all physicians that are

to be surveyed to allow them to obtain the

information before being contacted. The

physician may designate a proxy such as a
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30829

practice manager or accountant to answer the

practice expense questions if they do not

have the information.

However, it is important to stress that the

SMS data were never collected for the

purpose of developing relative values. We

feel that there are several potential problems

with using SMS data to construct practice

expense RVUs. These concerns were first

raised in a letter from the AMA to HCFA in

November 1996. In particular, we are

concerned that:

—Sample sizes for some specialties will be

too small to permit separate calculation of

expense data from SMS. Even among the

larger specialties, the inherent variability

of the expense data will mean that the

average expense figures provided will be

subject to significant sampling error.

—Response rates for the expense items tend

to be low relative to other questions on the

survey leading to potential non-response

bias.

—SMS is a physician-level survey, and

physicians in groups are asked for their

share of expenses rather than the practice’s

expenses. Practice-level data may provide

a better basis for constructing practice

expense RVUs.

Despite these problems, we recognize your

need to use the best available information.

The tables that you requested show the

means and standard errors of practice

expenses per direct patient care hour from

the 1995 through 1997 SMS surveys. Since

SMS collects practice expense data for the

prior year, these tables summarize SMS

respondents’ hourly expenses for the years

1994 through 1996. Only non-federal, nonresident, patient care physicians are surveyed

on SMS. In addition, only physicians who

are full or part-owners of their practices are

asked the practice expense questions. The

following records were excluded prior to

tabulating the data as you requested:

—Physicians practicing fewer than 26 weeks

the prior year (including cases where

weeks worked the previous year were

missing);

—Cases with a missing response to the

question on typical hours in direct patient

care per week (3 cases where the response

to this question was 168 hours were also

excluded);

—Cases where any of the individual expense

items (total non-physician personnel

expense; clerical non-physician personnel

expense; office expenses; medical supplies

expenses; medical equipment expenses;

and other or miscellaneous practice

expenses) were missing; and

—Cases where total expenses (excluding

professional liability insurance premiums

and employee physician payroll expense)

were zero.

Expenses per hour were calculated as you

requested (and as described in the notes to

the tables). All results were weighted for unit

non-response. It will not be possible to

replicate these figures exactly from the

AMA’s Physician Marketplace Statistics or

Socioeconomic Characteristics of Medical

Practice publications due, in part, to the

exclusions mentioned above.
30830 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

TABLE 1.—MEAN PRACTICE EXPENSES PER HOUR SPENT IN PATIENT CARE ACTIVITIES, HOURS AND EXPENSES

ADJUSTED FOR PRACTICE SIZE

[In dollars]

Specialty Number of

cases

Non-phys

payroll per

hour

Clerical

payroll per

hour*

Office expense per

hour

Supplies expense per

hour

Equipment

expense per

hour

Other expense per

hour

Total expense per

hour**

ALL PHYSICIANS ............. 3910 27.0 15.0 19.1 7.2 3.2 11.0 67.5

GENERAL/FAMILY PRACTICE ............................... 409 30.2 15.1 18.2 8.1 3.6 8.6 68.6

GENERAL INTERNAL

MEDICINE ..................... 430 22.4 13.3 17.0 6.4 2.1 6.2 54.2

CARDIOVASCULAR DISEASE ............................. 94 30.2 14.9 19.9 5.8 6.4 20.7 82.9

GASTROENTEROLOGY .. 84 23.2 15.4 17.9 2.7 1.8 11.0 56.6

ALLERGY/IMMUNOLOGY 31 66.2 27.0 33.3 17.5 3.3 16.4 136.6

PULMONARY DISEASE ... 49 20.0 12.2 15.0 2.8 1.6 6.4 45.8

ONCOLOGY ...................... 27 44.7 22.7 25.7 87.2 5.5 10.3 173.4

GENERAL SURGERY ...... 257 22.5 15.7 17.2 3.1 2.0 9.4 54.1

OTOLARYNGOLOGY ....... 103 44.8 27.3 33.4 7.7 5.8 18.3 110.1

ORTHOPEDIC SURGERY 203 42.9 26.0 30.8 10.3 3.6 18.1 105.6

OPHTHALMOLOGY .......... 210 52.9 27.8 35.9 11.3 9.0 22.7 131.8

UROLOGICAL SURGERY 118 29.6 18.6 22.8 24.5 6.0 11.6 94.6

PLASTIC SURGERY ......... 85 28.6 18.3 30.2 16.3 4.6 23.3 103.0

NEUROLOGICAL SURGERY ............................. 42 33.5 24.3 31.7 1.8 1.1 15.7 83.9

CARD/THOR/VASC SURGERY ............................. 44 30.1 16.2 18.3 1.4 3.1 11.0 63.8

PEDIATRICS ..................... 249 26.1 13.3 20.0 10.8 1.6 8.4 66.9

OBSTETRICS/GYNECOLOGY ........................ 266 32.3 16.9 21.2 7.3 3.4 11.7 75.9

RADIOLOGY ..................... 214 19.0 9.6 12.5 4.8 8.3 13.6 58.2

PSYCHIATRY .................... 351 7.3 5.3 10.1 0.4 0.3 7.5 25.6

ANESTHESIOLOGY ......... 232 14.4 3.7 5.9 0.3 0.4 5.7 26.7

PATHOLOGY .................... 82 16.7 8.4 6.7 4.0 1.6 17.7 46.7

DERMATOLOGY ............... 96 49.5 26.7 33.1 12.5 4.8 15.2 115.0

EMERGENCY MEDICINE 61 5.3 1.9 1.6 0.5 0.1 5.5 13.0

NEUROLOGY .................... 61 26.2 21.6 15.8 5.0 4.2 7.7 58.8

PHYS MED/

RHEUMATOLOGY ........ 75 38.6 23.2 28.5 4.9 3.9 12.0 88.0

OTHER SPECIALTY ......... 37 21.1 12.4 19.7 3.6 1.3 9.7 55.4

Source: American Medical Association, 1995–1997 Socioeconomic Monitoring System (SMS) surveys.

* Clerical payroll is included in total non-physician payroll.

** Total expenses exclude professional liability insurance premiums and employee physician payroll.

Notes:

(1) Only self-employed non-federal non-resident patient care physicians who responded to all relevant expense questions are included.

Self-employed physician respondents with no practice expenses for the year are excluded.

(2) Physicians whose typical number of hours worked in patient care activities per week is missing, less than 20, or equal to 168 (3 cases) are

excluded. Physicians whose number of weeks worked the previous year is missing or less than 26 are excluded.

(3) For each respondent, total practice expense and expense components per hour are calculated as (4)/(5) below.

(4) Expenses adjusted for practice size = self-employed respondent expenses* # physician owners.

(5) Hours adjusted for practice size = (respondent hours* # physician owners) + (employee physician hours (see (6) below)* # employee physicians).

6) The typical number of hours worked in patient care activities for the employee physician(s) of a self-employed physician’s practice is not

known. Mean hours worked in patient care activities for employee physicians of each specialty are used as an estimate of employee physician

hours.
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30831

TABLE 2.—STANDARD ERRORS OF MEAN PRACTICE EXPENSES PER HOUR SPENT IN PATIENT CARE ACTIVITIES, HOURS

AND EXPENSES ADJUSTED FOR PRACTICE SIZE

[In dollars]

Specialty Number of

cases

Non-phys

payroll per

hour

Clerical

payroll per

hour

Office expense per

hour

Supplies expense per

hour

Equipment

expense per

hour

Other expense per

hour

Total expenses per

hour**

ALL PHYSICIANS ............. 3910 0.5 0.3 0.4 0.3 0.2 0.3 1.1

GENERAL/FAMILY PRACTICE ............................... 409 1.3 0.6 1.2 0.5 0.7 0.6 3.0

GENERAL INTERNAL

MEDICINE ..................... 430 1.2 0.6 1.0 0.6 0.3 0.6 2.6

CARDIOVASCULAR DISEASE ............................. 94 2.9 1.4 1.9 0.8 1.3 5.2 8.0

GASTROENTEROLOGY .. 84 1.6 1.1 1.9 0.3 0.3 2.2 4.1

ALLERGY/IMMUNOLOGY 31 7.9 3.8 3.8 4.2 1.5 2.9 11.2

PULMONARY DISEASE ... 49 1.6 1.4 2.2 0.6 0.5 0.9 3.5

ONCOLOGY ...................... 27 7.5 3.8 5.7 16.4 1.4 3.8 23.2

GENERAL SURGERY ...... 257 1.4 0.9 0.9 0.3 0.3 0.8 2.5

OTOLARYNGOLOGY ....... 103 3.0 2.3 3.5 0.9 1.1 2.1 6.8

ORTHOPEDIC SURGERY 203 1.7 1.2 2.1 0.8 0.4 2.0 4.7

OPHTHALMOLOGY .......... 210 2.9 1.4 2.6 1.3 1.1 2.1 6.3

UROLOGICAL SURGERY 118 1.4 1.0 2.1 1.8 1.0 1.4 4.4

PLASTIC SURGERY ......... 85 2.3 1.4 3.5 2.8 1.0 3.4 8.1

NEUROLOGICAL SURGERY ............................. 42 4.0 2.5 5.7 0.7 0.4 2.1 9.4

CARD/THOR/VASC SURGERY ............................. 44 4.2 2.0 2.9 0.3 1.7 2.2 8.0

PEDIATRICS ..................... 249 1.6 0.7 1.7 1.0 0.3 1.2 3.8

OBSTETRICS/GYNECOLOGY ........................ 266 1.7 0.9 1.3 0.7 0.3 1.0 3.3

RADIOLOGY ..................... 214 2.0 0.9 2.0 0.8 1.9 1.3 5.7

PSYCHIATRY .................... 351 0.7 0.5 0.6 0.2 0.1 0.6 1.5

ANESTHESIOLOGY ......... 232 1.8 0.6 0.8 0.1 0.1 0.7 2.4

PATHOLOGY .................... 82 2.7 1.8 1.7 0.8 0.5 2.9 6.4

DERMATOLOGY ............... 96 4.8 2.0 5.2 2.0 1.2 1.8 10.4

EMERGENCY MEDICINE 61 1.4 0.6 0.5 0.3 0.1 0.9 2.1

NEUROLOGY .................... 61 3.1 3.1 1.4 1.5 1.1 2.2 6.4

PHYS MED/

RHEUMATOLOGY ........ 75 5.1 2.5 6.1 0.7 1.4 2.9 12.1

OTHER SPECIALTY ......... 37 4.4 2.4 5.1 1.1 0.6 2.1 9.5

Source: American Medical Association, 1995–1997 Socioeconomic Monitoring System (SMS) surveys.

* Clerical payroll is included in total non-physician payroll.

** Total expenses exclude professional liability insurance premiums and employee physician payroll.

Notes:

(1) Only self-employed non-federal non-resident patient care physicians who responded to all relevant expense questions are included. Selfemployed physician respondents with no practice expenses for the year are excluded.

(2) Physicians whose typical number of hours worked in patient care activities per week is missing, less than 20, or equal to 168 (3 cases) are

excluded. Physicians whose number of weeks worked the previous year is missing or less than 26 are excluded.

(3) For each respondent, total practice expense and expense components per hour are calculated as (4)/(5) below.

(4) Expenses adjusted for practice size = self-employed respondent expenses * # physician owners.

(5) Hours adjusted for practice size = (respondent hours * # physician owners) + (employee physician hours (see (6) below) * # employee physicians).

(6) The typical number of hours worked in patient care activities for the employee physician(s) of a self-employed physician’s practice is not

known. Mean hours worked in patient care activities for employee physicians of each specialty are used as an estimate of employee physician

hours.

12. Other Methodological Issues

a. Professional and Technical

Component Services. Using the

methodology described above, the

professional and technical components

of the resource-based practice expense

relative value units do not necessarily

sum to the global resource-based

practice expense relative value units

since specialties with different practice

expenses per hour provide the

components of these services in

different proportions. For example,

emergency medicine physicians have

proportionately more professional

component chest x-ray billings than

global billings relative to radiologists.

We used the following methodologies so

that the professional and technical

component resource-based practice

expense relative value units for a service

sum to the global resource-based

relative value units.

For codes with professional and

technical components excluding HCPCS

codes 70010 through 79440, G0030

through G0047, G0050, G0062, G0063,

G0106, G0120, G0122, G0125, and

G0126, we used the following

methodology:

After we determined the practice

expense RVUs using the practice

expense per hour methodology, we

budget neutrally distributed the total

(global, professional, and technical)

practice expense payments for each

code between the global, professional,

and technical components as follows:

Step 1: Calculate a weighted average

resource-based practice expense RVU

across the facility and nonfacility

settings using the allowed utilization

from the Medicare claims data.

Step 2: Using the RVUs calculated in

Step 1 for the global, professional, and
30832 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

technical components of each code and

the Medicare utilization data, calculate

the total new resource-based practice

expense payments for each code.

Step 3: Set the global resource-based

practice expense RVUs for each code

equal to the sum of the resource-based

practice expense RVUs for the

professional and technical components

calculated in Step 2.

Step 4: Using the global RVUs

calculated in Step 3, the professional

and technical component RVUs

calculated in Step 1, and the Medicare

utilization data, calculate practice

expense payments for each code.

Step 5: Multiply the global relative

value units calculated in Step 3 and the

professional and technical component

RVUs calculated in Step 1 by the ratio

of the practice expense payments for

each code calculated in Step 2 to the

practice expense payments for each

code calculated in Step 4.

For HCPCS codes 70010 through

79440, G0030 through G0047, G0050,

G0062, G0063, G0106, G0120, G0122,

G0125, and G0126, we used the

following methodology:

We used the current 1998 practice

expense RVUs for this set of codes,

which are based primarily on the

original radiology fee schedule, to

determine the relatives between the new

resource-based practice expense relative

value units as follows:

Step 1: Using the current 1998

practice expense RVUs, calculate the

current aggregate practice expense

payments for this set of codes.

Step 2: Using the resource-based

practice expense RVUs determined from

the methodology described above,

calculate the aggregate practice expense

payments for this set of codes.

Step 3: Uniformly multiply the

current practice expense RVUs by the

ratio of the aggregate resource-based

practice expense payments calculated in

Step 2 to the aggregate practice expense

payments calculated in Step 1.

For HCPCS codes Q0092, R0070, and

R0075, we used the following

methodology:

The practice expense RVUs for

HCPCS code Q0092 was determined by

applying the ratio described in Step 3

above to the existing practice expense

RVUs. The practice expense RVUs for

HCPCS codes R0070 and R0075 were

determined by applying the ratio

described above to practice expense

RVUs for these codes calculated from

the average allowed charge in the

Medicare claims data.

b. Practice Expenses per Hour

Adjustments and Specialty Crosswalks.

We have one general comment on our

use of the SMS practice expense per

hour data. Some practices employ

midlevel providers such as nurse

practitioners and optometrists. The

practice expenses per hour from the

SMS survey are calculated in terms of

hours spent in patient care activities by

physicians in a practice. These practice

expenses per hour are greater than

practice expenses per hour spent in

patient care activities by the physicians

and midlevel providers in a practice. As

a result, the practice expense per hour

methodology is potentially biased in

favor of specialties who use more,

relative to other specialties, midlevel

providers as physician extenders to

create billable services under the

Medicare fee schedule. Although we

made no adjustment to the practice

expenses per hour for this due to a lack

of data, we believe the issue should be

examined as part of the refinement of

the resource-based practice expense

RVUs.

Below are the adjustments we made to

the practice expense per hour data and

the crosswalks we used to assign the

specialties reflected in our claims data

to those found in the practice expense

tables from the SMS survey data.

• We set the medical materials and

supplies practice expenses per hour for

the specialties of ‘‘Oncology’’ and

‘‘Allergy and Immunology’’ equal to the

medical materials and supplies practice

expenses per hour for ‘‘All Physicians’’

since we make separate payment for the

drugs furnished by these specialties.

With regard to oncology, while

Medicare does not have an expansive

outpatient drug benefit, it does cover

outpatient drugs that are furnished by a

physician, oral cancer drugs, and certain

other specific drugs. In addition to

paying for the costs of these drugs

(outside the physician fee schedule),

Medicare also makes a separate payment

to physicians for the ‘‘administration’’

of cancer drugs (under the physician fee

schedule). This separate payment for

chemotherapy administration

recognizes the expenses involved with

ordering, storing and handling, and

performing other tasks associated with

administering such drugs. These

expenses are practice expenses and are

treated as part of resource-based

practice expenses; they are not part of

the costs of the drug and are not

included in Medicare payments for

chemotherapy drugs.

We believe that physicians’ expenses

for the administration of cancer drugs,

as well as the costs of the drugs

themselves, are included in their

responses to the AMA survey.

Therefore, to avoid a duplicate payment

(that is, paying for the drug separately

and also including the costs of the drug

in practice expenses), we need to

separate the costs of the drug from the

practice expenses for the administration

of the chemotherapy drugs.

We are proposing to use the ‘‘All

Physician’’ practice expenses per hour

for medical materials and supplies to

reflect, in a relative sense, all the

practice expenses for administration of

chemotherapy. The difference between

the practice expense per hour for

medical material and supplies for

oncologists and for all physicians would

be the costs of the drugs themselves. We

invite comments about our approach or

alternative ways to separate the costs of

the drugs from the costs of their

administration.

• We based the administrative

payroll, office, and other practice

expenses per hour for the specialties of

‘‘Physical Therapy’’ and ‘‘Occupational

Therapy’’ on data used to develop the

salary equivalency guidelines for these

specialties. (Since speech and language

pathologists are not identified as

Medicare specialties in our claims data,

we could not explicitly use their salary

equivalency guideline data.) The data

used to calculate the salary equivalency

practice expenses per hour for these

categories of expenses includes an

allowance for 250 square feet of space

per therapist, and the utilities and other

overhead to run the practice, including

administrative costs. We set the

remaining practice expense per hour

categories equal to the ‘‘All Physicians’’

practice expenses per hour from the

SMS survey data. We used the clinical

payroll expenses for ‘‘All Physicians’’

instead of the salary equivalency data

for physical therapy assistants and aides

since we are concerned that there may

be an overlap between the cost of

therapy assistants and aides reflected in

the practice expenses and the amount of

work allocated to services provided by

occupational and physical therapists.

• The following are the crosswalks

we used to assign the specialties

reflected in our claims data to those

found in the practice expense tables

from the SMS survey data. Note that we

refer to the difference between the

nonphysician payroll expenses per hour

and the clerical payroll expenses per

hour as the clinical payroll expenses per

hour.
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30833

TABLE 3.—PRACTICE EXPENSE PER HOUR CROSSWALKS

HCFA specialty code and description AMA specialty Clinical

labor PE/Hr

Medical

supplies

PE/Hr

Medical

equipment

PE/Hr

Cler., office,

and other

PE/Hr

01—General Practice ................................ General/Family Practice ........................... $15.10 $8.10 $3.60 $41.90

02—General Surgery ................................ General Surgery ....................................... 6.80 3.10 2.00 42.30

03—Allergy/Immunology ........................... Allergy And Immunology* ......................... 39.20 7.20 3.30 76.70

04—Otology, Laryn., Rhino ....................... Otolaryngology .......................................... 17.50 7.70 5.80 79.00

05—Anesthesiology ................................... Anesthesiology ......................................... 10.70 0.30 0.40 15.30

06—Cardiology .......................................... Cardiovascular Disease ............................ 15.30 5.80 6.40 55.50

07—Dermatology ....................................... Dermatology ............................................. 22.80 12.50 4.80 75.00

08—Family Practice .................................. General/Family Practice ........................... 15.10 8.10 3.60 41.90

10—Gastroenterology ............................... Gastroenterology ...................................... 7.80 2.70 1.80 44.30

11—Internal Medicine ............................... General Internal Medicine ........................ 9.10 6.40 2.10 36.50

12—Manip. Therapy .................................. All Physicians ........................................... 12.00 7.20 3.20 45.10

13—Neurology ........................................... Neurology ................................................. 4.60 5.00 4.20 45.10

14—Neurosurgery ..................................... Neurological Surgery ................................ 9.20 1.80 1.10 71.70

16—OB–GYN ............................................ Obstetrics/Gynecology .............................. 15.40 7.30 3.40 49.80

18—Ophthalmology ................................... Ophthalmology .......................................... 25.10 11.30 9.00 86.40

19—Oral Surgery ...................................... All Physicians ........................................... 12.00 7.20 3.20 45.10

20—Orthopedic Surgery ............................ Orthopedic Surgery .................................. 16.90 10.30 3.60 74.90

22—Pathology ........................................... Pathology .................................................. 8.30 4.00 1.60 32.80

24—Plastic Surgery ................................... Plastic Surgery ......................................... 10.30 16.30 4.60 71.80

25—Physical Medicine .............................. Physical Medicine/Rheumatology ............. 15.40 4.90 3.90 63.70

26—Psychiatry .......................................... Psychiatry ................................................. 2.00 0.40 0.30 22.90

28—Colorectal Surgery ............................. General Surgery ....................................... 6.80 3.10 2.00 42.30

29—Pulmonary Disease ............................ Pulmonary Disease .................................. 7.80 2.80 1.60 33.60

30—Radiology ........................................... Radiology .................................................. 9.40 4.80 8.30 35.70

33—Thoracic Surgery ............................... Cardiac/Thoracic/Vascular Surgery .......... 13.90 1.40 3.10 45.50

34—Urology ............................................... Urological Surgery .................................... 11.00 24.50 6.00 53.00

35—Chiropractor, Licensed ....................... General Internal Medicine ........................ 9.10 6.40 2.10 36.50

36—Nuclear Medicine ............................... Radiology .................................................. 9.40 4.80 8.30 35.70

37—Pediatrics ........................................... Pediatrics .................................................. 12.80 10.80 1.60 41.70

38—Geriatrics ............................................ General Internal Medicine ........................ 9.10 6.40 2.10 36.50

39—Nephrology ......................................... General Internal Medicine ........................ 9.10 6.40 2.10 36.50

40—Hand Surgery ..................................... Orthopedic Surgery .................................. 16.90 10.30 3.60 74.90

41—Optometrist ........................................ All Physicians ........................................... 12.00 7.20 3.20 45.10

43—CRNA/AA ........................................... Anesthesiology ......................................... 10.70 0.30 0.40 15.30

44—Infectious Disease ............................. General Internal Medicine ........................ 9.10 6.40 2.10 36.50

46—Endocrinology .................................... General Internal Medicine ........................ 9.10 6.40 2.10 36.50

48—Podiatry .............................................. General Surgery ....................................... 6.80 3.10 2.00 42.30

50—Nurse Practitioners ............................ General Internal Medicine ........................ 9.10 6.40 2.10 36.50

62—Psychologist (Billing Independently) .. Psychiatry ................................................. 2.00 0.40 0.30 22.90

65—Physical Therapist (Indep. Practice) .. All Physicians* .......................................... 12.00 7.20 3.20 10.90

66—Rheumatology .................................... Physical Medicine/Rheumatology ............. 15.40 4.90 3.90 63.70

67—Occupational Therapist ...................... All Physicians* .......................................... 12.00 7.20 3.20 10.90

68—Clinical Psychologist .......................... Psychiatry ................................................. 2.00 0.40 0.30 22.90

69—Independent Laboratory ..................... All Physicians ........................................... 12.00 7.20 3.20 45.10

70—Clinic Or Other Group ........................ All Physicians ........................................... 12.00 7.20 3.20 45.10

76—Periperal Vascular Disease ............... All Physicians ........................................... 12.00 7.20 3.20 45.10

77—Vascular Surgery ............................... Cardiac/Thoracic/Vascular Surgery .......... 13.90 1.40 3.10 45.50

78—Cardiac Surgery ................................. Cardiac/Thoracic/Vascular Surgery .......... 13.90 1.40 3.10 45.50

79—Addiction Medicine ............................. Psychiatry ................................................. 2.00 0.40 0.30 22.90

80—Clinical Social Worker ........................ Psychiatry ................................................. 2.00 0.40 0.30 22.90

81—Critical Care (Intensivists) .................. All Physicians ........................................... 12.00 7.20 3.20 45.10

82—Hematology ........................................ General Internal Medicine ........................ 9.10 6.40 2.10 36.50

83—Hematology/Oncology ........................ Oncology* ................................................. 22.00 7.20 5.50 58.70

84—Preventive Medicine .......................... General Internal Medicine ........................ 9.10 6.40 2.10 36.50

85—Maxillofacial Surgery .......................... All Physicians ........................................... 12.00 7.20 3.20 45.10

86—Neuropsychiatry ................................. Psychiatry ................................................. 2.00 0.40 0.30 22.90

89—Clinical Nurse Practitioner ................. General Internal Medicine ........................ 9.10 6.40 2.10 36.50

90—Medical Oncology .............................. Oncology ................................................... 22.00 7.20 5.50 58.70

91—Surgical Oncology .............................. All Physicians ........................................... 12.00 7.20 3.20 45.10

92—Radiation Oncology ........................... Radiology .................................................. 9.40 4.80 8.30 35.70

93—Emergency Medicine ......................... Emergency Medicine ................................ 3.40 0.50 0.10 9.00

94—Interventional Radiology .................... Radiology .................................................. 9.40 4.80 8.30 35.70

95—Indep. Physiological Lab .................... All Physicians ........................................... 12.00 7.20 3.20 45.10

97—Physician Assistants .......................... General/Family Practice ........................... 15.10 8.10 3.60 41.90

98—Gynecology/Oncology ........................ Obstetrics/Gynecology .............................. 15.40 7.30 3.40 49.80

*Practice expense per hour were adjusted as follows:

(1) Allergy & Immunology and Oncology use supplies for All Physicians.

(2) Physical Therapy and Occupational Therapy use salary equivalency data for clerical, office and other practice expenses per hour.
30834 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

• Due to uncertainty concerning the

appropriate crosswalk and time data for

the nonphysician specialty

‘‘Audiologist’’ and the fact that the

relatively few codes performed by

audiologists are also performed by other

specialties, we did not crosswalk this

specialty. Until we can obtain more

data, we derived the resource-based

practice expense RVUs for codes

performed by audiologists from the

practice expenses per hour of the other

specialties which perform these codes.

• Because we have no reason to

assume that the distribution of

radiologists by equipment ownership

reflected in the SMS survey data differs

from the distribution found in our

claims data, we did not attempt to

differentiate the practice expenses per

hour for radiologists by equipment

ownership. The use of the average

practice expenses per hour should

create the appropriate practice expense

pool for radiology. We invite comments

on this issue. We realize that practice

expenses vary by equipment ownership;

however, the appropriate recognition of

this is through the differential allocation

of the practice expense pool to the

professional, technical, and global

services performed by radiologists.

c. Time Associated with the Work

Relative Value Units. As a general

comment on the time data, we are

concerned that any imprecision in the

time estimates for high volume services

which have relatively little time

associated with them may potentially

bias the practice expense methodology

in favor of the specialties which perform

these services. For example, if a high

volume procedure which typically takes

four minutes to perform has a surveyed

time of 5 minutes, this procedure’s

contribution to the practice expense

pool for that specialty is inflated by 25

percent. In contrast, if a procedure

which typically takes 100 minutes to

perform has a surveyed time of 101

minutes, its contribution is only inflated

by 1 percent. We believe this issue

should be examined as part of the

refinement of the resource-based

practice expense RVUs.

• The time data from the Harvard

study performed for the initial

establishment of the work relative value

units were collected over a number of

years using primarily surveys of

practicing physicians. The time data

submitted to the RUC for the refinement

of the work relative value units were

also collected over a number of years

using primarily physician surveys. The

time data resulting from the refinement

of the work relative value units have

been systematically greater than the

time data obtained by the Harvard study

for the same services. On average, this

difference is approximately 25 percent.

We increased the Harvard time data in

order to ensure consistency between

these data sources.

• We calculated the total physician

time for CPT codes 70010 through

79440 using the work RVUs and the

work per unit time for CPT 99213,

except for codes in the range of CPT

codes 78000 through 78891 for which

we had Harvard survey data and codes

for which we had data from surveys

done for the AMA RUC.

• Based on the judgment of our

clinical staff, we calculated the total

physician time for CPT codes 90918

through 90921 using the work RVUs and

the work per unit time for CPT code

99213.

• Based on the judgment of our

clinical staff, we set the total time

associated with the work RVUs for CPT

97001 through 97770 as follows:

HCPCS Time

(min)

97001 ................................................ 30

97002 ................................................ 20

97003 ................................................ 45

97004 ................................................ 30

97010 ................................................ 5

97012 ................................................ 15

97014 ................................................ 13

97016 ................................................ 18

97018 ................................................ 13

97020 ................................................ 14

97022 ................................................ 15

97024 ................................................ 15

97026 ................................................ 10

97028 ................................................ 9

97032 ................................................ 18

97033 ................................................ 14

97034 ................................................ 16

97035 ................................................ 12

97036 ................................................ 15

97039 ................................................ 10

97110 ................................................ 15

97112 ................................................ 15

97113 ................................................ 15

97116 ................................................ 15

97122 ................................................ 15

97124 ................................................ 15

97139 ................................................ 15

97150 ................................................ 15

97250 ................................................ 15

97260 ................................................ 15

97261 ................................................ 15

97265 ................................................ 15

97504 ................................................ 15

97520 ................................................ 15

97530 ................................................ 15

97535 ................................................ 15

97537 ................................................ 15

97542 ................................................ 15

97703 ................................................ 15

97750 ................................................ 15

97770 ................................................ 15

• A high percentage of codes

performed by the nonphysician

specialties of Independent Physiological

Lab, Clinical Psychologist, and

Psychologist (Independent Billing) do

not have work RVUs and, therefore,

time data. Because the practice expenses

per hour for these specialties were

crosswalked from SMS specialties,

when calculating their practice expense

pools we used the maximum clinical

staff time from the CPEP data for the

codes that lack work RVUs.

• We calculated the time for CPT

codes 00100 through 01996 using the

base and time units from the anesthesia

fee schedule and the Medicare allowed

claims data.

13. Other Practice Expense Policies

a. Site-of-Service Payment

Differential. Under the physician fee

schedule, if a physician service of the

type routinely furnished in physician

offices is furnished in facility settings,

our current policy is that the fee

schedule amount for the service is

determined by reducing the practice

expense RVUs for the service by 50

percent. Certain services are excluded

from the regulation including rural

health clinic services, surgical services

not on the ambulatory surgical center

covered list that are furnished in an

ambulatory surgical center, anesthesia

services, and diagnostic and therapeutic

radiology services (see § 414.32

(Determining payments for certain

physician services furnished in facility

settings)).

The site-of-service payment

differential is a long established policy

to avoid duplicate payments for practice

costs while, at the same time,

recognizing that some office practice

cost is incurred when physicians

perform procedures outside the office

setting. The site-of-service policy

applies to both inpatient and outpatient

hospital settings.

Since the implementation of the

physician fee schedule, we have

compiled a list of services furnished

outside physician offices that are subject

to the site-of-service payment

differential. The current list includes

approximately 700 services.

As part of the resource-based practice

expense initiative, we are proposing to

replace the current policy that

systematically reduces the practice

expense RVU by 50 percent for certain

procedures with a policy that would

generally identify two different levels

(facility and nonfacility) of practice

expense RVUs for each procedure code

depending on the site-of-service. In

general, we would furnish two levels of

practice expense RVUs per code; one

when the procedure is performed in the

office or other site (or nonfacility) if no

additional facility fee is paid and
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30835

another when the procedure is

performed out of the office (for example,

in a hospital or an ambulatory surgical

center in which the costs of resources,

such as labor, medical supplies, and

medical equipment are paid outside the

physician fee schedule and only to the

hospital or ambulatory surgical center).

Some services, by the nature of their

codes, are performed only in certain

settings and would have only one level

of practice expense RVU per code. Many

of these are evaluation and management

codes with code descriptions specific as

to the site of service. Examples of these

codes are the following:

• Inpatient hospital care for new or

established patients (CPT codes 99221

through 99223).

• Subsequent hospital care (CPT

codes 99231 through 99239).

• Emergency department services for

new or established patients (CPT codes

99281 through 99285).

• Critical care services (CPT codes

99291 through 99297).

• Nursing facility services (CPT codes

99301 through 99303).

• Subsequent nursing facility care

(CPT codes 99311 through 99313).

• Domiciliary, rest home (CPT codes

99321 through 99333).

• Home services (CPT codes 99341

through 99350.

We note that office or outpatient

evaluation and management services

(CPT codes 99201 through 99215) are

used to report services furnished in the

physician office or in a hospital

outpatient department; therefore, these

procedure codes will have different

levels of practice expense RVUs. Other

services, such as most major surgical

services with a 90-day global period, are

performed entirely or almost entirely in

the hospital, and we are generally

providing a practice expense RVU only

for the out-of-office or facility setting.

In the majority of cases, however, we

would provide both facility and

nonfacility practice expense RVUs. The

higher nonfacility practice expense

RVUs are generally used to calculate

payments for services performed in a

physician office and for services

furnished to a patient in the patient’s

home, or facility or institution other

than a hospital, skilled nursing facility,

or ambulatory surgical center. For these

services, the physician typically bears

the cost of resources, such as labor,

medical supplies, and medical

equipment associated with the

physician service.

The lower facility practice expense

RVUs generally are used to calculate

payments for services furnished to

hospital, SNF, and ambulatory surgical

center patients. The costs for

nonphysician services and other items,

including medical equipment and

supplies, are typically borne by the

hospital, by the SNF, or the ambulatory

surgical center.

b. Additional Relative Value Units for

Additional Office-Based Expenses for

Certain Procedure Codes. Usually office

medical supplies or surgical services in

the physician office are included in the

practice expense portion of the payment

for the medical or surgical service to

which they are incidental. The

November 1991 final rule (56 FR 59522)

included a policy that allowed a

practice expense RVU of 1.0 to pay for

the supplies that are used incident to a

physician service but generally are not

the type of routine supplies included in

the practice expense RVUs for specific

services. For example, if the physician

performed a cystourethroscopy with a

biopsy (CPT code 52204) in the office

and billed for a surgical tray (HCFA

Common Procedure Coding System

(HCPCS) code A4550) in addition to the

procedure, the physician would receive

approximately $34.86 (an RVU of .95)

for the surgical tray in addition to the

payment for the cystourethroscopy with

biopsy. The November 1991 final rule

(56 FR 59811) listed 44 procedure codes

that qualified for additional RVUs if

furnished in the physician office. This

list was expanded in the December 1993

final rule (58 FR 63854) to include

several cystoscopy codes. Included in

this list of procedures for which an

additional amount for supplies may be

paid if performed in a physician office

are closing a tear duct (CPT code 68671)

and billing for a permanent lacrimal

duct implant (HCPCS A4263) and

inserting an access port (CPT code

36533) and billing for an implantable

vascular access portal/catheter (A4300).

These supplies were given the same

RVU as HCPCS code A4550.

We are proposing to revise this policy

under the resource-based practice

expense system. We believe the supply

costs that this policy is designed to

cover were included in the supply

inputs identified by the CPEPs and the

AMA’s SMS survey. Thus, they were

included in the practice expense RVUs

for each related procedure code.

Therefore, we are proposing to

discontinue separate payment for

supply codes A4263, A4300 and A4550.

c. Anesthesia Services. Although

physician anesthesia services are paid

under the physician fee schedule, these

services do not have practice expense

RVUs. Rather, payment for physician

anesthesia services is determined based

on the sum of allowable base and time

units multiplied by a locality-specific

anesthesia CF.

Since the beginning of the physician

fee schedule, overall budget neutrality

and work adjustments have been made

to the anesthesia CF and not to the base

and time units. We are proposing to

follow the same process and make an

adjustment to the anesthesia CF to move

anesthesia services under the resourcebased practice expense system. The

adjustment to the anesthesia CF is 3.5

percent.

14. Refinement

Section 4505(d)(1)(C) of the BBA

requires the Secretary to develop a

refinement process to be used during

each of the 4 years of the transition

period. In this section, we will describe

those aspects of this proposed rule that

we believe are subject to refinement as

well as our proposed process for

refinement during the coming year. In

light of the complexity of the issues

associated with establishing the initial

proposed practice expense RVUs, we

believe it is premature to propose, in

this proposed rule, the refinement

process for subsequent years of the

transition period. We also believe it

would be premature to finalize the

practice expense RVUs before the fall of

1999. Therefore, we will keep the

practice expense RVUs as interim RVUs

until at least the fall of 1999. We also

are open to extending the period during

which the practice expense RVUs are

interim beyond 1999 if we believe that

more time is needed to identify and

correct errors.

We are particularly interested in

receiving comments on our proposed

refinement process for this year, and we

are soliciting recommendations for the

process in subsequent years. Based on

our analysis of comments we receive,

we hope to describe our plans for the

entire refinement process in the final

rule.

a. Issues Involved in Refinement. We

believe the refinement process for

practice expense RVUs will enable us

to:

• Review and refine practice expense/

hour data.

• Obtain and review practice

expense/hour data for specialties or

practitioners not included in the SMS

survey.

• Address anomalies, if any, in the

code-specific Harvard/RUC physician

time data.

• Address anomalies, if any, in the

code-specific CPEP data on clinical staff

types and times, quantity and cost of

medical supplies, and quantity and cost

of medical equipment.

• Refine, as needed, our process of

developing practice expense RVUs for

codes that were not addressed by the
30836 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

CPEP process, for example, codes that

were new in 1996, 1997, and 1998.

• Develop practice expense RVUs for

codes that will be new in 1999 and

beyond.

Our plans for each of these six points

are as follows:

• Refinement of the practice expense/

hour data. The practice expense/hour

data are based on the SMS survey.

(These data can be found in Table 1).

Although the SMS survey was not

designed to support the development of

practice expense RVUs, we believe it is

the best available source of data on

actual practice costs that allows us to

recognize all staff, equipment, supplies,

and expenses, not just those that can be

tied to specific procedures. In fact, we

believe one advantage of the SMS data

is that they were collected before this

proposed rule.

The SMS survey data used in this

proposed rule do not include the

practice expense information on all

specialties recognized by Medicare.

However, for certain larger specialties,

for example, family practice and general

surgery, the sample of physicians

surveyed is of sufficient size to serve as

the basis of the practice expense/hour

calculation in the short term. For those

larger specialties, we are unlikely to

make any changes in the practice

expense/hour calculation in the final

rule to be published this fall. In the long

term, specifically, 1999 and beyond, we

are prepared to refine the practice

expense/hour data of the larger

specialties if we receive compelling

evidence that the SMS data are

incorrect. Any arguments that the

practice expense/hour for a given

specialty should be changed would be

strengthened by the submission of

survey data comparable to the SMS that

include data for a range of specialties

expected to gain and lose Medicare

revenue.

We are concerned that the validity of

future SMS surveys could be affected if

we decided to explicitly link the data

collected to future revisions of the

Medicare fee schedule. Also, SMS is a

physician level survey, and physicians

in groups are asked for their share of

expenses rather than the practices’

expenses. Practice level data may

provide a better basis for constructing

practice expense RVUs. We invite

comments on potential revisions to the

SMS survey or alternative sources of

data that could be used for long term

refinement. Finally, because the

calculation of the practice expense/hour

is so critical to our methodology, we

also invite comment on the need to

confirm, through audit or other means,

the survey data that would be used for

long term refinement.

• Refinement of the crosswalk for the

practice expense/hour data. The SMS

data we used for this proposed rule do

not include data for all specialties that

are recognized by Medicare, and they do

not include data on nonphysician

practitioners who are paid under the

physician fee schedule. To develop this

proposal, it was necessary to crosswalk

certain specialties and nonphysician

practitioners to the practice expense/

hour data we developed for the

specialties included in the SMS. We

invite comments on the appropriateness

of our crosswalks. Any arguments that

the practice expense/hour data should

be changed would be strengthened by

the submission of survey data

comparable to the SMS data.

• Refinement of the physician time

data. The number of practice expense

RVUs assigned to the services

performed by a given specialty is

determined by the practice expense/

hour data from the SMS and the

physician time data for each of the

codes. The physician time data are

based on the Harvard resource-based

RVS study and RUC survey data that

were developed as part of the

refinement of the work RVUs. We are

confident that these data are accurate

although there may be some codes for

which the final work RVUs we have

assigned may be inconsistent with the

time data. We will accept comments on

the code-specific physician time data

but must point out that any proposed

revisions to the time data have

implications for the work RVUs

assigned to those codes. We do not

intend to revisit work RVU issues that

have been already addressed as part of

the 5-year review. (Total physician time

data can be found in the ‘‘Total

Physician Time’’ file located on the

HCFA Homepage. Specific instructions

for accessing this and other Internet files

referred to in this proposed rule can be

found at the end of this refinement

section.)

• Refinement of the CPEP data. The

identification and correction of errors, if

any, in the code-specific CPEP data on

clinical staff types and times, quantity

and cost of medical supplies, and

quantity and cost of medical equipment

has its principal effect on the relative

relationship of the practice expense

RVUs assigned to services performed by

a given specialty.

It is important to understand that the

allocation of practice expense RVUs at

the code level is based on CPEP data

that have not been revised or edited in

any fashion. We have not made any

revisions or edits for two main reasons.

First, we received many comments in

response to last year’s proposed rule

that objected to the data reasonableness

edits and caps that were part of our

proposal. Second, we received many

comments in response to June 1997

proposed rule that objected to our

decision to exclude from the CPEP data

the direct inputs for medical equipment,

medical supplies, and clinical staff

recorded for hospital patients. In

addition, we found this decision to be

quite controversial in subsequent

meetings with representatives of various

specialty societies. Under our proposed

methodology that begins with the total

practice expense costs, the question as

to the appropriateness of including the

direct inputs for medical equipment,

medical supplies, and clinical staff in

the inputs for hospital patients is much

less important because the inclusion of

the data impacts the distribution of

practice expense RVUs across the entire

fee schedule only to the extent codes are

performed by more than one specialty.

For example, if a given specialty

performs cardiovascular procedures,

including time for nursing staff in the

hospital for these procedures allocates

more of the fixed practice expense pool

of dollars for that specialty to these

procedures, leaving fewer dollars for the

other codes performed by that specialty.

We believe the most appropriate method

for determining the relative relationship

of the RVUs assigned to cardiovascular

procedures in this proposed rule is to

rely on the CPEP that developed the

inputs for those procedures. Therefore,

the direct inputs for medical equipment,

medical supplies, and clinical staff

recorded for hospital patients have not

been removed from the CPEP data.

In deciding not to modify the CPEP

data, we recognize the possibility that

the RVUs assigned to some codes will

appear to be incorrect or anomalous.

Any apparent errors will be identified

and corrected in response to the

comments we receive on this proposed

rule and through our refinement

process. We received comments in

response to last year’s proposed rule

that pointed out apparent errors in the

RVUs, and many of the CPEP inputs

were revised during the validation

panels we conducted in October 1997.

We have not incorporated any of those

revisions to the data primarily because

our methodology for developing RVUs

has been revised, and we were not

convinced that all the revisions that

occurred during the validation panels

were correct. To the extent that

commenters believe that previously

submitted comments are still valid or

that data revisions that occurred during

the validation panels are still
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30837

appropriate, we request that they again

be brought to our attention in response

to this proposed rule.

While we will accept comments on

any code-specific data, we recommend

that commenters focus their attention

during this comment period on highvolume services with large aggregate

expenditures under Medicare. We will

review the comments with the

assistance of our carrier medical

directors. Time constraints preclude

convening multiple specialty panels to

assist us in our review of the comments.

However, as noted above, the practice

expense RVUs would be interim values

for at least 1999, including those we

change as a result of our review of the

comments.

Because all of the practice expense

RVUs will be interim during 1999,

commenters will have another

opportunity to identify errors in the

code-specific CPEP data during the

comment period of the final rule with

comment period to be published in the

fall of 1998. We believe that the codes

identified as possible errors during the

comment periods of the proposed rule

and the final rule will constitute the

universe of codes whose code-specific

CPEP data should be reviewed. In other

words, although we may keep all the

practice expense RVUs interim beyond

1999 as we refine other aspects of the

physician fee schedule, it is not our

intention to continually review the

inputs for all the codes on the fee

schedule on an annual basis.

We do believe it is important to have

the advice of practicing physicians on

the appropriateness of recommended

changes to the CPEP inputs. We have

two principal options for obtaining that

advice. The first option would be for us

to convene multiple specialty panels to

review the recommended changes. The

second option would be to ask the RUC,

or a new organization like the RUC that

includes broad representation across all

specialties and includes nonphysician

practitioners, to do this. We believe that

under either option, the panel or panels

should include individuals other than

physicians, for example, practice

managers or nurses, who could bring

additional experience and expertise to

the discussion. The panels would need

to meet no later than the summer of

1999 to consider the comments we

received on both the proposed rule and

the final rule. We invite comments on

these options and would welcome any

other recommendations.

• Refinement of the crosswalk for

1996, 1997, and 1998 codes. Because the

CPEP process was based on 1995 CPT

codes, it was necessary for us to develop

practice expense RVUs for new codes

that were developed for the 1996, 1997,

and 1998 CPT books. The process we

used was based on comparing the new

codes to other comparable codes for

which we had actual CPEP data. Files

containing information about the

crosswalks used for codes that were new

in 1996, 1997, and 1998 are available on

the HCFA homepage under the heading

‘‘CPEP Data Crosswalked to 1998 CPT

Codes.’’ Since this crosswalk was based

on our judgment rather than actual data,

we invite comments on the

appropriateness of our crosswalks. Also,

we will accept new code specific-data

on clinical staff types and times,

quantity and cost of medical supplies,

and quantity and cost of medical

equipment. Any comments we receive

on these codes will be reviewed as part

of the process of review described

above.

• Development of practice expense

RVUs for codes that will be new in 1999

and beyond. There will be new codes

included in CPT 1999 for which we will

not have practice expense data in time

for publication in the 1998 final rule.

We plan to develop interim practice

expense RVUs for these codes by

preparing a crosswalk of CPEP data from

existing codes. The crosswalk we use

will be available with the final rule, and

the practice expense values for the

codes will be subject to comment.

However, the interim values will serve

as the basis of payment during 1999.

We do not believe that preparing a

crosswalk of new codes is the most

appropriate method of developing

practice expense RVUs for new codes.

However, for 1999, time constraints do

not permit any other approach. Beyond

1999, we would like to develop a

process whereby we receive

recommended practice expense RVUs or

recommended inputs for clinical staff

types and times, quantity and cost of

medical supplies, and quantity and cost

of medical equipment.

For the assignment of work RVUs to

new and revised codes, we first look to

the RUC for recommended RVUs. Under

that process, codes that will be new or

revised in the next year’s CPT are

referred from the CPT editorial panel to

the RUC. Specialty societies are

informed of these codes and furnished

an opportunity to survey a sample of

physicians in their specialty for the

development of recommended RVUs.

The entire RUC then reviews the survey

results and forwards the recommended

work RVUs to us.

We then review the RUC’s

recommended work RVUs with the

assistance of our Medicare carrier

medical directors and publish our

decisions as interim RVUs in the final

rule for the upcoming year. For

example, work RVUs for codes that were

new or revised in CPT 1998 were

published as interim RVUs in the

October 1997 final rule.

Publishing RVUs as interim allows

the public the opportunity to furnish

comments on the appropriateness of our

interim work RVUs. During the

following year, we review any

comments we have received with the

assistance of multiple-specialty panels

we have convened. We consider our

analysis of any comments on the interim

work RVUs and the advice we receive

from the multiple specialty panels in

the assignment of the final work RVUs

that are announced in the final rule for

the next year’s physician fee schedule.

For practice expense RVUs, we

believe there are two principal options.

First, we could continue to crosswalk

new codes to existing codes, publish the

results of that crosswalk as interim

practice expense RVUs in the final rule,

and review comments we receive with

the assistance of our multiple specialty

panels. Second, we could request the

RUC or a RUC-like organization to

provide recommended practice expense

RVUs or recommended inputs before

publication of the proposed rule as we

do with work RVUs. This approach

would allow us to publish interim RVUs

based on the advice of practicing

physicians. As with the work RVUs, any

comments we received on the interim

RVUs could then be reviewed with the

assistance of HCFA multiple specialty

panels. We invite comments on these

options and would welcome any other

recommendations.

b. Example of the Process for

Reviewing and Commenting on Practice

Expense Relative Value Units. To

facilitate the development of responses

to this proposed rule, to illustrate the

issues involved in refining the RVUs for

practice expense, and to furnish further

guidance on the use of the data files that

are available on the Internet, we are

furnishing the following analysis of an

apparent anomaly in a family of codes.

This analysis is intended to serve as an

example of the process for reviewing

and commenting on the practice

expense RVUs. We have not concluded

that revisions to the RVUs proposed for

this family of codes are warranted. In

the event that no comments are received

on the RVUs for these codes, it is

unlikely that we will make any

revisions.

In the ophthalmology section of the

CPT, there are four codes for the

reporting of eye exams. The codes, brief

descriptors, and the proposed practice

expense RVUs follow:
30838 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

Code Descriptor

Practice expense

RVUs

92002 ........................ Eye exam, new patient, intermediate .............................................................................................................. 0.96

92004 ........................ Eye exam, new patient, comprehensive .......................................................................................................... 1.58

92012 ........................ Eye exam, established patient, intermediate ................................................................................................... 1.26

92014 ........................ Eye exam, established patient, comprehensive .............................................................................................. 1.25

We believe there is a rank order

anomaly in this family. We expected

that the practice expense RVUs for new

patients would be higher than the

practice expense RVUs for established

patients and that the practice expense

RVUs for comprehensive visits would

be higher than practice expense RVUs

for intermediate visits. For example, we

expected that CPT code 92014 would

have higher practice expenses than CPT

code 92012, which is not the case.

To analyze this apparent anomaly, we

first reviewed the data on which

specialties furnish the services. These

data are located on the HCFA Homepage

under the file name ‘‘Procedure Code

Utilization by Specialty.’’ This analysis

is important because one potential cause

of an anomaly is that codes in a given

family of codes are performed by

physicians in different specialties

whose practice expenses per hour are

different. In this case, the dominant

specialty performing the codes is

ophthalmology. Optometrists also

perform these services but with less

frequency than ophthalmologists. In

Table 2, the sum of the practice

expenses per hour for ophthalmology is

$131.80, and the sum of the practice

expenses per hour for optometry is

$67.50. Although the practice expense

per hour differs for ophthalmology and

optometry because ophthalmology is by

far the dominant specialty, this anomaly

cannot be attributed to differences in

practice expense per hour.

We next reviewed the code-specific

data for in-office services on clinical

labor, equipment, and supplies that are

included in the file ‘‘CPEP Data

Converted Into 1998 Dollar Amounts,’’

located on the HCFA Homepage. This

file is based on the raw CPEP data that

have been converted to monetary

amounts. It is considerably easier to

review than the raw CPEP data because

it includes fewer data points per code.

(The file containing raw CPEP data,

‘‘Raw CPEP Data’’, can also be found in

the HCFA Homepage. Both of these files

also contain CPEP data for supplies and

equipment.)

Code Descriptor Clin Eqp Sup Total services

% Ophthalmology% Optometry

92002 ......................... Eye exam, new patient, intermediate.15.44 11.76 3.41 354,000 48 50

92004 ......................... Eye exam, new patient, comprehensive.16.87 12.85 3.41 1,866,000 72 27

92012 ......................... Eye exam, est. patient, intermediate.11.15 8.49 27.60 6,022,000 85 13

92014 ......................... Eye exam, est. patient, comprehensive.14.01 10.67 3.41 6,980,000 79 20

These data show that the relative

relationship within the family of codes

appears to be appropriate for clinical

staff and equipment. However, for

supplies there is a large discrepancy in

that the supply costs for code 92012 are

eight times greater than the supply costs

for the other three codes. To determine

whether the supply costs for code 92012

are too high or the supply costs for the

other three codes are too low, it is

necessary to review the actual supply

inputs assigned to the codes by the

CPEP. These data may be found as a

subdirectory of the file, ‘‘CPEP Data

Converted to 1998 Dollars.’’ We

reviewed the inputs but have made no

judgments about them. We believe the

inputs should be reviewed by the

specialties providing the service.

As can be seen in the table, 85 percent

of the code 92012 services are furnished

by ophthalmologists, and 13 percent are

furnished by optometrists. The table

also shows that this is a high volume

family of codes and that errors in the

CPEP data could cause distortions in the

relative relationships of the RVUs

assigned to services furnished by

ophthalmologists and optometrists.

Under our proposed methodology for

developing RVUs, any revisions to the

CPEP data will primarily impact only

those specialties that furnish the

service. Thus, if we determine that the

supply inputs for code 92012 include

items that are not typically furnished

and are recommended for removal, that

will ‘‘free up’’ RVUs that can be

redistributed across the other services

furnished by the two specialties.

Conversely, if it is determined that the

supply inputs for the other three codes

are missing items that are typically

furnished and are recommended for

inclusion, that will require RVUs to be

taken from the other services furnished

by the two specialties, not from other

services on the physician fee schedule.

We view this as a significant advantage

of our proposed methodology in that the

highly contentious atmosphere of

refinement under our earlier

methodology is greatly reduced because,

except when multiple specialties

perform the same service, agreement or

disagreement with the CPEP inputs of

one specialty does not directly impact

the RVUs assigned to services furnished

by other specialties.

c. Information on Accessing Data

Files on HCFA’s Homepage. The

aforementioned files can be obtained on

the HCFA Homepage at

‘‘www.hcfa.gov.’’ Following is the step

by step process by which the data files

can be accessed.

Step 1: After accessing the HCFA

Homepage go to Stats and Data.

Step 2: Go to 1999 Resource-Based

Practice Expense.

Step 3: Under Resource-Based

Practice Expense, you will have the

option of accessing one of six files

related to resource-based practice

expense:

Raw CPEP Data

This file includes the original CPEP

data. There are four subgroups within

this file:

Clinical Work

Medical Supplies

Procedure Specific Medical Equipment
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30839

Overhead Medical Equipment

1998 Code Crosswalks

Since the CPEP data were based upon

1995 data, we performed crosswalks for

codes which were new codes in 1996,

1997, and 1998. This file shows the

crosswalks that were used for all codes

that were new after 1995. In addition,

this file also contains those codes gapfilled based on analogous procedures

due to an absence of data from the CPEP

process.

CPEP Data Crosswalked to 1998 Codes

This file crosswalks all CPEP data to

1998 codes.

CPEP Data Converted to 1998 Codes

Converted Into Dollars

This file converts the CPEP data,

crosswalked to 1998 codes, into dollars.

Procedure Code Utilization by Specialty

This file shows the Medicare allowed

services for each procedure code

performed by each specialty.

Time Associated With the Work Relative

Value Units

This file contains the time associated

with the work RVUs for each procedure.

15. Reductions in Practice Expense

Relative Value Units for Multiple

Procedures

In the June 1997 proposed rule (62 FR

33171), we had recommended reducing

the practice expense RVUs for multiple

nonsurgical services performed at the

same time as an evaluation and

management service. We had proposed

this as a way to reflect the lower

practice costs that would result when

more than one service is performed

during a single patient encounter. Many

commenters, as well as the Medicare

Payment Advisory Commission

(MEDPAC), recommended that we not

implement a multiple procedure

reduction, at least until this issue has

been further studied.

We have decided not to propose this

reduction at this time but will consider

it in the future. We invite comments on

this specific issue. The current multiple

surgical procedure reduction policy

with regard to physician work is not

affected by the practice expense

proposal.

16. Transition

Under the transition enacted under

BBA 1997, practice expense RVUs in

1999 are to be based 75 percent on the

old method and 25 percent on the

resource-based method. In 2000, the

shares are 50 percent old method and 50

percent resource-based. In 2001, the

shares are 25 percent old method and 75

percent resource-based. Beginning in

2002, practice expense RVUs are

entirely resource-based.

In our October 1997 final rule (62 FR

59052), we indicated that the old

method to be used in the formula

constitutes the 1998 practice expense

RVUs actually used for payment. We

received a comment that suggested that

we consider an alternative

interpretation of the law for purposes of

the transition starting point that would

eliminate the 1998 changes in practice

expenses enacted by BBA 1997. This

comment was based on the theory that

the 1998 changes were for 1 year only

and not intended to be included in the

base practice expense used for the

transition. This alternative would result

in higher payments for certain specialty

procedures and lower payments for

medical visits during 1999, 2000, and

2001. Beginning in 2002, the starting

point for the transition does not matter

as practice expenses are entirely

resource-based.

We have considered this suggestion.

We do not believe that we can, as

suggested by the commenter, utilize

1997 practice expense RVUs actually

used for payment because we do not

believe that we could treat the

reductions enacted in BBA 1997 for

1998 differently from the similar

reductions enacted in OBRA 1993 on

practice expenses for 1994, 1995, and

1996. That is, the effects of both

amendments should be included in the

base or excluded. We believe that the

appropriate option, other than using

1998 practice expense RVUs, is to

exclude the effects of both the OBRA

1993 and BBA 1997 provisions and

revert to practice expense RVUs as they

existed before any amendments. We do

not believe that this is the better

alternative. In addition to creating

practical problems of requiring

imputation of practice expense RVUs for

the many new codes that have been

established between 1991 and 1998, it

would seem contrary to the statute’s

plain intent of moving toward a

resource-based payment system. This

alternative could also potentially result

in a ‘‘yo-yoing’’ of practice expense

RVUs between 1998 and future years.

Practice expense RVUs for certain

procedures explicitly increased by the

Congress in 1998 could be reduced in

1999 only to be increased again when

the practice expense is fully resourcebased. If we were to use 1997 RVUs as

the base for the transitions, payments

for office visit procedure codes, for

example, would likely decrease

noticeably during 1999, reversing the

clear policy the Congress enacted in

BBA 1997 by raising them. To adopt

such a construction of the law would

not gradually ‘‘transition’’ payments to

the new resource-based system, but

instead would represent an abrupt

change in direction, a result at odds

with the purpose of having a transition

period and with transitions previously

established for payment changes in

Medicare. We find nothing in the

legislative history to suggest that the

Congress intended such an atypical

transition. Therefore, we propose to use

the 1998 practice expense RVUs for

purposes of the blend during the

transition years of 1999, 2000, and 2001.

17. Proposed Regulation Revisions

We are proposing to revise § 414.22

(Relative value units (RVUs)), paragraph

(b), (Practice expense RVUs), to state

that for services beginning January 1,

1999, the practice expense RVUs would

be based on a blend of 75 percent of the

1998 code-specific practice expense

RVUs and 25 percent of the relative

practice expense resources involved in

furnishing the service. For services

beginning January 1, 2000, the practice

expense RVUs would be based on a

blend of 50 percent of the 1998 codespecific practice expense RVUs and 50

percent of the relative practice expense

resources involved in furnishing the

service. For services beginning January

1, 2001, the practice expense RVUs

would be based on a blend of 25 percent

of the 1998 code-specific practice

expense RVUs and 75 percent of the

relative practice expense resources

involved in furnishing the service. For

services beginning January 1, 2002, the

practice expense RVUs would be based

on 100 percent of the relative practice

expense resources involved in

furnishing the service.

There would be only one level of

practice expense RVUs per code for the

following categories of services: those

that have only the technical component

of the practice expense RVUs; only the

professional component practice

expense RVUs; certain evaluation and

management services, such as hospital

or nursing facility visits that are

furnished exclusively in one setting;

and major surgical services. For other

services, there would be two different

levels of practice expense RVUs per

code. The lower practice expense RVUs

would apply to services furnished to

hospital or ambulatory surgical center

patients. The higher practice expense

RVUs would apply to services furnished

in a physician office or services other

than visits but performed in a patient’s

home and services furnished to patients

in a nursing facility, skilled nursing
30840 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

facility, or an institution other than a

hospital or ambulatory surgical center.

18. Response to GAO Recommendations

As previously discussed, the GAO

report to Congress on practice expense

made five recommendations for further

action; two of these are short term

recommendations that are addressed by

this proposed rule and three are longer

term recommendations that will be

addressed during the refinement

process. The GAO recommendations are

as follows:

• Short Term Recommendations.

+ Use sensitivity analyses to test the

effects of the limits we placed on the

panels’ estimates of clinical and

administrative labor and our

assumptions about equipment

utilization.

We believe that our proposed

methodology answers the concerns that

prompted this recommendation. Our

current proposal has eliminated the

limits previously placed on the CPEP

panels’ estimates of clinical and

administrative staff times. In addition,

because the proposed methodology is

based on specialty-specific RVU pools,

changes in assumptions about

equipment utilization rates would

impact redistributions between

specialties only to the extent that codes

are performed by more than one

specialty.

+ Evaluate the classification of the

administrative labor associated with

billing and other administrative

expenses as indirect expenses,

alternative methods for assigning

indirect expenses, and alternative

specifications of the regression model

used to link the panels’ estimates.

We again believe that our proposed

methodology is responsive to this

recommendation. Under our proposal,

administrative expenses are treated as

indirect costs, and we have developed a

method of assigning indirect expenses

that we believe most closely reflects the

various specialties’ actual costs. The

third part of the recommendation is now

moot as the current proposed

methodology no longer utilizes the

linking algorithm.

• Longer Term Recommendations.

+ Determine whether changes in

hospital staffing patterns and

physicians’ use of their clinical staff in

hospital settings warrant adjustments

between Medicare reimbursements to

hospitals and physicians. Similarly, we

should determine whether physicians

have shifted tasks to nonphysician

clinical staff in a way that warrants

reexamining the physician work RVUs.

+ Work with physician groups and

the AMA to develop a process for

collecting data from physician practices

as a cross-check on the calculated

practice expense RVUs and periodically

refine and update the RVUs.

+ Monitor indicators of beneficiary

access to care, focusing on those

services with the greatest cumulative

reductions in physician fee schedule

allowances, and consider any access

problems when making refinements to

the practice expense RVUs.

We agree with all of these

recommendations. One of the major

tasks of any proposed refinement

process will be determining when any

additional data are need, whether it be

on physician practice patterns or actual

practice expenses. We welcome

comments and suggestions on how best

to carry out these recommendations to

aid us in developing a strategy for data

gathering in our final rule. We plan to

monitor access to care.

B. Medical Direction for Anesthesia

Services

The conditions for payment of

medical direction were discussed in the

March 2, 1983 final rule (48 FR 8902)

that implemented section 108 of the Tax

Equity and Fiscal Responsibility Act

(TEFRA) of 1982, effective October 1,

1983.

TEFRA added section 1887 to the Act

and required that we distinguish

between services furnished by

physicians to patients that are now

payable under the physician fee

schedule and services furnished by

physicians to hospitals that are

reimbursed to the hospital on a

prospective payment basis for inpatients

or on a reasonable cost basis for

outpatients.

Section 1887 of the Act did not,

however, include a reference to

‘‘medical direction.’’ This is a term we

adopted from the medical profession

that refers to the necessary level of

direct involvement of the

anesthesiologist in each of two to four

concurrent anesthesia procedures so

that the service meets the definition of

physician services as required by

section 1887 of the Act.

Our definition of medical direction

closely followed the standards of

anesthesia care team practice

promulgated by the American Society of

Anesthesiologists (ASA).

The conditions for payment of

medical direction are included in

§ 415.110 (Conditions for payment:

Medically directed anesthesia services).

For each patient, the physician must

furnish seven kinds of services, and the

physician may not perform any other

services while he or she is directing the

concurrent procedures unless they meet

the exception as noted. The medical

direction activities in § 415.110(a)

(Services furnished directly or

concurrently) are as follows:

• Performs a pre-anesthesia

examination and evaluation.

• Prescribes the anesthesia plan.

• Personally participates in the most

demanding procedures in the anesthesia

plan, including induction and

emergence.

• Ensures that any procedures in the

anesthesia plan that he or she does not

perform are performed by a qualified

individual as defined in program

operating instructions.

• Monitors the course of anesthesia at

frequent intervals.

• Remains physically present and

available for immediate diagnosis and

treatment of emergencies.

• Provides indicated post-anesthesia

care.

The regulations currently refer to

these conditions as applying to services

furnished directly or concurrently. The

reference to services furnished directly

is not correct. It suggests that the

physician personally performing the

anesthesia services only has to provide

the same kind of services as the

physician medically directing the

anesthesia service. In fact, the physician

personally performing the anesthesia

service must perform the entire

anesthesia service alone. This policy is

included in § 414.46(c)(1)(i) (Additional

rules for payment of anesthesia services,

Physician personally performs the

anesthesia procedure). Therefore, we are

proposing to delete the reference in the

regulations to services furnished

directly.

The December 1995 final rule (60 FR

63152) included the policy to allow the

physician’s medical direction of a

certified registered nurse anesthetist

(CRNA) performing a single anesthesia

service. However, this provision did not

take effect until January 1, 1998. This

policy was incorporated in

§ 414.46(d)(iii) (Additional rules for

payment of anesthesia services,

Anesthesia services medically directed

by a physician). A program

memorandum explaining this policy

was issued to the Medicare carriers in

January 1998.

We are revising § 415.110 (Conditions

for payment: Medically directed

anesthesia services) so that it is

consistent with § 414.46(d)(iii) by

stating that medical direction can apply

to the single anesthesia service

furnished by a CRNA.

The Omnibus Budget Reconciliation

Act of 1993 (OBRA 1993) added section

1848(a)(4)(Special Rule For Medical

Direction) to the Act. This section of the
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30841

Act specified the calculation of the

payment allowances for medical

direction services on or after January 1,

1994. Thus, the specific payment policy

is specified in the law. The law provides

that the medical direction of the

performance of an anesthesia service

furnished on or after January 1, 1998, is

50 percent of the fee schedule amount

that would have been paid if the

anesthesia service was furnished by the

physician alone.

Both the ASA and the American

Association of Nurse Anesthetists

(AANA) have pointed out that the

current requirements are outdated and

too restrictive. The current requirements

are oriented to the administration of a

general anesthetic, which was the

predominate mode of practice when the

regulations were originally

implemented. There are other types of

anesthesia, such as regional, spinal or

epidural anesthesia, and monitored

anesthesia care, which are becoming

more common and for which the current

requirements are not completely

appropriate. For example, in monitored

anesthesia care, there is no definable

emergence as there is for general

anesthesia.

Also, the AANA has advised us that

requiring the presence of the

anesthesiologist for induction for all

cases may not be appropriate and may

delay the start of surgery and result in

the inefficient use of operating room

time. In addition, the ASA has advised

us that neither the regulations nor the

operating instructions explain the level

of documentation required by the

anesthesiologist to support the payment

for the medical direction service. The

ASA believes that the lack of

instructions for medical documentation

and the concerns about payment audits

have reportedly prompted

anesthesiologists to overly document

anesthesia records.

The ASA and the AANA have reached

consensus on a revised recommended

set of medical direction requirements.

We have reviewed their

recommendations and are proposing to

revise our regulations in § 415.110

(Conditions for payment: Anesthesia

services) to reflect current anesthesia

practice arrangements. Namely, we

would:

• Provide that the physician either

perform the pre-anesthesia examination

and evaluation or review one performed

by another qualified individual.

• No longer require the physician to

be present during induction and

emergence.

• Require that the physician monitor

the course of anesthesia at intervals

medically indicated by the nature of the

procedure and the patient’s condition.

C. Separate Payment for Physician

Interpretation of an Abnormal

Papanicolaou Smear

With the exception of hospital

inpatients, we currently do not allow

separate payment for the physician’s

interpretation of an abnormal

Papanicolaou (Pap) smear.

About 10 percent of Pap smears are

abnormal and are interpreted by a

physician, usually a pathologist. If a

physician interprets an abnormal Pap

smear for a patient, other than a hospital

inpatient, payment for the physician

interpretation (and the underlying test)

is made under the clinical laboratory fee

schedule payment for the Pap smear

test. The physician negotiates with the

laboratory for payment for the physician

service.

The clinical laboratory fee schedule

allowances were initially derived from

the 1984 prevailing charges made by

independent laboratories for the Pap

smear test. Historically, independent

laboratories did not bill separately for

the physician interpretation of the

abnormal Pap smear; thus, no separate

allowance was established. Therefore,

the initial clinical laboratory fee

schedule allowances reflect payment for

both the test and any associated

interpretation.

The 1998 clinical fee schedule

national allowance for the Pap smear

test is $7.15. The 1998 physician fee

schedule national allowance for the

physician interpretation of the abnormal

Pap smear for a hospital inpatient is

$28.62.

The College of American Pathologists

requested we recognize separate

payment for the physician interpretation

of the abnormal Pap smear in all

settings. We believe this proposal would

establish an understandable and

uniform definition of physician services

across sites. Therefore, we are proposing

to recognize, under the physician fee

schedule, separate payment for the

physician interpretation of an abnormal

Pap smear in all settings.

The Pap smear test may be furnished

by a hospital or an independent

laboratory. The independent laboratory

could bill for the complete service: the

technical component (the performance

of the test) and the professional

component (the interpretation of the

test) furnished by the independent

laboratory’s pathologist. For services to

hospital patients, the Pap smear

interpretation usually is furnished by

the hospital pathologist who can bill for

the professional component of the

service.

D. Rebasing and Revising the Medicare

Economic Index

1. Background

a. History. In the 1972 Amendments

to the Act (Public Law 92–603) enacted

on October 30, 1972, the Congress

mandated the use of an economic index

in determining payment for physician

services under Medicare Part B.

Although the 1972 Amendments did not

specify the particular type of index to be

used, we established the Medicare

Economic Index (MEI). The MEI follows

the recommendations outlined by the

Senate Finance Committee in its report

accompanying the legislation in that it

attempts to present an equitable

measure for changes in the costs of

physician time and operating expenses.

The current MEI represents a

weighted sum of annual price changes

for various inputs needed to produce

physician services. Since its inception,

the MEI has consisted of two principal

components or expense categories—

physician net income and physician

practice expenses. Physician net income

is further delineated into wages and

salaries and benefits. The physician

practice expense portion is delineated

into six major categories: (1)

Nonphysician employee compensation,

which includes the wages and salaries

and benefits of nonphysician employees

in physician offices; (2) office expenses;

(3) medical materials and supplies; (4)

professional liability insurance; (5)

medical equipment; and (6) other

professional expenses. These broad

expense categories are still the major

expense shares in the proposed MEI and

are discussed in greater detail in the

following sections.

b. Use of Current Data. The MEI was

last rebased and revised in the

November 25, 1992 final rule (57 FR

55896). The current base year for the

MEI is 1989. We believe that it is

desirable to rebase and revise the index

periodically so that the expense shares

and proxies will reflect current

conditions. For this reason, we are

proposing to rebase the MEI to reflect

1996 physician expenses and review the

proxies we currently use to ensure using

the most appropriate proxy for each

expense category. We will continue to

adjust the physician and nonphysician

employee compensation for economywide labor productivity to avoid

accounting for both physician

productivity and economy-wide

productivity in the physician update

framework.

The proposed MEI expense categories

were derived primarily from the 1997

AMA SMS, which measured physician

earnings and practice expenses for 1996.
30842 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

The AMA data were used to set

expenditure weights for physician

earnings and the six major physician

practice expense categories. To further

disaggregate into subcategories

reflecting more specific physician

expenses, we used data from the 1992

Asset and Expenditure Survey, the 1996

Bureau of the Census Current

Population Survey, the 1997 Bureau of

Labor Statistics Employment Cost Index,

and the Medical Economics Continuing

Survey data for 1996.

2. Rebasing and Revising Expense

Categories

Developing a rebased and revised MEI

requires selecting a base year and

determining the number and

composition of expense categories. As

mentioned earlier, we are proposing to

rebase the MEI to 1996. We chose 1996

as the base year for two main reasons:

(1) The 1996 data were the most recent

available data for most of the data

sources we are proposing to use; and (2)

the 1996 data were representative of the

changing distribution of physician

earnings and practice expenses over

time.

We determined the number and

composition of expense categories based

on the criteria used to develop the

current MEI expenditure weights and

our other input price index expenditure

weights (for more information on these

criteria see the November 25, 1992,

proposed rule (57 FR 55900)). Using

these criteria of mutually exclusiveness

and exhaustiveness, we developed the

rebased and revised MEI presented in

Table 4.

TABLE 4.—REVISED MEDICARE ECONOMIC INDEX EXPENDITURE CATEGORIES, WEIGHTS, AND PRICE PROXIES

Expense category

Weights Weights

Proposed price proxies

1989 (1) 1996 (1 2)

Total .................................................................................................. 100.000 100.000

Physician Earnings (4) ............................................................... 54.155 54.460

Wages and Salaries .................................................................. 45.342 44.197 AHE—Private (3).

Benefits (5) ................................................................................. 8.813 10.263 ECI—Ben: Private (3).

Physician Practice Expenses ........................................................... 45.845 45.540

Non-Physician Employee Compensation .................................. 16.296 16.812

Employee Wages and Salaries .......................................... 13.786 12.424

Prof/Tech Wages ................................................................ 3.790 5.662 ECI—W/S: Private P&T (3).

Managers Wages ............................................................... 2.620 2.410 ECI—W/S: Private Admin (3).

Clerical Wages ................................................................... 5.074 3.830 ECI—W/S: Private Clerical (3).

Services Wages ................................................................. 2.233 0.522 ECI—W/S: Private Service (3).

Craft Wages ....................................................................... 0.069

Employee Benefits (5) ........................................................ 2.510 4.388 ECI—Ben: Priv. White Collar (3).

Office Expenses ........................................................................ 10.280 11.581 CPI(U)—Housing.

Medical Materials and Supplies ................................................ 5.251 4.516 PPI Drugs/PPI Surg. Appl/CPI(U) Med Sup.

Professional Liability Insurance ................................................. 4.780 3.152 HCFA—Prof. Liab. Phys. Prem. Survey.

Medical Equipment .................................................................... 2.348 1.878 PPI—Medical Instruments and Equip.

Other Professional Expense ...................................................... 6.890 7.601

Automobile .......................................................................... 1.400 1.300 CPI(U)—Private Transportation.

All Other ............................................................................. 5.490 6.301 CPI(U)—All Items less Food and Energy.

Footnotes:

(1) Due to rounding, weights may not sum to 100.000%.

(2) Sources: Socioeconomic Monitoring System 1997 Survey of Physicians, Center for Health Policy Research, American Medical Association;

Anne L. Finger, ‘‘What it costs to run a practice,’’ Medical Economics, October 27, 1997; U.S. Department of Labor, Bureau of Labor Statistics;

and U.S. Department of Commerce, Bureau of the Census, 1992 Asset and Expenditure Survey, and 1997 Current Population Survey.

(3) Net of change in the 10-year moving average of output per man-hour for the non-farm business sector.

(4) Includes employee physician payroll.

(5) Includes paid leave.

To determine the expenditure

weights, we used currently available

and statistically valid data sources on

physician earnings and practice

expenses. While we consulted

numerous data sources, we used five

sources to determine the rebased and

revised MEI expenditure weights: (1)

The 1997 AMA SMS survey (1996 data);

(2) the March 1997 Bureau of Labor

Statistics (BLS) Employment Cost Index;

(3) the 1992 Bureau of the Census Asset

and Expenditure Survey (the latest

available); (4) the 1996 Bureau of the

Census Current Population Survey; and

(5) the Medical Economics continuing

survey published October 1997 (1996

data). No one data source provided all

of the information needed to determine

expenditure weights according to our

criteria. The use of each of these data

sources is described in detail below.

a. American Medical Association

Socioeconomic Monitoring System

Survey. Like the current MEI, the

proposed MEI will use AMA data on

mean physician net income (physician

earnings) and professional expenses for

self-employed physicians for the major

expenditure categories. The seven major

expenditure categories taken from the

AMA data, as shown in Table 1, are

physician earnings, nonphysician

employee compensation, office

expenses, medical materials and

supplies, professional liability

insurance, medical equipment, and

other professional expenses. The

weights represent each expenditure

category’s proportion of total expenses

in 1996. While many of the category

weights have changed since 1989, the

effect on the percent change in the MEI

has been minimal, as explained later.

The physician earnings expenditure

category in the rebased MEI is defined

differently from the one in the current

MEI as it includes employee physician

compensation. Until recently, employee

physician compensation was not

available through the AMA survey and

was not included in any AMA

expenditure categories. AMA reported

these data separately in 1996. We

believe it is appropriate, for our

purposes, to include employee

physician compensation in the MEI

category of physician earnings. The

physician income (earnings) and

overhead expenses generated by

employee physicians are currently

included in the AMA expenditure
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30843

categories. We propose including

employee physician payroll in

physician earnings to be consistent with

the current methodologies used in

payment under the physician fee

schedule. Under the physician fee

schedule, the work RVU is paid based

on the service provided and not on who

provides the service. Since employee

physicians do the same services as selfemployed physicians, employee

physician time would be included in

the work RVU. By including employee

physician compensation in the

physician earnings category for the MEI,

we have achieved two goals: (1)

Appropriately categorizing these

expenses to be consistent with the

physician fee schedule; and (2)

adjusting these expenses by the

appropriate price proxies for a

physician’s own time. A detailed

discussion of the price proxies is

presented below.

b. Employment Cost Index Survey.

The Employment Cost Index (ECI)

survey has shares of total compensation

for wages and salaries and benefits by

private industry health services

occupational category that can be used

to allocate the wage and fringe benefit

shares for nonphysician employees. The

data on these shares are produced for

March of every year. We determined

that March 1997 would be most

representative of the shares in 1996

because the March 1996 data would

miss any changes that occurred during

the last three quarters of that year. The

shares are determined from employer

costs per hour worked. Paid leave is

defined as a benefit under this survey.

Unfortunately, this survey does not have

data for offices of physicians. However,

data are available on wage and fringe

benefit shares for total health services

that include hospitals, nursing homes,

offices of physicians, and offices of

dentists. While not a direct measure of

employee wage and fringe benefit shares

in offices of physicians, the shares for

health services from the ECI survey do

provide a normative estimate of the split

between wages and fringes.

In the ECI survey for total health

services, the wage and fringe benefit

split of compensation was 73.9 percent

and 26.1 percent, respectively. For

comparison purposes, when we

included paid leave as part of wages,

these shares were very similar to

nonphysician employee wage and fringe

benefit share data from two physician

group practice studies. Based on this

analysis, we are proposing to use the

wage and fringe benefit shares for total

health services from the ECI survey,

with paid leave as a benefit, in the

rebased and revised MEI for

nonphysician employee compensation.

The wage and fringe benefit shares for

physicians and nonphysician

compensation in the current MEI were

developed from a special study

conducted by our Office of the Actuary.

These current and revised shares are

presented in Table 1.

c. Asset and Expenditure Survey. We

are proposing to use the 1992 Bureau of

the Census Asset and Expenditure

survey to derive an estimate of the wage

and fringe benefit share for physicians

under the MEI. The wage and fringe

benefit share for all persons employed

in physician offices is available from the

1992 Asset and Expenditure survey.

This share includes both physicians and

nonphysician employees in the

physician office. By aging this share to

1996 using the ECI for wages and fringe

benefits for total health services and

moving paid leave from wages to fringe

benefits based on analysis of ECI data on

health services, we were able to develop

a wage and fringe benefit share for

physician offices for 1996. The wage

share for physician offices was 79.4

percent, and the fringe benefit share

20.6 percent. Using this wage and fringe

benefit share, the wage and fringe

benefit share for nonphysician

employees developed from the ECI

survey, and the share for physician and

nonphysician compensation developed

from the AMA survey, we were able to

impute a wage and fringe benefit share

for physicians. The wage share was 81.2

percent, and the benefit share 18.8

percent for physicians. We compared

these shares to physician group data on

physician wage and fringe benefit shares

and found them to be very consistent.

Therefore, we are proposing to use these

wage and fringe benefit shares for

physicians in the rebased and revised

MEI, as shown in Table 1.

d. Current Population Survey. We are

proposing to use the 1996 Current

Population Survey (CPS) from the

Bureau of the Census to determine the

distribution of nonphysician employee

wages in the rebased and revised MEI.

The 1989 CPS was used to determine

the distribution for the current MEI. The

new distribution is presented in Table 5.

Craft and kindred workers are no longer

included in the distribution because

their share is not significant.

TABLE 5.—PERCENT DISTRIBUTION OF

NON-PHYSICIAN PAYROLL EXPENSE

BY OCCUPATIONAL GROUP: 1996

BLS occupational group Expenditure

shares (1)

Total .......................................... 100.000

TABLE 5.—PERCENT DISTRIBUTION OF

NON-PHYSICIAN PAYROLL EXPENSE

BY OCCUPATIONAL GROUP: 1996—

Continued

BLS occupational group Expenditure

shares (1)

Professional and Technical

Workers .......................... 45.570

Managers ........................... 19.399

Clerical Workers ................ 30.831

Service Workers ................ 4.199

(1) These weights were derived from the

1996 Current Population Survey, U.S. Bureau

of the Census.

e. Medical Economics Continuing

Survey. Consistent with the current

MEI, we are proposing to use the

Medical Economics Continuing Survey

to determine the weight for automobile

(professional car) expenses. We used the

1996 Continuing Survey published in

the October 27, 1997, Medical

Economics (Finger, 1997) to determine a

weight of 1.3 percent in the proposed

MEI for automobile expenses, which is

nearly identical to the 1.4 percent share

in the current MEI.

3. Selection of Price Proxies

a. Background. After the 1996 cost

weights for the revised MEI were

developed, we reviewed the current set

of price proxies to determine whether

they were still the most appropriate to

monitor the rate of price change for each

expenditure category. As was the case in

1992 (57 FR 55901), most of the

indicators we considered are based on

BLS data and are grouped into one of

the following five categories:

• Producer Price Indices (PPIs). PPIs

measure price changes for goods sold in

other than retail markets. They are the

preferred proxies for physician

purchases at the wholesale level. These

fixed-weight indexes are a measure of

price change at the producer or at the

intermediate stage of production.

• Consumer Price Indices (CPIs). CPIs

measure change in the prices of final

goods and services bought by

consumers. Similar to the PPIs, they are

fixed-weight. CPIs may not represent the

price changes faced by producers. For

this reason, CPIs were used absent an

appropriate PPI or if the expenditure

was similar to that of retail consumers

in general, rather than to a purchase at

the wholesale level.

• Average Hourly Earnings (AHEs).

AHEs permit the measurement of

changes in hourly earnings for

production and nonsupervisory workers

for specific industries as well as the

nonfarm business economy. AHEs are

calculated by dividing gross payrolls for

wages and salaries by total hours. The
30844 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

series reflects shifts in employment mix

and, thus, is representative of actual

changes in hourly earnings for

industries or for the nonfarm business

economy.

• ECIs for wages and salaries. These

ECIs measure the rate of change in

employee wage rates per hour worked.

These fixed-weight indices are not

affected by shifts in industry or

occupation employment levels.

• ECIs for employee benefits. These

ECIs measure the rate of change in

employer costs of employee benefits

such as the employer’s share of Social

Security taxes, pension and other

retirement plans, insurance benefits

(life, health, disability, and accident),

and paid leave. Like ECIs for wages and

salaries, they are not affected by changes

in industry output or occupational

shifts.

As with choosing the expenditure

categories, choosing appropriate wage

and price proxies for each expense

category necessarily involves making

tradeoffs and using judgment. The

strengths and weaknesses of each proxy

variable need to be evaluated using

several criteria that can potentially

conflict.

The first criterion is relevance. The

price variable should appropriately

represent price changes for specific

goods or services within the expense

category. Relevance may encompass

judgments about relative efficiency of

the market generating the price and

wage increases and may include

normative factors relating to fairness.

The second criterion is reliability or

low sampling variability. If the proxy

wage-price variable has a high sampling

variability or inexplicable erratic

patterns over time, its value is greatly

diminished since it is unlikely to reflect

accurately price changes in its

associated expenditure category. Low

sampling variability can conflict with

relevance since the more specifically a

price variable is defined in terms of

service, commodity, or geographic area

the higher the sampling variability in

some cases.

Timeliness of actual published data is

the third criterion. For this reason,

monthly and quarterly data take priority

over annual data.

The fourth criterion is the length of

time the time-series data has been in

use. A well-established time series is

needed to assess the reasonableness of

the series and to provide a solid base

from which to forecast future price

changes in the series. Forecasting the

MEI is required to make Federal budget

and Trustee’s report estimates.

The BLS price proxy categories

previously described meet the criteria of

relevance, reliability, timeliness, and

time-series length. The price-wage

proxies for the rebased and revised MEI

(shown in Table 1) are the same as those

chosen for the current MEI.

b. Expense Categories. (1) Physician

Time

Because the revenue associated with

physician time is the single largest cost

component in the MEI (54.5 percent),

the selection of the price proxy for

wages and salaries cost category is a

major determinant of the rate of change

in the MEI. For that reason, we are

furnishing an extensive discussion of

the selection of the price proxy for the

wages and salaries component as we did

in the November 1992 final rule (57 FR

55903). We have found no compelling

reason to change the wage proxy for this

expense category and offer the same

rationale that we used in the November

1992 final rule.

The legislative history of the MEI

reveals Congressional concern that

increases in physician charges are a

cause, rather than a result, of inflation.

The following language from the Senate

Finance Committee report

accompanying the 1972 Social Security

Amendments makes that point clearly:

The committee * * * believes that it is

necessary to move in the direction of an

approach to reasonable charge

reimbursement that ties recognition of fee

increases to appropriate economic indexes so

that the program will not merely recognize

whatever increases in charges are established

in a locality but would limit recognition of

charge increases to rates that economic data

indicate would be fair to all concerned

(emphasis added) and follow rather than lead

inflationary trends. * * * Initially, the

Secretary would be expected to base the

proposed economic indexes on presently

available information on changes in expenses

of practice and general earnings levels. * * *

S. Rep. No. 1230, 92d Cong., 2d Sess. 190–

191 (1972).

There is obvious circularity if

increases in prevailing charges are

linked to increases in physician charges,

which are then tied to increases in

physician income. The committee’s

expectation that the rate of price

inflation assigned to the physician time

portion of the MEI be permitted to

increase by an amount consistent with

increases in general earnings levels

seems to reflect the Congress’ preference

for an equitable external price proxy;

that is, a compensation proxy based on

compensation outside or external to the

physician services industry. We

examined the following three principal

alternatives for the wages and salary

component of the physician time cost

category:

• The use of AHEs for production and

nonsupervisory workers in the private

nonfarm economy.

This option suggests a standard of

payment that implies that price

increases for the physician labor

component should be the same as for

workers in the overall economy, that is,

general earnings. This option presumes

that the price increase for the physician

time category (excluding fringe benefits)

should reflect the changing mix of

industry output and employment. This

alternative appears to reflect most

closely the Senate Finance Committee’s

reference to general earnings levels.

Since earnings are per hour, a constant

quantity of labor input per unit of time

is reflected. In addition, the use of the

AHEs data is consistent with the BLS

labor productivity measures. The

revised MEI as well as the current MEI

incorporates an adjustment for

economy-wide labor productivity to

preclude a double-counting of

productivity. Economy-wide wage

increases reflect economy-wide

productivity increases. In addition,

physician practice productivity

increases associated with the fee-forservice Medicare payment system

automatically result in revenue

increases for the individual physician

practices. Economy-wide productivity

increases are adjusted out of the

compensation portion of the MEI so that

individual physician practices get all of

their own productivity increases, but

not economy-wide productivity

increases as well. The adjustment will

continue to be for the 10-year moving

average change in productivity.

• The use of ECIs for wages and

salaries of the total private nonfarm

economy.

This option suggests a standard of

payment that implies that price

increases for the physician labor

component should be the same as that

for workers in a hypothetical, overall

economy in which there are no shifts in

the employment patterns of workers.

The overall ECI weighs nine broad

occupational categories and permits

measurement of the change in the

hourly straight time wage rate for

private industry workers (Nathan, 1987

and Schwenk, 1985). ECIs are

unaffected by changes in occupational

employment shifts or industry output

shifts. Therefore, this alternative would

not recognize changes in the

composition of the work force over time

as intended by the Senate Finance

Committee.

• The use of an ECI for wages and

salaries for private professional and

technical workers.
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30845

This proxy implies that price changes

in the physician time component,

excluding fringe benefits, should

correspond to those for private sector

professional and technical workers. The

professional and technical workers

category is one of the nine categories

that comprise the overall ECI.

Physicians are a tiny subset of this

occupational group. The supply,

demand, and opportunity cost

characteristics of this broad category,

however, may be different from the

supply, demand, and opportunity cost

characteristics of an efficient market for

physician services. Most professional

and technical workers are in labor

markets where firms compete for

employees. Most office-based

physicians are self-employed. Some

occupations within the professional and

technical group are in short supply

leading to upward pressure on

compensation levels. Use of this price

series would take the MEI away from

the general earnings specified in the

enacting legislation.

Each of the above options implies a

different standard of equity. In Table 6,

we compare the annual rates of change

in the MEI using three different price

variables for physician earnings

suggested as options.

TABLE 6.—COMPARISON OF ANNUAL

PERCENT CHANGES IN THE MEI

WITH ALTERNATIVE PHYSICIAN

WAGE PRICE PROXIES

Year ending

June 30

Revised MEI with alternative proxies for physicians’ own time

AHE:

total

private

nonfarm

ECI:

wages/

salaries for

total

private

ECI:

wages/

salaries for

professional

and

technical

1992 .................. 2.8 3.1 3.4

1993 .................. 2.2 2.3 2.7

1994 .................. 2.1 2.3 2.3

1995 .................. 2.0 2.1 2.0

1996 .................. 1.9 1.9 1.8

1997 .................. 2.3 2.2 2.0

Average:

1992–1997 ..... 2.2 2.3 2.4

The proposed MEI uses AHEs for the

private nonfarm economy as the proxy

of choice for the physician wages and

salaries component of the input price

index and is the same price measure

used in the 1989-based MEI. In our

judgment, this alternative remains the

one that most closely comports with

Congressional intent as expressed in the

Senate Finance Committee’s 1972 report

referenced above. AHEs change in

accordance with market forces

associated with changes in the type and

mix of workers. This is not the case with

ECIs, since ECIs reflect a fixed

composition of the work force at a given

time. Therefore, the rate of change in an

ECI may differ substantially from an

actual AHE measure.

The current MEI uses the ECI for

fringe benefits for total private industry

as the price proxy for fringe benefits. We

propose using the same proxy for the

1996-based MEI. This means that both

the wage and fringe benefit proxies for

physician time are derived from the

nonfarm private sector and are both

computed on a per-hour basis.

(2) Nonphysician Employee

Compensation. As in the 1989-based

MEI, we are proposing to use the 1996

Current Population Survey data on

earnings and employment by

occupation to develop labor cost shares

for the nonphysician occupational

groups shown in Table 5. BLS maintains

an ECI for each of these occupational

groups and we are proposing to use

these as price proxies for nonphysician

employee wages in the same manner

they are used in the current MEI. We

multiplied each of the occupational cost

shares by the changes in the

occupational ECI for that category.

These values were summed to yield an

overall rate of price change.

The skill mix shift in physician

offices has been substantial in the last

few years as work formerly done in the

hospital increasingly is done in

ambulatory settings. These skill mix

shifts appropriately are held constant in

this Laspeyres index of nonphysician

employees’ wages and salaries. Skill

mix shifts that reflect rising intensity of

outputs in physician offices are

automatically paid for by higher charge

structures for the more complex mix of

service inputs. Physicians performing

more complex services may hire more

skilled employees, and, thus, may tend

to charge more for their services.

The current MEI uses the ECI for

fringe benefits for white collar

employees in the private sector. Most

nonphysician employees in physician

offices are white collar employees. We

are proposing to use the ECI for benefits

for white collar employees in the

rebased and revised MEI. Note that we

will continue to adjust the nonphysician

employee compensation portion of the

MEI by the 10-year moving average

change in economy-wide productivity

since physician practice productivity is

being recognized.

(3) Office Expense. Office expenses

include rent or mortgage for office

space, furnishings, insurance, utilities,

and telephone. We are proposing the

continued use of the CPI–U for housing

because it is a comprehensive measure

of the cost of housing including rent,

owner’s equivalent rent, insurance,

maintenance and repair services, fuels,

utilities, telephones, furnishings, and

housekeeping services. This proxy

covers about 80 percent of the

population.

(4) Medical Materials and Supplies.

This cost category includes drugs,

outside laboratory work, x-ray films,

and other related services. There is no

price proxy that includes this mix of

materials and supplies. In the absence of

one index, in the 1989-based MEI we

equally weighted the following three

price proxies associated with the

medical materials and supplies listed

above:

• The PPI for ethical drugs.

• The PPI for surgical appliances and

supplies.

• The CPI–U for medical equipment

and supplies.

We propose using the same blended

proxy for the 1996-based MEI.

(5) Professional Liability Insurance.

This cost category includes costs for

professional medical liability or

malpractice insurance premiums

including costs associated with selfinsurance. Changes in the cost of

medical liability insurance premiums

currently are measured based on our

survey of the rate of change in average

liability premiums for $100,000/

$300,000 coverage (that is, $100,000 for

per-case limitation and $300,000 for

total coverage or the minimum

furnished) among major insurers. We

measured change with historical data

each January 1 and interpolated

quarterly changes for March, June, and

September.

We improved the professional

medical liability index in two major

ways. First, we used actual rates for $1

million/$3 million premiums in the

index for the most current historical

period and estimated them for earlier

years. Starting with 1996 levels and

1997 percentage changes, rates for $1

million/$3 million premiums will be

computed; in future periods we will use

premiums for $1 million/$3 million of

coverage.

Second, the revised index uses data

on a quarterly basis that is calculated

into a four-quarter moving average

percent change like all our other price

proxies. We achieve this by tracking the

premium changes that occur during

each quarter. We gathered historical

premium data back to 1992 and

established average premium levels

based on the mix of physicians by

specialty in 1996. We calculated four-
30846 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

quarter moving averages and percent

changes from 1992 through 1997 to

more accurately forecast changes in

premium levels for future budget and

Trustees’ report estimates. The previous

method obtained the premium change

only for January 1 of each year.

We are proposing the changes

described above because we believe

they will improve the quality of

measuring change in physician

professional medical liability premiums.

Far more physicians have $1 million/$3

million coverage rather than $100,000/

$300,000 coverage. Taking quarterly

measurements and computing a fourquarter moving average percent change

is the same methodology used for all the

other price proxies. The resulting series

better captures the changes through the

year.

(6) Medical Equipment. Medical

equipment includes depreciation,

leases, and rent on medical equipment.

We propose to use the PPI for medical

instruments and equipment as the price

proxy for this category, consistent with

the price proxy used in the 1989-based

MEI.

(7) Other Professional Expenses. This

category has two subcomponents:

professional car and ‘‘other.’’ The

professional car category includes

depreciation and upkeep for the

practice-related use of a professional

car. We are proposing the continued use

of the CPI–U for private transportation

for this cost category, consistent with

the price proxy used in the 1989-based

MEI. This excludes airline fares, intercity bus and train transportation, and

intra-city bus and train transportation.

This category also includes the

residual subcategory of other expenses.

This residual category includes

professional expenses such as

accounting services, legal services,

office management services, continuing

education, professional association

memberships, journals, and other

professional expenses. In the absence of

one price proxy or even a group of price

proxies that might reflect this

heterogeneous mix of goods and

services, we use the CPI-U for all items

less food and energy, consistent with

the price proxy used in the 1989-based

MEI.

4. Summary of Changes

Updating the MEI to the 1996 base

year resulted in small changes in

expense category weights. Physician

earnings increased slightly from 54.2

percent of the index in 1989 to 54.5

percent in 1996. Physician practice

expenses dropped slightly due to

declines in the expense shares for

medical materials and supplies,

professional liability insurance, and

medical equipment. These declines

were mostly offset by increases in the

expense shares for nonphysician

employee compensation, office

expenses, and other professional

expenses.

TABLE 7.—ANNUAL PERCENT CHANGE

IN THE CURRENT AND REVISED

MEDICARE ECONOMIC INDEX

Years ending

June 30

Current

MEI

89-

base

%

change

Revised

MEI

96-

base

%

change

Difference

1985 .................. 3.3 3.2 ¥0.1

1986 .................. 3.3 3.0 ¥0.3

1987 .................. 3.0 2.7 ¥0.3

1988 .................. 3.6 3.4 ¥0.2

1989 .................. 3.4 3.5 0.1

1990 .................. 3.0 3.4 0.4

1991 .................. 3.2 3.4 0.2

1992 .................. 2.8 2.8 0.0

1993 .................. 2.1 2.2 0.1

1994 .................. 2.1 2.1 0.0

1995 .................. 2.0 2.0 0.0

1996 .................. 2.1 1.9 ¥0.2

1997 .................. 2.2 2.3 0.1

Average 1985—

1997 ............... 2.8 2.8 0.0

The rebased and revised MEI is very

similar to the current MEI. Using the

new expense category weights and new

proxy for professional medical liability

premiums, the difference in the annual

percent change in the index is within

two-tenths of one percent in most years

from 1985 through 1997. The average

annual percent change from 1985 to

1997 was identical. Thus, this revision

and rebasing, while making the expense

shares more timely, has little impact on

the percent changes in the MEI as a

whole.

III. Implementation of the Balanced

Budget Act of 1997 (BBA 1997)

In addition to the resource-based

practice expense relative value units,

BBA 1997 provides for revisions to the

payment policy for drugs and

biologicals, a provision allowing private

contracting with Medicare beneficiaries,

payment for outpatient rehabilitation

services based on the physician fee

schedule, and revisions to our policy for

nonphysician practitioners.

A. Payment for Drugs and Biologicals

Before January 1, 1998, drugs and

biologicals not paid on a cost or

prospective payment basis were paid

based on the lower of the estimated

acquisition cost (EAC) or the national

average wholesale price (AWP) as

reflected in sources such as the Red

Book, Blue Book, or Medispan. For

purposes of this discussion, we will use

the term ‘‘drugs’’ to refer to drugs and

biologicals. Examples of drugs that are

paid on this basis are drugs furnished

incident to a physician service, drugs

furnished by pharmacies under the

durable medical equipment (DME)

benefit, and drugs furnished by

independent dialysis facilities that are

not included in the end-stage renal

disease (ESRD) composite rate payment.

Section 4556 of BBA 1997 established

payment for drugs not paid on a cost or

prospective payment basis at the lower

of the actual billed amount or 95

percent of the AWP, effective January 1,

1998. In this proposed rule, we are

revising the current regulations at

§ 405.517 to conform to this statutory

change. This regulation would remove

the EAC and provide for payment at the

lower of the actual charge on the

Medicare claim or 95 percent of the

AWP.

Also, we are proposing to revise the

method of calculating the AWP. Our

current regulations provide that, for

multiple-source drugs, the AWP equals

the median AWP of the generic forms of

the drug. The AWP of the brand name

products is ignored on the presumption

the brand AWP is always higher than

the generic AWPs. While this may have

been true when the policy was first

promulgated, it is not always true now.

Therefore, we are proposing that the

AWP for multiple-source drugs would

equal the lower of the median price of

the generic AWPs or the lowest brand

name AWP.

B. Private Contracting With Medicare

Beneficiaries

Section 4507 of BBA 1997 amended

section 1802 of the Act to permit certain

physicians and practitioners to opt-out

of Medicare and to provide through

private contracts services that would

otherwise be covered by Medicare.

Under such contracts the mandatory

claims submission and limiting charge

rules of section 1848(g) of the Act would

not apply. This section, which was

effective on January 1, 1998, and was

implemented through operating

instructions, counters the effect of

certain provisions of Medicare law that,

absent section 4507 of BBA 1997,

preclude physicians and practitioners

from contracting privately with

Medicare beneficiaries to pay without

regard to Medicare limits.

Specifically, section 1848(g) of the

Act restricts the amounts that can be

collected from beneficiaries by

nonparticipating physicians who do not

take assignment on the Medicare claim

(physicians who take assignment
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30847

voluntarily agree to accept the Medicare

payment amount as payment in full and

collect only deductible and coinsurance

amounts from the beneficiary).

Moreover, section 1842(b)(18) requires

certain practitioners to take assignment

when they furnish covered services to

Medicare beneficiaries and restricts

what they can collect from beneficiaries

to deductible and coinsurance amounts.

The statute not only imposes these rules

(without an exception before passage of

section 4507 of BBA 1997), but it also

provides strong sanctions for violation

of them. Hence, Medicare law absent

section 4507 effectively precludes a

physician or practitioner from privately

contracting with a Medicare beneficiary

for the delivery of Medicare-covered

items and services, except in

compliance with these rules (for

example, to pay more than the limits set

by law). Section 4507 of BBA 1997

permits such private contracting,

provided the requirements of BBA 1997

are met.

The private contracting provision was

effective for private contracts entered

into, on, or after January 1, 1998. We

implemented it through a series of

operating instructions for Medicare

carriers and information that carriers

were instructed to provide to physicians

and practitioners. Specifically, in

November 1998, we issued Program

Memorandum No. B–97–9 (change

request number 294) that transmitted

the Medicare fee schedule for physician

services and contained the fact sheet

that carriers were instructed to send to

physicians and practitioners with the

1998 fee schedule information. This

document, which is commonly called

the ‘‘Dear Doctor letter,’’ advised

physicians and practitioners of the fee

schedule amounts for 1998, the changes

to regulations, and also the important

changes that BBA 1997 made to

coverage and payment for physician

services, including the private

contracting changes.

Due to the private contracting

provisions, we extended the

participating enrollment period to

February 2, 1998, to give physicians

sufficient time to consider the changes

made by BBA 1997 before making a

participation decision. In January 1998,

we issued Program Memorandum No. B

97–17 (change request number 193), that

was devoted in its entirety to private

contracting and not only laid out the

processes that would apply but also

answered the most frequently asked

questions about private contracting.

Carriers were instructed to share this

information with physicians and

practitioners through carrier bulletins.

Lastly, in April 1998, we issued

Program Memorandum No. B 98–12

(change request number 468), which

amended the process to be followed

when the carriers receive a claim from

a physician or practitioner who has

opted-out of Medicare under the private

contracting provision and thus should

not bill Medicare.

We are using this proposed rule to

place in regulations the requirements

that section 4507 of BBA 1997 added to

sections 1802(b) and 1862(a)(19) of the

Act. In addition to placing the statutory

requirements in regulations, this

proposed rule also proposes ancillary

policies that we believe are necessary to

clarify what it means when a physician

or practitioner exercises his or her

ability to ‘‘opt out’’ of Medicare.

There has been a lot of confusion and

misinformation about when private

contracts are needed. Before we discuss

our proposed rules governing private

contracting, we want to address some of

the most common questions about

Medicare claims submission rules and

private contracting.

• Do the private contracting rules

apply to Part A?

No. The Medicare claims submission

and private contracting rules apply only

when a physician or practitioner

furnishes Medicare-covered services to a

beneficiary who is enrolled in Medicare

Part B. They do not apply to individuals

who have only Medicare Part A or to

individuals who are age 65 or over but

who do not have Medicare. Therefore, if

the patient is not enrolled in Medicare

Part B, a private contract is not needed

for the physician or practitioner to

continue to bill the patient and to

charge without regard to the Medicare

mandatory claims submission and

limiting charge rules.

The private contracting provision of

the statute defines ‘‘beneficiary’’ (for

purposes of that section only) as a

person who is eligible for Part A or who

is enrolled in Part B. However, the

private contracting provisions of the law

set aside the mandatory claims and

limiting charge rules that apply only to

Part B. Therefore, notwithstanding the

statutory definition of the term

‘‘beneficiary’’ to mean, in part, an

individual who is eligible for Part A, as

a practical matter section 4507 applies

only to services furnished to an

individual who is enrolled in Part B.

• Must a physician or practitioner

who provides services that are not

covered by Medicare sign a private

contract with the beneficiary and optout of Medicare to be paid for

noncovered services?

No. Since Medicare rules do not apply

to services that Medicare does not cover,

a section 4507 private contract is not

needed to bill for them, and neither the

Medicare claims submission nor the

Medicare limiting charges rules apply to

these services. A private contract is

needed only for Medicare-covered

services and then only if the physician

or practitioner is opting-out or has

opted-out.

A physician or practitioner may

furnish a service that Medicare covers

under some or many circumstances but

that would likely be deemed as not

reasonable and necessary by Medicare

in a particular case (for example,

multiple nursing home visits, some

concurrent care services). In that

particular case, the physician or

practitioner should give the beneficiary

an advance beneficiary notice (ABN)

that states the service may not be

covered by Medicare and that the

beneficiary will be liable to pay for the

service if it is denied. If the claim is

denied by Medicare, a private contract

is not necessary to permit the physician

or practitioner to bill the beneficiary for

the service.

• What are the rules governing claims

submission to Medicare?

There are situations where a

physician or practitioner who has not

opted-out of Medicare is not authorized

to submit a claim for a covered item or

service provided to a Medicare

beneficiary. A beneficiary, for reasons of

his or her own, may decline to authorize

the physician or practitioner to submit

a claim or to furnish confidential

medical information that is needed to

submit a proper claim to Medicare. For

example, the beneficiary may not want

information about the beneficiary’s

mental illness or HIV/AIDS status to be

disclosed to anyone. If the beneficiary

does not sign the claim or otherwise

authorize the claim submission, the

physician or practitioner should not

submit the claim to Medicare. However,

the limiting charge would apply to the

service. Moreover, if the beneficiary or

his or her legal representative later

decides to authorize the submission of

a claim for the service and asks the

physician or practitioner to submit the

claim, the physician or practitioner

must do so.

Where the beneficiary authorizes the

claim submission, physicians and

practitioners must submit claims for

services furnished to an individual

enrolled in Medicare Part B unless they

have opted-out of Medicare under the

private contracting provisions of the

law.

Physicians and practitioners who

furnish services to a Medicare

beneficiary need not submit claims to

Medicare in the following cases:
30848 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

• The beneficiary is not enrolled in

Medicare Part B; Medicare limiting

charge does not apply.

• The beneficiary refuses to authorize

the physician or practitioner to submit

a claim for a covered service to

Medicare; Medicare limiting charge

does apply.

• The service is categorically

noncovered (for example, hearing aids

and meals on wheels for diabetics);

Medicare limiting charge does not

apply.

• The service is not covered because

the beneficiary is enrolled in a Medicare

risk HMO and the HMO will not pay for

the service because the physician or

practitioner is outside of the HMO’s

network; Medicare limiting charge does

not apply.

Provisions of the proposed rule

relating to private contracting.

Definitions

In § 405.400, we define certain terms.

We are proposing to define

‘‘beneficiary’’ to mean an individual

who is enrolled in Part B of Medicare.

As we discussed above, the statute’s

definition of the term has created

considerable confusion about whether

physicians must opt-out of Medicare to

charge individuals who are over age 65

and eligible for Part A of Medicare but

who are not enrolled in Part B of

Medicare. We believe it is necessary to

define the term ‘‘beneficiary’’ as being

limited to an individual who is enrolled

in Part B of Medicare in order to avoid

continued confusion on this issue. We

believe that having a definition that

differs from the statute’s definition is

justified because the context in which

the definition is used is that of Part B

claims submission rules, Part B limiting

charges, and coverage of Part B services.

None of these policies is applicable to

individuals who are not enrolled in Part

B of Medicare.

We propose to define ‘‘emergency

care services’’ as being services

furnished to an individual who has an

‘‘emergency medical condition’’ as that

term is defined in § 489.24. Reliance on

the longstanding definition of

emergency medical condition is, we

believe, an appropriate and useful way

to define emergency care services.

We are proposing to define ‘‘legal

representative’’ to mean an individual

who has been appointed as the

Medicare beneficiary’s legal guardian

under State law, or who has been

granted a power of attorney from the

beneficiary, which power of attorney is

sufficient to permit the individual to

enter into private contracts on the

Medicare beneficiary’s behalf. This is

necessary to clarify that, if a beneficiary

has a legal representative, that party can

act on the beneficiary’s behalf when

signing a private contract. We recognize

that this is a strict standard and we

invite comments on it. However, our

concern is that we ensure that only

parties who were authorized to make

legal and financial commitments on

behalf of the beneficiary be permitted to

sign private contracts on a beneficiary’s

behalf since signing such a contract may

incur a significant debt for a beneficiary.

We are defining the term ‘‘opt-out’’ to

mean the status of meeting the

conditions specified in § 405.410. When

the physician or practitioner meets

these conditions, he or she ceases to be

bound by Medicare’s mandatory claims

submission rule and, in the case of a

physician, the limiting charge rule or, in

the case of a practitioner, the mandatory

assignment rule.

We are defining ‘‘participating

physician’’ to mean a physician as

defined in this section who has signed

an agreement to participate in Part B.

We are defining ‘‘physician’’ to mean

a doctor of medicine or a doctor of

osteopathy (who is legally authorized to

practice as such in the State in which

he or she practices). This is the statutory

definition of the term for purposes of

this section as specified in section

1802(b)(5)(B) of the Act.

We are defining ‘‘practitioner’’ to

mean any of the following to the extent

that the individual is legally authorized

to practice as such by the State where

he or she furnishes services: a physician

assistant, nurse practitioner, clinical

nurse specialist, certified registered

nurse anesthetist, certified nurse

midwife, clinical psychologist, and

clinical social worker. These

practitioners are those included in the

statutory definition of practitioner for

this purpose in section 1802(b)(5)(C) of

the Act, that incorporates by reference

those practitioner types listed in section

1842(b)(18)(C) of the Act.

We are defining ‘‘private contract’’ to

mean a document that meets the criteria

in § 405.415.

We propose to define ‘‘properly optout’’ to mean to fully complete the

requirements in § 405.410, each of

which must be met for the physician or

practitioner to opt-out of Medicare and

furnish items or services under a private

contract.

We propose to define ‘‘properly

terminate opt-out’’ to mean to fully

complete the requirements in § 405.445,

each of which must be met for the

physician or practitioner who has

opted-out of Medicare to terminate his

or her opt-out.

We are proposing to define ‘‘urgent

care services’’ as services that are

provided to an individual who requires

services to be furnished within 12 hours

in order to avoid the likely onset of an

emergency medical condition.

We also adopted the concept of

‘‘emergency medical condition’’ as

defined in § 489.24 to help define urgent

care services because the former term

has a longstanding history of use in

Medicare with respect to when a

hospital must furnish emergency care to

an individual who appears at its door

(specifically, the ‘‘anti-dumping’’ rules).

We have no standardized definition of

‘‘urgent care services.’’ We have been

unable to find a definition of an ‘‘urgent

care service’’ in standard usage.

However, we think that an urgent care

service would appropriately be any

service that needs to be furnished

without significant delay so as to avoid

the onset of an emergency medical

condition. Therefore, we are proposing

that an ‘‘urgent care service’’ is one that

needs to be furnished within 12 hours

of the determination of need in order to

avoid the individual’s condition from

becoming an emergency medical

condition. The chief distinction

between urgent care services and

emergency care services is that urgent

care services do not have to be

furnished ‘‘immediately’’ as do

‘‘emergency care services.’’

General Rules

In § 405.405, we specify the general

rules that apply to private contracting.

Specifically, in § 405.405(a), we state

that a physician or practitioner may

enter into one or more private contracts

with Medicare beneficiaries for the

purpose of furnishing items or services

that would otherwise be covered by

Medicare when the requirements of

these rules are met. This is required by

section 1802(b)(1)of the Act.

In § 405.405(b), we specify that a

physician or practitioner who enters

into at least one private contract with a

Medicare beneficiary under this

provision, and who submits one or more

affidavits in accordance with these

rules, opts out of Medicare for a 2-year

period. This is required by section

1802(b)(3)(B)(ii) of the Act. We also

specify that the physician’s or

practitioner’s opt-out may be renewed

for subsequent 2-year periods. Since the

statute specifies that the physician or

practitioner who meets the criteria for

private contracting cannot be paid by

Medicare for a 2-year period and does

not address continuance of this period,

we have chosen to make the opt-out

period 2 years but to permit subsequent

opt-out periods. There is no limit on the

number of subsequent periods for which

a physician or practitioner may opt-out.
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30849

In § 405.405(c), we specify that both

the private contracts described in

paragraph (a) and the physician’s or

practitioner’s opt-out described in

paragraph (b) are null and void if the

physician or practitioner fails to

complete opt-out in accordance with

these rules or fails to remain in

compliance with the conditions for

opting-out. We specify the results of

failure to properly opt-out or to

maintain the conditions for opting-out

in § 405.430 and § 405.435. Sections

1802(b)(2) and (b)(3)(A) of the Act, the

criteria that governs the private contract

and the affidavit, must be met by

physicians and practitioners that want

to opt-out and to privately contract with

Medicare beneficiaries.

In § 405.405(d), we specify that

services furnished under private

contracts meeting the requirements of

this Subpart are not covered services

under Medicare and that no Medicare

payment will be made for such services

either directly or indirectly. This

implements section 1862(a)(19) of the

Act, which causes services furnished

under private contracts by physicians

and practitioners who opt-out to be

excluded from coverage under

Medicare.

Conditions for Opting-Out of Medicare

In § 405.410, we specify the

conditions that must be met for a

physician or practitioner to opt-out of

Medicare and to furnish services under

private contracts with Medicare

beneficiaries. Specifically, in

§ 405.410(a), we specify that each

private contract between a physician or

a practitioner and a Medicare

beneficiary must meet the specifications

of § 405.415. In § 405.410(b), we specify

that the physician or practitioner who

wants to privately contract with

Medicare beneficiaries must submit to

Medicare one or more affidavits that

meet the specifications of § 405.420. The

physician or practitioner must submit

an affidavit to each Medicare carrier to

which the physician or practitioner

submits claims for Medicare payment.

In § 405.410(c), we specify that a

nonparticipating physician or a

practitioner may opt-out of Medicare at

any time. We also specify that the 2-year

opt-out period begins the date the

affidavit meeting the requirements of

§ 405.420 is signed, as long as the

affidavit is timely filed (that is, within

10 days after the first private contract is

entered into). In addition, we specify

that if any required affidavit is not

timely filed, the 2-year opt-out period

begins when the last of the affidavits is

filed. In this event, the private contracts

signed by the parties before the last

required affidavit is properly filed

become effective upon the filing of the

last required affidavit, and the

furnishing of any items or services to

Medicare beneficiaries under contracts

before the last required affidavit is

properly filed are subject to standard

Medicare rules. Section 1802(b)(3)(B)(ii)

provides that the opt-out period begins

when the affidavit is signed, and section

1802(b)(3)(B)(iii) of the Act specifies

that the affidavit must be filed within 10

days of the date the first private contract

is signed.

In § 405.410(d), we specify that a

participating physician may opt-out of

Medicare at the beginning of any

calendar quarter, provided the affidavit

described in § 405.420 is submitted to

Medicare at least 30 days before the

beginning of such quarter. Private

contracts signed by the parties before

the beginning of the calendar quarter

become effective at the beginning of

such calendar quarter, and the

furnishing of any items or services to

Medicare beneficiaries under these

contracts before the beginning of that

calendar quarter is subject to standard

Medicare rules.

It is necessary to treat participating

physicians differently from

nonparticipating physicians because

each participating physician has entered

into a contract with Medicare to be paid

at the full fee schedule for the services

they furnish to Medicare beneficiaries

(rather than at 95 percent of the

payment amount for nonparticipating

physicians). When a participating

physician opts-out of Medicare, he or

she, in effect, terminates his or her

participation agreement with Medicare

since he or she no longer agrees to

accept assignment on all services

furnished to Medicare beneficiaries.

When a participating physician opts-out

of Medicare, the carrier (that is, each

applicable carrier) must make systems

changes to ensure the system pays the

physician at the higher participatingphysician rate for the period before the

effective date of the opt-out, pays the

physician as a nonparticipatingphysician for emergency and urgent care

services effective the date of the opt-out,

and does not pay at all for all other

items and services effective the date of

the opt-out. Therefore, carriers need at

least 30 days advance notice when a

participating physician opts-out to

ensure that the systems changes are

made correctly. Moreover, carriers

generally make systems changes no less

frequently than at the beginning of each

calendar quarter. Therefore,

participating physicians must provide

30 days notice that they intend to optout at the beginning of the next calendar

quarter for the changes to be made

properly. We do not anticipate that this

requirement will cause significant

hardship on participating physicians

who choose to opt-out or on

beneficiaries who choose to privately

contract with them.

Requirements of Private Contracts

In § 405.415, we are specifying criteria

for a physician or practitioner to opt-out

of Medicare. To opt-out of Medicare, the

physician or practitioner must meet all

of the criteria in this section.

In § 405.415, we specify the

requirements for a private contract. In

§ 405.415(a) we specify that it must be

in writing, in accordance with section

1802(b)(2)(A)(i) of the Act. In addition,

we are proposing requiring that the

contract be printed in sufficiently large

type to ensure that beneficiaries are able

to read the contract.

In § 405.415(b), we specify that, as

required by 1802(b)(2)(B) of the Act, it

must state whether the physician or

practitioner has been excluded from

Medicare under section 1128 of the Act.

In § 405.415(c), we specify that, as

required by 1802(b)(2)(B)(ii) of the Act,

it must state that the beneficiary or legal

representative accepts full responsibility

for payment of the physician’s or

practitioner’s charge for the services

furnished.

In § 405.415(d), as required by section

1802(b)(2)(B)(iii) of the Act, it must state

that the beneficiary or legal

representative understands that there

are no limits on what the physician or

practitioner may charge for items or

services furnished by the physician or

practitioner.

In § 405.415(e), we specify that, as

required by 1802(b)(2)(B)(i) of the Act,

it must state that the beneficiary or legal

representative agrees not to submit a

claim to Medicare nor to ask the

physician or practitioner to submit a

claim to Medicare.

In § 405.415(f), we specify that, as

required by section 1802(b)(2)(B)(ii) of

the Act, it must state that the beneficiary

or legal representative understands that

no Medicare payment will be made for

any services furnished by the physician

or practitioner, although such Medicarecovered services would likely be

covered and paid by Medicare if they

were provided by a physician or

practitioner who had not opted-out of

Medicare.

In § 405.415(g), we specify that, in

accordance with section 1802(b)(2)(B)(v)

of the Act, it must state that the

beneficiary or legal representative enters

into this contract with the knowledge

that he or she has the right to obtain

Medicare-covered items and services
30850 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

from physicians and practitioners who

have not opted-out of Medicare.

In § 405.415(h), we propose that the

private contract contain the beginning

effective date and expiration date of the

opt-out period. The private contract

must expire on the expiration date of

the opt-out period since, after the

expiration of the opt-out period, the

physician or practitioner is no longer

authorized to privately contract unless

he or she enters into a new opt-out

period.

In § 405.415(i), we specify, in accord

with section 1802(b)(2)(B)(iv) of the Act,

that the private contract must state that

the beneficiary understands that

Medigap plans do not, and that other

supplemental insurance plans may elect

not to, make payments for such items

and services because payment is not

made by Medicare.

In § 405.415(j), we specify that the

contract must be signed by the

beneficiary or by the beneficiary’s legal

representative and by the physician or

practitioner. Section 1802(b)(2)(A)(i) of

the Act expressly requires that the

contract must be signed by the

beneficiary. Although there is no

parallel express requirement for the

physician or practitioner, we believe

that such a requirement is implicit in

the statute, and we are, therefore,

proposing that the physician or

practitioner also sign the contract.

In § 405.415(k), in accordance with

1802(b)(2)(A)(iii), we specify that the

contract must not have been entered

into during a time when the beneficiary

requires emergency care services or

urgent care services.

405.415(l), we propose that the

beneficiary or legal representative must

receive a copy of the contract before

items or services are furnished under

the contract. This is standard practice

when parties sign binding contracts, and

we believe it is important in this case so

that the beneficiary or family members

have the contract available if questions

about charges for the services furnished

arise.

In § 405.415(m), we propose that the

physician or practitioner must retain a

copy of each private contract for the

duration of the opt-out period to which

the contract applies. Physicians and

practitioners may want to retain the

private contracts for a longer period of

time in case a beneficiary disputes

whether a valid contract was signed.

In § 405.415(n), we propose that the

physician or practitioner must permit us

to inspect each such contract upon

request. We propose these requirements

to ensure that the contracts will be

available if there are allegations that the

physician or practitioner has failed

properly opt-out or maintain opt-out or

if there is need to review them to

process an appeal under § 405.450.

In § 405.415(o), we propose that a

private contract must be entered into for

each opt-out period.

We have been requested to create a

standard form for the private contract.

We have decided that such a form is not

necessary. While the minimal content of

the contract is controlled by Federal law

and regulation, the contracts are

otherwise private agreements. Moreover,

such contracts will not generally be

provided to nor inspected by the

Government.

Requirements for Opt-Out Affidavits

In § 405.420, we specify the required

elements of the affidavit that the

physician or practitioner must file with

Medicare to opt-out. In § 405.420(a), as

required by section 1802(b)(3)(B)(i) of

the Act, we specify that the affidavit

must be in writing and be signed by the

physician or practitioner.

In § 405.420(b), we specify that the

affidavit must contain the physician or

practitioner’s full name, address,

telephone number, national provider

identifier (NPI) or billing number if one

has been assigned, uniform provider

identification number (UPIN) if one has

been assigned, or, if neither a NPI,

billing number nor a UPIN has been

assigned, the physician or practitioner’s

tax identification number (TIN). This

information is necessary to enable the

Medicare carrier to positively and

uniquely identify the opt-out physician

or practitioner, as required by section

1802(b)(3)(B)(i), and to ensure that no

Medicare payment is made to the

physician or practitioner or to any party

for the services of the physician or

practitioner (except for emergency and

urgent care services), as required by

section 1802(b)(1)(B)of the Act.

Medicare carriers will provide the

identifying information to

Medicare+Choice (M+C) plans to ensure

that they do not pay opt-out physicians

or practitioners or enable them to be

paid by Medicare funds for services they

furnish to Medicare beneficiaries.

The TIN is necessary for physicians

and practitioners that do not have a NPI,

billing number, or UPIN so that the

carrier can establish a means of tracking

them without forcing them to complete

the full Medicare enrollment process in

order to opt-out of Medicare.

Recent data indicate that

approximately 4 percent of physicians

in the nation do not provide services to

Medicare beneficiaries. We believe that

some of these physicians (and some

practitioners who are currently not

enrolled in Medicare) are likely to

choose to privately contract with

Medicare beneficiaries under section

1802(b) of the Act, since doing so will

open a market to them. It is also likely

that many of these physicians and

practitioners do not have Medicare

billing numbers or UPINs because they

have not been providing care to

Medicare beneficiaries. Now, however,

if such physicians and practitioners

wish to privately contract with

Medicare beneficiaries under section

1802 of the Act, they will need to be

enumerated, for purposes of monitoring

compliance with the law and

particularly in case they furnish

emergency or urgent care services for

which they must bill and be paid by

Medicare, notwithstanding that they

have opted-out. Since we expect the

provision of emergency or urgent care

services by opt-out physicians to be very

infrequent, and since we intend to

monitor for potential abuse, we believe

that the burden associated with

collecting this information is very slight,

is far outweighed by the benefit to

beneficiaries of having these physicians

available to provide emergency or

urgent care services if they need such

care, and is necessary to monitor

compliance.

In § 405.420(c), we specify, pursuant

to sections 1802(b)(3)(A), 1802(b)(3)(B),

and 1802(b)(3)(C) of the Act, that the

affidavit must state that the physician or

practitioner will provide items and

services to Medicare beneficiaries only

through private contracts that meet the

criteria of § 405.415.

In § 405.420(d), we specify that, in

accordance with section

1802(b)(3)(B)(ii) of the Act, the affidavit

must state that the physician or

practitioner will not submit a claim to

Medicare for any item or service

furnished to a Medicare beneficiary, nor

will the physician or practitioner permit

any entity acting on his or her behalf to

submit a claim to Medicare for any item

or service furnished to a Medicare

beneficiary. The extension of the

requirement to include any ‘‘entity’’

reflects our belief that very few

physicians and practitioners themselves

submit claims for services. Rather, we

believe that most physicians and

practitioners use a billing service or

reassign benefits to organizations that

bill and are paid for the physician’s or

practitioner’s services.

In § 405.420(e), we specify that, in

accordance with section

1802(b)(3)(B)(ii) of the Act, the affidavit

must state that the physician or

practitioner understands that he or she

may receive no direct or indirect

payment from Medicare for services to

Medicare beneficiaries who have signed
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30851

private contracts, whether as an

employee of an organization, a partner

in a partnership, under a reassignment

of benefits, or as payment for a service

furnished to a Medicare beneficiary

under a M+C plan. As with the

prohibition on billing, this provision

reflects the reality that most physician

and practitioner services are billed by

and paid to organizations to whom the

physician or practitioner reassigns

benefits.

When a physician or practitioner

opts-out of Medicare, no payment may

be made for the services of the

physician or practitioner, regardless of

whether another entity bills and is paid

for those services. In our experience,

physicians and practitioners frequently

fail to understand that organizations to

which they have reassigned benefits are

not, under Medicare law, considered to

be the entity that furnishes the service.

Therefore, where a physician reassigns

benefits to an organization and

subsequently decides to opt-out of

Medicare, he or she no longer has any

Medicare benefits to reassign and that

organization can no longer bill and be

paid by Medicare for the services of the

physician or practitioner. This has been

a source of confusion for physicians and

practitioners since the implementation

of the private contracting provisions on

January 1, 1998, and has resulted in

some physicians being terminated by

organizations that can no longer bill and

be paid by Medicare for their services.

Hence, we believe that this important

information should be placed in a

document that the physician or

practitioner must sign before opting-out.

Moreover, we believe that it is

important the physicians and

practitioners understand that opting-out

of Medicare means that they cannot be

paid by a Medicare risk or cost

contractor or, after June 1, 1998, a M+C

organization (for example, an HMO,

provider service organizations, M+C fee

for service plans, etc.), since payment by

these organizations for services to

Medicare beneficiaries would constitute

payment by Medicare and would be a

violation of the private contracting

rules.

In § 405.420(f), as required by section

1802(b)(3)(B)(ii) of the Act, the affidavit

must state that the physician or

practitioner acknowledges that the

services provided by the physician or

practitioner who opts-out of Medicare

are not covered by Medicare and that no

Medicare payment may be made to any

entity for those services, directly or on

a capitated basis. This is important to

note since, when Medicare does not

cover a service, it neither pays for the

item or service as primary payer nor

makes secondary payment when other

insurers are primary. (Also, many other

insurers will not make any payment

because the service is not covered by

Medicare.)

In § 405.420(g), we specify that the

affidavit must bind the physician or

practitioner to the terms of both the

affidavit and the private contracts for

the 2-year opt-out period. Section

1802(b)(3)(B)(ii) of the Act requires that

the physician or practitioner may optout for a period of not less than 2 years.

Accordingly, we have defined the optout period to be 2 years and have tied

the duration of the private contract to

the opt-out period.

In § 405.420(h), we propose that the

affidavit must acknowledge that the

physician or practitioner recognizes that

the terms of the affidavit apply to all

Medicare-covered items and services

furnished by the physician or

practitioner to Medicare beneficiaries,

regardless of any payment arrangement

in which the physician or practitioner

participates. It is not unusual for

physicians and practitioners to have

multiple sources of income and to

reassign benefits to multiple entities (for

example, multiple HMOs, preferred

provider organizations, private practice,

and part time employment by a facility).

When a physician or practitioner optsout, we want to ensure that he or she

understands that he or she opts-out for

all Medicare-covered items and services,

regardless of where or on whose behalf

they are provided. For example, a

physician who is employed by a facility

and who also has a private practice

cannot opt-out of Medicare with respect

to only the private practice and not optout for services he furnishes on behalf

of a facility or other organization for

which such services are billed to a

carrier and paid under Part B. If the

physician opts-out, no Medicare

payment can be made either to the

private practice or to the facility or other

organization for the services of the

physician. However, if the physician is

paid by the facility for administrative

functions which are not billable to

individual beneficiaries as physician

services, such as direction of a

department of a hospital or

administrative oversight of a teaching

program, the payment by the facility to

the physician is not affected.

In § 405.420(i), we propose that the

affidavit must acknowledge that the

physician or practitioner who has

previously signed a Part B participation

agreement understands that he or she

terminates that agreement as of the

effective date of the affidavit. We

believe that this is necessary to ensure

that the physician or practitioner

understands that he or she is no longer

a Medicare-participating physician or

practitioner. This is important with

regard to post opt-out billing for

emergency and urgent care services. The

physician or practitioner who provides

such care (for which Medicare will pay)

will be paid as a nonparticipating

physician if he or she submits those

claims for payment, notwithstanding

that he or she had a Part B participation

agreement before he or she opted-out.

In § 405.420(j), we specify that the

affidavit must acknowledge that the

physician or practitioner understands

that a beneficiary who has not signed a

private contract and who requires

emergency or urgent care services may

not be asked to sign a private contract

with respect to receiving those services.

If a physician or practitioner who opts

out of Medicare provides emergency or

urgent care services to a beneficiary who

has not previously signed a private

contract, the physician or practitioner

must submit a claim to Medicare for

those services and may not charge the

beneficiary more than the limiting

charge for those services.

In § 405.420(k), we propose that the

affidavit must be filed with each

Medicare carrier to which the physician

or practitioner has submitted claims in

the previous 2 years. This is necessary

to ensure that each Medicare claims

payment system that needs to know of

the opt-out is advised promptly so that

no Medicare payment is made for the

services of the opt-out physician or

practitioner. This is based on sections

1802(b)(1)(B) and 1802(b)(3)(B)(iii) of

the Act.

In § 405.420(l), we specify that in the

case of a nonparticipating physician or

a practitioner, all required affidavits

must be filed within 10 days after the

physician or practitioner signs his or her

first private contract with a Medicare

beneficiary. In the case of a participating

physician, we specify that all required

affidavits must be filed in accordance

with § 405.410(d), which requires that

the affidavits be filed no later than 30

days before the beginning of a calender

quarter and must be effective on the first

day of the calender quarter. Section

1802(b)(3)(B)(iii) of the Act requires that

the physician or practitioner file the

affidavit within 10 days after the

physician or practitioner signs his or her

first private contract with a Medicare

beneficiary. As discussed previously in

this preamble, participating physicians

are permitted to opt-out only on a

quarterly basis because of the systems

changes that must be made to reverse

the effect of the participation

agreements they previously entered

into.
30852 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

Various members of the public have

requested we create a standard affidavit

for submission to the Medicare carrier.

We do not see a reason to do this. The

criteria of a legally sufficient affidavit

will be clearly specified in regulations,

and we are confident that physicians

and practitioners and their counsel can

produce an affidavit without needing a

Government form to sign.

Effect of Opting-Out of Medicare

In section § 405.425, we specify the

effects of opting-out of Medicare.

Specifically, we state that, a physician’s

or practitioner’s opt-out of Medicare, for

the 2-year period for which the opt-out

is effective, has the following effects:

• In § 405.425(a), we state that (except

as provided in § 405.440), in accordance

with section 1802(b)(1)(B) of the Act, no

payment may be made directly by

Medicare or by any M+C plan to the

physician or practitioner or to any entity

to which the physician or practitioner

reassigns his or her right to receive

payment for services.

• In § 405.425(b), we state that, in

accord with section 1802(b)(3)(B)(ii) of

the Act, the physician or practitioner

may not furnish any item or service that

would otherwise be covered by

Medicare (except for emergency or

urgent care services) to any Medicare

beneficiary except through a private

contract that meets the requirements of

these rules.

• In § 405.425(c), we state that the

physician or practitioner is not subject

to the requirement to submit a claim for

items or services furnished to a

Medicare beneficiary (as specified in

§ 424.5(a)(6)), except as provided in

§ 405.440 with respect to emergency and

urgent care services.

• In § 405.425(d), in accordance with

section 1802(b)(3)(B)(ii) of the Act, we

state that the physician or practitioner is

prohibited from submitting a claim to

Medicare for items or services furnished

to a Medicare beneficiary, except as

provided in § 405.440 in the case of

emergency or urgent care services.

• In § 405.425(e), we state that, in

accordance with 1802(b)(4) of the Act,

the physician who has properly optedout is not subject to the limiting charge

provisions of § 414.48.

• In § 405.425(f), we state that a

physician or practitioner who has

properly opted-out is not subject to the

prohibition-on-reassignment provisions

of § 414.80. These are the rules that

restrict when physicians and

practitioners can reassign Medicare

benefits to organizations with which

they have financial arrangements.

• In § 405.425(g), we propose that in

the case of a practitioner, he or she is

not prohibited from billing or collecting

amounts from beneficiaries in excess of

those provided in section 1842(b)(18)(B)

of the Act. This is not specifically

provided for by section 4507 of BBA

1997; however, we believe that this

provision is consistent with sections

1802(b)(1) and (2)(B) of the Act, that,

when read together, permit practitioners

to collect more than the deductible and

coinsurance to which they are limited

under section 1842(b)(18)(B) of the Act

when they provide covered services to

Medicare beneficiaries under standard

Medicare rules. Section 1842(b)(18)(B)

of the Act specifies that practitioners

must take assignment on all claims and

may not collect more than Medicare

deductibles and coinsurance from

Medicare beneficiaries. We believe that

the private contracting provisions

exempt practitioners from these

restrictions.

• In § 405.425(h), we propose that the

death of a beneficiary who (or whose

legal representative) has entered into a

private contract does not invoke

§ 424.62 or § 424.64 with respect to the

physician or practitioner with whom the

beneficiary (or legal representative) has

privately contracted. These sections of

the regulations permit claims to be filed

and payment to be made for services

furnished to a beneficiary who has died.

We propose to include this section to

ensure that it is clear that the terms of

a private contract are not superseded by

the provisions of § 424.62 or § 424.64.

• In § 405.425(i), we specify that the

opt-out physician or practitioner may

make referrals and may order or certify

the need for Medicare-covered items

and services provided the physician or

practitioner is not paid directly or

indirectly by Medicare for those

services. A physician or practitioner

who has properly opted-out may

continue to act as a physician or

practitioner for purposes of ordering

Medicare-covered services (for example,

laboratory tests), making necessary

certifications (for example, home health

plan of care), attestations (for example,

hospital inpatient), etc., as long as he or

she is not being paid directly or

indirectly by Medicare for these

services.

Failure to Properly Opt-Out

In § 405.430(a), we specify that a

physician or practitioner fails to

properly opt-out if any private contract

between the physician or practitioner

and a Medicare beneficiary does not

meet the standards of § 405.415 or if the

physician or practitioner fails to submit

affidavit(s) in accordance with

§ 405.420. Sections 1802(b)(2) and

1802(b)(3) of the Act specify the criteria

that private contracts and affidavits

must meet in order for the physician or

practitioner to successfully opt-out of

Medicare.

In section § 405.430(b), we specify

that if a physician or practitioner fails

to properly opt-out as specified in

§ 405.430(a), the following result:

• All of the private contracts between

the physician or practitioner and

Medicare beneficiaries are deemed null

and void.

• The physician’s or practitioner’s

attempt to opt-out of Medicare is

nullified.

• The physician or practitioner must

submit claims to Medicare for all

Medicare-covered items and services

furnished to Medicare beneficiaries.

Section 1802(b)(4) of the Act, which

would excuse the physician and

practitioner from the mandatory claims

submission requirements of section

1848(g)(4) of the Act, is not effective

when the opt-out rules are not met.

• The physician is subject to the

limiting charge provisions of § 414.48.

Sections 1802(b)(1) and

1802(b)(2)(B)(iii), which excuse the

physician from the limiting charge

rules, do not apply and he or she

continues to be subject to the limiting

charge rules of section 1848(g) of the

Act.

• The physician or practitioner may

not reassign any claim except as

provided in § 424.80. Medicare payment

may be made only to the beneficiary, to

the physician or practitioner under an

assignment of benefits or to another

party for the services of a physician or

practitioner only when the requirements

of the reassignment of benefits provision

of § 424.80 are met.

• The practitioner may neither bill

nor collect an amount from the

beneficiary except for applicable

deductible and coinsurance amounts.

Section 1842(b)(18)(B) of the Act

explicitly prohibits practitioners from

collecting more than the deductible or

coinsurance from the beneficiary. While

this requirement would not apply if the

requirements to properly opt-out had

been satisfied, it does apply when the

criteria to properly opt-out have not

been met.

• The physician or practitioner may

attempt to properly opt-out at any time.

The statute does not preclude a

physician or practitioner who has not

complied totally with the statute’s

criteria for opting-out of Medicare from

subsequently meeting the criteria and

thus at that time properly opting-out.

Failure to Maintain Opt-out

In § 405.435(a), we specify four

circumstances, under any one of which
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30853

the physician or practitioner would be

considered to have failed to maintain

opt-out, that is, failed to remain in

compliance with the requirements of

these rules. Specifically, in

§ 405.435(a)(1), we state that a physician

or practitioner would be considered to

have failed to maintain the opt-out if he

or she knowingly and willfully submits

a claim for Medicare payment (except a

claim for emergency care services or

urgent care services) or receives

Medicare payment directly or indirectly

for services furnished to a Medicare

beneficiary (except when the services

are emergency care services or urgent

care services). This implements section

1802(b)(3)(C) of the Act.

In § 405.435(a)(2), we state that the

physician or practitioner would be

considered to have violated the terms of

the opt-out if he or she enters into

private contracts with Medicare

beneficiaries for the purpose of

furnishing items and services that

would otherwise be covered by

Medicare when the contracts fail to

meet the requirements of § 405.415. This

implements section 1802(b)(2) of the

Act that requires that the physician or

practitioner must enter into private

contracts that meet certain criteria for

the opt-out to be valid. This provision

is also consistent with the enforcement

provisions of section 1802(b)(3)(C) of

the Act.

In addition, in § 405.435(a)(3), we

specify that the physician or

practitioner would be considered to

have failed to maintain the opt-out if he

or she fails to comply with the

provisions of § 405.440 regarding billing

for emergency care services or urgent

care services. In part, this provision

implements section 1802(b)(2)(A)(iii) of

the Act that prohibits a physician or

practitioner from requesting that a

beneficiary enter into a private contract

when he or she is in need of emergency

or urgent care services and is otherwise

necessary to ensure access by Medicare

beneficiaries to emergency and urgent

care services.

In § 405.435(a)(4), we propose that the

physician or practitioner would be

considered to have failed to maintain

opt-out if he or she fails to retain a copy

of each private contract that he or she

entered into for the duration of the optout period for which such contracts are

applicable or fails to permit us to

inspect such contracts upon request.

The issue of retaining copies of private

contracts is discussed in § 405.415,

requirements of the private contract.

We intend to continue the

administrative process currently in

place for dealing with the submission of

claims by physicians and practitioners

who have opted-out of Medicare.

Specifically, we have instructed carriers

to pend claims they receive from

physicians and practitioners who have

filed an affidavit opting-out of Medicare

and to send the physician or

practitioner a letter asking him or her if

the submission of the claim was

intentional or accidental, and if the

latter by what date the physician or

practitioner can remedy the problem.

We recognize that most physicians and

practitioners may be somewhat distant

from the billing of their claims and that

the use of automation and billing

services increases the chance that one or

more claims may be accidentally

submitted to Medicare for an opt-out

physician or practitioner. We also

recognize that if the problem is

systematic, it may take some time to

correct. Hence, under the current

process, we give physicians and

practitioners 45 days from the date of

the postmark on the carrier’s letter to

respond to the carrier and to advise

them of when they believe the problem

can be fixed. Carrier notices to

beneficiaries will advise them that no

payment can be made for the services of

the opt-out physician, and that there are

no limits on what the physician or

practitioner can charge the beneficiary,

unless the physician or practitioner

does not respond timely to the carrier’s

letter, does not timely correct the billing

problem, or states that the submission of

the claim was intentional. We do not

believe that any of these scenarios will

happen often since physicians and

practitioner who opt-out of Medicare

clearly have an incentive to ensure that

they abide by the terms of the opt-out

and that neither they nor any party on

their behalf submit claims to Medicare.

In section § 405.435(b), we specify

that the effects of a physician or

practitioner failing to maintain opt-out

as specified in paragraph (a) are as

follows:

• All of the private contracts between

the physician or practitioner and

Medicare beneficiaries are deemed null

and void.

• The physician’s or practitioner’s

opt-out of Medicare is nullified.

• The physician or practitioner again

becomes subject to the mandatory

claims submission rule. Therefore, the

physician or practitioner must submit

claims to Medicare for all Medicarecovered items and services furnished to

Medicare beneficiaries.

• The physician or practitioner will

not receive Medicare payment on such

claims for the remainder of the opt-out

period. This is required by section

1802(b)(3)(C)(ii) of the Act.

• The physician is subject to the

limiting charge provisions of § 414.48.

This is required by section 1848(g) of

the Act pursuant to section

1802(b)(3)(C)(i) of the Act.

• The practitioner may neither bill

nor collect an amount from the

beneficiary except for applicable

deductible and coinsurance amounts.

This is required by section

1842(b)(18)(B) of the Act pursuant to

section 1802(b)(3)(C)(i) of the Act.

• The physician or practitioner may

not opt-out until the now-nullified 2-

year opt-out period expires. This is

necessary to give meaning to the

enforcement provisions specified in

section 1802(b)(3)(C) of the Act.

Emergency and Urgent Care Services

In § 405.440, we specify the rules that

apply to furnishing and billing for

emergency and urgent care services.

Specifically, in § 405.440(a), we specify

that a private contract is not necessary

for a physician or practitioner to furnish

emergency care services or urgent care

services to a Medicare beneficiary.

Accordingly, a physician or practitioner

will not be determined to have failed to

maintain opt-out if he or she furnishes

emergency care services or urgent care

services to a Medicare beneficiary with

whom the physician or practitioner has

not entered into a private contract,

provided the physician or practitioner

complies with the Medicare billing

requirements with respect to emergency

care services or urgent care services.

In § 405.440(b), we specify that when

a physician or practitioner furnishes

emergency care services or urgent care

services to a Medicare beneficiary with

whom the physician or practitioner has

not entered into a private contract, the

physician or practitioner must submit a

claim to Medicare in accordance with

42 CFR Part 424 and Medicare

instructions issued pursuant to such

regulations, including instructions on

coding emergency or urgent care

services. Also, we propose that the

physician may collect no more than the

Medicare limiting charge and that the

practitioner may collect no more than

the applicable deductible and

coinsurance amounts. We specify these

requirements because the physician or

practitioner cannot ask a beneficiary to

enter into a private contract when a

beneficiary is in need of emergency or

urgent care services. Therefore, when

the beneficiary has not previously

signed a private contract, the beneficiary

has not agreed to give up Medicare

coverage for the services of the

physician or practitioner and the

services are not excluded from coverage

under Medicare, nor is the physician or
30854 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

practitioner excluded from the

mandatory claims submission and

charge rules that would not apply had

he or she been able to sign a private

contract with the beneficiary.

In § 405.440(c), we specify that

emergency care services or urgent care

services furnished to a Medicare

beneficiary with whom the physician or

practitioner has previously entered into

a private contract (that is, entered into

before the onset of the emergency

medical condition or urgent medical

condition) are furnished under the

terms of the private contract. Although

section 1802(b)(2)(A)(iii) of the Act

precludes the physician or practitioner

from entering into a private contract

with a beneficiary when the beneficiary

needs emergency or urgent care

services, the private contracting rules

apply to a beneficiary who has

previously entered into a private

contract (at a time when the beneficiary

was not in need of emergency or urgent

care services).

In § 405.440(d), we specify that

Medicare may make payment for the

emergency care services or urgent care

services furnished by a physician or

practitioner who has properly optedout, provided that no private contract

has been entered into by the beneficiary

to whom emergency care services or

urgent care services were furnished.

Although the statute does not explicitly

address whether payment may be made

in these cases, we believe that it is both

permissible and desirable to do so since

this provision will facilitate access to

needed care in the circumstance when

the beneficiary or their legal

representative has not signed a private

contract and the physician or

practitioner who has opted-out cannot

lawfully request that the beneficiary or

their legal representative now do so.

Renewal and Early Termination of Optout

In § 405.445, we specify the terms of

renewal and early termination of the

opt-out. In § 405.445(a), we specify that

a physician or practitioner may renew

his or her opt-out by filing an affidavit

with each carrier to which an affidavit

was submitted for the first opt-out

period (as specified in § 405.420) and to

each carrier to which a claim was

submitted under § 405.440 during the

previous opt-out period, provided such

affidavits are filed within 30 days after

the current opt-out period expires.

While section 1802(b)(3)(B)(ii) of the

Act provides that the physician or

practitioner opts-out for a period of 2

years, it does not address renewal of

opt-out. Our proposal is to establish

reasonable standards and procedures for

the physician or practitioner to again

opt-out of Medicare for subsequent optout periods.

In § 405.445(b), we propose that the

physician or practitioner may terminate

the opt-out for any reason within the 90

days following the effective date of the

first affidavit filed with Medicare if he

or she agrees to do the following:

• Notify all Medicare carriers with

which he or she filed an affidavit to

properly opt-out of the termination of

the opt-out, no later than 90 days after

the effective date of the opt-out period.

• Refund to beneficiaries all payment

collected in excess of the Medicare

limiting charge, in the case of

physicians, or in excess of the

deductible and coinsurance, in the case

of practitioners.

• Notify all beneficiaries with whom

the physician or practitioner signed

private contracts of the physician’s or

practitioner’s decision to terminate optout and of the beneficiaries’ right to

have the physician or practitioner file

claims on their behalf, without charge,

with Medicare for the services furnished

during the period between the effective

date of the opt-out and the effective date

of the termination of the opt-out.

In § 405.445(c), we propose that when

the physician or practitioner properly

terminates opt-out in accordance with

paragraph (b), he or she will be

reinstated in Medicare as if there had

been no opt-out and the provisions of ’

405.425 will not apply for the 2 years

following the signing of the affidavit

unless the physician or practitioner

subsequently properly opts-out again.

We recognize that there may be cases

when the physician or practitioner may

not have understood the opt-out rules

and may want to return to Medicare. We

believe that it is advantageous to all

parties to permit a first-time opt-out

physician or practitioner to properly

terminate opt-out. However, we are

requiring that to properly terminate optout, the termination must be

accomplished within 90 days following

the effective date of the first opt-out,

and we are permitting only one

termination of opt-out by the physician

or practitioner. We believe that it would

be a mistake to permit repeated

terminations of opt-out, since it could

be abused to manipulate payment, could

create a significant expense for

Medicare systems, and would be

confusing to beneficiaries.

Appeals

In § 405.450, we propose procedures

for appeals by physicians or

practitioners and beneficiaries who

believe that they have been adversely

affected by these rules.

In § 405.450(a), we address appeals of

determinations by Medicare that a

physician or practitioner has failed to

properly opt-out, failed to maintain optout, failed to timely renew opt-out,

failed to privately contract, or failed to

properly terminate opt-out by proposing

that a determination with respect to any

such matter is an initial determination

for purposes of § 405.803. The effect of

this provision is that the appeals

mechanism found in Part 405, Subpart

H is made available to physicians or

practitioners for the purpose of

administrative review of Medicare

determinations on matters addressed in

this subpart. Although we believe that

these procedures will rarely be needed

for this purpose, we believe that it is

important to provide this mechanism

because of the potential adverse impact

on the physician or practitioner of any

such determination.

In § 405.450(b), we propose that a

determination by Medicare that no

payment can be made to the beneficiary

as a result of the application of any

provision of this subpart is a initial

determination for the purposes of

§ 405.803. We believe that the

beneficiary must have the right to

appeal a denial of Medicare payment on

a claim submitted by or on behalf of the

beneficiary when the basis for that

denial is the application of the

provisions of this subpart. The effect of

this provision is that the appeals

mechanism of Part 405, Subpart H is

made available to beneficiaries whose

claims for Medicare payment are denied

on the basis of the opt-out provisions of

this rule.

Under the BBA 1997 requirements,

the physician who opts out under these

provisions must sign an affidavit

agreeing for 2 years not to furnish

services to any Medicare beneficiary

without signing a private contract. We

expect that the vast majority of opt-out

physicians will fully comply with these

terms. Although we expect that

physicians will tell beneficiaries that

they have opted-out, we are concerned

that there may be cases when an opt-out

physician delivers non-emergency or

non-urgent services to a beneficiary

without entering into a private contract.

The beneficiary may be unaware that

the physician has opted out.

Nevertheless, the beneficiary would be

billed for the physician’s full charges for

the service. If the beneficiary seeks

reimbursement from Medicare, the

claim would be denied and the

beneficiary would be informed that the

reason for denial is that the physician

has opted-out of the Medicare program.

We do not believe that the Congress

intended that beneficiaries who have
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30855

not chosen to sign a private contract

would be financially harmed because

they unknowingly received services

from an opt-out physician. While the

statute does not provide a specific

remedy for this situation and we expect

the physician will tell beneficiaries that

they have opted-out, we believe that we

have authority to develop some

beneficiary protections in this case in

the limited cases when physicians do

not do so. One possibility would be to

indemnify the beneficiary for the

amount that Medicare would have

normally paid, ensuring that the

beneficiary is informed that the

physician is an opt-out physician. The

program would then recoup this amount

from the physician and the physician

would refund to the beneficiary any

balanced billing amounts above

Medicare’s limiting charge. The

beneficiary would remain liable for any

coinsurance and deductible amounts

that would have been paid in the

absence of a private contract. A means

of informing beneficiaries enrolled in

M+C organizations may be to require

that such organizations disclose

information on opt-out physicians upon

request by the beneficiary. We would

welcome comments on these and other

approaches to providing protection for

beneficiaries in these circumstances.

Medicare+Choice

In § 405.455, we propose to specify

the requirements that are to be imposed

on an organization that has a contract

with us to provide one or more M+C

plans to beneficiaries (Part 422 of this

chapter). The location of this section

may change to part 422 with the final

rule, once the M+C interim rules are

published. Part 422 will be the location

of the regulations that govern Part C of

Medicare, commonly known as M+C.

In § 405.455(a), we propose that the

M+C organization must acquire and

maintain information from Medicare

carriers on physicians and practitioners

who have opted-out of Medicare.

In § 405.455(b), we specify that the

M+C organization must make no

payment directly or indirectly for

Medicare-covered services furnished to

an enrolled Medicare beneficiary by a

physician or practitioner who has

opted-out of Medicare. The services of

physicians and practitioners who

properly opt-out are excluded from

Medicare under section 1862(a)(19) of

the Act. Therefore, no payment may be

made for them as Medicare-covered

services.

In § 405.455(c), we specify that M+C

organizations may make payment to a

physician or practitioner who has

properly opted-out if he or she furnishes

emergency or urgent care services to a

beneficiary who has not previously

entered into a private contract with the

physician or practitioner. This is

consistent with our policy in § 405.440

where Medicare payment is made by

carriers rather than through M+C

contracts.

C. Payment for Outpatient

Rehabilitation Services

The term outpatient rehabilitation

therapy encompasses outpatient

physical therapy (including speechlanguage pathology) and outpatient

occupational therapy.

1. Overview of Policies Before BBA

1997

a. Coverage. Section 1861(p) of the

Act defines outpatient physical therapy

services as physical therapy services

furnished to a beneficiary as an

outpatient who meets the following

criteria:

• Is under the care of a physician.

• Has a plan of treatment or care

established by either a physician or by

a qualified physical therapist.

• Has the plan of treatment or care

periodically reviewed by a physician.

The statute also incorporates speech

language pathology services within the

definition of outpatient physical therapy

services.

Section 1861(g) of the Act states that

the term ‘‘outpatient occupational

therapy services’’ has the same meaning

given the term ‘‘outpatient physical

therapy services’’ in section 1861(p),

except that the word ‘‘occupational’’ is

substituted for the word ‘‘physical’’

each time it is used in section 1861(p).

b. Providers of Outpatient

Rehabilitation Services. Outpatient

physical therapy services (including

speech-language pathology services) and

outpatient occupational therapy services

are furnished by providers of services,

clinics, rehabilitation agencies, public

health agencies, or by others under an

arrangement with, and under the

supervision of such entities. As defined

in section 1861(w) of the Act, the term

‘‘arrangements’’ is limited to

arrangements under which receipt of

payment by the provider discharges the

liability of the beneficiary to pay for

services.

Providers that furnish outpatient

physical and occupational therapy

services include hospitals, skilled

nursing facilities (SNFs), rehabilitation

agencies, home health agencies (HHAs),

hospices, and comprehensive outpatient

rehabilitation facilities (CORFs)

furnishing services to patients other

than those who receive SNF or inpatient

hospital benefits.

Hospital inpatients who have

exhausted their hospital inpatient

benefits and who are entitled to Part B,

and SNF patients who have exhausted

their SNF benefits and who are entitled

to Part B may receive outpatient

physical therapy services (including

speech-language pathology services) and

outpatient occupational therapy services

even though they are inpatients of the

provider. Section 1861(p) of the Act

defines outpatient physical therapy

services as those services that meet the

requirements of the first sentence of

1861(p), yet that are furnished to a

beneficiary as an inpatient of a hospital

or extended care facility. Section

1861(p) of the Act must be read in

conjunction with section 1833(d) of the

Act. The latter section provides that

Medicare Part B payments, such as

payment for outpatient physical and

occupational therapy services, may be

made only when there is no eligibility

for Medicare Part A payments for the

service, such as payments for inpatient

hospital or SNF care. Part B payment

may be made for inpatients only when

there is no eligibility for Medicare Part

A payments; this means only a

beneficiary who is not entitled to

Medicare Part A benefits or who has

exhausted his or her Part A benefits.

Also see § 410.60(b) (Outpatient

physical therapy services: Conditions,

Outpatient physical therapy services to

certain inpatients of a hospital or a CAH

or SNF).

Outpatient physical therapy

(including speech-language pathology)

and occupational therapy services

furnished by a home health agency may

be covered as ‘‘medical and other health

services’’ under section 1861(s) of the

Act when the beneficiary is not entitled

to receive home health benefits under

section 1814(a)(2)(C) because he or she

is not homebound. To qualify for home

health benefits, the beneficiary must be

homebound and need or have needed

skilled nursing care on an intermittent

basis or physical or speech therapy, or

in the case of an individual who no

longer has need for such care or therapy,

continues to need occupational therapy.

Thus, most rehabilitative services

furnished by home health agencies

under section 1861(s)(2)(D) provisions

are furnished to beneficiaries who are

not homebound.

Section 1861(cc)(1) of the Act defines

the services that can be provided by a

CORF. In addition to outpatient

rehabilitation services, CORF services

include: physician services; respiratory

therapy; prosthetic and orthotic devices;

social and psychological services;

nursing care; drugs and biologicals that

cannot be self-administered; supplies
30856 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

and medical equipment; and, such other

services as are medically necessary and

are ordinarily furnished by CORFs.

Services furnished by either a

qualified physical therapist or a

qualified occupational therapist in his

or her office or in the beneficiary’s

home, for example, services of a

physical therapist in independent

practice (PTIP) or occupational therapist

in independent practice (OTIP), are

included as outpatient physical therapy

services and outpatient occupational

therapy services. Medicare does not

cover the services of a speech-language

pathologist in independent practice.

c. Payment for Services. (1)

Reasonable Cost-Based Payments

Outpatient physical, occupational, and

speech-language pathology services

furnished by a provider of services, a

clinic, a rehabilitation agency or public

health agency are paid based on the

lesser of the charges imposed for the

services or the reasonable costs of

providing the services.

The reasonable cost of services

furnished under arrangements may not

exceed an amount equivalent to the

prevailing salary and additional costs

that would reasonably have been

incurred by such provider or other

organization had the services been

performed by an employee. See

§ 413.106 (Reasonable cost of physical

and other therapy services furnished

under arrangements).

The salary equivalency guideline

amounts currently in effect were

published as a final rule on January 30,

1998, (63 FR 5106). In that final rule, we

updated the physical and respiratory

therapy guideline amounts and

introduced new salary equivalency

guidelines for occupational therapy and

speech-language pathology services

furnished under an arrangement. These

guideline amounts are effective for

services furnished on or after April 10,

1998. The guidelines are used by fiscal

intermediaries to determine the

maximum allowable cost of those

services. In general, the salary

equivalency guideline amounts are

comprised of a prevailing hourly salary

rate based on the 75th percentile of the

range of salaries paid to full-time

employee therapists by providers in the

geographic area, by type of therapy, and

a fringe benefit and expense factor; a

standard travel allowance and

additional allowances for costs incurred

for services furnished by an outside

supplier.

(2) Fee Schedule Payments. Physical

and occupational therapy services

furnished by physicians and certain

other recognized practitioners are

payable by the carriers under the

physician fee schedule. This includes

services of PTIPs and OTIPs. The fee

schedule also applies to nonphysician

practitioners who furnish services that

would be physician services if furnished

by a physician. Nonphysician

practitioners include physician

assistants (section 1861(s)(2)(K)(i) of the

Act); and nurse practitioners and

clinical nurse specialists (sections

1861(s)(2)(K)(ii) and 1861(s)(2)(K)(iii) of

the Act) operating within the scope of

their State licenses and within certain

settings. Physical and occupational

therapy services provided incident to

the services of physicians or incident to

the services of the recognized

nonphysician practitioners cited above

are payable by the carriers under the

physician fee schedule.

d. Financial Limitation. Outpatient

physical therapy services provided by a

PTIP and outpatient occupational

therapy services furnished by an OTIP

are subject to an annual financial

limitation. This annual limitation or cap

is $900 per beneficiary of incurred

expenses for physical therapy services

and $900 per beneficiary of incurred

expenses for occupational therapy

services. There is a beneficiary liability

that is comprised of the Part B

deductible amount and 20-percent

coinsurance. If a beneficiary has already

satisfied the Part B deductible, the

maximum amount payable by the

Medicare program under each of these

benefits is $720, for example, 80 percent

of $900. The limit on expenses applies

only to items and services covered

under the therapy benefit. When a

beneficiary exceeds the annual

limitation or cap, the beneficiary is

financially liable for any additional

therapy services that are furnished

during the calendar year.

2. BBA 1997 Provisions Affecting

Payment for Outpatient Rehabilitation

Services

a. Reasonable Cost-Based Payments.

Section 4541(a) of BBA 1997 added new

section 1834(k) of the Act. Section

1834(k)(2) established a 10 percent

reduction in the reasonable cost of

therapy services furnished during 1998.

The 10-percent reduction does not

apply to outpatient therapy services

furnished by hospitals or critical access

hospitals. In accordance with this

provision, we are proposing to make

payment for outpatient rehabilitation

services furnished during 1998 based

upon the lesser of the charges imposed

or the reasonable cost determined for

such services, reduced by 10 percent.

The 10-percent reduction shall not

apply to outpatient physical therapy or

occupational therapy services furnished

by a hospital to an outpatient or to a

hospital inpatient entitled to benefits

under Part A but who has exhausted

benefits or is otherwise not in a covered

Part A stay.

The salary equivalency guidelines

will continue to remain in effect until

all BBA 1997 provisions regarding a

prospective payment system for

outpatient rehabilitation services are

implemented. The prospective payment

system will negate the need for salary

equivalency guidelines because

providers will no longer be paid on a

reasonable cost basis for their therapy

services. The salary equivalency

guidelines were a tool used to determine

the reasonable cost of therapy services

provided by practitioners other than

physicians.

b. Prospective Payment System for

Outpatient Rehabilitation Services. (1)

Overview. Section 4541 of BBA 1997

adds a new section 1834(k) to the Act

that provides for a prospective payment

system for outpatient rehabilitation

services and all services provided by

CORFs. The prospective payment

system is effective for services furnished

on or after January 1, 1999. Section

1834(k)(1)(B) of the Act provides for

payment for those services to be made

at 80 percent of the lesser of (1) the

actual charge for the services, or (2) the

applicable fee schedule. Section

1834(k)(3) defines the applicable fee

schedule amount as the amount

determined under the physician fee

schedule, or, if there is no such fee

schedule established for those services,

the amount determined under the fee

schedule established for comparable

services as specified by the Secretary.

The physician fee schedule is

currently applied to certain outpatient

rehabilitation therapy services. It is now

the basis of payment for outpatient

rehabilitation services furnished by

PTIPs and OTIPs, physicians, and

certain nonphysician practitioners or

incident to the services of such

physicians or nonphysician

practitioners. The physician fee

schedule has been the method of

payment for outpatient rehabilitation

therapy services provided by such

entities for several years. Fee schedule

payment will now apply when

outpatient physical therapy,

occupational therapy, and speech

language pathology services are

furnished by rehabilitation agencies,

public health agencies, clinics, SNFs,

home health agencies for beneficiaries

who are not eligible for home health

benefits because they are not

homebound, hospitals (when such

services are provided to an outpatient or

to a hospital inpatient who is entitled to
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30857

benefits under Part A but who has

exhausted benefits or is not entitled),

and CORFs. The fee schedule also

applies to outpatient rehabilitation

services furnished under an

arrangement with any of the cited

entities that are to be paid on the basis

of the physician fee schedule. The fee

schedule will not apply to outpatient

rehabilitation services furnished by

critical access hospitals. Under section

1833 of the Act as amended by Section

4541 of BBA 1997, these services will be

paid on a reasonable cost basis.

(2) Services Furnished by Skilled

Nursing Facilities. Section 4432(a) of

BBA 1997 added a new subsection(e) to

section 1888 of the Act to establish a

prospective payment systems for SNFs.

Under the statute, effective for cost

reporting periods beginning on or after

July 1, 1998, Medicare pays for covered

Part A SNF stays on the basis of

prospectively determined payment rates

which encompass all costs of ‘‘covered

skilled nursing facility services’’

furnished to a SNF resident. The statute

defines covered SNF services to include

(1) post-hospital extended care services

paid for under Part A, as well as (2)

certain services that may be paid under

Part B and which are furnished to SNF

residents receiving covered posthospital extended care services. Section

1888(e)(2) provides for exclusion of

specific services from the definition of

covered SNF services, but the statute

explicitly states that the exclusions do

not encompass ‘‘any physical,

occupational or speech language

therapy services regardless of whether

or not the services are furnished by, or

under the supervision of, a physician or

other health care professional.’’ Thus, if

a SNF resident is in a covered Part A

stay, therapy services furnished to the

SNF resident are encompassed in the

PPS payment and Medicare does not

make a separate Part B payment.

Under the new payment system for

SNF inpatient services, and consistent

with current policy (which applied

before enactment of BBA 1997, services

furnished to SNF residents that are not

covered under Part A may nevertheless

be covered under Part B. Section

4432(b) of BBA 1997 amended section

1842(b)(6) of the Act to require that

payment for most services furnished to

an individual who is a resident of a

SNF, including outpatient rehabilitation

services, be made to the facility (without

regard to whether the service was

furnished by the facility, by others

under arrangement with the facility, or

under any other arrangement). When the

services are not being furnished

directly, the facility then pays the

provider of therapy services. The

consolidated billing provision is

effective for services furnished on or

after July 1, 1998.

Section 4432(b)(3) of BBA 1997 added

a new paragraph (9) to section 1888(e)

of the Act to provide that, with respect

to a service covered under Part B that

is furnished to a SNF resident, the

amount of payment for the service shall

be the amount provided under the fee

schedule for such item or service. This

provision must be read in conjunction

with the provisions of section 4541 of

BBA 1997. Section 4541 added a new

section 1833(a)(8) to specify that the

amounts payable for outpatient

rehabilitation services furnished by a

SNF will be the amounts determined

under section 1834(k) of the Act.

Section 1834(k) of the Act provides that

payment in 1998 shall be based on

adjusted reasonable costs and in 1999

and thereafter, the physician fee

schedule. Thus, we are proposing that

SNF Part B inpatient services remain

payable on a reasonable cost basis until

January 1, 1999. Effective January 1,

1999, the services will be paid under the

physician fee schedule.

The physician fee schedule amount

applicable to services furnished in a

non-facility setting will apply to the Part

B services to inpatients and other

outpatient rehabilitation services

furnished by the SNF. The non-facility

amount applies because the

consolidated billing provision requires

that the SNF be directly paid for the

entire therapy service (including facility

costs) based on the physician fee

schedule. This is in contrast to the

amount applicable to physician

services, excluding outpatient

rehabilitation services, billed for SNF

residents. In this case, the physician

payment is not intended to cover the

facility costs associated with the service

and the fee schedule amount applicable

to services furnished in a facility

applies.

(3) Services Furnished by Home

Health Agencies. Section 1833(a)(8)(A)

requires that the physician fee schedule

applies to outpatient rehabilitation

services furnished by a HHA to an

individual who is not homebound. The

likelihood is great that most individuals

who are homebound and are receiving

physical therapy, speech-language

pathology, or occupational therapy are

entitled to home health benefits.

Therefore, most outpatient

rehabilitation services furnished by a

HHA under section 1861(s)(2)(D) is to

individuals who are not homebound.

There may be, however, some

individuals who are not homebound

and have not required a qualifying

service for home health benefits but

who need occupational therapy

services. If provided by a HHA, these

services could be provided under

section 1861(s)(2)(D) of the Act. Since

section 4541 of BBA 1997 did not

expressly address these services, they

remain payable on a reasonable cost

basis under section 1861(v)(1) of the

Act. All other services furnished by the

HHA will be paid under a prospective

payment system (effective October 1,

1999 with respect to home health

services). Section 1861(v)(1) provides

that the reasonable cost of any service

shall be the cost actually incurred,

excluding any costs unnecessary to the

efficient delivery of needed health

services. Since all other outpatient

rehabilitation services are to be paid

under the physician fee schedule, we

believe it would be unreasonable for the

costs of the services furnished to

homebound beneficiaries who are not

entitled to home health benefits to

exceed the amount payable under the

physician fee schedule. Therefore, we

are proposing to modify § 413.125 to

provide that effective for services

furnished on or after January 1, 1999,

the reasonable cost of outpatient

rehabilitation services furnished by a

HHA to homebound patients who are

not entitled to home health benefits may

not exceed the amounts payable under

the physician fee schedule.

(4) Services Furnished by

Comprehensive Outpatient

Rehabilitation Facilities. Section

4541(a)(1) adds a new section

1832(a)(2)(D)(9) of the Act to provide

that all services furnished by a CORF,

and not just outpatient rehabilitation

services, will be paid the applicable fee

schedule amount. In cases where there

is no physician fee schedule amount for

the services, section 1834(k) specifies

that the applicable fee schedule amount

will be the amount established for

comparable services as specified by the

Secretary. Therefore, we are proposing

that the existing fee schedules for

prosthetic and orthotic devices, durable

medical equipment, and supplies, and

drugs and biologicals apply when these

services are furnished by a CORF. We

believe that these fee schedules,

together with the physician fee

schedule, will encompass all CORF

services other than nursing services.

The physician fee schedule amount

applicable to services furnished in a

non-facility setting will apply to the

services furnished by the CORF since no

separate payment will be made for

facility costs.

To establish a fee schedule amount for

nursing services delivered within a

CORF, we created a new HCPCS code,

G0128. We are defining this code as
30858 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

direct face-to-face skilled nursing

services delivered to a CORF patient as

part of a rehabilitative plan of care. It is

a timed code and can be billed for 10-

minute intervals (when the initial

interval is longer than 5 minutes).

G0128 is to be used for services that are

not included in the work or practice

expense of another therapy or physician

service. An example might be a nurse

who spends 33 minutes instructing a

patient in the proper procedure of ‘‘in

and out’’ urethral catheterization; in this

situation, 3 units of G0128 would be

billed. We are proposing to set the RVUs

for this code at 0.26, based upon half the

value of the lowest level physician

follow-up visit, HCPCS code 99211, in

the non-facility setting. This results in a

payment for the time slightly more than

the average wage reported by the Bureau

of Labor Statistics (BLS) for RNs,

inflated to reflect benefits and overhead

(using the fringe benefit and expense

factor used to establish the salary

equivalency guideline).

(5) Site-of-Service Differential.

Providers of outpatient rehabilitation

services have suggested that we should

consider making a site-of-service

differential, specifically, a payment

amount greater than that provided by

the physician fee schedule for some of

the types of providers or sites at which

outpatient rehabilitation services are

furnished. We are not proposing such a

differential.

First, the law requires that these

services be paid the amount determined

‘‘under the fee schedule established

under section 1848.’’ Furthermore, we

believe higher payment amounts for

certain facilities, such as CORFs or

rehabilitation agencies, would create

payment incentives that favor one site

or setting over another. We believe the

statute establishes a ‘‘level playing

field’’ for these services. We find no

direction in the statutory language or

legislative history that we recognize

higher costs that some providers argue

might be associated with furnishing

services in a provider setting. To the

extent that CORFs or rehabilitation

facilities provide services to patients

who need additional care, CORFs or

rehabilitation facilities may bill for

additional, medically necessary

services. For these reasons, a site of

service adjustment or higher payment

amount for specific settings is not being

proposed; however, we welcome any

comments that you may present

regarding differences in services

furnished in the various settings that

would justify a differential payment.

(6) Mandatory Assignment. Section

1834(k)(6) of the Act, as added by BBA

1997, establishes a restraint on billing

for outpatient rehabilitation therapy

services; that is, this provision requires

that services paid under section 1834(k)

of the Act are subject to mandatory

assignment under the same terms

applicable to practitioners under section

1842(b)(18) of the Act. We propose,

therefore, in accordance with this

provision to require mandatory

assignment for services provided under

the outpatient rehabilitation prospective

payment system by hospitals, SNFs,

HHAs, rehabilitation agencies, public

health agencies, clinics, and CORFs.

The mandatory assignment provision

does not apply to therapy services

furnished by a physician or ‘‘incident

to’’ a physician’s service or to services

furnished by a physical therapist in

private practice or an occupational

therapist in private practice. However,

when these services are not furnished

on an assignment-related basis, the

limiting charge applies.

3. Uniform Procedure Codes for

Outpatient Rehabilitation Services

Section 4541(a)(2) of BBA 1997 added

section 1834(k)(5) of the Act. This new

statutory provision requires that claims

submitted on or after April 1, 1998 for

outpatient physical therapy services,

including speech language pathology

services and outpatient occupational

therapy services, include a code under

a uniform coding system that identifies

the services furnished.

The uniform coding requirement is

needed to assure proper payment under

the physician fee schedule. Hospitals,

SNFs, HHAs (for individuals who are

not eligible for home health services),

CORFs, and outpatient physical therapy

providers must use HCPCS codes to

report outpatient rehabilitation services

when furnished to their outpatients.

Hospitals and SNFs that provide

outpatient rehabilitation services to

their inpatients who are entitled to

benefits under Part A but who have

exhausted their benefits for inpatient

services during a spell of illness or to

their inpatients who are not entitled to

benefits under Part A are also required

to report HCPCS codes.

In March, 1998, we issued a program

memorandum AB–98–8 which

described the coding for outpatient

rehabilitation services. This

memorandum identifies the HCPCS

codes that will be considered to be

outpatient rehabilitation services and

specifies how these codes will be

reported on the UB–92. We assigned the

various codes to revenue centers, that is,

physical therapy, occupational therapy,

and speech-language pathology, for

purposes of applying the financial

limitation described below. Assigning

codes to revenue centers was not

intended to limit the scope of practice

or range of procedures that could be

furnished by therapists in a particular

discipline. We are in the process of

revising AB–98–8 because we intend to

implement the financial limitation by

using modifiers, as described below,

rather than assigning the HCPCS codes

to revenue centers.

In the program memorandum, we also

identify certain HCPCS codes available

for billing by CORFs that are not

generally rehabilitation services,

including vaccinations and nursing

services.

4. Financial Limitation

Outpatient rehabilitation therapy

services are subject to annual financial

limitations or caps commencing January

1, 1999. (The amount of the current cap

is $900.) There will be a $1,500 per

beneficiary annual limitation or cap on

incurred expenses for outpatient

physical therapy services including

outpatient speech-language pathology

services. A separate $1,500 per

beneficiary limitation will apply on

incurred expenses for outpatient

occupational therapy services. The

annual limitation does not apply to

services furnished directly or under

arrangements by a hospital or critical

access hospital to an outpatient or to an

inpatient who is not in a covered Part

A stay. The limitation will apply to

outpatient rehabilitation services

furnished by a separately certified

hospital-based provider, such as a

hospital-based SNF. The limitation also

applies to outpatient rehabilitation

services furnished by a physician or

nonphysician practitioner, or incident

to a physician’s professional services or

to a nonphysician practitioner’s

professional services.

As stated above, there is a single

$1,500 limitation for outpatient physical

therapy services and outpatient speechlanguage pathology services. As

amended, section 1833(g) of the Act

applies a single $1,500 limitation to

‘‘physical therapy services of the type

described in section 1861(p).’’ Section

1861(p) defines outpatient physical

therapy services and includes speechlanguage pathology services within that

definition.

Outpatient rehabilitation services are

subject to a 20 percent coinsurance

amount. Under the outpatient

prospective payment system, the

beneficiary will be responsible for 20

percent of the applicable fee schedule

amounts. The $1,500 limitation is on

incurred expenses. If a beneficiary has

already satisfied the Part B deductible,

the maximum amount payable by the
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30859

Medicare program is $1,200, that is, 80

percent of $1,500. Beginning January 1,

2002, the $1,500 annual limitations or

caps will be increased by the percentage

increase in the MEI.

In addition to outpatient physical

therapy services and outpatient

occupational therapy services (other

than those provided by a hospital), the

limitation applies to physical therapy

services (including speech-language

pathology services) and occupational

therapy services ‘‘of such type which

are furnished by a physician or as

incident to a physician service.’’ As

discussed elsewhere in this document,

Medicare covers under certain

conditions services performed by nurse

practitioners, clinical nurse specialists,

and physician assistants that would be

physicians’ services if furnished by a

physician. We are proposing to apply

the financial limitation to therapy

services furnished by these

nonphysician practitioners since such

therapy services are by definition the

same type as are furnished by

physicians. Similarly, we propose to

apply the financial limitation to therapy

services furnished incident to these

nonphysician practitioner’s services. We

have included in Addendum D a listing

of the specific services that we propose

would be subject to the limitation when

furnished by a physician or practitioner

directly or incident to their services.

Such outpatient rehabilitation services

included in Addendum D furnished

either directly or incident to the services

of a physician or practitioner are always

subject to the financial limitation. Other

services such as casting, splinting, and

strapping may be used in the treatment

of conditions (for example, fractures or

sprains) or as part of the postsurgical

treatment or medical treatment when no

other rehabilitation services are

delivered. If the services are delivered

by a physical or occupational therapist,

speech-language pathologist, therapy

assistant or therapy aide, are part of a

rehabilitation plan of care, or involve

services included in the aforementioned

Addendum D, then the services are

subject to the cap. These outpatient

rehabilitation services are delineated in

Addendum E and must be identified

with a discipline-specific modifier.

Addendum E contains a listing of

outpatient rehabilitation therapy codes.

Payment for certain HCPCS codes will

be made on a basis other than the

physician fee schedule in hospital

outpatient departments. Other HCPCS

codes are considered as CORF services.

Further program instructions will be

provided in a forthcoming program

memorandum regarding the use of

HCPCS codes for outpatient

rehabilitation therapy services.

With regard to ‘‘incident to’’ services,

we note that section 4541(b) of BBA

1997 amended section 1862(a) of the

Act to require that outpatient physical

therapy service (including speechlanguage pathology services) and

outpatient occupational therapy services

furnished ‘‘incident to’’ a physician’s

professional services meet the standards

and conditions (other than any licensing

requirement specified by the Secretary)

that apply to therapy services furnished

by a therapist. This provision was

effective January 1, 1998 and was

implemented through program

instructions.

The financial limitations apply only

to items and services furnished by nonhospital providers and therapists under

the outpatient physical therapy

(including speech-language pathology)

and the outpatient occupational therapy

benefit (section 1861(s)(2)(D) of the Act)

and therapy services furnished by

physicians and nonphysician

practitioners or incident to their

services. The limitations do not apply to

diagnostic tests covered under section

1861(s)(3) of the Act.

To track the financial limitation or

cap, we are proposing to use modifiers

that will be discipline-specific. Many of

the services, for example, physical

modalities or therapeutic procedures as

described by HCPCS codes, are

commonly delivered by both physical

and occupational therapists. Other

services may be delivered by either

occupational therapists or speechlanguage pathologists. For these

services, we expect the claim to include

a modifier which describes the type of

therapist who delivered the service; if

the service was not delivered by a

therapist, then the type of therapy plan

of care under which the service is

delivered would be specified. If the type

of therapy is not listed in the modifier

field, the claim would be rejected and

sent to the provider for resubmission.

As required by section 1833(g) of the

Act, as amended by section 4541 of

BBA, we propose to establish two

annual per beneficiary limits of $1,500.

There will be (1) an annual per

beneficiary limit for all outpatient

physical therapy services excluding

hospital outpatient therapy services and

(2) an annual per beneficiary limit for

all outpatient occupational therapy

services excluding hospital outpatient

therapy services. As stated previously,

outpatient physical therapy services

include speech-language pathology

services. A provider of outpatient

rehabilitation services with a provider

agreement under section 1866 of the Act

as will as physicians, PTIPs and OTIPs

will be allowed to collect payment from

a beneficiary for therapy services after

the $1,500 limit is reached. This is

consistent with current policy allowing

PTIPs and OTIPs to collect payment

from a beneficiary for therapy services

in excess of the current $900 limit.

We note that a report to the Congress

is due from the Secretary no later than

January 1, 2001. This report is to

include recommendations on the

establishment of a revised coverage

policy of outpatient physical therapy

services, including speech-language

pathology services and outpatient

occupational therapy services. The

revised policy is to be based on a

classification of individuals by

diagnosis category and prior use of

services in both inpatient and outpatient

settings. The report should include

recommendations on how such

durational limits by diagnostic category

could be implemented in a budgetneutral manner.

5. Qualified Therapists

Section 1861(p) includes services

furnished an individual by a physical

therapist who meets licensing and other

standards prescribed by the Secretary if

the services meet such conditions

relating to health and safety as the

Secretary may find necessary. The

services must be furnished in the

therapist’s office or the individual’s

home. By regulation, we have defined

therapists meeting the conditions for

coverage of services under this

provision as physical therapists in

independent practice. The conditions

for coverage are set forth in Part 486,

Subpart D (Conditions for coverage:

Outpatient Physical Therapy Services

Furnished by Physical Therapists in

Independent Practice) and require that

the services be provided by a therapist

in independent practice under § 410.60.

Under § 410.60, a therapist in

independent practice is one who:

• Engages in the practice of therapy

on a regular basis.

• Furnishes services on his or her

own responsibility without the

administrative and professional control

of an employer.

• Maintains at his or her own expense

office space and equipment.

• Furnishes services only in the office

or patient’s home.

• Treats individuals who are his or

her own patients and collects fees or

other compensation for the services.

Under § 486.151 (Conditions for

coverage: Supervision), all therapy

services must be furnished under the

direct supervision of a qualified

therapist in independent practice. In
30860 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

other words, the therapist in

independent practice must be on the

premises whenever services are

provided to Medicare beneficiaries,

including services provided by a

licensed physical therapist. This longstanding requirement has been

controversial with therapists in

independent practice. For example, a

therapist in independent practice

cannot have more than one office open

for services at the same time since he or

she could not be on both premises at

once.

We are proposing to replace the

existing ‘‘Conditions for Coverage:

Outpatient Physical Therapy Services

Furnished by Physical Therapists in

Independent Practice’’ (Part 486,

Subpart D), which requires survey and

certification, with a simplified criteria

for physical therapists in private

practice that would use a carrier

enrollment process. The impetus for this

change comes from congressional

statements associated with the fiscal

year 1997 appropriations process.

Statements in both the House and

Senate committee reports accompanying

HCFA’s fiscal year 1997 appropriations

addressed the issue of requiring that the

certified physical or occupational

therapist in independent practice

directly supervise all services performed

by his or her employees, even if those

employees are fully licensed therapists.

The House committee report urged that

we modify the regulations so that the

certified therapist need not be on

premises to supervise other licensed

therapists. The Senate urged us to

review this concern and recommend

regulatory or instructional changes.

We are proposing to redefine those

therapists who are qualified pursuant to

section 1861(p) of the Act. That is, we

would discontinue the focus of the

regulation on their ‘‘independent’’

status (which is not statutory) and

recognize therapists in private practice

who are employed by others and

therefore, do not meet our current

‘‘independent’’ criteria. This would be

consistent with health and safety

concerns and would conform to normal

private sector practice standards. The

following new requirements would

replace the current ones for qualified

therapists:

• The term ‘‘independent’’ would be

dropped and the benefit would be for an

individual physical therapist or

occupational therapist in private

practice.

Private practice would include an

‘‘individual’’ whose practice is in an

unincorporated solo practice,

unincorporated partnership, or

unincorporated group practice. Private

practice also would include an

‘‘individual’’ who is practicing therapy

as an employee of one of the above or

of a professional corporation or other

incorporated therapy practice. However,

private practice would not include

individuals when they are working as

employees of a provider. A provider as

defined in § 400.202 includes a hospital,

CAH, SNF, HHA, hospice, CORF,

CMHC, or an organization qualified

under Part 485, Subpart H (Conditions

of Participation for Clinics,

Rehabilitation Agencies, and Public

Health Agencies as Providers of

Outpatient Physical Therapy and

Speech-Language Pathology Services),

as a clinic, rehabilitation agency, or

public health agency.

• In implementing the statutory

requirement that services be furnished

to an individual in the therapist’s office,

or in the individual’s home, ‘‘in his

office’’ would be defined as the

location(s) where the practice is

operated, in the State(s) where the

therapist (and practice, if applicable) is

legally authorized to furnish services,

during the hours that the therapist

engages in practice at that location.

A therapist in private practice would

not be required to maintain a private

office, if services always are furnished

in patients’ homes. However, when

services are furnished in private

practice office space, that space would

have to be owned, leased, or rented by

the practice and used for the exclusive

purpose of operating the practice. For

example, because of the statutory

restriction on the site of services, a

therapist in private practice cannot

furnish covered services in a SNF.

Therefore, if a therapist wished to locate

his or her own private office on site at

a nursing facility, special care would

need to be taken. The private office

space could not be part of the Medicareparticipating SNF’s space, and the

therapist’s services could be furnished

only within that private office space.

Neither the therapist nor any assistants

or aides who help render services could

be employed by the SNF during the

same hours that they are working in the

private practice. Another example

where special attention would be

needed is space that generally serves

other purposes and is only used by a

therapy practice during limited hours.

For example, a therapist in private

practice may furnish aquatic therapy in

a community center pool on Wednesday

mornings. The practice would have to

rent or lease the pool for those hours,

and the use of the pool during that time

would have to be restricted to the

therapist’s patients, in order to

recognize the pool as part of the

therapist’s own private office during

those hours.

In describing other services that are

specifically limited to the patient’s

home, the statute uses qualifying

language. For example, the durable

medical equipment definition in section

1861(n) refers to a patient’s home as

‘‘including an institution used as his

home other than an institution that

meets the requirements of subsection

(e)(1) of this section or section

1819(a)(1).’’ This definition of home is

codified at § 410.38(b). The same

definition always has been used in the

Medicare Carriers Manual for purposes

of covering therapists’ services in a

patient’s home. We propose to continue

the current practice and to adopt that

definition formally in this regulation.

• Assistants and aides would have to

be personally supervised by the

therapist and employed directly by the

therapist, by the partnership or group to

which the therapist belongs, or by the

same private practice that employs the

therapist. Personal supervision requires

that the therapist be in the room during

the performance of the service. Levels of

supervision are defined in § 410.32.

• The therapist must be licensed or

otherwise legally authorized to engage

in private practice. We understand that

all States license or certify physical

therapists, so no alternative personnel

qualifications need to be specified.

• Each therapist would enroll ‘‘as an

individual’’ with the carrier.

There would be no survey and no

certification by HCFA. The Medicare

carrier would verify that the

qualifications proposed in § 410.59(c)(1)

or § 410.60(c)(1) are met. All applicants

for new enrollment would become

subject to these new rules and

procedures upon the effective date of

the final rule. For transition purposes,

we intend that independent therapists

who are certified and enrolled at that

time would be ‘‘grandfathered’’

temporarily and would become subject

to the new enrollment rules and

procedures at the time of their next

regular periodic reenrollment.

These changes would address the

concern that current rules require each

independent therapist to personally

supervise services performed by any

other licensed therapists that he or she

employs. Under our proposal, each

individual therapist in a practice could

qualify to separately enroll, and

enrolled therapists would not be

required for purposes of Medicare to be

supervised by their employer. These

changes also address the concern that

current rules prohibit an independent

therapist from being employed by any

entity. Under our proposal, a variety of
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30861

employment situations would be

permitted. The following examples

illustrate how our proposals would

apply:

• Three PTs operate an

unincorporated group practice, which

employs several physical therapy

assistants and aides and maintains two

offices in two towns. Each therapist

could enroll as a physical therapist in

private practice and could furnish

services in either office, while

personally supervising any of the

assistants or aides who are helping to

render therapy.

• A corporation operates a physical

therapy practice which employs four

physical therapists and several physical

therapy assistants and aides. Each

therapist could enroll as a physical

therapist in private practice and could

personally supervise any of the

assistants or aides who help to render

therapy. If two additional PTs are hired,

each must enroll before their services

could be covered without supervision

by one of the enrolled physical

therapists.

A physical therapist works for a

hospital’s rehabilitation department

during the day. During evening hours,

he operates his own incorporated

professional practice and goes to

patient’s homes to furnish therapy. He

could enroll as a physical therapist in

private practice for the evening hours

and would not need to maintain an

office for furnishing therapy.

A physician’s professional

corporation employs three physical

therapists and six physical therapy

assistants in a private therapy practice

associated with the physician’s office.

Each of the PTs could enroll as a

therapist in private practice. The

physician is not required to supervise

any of the therapy. All physical therapy

services for which Medicare payment is

sought are supervised by one of the

physical therapists.

These new requirements would be

established in a revised § 410.60(c) for

physical therapists. To date, the

statutory requirements for coverage of

outpatient occupational therapy services

have not been codified. We are

proposing to codify these requirements

by establishing a new § 410.59 for

outpatient occupational therapy

services. The proposed regulations

section for outpatient occupational

therapy parallels the § 410.60

requirements for outpatient physical

therapy, as revised in this proposed

rule. We are also proposing to make

conforming changes in § 410.61 to

include occupational therapy.

Therapists in private practice do not

participate in the Medicare program in

the same way that ‘‘providers of

services’’ do. Though they must be

approved as meeting certain

requirements, unlike ‘‘providers of

services,’’ they do not execute a formal

provider agreement with the Secretary

as described in Part 489 (Provider

Agreements and Supplier Approval) of

the CFR. Like physicians, they do have

the option of accepting a beneficiary’s

assignment of his or her claim for

Medicare Part B benefits and of

becoming a Medicare participating

supplier who agrees to accept

assignment in all cases.

6. Plan of Treatment

We are proposing to revise

§§ 410.61(e), 424.24(c)(4)(i), and

485.711(b), which concern the plan of

treatment review requirements for

outpatient rehabilitation therapy

services. Section 1861(p) of the Act

defines these therapy services, in part,

as services furnished to an individual

who is under the care of a physician and

for whom a plan, prescribing the type,

amount, and duration of therapy

services that are to be furnished, has

been established by a physician or a

qualified therapist and is periodically

reviewed by a physician.

Currently, providers that furnish

outpatient rehabilitation therapy

services are required to have a physician

review the plan of treatment and

recertify the need for care at least every

30 days. We are proposing that the

physician review and recertify the

required plan of treatment within the

first 62 days and at least every 31 days

after the first review and recertification.

The current requirement for the review

of a plan of treatment for patients of

physical therapists in independent

practice is similar in that the physician

must review the plan at least every 30

days. We are proposing to change this

review requirement as well to require

that the physician review and recertify

the plan of treatment within the first 62

days and at least every 31 days

thereafter.

We are recommending these changes

because it is our understanding that an

initial 2-month (62 day) review is

consistent with usual therapy course of

treatment. It is also consistent with our

current therapy requirements in the

home health setting. These changes

would reduce the burden on providers,

patients, and physicians by eliminating

the current requirement for an initial

review within the first 30 days. After the

first 62 days, we believe that patients

receiving outpatient rehabilitation

services are likely to show significant

progress that warrants subsequent

reviews every 31 days. Changes in the

patients’ level of function and need for

continued therapy can be expected to

occur more frequently after the first 2

months of therapy. We believe this

subsequent review schedule will help

control potential over-utilization that

results in excessive therapy to some

Medicare patients.

Under our proposal, the therapists

would be required to immediately notify

the physician of any changes in the

patient’s condition, and physicians

would retain the ability to review the

care at closer intervals if necessary.

D. Payment for Services of Certain

Nonphysician Practitioners and Services

Furnished Incident to Their Professional

Services

Nonphysician practitioner services

have been covered by Medicare since

the inception of the program; originally

the law did not provide for separate

payments for these services. Coverage

and payment of nonphysician services

was primarily within the context of

section 1861(s)(2)(A) of the Act as

implemented by section 2050 of the

Medicare Carriers Manual, for the

payment of services incident to a

physician’s professional services. In

recent years, the Congress has expanded

Medicare coverage of nonphysician

practitioner services in certain settings

to improve beneficiary access to medical

services. Separate Part B coverage is

specifically authorized for certain

nonphysician practitioner services and

for services and supplies furnished as

incident to those services.

For purposes of this proposal as it

applies to nonphysician practitioners,

we define nonphysician practitioners as

nurse practitioners, clinical nurse

specialists, certified nurse-midwives,

and physician assistants. With respect

to services and supplies furnished as

incident to a nonphysician

practitioner’s services, we are proposing

that to be covered by Medicare, the

services must meet the longstanding

requirements in section 2050 of the

Medicare Carriers Manual applicable to

services furnished as incident to the

professional services of a physician.

Therefore, we would specify, in

proposed new §§ 410.74(b), 410.75(d),

410.76(d), and 410.77(c) that Medicare

Part B covers services and supplies

(including drugs and biologicals that

cannot be self-administered) furnished

as incident to the nonphysician’s

services only if these services and

supplies would be covered if furnished

by a physician or furnished as incident

to a physician’s professional services. In

addition, §§ 410.74(b), 410.75(d),

410.76(d), and 410.77(c) would specify
30862 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

the various requirements for these

incidental services and supplies.

1. Coverage and Payment for Nurse

Practitioner Services Before BBA 1997

Effective for services furnished on or

after April 1, 1990, section 6114 of the

Omnibus Budget Reconciliation Act

(OBRA) of 1989 (Pub. L. 101–239)

authorized separate payment for the

services of nurse practitioners when

furnished to patients in SNFs and

nursing facilities. The services of nurse

practitioners are covered if they are

furnished in collaboration with a

physician, they are within the scope of

services authorized by State law, and

they are the type of services that would

be covered when furnished by a

physician. The term, collaboration is

defined as a process in which a nurse

practitioner works with a physician to

deliver health care services within the

scope of the practitioner’s professional

expertise, with medical direction and

appropriate supervision as provided for

in jointly developed guidelines, or other

mechanisms as defined by State law, in

the State in which the services are

performed.

Section 6114 of OBRA 1989 limited

routine visits by nurse practitioners who

are serving as members of a team to 1.5

team visits per month per resident of a

SNF or nursing facility. The team must

include a physician and a physician

assistant acting under the supervision of

the physician, or a nurse practitioner or

a clinical nurse specialist working in

collaboration with a physician.

Section 6114 of OBRA 1989 requires

that payment for nurse practitioner

services furnished to patients in SNFs

and nursing facilities be made on an

assignment-related basis to the nurse

practitioner’s employer only. This

provision also limited the prevailing

charges for the services of nurse

practitioners furnished before January 1,

1992, to 85 percent of the prevailing

charge rate determined for these

services when furnished by

nonspecialist physicians. For services

furnished on or after January 1, 1992,

OBRA 1989 limits the payment to 85

percent of the physician fee schedule

amount for those services furnished by

physicians who are not specialists.

The qualifications for nurse

practitioners require individuals to:

• Be a registered nurse who is

currently licensed to practice in the

State where he or she practices, be

authorized to perform the services of a

nurse practitioner in accordance with

State law, and have a master’s degree in

nursing;

• Be certified as a nurse practitioner

by a professional association recognized

by HCFA that has, at a minimum,

eligibility requirements that meet the

standards in the paragraph above; or

• Meet the requirements for a nurse

practitioner set forth in the first

paragraph, except for the master’s

degree requirement, and have received

before 3 years prior to the effective date

of a final rule, a certificate of

completion from a formal advanced

practice program that prepares

registered nurses to perform an

expanded role in the delivery of primary

care.

Section 4155 of OBRA 1990 (Pub. L.

101–508) extended coverage of nurse

practitioner services that was previously

restricted to SNFs and nursing facilities,

to all settings in rural areas.

Additionally, nurse practitioners were

authorized to either receive direct

payment or arrange for payment to be

made directly to their employer for

services furnished in collaboration with

a physician in all settings in a rural area,

with the exception of hospitals. This

provision also allowed for coverage of

services and supplies furnished as an

incident to a nurse practitioner’s

services if the services would have been

covered if furnished as an incident to a

physician’s professional services.

The term, ‘‘rural area’’ as defined at

section 1886(d)(2)(D) of the Act means

any area outside a Metropolitan

Statistical Area or New England County

Metropolitan Area, as defined by the

Executive Office of Management and

Budget, or outside any similar area the

Secretary has recognized by regulation

as an urban area.

Sections 4155(b) and (c) of OBRA

1990 imposes a civil monetary penalty

not to exceed $2,000 on any person who

knowingly and willfully presents a bill

or request for payment to a Medicare

beneficiary (except for coinsurance and

deductible amounts) for nurse

practitioner services furnished in a rural

area, or for services and supplies

furnished as an incident to those

services, and for nurse practitioner

services furnished in a SNF or nursing

facility.

Section 147(e)(4) of the Social

Security Act Amendments of 1994

(SSAA’94) (Pub. L. 103–432) unbundled

payment for nurse practitioner services

in SNFs and nursing facilities. It also

added nurse practitioner services to the

list of services that are excluded from

the definition of inpatient hospital

services. Accordingly, nurse

practitioners or their employer or

contractor were authorized to bill

directly for services furnished to

patients in SNFs or nursing facilities

and hospitals located in rural areas.

2. Coverage and Payment for Nurse

Practitioner Services Subsequent to BBA

1997

Effective for services furnished on or

after January 1, 1998, section 4511 of

BBA 1997 authorizes nurse practitioners

to bill the program directly for services

furnished in any setting, regardless of

whether the settings are located in rural

or urban areas, but only if the facility or

other providers of services do not charge

or are not paid any amounts with

respect to the furnishing of nurse

practitioner services. Accordingly, a

new § 410.75 of this proposed rule

specifies the qualifications for nurse

practitioners, lists the requirements for

the professional services of a nurse

practitioner and the requirements for

services furnished incident to the

professional services of a nurse

practitioner. This new section also

proposes a definition for the

collaboration process that is applicable

to the provision of nurse practitioner

services.

A new § 405.520(a), (b), and (c) of this

proposed rule provides the general rule,

requirements, and penalties for nurse

practitioners. A new paragraph (15) is

added to § 410.150(b) to authorize

payment for nurse practitioner services

when furnished in collaboration with a

physician in all settings located in both

rural and urban areas. A new paragraph

(c) is added to § 414.56 of this rule to

set forth the payment amount for nurse

practitioner services.

3. Coverage and Payment for Clinical

Nurse Specialist Services Before BBA

1997

In addition to authorizing Medicare

coverage of nurse practitioner services

furnished in rural areas, section 4155 of

OBRA 1990 also authorized the

coverage of services furnished by

clinical nurse specialists in rural areas.

The coverage provisions for clinical

nurse specialist services furnished in a

rural area parallel those established for

nurse practitioner services furnished in

rural areas. That is, clinical nurse

specialist services must be furnished in

collaboration with a physician and be

the type of physician services that

would otherwise be covered if furnished

by a physician. Additionally, the

services must be services that the

clinical nurse specialist is authorized by

State law to furnish in the State in

which they are practicing. Furthermore,

services furnished as an incident to the

professional services of a clinical nurse

specialist are covered if they are the

type of services that would be covered

if furnished incident to a physician’s
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30863

professional services and all the

incident to requirements are met.

A clinical nurse specialist is defined

as an individual who is legally

authorized to perform such services in

accordance with State law, and who

meets training, education, and

experience requirements as the

Secretary may prescribe in regulations.

Section 147(e)(4) of the SSAA’94 also

unbundled payment for clinical nurse

specialist services furnished in SNFs,

nursing facilities, and hospitals. The

services of clinical nurse specialists are

now paid under a separate benefit.

Payment for clinical nurse specialist

services is made to the clinical nurse

specialist or to his or her employer. As

is the case with nurse practitioners, the

services of clinical nurse specialists

furnished to patients in rural health

clinics (RHCs), federally qualified

health centers (FQHCs), and health

maintenance organizations (HMOs) are

not paid under the respective nurse

practitioner or clinical nurse specialist

benefits. Instead, the services that

nonphysician practitioners furnish in

RHCs, FQHCs, and HMOs education,

and experience requirements as the

Secretary may prescribe in regulations.

Section 147 (e)(4) of the SSAA’94 also

unbundled payment for clinical nurse

specialist services furnished in SNFs,

nursing facilities, and hospitals. The

services of clinical nurse specialists are

now paid under a separate benefit.

Payment for clinical nurse specialist

services is made to the clinical nurse

specialist or to his or her employer. As

is the case with nurse practitioners, the

services of clinical nurse specialists

furnished to patients in rural health

clinics (RHCs), federally qualified

health centers paid under the respective

nurse practitioner or clinical nurse

specialist benefits. Instead, the services

that nonphysician practitioners furnish

in RHCs, FQHCs, and HMOs are a part

of the facilities’ services and cannot be

billed or paid separately.

The payment provisions for clinical

nurse specialist services furnished in a

rural area parallel those established for

nurse practitioner services furnished in

rural areas. Accordingly, payment for

services is made on an assignmentrelated basis, the civil monetary penalty

provision for violation of the assignment

agreement applies, and the current

Medicare-approved amount for covered

clinical nurse specialist services

furnished in rural areas (other than in

hospitals) is limited to the lesser of the

actual charge or 85 percent of the

physician fee schedule amount for

nonspecialist physician services. For

covered services furnished in hospitals

located in rural areas, the Medicareapproved amount is limited to the lesser

of the actual charge or 75 percent of the

physician fee schedule amount for

nonspecialist physician services.

4. Coverage and Payment for Clinical

Nurse Specialist Services Subsequent to

BBA 1997

Effective for services furnished on or

after January 1, 1998, Section 4511 of

BBA 1997 authorizes clinical nurse

specialists to bill the program directly

for services furnished in any setting,

regardless of whether the settings are

located in rural or urban areas, but only

if the facility or other providers of

services does not charge or is not paid

any amounts with respect to the

furnishing of nurse practitioner services.

A new § 410.76(e) of this proposed rule

sets forth this provision.

The new § 410.76(b) sets forth new

qualifications for clinical nurse

specialists. Section 410.76(c) describes

the conditions of coverage for clinical

nurse specialists services, defines the

collaboration process, and paragraph (d)

lists the requirements for services

furnished incident to the professional

services of a clinical nurse specialist.

A new § 405.520(a), (b), and (c) of this

proposed rule provides the general rule,

requirements, and civil monetary

penalties for clinical nurse specialists. A

new paragraph (15) is added to section

410.150(b) to authorize payment for

clinical nurse specialist services when

furnished in collaboration with a

physician in all settings located in both

rural and urban areas. A new paragraph

(c) is added to section 414.56 of this rule

to set forth the payment amounts for

clinical nurse specialist services.

5. Coverage and Payment for Certified

Nurse-Midwife Services

Certified nurse-midwife services were

only covered under the Medicare

program when furnished incident to the

professional services of a physician or

under the supervision of a physician in

RHCs prior to these individuals gaining

statutory authorization to perform

services as independent nonphysician

practitioners.

Certified nurse-midwives were

defined initially section 1861(gg)(2) of

the Act and 42 CFR 405.2401 (b) as a

registered professional nurse who:

• Is currently licensed to practice in

the State as a registered professional

nurse;

• Is legally authorized under State

law or regulations to practice as a

certified nurse-midwife;

• Has completed a program of study

and clinical experience for certified

nurse-midwives, as specified by the

State, or, if the State does not specify a

program—

+ Is currently certified as a nursemidwife by the American College of

Nurse-Midwives;

+ Has satisfactorily completed a

formal education program (of at least 1

academic year) that, upon completion,

qualifies the nurse to take the

certification examination offered by the

American College of Nurse-Midwives;

or

+ Has successfully completed a

formal educational program that

prepares registered nurses to furnish

gynecological and obstetrical care to

women during pregnancy, delivery, and

the postpartum period, and care to

newborns, and practiced as a nursemidwife for a total of 12 months during

any 18-month period from August 8,

1976, to July 16, 1982.

Certified nurse-midwife services are

defined at section 1861(gg)(1) of the Act

as services furnished by a certified

nurse-midwife, and services and

supplies furnished as an incident to

those services, that the certified nursemidwife is legally authorized to

furnished under State law and that

would be covered by Medicare if

furnished by a physician or as an

incident to a physician’s service.

Effective for services furnished on or

after July 1, 1988, section 4073 of OBRA

1987 (Pub. L. 100–203) expanded Part B

coverage of the services of certified

nurse-midwives to include services

furnished independently of the

supervision of a physician.

Subsequently, section 411(h)(4) of the

Medicare Catastrophic Coverage Act

(MCCA) of 1988 (Pub. L. 100–360) made

several technical amendments to section

4073 of OBRA 1987 to categorize and

cover certified nurse-midwife services

as medical and other health services,

specify that payment for the services of

a certified nurse-midwife is 80 percent

of the lesser of the actual charge or the

amount determined by a fee schedule

established by the Secretary, and limit

the fee schedule to 65 percent of the

prevailing charge that would be allowed

for the same services furnished by a

physician. Additionally, section 4073 of

OBRA 1987 requires that payment for

certified nurse-midwife services be paid

on an assignment-related basis and that

violators of the assignment requirements

be subject to civil monetary penalties.

Section 6102(f)(7) of OBRA 1989 (Pub.

L. 101–239) provided that for services

furnished on or after January 1, 1992,

payment is determined based on the

lesser or the actual charge or 65 percent

of the Medicare physician fee schedule.

In 1990, in section 4157 of OBRA

1990 (Pub. L. 101–508) the Congress
30864 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

recognized certified nurse-midwife

services as separate and distinct from

hospital services. Accordingly, certified

nurse-midwife services are unbundled

from hospital services and are paid

separately under the certified nursemidwife benefit.

Ultimately, section 13554 of OBRA

1993 (Pub. L. 103–66) amended section

1861(gg)(2) of the Act to revise the

definition of certified nurse-midwife.

The revision eliminated the limitation

on coverage to include services

furnished by certified nurse-midwives

outside the maternity cycle. This change

was made effective for services

furnished on or after January 1, 1994.

A new § 410.77 of this proposed rule

lists the qualifications for certified

nurse-midwives and provides for the

conditions for coverage of certified

nurse-midwife services. Paragraph (d) of

§ 410.77 lists the coverage requirements

for the professional services of certified

nurse-midwives, while paragraph (c)

lists the requirements for services

furnished incident to the professional

services of a certified nurse-midwife.

6. Coverage and Payment for Physician

Assistant Services Before BBA 1997

For physician assistant services

furnished on or after January 1, 1987,

section 9338(a) of the Omnibus Budget

Reconciliation Act (OBRA) of 1986

(Pub. L. 99–509) authorized physician

assistants to bill the Medicare program

for the type of services that would be

considered as physicians’ services,

provided that the physician assistant is

legally authorized by the State to

furnish such services. Services

furnished incident to the physician

assistant’s professional services are also

covered if these same services would

have been covered when furnished

incident to the professional services of

a physician. Under this OBRA

provision, physician assistants

furnished their services under the

general supervision of a physician in a

hospital, SNF, nursing facility, or as an

assistant at surgery in both rural and

urban areas. In order to have furnished

services under the physician assistant

benefit, individuals must have met the

qualifications as follows:

1. Be certified currently by the

National Commission on Certification of

Physician Assistants to assist primary

care physicians;

2. Have completed satisfactorily a

program for preparing physician

assistants that—

• Was at least 1 academic year in

length;

• Consisted of supervised clinical

practice and at least 4 months (in the

aggregate) of classroom instruction that

prepared students to deliver health care;

and

• Is accredited by the AMA’s

Committee on Allied Health Education

and Accreditation; or

3. Have completed satisfactorily a

formal educational program for

preparing physician assistants (that does

not meet the requirements listed above)

and assisted primary care physicians for

a total of 12 months during the 18-

month period immediately preceding

January 1, 1987. Additionally, effective

January 1, 1989, section 4076 of OBRA

1987 (Pub. L. 100–203) authorized

physician assistants to furnish their

services under the supervision of a

physician in all settings located in rural

areas that were designated under section

332(a)(1)(A) of the Public Health Service

Act as health professional shortage areas

(HPSAs).

Payment for physician assistant

services prior to January 1, 1998 was

made only on an assignment-related

basis to the actual employer of the

physician assistant at 85 percent of the

physician fee schedule for professional

services. Payment for the services of a

physician assistant performing as an

assistant at surgery was made at 65

percent of the physician fee schedule.

The employer of a physician assistant

might have been a physician, medical

group, professional corporation,

hospital, SNF, or nursing facility.

7. Coverage and Payment for Physician

Assistant Services Subsequent to BBA

1997

Effective for services furnished on or

after January 1, 1998, the majority of the

conditions for coverage of physician

assistant services as indicated by new

§§ 410.74(a) and (b) remain unchanged

with the exception of the condition for

coverage of physician assistant services

furnished in certain areas and settings.

Section 4512 of BBA 1997 removes the

restrictions on the site of services in

which physician assistants may furnish

their professional services, regardless of

whether the settings are located in rural

or urban areas. Physician assistants are

authorized to furnish their professional

services as independent nonphysician

practitioners to practically all providers

of services and suppliers of services

only if the facility or other provider of

services does not charge or is not paid

any amounts with respect to the

furnishing of physician assistant

professional services. Accordingly,

separate payment may be made for

physician assistant services in all

settings with the exception of rural

health clinics (RHCs) and Federally

qualified health centers (FQHCs)

because Medicare payment for their

services is included in the all-inclusive

payment rate that the program makes to

these facilities.

Under new § 410.74(c), we are

proposing to amend the qualifications

for physician assistants to recognize

certification of physician assistants by

the National Board of Certification of

Orthopedic Physician Assistants. These

qualifications will also recognize

academic programs for physician

assistants that are accredited by either

the Commission on Accreditation of

Allied Health Education Programs or the

American Society of Orthopedic

Physician Assistants.

Additionally, effective January 1,

1998, physician assistants have the

option of furnishing services under a

different employment arrangement with

a physician. They can furnish services

as an employee of a physician under a

W–2 form employment arrangement or

they can furnish services as an

employee of a physician under a 1099

form, independent contractor

arrangement. Under either arrangement,

the employer of the physician assistant

must bill the program for physician

assistant services as required under

§ 410.150(b)(14). However, when an

individual furnishes services ‘‘incident’’

to the professional services of a

physician assistant, these ancillary

services must meet the requirements

under § 410.74(a)(2)(vi)(B).

The Medicare payment amount for

physician assistant professional services

as of January 1, 1998, as stated under

new paragraph (d) of § 414.52, remains

at 80 percent of the lesser of either the

actual charge or 85 percent of the

physician fee schedule amount for

professional services. However,

payment for physician assistant at

surgery services, as also described at

new paragraph (d) of § 414.52, increased

to allow Medicare payment at 80

percent of the lesser of either the actual

charge or 85 percent of the physician fee

schedule amount paid to a physician

assistant serving as an assistant at

surgery. Also, new § 405.520 provides

the general rule, requirements, and civil

monetary penalties for physician

assistants who furnish services under

the Medicare program.

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
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30865

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.

• 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

(ICRs) discussed below.

• New ICRs and Related Burden.

§ 405.410 (Conditions for opting-out of

Medicare.)

Section 405.410(a) states that each

private contract between a physician or

a practitioner and a Medicare

beneficiary must meet the specifications

of § 405.415.

The burden associated with these

requirements is the time to draft, and

then read, sign, photocopy and retain

the private contract. It is estimated that

it will take 300 physicians and/or

practitioners 2 hours each to create a

contract for a total of 600 hours. It is

estimated that it will take 10 minutes for

each to read, sign, photocopy and retain

the private contract for 25,000

beneficiaries for a total of 4,167 hours.

The burden for these ICRs total 4,767

hours.

Section 405.410(b) states that the

physician or practitioner must submit to

each Medicare carrier with which he or

she files claims an affidavit that meets

the specifications of § 405.420.

The burden associated with these

requirements is the burden to draft, sign

and submit the affidavit to the Medicare

carrier. It is estimated that it will take

300 physicians and/or practitioners

approximately 2 hours each for a total

of 600 burden hours.

§ 405.445 (Renewal and early termination of

opt-out.)

Section 405.445(b)(2) states that a

physician or practitioner must notify all

Medicare carriers with which he or she

filed an affidavit of the termination of

the opt-out no later than 90 days after

the effective date of the opt-out period.

The burden associated with this

requirement is the time for the

physician or practitioner to notify all

Medicare carriers of the affidavit. It is

estimated that it will take 30 physicians

and/or practitioners 10 minutes each for

a total of 5 hours.

Section 405.445(b)(4) states that a

physician or practitioner must notify all

beneficiaries with whom the physician

or practitioner entered into private

contracts of the physician’s decision to

terminate opt-out and of the

beneficiaries’ right to have claims filed

on their behalf with Medicare for the

services furnished during the period

between the effective date of the opt-out

and the effective date of the termination

of the opt-out period.

The burden associated with this

requirement is the time for the

physician and/or practitioner to notify

all beneficiaries of his or her decision to

terminate opt-out and of the

beneficiaries’ right to have claims filed

on their behalf with Medicare. It is

estimated that it will take 30 physicians

and/or practitioners each 2 hours to

notify their beneficiaries via bulk

mailings for a total of 60 hours.

§ 405.455 (Medicare+Choice.)

Section 405.455(a) states that an

organization that has a contract with

HCFA to provide one or more

Medicare+Choice (M+C) plans to

beneficiaries must acquire and maintain

information from Medicare carriers on

physicians and practitioners who have

opted-out of Medicare.

The burden associated with these

requirements is the time associated with

acquiring and maintaining information

provided by Medicare carriers on

physicians and practitioners who have

opted-out of Medicare. It is estimated

that 500 organizations will spend 1 hour

annually to acquire and maintain this

information for a total of 500 hours. The

total burden for these ICRs is 500 hours.

ESTIMATED ANNUAL BURDEN

CFR section Responses Average burden

per response

Annual burden

hours

405.410(a)

—Draft document ..................................................................................................... 300 2 hours ............................... 600

—Read, sign, photocopy, retain document ............................................................. 25,000 10 minutes .......................... 4,167

Sub-total ............................................................................................................ .................... ............................................ 4,767

405.410(b) ....................................................................................................................... 300 2 hours ............................... 600

405.445(b)(2) ................................................................................................................... 30 10 minutes .......................... 5

405.445(b)(4) ................................................................................................................... 30 2 hours ............................... 60

405.455(a) ....................................................................................................................... 500 1 hour ................................. 500

Total .................................................................................................................. .................... ............................................ 5,932

• New ICRs Without Burden.

The ICR below is subject to the Act.

However, we believe the burden

associated with this ICR is exempt since

the burden is imposed by § 405.410 and

meets the specifications in § 405.420.

§ 405.445 (Renewal and early termination of

opt-out.)

Section 405.445(a) states that a

physician or practitioner may renew

opt-out by filing an affidavit with each

carrier to which an affidavit was

submitted for the first opt-out period (as

specified in § 405.420), and to each

carrier to which a claim was submitted

under § 405.440 during the previous

opt-out period, provided the affidavits

are filed within 30 days after the current

opt-out period expires.

The ICRs below are subject to the Act.

However, we believe the burden

associated with these ICRs are exempt,

as defined by 5 CFR 1320.3(b)(2),

because the time, effort, and financial

resources necessary to comply with

these requirements would be incurred

by persons in the normal course of their

activities. Physicians and practitioners

routinely develop and update a plan of

treatment so the patient understands

how often and when he or she will

require care. In addition, physicians and

practitioners routinely maintain
30866 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

documentation in the patient’s medical

record.

§ 410.61 (Plan of treatment requirements for

outpatient physical therapy and speech

language pathology services.)

Section 410.61(e) states that the

physician review the plan as often as

the individual’s condition requires, but

at least within the first 62 days and at

least 31 days after each previous review.

§ 415.110 (Conditions for payment: Medically

directed anesthesiology services.)

Section 415.110(b) states that the

physician inclusively documents in the

patient’s medical record that the

conditions set forth in paragraph (a)(1)

of this section have been satisfied,

specifically documenting personal

participation in the most demanding

aspects of the anesthesia plan.

The ICRs below are subject to the Act.

However, we believe the burden

associated with these ICRs are exempt,

as defined by 5 CFR 1320.3(b)(2),

because the time, effort, and financial

resources necessary to comply with

these requirements would be incurred

by persons in the normal course of their

activities. We believe the record keeping

requirements described below are a

reasonable and customary part of the

plan of treatment described in section

410.61.

§ 424.24 (Requirements for medical and other

health services furnished by providers under

Medicare Part B.)

In summary § 424.24(c)(1)(iii) and (3)

requires that the services that were

furnished under a plan of treatment that

meets the requirements in § 410.61. If

the plan of treatment is established by

a physical therapist or speech-language

pathologist, the certification must be

signed by a physician who has

knowledge of the case.

Section 424.24(c)(4) states that the

first recertification is required by no

later than the 62nd day and subsequent

recertifications are required at least

every 31 days. The recertification

statement must indicate the continuing

need for physical therapy or speechlanguage pathology services and an

estimate of how much longer the

services will be needed. Recertifications

must be signed by the physician who

reviews the plan of treatment.

• Currently Approved ICRs.

While the ICRs below are subject to

the Act; the burden associated with this

requirement is captured in the HCFA–

1500, OMB Number 0938–0008,

Medicare Common Claim Form, which

expires on August 31, 1998.

§ 405.430 (Failure to perfect opt-out.)

Section 405.430(b)(3) states that the

physician or practitioner must submit

claims to Medicare for all Medicarecovered items and services furnished to

Medicare beneficiaries.

§ 405.435 (Failure to maintain opt-out.)

Section 405.435(b)(3) states that the

physician or practitioner must submit

claims to Medicare for all Medicarecovered items and services furnished to

Medicare beneficiaries.

§ 405.440 (Emergency and urgent care

services.)

Section 405.440(b)(1) states that when

a physician or practitioner furnishes

emergency or urgent care services to a

Medicare beneficiary with whom the

physician or practitioner has not

previously entered into a private

contract, the physician or practitioner

must submit a claim to Medicare in

accordance with both 42 CFR Part 424

and Medicare instruction (including but

not limited to complying with proper

coding of emergency or urgent care

services furnished by physicians and

practitioners who have opted-out of

Medicare).

We have submitted a copy of this

proposed rule to OMB for its review of

the ICRs described above. These

requirements are not effective until they

have been approved by OMB.

If you comment on any of these

information collection and record

keeping requirements, please mail

copies directly to the following:

Health Care Financing Administration,

office of Information Services,

Information Technology Investment

Management Group, Division of

HCFA Enterprise Standards, Room

C2–26–17, 7500 Security Boulevard,

Baltimore, MD 21244–1850, Attn.:

Louis Blank, HCFA–1006,

Office of Information and Regulatory

Affairs, Office of Management and

Budget, Room 10235, New Executive

Office Building, Washington, D.C.

20503, Attn.: Allison Herron Eydt,

HCFA Desk Officer

V. Response to Comments

Because of the large number of items

of correspondence we normally receive

on Federal Register documents

published for comment, we are not able

to acknowledge or respond to them

individually. We will consider all

comments we receive by the date and

time specified in the DATES section of

this preamble, and, if we proceed with

a subsequent document, we will

respond to the comments in the

preamble to that document.

VI. Regulatory Impact Analysis

We have examined the impacts of this

proposed rule as required by Executive

Order (EO) 12866, the Unfunded

Mandates Act of 1995, and the

Regulatory Flexibility Act (RFA) (Public

Law 96–354). Executive Order 12866

directs agencies to assess all costs and

benefits of available regulatory

alternatives and, 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).

This proposed rule is expected to

have varying effects on the distribution

of Medicare physician payments and

services. With few exceptions, we

expect that the impact would be limited.

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.

This proposed rule will have no

consequential effect on State, local, or

tribal governments. We believe the

private sector cost of this rule falls

below these thresholds as well.

A. Regulatory Flexibility Act

Consistent with the provisions of the

Regulatory Flexibility Act, we analyze

options for regulatory relief for small

businesses and other small entities. We

prepare a Regulatory Flexibility

Analysis (RFA) unless we certify that a

rule would not have a significant

economic impact on a substantial

number of small entities. The RFA is to

include a justification of why action is

being taken, the kinds and number of

small entities the proposed rule would

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, all

physicians are considered to be small

entities. There are about 700,000

physicians and other practitioners who

receive Medicare payment under the

physician fee schedule. Thus, we have

prepared the following analysis, which,

together with the rest of this preamble,

meets all three assessment

requirements. It explains the rationale

for and purposes of the rule, details the

costs and benefits of the rule, analyzes
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30867

alternatives, and presents the measures

we propose to minimize the burden on

small entities.

B. Resource-Based Practice Expense

Relative Value Units

Our proposal uses a methodology for

implementing resource-based practice

expense RVUs for each physician

service. The methodology considers the

staff, equipment, and supplies used in

the provision of various medical and

surgical services in various settings,

including those that cannot be

attributed to specific procedures. We are

required to begin the transition to the

new practice expense relative value

units on January 1, 1999.

By law, the conversion to a resourcebased determination for the payment of

physician practice expenses must be

budget-neutral. In other words, the total

Medicare expenditures for calendar year

1999 must be the same as the amount

that would have been paid under the

prior method of paying practice

expenses.

Each year since the fee schedule has

been implemented, our actuaries have

determined any adjustments needed to

meet this requirement. A key

component of the actuarial

determination of budget neutrality

involves estimating the impact of

changes in the volume-and-intensity of

physician services provided to Medicare

beneficiaries as a result of the proposed

changes.

In estimating the impacts of proposed

changes under the physician fee

schedule on the volume-and-intensity of

services, the actuaries have historically

used a model that assumes that 50

percent of the change in net revenue for

a practice would be recouped. This does

not mean that payments are reduced by

50 percent. In fact, payments have

typically been reduced only a few

percent or less. The actuaries also

assume that there is no offsetting

reduction in volume-and-intensity for

physicians whose Medicare revenue

increases.

Our actuaries have reviewed the

literature and conducted data analysis

of the volume-and-intensity response.

For the purpose of establishing budget

neutrality for the physician practice

expense determination, the actuaries

plan to use a model that assumes a 30

percent volume-and-intensity response

to price reductions but no reduction in

volume-and-intensity in response to a

price increase. We plan to make the

actuary’s analysis of the volume-andintensity response available soon. We

expect it to be available on our

homepage (www.hcfa.gov).

Using the revised actuarial model,

achieving budget neutrality for the

practice expense per hour method

would require lowering physician

payments in calendar year 1999 by 0.33

percent (1.31 percent cumulative from

1999–2002). The 0.33 percent volumeand-intensity adjustment results in a

reduction in the 1999 physician CF of

$0.1223. (The corresponding figures for

the modified June 1997 proposed rule

method would be 0.61 percent in 1999,

2.43 percent cumulative, and a $0.2248

reduction in the 1999 CF. The

adjustments are larger due to the greater

payment redistributions under this

method.) We do not believe that we can

use the Sustainable Growth Rate (SGR)

mechanism alone, without the

adjustment for volume-and-intensity for

1999, because any SGR adjustment

would be in the future and the actuaries

would not determine us to be in

compliance with the statutory budgetneutrality requirement for 1999. To the

extent that the volume-and-intensity

response does not occur, the SGR

system enacted as part of the BBA 1997

will return the volume-and-intensity

adjustment in the form of higher future

updates to the Medicare physician fee

schedule conversion factor.

Table 8, ‘‘Impact on Total Allowed

Charges by Specialty of the ResourceBased Practice Expense Relative Value

Units under the Practice Expense per

Hour and Modified June 97 NPRM

Methods’’ shows the change in

Medicare physician fees resulting from

the practice expense per hour and the

modified proposed rule methodologies

discussed earlier in this proposed rule.

The impact of the changes on the total

revenue (Medicare and non-Medicare)

for a given specialty is less than the

impact displayed in Table 8 since

physicians furnish services to both

Medicare and non-Medicare patients.

The magnitude of the Medicare

impact depends generally on the mix of

services the specialty provides and the

sites in which the services are

performed. In general, those specialties

that furnish more office-based services

are expected to experience larger

increases in Medicare payments than

specialties that provide fewer officebased services. Table 8 also includes the

impact on the conversion factor of the

volume and intensity adjustments

discussed above, but not the impact of

the volume response on revenues.

TABLE 8.—IMPACT ON TOTAL ALLOWED CHARGES BY SPECIALTY OF THE RESOURCE-BASED PRACTICE EXPENSE RELATIVE VALUE UNITS UNDER THE PRACTICE EXPENSE PER HOUR (TOP-DOWN) AND MODIFIED JUNE 97 NPRM (BOTTOM-UP) METHODS (PERCENT CHANGE)

Specialty

Impact per year Cumulative four year

PE/HR

Modified

June 97

NPRM

PE/HR

Modified

June 97

NPRM

M.D./D.O. Physicians:

Anesthesiology .......................................................................................................... 0 2 2 9

Cardiac Surgery ........................................................................................................ ¥4 ¥11 ¥14 ¥37

Cardiology ................................................................................................................. ¥3 ¥6 ¥13 ¥21

Clinics ........................................................................................................................ ¥1 ¥1 ¥3 ¥5

Dermatology .............................................................................................................. 6 8 27 36

Emergency Medicine ................................................................................................. ¥3 ¥2 ¥13 ¥6

Family Practice .......................................................................................................... 1 2 6 7

Gastroenterology ....................................................................................................... ¥4 ¥7 ¥14 ¥24

General Practice ........................................................................................................ 1 1 3 5

General Surgery ........................................................................................................ ¥1 ¥4 ¥6 ¥16

Hematology/Oncology ............................................................................................... 1 4 2 15

Internal Medicine ....................................................................................................... 0 0 1 ¥2

Nephrology ................................................................................................................ ¥1 ¥5 ¥5 ¥17

Neurology .................................................................................................................. 0 ¥2 0 ¥7

Neurosurgery ............................................................................................................. ¥3 ¥7 ¥10 ¥27
30868 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

TABLE 8.—IMPACT ON TOTAL ALLOWED CHARGES BY SPECIALTY OF THE RESOURCE-BASED PRACTICE EXPENSE RELATIVE VALUE UNITS UNDER THE PRACTICE EXPENSE PER HOUR (TOP-DOWN) AND MODIFIED JUNE 97 NPRM (BOTTOM-UP) METHODS (PERCENT CHANGE)—Continued

Specialty

Impact per year Cumulative four year

PE/HR

Modified

June 97

NPRM

PE/HR

Modified

June 97

NPRM

Obstetrics/Gynecology .............................................................................................. 1 0 5 0

Ophthalmology .......................................................................................................... 3 ¥1 11 ¥3

Orthopedic Surgery ................................................................................................... 0 ¥4 ¥1 ¥14

Other Physician * ....................................................................................................... 0 0 0 2

Otolaryngology .......................................................................................................... 1 2 6 8

Pathology ................................................................................................................... ¥3 1 ¥10 5

Plastic Surgery .......................................................................................................... 1 ¥2 5 ¥9

Psychiatry .................................................................................................................. 1 4 4 19

Pulmonary ................................................................................................................. ¥1 ¥3 ¥3 ¥10

Radiation Oncology ................................................................................................... ¥3 3 ¥13 15

Radiology ................................................................................................................... ¥4 ¥3 ¥13 ¥13

Rheumatology ........................................................................................................... 4 3 15 11

Thoracic Surgery ....................................................................................................... ¥4 ¥10 ¥13 ¥33

Urology ...................................................................................................................... 2 0 7 2

Vascular Surgery ....................................................................................................... ¥3 ¥6 ¥12 ¥23

Others:

Chiropractic ............................................................................................................... 0 4 ¥2 19

Nonphysician Practitioner .......................................................................................... 0 6 ¥1 26

Optometry .................................................................................................................. 8 7 36 30

Podiatry ..................................................................................................................... 1 9 5 44

Suppliers .................................................................................................................... ¥5 9 ¥18 39

* Other physician includes allergy/immunology, oral surgery, physical medicine and rehabilitation, pediatrics, critical care, and hematology.

For several reasons, it is difficult to

compare the impacts between the

impacts in last year’s June 18, 1997,

proposed rule and the impacts in this

proposed rule since BBA 1997 made

several changes in physician payment.

Although BBA 1997 delayed the initial

implementation of the resource-based

practice expense system until 1999, it

created a down payment for the new

system by increasing the practice

expense payments for office visits in

1998 funded through decreases in the

1998 practice expense payments for

certain procedures. For comparison

purposes, the cumulative 4-year impacts

displayed in Table 8 are shown below

alongside the impacts in last year’s June

1997 proposed rule adjusted for the

down payment.

TABLE 9.—COMPARISON OF RESOURCE-BASED PRACTICE EXPENSE RELATIVE VALUE UNITS IMPACTS ON TOTAL ALLOWED

CHARGES BY SPECIALTY WITH THE JUNE 97 NPRM NET OF THE DOWN PAYMENT (PERCENT CHANGE)

Specialty June 97

NPRM

Impact of

practice expense

June 97

NPRM

Modified

June 97 PE/HR

M.D./D.O. Physicians:

Anesthesiology .................................................................................. 4.0 0.2 3.8 9 2

Cardiac Surgery ................................................................................. ¥32.0 ¥2.9 ¥30.0 ¥37 ¥14

Cardiology .......................................................................................... ¥17.0 ¥1.1 ¥16.1 ¥21 ¥13

Clinics ................................................................................................ ¥3.0 0.1 ¥3.1 ¥5 ¥3

Dermatology ...................................................................................... 18.0 0.6 17.2 36 27

Emergency Medicine ......................................................................... ¥2.0 ¥0.1 ¥1.9 ¥6 ¥13

Family Practice .................................................................................. 12.0 2.0 9.8 7 6

Gastroenterology ............................................................................... ¥20.0 ¥0.9 ¥19.3 ¥24 ¥14

General Practice ................................................................................ 9.0 1.5 7.4 5 3

General Surgery ................................................................................ ¥9.0 ¥0.2 ¥8.8 ¥16 ¥6

Hematology/Oncology ....................................................................... 11.0 1.2 9.7 15 2

Internal Medicine ............................................................................... 3.0 1.2 1.8 ¥2 1

Nephrology ........................................................................................ ¥13.0 ¥0.7 ¥12.4 ¥17 ¥5

Neurology .......................................................................................... ¥3.0 0.5 ¥3.4 ¥7 0

Neurosurgery ..................................................................................... ¥21.0 ¥1.6 ¥19.7 ¥27 ¥10

Obstetrics/Gynecology ....................................................................... 4.0 1.5 2.5 0 5

Ophthalmology ................................................................................... ¥11.0 ¥3.3 ¥8.0 ¥3 11

Orthopedic Surgery ........................................................................... ¥11.0 ¥0.9 ¥10.1 ¥14 ¥1

Other Physician * ............................................................................... 4.0 0.2 3.8 2 0

Otolaryngology ................................................................................... 7.0 0.5 6.5 8 6

Pathology ........................................................................................... 1.0 ¥0.6 1.6 5 ¥10

Plastic Surgery .................................................................................. ¥3.0 ¥0.3 ¥2.7 ¥9 5

Psychiatry .......................................................................................... 3.0 ¥0.1 3.1 19 4

Pulmonary .......................................................................................... ¥6.0 0.1 ¥6.1 ¥10 ¥3
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30869

TABLE 9.—COMPARISON OF RESOURCE-BASED PRACTICE EXPENSE RELATIVE VALUE UNITS IMPACTS ON TOTAL ALLOWED

CHARGES BY SPECIALTY WITH THE JUNE 97 NPRM NET OF THE DOWN PAYMENT (PERCENT CHANGE)—Continued

Specialty June 97

NPRM

Impact of

practice expense

June 97

NPRM

Modified

June 97 PE/HR

Radiation Oncology ........................................................................... 10.0 ¥0.4 10.4 15 ¥13

Radiology ........................................................................................... ¥9.0 ¥0.3 ¥8.7 ¥13 ¥13

Rheumatology .................................................................................... 15.0 2.0 12.8 11 15

Thoracic Surgery ............................................................................... ¥28.0 ¥2.3 ¥26.3 ¥33 ¥13

Urology .............................................................................................. 1.0 0.1 0.9 2 7

Vascular Surgery ............................................................................... ¥17.0 0.3 ¥17.2 ¥23 ¥12

Others:

Chiropractic ........................................................................................ 14.0 ¥0.3 14.3 ¥2 ¥2

Nonphysician Practitioner .................................................................. 4.0 ¥0.7 4.8 ¥1 ¥1

Optometry .......................................................................................... 15.0 0.7 14.2 36 36

Podiatry .............................................................................................. 24.0 0.6 23.3 5 5

Suppliers ............................................................................................ 14.0 ¥0.8 14.9 ¥18 ¥18

* Other physician includes allergy/immunology, oral surgery, physical medicine and rehabilitation, pediatrics, critical care, and hematology.

Note: Columns do not add because figures are multiplicative. For example, the ¥30 June 97 NPRM net of the downpayment for cardiac surgery is derived from (1¥(32/100))/(1¥(2.9/100)).

In addition to the downpayment,

other 1998 changes that significantly

impacted Medicare physician fee

schedule payments were the BBA 1997

move to a single CF and changes to the

work RVUs contained in the October 31,

1997 final rule for the 1998 Medicare

physician fee schedule. To provide a

context for the current proposal, we are

again publishing the impacts of these

changes published in the October 1997

final notice (62 FR 59262). We are also

expanding that table to separate the total

change due to relative value units into

change due to the downpayment and

change due to work RVU revisions.

TABLE 10.—IMPACT ON 1998 ALLOWED CHARGES BY SPECIALTY OF THE SINGLE CONVERSION FACTOR, PRACTICE

EXPENSE DOWN PAYMENT, AND WORK RVU CHANGES

[Percent change]

Specialty

Impact of the

move to a single

CF

Impact of the

practice expense

down payment

Impact of changes

in work relative

value units

Combined impact

of the single CF,

down payment,

and work RVU

M.D./D.O. Physicians:

Anesthesiology .................................................................. 1.2 0.2 0.7 2.1

Cardiac Surgery ................................................................ ¥8.1 ¥2.9 2.3 ¥8.8

Cardiology ......................................................................... 7.9 ¥1.1 ¥0.3 6.4

Clinics ................................................................................ 4.5 0.1 ¥0.2 4.4

Dermatology ...................................................................... ¥4.8 0.6 ¥0.4 ¥4.6

Emergency Medicine ......................................................... 3.8 ¥0.1 ¥0.5 3.2

Family Practice .................................................................. 5.0 2.0 ¥0.6 6.4

Gastroenterology ............................................................... 8.5 ¥0.9 ¥0.4 7.1

General Practice ................................................................ 4.7 1.5 ¥0.3 6.0

General Surgery ................................................................ ¥4.0 ¥0.2 2.0 ¥2.3

Hematology/Oncology ....................................................... 7.1 1.2 ¥0.3 8.0

Internal Medicine ............................................................... 6.4 1.2 ¥0.5 7.0

Nephrology ........................................................................ 6.0 ¥0.7 ¥0.5 4.7

Neurology .......................................................................... 7.9 0.5 ¥0.4 7.9

Neurosurgery ..................................................................... ¥5.7 ¥1.6 1.5 ¥5.9

Obstetrics/Gynecology ...................................................... ¥2.3 1.5 1.5 0.6

Ophthalmology .................................................................. ¥3.3 ¥3.3 0.7 ¥5.8

Orthopedic Surgery ........................................................... ¥4.8 ¥0.9 1.8 ¥4.0

Other Physician* ................................................................ 6.4 0.2 ¥0.4 6.2

Otolaryngology .................................................................. ¥0.1 0.5 0.1 0.5

Pathology ........................................................................... 9.3 ¥0.6 ¥0.5 8.1

Plastic Surgery .................................................................. ¥6.9 ¥0.3 2.0 ¥5.3

Psychiatry .......................................................................... 9.0 ¥0.1 ¥0.6 8.2

Pulmonary ......................................................................... 8.1 0.1 ¥0.5 7.7

Radiation Oncology ........................................................... 9.2 ¥0.4 ¥0.3 8.4

Radiology ........................................................................... 9.0 ¥0.3 ¥0.4 8.2

Rheumatology ................................................................... 5.7 2.0 ¥0.6 7.2

Thoracic Surgery ............................................................... ¥7.0 ¥2.3 2.2 ¥7.2

Urology .............................................................................. ¥3.3 0.1 0.3 ¥2.9

Vascular Surgery ............................................................... ¥4.0 0.3 1.3 ¥2.6

Others:

Chiropractic ....................................................................... 9.3 ¥0.3 ¥0.5 8.4

Nonphysician Practitioner .................................................. 5.1 ¥0.7 0.2 4.5

Optometry .......................................................................... 5.7 0.7 ¥0.6 5.8
30870 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

TABLE 10.—IMPACT ON 1998 ALLOWED CHARGES BY SPECIALTY OF THE SINGLE CONVERSION FACTOR, PRACTICE

EXPENSE DOWN PAYMENT, AND WORK RVU CHANGES—Continued

[Percent change]

Specialty

Impact of the

move to a single

CF

Impact of the

practice expense

down payment

Impact of changes

in work relative

value units

Combined impact

of the single CF,

down payment,

and work RVU

Podiatry ............................................................................. ¥5.2 0.6 0.2 ¥4.4

Suppliers ............................................................................ 9.3 ¥0.8 ¥0.1 8.2

* Other physician includes allergy/immunology, oral surgery, physical medicine and rehabilitation, pediatrics, critical care, and hematology.

Finally, it is difficult to compare the

impacts from last year’s proposed rule

to this proposed rule because of

technical modifications to last year’s

methodology that are incorporated into

this year’s modified proposed rule

approach. Technical modifications

include elimination of last year’s limits

and caps on the CPEP estimates of

clinical and administrative labor. We

had received many comments

(including from GAO) questioning this

element of last year’s methodology. The

elimination of the caps partially

explains the difference between the 9.8

percent increase for family practitioners

last year (after netting out the effects of

the downpayment) and the 7 percent

increase that would occur with the

modified proposed rule approach in this

year’s rule. It also partially explains the

increase in payments for dermatologists

from last year’s 17.2 percent (netting out

the effect of the downpayment) to the 36

percent increase which would occur

under the modified proposed rule

approach in this year’s rule.

Table 11. ‘‘Total Payment for Selected

Procedures,’’ shows the percentage

change in total payment allowances (in

1998 dollars) between the current and

the fully phased-in resource-based

practice expense system for certain high

volume procedures.

TABLE 11.—TOTAL PAYMENT FOR SELECTED PROCEDURES

Code Mod Description Current

non-facility

Resource

based nonfacility

Non-facility

percent

change

Current facility

Resource

based facility

11721 ...... .......... Debride nail, 6 or more ........................................ $39.81 $31.69 ¥20 $29.91 $30.90

17000 ...... .......... Destroy benign/premal lesion ............................... 36.69 52.12 42 28.99 42.82

27130 ...... .......... Total hip replacement .......................................... NA NA NA 1,656.80 1,383.69

27236 ...... .......... Repair of thigh fracture ........................................ NA NA NA 1,244.62 1,065.87

27244 ...... .......... Repair of thigh fracture ........................................ NA NA NA 1,230.38 1,083.55

27447 ...... .......... Total knee replacement ....................................... NA NA NA 1,771.16 1,454.99

33533 ...... .......... CABG, arterial, single .......................................... NA NA NA 2,107.91 1,764.20

35301 ...... .......... Rechanneling of artery ......................................... NA NA NA 1,262.70 1,069.02

43239 ...... .......... Upper GI endoscopy, biopsy ............................... 228.81 241.66 6% 211.20 140.58

45378 ...... .......... Diagnostic colonoscopy ....................................... 290.30 292.34 1 288.10 208.17

45385 ...... .......... Colonoscopy, lesion removal ............................... 443.89 375.88 ¥15 414.17 277.71

66821 ...... .......... After cataract laser surgery .................................. 187.65 192.66 3 187.65 184.24

66984 ...... .......... Remove cataract, insert lens ............................... NA NA NA 795.26 677.97

67210 ...... .......... Treatment of retinal lesion ................................... 686.27 639.55 ¥7 520.81 596.86

71010 ...... 26 ..... Chest x-ray ........................................................... 9.36 8.49 ¥9 9.36 8.49

71020 ...... .......... Chest x-ray ........................................................... 34.55 27.71 ¥20 34.55 27.71

71020 ...... 26 ..... Chest x-ray ........................................................... 11.44 10.36 ¥9 11.44 10.36

77430 ...... .......... Weekly radiation therapy ..................................... 188.62 171.24 ¥9 188.62 171.24

78465 ...... .......... Heart image (3D) multiple .................................... 514.68 397.85 ¥23 514.68 397.85

88305 ...... .......... Tissue exam by pathologist ................................. 65.95 66.01 0 65.95 66.01

88305 ...... 26 ..... Tissue exam by pathologist ................................. 46.14 37.58 ¥19 46.14 37.58

90801 ...... .......... Psy dx interview ................................................... 122.08 135.64 11 122.08 134.08

90806 ...... .......... Psytx, office (45–50) ............................................ 80.95 86.09 6 80.95 82.49

90807 ...... .......... Psytx, office (45–50) w/e&m ................................ 90.03 98.66 10 90.03 94.67

90862 ...... .......... Medication management ...................................... 47.37 46.51 ¥2 47.37 45.88

90921 ...... .......... ESRD related services, month ............................. 235.86 226.79 ¥4 235.86 226.79

90935 ...... .......... Hemodialysis, one evaluation .............................. NA NA NA 93.87 64.99

92004 ...... .......... Eye exam, new patient ........................................ 77.83 113.47 46 67.37 87.79

92012 ...... .......... Eye exam established pt ...................................... 39.42 68.43 74 31.35 35.68

92014 ...... .......... Eye exam & treatment ......................................... 57.55 82.39 43 47.65 58.21

92980 ...... .......... Insert intracoronary stent ..................................... NA NA NA 1,142.75 899.31

92982 ...... .......... Coronary artery dilation ........................................ NA NA NA 857.33 680.44

93000 ...... .......... Electrocardiogram, complete ............................... 28.83 15.87 ¥45 28.83 15.87

93010 ...... .......... Electrocardiogram report ...................................... 11.96 8.45 ¥29 11.96 8.45

93015 ...... .......... Cardiovascular stress test .................................... 116.95 98.79 ¥16 116.95 98.79

93307 ...... .......... Echo exam of heart .............................................. 215.85 103.39 ¥52 215.85 103.39

93307 ...... 26 ..... Echo exam of heart .............................................. 70.94 50.80 ¥28 70.94 50.80

93510 ...... 26 ..... Left heart catheterization ..................................... 266.37 222.31 ¥17 266.37 222.31

98941 ...... .......... Chiropractic manipulation ..................................... 32.87 32.55 ¥1 27.55 28.26

99202 ...... .......... Office/outpatient visit, new ................................... 50.15 71.19 42 39.69 49.05

99203 ...... .......... Office/outpatient visit, new ................................... 68.93 100.60 46 56.82 73.17
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30871

TABLE 11.—TOTAL PAYMENT FOR SELECTED PROCEDURES—Continued

Code Mod Description Current

non-facility

Resource

based nonfacility

Non-facility

percent

change

Current facility

Resource

based facility

99204 ...... .......... Office/outpatient visit, new ................................... 102.50 141.83 38 84.53 105.52

99205 ...... .......... Office/outpatient visit, new ................................... 128.35 173.06 35 108.72 135.83

99211 ...... .......... Office/outpatient visit, est ..................................... 14.16 17.96 27 9.94 12.22

99212 ...... .......... Office/outpatient visit, est ..................................... 27.61 32.09 16 21.01 25.83

99213 ...... .......... Office/outpatient visit, est ..................................... 39.42 43.39 10 30.61 35.86

99214 ...... .......... Office/outpatient visit, est ..................................... 59.39 68.39 15 47.65 57.82

99215 ...... .......... Office/outpatient visit, est ..................................... 93.67 101.73 9 76.06 90.38

99221 ...... .......... Initial hospital care ............................................... NA NA NA 69.84 67.71

99222 ...... .......... Initial hospital care ............................................... NA NA NA 113.45 108.20

99223 ...... .......... Initial hospital care ............................................... NA NA NA 144.98 147.84

99231 ...... .......... Subsequent hospital care .................................... NA NA NA 36.57 32.35

99232 ...... .......... Subsequent hospital care .................................... NA NA NA 53.64 52.07

99233 ...... .......... Subsequent hospital care .................................... NA NA NA 74.65 73.72

99236 ...... .......... Observ/hosp same date ....................................... NA NA NA 188.78 207.45

99238 ...... .......... Hospital discharge day ......................................... NA NA NA 63.24 64.40

99239 ...... .......... Hospital discharge day ......................................... NA NA NA 79.05 86.11

99241 ...... .......... Office consultation ................................................ 47.95 50.20 5 36.21 38.46

99242 ...... .......... Office consultation ................................................ 74.95 86.81 16 60.82 69.87

99243 ...... .......... Office consultation ................................................ 97.12 111.83 15 79.33 92.28

99244 ...... .......... Office consultation ................................................ 135.96 154.79 14 113.40 132.87

99245 ...... .......... Office consultation ................................................ 183.26 196.49 7 152.26 174.83

99251 ...... .......... Initial inpatient consult .......................................... NA NA NA 49.72 39.47

99252 ...... .......... Initial inpatient consult .......................................... NA NA NA 75.59 72.93

99253 ...... .......... Initial inpatient consult .......................................... NA NA NA 99.75 98.25

99254 ...... .......... Initial inpatient consult .......................................... NA NA NA 136.88 137.30

99255 ...... .......... Initial inpatient consult .......................................... NA NA NA 185.53 186.50

99261 ...... .......... Follow-up inpatient consult .................................. NA NA NA 27.34 25.99

99262 ...... .......... Follow-up inpatient consult .................................. NA NA NA 46.94 47.05

99263 ...... .......... Follow-up inpatient consult .................................. NA NA NA 68.77 67.16

99282 ...... .......... Emergency dept visit ............................................ NA NA NA 33.55 24.76

99283 ...... .......... Emergency dept visit ............................................ NA NA NA 61.16 52.53

99284 ...... .......... Emergency dept visit ............................................ NA NA NA 93.48 81.10

99285 ...... .......... Emergency dept visit ............................................ NA NA NA 147.34 125.14

99291 ...... .......... Critical care, first hour .......................................... 191.07 189.23 ¥1 191.07 191.13

99292 ...... .......... Critical care, addl 30 min ..................................... 91.86 96.23 5 91.86 96.62

99301 ...... .......... Nursing facility care .............................................. NA NA NA 57.98 65.81

99302 ...... .......... Nursing facility care .............................................. NA NA NA 73.98 87.08

99303 ...... .......... Nursing facility care .............................................. NA NA NA 105.04 107.40

99311 ...... .......... Nursing facility care, subseq ................................ NA NA NA 33.76 34.61

99312 ...... .......... Nursing facility care, subseq ................................ NA NA NA 49.78 53.24

99313 ...... .......... Nursing facility care, subseq ................................ NA NA NA 66.12 73.34

99348 ...... .......... Home visit, estab patient ..................................... 63.30 65.30 3 63.30 74.41

99350 ...... .......... Home visit, estab patient ..................................... 132.39 148.19 12 132.39 141.51

BBA 1997 requires that we consider

the geographic impacts of the new

payment system. The following table

displays the impact of the practice

expense per hour methodology by

Medicare payment locality, including

the volume-and-intensity increase and

corresponding conversion factor

adjustment discussed earlier.

TABLE 12.—IMPACT OF PRACTICE EXPENSE PER HOUR METHODOLOGY ON TOTAL ALLOWED CHARGES BY MEDICARE

LOCALITY

[Percent change]

Locality State Impact per

year

Cumulative

four year

impact

All ....................................................................................... Alabama ........................................................................... ¥0.3 ¥1.0

All ....................................................................................... Alaska .............................................................................. 0.1 0.5

All ....................................................................................... Arizona ............................................................................. 0.1 0.3

All ....................................................................................... Arkansas .......................................................................... ¥0.1 ¥0.3

Marin/Napa/Solano ............................................................ California .......................................................................... 0.8 3.4

San Francisco .................................................................... California .......................................................................... 0.9 3.5

San Mateo ......................................................................... California .......................................................................... 0.6 2.5

Oakland/Berkeley .............................................................. California .......................................................................... 0.3 1.1

Santa Clara ........................................................................ California .......................................................................... 0.3 1.0

Rest of California ............................................................... California .......................................................................... 0.2 0.8
30872 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

TABLE 12.—IMPACT OF PRACTICE EXPENSE PER HOUR METHODOLOGY ON TOTAL ALLOWED CHARGES BY MEDICARE

LOCALITY—Continued

[Percent change]

Locality State Impact per

year

Cumulative

four year

impact

Ventura .............................................................................. California .......................................................................... 0.3 1.4

Los Angeles ....................................................................... California .......................................................................... 0.5 1.9

Anaheim/Santa Ana ........................................................... California .......................................................................... 0.6 2.6

Rest of California ............................................................... California .......................................................................... 0.7 3.0

All ....................................................................................... Colorado ........................................................................... 0.3 1.1

All ....................................................................................... Connecticut ...................................................................... 0.1 0.3

All ....................................................................................... Delaware .......................................................................... ¥0.2 ¥0.7

All ....................................................................................... District of Columbia .......................................................... ¥0.1 ¥0.3

Ft Lauderdale .................................................................... Florida .............................................................................. 0.5 2.1

Miami ................................................................................. Florida .............................................................................. ¥0.3 ¥1.3

Rest of Florida ................................................................... Florida .............................................................................. 0.0 0.0

Atlanta ................................................................................ Georgia ............................................................................ ¥0.3 ¥1.2

Rest of Georgia ................................................................. Georgia ............................................................................ ¥0.1 ¥0.4

All ....................................................................................... Hawaii .............................................................................. 0.9 3.7

All ....................................................................................... Idaho ................................................................................ 0.1 0.5

East St Louis ..................................................................... Illinois ............................................................................... 0.1 0.3

Suburban Chicago ............................................................. Illinois ............................................................................... 0.0 0.1

Chicago .............................................................................. Illinois ............................................................................... ¥0.3 ¥1.1

Rest of Illinois .................................................................... Illinois ............................................................................... ¥0.2 ¥0.6

All ....................................................................................... Indiana ............................................................................. ¥0.2 ¥0.7

All ....................................................................................... Iowa .................................................................................. 0.2 0.9

All ....................................................................................... Kansas ............................................................................. ¥0.1 ¥0.2

All ....................................................................................... Kentucky .......................................................................... ¥0.2 ¥0.8

New Orleans ...................................................................... Louisiana .......................................................................... 0.0 0.1

Rest of Louisiana ............................................................... Louisiana .......................................................................... ¥0.1 ¥0.5

Southern Maine ................................................................. Maine ............................................................................... ¥0.1 ¥0.4

Rest of Maine .................................................................... Maine ............................................................................... 0.2 0.7

Balto/Surr Ctys .................................................................. Maryland .......................................................................... ¥0.3 ¥1.2

Rest of Maryland ............................................................... Maryland .......................................................................... ¥0.1 ¥0.6

Boston ................................................................................ Massachusetts ................................................................. 0.2 1.0

Rest of Massachusetts ...................................................... Massachusetts ................................................................. 0.2 1.0

Detroit ................................................................................ Michigan ........................................................................... ¥0.3 ¥1.2

Rest of Michigan ................................................................ Michigan ........................................................................... ¥0.2 ¥1.0

All ....................................................................................... Minnesota ......................................................................... ¥0.2 ¥0.9

All ....................................................................................... Mississippi ........................................................................ ¥0.2 ¥0.9

Metro Kansas City ............................................................. Missouri ............................................................................ ¥0.6 ¥2.2

Rest of Missouri ................................................................. Missouri ............................................................................ 0.1 0.3

St Louis .............................................................................. Missouri ............................................................................ ¥0.1 ¥0.5

Rest of Missouri ................................................................. Missouri ............................................................................ 0.3 1.2

All ....................................................................................... Montana ........................................................................... 0.1 0.4

All ....................................................................................... Nebraska .......................................................................... 0.1 0.4

All ....................................................................................... Nevada ............................................................................. ¥0.3 ¥1.2

All ....................................................................................... New Hampshire ............................................................... 0.2 0.8

Northern New Jersey ......................................................... New Jersey ...................................................................... ¥0.1 ¥0.4

Rest of New Jersey ........................................................... New Jersey ...................................................................... ¥0.1 ¥0.5

All ....................................................................................... New Mexico ..................................................................... 0.3 1.3

Rest of New York .............................................................. New York ......................................................................... ¥0.2 ¥0.6

Manhattan .......................................................................... New York ......................................................................... 0.3 1.1

NYC Suburbs/LI ................................................................. New York ......................................................................... ¥0.1 ¥0.5

Poughkpsie/N NYC ............................................................ New York ......................................................................... 0.3 1.2

Queens .............................................................................. New York ......................................................................... 0.3 1.0

All ....................................................................................... North Carolina .................................................................. 0.0 0.0

All ....................................................................................... North Dakota .................................................................... ¥0.3 ¥1.2

All ....................................................................................... Ohio .................................................................................. ¥0.1 ¥0.2

All ....................................................................................... Oklahoma ......................................................................... 0.1 0.3

Portland ............................................................................. Oregon ............................................................................. 0.0 0.0

Rest of Oregon .................................................................. Oregon ............................................................................. 0.5 2.1

Philadelphia ....................................................................... Pennsylvania .................................................................... ¥0.2 ¥0.8

Rest of Pennsylvania ......................................................... Pennsylvania .................................................................... ¥0.1 ¥0.4

All ....................................................................................... Puerto Rico ...................................................................... 0.8 3.2

All ....................................................................................... Rhode Island .................................................................... 0.0 0.2

All ....................................................................................... South Carolina ................................................................. 0.0 0.0

All ....................................................................................... South Dakota ................................................................... ¥0.3 ¥1.1

All ....................................................................................... Tennessee ....................................................................... ¥0.3 ¥1.0

Brazoria ............................................................................. Texas ............................................................................... 0.8 3.4

Dallas ................................................................................. Texas ............................................................................... ¥0.1 ¥0.4

Galveston ........................................................................... Texas ............................................................................... 0.1 0.6

Houston ............................................................................. Texas ............................................................................... ¥0.3 ¥1.2
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30873

TABLE 12.—IMPACT OF PRACTICE EXPENSE PER HOUR METHODOLOGY ON TOTAL ALLOWED CHARGES BY MEDICARE

LOCALITY—Continued

[Percent change]

Locality State Impact per

year

Cumulative

four year

impact

Beaumont .......................................................................... Texas ............................................................................... ¥0.4 ¥1.8

Fort Worth .......................................................................... Texas ............................................................................... ¥0.2 ¥0.8

Austin ................................................................................. Texas ............................................................................... ¥0.4 ¥1.5

Rest of Texas .................................................................... Texas ............................................................................... 0.0 ¥0.2

All ....................................................................................... Utah .................................................................................. 0.3 1.0

All ....................................................................................... Vermont ............................................................................ 0.5 2.1

All ....................................................................................... Virgin Islands ................................................................... 0.6 2.6

All ....................................................................................... Virginia ............................................................................. 0.1 0.5

Seattle (King Co) ............................................................... Washington ...................................................................... 0.1 0.3

Rest of Washington ........................................................... Washington ...................................................................... 0.2 0.8

All ....................................................................................... West Virginia .................................................................... ¥0.1 ¥0.4

All ....................................................................................... Wisconsin ......................................................................... ¥0.1 ¥0.6

All ....................................................................................... Wyoming .......................................................................... 0.5 2.1

BBA 1997 requires that we consider

the impacts of the new system on urban

and rural localities. The geographic

payment areas we use for payment

under the physician fee schedule do not

follow urban and rural configurations.

For example, in 34 States (plus the

District of Columbia, Puerto Rico, and

the Virgin Islands) the payment areas

are statewide; that is, the Medicare

payment is the same in both urban and

rural areas. In those States, there would

be no differential impact of this

proposal on urban and rural areas. Since

our payment areas do not track urban

and rural locations, our claims payment

system does not distinguish between

urban and rural locations, and we do

not have data easily available to

undertake an urban-rural impact

analysis. We do not believe that this

proposal will have much urban-rural

impact, particularly since 34 States

(plus the District of Columbia, Puerto

Rico, and the Virgin Islands) have

statewide payment areas. Any urbanrural impact should largely be explained

by differences in the mix and site of

services among urban and rural

localities.

BBA 1997 requires us to consider

impact projections that compare new

proposed payment amounts to data on

actual physician practice expenses. We

have satisfied this requirement by

basing the new proposed payments

amounts on actual physician practice

expense data.

C. Medical Direction for Anesthesia

Services

We are proposing to revise the

conditions for payment of medical

direction performed by a physician.

Thus, we are proposing to revise our

regulations in § 415.10 (Conditions for

payment: Anesthesiology services) to

state that we will pay a physician for

medical direction of anesthesia services,

for a single case or for two, three, or four

concurrent cases if the services meet the

condition in § 415.102(a) (Conditions for

fee schedule payment for physician

services to beneficiaries in providers).

This proposal has no payment

implications. The payment rate for

medical direction, which is included in

the statute, would not change.

D. Separate Payment for Physician

Interpretation of an Abnormal

Papanicolaou Smear

Under our proposed policy, we would

allow separate payment, under the

physician fee schedule, for the

physician interpretation of Pap smears

in all sites. Currently, separate payment

to physicians is limited to services

furnished for hospital inpatients. We

estimate that there would be a minimal

cost impact in payments under the

physician fee schedule for this change

in Pap smear interpretations. This cost

would be more than offset by the

savings resulting from the change in the

calculation of the median for payment

of drugs and biologicals.

E. Rebasing and Revising the Medicare

Economic Index

There is negligible impact on

Medicare expenditures as a result of this

change.

F. Payment for Nurse Midwives’ Services

The provision for nurse midwives’

services would place into regulations

text a provision of OBRA 1993 that

eliminates the limitation on coverage of

services furnished outside the maternity

cycle by nurse midwives. This provision

has been implemented previously

through program instructions; therefore,

this change in the regulations text

would have no impact.

G. BBA 1997 Provisions Included in

This Proposed Rule

The following four provisions of BBA

1997 are included in this proposed rule.

This proposed rule conforms the

regulations text to the BBA 1977

provisions. The following table provides

the cost and savings estimates (in

millions of dollars) for these provisions

for the fiscal years shown:

Provision

Section Subject 1999 2000 2001 2002 2003

4511 ........................... Nurse practitioners and Clinical Nurse Specialists.290 330 370 440 490

4512 ........................... Physician Assistants ......................................... 60 60 70 90 100

4541 ........................... Outpatient Physical Therapy ............................ ¥130 ¥190 ¥200 ¥230 ¥250

4556 ........................... Drugs ................................................................ ¥60 ¥70 ¥70 ¥80 ¥80
30874 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

1. Payment for Services of Certain

Nonphysician Practitioners and Services

Furnished Incident to Their Professional

Services

Sections 4511 and 4512 of BBA 1997

provide for the expanded coverage of

nurse practitioner, clinical nurse

specialist, and physician assistant

services. This provision is selfimplementing. This proposed rule

changes the regulations text to conform

to the BBA 1997 provisions. We are

taking this opportunity to clarify the

following two existing issues unrelated

to the BBA 1997 provisions for

nonphysician practitioners.

• Proposing a revised definition of

physician collaboration for nurse

practitioners and clinical nurse

specialists.

• Modifying the qualifications of

physicians assistants to recognize

orthopedic physician assistants as

physician assistants.

The impact of the BBA 1997 provision

is shown in the table above (a

combination of sections 4511 and 4512

of BBA 1997). The proposals being

made in this proposed rule would have

negligible budgetary impact.

2. Payment for Outpatient Rehabilitation

Services

Sections 4541(a)(2)(B) and 4541(a)(3)

of BBA 1997 change the payment of

outpatient rehabilitation services from

cost-based to a payment system based

on the physician fee schedule. These

provisions are self-implementing. The

impact of this proposal is shown in the

table above. The regulatory changes are

to conform our regulations to the

provisions of BBA 1997.

The following proposals are being

made in this proposed rule to furnish

information for identification of the

outpatient rehabilitation services and

for administrative purposes:

• Specifying HCPCS as the coding

system for rehabilitation services since

it is used by the fee schedule in section

1848 of the Act.

• Providing for discipline-specific

modifiers to be used in coding services.

• Providing for a code for nursing

services performed in CORFs.

These proposals will have a negligible

impact.

We are providing some additional

impact information regarding this BBA

1997 provision. There are several

different types of providers that will be

affected by this BBA 1997 provision.

They are SNFs, outpatient rehabilitation

facilities, and hospital outpatient

departments. There about 15,000 SNFs,

2,500 outpatient rehabilitation facilities,

and about 5,600 outpatient hospital

facilities. In estimating the impacts of

this provision on these entities, we

determined that the services that would

be affected by these changes account for

about 5 percent of facility payments in

these providers.

We realize there may be an impact on

small rural hospitals; however, we have

been unable to assess this impact

because we do not have the data to

make this analysis. Also, data that

would identify the extent to which these

services are currently being furnished in

small rural hospitals to serve as the

baseline for comparing impact of the

legislative changes are not available. In

addition, we do not maintain data that

identify services furnished under the

physician fee schedule in areas where

rural hospitals are located. Although

there are localities designated for

payment purposes, there is very little

correlation between the payment

localities (most of which are state-wide)

and areas where small rural hospitals

are located.

3. Payment for Drugs and Biologicals

The impact of this BBA 1997

provision is shown in the table above.

This proposed rule modifies the current

regulatory language regarding drug

reimbursement to conform to the BBA

1997 changes. The proposal in this

proposed rule to modify the method

used to calculate the median to include

the brand name of the drug is not

related to the BBA 1997 drug provision

but would have a slight program

savings. This is offset by the cost for the

proposal to provide a separate payment

for the interpretation of an abnormal

Pap smear, which was described above.

4. Private Contracting with Medicare

Beneficiaries

We anticipate that there would be a

negligible impact on Medicare trust

fund payments as a result of the

regulation that implements the law. The

program impact of the provision when

it was assessed in the legislative process

was negligible and vanished under our

rounding rules. The impact on

beneficiaries, physicians, and

practitioners is impossible to assess in

any quantitative way.

Specifically, beneficiaries who have

had difficulty in finding physicians or

practitioners to furnish services because

the physicians or practitioners were

dissatisfied with the Medicare payment

rates may find it easier to acquire care.

On the other hand, beneficiaries who

cannot afford to privately contract with

physicians or practitioners who opt-out

of Medicare may have more limited

access to care as they try to seek care

from reduced numbers of physicians

and practitioners who will accept

Medicare payment rules.

Physicians and practitioners who optout of Medicare may see increased

incomes as a result of their ability to

charge without regard to the Medicare

limiting charge. However, to the extent

that beneficiaries cease to seek

treatment from them because they have

opted-out of Medicare, their incomes

may decline. Moreover, organizations to

which physicians and practitioners had

reassigned Medicare benefits may cease

their contracts with them if they opt-out

since they could no longer be paid by

Medicare for the physician or

practitioner service. Managed care plans

that have a contract with Medicare may

cease their contractual arrangement

with physicians and practitioners who

opt-out of Medicare since the plan

cannot pay for any of their services to

Medicare beneficiaries and, hence, their

services no longer offer access to care

under the plan. Similarly, insurance

plans other than Medicare can choose to

not pay for the services provided to any

of their enrollees by physicians and

practitioners who opt-out of Medicare,

causing the physicians and practitioners

who opt-out further loss of income.

H. Impact on Beneficiaries

Although changes in physician

payments when the physician fee

schedule was implemented in 1992

were large, we detected no problems

with beneficiary access to care. Because

there is a 4-year transition to the

proposed values, we anticipate a

minimal impact on beneficiaries.

In accordance with the provisions of

Executive Order 12866, this regulation

was reviewed by the Office of

Management and Budget.

List of Subjects

42 CFR Part 405

Administrative practice and

procedure, Health facilities, Health

professions, Kidney diseases, Medicare,

Reporting and recordkeeping

requirements, Rural areas, X-rays.

42 CFR Part 410

Health facilities, Health professions,

Kidney diseases, Laboratories,

Medicare, Rural areas, X-rays.

42 CFR Part 413

Health facilities, Kidney diseases,

Medicare, Reporting and recordkeeping

requirements.

42 CFR Part 414

Administrative practice and

procedure, Health facilities, Health

professions, Kidney diseases, Medicare,
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30875

Reporting and recordkeeping

requirements, Rural areas, X-rays.

42 CFR Part 415

Health facilities, Health professions,

Medicare Reporting and recordkeeping

requirements.

42 CFR Part 424

Emergency medical services, Health

facilities, Health professions, Medicare.

42 CFR Part 485

Grant programs-health, Health

facilities, Medicaid, Medicare,

Reporting and recordkeeping

requirements.

For the reasons set forth in the

preamble, 42 CFR chapter IV would be

amended as follows:

PART 405—FEDERAL HEALTH

INSURANCE FOR THE AGED AND

DISABLED

A. Part 405 is amended as set forth

below:

1. A new subpart D, consisting of

§§ 405.400, 405.405, 405.410, 405.415,

405.420, 405.425, 405.430, 405.435,

405.440, 405.445, 405.450, and 405.455

is added to read as follows:

Subpart D—Private Contracts

Secs.

405.400 Definitions.

405.405 General rules.

405.410 Conditions for properly opting-out

of Medicare.

405.415 Requirements of private contracts.

405.420 Requirements of opt-out affidavit.

405.425 Effects of opting-out of Medicare.

405.430 Failure to properly opt-out.

405.435 Failure to maintain opt-out.

405.440 Emergency and urgent care

services.

405.445 Renewal and early termination of

opt-out.

405.450 Appeals.

405.455 Medicare+Choice.

Subpart D—Private Contracts

Authority: Secs. 1102 and 1871 of the

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

1395hh).

§ 405.400 Definitions.

For purposes of this subpart, the

following definitions apply:

Beneficiary means an individual who

is enrolled in Part B of Medicare.

Emergency care services means

services furnished to an individual for

treatment of an ‘‘emergency medical

condition’’ as that term is defined in

§ 489.24 of this chapter.

Legal representative means an

individual who has been appointed as

the beneficiary’s legal guardian under

State law or who has been granted a

power of attorney from the beneficiary,

which power of attorney is sufficient to

permit the individual to enter into

private contracts on the beneficiary’s

behalf.

Opt-out means the status of meeting

the conditions specified in § 405.410.

Opt-out period means the 2-year

period beginning on the effective date of

the affidavit as specified by

§ 405.410(c)(1) or § 405.410(c)(2), as

applicable.

Participating physician means a

‘‘physician’’ as defined in this section

who has signed an agreement to

participate in Part B of Medicare.

Physician means a doctor of medicine

or a doctor of osteopathy who is

currently licensed as that type of doctor

in each State in which he or she

furnishes services to patients.

Practitioner means a physician

assistant, nurse practitioner, clinical

nurse specialist, certified registered

nurse anesthetist, certified nurse

midwife, clinical psychologist, or

clinical social worker, who is currently

legally authorized to practice in that

capacity by each State in which he or

she furnishes services to patients or

clients.

Private contract means a document

that meets the criteria specified in

§ 405.415.

Properly opt-out means to complete,

without defect, the requirements for optout as specified in § 405.410.

Properly terminate opt-out means to

complete, without defect, the

requirements for terminating opt-out as

specified in § 405.445.

Urgent care services means services

furnished to an individual who requires

services to be furnished within 12 hours

in order to avoid the likely onset of an

emergency medical condition.

§ 405.405 General rules.

(a) A physician or practitioner may

enter into one or more private contracts

with Medicare beneficiaries for the

purpose of furnishing items or services

that would otherwise be covered by

Medicare, provided the conditions of

this subpart are met.

(b) A physician or practitioner who

enters into at least one private contract

with a Medicare beneficiary under the

conditions of this subpart, and who

submits one or more affidavits in

accordance with this subpart, opts-out

of Medicare for a 2-year period. The

physician’s or practitioner’s opt-out may

be renewed for subsequent 2-year

periods.

(c) Both the private contracts

described in paragraph (a) of this

section and the physician’s or

practitioner’s opt-out described in

paragraph (b) of this section are null and

void if the physician or practitioner fails

to properly opt-out in accordance with

the conditions of this subpart, or fails to

remain in compliance with the

conditions of this subpart during the

opt-out period.

(d) Services furnished under private

contracts meeting the requirements of

this subpart are not covered services

under Medicare, and no Medicare

payment would be made for such

services either directly or indirectly.

§ 405.410 Conditions for properly optingout of Medicare.

The following conditions must be met

for a physician or practitioner to

properly opt-out of Medicare:

(a) Each private contract between a

physician or a practitioner and a

Medicare beneficiary must meet the

specifications of § 405.415.

(b) The physician or practitioner must

submit to each Medicare carrier with

which he or she files claims an affidavit

that meets the specifications of

§ 405.420.

(c) A nonparticipating physician or a

practitioner may opt-out of Medicare at

any time in accordance with the

following:

(1) The 2-year opt-out period begins

the date the affidavit meeting the

requirements of § 405.420 is signed,

provided the affidavit is timely filed

(that is, within 10 days after the first

private contract is entered into).

(2) If the physician or practitioner

does not timely file any required

affidavit, the 2-year opt-out period

begins when the last such affidavit is

filed. Any private contract entered into

before the last required affidavit is filed

becomes effective upon the filing of the

last required affidavit and the furnishing

of any items or services to a Medicare

beneficiary under such contract before

the last required affidavit is filed is

subject to standard Medicare rules.

(d) A participating physician may

properly opt-out of Medicare at the

beginning of any calendar quarter,

provided that the affidavit described in

§ 405.420 is submitted to the

participating physician’s Medicare

carriers at least 30 days before the

beginning of the selected calendar

quarter. A private contract entered into

before the beginning of the selected

calendar quarter becomes effective at

the beginning of the selected calendar

quarter and the furnishing of any items

or services to a Medicare beneficiary

under such contract before the

beginning of the selected calendar

quarter is subject to standard Medicare

rules.
30876 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

§ 405.415 Requirements of the private

contract.

A private contract under this subpart

must:

(a) Be in writing and in print

sufficiently large to ensure that

beneficiaries are able to read the

contract.

(b) State whether the physician or

practitioner is excluded from Medicare

under section 1128 of the Social

Security Act.

(c) State that the beneficiary or his or

her legal representative accepts full

responsibility for payment of the

physician’s or practitioner’s charge for

the services furnished.

(d) State that the beneficiary or his or

her legal representative understands

that Medicare limits do not apply to

what the physician or practitioner may

charge for items or services furnished by

the physician or practitioner.

(e) State that the beneficiary or his or

her legal representative agrees not to

submit a claim to Medicare or to ask the

physician or practitioner to submit a

claim to Medicare.

(f) State that the beneficiary or his or

her legal representative understands

that Medicare payment will not be made

for any items or services furnished by

the physician or practitioner that would

have otherwise been covered by

Medicare if there was no private

contract and a proper Medicare claim

had been submitted.

(g) State that the beneficiary or his or

her legal representative enters into this

contract with the knowledge that he or

she has the right to obtain Medicarecovered items and services from

physicians and practitioners who have

not opted-out of Medicare.

(h) State the expected effective date

and expected expiration date of the optout period.

(i) State that the beneficiary or his or

her legal representative understands

that Medigap plans do not, and that

other supplemental plans may elect not

to, make payments for items and

services not paid for by Medicare.

(j) Be signed by the beneficiary or his

or her legal representative and by the

physician or practitioner.

(k) Not be entered into by the

beneficiary or by the beneficiary’s legal

representative during a time when the

beneficiary requires emergency care

services or urgent care services.

(However, a physician or practitioner

may furnish emergency or urgent care

services to a Medicare beneficiary in

accordance with § 405.440.)

(l) Be provided (a photocopy is

permissible) to the beneficiary or to his

or her legal representative before items

or services are furnished to the

beneficiary under the terms of the

contract.

(m) Be retained (original signatures of

both parties required) by the physician

or practitioner for the duration of the

opt-out period.

(n) Be made available to HCFA upon

request.

(o) Be entered into for each opt-out

period.

§ 405.420 Requirements of the opt-out

affidavit.

An affidavit under this subpart must:

(a) Be in writing and be signed by the

physician or practitioner.

(b) Contain the physician’s or

practitioner’s full name, address,

telephone number, national provider

identifier (NPI) or billing number, if one

has been assigned, uniform provider

identification number (UPIN) if one has

been assigned, or, if neither an NPI nor

a UPIN has been assigned, the

physician’s or practitioner’s tax

identification number (TIN).

(c) State that, during the opt-out

period, the physician or practitioner

will provide services to Medicare

beneficiaries only through private

contracts that meet the criteria of

paragraph § 405.415 for services that,

except for their provision under a

private contract, would have been

Medicare-covered services.

(d) State that the physician or

practitioner will not submit a claim to

Medicare for any service furnished to a

Medicare beneficiary during the opt-out

period, nor will the physician or

practitioner permit any entity acting on

his or her behalf to submit a claim to

Medicare for services furnished to a

Medicare beneficiary, except as

specified in § 405.440.

(e) State that, during the opt-out

period, the physician or practitioner

understands that he or she may receive

no direct or indirect Medicare payment

for services that he or she furnishes to

Medicare beneficiaries with whom he or

she has privately contracted, whether as

an individual, an employee of an

organization, a partner in a partnership,

under a reassignment of benefits, or as

payment for a service furnished to a

Medicare beneficiary under a

Medicare+Choice plan.

(f) State that a physician or

practitioner who opts-out of Medicare

acknowledges that, during the opt-out

period, his or her services are not

covered under Medicare and that no

Medicare payment may be made to any

entity for his or her services, directly or

on a capitated basis.

(g) State a promise by the physician

or practitioner to the effect that, during

the opt-out period, the physician or

practitioner agrees to be bound by the

terms of both the affidavit and the

private contracts that he or she has

entered into.

(h) Acknowledge that the physician or

practitioner recognizes that the terms of

the affidavit apply to all Medicarecovered items and services furnished to

Medicare beneficiaries by the physician

or practitioner during the opt-out period

(except for emergency or urgent care

services furnished to the beneficiaries

with whom he or she has not previously

privately contracted) without regard to

any payment arrangements the

physician or practitioner may make.

(i) With respect to a physician who

has signed a Part B participation

agreement, acknowledge that such

agreement terminates on the effective

date of the affidavit.

(j) Acknowledge that the physician or

practitioner understands that a

beneficiary who has not entered into a

private contract and who requires

emergency or urgent care services may

not be asked to enter into a private

contract with respect to receiving such

services and that the rules of § 405.440

apply if the physician furnishes such

services.

(k) Be submitted to:

(1) Each Medicare carrier to which the

physician or practitioner has submitted

claims within the past 2 years.

(2) To any additional carriers to

which claims would be sent on the date

the first private contract is entered into,

in accordance with Medicare

instructions on claim submission then

in effect.

(l) With respect to nonparticipating

physicians and with respect to

practitioners, be submitted within 10

days after the nonparticipating

physician or practitioner signs his or her

first private contract with a Medicare

beneficiary.

(m) With respect to participating

physicians, be submitted in accordance

with § 405.410(d).

§ 405.425 Effects of opting-out of

Medicare.

If a physician or practitioner opts-out

of Medicare in accordance with this

subpart for the 2-year period for which

the opt-out is effective, the following

results obtain:

(a) Except as provided in § 405.440,

no payment may be made directly by

Medicare or by any Medicare+Choice

plan to the physician or practitioner or

to any entity to which the physician or

practitioner reassigns his right to receive

payment for services.

(b) The physician or practitioner may

not furnish any item or service that

would otherwise be covered by
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30877

Medicare (except for emergency or

urgent care services) to any Medicare

beneficiary except through a private

contract that meets the requirements of

this subpart.

(c) The physician or practitioner is

not subject to the requirement to submit

a claim for items or services furnished

to a Medicare beneficiary, as specified

in § 424.5(a)(6) of this chapter, except as

provided in § 405.440.

(d) The physician or practitioner is

prohibited from submitting a claim to

Medicare for items or services furnished

to a Medicare beneficiary except as

provided in § 405.440.

(e) In the case of a physician, he or

she is not subject to the limiting charge

provisions of § 414.48 of this chapter.

(f) The physician or practitioner is not

subject to the prohibition-onreassignment provisions of § 414.80 of

this chapter.

(g) In the case of a practitioner, he or

she is not prohibited from billing or

collecting amounts from beneficiaries

(as provided in 42 U.S.C.

1395u(b)(18)(B)).

(h) The death of a beneficiary who has

entered into a private contract (or whose

legal representative has done so) does

not invoke § 424.62 or § 424.64 of this

chapter with respect to the physician or

practitioner with whom the beneficiary

(or legal representative) has privately

contracted.

(i) The physician or practitioner may

order, certify the need for, or refer a

beneficiary for Medicare-covered items

and services, provided the physician or

practitioner is not paid, directly or

indirectly, for such ordering, certifying,

or referring services.

§ 405.430 Failure to properly opt-out.

(a) A physician or practitioner fails to

properly opt-out if—

(1) Any private contract between the

physician or practitioner and a

Medicare beneficiary, that was entered

into before the affidavit described in

§ 405.420 was filed, does not meet the

specifications of § 405.415; or

(2) He or she fails to submit the

affidavit(s) in accordance with

§ 405.420.

(b) If a physician or practitioner fails

to properly opt-out in accordance with

paragraph (a) of this section, the

following results obtain:

(1) All of the private contracts

between the physician or practitioner

and Medicare beneficiaries are deemed

null and void.

(2) The physician’s or practitioner’s

attempt to opt-out of Medicare is

nullified.

(3) The physician or practitioner must

submit claims to Medicare for all

Medicare-covered items and services

furnished to Medicare beneficiaries.

(4) The physician is subject to the

limiting charge provisions of § 414.48 of

this chapter.

(5) The practitioner may not reassign

any claim except as provided in

§ 424.80 of this chapter.

(6) The practitioner may neither bill

nor collect an amount from the

beneficiary except for applicable

deductible and coinsurance amounts.

(7) The physician or practitioner may

make another attempt to properly optout at any time.

§ 405.435 Failure to maintain opt-out.

(a) A physician or practitioner fails to

maintain opt-out under this subpart if,

during the opt-out period—

(1) He or she knowingly and

willfully—

(i) Submits a claim for Medicare

payment (except as provided in

§ 405.440); or

(ii) Receives Medicare payment

directly or indirectly for Medicarecovered services furnished to a

Medicare beneficiary (except as

provided in § 405.440).

(2) He or she enters into private

contracts with Medicare beneficiaries

for the purpose of furnishing items and

services that would otherwise be

covered by Medicare, but such contracts

fail to meet the specifications of

§ 405.415; or

(3) He or she fails to comply with the

provisions of § 405.440 regarding billing

for emergency care services or urgent

care services; or

(4) He or she fails to retain a copy of

each private contract that he or she has

entered into for the duration of the optout period for which the contracts are

applicable or fails to permit HCFA to

inspect them upon request.

(b) If a physician or practitioner fails

to maintain opt-out in accordance with

paragraph (a) of this section, the

following results obtain:

(1) All of the private contracts

between the physician or practitioner

and Medicare beneficiaries are deemed

null and void.

(2) The physician’s or practitioner’s

opt-out of Medicare is nullified.

(3) The physician or practitioner must

submit claims to Medicare for all

Medicare-covered items and services

furnished to Medicare beneficiaries.

(4) The physician or practitioner will

not receive Medicare payment on

Medicare claims for the remainder of

the opt-out period.

(5) The physician is subject to the

limiting charge provisions of § 414.48 of

this chapter.

(6) The practitioner may not reassign

any claim except as provided in

§ 424.80 of this chapter.

(7) The practitioner may neither bill

nor collect an amount from the

beneficiary except for applicable

deductible and coinsurance amounts.

(8) The physician or practitioner may

not attempt to once more meet the

criteria for properly opting-out until the

now-nullified 2-year opt-out period

expires.

§ 405.440 Emergency and urgent care

services.

(a) A physician or practitioner who

has opted-out of Medicare under this

subpart need not enter into a private

contract to furnish emergency care

services or urgent care services to a

Medicare beneficiary. Accordingly, a

physician or practitioner will not be

determined to have failed to maintain

opt-out if he or she furnishes emergency

care services or urgent care services to

a Medicare beneficiary with whom the

physician or practitioner has not

previously entered into a private

contract, provided the physician or

practitioner complies with the billing

requirements specified in paragraph (b)

of this section.

(b) When a physician or practitioner

furnishes emergency care services or

urgent care services to a Medicare

beneficiary with whom the physician or

practitioner has not previously entered

into a private contract, he or she:

(1) Must submit a claim to Medicare

in accordance with both 42 CFR part

424 and Medicare instructions

(including but not limited to complying

with proper coding of emergency or

urgent care services furnished by

physicians and practitioners who have

opted-out of Medicare).

(2) May collect no more than—

(i) The Medicare limiting charge, in

the case of a physician; or

(ii) The deductible and coinsurance,

in the case of a practitioner.

(c) Emergency care services or urgent

care services furnished to a Medicare

beneficiary with whom the physician or

practitioner has previously entered into

a private contract (that is, entered into

before the onset of the emergency

medical condition or urgent medical

condition), are furnished under the

terms of the private contract.

(d) Medicare may make payment for

emergency care services or urgent care

services furnished by a physician or

practitioner who has properly opted-out

when the services are furnished and the

claim for services is made in accordance

with this section.
30878 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

§ 405.445 Renewal and early termination of

opt-out.

(a) A physician or practitioner may

renew opt-out by filing an affidavit with

each carrier to which an affidavit was

submitted for the first opt-out period,

(as specified in § 405.420), and to each

carrier to which a claim was submitted

under § 405.440 during the previous

opt-out period, provided the affidavits

are filed within 30 days after the current

opt-out period expires.

(b) To properly terminate opt-out a

physician or practitioner must:

(1) Not have previously opted out of

Medicare.

(2) Notify all Medicare carriers with

which he or she filed an affidavit of the

termination of the opt-out no later than

90 days after the effective date of the

opt-out period.

(3) Refund to each beneficiary with

whom he or she has privately contracted

all payment collected in excess of:

(i) In the case of physicians: the

Medicare limiting charge; or

(ii) In the case of practitioners: the

deductible and coinsurance.

(4) Notify all beneficiaries with whom

the physician or practitioner entered

into private contracts of the physician’s

or practitioner’s decision to terminate

opt-out and of the beneficiaries’ right to

have claims filed on their behalf with

Medicare for the services furnished

during the period between the effective

date of the opt-out and the effective date

of the termination of the opt-out period.

(c) When the physician or practitioner

properly terminates opt-out in

accordance with paragraph (b), he or she

will be reinstated in Medicare as if there

had been no opt-out, and the provision

of § 405.425 shall not apply unless the

physician or practitioner subsequently

properly opts out.

§ 405.450 Appeals.

(a) A determination by HCFA that a

physician or practitioner has failed to

properly opt-out, failed to maintain optout, failed to timely renew opt-out,

failed to privately contract, or failed to

properly terminate opt-out is an initial

determination for purposes of § 405.803.

(b) A determination by HCFA that no

payment can be made to a beneficiary

for the services of a physician who has

opted-out is an initial determination for

purposes of § 405.803.

§ 405.455 Medicare+Choice.

An organization that has a contract

with HCFA to provide one or more

Medicare+Choice (M+C) plans to

beneficiaries (part 422 of this chapter):

(a) Must acquire and maintain

information from Medicare carriers on

physicians and practitioners who have

opted-out of Medicare.

(b) Must make no payment directly or

indirectly for Medicare covered services

furnished to a Medicare beneficiary by

a physician or practitioner who has

opted-out of Medicare.

(c) May make payment to a physician

or practitioner who furnishes emergency

or urgent care services to a beneficiary

who has not previously entered into a

private contract with the physician or

practitioner.

Subpart E—Criteria for Determining

Reasonable Charges

2. The authority citation for part 405,

subpart E, continues to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh).

3. Section 405.517 is revised to read

as follows:

§ 405.517 Payment for drugs and

biologicals that are not paid on a cost or

prospective payment basis.

(a) Applicability. Payment for a drug

or biological that is not paid on a cost

or prospective payment basis is

determined by the standard

methodology described in paragraph (b)

of this section. Examples of when this

procedure applies include a drug or

biological furnished incident to a

physician service, a drug or biological

furnished by an independent dialysis

facility that is not included in the ESRD

composite rate set forth in § 413.170(c)

of this chapter, and a drug or biological

furnished as part of the durable medical

equipment benefit.

(b) Methodology. Payment for a drug

or biological described in paragraph (a)

of this section is based on the lower of

the actual charge on the Medicare claim

for benefits or 95 percent of the national

average wholesale price of the drug or

biological.

(c) Multiple-source drugs. For

multiple-source drugs and biologicals,

for purposes of this regulation, the

average wholesale price is defined as

the lesser of the median average

wholesale price for all sources of the

generic forms of the drug or biological

or the lowest average wholesale price of

the brand name forms of the drug or

biological.

4. A new § 405.520 is added to read

as follows:

§ 405.520 Payment for physician assistant,

nurse practitioner, and clinical nurse

specialist services and services furnished

incident to their professional services.

(a) General rule. Physician assistant,

nurse practitioner, and clinical nurse

specialist services, and services and

supplies furnished incident to their

professional services, are paid in

accordance with the physician fee

schedule. The payment for physician

assistant services may not exceed the

limits at § 414.52 of this chapter. The

payment for nurse practitioner and

clinical nurse specialist services may

not exceed the limits at § 414.56 of this

chapter.

(b) Requirements. Medicare payment

is made only if all claims for payment

are made on an assignment-related basis

in accordance with § 424.55 of this

chapter, that sets forth, respectively, the

conditions for coverage of physician

assistant services, nurse practitioner

services and clinical nurse specialist

services, and services and supplies

furnished incident to their professional

services.

(c) Civil money penalties. Any person

or entity who knowingly and willingly

bills a Medicare beneficiary amounts in

excess of the appropriate coinsurance

and deductible is subject to a civil

money penalty not to exceed $2,000 for

each bill or request for payment.

PART 410—SUPPLEMENTARY

MEDICAL INSURANCE (SMI)

BENEFITS

B. Part 410 is amended as set forth

below:

1. The authority citation for part 410

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh).

§ 410.32 [Amended]

2. In § 410.32(a)(3), the last word,

‘‘section,’’ is removed and the word

‘‘paragraph’’ is added in its place.

3. A new section 410.59 is added to

read as follows:

§ 410.59 Outpatient occupational therapy

services: Conditions.

(a) Basic rule. Medicare Part B pays

for outpatient occupational therapy

services if they meet the following

conditions:

(1) They are furnished to a beneficiary

while he or she is under the care of a

physician who is a doctor of medicine,

osteopathy, or podiatric medicine.

(2) They are furnished under a written

plan of treatment that meets the

requirements of § 410.61.

(3) They are furnished—

(i) By a provider as defined in § 489.2

of this chapter, or by others under

arrangements with, and under the

supervision of, a provider; or

(ii) By or under the personal

supervision of an occupational therapist

in private practice as described in

paragraph (c) of this section.

(b) Outpatient occupational therapy

services to certain inpatients of a
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30879

hospital or a CAH or SNF. Medicare Part

B pays for outpatient occupational

therapy services to an inpatient of a

hospital, CAH, or SNF who requires

them but who has exhausted or is

otherwise ineligible for benefit days

under Medicare Part A.

(c) Special provisions for services

furnished by occupational therapists in

private practice. (1) Basic

Qualifications. In order to qualify under

Medicare as a supplier of outpatient

occupational therapy services, each

individual occupational therapist in

private practice must meet the following

requirements:

(i) Is legally authorized (if applicable,

licensed, certified, or registered) to

engage in the private practice of

occupational therapy by the State in

which he or she practices, and practices

only within the scope of his or her

license, certification, or registration.

(ii) Engages in the private practice of

occupational therapy on a regular basis,

in one of the following practice types:

(A) An individual operating an

unincorporated solo practice.

(B) An individual practicing as a

member of a partnership or

unincorporated group practice.

(C) An individual practicing as an

employee of an unincorporated solo

practice, partnership, or group practice,

or an employee of a professional

corporation or other incorporated

occupational therapy practice. Private

practice does not include any individual

during the time he or she is working as

an employee of a provider.

(iii) Bills Medicare only for services

furnished in his or her private practice

office space, or in the patient’s home. A

therapist’s private practice office space

refers to the location(s) where the

practice is operated, in the State(s)

where the therapist (and practice, if

applicable) is legally authorized to

furnish services, during the hours that

the therapist engages in practice at that

location. When services are furnished in

private practice office space, that space

must be owned, leased, or rented by the

practice and used for the exclusive

purpose of operating the practice. A

patient’s home does not include any

institution that is a hospital, an CAH, or

a SNF.

(iv) Treats individuals who are

patients of the practice and for whom

the practice collects fees for the services

furnished.

(2) Supervision of occupational

therapy services. Occupational therapy

services are performed by, or under the

personal supervision of, the

occupational therapist in private

practice. All services not performed

personally by the therapist must be

performed by employees of the practice,

personally supervised by the therapist,

and included in the fee for the

therapist’s services.

(d) Excluded expenses. No service is

included as an outpatient occupational

therapy service if it would not be

included as an inpatient hospital service

if furnished to a hospital or CAH

inpatient.

(e) Annual limitation on incurred

expenses. (1) Amount of limitation. (i)

In 1999, no more than $1500 of

allowable charges incurred in a calendar

year for outpatient occupational therapy

services are recognized incurred

expenses.

(ii) In 2002 and thereafter, the

limitation shall be determined by

increasing the limitation in effect in the

previous calendar year by the increase

in the Medicare Economic Index for the

current year.

(2) For purposes of applying the

limitation, outpatient physical therapy

includes:

(i) Except as provided in paragraph

(e)(3) of this section, outpatient

occupational therapy services furnished

under this section;

(ii) Outpatient occupational therapy

services furnished by a comprehensive

outpatient rehabilitation facility;

(iii) Outpatient occupational therapy

services furnished by a physician or

incident to a physician’s service;

(iv) Outpatient occupational therapy

services furnished by a nurse

practitioner, certified nurse specialist,

or physician assistant or incident to

their services.

(3) For purposes of applying the

limitation, outpatient occupational

therapy services excludes services

furnished by a hospital or CAH directly

or under arrangements.

4. Section 410.60 is revised to read as

follows:

§ 410.60 Outpatient physical therapy

services: Conditions.

(a) Basic rule. Medicare Part B pays

for outpatient physical therapy services

if they meet the following conditions:

(1) They are furnished to a beneficiary

while he or she is under the care of a

physician who is a doctor of medicine,

osteopathy, or podiatric medicine.

(2) They are furnished under a written

plan of treatment that meets the

requirements of § 410.61.

(3) They are furnished—

(i) By a provider as defined in § 489.2

of this chapter, or by others under

arrangements with, and under the

supervision of, a provider; or

(ii) By or under the personal

supervision of a physical therapist in

private practice as described in

paragraph (c) of this section.

(b) Outpatient physical therapy

services to certain inpatients of a

hospital or a CAH or SNF. Medicare Part

B pays for outpatient occupational

therapy services to an inpatient of a

hospital, CAH, or SNF who requires

them but who has exhausted or is

otherwise ineligible for benefit days

under Medicare Part A.

(c) Special provisions for services

furnished by physical therapists in

private practice. (1) Basic

Qualifications.

In order to qualify under Medicare as

a supplier of outpatient physical

therapy services, each individual

physical therapist in private practice

must meet the following requirements:

(i) Is legally authorized (if applicable,

licensed, certified, or registered) to

engage in the private practice of

physical therapy by the State in which

he or she practices, and practices only

within the scope of his or her license,

certification, or registration.

(ii) Engages in the private practice of

physical therapy on a regular basis, in

one of the following practice types:

(A) An individual operating an

unincorporated solo practice.

(B) An individual practicing as a

member of an unincorporated

partnership or unincorporated group

practice.

(C) An individual practicing as an

employee of an unincorporated solo

practice, partnership, or group practice,

or an employee of a professional

corporation or other incorporated

physical therapy practice. Private

practice does not include any individual

during the time he or she is working as

an employee of a provider.

(iii) Bills Medicare only for services

furnished in his or her private practice

office space, or in the patient’s home. A

therapist’s private practice office space

refers to the location(s) where the

practice is operated, in the State(s)

where the therapist (and practice, if

applicable) is legally authorized to

furnish services, during the hours that

the therapist engages in practice at that

location. When services are furnished in

private practice office space, that space

must be owned, leased, or rented by the

practice and used for the exclusive

purpose of operating the practice. A

patient’s home does not include any

institution that is a hospital, a CAH, or

a SNF.

(iv) Treats individuals who are

patients of the practice and for whom

the practice collects fees for the services

furnished.

(2) Supervision of physical therapy

services. Physical therapy services are

performed by, or under the personal

supervision of, the physical therapist in
30880 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

private practice. All services not

performed personally by the therapist

must be performed by employees of the

practice, personally supervised by the

therapist, and included in the fee for the

therapist’s services.

(d) Excluded expenses. No service is

included as an outpatient physical

therapy service if it would not be

included as an inpatient hospital service

if furnished to a hospital or CAH

inpatient.

(e) Annual limitation on incurred

expenses. (1) Amount of limitation. In

1999, no more than $1500 of allowable

charges incurred in a calendar year for

outpatient physical therapy services are

recognized incurred expenses.

(ii) In 2002 and thereafter, the

limitation shall be determined by

increasing the limitation in effect in the

previous calendar year by the increase

in the Medicare Economic Index for the

current year.

(2) For purposes of applying the

limitation, outpatient occupational

therapy includes:

(i) Except as provided in paragraph

(e)(3) of this section, outpatient physical

therapy services furnished under this

section;

(ii) Except as provided in paragraph

(e)(3) of this section, outpatient speechlanguage pathology services furnished

under § 410.62;

(iii) Outpatient physical therapy and

speech-language pathology services

furnished by a comprehensive

outpatient rehabilitation facility;

(iv) Outpatient physical therapy and

speech-language pathology services

furnished by a physician or incident to

a physician’s service;

(v) Outpatient physical therapy and

speech-language pathology services

furnished by a nurse practitioner,

certified nurse specialist, or physician

assistant or incident to their services.

(3) For purposes of applying the

limitation, outpatient physical therapy

excludes services furnished by a

hospital or CAH directly or under

arrangements.

5. In § 410.61 pargraphs (a) through

(d) and (e)(1) are revised to read as

follows:

§ 410.61 Plan of treatment requirements

for outpatient rehabilitation services.

(a) Basic requirement. Outpatient

rehabilitation services (including

services furnished by a qualified

physical or occupational therapist in

private practice), must be furnished

under a written plan of treatment that

meets the requirements of paragraphs

(b) through (e) of this section.

(b) Establishment of the plan. The

plan is established before treatment is

begun by one of the following:

(1) A physician.

(2) A physical therapist who will

furnish the physical therapy services.

(3) A speech-language pathologist

who will furnish the speech-language

pathology services.

(4) An occupational therapist who

will furnish the occupational therapy

services.

(c) Content of the plan. The plan

prescribes the type, amount, frequency,

and duration of the physical therapy,

occupational therapy, or speechlanguage pathology services to be

furnished to the individual, and

indicates the diagnosis and anticipated

goals.

(d) Changes in the plan. Any changes

in the plan—

(1) Are made in writing and signed by

one of the following:

(i) The physician.

(ii) The physical therapist who

furnished the physical therapy services.

(iii) The occupational therapist who

furnishes the physical therapy services.

(iv) The speech-language pathologist

who furnishes the speech-language

pathology services.

(v) A registered professional nurse or

a staff physician, in accordance with

oral orders from the physician, physical

therapist, occupational therapist, or

speech-language pathologist who

furnishes the services.

(2) The changes are incorporated in

the plan immediately.

(e) Review of the plan. (1) The

physician reviews the plan as often as

the individual’s condition requires, but

at least within the first 62 days and at

least every 31 days after each previous

review.

* * * * *

6. In § 410.62, the section heading is

revised, paragraph (a)(3) is amended to

add ‘‘as defined in § 489.2’’ after the

words, ‘‘by a provider’’, and a new

paragraph (d) is added to read as

follows:

§ 410.62 Outpatient speech-language

pathology services: Conditions and

exclusions.

* * * * *

(d) Limitation. After 1998, outpatient

speech pathology services are subject to

the limitation in 410.60(e).

* * * * *

7. New §§ 410.74, 410.75, 410.76, and

410.77 are added to subpart B to read as

follows:

Subpart B—Medical and Other Health

Services

* * * * *

§ 410.74 Physician assistant services.

(a) Basic rule. Medicare Part B covers

physician assistant services only if the

following conditions are met:

(1) The services would be covered as

physician services if furnished by a

physician (as used in this section, the

term ‘‘physician’’ means a doctor of

medicine or osteopathy, as set forth in

section 1861(r)(1) of the Act).

(2) The physician assistant—

(i) Meets the qualification

requirements set forth in paragraph (c)

of this section;

(ii) Is legally authorized to perform

the services in the State which they are

performed;

(iii) Performs services that are not

otherwise precluded from coverage

because of a statutory exclusion;

(iv) Performs the services under the

general supervision of a physician (that

is, the supervising physician need not

be physically present when the

physician assistant is performing the

services unless required by State law;

however, the supervising physician

must be immediately available to the

physician assistant for consultation);

and

(v) Furnishes services that are billed

by the employer of a physician assistant;

and

(vi) Performs the services—

(A) In all settings in either rural and

urban areas; or

(B) As an assistant at surgery.

(b) Services and supplies furnished

incident to physician assistant services.

Medicare covers services and supplies

(including drugs and biologicals that

cannot be self-administered) that are

furnished incident to the physician

assistant services described in

paragraph (a) of this section. These

services and supplies are covered only

if they—

(1) Would be covered if furnished by

a physician or as incident to the

professional services of a physician;

(2) Are the type that are commonly

furnished in a physician office and are

either furnished without charge or are

included in the bill for the physician

assistant services;

(3) Are, although incidental, an

integral part of the professional service

performed by the physician;

(4) Are performed under the direct

supervision of the physician assistant

(that is, the physician assistant is

physically present and immediately

available); and

(5) Are performed by the employee of

a physician assistant or an entity that

employs both the physician assistant or

ancillary personnel.

(c) Qualifications. For Medicare Part

B coverage of his or her services, a
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30881

physician assistant must meet the

applicable State requirements governing

the qualifications for physician

assistants and at least one of the

following conditions:

(1) Be certified by either the National

Commission on Certification of

Physician Assistants to assist primary

care physicians or the National Board

for Certification of Orthopedic

Physician assistants to assist orthopedic

surgeons; or

(2) Have satisfactorily completed a

program for preparing physician

assistants that was at least 1 academic

year in length, consisted of supervised

clinical practice and at least 4 months

(in aggregate) of classroom instruction

directed toward preparing students to

deliver health care, and was accredited

by either the Commission on

Accreditation of Allied Health

Education Programs or the American

Society of Orthopedic Physician

Assistants; or

(3) Have satisfactorily completed a

formal education program for preparing

physician assistants that does not meet

the requirements of § 410.74(c)(2) and

have assisted physicians for a total of 12

months during the 18-month period that

ended on [Insert 18 months from the

effective date of final rule].

(d) Professional services. Physician

assistants can be paid for professional

services only if the services have been

professionally performed by them and

no facility or other provider charges for

the service or is paid any amount for the

furnishing of those professional

services.

(1) Supervision of other nonphysician

staff by physician does not constitute

personal performance of a professional

service by physician assistants.

(2) If a service is not payable by HCFA

under this provision, the beneficiary is

not liable for payment for the service.

Physician assistants may not charge a

beneficiary for a service not payable

under this provision. If a beneficiary has

made payment for the services,

physician assistants must make the

appropriate refund to the beneficiary.

(3) Examples of the types of

professional services that physician

assistants may furnish include services

such as physical examinations, minor

surgery, setting casts for simple

fractures, interpreting x-rays, and other

activities that involve an independent

evaluation or treatment of the patient’s

condition. These are services that have

been traditionally reserved for

physicians and can be furnished by

physician assistants only if State law or

regulation governing the physician

assistant scope of practice authorizes

them to perform such services in the

State in which they are practicing.

§ 410.75 Nurse practitioner services.

(a) Definition. As used in this section,

the term ‘‘physician’’ means a doctor of

medicine or osteopathy, as set forth in

section 1861(r)(1) of the Act.

(b) Qualifications. For Medicare Part

B coverage of his or her services, a nurse

practitioner must—

(1) Be a registered nurse who is

currently licensed to practice in the

State where he or she practices, be

authorized to perform the services of a

nurse practitioner in accordance with

State law, and have a master’s degree in

nursing;

(2) Be certified as a nurse practitioner

by a professional association recognized

by HCFA that has, at a minimum,

eligibility requirements that meet the

standards in paragraph (b)(1) of this

section; or

(3) Meet the requirements for a nurse

practitioner set forth in paragraph (b)(1)

of this section, except for the master’s

degree requirement, and have received

before [Insert 3 years from effective date

of final rule] a certificate of completion

from a formal advanced practice

program that prepares registered nurses

to perform an expanded role in the

delivery of primary care.

(c) Services. Medicare Part B covers

nurse practitioner services in all settings

in both rural and urban areas, only if the

services would be covered if furnished

by a physician and the nurse

practitioner—

(1) Is legally authorized to perform

them in the State in which they are

performed;

(2) Performs them while working in

collaboration with a physician;

(i) Collaboration is a process in which

a nurse practitioner works with a

physician to deliver health care services

within the scope of the practitioner’s

expertise, with medical direction and

appropriate supervision as provided for

in guidelines jointly developed by the

practitioner and the physician, or as

provided for by other mechanisms

defined by Federal regulations, or by the

law of the State in which the services

are performed.

(ii) The absence of State law or

guidelines does not negate the

requirement for collaboration.

(iii) The collaborating physician does

not need to be present with the nurse

practitioner when the service is

furnished or to make an independent

evaluation of each patient seen by the

nurse practitioner.

(iv) Collaboration involves systematic

formal planning, assessment, and a

practice arrangement that reflects and

demonstrates evidence of consultation,

recognition of statutory limits, clinical

authority and accountability for patient

care, according to a mutual agreement

that allows the physician and the nurse

practitioner to function independently

as appropriate; and

(3) Is not performing services

otherwise precluded from coverage

because of one of the statutory

exclusions.

(d) Services and supplies incident to

nurse practitioner services. Medicare

Part B covers services and supplies

(including drugs and biologicals that

cannot be self-administered) incident to

nurse practitioner services that meet the

requirements in paragraph (c) of this

section. These services and supplies are

covered only if they—

(1) Would be covered if furnished by

a physician or as incident to the

professional services of a physician;

(2) Are of the type that are commonly

furnished in a physician office and are

either furnished without charge or are

included in the bill for the nurse

practitioner services;

(3) Although incidental, are an

integral part of the professional service

performed by the nurse practitioner; and

(4) Are performed under the direct

supervision of the nurse practitioner

(that is, the nurse practitioner must be

physically present and immediately

available).

(e) Professional services. Nurse

practitioners can be paid for

professional services only when the

services have been personally

performed by them and no facility or

other provider charges or is paid any

amount for the furnishing of such

professional services.

(1) Supervision of other nonphysician

staff by nurse practitioners does not

constitute personal performance of a

professional service by nurse

practitioners.

(2) If a service is not payable by HCFA

under this provision, the beneficiary is

not liable for payment for the service.

Nurse practitioners may not charge a

beneficiary for a service not payable

under this provision. If a beneficiary has

made payment for the services, the

nurse practitioner must make the

appropriate refund to the beneficiary.

(3) Examples of the types of

professional services that nurse

practitioners may provide include

services such as physical examinations,

minor surgery, setting casts for simple

fractures, interpreting x-rays, and other

activities that involve an independent

evaluation or treatment of the patient’s

condition. These are services that have

been traditionally reserved for

physicians and can only be furnished by
30882 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

nurse practitioners if State law or

regulation governing the nurse

practitioner scope of practice authorizes

them to perform such services in the

State in which they are practicing.

§ 410.76 Clinical nurse specialist services.

(a) Definition. As used in this section,

the term ‘‘physician’’ means a doctor of

medicine or osteopathy, as set forth in

section 1861(r)(1) of the Act.

(b) Qualifications. For Medicare Part

B coverage of his or her services, a

clinical nurse specialist must—

(1) Be a registered nurse who is

currently licensed to practice in the

State where he or she practices, be

authorized to perform the services of a

clinical nurse specialist in accordance

with State law, and have a master’s

degree in a defined clinical area of

nursing from an accredited educational

institution;

(2) Be certified as a clinical nurse

specialist by a professional association

recognized by HCFA that has, at a

minimum, eligibility requirements that

meet the standards in paragraph (b)(1) of

this section; or

(3) Meet the requirements for a

clinical nurse specialist set forth in

paragraph (b)(1) of this section, except

for the master’s degree requirement, and

have received before [Insert 3 years from

effective date of final rule] a certificate

of completion from a formal advanced

practice program that prepares

registered nurses to perform an

expanded role in the delivery of primary

care.

(c) Services. Medicare Part B covers

clinical nurse specialist services in all

settings in both rural and urban areas

only if the services would be covered if

furnished by a physician and the

clinical nurse specialist—

(1) Is legally authorized to perform

them in the State in which they are

performed; and

(2) Performs them while working in

collaboration with a physician.

(i) Collaboration is a process in which

a clinical nurse specialist works with a

physician to deliver health care services

within the scope of the clinical nurse

specialist’s expertise, with medical

direction and appropriate supervision as

provided for in guidelines jointly

developed by the clinical nurse

specialist and the physician, or as

provided for by other mechanisms

defined by Federal regulations, or by the

law of the State in which the services

are performed.

(ii) The absence of State law or

guidelines does not negate the

requirement for collaboration.

(iii) The collaborating physician does

not need to be present with the clinical

nurse specialist when the service is

furnished or to make an independent

evaluation of each patient seen by the

clinical nurse specialist.

(iv) Collaboration involves systematic

formal planning, assessment, and a

practice arrangement that reflects and

demonstrates evidence of consultation,

recognition of statutory limits, clinical

authority and accountability for patient

care, according to a mutual agreement

that allows the physician and the

clinical nurse specialist to function

independently as appropriate; and

(3) Is not performing services that are

otherwise precluded from coverage by

one of the statutory exclusions.

(d) Services and supplies incident to

clinical nurse specialist services.

Medicare Part B covers services and

supplies (including drugs and

biologicals that cannot be selfadministered) incident to a clinical

nurse specialist’s services that meet the

requirements in paragraph (c) of this

section. These services and supplies are

covered only if they—

(1) Would be covered if furnished by

a physician or as incident to the

professional services of a physician;

(2) Are of the type that are commonly

furnished in a physician office and are

either furnished without charge or are

included in the bill for the clinical

nurse specialist services;

(3) Although incidental, are an

integral part of the professional service

performed by the clinical nurse

specialist; and

(4) Are performed under the direct

supervision of the clinical nurse

specialist (that is, the clinical nurse

specialist must be physically present

and immediately available).

(e) Professional services. Clinical

nurse specialists can be paid for

professional services only when the

services have been personally

performed by them and no facility or

other provider charges or is paid any

amount for the furnishing of such

professional services.

(1) Supervision of other nonphysician

staff by clinical nurse specialists does

not constitute personal performance of a

professional service by clinical nurse

specialists.

(2) If a service is not payable by HCFA

under this provision, the beneficiary is

not liable for payment for the service.

Clinical nurse specialists may not

charge a beneficiary for a service not

payable under this provision. If a

beneficiary has made payment for the

services, the clinical nurse specialist

must make the appropriate refund to the

beneficiary.

(3) Examples of the types of

professional services that clinical nurse

specialists may provide include services

such as physical examinations, minor

surgery, setting casts for simple

fractures, interpreting x-rays, and other

activities that involve an independent

evaluation or treatment of the patient’s

condition. These are services that have

been traditionally reserved for

physicians and can only be furnished by

clinical nurse specialists if State law or

regulation governing the clinical nurse

specialist scope of practice authorizes

them to perform such services in the

State in which they are practicing.

§ 410.77 Certified nurse-midwife services:

Qualifications and conditions.

(a) Qualifications. For Medicare

coverage of his or her services, a

certified nurse-midwife must—

(1) Be currently licensed to practice in

the State as a registered professional

nurse;

(2) Be legally authorized under State

law or regulations to practice as a nursemidwife in the State in which the

services are performed;

(3) Have successfully completed a

program of study and clinical

experience for nurse-midwives, as

specified by the State, or, if the State

does not specify a program of study and

clinical experience that nurse-midwives

must complete to practice in that State,

meet one of the following criteria:

(i) Be currently certified as a nursemidwife by the American College of

Nurse-Midwives, in accordance with its

October 1994 requirements or

subsequent amendments to those

requirements recognized by the

Secretary, or by another certifying entity

recognized by the Secretary.

(ii) Have successfully completed a

formal educational program (of at least

1 academic year) that, upon completion,

qualifies him or her to take the

certification examination offered by the

American College of Nurse-Midwives or

by another certifying entity recognized

by the Secretary. (The individual is not

required to take the examination,

however.)

(iii) Have successfully completed a

formal educational program for

preparing registered nurses to furnish

gynecological and obstetrical care

during pregnancy, delivery, and the

postpartum period and care to normal

newborns, and practiced as a nursemidwife for a total of 12 months during

any 18-month period from August 8,

1976 to July 16, 1982.

(b) Services. Certified nurse-midwife

services are services furnished by a

certified nurse-midwife and services

and supplies furnished as an incident to

the certified nurse-midwife services

that—
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30883

(1) Are within the scope of practice

authorized by the law of the State in

which they are furnished and would

otherwise be covered if furnished by a

physician or as an incident to a

physician service; and

(2) Unless required by State law, are

provided without regard to whether the

certified nurse-midwife is under the

supervision of, or associated with, a

physician or other health care provider.

(c) Incident to services: Basic rule.

Medicare covers services and supplies

furnished incident to the services of a

certified nurse-midwife, including drugs

and biologicals that cannot be selfadministered, if the services and

supplies meet the following conditions:

(1) They would be covered if

furnished by a physician or as incident

to the professional services of a

physician.

(2) They are of the type that are

commonly furnished in a physician

office and are either furnished without

charge or are included in the bill for the

certified nurse-midwife services.

(3) Although incidental, they are an

integral part of the professional service

performed by the certified nursemidwife.

(4) They are furnished under the

direct supervision of a certified nursemidwife (that is, the midwife is

physically present and immediately

available).

(d) Professional services. A nursemidwife can be paid for a professional

service only when the service has been

personally performed by the nursemidwife.

(1) Supervision of other nonphysician

staff by a nurse-midwife does not

constitute personal performance of a

professional service by the nursemidwife.

(2) If a service is not payable by HCFA

under this provision, the beneficiary is

not liable for payment for the service. A

nurse-midwife may not charge a

beneficiary for a service not payable

under this provision. If the beneficiary

has made payment for the service, the

nurse-midwife must make the

appropriate refund to the beneficiary.

(3) A nurse-midwife may provide

services related to the maternity cycle

that includes pregnancy, labor, and the

immediate post partum period and other

services including obstetrical and

gynecological services.

(4) The services that the nursemidwife performs are not services

otherwise precluded from coverage

because of one of the statutory

exclusions.

7. In § 410.150, the introductory text

to paragraph (b) is republished, and new

paragraphs (b)(15) and (b)(16) are added

to read as follows:

§ 410.150 To whom payment is made.

* * * * *

(b) Specific rules. Subject to the

conditions set forth in paragraph (a) of

this section, Medicare Part B pays as

follows:

* * * * *

(15) To the qualified employer of a

physician assistant for professional

services furnished by the physician

assistant and for services and supplies

furnished incident to their services.

Payment is made to the employer of a

physician assistant regardless of

whether the physician assistant is

employed as a W–2 employee or

whether the physician assistant is a

1099 employee who is acting as an

independent contractor. A qualified

employer is not a group of physician

assistants that incorporate to bill for

their services. Payment is made only if

no facility or other provider charges or

is paid any amount for services

furnished by a physician assistant.

(16) To a nurse practitioner or clinical

nurse specialist for professional services

furnished by a nurse practitioner or

clinical nurse specialist in all settings in

both rural and nonrural areas and for

services and supplies furnished incident

to those services. Payment is made only

if no facility or other provider charges

or is paid any amount for the furnishing

of the professional services of the nurse

practitioner or clinical nurse specialist.

8. In § 410.152, the headings to

paragraphs (a) and (a)(1) are

republished, and paragraph (a)(1)(v) is

revised to read as follows:

§ 410.152 Amount of payment.

(a) General provisions—(1) Exclusion

from incurred expenses. * * *

(v) In the case of expenses incurred

for outpatient physical therapy services

including speech-language pathology

services, the expenses excluded are

from the incurred expenses under

§ 410.60(e). In the case of expenses

incurred for outpatient occupational

therapy including speech-language

pathology services, the expenses

excluded are from the incurred

expenses under § 410.59(e).

* * * * *

PART 413—PRINCIPLES OF

REASONABLE COST

REIMBURSEMENT; PAYMENT FOR

END-STAGE RENAL DISEASE

SERVICES; OPTIONAL

PROSPECTIVELY DETERMINED

PAYMENT RATES FOR SKILLED

NURSING FACILITIES

c. Part 413 is amended as set forth

below.

1. The authority citation for part 413

continues to read as follows:

Authority: Secs. 1102, 1861(v)(1)(A), and

1871 of the Social Security Act (42 U.S.C.

1302, 1395x(v)(1)(A), and 1395hh).

2. Section 413.125 is revised to read

as follows:

§ 413.125 Payment for home health agency

services.

The reasonable cost of outpatient

rehabilitation services furnished by a

home health agency to homebound

patients who are not entitled to home

health benefits may not exceed the

amounts payable under part 414 of this

chapter for comparable services.

PART 414—PAYMENT FOR PART B

MEDICAL AND OTHER HEALTH

SERVICES

C. Part 414 is amended as set forth

below:

1. The authority citation for part 414

continues to read as follows:

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

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

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

2. In § 414.1, the introductory text is

republished, and the following statutory

authority is added in numerical order to

read as follows:

§ 414.1 Basis and scope.

This part implements the indicated

provisions of the following sections of

the Act:

1802—Rules for private contracts by

Medicare beneficiaries.

* * * * *

3. Sections 414.20 through 414.62 are

redesignated as subpart B, and a new

heading is added to read ‘‘Physicians

and Other Practitioners’’.

4. In § 414.22, the introductory text to

the section and the heading to

paragraph (b) are republished, and new

paragraph (b)(5) is added to read as

follows:

§ 414.22 Relative value units (RVUs).

HCFA establishes RVUs for physician

work, physician practice expense, and

malpractice insurance.

* * * * *

(b) Practice expense RVUs. * * *
30884 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

(5) For services furnished in 1999, the

practice expense RVUs are based on 75

percent of the practice expense RVUs

applicable to services furnished in 1998

and 25 percent of the relative practice

expense resources involved in

furnishing the service. For services

furnished in 2000, the practice expense

RVUs are based on 50 percent of the

practice expense RVUs applicable to

services furnished in 1998 and 50

percent of the relative practice expense

resources involved in furnishing the

service. For services furnished in 2001,

the practice expense RVUs are based on

25 percent of the practice expense RVUs

applicable to services furnished in 1998

and 75 percent of the relative practice

expense resources involved in

furnishing the service. For services

furnished in 2002 and subsequent years,

the practice expense RVUs are based

entirely on relative practice expense

resources.

(i) Usually one of two levels of

practice expense RVUs per code can be

applied to each service. The lower

practice expense RVUs apply to services

furnished to hospital or ambulatory

surgical center patients. The higher

practice expense RVUs apply to services

performed in a physician office;

services, other than evaluation and

management services, furnished to

patients in a nursing facility, in a

facility or institution other than a

hospital or ambulatory surgical center,

or in the home; and other services

furnished to facility patients for which

the facility payment does not include

physician practice costs.

(ii) Only one practice expense RVU

per code can be applied for each of the

following services: services that have

only technical component practice

expense RVUs or only professional

component practice expense RVUs;

evaluation and management services,

such as hospital or nursing facility

visits, that are furnished exclusively in

one setting; and major surgical services.

* * * * *

6. In § 414.32, paragraph (b) is revised

to read as follows:

§ 414.32 Determining payments for certain

physician services furnished in facility

settings.

* * * * *

(b) General rule. If physician services

of the type routinely furnished in

physician offices are furnished in

facility settings before January 1, 1999,

the physician fee schedule amount for

those services is determined by

reducing the practice expense RVUs for

the services by 50 percent. For services

furnished on or after January 1, 1999,

the practice expense RVUs are

determined in accordance with

§ 414.22(b)(5).

* * * * *

7. In § 414.34, the section heading is

revised, and a new paragraph (a)(2)(iii)

is added to read as follows:

§ 414.34 Payment for services and

supplies incident to a physician service.

* * * * *

(a) Medical supplies. * * *

(2) * * *

(iii) It is furnished before January 1,

1999.

* * * * *

8. In § 414.52, the section heading and

the introductory text are revised, and a

new paragraph (d) is added to read as

follows:

§ 414.52 Payment for physician assistant

services.

Allowed amounts for the services of a

physician assistant furnished beginning

January 1, 1992 and ending December

31, 1997, may not exceed the limits

specified in paragraphs (a) through (c) of

this section. Allowed amounts for the

services of a physician assistant

furnished beginning January 1, 1998,

may not exceed the limits specified in

paragraph (d) of this section.

* * * * *

(d) For services (other than assistantat-surgery services) furnished beginning

January 1, 1998, 85 percent of the

physician fee schedule amount for the

service. For assistant-at-surgery services,

85 percent of the physician fee schedule

amount that would be allowed under

the physician fee schedule if the

assistant-at-surgery services were

furnished by a physician.

9. Section 414.56 is revised to read as

follows:

§ 414.56 Payment for nurse practitioner

and clinical nurse specialist services.

(a) Rural areas. For services furnished

beginning January 1, 1992 and ending

December 31, 1997, allowed amounts

for the services of a nurse practitioner

or a clinical nurse specialist in a rural

area (as described in section

1861(s)(2)(K)(iii) of the Act) may not

exceed the following limits.

(1) for services furnished in a hospital

(including assistant-at-surgery services),

75 percent of the physician fee schedule

amount for the service.

(2) For all other services, 85 percent

of the physician fee schedule amount

for the service.

(b) Non-rural areas. For services

furnished beginning January 1, 1992 and

ending December 31, 1997, allowed

amounts for the services of a nurse

practitioner or a clinical nurse specialist

in a nursing facility may not exceed 85

percent of the physician fee schedule

amount for the service.

(c) Beginning January 1, 1998. For

services (other than assistant at surgery

services) furnished beginning January 1,

1998, allowed amounts for the services

of a nurse practitioner or clinical nurse

specialist may not exceed 85 percent of

the physician fee schedule amount for

the service. For assistant at surgery

services, allowed amounts for the

services of a nurse practitioner or

clinical nurse specialist may not exceed

85 percent of the physician fee schedule

amount that would be allowed under

the physician fee schedule if the

assistant at surgery service were

furnished by a physician.

PART 415—SERVICES FURNISHED BY

PHYSICIANS IN PROVIDERS,

SUPERVISING PHYSICIANS IN

TEACHING SETTINGS, AND

RESIDENTS IN CERTAIN SETTINGS

D. Part 415 is amended as set forth

below:

1. The authority citation for part 415

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (41 U.S.C. 1302 and

1395hh).

2. In § 415.110, the section heading is

revised, paragraph (a) is revised,

paragraph (b) is redesignated as

paragraph (c), and a new paragraph (b)

is added to read as follows:

§ 415.110 Conditions for payment:

Medically directed anesthesia services.

(a) General payment rule. The

Medicare carrier pays for the

physician’s medical direction of

anesthesia services for one service or

two through four concurrent anesthesia

services furnished after December 31,

1998, only if each of the services meets

the condition in § 415.102(a) and the

following additional conditions:

(1) For each patient, the physician—

(i) Performs a pre-anesthetic

examination and evaluation, or reviews

one performed by another qualified

individual permitted by the State to

administer anesthetics;

(ii) Participates in the development of

the anesthesia plan and gives final

approval of the proposed plan;

(iii) Personally participates in the

most demanding aspects of the

anesthesia plan;

(iv) Ensures that any aspect of the

anesthesia plan not performed by the

anesthesiologist is performed by a

qualified individual as specified in

operating instructions;

(v) Monitors the course of anesthesia

at intervals medically indicated by the

nature of the procedure and the

patient’s condition;
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30885

(vi) Remains physically present in the

facility and immediately available for

diagnostic and therapeutic emergencies;

(vii) Provides indicated postanesthesia care or ensures that it is

provided by a qualified individual as

described in paragraph (a)(1)(iv) of this

section.

(2) The physician directs no more

than four anesthesia services

concurrently and does not perform any

other services while he or she is

directing the single or concurrent

services so that one or more of the

conditions in paragraph (a)(1) of this

section are not violated.

(3) If the physician personally

performs the anesthesia service, the

payment rules in § 414.46(c) of this

chapter (Physician personally performs

the anesthesia procedure) apply.

(b) Medical documentation. The

physician inclusively documents in the

patient’s medical record that the

conditions set forth in paragraph (a)(1)

of this section have been satisfied,

specifically documenting personal

participation in the most demanding

aspects of the anesthesia plan.

* * * * *

PART 424—CONDITIONS FOR

MEDICARE PAYMENT

E. Part 424 is amended as set forth

below:

1. The authority citation for part 424

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (41 U.S.C. 1302 and

1395hh).

2. In § 424.24, paragraphs (c)(1)(iii),

(c)(3)(ii), and (c)(4) are revised to read

as follows:

§ 424.24 Requirements for medical and

other health services furnished by

providers under Medicare Part B.

* * * * *

(c) Outpatient physical therapy and

speech-language pathology services—(1)

Content of certification. * * *

(iii) The services were furnished

under a plan of treatment that meets the

requirements of § 410.61.

* * * * *

(3) Signature. * * *

(ii) If the plan of treatment is

established by a physical therapist or

speech-language pathologist, the

certification must be signed by a

physician who has knowledge of the

case.

(4) Recertification—(i) Timing. The

first recertification is required by no

later than the 62nd day and subsequent

recertifications are required at least

every 31 days.

(ii) Content. The recertification

statement must indicate the continuing

need for physical therapy or speechlanguage pathology services and an

estimate of how much longer the

services will be needed.

(iii) Signature. Recertifications must

be signed by the physician who reviews

the plan of treatment.

* * * * *

PART 485—CONDITIONS OF

PARTICIPATION: SPECIALIZED

PROVIDERS

F. Part 485 is amended as set forth

below:

1. The authority citation for part 485

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (41 U.S.C. 1302 and

1395hh).

2. Section 485.705 is revised to read

as follows:

§ 485.705 Personnel qualifications.

(a) General qualification

requirements. Except as specified in

paragraphs (b) and (c) of this section, all

personnel who are involved in the

furnishing of outpatient physical

therapy, occupational therapy, and

speech-language pathology services

directly by or under arrangements with

an organization must be legally

authorized (licensed or, if applicable,

certified or registered) to practice by the

State in which he or she performs the

functions or actions, and must act only

within the scope of his or her state

license or State certification or

registration.

(b) Exception for Federally defined

qualifications. The following Federally

defined qualifications must be met:

(1) For a physician, the qualifications

and conditions as defined in section

1861(r) of the Act and the requirements

in part 484 of this chapter.

(2) For a speech-language pathologist,

the qualifications specified in section

1861(11)(1) of the Act and the

requirements in part 484.

(c) Exceptions when no State

Licensing laws or State certification or

registration requirements exist. If no

State licensing laws or State

certification or registration requirements

exist for the profession, the following

requirements must be met:

(1) An administrator is a person who

has a bachelor’s degree and:

(i) Has experience or specialized

training in the administration of health

institutions or agencies; or

(ii) Is qualified and has experience in

one of the professional health

disciplines.

(2) An occupational therapist must

meet the requirements in part 484.

(3) An occupational therapy assistant

must meet the requirements in part 484.

(4) A physical therapist must meet the

requirements in part 484.

(5) A physical therapist assistant must

meet the requirements in part 484.

(6) A social worker must meet the

requirements in part 484.

(7) A vocational specialist is a person

who has a baccalaureate degree and:

(i) Two years experience in vocational

counseling in a rehabilitation setting

such as a sheltered workshop, State

employment service agency, etc.; or

(ii) At least 18 semester hours in

vocational rehabilitation, educational or

vocational guidance, psychology, social

work, special education or personnel

administration, and 1 year of experience

in vocational counseling in a

rehabilitation setting; or

(iii) A master’s degree in vocational

counseling.

3. In § 485.711, paragraph (b)(3) is

revised to read as follows:

§ 485.711 Conditions of participation: Plan

of care and physician involvement.

* * * * *

(b) * * *

(3) The plan of care and results of

treatment are reviewed by the physician

or by the individual who established the

plan at least as often as the patient’s

condition requires, and the indicated

action is taken. (For Medicare patients,

the plan must be reviewed by a

physician within the first 62 days and

at least every 31 days thereafter, in

accordance with § 410.61(e) of this

chapter.)

* * * * *

(Catalog of Federal Domestic Assistance

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program)

Dated: May 15, 1998.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing

Administration.

Dated: May 21, 1998.

Donna E. Shalala,

Secretary.

Note: The following addendums will not

appear in the Code of Federal Regulations.

Addendum A—Description of Clinical

Practice Expert Panel Data and

Methodology

To aid us in collecting the data to

implement our methodology for a

resource-based system for determining

practice expense RVUs for each

physician service, we awarded a

contract to Abt Associates in March

1995. Under the contract, Abt used

Clinical Practice Expert Panels (CPEPs)
30886 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

to collect data that could be used to

generate direct practice expense RVUs

for each service. Through the use of

CPEPs, Abt furnished us with the direct

inputs of physician services. Direct

inputs are the quantity and type of

nonphysician labor, medical supplies,

and medical equipment associated with

a service, such as the minutes of a

registered nurse’s time, a pair of sterile

gloves, and a surgical mask. The CPEPs

also reported additional items as direct

inputs, such as administrative services,

including the amount of time medical

secretaries and billing and insurance

personnel spend in activities related to

specific services. Abt priced the direct

inputs and determined the direct costs

for each service.

The direct inputs do not include the

physician’s time. Physician time and

effort are components of work RVUs and

are paid under the work component of

the physician fee schedule.

The general approach for establishing

a resource-based practice expense

system was to use CPEPs to identify as

many direct inputs as possible for a

physician service furnished to a typical

patient (across all age groups) in various

settings.

The CPEPs consisted of panels of

physicians, practice administrators, and

nonphysicians (such as registered

nurses, psychologists, and physical

therapists). Physician specialty societies

and other groups nominated individuals

for these positions. Final selections

were made by Abt with our assistance.

In all, there were 15 CPEPs. The

panels consisted of over 180 members

from more than 61 specialties and

subspecialties; approximately 50

percent of the panelists were

physicians. Each CPEP consisted of 12

to 15 members.

The CPEPs identified the direct inputs

involved in each physician service in an

office setting and an out-of-office setting

(such as a hospital and an ambulatory

surgical center). Generally, if a service

was furnished both in an office setting

and an out-of-office setting but less than

10 percent of the time in either of these

settings, it was not profiled in that

setting.

We assisted Abt in identifying

approximately 6,300 procedure codes

for which resource-based practice

expense RVUs were to be developed.

Approximately 850 of these procedure

codes have both technical components

(TCs) and professional components

(PCs), and we developed practice

expense RVUs for both the TC and PC

for each of the 850 procedures.

Abt grouped procedure codes

included under the physician fee

schedule into families of codes

clinically related and with relatively

comparable direct costs. The

classification system for families of

procedure codes is a hybrid of the

Ambulatory Patient Groups System

developed by 3M and the BerensonEggers-Holahan (Urban Institute)

system. Abt assigned each family of

codes to a CPEP based on the physician

specialty that predominantly furnished

the services. For example, the panels

were categorized as integumentary, male

genital and urinary, orthopedics,

obstetrics and gynecology,

ophthalmology, radiology, evaluation

and management, general surgery,

otolaryngology, miscellaneous internal

medicine, gastroenterology,

cardiothoracic and vascular, cardiology,

anesthesia and pathology, and

neurosurgery CPEPs.

Our medical staff, Abt’s clinical

consultants, and other advisors

reviewed this system. Some families of

codes were assigned to more than one

CPEP to validate resource inputs across

CPEPs. For example, the evaluation and

management family of codes was

assigned to every CPEP except the

radiology CPEP and the anesthesia and

pathology CPEP.

Abt selected a reference service for

each family of codes. (Abt compiled the

initial list of reference services based on

recommendations from numerous

specialty societies.) The following four

criteria were established to guide the

selection process for the reference

service:

• It had to be commonly performed.

• It had to have a mid-range level of

resource use relative to other codes in

the family.

• It had to be a code whose definition

or coding application has not markedly

changed in the last several years.

• It had to be performed with

minimal variation by all physicians.

In August 1995, physician specialty

groups were given an opportunity to

review and comment on a draft

document containing the procedure

code family classification system, the

reference code (to serve as a benchmark

for creating resource profiles for the

remainder of services within each

family of procedure codes), and the

CPEP to which the family was assigned.

The comments were considered by Abt

and HCFA in designing the final

classification system including the

number of CPEPs.

The final classification system

contained 229 unique families of codes

assigned to 15 CPEP panels. Twelve to

29 families of procedure codes were

assigned to each CPEP with most CPEPs

reviewing 19 to 23 families of procedure

codes.

The CPEPs met twice. During the first

CPEP session in February 1996, the

CPEPs identified the direct inputs for

designated reference services. The

CPEPs met again in June 1996 to

identify the inputs for the remaining

procedure codes covered under the

physician fee schedule.

a. Collection of Information From the

Clinical Practice Expert Panels

Abt designed the following four

uniform worksheets that were used to

collect the inputs identified by the

CPEPs:

• Worksheet Package G: Services with

a global period.

• Worksheet Package P: Services

without a global period.

• Worksheet Package M: Evaluation

and Management services.

• Worksheet Package Pa: Pathology

services.

For labor inputs, either clinical or

administrative, the worksheets

identified the function or activity with

the occupational category of the

individual furnishing the service. For

clinical functions, examples of

occupational categories included a

registered nurse, licensed practical

nurse, and certified medical assistant.

For administrative functions, examples

of occupational categories included

medical secretaries, insurance or billing

clerks, transcriptionists, and scheduling

secretaries. The clinical labor

worksheets accumulated labor inputs by

preservice, service, and postservice

periods for surgical procedures with a

global period. For surgical procedures

without a global period, evaluation and

management services, and pathology

services, the worksheets accumulated

labor inputs by the service period. The

administrative labor worksheets

collected labor inputs by preservice and

postservice periods.

During the first round of the CPEPs,

Abt collected detailed data by each of

the functions listed within the

preservice, service, and postsurgical

visit periods of each service. These were

activities performed by nonphysician

clinical and administrative personnel,

not physicians. For example, the

evaluation and management services

worksheet listed the following clinical

activities in the preservice period:

• Obtain medical history/review

patient charts.

• Greet patient/provide gowning.

• Perform room preparation/prepare

medical equipment.

• Prepare patient.

• Obtain vital signs.

• Other.
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30887

Similarly, the following

administrative activities were listed in

the preservice period:

• Obtain referral from referring M.D.

• Schedule patient/remind patient of

appointment.

• Obtain medical records, manage/

recall patient database, assemble/

develop patient chart.

• Precertify patient/conduct

preservice billing.

• Verify insurance/review coverage/

register patient.

For the intraservice period, the

following clinical activities were listed:

• Obtain medical history.

• Record notes.

• Other.

The following clinical activities were

listed in the postservice period:

• Clean room/equipment/shut down

equipment.

• Provide postservice education.

• Complete diagnostic medical forms,

x-ray requisitions, prescriptions.

• Review results.

• Checkout/provide discharge

instructions/complete nursing forms.

• Conduct follow-up phone calls to

patient/respond to patient calls/call-in

prescription refills.

• Other.

Similarly the following administrative

activities were listed in the postservice

period:

• Transcribe results/file and manage

patient records.

• Schedule postoperative return

evaluation and management services/

arrange for hospital readmission.

• Notify and complete reports to

referring MDs.

• Conduct billing activities

(coordinate bill collection/rebilling,

collect coinsurance payments or

deductibles, postcertify patient).

During the second round of the

CPEPs, Abt collected the inputs by the

broader category of service. For

example, for additional evaluation and

management services codes in the same

family as the reference code, Abt

collected totals on clinical times for the

preservice period, the intraservice

period, and the postservice period.

Similarly, the same process was

followed for administrative inputs. This

less detailed, more aggregated, process

was used because of the large volume of

procedure codes the CPEPs had to

review during the second round and

because the CPEPs believed this level of

detail was sufficient.

b. Pricing of Clinical Practice Expert

Panels’ Direct Inputs

Having identified the type and

quantity of direct inputs from the CPEP

process, our methodology required the

assignment of a national price for each

resource input. Abt priced each of the

CPEP direct inputs (nonphysician labor,

medical supplies, and medical

equipment) using a specific

methodology. The methodology for each

of these items is discussed below.

(1) Nonphysician Labor

Abt calculated the total compensation

per minute for approximately 100

occupational categories that include

clinical and administrative staff. The

data sources for these staff identified

hourly wages, including fringe benefits,

per person for 1993 or 1994. These

wages were updated to 1995 using the

Employment Cost Index for Wages and

Salaries in Private Health Industries

(published by the Bureau of Labor

Statistics). They were converted to total

compensation by adjusting the wage rate

by a fringe benefits multiplier. The

fringe benefits multiplier is 36.6 percent

for all occupational categories. This is

estimated from the Bureau of Labor

Statistics Employer Costs for Employee

Compensation for March 1995. Abt

calculated the fringe benefit multiplied

from the Bureau of Labor Statistics data

using the ratio of the total cost of all

benefits to the wage rate for all workers

in private health services industries.

Three specific data sources were used.

They were: (1) The Bureau of Labor

Statistics’ ‘‘White Collar Pay Survey of

Service-Producing Industries’’ dated

1989 and the ‘‘Occupational

Compensation Survey’’ dated 1994; (2)

‘‘The Survey of Hospital and Medical

School Salaries’’ dated 1994 performed

by the University of Texas Medical

Branch; and (3) the Current Population

Survey dated 1993. Although all three

data sources were used, in cases of

similar categories across data sets, the

Bureau of Labor Statistics data were

considered to be the primary data set.

The University of Texas Medical Branch

and Current Population Survey data

were treated as supplements to be used

when the Bureau of Labor Statistics’

data could not furnish sufficient detail.

Abt categorized all personnel into five

broad categories: clinical staff,

administrative staff, clinical composite

staff, administrative composite staff, and

clinical/administrative composite staff.

The administrative composite staff

refers, for example, to a function

described by a CPEP that could be

performed by different personnel. A

composite labor rate was calculated for

this function for this CPEP.

We use the occupational category of

the medical secretary to illustrate the

mapping of the price for an

administrative staff position. Every

CPEP reported that a medical secretary

performed certain functions as part of

the procedure codes reviewed by that

CPEP. From the Bureau of Labor

Statistics’ data, the updated 1995 total

compensation, including fringe benefits,

for a level II medical secretary is $16.43

per hour. (The Bureau of Labor Statistics

furnishes skilled level variations in

wages and duties for registered nurses,

licensed practical nurses, secretaries,

office clerks, and nursing assistants. In

general, as we advised, Abt used the

Bureau of Labor Statistics’ wage for

level II staff.) This converts to a total

compensation per minute of $0.274 for

a medical secretary, and this labor rate

was made uniform across all CPEPs. If,

for example, a CPEP specified that a

medical secretary was needed for 10

minutes to provide administrative

services for a specific CPT code, that

labor input would be costed at $2.74.

Similarly, we use the occupational

category of a registered nurse to

illustrate the mapping of the price for a

clinical staff position. Every CPEP,

except the gastroenterology CPEP,

reported that a registered nurse

performed certain functions with

respect to the procedure codes reviewed

by that CPEP. The hourly wage for a

level II registered nurse was $18.52

under the Bureau of Labor Statistics’

survey. The total compensation,

including fringe benefits, for a registered

nurse is $25.30 per hour. This converts

to a total compensation per minute of

$0.422. Thus, for each CPEP, the

minutes of a registered nurse’s time are

costed at $0.422. If, for example, a CPEP

specified that a registered nurse was

needed for 10 minutes to provide

clinical services for a specific CPT code

for a patient, that direct input would be

costed at $4.22.

(2) Medical Supplies

Overall, the CPEPs identified 665

supply items for which Abt obtained

prices from three types of sources:

• Published catalogs—These were

used for the most common supplies and

CPEP panelists often provided

recommendations of catalogs or other

sources.

• Contacts with suppliers—This

source was used primarily for

specialized supplies.

• CPEP members—This source was

used if prices were unavailable from

catalogs or suppliers.

Examples of medical supplies include

disposable gowns, examination table

paper, disposable pillow cases,

nonsterile or sterile gloves, disposable

suture removal kit, Vicryl suture, 4–0

and 5–0, and sterile gauze. Abt used the

same prices for these supplies across all

CPEPs. For example, for all CPEPs, the
30888 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

price of the disposable gown is $0.57

per item and is based on a

representative price from Baxter

Healthcare Corporation, a major medical

supplier. Similarly, the price of the

disposable suture removal kit for all

CPEPs is $5.45 per kit and is based on

a representative price from Darby Drug

Company.

(3) Medical Equipment

Medical equipment was divided into

two categories—procedure-specific

equipment and overhead equipment.

Procedure-specific medical equipment

is used for a specific subset of services

within a specialty, such as a stress-test

treadmill as part of a cardiology

procedure. Overhead medical

equipment is either used for all services

furnished or is rarely used (for example,

a crash cart containing emergency

supplies) but is routinely purchased and

maintained in a practice and is difficult

to attribute to a specific service. Only

equipment with costs equal to or

exceeding $500 was costed under the

medical equipment methodology. The

cost per use for equipment costing less

than $500 was considered to be trivial.

Information about the type of

equipment used to furnish each service

was obtained from the CPEPs. Abt

applied price data to the resource

profiles generated by the CPEPs. In most

cases, Abt collected list prices from

equipment suppliers. For example, the

list price for a flexible laryngoscope is

$5,080 (this information is from WelchAllyn, a medical equipment supplier).

Prices were obtained for almost 400

equipment items.

To cost procedure-specific and

overhead equipment, Abt assumed 70-

percent and 100-percent utilization

rates, respectively. Based on comments

from the physician specialty groups, we

have changed the utilization level for

procedure-specific equipment from 70

percent to 50 percent.

Procedure-specific equipment was

costed based on the number of minutes

the equipment was used for the

procedure. The proxy for this is usually

technician time. Overhead equipment

was costed based on the estimated time

for the staff with the most involvement

in the procedure. For example, if a

procedure involving a piece of

equipment was performed in the office

and involved 15 minutes of registered

nurse time and 30 minutes of physician

assistant time, the time of the procedure

would be 30 minutes since this is the

longest of the nonphysician clinical staff

times.

The objective in pricing medical

equipment was to establish an

equipment cost per minute. The

equipment pricing model uses the

following variables:

• The purchase price of the

equipment with primary sources of

information from national

manufacturers.

• The useful life of the equipment

with primary sources of information

from ‘‘Useful Life Guidelines’’ from the

American Hospital Association.

• The annual maintenance cost with

primary sources of information from the

Medical Group Management

Association.

• The cost of capital.

• The time per procedure with

primary sources of information from

CPEP labor estimates.

• The hours of practice (that is, 50

hours per week and 50 weeks per year)

with primary sources of information

from the Medical Group Management

Association and the AMA.

• The machine capacity, based on a

practice’s hours, with the assumption

that the equipment operates at a fixed

percentage (in this case 50 percent) of

capacity.

Ideally, a cost of capital would be

established from a nationally

representative sample of data containing

loan rates and length of loan for

physician practices. Such data do not

exist. As a result, Abt developed proxy

data based on prevailing loan rates for

small businesses. In this model, interest

rates varied by the loan period (one rate

for periods less than or equal to 7 years

and another for periods greater than 7

years) and based on the purchase price

of the equipment (one rate for

equipment costing less than or equal to

$25,000 and another for equipment

costing more than $25,000).

Amount

Interest rate (percent)

Loan period

≤7 years

Loan period

>7 Years

>$25,000 ........... 9.5 10.

≤$25,000 ........... 10.5 11

For example, the cost of capital for an

item of medical equipment costing more

than $25,000 and with a useful life less

than 7 years was assigned an interest

rate of 9.5 percent.

The following example illustrates the

application of the pricing model for

equipment that is used to perform only

one type of procedure code, assuming

the following:

• The equipment is operated at 50

percent of capacity.

• The practice operates 50 hours per

week or 105,000 minutes per year (60

minutes/hour×50 hours/week×50

weeks/year×.50=75,000 minutes).

• The cost of capital (that is, the

interest cost of a loan or opportunity

cost of invested funds is 9.5 percent).

• The purchase price of the

equipment is $30,000.

• The useful life of the equipment is

5 years.

• The annual maintenance costs are 5

percent of the annual purchase price

(.05×$30,000) or $1,500.

• The procedure performed on the

equipment takes 10 minutes.

Cost per procedure=10×[$30,000/

(75,000×3.8397)+1,500/75,000]

Cost per procedure=$1.24

Note: 3.38397 represents Σ1/(1+r)t where

t=0 to 5. The cost of capital is discounted by

the number of years of useful life. The

annualized capitalized cost for the

equipment is $9,313, which is the annual

maintenance cost of $1,500, plus the

annualized purchase price ($7,813), taking

into account the opportunity cost of capital

or $30,000 divided by 3.8397.

Addendum B. Resource Based Practice

Expense Methodology and Example

Step 1: By specialty, use the American

Medical Association’s Socioeconomic

Monitoring Survey actual cost data for

1995–1997 (SMS data) to determine

practice expenses per hour by cost

category.

Methodology

(1) Derive the expenses at the

physician practice level using the SMS

data by cost category. The cost

categories are:

(a) total non-physician payroll

expenses, which are payroll expenses

(including fringe benefits) for nonphysician personnel;

(b) administrative payroll expenses,

which are payroll expenses (including

fringe benefits) for non-physician

personnel involved in administrative,

secretarial, or clerical activities;

(c) office expenses, which include

expenses for rent, mortgage interest,

depreciation on medical buildings,

utilities, and telephone;

(d) medical material and supply

expenses, which include expenses for

drugs, x-ray films, and disposable

medical products;

(e) medical equipment expenses,

which include expenses for

depreciation, leases, and rent of medical

equipment used in the diagnosis or

treatment of patients;

(f) all other expenses, which include

expenses for legal services, accounting

services, office management services,

professional association memberships,

journals and continuing education,

professional car upkeep and

depreciation, and any professional

expenses not mentioned above.
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30889

We refer to the difference between the

total nonphysician payroll expense

category and the clerical payroll

expense category as the clinical payroll

expense category.

(2) Derive the number of hours spent

in patient care activities by physicians

in the practice.

(3) Divide the expenses at the practice

level by the number of hours spent in

patient care activities by the physicians

in the practice.

Derivations

Practice expenses per hour for cost

category x of specialty j = PEHRx,j =

( ) ∗

( ) ∗ + ∗ ( ) ∑ ∗

∑

pe o

rh o e eh

w

w

i j x i j

i j i j i j j

i j

i

i j

i

, , ,

, , ,

,

,

i,j = respondent physician i of specialty

j

pei,j,x = category x practice expenses for

respondent i of specialty j

oi,j = number of physician owners in the

practice of respondent i of specialty

j

rhi,j = number of hours worked in

patient care activities during the

year by respondent i of specialty j

ei,j = number of employee physicians in

the practice of respondent i of

specialty j

ehj = average number of hours worked

in patient care activities for

employee physician’s in specialty j

wi,j= SMS weight for respondent i of

specialty j to correct for potential

nonresponse bias

Step 2: By specialty, determine the

number of physician hours spent

treating Medicare patients as reflected

in the Medicare claims data.

Methodology

By specialty, determine the number of

physician hours reflected in the

Medicare physician fee schedule claims

data as a weighted sum of the physician

time associated with each procedure

code on the fee schedule.

physician hours for specialty j = HOURSJ = ∗ ∑( ) t f k k j

k

,

K = procedure code performed by

specialty j

tk = the physician time associated with

procedure k, taken primarily from

the AMA Relative Value Update

committee surveys (where

available) or surveys done for the

initial establishment of the work

relative value units

fk,j = the frequency with which

procedure code k is performed on

Medicare patients by the physicians

in specialty j as reflected in the

Medicare allowed claims data

Step 3: By specialty, multiply the

SMS practice expenses per hour for

each cost category (as calculated in Step

1) by the number of physician hours

reflected in the Medicare physician fee

schedule claims data (as calculated in

Step 2).

Methodology

The practice expense pool for

cost category x of specialty j = POOL = PEHR

X,J x j J , ∗HOURS

calculated for each × from 1 to 4, with

1 = clinical payroll expense, 2 = medical

materials and supplies expense, 3 =

medical equipment expense, 4 = a

combined category of clerical payroll

expense, office expense, and all other

expenses.

Step 4: For each specialty and cost

category, allocate the practice expense

pool calculated in Step 3 to the

procedures performed by that specialty.

Methodology

(1) Clinical payroll expense, medical

materials and supplies, and medical

equipment SMS pools.

The CPEP cost categories of clinical

labor, medical supplies, and medical

equipment in the facility and nonfacility

place of service settings are used to

allocate, respectively, the SMS cost

category pools for clinical payroll

expense, medical materials and

supplies, and medical equipment.

Practice expense pool allocation for category x

to procedure code k for specialty j in place of

service p = costsx,k,j,p

= ∗∑∑ ∗ cpep

POOL

cpep f x k p

x j

x k p k j p

k p

, ,

,

, , , ,

p = place of service where the procedure

is performed with p=1 the facility

setting (eg hospital) and p=2 the

nonfacility setting (eg physician’s

office)

cpepx,k,p = CPEP costs for category x for

procedure code k in setting p

(procedure codes costed in a setting

as nonzero by more than one CPEP

are averaged)

fk,j,p = the frequency with which

procedure code k was performed in

place of service p on Medicare

patients by the physicians in
30890 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

specialty j as reflected in the

Medicare allowed claims data

calculate for each × from 1 to 3

(2) Administrative payroll expense,

office expense, and other expense SMS

pools.

A combination of the clinical payroll,

medical materials and supplies, and

medical equipment code allocations

calculated in (1) and the physician fee

schedule work relative value units are

used to allocate the combined SMS cost

category pool for administrative payroll

expense, office expense, and other

expense (category 4).

Practice expense pool allocation

for category 4 to procedure code k

for specialty j in setting p = costs4,k,j,p

= 









 + ∗ ( ) 















∗











 + ∗ ( ) 









∗ 















=

=

∑

∑∑ ∑

cos

cos

, , ,

,

, , , , ,

ts w s

POOL

ts w s f

x k j p

x

k

x j

x k j p

x

k k j p

k p

1

3

1

3

wk = the work relative value units for

procedure code k

s = factor to convert work relative value

units to SMS category pool dollars

Step 5: Weight average the allocations

calculated in Step 4 to account for

procedure codes performed by more

than one specialty.

Methodology

For procedure codes performed by

only one specialty, use that specialty’s

allocation. For procedure codes

performed by more than one specialty,

take a weighted average of the

allocations for the specialties which

perform the procedure, where the

weight is the frequency with which the

procedure is performed by that

specialty.

Practice expense pool allocation for

category x to procedure code k in place

of service p = costsx,k,p =

Practice expense pool allocation

for category x to procedure code k

in place of service p = costsx,k,p

=

∑( ) ∗

∑

cos , , , , ,

, ,

ts f

f

x j k p k j p

j

k j p

j

Step 6: From the allocations

calculated in Step 5, create the new

practice expense relative units by place

of service for each procedure code.

Methodology

For each procedure code, multiply the

sum of the allocations from Step 5 for

the four cost categories by the ratio of

the available pool of practice expense

relative value units to the weighted sum

of all the procedure code allocations.

Although not illustrated below,

procedure codes with professional and

technical components were adjusted as

described earlier in this Federal

Register notice to ensure that the

technical and professional components

sum to the global for the service. New

practice expense relative value unit for

procedure code k in place of service p

= rvunewk,p =

new practice expense relative value unit

for procedure code k in place of

service p = rvunewk,p

= ∗

( ) ∗











∗ 











∑∑

∑∑ ∑

∑cos

cos

, ,

, ,

, , ,

ts

rvuold f

ts f

x k p

k p k p

k p

x k p

x

k p

k p

x

Example

The following example is designed to

illustrate the resource based practice

expense methodology described above.

For simplicity, the entire Medicare

physician fee schedule universe is

assumed to consist of two specialties

and six procedure codes. This example

does not yield the actual resource based

practice expense relative value units

found in Addendum C for the six codes.

BILLING CODE 4120–03–P
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30891
30892 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30893
30894 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30895
30896 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30897
30898 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30899
30900 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 30901
30902

BILLING CODE 4120–03–C

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

10040 ............ A Acne surgery of skin abscess ............................ 1.18 1.47 4.46 0.03 2.68 15.78 010

10060 ............ A Drainage of skin abscess ................................... 1.17 0.86 0.52 0.04 2.07 1.73 010

10061 ............ A Drainage of skin abscess ................................... 2.40 1.49 1.06 0.06 3.95 3.52 010

10080 ............ A Drainage of pilonidal cyst ................................... 1.17 1.41 0.51 0.05 2.63 1.73 010

10081 ............ A Drainage of pilonidal cyst ................................... 2.45 1.95 1.25 0.16 4.56 3.86 010

10120 ............ A Remove foreign body ......................................... 1.22 1.23 0.48 0.05 2.50 1.75 010

10121 ............ A Remove foreign body ......................................... 2.69 2.08 1.35 0.12 4.89 4.16 010

10140 ............ A Drainage of hematoma/fluid ............................... 1.53 0.94 0.79 0.05 2.52 2.37 010

10160 ............ A Puncture drainage of lesion ............................... 1.20 1.07 0.61 0.05 2.32 1.86 010
30903

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

10180 ............ A Complex drainage, wound ................................. 2.25 1.17 1.18 0.18 3.60 3.61 010

11000 ............ A Debride infected skin ......................................... 0.60 0.37 0.24 0.04 1.01 0.88 000

11001 ............ A Debride infect skin add ...................................... 0.30 0.20 0.13 0.02 0.52 0.45 ZZZ

11010 ............ A Debride skin, fx .................................................. 4.20 2.01 1.78 0.65 6.86 6.63 010

11011 ............ A Debride skin/muscle, fx ...................................... 4.95 2.88 2.44 0.77 8.60 8.16 000

11012 ............ A Debride skin/muscle/bone, fx ............................. 6.88 3.82 3.58 1.07 11.77 11.53 000

11040 ............ A Debride skin partial ............................................ 0.50 0.32 0.20 0.04 0.86 0.74 000

11041 ............ A Debride skin full ................................................. 0.82 0.47 0.35 0.06 1.35 1.23 000

11042 ............ A Debride skin/tissue ............................................. 1.12 0.68 0.48 0.08 1.88 1.68 000

11043 ............ A Debride tissue/muscle ........................................ 2.38 1.79 1.30 0.34 4.51 4.02 010

11044 ............ A Debride tissue/muscle/bone ............................... 3.06 2.35 1.77 0.49 5.90 5.32 010

11055 ............ R Trim skin lesion .................................................. 0.27 0.32 0.12 0.02 0.61 0.41 000

11056 ............ R Trim 2 to 4 skin lesions ...................................... 0.39 0.36 0.17 0.03 0.78 0.59 000

11057 ............ R Trim over 4 skin lesions ..................................... 0.50 0.41 0.22 0.03 0.94 0.75 000

11100 ............ A Biopsy of skin lesion .......................................... 0.81 1.26 0.73 0.04 2.11 1.58 000

11101 ............ A Biopsy, each added lesion ................................. 0.41 0.72 0.53 0.02 1.15 0.96 ZZZ

11200 ............ A Removal of skin tags ......................................... 0.77 1.72 0.56 0.04 2.53 1.37 010

11201 ............ A Removal of added skin tags .............................. 0.29 0.69 0.67 0.02 1.00 0.98 ZZZ

11300 ............ A Shave skin lesion ............................................... 0.51 1.04 0.70 0.05 1.60 1.26 000

11301 ............ A Shave skin lesion ............................................... 0.85 1.10 0.95 0.06 2.01 1.86 000

11302 ............ A Shave skin lesion ............................................... 1.05 1.19 1.13 0.09 2.33 2.27 000

11303 ............ A Shave skin lesion ............................................... 1.24 1.34 1.29 0.17 2.75 2.70 000

11305 ............ A Shave skin lesion ............................................... 0.67 0.81 0.75 0.05 1.53 1.47 000

11306 ............ A Shave skin lesion ............................................... 0.99 1.06 1.01 0.07 2.12 2.07 000

11307 ............ A Shave skin lesion ............................................... 1.14 1.15 1.12 0.10 2.39 2.36 000

11308 ............ A Shave skin lesion ............................................... 1.41 1.21 1.30 0.17 2.79 2.88 000

11310 ............ A Shave skin lesion ............................................... 0.73 1.11 0.83 0.06 1.90 1.62 000

11311 ............ A Shave skin lesion ............................................... 1.05 1.21 1.12 0.08 2.34 2.25 000

11312 ............ A Shave skin lesion ............................................... 1.20 1.27 1.28 0.11 2.58 2.59 000

11313 ............ A Shave skin lesion ............................................... 1.62 1.62 1.57 0.15 3.39 3.34 000

11400 ............ A Removal of skin lesion ....................................... 0.91 1.57 0.60 0.05 2.53 1.56 010

11401 ............ A Removal of skin lesion ....................................... 1.32 1.65 0.77 0.06 3.03 2.15 010

11402 ............ A Removal of skin lesion ....................................... 1.61 1.77 0.86 0.09 3.47 2.56 010

11403 ............ A Removal of skin lesion ....................................... 1.92 1.67 0.99 0.13 3.72 3.04 010

11404 ............ A Removal of skin lesion ....................................... 2.20 1.81 1.10 0.17 4.18 3.47 010

11406 ............ A Removal of skin lesion ....................................... 2.76 2.42 1.33 0.33 5.51 4.42 010

11420 ............ A Removal of skin lesion ....................................... 1.06 1.33 0.68 0.05 2.44 1.79 010

11421 ............ A Removal of skin lesion ....................................... 1.53 1.62 0.90 0.07 3.22 2.50 010

11422 ............ A Removal of skin lesion ....................................... 1.76 1.75 0.97 0.10 3.61 2.83 010

11423 ............ A Removal of skin lesion ....................................... 2.17 1.77 1.14 0.15 4.09 3.46 010

11424 ............ A Removal of skin lesion ....................................... 2.62 1.97 1.33 0.16 4.75 4.11 010

11426 ............ A Removal of skin lesion ....................................... 3.78 2.86 1.83 0.29 6.93 5.90 010

11440 ............ A Removal of skin lesion ....................................... 1.15 1.72 0.82 0.06 2.93 2.03 010

11441 ............ A Removal of skin lesion ....................................... 1.61 1.85 1.05 0.08 3.54 2.74 010

11442 ............ A Removal of skin lesion ....................................... 1.87 1.96 1.14 0.11 3.94 3.12 010

11443 ............ A Removal of skin lesion ....................................... 2.49 2.39 1.47 0.15 5.03 4.11 010

11444 ............ A Removal of skin lesion ....................................... 3.42 2.60 1.96 0.14 6.16 5.52 010

11446 ............ A Removal of skin lesion ....................................... 4.49 3.52 2.47 0.18 8.19 7.14 010

11450 ............ A Removal, sweat gland lesion ............................. 2.73 5.45 1.79 0.44 8.62 4.96 090

11451 ............ A Removal, sweat gland lesion ............................. 3.95 7.23 2.48 0.46 11.64 6.89 090

11462 ............ A Removal, sweat gland lesion ............................. 2.51 5.50 1.83 0.36 8.37 4.70 090

11463 ............ A Removal, sweat gland lesion ............................. 3.95 6.91 2.02 0.34 11.20 6.31 090

11470 ............ A Removal, sweat gland lesion ............................. 3.25 6.63 1.90 0.45 10.33 5.60 090

11471 ............ A Removal, sweat gland lesion ............................. 4.41 7.55 2.63 0.48 12.44 7.52 090

11600 ............ A Removal of skin lesion ....................................... 1.41 1.75 0.84 0.10 3.26 2.35 010

11601 ............ A Removal of skin lesion ....................................... 1.93 2.67 1.11 0.12 4.72 3.16 010

11602 ............ A Removal of skin lesion ....................................... 2.09 1.91 1.17 0.16 4.16 3.42 010

11603 ............ A Removal of skin lesion ....................................... 2.35 1.86 1.25 0.21 4.42 3.81 010

11604 ............ A Removal of skin lesion ....................................... 2.58 1.99 1.35 0.26 4.83 4.19 010

11606 ............ A Removal of skin lesion ....................................... 3.43 2.74 1.68 0.49 6.66 5.60 010

11620 ............ A Removal of skin lesion ....................................... 1.34 1.71 0.87 0.12 3.17 2.33 010

11621 ............ A Removal of skin lesion ....................................... 1.97 1.88 1.20 0.16 4.01 3.33 010

11622 ............ A Removal of skin lesion ....................................... 2.34 2.06 1.34 0.19 4.59 3.87 010

11623 ............ A Removal of skin lesion ....................................... 2.93 2.17 1.59 0.25 5.35 4.77 010

11624 ............ A Removal of skin lesion ....................................... 3.43 2.48 1.86 0.32 6.23 5.61 010

11626 ............ A Removal of skin lesion ....................................... 4.30 3.20 2.28 0.51 8.01 7.09 010

11640 ............ A Removal of skin lesion ....................................... 1.53 1.77 1.02 0.15 3.45 2.70 010

11641 ............ A Removal of skin lesion ....................................... 2.44 2.15 1.51 0.18 4.77 4.13 010

11642 ............ A Removal of skin lesion ....................................... 2.93 2.24 1.74 0.23 5.40 4.90 010

11643 ............ A Removal of skin lesion ....................................... 3.50 2.57 2.05 0.28 6.35 5.83 010

11644 ............ A Removal of skin lesion ....................................... 4.55 3.17 2.61 0.33 8.05 7.49 010

11646 ............ A Removal of skin lesion ....................................... 5.95 4.21 3.41 0.60 10.76 9.96 010

11719 ............ R Trim nail(s) ......................................................... 0.11 0.16 0.05 0.02 0.29 0.18 000

11720 ............ A Debride nail, 1–5 ................................................ 0.32 0.23 0.21 0.03 0.58 0.56 000
30904

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

11721 ............ A Debride nail, 6 or more ...................................... 0.54 0.33 0.31 0.05 0.92 0.90 000

11730 ............ A Removal of nail plate ......................................... 1.13 0.59 0.55 0.04 1.76 1.72 000

11731 ............ A Removal of second nail plate ............................ 0.57 0.27 0.27 0.05 0.89 0.89 ZZZ

11732 ............ A Remove additional nail plate .............................. 0.57 0.27 0.30 0.02 0.86 0.89 ZZZ

11740 ............ A Drain blood from under nail ............................... 0.37 0.32 0.08 0.04 0.73 0.49 000

11750 ............ A Removal of nail bed ........................................... 1.86 1.37 1.16 0.19 3.42 3.21 010

11752 ............ A Remove nail bed/finger tip ................................. 2.67 1.49 1.93 0.36 4.52 4.96 010

11755 ............ A Biopsy, nail unit .................................................. 1.31 0.82 0.96 0.12 2.25 2.39 000

11760 ............ A Reconstruction of nail bed ................................. 1.58 1.10 1.24 0.09 2.77 2.91 010

11762 ............ A Reconstruction of nail bed ................................. 2.89 1.54 2.05 0.24 4.67 5.18 010

11765 ............ A Excision of nail fold, toe ..................................... 0.69 0.53 0.55 0.05 1.27 1.29 010

11770 ............ A Removal of pilonidal lesion ................................ 2.61 2.05 1.21 0.44 5.10 4.26 010

11771 ............ A Removal of pilonidal lesion ................................ 5.74 4.26 3.31 0.92 10.92 9.97 090

11772 ............ A Removal of pilonidal lesion ................................ 6.98 5.22 3.81 1.01 13.21 11.80 090

11900 ............ A Injection into skin lesions ................................... 0.52 0.84 0.24 0.02 1.38 0.78 000

11901 ............ A Added skin lesions injection ............................... 0.80 0.97 0.38 0.03 1.80 1.21 000

11920 ............ R Correct skin color defects .................................. 1.61 2.43 0.94 0.23 4.27 2.78 000

11921 ............ R Correct skin color defects .................................. 1.93 1.87 1.13 0.28 4.08 3.34 000

11922 ............ R Correct skin color defects .................................. 0.49 2.10 0.52 0.07 2.66 1.08 ZZZ

11950 ............ R Therapy for contour defects ............................... 0.84 1.01 0.33 0.11 1.96 1.28 000

11951 ............ R Therapy for contour defects ............................... 1.19 1.65 0.77 0.11 2.95 2.07 000

11952 ............ R Therapy for contour defects ............................... 1.69 2.47 0.99 0.11 4.27 2.79 000

11954 ............ R Therapy for contour defects ............................... 1.85 2.20 0.82 0.11 4.16 2.78 000

11960 ............ A Insert tissue expander(s) ................................... 9.08 NA 8.08 1.48 NA 18.64 090

11970 ............ A Replace tissue expander ................................... 7.06 NA 4.67 1.61 NA 13.34 090

11971 ............ A Remove tissue expander(s) ............................... 2.13 4.01 2.53 0.82 6.96 5.48 090

11975 ............ N Insert contraceptive cap ..................................... +1.48 2.81 1.48 0.25 4.54 3.21 XXX

11976 ............ R Removal of contraceptive cap ........................... 1.78 1.34 0.71 0.30 3.42 2.79 XXX

11977 ............ N Removal/reinsert contra cap .............................. +3.30 4.63 3.30 0.55 8.48 7.15 XXX

12001 ............ A Repair superficial wound(s) ............................... 1.70 1.69 0.53 0.05 3.44 2.28 010

12002 ............ A Repair superficial wound(s) ............................... 1.86 1.78 0.56 0.07 3.71 2.49 010

12004 ............ A Repair superficial wound(s) ............................... 2.24 1.95 0.66 0.10 4.29 3.00 010

12005 ............ A Repair superficial wound(s) ............................... 2.86 2.32 0.87 0.14 5.32 3.87 010

12006 ............ A Repair superficial wound(s) ............................... 3.67 3.11 1.27 0.19 6.97 5.13 010

12007 ............ A Repair superficial wound(s) ............................... 4.12 3.52 1.64 0.19 7.83 5.95 010

12011 ............ A Repair superficial wound(s) ............................... 1.76 1.77 0.52 0.06 3.59 2.34 010

12013 ............ A Repair superficial wound(s) ............................... 1.99 1.88 0.57 0.08 3.95 2.64 010

12014 ............ A Repair superficial wound(s) ............................... 2.46 2.15 0.71 0.10 4.71 3.27 010

12015 ............ A Repair superficial wound(s) ............................... 3.19 2.56 0.83 0.14 5.89 4.16 010

12016 ............ A Repair superficial wound(s) ............................... 3.93 2.85 1.06 0.19 6.97 5.18 010

12017 ............ A Repair superficial wound(s) ............................... 4.71 3.97 1.78 0.31 8.99 6.80 010

12018 ............ A Repair superficial wound(s) ............................... 5.53 3.98 2.22 0.48 9.99 8.23 010

12020 ............ A Closure of split wound ....................................... 2.62 2.06 1.36 0.18 4.86 4.16 010

12021 ............ A Closure of split wound ....................................... 1.84 1.67 1.03 0.11 3.62 2.98 010

12031 ............ A Layer closure of wound(s) ................................. 2.15 1.98 0.96 0.07 4.20 3.18 010

12032 ............ A Layer closure of wound(s) ................................. 2.47 2.05 0.98 0.10 4.62 3.55 010

12034 ............ A Layer closure of wound(s) ................................. 2.92 2.29 1.13 0.15 5.36 4.20 010

12035 ............ A Layer closure of wound(s) ................................. 3.43 2.44 1.38 0.23 6.10 5.04 010

12036 ............ A Layer closure of wound(s) ................................. 4.05 3.93 2.13 0.37 8.35 6.55 010

12037 ............ A Layer closure of wound(s) ................................. 4.67 3.69 2.57 0.48 8.84 7.72 010

12041 ............ A Layer closure of wound(s) ................................. 2.37 2.19 0.97 0.08 4.64 3.42 010

12042 ............ A Layer closure of wound(s) ................................. 2.74 2.24 1.10 0.12 5.10 3.96 010

12044 ............ A Layer closure of wound(s) ................................. 3.14 2.38 1.30 0.17 5.69 4.61 010

12045 ............ A Layer closure of wound(s) ................................. 3.64 2.67 1.63 0.23 6.54 5.50 010

12046 ............ A Layer closure of wound(s) ................................. 4.25 3.76 2.25 0.37 8.38 6.87 010

12047 ............ A Layer closure of wound(s) ................................. 4.65 4.47 2.50 0.56 9.68 7.71 010

12051 ............ A Layer closure of wound(s) ................................. 2.47 2.18 1.09 0.10 4.75 3.66 010

12052 ............ A Layer closure of wound(s) ................................. 2.77 2.19 0.99 0.14 5.10 3.90 010

12053 ............ A Layer closure of wound(s) ................................. 3.12 2.36 1.08 0.17 5.65 4.37 010

12054 ............ A Layer closure of wound(s) ................................. 3.46 2.64 1.25 0.25 6.35 4.96 010

12055 ............ A Layer closure of wound(s) ................................. 4.43 3.33 1.73 0.37 8.13 6.53 010

12056 ............ A Layer closure of wound(s) ................................. 5.24 4.75 2.72 0.52 10.51 8.48 010

12057 ............ A Layer closure of wound(s) ................................. 5.96 4.47 3.39 0.48 10.91 9.83 010

13100 ............ A Repair of wound or lesion .................................. 3.12 2.60 1.76 0.13 5.85 5.01 010

13101 ............ A Repair of wound or lesion .................................. 3.92 2.88 2.18 0.21 7.01 6.31 010

13120 ............ A Repair of wound or lesion .................................. 3.30 2.73 1.64 0.17 6.20 5.11 010

13121 ............ A Repair of wound or lesion .................................. 4.33 3.12 2.15 0.33 7.78 6.81 010

13131 ............ A Repair of wound or lesion .................................. 3.79 3.02 2.11 0.23 7.04 6.13 010

13132 ............ A Repair of wound or lesion .................................. 5.95 3.98 3.12 0.44 10.37 9.51 010

13150 ............ A Repair of wound or lesion .................................. 3.81 3.86 2.37 0.23 7.90 6.41 010

13151 ............ A Repair of wound or lesion .................................. 4.45 3.92 2.75 0.35 8.72 7.55 010

13152 ............ A Repair of wound or lesion .................................. 6.33 4.71 3.73 0.68 11.72 10.74 010

13160 ............ A Late closure of wound ........................................ 10.48 NA 5.87 0.58 NA 16.93 090

13300 ............ A Repair of wound or lesion .................................. 5.27 3.69 2.87 0.86 9.82 9.00 010
30905

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

14000 ............ A Skin tissue rearrangement ................................. 5.89 5.26 3.91 0.38 11.53 10.18 090

14001 ............ A Skin tissue rearrangement ................................. 8.47 6.60 5.33 0.76 15.83 14.56 090

14020 ............ A Skin tissue rearrangement ................................. 6.59 5.78 4.49 0.49 12.86 11.57 090

14021 ............ A Skin tissue rearrangement ................................. 10.06 7.47 6.47 0.94 18.47 17.47 090

14040 ............ A Skin tissue rearrangement ................................. 7.87 6.25 5.40 0.65 14.77 13.92 090

14041 ............ A Skin tissue rearrangement ................................. 11.49 8.13 7.41 1.02 20.64 19.92 090

14060 ............ A Skin tissue rearrangement ................................. 8.50 6.81 6.12 1.04 16.35 15.66 090

14061 ............ A Skin tissue rearrangement ................................. 12.29 8.96 8.34 1.27 22.52 21.90 090

14300 ............ A Skin tissue rearrangement ................................. 11.76 8.29 7.69 1.84 21.89 21.29 090

14350 ............ A Skin tissue rearrangement ................................. 9.61 NA 5.87 1.05 NA 16.53 090

15000 ............ A Skin graft procedure ........................................... 1.95 1.26 1.04 0.53 3.74 3.52 ZZZ

15050 ............ A Skin pinch graft procedure ................................. 4.30 3.65 3.16 0.30 8.25 7.76 090

15100 ............ A Skin split graft procedure ................................... 9.05 5.64 6.52 0.89 15.58 16.46 090

15101 ............ A Skin split graft procedure ................................... 1.72 1.16 0.83 0.33 3.21 2.88 ZZZ

15120 ............ A Skin split graft procedure ................................... 9.83 6.78 6.22 0.94 17.55 16.99 090

15121 ............ A Skin split graft procedure ................................... 2.67 1.58 1.40 0.53 4.78 4.60 ZZZ

15200 ............ A Skin full graft procedure ..................................... 8.03 7.04 5.00 0.69 15.76 13.72 090

15201 ............ A Skin full graft procedure ..................................... 1.32 0.84 0.69 0.50 2.66 2.51 ZZZ

15220 ............ A Skin full graft procedure ..................................... 7.87 6.91 5.28 0.85 15.63 14.00 090

15221 ............ A Skin full graft procedure ..................................... 1.19 0.77 0.66 0.50 2.46 2.35 ZZZ

15240 ............ A Skin full graft procedure ..................................... 9.04 7.11 6.10 1.03 17.18 16.17 090

15241 ............ A Skin full graft procedure ..................................... 1.86 1.25 1.04 0.58 3.69 3.48 ZZZ

15260 ............ A Skin full graft procedure ..................................... 10.06 7.34 6.92 0.99 18.39 17.97 090

15261 ............ A Skin full graft procedure ..................................... 2.23 1.40 1.27 0.60 4.23 4.10 ZZZ

15350 ............ A Skin homograft procedure .................................. 4.36 6.41 5.19 0.42 11.19 9.97 090

15400 ............ A Skin heterograft procedure ................................ 5.78 3.84 4.86 0.17 9.79 10.81 090

15570 ............ A Form skin pedicle flap ........................................ 9.21 5.97 6.57 2.08 17.26 17.86 090

15572 ............ A Form skin pedicle flap ........................................ 9.27 6.35 6.52 1.86 17.48 17.65 090

15574 ............ A Form skin pedicle flap ........................................ 9.88 6.89 6.44 1.66 18.43 17.98 090

15576 ............ A Form skin pedicle flap ........................................ 8.69 6.95 5.87 0.60 16.24 15.16 090

15580 ............ A Attach skin pedicle graft ..................................... 9.46 NA 6.38 1.30 NA 17.14 090

15600 ............ A Skin graft procedure ........................................... 1.91 3.27 1.71 0.88 6.06 4.50 090

15610 ............ A Skin graft procedure ........................................... 2.42 3.45 1.90 0.80 6.67 5.12 090

15620 ............ A Skin graft procedure ........................................... 2.94 3.88 2.55 0.86 7.68 6.35 090

15625 ............ A Skin graft procedure ........................................... 1.91 NA 2.88 0.78 NA 5.57 090

15630 ............ A Skin graft procedure ........................................... 3.27 4.16 2.83 0.90 8.33 7.00 090

15650 ............ A Transfer skin pedicle flap ................................... 3.97 4.02 2.95 0.93 8.92 7.85 090

15732 ............ A Muscle-skin graft, head/neck ............................. 17.84 NA 11.45 3.46 NA 32.75 090

15734 ............ A Muscle-skin graft, trunk ...................................... 17.79 NA 10.90 3.24 NA 31.93 090

15736 ............ A Muscle-skin graft, arm ........................................ 16.27 NA 10.22 3.02 NA 29.51 090

15738 ............ A Muscle-skin graft, leg ......................................... 17.92 NA 10.91 3.29 NA 32.12 090

15740 ............ A Island pedicle flap graft ...................................... 10.25 7.20 6.61 1.62 19.07 18.48 090

15750 ............ A Neurovascular pedicle graft ............................... 11.41 NA 7.69 2.03 NA 21.13 090

15756 ............ A Free muscle flap, microvasc .............................. 35.23 NA 21.75 5.33 NA 62.31 090

15757 ............ A Free skin flap, microvasc ................................... 35.23 NA 21.75 5.33 NA 62.31 090

15758 ............ A Free fascial flap, microvasc ............................... 35.10 NA 21.68 5.33 NA 62.11 090

15760 ............ A Composite skin graft .......................................... 8.74 7.06 7.41 1.11 16.91 17.26 090

15770 ............ A Derma-fat-fascia graft ........................................ 7.52 NA 5.51 0.95 NA 13.98 090

15775 ............ R Hair transplant punch grafts ............................... 3.96 6.08 3.99 0.56 10.60 8.51 000

15776 ............ R Hair transplant punch grafts ............................... 5.54 5.09 3.61 0.79 11.42 9.94 000

15780 ............ A Abrasion treatment of skin ................................. 7.29 5.50 5.53 0.13 12.92 12.95 090

15781 ............ A Abrasion treatment of skin ................................. 4.85 3.91 4.03 0.39 9.15 9.27 090

15782 ............ A Abrasion treatment of skin ................................. 4.32 3.14 3.04 0.13 7.59 7.49 090

15783 ............ A Abrasion treatment of skin ................................. 4.29 3.36 3.58 0.19 7.84 8.06 090

15786 ............ A Abrasion treatment of lesion .............................. 2.03 1.40 1.30 0.06 3.49 3.39 010

15787 ............ A Abrasion, added skin lesions ............................. 0.33 0.24 0.20 0.03 0.60 0.56 ZZZ

15788 ............ R Chemical peel, face, epiderm ............................ 2.09 2.41 1.20 0.12 4.62 3.41 090

15789 ............ R Chemical peel, face, dermal .............................. 4.92 4.08 3.54 0.12 9.12 8.58 090

15792 ............ R Chemical peel, nonfacial .................................... 1.86 1.84 1.37 0.05 3.75 3.28 090

15793 ............ A Chemical peel, nonfacial .................................... 3.74 NA 2.90 0.05 NA 6.69 090

15810 ............ A Salabrasion ........................................................ 4.74 3.54 3.60 0.29 8.57 8.63 090

15811 ............ A Salabrasion ........................................................ 5.39 4.95 4.14 0.73 11.07 10.26 090

15819 ............ A Plastic surgery, neck .......................................... 9.38 NA 5.81 0.87 NA 16.06 090

15820 ............ A Revision of lower eyelid ..................................... 5.15 7.71 6.23 0.64 13.50 12.02 090

15821 ............ A Revision of lower eyelid ..................................... 5.72 7.98 6.68 0.68 14.38 13.08 090

15822 ............ A Revision of upper eyelid .................................... 4.45 7.04 5.85 0.56 12.05 10.86 090

15823 ............ A Revision of upper eyelid .................................... 7.05 8.71 7.43 0.61 16.37 15.09 090

15831 ............ A Excise excessive skin tissue .............................. 12.40 NA 8.16 2.01 NA 22.57 090

15832 ............ A Excise excessive skin tissue .............................. 11.59 NA 8.09 1.33 NA 21.01 090

15833 ............ A Excise excessive skin tissue .............................. 10.64 NA 7.38 1.12 NA 19.14 090

15834 ............ A Excise excessive skin tissue .............................. 10.85 NA 5.52 1.22 NA 17.59 090

15835 ............ A Excise excessive skin tissue .............................. 11.67 NA 6.43 1.22 NA 19.32 090

15836 ............ A Excise excessive skin tissue .............................. 9.34 NA 7.09 1.10 NA 17.53 090

15837 ............ A Excise excessive skin tissue .............................. 8.43 5.69 5.87 0.85 14.97 15.15 090
30906

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

15838 ............ A Excise excessive skin tissue .............................. 7.13 NA 5.97 0.73 NA 13.83 090

15839 ............ A Excise excessive skin tissue .............................. 9.38 6.20 5.68 0.46 16.04 15.52 090

15840 ............ A Graft for face nerve palsy .................................. 13.26 NA 9.23 2.28 NA 24.77 090

15841 ............ A Graft for face nerve palsy .................................. 23.26 NA 13.57 2.76 NA 39.59 090

15842 ............ A Graft for face nerve palsy .................................. 37.96 NA 23.74 2.68 NA 64.38 090

15845 ............ A Skin and muscle repair, face ............................. 12.57 NA 8.35 2.54 NA 23.46 090

15850 ............ B Removal of sutures ............................................ +0.78 2.24 0.82 0.04 3.06 1.64 XXX

15851 ............ A Removal of sutures ............................................ 0.86 1.17 0.37 0.03 2.06 1.26 000

15852 ............ A Dressing change,not for burn ............................ 0.86 1.14 0.41 0.07 2.07 1.34 000

15860 ............ A Test for blood flow in graft ................................. 1.95 1.26 0.99 0.25 3.46 3.19 000

15920 ............ A Removal of tail bone ulcer ................................. 7.95 NA 4.64 0.63 NA 13.22 090

15922 ............ A Removal of tail bone ulcer ................................. 9.90 NA 5.97 1.19 NA 17.06 090

15931 ............ A Remove sacrum pressure sore .......................... 9.24 NA 4.66 0.55 NA 14.45 090

15933 ............ A Remove sacrum pressure sore .......................... 10.85 NA 6.91 1.43 NA 19.19 090

15934 ............ A Remove sacrum pressure sore .......................... 12.69 NA 7.56 1.50 NA 21.75 090

15935 ............ A Remove sacrum pressure sore .......................... 14.57 NA 9.07 2.27 NA 25.91 090

15936 ............ A Remove sacrum pressure sore .......................... 12.38 NA 7.87 2.05 NA 22.30 090

15937 ............ A Remove sacrum pressure sore .......................... 14.21 NA 9.27 2.67 NA 26.15 090

15940 ............ A Removal of pressure sore .................................. 9.34 NA 5.24 0.73 NA 15.31 090

15941 ............ A Removal of pressure sore .................................. 11.43 NA 8.15 1.39 NA 20.97 090

15944 ............ A Removal of pressure sore .................................. 11.46 NA 7.59 1.82 NA 20.87 090

15945 ............ A Removal of pressure sore .................................. 12.69 NA 8.41 2.09 NA 23.19 090

15946 ............ A Removal of pressure sore .................................. 21.57 NA 13.57 3.24 NA 38.38 090

15950 ............ A Remove thigh pressure sore .............................. 7.54 NA 4.19 0.58 NA 12.31 090

15951 ............ A Remove thigh pressure sore .............................. 10.72 NA 6.78 1.58 NA 19.08 090

15952 ............ A Remove thigh pressure sore .............................. 11.39 NA 6.66 1.37 NA 19.42 090

15953 ............ A Remove thigh pressure sore .............................. 12.63 NA 7.55 1.87 NA 22.05 090

15956 ............ A Remove thigh pressure sore .............................. 15.52 NA 9.76 3.39 NA 28.67 090

15958 ............ A Remove thigh pressure sore .............................. 15.48 NA 9.87 3.76 NA 29.11 090

16000 ............ A Initial treatment of burn(s) .................................. 0.89 0.76 0.21 0.03 1.68 1.13 000

16010 ............ A Treatment of burn(s) .......................................... 0.87 0.82 0.34 0.03 1.72 1.24 000

16015 ............ A Treatment of burn(s) .......................................... 2.35 1.40 1.08 0.38 4.13 3.81 000

16020 ............ A Treatment of burn(s) .......................................... 0.80 0.80 0.23 0.03 1.63 1.06 000

16025 ............ A Treatment of burn(s) .......................................... 1.85 1.31 0.64 0.05 3.21 2.54 000

16030 ............ A Treatment of burn(s) .......................................... 2.08 1.93 0.99 0.08 4.09 3.15 000

16035 ............ A Incision of burn scab .......................................... 4.82 2.95 2.15 0.34 8.11 7.31 090

16040 ............ A Burn wound excision .......................................... 1.02 1.63 0.49 0.53 3.18 2.04 000

16041 ............ A Burn wound excision .......................................... 2.70 2.10 1.31 0.53 5.33 4.54 000

16042 ............ A Burn wound excision .......................................... 2.35 NA 1.17 0.53 NA 4.05 000

17000 ............ A Destroy benign/premal lesion ............................ 0.60 0.86 0.60 0.03 1.49 1.23 010

17003 ............ A Destroy 2–14 lesions ......................................... 0.15 0.54 0.38 0.01 0.70 0.54 ZZZ

17004 ............ A Destroy 15 & more lesions ................................ 2.79 2.05 1.74 0.20 5.04 4.73 010

17106 ............ A Destruction of skin lesions ................................. 4.59 3.21 2.78 0.18 7.98 7.55 090

17107 ............ A Destruction of skin lesions ................................. 9.16 5.82 5.26 0.39 15.37 14.81 090

17108 ............ A Destruction of skin lesions ................................. 13.20 8.55 7.73 0.69 22.44 21.62 090

17110 ............ A Destruct lesion, 1–14 ......................................... 0.65 1.18 0.71 0.03 1.86 1.39 010

17111 ............ A Destruct lesion, 15 or more ............................... 0.92 1.30 0.83 0.05 2.27 1.80 010

17250 ............ A Chemical cautery, tissue .................................... 0.50 0.45 0.20 0.04 0.99 0.74 000

17260 ............ A Destruction of skin lesions ................................. 0.91 1.21 0.56 0.10 2.22 1.57 010

17261 ............ A Destruction of skin lesions ................................. 1.17 1.30 0.70 0.12 2.59 1.99 010

17262 ............ A Destruction of skin lesions ................................. 1.58 1.52 0.91 0.16 3.26 2.65 010

17263 ............ A Destruction of skin lesions ................................. 1.79 1.64 1.00 0.21 3.64 3.00 010

17264 ............ A Destruction of skin lesions ................................. 1.94 1.73 1.11 0.26 3.93 3.31 010

17266 ............ A Destruction of skin lesions ................................. 2.34 1.98 1.21 0.49 4.81 4.04 010

17270 ............ A Destruction of skin lesions ................................. 1.32 1.43 0.77 0.12 2.87 2.21 010

17271 ............ A Destruction of skin lesions ................................. 1.49 1.47 0.87 0.16 3.12 2.52 010

17272 ............ A Destruction of skin lesions ................................. 1.77 1.62 1.01 0.19 3.58 2.97 010

17273 ............ A Destruction of skin lesions ................................. 2.05 1.79 1.14 0.25 4.09 3.44 010

17274 ............ A Destruction of skin lesions ................................. 2.59 2.08 1.30 0.32 4.99 4.21 010

17276 ............ A Destruction of skin lesions ................................. 3.20 2.09 1.76 0.51 5.80 5.47 010

17280 ............ A Destruction of skin lesions ................................. 1.17 1.33 0.70 0.15 2.65 2.02 010

17281 ............ A Destruction of skin lesions ................................. 1.72 1.60 1.01 0.18 3.50 2.91 010

17282 ............ A Destruction of skin lesions ................................. 2.04 1.77 1.19 0.23 4.04 3.46 010

17283 ............ A Destruction of skin lesions ................................. 2.64 2.11 1.51 0.28 5.03 4.43 010

17284 ............ A Destruction of skin lesions ................................. 3.21 2.42 1.86 0.33 5.96 5.40 010

17286 ............ A Destruction of skin lesions ................................. 4.44 2.80 2.58 0.60 7.84 7.62 010

17304 ............ A Chemosurgery of skin lesion ............................. 7.60 5.90 4.28 0.31 13.81 12.19 000

17305 ............ A 2nd stage chemosurgery ................................... 2.85 2.23 1.66 0.17 5.25 4.68 000

17306 ............ A 3rd stage chemosurgery .................................... 2.85 2.23 1.67 0.11 5.19 4.63 000

17307 ............ A Followup skin lesion therapy .............................. 2.85 2.23 1.69 0.12 5.20 4.66 000

17310 ............ A Extensive skin chemosurgery ............................ 0.95 0.87 0.54 0.01 1.83 1.50 000

17340 ............ A Cryotherapy of skin ............................................ 0.76 1.54 0.86 0.02 2.32 1.64 010

17360 ............ A Skin peel therapy ............................................... 1.43 1.38 0.91 0.02 2.83 2.36 010

19000 ............ A Drainage of breast lesion ................................... 0.84 1.16 0.28 0.07 2.07 1.19 000
30907

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

19001 ............ A Drain added breast lesion .................................. 0.42 0.86 0.14 0.05 1.33 0.61 ZZZ

19020 ............ A Incision of breast lesion ..................................... 3.57 4.63 2.48 0.28 8.48 6.33 090

19030 ............ A Injection for breast x-ray .................................... 1.53 9.38 0.94 0.04 10.95 2.51 000

19100 ............ A Biopsy of breast ................................................. 1.27 2.45 0.79 0.13 3.85 2.19 000

19101 ............ A Biopsy of breast ................................................. 3.18 5.91 2.32 0.45 9.54 5.95 010

19110 ............ A Nipple exploration .............................................. 4.30 5.66 3.12 0.51 10.47 7.93 090

19112 ............ A Excise breast duct fistula ................................... 3.67 4.79 2.33 0.35 8.81 6.35 090

19120 ............ A Removal of breast lesion ................................... 5.56 3.29 4.14 0.60 9.45 10.30 090

19125 ............ A Excision, breast lesion ....................................... 6.06 3.61 4.75 0.60 10.27 11.41 090

19126 ............ A Excision, add/-El breast lesion ........................... 2.93 NA 1.28 0.31 NA 4.52 ZZZ

19140 ............ A Removal of breast tissue ................................... 5.14 6.25 2.91 0.91 12.30 8.96 090

19160 ............ A Removal of breast tissue ................................... 5.99 NA 3.57 0.88 NA 10.44 090

19162 ............ A Remove breast tissue, nodes ............................ 13.53 NA 7.01 1.96 NA 22.50 090

19180 ............ A Removal of breast .............................................. 8.80 NA 5.01 1.17 NA 14.98 090

19182 ............ A Removal of breast .............................................. 7.73 NA 4.40 1.27 NA 13.40 090

19200 ............ A Removal of breast .............................................. 15.49 NA 8.03 2.15 NA 25.67 090

19220 ............ A Removal of breast .............................................. 15.72 NA 8.48 2.38 NA 26.58 090

19240 ............ A Removal of breast .............................................. 16.00 NA 7.96 1.99 NA 25.95 090

19260 ............ A Removal of chest wall lesion ............................. 15.44 NA 10.33 1.04 NA 26.81 090

19271 ............ A Revision of chest wall ........................................ 18.90 NA 12.42 2.77 NA 34.09 090

19272 ............ A Extensive chest wall surgery ............................. 21.55 NA 14.21 2.56 NA 38.32 090

19290 ............ A Place needle wire, breast .................................. 1.27 5.74 0.85 0.07 7.08 2.19 000

19291 ............ A Place needle wire, breast .................................. 0.63 3.63 0.65 0.04 4.30 1.32 ZZZ

19316 ............ A Suspension of breast ......................................... 10.69 NA 7.01 2.43 NA 20.13 090

19318 ............ A Reduction of large breast ................................... 15.62 NA 9.83 3.23 NA 28.68 090

19324 ............ A Enlarge breast .................................................... 5.85 NA 3.44 0.67 NA 9.96 090

19325 ............ A Enlarge breast with implant ............................... 8.45 NA 5.87 1.13 NA 15.45 090

19328 ............ A Removal of breast implant ................................. 5.68 NA 3.94 0.73 NA 10.35 090

19330 ............ A Removal of implant material .............................. 7.59 NA 4.90 0.75 NA 13.24 090

19340 ............ A Immediate breast prosthesis .............................. 6.33 NA 3.57 2.06 NA 11.96 ZZZ

19342 ............ A Delayed breast prosthesis ................................. 11.20 NA 7.32 2.03 NA 20.55 090

19350 ............ A Breast reconstruction ......................................... 8.92 9.60 6.05 1.38 19.90 16.35 090

19355 ............ A Correct inverted nipple(s) ................................... 7.57 10.44 5.12 1.00 19.01 13.69 090

19357 ............ A Breast reconstruction ......................................... 18.16 NA 12.25 2.37 NA 32.78 090

19361 ............ A Breast reconstruction ......................................... 19.26 NA 11.82 3.88 NA 34.96 090

19364 ............ A Breast reconstruction ......................................... 29.04 NA 17.48 3.58 NA 50.10 090

19366 ............ A Breast reconstruction ......................................... 21.28 NA 11.46 3.18 NA 35.92 090

19367 ............ A Breast reconstruction ......................................... 25.73 NA 15.21 3.88 NA 44.82 090

19368 ............ A Breast reconstruction ......................................... 32.42 NA 19.61 3.88 NA 55.91 090

19369 ............ A Breast reconstruction ......................................... 29.82 NA 17.91 3.88 NA 51.61 090

19370 ............ A Surgery of breast capsule .................................. 8.05 NA 5.49 1.19 NA 14.73 090

19371 ............ A Removal of breast capsule ................................ 9.35 NA 5.70 1.54 NA 16.59 090

19380 ............ A Revise breast reconstruction ............................. 9.14 NA 6.24 1.57 NA 16.95 090

19396 ............ A Design custom breast implant ........................... 2.17 2.97 1.26 0.31 5.45 3.74 000

20000 ............ A Incision of abscess ............................................. 2.12 1.59 1.03 0.08 3.79 3.23 010

20005 ............ A Incision of deep abscess ................................... 3.42 2.27 1.92 0.28 5.97 5.62 010

20100 ............ A Explore wound, neck .......................................... 10.08 5.22 4.35 1.16 16.46 15.59 010

20101 ............ A Explore wound, chest ......................................... 3.22 1.73 1.49 0.37 5.32 5.08 010

20102 ............ A Explore wound, abdomen .................................. 3.94 2.50 1.78 0.45 6.89 6.17 010

20103 ............ A Explore wound, extremity ................................... 5.30 3.52 2.68 0.60 9.42 8.58 010

20150 ............ A Excise epiphyseal bar ........................................ 13.69 NA 19.46 2.03 NA 35.18 090

20200 ............ A Muscle biopsy .................................................... 1.46 1.28 0.64 0.18 2.92 2.28 000

20205 ............ A Deep muscle biopsy ........................................... 2.35 3.17 1.14 0.33 5.85 3.82 000

20206 ............ A Needle biopsy, muscle ....................................... 0.99 2.14 0.92 0.14 3.27 2.05 000

20220 ............ A Bone biopsy, trocar/needle ................................ 1.27 1.67 1.36 0.09 3.03 2.72 000

20225 ............ A Bone biopsy, trocar/needle ................................ 1.87 0.73 1.76 0.28 2.88 3.91 000

20240 ............ A Bone biopsy, excisional ..................................... 3.23 NA 2.69 0.18 NA 6.10 010

20245 ............ A Bone biopsy, excisional ..................................... 3.95 NA 3.60 0.44 NA 7.99 010

20250 ............ A Open bone biopsy .............................................. 5.03 NA 3.61 0.76 NA 9.40 010

20251 ............ A Open bone biopsy .............................................. 5.56 NA 4.37 0.92 NA 10.85 010

20500 ............ A Injection of sinus tract ........................................ 1.23 2.80 2.12 0.04 4.07 3.39 010

20501 ............ A Inject sinus tract for x-ray .................................. 0.76 7.35 0.42 0.02 8.13 1.20 000

20520 ............ A Removal of foreign body .................................... 1.85 3.00 1.93 0.08 4.93 3.86 010

20525 ............ A Removal of foreign body .................................... 3.50 3.75 3.05 0.33 7.58 6.88 010

20550 ............ A Inj tendon/ligament/cyst ..................................... 0.86 2.07 0.29 0.04 2.97 1.19 000

20600 ............ A Drain/inject joint/bursa ........................................ 0.66 1.25 0.39 0.05 1.96 1.10 000

20605 ............ A Drain/inject joint/bursa ........................................ 0.68 1.76 0.38 0.05 2.49 1.11 000

20610 ............ A Drain/inject joint/bursa ........................................ 0.79 1.38 0.45 0.05 2.22 1.29 000

20615 ............ A Treatment of bone cyst ...................................... 2.28 2.75 1.84 0.06 5.09 4.18 010

20650 ............ A Insert and remove bone pin ............................... 2.23 2.45 2.05 0.14 4.82 4.42 010

20660 ............ A Apply,remove fixation device ............................. 2.51 NA 1.40 0.21 NA 4.12 000

20661 ............ A Application of head brace .................................. 4.89 NA 5.01 0.65 NA 10.55 090

20662 ............ A Application of pelvis brace ................................. 6.07 NA 4.67 1.03 NA 11.77 090

20663 ............ A Application of thigh brace .................................. 5.43 NA 4.52 0.76 NA 10.71 090
30908

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

20664 ............ A Halo brace application ....................................... 8.06 NA 6.77 0.65 NA 15.48 090

20665 ............ A Removal of fixation device ................................. 1.31 1.31 1.09 0.07 2.69 2.47 010

20670 ............ A Removal of support implant ............................... 1.74 3.72 2.50 0.11 5.57 4.35 010

20680 ............ A Removal of support implant ............................... 3.35 3.33 6.39 0.51 7.19 10.25 090

20690 ............ A Apply bone fixation device ................................. 3.52 NA 2.31 0.58 NA 6.41 ZZZ

20692 ............ A Apply bone fixation device ................................. 6.41 NA 3.92 0.89 NA 11.22 ZZZ

20693 ............ A Adjust bone fixation device ................................ 5.86 NA 8.69 0.42 NA 14.97 090

20694 ............ A Remove bone fixation device ............................. 4.16 6.02 4.74 0.41 10.59 9.31 090

20802 ............ A Replantation, arm, complete .............................. 41.15 NA 29.93 6.17 NA 77.25 090

20805 ............ A Replant forearm, complete ................................. 50.00 NA 34.58 7.56 NA 92.14 090

20808 ............ A Replantation, hand, complete ............................ 61.65 NA 46.78 9.40 NA 117.83 090

20816 ............ A Replantation digit, complete ............................... 30.94 NA 34.06 4.63 NA 69.63 090

20822 ............ A Replantation digit, complete ............................... 25.59 NA 27.59 3.83 NA 57.01 090

20824 ............ A Replantation thumb, complete ........................... 30.94 NA 25.23 4.63 NA 60.80 090

20827 ............ A Replantation thumb, complete ........................... 26.41 NA 29.76 3.94 NA 60.11 090

20838 ............ A Replantation, foot, complete .............................. 41.41 NA 28.93 6.17 NA 76.51 090

20900 ............ A Removal of bone for graft .................................. 5.58 4.53 5.00 0.45 10.56 11.03 090

20902 ............ A Removal of bone for graft .................................. 7.55 NA 7.14 0.80 NA 15.49 090

20910 ............ A Remove cartilage for graft ................................. 5.34 5.32 4.76 0.09 10.75 10.19 090

20912 ............ A Remove cartilage for graft ................................. 6.35 NA 4.97 0.64 NA 11.96 090

20920 ............ A Removal of fascia for graft ................................. 5.31 NA 4.72 0.50 NA 10.53 090

20922 ............ A Removal of fascia for graft ................................. 6.61 5.86 5.18 0.71 13.18 12.50 090

20924 ............ A Removal of tendon for graft ............................... 6.48 NA 5.62 0.85 NA 12.95 090

20926 ............ A Removal of tissue for graft ................................. 5.53 NA 4.71 0.39 NA 10.63 090

20931 ............ A Spinal bone allograft .......................................... 1.81 NA 1.24 0.28 NA 3.33 ZZZ

20937 ............ A Spinal bone autograft ......................................... 2.79 NA 1.84 0.44 NA 5.07 ZZZ

20938 ............ A Spinal bone autograft ......................................... 3.02 NA 1.93 0.47 NA 5.42 ZZZ

20950 ............ A Record fluid pressure,muscle ............................ 1.26 NA 1.54 0.17 NA 2.97 000

20955 ............ A Fibula bone graft, microvasc .............................. 39.21 NA 26.94 5.87 NA 72.02 090

20956 ............ A Iliac bone graft, microvasc ................................. 39.27 NA 49.63 5.26 NA 94.16 090

20957 ............ A Mt bone graft, microvasc ................................... 40.65 NA 51.01 5.45 NA 97.11 090

20962 ............ A Other bone graft, microvasc .............................. 39.27 NA 25.47 5.26 NA 70.00 090

20969 ............ A Bone/skin graft, microvasc ................................. 43.92 NA 28.73 6.57 NA 79.22 090

20970 ............ A Bone/skin graft, iliac crest .................................. 43.06 NA 28.02 6.44 NA 77.52 090

20972 ............ A Bone-skin graft, metatarsal ................................ 42.99 NA 19.72 6.49 NA 69.20 090

20973 ............ A Bone-skin graft, great toe .................................. 45.76 NA 28.05 6.91 NA 80.72 090

20974 ............ A Electrical bone stimulation ................................. 0.62 0.32 0.35 0.53 1.47 1.50 000

20975 ............ A Electrical bone stimulation ................................. 2.60 NA 1.48 0.56 NA 4.64 ZZZ

21010 ............ A Incision of jaw joint ............................................. 10.14 NA 7.03 0.93 NA 18.10 090

21015 ............ A Resection of facial tumor ................................... 5.29 NA 5.98 1.13 NA 12.40 090

21025 ............ A Excision of bone, lower jaw ............................... 10.06 6.82 6.53 0.38 17.26 16.97 090

21026 ............ A Excision of facial bone(s) ................................... 4.85 4.64 4.23 0.28 9.77 9.36 090

21029 ............ A Contour of face bone lesion ............................... 7.71 5.81 5.77 0.78 14.30 14.26 090

21030 ............ A Removal of face bone lesion ............................. 6.46 5.05 4.42 0.29 11.80 11.17 090

21031 ............ A Remove exostosis, mandible ............................. 3.24 3.24 2.14 0.32 6.80 5.70 090

21032 ............ A Remove exostosis, maxilla ................................ 3.24 3.21 2.19 0.35 6.80 5.78 090

21034 ............ A Removal of face bone lesion ............................. 16.17 9.87 10.61 0.89 26.93 27.67 090

21040 ............ A Removal of jaw bone lesion ............................... 2.11 2.89 1.77 0.24 5.24 4.12 090

21041 ............ A Removal of jaw bone lesion ............................... 6.71 5.24 4.24 0.50 12.45 11.45 090

21044 ............ A Removal of jaw bone lesion ............................... 11.86 NA 7.91 1.11 NA 20.88 090

21045 ............ A Extensive jaw surgery ........................................ 16.17 NA 10.49 1.58 NA 28.24 090

21050 ............ A Removal of jaw joint ........................................... 10.77 NA 10.16 1.08 NA 22.01 090

21060 ............ A Remove jaw joint cartilage ................................. 10.23 NA 8.88 1.04 NA 20.15 090

21070 ............ A Remove coronoid process ................................. 8.20 NA 6.32 0.82 NA 15.34 090

21076 ............ A Prepare face/oral prosthesis .............................. 13.42 6.70 5.60 1.35 21.47 20.37 010

21077 ............ A Prepare face/oral prosthesis .............................. 33.75 14.90 17.42 3.39 52.04 54.56 090

21079 ............ A Prepare face/oral prosthesis .............................. 22.34 10.55 9.52 2.25 35.14 34.11 090

21080 ............ A Prepare face/oral prosthesis .............................. 25.10 11.63 10.47 2.52 39.25 38.09 090

21081 ............ A Prepare face/oral prosthesis .............................. 22.88 10.89 9.62 2.30 36.07 34.80 090

21082 ............ A Prepare face/oral prosthesis .............................. 20.87 9.85 8.69 2.10 32.82 31.66 090

21083 ............ A Prepare face/oral prosthesis .............................. 19.30 9.20 8.08 1.94 30.44 29.32 090

21084 ............ A Prepare face/oral prosthesis .............................. 22.51 12.25 12.54 2.28 37.04 37.33 090

21085 ............ A Prepare face/oral prosthesis .............................. 9.00 5.01 3.87 0.90 14.91 13.77 010

21086 ............ A Prepare face/oral prosthesis .............................. 24.92 12.00 13.68 2.51 39.43 41.11 090

21087 ............ A Prepare face/oral prosthesis .............................. 24.92 11.66 11.30 2.51 39.09 38.73 090

21100 ............ A Maxillofacial fixation ........................................... 4.22 4.14 3.69 0.11 8.47 8.02 090

21110 ............ A Interdental fixation .............................................. 5.21 4.75 3.82 0.46 10.42 9.49 090

21116 ............ A Injection, jaw joint x-ray ..................................... 0.81 5.51 0.27 0.06 6.38 1.14 000

21120 ............ A Reconstruction of chin ....................................... 4.93 5.71 5.13 0.42 11.06 10.48 090

21121 ............ A Reconstruction of chin ....................................... 7.64 6.30 6.30 0.66 14.60 14.60 090

21122 ............ A Reconstruction of chin ....................................... 8.52 NA 7.00 0.73 NA 16.25 090

21123 ............ A Reconstruction of chin ....................................... 11.16 NA 20.06 0.95 NA 32.17 090

21125 ............ A Augmentation lower jaw bone ............................ 10.62 7.69 7.67 0.54 18.85 18.83 090

21127 ............ A Augmentation lower jaw bone ............................ 11.12 8.30 7.47 0.92 20.34 19.51 090
30909

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

21137 ............ A Reduction of forehead ........................................ 9.82 NA 7.29 0.83 NA 17.94 090

21138 ............ A Reduction of forehead ........................................ 12.19 NA 7.64 1.04 NA 20.87 090

21139 ............ A Reduction of forehead ........................................ 14.61 NA 11.04 1.25 NA 26.90 090

21141 ............ A Reconstruct midface, lefort ................................ 18.10 NA 10.89 1.68 NA 30.67 090

21142 ............ A Reconstruct midface, lefort ................................ 18.81 NA 13.27 1.74 NA 33.82 090

21143 ............ A Reconstruct midface, lefort ................................ 19.58 NA 11.67 1.81 NA 33.06 090

21145 ............ A Reconstruct midface, lefort ................................ 19.94 NA 11.71 1.68 NA 33.33 090

21146 ............ A Reconstruct midface, lefort ................................ 20.71 NA 12.56 1.74 NA 35.01 090

21147 ............ A Reconstruct midface, lefort ................................ 21.77 NA 13.16 1.81 NA 36.74 090

21150 ............ A Reconstruct midface, lefort ................................ 25.24 NA 15.59 2.17 NA 43.00 090

21151 ............ A Reconstruct midface, lefort ................................ 28.30 NA 15.30 2.42 NA 46.02 090

21154 ............ A Reconstruct midface, lefort ................................ 30.52 NA 22.04 2.59 NA 55.15 090

21155 ............ A Reconstruct midface, lefort ................................ 34.45 NA 51.03 2.94 NA 88.42 090

21159 ............ A Reconstruct midface, lefort ................................ 42.38 NA 60.58 3.63 NA 106.59 090

21160 ............ A Reconstruct midface, lefort ................................ 46.44 NA 64.64 3.98 NA 115.06 090

21172 ............ A Reconstruct orbit/forehead ................................. 27.80 NA 21.24 2.37 NA 51.41 090

21175 ............ A Reconstruct orbit/forehead ................................. 33.17 NA 24.31 2.85 NA 60.33 090

21179 ............ A Reconstruct entire forehead ............................... 22.25 NA 18.66 1.90 NA 42.81 090

21180 ............ A Reconstruct entire forehead ............................... 25.19 NA 24.32 2.17 NA 51.68 090

21181 ............ A Contour cranial bone lesion ............................... 9.90 NA 8.05 0.83 NA 18.78 090

21182 ............ A Reconstruct cranial bone ................................... 32.19 NA 24.10 2.77 NA 59.06 090

21183 ............ A Reconstruct cranial bone ................................... 35.31 NA 25.88 3.03 NA 64.22 090

21184 ............ A Reconstruct cranial bone ................................... 38.24 NA 29.40 3.28 NA 70.92 090

21188 ............ A Reconstruction of midface ................................. 22.46 NA 18.26 1.90 NA 42.62 090

21193 ............ A Reconstruct lower jaw bone ............................... 17.15 NA 10.91 1.44 NA 29.50 090

21194 ............ A Reconstruct lower jaw bone ............................... 19.84 NA 12.92 1.67 NA 34.43 090

21195 ............ A Reconstruct lower jaw bone ............................... 17.24 NA 11.08 1.44 NA 29.76 090

21196 ............ A Reconstruct lower jaw bone ............................... 18.91 NA 13.53 1.58 NA 34.02 090

21198 ............ A Reconstruct lower jaw bone ............................... 14.16 NA 10.93 1.74 NA 26.83 090

21206 ............ A Reconstruct upper jaw bone .............................. 14.10 NA 10.52 1.19 NA 25.81 090

21208 ............ A Augmentation of facial bones ............................ 10.23 7.88 8.26 1.07 19.18 19.56 090

21209 ............ A Reduction of facial bones .................................. 6.72 6.05 6.22 0.76 13.53 13.70 090

21210 ............ A Face bone graft .................................................. 10.23 7.72 7.87 1.29 19.24 19.39 090

21215 ............ A Lower jaw bone graft ......................................... 10.77 7.83 7.13 1.42 20.02 19.32 090

21230 ............ A Rib cartilage graft ............................................... 10.77 NA 9.34 1.69 NA 21.80 090

21235 ............ A Ear cartilage graft ............................................... 6.72 8.15 7.42 1.09 15.96 15.23 090

21240 ............ A Reconstruction of jaw joint ................................. 14.05 NA 10.46 2.09 NA 26.60 090

21242 ............ A Reconstruction of jaw joint ................................. 12.95 NA 10.05 2.25 NA 25.25 090

21243 ............ A Reconstruction of jaw joint ................................. 20.79 NA 13.24 1.68 NA 35.71 090

21244 ............ A Reconstruction of lower jaw ............................... 11.86 NA 9.33 1.93 NA 23.12 090

21245 ............ A Reconstruction of jaw ......................................... 11.86 8.63 9.93 1.31 21.80 23.10 090

21246 ............ A Reconstruction of jaw ......................................... 12.47 8.83 9.24 1.04 22.34 22.75 090

21247 ............ A Reconstruct lower jaw bone ............................... 22.63 NA 14.51 2.27 NA 39.41 090

21248 ............ A Reconstruction of jaw ......................................... 11.48 7.91 7.71 1.75 21.14 20.94 090

21249 ............ A Reconstruction of jaw ......................................... 17.52 10.43 10.44 3.29 31.24 31.25 090

21255 ............ A Reconstruct lower jaw bone ............................... 16.72 NA 11.63 1.68 NA 30.03 090

21256 ............ A Reconstruction of orbit ....................................... 16.19 NA 14.89 1.63 NA 32.71 090

21260 ............ A Revise eye sockets ............................................ 16.52 NA 14.04 1.66 NA 32.22 090

21261 ............ A Revise eye sockets ............................................ 31.49 NA 17.06 1.65 NA 50.20 090

21263 ............ A Revise eye sockets ............................................ 28.42 NA 45.24 2.86 NA 76.52 090

21267 ............ A Revise eye sockets ............................................ 18.90 NA 20.67 2.13 NA 41.70 090

21268 ............ A Revise eye sockets ............................................ 24.48 NA 18.34 3.13 NA 45.95 090

21270 ............ A Augmentation cheek bone ................................. 10.23 5.40 9.69 1.41 17.04 21.33 090

21275 ............ A Revision orbitofacial bones ................................ 11.24 NA 13.42 1.26 NA 25.92 090

21280 ............ A Revision of eyelid ............................................... 6.03 NA 8.21 0.61 NA 14.85 090

21282 ............ A Revision of eyelid ............................................... 3.49 NA 6.72 0.79 NA 11.00 090

21295 ............ A Revision of jaw muscle/bone ............................. 1.53 NA 3.72 0.13 NA 5.38 090

21296 ............ A Revision of jaw muscle/bone ............................. 4.25 NA 5.02 0.22 NA 9.49 090

21300 ............ A Treatment of skull fracture ................................. 0.72 3.32 0.21 0.11 4.15 1.04 000

21310 ............ A Treatment of nose fracture ................................ 0.58 2.47 0.11 0.09 3.14 0.78 000

21315 ............ A Treatment of nose fracture ................................ 1.51 2.93 0.89 0.21 4.65 2.61 010

21320 ............ A Treatment of nose fracture ................................ 1.85 3.06 1.65 0.34 5.25 3.84 010

21325 ............ A Repair of nose fracture ...................................... 3.77 NA 2.81 0.52 NA 7.10 090

21330 ............ A Repair of nose fracture ...................................... 5.38 NA 5.97 0.86 NA 12.21 090

21335 ............ A Repair of nose fracture ...................................... 8.61 NA 8.02 1.56 NA 18.19 090

21336 ............ A Repair nasal septal fracture ............................... 5.72 NA 5.91 0.52 NA 12.15 090

21337 ............ A Repair nasal septal fracture ............................... 2.70 4.38 2.39 0.38 7.46 5.47 090

21338 ............ A Repair nasoethmoid fracture .............................. 6.46 NA 6.39 0.66 NA 13.51 090

21339 ............ A Repair nasoethmoid fracture .............................. 8.09 NA 7.31 0.70 NA 16.10 090

21340 ............ A Repair of nose fracture ...................................... 10.77 NA 9.73 1.04 NA 21.54 090

21343 ............ A Repair of sinus fracture ...................................... 12.95 NA 9.61 1.08 NA 23.64 090

21344 ............ A Repair of sinus fracture ...................................... 19.72 NA 14.46 1.08 NA 35.26 090

21345 ............ A Repair of nose/jaw fracture ................................ 8.16 7.04 7.45 0.81 16.01 16.42 090

21346 ............ A Repair of nose/jaw fracture ................................ 10.61 NA 9.74 1.04 NA 21.39 090
30910

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

21347 ............ A Repair of nose/jaw fracture ................................ 12.69 NA 9.53 1.36 NA 23.58 090

21348 ............ A Repair of nose/jaw fracture ................................ 16.69 NA 12.22 2.22 NA 31.13 090

21355 ............ A Repair cheek bone fracture ............................... 3.77 3.40 1.74 0.17 7.34 5.68 010

21356 ............ A Repair cheek bone fracture ............................... 4.15 NA 4.79 0.89 NA 9.83 010

21360 ............ A Repair cheek bone fracture ............................... 6.46 NA 6.84 0.89 NA 14.19 090

21365 ............ A Repair cheek bone fracture ............................... 14.95 NA 11.74 1.63 NA 28.32 090

21366 ............ A Repair cheek bone fracture ............................... 17.77 NA 9.32 2.36 NA 29.45 090

21385 ............ A Repair eye socket fracture ................................. 9.16 NA 7.61 1.13 NA 17.90 090

21386 ............ A Repair eye socket fracture ................................. 9.16 NA 8.63 1.25 NA 19.04 090

21387 ............ A Repair eye socket fracture ................................. 9.70 NA 9.10 0.96 NA 19.76 090

21390 ............ A Repair eye socket fracture ................................. 10.13 NA 10.45 1.37 NA 21.95 090

21395 ............ A Repair eye socket fracture ................................. 12.68 NA 10.66 1.37 NA 24.71 090

21400 ............ A Treat eye socket fracture ................................... 1.40 3.31 0.65 0.17 4.88 2.22 090

21401 ............ A Repair eye socket fracture ................................. 3.26 3.98 2.31 0.32 7.56 5.89 090

21406 ............ A Repair eye socket fracture ................................. 7.01 NA 7.24 0.74 NA 14.99 090

21407 ............ A Repair eye socket fracture ................................. 8.61 NA 8.85 0.78 NA 18.24 090

21408 ............ A Repair eye socket fracture ................................. 12.38 NA 9.57 0.99 NA 22.94 090

21421 ............ A Treat mouth roof fracture ................................... 5.14 6.15 5.17 0.62 11.91 10.93 090

21422 ............ A Repair mouth roof fracture ................................. 8.32 NA 7.33 1.19 NA 16.84 090

21423 ............ A Repair mouth roof fracture ................................. 10.40 NA 8.31 1.19 NA 19.90 090

21431 ............ A Treat craniofacial fracture .................................. 7.05 NA 5.95 0.71 NA 13.71 090

21432 ............ A Repair craniofacial fracture ................................ 8.61 NA 7.78 0.84 NA 17.23 090

21433 ............ A Repair craniofacial fracture ................................ 25.35 NA 17.90 2.10 NA 45.35 090

21435 ............ A Repair craniofacial fracture ................................ 17.25 NA 13.29 1.88 NA 32.42 090

21436 ............ A Repair craniofacial fracture ................................ 28.04 NA 17.06 2.08 NA 47.18 090

21440 ............ A Repair dental ridge fracture ............................... 2.70 4.56 3.56 0.28 7.54 6.54 090

21445 ............ A Repair dental ridge fracture ............................... 5.38 5.56 5.29 0.56 11.50 11.23 090

21450 ............ A Treat lower jaw fracture ..................................... 2.97 4.24 3.45 0.26 7.47 6.68 090

21451 ............ A Treat lower jaw fracture ..................................... 4.87 5.43 4.60 0.74 11.04 10.21 090

21452 ............ A Treat lower jaw fracture ..................................... 1.98 6.58 3.89 0.17 8.73 6.04 090

21453 ............ A Treat lower jaw fracture ..................................... 5.54 5.95 5.49 0.55 12.04 11.58 090

21454 ............ A Treat lower jaw fracture ..................................... 6.46 NA 5.76 1.42 NA 13.64 090

21461 ............ A Repair lower jaw fracture ................................... 8.09 8.12 7.14 1.30 17.51 16.53 090

21462 ............ A Repair lower jaw fracture ................................... 9.79 8.46 7.77 1.34 19.59 18.90 090

21465 ............ A Repair lower jaw fracture ................................... 11.91 NA 8.02 0.99 NA 20.92 090

21470 ............ A Repair lower jaw fracture ................................... 15.34 NA 10.11 1.74 NA 27.19 090

21480 ............ A Reset dislocated jaw .......................................... 0.61 1.75 0.16 0.09 2.45 0.86 000

21485 ............ A Reset dislocated jaw .......................................... 3.99 3.72 2.48 0.20 7.91 6.67 090

21490 ............ A Repair dislocated jaw ......................................... 11.86 NA 7.48 0.52 NA 19.86 090

21493 ............ A Treat hyoid bone fracture ................................... 1.27 0.59 3.15 0.13 1.99 4.55 090

21494 ............ A Repair hyoid bone fracture ................................ 6.28 2.63 3.70 0.63 9.54 10.61 090

21495 ............ A Repair hyoid bone fracture ................................ 5.69 NA 5.95 0.51 NA 12.15 090

21497 ............ A Interdental wiring ................................................ 3.86 4.11 3.29 0.38 8.35 7.53 090

21501 ............ A Drain neck/chest lesion ...................................... 3.81 3.16 2.67 0.26 7.23 6.74 090

21502 ............ A Drain chest lesion .............................................. 7.12 NA 9.17 0.75 NA 17.04 090

21510 ............ A Drainage of bone lesion ..................................... 5.74 NA 7.85 0.50 NA 14.09 090

21550 ............ A Biopsy of neck/chest .......................................... 2.06 1.72 1.17 0.12 3.90 3.35 010

21555 ............ A Remove lesion neck/chest ................................. 4.35 3.34 2.37 0.25 7.94 6.97 090

21556 ............ A Remove lesion neck/chest ................................. 5.57 NA 3.17 0.64 NA 9.38 090

21557 ............ A Remove tumor, neck or chest ............................ 8.88 NA 8.79 1.41 NA 19.08 090

21600 ............ A Partial removal of rib .......................................... 6.89 NA 8.31 0.88 NA 16.08 090

21610 ............ A Partial removal of rib .......................................... 14.61 NA 9.89 0.76 NA 25.26 090

21615 ............ A Removal of rib .................................................... 9.87 NA 8.38 1.96 NA 20.21 090

21616 ............ A Removal of rib and nerves ................................. 12.04 NA 9.33 1.50 NA 22.87 090

21620 ............ A Partial removal of sternum ................................. 6.79 NA 7.60 1.23 NA 15.62 090

21627 ............ A Sternal debridement ........................................... 6.81 NA 12.71 0.90 NA 20.42 090

21630 ............ A Extensive sternum surgery ................................ 17.38 NA 15.34 2.40 NA 35.12 090

21632 ............ A Extensive sternum surgery ................................ 18.14 NA 13.05 2.22 NA 33.41 090

21700 ............ A Revision of neck muscle .................................... 6.19 5.11 4.88 0.50 11.80 11.57 090

21705 ............ A Revision of neck muscle/rib ............................... 9.60 NA 10.23 0.96 NA 20.79 090

21720 ............ A Revision of neck muscle .................................... 5.68 6.36 4.90 0.52 12.56 11.10 090

21725 ............ A Revision of neck muscle .................................... 6.99 NA 6.16 0.74 NA 13.89 090

21740 ............ A Reconstruction of sternum ................................. 16.50 NA 13.90 1.64 NA 32.04 090

21750 ............ A Repair of sternum separation ............................ 10.77 NA 9.53 1.43 NA 21.73 090

21800 ............ A Treatment of rib fracture .................................... 0.96 1.33 0.63 0.07 2.36 1.66 090

21805 ............ A Treatment of rib fracture .................................... 2.75 NA 3.08 0.17 NA 6.00 090

21810 ............ A Treatment of rib fracture(s) ................................ 6.86 NA 8.65 0.61 NA 16.12 090

21820 ............ A Treat sternum fracture ....................................... 1.28 1.74 0.99 0.17 3.19 2.44 090

21825 ............ A Repair sternum fracture ..................................... 7.41 NA 7.42 1.12 NA 15.95 090

21920 ............ A Biopsy soft tissue of back .................................. 2.06 1.75 0.85 0.11 3.92 3.02 010

21925 ............ A Biopsy soft tissue of back .................................. 4.49 7.49 3.55 0.32 12.30 8.36 090

21930 ............ A Remove lesion, back or flank ............................ 5.00 3.64 2.52 0.49 9.13 8.01 090

21935 ............ A Remove tumor of back ....................................... 17.96 NA 11.23 1.30 NA 30.49 090

22100 ............ A Remove part of neck vertebra ........................... 9.73 NA 7.68 1.09 NA 18.50 090
30911

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

22101 ............ A Remove part, thorax vertebra ............................ 9.81 NA 7.77 1.38 NA 18.96 090

22102 ............ A Remove part, lumbar vertebra ........................... 9.81 NA 7.35 0.67 NA 17.83 090

22103 ............ A Remove extra spine segment ............................ 2.34 NA 1.45 0.37 NA 4.16 ZZZ

22110 ............ A Remove part of neck vertebra ........................... 12.74 NA 9.72 1.64 NA 24.10 090

22112 ............ A Remove part, thorax vertebra ............................ 12.81 NA 9.70 1.63 NA 24.14 090

22114 ............ A Remove part, lumbar vertebra ........................... 12.81 NA 9.69 1.17 NA 23.67 090

22116 ............ A Remove extra spine segment ............................ 2.32 NA 1.42 0.36 NA 4.10 ZZZ

22210 ............ A Revision of neck spine ....................................... 23.82 NA 16.43 2.43 NA 42.68 090

22212 ............ A Revision of thorax spine .................................... 19.42 NA 14.76 2.83 NA 37.01 090

22214 ............ A Revision of lumbar spine ................................... 19.45 NA 13.95 2.68 NA 36.08 090

22216 ............ A Revise, extra spine segment ............................. 6.04 NA 3.51 0.89 NA 10.44 ZZZ

22220 ............ A Revision of neck spine ....................................... 21.37 NA 14.66 2.63 NA 38.66 090

22222 ............ A Revision of thorax spine .................................... 21.52 NA 13.03 1.58 NA 36.13 090

22224 ............ A Revision of lumbar spine ................................... 21.52 NA 14.52 2.66 NA 38.70 090

22226 ............ A Revise, extra spine segment ............................. 6.04 NA 3.43 0.89 NA 10.36 ZZZ

22305 ............ A Treat spine process fracture .............................. 2.05 2.22 1.58 0.37 4.64 4.00 090

22310 ............ A Treat spine fracture ............................................ 2.61 3.25 2.82 0.69 6.55 6.12 090

22315 ............ A Treat spine fracture ............................................ 8.84 NA 7.92 0.86 NA 17.62 090

22325 ............ A Repair of spine fracture ..................................... 18.30 NA 11.68 1.34 NA 31.32 090

22326 ............ A Repair neck spine fracture ................................. 19.59 NA 14.02 2.74 NA 36.35 090

22327 ............ A Repair thorax spine fracture .............................. 19.20 NA 13.47 2.35 NA 35.02 090

22328 ............ A Repair each add spine fx ................................... 4.61 NA 2.57 0.72 NA 7.90 ZZZ

22505 ............ A Manipulation of spine ......................................... 1.87 2.43 1.66 0.17 4.47 3.70 010

22548 ............ A Neck spine fusion ............................................... 25.82 NA 17.17 3.82 NA 46.81 090

22554 ............ A Neck spine fusion ............................................... 18.62 NA 12.68 3.52 NA 34.82 090

22556 ............ A Thorax spine fusion ............................................ 23.46 NA 16.24 3.58 NA 43.28 090

22558 ............ A Lumbar spine fusion ........................................... 22.28 NA 15.16 3.38 NA 40.82 090

22585 ............ A Additional spinal fusion ...................................... 5.53 NA 3.18 0.93 NA 9.64 ZZZ

22590 ............ A Spine & skull spinal fusion ................................. 20.51 NA 14.43 3.44 NA 38.38 090

22595 ............ A Neck spinal fusion .............................................. 19.39 NA 13.40 3.87 NA 36.66 090

22600 ............ A Neck spine fusion ............................................... 16.14 NA 11.81 3.32 NA 31.27 090

22610 ............ A Thorax spine fusion ............................................ 16.02 NA 12.11 2.75 NA 30.88 090

22612 ............ A Lumbar spine fusion ........................................... 21.00 NA 14.94 3.33 NA 39.27 090

22614 ............ A Spine fusion, extra segment .............................. 6.44 NA 3.78 0.92 NA 11.14 ZZZ

22630 ............ A Lumbar spine fusion ........................................... 20.84 NA 14.85 3.15 NA 38.84 090

22632 ............ A Spine fusion, extra segment .............................. 5.23 NA 3.01 0.82 NA 9.06 ZZZ

22800 ............ A Fusion of spine ................................................... 18.25 NA 13.50 3.58 NA 35.33 090

22802 ............ A Fusion of spine ................................................... 30.88 NA 21.23 4.61 NA 56.72 090

22804 ............ A Fusion of spine ................................................... 36.27 NA 24.20 4.61 NA 65.08 090

22808 ............ A Fusion of spine ................................................... 26.27 NA 18.13 3.15 NA 47.55 090

22810 ............ A Fusion of spine ................................................... 30.27 NA 19.97 3.15 NA 53.39 090

22812 ............ A Fusion of spine ................................................... 32.70 NA 21.49 4.24 NA 58.43 090

22818 ............ A Kyphectomy, 1–2 segments ............................... 31.83 NA 19.42 4.85 NA 56.10 090

22819 ............ A Kyphectomy, 3 & more segment ....................... 36.44 NA 21.75 4.85 NA 63.04 090

22830 ............ A Exploration of spinal fusion ................................ 10.85 NA 8.96 2.18 NA 21.99 090

22840 ............ A Insert spine fixation device ................................ 12.54 NA 7.94 0.98 NA 21.46 ZZZ

22842 ............ A Insert spine fixation device ................................ 12.58 NA 7.54 1.12 NA 21.24 ZZZ

22843 ............ A Insert spine fixation device ................................ 13.46 NA 8.67 1.40 NA 23.53 ZZZ

22844 ............ A Insert spine fixation device ................................ 16.44 NA 10.38 1.71 NA 28.53 ZZZ

22845 ............ A Insert spine fixation device ................................ 11.96 NA 7.56 0.93 NA 20.45 ZZZ

22846 ............ A Insert spine fixation device ................................ 12.42 NA 7.87 1.29 NA 21.58 ZZZ

22847 ............ A Insert spine fixation device ................................ 13.80 NA 8.62 1.44 NA 23.86 ZZZ

22848 ............ A Insert pelvic fixation device ................................ 6.00 NA 4.63 0.94 NA 11.57 ZZZ

22849 ............ A Reinsert spinal fixation ....................................... 18.51 NA 13.16 1.97 NA 33.64 090

22850 ............ A Remove spine fixation device ............................ 9.52 NA 7.79 1.50 NA 18.81 090

22851 ............ A Apply spine prosth device .................................. 6.71 NA 4.70 1.05 NA 12.46 ZZZ

22852 ............ A Remove spine fixation device ............................ 9.01 NA 7.52 1.57 NA 18.10 090

22855 ............ A Remove spine fixation device ............................ 15.13 NA 10.74 1.25 NA 27.12 090

22900 ............ A Remove abdominal wall lesion .......................... 5.80 NA 3.87 0.60 NA 10.27 090

23000 ............ A Removal of calcium deposits ............................. 4.36 5.42 5.20 0.47 10.25 10.03 090

23020 ............ A Release shoulder joint ....................................... 8.93 NA 8.38 1.09 NA 18.40 090

23030 ............ A Drain shoulder lesion ......................................... 3.43 3.56 3.34 0.35 7.34 7.12 010

23031 ............ A Drain shoulder bursa .......................................... 2.74 3.26 3.12 0.05 6.05 5.91 010

23035 ............ A Drain shoulder bone lesion ................................ 8.61 NA 11.29 1.04 NA 20.94 090

23040 ............ A Exploratory shoulder surgery ............................. 9.20 NA 9.44 1.47 NA 20.11 090

23044 ............ A Exploratory shoulder surgery ............................. 7.12 NA 7.98 1.18 NA 16.28 090

23065 ............ A Biopsy shoulder tissues ..................................... 2.27 2.22 1.28 0.09 4.58 3.64 010

23066 ............ A Biopsy shoulder tissues ..................................... 4.16 4.62 4.33 0.10 8.88 8.59 090

23075 ............ A Removal of shoulder lesion ............................... 2.39 2.93 2.25 0.29 5.61 4.93 010

23076 ............ A Removal of shoulder lesion ............................... 7.63 NA 6.07 0.65 NA 14.35 090

23077 ............ A Remove tumor of shoulder ................................ 16.09 NA 11.47 1.38 NA 28.94 090

23100 ............ A Biopsy of shoulder joint ...................................... 6.03 NA 6.40 1.24 NA 13.67 090

23101 ............ A Shoulder joint surgery ........................................ 5.58 NA 6.34 1.21 NA 13.13 090

23105 ............ A Remove shoulder joint lining .............................. 8.23 NA 7.89 1.73 NA 17.85 090
30912

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

23106 ............ A Incision of collarbone joint ................................. 5.96 NA 6.22 0.80 NA 12.98 090

23107 ............ A Explore,treat shoulder joint ................................ 8.62 NA 8.13 1.60 NA 18.35 090

23120 ............ A Partial removal, collar bone ............................... 7.11 NA 7.35 0.74 NA 15.20 090

23125 ............ A Removal of collarbone ....................................... 9.39 NA 8.49 1.27 NA 19.15 090

23130 ............ A Partial removal, shoulderbone ........................... 7.55 NA 7.61 1.14 NA 16.30 090

23140 ............ A Removal of bone lesion ..................................... 6.89 NA 5.98 0.73 NA 13.60 090

23145 ............ A Removal of bone lesion ..................................... 9.09 NA 8.41 1.33 NA 18.83 090

23146 ............ A Removal of bone lesion ..................................... 7.83 NA 17.31 1.01 NA 26.15 090

23150 ............ A Removal of humerus lesion ............................... 8.48 NA 7.89 1.01 NA 17.38 090

23155 ............ A Removal of humerus lesion ............................... 10.35 NA 9.85 1.37 NA 21.57 090

23156 ............ A Removal of humerus lesion ............................... 8.68 NA 8.40 1.25 NA 18.33 090

23170 ............ A Remove collarbone lesion .................................. 6.86 NA 7.68 0.78 NA 15.32 090

23172 ............ A Remove shoulder blade lesion .......................... 6.90 NA 7.76 0.73 NA 15.39 090

23174 ............ A Remove humerus lesion .................................... 9.51 NA 9.23 1.21 NA 19.95 090

23180 ............ A Remove collar bone lesion ................................ 8.53 NA 11.46 0.67 NA 20.66 090

23182 ............ A Remove shoulder blade lesion .......................... 8.15 NA 10.95 1.13 NA 20.23 090

23184 ............ A Remove humerus lesion .................................... 9.38 NA 12.03 1.48 NA 22.89 090

23190 ............ A Partial removal of scapula ................................. 7.24 NA 6.52 0.98 NA 14.74 090

23195 ............ A Removal of head of humerus ............................ 9.81 NA 8.88 1.45 NA 20.14 090

23200 ............ A Removal of collar bone ...................................... 12.08 NA 9.81 1.26 NA 23.15 090

23210 ............ A Removal of shoulderblade ................................. 12.49 NA 10.38 1.41 NA 24.28 090

23220 ............ A Partial removal of humerus ................................ 14.56 NA 12.42 2.03 NA 29.01 090

23221 ............ A Partial removal of humerus ................................ 17.74 NA 13.26 1.19 NA 32.19 090

23222 ............ A Partial removal of humerus ................................ 23.92 NA 17.77 2.30 NA 43.99 090

23330 ............ A Remove shoulder foreign body .......................... 1.85 3.00 2.14 0.07 4.92 4.06 010

23331 ............ A Remove shoulder foreign body .......................... 7.38 NA 7.54 0.38 NA 15.30 090

23332 ............ A Remove shoulder foreign body .......................... 11.62 NA 10.00 1.57 NA 23.19 090

23350 ............ A Injection for shoulder x-ray ................................ 1.00 7.27 0.32 0.05 8.32 1.37 000

23395 ............ A Muscle transfer, shoulder/arm ........................... 16.85 NA 12.50 1.84 NA 31.19 090

23397 ............ A Muscle transfers ................................................. 16.13 NA 12.69 2.34 NA 31.16 090

23400 ............ A Fixation of shoulder blade .................................. 13.54 NA 11.05 1.68 NA 26.27 090

23405 ............ A Incision of tendon & muscle ............................... 8.37 NA 7.26 0.99 NA 16.62 090

23406 ............ A Incise tendon(s) & muscle(s) ............................. 10.79 NA 9.63 1.58 NA 22.00 090

23410 ............ A Repair of tendon(s) ............................................ 12.45 NA 10.34 1.75 NA 24.54 090

23412 ............ A Repair of tendon(s) ............................................ 13.31 NA 10.87 2.16 NA 26.34 090

23415 ............ A Release of shoulder ligament ............................ 9.97 NA 8.38 0.83 NA 19.18 090

23420 ............ A Repair of shoulder .............................................. 13.30 NA 11.39 2.34 NA 27.03 090

23430 ............ A Repair biceps tendon ......................................... 9.98 NA 8.91 1.19 NA 20.08 090

23440 ............ A Removal/transplant tendon ................................ 10.48 NA 9.31 1.17 NA 20.96 090

23450 ............ A Repair shoulder capsule .................................... 13.40 NA 10.73 2.04 NA 26.17 090

23455 ............ A Repair shoulder capsule .................................... 14.37 NA 11.51 2.50 NA 28.38 090

23460 ............ A Repair shoulder capsule .................................... 15.37 NA 6.49 2.24 NA 24.10 090

23462 ............ A Repair shoulder capsule .................................... 15.30 NA 12.08 2.48 NA 29.86 090

23465 ............ A Repair shoulder capsule .................................... 15.85 NA 12.50 2.27 NA 30.62 090

23466 ............ A Repair shoulder capsule .................................... 14.22 NA 11.54 2.67 NA 28.43 090

23470 ............ A Reconstruct shoulder joint ................................. 17.15 NA 13.00 2.65 NA 32.80 090

23472 ............ A Reconstruct shoulder joint ................................. 16.92 NA 13.09 4.89 NA 34.90 090

23480 ............ A Revision of collarbone ........................................ 11.18 NA 9.78 1.02 NA 21.98 090

23485 ............ A Revision of collar bone ...................................... 13.43 NA 11.19 1.87 NA 26.49 090

23490 ............ A Reinforce clavicle ............................................... 11.86 NA 9.43 0.80 NA 22.09 090

23491 ............ A Reinforce shoulder bones .................................. 14.21 NA 11.56 2.11 NA 27.88 090

23500 ............ A Treat clavicle fracture ......................................... 2.08 2.63 1.61 0.21 4.92 3.90 090

23505 ............ A Treat clavicle fracture ......................................... 3.69 4.24 3.17 0.38 8.31 7.24 090

23515 ............ A Repair clavicle fracture ...................................... 7.41 NA 6.65 1.12 NA 15.18 090

23520 ............ A Treat clavicle dislocation .................................... 2.16 2.54 1.82 0.19 4.89 4.17 090

23525 ............ A Treat clavicle dislocation .................................... 3.60 4.07 3.00 0.27 7.94 6.87 090

23530 ............ A Repair clavicle dislocation .................................. 7.31 NA 5.55 0.91 NA 13.77 090

23532 ............ A Repair clavicle dislocation .................................. 8.01 NA 7.16 1.19 NA 16.36 090

23540 ............ A Treat clavicle dislocation .................................... 2.23 3.04 1.43 0.19 5.46 3.85 090

23545 ............ A Treat clavicle dislocation .................................... 3.25 3.55 2.57 0.29 7.09 6.11 090

23550 ............ A Repair clavicle dislocation .................................. 7.24 NA 6.40 1.46 NA 15.10 090

23552 ............ A Repair clavicle dislocation .................................. 8.45 NA 7.05 1.17 NA 16.67 090

23570 ............ A Treat shoulderblade fracture .............................. 2.23 2.68 2.01 0.25 5.16 4.49 090

23575 ............ A Treat shoulderblade fracture .............................. 4.06 4.54 3.46 0.43 9.03 7.95 090

23585 ............ A Repair scapula fracture ...................................... 8.96 NA 7.78 1.29 NA 18.03 090

23600 ............ A Treat humerus fracture ...................................... 2.93 4.15 2.57 0.43 7.51 5.93 090

23605 ............ A Treat humerus fracture ...................................... 4.87 6.21 5.13 0.76 11.84 10.76 090

23615 ............ A Repair humerus fracture .................................... 9.35 NA 8.32 1.78 NA 19.45 090

23616 ............ A Repair humerus fracture .................................... 21.27 NA 14.86 3.54 NA 39.67 090

23620 ............ A Treat humerus fracture ...................................... 2.40 3.85 2.21 0.46 6.71 5.07 090

23625 ............ A Treat humerus fracture ...................................... 3.93 5.44 4.29 0.60 9.97 8.82 090

23630 ............ A Repair humerus fracture .................................... 7.35 NA 6.58 1.40 NA 15.33 090

23650 ............ A Treat shoulder dislocation .................................. 3.39 3.73 1.91 0.24 7.36 5.54 090

23655 ............ A Treat shoulder dislocation .................................. 4.57 NA 3.11 0.44 NA 8.12 090
30913

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

23660 ............ A Repair shoulder dislocation ................................ 7.49 NA 6.16 1.40 NA 15.05 090

23665 ............ A Treat dislocation/fracture .................................... 4.47 5.60 4.59 0.51 10.58 9.57 090

23670 ............ A Repair dislocation/fracture ................................. 7.90 NA 7.09 1.85 NA 16.84 090

23675 ............ A Treat dislocation/fracture .................................... 6.05 6.66 5.56 0.61 13.32 12.22 090

23680 ............ A Repair dislocation/fracture ................................. 10.06 NA 8.32 2.13 NA 20.51 090

23700 ............ A Fixation of shoulder ............................................ 2.52 NA 2.79 0.34 NA 5.65 010

23800 ............ A Fusion of shoulder joint ...................................... 14.16 NA 11.49 2.63 NA 28.28 090

23802 ............ A Fusion of shoulder joint ...................................... 16.60 NA 13.56 2.24 NA 32.40 090

23900 ............ A Amputation of arm & girdle ................................ 19.72 NA 13.23 2.40 NA 35.35 090

23920 ............ A Amputation at shoulder joint .............................. 14.61 NA 11.09 2.54 NA 28.24 090

23921 ............ A Amputation follow-up surgery ............................ 5.49 6.05 4.83 0.74 12.28 11.06 090

23930 ............ A Drainage of arm lesion ....................................... 2.94 3.45 2.68 0.24 6.63 5.86 010

23931 ............ A Drainage of arm bursa ....................................... 1.79 3.20 2.61 0.11 5.10 4.51 010

23935 ............ A Drain arm/elbow bone lesion ............................. 6.09 NA 8.88 0.78 NA 15.75 090

24000 ............ A Exploratory elbow surgery ................................. 5.82 NA 5.29 1.44 NA 12.55 090

24006 ............ A Release elbow joint ............................................ 9.31 NA 7.32 1.17 NA 17.80 090

24065 ............ A Biopsy arm/elbow soft tissue ............................. 2.08 2.91 2.19 0.10 5.09 4.37 010

24066 ............ A Biopsy arm/elbow soft tissue ............................. 5.21 5.26 4.91 0.41 10.88 10.53 090

24075 ............ A Remove arm/elbow lesion .................................. 3.92 4.47 3.94 0.35 8.74 8.21 090

24076 ............ A Remove arm/elbow lesion .................................. 6.30 NA 5.29 0.67 NA 12.26 090

24077 ............ A Remove tumor of arm/elbow .............................. 11.76 NA 9.56 1.87 NA 23.19 090

24100 ............ A Biopsy elbow joint lining ..................................... 4.93 NA 4.41 0.69 NA 10.03 090

24101 ............ A Explore/treat elbow joint ..................................... 6.13 NA 5.48 1.41 NA 13.02 090

24102 ............ A Remove elbow joint lining .................................. 8.03 NA 5.02 1.81 NA 14.86 090

24105 ............ A Removal of elbow bursa .................................... 3.61 NA 3.83 0.63 NA 8.07 090

24110 ............ A Remove humerus lesion .................................... 7.39 NA 7.38 1.22 NA 15.99 090

24115 ............ A Remove/graft bone lesion .................................. 9.63 NA 9.08 1.33 NA 20.04 090

24116 ............ A Remove/graft bone lesion .................................. 11.81 NA 10.34 1.47 NA 23.62 090

24120 ............ A Remove elbow lesion ......................................... 6.65 NA 5.69 0.98 NA 13.32 090

24125 ............ A Remove/graft bone lesion .................................. 7.89 NA 6.71 0.61 NA 15.21 090

24126 ............ A Remove/graft bone lesion .................................. 8.31 NA 5.16 1.21 NA 14.68 090

24130 ............ A Removal of head of radius ................................. 6.25 NA 5.61 1.08 NA 12.94 090

24134 ............ A Removal of arm bone lesion .............................. 9.73 NA 11.90 1.24 NA 22.87 090

24136 ............ A Remove radius bone lesion ............................... 7.99 NA 5.46 0.92 NA 14.37 090

24138 ............ A Remove elbow bone lesion ................................ 8.05 NA 6.86 1.06 NA 15.97 090

24140 ............ A Partial removal of arm bone .............................. 9.18 NA 12.04 1.45 NA 22.67 090

24145 ............ A Partial removal of radius .................................... 7.58 NA 8.91 1.03 NA 17.52 090

24147 ............ A Partial removal of elbow .................................... 7.54 NA 8.68 1.08 NA 17.30 090

24149 ............ A Radical resection of elbow ................................. 14.20 NA 9.65 2.07 NA 25.92 090

24150 ............ A Extensive humerus surgery ............................... 13.27 NA 11.56 2.24 NA 27.07 090

24151 ............ A Extensive humerus surgery ............................... 15.58 NA 12.80 2.11 NA 30.49 090

24152 ............ A Extensive radius surgery .................................... 10.06 NA 8.54 1.16 NA 19.76 090

24153 ............ A Extensive radius surgery .................................... 11.54 NA 6.20 1.71 NA 19.45 090

24155 ............ A Removal of elbow joint ....................................... 11.73 NA 8.35 1.72 NA 21.80 090

24160 ............ A Remove elbow joint implant ............................... 7.83 NA 6.62 0.80 NA 15.25 090

24164 ............ A Remove radius head implant ............................. 6.23 NA 5.52 0.90 NA 12.65 090

24200 ............ A Removal of arm foreign body ............................ 1.76 2.87 1.96 0.06 4.69 3.78 010

24201 ............ A Removal of arm foreign body ............................ 4.56 5.46 4.53 0.49 10.51 9.58 090

24220 ............ A Injection for elbow x-ray ..................................... 1.31 8.29 0.43 0.05 9.65 1.79 000

24301 ............ A Muscle/tendon transfer ....................................... 10.20 NA 7.76 1.23 NA 19.19 090

24305 ............ A Arm tendon lengthening ..................................... 7.45 NA 6.23 0.29 NA 13.97 090

24310 ............ A Revision of arm tendon ...................................... 5.98 NA 6.20 0.48 NA 12.66 090

24320 ............ A Repair of arm tendon ......................................... 10.56 NA 7.53 1.29 NA 19.38 090

24330 ............ A Revision of arm muscles .................................... 9.60 NA 7.25 1.43 NA 18.28 090

24331 ............ A Revision of arm muscles .................................... 10.65 NA 8.39 1.57 NA 20.61 090

24340 ............ A Repair of biceps tendon ..................................... 7.89 NA 6.50 1.13 NA 15.52 090

24341 ............ A Repair tendon/muscle arm ................................. 7.90 NA 6.57 1.14 NA 15.61 090

24342 ............ A Repair of ruptured tendon .................................. 10.62 NA 8.13 1.76 NA 20.51 090

24350 ............ A Repair of tennis elbow ....................................... 5.25 NA 4.97 0.69 NA 10.91 090

24351 ............ A Repair of tennis elbow ....................................... 5.91 NA 5.44 0.73 NA 12.08 090

24352 ............ A Repair of tennis elbow ....................................... 6.43 NA 5.76 0.93 NA 13.12 090

24354 ............ A Repair of tennis elbow ....................................... 6.48 NA 5.81 0.94 NA 13.23 090

24356 ............ A Revision of tennis elbow .................................... 6.68 NA 5.85 1.18 NA 13.71 090

24360 ............ A Reconstruct elbow joint ...................................... 12.34 NA 9.03 2.47 NA 23.84 090

24361 ............ A Reconstruct elbow joint ...................................... 14.08 NA 10.28 2.00 NA 26.36 090

24362 ............ A Reconstruct elbow joint ...................................... 14.99 NA 8.91 0.80 NA 24.70 090

24363 ............ A Replace elbow joint ............................................ 18.49 NA 12.86 4.13 NA 35.48 090

24365 ............ A Reconstruct head of radius ................................ 8.39 NA 6.95 1.19 NA 16.53 090

24366 ............ A Reconstruct head of radius ................................ 9.13 NA 7.19 1.80 NA 18.12 090

24400 ............ A Revision of humerus .......................................... 11.06 NA 10.14 1.37 NA 22.57 090

24410 ............ A Revision of humerus .......................................... 14.82 NA 11.94 2.06 NA 28.82 090

24420 ............ A Revision of humerus .......................................... 13.44 NA 13.08 2.01 NA 28.53 090

24430 ............ A Repair of humerus ............................................. 12.81 NA 10.71 2.34 NA 25.86 090

24435 ............ A Repair humerus with graft .................................. 13.17 NA 11.46 2.84 NA 27.47 090
30914

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

24470 ............ A Revision of elbow joint ....................................... 8.74 NA 4.63 1.30 NA 14.67 090

24495 ............ A Decompression of forearm ................................. 8.12 NA 7.31 1.10 NA 16.53 090

24498 ............ A Reinforce humerus ............................................. 11.92 NA 10.21 1.62 NA 23.75 090

24500 ............ A Treat humerus fracture ...................................... 3.21 5.47 2.28 0.36 9.04 5.85 090

24505 ............ A Treat humerus fracture ...................................... 5.17 8.36 5.37 0.71 14.24 11.25 090

24515 ............ A Repair humerus fracture .................................... 11.65 NA 9.55 1.54 NA 22.74 090

24516 ............ A Repair humerus fracture .................................... 11.65 NA 9.97 1.54 NA 23.16 090

24530 ............ A Treat humerus fracture ...................................... 3.50 6.29 3.38 0.42 10.21 7.30 090

24535 ............ A Treat humerus fracture ...................................... 6.87 8.76 5.80 0.78 16.41 13.45 090

24538 ............ A Treat humerus fracture ...................................... 9.43 NA 8.63 1.26 NA 19.32 090

24545 ............ A Repair humerus fracture .................................... 10.46 NA 8.63 1.59 NA 20.68 090

24546 ............ A Repair humerus fracture .................................... 15.69 NA 11.88 1.59 NA 29.16 090

24560 ............ A Treat humerus fracture ...................................... 2.80 5.22 1.84 0.30 8.32 4.94 090

24565 ............ A Treat humerus fracture ...................................... 5.56 7.80 4.89 0.54 13.90 10.99 090

24566 ............ A Treat humerus fracture ...................................... 7.79 NA 7.72 0.96 NA 16.47 090

24575 ............ A Repair humerus fracture .................................... 10.66 NA 7.63 1.24 NA 19.53 090

24576 ............ A Treat humerus fracture ...................................... 2.86 5.19 2.32 0.33 8.38 5.51 090

24577 ............ A Treat humerus fracture ...................................... 5.79 8.10 5.13 0.61 14.50 11.53 090

24579 ............ A Repair humerus fracture .................................... 11.60 NA 9.50 1.35 NA 22.45 090

24582 ............ A Treat humerus fracture ...................................... 8.55 NA 7.95 1.06 NA 17.56 090

24586 ............ A Repair elbow fracture ......................................... 15.21 NA 10.29 2.36 NA 27.86 090

24587 ............ A Repair elbow fracture ......................................... 15.16 NA 10.16 2.17 NA 27.49 090

24600 ............ A Treat elbow dislocation ...................................... 4.23 6.87 3.19 0.26 11.36 7.68 090

24605 ............ A Treat elbow dislocation ...................................... 5.42 NA 4.19 0.37 NA 9.98 090

24615 ............ A Repair elbow dislocation .................................... 9.42 NA 7.03 1.48 NA 17.93 090

24620 ............ A Treat elbow fracture ........................................... 6.98 NA 5.53 0.57 NA 13.08 090

24635 ............ A Repair elbow fracture ......................................... 13.19 NA 17.15 1.78 NA 32.12 090

24640 ............ A Treat elbow dislocation ...................................... 1.20 3.49 0.77 0.08 4.77 2.05 010

24650 ............ A Treat radius fracture ........................................... 2.16 4.93 1.72 0.33 7.42 4.21 090

24655 ............ A Treat radius fracture ........................................... 4.40 7.15 4.13 0.45 12.00 8.98 090

24665 ............ A Repair radius fracture ........................................ 8.14 NA 7.41 1.14 NA 16.69 090

24666 ............ A Repair radius fracture ........................................ 9.49 NA 8.31 1.60 NA 19.40 090

24670 ............ A Treatment of ulna fracture ................................. 2.54 4.99 2.09 0.27 7.80 4.90 090

24675 ............ A Treatment of ulna fracture ................................. 4.72 7.44 4.48 0.54 12.70 9.74 090

24685 ............ A Repair ulna fracture ........................................... 8.80 NA 7.82 1.34 NA 17.96 090

24800 ............ A Fusion of elbow joint .......................................... 11.20 NA 8.22 1.55 NA 20.97 090

24802 ............ A Fusion/graft of elbow joint .................................. 13.69 NA 10.51 1.99 NA 26.19 090

24900 ............ A Amputation of upper arm ................................... 9.60 NA 8.14 1.39 NA 19.13 090

24920 ............ A Amputation of upper arm ................................... 9.54 NA 9.61 1.19 NA 20.34 090

24925 ............ A Amputation follow-up surgery ............................ 7.07 NA 6.11 0.75 NA 13.93 090

24930 ............ A Amputation follow-up surgery ............................ 10.25 NA 9.60 1.17 NA 21.02 090

24931 ............ A Amputate upper arm & implant .......................... 12.72 NA 11.49 1.84 NA 26.05 090

24935 ............ A Revision of amputation ...................................... 15.56 NA 10.07 2.24 NA 27.87 090

25000 ............ A Incision of tendon sheath ................................... 3.38 NA 5.29 0.62 NA 9.29 090

25020 ............ A Decompression of forearm ................................. 5.92 NA 7.99 0.77 NA 14.68 090

25023 ............ A Decompression of forearm ................................. 12.96 NA 13.16 0.94 NA 27.06 090

25028 ............ A Drainage of forearm lesion ................................ 5.25 NA 6.95 0.36 NA 12.56 090

25031 ............ A Drainage of forearm bursa ................................. 4.14 NA 6.81 0.09 NA 11.04 090

25035 ............ A Treat forearm bone lesion .................................. 7.36 NA 11.52 1.01 NA 19.89 090

25040 ............ A Explore/treat wrist joint ....................................... 7.18 NA 7.45 0.90 NA 15.53 090

25065 ............ A Biopsy forearm soft tissues ................................ 1.99 1.90 2.55 0.09 3.98 4.63 010

25066 ............ A Biopsy forearm soft tissues ................................ 4.13 NA 6.13 0.22 NA 10.48 090

25075 ............ A Removal of forearm lesion ................................. 3.74 NA 5.14 0.37 NA 9.25 090

25076 ............ A Removal of forearm lesion ................................. 4.92 NA 8.53 0.67 NA 14.12 090

25077 ............ A Remove tumor, forearm/wrist ............................. 9.76 NA 10.69 1.67 NA 22.12 090

25085 ............ A Incision of wrist capsule ..................................... 5.50 NA 7.81 0.71 NA 14.02 090

25100 ............ A Biopsy of wrist joint ............................................ 3.90 NA 5.49 0.79 NA 10.18 090

25101 ............ A Explore/treat wrist joint ....................................... 4.69 NA 5.99 0.98 NA 11.66 090

25105 ............ A Remove wrist joint lining .................................... 5.85 NA 8.15 1.19 NA 15.19 090

25107 ............ A Remove wrist joint cartilage ............................... 6.43 NA 8.52 0.89 NA 15.84 090

25110 ............ A Remove wrist tendon lesion ............................... 3.92 NA 5.83 0.46 NA 10.21 090

25111 ............ A Remove wrist tendon lesion ............................... 3.39 NA 4.52 0.55 NA 8.46 090

25112 ............ A Reremove wrist tendon lesion ........................... 4.53 NA 5.26 0.66 NA 10.45 090

25115 ............ A Remove wrist/forearm lesion ............................. 8.82 NA 11.76 1.23 NA 21.81 090

25116 ............ A Remove wrist/forearm lesion ............................. 7.11 NA 10.94 1.38 NA 19.43 090

25118 ............ A Excise wrist tendon sheath ................................ 4.37 NA 5.83 1.02 NA 11.22 090

25119 ............ A Partial removal of ulna ....................................... 6.04 NA 8.38 1.32 NA 15.74 090

25120 ............ A Removal of forearm lesion ................................. 6.10 NA 10.24 1.14 NA 17.48 090

25125 ............ A Remove/graft forearm lesion .............................. 7.48 NA 10.82 1.04 NA 19.34 090

25126 ............ A Remove/graft forearm lesion .............................. 7.55 NA 11.84 1.12 NA 20.51 090

25130 ............ A Removal of wrist lesion ...................................... 5.26 NA 6.41 0.67 NA 12.34 090

25135 ............ A Remove & graft wrist lesion ............................... 6.89 NA 7.29 0.97 NA 15.15 090

25136 ............ A Remove & graft wrist lesion ............................... 5.97 NA 6.61 0.85 NA 13.43 090

25145 ............ A Remove forearm bone lesion ............................. 6.37 NA 10.24 0.75 NA 17.36 090
30915

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

25150 ............ A Partial removal of ulna ....................................... 7.09 NA 8.99 1.12 NA 17.20 090

25151 ............ A Partial removal of radius .................................... 7.39 NA 11.22 1.02 NA 19.63 090

25170 ............ A Extensive forearm surgery ................................. 11.09 NA 12.78 1.51 NA 25.38 090

25210 ............ A Removal of wrist bone ....................................... 5.95 NA 6.68 0.80 NA 13.43 090

25215 ............ A Removal of wrist bones ..................................... 7.89 NA 9.32 1.42 NA 18.63 090

25230 ............ A Partial removal of radius .................................... 5.23 NA 6.38 0.85 NA 12.46 090

25240 ............ A Partial removal of ulna ....................................... 5.17 NA 7.82 0.86 NA 13.85 090

25246 ............ A Injection for wrist x-ray ....................................... 1.45 8.10 0.47 0.05 9.60 1.97 000

25248 ............ A Remove forearm foreign body ........................... 5.14 NA 6.89 0.37 NA 12.40 090

25250 ............ A Removal of wrist prosthesis ............................... 6.60 NA 7.13 0.91 NA 14.64 090

25251 ............ A Removal of wrist prosthesis ............................... 9.57 NA 10.66 1.39 NA 21.62 090

25260 ............ A Repair forearm tendon/muscle ........................... 7.80 NA 11.24 0.78 NA 19.82 090

25263 ............ A Repair forearm tendon/muscle ........................... 7.82 NA 10.83 1.03 NA 19.68 090

25265 ............ A Repair forearm tendon/muscle ........................... 9.88 NA 12.92 1.41 NA 24.21 090

25270 ............ A Repair forearm tendon/muscle ........................... 6.00 NA 10.35 0.55 NA 16.90 090

25272 ............ A Repair forearm tendon/muscle ........................... 7.04 NA 10.95 0.54 NA 18.53 090

25274 ............ A Repair forearm tendon/muscle ........................... 8.75 NA 11.62 1.13 NA 21.50 090

25280 ............ A Revise wrist/forearm tendon .............................. 7.22 NA 11.21 0.69 NA 19.12 090

25290 ............ A Incise wrist/forearm tendon ................................ 5.29 NA 12.04 0.41 NA 17.74 090

25295 ............ A Release wrist/forearm tendon ............................ 6.55 NA 9.86 0.52 NA 16.93 090

25300 ............ A Fusion of tendons at wrist .................................. 8.80 NA 8.20 1.19 NA 18.19 090

25301 ............ A Fusion of tendons at wrist .................................. 8.40 NA 7.92 1.18 NA 17.50 090

25310 ............ A Transplant forearm tendon ................................. 8.14 NA 11.53 1.17 NA 20.84 090

25312 ............ A Transplant forearm tendon ................................. 9.57 NA 12.17 1.31 NA 23.05 090

25315 ............ A Revise palsy hand tendon(s) ............................. 10.20 NA 13.02 1.34 NA 24.56 090

25316 ............ A Revise palsy hand tendon(s) ............................. 12.33 NA 14.28 1.78 NA 28.39 090

25320 ............ A Repair/revise wrist joint ...................................... 10.77 NA 9.55 1.45 NA 21.77 090

25332 ............ A Revise wrist joint ................................................ 11.41 NA 9.84 1.61 NA 22.86 090

25335 ............ A Realignment of hand .......................................... 12.88 NA 12.17 1.56 NA 26.61 090

25337 ............ A Reconstruct ulna/radioulnar ............................... 10.17 NA 10.87 1.45 NA 22.49 090

25350 ............ A Revision of radius .............................................. 8.78 NA 11.95 1.26 NA 21.99 090

25355 ............ A Revision of radius .............................................. 10.17 NA 12.54 1.49 NA 24.20 090

25360 ............ A Revision of ulna ................................................. 8.43 NA 11.72 0.99 NA 21.14 090

25365 ............ A Revise radius & ulna .......................................... 12.40 NA 13.58 1.57 NA 27.55 090

25370 ............ A Revise radius or ulna ......................................... 13.36 NA 15.03 1.92 NA 30.31 090

25375 ............ A Revise radius & ulna .......................................... 13.04 NA 14.84 0.87 NA 28.75 090

25390 ............ A Shorten radius/ulna ............................................ 10.40 NA 13.14 1.50 NA 25.04 090

25391 ............ A Lengthen radius/ulna .......................................... 13.65 NA 14.69 1.93 NA 30.27 090

25392 ............ A Shorten radius & ulna ........................................ 13.95 NA 13.19 2.04 NA 29.18 090

25393 ............ A Lengthen radius & ulna ...................................... 15.87 NA 16.01 2.32 NA 34.20 090

25400 ............ A Repair radius or ulna ......................................... 10.92 NA 13.41 1.75 NA 26.08 090

25405 ............ A Repair/graft radius or ulna ................................. 14.38 NA 15.51 2.02 NA 31.91 090

25415 ............ A Repair radius & ulna .......................................... 13.35 NA 14.84 1.92 NA 30.11 090

25420 ............ A Repair/graft radius & ulna .................................. 16.33 NA 16.41 2.28 NA 35.02 090

25425 ............ A Repair/graft radius or ulna ................................. 13.21 NA 19.06 1.87 NA 34.14 090

25426 ............ A Repair/graft radius & ulna .................................. 15.82 NA 15.54 2.13 NA 33.49 090

25440 ............ A Repair/graft wrist bone ....................................... 10.44 NA 9.35 1.50 NA 21.29 090

25441 ............ A Reconstruct wrist joint ........................................ 12.90 NA 10.57 1.89 NA 25.36 090

25442 ............ A Reconstruct wrist joint ........................................ 10.85 NA 9.78 1.22 NA 21.85 090

25443 ............ A Reconstruct wrist joint ........................................ 10.39 NA 11.14 1.52 NA 23.05 090

25444 ............ A Reconstruct wrist joint ........................................ 11.15 NA 11.18 1.66 NA 23.99 090

25445 ............ A Reconstruct wrist joint ........................................ 9.69 NA 10.54 1.72 NA 21.95 090

25446 ............ A Wrist replacement .............................................. 16.55 NA 12.82 3.49 NA 32.86 090

25447 ............ A Repair wrist joint(s) ............................................ 10.37 NA 9.41 1.56 NA 21.34 090

25449 ............ A Remove wrist joint implant ................................. 14.49 NA 13.45 1.16 NA 29.10 090

25450 ............ A Revision of wrist joint ......................................... 7.87 NA 6.29 1.19 NA 15.35 090

25455 ............ A Revision of wrist joint ......................................... 9.49 NA 12.73 1.42 NA 23.64 090

25490 ............ A Reinforce radius ................................................. 9.54 NA 12.48 1.42 NA 23.44 090

25491 ............ A Reinforce ulna .................................................... 9.96 NA 12.22 1.49 NA 23.67 090

25492 ............ A Reinforce radius and ulna .................................. 12.33 NA 14.20 1.84 NA 28.37 090

25500 ............ A Treat fracture of radius ...................................... 2.45 4.50 1.75 0.29 7.24 4.49 090

25505 ............ A Treat fracture of radius ...................................... 5.21 7.56 4.57 0.51 13.28 10.29 090

25515 ............ A Repair fracture of radius .................................... 9.18 NA 8.04 1.22 NA 18.44 090

25520 ............ A Repair fracture of radius .................................... 6.26 7.33 5.16 0.94 14.53 12.36 090

25525 ............ A Repair fracture of radius .................................... 12.24 NA 9.89 1.83 NA 23.96 090

25526 ............ A Repair fracture of radius .................................... 12.98 NA 14.96 1.94 NA 29.88 090

25530 ............ A Treat fracture of ulna ......................................... 2.09 4.66 1.88 0.35 7.10 4.32 090

25535 ............ A Treat fracture of ulna ......................................... 5.14 7.62 4.56 0.54 13.30 10.24 090

25545 ............ A Repair fracture of ulna ....................................... 8.90 NA 7.87 1.20 NA 17.97 090

25560 ............ A Treat fracture radius & ulna ............................... 2.44 4.72 1.52 0.27 7.43 4.23 090

25565 ............ A Treat fracture radius & ulna ............................... 5.63 7.84 4.83 0.70 14.17 11.16 090

25574 ............ A Treat fracture radius & ulna ............................... 7.01 NA 6.77 1.73 NA 15.51 090

25575 ............ A Repair fracture radius/ulna ................................. 10.45 NA 8.74 1.73 NA 20.92 090

25600 ............ A Treat fracture radius/ulna ................................... 2.63 5.04 1.96 0.42 8.09 5.01 090
30916

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

25605 ............ A Treat fracture radius/ulna ................................... 5.81 8.09 5.07 0.61 14.51 11.49 090

25611 ............ A Repair fracture radius/ulna ................................. 7.77 NA 7.72 0.97 NA 16.46 090

25620 ............ A Repair fracture radius/ulna ................................. 8.55 NA 7.68 1.14 NA 17.37 090

25622 ............ A Treat wrist bone fracture .................................... 2.61 4.94 1.89 0.33 7.88 4.83 090

25624 ............ A Treat wrist bone fracture .................................... 4.53 7.20 4.03 0.57 12.30 9.13 090

25628 ............ A Repair wrist bone fracture .................................. 8.43 NA 7.54 1.16 NA 17.13 090

25630 ............ A Treat wrist bone fracture .................................... 2.88 5.15 1.89 0.30 8.33 5.07 090

25635 ............ A Treat wrist bone fracture .................................... 4.39 7.04 2.65 0.50 11.93 7.54 090

25645 ............ A Repair wrist bone fracture .................................. 7.25 NA 6.63 0.95 NA 14.83 090

25650 ............ A Repair wrist bone fracture .................................. 3.05 5.07 1.85 0.36 8.48 5.26 090

25660 ............ A Treat wrist dislocation ........................................ 4.76 NA 3.77 0.26 NA 8.79 090

25670 ............ A Repair wrist dislocation ...................................... 7.92 NA 7.24 1.12 NA 16.28 090

25675 ............ A Treat wrist dislocation ........................................ 4.67 6.88 3.73 0.34 11.89 8.74 090

25676 ............ A Repair wrist dislocation ...................................... 8.04 NA 7.31 1.11 NA 16.46 090

25680 ............ A Treat wrist fracture ............................................. 5.99 NA 4.82 0.36 NA 11.17 090

25685 ............ A Repair wrist fracture ........................................... 9.78 NA 8.08 1.44 NA 19.30 090

25690 ............ A Treat wrist dislocation ........................................ 5.50 NA 5.30 0.73 NA 11.53 090

25695 ............ A Repair wrist dislocation ...................................... 8.34 NA 7.53 1.17 NA 17.04 090

25800 ............ A Fusion of wrist joint ............................................ 9.76 NA 9.00 1.80 NA 20.56 090

25805 ............ A Fusion/graft of wrist joint .................................... 11.28 NA 9.89 2.09 NA 23.26 090

25810 ............ A Fusion/graft of wrist joint .................................... 10.57 NA 9.51 2.06 NA 22.14 090

25820 ............ A Fusion of hand bones ........................................ 7.45 NA 7.22 1.48 NA 16.15 090

25825 ............ A Fusion hand bones with graft ............................ 9.27 NA 8.75 1.99 NA 20.01 090

25830 ............ A Fusion radioulnar jnt/ulna ................................... 10.06 NA 12.33 1.45 NA 23.84 090

25900 ............ A Amputation of forearm ....................................... 9.01 NA 10.20 1.31 NA 20.52 090

25905 ............ A Amputation of forearm ....................................... 9.12 NA 10.56 1.15 NA 20.83 090

25907 ............ A Amputation follow-up surgery ............................ 7.80 NA 9.44 1.00 NA 18.24 090

25909 ............ A Amputation follow-up surgery ............................ 8.96 NA 9.25 1.06 NA 19.27 090

25915 ............ A Amputation of forearm ....................................... 17.08 NA 27.86 2.59 NA 47.53 090

25920 ............ A Amputate hand at wrist ...................................... 8.68 NA 7.64 1.20 NA 17.52 090

25922 ............ A Amputate hand at wrist ...................................... 7.42 NA 8.39 1.02 NA 16.83 090

25924 ............ A Amputation follow-up surgery ............................ 8.46 NA 6.74 1.22 NA 16.42 090

25927 ............ A Amputation of hand ............................................ 8.80 NA 9.39 1.22 NA 19.41 090

25929 ............ A Amputation follow-up surgery ............................ 7.59 NA 5.42 0.96 NA 13.97 090

25931 ............ A Amputation follow-up surgery ............................ 7.81 NA 9.81 0.90 NA 18.52 090

26010 ............ A Drainage of finger abscess ................................ 1.54 3.16 2.25 0.05 4.75 3.84 010

26011 ............ A Drainage of finger abscess ................................ 2.19 4.46 4.45 0.24 6.89 6.88 010

26020 ............ A Drain hand tendon sheath ................................. 4.67 NA 8.66 0.63 NA 13.96 090

26025 ............ A Drainage of palm bursa ..................................... 4.82 NA 8.82 0.76 NA 14.40 090

26030 ............ A Drainage of palm bursa(s) ................................. 5.93 NA 9.38 0.98 NA 16.29 090

26034 ............ A Treat hand bone lesion ...................................... 6.23 NA 10.41 0.71 NA 17.35 090

26035 ............ A Decompress fingers/hand .................................. 9.51 NA 11.92 0.86 NA 22.29 090

26037 ............ A Decompress fingers/hand .................................. 7.25 NA 7.75 1.05 NA 16.05 090

26040 ............ A Release palm contracture .................................. 3.33 NA 7.99 0.49 NA 11.81 090

26045 ............ A Release palm contracture .................................. 5.56 NA 9.39 0.81 NA 15.76 090

26055 ............ A Incise finger tendon sheath ................................ 2.69 5.15 8.67 0.56 8.40 11.92 090

26060 ............ A Incision of finger tendon ..................................... 2.81 NA 5.19 0.17 NA 8.17 090

26070 ............ A Explore/treat hand joint ...................................... 3.69 NA 7.33 0.42 NA 11.44 090

26075 ............ A Explore/treat finger joint ..................................... 3.79 NA 7.85 0.62 NA 12.26 090

26080 ............ A Explore/treat finger joint ..................................... 4.24 NA 8.63 0.51 NA 13.38 090

26100 ............ A Biopsy hand joint lining ...................................... 3.67 NA 5.43 0.45 NA 9.55 090

26105 ............ A Biopsy finger joint lining ..................................... 3.71 NA 8.19 0.67 NA 12.57 090

26110 ............ A Biopsy finger joint lining ..................................... 3.53 NA 7.67 0.50 NA 11.70 090

26115 ............ A Removal of hand lesion ..................................... 3.86 4.94 9.00 0.34 9.14 13.20 090

26116 ............ A Removal of hand lesion ..................................... 5.53 NA 9.13 0.62 NA 15.28 090

26117 ............ A Remove tumor, hand/finger ............................... 8.55 NA 10.50 0.91 NA 19.96 090

26121 ............ A Release palm contracture .................................. 7.54 NA 10.65 1.61 NA 19.80 090

26123 ............ A Release palm contracture .................................. 9.29 NA 11.74 1.53 NA 22.56 090

26125 ............ A Release palm contracture .................................. 4.61 NA 2.91 0.45 NA 7.97 ZZZ

26130 ............ A Remove wrist joint lining .................................... 5.42 NA 10.50 0.86 NA 16.78 090

26135 ............ A Revise finger joint, each .................................... 6.96 NA 11.26 0.82 NA 19.04 090

26140 ............ A Revise finger joint, each .................................... 6.17 NA 10.68 0.75 NA 17.60 090

26145 ............ A Tendon excision, palm/finger ............................. 6.32 NA 10.64 0.80 NA 17.76 090

26160 ............ A Remove tendon sheath lesion ........................... 3.15 4.64 8.83 0.40 8.19 12.38 090

26170 ............ A Removal of palm tendon, each .......................... 4.77 NA 6.08 0.45 NA 11.30 090

26180 ............ A Removal of finger tendon ................................... 5.18 NA 6.32 0.71 NA 12.21 090

26185 ............ A Remove finger bone ........................................... 5.25 NA 11.35 0.41 NA 17.01 090

26200 ............ A Remove hand bone lesion ................................. 5.51 NA 9.13 0.72 NA 15.36 090

26205 ............ A Remove/graft bone lesion .................................. 7.70 NA 10.26 1.03 NA 18.99 090

26210 ............ A Removal of finger lesion .................................... 5.15 NA 9.15 0.64 NA 14.94 090

26215 ............ A Remove/graft finger lesion ................................. 7.10 NA 10.24 0.94 NA 18.28 090

26230 ............ A Partial removal of hand bone ............................. 6.33 NA 9.17 0.69 NA 16.19 090

26235 ............ A Partial removal, finger bone ............................... 6.19 NA 8.93 0.71 NA 15.83 090

26236 ............ A Partial removal, finger bone ............................... 5.32 NA 8.66 0.66 NA 14.64 090
30917

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

26250 ............ A Extensive hand surgery ..................................... 7.55 NA 11.60 1.07 NA 20.22 090

26255 ............ A Extensive hand surgery ..................................... 12.43 NA 13.32 1.54 NA 27.29 090

26260 ............ A Extensive finger surgery .................................... 7.03 NA 10.85 0.97 NA 18.85 090

26261 ............ A Extensive finger surgery .................................... 9.09 NA 12.59 1.31 NA 22.99 090

26262 ............ A Partial removal of finger ..................................... 5.67 NA 9.35 0.76 NA 15.78 090

26320 ............ A Removal of implant from hand ........................... 3.98 NA 8.38 0.57 NA 12.93 090

26350 ............ A Repair finger/hand tendon ................................. 5.99 NA 11.30 0.99 NA 18.28 090

26352 ............ A Repair/graft hand tendon ................................... 7.68 NA 13.41 1.10 NA 22.19 090

26356 ............ A Repair finger/hand tendon ................................. 8.07 NA 13.66 1.24 NA 22.97 090

26357 ............ A Repair finger/hand tendon ................................. 8.58 NA 14.49 1.19 NA 24.26 090

26358 ............ A Repair/graft hand tendon ................................... 9.14 NA 14.42 1.27 NA 24.83 090

26370 ............ A Repair finger/hand tendon ................................. 7.11 NA 13.28 1.13 NA 21.52 090

26372 ............ A Repair/graft hand tendon ................................... 8.76 NA 14.09 1.15 NA 24.00 090

26373 ............ A Repair finger/hand tendon ................................. 8.16 NA 12.55 1.11 NA 21.82 090

26390 ............ A Revise hand/finger tendon ................................. 9.19 NA 11.26 1.23 NA 21.68 090

26392 ............ A Repair/graft hand tendon ................................... 10.26 NA 14.13 1.26 NA 25.65 090

26410 ............ A Repair hand tendon ........................................... 4.63 NA 10.00 0.51 NA 15.14 090

26412 ............ A Repair/graft hand tendon ................................... 6.31 NA 11.04 0.97 NA 18.32 090

26415 ............ A Excision, hand/finger tendon .............................. 8.34 NA 11.11 0.90 NA 20.35 090

26416 ............ A Graft hand or finger tendon ............................... 9.37 NA 12.62 1.41 NA 23.40 090

26418 ............ A Repair finger tendon .......................................... 4.25 NA 9.77 0.59 NA 14.61 090

26420 ............ A Repair/graft finger tendon .................................. 6.77 NA 11.47 0.96 NA 19.20 090

26426 ............ A Repair finger/hand tendon ................................. 6.15 NA 11.03 1.07 NA 18.25 090

26428 ............ A Repair/graft finger tendon .................................. 7.21 NA 11.25 1.00 NA 19.46 090

26432 ............ A Repair finger tendon .......................................... 4.02 NA 8.58 0.51 NA 13.11 090

26433 ............ A Repair finger tendon .......................................... 4.56 NA 9.01 0.66 NA 14.23 090

26434 ............ A Repair/graft finger tendon .................................. 6.09 NA 9.84 0.84 NA 16.77 090

26437 ............ A Realignment of tendons ..................................... 5.82 NA 9.50 0.68 NA 16.00 090

26440 ............ A Release palm/finger tendon ............................... 5.02 NA 11.65 0.59 NA 17.26 090

26442 ............ A Release palm & finger tendon ........................... 8.16 NA 13.05 0.59 NA 21.80 090

26445 ............ A Release hand/finger tendon ............................... 4.31 NA 10.94 0.54 NA 15.79 090

26449 ............ A Release forearm/hand tendon ........................... 7.00 NA 12.08 0.96 NA 20.04 090

26450 ............ A Incision of palm tendon ...................................... 3.67 NA 5.96 0.36 NA 9.99 090

26455 ............ A Incision of finger tendon ..................................... 3.64 NA 5.84 0.33 NA 9.81 090

26460 ............ A Incise hand/finger tendon ................................... 3.46 NA 5.58 0.30 NA 9.34 090

26471 ............ A Fusion of finger tendons .................................... 5.73 NA 9.06 0.67 NA 15.46 090

26474 ............ A Fusion of finger tendons .................................... 5.32 NA 9.37 0.75 NA 15.44 090

26476 ............ A Tendon lengthening ........................................... 5.18 NA 8.35 0.27 NA 13.80 090

26477 ............ A Tendon shortening ............................................. 5.15 NA 9.42 0.73 NA 15.30 090

26478 ............ A Lengthening of hand tendon .............................. 5.80 NA 9.83 0.72 NA 16.35 090

26479 ............ A Shortening of hand tendon ................................ 5.74 NA 9.62 0.86 NA 16.22 090

26480 ............ A Transplant hand tendon ..................................... 6.69 NA 12.55 1.11 NA 20.35 090

26483 ............ A Transplant/graft hand tendon ............................. 8.29 NA 13.35 1.40 NA 23.04 090

26485 ............ A Transplant palm tendon ..................................... 7.70 NA 13.33 1.08 NA 22.11 090

26489 ............ A Transplant/graft palm tendon ............................. 9.55 NA 11.16 0.51 NA 21.22 090

26490 ............ A Revise thumb tendon ......................................... 8.41 NA 11.00 1.28 NA 20.69 090

26492 ............ A Tendon transfer with graft .................................. 9.62 NA 11.46 1.21 NA 22.29 090

26494 ............ A Hand tendon/muscle transfer ............................. 8.47 NA 9.62 1.23 NA 19.32 090

26496 ............ A Revise thumb tendon ......................................... 9.59 NA 11.45 1.53 NA 22.57 090

26497 ............ A Finger tendon transfer ........................................ 9.57 NA 11.79 1.38 NA 22.74 090

26498 ............ A Finger tendon transfer ........................................ 14.00 NA 14.34 2.04 NA 30.38 090

26499 ............ A Revision of finger ............................................... 8.98 NA 9.91 1.25 NA 20.14 090

26500 ............ A Hand tendon reconstruction ............................... 5.96 NA 9.52 0.60 NA 16.08 090

26502 ............ A Hand tendon reconstruction ............................... 7.14 NA 10.61 0.95 NA 18.70 090

26504 ............ A Hand tendon reconstruction ............................... 7.47 NA 11.04 1.11 NA 19.62 090

26508 ............ A Release thumb contracture ................................ 6.01 NA 8.30 0.72 NA 15.03 090

26510 ............ A Thumb tendon transfer ....................................... 5.43 NA 9.31 0.68 NA 15.42 090

26516 ............ A Fusion of knuckle joint ....................................... 7.15 NA 10.32 0.67 NA 18.14 090

26517 ............ A Fusion of knuckle joints ..................................... 8.83 NA 10.98 1.23 NA 21.04 090

26518 ............ A Fusion of knuckle joints ..................................... 9.02 NA 11.97 1.22 NA 22.21 090

26520 ............ A Release knuckle contracture .............................. 5.30 NA 11.54 0.71 NA 17.55 090

26525 ............ A Release finger contracture ................................. 5.33 NA 11.66 0.62 NA 17.61 090

26530 ............ A Revise knuckle joint ........................................... 6.69 NA 12.18 0.85 NA 19.72 090

26531 ............ A Revise knuckle with implant ............................... 7.91 NA 13.33 1.11 NA 22.35 090

26535 ............ A Revise finger joint .............................................. 5.24 NA 5.91 0.58 NA 11.73 090

26536 ............ A Revise/implant finger joint .................................. 6.37 NA 11.33 1.19 NA 18.89 090

26540 ............ A Repair hand joint ................................................ 6.43 NA 9.89 1.12 NA 17.44 090

26541 ............ A Repair hand joint with graft ................................ 8.62 NA 11.26 1.47 NA 21.35 090

26542 ............ A Repair hand joint with graft ................................ 6.78 NA 10.32 0.97 NA 18.07 090

26545 ............ A Reconstruct finger joint ...................................... 6.92 NA 10.33 0.94 NA 18.19 090

26546 ............ A Repair non-union hand ...................................... 8.92 NA 18.85 1.33 NA 29.10 090

26548 ............ A Reconstruct finger joint ...................................... 8.03 NA 10.73 1.00 NA 19.76 090

26550 ............ A Construct thumb replacement ............................ 21.24 NA 20.05 3.24 NA 44.53 090

26551 ............ A Great toe-hand transfer ...................................... 46.58 NA 60.48 6.92 NA 113.98 090
30918

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

26553 ............ A Single toe-hand transfer ..................................... 46.27 NA 60.17 6.87 NA 113.31 090

26554 ............ A Double toe-hand transfer ................................... 54.95 NA 68.86 8.20 NA 132.01 090

26555 ............ A Positional change of finger ................................ 16.63 NA 16.58 2.52 NA 35.73 090

26556 ............ A Toe joint transfer ................................................ 47.26 NA 61.16 6.99 NA 115.41 090

26560 ............ A Repair of web finger ........................................... 5.38 NA 8.35 0.66 NA 14.39 090

26561 ............ A Repair of web finger ........................................... 10.92 NA 13.22 1.56 NA 25.70 090

26562 ............ A Repair of web finger ........................................... 9.68 NA 12.46 0.82 NA 22.96 090

26565 ............ A Correct metacarpal flaw ..................................... 6.74 NA 10.26 0.85 NA 17.85 090

26567 ............ A Correct finger deformity ..................................... 6.82 NA 9.90 0.67 NA 17.39 090

26568 ............ A Lengthen metacarpal/finger ............................... 9.08 NA 11.61 1.06 NA 21.75 090

26580 ............ A Repair hand deformity ........................................ 18.18 NA 12.16 2.76 NA 33.10 090

26585 ............ A Repair finger deformity ....................................... 14.05 NA 12.14 2.12 NA 28.31 090

26590 ............ A Repair finger deformity ....................................... 17.96 NA 13.66 2.72 NA 34.34 090

26591 ............ A Repair muscles of hand ..................................... 3.25 NA 7.72 0.39 NA 11.36 090

26593 ............ A Release muscles of hand .................................. 5.31 NA 9.00 0.70 NA 15.01 090

26596 ............ A Excision constricting tissue ................................ 8.95 NA 7.08 1.35 NA 17.38 090

26597 ............ A Release of scar contracture ............................... 9.82 NA 11.96 1.37 NA 23.15 090

26600 ............ A Treat metacarpal fracture ................................... 1.96 4.60 1.62 0.22 6.78 3.80 090

26605 ............ A Treat metacarpal fracture ................................... 2.85 5.96 3.11 0.36 9.17 6.32 090

26607 ............ A Treat metacarpal fracture ................................... 5.36 NA 6.40 0.57 NA 12.33 090

26608 ............ A Treat metacarpal fracture ................................... 5.36 NA 6.27 0.57 NA 12.20 090

26615 ............ A Repair metacarpal fracture ................................ 5.33 NA 5.76 0.80 NA 11.89 090

26641 ............ A Treat thumb dislocation ...................................... 3.94 5.89 2.68 0.14 9.97 6.76 090

26645 ............ A Treat thumb fracture .......................................... 4.41 6.82 3.68 0.33 11.56 8.42 090

26650 ............ A Repair thumb fracture ........................................ 5.72 NA 6.42 0.64 NA 12.78 090

26665 ............ A Repair thumb fracture ........................................ 7.60 NA 6.85 1.09 NA 15.54 090

26670 ............ A Treat hand dislocation ........................................ 3.69 6.06 2.34 0.10 9.85 6.13 090

26675 ............ A Treat hand dislocation ........................................ 4.64 5.89 3.88 0.60 11.13 9.12 090

26676 ............ A Pin hand dislocation ........................................... 5.52 NA 6.35 0.67 NA 12.54 090

26685 ............ A Repair hand dislocation ..................................... 6.98 NA 6.54 0.91 NA 14.43 090

26686 ............ A Repair hand dislocation ..................................... 7.94 NA 7.17 1.04 NA 16.15 090

26700 ............ A Treat knuckle dislocation ................................... 3.69 3.41 1.51 0.10 7.20 5.30 090

26705 ............ A Treat knuckle dislocation ................................... 4.19 5.82 3.33 0.27 10.28 7.79 090

26706 ............ A Pin knuckle dislocation ....................................... 5.12 NA 4.71 0.75 NA 10.58 090

26715 ............ A Repair knuckle dislocation ................................. 5.74 NA 6.05 0.66 NA 12.45 090

26720 ............ A Treat finger fracture, each ................................. 1.66 2.06 1.08 0.15 3.87 2.89 090

26725 ............ A Treat finger fracture, each ................................. 3.33 3.74 2.59 0.23 7.30 6.15 090

26727 ............ A Treat finger fracture, each ................................. 5.23 NA 6.14 0.38 NA 11.75 090

26735 ............ A Repair finger fracture, each ............................... 5.98 NA 6.06 0.61 NA 12.65 090

26740 ............ A Treat finger fracture, each ................................. 1.94 2.52 1.77 0.16 4.62 3.87 090

26742 ............ A Treat finger fracture, each ................................. 3.85 6.77 3.77 0.32 10.94 7.94 090

26746 ............ A Repair finger fracture, each ............................... 5.81 NA 6.06 0.80 NA 12.67 090

26750 ............ A Treat finger fracture, each ................................. 1.70 2.33 1.28 0.10 4.13 3.08 090

26755 ............ A Treat finger fracture, each ................................. 3.10 3.50 2.15 0.15 6.75 5.40 090

26756 ............ A Pin finger fracture, each ..................................... 4.39 NA 5.69 0.33 NA 10.41 090

26765 ............ A Repair finger fracture, each ............................... 4.17 NA 4.92 0.45 NA 9.54 090

26770 ............ A Treat finger dislocation ....................................... 3.02 3.17 1.37 0.08 6.27 4.47 090

26775 ............ A Treat finger dislocation ....................................... 3.71 5.64 2.73 0.17 9.52 6.61 090

26776 ............ A Pin finger dislocation .......................................... 4.80 NA 5.88 0.35 NA 11.03 090

26785 ............ A Repair finger dislocation .................................... 4.21 NA 5.08 0.48 NA 9.77 090

26820 ............ A Thumb fusion with graft ..................................... 8.26 NA 11.44 1.05 NA 20.75 090

26841 ............ A Fusion of thumb ................................................. 7.13 NA 10.68 1.00 NA 18.81 090

26842 ............ A Thumb fusion with graft ..................................... 8.24 NA 11.52 1.37 NA 21.13 090

26843 ............ A Fusion of hand joint ........................................... 7.61 NA 10.80 1.10 NA 19.51 090

26844 ............ A Fusion/graft of hand joint ................................... 8.73 NA 11.85 1.19 NA 21.77 090

26850 ............ A Fusion of knuckle ............................................... 6.97 NA 10.39 0.76 NA 18.12 090

26852 ............ A Fusion of knuckle with graft ............................... 8.46 NA 11.32 1.00 NA 20.78 090

26860 ............ A Fusion of finger joint .......................................... 4.69 NA 8.73 0.68 NA 14.10 090

26861 ............ A Fusion of finger joint, added .............................. 1.74 NA 1.24 0.43 NA 3.41 ZZZ

26862 ............ A Fusion/graft of finger joint .................................. 7.37 NA 10.40 0.85 NA 18.62 090

26863 ............ A Fuse/graft added joint ........................................ 3.90 NA 2.53 0.57 NA 7.00 ZZZ

26910 ............ A Amputate metacarpal bone ................................ 7.60 NA 9.46 0.93 NA 17.99 090

26951 ............ A Amputation of finger/thumb ................................ 4.59 NA 8.17 0.49 NA 13.25 090

26952 ............ A Amputation of finger/thumb ................................ 6.31 NA 9.37 0.69 NA 16.37 090

26990 ............ A Drainage of pelvis lesion .................................... 7.48 NA 11.61 0.51 NA 19.60 090

26991 ............ A Drainage of pelvis bursa .................................... 6.68 6.46 7.02 0.29 13.43 13.99 090

26992 ............ A Drainage of bone lesion ..................................... 13.02 NA 16.12 1.05 NA 30.19 090

27000 ............ A Incision of hip tendon ......................................... 5.62 NA 5.77 0.24 NA 11.63 090

27001 ............ A Incision of hip tendon ......................................... 6.94 NA 6.57 0.38 NA 13.89 090

27003 ............ A Incision of hip tendon ......................................... 7.34 NA 7.34 1.08 NA 15.76 090

27005 ............ A Incision of hip tendon ......................................... 9.66 NA 8.44 0.54 NA 18.64 090

27006 ............ A Incision of hip tendons ....................................... 9.68 NA 8.57 0.77 NA 19.02 090

27025 ............ A Incision of hip/thigh fascia .................................. 11.16 NA 8.69 1.02 NA 20.87 090

27030 ............ A Drainage of hip joint ........................................... 13.01 NA 10.67 1.86 NA 25.54 090
30919

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27033 ............ A Exploration of hip joint ....................................... 13.39 NA 10.76 1.85 NA 26.00 090

27035 ............ A Denervation of hip joint ...................................... 16.69 NA 13.32 2.21 NA 32.22 090

27036 ............ A Excision of hip joint/muscle ................................ 12.88 NA 22.96 1.87 NA 37.71 090

27040 ............ A Biopsy of soft tissues ......................................... 2.87 3.49 2.69 0.11 6.47 5.67 010

27041 ............ A Biopsy of soft tissues ......................................... 9.89 NA 6.86 0.44 NA 17.19 090

27047 ............ A Remove hip/pelvis lesion ................................... 7.45 6.09 5.33 0.32 13.86 13.10 090

27048 ............ A Remove hip/pelvis lesion ................................... 6.25 NA 5.67 0.82 NA 12.74 090

27049 ............ A Remove tumor, hip/pelvis .................................. 13.66 NA 9.93 1.87 NA 25.46 090

27050 ............ A Biopsy of sacroiliac joint .................................... 4.36 NA 5.40 0.90 NA 10.66 090

27052 ............ A Biopsy of hip joint ............................................... 6.23 NA 6.46 1.59 NA 14.28 090

27054 ............ A Removal of hip joint lining .................................. 8.54 NA 8.31 2.26 NA 19.11 090

27060 ............ A Removal of ischial bursa .................................... 5.43 NA 5.20 0.68 NA 11.31 090

27062 ............ A Remove femur lesion/bursa ............................... 5.37 NA 5.67 0.70 NA 11.74 090

27065 ............ A Removal of hip bone lesion ............................... 5.90 NA 6.39 0.90 NA 13.19 090

27066 ............ A Removal of hip bone lesion ............................... 10.33 NA 9.79 1.30 NA 21.42 090

27067 ............ A Remove/graft hip bone lesion ............................ 13.83 NA 12.28 1.93 NA 28.04 090

27070 ............ A Partial removal of hip bone ................................ 10.72 NA 14.61 1.21 NA 26.54 090

27071 ............ A Partial removal of hip bone ................................ 11.46 NA 14.77 1.45 NA 27.68 090

27075 ............ A Extensive hip surgery ......................................... 17.23 NA 12.72 2.32 NA 32.27 090

27076 ............ A Extensive hip surgery ......................................... 22.12 NA 16.75 2.61 NA 41.48 090

27077 ............ A Extensive hip surgery ......................................... 23.13 NA 16.40 3.24 NA 42.77 090

27078 ............ A Extensive hip surgery ......................................... 13.44 NA 12.41 1.67 NA 27.52 090

27079 ............ A Extensive hip surgery ......................................... 13.75 NA 10.65 1.66 NA 26.06 090

27080 ............ A Removal of tail bone .......................................... 6.39 NA 5.55 0.87 NA 12.81 090

27086 ............ A Remove hip foreign body ................................... 1.87 3.23 2.61 0.07 5.17 4.55 010

27087 ............ A Remove hip foreign body ................................... 8.54 NA 7.34 0.60 NA 16.48 090

27090 ............ A Removal of hip prosthesis ................................. 11.15 NA 9.72 1.46 NA 22.33 090

27091 ............ A Removal of hip prosthesis ................................. 22.14 NA 16.12 3.16 NA 41.42 090

27093 ............ A Injection for hip x-ray ......................................... 1.30 7.97 0.49 0.11 9.38 1.90 000

27095 ............ A Injection for hip x-ray ......................................... 1.50 8.30 0.50 0.13 9.93 2.13 000

27097 ............ A Revision of hip tendon ....................................... 8.80 NA 8.03 1.26 NA 18.09 090

27098 ............ A Transfer tendon to pelvis ................................... 8.83 NA 7.42 1.26 NA 17.51 090

27100 ............ A Transfer of abdominal muscle ........................... 11.08 NA 9.91 1.42 NA 22.41 090

27105 ............ A Transfer of spinal muscle ................................... 11.77 NA 6.42 1.36 NA 19.55 090

27110 ............ A Transfer of iliopsoas muscle .............................. 13.26 NA 10.43 1.86 NA 25.55 090

27111 ............ A Transfer of iliopsoas muscle .............................. 12.15 NA 8.05 1.65 NA 21.85 090

27120 ............ A Reconstruction of hip socket .............................. 18.01 NA 13.42 2.95 NA 34.38 090

27122 ............ A Reconstruction of hip socket .............................. 14.98 NA 12.41 2.94 NA 30.33 090

27125 ............ A Partial hip replacement ...................................... 14.69 NA 11.92 3.01 NA 29.62 090

27130 ............ A Total hip replacement ........................................ 20.12 NA 15.19 4.58 NA 39.89 090

27132 ............ A Total hip replacement ........................................ 23.30 NA 17.05 5.09 NA 45.44 090

27134 ............ A Revise hip joint replacement .............................. 28.52 NA 19.95 5.96 NA 54.43 090

27137 ............ A Revise hip joint replacement .............................. 21.17 NA 15.94 4.82 NA 41.93 090

27138 ............ A Revise hip joint replacement .............................. 22.17 NA 16.55 4.58 NA 43.30 090

27140 ............ A Transplant of femur ridge ................................... 12.24 NA 10.20 1.71 NA 24.15 090

27146 ............ A Incision of hip bone ............................................ 17.43 NA 13.63 1.35 NA 32.41 090

27147 ............ A Revision of hip bone .......................................... 20.58 NA 15.63 2.76 NA 38.97 090

27151 ............ A Incision of hip bones .......................................... 22.51 NA 15.69 2.90 NA 41.10 090

27156 ............ A Revision of hip bones ........................................ 24.63 NA 18.51 3.08 NA 46.22 090

27158 ............ A Revision of pelvis ............................................... 19.74 NA 14.29 2.64 NA 36.67 090

27161 ............ A Incision of neck of femur .................................... 16.71 NA 12.80 2.31 NA 31.82 090

27165 ............ A Incision/fixation of femur .................................... 17.91 NA 13.59 2.63 NA 34.13 090

27170 ............ A Repair/graft femur head/neck ............................ 16.07 NA 12.55 2.65 NA 31.27 090

27175 ............ A Treat slipped epiphysis ...................................... 8.46 NA 7.03 0.18 NA 15.67 090

27176 ............ A Treat slipped epiphysis ...................................... 12.05 NA 9.33 1.70 NA 23.08 090

27177 ............ A Repair slipped epiphysis .................................... 15.08 NA 10.93 2.05 NA 28.06 090

27178 ............ A Repair slipped epiphysis .................................... 11.99 NA 8.19 1.55 NA 21.73 090

27179 ............ A Revise head/neck of femur ................................ 12.98 NA 18.75 1.83 NA 33.56 090

27181 ............ A Repair slipped epiphysis .................................... 14.68 NA 11.12 2.16 NA 27.96 090

27185 ............ A Revision of femur epiphysis ............................... 9.18 NA 8.55 0.87 NA 18.60 090

27187 ............ A Reinforce hip bones ........................................... 13.54 NA 11.36 2.76 NA 27.66 090

27193 ............ A Treat pelvic ring fracture .................................... 5.56 5.61 4.69 0.39 11.56 10.64 090

27194 ............ A Treat pelvic ring fracture .................................... 9.65 8.18 7.22 0.50 18.33 17.37 090

27200 ............ A Treat tail bone fracture ....................................... 1.84 2.14 1.29 0.17 4.15 3.30 090

27202 ............ A Repair tail bone fracture .................................... 7.04 NA 9.32 0.89 NA 17.25 090

27215 ............ A Pelvic fracture(s) treatment ................................ 10.05 NA 7.12 2.33 NA 19.50 090

27216 ............ A Treat pelvic ring fracture .................................... 15.19 NA 12.70 0.66 NA 28.55 090

27217 ............ A Treat pelvic ring fracture .................................... 14.11 NA 11.11 2.33 NA 27.55 090

27218 ............ A Treat pelvic ring fracture .................................... 20.15 NA 14.75 2.33 NA 37.23 090

27220 ............ A Treat hip socket fracture .................................... 6.18 5.95 5.07 0.64 12.77 11.89 090

27222 ............ A Treat hip socket fracture .................................... 12.70 NA 9.89 1.03 NA 23.62 090

27226 ............ A Treat hip wall fracture ........................................ 14.91 NA 11.22 2.52 NA 28.65 090

27227 ............ A Treat hip fracture(s) ........................................... 23.45 NA 15.66 3.20 NA 42.31 090

27228 ............ A Treat hip fracture(s) ........................................... 27.16 NA 18.73 3.20 NA 49.09 090
30920

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27230 ............ A Treat fracture of thigh ........................................ 5.50 5.79 4.53 0.41 11.70 10.44 090

27232 ............ A Treat fracture of thigh ........................................ 10.68 NA 9.07 1.46 NA 21.21 090

27235 ............ A Repair of thigh fracture ...................................... 12.16 NA 10.54 2.60 NA 25.30 090

27236 ............ A Repair of thigh fracture ...................................... 15.60 NA 12.42 2.71 NA 30.73 090

27238 ............ A Treatment of thigh fracture ................................ 5.52 NA 4.93 0.71 NA 11.16 090

27240 ............ A Treatment of thigh fracture ................................ 12.50 NA 10.45 1.53 NA 24.48 090

27244 ............ A Repair of thigh fracture ...................................... 15.94 NA 12.69 2.62 NA 31.25 090

27245 ............ A Repair of thigh fracture ...................................... 20.31 NA 15.31 2.62 NA 38.24 090

27246 ............ A Treatment of thigh fracture ................................ 4.71 5.45 4.88 0.60 10.76 10.19 090

27248 ............ A Repair of thigh fracture ...................................... 10.45 NA 9.43 2.11 NA 21.99 090

27250 ............ A Treat hip dislocation ........................................... 6.95 NA 4.07 0.45 NA 11.47 090

27252 ............ A Treat hip dislocation ........................................... 10.39 NA 7.43 0.68 NA 18.50 090

27253 ............ A Repair of hip dislocation .................................... 12.92 NA 9.77 2.11 NA 24.80 090

27254 ............ A Repair of hip dislocation .................................... 18.26 NA 12.68 2.27 NA 33.21 090

27256 ............ A Treatment of hip dislocation ............................... 4.12 NA 3.03 0.31 NA 7.46 010

27257 ............ A Treatment of hip dislocation ............................... 5.22 NA 3.86 0.73 NA 9.81 010

27258 ............ A Repair of hip dislocation .................................... 15.43 NA 12.39 2.25 NA 30.07 090

27259 ............ A Repair of hip dislocation .................................... 21.55 NA 14.58 2.82 NA 38.95 090

27265 ............ A Treatment of hip dislocation ............................... 5.05 NA 4.66 0.54 NA 10.25 090

27266 ............ A Treatment of hip dislocation ............................... 7.49 NA 6.43 0.71 NA 14.63 090

27275 ............ A Manipulation of hip joint ..................................... 2.27 NA 2.72 0.30 NA 5.29 010

27280 ............ A Fusion of sacroiliac joint .................................... 13.39 NA 11.68 1.77 NA 26.84 090

27282 ............ A Fusion of pubic bones ........................................ 11.34 NA 9.76 1.69 NA 22.79 090

27284 ............ A Fusion of hip joint ............................................... 16.76 NA 13.03 2.40 NA 32.19 090

27286 ............ A Fusion of hip joint ............................................... 16.79 NA 13.64 2.26 NA 32.69 090

27290 ............ A Amputation of leg at hip ..................................... 23.28 NA 15.18 4.70 NA 43.16 090

27295 ............ A Amputation of leg at hip ..................................... 18.65 NA 12.45 2.95 NA 34.05 090

27301 ............ A Drain thigh/knee lesion ...................................... 6.49 8.70 8.59 0.40 15.59 15.48 090

27303 ............ A Drainage of bone lesion ..................................... 8.28 NA 10.78 0.96 NA 20.02 090

27305 ............ A Incise thigh tendon & fascia ............................... 5.92 NA 6.41 0.68 NA 13.01 090

27306 ............ A Incision of thigh tendon ...................................... 4.62 NA 5.49 0.32 NA 10.43 090

27307 ............ A Incision of thigh tendons .................................... 5.80 NA 6.03 0.48 NA 12.31 090

27310 ............ A Exploration of knee joint .................................... 9.27 NA 8.60 1.51 NA 19.38 090

27315 ............ A Partial removal, thigh nerve ............................... 6.97 NA 4.64 0.96 NA 12.57 090

27320 ............ A Partial removal, thigh nerve ............................... 6.30 NA 4.45 0.73 NA 11.48 090

27323 ............ A Biopsy thigh soft tissues .................................... 2.28 3.08 2.40 0.13 5.49 4.81 010

27324 ............ A Biopsy thigh soft tissues .................................... 4.90 NA 4.93 0.45 NA 10.28 090

27327 ............ A Removal of thigh lesion ..................................... 4.47 4.69 4.36 0.40 9.56 9.23 090

27328 ............ A Removal of thigh lesion ..................................... 5.57 NA 5.11 0.73 NA 11.41 090

27329 ............ A Remove tumor, thigh/knee ................................. 14.14 NA 10.87 2.14 NA 27.15 090

27330 ............ A Biopsy knee joint lining ...................................... 4.97 NA 5.09 1.19 NA 11.25 090

27331 ............ A Explore/treat knee joint ...................................... 5.88 NA 6.01 1.49 NA 13.38 090

27332 ............ A Removal of knee cartilage ................................. 8.27 NA 7.21 1.73 NA 17.21 090

27333 ............ A Removal of knee cartilage ................................. 7.30 NA 6.73 2.52 NA 16.55 090

27334 ............ A Remove knee joint lining .................................... 8.70 NA 7.78 1.77 NA 18.25 090

27335 ............ A Remove knee joint lining .................................... 10.00 NA 8.93 2.05 NA 20.98 090

27340 ............ A Removal of kneecap bursa ................................ 4.18 NA 4.60 0.62 NA 9.40 090

27345 ............ A Removal of knee cyst ........................................ 5.92 NA 5.87 0.95 NA 12.74 090

27350 ............ A Removal of kneecap .......................................... 8.17 NA 7.36 1.54 NA 17.07 090

27355 ............ A Remove femur lesion ......................................... 7.65 NA 7.95 1.23 NA 16.83 090

27356 ............ A Remove femur lesion/graft ................................. 9.48 NA 9.14 1.34 NA 19.96 090

27357 ............ A Remove femur lesion/graft ................................. 10.53 NA 9.44 1.43 NA 21.40 090

27358 ............ A Remove femur lesion/fixation ............................. 4.74 NA 2.94 0.72 NA 8.40 ZZZ

27360 ............ A Partial removal leg bone(s) ................................ 10.50 NA 14.47 1.40 NA 26.37 090

27365 ............ A Extensive leg surgery ......................................... 16.27 NA 12.69 2.43 NA 31.39 090

27370 ............ A Injection for knee x-ray ...................................... 0.96 7.73 0.31 0.05 8.74 1.32 000

27372 ............ A Removal of foreign body .................................... 5.07 5.07 4.89 0.54 10.68 10.50 090

27380 ............ A Repair of kneecap tendon .................................. 7.16 NA 7.06 1.29 NA 15.51 090

27381 ............ A Repair/graft kneecap tendon .............................. 10.34 NA 8.92 1.82 NA 21.08 090

27385 ............ A Repair of thigh muscle ....................................... 7.76 NA 7.40 1.42 NA 16.58 090

27386 ............ A Repair/graft of thigh muscle ............................... 10.56 NA 9.31 2.02 NA 21.89 090

27390 ............ A Incision of thigh tendon ...................................... 5.33 NA 5.82 0.71 NA 11.86 090

27391 ............ A Incision of thigh tendons .................................... 7.20 NA 7.09 0.90 NA 15.19 090

27392 ............ A Incision of thigh tendons .................................... 9.20 NA 8.49 1.28 NA 18.97 090

27393 ............ A Lengthening of thigh tendon .............................. 6.39 NA 6.44 0.93 NA 13.76 090

27394 ............ A Lengthening of thigh tendons ............................ 8.50 NA 8.42 0.94 NA 17.86 090

27395 ............ A Lengthening of thigh tendons ............................ 11.73 NA 10.86 1.65 NA 24.24 090

27396 ............ A Transplant of thigh tendon ................................. 7.86 NA 8.07 1.11 NA 17.04 090

27397 ............ A Transplants of thigh tendons ............................. 11.28 NA 9.88 1.45 NA 22.61 090

27400 ............ A Revise thigh muscles/tendons ........................... 9.02 NA 8.62 1.24 NA 18.88 090

27403 ............ A Repair of knee cartilage ..................................... 8.33 NA 7.30 1.44 NA 17.07 090

27405 ............ A Repair of knee ligament ..................................... 8.65 NA 7.90 1.67 NA 18.22 090

27407 ............ A Repair of knee ligament ..................................... 10.28 NA 8.42 1.42 NA 20.12 090

27409 ............ A Repair of knee ligaments ................................... 12.90 NA 10.23 2.48 NA 25.61 090
30921

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27418 ............ A Repair degenerated kneecap ............................. 10.85 NA 9.39 1.85 NA 22.09 090

27420 ............ A Revision of unstable kneecap ............................ 9.83 NA 8.26 1.74 NA 19.83 090

27422 ............ A Revision of unstable kneecap ............................ 9.78 NA 8.37 1.83 NA 19.98 090

27424 ............ A Revision/removal of kneecap ............................. 9.81 NA 8.18 1.89 NA 19.88 090

27425 ............ A Lateral retinacular release ................................. 5.22 NA 5.58 1.08 NA 11.88 090

27427 ............ A Reconstruction, knee ......................................... 9.36 NA 8.06 2.25 NA 19.67 090

27428 ............ A Reconstruction, knee ......................................... 14.00 NA 10.92 2.71 NA 27.63 090

27429 ............ A Reconstruction, knee ......................................... 15.52 NA 12.11 1.83 NA 29.46 090

27430 ............ A Revision of thigh muscles .................................. 9.67 NA 8.21 1.50 NA 19.38 090

27435 ............ A Incision of knee joint .......................................... 9.49 NA 8.02 1.13 NA 18.64 090

27437 ............ A Revise kneecap .................................................. 8.46 NA 7.01 1.55 NA 17.02 090

27438 ............ A Revise kneecap with implant ............................. 11.23 NA 9.40 2.14 NA 22.77 090

27440 ............ A Revision of knee joint ......................................... 10.43 NA 8.60 2.10 NA 21.13 090

27441 ............ A Revision of knee joint ......................................... 10.82 NA 9.37 1.51 NA 21.70 090

27442 ............ A Revision of knee joint ......................................... 11.89 NA 9.63 3.05 NA 24.57 090

27443 ............ A Revision of knee joint ......................................... 10.93 NA 9.71 3.34 NA 23.98 090

27445 ............ A Revision of knee joint ......................................... 17.68 NA 13.38 4.21 NA 35.27 090

27446 ............ A Revision of knee joint ......................................... 15.84 NA 11.45 3.87 NA 31.16 090

27447 ............ A Total knee replacement ..................................... 21.48 NA 15.54 4.95 NA 41.97 090

27448 ............ A Incision of thigh .................................................. 11.06 NA 9.86 2.09 NA 23.01 090

27450 ............ A Incision of thigh .................................................. 13.98 NA 11.94 2.36 NA 28.28 090

27454 ............ A Realignment of thigh bone ................................. 17.56 NA 13.71 2.82 NA 34.09 090

27455 ............ A Realignment of knee .......................................... 12.82 NA 10.77 1.95 NA 25.54 090

27457 ............ A Realignment of knee .......................................... 13.45 NA 10.24 2.14 NA 25.83 090

27465 ............ A Shortening of thigh bone .................................... 13.87 NA 11.42 2.00 NA 27.29 090

27466 ............ A Lengthening of thigh bone ................................. 16.33 NA 13.67 2.27 NA 32.27 090

27468 ............ A Shorten/lengthen thighs ..................................... 18.97 NA 29.82 2.75 NA 51.54 090

27470 ............ A Repair of thigh .................................................... 16.07 NA 13.53 2.60 NA 32.20 090

27472 ............ A Repair/graft of thigh ........................................... 17.72 NA 14.45 3.16 NA 35.33 090

27475 ............ A Surgery to stop leg growth ................................. 8.64 NA 7.93 1.27 NA 17.84 090

27477 ............ A Surgery to stop leg growth ................................. 9.85 NA 8.01 2.57 NA 20.43 090

27479 ............ A Surgery to stop leg growth ................................. 12.80 NA 10.49 1.89 NA 25.18 090

27485 ............ A Surgery to stop leg growth ................................. 8.84 NA 7.73 1.30 NA 17.87 090

27486 ............ A Revise knee joint replace ................................... 19.27 NA 14.36 4.26 NA 37.89 090

27487 ............ A Revise knee joint replace ................................... 25.27 NA 17.79 5.97 NA 49.03 090

27488 ............ A Removal of knee prosthesis .............................. 15.74 NA 12.45 2.58 NA 30.77 090

27495 ............ A Reinforce thigh ................................................... 15.55 NA 13.08 2.82 NA 31.45 090

27496 ............ A Decompression of thigh/knee ............................ 6.11 NA 5.36 0.74 NA 12.21 090

27497 ............ A Decompression of thigh/knee ............................ 7.17 NA 6.09 0.91 NA 14.17 090

27498 ............ A Decompression of thigh/knee ............................ 7.99 NA 5.92 1.04 NA 14.95 090

27499 ............ A Decompression of thigh/knee ............................ 9.00 NA 7.44 1.19 NA 17.63 090

27500 ............ A Treatment of thigh fracture ................................ 5.92 11.07 5.44 0.82 17.81 12.18 090

27501 ............ A Treatment of thigh fracture ................................ 5.92 11.72 6.52 0.82 18.46 13.26 090

27502 ............ A Treatment of thigh fracture ................................ 10.58 NA 9.32 1.21 NA 21.11 090

27503 ............ A Treatment of thigh fracture ................................ 10.58 NA 9.44 1.21 NA 21.23 090

27506 ............ A Repair of thigh fracture ...................................... 17.45 NA 12.72 2.56 NA 32.73 090

27507 ............ A Treatment of thigh fracture ................................ 13.99 NA 11.03 2.56 NA 27.58 090

27508 ............ A Treatment of thigh fracture ................................ 5.83 7.50 4.61 0.65 13.98 11.09 090

27509 ............ A Treatment of thigh fracture ................................ 7.71 NA 7.80 0.65 NA 16.16 090

27510 ............ A Treatment of thigh fracture ................................ 9.13 NA 6.77 1.09 NA 16.99 090

27511 ............ A Treatment of thigh fracture ................................ 13.64 NA 11.72 2.56 NA 27.92 090

27513 ............ A Treatment of thigh fracture ................................ 17.92 NA 13.58 2.56 NA 34.06 090

27514 ............ A Repair of thigh fracture ...................................... 17.30 NA 13.40 2.53 NA 33.23 090

27516 ............ A Repair of thigh growth plate ............................... 5.37 7.59 4.90 0.71 13.67 10.98 090

27517 ............ A Repair of thigh growth plate ............................... 8.78 9.97 6.87 1.28 20.03 16.93 090

27519 ............ A Repair of thigh growth plate ............................... 15.02 NA 12.54 2.05 NA 29.61 090

27520 ............ A Treat kneecap fracture ....................................... 2.86 5.74 2.53 0.45 9.05 5.84 090

27524 ............ A Repair of kneecap fracture ................................ 10.00 NA 7.92 1.65 NA 19.57 090

27530 ............ A Treatment of knee fracture ................................ 3.78 6.31 3.37 0.51 10.60 7.66 090

27532 ............ A Treatment of knee fracture ................................ 7.30 6.38 5.78 0.91 14.59 13.99 090

27535 ............ A Treatment of knee fracture ................................ 11.50 NA 10.54 1.88 NA 23.92 090

27536 ............ A Repair of knee fracture ...................................... 15.65 NA 11.30 1.88 NA 28.83 090

27538 ............ A Treat knee fracture(s) ........................................ 4.87 7.56 4.48 0.51 12.94 9.86 090

27540 ............ A Repair of knee fracture ...................................... 13.10 NA 9.57 1.74 NA 24.41 090

27550 ............ A Treat knee dislocation ........................................ 5.76 7.18 3.99 0.36 13.30 10.11 090

27552 ............ A Treat knee dislocation ........................................ 7.90 NA 6.78 0.53 NA 15.21 090

27556 ............ A Repair of knee dislocation ................................. 14.41 NA 12.43 1.95 NA 28.79 090

27557 ............ A Repair of knee dislocation ................................. 16.77 NA 14.14 2.43 NA 33.34 090

27558 ............ A Repair of knee dislocation ................................. 17.72 NA 14.48 2.43 NA 34.63 090

27560 ............ A Treat kneecap dislocation .................................. 3.82 6.18 2.00 0.16 10.16 5.98 090

27562 ............ A Treat kneecap dislocation .................................. 5.79 NA 4.57 0.76 NA 11.12 090

27566 ............ A Repair kneecap dislocation ................................ 12.23 NA 9.13 1.67 NA 23.03 090

27570 ............ A Fixation of knee joint .......................................... 1.74 NA 2.47 0.28 NA 4.49 010

27580 ............ A Fusion of knee ................................................... 19.37 NA 14.92 2.56 NA 36.85 090
30922

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27590 ............ A Amputate leg at thigh ......................................... 12.03 NA 8.47 1.80 NA 22.30 090

27591 ............ A Amputate leg at thigh ......................................... 12.68 NA 10.89 2.11 NA 25.68 090

27592 ............ A Amputate leg at thigh ......................................... 10.02 NA 8.01 1.61 NA 19.64 090

27594 ............ A Amputation follow-up surgery ............................ 6.92 NA 5.82 0.68 NA 13.42 090

27596 ............ A Amputation follow-up surgery ............................ 10.60 NA 8.42 1.42 NA 20.44 090

27598 ............ A Amputate lower leg at knee ............................... 10.53 NA 8.21 1.78 NA 20.52 090

27600 ............ A Decompression of lower leg .............................. 5.65 NA 4.80 0.64 NA 11.09 090

27601 ............ A Decompression of lower leg .............................. 5.64 NA 4.66 0.67 NA 10.97 090

27602 ............ A Decompression of lower leg .............................. 7.35 NA 5.39 0.77 NA 13.51 090

27603 ............ A Drain lower leg lesion ........................................ 4.94 8.33 6.14 0.41 13.68 11.49 090

27604 ............ A Drain lower leg bursa ......................................... 4.47 5.29 4.08 0.14 9.90 8.69 090

27605 ............ A Incision of achilles tendon .................................. 2.87 6.16 2.85 0.14 9.17 5.86 010

27606 ............ A Incision of achilles tendon .................................. 4.14 9.65 4.04 0.35 14.14 8.53 010

27607 ............ A Treat lower leg bone lesion ............................... 7.97 NA 10.46 0.98 NA 19.41 090

27610 ............ A Explore/treat ankle joint ..................................... 8.34 NA 7.48 1.13 NA 16.95 090

27612 ............ A Exploration of ankle joint .................................... 7.33 NA 6.22 1.30 NA 14.85 090

27613 ............ A Biopsy lower leg soft tissue ............................... 2.17 3.22 1.92 0.10 5.49 4.19 010

27614 ............ A Biopsy lower leg soft tissue ............................... 5.66 6.67 5.06 0.38 12.71 11.10 090

27615 ............ A Remove tumor, lower leg ................................... 12.56 NA 11.29 1.42 NA 25.27 090

27618 ............ A Remove lower leg lesion .................................... 5.09 6.78 4.63 0.32 12.19 10.04 090

27619 ............ A Remove lower leg lesion .................................... 8.40 8.20 6.66 0.67 17.27 15.73 090

27620 ............ A Explore, treat ankle joint .................................... 5.98 NA 6.09 0.96 NA 13.03 090

27625 ............ A Remove ankle joint lining ................................... 8.30 NA 7.31 1.27 NA 16.88 090

27626 ............ A Remove ankle joint lining ................................... 8.91 NA 8.21 1.25 NA 18.37 090

27630 ............ A Removal of tendon lesion .................................. 4.80 6.25 4.87 0.46 11.51 10.13 090

27635 ............ A Remove lower leg bone lesion .......................... 7.78 NA 8.23 1.27 NA 17.28 090

27637 ............ A Remove/graft leg bone lesion ............................ 9.85 NA 9.84 1.40 NA 21.09 090

27638 ............ A Remove/graft leg bone lesion ............................ 10.57 NA 10.21 1.52 NA 22.30 090

27640 ............ A Partial removal of tibia ....................................... 11.37 NA 13.25 1.57 NA 26.19 090

27641 ............ A Partial removal of fibula ..................................... 9.24 NA 11.40 1.18 NA 21.82 090

27645 ............ A Extensive lower leg surgery ............................... 14.17 NA 13.99 1.98 NA 30.14 090

27646 ............ A Extensive lower leg surgery ............................... 12.66 NA 12.92 1.71 NA 27.29 090

27647 ............ A Extensive ankle/heel surgery ............................. 12.24 NA 8.33 1.35 NA 21.92 090

27648 ............ A Injection for ankle x-ray ...................................... 0.96 6.60 0.33 0.05 7.61 1.34 000

27650 ............ A Repair achilles tendon ....................................... 9.69 NA 7.90 1.41 NA 19.00 090

27652 ............ A Repair/graft achilles tendon ............................... 10.33 NA 7.94 1.56 NA 19.83 090

27654 ............ A Repair of achilles tendon ................................... 10.02 NA 8.49 1.65 NA 20.16 090

27656 ............ A Repair leg fascia defect ..................................... 4.57 7.73 4.37 0.54 12.84 9.48 090

27658 ............ A Repair of leg tendon, each ................................ 4.98 6.07 6.15 0.60 11.65 11.73 090

27659 ............ A Repair of leg tendon, each ................................ 6.81 13.52 6.92 0.86 21.19 14.59 090

27664 ............ A Repair of leg tendon, each ................................ 4.59 11.75 5.94 0.52 16.86 11.05 090

27665 ............ A Repair of leg tendon, each ................................ 5.40 12.69 6.38 0.76 18.85 12.54 090

27675 ............ A Repair lower leg tendons ................................... 7.18 NA 6.29 0.94 NA 14.41 090

27676 ............ A Repair lower leg tendons ................................... 8.42 NA 7.44 1.14 NA 17.00 090

27680 ............ A Release of lower leg tendon .............................. 5.74 NA 5.60 0.61 NA 11.95 090

27681 ............ A Release of lower leg tendons ............................ 6.82 NA 6.59 0.86 NA 14.27 090

27685 ............ A Revision of lower leg tendon ............................. 6.50 4.66 6.08 0.41 11.57 12.99 090

27686 ............ A Revise lower leg tendons ................................... 7.46 5.57 7.66 0.90 13.93 16.02 090

27687 ............ A Revision of calf tendon ...................................... 6.24 NA 5.40 0.76 NA 12.40 090

27690 ............ A Revise lower leg tendon .................................... 8.71 NA 7.22 0.88 NA 16.81 090

27691 ............ A Revise lower leg tendon .................................... 9.96 NA 8.91 1.23 NA 20.10 090

27692 ............ A Revise additional leg tendon .............................. 1.87 NA 1.29 0.29 NA 3.45 ZZZ

27695 ............ A Repair of ankle ligament .................................... 6.51 NA 6.79 1.32 NA 14.62 090

27696 ............ A Repair of ankle ligaments .................................. 8.27 NA 7.80 1.16 NA 17.23 090

27698 ............ A Repair of ankle ligament .................................... 9.36 NA 7.13 1.86 NA 18.35 090

27700 ............ A Revision of ankle joint ........................................ 9.29 NA 6.00 1.51 NA 16.80 090

27702 ............ A Reconstruct ankle joint ....................................... 13.67 NA 11.18 3.99 NA 28.84 090

27703 ............ A Reconstruction, ankle joint ................................. 15.87 NA 11.86 2.25 NA 29.98 090

27704 ............ A Removal of ankle implant .................................. 7.62 NA 7.48 0.98 NA 16.08 090

27705 ............ A Incision of tibia ................................................... 10.38 NA 9.24 1.76 NA 21.38 090

27707 ............ A Incision of fibula ................................................. 4.37 NA 5.92 0.79 NA 11.08 090

27709 ............ A Incision of tibia & fibula ...................................... 9.95 NA 9.21 2.14 NA 21.30 090

27712 ............ A Realignment of lower leg ................................... 14.25 NA 11.78 1.63 NA 27.66 090

27715 ............ A Revision of lower leg .......................................... 14.39 NA 12.54 1.88 NA 28.81 090

27720 ............ A Repair of tibia ..................................................... 11.79 NA 10.92 2.25 NA 24.96 090

27722 ............ A Repair/graft of tibia ............................................. 11.82 NA 11.09 1.64 NA 24.55 090

27724 ............ A Repair/graft of tibia ............................................. 14.99 NA 12.75 2.87 NA 30.61 090

27725 ............ A Repair of lower leg ............................................. 15.59 NA 13.20 1.53 NA 30.32 090

27727 ............ A Repair of lower leg ............................................. 14.01 NA 12.46 1.84 NA 28.31 090

27730 ............ A Repair of tibia epiphysis ..................................... 7.41 11.61 7.25 0.84 19.86 15.50 090

27732 ............ A Repair of fibula epiphysis ................................... 5.32 6.26 3.86 0.79 12.37 9.97 090

27734 ............ A Repair lower leg epiphyses ................................ 8.48 NA 8.56 1.23 NA 18.27 090

27740 ............ A Repair of leg epiphyses ..................................... 9.30 3.15 6.39 1.36 13.81 17.05 090

27742 ............ A Repair of leg epiphyses ..................................... 10.30 15.04 9.64 1.52 26.86 21.46 090
30923

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

27745 ............ A Reinforce tibia .................................................... 10.07 NA 9.10 1.39 NA 20.56 090

27750 ............ A Treatment of tibia fracture .................................. 3.19 5.92 2.96 0.50 9.61 6.65 090

27752 ............ A Treatment of tibia fracture .................................. 5.84 8.11 5.23 0.81 14.76 11.88 090

27756 ............ A Repair of tibia fracture ....................................... 6.78 NA 7.87 1.70 NA 16.35 090

27758 ............ A Repair of tibia fracture ....................................... 11.67 NA 10.04 2.22 NA 23.93 090

27759 ............ A Repair of tibia fracture ....................................... 13.76 NA 11.36 2.22 NA 27.34 090

27760 ............ A Treatment of ankle fracture ................................ 3.01 5.55 2.40 0.37 8.93 5.78 090

27762 ............ A Treatment of ankle fracture ................................ 5.25 7.28 4.63 0.50 13.03 10.38 090

27766 ............ A Repair of ankle fracture ..................................... 8.36 NA 7.06 1.26 NA 16.68 090

27780 ............ A Treatment of fibula fracture ................................ 2.65 3.74 2.30 0.26 6.65 5.21 090

27781 ............ A Treatment of fibula fracture ................................ 4.40 6.67 3.89 0.49 11.56 8.78 090

27784 ............ A Repair of fibula fracture ..................................... 7.11 NA 6.76 0.87 NA 14.74 090

27786 ............ A Treatment of ankle fracture ................................ 2.84 5.55 2.43 0.38 8.77 5.65 090

27788 ............ A Treatment of ankle fracture ................................ 4.45 6.64 3.75 0.50 11.59 8.70 090

27792 ............ A Repair of ankle fracture ..................................... 7.66 NA 6.66 1.17 NA 15.49 090

27808 ............ A Treatment of ankle fracture ................................ 2.83 6.23 2.93 0.39 9.45 6.15 090

27810 ............ A Treatment of ankle fracture ................................ 5.13 7.60 4.66 0.80 13.53 10.59 090

27814 ............ A Repair of ankle fracture ..................................... 10.68 NA 9.06 1.60 NA 21.34 090

27816 ............ A Treatment of ankle fracture ................................ 2.89 5.90 2.93 0.55 9.34 6.37 090

27818 ............ A Treatment of ankle fracture ................................ 5.50 8.00 4.84 1.06 14.56 11.40 090

27822 ............ A Repair of ankle fracture ..................................... 9.20 NA 26.99 1.88 NA 38.07 090

27823 ............ A Repair of ankle fracture ..................................... 11.80 NA 28.40 2.05 NA 42.25 090

27824 ............ A Treat lower leg fracture ...................................... 2.89 6.16 3.15 0.55 9.60 6.59 090

27825 ............ A Treat lower leg fracture ...................................... 6.19 7.96 5.44 1.06 15.21 12.69 090

27826 ............ A Treat lower leg fracture ...................................... 8.54 NA 26.59 1.88 NA 37.01 090

27827 ............ A Treat lower leg fracture ...................................... 14.06 NA 29.89 1.88 NA 45.83 090

27828 ............ A Treat lower leg fracture ...................................... 16.23 NA 31.03 2.05 NA 49.31 090

27829 ............ A Treat lower leg joint ........................................... 5.49 NA 19.75 1.37 NA 26.61 090

27830 ............ A Treat lower leg dislocation ................................. 3.79 5.77 3.25 0.46 10.02 7.50 090

27831 ............ A Treat lower leg dislocation ................................. 4.56 NA 4.53 0.59 NA 9.68 090

27832 ............ A Repair lower leg dislocation ............................... 6.49 NA 7.05 0.89 NA 14.43 090

27840 ............ A Treat ankle dislocation ....................................... 4.58 NA 3.17 0.21 NA 7.96 090

27842 ............ A Treat ankle dislocation ....................................... 6.21 NA 4.00 0.34 NA 10.55 090

27846 ............ A Repair ankle dislocation ..................................... 9.79 NA 8.29 1.37 NA 19.45 090

27848 ............ A Repair ankle dislocation ..................................... 11.20 NA 22.13 1.32 NA 34.65 090

27860 ............ A Fixation of ankle joint ......................................... 2.34 NA 2.68 0.23 NA 5.25 010

27870 ............ A Fusion of ankle joint ........................................... 13.91 NA 11.49 2.22 NA 27.62 090

27871 ............ A Fusion of tibiofibular joint ................................... 9.17 NA 8.82 1.21 NA 19.20 090

27880 ............ A Amputation of lower leg ..................................... 11.85 NA 8.36 1.60 NA 21.81 090

27881 ............ A Amputation of lower leg ..................................... 12.34 NA 10.11 1.87 NA 24.32 090

27882 ............ A Amputation of lower leg ..................................... 8.94 NA 8.19 1.42 NA 18.55 090

27884 ............ A Amputation follow-up surgery ............................ 8.21 NA 7.12 0.61 NA 15.94 090

27886 ............ A Amputation follow-up surgery ............................ 9.32 NA 7.73 1.34 NA 18.39 090

27888 ............ A Amputation of foot at ankle ................................ 9.67 NA 8.39 1.65 NA 19.71 090

27889 ............ A Amputation of foot at ankle ................................ 9.98 NA 7.15 1.55 NA 18.68 090

27892 ............ A Decompression of leg ........................................ 7.39 NA 5.48 0.64 NA 13.51 090

27893 ............ A Decompression of leg ........................................ 7.35 NA 5.87 0.67 NA 13.89 090

27894 ............ A Decompression of leg ........................................ 10.49 NA 7.07 0.77 NA 18.33 090

28001 ............ A Drainage of bursa of foot ................................... 2.73 2.36 2.64 0.05 5.14 5.42 010

28002 ............ A Treatment of foot infection ................................. 4.62 3.28 3.68 0.33 8.23 8.63 010

28003 ............ A Treatment of foot infection ................................. 8.41 5.39 7.51 0.59 14.39 16.51 090

28005 ............ A Treat foot bone lesion ........................................ 8.68 NA 7.52 0.61 NA 16.81 090

28008 ............ A Incision of foot fascia ......................................... 4.45 3.40 3.82 0.29 8.14 8.56 090

28010 ............ A Incision of toe tendon ......................................... 2.84 3.00 3.35 0.33 6.17 6.52 090

28011 ............ A Incision of toe tendons ....................................... 4.14 4.82 4.92 0.19 9.15 9.25 090

28020 ............ A Exploration of a foot joint ................................... 5.01 4.78 4.46 0.56 10.35 10.03 090

28022 ............ A Exploration of a foot joint ................................... 4.67 3.52 4.02 0.31 8.50 9.00 090

28024 ............ A Exploration of a toe joint .................................... 4.38 3.91 3.97 0.24 8.53 8.59 090

28030 ............ A Removal of foot nerve ........................................ 6.15 NA 3.17 0.42 NA 9.74 090

28035 ............ A Decompression of tibia nerve ............................ 5.09 4.87 4.14 0.90 10.86 10.13 090

28043 ............ A Excision of foot lesion ........................................ 3.54 3.36 3.49 0.20 7.10 7.23 090

28045 ............ A Excision of foot lesion ........................................ 4.72 3.80 3.88 0.46 8.98 9.06 090

28046 ............ A Resection of tumor, foot ..................................... 10.18 7.36 7.71 0.79 18.33 18.68 090

28050 ............ A Biopsy of foot joint lining .................................... 4.25 3.01 3.79 0.53 7.79 8.57 090

28052 ............ A Biopsy of foot joint lining .................................... 3.94 3.12 4.25 0.43 7.49 8.62 090

28054 ............ A Biopsy of toe joint lining ..................................... 3.45 4.08 4.07 0.28 7.81 7.80 090

28060 ............ A Partial removal foot fascia ................................. 5.23 4.14 4.05 0.53 9.90 9.81 090

28062 ............ A Removal of foot fascia ....................................... 6.52 4.32 4.26 0.86 11.70 11.64 090

28070 ............ A Removal of foot joint lining ................................ 5.10 3.53 3.99 0.48 9.11 9.57 090

28072 ............ A Removal of foot joint lining ................................ 4.58 3.68 4.67 0.42 8.68 9.67 090

28080 ............ A Removal of foot lesion ....................................... 3.58 3.13 3.36 0.45 7.16 7.39 090

28086 ............ A Excise foot tendon sheath ................................. 4.78 5.90 5.34 0.46 11.14 10.58 090

28088 ............ A Excise foot tendon sheath ................................. 3.86 4.26 4.80 0.40 8.52 9.06 090

28090 ............ A Removal of foot lesion ....................................... 4.41 3.52 3.73 0.29 8.22 8.43 090
30924

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

28092 ............ A Removal of toe lesions ...................................... 3.64 3.86 3.97 0.25 7.75 7.86 090

28100 ............ A Removal of ankle/heel lesion ............................. 5.66 6.43 5.26 0.56 12.65 11.48 090

28102 ............ A Remove/graft foot lesion .................................... 7.73 NA 6.81 0.85 NA 15.39 090

28103 ............ A Remove/graft foot lesion .................................... 6.50 4.89 5.49 0.69 12.08 12.68 090

28104 ............ A Removal of foot lesion ....................................... 5.12 3.88 4.63 0.49 9.49 10.24 090

28106 ............ A Remove/graft foot lesion .................................... 7.16 NA 5.32 0.79 NA 13.27 090

28107 ............ A Remove/graft foot lesion .................................... 5.56 3.69 5.13 0.48 9.73 11.17 090

28108 ............ A Removal of toe lesions ...................................... 4.16 3.08 3.44 0.38 7.62 7.98 090

28110 ............ A Part removal of metatarsal ................................. 4.08 3.49 4.07 0.39 7.96 8.54 090

28111 ............ A Part removal of metatarsal ................................. 5.01 4.27 4.80 0.65 9.93 10.46 090

28112 ............ A Part removal of metatarsal ................................. 4.49 3.84 4.60 0.45 8.78 9.54 090

28113 ............ A Part removal of metatarsal ................................. 4.79 3.80 4.31 0.48 9.07 9.58 090

28114 ............ A Removal of metatarsal heads ............................ 9.79 8.36 8.15 1.42 19.57 19.36 090

28116 ............ A Revision of foot .................................................. 7.75 4.54 5.19 0.57 12.86 13.51 090

28118 ............ A Removal of heel bone ........................................ 5.96 4.43 4.86 0.66 11.05 11.48 090

28119 ............ A Removal of heel spur ......................................... 5.39 3.77 4.09 0.57 9.73 10.05 090

28120 ............ A Part removal of ankle/heel ................................. 5.40 5.08 6.36 0.67 11.15 12.43 090

28122 ............ A Partial removal of foot bone ............................... 7.29 5.33 6.53 0.54 13.16 14.36 090

28124 ............ A Partial removal of toe ......................................... 4.81 3.80 4.88 0.37 8.98 10.06 090

28126 ............ A Partial removal of toe ......................................... 3.52 3.08 4.12 0.36 6.96 8.00 090

28130 ............ A Removal of ankle bone ...................................... 8.11 NA 6.47 0.88 NA 15.46 090

28140 ............ A Removal of metatarsal ....................................... 6.91 4.68 5.42 0.62 12.21 12.95 090

28150 ............ A Removal of toe ................................................... 4.09 3.60 4.60 0.38 8.07 9.07 090

28153 ............ A Partial removal of toe ......................................... 3.66 3.05 2.86 0.36 7.07 6.88 090

28160 ............ A Partial removal of toe ......................................... 3.74 3.18 4.38 0.38 7.30 8.50 090

28171 ............ A Extensive foot surgery ....................................... 9.60 NA 5.64 0.88 NA 16.12 090

28173 ............ A Extensive foot surgery ....................................... 8.80 6.10 6.02 0.74 15.64 15.56 090

28175 ............ A Extensive foot surgery ....................................... 6.05 4.62 4.13 0.58 11.25 10.76 090

28190 ............ A Removal of foot foreign body ............................. 1.96 2.82 1.70 0.05 4.83 3.71 010

28192 ............ A Removal of foot foreign body ............................. 4.64 4.21 3.75 0.24 9.09 8.63 090

28193 ............ A Removal of foot foreign body ............................. 5.73 4.89 4.33 0.30 10.92 10.36 090

28200 ............ A Repair of foot tendon ......................................... 4.60 3.65 4.03 0.50 8.75 9.13 090

28202 ............ A Repair/graft of foot tendon ................................. 6.84 4.25 5.68 0.77 11.86 13.29 090

28208 ............ A Repair of foot tendon ......................................... 4.37 3.33 3.57 0.28 7.98 8.22 090

28210 ............ A Repair/graft of foot tendon ................................. 6.35 4.43 4.37 0.60 11.38 11.32 090

28220 ............ A Release of foot tendon ....................................... 4.53 3.27 3.85 0.43 8.23 8.81 090

28222 ............ A Release of foot tendons ..................................... 5.62 3.78 4.41 0.63 10.03 10.66 090

28225 ............ A Release of foot tendon ....................................... 3.66 3.15 3.53 0.25 7.06 7.44 090

28226 ............ A Release of foot tendons ..................................... 4.53 3.24 3.86 0.40 8.17 8.79 090

28230 ............ A Incision of foot tendon(s) ................................... 4.24 3.29 4.49 0.22 7.75 8.95 090

28232 ............ A Incision of toe tendon ......................................... 3.39 3.12 4.14 0.15 6.66 7.68 090

28234 ............ A Incision of foot tendon ........................................ 3.37 2.99 3.82 0.14 6.50 7.33 090

28238 ............ A Revision of foot tendon ...................................... 7.73 5.32 5.38 0.85 13.90 13.96 090

28240 ............ A Release of big toe .............................................. 4.36 3.22 3.97 0.23 7.81 8.56 090

28250 ............ A Revision of foot fascia ........................................ 5.92 4.03 4.24 0.50 10.45 10.66 090

28260 ............ A Release of midfoot joint ..................................... 7.96 5.31 5.36 0.48 13.75 13.80 090

28261 ............ A Revision of foot tendon ...................................... 11.73 6.39 7.41 0.58 18.70 19.72 090

28262 ............ A Revision of foot and ankle ................................. 15.83 8.31 12.72 1.44 25.58 29.99 090

28264 ............ A Release of midfoot joint ..................................... 10.35 5.92 6.61 1.17 17.44 18.13 090

28270 ............ A Release of foot contracture ................................ 4.76 3.51 4.31 0.23 8.50 9.30 090

28272 ............ A Release of toe joint, each .................................. 3.80 2.94 3.54 0.18 6.92 7.52 090

28280 ............ A Fusion of toes .................................................... 5.19 4.73 5.19 0.30 10.22 10.68 090

28285 ............ A Repair of hammertoe ......................................... 4.59 3.54 4.03 0.39 8.52 9.01 090

28286 ............ A Repair of hammertoe ......................................... 4.56 3.52 4.01 0.38 8.46 8.95 090

28288 ............ A Partial removal of foot bone ............................... 4.74 3.93 5.42 0.43 9.10 10.59 090

28290 ............ A Correction of bunion ........................................... 5.66 4.30 6.27 0.63 10.59 12.56 090

28292 ............ A Correction of bunion ........................................... 7.04 4.62 5.09 0.74 12.40 12.87 090

28293 ............ A Correction of bunion ........................................... 9.15 5.73 5.49 0.98 15.86 15.62 090

28294 ............ A Correction of bunion ........................................... 8.56 5.35 5.12 0.86 14.77 14.54 090

28296 ............ A Correction of bunion ........................................... 9.18 5.60 6.12 0.98 15.76 16.28 090

28297 ............ A Correction of bunion ........................................... 9.18 9.18 7.35 1.05 19.41 17.58 090

28298 ............ A Correction of bunion ........................................... 7.94 5.03 5.50 0.79 13.76 14.23 090

28299 ............ A Correction of bunion ........................................... 8.88 5.32 5.58 1.08 15.28 15.54 090

28300 ............ A Incision of heel bone .......................................... 9.54 6.28 7.24 0.79 16.61 17.57 090

28302 ............ A Incision of ankle bone ........................................ 9.55 5.33 6.63 1.12 16.00 17.30 090

28304 ............ A Incision of midfoot bones ................................... 9.16 5.85 6.00 0.70 15.71 15.86 090

28305 ............ A Incise/graft midfoot bones .................................. 10.50 7.76 7.22 1.03 19.29 18.75 090

28306 ............ A Incision of metatarsal ......................................... 5.86 4.29 4.37 0.47 10.62 10.70 090

28307 ............ A Incision of metatarsal ......................................... 6.33 5.57 6.27 0.76 12.66 13.36 090

28308 ............ A Incision of metatarsal ......................................... 5.29 3.50 3.50 0.50 9.29 9.29 090

28309 ............ A Incision of metatarsals ....................................... 12.78 NA 9.00 1.00 NA 22.78 090

28310 ............ A Revision of big toe ............................................. 5.43 3.82 3.97 0.42 9.67 9.82 090

28312 ............ A Revision of toe ................................................... 4.55 3.53 4.34 0.45 8.53 9.34 090

28313 ............ A Repair deformity of toe ...................................... 5.01 3.89 6.32 0.31 9.21 11.64 090
30925

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

28315 ............ A Removal of sesamoid bone ............................... 4.86 3.47 3.57 0.41 8.74 8.84 090

28320 ............ A Repair of foot bones .......................................... 9.18 NA 7.29 1.03 NA 17.50 090

28322 ............ A Repair of metatarsals ......................................... 8.34 5.66 6.58 0.52 14.52 15.44 090

28340 ............ A Resect enlarged toe tissue ................................ 6.98 4.31 4.45 0.91 12.20 12.34 090

28341 ............ A Resect enlarged toe ........................................... 8.41 4.94 5.65 0.96 14.31 15.02 090

28344 ............ A Repair extra toe(s) ............................................. 4.26 3.01 4.00 0.60 7.87 8.86 090

28345 ............ A Repair webbed toe(s) ......................................... 5.92 4.96 5.47 0.73 11.61 12.12 090

28360 ............ A Reconstruct cleft foot ......................................... 13.34 NA 12.53 1.95 NA 27.82 090

28400 ............ A Treatment of heel fracture ................................. 2.16 5.37 3.00 0.40 7.93 5.56 090

28405 ............ A Treatment of heel fracture ................................. 4.57 6.46 4.76 0.58 11.61 9.91 090

28406 ............ A Treatment of heel fracture ................................. 6.31 NA 6.85 0.93 NA 14.09 090

28415 ............ A Repair of heel fracture ....................................... 15.97 NA 28.96 1.39 NA 46.32 090

28420 ............ A Repair/graft heel fracture ................................... 16.64 NA 30.12 1.63 NA 48.39 090

28430 ............ A Treatment of ankle fracture ................................ 2.09 5.07 2.26 0.35 7.51 4.70 090

28435 ............ A Treatment of ankle fracture ................................ 3.40 5.14 3.72 0.50 9.04 7.62 090

28436 ............ A Treatment of ankle fracture ................................ 4.71 NA 5.92 0.68 NA 11.31 090

28445 ............ A Repair of ankle fracture ..................................... 9.33 NA 8.25 1.40 NA 18.98 090

28450 ............ A Treat midfoot fracture, each ............................... 1.90 4.76 2.28 0.25 6.91 4.43 090

28455 ............ A Treat midfoot fracture, each ............................... 3.09 4.07 3.81 0.34 7.50 7.24 090

28456 ............ A Repair midfoot fracture ...................................... 2.68 NA 4.36 0.38 NA 7.42 090

28465 ............ A Repair midfoot fracture, each ............................ 7.01 NA 15.39 0.81 NA 23.21 090

28470 ............ A Treat metatarsal fracture .................................... 1.99 4.39 1.94 0.23 6.61 4.16 090

28475 ............ A Treat metatarsal fracture .................................... 2.97 4.47 3.30 0.30 7.74 6.57 090

28476 ............ A Repair metatarsal fracture ................................. 3.38 NA 4.92 0.45 NA 8.75 090

28485 ............ A Repair metatarsal fracture ................................. 5.71 NA 16.10 0.60 NA 22.41 090

28490 ............ A Treat big toe fracture ......................................... 1.09 1.50 1.10 0.10 2.69 2.29 090

28495 ............ A Treat big toe fracture ......................................... 1.58 1.50 1.56 0.13 3.21 3.27 090

28496 ............ A Repair big toe fracture ....................................... 2.33 3.13 3.93 0.31 5.77 6.57 090

28505 ............ A Repair big toe fracture ....................................... 3.81 11.81 12.54 0.43 16.05 16.78 090

28510 ............ A Treatment of toe fracture ................................... 1.09 1.26 1.02 0.09 2.44 2.20 090

28515 ............ A Treatment of toe fracture ................................... 1.46 1.35 1.31 0.11 2.92 2.88 090

28525 ............ A Repair of toe fracture ......................................... 3.32 10.38 14.94 0.29 13.99 18.55 090

28530 ............ A Treat sesamoid bone fracture ............................ 1.06 1.70 1.61 0.10 2.86 2.77 090

28531 ............ A Treat sesamoid bone fracture ............................ 2.35 2.86 12.41 0.32 5.53 15.08 090

28540 ............ A Treat foot dislocation .......................................... 2.04 2.37 2.11 0.06 4.47 4.21 090

28545 ............ A Treat foot dislocation .......................................... 2.45 1.84 3.50 0.14 4.43 6.09 090

28546 ............ A Treat foot dislocation .......................................... 3.20 7.60 4.19 0.45 11.25 7.84 090

28555 ............ A Repair foot dislocation ....................................... 6.30 21.63 17.07 0.73 28.66 24.10 090

28570 ............ A Treat foot dislocation .......................................... 1.66 3.36 2.59 0.17 5.19 4.42 090

28575 ............ A Treat foot dislocation .......................................... 3.31 4.96 4.00 0.42 8.69 7.73 090

28576 ............ A Treat foot dislocation .......................................... 4.17 6.82 5.28 0.42 11.41 9.87 090

28585 ............ A Repair foot dislocation ....................................... 7.99 8.08 15.29 0.55 16.62 23.83 090

28600 ............ A Treat foot dislocation .......................................... 1.89 3.83 2.55 0.08 5.80 4.52 090

28605 ............ A Treat foot dislocation .......................................... 2.71 3.53 3.68 0.34 6.58 6.73 090

28606 ............ A Treat foot dislocation .......................................... 4.90 5.37 5.57 0.55 10.82 11.02 090

28615 ............ A Repair foot dislocation ....................................... 7.77 NA 20.06 0.78 NA 28.61 090

28630 ............ A Treat toe dislocation ........................................... 1.70 1.64 1.21 0.11 3.45 3.02 010

28635 ............ A Treat toe dislocation ........................................... 1.91 1.94 2.13 0.18 4.03 4.22 010

28636 ............ A Treat toe dislocation ........................................... 2.77 1.93 2.86 0.42 5.12 6.05 010

28645 ............ A Repair toe dislocation ........................................ 4.22 3.54 6.04 0.38 8.14 10.64 090

28660 ............ A Treat toe dislocation ........................................... 1.23 2.55 1.12 0.06 3.84 2.41 010

28665 ............ A Treat toe dislocation ........................................... 1.92 1.93 2.12 0.11 3.96 4.15 010

28666 ............ A Treat toe dislocation ........................................... 2.66 8.44 2.68 0.40 11.50 5.74 010

28675 ............ A Repair of toe dislocation .................................... 2.92 4.34 9.17 0.41 7.67 12.50 090

28705 ............ A Fusion of foot bones .......................................... 15.21 NA 11.62 2.35 NA 29.18 090

28715 ............ A Fusion of foot bones .......................................... 13.10 NA 10.62 1.89 NA 25.61 090

28725 ............ A Fusion of foot bones .......................................... 11.61 NA 9.76 1.44 NA 22.81 090

28730 ............ A Fusion of foot bones .......................................... 10.76 NA 8.67 1.33 NA 20.76 090

28735 ............ A Fusion of foot bones .......................................... 10.85 NA 8.94 1.37 NA 21.16 090

28737 ............ A Revision of foot bones ....................................... 9.64 NA 7.47 1.13 NA 18.24 090

28740 ............ A Fusion of foot bones .......................................... 8.02 8.02 6.91 0.72 16.76 15.65 090

28750 ............ A Fusion of big toe joint ........................................ 7.30 8.03 6.99 0.82 16.15 15.11 090

28755 ............ A Fusion of big toe joint ........................................ 4.74 3.64 4.51 0.45 8.83 9.70 090

28760 ............ A Fusion of big toe joint ........................................ 7.75 5.31 6.10 0.65 13.71 14.50 090

28800 ............ A Amputation of midfoot ........................................ 8.21 NA 6.55 1.19 NA 15.95 090

28805 ............ A Amputation thru metatarsal ................................ 8.39 NA 6.21 1.21 NA 15.81 090

28810 ............ A Amputation toe & metatarsal ............................. 6.21 NA 5.18 0.75 NA 12.14 090

28820 ............ A Amputation of toe ............................................... 4.41 5.54 4.59 0.46 10.41 9.46 090

28825 ............ A Partial amputation of toe .................................... 3.59 5.41 4.10 0.41 9.41 8.10 090

29000 ............ A Application of body cast ..................................... 2.25 7.59 1.34 0.21 10.05 3.80 000

29010 ............ A Application of body cast ..................................... 2.06 9.76 1.22 0.34 12.16 3.62 000

29015 ............ A Application of body cast ..................................... 2.41 6.34 1.07 0.33 9.08 3.81 000

29020 ............ A Application of body cast ..................................... 2.11 6.03 1.05 0.23 8.37 3.39 000

29025 ............ A Application of body cast ..................................... 2.40 8.76 1.43 0.14 11.30 3.97 000
30926

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

29035 ............ A Application of body cast ..................................... 1.77 10.29 1.11 0.32 12.38 3.20 000

29040 ............ A Application of body cast ..................................... 2.22 7.79 0.91 0.30 10.31 3.43 000

29044 ............ A Application of body cast ..................................... 2.12 13.00 1.35 0.34 15.46 3.81 000

29046 ............ A Application of body cast ..................................... 2.41 11.41 1.46 0.36 14.18 4.23 000

29049 ............ A Application of figure eight .................................. 0.89 3.83 0.38 0.06 4.78 1.33 000

29055 ............ A Application of shoulder cast ............................... 1.78 8.03 0.98 0.17 9.98 2.93 000

29058 ............ A Application of shoulder cast ............................... 1.31 5.55 0.57 0.09 6.95 1.97 000

29065 ............ A Application of long arm cast .............................. 0.87 3.61 0.53 0.13 4.61 1.53 000

29075 ............ A Application of forearm cast ................................ 0.77 3.22 0.45 0.10 4.09 1.32 000

29085 ............ A Apply hand/wrist cast ......................................... 0.87 3.14 0.48 0.08 4.09 1.43 000

29105 ............ A Apply long arm splint ......................................... 0.87 2.50 0.31 0.08 3.45 1.26 000

29125 ............ A Apply forearm splint ........................................... 0.59 1.99 0.18 0.05 2.63 0.82 000

29126 ............ A Apply forearm splint ........................................... 0.77 2.55 0.41 0.06 3.38 1.24 000

29130 ............ A Application of finger splint .................................. 0.50 0.61 0.15 0.02 1.13 0.67 000

29131 ............ A Application of finger splint .................................. 0.55 0.82 0.25 0.06 1.43 0.86 000

29200 ............ A Strapping of chest .............................................. 0.65 0.75 0.17 0.03 1.43 0.85 000

29220 ............ A Strapping of low back ........................................ 0.64 0.79 0.25 0.05 1.48 0.94 000

29240 ............ A Strapping of shoulder ......................................... 0.71 0.86 0.21 0.03 1.60 0.95 000

29260 ............ A Strapping of elbow or wrist ................................ 0.55 0.71 0.15 0.03 1.29 0.73 000

29280 ............ A Strapping of hand or finger ................................ 0.51 0.68 0.14 0.02 1.21 0.67 000

29305 ............ A Application of hip cast ........................................ 2.03 10.18 1.27 0.31 12.52 3.61 000

29325 ............ A Application of hip casts ...................................... 2.32 9.99 1.42 0.28 12.59 4.02 000

29345 ............ A Application of long leg cast ................................ 1.40 4.54 0.83 0.16 6.10 2.39 000

29355 ............ A Application of long leg cast ................................ 1.53 4.43 0.91 0.17 6.13 2.61 000

29358 ............ A Apply long leg cast brace .................................. 1.43 5.28 0.91 0.33 7.04 2.67 000

29365 ............ A Application of long leg cast ................................ 1.18 3.96 0.72 0.14 5.28 2.04 000

29405 ............ A Apply short leg cast ........................................... 0.86 3.26 0.50 0.12 4.24 1.48 000

29425 ............ A Apply short leg cast ........................................... 1.01 3.09 0.56 0.14 4.24 1.71 000

29435 ............ A Apply short leg cast ........................................... 1.18 5.52 0.74 0.18 6.88 2.10 000

29440 ............ A Addition of walker to cast ................................... 0.57 1.67 0.30 0.03 2.27 0.90 000

29445 ............ A Apply rigid leg cast ............................................. 1.78 4.94 0.98 0.28 7.00 3.04 000

29450 ............ A Application of leg cast ........................................ 1.02 2.89 0.46 0.04 3.95 1.52 000

29505 ............ A Application long leg splint .................................. 0.69 2.84 0.26 0.07 3.60 1.02 000

29515 ............ A Application lower leg splint ................................ 0.73 1.81 0.25 0.06 2.60 1.04 000

29520 ............ A Strapping of hip .................................................. 0.54 0.68 0.32 0.03 1.25 0.89 000

29530 ............ A Strapping of knee ............................................... 0.57 0.72 0.16 0.05 1.34 0.78 000

29540 ............ A Strapping of ankle .............................................. 0.51 0.32 0.18 0.03 0.86 0.72 000

29550 ............ A Strapping of toes ................................................ 0.47 0.30 0.18 0.03 0.80 0.68 000

29580 ............ A Application of paste boot ................................... 0.57 0.60 0.27 0.04 1.21 0.88 000

29590 ............ A Application of foot splint ..................................... 0.76 0.47 0.34 0.03 1.26 1.13 000

29700 ............ A Removal/revision of cast .................................... 0.57 0.54 0.26 0.05 1.16 0.88 000

29705 ............ A Removal/revision of cast .................................... 0.76 0.77 0.35 0.05 1.58 1.16 000

29710 ............ A Removal/revision of cast .................................... 1.34 1.22 0.89 0.07 2.63 2.30 000

29715 ............ A Removal/revision of cast .................................... 0.94 2.86 0.65 0.12 3.92 1.71 000

29720 ............ A Repair of body cast ............................................ 0.68 3.21 0.42 0.04 3.93 1.14 000

29730 ............ A Windowing of cast .............................................. 0.75 0.73 0.35 0.04 1.52 1.14 000

29740 ............ A Wedging of cast ................................................. 1.12 2.35 0.64 0.06 3.53 1.82 000

29750 ............ A Wedging of clubfoot cast ................................... 1.26 1.03 0.65 0.07 2.36 1.98 000

29800 ............ A Jaw arthroscopy/surgery .................................... 6.43 NA 7.16 0.46 NA 14.05 090

29804 ............ A Jaw arthroscopy/surgery .................................... 8.14 NA 7.84 1.46 NA 17.44 090

29815 ............ A Shoulder arthroscopy ......................................... 5.89 NA 6.09 0.76 NA 12.74 090

29819 ............ A Shoulder arthroscopy/surgery ............................ 7.62 NA 7.41 1.73 NA 16.76 090

29820 ............ A Shoulder arthroscopy/surgery ............................ 7.07 NA 7.33 1.73 NA 16.13 090

29821 ............ A Shoulder arthroscopy/surgery ............................ 7.72 NA 7.75 2.13 NA 17.60 090

29822 ............ A Shoulder arthroscopy/surgery ............................ 7.43 NA 7.54 1.74 NA 16.71 090

29823 ............ A Shoulder arthroscopy/surgery ............................ 8.17 NA 7.97 2.32 NA 18.46 090

29825 ............ A Shoulder arthroscopy/surgery ............................ 7.62 NA 7.65 2.05 NA 17.32 090

29826 ............ A Shoulder arthroscopy/surgery ............................ 8.99 NA 8.42 2.31 NA 19.72 090

29830 ............ A Elbow arthroscopy .............................................. 5.76 NA 5.00 0.83 NA 11.59 090

29834 ............ A Elbow arthroscopy/surgery ................................. 6.28 NA 5.66 0.96 NA 12.90 090

29835 ............ A Elbow arthroscopy/surgery ................................. 6.48 NA 5.73 0.99 NA 13.20 090

29836 ............ A Elbow arthroscopy/surgery ................................. 7.55 NA 6.20 1.15 NA 14.90 090

29837 ............ A Elbow arthroscopy/surgery ................................. 6.87 NA 6.03 1.06 NA 13.96 090

29838 ............ A Elbow arthroscopy/surgery ................................. 7.71 NA 6.54 1.14 NA 15.39 090

29840 ............ A Wrist arthroscopy ............................................... 5.54 NA 6.26 0.54 NA 12.34 090

29843 ............ A Wrist arthroscopy/surgery .................................. 6.01 NA 6.75 0.91 NA 13.67 090

29844 ............ A Wrist arthroscopy/surgery .................................. 6.37 NA 7.14 0.95 NA 14.46 090

29845 ............ A Wrist arthroscopy/surgery .................................. 7.52 NA 7.93 1.15 NA 16.60 090

29846 ............ A Wrist arthroscopy/surgery .................................. 6.75 NA 8.86 2.20 NA 17.81 090

29847 ............ A Wrist arthroscopy/surgery .................................. 7.08 NA 8.94 0.97 NA 16.99 090

29848 ............ A Wrist arthroscopy/surgery .................................. 5.44 NA 6.41 0.62 NA 12.47 090

29850 ............ A Knee arthroscopy/surgery .................................. 8.19 NA 5.47 1.74 NA 15.40 090

29851 ............ A Knee arthroscopy/surgery .................................. 13.10 NA 10.43 1.74 NA 25.27 090

29855 ............ A Tibial arthroscopy/surgery .................................. 10.62 NA 8.87 1.88 NA 21.37 090
30927

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

29856 ............ A Tibial arthroscopy/surgery .................................. 14.14 NA 11.01 1.88 NA 27.03 090

29860 ............ A Hip arthroscopy, dx ............................................ 8.05 NA 6.22 0.76 NA 15.03 090

29861 ............ A Hip arthroscopy/surgery ..................................... 9.15 NA 7.11 1.73 NA 17.99 090

29862 ............ A Hip arthroscopy/surgery ..................................... 9.90 NA 7.51 2.32 NA 19.73 090

29863 ............ A Hip arthroscopy/surgery ..................................... 9.90 NA 7.80 1.73 NA 19.43 090

29870 ............ A Knee arthroscopy, diagnostic ............................. 5.07 NA 4.90 0.64 NA 10.61 090

29871 ............ A Knee arthroscopy/drainage ................................ 6.55 NA 6.54 0.96 NA 14.05 090

29874 ............ A Knee arthroscopy/surgery .................................. 7.05 NA 6.37 1.52 NA 14.94 090

29875 ............ A Knee arthroscopy/surgery .................................. 6.31 NA 6.16 1.61 NA 14.08 090

29876 ............ A Knee arthroscopy/surgery .................................. 7.92 NA 7.42 1.95 NA 17.29 090

29877 ............ A Knee arthroscopy/surgery .................................. 7.35 NA 6.80 1.81 NA 15.96 090

29879 ............ A Knee arthroscopy/surgery .................................. 8.04 NA 7.21 2.19 NA 17.44 090

29880 ............ A Knee arthroscopy/surgery .................................. 8.50 NA 7.47 2.22 NA 18.19 090

29881 ............ A Knee arthroscopy/surgery .................................. 7.76 NA 7.04 1.82 NA 16.62 090

29882 ............ A Knee arthroscopy/surgery .................................. 8.65 NA 7.05 1.90 NA 17.60 090

29883 ............ A Knee arthroscopy/surgery .................................. 9.46 NA 8.10 2.80 NA 20.36 090

29884 ............ A Knee arthroscopy/surgery .................................. 7.33 NA 7.08 1.56 NA 15.97 090

29885 ............ A Knee arthroscopy/surgery .................................. 9.09 NA 8.18 1.35 NA 18.62 090

29886 ............ A Knee arthroscopy/surgery .................................. 7.54 NA 7.14 1.12 NA 15.80 090

29887 ............ A Knee arthroscopy/surgery .................................. 9.04 NA 7.82 1.71 NA 18.57 090

29888 ............ A Knee arthroscopy/surgery .................................. 13.90 NA 10.66 3.18 NA 27.74 090

29889 ............ A Knee arthroscopy/surgery .................................. 15.13 NA 11.08 1.68 NA 27.89 090

29891 ............ A Ankle arthroscopy/surgery ................................. 8.40 NA 6.99 1.77 NA 17.16 090

29892 ............ A Ankle arthroscopy/surgery ................................. 9.00 NA 7.27 1.77 NA 18.04 090

29893 ............ A Scope, plantar fasciotomy .................................. 5.22 NA 3.78 0.46 NA 9.46 090

29894 ............ A Ankle arthroscopy/surgery ................................. 7.21 NA 6.37 1.47 NA 15.05 090

29895 ............ A Ankle arthroscopy/surgery ................................. 6.99 NA 6.23 1.51 NA 14.73 090

29897 ............ A Ankle arthroscopy/surgery ................................. 7.18 NA 6.81 1.77 NA 15.76 090

29898 ............ A Ankle arthroscopy/surgery ................................. 8.32 NA 6.72 1.91 NA 16.95 090

30000 ............ A Drainage of nose lesion ..................................... 1.43 1.59 1.40 0.05 3.07 2.88 010

30020 ............ A Drainage of nose lesion ..................................... 1.43 1.57 1.44 0.06 3.06 2.93 010

30100 ............ A Intranasal biopsy ................................................ 0.94 0.93 0.58 0.08 1.95 1.60 000

30110 ............ A Removal of nose polyp(s) .................................. 1.63 1.81 0.99 0.14 3.58 2.76 010

30115 ............ A Removal of nose polyp(s) .................................. 4.35 NA 4.11 0.30 NA 8.76 090

30117 ............ A Removal of intranasal lesion .............................. 3.16 3.15 2.83 0.31 6.62 6.30 090

30118 ............ A Removal of intranasal lesion .............................. 9.69 NA 7.57 0.92 NA 18.18 090

30120 ............ A Revision of nose ................................................ 5.27 4.23 5.03 1.00 10.50 11.30 090

30124 ............ A Removal of nose lesion ..................................... 3.10 NA 2.96 0.16 NA 6.22 090

30125 ............ A Removal of nose lesion ..................................... 7.16 NA 6.04 0.73 NA 13.93 090

30130 ............ A Removal of turbinate bones ............................... 3.38 NA 3.60 0.17 NA 7.15 090

30140 ............ A Removal of turbinate bones ............................... 3.43 NA 3.81 0.34 NA 7.58 090

30150 ............ A Partial removal of nose ...................................... 9.14 NA 7.40 1.07 NA 17.61 090

30160 ............ A Removal of nose ................................................ 9.58 NA 7.73 1.73 NA 19.04 090

30200 ............ A Injection treatment of nose ................................ 0.78 0.87 0.49 0.04 1.69 1.31 000

30210 ............ A Nasal sinus therapy ........................................... 1.08 1.36 0.69 0.03 2.47 1.80 010

30220 ............ A Insert nasal septal button ................................... 1.54 1.68 0.98 0.16 3.38 2.68 010

30300 ............ A Remove nasal foreign body ............................... 1.04 1.56 0.39 0.05 2.65 1.48 010

30310 ............ A Remove nasal foreign body ............................... 1.96 NA 1.83 0.18 NA 3.97 010

30320 ............ A Remove nasal foreign body ............................... 4.52 NA 4.23 0.43 NA 9.18 090

30400 ............ R Reconstruction of nose ...................................... 9.83 NA 7.98 1.36 NA 19.17 090

30410 ............ R Reconstruction of nose ...................................... 12.98 NA 9.78 2.01 NA 24.77 090

30420 ............ R Reconstruction of nose ...................................... 15.88 NA 11.71 2.22 NA 29.81 090

30430 ............ R Revision of nose ................................................ 7.21 NA 6.28 0.66 NA 14.15 090

30435 ............ R Revision of nose ................................................ 11.71 NA 9.29 1.10 NA 22.10 090

30450 ............ R Revision of nose ................................................ 18.65 NA 13.35 0.91 NA 32.91 090

30460 ............ A Revision of nose ................................................ 9.96 NA 7.10 0.93 NA 17.99 090

30462 ............ A Revision of nose ................................................ 19.57 NA 13.86 1.87 NA 35.30 090

30520 ............ A Repair of nasal septum ...................................... 5.70 NA 5.13 0.96 NA 11.79 090

30540 ............ A Repair nasal defect ............................................ 7.75 NA 5.87 0.70 NA 14.32 090

30545 ............ A Repair nasal defect ............................................ 11.38 NA 7.57 0.93 NA 19.88 090

30560 ............ A Release of nasal adhesions ............................... 1.26 1.52 1.38 0.06 2.84 2.70 010

30580 ............ A Repair upper jaw fistula ..................................... 6.69 4.15 4.89 0.57 11.41 12.15 090

30600 ............ A Repair mouth/nose fistula .................................. 6.02 3.84 4.84 0.36 10.22 11.22 090

30620 ............ A Intranasal reconstruction .................................... 5.97 NA 5.50 1.10 NA 12.57 090

30630 ............ A Repair nasal septum defect ............................... 7.12 NA 6.14 0.71 NA 13.97 090

30801 ............ A Cauterization inner nose .................................... 1.09 1.55 1.84 0.05 2.69 2.98 010

30802 ............ A Cauterization inner nose .................................... 2.03 2.15 2.48 0.11 4.29 4.62 010

30901 ............ A Control of nosebleed .......................................... 1.21 1.48 0.46 0.06 2.75 1.73 000

30903 ............ A Control of nosebleed .......................................... 1.54 1.76 0.74 0.08 3.38 2.36 000

30905 ............ A Control of nosebleed .......................................... 1.97 2.94 1.18 0.17 5.08 3.32 000

30906 ............ A Repeat control of nosebleed .............................. 2.45 3.23 1.76 0.11 5.79 4.32 000

30915 ............ A Ligation nasal sinus artery ................................. 7.20 NA 6.23 0.52 NA 13.95 090

30920 ............ A Ligation upper jaw artery ................................... 9.83 NA 7.88 1.32 NA 19.03 090

30930 ............ A Therapy fracture of nose .................................... 1.26 NA 1.93 0.08 NA 3.27 010
30928

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

31000 ............ A Irrigation maxillary sinus .................................... 1.15 1.46 0.72 0.05 2.66 1.92 010

31002 ............ A Irrigation sphenoid sinus .................................... 1.91 NA 2.05 0.05 NA 4.01 010

31020 ............ A Exploration maxillary sinus ................................ 2.94 2.99 3.01 0.29 6.22 6.24 090

31030 ............ A Exploration maxillary sinus ................................ 5.92 3.80 4.65 0.86 10.58 11.43 090

31032 ............ A Explore sinus,remove polyps ............................. 6.57 NA 5.59 0.99 NA 13.15 090

31040 ............ A Exploration behind upper jaw ............................ 9.42 NA 6.12 0.86 NA 16.40 090

31050 ............ A Exploration sphenoid sinus ................................ 5.28 NA 4.68 0.64 NA 10.60 090

31051 ............ A Sphenoid sinus surgery ..................................... 7.11 NA 5.98 0.85 NA 13.94 090

31070 ............ A Exploration of frontal sinus ................................ 4.28 NA 4.22 0.50 NA 9.00 090

31075 ............ A Exploration of frontal sinus ................................ 9.16 NA 7.54 1.10 NA 17.80 090

31080 ............ A Removal of frontal sinus .................................... 11.42 NA 8.20 1.12 NA 20.74 090

31081 ............ A Removal of frontal sinus .................................... 12.75 NA 9.00 1.30 NA 23.05 090

31084 ............ A Removal of frontal sinus .................................... 13.51 NA 10.25 1.62 NA 25.38 090

31085 ............ A Removal of frontal sinus .................................... 14.20 NA 10.54 1.76 NA 26.50 090

31086 ............ A Removal of frontal sinus .................................... 12.86 NA 9.98 1.15 NA 23.99 090

31087 ............ A Removal of frontal sinus .................................... 13.10 NA 10.08 1.33 NA 24.51 090

31090 ............ A Exploration of sinuses ........................................ 9.53 NA 7.93 2.12 NA 19.58 090

31200 ............ A Removal of ethmoid sinus ................................. 4.97 NA 5.42 0.48 NA 10.87 090

31201 ............ A Removal of ethmoid sinus ................................. 8.37 NA 7.04 0.75 NA 16.16 090

31205 ............ A Removal of ethmoid sinus ................................. 10.24 NA 8.74 0.81 NA 19.79 090

31225 ............ A Removal of upper jaw ........................................ 19.23 NA 15.40 2.37 NA 37.00 090

31230 ............ A Removal of upper jaw ........................................ 21.94 NA 17.90 2.48 NA 42.32 090

31231 ............ A Nasal endoscopy, dx .......................................... 1.10 1.33 0.66 0.15 2.58 1.91 000

31233 ............ A Nasal/sinus endoscopy, dx ................................ 2.18 2.02 1.36 0.31 4.51 3.85 000

31235 ............ A Nasal/sinus endoscopy, dx ................................ 2.64 2.33 1.69 0.26 5.23 4.59 000

31237 ............ A Nasal/sinus endoscopy, surg ............................. 2.98 2.57 1.85 0.37 5.92 5.20 000

31238 ............ A Nasal/sinus endoscopy, surg ............................. 3.26 2.87 2.07 0.45 6.58 5.78 000

31239 ............ A Nasal/sinus endoscopy, surg ............................. 8.70 NA 6.90 1.18 NA 16.78 010

31240 ............ A Nasal/sinus endoscopy, surg ............................. 2.61 NA 1.94 0.37 NA 4.92 000

31254 ............ A Revision of ethmoid sinus .................................. 4.65 NA 3.27 0.69 NA 8.61 000

31255 ............ A Removal of ethmoid sinus ................................. 6.96 NA 4.84 1.14 NA 12.94 000

31256 ............ A Exploration maxillary sinus ................................ 3.29 NA 2.38 0.41 NA 6.08 000

31267 ............ A Endoscopy, maxillary sinus ................................ 5.46 NA 3.74 0.81 NA 10.01 000

31276 ............ A Sinus surgical endoscopy .................................. 8.85 NA 5.94 0.73 NA 15.52 000

31287 ............ A Nasal/sinus endoscopy, surg ............................. 3.92 NA 2.76 0.65 NA 7.33 000

31288 ............ A Nasal/sinus endoscopy, surg ............................. 4.58 NA 3.19 0.78 NA 8.55 000

31290 ............ A Nasal/sinus endoscopy, surg ............................. 17.24 NA 12.19 1.80 NA 31.23 010

31291 ............ A Nasal/sinus endoscopy, surg ............................. 18.19 NA 12.96 1.88 NA 33.03 010

31292 ............ A Nasal/sinus endoscopy, surg ............................. 14.76 NA 10.38 1.45 NA 26.59 010

31293 ............ A Nasal/sinus endoscopy, surg ............................. 16.21 NA 11.96 1.59 NA 29.76 010

31294 ............ A Nasal/sinus endoscopy, surg ............................. 19.06 NA 12.98 1.83 NA 33.87 010

31300 ............ A Removal of larynx lesion .................................... 14.29 NA 14.31 1.28 NA 29.88 090

31320 ............ A Diagnostic incision larynx ................................... 5.26 NA 9.19 0.48 NA 14.93 090

31360 ............ A Removal of larynx .............................................. 17.08 NA 17.11 2.19 NA 36.38 090

31365 ............ A Removal of larynx .............................................. 24.16 NA 21.72 3.10 NA 48.98 090

31367 ............ A Partial removal of larynx .................................... 21.86 NA 21.02 1.88 NA 44.76 090

31368 ............ A Partial removal of larynx .................................... 27.09 NA 25.77 3.06 NA 55.92 090

31370 ............ A Partial removal of larynx .................................... 21.38 NA 20.44 1.88 NA 43.70 090

31375 ............ A Partial removal of larynx .................................... 20.21 NA 18.73 1.56 NA 40.50 090

31380 ............ A Partial removal of larynx .................................... 20.21 NA 18.65 1.88 NA 40.74 090

31382 ............ A Partial removal of larynx .................................... 20.52 NA 19.85 1.78 NA 42.15 090

31390 ............ A Removal of larynx & pharynx ............................. 27.53 NA 25.76 4.05 NA 57.34 090

31395 ............ A Reconstruct larynx & pharynx ............................ 31.09 NA 30.56 4.42 NA 66.07 090

31400 ............ A Revision of larynx ............................................... 10.31 NA 11.89 0.91 NA 23.11 090

31420 ............ A Removal of epiglottis .......................................... 10.22 NA 12.46 0.84 NA 23.52 090

31500 ............ A Insert emergency airway .................................... 2.33 NA 0.62 0.14 NA 3.09 000

31502 ............ A Change of windpipe airway ................................ 0.65 1.09 0.28 0.07 1.81 1.00 000

31505 ............ A Diagnostic laryngoscopy .................................... 0.61 1.05 0.35 0.05 1.71 1.01 000

31510 ............ A Laryngoscopy with biopsy .................................. 1.92 1.90 1.01 0.07 3.89 3.00 000

31511 ............ A Remove foreign body, larynx ............................. 2.16 2.12 0.70 0.10 4.38 2.96 000

31512 ............ A Removal of larynx lesion .................................... 2.07 2.07 1.23 0.20 4.34 3.50 000

31513 ............ A Injection into vocal cord ..................................... 2.10 NA 1.55 0.38 NA 4.03 000

31515 ............ A Laryngoscopy for aspiration ............................... 1.80 1.03 1.13 0.14 2.97 3.07 000

31520 ............ A Diagnostic laryngoscopy .................................... 2.56 NA 1.66 0.18 NA 4.40 000

31525 ............ A Diagnostic laryngoscopy .................................... 2.63 2.29 1.84 0.23 5.15 4.70 000

31526 ............ A Diagnostic laryngoscopy .................................... 2.57 NA 1.85 0.38 NA 4.80 000

31527 ............ A Laryngoscopy for treatment ............................... 3.27 NA 2.00 0.30 NA 5.57 000

31528 ............ A Laryngoscopy and dilatation .............................. 2.37 NA 1.56 0.30 NA 4.23 000

31529 ............ A Laryngoscopy and dilatation .............................. 2.68 NA 1.89 0.25 NA 4.82 000

31530 ............ A Operative laryngoscopy ..................................... 3.39 NA 1.97 0.39 NA 5.75 000

31531 ............ A Operative laryngoscopy ..................................... 3.59 NA 2.54 0.60 NA 6.73 000

31535 ............ A Operative laryngoscopy ..................................... 3.16 NA 2.16 0.45 NA 5.77 000

31536 ............ A Operative laryngoscopy ..................................... 3.56 NA 2.53 0.59 NA 6.68 000

31540 ............ A Operative laryngoscopy ..................................... 4.13 NA 2.78 0.61 NA 7.52 000
30929

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

31541 ............ A Operative laryngoscopy ..................................... 4.53 NA 3.15 0.75 NA 8.43 000

31560 ............ A Operative laryngoscopy ..................................... 5.46 NA 3.57 0.51 NA 9.54 000

31561 ............ A Operative laryngoscopy ..................................... 6.00 NA 4.13 1.08 NA 11.21 000

31570 ............ A Laryngoscopy with injection ............................... 3.87 2.38 2.77 0.60 6.85 7.24 000

31571 ............ A Laryngoscopy with injection ............................... 4.27 NA 2.98 0.69 NA 7.94 000

31575 ............ A Diagnostic laryngoscopy .................................... 1.10 1.37 0.65 0.17 2.64 1.92 000

31576 ............ A Laryngoscopy with biopsy .................................. 1.97 1.64 1.12 0.33 3.94 3.42 000

31577 ............ A Remove foreign body, larynx ............................. 2.47 1.97 1.22 0.37 4.81 4.06 000

31578 ............ A Removal of larynx lesion .................................... 2.84 2.17 1.35 0.48 5.49 4.67 000

31579 ............ A Diagnostic laryngoscopy .................................... 2.26 2.16 1.25 0.26 4.68 3.77 000

31580 ............ A Revision of larynx ............................................... 12.38 NA 13.28 1.63 NA 27.29 090

31582 ............ A Revision of larynx ............................................... 21.62 NA 19.49 1.94 NA 43.05 090

31584 ............ A Repair of larynx fracture .................................... 19.64 NA 17.42 1.34 NA 38.40 090

31585 ............ A Repair of larynx fracture .................................... 4.64 NA 6.56 0.40 NA 11.60 090

31586 ............ A Repair of larynx fracture .................................... 8.03 NA 9.67 0.71 NA 18.41 090

31587 ............ A Revision of larynx ............................................... 11.99 NA 13.22 0.79 NA 26.00 090

31588 ............ A Revision of larynx ............................................... 13.11 NA 14.51 1.16 NA 28.78 090

31590 ............ A Reinnervate larynx ............................................. 6.97 NA 9.63 0.62 NA 17.22 090

31595 ............ A Larynx nerve surgery ......................................... 8.34 NA 9.26 0.74 NA 18.34 090

31600 ............ A Incision of windpipe ............................................ 3.62 NA 2.22 0.65 NA 6.49 000

31601 ............ A Incision of windpipe ............................................ 4.45 NA 2.90 0.66 NA 8.01 000

31603 ............ A Incision of windpipe ............................................ 4.15 NA 2.49 0.66 NA 7.30 000

31605 ............ A Incision of windpipe ............................................ 3.58 NA 1.76 0.50 NA 5.84 000

31610 ............ A Incision of windpipe ............................................ 8.76 NA 9.04 0.92 NA 18.72 090

31611 ............ A Surgery/speech prosthesis ................................. 5.64 NA 7.88 1.04 NA 14.56 090

31612 ............ A Puncture/clear windpipe ..................................... 0.91 1.14 0.52 0.12 2.17 1.55 000

31613 ............ A Repair windpipe opening ................................... 4.59 NA 6.56 0.28 NA 11.43 090

31614 ............ A Repair windpipe opening ................................... 7.12 NA 9.23 0.73 NA 17.08 090

31615 ............ A Visualization of windpipe .................................... 2.09 4.04 1.44 0.22 6.35 3.75 000

31622 ............ A Diagnostic bronchoscopy ................................... 2.80 2.75 1.37 0.34 5.89 4.51 000

31625 ............ A Bronchoscopy with biopsy ................................. 3.37 2.79 1.50 0.35 6.51 5.22 000

31628 ............ A Bronchoscopy with biopsy ................................. 3.81 2.77 1.59 0.38 6.96 5.78 000

31629 ............ A Bronchoscopy with biopsy ................................. 3.37 NA 1.28 0.34 NA 4.99 000

31630 ............ A Bronchoscopy with repair ................................... 3.82 NA 2.03 0.50 NA 6.35 000

31631 ............ A Bronchoscopy with dilation ................................ 4.37 NA 2.10 0.48 NA 6.95 000

31635 ............ A Remove foreign body, airway ............................ 3.68 NA 1.72 0.53 NA 5.93 000

31640 ............ A Bronchoscopy & remove lesion ......................... 4.94 NA 2.38 0.67 NA 7.99 000

31641 ............ A Bronchoscopy, treat blockage ............................ 5.03 NA 2.10 0.85 NA 7.98 000

31645 ............ A Bronchoscopy, clear airways ............................. 3.16 NA 1.28 0.30 NA 4.74 000

31646 ............ A Bronchoscopy, reclear airways .......................... 2.72 NA 1.16 0.27 NA 4.15 000

31656 ............ A Bronchoscopy, inject for xray ............................. 2.17 NA 0.95 0.31 NA 3.43 000

31700 ............ A Insertion of airway catheter ................................ 1.34 1.85 0.64 0.17 3.36 2.15 000

31708 ............ A Instill airway contrast dye ................................... 1.41 NA 0.76 0.09 NA 2.26 000

31710 ............ A Insertion of airway catheter ................................ 1.30 NA 0.70 0.12 NA 2.12 000

31715 ............ A Injection for bronchus x-ray ............................... 1.11 NA 0.57 0.04 NA 1.72 000

31717 ............ A Bronchial brush biopsy ....................................... 2.12 2.11 0.87 0.06 4.29 3.05 000

31720 ............ A Clearance of airways ......................................... 1.06 1.59 0.51 0.09 2.74 1.66 000

31725 ............ A Clearance of airways ......................................... 1.96 NA 0.83 0.15 NA 2.94 000

31730 ............ A Intro windpipe wire/tube ..................................... 2.85 1.76 1.06 0.23 4.84 4.14 000

31750 ............ A Repair of windpipe ............................................. 13.02 NA 13.74 1.09 NA 27.85 090

31755 ............ A Repair of windpipe ............................................. 15.93 NA 16.59 1.44 NA 33.96 090

31760 ............ A Repair of windpipe ............................................. 22.35 NA 14.37 2.55 NA 39.27 090

31766 ............ A Reconstruction of windpipe ................................ 30.43 NA 19.67 1.12 NA 51.22 090

31770 ............ A Repair/graft of bronchus .................................... 22.51 NA 15.37 2.08 NA 39.96 090

31775 ............ A Reconstruct bronchus ........................................ 23.54 NA 18.49 1.92 NA 43.95 090

31780 ............ A Reconstruct windpipe ......................................... 17.72 NA 15.56 2.08 NA 35.36 090

31781 ............ A Reconstruct windpipe ......................................... 23.53 NA 22.21 1.96 NA 47.70 090

31785 ............ A Remove windpipe lesion .................................... 17.23 NA 16.74 1.17 NA 35.14 090

31786 ............ A Remove windpipe lesion .................................... 23.98 NA 21.83 2.24 NA 48.05 090

31800 ............ A Repair of windpipe injury ................................... 7.43 NA 8.70 0.76 NA 16.89 090

31805 ............ A Repair of windpipe injury ................................... 13.13 NA 12.12 1.41 NA 26.66 090

31820 ............ A Closure of windpipe lesion ................................. 4.49 5.74 6.36 0.46 10.69 11.31 090

31825 ............ A Repair of windpipe defect .................................. 6.81 7.91 8.99 0.58 15.30 16.38 090

31830 ............ A Revise windpipe scar ......................................... 4.50 5.74 6.40 0.42 10.66 11.32 090

32000 ............ A Drainage of chest ............................................... 1.54 2.62 0.66 0.08 4.24 2.28 000

32002 ............ A Treatment of collapsed lung .............................. 2.19 NA 0.92 0.22 NA 3.33 000

32005 ............ A Treat lung lining chemically ............................... 2.19 NA 0.96 0.15 NA 3.30 000

32020 ............ A Insertion of chest tube ....................................... 3.98 NA 1.61 0.43 NA 6.02 000

32035 ............ A Exploration of chest ........................................... 8.67 NA 8.41 1.25 NA 18.33 090

32036 ............ A Exploration of chest ........................................... 9.68 NA 8.84 1.32 NA 19.84 090

32095 ............ A Biopsy through chest wall .................................. 8.36 NA 8.11 1.45 NA 17.92 090

32100 ............ A Exploration/biopsy of chest ................................ 11.84 NA 9.52 2.10 NA 23.46 090

32110 ............ A Explore/repair chest ........................................... 13.62 NA 11.93 2.01 NA 27.56 090

32120 ............ A Re-exploration of chest ...................................... 11.54 NA 9.94 1.72 NA 23.20 090
30930

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

32124 ............ A Explore chest, free adhesions ........................... 12.72 NA 10.22 2.21 NA 25.15 090

32140 ............ A Removal of lung lesion(s) .................................. 13.93 NA 10.82 2.42 NA 27.17 090

32141 ............ A Remove/treat lung lesions ................................. 14.00 NA 12.36 2.53 NA 28.89 090

32150 ............ A Removal of lung lesion(s) .................................. 14.15 NA 10.82 2.01 NA 26.98 090

32151 ............ A Remove lung foreign body ................................. 14.21 NA 10.55 1.37 NA 26.13 090

32160 ............ A Open chest heart massage ................................ 9.30 NA 8.36 1.52 NA 19.18 090

32200 ............ A Open drainage, lung lesion ................................ 15.29 NA 13.85 0.93 NA 30.07 090

32201 ............ A Percut drainage, lung lesion .............................. 4.00 NA 9.66 0.35 NA 14.01 000

32215 ............ A Treat chest lining ................................................ 11.33 NA 8.92 1.28 NA 21.53 090

32220 ............ A Release of lung .................................................. 19.27 NA 14.67 3.01 NA 36.95 090

32225 ............ A Partial release of lung ........................................ 13.96 NA 12.42 2.28 NA 28.66 090

32310 ............ A Removal of chest lining ...................................... 13.44 NA 12.07 2.10 NA 27.61 090

32320 ............ A Free/remove chest lining .................................... 20.54 NA 14.84 3.40 NA 38.78 090

32400 ............ A Needle biopsy chest lining ................................. 1.76 1.32 0.98 0.12 3.20 2.86 000

32402 ............ A Open biopsy chest lining .................................... 7.56 NA 6.91 1.34 NA 15.81 090

32405 ............ A Biopsy, lung or mediastinum .............................. 1.93 1.49 1.24 0.18 3.60 3.35 000

32420 ............ A Puncture/clear lung ............................................ 2.18 NA 0.92 0.13 NA 3.23 000

32440 ............ A Removal of lung ................................................. 21.02 NA 14.46 3.55 NA 39.03 090

32442 ............ A Sleeve pneumonectomy ..................................... 26.24 NA 17.50 3.50 NA 47.24 090

32445 ............ A Removal of lung ................................................. 25.09 NA 17.24 3.88 NA 46.21 090

32480 ............ A Partial removal of lung ....................................... 18.32 NA 11.23 3.23 NA 32.78 090

32482 ............ A Bilobectomy ........................................................ 19.71 NA 12.90 3.23 NA 35.84 090

32484 ............ A Segmentectomy ................................................. 20.69 NA 13.37 3.23 NA 37.29 090

32486 ............ A Sleeve lobectomy ............................................... 23.92 NA 16.28 3.23 NA 43.43 090

32488 ............ A Completion pneumonectomy ............................. 25.71 NA 16.85 3.46 NA 46.02 090

32491 ............ R Lung volume reduction ....................................... 21.25 NA 45.14 3.02 NA 69.41 090

32500 ............ A Partial removal of lung ....................................... 14.30 NA 10.60 2.56 NA 27.46 090

32501 ............ A Repair bronchus (add-on) .................................. 4.69 NA 1.92 0.70 NA 7.31 ZZZ

32520 ............ A Remove lung & revise chest .............................. 21.68 NA 14.48 3.93 NA 40.09 090

32522 ............ A Remove lung & revise chest .............................. 24.20 NA 16.71 4.19 NA 45.10 090

32525 ............ A Remove lung & revise chest .............................. 26.50 NA 17.36 4.61 NA 48.47 090

32540 ............ A Removal of lung lesion ...................................... 14.64 NA 12.62 2.05 NA 29.31 090

32601 ............ A Thoracoscopy, diagnostic .................................. 5.46 NA 4.37 0.57 NA 10.40 000

32602 ............ A Thoracoscopy, diagnostic .................................. 5.96 NA 4.59 0.64 NA 11.19 000

32603 ............ A Thoracoscopy, diagnostic .................................. 7.81 NA 5.71 0.57 NA 14.09 000

32604 ............ A Thoracoscopy, diagnostic .................................. 8.78 NA 5.85 0.64 NA 15.27 000

32605 ............ A Thoracoscopy, diagnostic .................................. 6.93 NA 4.86 0.57 NA 12.36 000

32606 ............ A Thoracoscopy, diagnostic .................................. 8.40 NA 5.59 0.64 NA 14.63 000

32650 ............ A Thoracoscopy, surgical ...................................... 10.75 NA 9.05 1.28 NA 21.08 090

32651 ............ A Thoracoscopy, surgical ...................................... 12.91 NA 10.09 2.28 NA 25.28 090

32652 ............ A Thoracoscopy, surgical ...................................... 18.66 NA 13.47 3.01 NA 35.14 090

32653 ............ A Thoracoscopy, surgical ...................................... 12.87 NA 11.02 2.01 NA 25.90 090

32654 ............ A Thoracoscopy, surgical ...................................... 12.44 NA 11.35 2.01 NA 25.80 090

32655 ............ A Thoracoscopy, surgical ...................................... 13.10 NA 11.32 2.53 NA 26.95 090

32656 ............ A Thoracoscopy, surgical ...................................... 12.91 NA 9.83 2.36 NA 25.10 090

32657 ............ A Thoracoscopy, surgical ...................................... 13.65 NA 10.22 2.56 NA 26.43 090

32658 ............ A Thoracoscopy, surgical ...................................... 11.63 NA 9.63 2.52 NA 23.78 090

32659 ............ A Thoracoscopy, surgical ...................................... 11.59 NA 9.64 2.61 NA 23.84 090

32660 ............ A Thoracoscopy, surgical ...................................... 17.43 NA 12.53 3.56 NA 33.52 090

32661 ............ A Thoracoscopy, surgical ...................................... 13.25 NA 9.98 1.47 NA 24.70 090

32662 ............ A Thoracoscopy, surgical ...................................... 16.44 NA 10.82 2.74 NA 30.00 090

32663 ............ A Thoracoscopy, surgical ...................................... 18.47 NA 12.95 3.23 NA 34.65 090

32664 ............ A Thoracoscopy, surgical ...................................... 14.20 NA 9.81 2.04 NA 26.05 090

32665 ............ A Thoracoscopy, surgical ...................................... 15.54 NA 10.92 2.64 NA 29.10 090

32800 ............ A Repair lung hernia .............................................. 13.69 NA 9.95 1.58 NA 25.22 090

32810 ............ A Close chest after drainage ................................. 13.05 NA 10.62 1.19 NA 24.86 090

32815 ............ A Close bronchial fistula ........................................ 23.15 NA 16.10 2.62 NA 41.87 090

32820 ............ A Reconstruct injured chest .................................. 21.48 NA 16.63 3.24 NA 41.35 090

32851 ............ A Lung transplant, single ....................................... 38.63 NA 21.92 4.99 NA 65.54 090

32852 ............ A Lung transplant w/bypass .................................. 41.80 NA 24.20 5.41 NA 71.41 090

32853 ............ A Lung transplant, double ..................................... 47.81 NA 27.72 6.24 NA 81.77 090

32854 ............ A Lung transplant w/bypass .................................. 50.98 NA 29.31 6.67 NA 86.96 090

32900 ............ A Removal of rib(s) ................................................ 20.27 NA 13.27 1.63 NA 35.17 090

32905 ............ A Revise & repair chest wall ................................. 20.75 NA 13.80 2.60 NA 37.15 090

32906 ............ A Revise & repair chest wall ................................. 26.77 NA 18.37 2.92 NA 48.06 090

32940 ............ A Revision of lung ................................................. 19.43 NA 12.97 1.75 NA 34.15 090

32960 ............ A Therapeutic pneumothorax ................................ 1.84 1.70 0.53 0.13 3.67 2.50 000

33010 ............ A Drainage of heart sac ........................................ 2.24 NA 0.95 0.14 NA 3.33 000

33011 ............ A Repeat drainage of heart sac ............................ 2.24 NA 1.18 0.12 NA 3.54 000

33015 ............ A Incision of heart sac ........................................... 6.80 NA 4.01 0.62 NA 11.43 090

33020 ............ A Incision of heart sac ........................................... 12.61 NA 7.40 2.52 NA 22.53 090

33025 ............ A Incision of heart sac ........................................... 12.09 NA 6.97 2.61 NA 21.67 090

33030 ............ A Partial removal of heart sac ............................... 18.71 NA 14.40 3.92 NA 37.03 090

33031 ............ A Partial removal of heart sac ............................... 21.79 NA 18.63 2.50 NA 42.92 090
30931

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

33050 ............ A Removal of heart sac lesion .............................. 14.36 NA 10.51 1.47 NA 26.34 090

33120 ............ A Removal of heart lesion ..................................... 24.56 NA 21.61 5.17 NA 51.34 090

33130 ............ A Removal of heart lesion ..................................... 21.39 NA 14.67 2.22 NA 38.28 090

33200 ............ A Insertion of heart pacemaker ............................. 12.48 NA 9.41 1.90 NA 23.79 090

33201 ............ A Insertion of heart pacemaker ............................. 10.18 NA 7.50 1.67 NA 19.35 090

33206 ............ A Insertion of heart pacemaker ............................. 6.67 NA 5.04 1.34 NA 13.05 090

33207 ............ A Insertion of heart pacemaker ............................. 8.04 NA 5.67 1.33 NA 15.04 090

33208 ............ A Insertion of heart pacemaker ............................. 8.13 NA 5.92 1.54 NA 15.59 090

33210 ............ A Insertion of heart electrode ................................ 3.30 NA 1.64 0.27 NA 5.21 000

33211 ............ A Insertion of heart electrode ................................ 3.40 NA 1.80 0.27 NA 5.47 000

33212 ............ A Insertion of pulse generator ............................... 5.52 NA 4.00 0.88 NA 10.40 090

33213 ............ A Insertion of pulse generator ............................... 6.37 NA 4.52 0.88 NA 11.77 090

33214 ............ A Upgrade of pacemaker system .......................... 7.75 NA 5.62 1.06 NA 14.43 090

33216 ............ A Revision implanted electrode ............................. 5.39 NA 4.31 0.55 NA 10.25 090

33217 ............ A Insert/revise electrode ........................................ 5.75 NA 4.80 0.55 NA 11.10 090

33218 ............ A Repair pacemaker electrodes ............................ 5.44 NA 4.09 0.62 NA 10.15 090

33220 ............ A Repair pacemaker electrode .............................. 5.52 NA 4.33 0.62 NA 10.47 090

33222 ............ A Pacemaker aicd pocket ...................................... 4.96 NA 3.78 1.01 NA 9.75 090

33223 ............ A Pacemaker aicd pocket ...................................... 6.46 NA 5.03 1.01 NA 12.50 090

33233 ............ A Removal of pacemaker system ......................... 3.29 NA 3.15 0.05 NA 6.49 090

33234 ............ A Removal of pacemaker system ......................... 7.82 NA 5.18 0.23 NA 13.23 090

33235 ............ A Removal pacemaker electrode .......................... 9.40 NA 5.96 0.33 NA 15.69 090

33236 ............ A Remove electrode/thoracotomy ......................... 12.60 NA 9.10 0.62 NA 22.32 090

33237 ............ A Remove electrode/thoracotomy ......................... 13.71 NA 9.86 1.13 NA 24.70 090

33238 ............ A Remove electrode/thoracotomy ......................... 15.22 NA 9.93 2.01 NA 27.16 090

33240 ............ A Insert/replace pulse gener ................................. 7.60 NA 5.48 0.88 NA 13.96 090

33241 ............ A Remove pulse generator only ............................ 3.24 NA 3.27 0.43 NA 6.94 090

33242 ............ A Repair pulse generator/leads ............................. 6.17 NA 5.28 1.54 NA 12.99 090

33243 ............ A Remove generator/thoracotomy ......................... 22.64 NA 12.43 1.54 NA 36.61 090

33244 ............ A Remove generator ............................................. 8.97 NA 5.88 1.54 NA 16.39 090

33245 ............ A Implant heart defibrillator ................................... 14.30 NA 10.81 2.36 NA 27.47 090

33246 ............ A Implant heart defibrillator ................................... 20.71 NA 13.35 3.19 NA 37.25 090

33247 ............ A Insert/replace leads ............................................ 10.21 NA 6.52 2.36 NA 19.09 090

33249 ............ A Insert/replace leads/gener .................................. 13.28 NA 8.88 3.19 NA 25.35 090

33250 ............ A Ablate heart dysrhythm focus ............................ 21.85 NA 21.85 0.86 NA 44.56 090

33251 ............ A Ablate heart dysrhythm focus ............................ 24.88 NA 19.99 3.21 NA 48.08 090

33253 ............ A Reconstruct atria ................................................ 31.06 NA 22.52 4.26 NA 57.84 090

33261 ............ A Ablate heart dysrhythm focus ............................ 24.88 NA 20.05 2.73 NA 47.66 090

33300 ............ A Repair of heart wound ....................................... 17.92 NA 13.72 2.60 NA 34.24 090

33305 ............ A Repair of heart wound ....................................... 21.44 NA 18.22 3.07 NA 42.73 090

33310 ............ A Exploratory heart surgery ................................... 18.51 NA 13.81 1.93 NA 34.25 090

33315 ............ A Exploratory heart surgery ................................... 22.37 NA 18.11 2.57 NA 43.05 090

33320 ............ A Repair major blood vessel(s) ............................. 16.79 NA 13.37 2.51 NA 32.67 090

33321 ............ A Repair major vessel ........................................... 20.20 NA 14.89 3.61 NA 38.70 090

33322 ............ A Repair major blood vessel(s) ............................. 20.62 NA 17.45 3.61 NA 41.68 090

33330 ............ A Insert major vessel graft .................................... 21.43 NA 16.43 1.93 NA 39.79 090

33332 ............ A Insert major vessel graft .................................... 23.96 NA 16.43 2.39 NA 42.78 090

33335 ............ A Insert major vessel graft .................................... 30.01 NA 22.99 2.39 NA 55.39 090

33400 ............ A Repair of aortic valve ......................................... 25.34 NA 19.64 2.83 NA 47.81 090

33401 ............ A Valvuloplasty, open ............................................ 23.91 NA 16.16 2.83 NA 42.90 090

33403 ............ A Valvuloplasty, w/cp bypass ................................ 24.89 NA 19.19 2.83 NA 46.91 090

33404 ............ A Prepare heart-aorta conduit ............................... 28.54 NA 21.32 5.59 NA 55.45 090

33405 ............ A Replacement of aortic valve .............................. 30.61 NA 22.26 5.33 NA 58.20 090

33406 ............ A Replacement, aortic valve .................................. 32.30 NA 23.15 7.45 NA 62.90 090

33411 ............ A Replacement of aortic valve .............................. 32.47 NA 23.68 7.45 NA 63.60 090

33412 ............ A Replacement of aortic valve .............................. 34.79 NA 26.42 7.45 NA 68.66 090

33413 ............ A Replacement, aortic valve .................................. 35.24 NA 26.89 7.23 NA 69.36 090

33414 ............ A Repair, aortic valve ............................................ 30.35 NA 23.29 7.45 NA 61.09 090

33415 ............ A Revision, subvalvular tissue ............................... 27.15 NA 19.43 5.33 NA 51.91 090

33416 ............ A Revise ventricle muscle ..................................... 30.35 NA 22.06 4.99 NA 57.40 090

33417 ............ A Repair of aortic valve ......................................... 28.53 NA 20.93 6.18 NA 55.64 090

33420 ............ A Revision of mitral valve ...................................... 22.70 NA 14.14 2.45 NA 39.29 090

33422 ............ A Revision of mitral valve ...................................... 25.94 NA 19.49 6.45 NA 51.88 090

33425 ............ A Repair of mitral valve ......................................... 27.00 NA 20.19 5.42 NA 52.61 090

33426 ............ A Repair of mitral valve ......................................... 31.03 NA 22.99 5.80 NA 59.82 090

33427 ............ A Repair of mitral valve ......................................... 33.72 NA 25.61 6.30 NA 65.63 090

33430 ............ A Replacement of mitral valve .............................. 31.43 NA 23.99 6.11 NA 61.53 090

33460 ............ A Revision of tricuspid valve ................................. 23.60 NA 18.79 4.73 NA 47.12 090

33463 ............ A Valvuloplasty, tricuspid ....................................... 25.62 NA 19.35 5.95 NA 50.92 090

33464 ............ A Valvuloplasty, tricuspid ....................................... 27.33 NA 20.43 5.95 NA 53.71 090

33465 ............ A Replace tricuspid valve ...................................... 28.79 NA 21.25 5.95 NA 55.99 090

33468 ............ A Revision of tricuspid valve ................................. 30.12 NA 22.60 6.30 NA 59.02 090

33470 ............ A Revision of pulmonary valve .............................. 20.81 NA 21.86 2.45 NA 45.12 090

33471 ............ A Valvotomy, pulmonary valve .............................. 22.25 NA 16.00 2.83 NA 41.08 090
30932

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

33472 ............ A Revision of pulmonary valve .............................. 22.25 NA 43.06 2.83 NA 68.14 090

33474 ............ A Revision of pulmonary valve .............................. 23.04 NA 17.82 2.83 NA 43.69 090

33475 ............ A Replacement, pulmonary valve .......................... 28.41 NA 21.61 6.11 NA 56.13 090

33476 ............ A Revision of heart chamber ................................. 25.77 NA 20.87 4.99 NA 51.63 090

33478 ............ A Revision of heart chamber ................................. 26.74 NA 19.25 5.42 NA 51.41 090

33496 ............ A Repair, prosth valve clot .................................... 27.25 NA 20.82 5.33 NA 53.40 090

33500 ............ A Repair heart vessel fistula ................................. 25.55 NA 17.29 5.20 NA 48.04 090

33501 ............ A Repair heart vessel fistula ................................. 17.78 NA 12.14 2.51 NA 32.43 090

33502 ............ A Coronary artery correction ................................. 21.04 NA 15.92 2.51 NA 39.47 090

33503 ............ A Coronary artery graft .......................................... 21.78 NA 15.61 5.20 NA 42.59 090

33504 ............ A Coronary artery graft .......................................... 24.66 NA 21.49 5.20 NA 51.35 090

33505 ............ A Repair artery w/tunnel ........................................ 26.84 NA 21.99 6.03 NA 54.86 090

33506 ............ A Repair artery, translocation ................................ 26.71 NA 27.49 6.03 NA 60.23 090

33510 ............ A CABG, vein, single ............................................. 25.12 NA 19.13 5.20 NA 49.45 090

33511 ............ A CABG, vein, two ................................................. 27.40 NA 20.51 5.71 NA 53.62 090

33512 ............ A CABG, vein, three .............................................. 29.67 NA 22.07 6.22 NA 57.96 090

33513 ............ A CABG, vein, four ................................................ 31.95 NA 23.50 6.73 NA 62.18 090

33514 ............ A CABG, vein, five ................................................. 35.00 NA 25.94 7.23 NA 68.17 090

33516 ............ A CABG, vein, six+ ................................................ 37.40 NA 27.00 7.74 NA 72.14 090

33517 ............ A CABG, artery-vein, single .................................. 2.57 NA 1.89 0.50 NA 4.96 090

33518 ............ A CABG, artery-vein, two ...................................... 4.85 NA 3.38 1.02 NA 9.25 090

33519 ............ A CABG, artery-vein, three .................................... 7.12 NA 4.86 1.52 NA 13.50 090

33521 ............ A CABG, artery-vein, four ...................................... 9.40 NA 6.34 2.03 NA 17.77 090

33522 ............ A CABG, artery-vein, five ...................................... 11.67 NA 7.81 2.54 NA 22.02 090

33523 ............ A CABG, artery-vein, six+ ..................................... 13.95 NA 9.30 3.05 NA 26.30 090

33530 ............ A Coronary artery, bypass/reop ............................ 5.86 NA 12.93 2.18 NA 20.97 ZZZ

33533 ............ A CABG, arterial, single ........................................ 25.83 NA 19.68 5.36 NA 50.87 090

33534 ............ A CABG, arterial, two ............................................ 28.82 NA 21.60 6.03 NA 56.45 090

33535 ............ A CABG, arterial, three .......................................... 31.81 NA 21.94 6.70 NA 60.45 090

33536 ............ A CABG, arterial, four+ .......................................... 34.79 NA 25.27 7.37 NA 67.43 090

33542 ............ A Removal of heart lesion ..................................... 28.85 NA 23.04 5.53 NA 57.42 090

33545 ............ A Repair of heart damage ..................................... 36.78 NA 28.76 6.28 NA 71.82 090

33572 ............ A Open coronary endarterectomy ......................... 4.45 NA 2.18 0.63 NA 7.26 ZZZ

33600 ............ A Closure of valve ................................................. 29.51 NA 23.71 6.11 NA 59.33 090

33602 ............ A Closure of valve ................................................. 28.54 NA 20.46 5.33 NA 54.33 090

33606 ............ A Anastomosis/artery-aorta ................................... 30.74 NA 26.86 7.45 NA 65.05 090

33608 ............ A Repair anomaly w/conduit .................................. 31.09 NA 22.38 7.45 NA 60.92 090

33610 ............ A Repair by enlargement ....................................... 30.61 NA 24.18 7.45 NA 62.24 090

33611 ............ A Repair double ventricle ...................................... 32.30 NA 22.97 7.45 NA 62.72 090

33612 ............ A Repair double ventricle ...................................... 33.26 NA 25.25 7.45 NA 65.96 090

33615 ............ A Repair (simple fontan) ........................................ 32.06 NA 23.68 7.45 NA 63.19 090

33617 ............ A Repair by modified fontan .................................. 34.03 NA 24.49 7.45 NA 65.97 090

33619 ............ A Repair single ventricle ........................................ 37.57 NA 31.02 8.04 NA 76.63 090

33641 ............ A Repair heart septum defect ............................... 21.39 NA 16.49 4.87 NA 42.75 090

33645 ............ A Revision of heart veins ...................................... 24.82 NA 17.60 4.87 NA 47.29 090

33647 ............ A Repair heart septum defects .............................. 28.73 NA 20.98 6.28 NA 55.99 090

33660 ............ A Repair of heart defects ...................................... 25.54 NA 18.72 5.42 NA 49.68 090

33665 ............ A Repair of heart defects ...................................... 28.60 NA 19.06 5.42 NA 53.08 090

33670 ............ A Repair of heart chambers .................................. 32.73 NA 20.41 7.45 NA 60.59 090

33681 ............ A Repair heart septum defect ............................... 27.67 NA 20.17 6.28 NA 54.12 090

33684 ............ A Repair heart septum defect ............................... 29.65 NA 23.79 6.28 NA 59.72 090

33688 ............ A Repair heart septum defect ............................... 30.62 NA 63.16 6.28 NA 100.06 090

33690 ............ A Reinforce pulmonary artery ................................ 19.55 NA 16.44 4.29 NA 40.28 090

33692 ............ A Repair of heart defects ...................................... 30.75 NA 21.13 7.45 NA 59.33 090

33694 ............ A Repair of heart defects ...................................... 31.73 NA 21.61 7.45 NA 60.79 090

33697 ............ A Repair of heart defects ...................................... 33.71 NA 22.46 7.45 NA 63.62 090

33702 ............ A Repair of heart defects ...................................... 26.54 NA 20.22 5.33 NA 52.09 090

33710 ............ A Repair of heart defects ...................................... 29.71 NA 21.83 6.28 NA 57.82 090

33720 ............ A Repair of heart defect ........................................ 26.56 NA 19.32 5.33 NA 51.21 090

33722 ............ A Repair of heart defect ........................................ 28.41 NA 21.06 5.33 NA 54.80 090

33730 ............ A Repair heart-vein defect(s) ................................ 31.67 NA 22.08 7.45 NA 61.20 090

33732 ............ A Repair heart-vein defect ..................................... 28.16 NA 23.01 5.42 NA 56.59 090

33735 ............ A Revision of heart chamber ................................. 21.39 NA 12.93 4.87 NA 39.19 090

33736 ............ A Revision of heart chamber ................................. 23.52 NA 19.80 4.87 NA 48.19 090

33737 ............ A Revision of heart chamber ................................. 21.76 NA 42.57 4.87 NA 69.20 090

33750 ............ A Major vessel shunt ............................................. 21.41 NA 14.24 4.29 NA 39.94 090

33755 ............ A Major vessel shunt ............................................. 21.79 NA 13.68 4.29 NA 39.76 090

33762 ............ A Major vessel shunt ............................................. 21.79 NA 41.95 4.29 NA 68.03 090

33764 ............ A Major vessel shunt & graft ................................. 21.79 NA 16.45 4.29 NA 42.53 090

33766 ............ A Major vessel shunt ............................................. 22.76 NA 15.04 4.29 NA 42.09 090

33767 ............ A Atrial septectomy/septostomy ............................ 24.50 NA 19.22 4.87 NA 48.59 090

33770 ............ A Repair great vessels defect ............................... 33.29 NA 24.12 7.45 NA 64.86 090

33771 ............ A Repair great vessels defect ............................... 34.65 NA 22.66 7.45 NA 64.76 090

33774 ............ A Repair great vessels defect ............................... 30.98 NA 22.61 5.42 NA 59.01 090
30933

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

33775 ............ A Repair great vessels defect ............................... 32.20 NA 66.64 5.42 NA 104.26 090

33776 ............ A Repair great vessels defect ............................... 34.04 NA 69.46 6.28 NA 109.78 090

33777 ............ A Repair great vessels defect ............................... 33.46 NA 68.87 5.42 NA 107.75 090

33778 ............ A Repair great vessels defect ............................... 35.82 NA 26.25 7.37 NA 69.44 090

33779 ............ A Repair great vessels defect ............................... 36.21 NA 74.50 7.37 NA 118.08 090

33780 ............ A Repair great vessels defect ............................... 36.94 NA 21.44 7.37 NA 65.75 090

33781 ............ A Repair great vessels defect ............................... 36.45 NA 74.00 7.37 NA 117.82 090

33786 ............ A Repair arterial trunk ........................................... 34.84 NA 25.43 7.45 NA 67.72 090

33788 ............ A Revision of pulmonary artery ............................. 26.62 NA 19.74 5.20 NA 51.56 090

33800 ............ A Aortic suspension ............................................... 16.24 NA 12.22 2.51 NA 30.97 090

33802 ............ A Repair vessel defect .......................................... 17.66 NA 12.54 4.29 NA 34.49 090

33803 ............ A Repair vessel defect .......................................... 19.60 NA 13.73 4.29 NA 37.62 090

33813 ............ A Repair septal defect ........................................... 20.65 NA 14.15 4.29 NA 39.09 090

33814 ............ A Repair septal defect ........................................... 25.77 NA 20.07 5.33 NA 51.17 090

33820 ............ A Revise major vessel ........................................... 16.29 NA 10.40 4.29 NA 30.98 090

33822 ............ A Revise major vessel ........................................... 17.32 NA 11.47 4.29 NA 33.08 090

33824 ............ A Revise major vessel ........................................... 19.52 NA 14.73 4.29 NA 38.54 090

33840 ............ A Remove aorta constriction ................................. 20.63 NA 14.20 5.59 NA 40.42 090

33845 ............ A Remove aorta constriction ................................. 22.12 NA 15.14 5.59 NA 42.85 090

33851 ............ A Remove aorta constriction ................................. 21.27 NA 38.59 5.59 NA 65.45 090

33852 ............ A Repair septal defect ........................................... 23.71 NA 15.49 5.59 NA 44.79 090

33853 ............ A Repair septal defect ........................................... 31.72 NA 22.13 7.45 NA 61.30 090

33860 ............ A Ascending aorta graft ......................................... 33.96 NA 24.68 6.18 NA 64.82 090

33861 ............ A Ascending aorta graft ......................................... 34.52 NA 25.56 6.18 NA 66.26 090

33863 ............ A Ascending aorta graft ......................................... 36.47 NA 26.75 6.18 NA 69.40 090

33870 ............ A Transverse aortic arch graft ............................... 40.31 NA 28.86 8.04 NA 77.21 090

33875 ............ A Thoracic aorta graft ............................................ 33.06 NA 24.29 5.59 NA 62.94 090

33877 ............ A Thoracoabdominal graft ..................................... 42.60 NA 33.86 8.38 NA 84.84 090

33910 ............ A Remove lung artery emboli ................................ 24.59 NA 19.32 2.77 NA 46.68 090

33915 ............ A Remove lung artery emboli ................................ 21.02 NA 14.95 2.22 NA 38.19 090

33916 ............ A Surgery of great vessel ...................................... 25.83 NA 21.82 3.43 NA 51.08 090

33917 ............ A Repair pulmonary artery .................................... 24.50 NA 18.33 6.30 NA 49.13 090

33918 ............ A Repair pulmonary atresia ................................... 26.45 NA 47.27 5.20 NA 78.92 090

33919 ............ A Repair pulmonary atresia ................................... 32.67 NA 70.82 7.45 NA 110.94 090

33920 ............ A Repair pulmonary atresia ................................... 31.95 NA 67.30 7.45 NA 106.70 090

33922 ............ A Transect pulmonary artery ................................. 23.52 NA 18.86 2.83 NA 45.21 090

33924 ............ A Remove pulmonary shunt .................................. 5.50 NA 6.42 0.78 NA 12.70 ZZZ

33935 ............ R Transplantation, heart/lung ................................ 60.96 NA 33.17 13.54 NA 107.67 090

33945 ............ R Transplantation of heart ..................................... 42.10 NA 23.73 11.05 NA 76.88 090

33960 ............ A External circulation assist .................................. 19.36 NA 10.19 0.94 NA 30.49 XXX

33961 ............ A External circulation assist .................................. 10.93 NA 9.18 0.94 NA 21.05 XXX

33970 ............ A Aortic circulation assist ...................................... 6.75 NA 6.02 1.00 NA 13.77 000

33971 ............ A Aortic circulation assist ...................................... 9.69 NA 9.35 0.91 NA 19.95 090

33973 ............ A Insert balloon device .......................................... 9.76 NA 4.53 1.00 NA 15.29 000

33974 ............ A Remove intra-aortic balloon ............................... 14.41 NA 12.17 0.91 NA 27.49 090

33975 ............ A Implant ventricular device .................................. 21.60 NA 27.04 2.77 NA 51.41 090

33976 ............ A Implant ventricular device .................................. 29.10 NA 30.12 3.78 NA 63.00 090

33977 ............ A Remove ventricular device ................................. 19.29 NA 15.19 2.43 NA 36.91 090

33978 ............ A Remove ventricular device ................................. 21.73 NA 15.83 2.77 NA 40.33 090

34001 ............ A Removal of artery clot ........................................ 12.91 NA 6.63 1.87 NA 21.41 090

34051 ............ A Removal of artery clot ........................................ 15.21 NA 8.32 1.59 NA 25.12 090

34101 ............ A Removal of artery clot ........................................ 9.97 NA 5.11 1.71 NA 16.79 090

34111 ............ A Removal of arm artery clot ................................ 8.07 NA 4.24 1.59 NA 13.90 090

34151 ............ A Removal of artery clot ........................................ 16.86 NA 8.78 2.39 NA 28.03 090

34201 ............ A Removal of artery clot ........................................ 9.13 NA 5.06 1.78 NA 15.97 090

34203 ............ A Removal of leg artery clot .................................. 12.21 NA 6.50 1.72 NA 20.43 090

34401 ............ A Removal of vein clot .......................................... 12.86 NA 6.97 1.39 NA 21.22 090

34421 ............ A Removal of vein clot .......................................... 9.93 NA 5.53 1.51 NA 16.97 090

34451 ............ A Removal of vein clot .......................................... 14.44 NA 7.56 2.14 NA 24.14 090

34471 ............ A Removal of vein clot .......................................... 10.18 NA 5.99 0.55 NA 16.72 090

34490 ............ A Removal of vein clot .......................................... 7.60 NA 4.44 1.54 NA 13.58 090

34501 ............ A Repair valve, femoral vein ................................. 10.93 NA 6.64 0.86 NA 18.43 090

34502 ............ A Reconstruct, vena cava ..................................... 26.95 NA 13.27 3.64 NA 43.86 090

34510 ............ A Transposition of vein valve ................................ 13.25 NA 7.27 1.04 NA 21.56 090

34520 ............ A Cross-over vein graft .......................................... 13.74 NA 7.82 1.09 NA 22.65 090

34530 ............ A Leg vein fusion ................................................... 17.61 NA 8.53 1.44 NA 27.58 090

35001 ............ A Repair defect of artery ....................................... 19.64 NA 9.74 3.18 NA 32.56 090

35002 ............ A Repair artery rupture, neck ................................ 21.00 NA 10.45 2.41 NA 33.86 090

35005 ............ A Repair defect of artery ....................................... 18.12 NA 8.37 2.19 NA 28.68 090

35011 ............ A Repair defect of artery ....................................... 11.65 NA 6.04 2.76 NA 20.45 090

35013 ............ A Repair artery rupture, arm ................................. 17.40 NA 8.36 3.03 NA 28.79 090

35021 ............ A Repair defect of artery ....................................... 19.65 NA 10.62 3.06 NA 33.33 090

35022 ............ A Repair artery rupture, chest ............................... 23.18 NA 11.79 2.80 NA 37.77 090

35045 ............ A Repair defect of arm artery ................................ 11.26 NA 6.20 2.50 NA 19.96 090
30934

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

35081 ............ A Repair defect of artery ....................................... 28.01 NA 13.63 4.18 NA 45.82 090

35082 ............ A Repair artery rupture, aorta ............................... 36.35 NA 16.98 4.59 NA 57.92 090

35091 ............ A Repair defect of artery ....................................... 35.40 NA 17.11 4.25 NA 56.76 090

35092 ............ A Repair artery rupture, aorta ............................... 38.39 NA 18.51 5.21 NA 62.11 090

35102 ............ A Repair defect of artery ....................................... 30.76 NA 14.86 4.32 NA 49.94 090

35103 ............ A Repair artery rupture, groin ................................ 33.57 NA 16.03 5.21 NA 54.81 090

35111 ............ A Repair defect of artery ....................................... 16.43 NA 8.76 3.70 NA 28.89 090

35112 ............ A Repair artery rupture, spleen ............................. 18.69 NA 9.51 2.22 NA 30.42 090

35121 ............ A Repair defect of artery ....................................... 25.99 NA 13.06 3.66 NA 42.71 090

35122 ............ A Repair artery rupture, belly ................................ 33.45 NA 16.16 3.96 NA 53.57 090

35131 ............ A Repair defect of artery ....................................... 18.55 NA 10.00 3.15 NA 31.70 090

35132 ............ A Repair artery rupture, groin ................................ 21.95 NA 11.46 3.58 NA 36.99 090

35141 ............ A Repair defect of artery ....................................... 14.46 NA 7.74 2.88 NA 25.08 090

35142 ............ A Repair artery rupture, thigh ................................ 15.86 NA 8.30 3.24 NA 27.40 090

35151 ............ A Repair defect of artery ....................................... 17.00 NA 9.27 2.94 NA 29.21 090

35152 ............ A Repair artery rupture, knee ................................ 16.70 NA 9.28 1.95 NA 27.93 090

35161 ............ A Repair defect of artery ....................................... 18.76 NA 10.07 3.15 NA 31.98 090

35162 ............ A Repair artery rupture .......................................... 19.78 NA 10.70 3.58 NA 34.06 090

35180 ............ A Repair blood vessel lesion ................................. 13.62 NA 6.71 1.48 NA 21.81 090

35182 ............ A Repair blood vessel lesion ................................. 17.74 NA 8.29 1.61 NA 27.64 090

35184 ............ A Repair blood vessel lesion ................................. 12.25 NA 6.82 1.96 NA 21.03 090

35188 ............ A Repair blood vessel lesion ................................. 14.28 NA 7.97 1.59 NA 23.84 090

35189 ............ A Repair blood vessel lesion ................................. 18.43 NA 9.60 2.21 NA 30.24 090

35190 ............ A Repair blood vessel lesion ................................. 12.75 NA 6.87 2.14 NA 21.76 090

35201 ............ A Repair blood vessel lesion ................................. 9.99 NA 5.50 1.94 NA 17.43 090

35206 ............ A Repair blood vessel lesion ................................. 9.25 NA 5.52 2.03 NA 16.80 090

35207 ............ A Repair blood vessel lesion ................................. 10.15 NA 8.47 1.93 NA 20.55 090

35211 ............ A Repair blood vessel lesion ................................. 22.12 NA 18.02 2.59 NA 42.73 090

35216 ............ A Repair blood vessel lesion ................................. 18.75 NA 17.42 2.08 NA 38.25 090

35221 ............ A Repair blood vessel lesion ................................. 16.42 NA 8.49 2.20 NA 27.11 090

35226 ............ A Repair blood vessel lesion ................................. 9.06 NA 5.51 1.95 NA 16.52 090

35231 ............ A Repair blood vessel lesion ................................. 12.00 NA 6.96 2.91 NA 21.87 090

35236 ............ A Repair blood vessel lesion ................................. 10.54 NA 6.24 2.56 NA 19.34 090

35241 ............ A Repair blood vessel lesion ................................. 23.12 NA 20.47 2.60 NA 46.19 090

35246 ............ A Repair blood vessel lesion ................................. 19.84 NA 19.39 2.15 NA 41.38 090

35251 ............ A Repair blood vessel lesion ................................. 17.49 NA 9.04 1.88 NA 28.41 090

35256 ............ A Repair blood vessel lesion ................................. 11.38 NA 6.68 2.39 NA 20.45 090

35261 ............ A Repair blood vessel lesion ................................. 11.63 NA 6.10 2.66 NA 20.39 090

35266 ............ A Repair blood vessel lesion ................................. 10.30 NA 5.93 2.41 NA 18.64 090

35271 ............ A Repair blood vessel lesion ................................. 22.12 NA 20.24 2.56 NA 44.92 090

35276 ............ A Repair blood vessel lesion ................................. 18.75 NA 17.51 2.26 NA 38.52 090

35281 ............ A Repair blood vessel lesion ................................. 16.48 NA 8.93 3.37 NA 28.78 090

35286 ............ A Repair blood vessel lesion ................................. 11.87 NA 6.88 2.33 NA 21.08 090

35301 ............ A Rechanneling of artery ....................................... 18.70 NA 9.57 2.81 NA 31.08 090

35311 ............ A Rechanneling of artery ....................................... 23.85 NA 12.29 4.61 NA 40.75 090

35321 ............ A Rechanneling of artery ....................................... 11.97 NA 5.89 2.69 NA 20.55 090

35331 ............ A Rechanneling of artery ....................................... 23.52 NA 11.84 2.66 NA 38.02 090

35341 ............ A Rechanneling of artery ....................................... 25.11 NA 12.97 3.53 NA 41.61 090

35351 ............ A Rechanneling of artery ....................................... 20.11 NA 10.51 2.97 NA 33.59 090

35355 ............ A Rechanneling of artery ....................................... 16.09 NA 8.95 2.99 NA 28.03 090

35361 ............ A Rechanneling of artery ....................................... 23.59 NA 11.90 3.88 NA 39.37 090

35363 ............ A Rechanneling of artery ....................................... 24.66 NA 12.69 4.40 NA 41.75 090

35371 ............ A Rechanneling of artery ....................................... 11.64 NA 6.48 2.50 NA 20.62 090

35372 ............ A Rechanneling of artery ....................................... 13.56 NA 7.08 2.28 NA 22.92 090

35381 ............ A Rechanneling of artery ....................................... 15.81 NA 8.02 2.71 NA 26.54 090

35390 ............ A Reoperation, carotid ........................................... 3.19 NA 1.47 0.39 NA 5.05 ZZZ

35400 ............ A Angioscopy ......................................................... 3.00 NA 1.39 0.27 NA 4.66 ZZZ

35450 ............ A Repair arterial blockage ..................................... 10.07 NA 5.11 1.38 NA 16.56 000

35452 ............ A Repair arterial blockage ..................................... 6.91 NA 3.96 0.61 NA 11.48 000

35454 ............ A Repair arterial blockage ..................................... 6.04 NA 3.32 1.53 NA 10.89 000

35456 ............ A Repair arterial blockage ..................................... 7.35 NA 3.90 1.69 NA 12.94 000

35458 ............ A Repair arterial blockage ..................................... 9.49 NA 4.81 1.83 NA 16.13 000

35459 ............ A Repair arterial blockage ..................................... 8.63 NA 4.38 1.69 NA 14.70 000

35460 ............ A Repair venous blockage .................................... 6.04 NA 3.09 0.74 NA 9.87 000

35470 ............ A Repair arterial blockage ..................................... 8.63 NA 4.92 1.69 NA 15.24 000

35471 ............ A Repair arterial blockage ..................................... 10.07 NA 5.54 1.38 NA 16.99 000

35472 ............ A Repair arterial blockage ..................................... 6.91 NA 4.11 0.85 NA 11.87 000

35473 ............ A Repair arterial blockage ..................................... 6.04 NA 3.76 1.53 NA 11.33 000

35474 ............ A Repair arterial blockage ..................................... 7.36 NA 4.17 1.69 NA 13.22 000

35475 ............ R Repair arterial blockage ..................................... 9.49 NA 4.98 1.83 NA 16.30 000

35476 ............ A Repair venous blockage .................................... 6.04 NA 3.62 0.74 NA 10.40 000

35480 ............ A Atherectomy, open ............................................. 11.08 NA 5.46 1.38 NA 17.92 000

35481 ............ A Atherectomy, open ............................................. 7.61 NA 4.07 0.61 NA 12.29 000

35482 ............ A Atherectomy, open ............................................. 6.65 NA 3.63 1.53 NA 11.81 000
30935

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

35483 ............ A Atherectomy, open ............................................. 8.10 NA 4.29 1.69 NA 14.08 000

35484 ............ A Atherectomy, open ............................................. 10.44 NA 5.02 1.83 NA 17.29 000

35485 ............ A Atherectomy, open ............................................. 9.49 NA 5.02 1.06 NA 15.57 000

35490 ............ A Atherectomy, percutaneous ............................... 11.08 NA 6.00 1.38 NA 18.46 000

35491 ............ A Atherectomy, percutaneous ............................... 7.61 NA 3.71 0.61 NA 11.93 000

35492 ............ A Atherectomy, percutaneous ............................... 6.65 NA 4.06 1.53 NA 12.24 000

35493 ............ A Atherectomy, percutaneous ............................... 8.10 NA 4.99 1.69 NA 14.78 000

35494 ............ A Atherectomy, percutaneous ............................... 10.44 NA 5.22 1.83 NA 17.49 000

35495 ............ A Atherectomy, percutaneous ............................... 9.49 NA 5.63 1.06 NA 16.18 000

35501 ............ A Artery bypass graft ............................................. 19.19 NA 9.34 3.49 NA 32.02 090

35506 ............ A Artery bypass graft ............................................. 19.67 NA 9.60 3.64 NA 32.91 090

35507 ............ A Artery bypass graft ............................................. 19.67 NA 9.58 3.61 NA 32.86 090

35508 ............ A Artery bypass graft ............................................. 18.65 NA 9.64 3.43 NA 31.72 090

35509 ............ A Artery bypass graft ............................................. 18.07 NA 9.12 3.92 NA 31.11 090

35511 ............ A Artery bypass graft ............................................. 16.83 NA 8.53 1.92 NA 27.28 090

35515 ............ A Artery bypass graft ............................................. 18.65 NA 9.09 2.01 NA 29.75 090

35516 ............ A Artery bypass graft ............................................. 16.32 NA 8.02 3.54 NA 27.88 090

35518 ............ A Artery bypass graft ............................................. 15.42 NA 7.63 3.38 NA 26.43 090

35521 ............ A Artery bypass graft ............................................. 16.17 NA 8.51 3.34 NA 28.02 090

35526 ............ A Artery bypass graft ............................................. 20.00 NA 11.12 2.44 NA 33.56 090

35531 ............ A Artery bypass graft ............................................. 25.61 NA 12.68 3.90 NA 42.19 090

35533 ............ A Artery bypass graft ............................................. 20.52 NA 10.25 4.43 NA 35.20 090

35536 ............ A Artery bypass graft ............................................. 23.11 NA 11.63 4.17 NA 38.91 090

35541 ............ A Artery bypass graft ............................................. 25.80 NA 13.09 3.65 NA 42.54 090

35546 ............ A Artery bypass graft ............................................. 25.54 NA 13.05 4.26 NA 42.85 090

35548 ............ A Artery bypass graft ............................................. 21.57 NA 10.45 3.65 NA 35.67 090

35549 ............ A Artery bypass graft ............................................. 23.35 NA 11.99 4.26 NA 39.60 090

35551 ............ A Artery bypass graft ............................................. 26.67 NA 13.47 3.87 NA 44.01 090

35556 ............ A Artery bypass graft ............................................. 21.76 NA 10.85 3.71 NA 36.32 090

35558 ............ A Artery bypass graft ............................................. 14.04 NA 7.38 3.23 NA 24.65 090

35560 ............ A Artery bypass graft ............................................. 23.56 NA 12.08 3.93 NA 39.57 090

35563 ............ A Artery bypass graft ............................................. 15.14 NA 8.31 1.70 NA 25.15 090

35565 ............ A Artery bypass graft ............................................. 15.14 NA 8.29 3.51 NA 26.94 090

35566 ............ A Artery bypass graft ............................................. 26.92 NA 14.80 4.08 NA 45.80 090

35571 ............ A Artery bypass graft ............................................. 18.58 NA 10.80 3.87 NA 33.25 090

35582 ............ A Vein bypass graft ............................................... 27.13 NA 13.35 4.89 NA 45.37 090

35583 ............ A Vein bypass graft ............................................... 22.37 NA 11.75 4.13 NA 38.25 090

35585 ............ A Vein bypass graft ............................................... 28.39 NA 14.81 4.63 NA 47.83 090

35587 ............ A Vein bypass graft ............................................... 19.05 NA 11.24 4.13 NA 34.42 090

35601 ............ A Artery bypass graft ............................................. 17.50 NA 8.65 3.33 NA 29.48 090

35606 ............ A Artery bypass graft ............................................. 18.71 NA 9.06 3.51 NA 31.28 090

35612 ............ A Artery bypass graft ............................................. 15.76 NA 8.05 3.30 NA 27.11 090

35616 ............ A Artery bypass graft ............................................. 15.70 NA 7.83 3.42 NA 26.95 090

35621 ............ A Artery bypass graft ............................................. 14.54 NA 7.60 3.80 NA 25.94 090

35623 ............ A Bypass graft, not vein ........................................ 16.62 NA 8.71 1.88 NA 27.21 090

35626 ............ A Artery bypass graft ............................................. 23.63 NA 12.27 4.08 NA 39.98 090

35631 ............ A Artery bypass graft ............................................. 24.60 NA 12.40 3.57 NA 40.57 090

35636 ............ A Artery bypass graft ............................................. 22.46 NA 11.18 2.45 NA 36.09 090

35641 ............ A Artery bypass graft ............................................. 24.57 NA 12.51 4.08 NA 41.16 090

35642 ............ A Artery bypass graft ............................................. 17.98 NA 8.88 2.20 NA 29.06 090

35645 ............ A Artery bypass graft ............................................. 17.47 NA 8.37 2.05 NA 27.89 090

35646 ............ A Artery bypass graft ............................................. 25.81 NA 13.02 4.73 NA 43.56 090

35650 ............ A Artery bypass graft ............................................. 14.36 NA 7.08 3.56 NA 25.00 090

35651 ............ A Artery bypass graft ............................................. 25.04 NA 12.98 4.69 NA 42.71 090

35654 ............ A Artery bypass graft ............................................. 18.61 NA 9.57 4.42 NA 32.60 090

35656 ............ A Artery bypass graft ............................................. 19.53 NA 9.51 3.60 NA 32.64 090

35661 ............ A Artery bypass graft ............................................. 13.18 NA 6.84 3.30 NA 23.32 090

35663 ............ A Artery bypass graft ............................................. 14.17 NA 7.96 3.80 NA 25.93 090

35665 ............ A Artery bypass graft ............................................. 15.40 NA 8.43 3.57 NA 27.40 090

35666 ............ A Artery bypass graft ............................................. 19.19 NA 11.24 4.00 NA 34.43 090

35671 ............ A Artery bypass graft ............................................. 14.80 NA 9.14 4.08 NA 28.02 090

35681 ............ A Artery bypass graft ............................................. 8.05 NA 4.35 3.52 NA 15.92 ZZZ

35691 ............ A Arterial transposition .......................................... 18.05 NA 8.66 3.81 NA 30.52 090

35693 ............ A Arterial transposition .......................................... 15.36 NA 7.72 1.91 NA 24.99 090

35694 ............ A Arterial transposition .......................................... 19.16 NA 9.16 2.17 NA 30.49 090

35695 ............ A Arterial transposition .......................................... 19.16 NA 9.16 2.17 NA 30.49 090

35700 ............ A Reoperation, bypass graft .................................. 3.08 NA 2.49 0.38 NA 5.95 ZZZ

35701 ............ A Exploration, carotid artery .................................. 5.55 NA 3.90 1.25 NA 10.70 090

35721 ............ A Exploration, femoral artery ................................. 5.28 NA 3.58 1.11 NA 9.97 090

35741 ............ A Exploration popliteal artery ................................ 5.37 NA 3.66 1.15 NA 10.18 090

35761 ............ A Exploration of artery/vein ................................... 5.37 NA 3.77 1.14 NA 10.28 090

35800 ............ A Explore neck vessels ......................................... 7.02 NA 4.07 0.97 NA 12.06 090

35820 ............ A Explore chest vessels ........................................ 12.88 NA 8.88 1.43 NA 23.19 090

35840 ............ A Explore abdominal vessels ................................ 9.77 NA 5.99 1.44 NA 17.20 090
30936

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

35860 ............ A Explore limb vessels .......................................... 5.55 NA 3.64 1.15 NA 10.34 090

35870 ............ A Repair vessel graft defect .................................. 22.17 NA 12.13 2.47 NA 36.77 090

35875 ............ A Removal of clot in graft ...................................... 10.01 NA 5.62 1.65 NA 17.28 090

35876 ............ A Removal of clot in graft ...................................... 13.67 NA 7.42 1.65 NA 22.74 090

35901 ............ A Excision, graft, neck ........................................... 8.19 NA 5.37 1.46 NA 15.02 090

35903 ............ A Excision, graft, extremity .................................... 9.39 NA 7.09 1.46 NA 17.94 090

35905 ............ A Excision, graft, thorax ........................................ 18.19 NA 17.16 1.46 NA 36.81 090

35907 ............ A Excision, graft, abdomen ................................... 19.24 NA 11.58 1.46 NA 32.28 090

36000 ............ A Place needle in vein ........................................... 0.18 0.31 0.05 0.04 0.53 0.27 XXX

36005 ............ A Injection, venography ......................................... 0.95 11.83 0.31 0.04 12.82 1.30 000

36010 ............ A Place catheter in vein ........................................ 2.43 NA 1.48 0.31 NA 4.22 XXX

36011 ............ A Place catheter in vein ........................................ 3.14 NA 1.82 0.22 NA 5.18 XXX

36012 ............ A Place catheter in vein ........................................ 3.52 NA 2.28 0.32 NA 6.12 XXX

36013 ............ A Place catheter in artery ...................................... 2.52 NA 1.38 0.31 NA 4.21 XXX

36014 ............ A Place catheter in artery ...................................... 3.02 NA 1.90 0.27 NA 5.19 XXX

36015 ............ A Place catheter in artery ...................................... 3.52 NA 2.03 0.32 NA 5.87 XXX

36100 ............ A Establish access to artery .................................. 3.02 NA 1.98 0.32 NA 5.32 XXX

36120 ............ A Establish access to artery .................................. 2.01 NA 1.45 0.30 NA 3.76 XXX

36140 ............ A Establish access to artery .................................. 2.01 NA 1.45 0.24 NA 3.70 XXX

36145 ............ A Artery to vein shunt ............................................ 2.01 NA 1.55 0.49 NA 4.05 XXX

36160 ............ A Establish access to aorta ................................... 2.52 NA 1.68 0.35 NA 4.55 XXX

36200 ............ A Place catheter in aorta ....................................... 3.02 NA 1.94 0.28 NA 5.24 XXX

36215 ............ A Place catheter in artery ...................................... 4.68 NA 2.50 0.23 NA 7.41 XXX

36216 ............ A Place catheter in artery ...................................... 5.28 NA 2.88 0.27 NA 8.43 XXX

36217 ............ A Place catheter in artery ...................................... 6.30 NA 3.27 0.32 NA 9.89 XXX

36218 ............ A Place catheter in artery ...................................... 1.01 NA 1.48 0.05 NA 2.54 XXX

36245 ............ A Place catheter in artery ...................................... 4.68 NA 2.57 0.26 NA 7.51 XXX

36246 ............ A Place catheter in artery ...................................... 5.28 NA 2.93 0.27 NA 8.48 XXX

36247 ............ A Place catheter in artery ...................................... 6.30 NA 3.23 0.32 NA 9.85 XXX

36248 ............ A Place catheter in artery ...................................... 1.01 NA 1.47 0.05 NA 2.53 XXX

36260 ............ A Insertion of infusion pump .................................. 9.71 NA 5.54 1.41 NA 16.66 090

36261 ............ A Revision of infusion pump .................................. 5.45 NA 3.31 0.42 NA 9.18 090

36262 ............ A Removal of infusion pump ................................. 4.02 NA 2.77 0.40 NA 7.19 090

36400 ............ A Drawing blood .................................................... 0.18 0.39 0.05 0.01 0.58 0.24 XXX

36405 ............ A Drawing blood .................................................... 0.18 0.29 0.04 0.03 0.50 0.25 XXX

36406 ............ A Drawing blood .................................................... 0.18 0.32 0.06 0.01 0.51 0.25 XXX

36410 ............ A Drawing blood .................................................... 0.18 0.30 0.05 0.02 0.50 0.25 XXX

36420 ............ A Establish access to vein .................................... 1.01 NA 0.41 0.05 NA 1.47 XXX

36425 ............ A Establish access to vein .................................... 0.76 2.17 0.25 0.01 2.94 1.02 XXX

36430 ............ A Blood transfusion service ................................... 0.00 1.50 0.10 0.07 1.57 0.17 XXX

36440 ............ A Blood transfusion service ................................... 1.03 NA 0.37 0.07 NA 1.47 XXX

36450 ............ A Exchange transfusion service ............................ 2.23 NA 1.15 0.18 NA 3.56 XXX

36455 ............ A Exchange transfusion service ............................ 2.43 NA 0.92 0.22 NA 3.57 XXX

36460 ............ A Transfusion service, fetal ................................... 6.59 NA 2.91 1.09 NA 10.59 XXX

36470 ............ A Injection therapy of vein ..................................... 1.09 1.89 0.44 0.04 3.02 1.57 010

36471 ............ A Injection therapy of veins ................................... 1.57 2.13 0.64 0.05 3.75 2.26 010

36481 ............ A Insertion of catheter, vein .................................. 6.99 NA 2.56 0.61 NA 10.16 000

36488 ............ A Insertion of catheter, vein .................................. 1.35 NA 0.54 0.14 NA 2.03 000

36489 ............ A Insertion of catheter, vein .................................. 1.22 2.72 0.45 0.17 4.11 1.84 000

36490 ............ A Insertion of catheter, vein .................................. 1.67 NA 0.65 0.20 NA 2.52 000

36491 ............ A Insertion of catheter, vein .................................. 1.43 NA 0.59 0.32 NA 2.34 000

36493 ............ A Repositioning of cvc ........................................... 1.21 NA 0.59 0.16 NA 1.96 000

36500 ............ A Insertion of catheter, vein .................................. 3.52 NA 1.78 0.01 NA 5.31 000

36510 ............ A Insertion of catheter, vein .................................. 1.09 NA 0.72 0.02 NA 1.83 000

36520 ............ A Plasma and/or cell exchange ............................. 1.74 NA 0.82 0.12 NA 2.68 000

36522 ............ A Photopheresis .................................................... 1.67 4.18 1.01 0.37 6.22 3.05 000

36530 ............ R Insertion of infusion pump .................................. 6.20 NA 3.34 1.02 NA 10.56 010

36531 ............ R Revision of infusion pump .................................. 4.87 NA 2.88 0.27 NA 8.02 010

36532 ............ R Removal of infusion pump ................................. 3.30 NA 1.64 0.37 NA 5.31 010

36533 ............ A Insertion of access port ...................................... 5.32 3.02 3.92 0.85 9.19 10.09 010

36534 ............ A Revision of access port ...................................... 2.80 NA 1.52 0.21 NA 4.53 010

36535 ............ A Removal of access port ..................................... 2.27 1.92 1.99 0.38 4.57 4.64 010

36600 ............ A Withdrawal of arterial blood ............................... 0.32 0.27 0.08 0.02 0.61 0.42 XXX

36620 ............ A Insertion catheter, artery .................................... 1.15 NA 0.38 0.14 NA 1.67 000

36625 ............ A Insertion catheter, artery .................................... 2.11 NA 0.59 0.18 NA 2.88 000

36640 ............ A Insertion catheter, artery .................................... 2.10 NA 1.06 0.40 NA 3.56 000

36660 ............ A Insertion catheter, artery .................................... 1.40 NA 0.72 0.04 NA 2.16 000

36680 ............ A Insert needle, bone cavity .................................. 1.20 NA 0.42 0.10 NA 1.72 000

36800 ............ A Insertion of cannula ............................................ 2.43 NA 1.47 0.28 NA 4.18 000

36810 ............ A Insertion of cannula ............................................ 3.97 NA 2.41 0.74 NA 7.12 000

36815 ............ A Insertion of cannula ............................................ 2.62 NA 1.90 0.70 NA 5.22 000

36821 ............ A Artery-vein fusion ............................................... 8.93 NA 4.71 1.46 NA 15.10 090

36822 ............ A Insertion of cannula(s) ....................................... 5.42 NA 6.99 0.77 NA 13.18 090

36825 ............ A Artery-vein graft .................................................. 9.84 NA 5.38 2.21 NA 17.43 090
30937

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

36830 ............ A Artery-vein graft .................................................. 12.00 NA 6.05 2.36 NA 20.41 090

36832 ............ A Revise artery-vein fistula .................................... 6.45 NA 3.82 2.38 NA 12.65 090

36834 ............ A Repair A–V aneurysm ........................................ 9.93 NA 5.01 1.66 NA 16.60 090

36835 ............ A Artery to vein shunt ............................................ 7.15 NA 4.03 0.79 NA 11.97 090

36860 ............ A Cannula declotting ............................................. 2.01 2.05 3.31 0.43 4.49 5.75 000

36861 ............ A Cannula declotting ............................................. 2.52 NA 1.52 1.01 NA 5.05 000

37140 ............ A Revision of circulation ........................................ 23.60 NA 11.09 3.34 NA 38.03 090

37145 ............ A Revision of circulation ........................................ 24.61 NA 13.07 1.72 NA 39.40 090

37160 ............ A Revision of circulation ........................................ 21.60 NA 10.56 3.79 NA 35.95 090

37180 ............ A Revision of circulation ........................................ 24.61 NA 11.66 2.76 NA 39.03 090

37181 ............ A Splice spleen/kidney veins ................................. 26.68 NA 12.36 3.52 NA 42.56 090

37195 ............ A Thrombolytic therapy, stroke .............................. 0.00 2.02 0.16 0.54 2.56 0.70 XXX

37200 ............ A Transcatheter biopsy .......................................... 4.56 NA 3.39 0.13 NA 8.08 000

37201 ............ A Transcatheter therapy infuse ............................. 5.00 NA 2.97 0.64 NA 8.61 000

37202 ............ A Transcatheter therapy infuse ............................. 5.68 NA 3.78 0.50 NA 9.96 000

37203 ............ A Transcatheter retrieval ....................................... 5.03 NA 2.93 0.45 NA 8.41 000

37204 ............ A Transcatheter occlusion ..................................... 18.14 NA 7.97 1.60 NA 27.71 000

37205 ............ A Transcatheter stent ............................................ 8.28 NA 4.71 0.42 NA 13.41 000

37206 ............ A Transcatheter stent ............................................ 4.13 NA 2.40 0.21 NA 6.74 ZZZ

37207 ............ A Transcatheter stent ............................................ 8.28 NA 4.34 0.42 NA 13.04 000

37208 ............ A Transcatheter stent ............................................ 4.13 NA 1.94 0.21 NA 6.28 ZZZ

37209 ............ A Exchange arterial catheter ................................. 2.27 NA 1.64 0.11 NA 4.02 000

37250 ............ A Intravascular us .................................................. 2.10 NA 3.83 0.13 NA 6.06 ZZZ

37251 ............ A Intravascular us .................................................. 1.60 NA 3.33 0.10 NA 5.03 ZZZ

37565 ............ A Ligation of neck vein .......................................... 4.44 NA 2.84 0.74 NA 8.02 090

37600 ............ A Ligation of neck artery ....................................... 4.57 NA 3.45 0.80 NA 8.82 090

37605 ............ A Ligation of neck artery ....................................... 6.19 NA 4.06 1.04 NA 11.29 090

37606 ............ A Ligation of neck artery ....................................... 6.28 NA 4.94 0.72 NA 11.94 090

37607 ............ A Ligation of fistula ................................................ 6.16 NA 3.24 0.71 NA 10.11 090

37609 ............ A Temporal artery procedure ................................ 2.30 4.20 1.94 0.38 6.88 4.62 010

37615 ............ A Ligation of neck artery ....................................... 5.73 NA 3.99 1.11 NA 10.83 090

37616 ............ A Ligation of chest artery ...................................... 16.49 NA 13.38 0.83 NA 30.70 090

37617 ............ A Ligation of abdomen artery ................................ 15.95 NA 8.73 1.54 NA 26.22 090

37618 ............ A Ligation of extremity artery ................................ 4.84 NA 3.33 1.06 NA 9.23 090

37620 ............ A Revision of major vein ....................................... 10.56 NA 5.78 1.48 NA 17.82 090

37650 ............ A Revision of major vein ....................................... 5.13 NA 3.12 0.52 NA 8.77 090

37660 ............ A Revision of major vein ....................................... 10.61 NA 6.09 1.07 NA 17.77 090

37700 ............ A Revise leg vein ................................................... 3.73 NA 2.49 0.73 NA 6.95 090

37720 ............ A Removal of leg vein ........................................... 5.66 NA 3.17 1.04 NA 9.87 090

37730 ............ A Removal of leg veins ......................................... 7.33 NA 4.19 1.40 NA 12.92 090

37735 ............ A Removal of leg veins/lesion ............................... 10.53 NA 6.07 1.68 NA 18.28 090

37760 ............ A Revision of leg veins .......................................... 10.47 NA 6.21 1.52 NA 18.20 090

37780 ............ A Revision of leg vein ............................................ 3.84 NA 2.51 0.35 NA 6.70 090

37785 ............ A Revise secondary varicosity .............................. 3.88 4.63 3.11 0.18 8.69 7.17 090

37788 ............ A Revascularization, penis .................................... 22.01 NA 11.57 1.48 NA 35.06 090

37790 ............ A Penile venous occlusion .................................... 8.34 NA 5.86 0.55 NA 14.75 090

38100 ............ A Removal of spleen, total .................................... 13.01 NA 6.41 1.81 NA 21.23 090

38101 ............ A Removal of spleen, partial ................................. 13.74 NA 6.94 1.51 NA 22.19 090

38102 ............ A Removal of spleen, total .................................... 4.80 NA 2.03 0.58 NA 7.41 ZZZ

38115 ............ A Repair of ruptured spleen .................................. 14.19 NA 6.91 1.49 NA 22.59 090

38200 ............ A Injection for spleen x-ray .................................... 2.64 NA 0.83 0.15 NA 3.62 000

38230 ............ R Bone marrow collection ...................................... 4.54 NA 2.23 0.21 NA 6.98 010

38231 ............ R Stem cell collection ............................................ 1.50 NA 0.58 0.08 NA 2.16 000

38240 ............ R Bone marrow/stem transplant ............................ 2.24 NA 1.20 0.14 NA 3.58 XXX

38241 ............ R Bone marrow/stem transplant ............................ 2.24 NA 1.28 0.13 NA 3.65 XXX

38300 ............ A Drainage lymph node lesion .............................. 1.53 2.60 1.54 0.10 4.23 3.17 010

38305 ............ A Drainage lymph node lesion .............................. 4.61 5.06 4.08 0.36 10.03 9.05 090

38308 ............ A Incision of lymph channels ................................. 4.95 NA 3.75 0.45 NA 9.15 090

38380 ............ A Thoracic duct procedure .................................... 7.46 NA 5.68 0.76 NA 13.90 090

38381 ............ A Thoracic duct procedure .................................... 12.88 NA 10.21 1.50 NA 24.59 090

38382 ............ A Thoracic duct procedure .................................... 10.08 NA 9.37 1.13 NA 20.58 090

38500 ............ A Biopsy/removal, lymph node(s) .......................... 2.88 2.02 1.92 0.31 5.21 5.11 010

38505 ............ A Needle biopsy, lymph node(s) ........................... 1.14 1.98 1.04 0.17 3.29 2.35 000

38510 ............ A Biopsy/removal, lymph node(s) .......................... 4.14 NA 3.28 0.45 NA 7.87 090

38520 ............ A Biopsy/removal, lymph node(s) .......................... 5.12 NA 3.57 0.56 NA 9.25 090

38525 ............ A Biopsy/removal, lymph node(s) .......................... 4.66 NA 2.95 0.53 NA 8.14 090

38530 ............ A Biopsy/removal, lymph node(s) .......................... 6.13 NA 4.08 0.65 NA 10.86 090

38542 ............ A Explore deep node(s), neck ............................... 5.91 NA 4.90 0.59 NA 11.40 090

38550 ............ A Removal neck/armpit lesion ............................... 6.73 NA 4.15 0.63 NA 11.51 090

38555 ............ A Removal neck/armpit lesion ............................... 14.27 NA 8.94 1.38 NA 24.59 090

38562 ............ A Removal, pelvic lymph nodes ............................ 10.49 NA 6.35 1.20 NA 18.04 090

38564 ............ A Removal, abdomen lymph nodes ...................... 10.83 NA 6.15 1.51 NA 18.49 090

38700 ............ A Removal of lymph nodes, neck ......................... 8.24 NA 10.81 1.31 NA 20.36 090

38720 ............ A Removal of lymph nodes, neck ......................... 13.61 NA 13.91 2.04 NA 29.56 090
30938

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

38724 ............ A Removal of lymph nodes, neck ......................... 14.54 NA 14.45 2.00 NA 30.99 090

38740 ............ A Remove armpit lymph nodes ............................. 6.77 NA 3.81 1.00 NA 11.58 090

38745 ............ A Remove armpits lymph nodes ........................... 8.84 NA 5.36 1.76 NA 15.96 090

38746 ............ A Remove thoracic lymph nodes .......................... 4.39 NA 2.29 0.53 NA 7.21 ZZZ

38747 ............ A Remove abdominal lymph nodes ...................... 4.89 NA 2.24 0.59 NA 7.72 ZZZ

38760 ............ A Remove groin lymph nodes ............................... 8.74 NA 4.84 1.35 NA 14.93 090

38765 ............ A Remove groin lymph nodes ............................... 16.06 NA 9.45 2.42 NA 27.93 090

38770 ............ A Remove pelvis lymph nodes .............................. 13.23 NA 7.39 1.73 NA 22.35 090

38780 ............ A Remove abdomen lymph nodes ........................ 16.59 NA 9.80 3.13 NA 29.52 090

38790 ............ A Injection for lymphatic xray ................................ 1.29 15.73 0.46 0.19 17.21 1.94 000

38794 ............ A Access thoracic lymph duct ............................... 4.45 NA 1.63 0.38 NA 6.46 090

39000 ............ A Exploration of chest ........................................... 6.10 NA 7.52 1.08 NA 14.70 090

39010 ............ A Exploration of chest ........................................... 11.79 NA 10.10 2.08 NA 23.97 090

39200 ............ A Removal chest lesion ......................................... 13.62 NA 9.99 2.14 NA 25.75 090

39220 ............ A Removal chest lesion ......................................... 17.42 NA 11.53 2.83 NA 31.78 090

39400 ............ A Visualization of chest ......................................... 5.61 NA 5.83 0.95 NA 12.39 010

39501 ............ A Repair diaphragm laceration .............................. 13.19 NA 8.27 2.10 NA 23.56 090

39502 ............ A Repair paraesophageal hernia ........................... 16.33 NA 9.21 2.45 NA 27.99 090

39503 ............ A Repair of diaphragm hernia ............................... 34.85 NA 16.15 2.94 NA 53.94 090

39520 ............ A Repair of diaphragm hernia ............................... 16.10 NA 10.12 2.46 NA 28.68 090

39530 ............ A Repair of diaphragm hernia ............................... 15.41 NA 9.39 2.71 NA 27.51 090

39531 ............ A Repair of diaphragm hernia ............................... 16.42 NA 10.12 1.80 NA 28.34 090

39540 ............ A Repair of diaphragm hernia ............................... 13.32 NA 7.38 2.51 NA 23.21 090

39541 ............ A Repair of diaphragm hernia ............................... 14.41 NA 8.60 2.37 NA 25.38 090

39545 ............ A Revision of diaphragm ....................................... 13.37 NA 8.87 1.31 NA 23.55 090

40490 ............ A Biopsy of lip ........................................................ 1.22 1.11 0.68 0.07 2.40 1.97 000

40500 ............ A Partial excision of lip .......................................... 4.28 3.71 4.46 0.94 8.93 9.68 090

40510 ............ A Partial excision of lip .......................................... 4.70 4.37 4.92 0.83 9.90 10.45 090

40520 ............ A Partial excision of lip .......................................... 4.67 4.80 5.06 0.68 10.15 10.41 090

40525 ............ A Reconstruct lip with flap ..................................... 7.55 NA 6.94 1.43 NA 15.92 090

40527 ............ A Reconstruct lip with flap ..................................... 9.13 NA 8.05 1.65 NA 18.83 090

40530 ............ A Partial removal of lip .......................................... 5.40 4.34 4.99 0.74 10.48 11.13 090

40650 ............ A Repair lip ............................................................ 3.64 3.35 3.03 0.65 7.64 7.32 090

40652 ............ A Repair lip ............................................................ 4.26 4.36 4.46 0.79 9.41 9.51 090

40654 ............ A Repair lip ............................................................ 5.31 4.81 5.43 1.00 11.12 11.74 090

40700 ............ A Repair cleft lip/nasal ........................................... 12.79 NA 9.03 1.28 NA 23.10 090

40701 ............ A Repair cleft lip/nasal ........................................... 15.85 NA 8.34 1.62 NA 25.81 090

40702 ............ A Repair cleft lip/nasal ........................................... 13.04 NA 8.30 1.10 NA 22.44 090

40720 ............ A Repair cleft lip/nasal ........................................... 13.55 NA 9.97 1.79 NA 25.31 090

40761 ............ A Repair cleft lip/nasal ........................................... 14.72 NA 11.73 1.74 NA 28.19 090

40800 ............ A Drainage of mouth lesion ................................... 1.17 2.22 1.41 0.07 3.46 2.65 010

40801 ............ A Drainage of mouth lesion ................................... 2.53 1.94 1.90 0.16 4.63 4.59 010

40804 ............ A Removal foreign body, mouth ............................ 1.24 1.67 1.50 0.06 2.97 2.80 010

40805 ............ A Removal foreign body, mouth ............................ 2.69 2.40 2.50 0.30 5.39 5.49 010

40806 ............ A Incision of lip fold ............................................... 0.31 0.58 0.60 0.03 0.92 0.94 000

40808 ............ A Biopsy of mouth lesion ....................................... 0.96 1.32 1.60 0.08 2.36 2.64 010

40810 ............ A Excision of mouth lesion .................................... 1.31 1.76 1.85 0.11 3.18 3.27 010

40812 ............ A Excise/repair mouth lesion ................................. 2.31 2.16 2.45 0.14 4.61 4.90 010

40814 ............ A Excise/repair mouth lesion ................................. 3.42 3.08 3.61 0.32 6.82 7.35 090

40816 ............ A Excision of mouth lesion .................................... 3.67 3.32 3.85 0.33 7.32 7.85 090

40818 ............ A Excise oral mucosa for graft .............................. 2.41 2.76 4.56 0.20 5.37 7.17 090

40819 ............ A Excise lip or cheek fold ...................................... 2.41 2.57 2.64 0.14 5.12 5.19 090

40820 ............ A Treatment of mouth lesion ................................. 1.28 1.54 1.80 0.06 2.88 3.14 010

40830 ............ A Repair mouth laceration ..................................... 1.76 1.71 1.52 0.07 3.54 3.35 010

40831 ............ A Repair mouth laceration ..................................... 2.46 2.11 2.14 0.21 4.78 4.81 010

40840 ............ R Reconstruction of mouth .................................... 8.73 5.13 6.14 0.73 14.59 15.60 090

40842 ............ R Reconstruction of mouth .................................... 8.73 5.21 6.40 0.73 14.67 15.86 090

40843 ............ R Reconstruction of mouth .................................... 12.10 6.00 8.99 1.03 19.13 22.12 090

40844 ............ R Reconstruction of mouth .................................... 16.01 8.17 8.59 1.36 25.54 25.96 090

40845 ............ R Reconstruction of mouth .................................... 18.58 9.57 10.76 1.93 30.08 31.27 090

41000 ............ A Drainage of mouth lesion ................................... 1.30 1.53 1.44 0.08 2.91 2.82 010

41005 ............ A Drainage of mouth lesion ................................... 1.26 1.50 1.28 0.07 2.83 2.61 010

41006 ............ A Drainage of mouth lesion ................................... 3.24 2.72 2.86 0.11 6.07 6.21 090

41007 ............ A Drainage of mouth lesion ................................... 3.10 2.67 2.82 0.30 6.07 6.22 090

41008 ............ A Drainage of mouth lesion ................................... 3.37 2.74 2.81 0.11 6.22 6.29 090

41009 ............ A Drainage of mouth lesion ................................... 3.59 2.82 2.85 0.34 6.75 6.78 090

41010 ............ A Incision of tongue fold ........................................ 1.06 1.93 2.83 0.04 3.03 3.93 010

41015 ............ A Drainage of mouth lesion ................................... 3.96 3.03 3.07 0.10 7.09 7.13 090

41016 ............ A Drainage of mouth lesion ................................... 4.07 3.07 3.13 0.38 7.52 7.58 090

41017 ............ A Drainage of mouth lesion ................................... 4.07 3.10 3.12 0.14 7.31 7.33 090

41018 ............ A Drainage of mouth lesion ................................... 5.10 3.61 3.52 0.38 9.09 9.00 090

41100 ............ A Biopsy of tongue ................................................ 1.63 1.76 2.03 0.08 3.47 3.74 010

41105 ............ A Biopsy of tongue ................................................ 1.42 1.61 1.92 0.12 3.15 3.46 010

41108 ............ A Biopsy of floor of mouth ..................................... 1.05 1.44 1.68 0.09 2.58 2.82 010
30939

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

41110 ............ A Excision of tongue lesion ................................... 1.51 1.97 1.98 0.15 3.63 3.64 010

41112 ............ A Excision of tongue lesion ................................... 2.73 2.56 2.94 0.23 5.52 5.90 090

41113 ............ A Excision of tongue lesion ................................... 3.19 2.70 4.71 0.37 6.26 8.27 090

41114 ............ A Excision of tongue lesion ................................... 8.47 NA 6.15 0.73 NA 15.35 090

41115 ............ A Excision of tongue fold ....................................... 1.74 1.85 2.00 0.17 3.76 3.91 010

41116 ............ A Excision of mouth lesion .................................... 2.44 2.42 2.78 0.27 5.13 5.49 090

41120 ............ A Partial removal of tongue ................................... 9.77 NA 7.88 0.88 NA 18.53 090

41130 ............ A Partial removal of tongue ................................... 11.15 NA 8.73 1.14 NA 21.02 090

41135 ............ A Tongue and neck surgery .................................. 23.09 NA 16.39 2.64 NA 42.12 090

41140 ............ A Removal of tongue ............................................. 25.50 NA 17.08 2.45 NA 45.03 090

41145 ............ A Tongue removal; neck surgery .......................... 30.06 NA 20.79 2.95 NA 53.80 090

41150 ............ A Tongue, mouth, jaw surgery .............................. 23.04 NA 16.14 2.46 NA 41.64 090

41153 ............ A Tongue, mouth, neck surgery ............................ 23.77 NA 17.27 3.03 NA 44.07 090

41155 ............ A Tongue, jaw, & neck surgery ............................. 27.72 NA 19.93 3.75 NA 51.40 090

41250 ............ A Repair tongue laceration .................................... 1.91 1.89 1.50 0.11 3.91 3.52 010

41251 ............ A Repair tongue laceration .................................... 2.27 1.94 1.88 0.21 4.42 4.36 010

41252 ............ A Repair tongue laceration .................................... 2.97 2.48 2.21 0.26 5.71 5.44 010

41500 ............ A Fixation of tongue .............................................. 3.71 NA 2.80 0.26 NA 6.77 090

41510 ............ A Tongue to lip surgery ......................................... 3.42 NA 3.04 0.45 NA 6.91 090

41520 ............ A Reconstruction, tongue fold ............................... 2.73 2.31 2.90 0.28 5.32 5.91 090

41800 ............ A Drainage of gum lesion ...................................... 1.17 1.35 1.12 0.07 2.59 2.36 010

41805 ............ A Removal foreign body, gum ............................... 1.24 1.36 1.78 0.08 2.68 3.10 010

41806 ............ A Removal foreign body, jawbone ........................ 2.69 2.00 2.33 0.15 4.84 5.17 010

41822 ............ R Excision of gum lesion ....................................... 2.31 3.15 2.96 0.25 5.71 5.52 010

41823 ............ R Excision of gum lesion ....................................... 3.30 2.76 2.83 0.34 6.40 6.47 090

41825 ............ A Excision of gum lesion ....................................... 1.31 1.67 1.78 0.14 3.12 3.23 010

41826 ............ A Excision of gum lesion ....................................... 2.31 2.05 2.24 0.18 4.54 4.73 010

41827 ............ A Excision of gum lesion ....................................... 3.42 2.79 3.30 0.38 6.59 7.10 090

41828 ............ R Excision of gum lesion ....................................... 3.09 2.44 2.33 0.33 5.86 5.75 010

41830 ............ R Removal of gum tissue ...................................... 3.35 2.49 2.74 0.36 6.20 6.45 010

41872 ............ R Repair gum ......................................................... 2.59 2.40 2.44 0.27 5.26 5.30 090

41874 ............ R Repair tooth socket ............................................ 3.09 2.27 2.26 0.32 5.68 5.67 090

42000 ............ A Drainage mouth roof lesion ................................ 1.23 1.65 1.41 0.06 2.94 2.70 010

42100 ............ A Biopsy roof of mouth .......................................... 1.31 1.57 1.84 0.08 2.96 3.23 010

42104 ............ A Excision lesion, mouth roof ................................ 1.64 1.72 2.08 0.17 3.53 3.89 010

42106 ............ A Excision lesion, mouth roof ................................ 2.10 1.99 2.29 0.21 4.30 4.60 010

42107 ............ A Excision lesion, mouth roof ................................ 4.44 3.32 3.94 0.50 8.26 8.88 090

42120 ............ A Remove palate/lesion ......................................... 6.17 NA 5.28 1.01 NA 12.46 090

42140 ............ A Excision of uvula ................................................ 1.62 2.22 2.38 0.15 3.99 4.15 090

42145 ............ A Repair, palate, pharynx/uvula ............................ 8.05 NA 6.73 1.45 NA 16.23 090

42160 ............ A Treatment mouth roof lesion .............................. 1.80 2.02 2.10 0.16 3.98 4.06 010

42180 ............ A Repair palate ...................................................... 2.50 2.01 1.94 0.26 4.77 4.70 010

42182 ............ A Repair palate ...................................................... 3.83 2.77 3.02 0.38 6.98 7.23 010

42200 ............ A Reconstruct cleft palate ..................................... 12.00 NA 9.19 0.85 NA 22.04 090

42205 ............ A Reconstruct cleft palate ..................................... 9.59 NA 7.39 0.79 NA 17.77 090

42210 ............ A Reconstruct cleft palate ..................................... 14.50 NA 9.13 0.95 NA 24.58 090

42215 ............ A Reconstruct cleft palate ..................................... 8.82 NA 7.70 0.86 NA 17.38 090

42220 ............ A Reconstruct cleft palate ..................................... 7.02 NA 5.37 0.81 NA 13.20 090

42225 ............ A Reconstruct cleft palate ..................................... 9.54 NA 7.73 1.08 NA 18.35 090

42226 ............ A Lengthening of palate ........................................ 10.01 NA 8.78 0.86 NA 19.65 090

42227 ............ A Lengthening of palate ........................................ 9.52 NA 14.99 0.38 NA 24.89 090

42235 ............ A Repair palate ...................................................... 7.87 NA 5.57 0.49 NA 13.93 090

42260 ............ A Repair nose to lip fistula .................................... 9.80 5.49 7.44 0.44 15.73 17.68 090

42280 ............ A Preparation, palate mold .................................... 1.54 1.14 0.82 0.17 2.85 2.53 010

42281 ............ A Insertion, palate prosthesis ................................ 1.93 1.30 1.09 0.15 3.38 3.17 010

42300 ............ A Drainage of salivary gland ................................. 1.93 1.87 2.26 0.12 3.92 4.31 010

42305 ............ A Drainage of salivary gland ................................. 6.07 NA 5.09 0.27 NA 11.43 090

42310 ............ A Drainage of salivary gland ................................. 1.56 1.60 1.95 0.12 3.28 3.63 010

42320 ............ A Drainage of salivary gland ................................. 2.35 2.10 2.40 0.22 4.67 4.97 010

42325 ............ A Create salivary cyst drain .................................. 2.75 2.35 1.15 0.20 5.30 4.10 090

42326 ............ A Create salivary cyst drain .................................. 3.78 3.65 1.44 0.33 7.76 5.55 090

42330 ............ A Removal of salivary stone .................................. 2.21 2.04 1.27 0.12 4.37 3.60 010

42335 ............ A Removal of salivary stone .................................. 3.31 2.78 3.56 0.27 6.36 7.14 090

42340 ............ A Removal of salivary stone .................................. 4.60 3.74 4.38 0.45 8.79 9.43 090

42400 ............ A Biopsy of salivary gland ..................................... 0.78 1.63 0.74 0.10 2.51 1.62 000

42405 ............ A Biopsy of salivary gland ..................................... 3.29 2.54 3.25 0.19 6.02 6.73 010

42408 ............ A Excision of salivary cyst ..................................... 4.54 3.45 4.37 0.38 8.37 9.29 090

42409 ............ A Drainage of salivary cyst .................................... 2.81 2.44 3.35 0.30 5.55 6.46 090

42410 ............ A Excise parotid gland/lesion ................................ 9.34 NA 6.83 0.92 NA 17.09 090

42415 ............ A Excise parotid gland/lesion ................................ 16.89 NA 12.33 1.68 NA 30.90 090

42420 ............ A Excise parotid gland/lesion ................................ 19.59 NA 14.21 1.87 NA 35.67 090

42425 ............ A Excise parotid gland/lesion ................................ 13.02 NA 10.06 1.43 NA 24.51 090

42426 ............ A Excise parotid gland/lesion ................................ 21.26 NA 15.55 3.21 NA 40.02 090

42440 ............ A Excision submaxillary gland ............................... 6.97 NA 5.73 0.99 NA 13.69 090
30940

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

42450 ............ A Excision sublingual gland ................................... 4.62 3.71 4.47 0.35 8.68 9.44 090

42500 ............ A Repair salivary duct ........................................... 4.30 3.70 4.34 0.50 8.50 9.14 090

42505 ............ A Repair salivary duct ........................................... 6.18 4.43 5.38 0.86 11.47 12.42 090

42507 ............ A Parotid duct diversion ........................................ 6.11 NA 5.22 0.67 NA 12.00 090

42508 ............ A Parotid duct diversion ........................................ 9.10 NA 7.48 0.94 NA 17.52 090

42509 ............ A Parotid duct diversion ........................................ 11.54 NA 9.89 1.23 NA 22.66 090

42510 ............ A Parotid duct diversion ........................................ 8.15 NA 5.61 0.84 NA 14.60 090

42550 ............ A Injection for salivary x-ray .................................. 1.25 7.23 0.40 0.04 8.52 1.69 000

42600 ............ A Closure of salivary fistula ................................... 4.82 4.52 4.79 0.46 9.80 10.07 090

42650 ............ A Dilation of salivary duct ...................................... 0.77 1.10 1.36 0.04 1.91 2.17 000

42660 ............ A Dilation of salivary duct ...................................... 1.13 0.96 1.78 0.06 2.15 2.97 000

42665 ............ A Ligation of salivary duct ..................................... 2.53 2.88 3.17 0.25 5.66 5.95 090

42700 ............ A Drainage of tonsil abscess ................................. 1.62 1.96 1.78 0.10 3.68 3.50 010

42720 ............ A Drainage of throat abscess ................................ 5.42 4.08 4.43 0.22 9.72 10.07 010

42725 ............ A Drainage of throat abscess ................................ 10.72 NA 7.89 0.53 NA 19.14 090

42800 ............ A Biopsy of throat .................................................. 1.39 1.79 1.92 0.08 3.26 3.39 010

42802 ............ A Biopsy of throat .................................................. 1.54 1.89 2.02 0.12 3.55 3.68 010

42804 ............ A Biopsy of upper nose/throat ............................... 1.24 1.71 1.85 0.13 3.08 3.22 010

42806 ............ A Biopsy of upper nose/throat ............................... 1.58 2.01 2.16 0.16 3.75 3.90 010

42808 ............ A Excise pharynx lesion ........................................ 2.30 2.84 2.56 0.29 5.43 5.15 010

42809 ............ A Remove pharynx foreign body ........................... 1.81 2.09 1.45 0.08 3.98 3.34 010

42810 ............ A Excision of neck cyst ......................................... 3.33 3.66 3.33 0.47 7.46 7.13 090

42815 ............ A Excision of neck cyst ......................................... 7.23 NA 5.86 1.12 NA 14.21 090

42820 ............ A Remove tonsils and adenoids ............................ 3.91 NA 3.38 0.32 NA 7.61 090

42821 ............ A Remove tonsils and adenoids ............................ 4.29 NA 3.69 0.46 NA 8.44 090

42825 ............ A Removal of tonsils .............................................. 3.42 NA 3.27 0.33 NA 7.02 090

42826 ............ A Removal of tonsils .............................................. 3.38 NA 3.24 0.43 NA 7.05 090

42830 ............ A Removal of adenoids ......................................... 2.57 NA 2.28 0.27 NA 5.12 090

42831 ............ A Removal of adenoids ......................................... 2.71 NA 2.50 0.25 NA 5.46 090

42835 ............ A Removal of adenoids ......................................... 2.30 NA 2.54 0.10 NA 4.94 090

42836 ............ A Removal of adenoids ......................................... 3.18 NA 3.13 0.31 NA 6.62 090

42842 ............ A Extensive surgery of throat ................................ 8.76 NA 7.14 0.73 NA 16.63 090

42844 ............ A Extensive surgery of throat ................................ 14.31 NA 10.67 1.27 NA 26.25 090

42845 ............ A Extensive surgery of throat ................................ 24.29 NA 17.14 2.22 NA 43.65 090

42860 ............ A Excision of tonsil tags ........................................ 2.22 NA 2.43 0.21 NA 4.86 090

42870 ............ A Excision of lingual tonsil ..................................... 5.40 NA 5.08 0.26 NA 10.74 090

42890 ............ A Partial removal of pharynx ................................. 12.94 NA 10.10 1.03 NA 24.07 090

42892 ............ A Revision of pharyngeal walls ............................. 15.83 NA 12.11 1.27 NA 29.21 090

42894 ............ A Revision of pharyngeal walls ............................. 22.88 NA 16.72 1.83 NA 41.43 090

42900 ............ A Repair throat wound ........................................... 5.25 NA 3.94 0.48 NA 9.67 010

42950 ............ A Reconstruction of throat ..................................... 8.10 NA 6.76 1.10 NA 15.96 090

42953 ............ A Repair throat, esophagus ................................... 8.96 NA 7.93 0.93 NA 17.82 090

42955 ............ A Surgical opening of throat .................................. 7.39 NA 5.74 0.43 NA 13.56 090

42960 ............ A Control throat bleeding ....................................... 2.33 NA 2.09 0.12 NA 4.54 010

42961 ............ A Control throat bleeding ....................................... 5.59 NA 4.67 0.19 NA 10.45 090

42962 ............ A Control throat bleeding ....................................... 7.14 NA 4.55 0.68 NA 12.37 090

42970 ............ A Control nose/throat bleeding .............................. 5.43 NA 3.46 0.10 NA 8.99 090

42971 ............ A Control nose/throat bleeding .............................. 6.21 NA 4.85 0.34 NA 11.40 090

42972 ............ A Control nose/throat bleeding .............................. 7.20 NA 5.58 0.73 NA 13.51 090

43020 ............ A Incision of esophagus ........................................ 8.09 NA 5.75 0.71 NA 14.55 090

43030 ............ A Throat muscle surgery ....................................... 7.69 NA 6.16 1.21 NA 15.06 090

43045 ............ A Incision of esophagus ........................................ 20.12 NA 11.38 2.36 NA 33.86 090

43100 ............ A Excision of esophagus lesion ............................ 9.19 NA 7.68 0.95 NA 17.82 090

43101 ............ A Excision of esophagus lesion ............................ 16.24 NA 9.49 1.88 NA 27.61 090

43107 ............ A Removal of esophagus ...................................... 28.79 NA 16.54 4.42 NA 49.75 090

43108 ............ A Removal of esophagus ...................................... 34.19 NA 18.50 4.77 NA 57.46 090

43112 ............ A Removal of esophagus ...................................... 31.22 NA 17.71 4.22 NA 53.15 090

43113 ............ A Removal of esophagus ...................................... 35.27 NA 19.69 4.77 NA 59.73 090

43116 ............ A Partial removal of esophagus ............................ 31.22 NA 22.24 4.77 NA 58.23 090

43117 ............ A Partial removal of esophagus ............................ 30.02 NA 17.20 4.77 NA 51.99 090

43118 ............ A Partial removal of esophagus ............................ 33.20 NA 17.53 4.77 NA 55.50 090

43121 ............ A Partial removal of esophagus ............................ 29.19 NA 16.84 4.19 NA 50.22 090

43122 ............ A Parital removal of esophagus ............................ 29.11 NA 16.10 4.19 NA 49.40 090

43123 ............ A Partial removal of esophagus ............................ 33.20 NA 18.08 4.77 NA 56.05 090

43124 ............ A Removal of esophagus ...................................... 27.32 NA 16.97 4.42 NA 48.71 090

43130 ............ A Removal of esophagus pouch ........................... 11.75 NA 9.35 1.60 NA 22.70 090

43135 ............ A Removal of esophagus pouch ........................... 16.10 NA 10.05 2.17 NA 28.32 090

43200 ............ A Esophagus endoscopy ....................................... 1.59 3.93 1.00 0.26 5.78 2.85 000

43202 ............ A Esophagus endoscopy, biopsy .......................... 1.89 3.61 0.94 0.31 5.81 3.14 000

43204 ............ A Esophagus endoscopy & inject .......................... 3.77 NA 1.45 0.36 NA 5.58 000

43205 ............ A Esophagus endoscopy/ligation .......................... 3.79 NA 1.47 0.18 NA 5.44 000

43215 ............ A Esophagus endoscopy ....................................... 2.60 NA 1.16 0.46 NA 4.22 000

43216 ............ A Esophagus endoscopy/lesion ............................ 2.40 NA 1.06 0.37 NA 3.83 000

43217 ............ A Esophagus endoscopy ....................................... 2.90 NA 1.25 0.37 NA 4.52 000
30941

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

43219 ............ A Esophagus endoscopy ....................................... 2.80 NA 1.22 0.34 NA 4.36 000

43220 ............ A Esophagus endoscopy, dilation ......................... 2.10 NA 0.91 0.27 NA 3.28 000

43226 ............ A Esophagus endoscopy, dilation ......................... 2.34 NA 0.96 0.26 NA 3.56 000

43227 ............ A Esophagus endoscopy, repair ........................... 3.60 NA 1.41 0.34 NA 5.35 000

43228 ............ A Esophagus endoscopy, ablation ........................ 3.77 NA 1.56 0.38 NA 5.71 000

43234 ............ A Upper GI endoscopy, exam ............................... 2.01 2.35 0.86 0.30 4.66 3.17 000

43235 ............ A Upper gi endoscopy, diagnosis .......................... 2.39 3.80 0.98 0.29 6.48 3.66 000

43239 ............ A Upper GI endoscopy, biopsy ............................. 2.69 3.88 1.09 0.33 6.90 4.11 000

43241 ............ A Upper GI endoscopy with tube .......................... 2.59 NA 1.04 0.38 NA 4.01 000

43243 ............ A Upper GI endoscopy & inject. ............................ 4.57 NA 1.73 0.39 NA 6.69 000

43244 ............ A Upper GI endoscopy/ligation .............................. 4.59 NA 1.74 0.41 NA 6.74 000

43245 ............ A Operative upper GI endoscopy .......................... 3.39 NA 1.33 0.40 NA 5.12 000

43246 ............ A Place gastrostomy tube ..................................... 4.33 NA 1.65 0.51 NA 6.49 000

43247 ............ A Operative upper GI endoscopy .......................... 3.39 NA 1.33 0.38 NA 5.10 000

43248 ............ A Upper GI endoscopy/guidewire .......................... 3.15 NA 1.23 0.35 NA 4.73 000

43249 ............ A Esophagus endoscopy, dilation ......................... 2.90 NA 1.15 0.30 NA 4.35 000

43250 ............ A Upper GI endoscopy/tumor ................................ 3.20 NA 1.26 0.43 NA 4.89 000

43251 ............ A Operative upper GI endoscopy .......................... 3.70 NA 1.43 0.43 NA 5.56 000

43255 ............ A Operative upper GI endoscopy .......................... 4.40 NA 1.62 0.38 NA 6.40 000

43258 ............ A Operative upper GI endoscopy .......................... 4.55 NA 1.73 0.38 NA 6.66 000

43259 ............ A Endoscopic ultrasound exam ............................. 4.89 NA 1.88 0.35 NA 7.12 000

43260 ............ A Endoscopy, bile duct/pancreas .......................... 5.96 NA 2.21 0.39 NA 8.56 000

43261 ............ A Endoscopy, bile duct/pancreas .......................... 6.27 NA 2.33 0.39 NA 8.99 000

43262 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 NA 2.72 0.58 NA 10.69 000

43263 ............ A Endoscopy, bile duct/pancreas .......................... 6.19 NA 2.31 0.38 NA 8.88 000

43264 ............ A Endoscopy, bile duct/pancreas .......................... 8.90 NA 3.26 0.61 NA 12.77 000

43265 ............ A Endoscopy, bile duct/pancreas .......................... 8.90 NA 3.27 0.49 NA 12.66 000

43267 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 NA 2.72 0.48 NA 10.59 000

43268 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 NA 2.72 0.56 NA 10.67 000

43269 ............ A Endoscopy, bile duct/pancreas .......................... 6.04 NA 2.25 0.51 NA 8.80 000

43271 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 NA 2.72 0.50 NA 10.61 000

43272 ............ A Endoscopy, bile duct/pancreas .......................... 7.39 NA 2.74 0.42 NA 10.55 000

43300 ............ A Repair of esophagus .......................................... 9.14 NA 6.70 1.70 NA 17.54 090

43305 ............ A Repair esophagus and fistula ............................ 17.15 NA 15.03 1.78 NA 33.96 090

43310 ............ A Repair of esophagus .......................................... 25.39 NA 15.67 3.23 NA 44.29 090

43312 ............ A Repair esophagus and fistula ............................ 28.42 NA 18.88 2.30 NA 49.60 090

43320 ............ A Fuse esophagus & stomach .............................. 16.07 NA 10.25 2.05 NA 28.37 090

43324 ............ A Revise esophagus & stomach ........................... 16.58 NA 9.19 2.53 NA 28.30 090

43325 ............ A Revise esophagus & stomach ........................... 16.17 NA 9.81 2.29 NA 28.27 090

43326 ............ A Revise esophagus & stomach ........................... 15.91 NA 10.44 1.75 NA 28.10 090

43330 ............ A Repair of esophagus .......................................... 15.94 NA 9.56 2.39 NA 27.89 090

43331 ............ A Repair of esophagus .......................................... 16.23 NA 10.50 2.64 NA 29.37 090

43340 ............ A Fuse esophagus & intestine .............................. 15.81 NA 9.82 2.52 NA 28.15 090

43341 ............ A Fuse esophagus & intestine .............................. 16.81 NA 10.70 1.56 NA 29.07 090

43350 ............ A Surgical opening, esophagus ............................. 12.72 NA 10.38 1.15 NA 24.25 090

43351 ............ A Surgical opening, esophagus ............................. 14.79 NA 9.21 1.53 NA 25.53 090

43352 ............ A Surgical opening, esophagus ............................. 12.30 NA 9.19 1.47 NA 22.96 090

43360 ............ A Gastrointestinal repair ........................................ 28.78 NA 16.01 4.19 NA 48.98 090

43361 ............ A Gastrointestinal repair ........................................ 32.65 NA 18.33 4.77 NA 55.75 090

43400 ............ A Ligate esophagus veins ..................................... 17.09 NA 9.76 1.63 NA 28.48 090

43401 ............ A Esophagus surgery for veins ............................. 17.81 NA 10.85 1.93 NA 30.59 090

43405 ............ A Ligate/staple esophagus .................................... 16.13 NA 10.21 2.64 NA 28.98 090

43410 ............ A Repair esophagus wound .................................. 10.86 NA 8.25 1.54 NA 20.65 090

43415 ............ A Repair esophagus wound .................................. 17.06 NA 10.46 2.52 NA 30.04 090

43420 ............ A Repair esophagus opening ................................ 11.57 NA 8.52 0.78 NA 20.87 090

43425 ............ A Repair esophagus opening ................................ 16.95 NA 10.15 1.71 NA 28.81 090

43450 ............ A Dilate esophagus ............................................... 1.38 0.91 0.54 0.05 2.34 1.97 000

43453 ............ A Dilate esophagus ............................................... 1.51 NA 0.58 0.11 NA 2.20 000

43456 ............ A Dilate esophagus ............................................... 2.57 NA 0.97 0.24 NA 3.78 000

43458 ............ A Dilation of esophagus ........................................ 3.06 NA 1.15 0.27 NA 4.48 000

43460 ............ A Pressure treatment esophagus .......................... 3.80 NA 1.74 0.15 NA 5.69 000

43500 ............ A Surgical opening of stomach ............................. 8.44 NA 4.35 1.20 NA 13.99 090

43501 ............ A Surgical repair of stomach ................................. 15.31 NA 7.45 1.83 NA 24.59 090

43502 ............ A Surgical repair of stomach ................................. 17.67 NA 8.37 1.83 NA 27.87 090

43510 ............ A Surgical opening of stomach ............................. 9.99 NA 5.88 0.94 NA 16.81 090

43520 ............ A Incision of pyloric muscle ................................... 7.63 NA 4.44 0.87 NA 12.94 090

43600 ............ A Biopsy of stomach .............................................. 1.91 NA 0.80 0.05 NA 2.76 000

43605 ............ A Biopsy of stomach .............................................. 9.15 NA 4.62 1.29 NA 15.06 090

43610 ............ A Excision of stomach lesion ................................ 11.15 NA 5.84 1.71 NA 18.70 090

43611 ............ A Excision of stomach lesion ................................ 13.63 NA 6.85 1.71 NA 22.19 090

43620 ............ A Removal of stomach .......................................... 22.54 NA 11.01 3.19 NA 36.74 090

43621 ............ A Removal of stomach .......................................... 23.06 NA 11.28 3.19 NA 37.53 090

43622 ............ A Removal of stomach .......................................... 24.41 NA 11.86 3.19 NA 39.46 090

43631 ............ A Removal of stomach, partial .............................. 19.66 NA 9.48 2.66 NA 31.80 090
30942

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

43632 ............ A Removal stomach, partial .................................. 19.66 NA 9.48 2.66 NA 31.80 090

43633 ............ A Removal stomach, partial .................................. 20.10 NA 9.74 2.66 NA 32.50 090

43634 ............ A Removal stomach, partial .................................. 21.86 NA 10.69 4.57 NA 37.12 090

43635 ............ A Partial removal of stomach ................................ 2.06 NA 0.89 0.26 NA 3.21 ZZZ

43638 ............ A Partial removal of stomach ................................ 21.76 NA 10.27 2.73 NA 34.76 090

43639 ............ A Removal stomach, partial .................................. 22.25 NA 10.59 2.73 NA 35.57 090

43640 ............ A Vagotomy & pylorus repair ................................ 14.81 NA 7.28 2.19 NA 24.28 090

43641 ............ A Vagotomy & pylorus repair ................................ 15.03 NA 7.36 2.18 NA 24.57 090

43750 ............ A Place gastrostomy tube ..................................... 4.49 NA 2.33 0.56 NA 7.38 010

43760 ............ A Change gastrostomy tube .................................. 1.10 0.88 0.50 0.09 2.07 1.69 000

43761 ............ A Reposition gastrostomy tube ............................. 2.01 NA 0.71 0.25 NA 2.97 000

43800 ............ A Reconstruction of pylorus .................................. 10.46 NA 5.53 1.47 NA 17.46 090

43810 ............ A Fusion of stomach and bowel ............................ 11.19 NA 5.86 1.53 NA 18.58 090

43820 ............ A Fusion of stomach and bowel ............................ 11.74 NA 6.01 1.75 NA 19.50 090

43825 ............ A Fusion of stomach and bowel ............................ 14.68 NA 7.24 2.30 NA 24.22 090

43830 ............ A Place gastrostomy tube ..................................... 7.28 NA 4.11 1.19 NA 12.58 090

43831 ............ A Place gastrostomy tube ..................................... 7.33 NA 4.08 0.93 NA 12.34 090

43832 ............ A Place gastrostomy tube ..................................... 11.92 NA 6.23 1.36 NA 19.51 090

43840 ............ A Repair of stomach lesion ................................... 11.89 NA 6.02 1.66 NA 19.57 090

43842 ............ A Gastroplasty for obesity ..................................... 14.71 NA 8.34 2.93 NA 25.98 090

43843 ............ A Gastroplasty for obesity ..................................... 14.85 NA 8.41 2.93 NA 26.19 090

43846 ............ A Gastric bypass for obesity ................................. 19.15 NA 10.32 3.30 NA 32.77 090

43847 ............ A Gastric bypass for obesity ................................. 21.44 NA 11.57 3.30 NA 36.31 090

43848 ............ A Revision gastroplasty ......................................... 23.41 NA 12.70 3.30 NA 39.41 090

43850 ............ A Revise stomach-bowel fusion ............................ 19.69 NA 9.27 2.25 NA 31.21 090

43855 ............ A Revise stomach-bowel fusion ............................ 20.83 NA 9.71 2.28 NA 32.82 090

43860 ............ A Revise stomach-bowel fusion ............................ 19.91 NA 9.43 2.51 NA 31.85 090

43865 ............ A Revise stomach-bowel fusion ............................ 21.12 NA 9.97 2.98 NA 34.07 090

43870 ............ A Repair stomach opening .................................... 7.40 NA 4.13 1.14 NA 12.67 090

43880 ............ A Repair stomach-bowel fistula ............................. 19.63 NA 9.75 1.76 NA 31.14 090

44005 ............ A Freeing of bowel adhesion ................................. 13.84 NA 6.88 1.75 NA 22.47 090

44010 ............ A Incision of small bowel ....................................... 10.68 NA 5.89 1.42 NA 17.99 090

44015 ............ A Insert needle catheter,bowel .............................. 2.62 NA 1.10 0.45 NA 4.17 ZZZ

44020 ............ A Exploration of small bowel ................................. 11.93 NA 6.06 1.65 NA 19.64 090

44021 ............ A Decompress small bowel ................................... 12.01 NA 6.30 1.48 NA 19.79 090

44025 ............ A Incision of large bowel ....................................... 12.18 NA 6.03 1.61 NA 19.82 090

44050 ............ A Reduce bowel obstruction .................................. 11.40 NA 5.86 1.64 NA 18.90 090

44055 ............ A Correct malrotation of bowel .............................. 13.14 NA 6.56 1.60 NA 21.30 090

44100 ............ A Biopsy of bowel .................................................. 2.01 NA 0.86 0.13 NA 3.00 000

44110 ............ A Excision of bowel lesion(s) ................................ 10.07 NA 5.42 1.58 NA 17.07 090

44111 ............ A Excision of bowel lesion(s) ................................ 12.19 NA 6.68 2.14 NA 21.01 090

44120 ............ A Removal of small intestine ................................. 14.50 NA 7.15 2.02 NA 23.67 090

44121 ............ A Removal of small intestine ................................. 4.45 NA 1.98 0.54 NA 6.97 ZZZ

44125 ............ A Removal of small intestine ................................. 14.96 NA 7.39 2.28 NA 24.63 090

44130 ............ A Bowel to bowel fusion ........................................ 12.36 NA 6.29 1.86 NA 20.51 090

44139 ............ A Mobilization of colon .......................................... 2.23 NA 0.98 0.27 NA 3.48 ZZZ

44140 ............ A Partial removal of colon ..................................... 18.35 NA 8.86 2.40 NA 29.61 090

44141 ............ A Partial removal of colon ..................................... 19.51 NA 11.52 2.55 NA 33.58 090

44143 ............ A Partial removal of colon ..................................... 20.17 NA 11.83 2.62 NA 34.62 090

44144 ............ A Partial removal of colon ..................................... 18.89 NA 10.76 2.53 NA 32.18 090

44145 ............ A Partial removal of colon ..................................... 23.18 NA 11.32 2.78 NA 37.28 090

44146 ............ A Partial removal of colon ..................................... 24.16 NA 13.56 3.14 NA 40.86 090

44147 ............ A Partial removal of colon ..................................... 18.17 NA 9.40 3.30 NA 30.87 090

44150 ............ A Removal of colon ............................................... 21.01 NA 12.18 3.17 NA 36.36 090

44151 ............ A Removal of colon/ileostomy ............................... 20.04 NA 12.76 2.22 NA 35.02 090

44152 ............ A Removal of colon/ileostomy ............................... 24.41 NA 15.25 3.36 NA 43.02 090

44153 ............ A Removal of colon/ileostomy ............................... 26.83 NA 15.26 3.63 NA 45.72 090

44155 ............ A Removal of colon ............................................... 24.44 NA 13.46 3.50 NA 41.40 090

44156 ............ A Removal of colon/ileostomy ............................... 23.01 NA 13.26 2.52 NA 38.79 090

44160 ............ A Removal of colon ............................................... 15.88 NA 7.85 2.68 NA 26.41 090

44300 ............ A Open bowel to skin ............................................ 8.88 NA 5.32 1.29 NA 15.49 090

44310 ............ A Ileostomy/jejunostomy ........................................ 11.70 NA 7.71 1.66 NA 21.07 090

44312 ............ A Revision of ileostomy ......................................... 5.88 NA 4.12 0.45 NA 10.45 090

44314 ............ A Revision of ileostomy ......................................... 11.04 NA 7.79 1.21 NA 20.04 090

44316 ............ A Devise bowel pouch ........................................... 15.47 NA 11.49 1.43 NA 28.39 090

44320 ............ A Colostomy .......................................................... 12.94 NA 8.94 1.57 NA 23.45 090

44322 ............ A Colostomy with biopsies .................................... 11.98 NA 8.75 1.88 NA 22.61 090

44340 ............ A Revision of colostomy ........................................ 5.66 NA 3.74 0.35 NA 9.75 090

44345 ............ A Revision of colostomy ........................................ 11.32 NA 6.80 1.03 NA 19.15 090

44346 ............ A Revision of colostomy ........................................ 12.46 NA 7.25 1.38 NA 21.09 090

44360 ............ A Small bowel endoscopy ..................................... 2.92 NA 1.19 0.32 NA 4.43 000

44361 ............ A Small bowel endoscopy,biopsy .......................... 3.23 NA 1.29 0.34 NA 4.86 000

44363 ............ A Small bowel endoscopy ..................................... 3.94 NA 1.52 0.36 NA 5.82 000

44364 ............ A Small bowel endoscopy ..................................... 4.22 NA 1.67 0.72 NA 6.61 000
30943

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

44365 ............ A Small bowel endoscopy ..................................... 3.73 NA 1.50 0.72 NA 5.95 000

44366 ............ A Small bowel endoscopy ..................................... 4.97 NA 1.90 0.45 NA 7.32 000

44369 ............ A Small bowel endoscopy ..................................... 5.09 NA 1.96 0.50 NA 7.55 000

44372 ............ A Small bowel endoscopy ..................................... 4.97 NA 1.96 0.67 NA 7.60 000

44373 ............ A Small bowel endoscopy ..................................... 3.94 NA 1.57 0.50 NA 6.01 000

44376 ............ A Small bowel endoscopy ..................................... 5.69 NA 2.19 0.26 NA 8.14 000

44377 ............ A Small bowel endoscopy ..................................... 5.98 NA 2.27 0.28 NA 8.53 000

44378 ............ A Small bowel endoscopy ..................................... 7.71 NA 2.90 0.35 NA 10.96 000

44380 ............ A Small bowel endoscopy ..................................... 1.51 NA 0.70 0.22 NA 2.43 000

44382 ............ A Small bowel endoscopy ..................................... 1.82 NA 0.81 0.29 NA 2.92 000

44385 ............ A Endoscopy of bowel pouch ................................ 1.82 2.87 0.90 0.34 5.03 3.06 000

44386 ............ A Endoscopy, bowel pouch, biopsy ...................... 2.12 3.78 1.04 0.15 6.05 3.31 000

44388 ............ A Colon endoscopy ............................................... 2.82 3.48 1.30 0.50 6.80 4.62 000

44389 ............ A Colonoscopy with biopsy ................................... 3.13 4.09 1.41 0.45 7.67 4.99 000

44390 ............ A Colonoscopy for foreign body ............................ 3.83 4.31 1.71 0.28 8.42 5.82 000

44391 ............ A Colonoscopy for bleeding .................................. 4.32 3.79 1.81 0.53 8.64 6.66 000

44392 ............ A Colonoscopy & polypectomy .............................. 3.82 4.34 1.66 0.70 8.86 6.18 000

44393 ............ A Colonoscopy, lesion removal ............................. 4.84 4.39 2.01 0.70 9.93 7.55 000

44394 ............ A Colonoscopy w/snare ......................................... 4.43 4.53 1.90 0.70 9.66 7.03 000

44500 ............ A Intro, gastrointestinal tube .................................. 0.49 NA 0.25 0.02 NA 0.76 000

44602 ............ A Suture, small intestine ........................................ 10.61 NA 5.66 1.62 NA 17.89 090

44603 ............ A Suture, small intestine ........................................ 14.00 NA 7.23 1.96 NA 23.19 090

44604 ............ A Suture, large intestine ........................................ 14.28 NA 7.08 1.67 NA 23.03 090

44605 ............ A Repair of bowel lesion ....................................... 15.37 NA 7.91 2.02 NA 25.30 090

44615 ............ A Intestinal stricturoplasty ...................................... 14.19 NA 7.34 1.57 NA 23.10 090

44620 ............ A Repair bowel opening ........................................ 10.87 NA 5.63 1.26 NA 17.76 090

44625 ............ A Repair bowel opening ........................................ 13.41 NA 6.71 2.03 NA 22.15 090

44626 ............ A Repair bowel opening ........................................ 22.59 NA 10.26 2.40 NA 35.25 090

44640 ............ A Repair bowel-skin fistula .................................... 14.83 NA 7.81 1.35 NA 23.99 090

44650 ............ A Repair bowel fistula ............................................ 15.25 NA 7.97 1.46 NA 24.68 090

44660 ............ A Repair bowel-bladder fistula .............................. 14.63 NA 7.85 1.21 NA 23.69 090

44661 ............ A Repair bowel-bladder fistula .............................. 16.99 NA 8.69 2.52 NA 28.20 090

44680 ............ A Surgical revision, intestine ................................. 13.72 NA 7.51 2.14 NA 23.37 090

44700 ............ A Suspend bowel w/prosthesis ............................. 14.35 NA 7.86 2.40 NA 24.61 090

44800 ............ A Excision of bowel pouch .................................... 11.23 NA 5.71 1.08 NA 18.02 090

44820 ............ A Excision of mesentery lesion ............................. 10.31 NA 5.39 1.21 NA 16.91 090

44850 ............ A Repair of mesentery ........................................... 9.57 NA 5.09 1.18 NA 15.84 090

44900 ............ A Drain, app abscess, open .................................. 8.82 NA 5.23 0.88 NA 14.93 090

44901 ............ A Drain, app abscess, perc ................................... 3.38 NA 3.15 0.30 NA 6.83 000

44950 ............ A Appendectomy ................................................... 8.70 NA 4.46 1.01 NA 14.17 090

44955 ............ A Appendectomy ................................................... 1.53 NA 0.68 0.60 NA 2.81 ZZZ

44960 ............ A Appendectomy ................................................... 10.74 NA 5.72 1.24 NA 17.70 090

45000 ............ A Drainage of pelvic abscess ................................ 4.52 NA 3.28 0.24 NA 8.04 090

45005 ............ A Drainage of rectal abscess ................................ 1.99 2.91 1.24 0.21 5.11 3.44 010

45020 ............ A Drainage of rectal abscess ................................ 4.72 NA 3.18 0.51 NA 8.41 090

45100 ............ A Biopsy of rectum ................................................ 3.68 3.40 1.91 0.35 7.43 5.94 090

45108 ............ A Removal of anorectal lesion .............................. 4.76 4.36 2.54 0.53 9.65 7.83 090

45110 ............ A Removal of rectum ............................................. 23.80 NA 11.87 3.43 NA 39.10 090

45111 ............ A Partial removal of rectum ................................... 16.48 NA 8.73 2.49 NA 27.70 090

45112 ............ A Removal of rectum ............................................. 25.96 NA 12.03 3.36 NA 41.35 090

45113 ............ A Partial proctectomy ............................................ 25.99 NA 12.33 3.36 NA 41.68 090

45114 ............ A Partial removal of rectum ................................... 23.22 NA 11.45 3.24 NA 37.91 090

45116 ............ A Partial removal of rectum ................................... 20.89 NA 10.07 2.34 NA 33.30 090

45119 ............ A Remove, rectum w/reservoir .............................. 26.21 NA 12.12 3.36 NA 41.69 090

45120 ............ A Removal of rectum ............................................. 24.60 NA 12.00 3.54 NA 40.14 090

45121 ............ A Removal of rectum and colon ............................ 27.04 NA 13.11 2.01 NA 42.16 090

45123 ............ A Partial proctectomy ............................................ 14.20 NA 7.46 2.49 NA 24.15 090

45130 ............ A Excision of rectal prolapse ................................. 13.97 NA 6.51 1.79 NA 22.27 090

45135 ............ A Excision of rectal prolapse ................................. 16.39 NA 8.28 3.50 NA 28.17 090

45150 ............ A Excision of rectal stricture .................................. 5.67 4.05 2.84 0.63 10.35 9.14 090

45160 ............ A Excision of rectal lesion ..................................... 13.02 NA 6.50 1.56 NA 21.08 090

45170 ............ A Excision of rectal lesion ..................................... 9.77 NA 4.81 0.96 NA 15.54 090

45190 ............ A Destruction, rectal tumor .................................... 8.28 NA 4.15 1.06 NA 13.49 090

45300 ............ A Proctosigmoidoscopy ......................................... 0.70 2.68 0.30 0.07 3.45 1.07 000

45303 ............ A Proctosigmoidoscopy ......................................... 0.80 3.28 0.34 0.12 4.20 1.26 000

45305 ............ A Proctosigmoidoscopy; biopsy ............................. 1.01 2.65 0.42 0.14 3.80 1.57 000

45307 ............ A Proctosigmoidoscopy ......................................... 1.71 3.54 0.60 0.18 5.43 2.49 000

45308 ............ A Proctosigmoidoscopy ......................................... 1.51 2.24 0.62 0.20 3.95 2.33 000

45309 ............ A Proctosigmoidoscopy ......................................... 2.01 3.03 0.81 0.20 5.24 3.02 000

45315 ............ A Proctosigmoidoscopy ......................................... 2.54 3.79 1.00 0.18 6.51 3.72 000

45317 ............ A Proctosigmoidoscopy ......................................... 2.73 2.62 1.06 0.19 5.54 3.98 000

45320 ............ A Proctosigmoidoscopy ......................................... 2.88 2.85 1.13 0.34 6.07 4.35 000

45321 ............ A Proctosigmoidoscopy ......................................... 2.12 NA 0.84 0.27 NA 3.23 000

45330 ............ A Sigmoidoscopy, diagnostic ................................. 0.96 3.42 0.38 0.12 4.50 1.46 000
30944

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

45331 ............ A Sigmoidoscopy and biopsy ................................ 1.26 3.44 0.49 0.15 4.85 1.90 000

45332 ............ A Sigmoidoscopy ................................................... 1.96 4.71 0.75 0.16 6.83 2.87 000

45333 ............ A Sigmoidoscopy & polypectomy .......................... 1.96 3.76 0.75 0.26 5.98 2.97 000

45334 ............ A Sigmoidoscopy for bleeding ............................... 2.99 NA 1.11 0.23 NA 4.33 000

45337 ............ A Sigmoidoscopy, decompression ........................ 2.36 NA 0.90 0.38 NA 3.64 000

45338 ............ A Sigmoidoscopy ................................................... 2.57 4.21 0.97 0.26 7.04 3.80 000

45339 ............ A Sigmoidoscopy ................................................... 3.14 3.94 1.16 0.31 7.39 4.61 000

45355 ............ A Surgical colonoscopy ......................................... 3.52 NA 1.71 0.10 NA 5.33 000

45378 ............ A Diagnostic colonoscopy ..................................... 3.70 4.29 1.97 0.39 8.38 6.06 000

45378 53 A Diagnostic colonoscopy ..................................... 0.96 1.28 0.59 0.12 2.36 1.67 000

45379 ............ A Colonoscopy ....................................................... 4.72 4.69 2.08 0.45 9.86 7.25 000

45380 ............ A Colonoscopy and biopsy .................................... 4.01 4.37 1.74 0.40 8.78 6.15 000

45382 ............ A Colonoscopy,control bleeding ............................ 5.73 5.11 2.33 0.41 11.25 8.47 000

45383 ............ A Colonoscopy, lesion removal ............................. 5.87 5.21 2.42 0.50 11.58 8.79 000

45384 ............ A Colonoscopy ....................................................... 4.70 4.73 2.01 0.58 10.01 7.29 000

45385 ............ A Colonoscopy, lesion removal ............................. 5.31 4.93 2.22 0.58 10.82 8.11 000

45500 ............ A Repair of rectum ................................................ 7.29 NA 3.84 1.21 NA 12.34 090

45505 ............ A Repair of rectum ................................................ 6.02 NA 3.05 1.23 NA 10.30 090

45520 ............ A Treatment of rectal prolapse .............................. 0.55 0.46 0.21 0.10 1.11 0.86 000

45540 ............ A Correct rectal prolapse ....................................... 12.92 NA 6.63 2.10 NA 21.65 090

45541 ............ A Correct rectal prolapse ....................................... 10.64 NA 5.55 2.04 NA 18.23 090

45550 ............ A Repair rectum; remove sigmoid ......................... 18.26 NA 8.85 2.38 NA 29.49 090

45560 ............ A Repair of rectocele ............................................. 8.40 NA 4.94 0.98 NA 14.32 090

45562 ............ A Exploration/repair of rectum ............................... 12.21 NA 6.07 1.58 NA 19.86 090

45563 ............ A Exploration/repair of rectum ............................... 18.63 NA 9.55 2.49 NA 30.67 090

45800 ............ A Repair rectumbladder fistula .............................. 14.11 NA 6.95 1.45 NA 22.51 090

45805 ............ A Repair fistula; colostomy .................................... 16.50 NA 8.63 2.39 NA 27.52 090

45820 ............ A Repair rectourethral fistula ................................. 14.67 NA 7.07 1.23 NA 22.97 090

45825 ............ A Repair fistula; colostomy .................................... 16.87 NA 9.22 1.66 NA 27.75 090

45900 ............ A Reduction of rectal prolapse .............................. 1.83 NA 0.96 0.11 NA 2.90 010

45905 ............ A Dilation of anal sphincter ................................... 1.61 1.75 0.78 0.12 3.48 2.51 010

45910 ............ A Dilation of rectal narrowing ................................ 1.96 2.25 0.92 0.13 4.34 3.01 010

45915 ............ A Remove rectal obstruction ................................. 2.20 2.70 0.92 0.09 4.99 3.21 010

46030 ............ A Removal of rectal marker ................................... 1.23 1.57 0.93 0.07 2.87 2.23 010

46040 ............ A Incision of rectal abscess ................................... 4.96 3.80 2.63 0.34 9.10 7.93 090

46045 ............ A Incision of rectal abscess ................................... 4.32 NA 2.35 0.38 NA 7.05 090

46050 ............ A Incision of anal abscess ..................................... 1.19 2.11 0.91 0.11 3.41 2.21 010

46060 ............ A Incision of rectal abscess ................................... 5.69 NA 3.10 1.12 NA 9.91 090

46070 ............ A Incision of anal septum ...................................... 2.71 NA 5.74 0.33 NA 8.78 090

46080 ............ A Incision of anal sphincter ................................... 2.49 2.33 1.43 0.43 5.25 4.35 010

46083 ............ A Incise external hemorrhoid ................................. 1.40 2.90 0.98 0.08 4.38 2.46 010

46200 ............ A Removal of anal fissure ..................................... 3.42 2.53 1.97 0.66 6.61 6.05 090

46210 ............ A Removal of anal crypt ........................................ 2.67 3.28 1.65 0.14 6.09 4.46 090

46211 ............ A Removal of anal crypts ...................................... 4.25 3.26 2.29 0.38 7.89 6.92 090

46220 ............ A Removal of anal tab ........................................... 1.56 0.99 0.60 0.12 2.67 2.28 010

46221 ............ A Ligation of hemorrhoid(s) ................................... 1.43 1.81 0.55 0.14 3.38 2.12 010

46230 ............ A Removal of anal tabs ......................................... 2.57 2.78 1.48 0.12 5.47 4.17 010

46250 ............ A Hemorrhoidectomy ............................................. 4.53 3.80 2.48 0.52 8.85 7.53 090

46255 ............ A Hemorrhoidectomy ............................................. 5.36 4.10 2.83 0.85 10.31 9.04 090

46257 ............ A Remove hemorrhoids & fissure ......................... 6.28 NA 3.16 1.08 NA 10.52 090

46258 ............ A Remove hemorrhoids & fistula ........................... 6.67 NA 3.35 1.22 NA 11.24 090

46260 ............ A Hemorrhoidectomy ............................................. 7.42 NA 3.78 1.25 NA 12.45 090

46261 ............ A Remove hemorrhoids & fissure ......................... 8.24 NA 4.05 1.34 NA 13.63 090

46262 ............ A Remove hemorrhoids & fistula ........................... 8.73 NA 4.31 1.39 NA 14.43 090

46270 ............ A Removal of anal fistula ...................................... 3.72 3.41 2.13 0.37 7.50 6.22 090

46275 ............ A Removal of anal fistula ...................................... 4.56 3.52 2.42 1.13 9.21 8.11 090

46280 ............ A Removal of anal fistula ...................................... 5.98 NA 3.23 1.24 NA 10.45 090

46285 ............ A Removal of anal fistula ...................................... 4.09 2.52 2.21 0.43 7.04 6.73 090

46288 ............ A Repair anal fistula .............................................. 7.13 NA 3.27 0.83 NA 11.23 090

46320 ............ A Removal of hemorrhoid clot ............................... 1.61 2.39 0.98 0.11 4.11 2.70 010

46500 ............ A Injection into hemorrhoids .................................. 1.61 1.56 0.60 0.06 3.23 2.27 010

46600 ............ A Diagnostic anoscopy .......................................... 0.50 0.56 0.14 0.03 1.09 0.67 000

46604 ............ A Anoscopy and dilation ........................................ 1.31 0.77 0.49 0.06 2.14 1.86 000

46606 ............ A Anoscopy and biopsy ......................................... 0.81 0.64 0.31 0.06 1.51 1.18 000

46608 ............ A Anoscopy; remove foreign body ........................ 1.51 1.34 0.39 0.12 2.97 2.02 000

46610 ............ A Anoscopy; remove lesion ................................... 1.32 1.12 0.51 0.15 2.59 1.98 000

46611 ............ A Anoscopy ............................................................ 1.81 1.45 0.70 0.15 3.41 2.66 000

46612 ............ A Anoscopy; remove lesions ................................. 2.34 1.66 0.87 0.20 4.20 3.41 000

46614 ............ A Anoscopy; control bleeding ................................ 2.01 1.26 0.73 0.25 3.52 2.99 000

46615 ............ A Anoscopy ............................................................ 2.68 1.47 1.03 0.25 4.40 3.96 000

46700 ............ A Repair of anal stricture ....................................... 7.25 NA 3.64 1.24 NA 12.13 090

46705 ............ A Repair of anal stricture ....................................... 7.17 NA 3.84 0.77 NA 11.78 090

46715 ............ A Repair of anovaginal fistula ............................... 7.46 NA 5.30 0.82 NA 13.58 090

46716 ............ A Repair of anovaginal fistula ............................... 12.15 NA 18.73 1.40 NA 32.28 090
30945

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

46730 ............ A Construction of absent anus .............................. 21.57 NA 10.64 2.50 NA 34.71 090

46735 ............ A Construction of absent anus .............................. 25.94 NA 12.05 3.04 NA 41.03 090

46740 ............ A Construction of absent anus .............................. 23.11 NA 10.68 2.68 NA 36.47 090

46742 ............ A Repair, imperforated anus ................................. 29.67 NA 40.97 1.93 NA 72.57 090

46744 ............ A Repair, cloacal anomaly ..................................... 33.21 NA 15.40 2.17 NA 50.78 090

46746 ............ A Repair, cloacal anomaly ..................................... 36.74 NA 16.73 2.37 NA 55.84 090

46748 ............ A Repair, cloacal anomaly ..................................... 40.52 NA 53.98 2.64 NA 97.14 090

46750 ............ A Repair of anal sphincter ..................................... 8.14 NA 4.39 1.22 NA 13.75 090

46751 ............ A Repair of anal sphincter ..................................... 8.56 NA 13.65 0.95 NA 23.16 090

46753 ............ A Reconstruction of anus ...................................... 6.58 NA 3.24 1.02 NA 10.84 090

46754 ............ A Removal of suture from anus ............................ 1.54 2.74 1.09 0.30 4.58 2.93 010

46760 ............ A Repair of anal sphincter ..................................... 11.46 NA 6.44 1.41 NA 19.31 090

46761 ............ A Repair of anal sphincter ..................................... 10.99 NA 5.26 1.35 NA 17.60 090

46762 ............ A Implant artificial sphincter .................................. 10.09 NA 5.03 1.21 NA 16.33 090

46900 ............ A Destruction, anal lesion(s) ................................. 1.91 2.68 1.27 0.06 4.65 3.24 010

46910 ............ A Destruction, anal lesion(s) ................................. 1.86 2.22 1.27 0.08 4.16 3.21 010

46916 ............ A Cryosurgery, anal lesion(s) ................................ 1.86 2.01 1.33 0.06 3.93 3.25 010

46917 ............ A Laser surgery,anal lesion(s) ............................... 1.86 2.27 1.37 0.31 4.44 3.54 010

46922 ............ A Excision of anal lesion(s) ................................... 1.86 2.25 1.26 0.23 4.34 3.35 010

46924 ............ A Destruction, anal lesion(s) ................................. 2.76 2.99 1.63 0.46 6.21 4.85 010

46934 ............ A Destruction of hemorrhoids ................................ 4.08 3.64 2.61 0.17 7.89 6.86 090

46935 ............ A Destruction of hemorrhoids ................................ 2.43 4.73 1.60 0.22 7.38 4.25 010

46936 ............ A Destruction of hemorrhoids ................................ 4.30 3.45 2.70 0.24 7.99 7.24 090

46937 ............ A Cryotherapy of rectal lesion ............................... 2.69 2.73 1.54 0.45 5.87 4.68 010

46938 ............ A Cryotherapy of rectal lesion ............................... 4.66 4.51 2.99 0.52 9.69 8.17 090

46940 ............ A Treatment of anal fissure ................................... 2.32 2.58 1.20 0.09 4.99 3.61 010

46942 ............ A Treatment of anal fissure ................................... 2.04 2.01 1.19 0.08 4.13 3.31 010

46945 ............ A Ligation of hemorrhoids ..................................... 2.14 2.53 1.51 0.12 4.79 3.77 090

46946 ............ A Ligation of hemorrhoids ..................................... 3.00 2.59 1.88 0.17 5.76 5.05 090

47000 ............ A Needle biopsy of liver ........................................ 1.90 5.71 1.13 0.13 7.74 3.16 000

47001 ............ A Needle biopsy, liver ............................................ 1.90 NA 0.83 0.13 NA 2.86 ZZZ

47010 ............ A Open drainage, liver lesion ................................ 10.28 NA 7.53 1.13 NA 18.94 090

47011 ............ A Percut drain, liver lesion .................................... 3.70 NA 5.32 0.33 NA 9.35 000

47015 ............ A Inject/aspirate liver cyst ...................................... 9.70 NA 5.97 1.13 NA 16.80 090

47100 ............ A Wedge biopsy of liver ........................................ 7.49 NA 4.54 0.67 NA 12.70 090

47120 ............ A Partial removal of liver ....................................... 22.79 NA 12.14 2.48 NA 37.41 090

47122 ............ A Extensive removal of liver .................................. 35.39 NA 18.09 3.59 NA 57.07 090

47125 ............ A Partial removal of liver ....................................... 31.58 NA 15.94 3.61 NA 51.13 090

47130 ............ A Partial removal of liver ....................................... 34.25 NA 17.15 3.89 NA 55.29 090

47134 ............ R Partial removal, donor liver ................................ 39.15 NA 16.42 4.77 NA 60.34 XXX

47135 ............ R Transplantation of liver ....................................... 81.52 NA 42.58 8.49 NA 132.59 090

47136 ............ R Transplantation of liver ....................................... 68.60 NA 114.97 7.79 NA 191.36 090

47300 ............ A Surgery for liver lesion ....................................... 9.68 NA 5.76 1.59 NA 17.03 090

47350 ............ A Repair liver wound ............................................. 12.56 NA 6.72 1.49 NA 20.77 090

47360 ............ A Repair liver wound ............................................. 17.28 NA 9.73 2.18 NA 29.19 090

47361 ............ A Repair liver wound ............................................. 30.25 NA 14.34 3.41 NA 48.00 090

47362 ............ A Repair liver wound ............................................. 11.88 NA 7.38 1.22 NA 20.48 090

47400 ............ A Incision of liver duct ........................................... 20.86 NA 10.76 1.36 NA 32.98 090

47420 ............ A Incision of bile duct ............................................ 16.72 NA 8.61 1.99 NA 27.32 090

47425 ............ A Incision of bile duct ............................................ 16.68 NA 8.96 2.45 NA 28.09 090

47460 ............ A Incise bile duct sphincter ................................... 15.17 NA 8.18 1.82 NA 25.17 090

47480 ............ A Incision of gallbladder ........................................ 9.10 NA 5.82 1.59 NA 16.51 090

47490 ............ A Incision of gallbladder ........................................ 7.23 NA 6.73 0.38 NA 14.34 090

47500 ............ A Injection for liver x-rays ...................................... 1.96 NA 0.62 0.14 NA 2.72 000

47505 ............ A Injection for liver x-rays ...................................... 0.76 7.82 0.24 0.14 8.72 1.14 000

47510 ............ A Insert catheter, bile duct .................................... 7.83 NA 22.22 0.25 NA 30.30 090

47511 ............ A Insert bile duct drain .......................................... 10.50 NA 23.45 0.25 NA 34.20 090

47525 ............ A Change bile duct catheter .................................. 5.55 NA 3.18 0.16 NA 8.89 010

47530 ............ A Revise, reinsert bile tube ................................... 5.85 NA 4.65 0.19 NA 10.69 090

47550 ............ A Bile duct endoscopy ........................................... 3.02 NA 1.28 0.35 NA 4.65 000

47552 ............ A Biliary endoscopy, thru skin ............................... 6.04 NA 2.34 0.21 NA 8.59 000

47553 ............ A Biliary endoscopy, thru skin ............................... 6.35 NA 2.27 0.62 NA 9.24 000

47554 ............ A Biliary endoscopy, thru skin ............................... 9.06 NA 3.49 0.67 NA 13.22 000

47555 ............ A Biliary endoscopy, thru skin ............................... 7.56 NA 2.65 0.30 NA 10.51 000

47556 ............ A Biliary endoscopy, thru skin ............................... 8.56 NA 2.96 0.30 NA 11.82 000

47600 ............ A Removal of gallbladder ...................................... 11.42 NA 6.00 1.58 NA 19.00 090

47605 ............ A Removal of gallbladder ...................................... 12.36 NA 6.40 1.75 NA 20.51 090

47610 ............ A Removal of gallbladder ...................................... 15.83 NA 8.09 2.00 NA 25.92 090

47612 ............ A Removal of gallbladder ...................................... 15.80 NA 8.17 3.05 NA 27.02 090

47620 ............ A Removal of gallbladder ...................................... 17.36 NA 8.97 2.36 NA 28.69 090

47630 ............ A Remove bile duct stone ..................................... 9.11 NA 3.49 0.40 NA 13.00 090

47700 ............ A Exploration of bile ducts ..................................... 14.93 NA 8.10 1.58 NA 24.61 090

47701 ............ A Bile duct revision ................................................ 27.81 NA 13.96 1.90 NA 43.67 090

47711 ............ A Excision of bile duct tumor ................................. 19.37 NA 10.08 2.46 NA 31.91 090
30946

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

47712 ............ A Excision of bile duct tumor ................................. 25.44 NA 12.63 2.46 NA 40.53 090

47715 ............ A Excision of bile duct cyst ................................... 15.81 NA 8.45 1.71 NA 25.97 090

47716 ............ A Fusion of bile duct cyst ...................................... 13.83 NA 7.61 1.53 NA 22.97 090

47720 ............ A Fuse gallbladder & bowel .................................. 13.38 NA 7.30 1.93 NA 22.61 090

47721 ............ A Fuse upper gi structures .................................... 16.08 NA 8.50 2.47 NA 27.05 090

47740 ............ A Fuse gallbladder & bowel .................................. 15.54 NA 8.29 2.14 NA 25.97 090

47741 ............ A Fuse gallbladder & bowel .................................. 17.95 NA 9.30 3.02 NA 30.27 090

47760 ............ A Fuse bile ducts and bowel ................................. 21.74 NA 10.76 2.53 NA 35.03 090

47765 ............ A Fuse liver ducts & bowel .................................... 20.93 NA 11.52 2.97 NA 35.42 090

47780 ............ A Fuse bile ducts and bowel ................................. 22.29 NA 11.27 2.73 NA 36.29 090

47785 ............ A Fuse bile ducts and bowel ................................. 26.23 NA 13.50 2.73 NA 42.46 090

47800 ............ A Reconstruction of bile ducts ............................... 19.60 NA 10.14 2.43 NA 32.17 090

47801 ............ A Placement, bile duct support ............................. 12.76 NA 8.03 0.81 NA 21.60 090

47802 ............ A Fuse liver duct & intestine ................................. 18.13 NA 9.88 1.75 NA 29.76 090

47900 ............ A Suture bile duct injury ........................................ 16.74 NA 8.87 2.43 NA 28.04 090

48000 ............ A Drainage of abdomen ........................................ 14.91 NA 8.86 1.40 NA 25.17 090

48001 ............ A Placement of drain, pancreas ............................ 18.83 NA 10.21 1.89 NA 30.93 090

48005 ............ A Resect/debride pancreas ................................... 22.40 NA 11.28 2.14 NA 35.82 090

48020 ............ A Removal of pancreatic stone ............................. 14.22 NA 7.80 1.57 NA 23.59 090

48100 ............ A Biopsy of pancreas ............................................ 11.08 NA 6.06 0.79 NA 17.93 090

48102 ............ A Needle biopsy, pancreas ................................... 4.68 5.97 2.73 0.25 10.90 7.66 010

48120 ............ A Removal of pancreas lesion .............................. 14.36 NA 7.39 2.07 NA 23.82 090

48140 ............ A Partial removal of pancreas ............................... 20.78 NA 10.31 2.83 NA 33.92 090

48145 ............ A Partial removal of pancreas ............................... 21.76 NA 11.16 3.16 NA 36.08 090

48146 ............ A Pancreatectomy ................................................. 23.91 NA 12.87 1.92 NA 38.70 090

48148 ............ A Removal of pancreatic duct ............................... 15.71 NA 8.32 1.68 NA 25.71 090

48150 ............ A Partial removal of pancreas ............................... 43.48 NA 21.74 4.75 NA 69.97 090

48152 ............ A Pancreatectomy ................................................. 39.63 NA 19.76 4.75 NA 64.14 090

48153 ............ A Pancreatectomy ................................................. 43.38 NA 21.70 4.75 NA 69.83 090

48154 ............ A Pancreatectomy ................................................. 39.95 NA 20.03 4.75 NA 64.73 090

48155 ............ A Removal of pancreas ......................................... 22.32 NA 13.03 4.26 NA 39.61 090

48180 ............ A Fuse pancreas and bowel .................................. 22.39 NA 11.09 2.63 NA 36.11 090

48400 ............ A Injection, intraoperative ...................................... 1.95 NA 0.77 0.24 NA 2.96 ZZZ

48500 ............ A Surgery of pancreas cyst ................................... 13.84 NA 7.20 1.66 NA 22.70 090

48510 ............ A Drain pancreatic pseudocyst .............................. 12.96 NA 7.51 1.44 NA 21.91 090

48511 ............ A Drain pancreatic pseudocyst .............................. 4.00 NA 4.36 0.35 NA 8.71 000

48520 ............ A Fuse pancreas cyst and bowel .......................... 14.12 NA 7.23 2.43 NA 23.78 090

48540 ............ A Fuse pancreas cyst and bowel .......................... 17.86 NA 8.85 2.65 NA 29.36 090

48545 ............ A Pancreatorrhaphy ............................................... 16.47 NA 8.38 1.79 NA 26.64 090

48547 ............ A Duodenal exclusion ............................................ 23.40 NA 11.06 2.58 NA 37.04 090

48554 ............ N Transplantallograft pancreas .............................. +34.17 NA 57.19 4.16 NA 95.52 XXX

48556 ............ A Removal, allograft pancreas .............................. 15.71 NA 8.69 1.69 NA 26.09 090

49000 ............ A Exploration of abdomen ..................................... 11.68 NA 5.90 1.40 NA 18.98 090

49002 ............ A Reopening of abdomen ...................................... 10.49 NA 5.84 1.21 NA 17.54 090

49010 ............ A Exploration behind abdomen ............................. 12.28 NA 6.40 1.31 NA 19.99 090

49020 ............ A Drain abdominal abscess ................................... 16.79 NA 9.55 0.91 NA 27.25 090

49021 ............ A Drain abdominal abscess ................................... 3.38 NA 4.88 0.91 NA 9.17 000

49040 ............ A Open drainage abdom abscess ......................... 9.94 NA 6.91 1.27 NA 18.12 090

49041 ............ A Percut drain abdom abscess ............................. 4.00 NA 4.79 0.35 NA 9.14 000

49060 ............ A Open drain retroper abscess ............................. 11.66 NA 7.71 1.01 NA 20.38 090

49061 ............ A Percutdrain retroper abscess ............................. 3.70 NA 5.01 0.33 NA 9.04 000

49062 ............ A Drain to peritoneal cavity ................................... 11.36 NA 6.59 0.79 NA 18.74 090

49080 ............ A Puncture, peritoneal cavity ................................. 1.35 1.86 0.65 0.08 3.29 2.08 000

49081 ............ A Removal of abdominal fluid ............................... 1.26 2.12 0.61 0.07 3.45 1.94 000

49085 ............ A Remove abdomen foreign body ......................... 8.93 NA 5.02 0.67 NA 14.62 090

49180 ............ A Biopsy, abdominal mass .................................... 1.73 4.35 1.34 0.20 6.28 3.27 000

49200 ............ A Removal of abdominal lesion ............................. 10.25 NA 5.98 1.70 NA 17.93 090

49201 ............ A Removal of abdominal lesion ............................. 14.84 NA 8.52 2.50 NA 25.86 090

49215 ............ A Excise sacral spine tumor .................................. 22.36 NA 11.08 1.59 NA 35.03 090

49220 ............ A Multiple surgery, abdomen ................................. 14.88 NA 7.86 2.53 NA 25.27 090

49250 ............ A Excision of umbilicus .......................................... 8.35 NA 4.41 0.96 NA 13.72 090

49255 ............ A Removal of omentum ......................................... 11.14 NA 6.40 1.15 NA 18.69 090

49400 ............ A Air injection into abdomen ................................. 1.88 NA 0.87 0.17 NA 2.92 000

49420 ............ A Insert abdominal drain ....................................... 2.22 NA 1.20 0.20 NA 3.62 000

49421 ............ A Insert abdominal drain ....................................... 5.54 NA 3.52 0.81 NA 9.87 090

49422 ............ A Remove perm cannula/catheter ......................... 6.25 NA 3.03 0.81 NA 10.09 010

49423 ............ A Exchange drainage cath .................................... 1.46 NA 2.00 0.13 NA 3.59 000

49424 ............ A Assess cyst, contrast inj .................................... 0.76 NA 1.30 0.07 NA 2.13 000

49425 ............ A Insert abdomen-venous drain ............................ 11.37 NA 6.08 1.78 NA 19.23 090

49426 ............ A Revise abdomen-venous shunt ......................... 9.63 NA 5.42 1.07 NA 16.12 090

49427 ............ A Injection, abdominal shunt ................................. 0.89 NA 0.56 0.03 NA 1.48 000

49428 ............ A Ligation of shunt ................................................. 2.38 NA 1.42 0.24 NA 4.04 010

49429 ............ A Removal of shunt ............................................... 7.40 NA 4.02 0.77 NA 12.19 010

49495 ............ A Repair inguinal hernia, init ................................. 5.89 NA 3.06 0.95 NA 9.90 090
30947

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

49496 ............ A Repair inguinal hernia, init ................................. 8.79 NA 5.33 1.08 NA 15.20 090

49500 ............ A Repair inguinal hernia ........................................ 4.68 NA 2.69 0.95 NA 8.32 090

49501 ............ A Repair inguinal hernia, init ................................. 7.58 NA 3.84 1.08 NA 12.50 090

49505 ............ A Repair inguinal hernia ........................................ 6.49 3.34 4.15 0.94 10.77 11.58 090

49507 ............ A Repair, inguinal hernia ....................................... 8.17 NA 4.80 1.08 NA 14.05 090

49520 ............ A Rerepair inguinal hernia ..................................... 8.22 NA 4.39 1.11 NA 13.72 090

49521 ............ A Repair inguinal hernia, rec ................................. 10.22 NA 5.10 1.08 NA 16.40 090

49525 ............ A Repair inguinal hernia ........................................ 7.32 NA 3.91 1.16 NA 12.39 090

49540 ............ A Repair lumbar hernia ......................................... 8.87 NA 4.66 1.12 NA 14.65 090

49550 ............ A Repair femoral hernia ........................................ 7.37 NA 3.70 0.97 NA 12.04 090

49553 ............ A Repair femoral hernia, init .................................. 8.06 NA 4.29 0.97 NA 13.32 090

49555 ............ A Repair femoral hernia ........................................ 7.71 NA 4.25 1.26 NA 13.22 090

49557 ............ A Repair femoral hernia, recur .............................. 9.52 NA 4.85 1.26 NA 15.63 090

49560 ............ A Repair abdominal hernia .................................... 9.88 NA 5.05 1.19 NA 16.12 090

49561 ............ A Repair incisional hernia ...................................... 12.17 NA 5.94 1.19 NA 19.30 090

49565 ............ A Rerepair abdominal hernia ................................. 9.88 NA 5.28 1.35 NA 16.51 090

49566 ............ A Repair incisional hernia ...................................... 12.30 NA 6.02 1.35 NA 19.67 090

49568 ............ A Hernia repair w/mesh ......................................... 4.89 NA 2.07 0.59 NA 7.55 ZZZ

49570 ............ A Repair epigastric hernia ..................................... 4.86 NA 2.74 0.91 NA 8.51 090

49572 ............ A Repair, epigastric hernia .................................... 5.75 NA 3.43 1.18 NA 10.36 090

49580 ............ A Repair umbilical hernia ...................................... 3.51 NA 2.17 0.94 NA 6.62 090

49582 ............ A Repair umbilical hernia ...................................... 5.68 NA 3.63 0.94 NA 10.25 090

49585 ............ A Repair umbilical hernia ...................................... 5.32 NA 3.10 0.91 NA 9.33 090

49587 ............ A Repair umbilical hernia ...................................... 6.46 NA 3.65 0.91 NA 11.02 090

49590 ............ A Repair abdominal hernia .................................... 7.29 NA 3.84 1.22 NA 12.35 090

49600 ............ A Repair umbilical lesion ....................................... 10.35 NA 5.21 0.77 NA 16.33 090

49605 ............ A Repair umbilical lesion ....................................... 22.66 NA 11.17 1.77 NA 35.60 090

49606 ............ A Repair umbilical lesion ....................................... 18.60 NA 9.65 0.96 NA 29.21 090

49610 ............ A Repair umbilical lesion ....................................... 10.50 NA 6.60 1.27 NA 18.37 090

49611 ............ A Repair umbilical lesion ....................................... 8.92 NA 16.34 0.58 NA 25.84 090

49900 ............ A Repair of abdominal wall ................................... 12.28 NA 6.58 0.75 NA 19.61 090

49905 ............ A Omental flap ....................................................... 6.55 NA 3.08 0.80 NA 10.43 ZZZ

50010 ............ A Exploration of kidney .......................................... 10.98 NA 6.07 1.13 NA 18.18 090

50020 ............ A Open drain renal abscess .................................. 14.66 NA 9.96 0.85 NA 25.47 090

50021 ............ A Percut drain renal abscess ................................ 3.38 NA 6.17 0.30 NA 9.85 000

50040 ............ A Drainage of kidney ............................................. 14.94 NA 9.11 0.62 NA 24.67 090

50045 ............ A Exploration of kidney .......................................... 15.46 NA 7.78 0.89 NA 24.13 090

50060 ............ A Removal of kidney stone ................................... 19.30 NA 9.20 1.21 NA 29.71 090

50065 ............ A Incision of kidney ............................................... 20.79 NA 9.81 1.35 NA 31.95 090

50070 ............ A Incision of kidney ............................................... 20.32 NA 9.58 1.35 NA 31.25 090

50075 ............ A Removal of kidney stone ................................... 25.34 NA 11.74 1.62 NA 38.70 090

50080 ............ A Removal of kidney stone ................................... 14.71 NA 9.10 1.15 NA 24.96 090

50081 ............ A Removal of kidney stone ................................... 21.80 NA 11.69 1.44 NA 34.93 090

50100 ............ A Revise kidney blood vessels .............................. 16.09 NA 8.58 1.35 NA 26.02 090

50120 ............ A Exploration of kidney .......................................... 15.91 NA 8.00 1.24 NA 25.15 090

50125 ............ A Explore and drain kidney ................................... 16.52 NA 8.02 1.06 NA 25.60 090

50130 ............ A Removal of kidney stone ................................... 17.29 NA 8.46 1.26 NA 27.01 090

50135 ............ A Exploration of kidney .......................................... 19.18 NA 9.18 1.63 NA 29.99 090

50200 ............ A Biopsy of kidney ................................................. 2.63 NA 1.25 0.22 NA 4.10 000

50205 ............ A Biopsy of kidney ................................................. 11.31 NA 5.98 0.69 NA 17.98 090

50220 ............ A Removal of kidney ............................................. 17.15 NA 8.40 1.43 NA 26.98 090

50225 ............ A Removal of kidney ............................................. 20.23 NA 9.58 1.70 NA 31.51 090

50230 ............ A Removal of kidney ............................................. 22.07 NA 10.27 1.84 NA 34.18 090

50234 ............ A Removal of kidney & ureter ............................... 22.40 NA 10.39 1.65 NA 34.44 090

50236 ............ A Removal of kidney & ureter ............................... 24.86 NA 12.78 1.74 NA 39.38 090

50240 ............ A Partial removal of kidney ................................... 22.00 NA 11.71 1.70 NA 35.41 090

50280 ............ A Removal of kidney lesion ................................... 15.67 NA 7.84 1.16 NA 24.67 090

50290 ............ A Removal of kidney lesion ................................... 14.73 NA 7.26 1.19 NA 23.18 090

50320 ............ A Removal of donor kidney ................................... 22.21 NA 10.23 2.40 NA 34.84 090

50340 ............ A Removal of kidney ............................................. 12.15 NA 5.67 2.24 NA 20.06 090

50360 ............ A Transplantation of kidney ................................... 31.53 NA 16.90 4.24 NA 52.67 090

50365 ............ A Transplantation of kidney ................................... 36.81 NA 19.94 3.89 NA 60.64 090

50370 ............ A Remove transplanted kidney ............................. 13.72 NA 8.02 1.92 NA 23.66 090

50380 ............ A Reimplantation of kidney .................................... 20.76 NA 12.25 1.71 NA 34.72 090

50390 ............ A Drainage of kidney lesion .................................. 1.96 NA 1.18 0.15 NA 3.29 000

50392 ............ A Insert kidney drain .............................................. 3.38 NA 1.63 0.20 NA 5.21 000

50393 ............ A Insert ureteral tube ............................................. 4.16 NA 1.87 0.26 NA 6.29 000

50394 ............ A Injection for kidney x-ray .................................... 0.76 10.57 0.24 0.05 11.38 1.05 000

50395 ............ A Create passage to kidney .................................. 3.38 NA 1.61 0.29 NA 5.28 000

50396 ............ A Measure kidney pressure ................................... 2.09 NA 0.76 0.05 NA 2.90 000

50398 ............ A Change kidney tube ........................................... 1.46 0.79 1.66 0.05 2.30 3.17 000

50400 ............ A Revision of kidney/ureter ................................... 19.50 NA 9.32 1.36 NA 30.18 090

50405 ............ A Revision of kidney/ureter ................................... 23.93 NA 12.08 1.74 NA 37.75 090

50500 ............ A Repair of kidney wound ..................................... 19.57 NA 9.85 1.64 NA 31.06 090
30948

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

50520 ............ A Close kidney-skin fistula .................................... 17.23 NA 9.54 1.50 NA 28.27 090

50525 ............ A Repair renal-abdomen fistula ............................. 22.27 NA 11.53 1.99 NA 35.79 090

50526 ............ A Repair renal-abdomen fistula ............................. 24.02 NA 19.58 2.32 NA 45.92 090

50540 ............ A Revision of horseshoe kidney ............................ 19.93 NA 8.91 1.54 NA 30.38 090

50551 ............ A Kidney endoscopy .............................................. 5.60 3.89 2.30 0.21 9.70 8.11 000

50553 ............ A Kidney endoscopy .............................................. 5.99 13.31 2.48 0.17 19.47 8.64 000

50555 ............ A Kidney endoscopy & biopsy ............................... 6.53 14.10 2.65 0.45 21.08 9.63 000

50557 ............ A Kidney endoscopy & treatment .......................... 6.62 14.38 2.68 0.49 21.49 9.79 000

50559 ............ A Renal endoscopy; radiotracer ............................ 6.78 NA 2.74 0.14 NA 9.66 000

50561 ............ A Kidney endoscopy & treatment .......................... 7.59 12.38 3.03 0.49 20.46 11.11 000

50570 ............ A Kidney endoscopy .............................................. 9.54 NA 3.77 0.14 NA 13.45 000

50572 ............ A Kidney endoscopy .............................................. 10.35 NA 4.03 0.75 NA 15.13 000

50574 ............ A Kidney endoscopy & biopsy ............................... 11.02 NA 4.36 0.64 NA 16.02 000

50575 ............ A Kidney endoscopy .............................................. 13.98 NA 5.42 0.97 NA 20.37 000

50576 ............ A Kidney endoscopy & treatment .......................... 10.99 NA 4.32 0.77 NA 16.08 000

50578 ............ A Renal endoscopy; radiotracer ............................ 11.35 NA 4.44 1.19 NA 16.98 000

50580 ............ A Kidney endoscopy & treatment .......................... 11.86 NA 4.62 0.35 NA 16.83 000

50590 ............ A Fragmenting of kidney stone ............................. 9.09 4.97 6.03 0.97 15.03 16.09 090

50600 ............ A Exploration of ureter ........................................... 15.84 NA 7.94 1.01 NA 24.79 090

50605 ............ A Insert ureteral support ........................................ 15.46 NA 7.72 0.60 NA 23.78 090

50610 ............ A Removal of ureter stone .................................... 15.92 NA 8.07 1.17 NA 25.16 090

50620 ............ A Removal of ureter stone .................................... 15.16 NA 7.61 1.16 NA 23.93 090

50630 ............ A Removal of ureter stone .................................... 14.94 NA 7.56 1.25 NA 23.75 090

50650 ............ A Removal of ureter .............................................. 17.41 NA 8.64 1.21 NA 27.26 090

50660 ............ A Removal of ureter .............................................. 19.55 NA 9.48 1.53 NA 30.56 090

50684 ............ A Injection for ureter x-ray ..................................... 0.76 10.95 0.27 0.05 11.76 1.08 000

50686 ............ A Measure ureter pressure .................................... 1.51 3.50 0.58 0.04 5.05 2.13 000

50688 ............ A Change of ureter tube ........................................ 1.17 NA 1.59 0.04 NA 2.80 010

50690 ............ A Injection for ureter x-ray ..................................... 1.16 12.38 0.38 0.03 13.57 1.57 000

50700 ............ A Revision of ureter ............................................... 15.21 NA 7.72 1.29 NA 24.22 090

50715 ............ A Release of ureter ............................................... 18.90 NA 10.01 1.49 NA 30.40 090

50722 ............ A Release of ureter ............................................... 16.35 NA 8.95 1.97 NA 27.27 090

50725 ............ A Release/revise ureter ......................................... 18.49 NA 9.15 1.75 NA 29.39 090

50727 ............ A Revise ureter ...................................................... 8.18 NA 5.20 0.51 NA 13.89 090

50728 ............ A Revise ureter ...................................................... 12.02 NA 6.78 0.77 NA 19.57 090

50740 ............ A Fusion of ureter & kidney ................................... 18.42 NA 8.77 1.88 NA 29.07 090

50750 ............ A Fusion of ureter & kidney ................................... 19.51 NA 9.57 1.26 NA 30.34 090

50760 ............ A Fusion of ureters ................................................ 18.42 NA 9.00 1.48 NA 28.90 090

50770 ............ A Splicing of ureters .............................................. 19.51 NA 9.41 1.53 NA 30.45 090

50780 ............ A Reimplant ureter in bladder ............................... 18.36 NA 9.00 1.46 NA 28.82 090

50782 ............ A Reimplant ureter in bladder ............................... 19.54 NA 9.60 1.46 NA 30.60 090

50783 ............ A Reimplant ureter in bladder ............................... 20.55 NA 10.09 1.46 NA 32.10 090

50785 ............ A Reimplant ureter in bladder ............................... 20.52 NA 9.83 1.80 NA 32.15 090

50800 ............ A Implant ureter in bowel ...................................... 14.52 NA 8.21 1.51 NA 24.24 090

50810 ............ A Fusion of ureter & bowel .................................... 20.05 NA 10.52 1.75 NA 32.32 090

50815 ............ A Urine shunt to bowel .......................................... 19.93 NA 10.42 2.75 NA 33.10 090

50820 ............ A Construct bowel bladder .................................... 21.89 NA 10.95 2.50 NA 35.34 090

50825 ............ A Construct bowel bladder .................................... 28.18 NA 13.66 3.33 NA 45.17 090

50830 ............ A Revise urine flow ................................................ 31.28 NA 14.49 2.27 NA 48.04 090

50840 ............ A Replace ureter by bowel .................................... 20.00 NA 10.26 1.35 NA 31.61 090

50845 ............ A Appendico-vesicostomy ..................................... 20.89 NA 10.44 1.35 NA 32.68 090

50860 ............ A Transplant ureter to skin .................................... 15.36 NA 7.87 1.16 NA 24.39 090

50900 ............ A Repair of ureter .................................................. 13.62 NA 6.95 1.15 NA 21.72 090

50920 ............ A Closure ureter/skin fistula .................................. 14.33 NA 7.26 0.99 NA 22.58 090

50930 ............ A Closure ureter/bowel fistula ............................... 18.72 NA 8.90 1.22 NA 28.84 090

50940 ............ A Release of ureter ............................................... 14.51 NA 7.41 0.95 NA 22.87 090

50951 ............ A Endoscopy of ureter ........................................... 5.84 4.15 2.39 0.17 10.16 8.40 000

50953 ............ A Endoscopy of ureter ........................................... 6.24 13.47 2.55 0.16 19.87 8.95 000

50955 ............ A Ureter endoscopy & biopsy ................................ 6.75 14.05 2.72 0.25 21.05 9.72 000

50957 ............ A Ureter endoscopy & treatment ........................... 6.79 10.33 2.92 0.25 17.37 9.96 000

50959 ............ A Ureter endoscopy & tracer ................................. 4.40 NA 1.85 0.29 NA 6.54 000

50961 ............ A Ureter endoscopy & treatment ........................... 6.05 16.81 2.43 0.26 23.12 8.74 000

50970 ............ A Ureter endoscopy ............................................... 7.14 NA 2.87 0.52 NA 10.53 000

50972 ............ A Ureter endoscopy & catheter ............................. 6.89 NA 2.81 0.16 NA 9.86 000

50974 ............ A Ureter endoscopy & biopsy ................................ 9.17 NA 3.62 0.65 NA 13.44 000

50976 ............ A Ureter endoscopy & treatment ........................... 9.04 NA 3.60 0.62 NA 13.26 000

50978 ............ A Ureter endoscopy & tracer ................................. 5.10 NA 2.26 0.48 NA 7.84 000

50980 ............ A Ureter endoscopy & treatment ........................... 6.85 NA 2.77 0.30 NA 9.92 000

51000 ............ A Drainage of bladder ........................................... 0.78 1.24 0.53 0.05 2.07 1.36 000

51005 ............ A Drainage of bladder ........................................... 1.02 2.05 0.58 0.04 3.11 1.64 000

51010 ............ A Drainage of bladder ........................................... 3.53 5.13 1.95 0.11 8.77 5.59 010

51020 ............ A Incise & treat bladder ......................................... 6.71 NA 4.46 0.71 NA 11.88 090

51030 ............ A Incise & treat bladder ......................................... 6.77 NA 4.77 0.43 NA 11.97 090

51040 ............ A Incise & drain bladder ........................................ 4.40 NA 3.41 0.75 NA 8.56 090
30949

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

51045 ............ A Incise bladder, drain ureter ................................ 6.77 NA 4.53 0.50 NA 11.80 090

51050 ............ A Removal of bladder stone .................................. 6.92 NA 4.31 0.70 NA 11.93 090

51060 ............ A Removal of ureter stone .................................... 8.85 NA 5.28 1.19 NA 15.32 090

51065 ............ A Removal of ureter stone .................................... 8.85 NA 5.25 0.71 NA 14.81 090

51080 ............ A Drainage of bladder abscess ............................. 5.96 NA 4.24 0.57 NA 10.77 090

51500 ............ A Removal of bladder cyst .................................... 10.14 NA 4.05 1.21 NA 15.40 090

51520 ............ A Removal of bladder lesion ................................. 9.29 NA 5.41 0.87 NA 15.57 090

51525 ............ A Removal of bladder lesion ................................. 13.97 NA 7.17 1.06 NA 22.20 090

51530 ............ A Removal of bladder lesion ................................. 12.38 NA 6.59 1.02 NA 19.99 090

51535 ............ A Repair of ureter lesion ....................................... 12.57 NA 6.99 1.14 NA 20.70 090

51550 ............ A Partial removal of bladder .................................. 15.66 NA 7.75 1.17 NA 24.58 090

51555 ............ A Partial removal of bladder .................................. 21.23 NA 10.07 1.31 NA 32.61 090

51565 ............ A Revise bladder & ureter(s) ................................. 21.62 NA 10.46 1.67 NA 33.75 090

51570 ............ A Removal of bladder ............................................ 24.24 NA 11.63 1.62 NA 37.49 090

51575 ............ A Removal of bladder & nodes ............................. 30.45 NA 14.31 2.25 NA 47.01 090

51580 ............ A Remove bladder; revise tract ............................. 31.08 NA 14.70 2.04 NA 47.82 090

51585 ............ A Removal of bladder & nodes ............................. 35.23 NA 16.24 2.42 NA 53.89 090

51590 ............ A Remove bladder; revise tract ............................. 32.66 NA 15.03 2.56 NA 50.25 090

51595 ............ A Remove bladder; revise tract ............................. 37.14 NA 16.73 3.34 NA 57.21 090

51596 ............ A Remove bladder, create pouch .......................... 39.52 NA 17.86 3.45 NA 60.83 090

51597 ............ A Removal of pelvic structures .............................. 38.35 NA 17.46 4.31 NA 60.12 090

51600 ............ A Injection for bladder x-ray .................................. 0.88 11.09 0.29 0.03 12.00 1.20 000

51605 ............ A Preparation for bladder xray .............................. 0.64 11.15 0.22 0.03 11.82 0.89 000

51610 ............ A Injection for bladder x-ray .................................. 1.05 11.29 0.36 0.02 12.36 1.43 000

51700 ............ A Irrigation of bladder ............................................ 0.88 2.77 0.34 0.02 3.67 1.24 000

51705 ............ A Change of bladder tube ..................................... 1.02 1.84 1.16 0.04 2.90 2.22 010

51710 ............ A Change of bladder tube ..................................... 1.49 3.52 1.40 0.06 5.07 2.95 010

51715 ............ A Endoscopic injection/implant .............................. 3.74 3.30 1.62 0.27 7.31 5.63 000

51720 ............ A Treatment of bladder lesion ............................... 1.96 2.97 0.99 0.05 4.98 3.00 000

51725 ............ A Simple cystometrogram ..................................... 1.51 3.96 3.96 0.11 5.58 5.58 000

51725 26 A Simple cystometrogram ..................................... 1.51 0.59 0.59 0.07 2.17 2.17 000

51725 TC A Simple cystometrogram ..................................... 0.00 3.37 3.37 0.04 3.41 3.41 000

51726 ............ A Complex cystometrogram .................................. 1.71 3.15 3.15 0.13 4.99 4.99 000

51726 26 A Complex cystometrogram .................................. 1.71 0.64 0.64 0.08 2.43 2.43 000

51726 TC A Complex cystometrogram .................................. 0.00 2.51 2.51 0.05 2.56 2.56 000

51736 ............ A Urine flow measurement .................................... 0.61 0.63 0.63 0.04 1.28 1.28 000

51736 26 A Urine flow measurement .................................... 0.61 0.24 0.24 0.03 0.88 0.88 000

51736 TC A Urine flow measurement .................................... 0.00 0.39 0.39 0.01 0.40 0.40 000

51741 ............ A Electro-uroflowmetry, first .................................. 1.14 1.20 1.20 0.06 2.40 2.40 000

51741 26 A Electro-uroflowmetry, first .................................. 1.14 0.43 0.43 0.04 1.61 1.61 000

51741 TC A Electro-uroflowmetry, first .................................. 0.00 0.77 0.77 0.02 0.79 0.79 000

51772 ............ A Urethra pressure profile ..................................... 1.61 3.20 3.20 0.11 4.92 4.92 000

51772 26 A Urethra pressure profile ..................................... 1.61 0.61 0.61 0.06 2.28 2.28 000

51772 TC A Urethra pressure profile ..................................... 0.00 2.59 2.59 0.05 2.64 2.64 000

51784 ............ A Anal/urinary muscle study .................................. 1.53 2.13 2.13 0.11 3.77 3.77 000

51784 26 A Anal/urinary muscle study .................................. 1.53 0.78 0.78 0.07 2.38 2.38 000

51784 TC A Anal/urinary muscle study .................................. 0.00 1.35 1.35 0.04 1.39 1.39 000

51785 ............ A Anal/urinary muscle study .................................. 1.53 2.25 2.25 0.11 3.89 3.89 000

51785 26 A Anal/urinary muscle study .................................. 1.53 0.58 0.58 0.07 2.18 2.18 000

51785 TC A Anal/urinary muscle study .................................. 0.00 1.67 1.67 0.04 1.71 1.71 000

51792 ............ A Urinary reflex study ............................................ 1.10 2.34 2.34 0.20 3.64 3.64 000

51792 26 A Urinary reflex study ............................................ 1.10 0.25 0.25 0.06 1.41 1.41 000

51792 TC A Urinary reflex study ............................................ 0.00 2.09 2.09 0.14 2.23 2.23 000

51795 ............ A Urine voiding pressure study ............................. 1.53 3.21 3.21 0.16 4.90 4.90 000

51795 26 A Urine voiding pressure study ............................. 1.53 0.57 0.57 0.06 2.16 2.16 000

51795 TC A Urine voiding pressure study ............................. 0.00 2.64 2.64 0.10 2.74 2.74 000

51797 ............ A Intraabdominal pressure test ............................. 1.60 3.27 3.27 0.10 4.97 4.97 000

51797 26 A Intraabdominal pressure test ............................. 1.60 0.61 0.61 0.05 2.26 2.26 000

51797 TC A Intraabdominal pressure test ............................. 0.00 2.66 2.66 0.05 2.71 2.71 000

51800 ............ A Revision of bladder/urethra ................................ 17.42 NA 8.68 1.47 NA 27.57 090

51820 ............ A Revision of urinary tract ..................................... 17.89 NA 9.48 1.32 NA 28.69 090

51840 ............ A Attach bladder/urethra ........................................ 10.71 NA 5.93 1.26 NA 17.90 090

51841 ............ A Attach bladder/urethra ........................................ 13.03 NA 7.26 1.48 NA 21.77 090

51845 ............ A Repair bladder neck ........................................... 9.73 NA 5.72 1.09 NA 16.54 090

51860 ............ A Repair of bladder wound .................................... 12.02 NA 6.57 0.91 NA 19.50 090

51865 ............ A Repair of bladder wound .................................... 15.04 NA 7.78 1.27 NA 24.09 090

51880 ............ A Repair of bladder opening ................................. 7.66 NA 4.65 0.52 NA 12.83 090

51900 ............ A Repair bladder/vagina lesion ............................. 12.97 NA 6.95 1.41 NA 21.33 090

51920 ............ A Close bladder-uterus fistula ............................... 11.81 NA 6.38 0.73 NA 18.92 090

51925 ............ A Hysterectomy/bladder repair .............................. 15.58 NA 8.45 2.33 NA 26.36 090

51940 ............ A Correction of bladder defect .............................. 26.81 NA 13.08 2.22 NA 42.11 090

51960 ............ A Revision of bladder & bowel .............................. 23.01 NA 11.75 2.27 NA 37.03 090

51980 ............ A Construct bladder opening ................................. 11.36 NA 6.25 0.75 NA 18.36 090

52000 ............ A Cystoscopy ......................................................... 2.01 2.44 0.96 0.14 4.59 3.11 000
30950

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

52005 ............ A Cystoscopy & ureter catheter ............................ 2.37 3.76 1.09 0.22 6.35 3.68 000

52007 ............ A Cystoscopy and biopsy ...................................... 3.02 NA 1.33 0.28 NA 4.63 000

52010 ............ A Cystoscopy & duct catheter ............................... 3.02 4.04 1.35 0.20 7.26 4.57 000

52204 ............ A Cystoscopy ......................................................... 2.37 4.32 1.09 0.24 6.93 3.70 000

52214 ............ A Cystoscopy and treatment ................................. 3.71 4.76 1.59 0.28 8.75 5.58 000

52224 ............ A Cystoscopy and treatment ................................. 3.14 4.59 1.38 0.29 8.02 4.81 000

52234 ............ A Cystoscopy and treatment ................................. 4.63 5.41 1.94 0.45 10.49 7.02 000

52235 ............ A Cystoscopy and treatment ................................. 5.45 5.72 2.24 0.81 11.98 8.50 000

52240 ............ A Cystoscopy and treatment ................................. 9.72 7.33 4.04 1.04 18.09 14.80 000

52250 ............ A Cystoscopy & radiotracer ................................... 4.50 NA 1.88 0.29 NA 6.67 000

52260 ............ A Cystoscopy & treatment ..................................... 3.92 NA 1.72 0.22 NA 5.86 000

52265 ............ A Cystoscopy & treatment ..................................... 2.94 2.84 1.30 0.14 5.92 4.38 000

52270 ............ A Cystoscopy & revise urethra .............................. 3.37 4.97 1.50 0.35 8.69 5.22 000

52275 ............ A Cystoscopy & revise urethra .............................. 4.70 5.52 2.00 0.34 10.56 7.04 000

52276 ............ A Cystoscopy and treatment ................................. 5.00 5.63 2.34 0.45 11.08 7.79 000

52277 ............ A Cystoscopy and treatment ................................. 6.17 NA 2.54 0.47 NA 9.18 000

52281 ............ A Cystoscopy and treatment ................................. 2.80 2.82 1.25 0.23 5.85 4.28 000

52282 ............ A Cystoscopy, implant stent .................................. 6.40 5.98 2.83 0.45 12.83 9.68 000

52283 ............ A Cystoscopy and treatment ................................. 3.74 4.95 1.60 0.15 8.84 5.49 000

52285 ............ A Cystoscopy and treatment ................................. 3.61 5.10 1.55 0.30 9.01 5.46 000

52290 ............ A Cystoscopy and treatment ................................. 4.59 NA 1.92 0.24 NA 6.75 000

52300 ............ A Cystoscopy and treatment ................................. 5.31 NA 2.19 0.36 NA 7.86 000

52301 ............ A Cystoscopy and treatment ................................. 5.51 NA 2.26 0.36 NA 8.13 000

52305 ............ A Cystoscopy and treatment ................................. 5.31 NA 2.19 0.35 NA 7.85 000

52310 ............ A Cystoscopy and treatment ................................. 2.81 10.72 1.26 0.30 13.83 4.37 000

52315 ............ A Cystoscopy and treatment ................................. 5.21 11.74 2.13 0.40 17.35 7.74 000

52317 ............ A Remove bladder stone ....................................... 6.72 17.78 2.72 0.59 25.09 10.03 000

52318 ............ A Remove bladder stone ....................................... 9.19 NA 3.64 0.77 NA 13.60 000

52320 ............ A Cystoscopy and treatment ................................. 4.70 NA 1.96 0.47 NA 7.13 000

52325 ............ A Cystoscopy, stone removal ................................ 6.16 NA 2.50 0.68 NA 9.34 000

52327 ............ A Cystoscopy, inject material ................................ 5.19 NA 2.15 0.36 NA 7.70 000

52330 ............ A Cystoscopy and treatment ................................. 5.04 14.55 2.09 0.35 19.94 7.48 000

52332 ............ A Cystoscopy and treatment ................................. 2.83 20.61 1.26 0.32 23.76 4.41 000

52334 ............ A Create passage to kidney .................................. 4.83 NA 2.00 0.34 NA 7.17 000

52335 ............ A Endoscopy of urinary tract ................................. 5.86 NA 2.40 0.45 NA 8.71 000

52336 ............ A Cystoscopy, stone removal ................................ 6.88 NA 2.78 0.99 NA 10.65 000

52337 ............ A Cystoscopy, stone removal ................................ 7.97 NA 3.18 1.08 NA 12.23 000

52338 ............ A Cystoscopy and treatment ................................. 7.34 NA 2.94 0.57 NA 10.85 000

52339 ............ A Cystoscopy and treatment ................................. 8.82 NA 3.39 0.57 NA 12.78 000

52340 ............ A Cystoscopy and treatment ................................. 9.68 NA 5.05 0.50 NA 15.23 090

52450 ............ A Incision of prostate ............................................. 7.64 NA 5.33 0.49 NA 13.46 090

52500 ............ A Revision of bladder neck ................................... 8.47 NA 5.64 0.72 NA 14.83 090

52510 ............ A Dilation prostatic urethra .................................... 6.72 NA 4.75 0.74 NA 12.21 090

52601 ............ A Prostatectomy (TURP) ....................................... 12.37 NA 7.09 1.16 NA 20.62 090

52606 ............ A Control postop bleeding ..................................... 8.13 NA 5.25 0.33 NA 13.71 090

52612 ............ A Prostatectomy, first stage .................................. 7.98 NA 5.46 0.99 NA 14.43 090

52614 ............ A Prostatectomy, second stage ............................. 6.84 NA 5.02 0.68 NA 12.54 090

52620 ............ A Remove residual prostate .................................. 6.61 NA 4.94 0.51 NA 12.06 090

52630 ............ A Remove prostate regrowth ................................. 7.26 NA 5.19 1.13 NA 13.58 090

52640 ............ A Relieve bladder contracture ............................... 6.62 NA 4.70 0.62 NA 11.94 090

52647 ............ A Laser surgery of prostate ................................... 10.36 NA 6.35 1.16 NA 17.87 090

52648 ............ A Laser surgery of prostate ................................... 11.21 NA 6.62 1.16 NA 18.99 090

52700 ............ A Drainage of prostate abscess ............................ 6.80 NA 5.00 0.34 NA 12.14 090

53000 ............ A Incision of urethra .............................................. 2.28 4.63 2.02 0.17 7.08 4.47 010

53010 ............ A Incision of urethra .............................................. 3.64 NA 3.23 0.37 NA 7.24 090

53020 ............ A Incision of urethra .............................................. 1.77 3.07 0.69 0.09 4.93 2.55 000

53025 ............ A Incision of urethra .............................................. 1.13 3.25 0.45 0.08 4.46 1.66 000

53040 ............ A Drainage of urethra abscess .............................. 6.40 7.08 8.13 0.19 13.67 14.72 090

53060 ............ A Drainage of urethra abscess .............................. 2.63 4.88 2.02 0.07 7.58 4.72 010

53080 ............ A Drainage of urinary leakage ............................... 6.29 NA 6.39 0.45 NA 13.13 090

53085 ............ A Drainage of urinary leakage ............................... 10.27 NA 7.98 0.70 NA 18.95 090

53200 ............ A Biopsy of urethra ................................................ 2.59 3.96 1.01 0.12 6.67 3.72 000

53210 ............ A Removal of urethra ............................................ 12.57 NA 6.79 0.67 NA 20.03 090

53215 ............ A Removal of urethra ............................................ 15.58 NA 7.84 0.96 NA 24.38 090

53220 ............ A Treatment of urethra lesion ................................ 7.00 NA 4.47 0.49 NA 11.96 090

53230 ............ A Removal of urethra lesion .................................. 9.58 NA 5.50 0.79 NA 15.87 090

53235 ............ A Removal of urethra lesion .................................. 10.14 NA 5.52 0.49 NA 16.15 090

53240 ............ A Surgery for urethra pouch .................................. 6.45 NA 4.14 0.45 NA 11.04 090

53250 ............ A Removal of urethra gland .................................. 5.89 NA 3.63 0.40 NA 9.92 090

53260 ............ A Treatment of urethra lesion ................................ 2.98 4.34 1.93 0.16 7.48 5.07 010

53265 ............ A Treatment of urethra lesion ................................ 3.12 4.79 1.93 0.22 8.13 5.27 010

53270 ............ A Removal of urethra gland .................................. 3.09 4.35 2.03 0.18 7.62 5.30 010

53275 ............ A Repair of urethra defect ..................................... 4.53 NA 2.98 0.25 NA 7.76 010

53400 ............ A Revise urethra, 1st stage ................................... 12.77 NA 6.89 0.76 NA 20.42 090
30951

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

53405 ............ A Revise urethra, 2nd stage .................................. 14.48 NA 7.42 1.21 NA 23.11 090

53410 ............ A Reconstruction of urethra ................................... 16.44 NA 8.19 0.84 NA 25.47 090

53415 ............ A Reconstruction of urethra ................................... 19.41 NA 9.33 1.15 NA 29.89 090

53420 ............ A Reconstruct urethra, stage 1 ............................. 14.08 NA 7.15 1.05 NA 22.28 090

53425 ............ A Reconstruct urethra, stage 2 ............................. 15.98 NA 7.99 0.88 NA 24.85 090

53430 ............ A Reconstruction of urethra ................................... 16.34 NA 8.23 0.76 NA 25.33 090

53440 ............ A Correct bladder function ..................................... 12.34 NA 6.87 1.39 NA 20.60 090

53442 ............ A Remove perineal prosthesis .............................. 8.27 NA 5.01 0.67 NA 13.95 090

53443 ............ A Reconstruction of urethra ................................... 19.89 NA 9.15 1.07 NA 30.11 090

53445 ............ A Correct urine flow control ................................... 14.06 NA 7.48 2.03 NA 23.57 090

53447 ............ A Remove artificial sphincter ................................. 13.17 NA 6.93 0.89 NA 20.99 090

53449 ............ A Correct artificial sphincter .................................. 9.70 NA 5.63 0.82 NA 16.15 090

53450 ............ A Revision of urethra ............................................. 6.14 NA 4.08 0.27 NA 10.49 090

53460 ............ A Revision of urethra ............................................. 7.12 NA 4.45 0.25 NA 11.82 090

53502 ............ A Repair of urethra injury ...................................... 7.63 NA 4.76 0.56 NA 12.95 090

53505 ............ A Repair of urethra injury ...................................... 7.63 NA 4.63 0.51 NA 12.77 090

53510 ............ A Repair of urethra injury ...................................... 10.11 NA 5.90 0.66 NA 16.67 090

53515 ............ A Repair of urethra injury ...................................... 13.31 NA 6.76 0.88 NA 20.95 090

53520 ............ A Repair of urethra defect ..................................... 8.68 NA 4.96 0.56 NA 14.20 090

53600 ............ A Dilate urethra stricture ........................................ 1.21 2.94 0.50 0.03 4.18 1.74 000

53601 ............ A Dilate urethra stricture ........................................ 0.98 2.86 0.42 0.03 3.87 1.43 000

53605 ............ A Dilate urethra stricture ........................................ 1.28 NA 0.69 0.05 NA 2.02 000

53620 ............ A Dilate urethra stricture ........................................ 1.62 4.35 0.81 0.05 6.02 2.48 000

53621 ............ A Dilate urethra stricture ........................................ 1.35 4.31 0.71 0.04 5.70 2.10 000

53660 ............ A Dilation of urethra ............................................... 0.71 2.68 0.32 0.03 3.42 1.06 000

53661 ............ A Dilation of urethra ............................................... 0.72 2.74 0.27 0.03 3.49 1.02 000

53665 ............ A Dilation of urethra ............................................... 0.76 NA 0.56 0.04 NA 1.36 000

53670 ............ A Insert urinary catheter ........................................ 0.50 2.57 0.15 0.02 3.09 0.67 000

53675 ............ A Insert urinary catheter ........................................ 1.47 3.45 0.71 0.05 4.97 2.23 000

53850 ............ A Prostatic microwave thermotx ............................ 9.45 NA 6.00 0.66 NA 16.11 090

53852 ............ A Prostatic rf thermotx ........................................... 9.88 NA 6.16 0.69 NA 16.73 090

54000 ............ A Slitting of prepuce .............................................. 1.54 3.93 1.19 0.07 5.54 2.80 010

54001 ............ A Slitting of prepuce .............................................. 2.19 4.35 1.66 0.09 6.63 3.94 010

54015 ............ A Drain penis lesion .............................................. 5.32 5.33 2.84 0.09 10.74 8.25 010

54050 ............ A Destruction, penis lesion(s) ................................ 1.24 4.80 1.12 0.03 6.07 2.39 010

54055 ............ A Destruction, penis lesion(s) ................................ 1.22 4.14 1.08 0.06 5.42 2.36 010

54056 ............ A Cryosurgery, penis lesion(s) .............................. 1.24 3.11 1.18 0.04 4.39 2.46 010

54057 ............ A Laser surg, penis lesion(s) ................................. 1.24 1.62 1.10 0.21 3.07 2.55 010

54060 ............ A Excision of penis lesion(s) ................................. 1.93 3.63 1.34 0.12 5.68 3.39 010

54065 ............ A Destruction, penis lesion(s) ................................ 2.42 3.40 1.74 0.25 6.07 4.41 010

54100 ............ A Biopsy of penis ................................................... 1.90 2.41 0.77 0.07 4.38 2.74 000

54105 ............ A Biopsy of penis ................................................... 3.50 4.58 1.94 0.11 8.19 5.55 010

54110 ............ A Treatment of penis lesion .................................. 10.13 NA 6.85 0.61 NA 17.59 090

54111 ............ A Treat penis lesion, graft ..................................... 13.57 NA 8.25 0.97 NA 22.79 090

54112 ............ A Treat penis lesion, graft ..................................... 15.86 NA 9.29 1.14 NA 26.29 090

54115 ............ A Treatment of penis lesion .................................. 6.15 7.66 5.34 0.44 14.25 11.93 090

54120 ............ A Partial removal of penis ..................................... 9.97 NA 6.87 0.62 NA 17.46 090

54125 ............ A Removal of penis ............................................... 13.53 NA 8.24 1.17 NA 22.94 090

54130 ............ A Remove penis & nodes ...................................... 20.14 NA 10.87 1.32 NA 32.33 090

54135 ............ A Remove penis & nodes ...................................... 26.36 NA 13.23 1.74 NA 41.33 090

54150 ............ A Circumcision ....................................................... 1.81 3.25 1.48 0.05 5.11 3.34 010

54152 ............ A Circumcision ....................................................... 2.31 NA 1.47 0.20 NA 3.98 010

54160 ............ A Circumcision ....................................................... 2.48 3.66 1.54 0.21 6.35 4.23 010

54161 ............ A Circumcision ....................................................... 3.27 NA 1.85 0.23 NA 5.35 010

54200 ............ A Treatment of penis lesion .................................. 1.06 1.79 0.40 0.03 2.88 1.49 010

54205 ............ A Treatment of penis lesion .................................. 7.93 NA 6.08 0.50 NA 14.51 090

54220 ............ A Treatment of penis lesion .................................. 2.42 1.72 0.99 0.17 4.31 3.58 000

54230 ............ A Prepare penis study ........................................... 1.34 NA 0.49 0.13 NA 1.96 000

54231 ............ A Dynamic cavernosometry ................................... 2.04 1.56 0.81 0.14 3.74 2.99 000

54235 ............ A Penile injection ................................................... 1.19 0.85 0.44 0.04 2.08 1.67 000

54240 ............ A Penis study ......................................................... 1.31 1.16 1.16 0.12 2.59 2.59 000

54240 26 A Penis study ......................................................... 1.31 0.38 0.38 0.06 1.75 1.75 000

54240 TC A Penis study ......................................................... 0.00 0.78 0.78 0.06 0.84 0.84 000

54250 ............ A Penis study ......................................................... 2.22 2.00 2.00 0.08 4.30 4.30 000

54250 26 A Penis study ......................................................... 2.22 0.77 0.77 0.05 3.04 3.04 000

54250 TC A Penis study ......................................................... 0.00 1.23 1.23 0.03 1.26 1.26 000

54300 ............ A Revision of penis ................................................ 10.41 NA 7.30 0.87 NA 18.58 090

54304 ............ A Revision of penis ................................................ 12.49 NA 8.54 0.90 NA 21.93 090

54308 ............ A Reconstruction of urethra ................................... 11.83 NA 8.36 0.74 NA 20.93 090

54312 ............ A Reconstruction of urethra ................................... 13.57 NA 9.92 0.91 NA 24.40 090

54316 ............ A Reconstruction of urethra ................................... 16.82 NA 6.95 1.12 NA 24.89 090

54318 ............ A Reconstruction of urethra ................................... 11.25 NA 19.72 1.11 NA 32.08 090

54322 ............ A Reconstruction of urethra ................................... 13.01 NA 7.94 0.74 NA 21.69 090

54324 ............ A Reconstruction of urethra ................................... 16.31 NA 9.76 1.08 NA 27.15 090
30952

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

54326 ............ A Reconstruction of urethra ................................... 15.72 NA 9.17 1.03 NA 25.92 090

54328 ............ A Revise penis, urethra ......................................... 15.65 NA 9.45 1.24 NA 26.34 090

54332 ............ A Revise penis, urethra ......................................... 17.08 NA 10.05 1.13 NA 28.26 090

54336 ............ A Revise penis, urethra ......................................... 20.04 NA 11.41 1.40 NA 32.85 090

54340 ............ A Secondary urethral surgery ................................ 8.91 NA 6.44 0.59 NA 15.94 090

54344 ............ A Secondary urethral surgery ................................ 15.94 NA 11.37 1.10 NA 28.41 090

54348 ............ A Secondary urethral surgery ................................ 17.15 NA 14.36 1.14 NA 32.65 090

54352 ............ A Reconstruct urethra, penis ................................. 24.74 NA 13.56 1.49 NA 39.79 090

54360 ............ A Penis plastic surgery .......................................... 11.93 NA 7.60 0.73 NA 20.26 090

54380 ............ A Repair penis ....................................................... 13.18 NA 8.00 0.75 NA 21.93 090

54385 ............ A Repair penis ....................................................... 15.39 NA 9.03 0.89 NA 25.31 090

54390 ............ A Repair penis and bladder ................................... 21.61 NA 30.09 1.58 NA 53.28 090

54400 ............ A Insert semi-rigid prosthesis ................................ 8.99 NA 5.39 1.27 NA 15.65 090

54401 ............ A Insert self-contd prosthesis ................................ 10.28 NA 6.08 1.73 NA 18.09 090

54402 ............ A Remove penis prosthesis ................................... 9.21 NA 5.44 0.58 NA 15.23 090

54405 ............ A Insert multi-comp prosthesis .............................. 13.43 NA 7.25 2.10 NA 22.78 090

54407 ............ A Remove multi-comp prosthesis .......................... 13.34 NA 7.00 1.10 NA 21.44 090

54409 ............ A Revise penis prosthesis ..................................... 12.20 NA 6.59 0.87 NA 19.66 090

54420 ............ A Revision of penis ................................................ 11.42 NA 7.23 0.87 NA 19.52 090

54430 ............ A Revision of penis ................................................ 10.15 NA 6.87 0.69 NA 17.71 090

54435 ............ A Revision of penis ................................................ 6.12 NA 5.12 0.39 NA 11.63 090

54450 ............ A Preputial stretching ............................................ 1.12 0.85 0.46 0.07 2.04 1.65 000

54500 ............ A Biopsy of testis ................................................... 1.31 4.14 0.74 0.05 5.50 2.10 000

54505 ............ A Biopsy of testis ................................................... 3.46 NA 2.32 0.22 NA 6.00 010

54510 ............ A Removal of testis lesion ..................................... 5.45 NA 3.16 0.38 NA 8.99 090

54520 ............ A Removal of testis ............................................... 5.23 NA 3.22 0.52 NA 8.97 090

54530 ............ A Removal of testis ............................................... 8.58 NA 4.78 0.77 NA 14.13 090

54535 ............ A Extensive testis surgery ..................................... 12.16 NA 6.30 1.02 NA 19.48 090

54550 ............ A Exploration for testis .......................................... 7.78 NA 4.37 0.61 NA 12.76 090

54560 ............ A Exploration for testis .......................................... 11.13 NA 6.09 0.81 NA 18.03 090

54600 ............ A Reduce testis torsion ......................................... 7.01 NA 3.90 0.48 NA 11.39 090

54620 ............ A Suspension of testis ........................................... 4.90 NA 2.88 0.33 NA 8.11 010

54640 ............ A Suspension of testis ........................................... 6.90 NA 3.90 0.91 NA 11.71 090

54650 ............ A Orchiopexy (Fowler-Stephens) .......................... 11.45 NA 6.05 0.91 NA 18.41 090

54660 ............ A Revision of testis ................................................ 5.11 NA 3.20 0.34 NA 8.65 090

54670 ............ A Repair testis injury ............................................. 6.41 NA 3.71 0.43 NA 10.55 090

54680 ............ A Relocation of testis(es) ...................................... 12.65 NA 6.61 0.80 NA 20.06 090

54700 ............ A Drainage of scrotum ........................................... 3.43 6.31 2.81 0.11 9.85 6.35 010

54800 ............ A Biopsy of epididymis .......................................... 2.33 3.92 1.15 0.19 6.44 3.67 000

54820 ............ A Exploration of epididymis ................................... 5.14 NA 3.21 0.29 NA 8.64 090

54830 ............ A Remove epididymis lesion ................................. 5.38 NA 3.28 0.39 NA 9.05 090

54840 ............ A Remove epididymis lesion ................................. 5.20 NA 3.25 0.48 NA 8.93 090

54860 ............ A Removal of epididymis ....................................... 6.32 NA 3.81 0.50 NA 10.63 090

54861 ............ A Removal of epididymis ....................................... 8.90 NA 4.83 0.72 NA 14.45 090

54900 ............ A Fusion of spermatic ducts .................................. 13.20 NA 6.55 0.87 NA 20.62 090

54901 ............ A Fusion of spermatic ducts .................................. 17.94 NA 8.55 1.20 NA 27.69 090

55000 ............ A Drainage of hydrocele ........................................ 1.43 1.36 0.76 0.04 2.83 2.23 000

55040 ............ A Removal of hydrocele ........................................ 5.36 NA 3.12 0.55 NA 9.03 090

55041 ............ A Removal of hydroceles ...................................... 7.74 NA 4.21 0.81 NA 12.76 090

55060 ............ A Repair of hydrocele ............................................ 5.52 NA 3.19 0.50 NA 9.21 090

55100 ............ A Drainage of scrotum abscess ............................ 2.13 7.25 2.72 0.07 9.45 4.92 010

55110 ............ A Explore scrotum ................................................. 5.70 NA 3.04 0.37 NA 9.11 090

55120 ............ A Removal of scrotum lesion ................................ 5.09 NA 3.07 0.21 NA 8.37 090

55150 ............ A Removal of scrotum ........................................... 7.22 NA 4.20 0.57 NA 11.99 090

55175 ............ A Revision of scrotum ........................................... 5.24 NA 3.32 0.48 NA 9.04 090

55180 ............ A Revision of scrotum ........................................... 10.72 NA 5.79 0.82 NA 17.33 090

55200 ............ A Incision of sperm duct ........................................ 4.24 NA 2.77 0.20 NA 7.21 090

55250 ............ A Removal of sperm duct(s) .................................. 3.29 6.89 2.51 0.28 10.46 6.08 090

55300 ............ A Preparation, sperm duct x-ray ........................... 3.51 NA 1.50 0.27 NA 5.28 000

55400 ............ A Repair of sperm duct ......................................... 8.49 NA 4.85 0.62 NA 13.96 090

55450 ............ A Ligation of sperm duct ....................................... 4.12 6.35 2.47 0.32 10.79 6.91 010

55500 ............ A Removal of hydrocele ........................................ 5.59 NA 3.04 0.50 NA 9.13 090

55520 ............ A Removal of sperm cord lesion ........................... 6.03 NA 3.27 0.51 NA 9.81 090

55530 ............ A Revise spermatic cord veins .............................. 5.66 NA 3.39 0.60 NA 9.65 090

55535 ............ A Revise spermatic cord veins .............................. 6.56 NA 3.78 0.45 NA 10.79 090

55540 ............ A Revise hernia & sperm veins ............................. 7.67 NA 3.90 0.91 NA 12.48 090

55600 ............ A Incise sperm duct pouch .................................... 6.38 NA 3.93 0.55 NA 10.86 090

55605 ............ A Incise sperm duct pouch .................................... 7.96 NA 4.56 0.59 NA 13.11 090

55650 ............ A Remove sperm duct pouch ................................ 11.80 NA 6.04 0.76 NA 18.60 090

55680 ............ A Remove sperm pouch lesion ............................. 5.19 NA 3.35 0.38 NA 8.92 090

55700 ............ A Biopsy of prostate .............................................. 1.57 2.69 0.82 0.15 4.41 2.54 000

55705 ............ A Biopsy of prostate .............................................. 4.57 NA 3.16 0.34 NA 8.07 010

55720 ............ A Drainage of prostate abscess ............................ 7.64 NA 4.80 0.37 NA 12.81 090

55725 ............ A Drainage of prostate abscess ............................ 8.68 NA 5.32 0.54 NA 14.54 090
30953

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

55801 ............ A Removal of prostate ........................................... 17.80 NA 8.82 1.44 NA 28.06 090

55810 ............ A Extensive prostate surgery ................................ 22.58 NA 10.82 1.77 NA 35.17 090

55812 ............ A Extensive prostate surgery ................................ 27.51 NA 12.82 1.94 NA 42.27 090

55815 ............ A Extensive prostate surgery ................................ 30.46 NA 13.64 2.42 NA 46.52 090

55821 ............ A Removal of prostate ........................................... 14.25 NA 7.29 1.35 NA 22.89 090

55831 ............ A Removal of prostate ........................................... 15.62 NA 7.82 1.44 NA 24.88 090

55840 ............ A Extensive prostate surgery ................................ 22.69 NA 11.10 1.61 NA 35.40 090

55842 ............ A Extensive prostate surgery ................................ 24.38 NA 11.72 1.88 NA 37.98 090

55845 ............ A Extensive prostate surgery ................................ 28.55 NA 13.27 2.44 NA 44.26 090

55859 ............ A Percut/needle insert, pros .................................. 12.52 NA 6.62 0.58 NA 19.72 090

55860 ............ A Surgical exposure, prostate ............................... 14.45 NA 7.42 0.70 NA 22.57 090

55862 ............ A Extensive prostate surgery ................................ 18.39 NA 8.86 1.20 NA 28.45 090

55865 ............ A Extensive prostate surgery ................................ 22.87 NA 10.69 2.39 NA 35.95 090

55870 ............ A Electroejaculation ............................................... 2.58 1.52 0.99 0.18 4.28 3.75 000

56300 ............ A Laparoscopy; diagnostic .................................... 5.10 NA 2.79 0.93 NA 8.82 010

56301 ............ A Laparoscopy; tubal cautery ................................ 5.60 NA 3.48 1.28 NA 10.36 010

56302 ............ A Laparoscopy; tubal block ................................... 5.60 NA 3.49 1.32 NA 10.41 010

56303 ............ A Laparoscopy; excise lesions .............................. 11.79 NA 5.25 1.16 NA 18.20 090

56304 ............ A Laparoscopy; lysis .............................................. 11.29 NA 5.20 1.20 NA 17.69 090

56305 ............ A Laparoscopy; biopsy .......................................... 5.40 NA 2.87 0.79 NA 9.06 010

56306 ............ A Laparoscopy; aspiration ..................................... 5.70 NA 3.28 1.18 NA 10.16 010

56307 ............ A Laparoscopy; remove adnexa ............................ 11.05 NA 5.11 1.60 NA 17.76 010

56308 ............ A Laparoscopy; hysterectomy ............................... 14.19 NA 6.56 2.07 NA 22.82 010

56309 ............ A Laparoscopy; remove myoma ............................ 14.21 NA 6.53 1.03 NA 21.77 010

56310 ............ A Laparoscopic enterolysis .................................... 14.44 NA 7.11 1.75 NA 23.30 090

56311 ............ A Laparoscopic lymph node biop .......................... 9.25 NA 4.59 1.47 NA 15.31 010

56312 ............ A Laparoscopic lymphadenectomy ........................ 12.38 NA 5.86 0.84 NA 19.08 010

56313 ............ A Laparoscopic lymphadenectomy ........................ 14.32 NA 6.96 2.31 NA 23.59 010

56314 ............ A Lapar; drain lymphocele ..................................... 9.48 NA 4.66 0.66 NA 14.80 090

56315 ............ A Laparoscopic appendectomy ............................. 8.70 NA 4.28 1.01 NA 13.99 090

56316 ............ A Laparoscopic hernia repair ................................ 6.27 NA 3.23 0.94 NA 10.44 090

56317 ............ A Laparoscopic hernia repair ................................ 8.24 NA 4.20 1.11 NA 13.55 090

56318 ............ A Laparoscopic orchiectomy ................................. 10.96 NA 6.02 0.81 NA 17.79 090

56320 ............ A Laparoscopy, spermatic veins ........................... 6.57 NA 3.54 0.45 NA 10.56 090

56322 ............ A Laparoscopy, vagus nerves ............................... 10.15 NA 4.84 1.18 NA 16.17 090

56323 ............ A Laparoscopy, vagus nerves ............................... 12.15 NA 5.91 1.41 NA 19.47 090

56324 ............ A Laparoscopy, cholecystoenter ........................... 12.58 NA 6.23 1.93 NA 20.74 090

56340 ............ A Laparoscopic cholecystectomy .......................... 11.09 NA 5.25 1.74 NA 18.08 090

56341 ............ A Laparoscopic cholecystectomy .......................... 11.94 NA 5.68 1.84 NA 19.46 090

56342 ............ A Laparoscopic cholecystectomy .......................... 14.23 NA 7.04 2.00 NA 23.27 090

56343 ............ A Laparoscopic salpingostomy .............................. 13.74 NA 6.70 1.11 NA 21.55 090

56344 ............ A Laparoscopic fimbrioplasty ................................. 12.88 NA 5.77 1.19 NA 19.84 090

56346 ............ A Laparoscopic gastrostomy ................................. 7.73 NA 4.29 1.19 NA 13.21 090

56348 ............ A Laparo; resect intestine ...................................... 22.04 NA 10.28 2.78 NA 35.10 090

56349 ............ A Laparoscopy; fundoplasty .................................. 17.25 NA 9.46 2.53 NA 29.24 090

56350 ............ A Hysteroscopy; diagnostic ................................... 3.33 2.58 1.44 0.44 6.35 5.21 000

56351 ............ A Hysteroscopy; biopsy ......................................... 4.75 3.17 2.03 0.44 8.36 7.22 000

56352 ............ A Hysteroscopy; lysis ............................................ 6.17 NA 2.59 0.85 NA 9.61 000

56353 ............ A Hysteroscopy; resect septum ............................. 7.00 NA 2.98 0.85 NA 10.83 000

56354 ............ A Hysteroscopy; remove myoma .......................... 10.00 NA 4.19 1.30 NA 15.49 000

56355 ............ A Hysteroscopy; remove impact ............................ 5.21 NA 2.19 0.44 NA 7.84 000

56356 ............ A Hysteroscopy; ablation ....................................... 6.17 NA 2.61 1.49 NA 10.27 000

56362 ............ A Laparoscopy w/cholangio ................................... 4.89 NA 2.29 0.19 NA 7.37 000

56363 ............ A Laparoscopy w/biopsy ........................................ 5.18 NA 2.50 0.45 NA 8.13 000

56405 ............ A I & D of vulva/perineum ..................................... 1.44 1.88 1.01 0.15 3.47 2.60 010

56420 ............ A Drainage of gland abscess ................................ 1.39 1.86 0.88 0.13 3.38 2.40 010

56440 ............ A Surgery for vulva lesion ..................................... 2.84 2.83 2.05 0.52 6.19 5.41 010

56441 ............ A Lysis of labial lesion(s) ....................................... 1.97 2.15 1.80 0.30 4.42 4.07 010

56501 ............ A Destruction, vulva lesion(s) ................................ 1.53 1.85 1.18 0.11 3.49 2.82 010

56515 ............ A Destruction, vulva lesion(s) ................................ 1.88 2.17 1.67 0.66 4.71 4.21 010

56605 ............ A Biopsy of vulva/perineum ................................... 1.10 1.44 0.47 0.15 2.69 1.72 000

56606 ............ A Biopsy of vulva/perineum ................................... 0.55 1.21 0.25 0.08 1.84 0.88 000

56620 ............ A Partial removal of vulva ..................................... 7.47 NA 4.32 1.40 NA 13.19 090

56625 ............ A Complete removal of vulva ................................ 8.40 NA 4.96 2.13 NA 15.49 090

56630 ............ A Extensive vulva surgery ..................................... 12.36 NA 6.83 3.28 NA 22.47 090

56631 ............ A Extensive vulva surgery ..................................... 16.20 NA 8.96 4.51 NA 29.67 090

56632 ............ A Extensive vulva surgery ..................................... 20.29 NA 10.64 4.51 NA 35.44 090

56633 ............ A Extensive vulva surgery ..................................... 16.47 NA 8.54 3.28 NA 28.29 090

56634 ............ A Extensive vulva surgery ..................................... 17.88 NA 9.67 4.51 NA 32.06 090

56637 ............ A Extensive vulva surgery ..................................... 21.97 NA 11.32 4.51 NA 37.80 090

56640 ............ A Extensive vulva surgery ..................................... 22.17 NA 11.23 4.36 NA 37.76 090

56700 ............ A Partial removal of hymen ................................... 2.52 2.45 1.78 0.35 5.32 4.65 010

56720 ............ A Incision of hymen ............................................... 0.68 1.32 0.61 0.11 2.11 1.40 000

56740 ............ A Remove vagina gland lesion .............................. 3.76 2.82 2.37 0.55 7.13 6.68 010
30954

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

56800 ............ A Repair of vagina ................................................. 3.89 NA 2.54 0.57 NA 7.00 010

56805 ............ A Repair clitoris ..................................................... 18.86 NA 9.03 1.37 NA 29.26 090

56810 ............ A Repair of perineum ............................................ 4.13 NA 2.57 0.51 NA 7.21 010

57000 ............ A Exploration of vagina ......................................... 2.97 NA 2.08 0.35 NA 5.40 010

57010 ............ A Drainage of pelvic abscess ................................ 6.03 NA 3.54 0.51 NA 10.08 090

57020 ............ A Drainage of pelvic fluid ...................................... 1.50 1.24 0.60 0.14 2.88 2.24 000

57061 ............ A Destruction vagina lesion(s) ............................... 1.25 1.77 1.06 0.17 3.19 2.48 010

57065 ............ A Destruction vagina lesion(s) ............................... 2.61 2.42 1.96 0.74 5.77 5.31 010

57100 ............ A Biopsy of vagina ................................................. 0.97 1.14 0.41 0.13 2.24 1.51 000

57105 ............ A Biopsy of vagina ................................................. 1.69 1.99 1.57 0.33 4.01 3.59 010

57108 ............ A Partial removal of vagina ................................... 6.36 NA 3.73 1.10 NA 11.19 090

57110 ............ A Removal of vagina ............................................. 14.29 NA 6.92 1.76 NA 22.97 090

57120 ............ A Closure of vagina ............................................... 7.41 NA 4.33 1.51 NA 13.25 090

57130 ............ A Remove vagina lesion ........................................ 2.43 NA 1.85 0.55 NA 4.83 010

57135 ............ A Remove vagina lesion ........................................ 2.67 2.39 1.97 0.38 5.44 5.02 010

57150 ............ A Treat vagina infection ......................................... 0.55 0.81 0.22 0.04 1.40 0.81 000

57160 ............ A Insertion of pessary/device ................................ 0.89 1.07 0.36 0.05 2.01 1.30 000

57170 ............ A Fitting of diaphragm/cap .................................... 0.91 1.07 0.35 0.06 2.04 1.32 000

57180 ............ A Treat vaginal bleeding ........................................ 1.58 1.78 1.19 0.11 3.47 2.88 010

57200 ............ A Repair of vagina ................................................. 3.94 NA 2.66 0.60 NA 7.20 090

57210 ............ A Repair vagina/perineum ..................................... 5.17 NA 3.20 0.65 NA 9.02 090

57220 ............ A Revision of urethra ............................................. 4.31 NA 3.05 0.80 NA 8.16 090

57230 ............ A Repair of urethral lesion ..................................... 5.64 NA 3.76 0.64 NA 10.04 090

57240 ............ A Repair bladder & vagina .................................... 6.07 NA 3.92 1.60 NA 11.59 090

57250 ............ A Repair rectum & vagina ..................................... 5.53 NA 3.53 1.69 NA 10.75 090

57260 ............ A Repair of vagina ................................................. 8.27 NA 4.66 1.88 NA 14.81 090

57265 ............ A Extensive repair of vagina ................................. 11.34 NA 6.28 2.11 NA 19.73 090

57268 ............ A Repair of bowel bulge ........................................ 6.76 NA 4.03 1.50 NA 12.29 090

57270 ............ A Repair of bowel pouch ....................................... 12.11 NA 6.08 1.44 NA 19.63 090

57280 ............ A Suspension of vagina ......................................... 15.04 NA 7.27 1.85 NA 24.16 090

57282 ............ A Repair of vaginal prolapse ................................. 8.86 NA 4.91 1.89 NA 15.66 090

57284 ............ A Repair paravaginal defect .................................. 12.70 NA 6.67 0.84 NA 20.21 090

57288 ............ A Repair bladder defect ......................................... 13.02 NA 6.65 1.36 NA 21.03 090

57289 ............ A Repair bladder & vagina .................................... 11.58 NA 6.21 1.13 NA 18.92 090

57291 ............ A Construction of vagina ....................................... 7.95 NA 5.76 1.19 NA 14.90 090

57292 ............ A Construct vagina with graft ................................ 13.09 NA 6.89 1.38 NA 21.36 090

57300 ............ A Repair rectum-vagina fistula .............................. 7.61 NA 4.30 1.66 NA 13.57 090

57305 ............ A Repair rectum-vagina fistula .............................. 13.77 NA 7.02 1.56 NA 22.35 090

57307 ............ A Fistula repair & colostomy ................................. 15.93 NA 7.93 1.28 NA 25.14 090

57308 ............ A Fistula repair, transperine .................................. 9.94 NA 4.76 1.41 NA 16.11 090

57310 ............ A Repair urethrovaginal lesion .............................. 6.78 NA 4.22 0.48 NA 11.48 090

57311 ............ A Repair urethrovaginal lesion .............................. 7.98 NA 4.74 0.41 NA 13.13 090

57320 ............ A Repair bladder-vagina lesion ............................. 8.01 NA 4.77 1.35 NA 14.13 090

57330 ............ A Repair bladder-vagina lesion ............................. 12.35 NA 6.21 0.81 NA 19.37 090

57335 ............ A Repair vagina ..................................................... 18.73 NA 9.14 0.81 NA 28.68 090

57400 ............ A Dilation of vagina ............................................... 2.27 NA 1.22 0.06 NA 3.55 000

57410 ............ A Pelvic examination ............................................. 1.75 1.93 1.01 0.05 3.73 2.81 000

57415 ............ A Removal vaginal foreign body ........................... 2.17 2.75 1.78 0.05 4.97 4.00 010

57452 ............ A Examination of vagina ........................................ 0.99 1.30 0.39 0.14 2.43 1.52 000

57454 ............ A Vagina examination & biopsy ............................ 1.27 1.42 0.51 0.26 2.95 2.04 000

57460 ............ A Cervix excision ................................................... 2.83 1.83 1.16 0.46 5.12 4.45 000

57500 ............ A Biopsy of cervix .................................................. 0.97 1.17 0.42 0.12 2.26 1.51 000

57505 ............ A Endocervical curettage ....................................... 1.14 1.54 1.07 0.13 2.81 2.34 010

57510 ............ A Cauterization of cervix ....................................... 1.90 2.45 1.38 0.09 4.44 3.37 010

57511 ............ A Cryocautery of cervix ......................................... 1.90 1.99 0.75 0.17 4.06 2.82 010

57513 ............ A Laser surgery of cervix ...................................... 1.90 2.06 1.35 0.67 4.63 3.92 010

57520 ............ A Conization of cervix ............................................ 4.04 3.50 2.56 0.73 8.27 7.33 090

57522 ............ A Conization of cervix ............................................ 3.36 3.16 2.30 0.73 7.25 6.39 090

57530 ............ A Removal of cervix .............................................. 4.79 NA 3.23 0.78 NA 8.80 090

57531 ............ A Removal of cervix, radical .................................. 28.00 NA 12.75 3.87 NA 44.62 090

57540 ............ A Removal of residual cervix ................................. 12.22 NA 5.99 1.51 NA 19.72 090

57545 ............ A Remove cervix, repair pelvis .............................. 13.03 NA 6.53 1.03 NA 20.59 090

57550 ............ A Removal of residual cervix ................................. 5.53 NA 3.52 1.54 NA 10.59 090

57555 ............ A Remove cervix, repair vagina ............................ 8.95 NA 5.09 2.17 NA 16.21 090

57556 ............ A Remove cervix, repair bowel ............................. 8.37 NA 4.64 1.92 NA 14.93 090

57700 ............ A Revision of cervix ............................................... 3.55 NA 2.27 0.34 NA 6.16 090

57720 ............ A Revision of cervix ............................................... 4.13 NA 2.97 0.50 NA 7.60 090

57800 ............ A Dilation of cervical canal .................................... 0.77 0.94 0.33 0.10 1.81 1.20 000

57820 ............ A D&C of residual cervix ....................................... 1.67 2.07 1.86 0.46 4.20 3.99 010

58100 ............ A Biopsy of uterus lining ........................................ 0.71 0.92 0.29 0.14 1.77 1.14 000

58120 ............ A Dilation and curettage (D&C) ............................. 3.27 3.12 2.22 0.56 6.95 6.05 010

58140 ............ A Removal of uterus lesion ................................... 14.60 NA 6.98 1.71 NA 23.29 090

58145 ............ A Removal of uterus lesion ................................... 8.04 NA 4.57 1.54 NA 14.15 090

58150 ............ A Total hysterectomy ............................................. 15.24 NA 7.32 2.08 NA 24.64 090
30955

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

58152 ............ A Total hysterectomy ............................................. 15.09 NA 7.28 2.59 NA 24.96 090

58180 ............ A Partial hysterectomy ........................................... 15.29 NA 7.27 2.11 NA 24.67 090

58200 ............ A Extensive hysterectomy ..................................... 21.59 NA 10.57 2.80 NA 34.96 090

58210 ............ A Extensive hysterectomy ..................................... 28.85 NA 13.49 3.87 NA 46.21 090

58240 ............ A Removal of pelvis contents ................................ 38.39 NA 17.76 6.15 NA 62.30 090

58260 ............ A Vaginal hysterectomy ......................................... 12.20 NA 5.84 2.07 NA 20.11 090

58262 ............ A Vaginal hysterectomy ......................................... 13.99 NA 6.57 2.07 NA 22.63 090

58263 ............ A Vaginal hysterectomy ......................................... 15.28 NA 6.88 2.22 NA 24.38 090

58267 ............ A Hysterectomy & vagina repair ............................ 15.00 NA 6.93 2.46 NA 24.39 090

58270 ............ A Hysterectomy & vagina repair ............................ 13.48 NA 6.37 2.22 NA 22.07 090

58275 ............ A Hysterectomy, revise vagina .............................. 14.98 NA 6.95 2.32 NA 24.25 090

58280 ............ A Hysterectomy, revise vagina .............................. 15.41 NA 7.10 2.30 NA 24.81 090

58285 ............ A Extensive hysterectomy ..................................... 18.57 NA 9.55 2.70 NA 30.82 090

58300 ............ N Insert intrauterine device .................................... +1.01 2.37 1.01 0.13 3.51 2.15 XXX

58301 ............ A Remove intrauterine device ............................... 1.27 1.20 0.49 0.08 2.55 1.84 000

58321 ............ A Artificial insemination ......................................... 0.92 0.86 0.34 0.15 1.93 1.41 000

58322 ............ A Artificial insemination ......................................... 1.10 0.90 0.42 0.15 2.15 1.67 000

58323 ............ A Sperm washing .................................................. 0.23 0.37 0.10 0.04 0.64 0.37 000

58340 ............ A Catheter for hysterography ................................ 0.88 9.69 0.32 0.08 10.65 1.28 000

58345 ............ A Reopen fallopian tube ........................................ 4.66 NA 1.74 0.41 NA 6.81 010

58350 ............ A Reopen fallopian tube ........................................ 1.01 1.58 0.98 0.16 2.75 2.15 010

58400 ............ A Suspension of uterus ......................................... 6.36 NA 3.70 1.16 NA 11.22 090

58410 ............ A Suspension of uterus ......................................... 12.73 NA 6.19 0.84 NA 19.76 090

58520 ............ A Repair of ruptured uterus ................................... 11.92 NA 5.74 0.99 NA 18.65 090

58540 ............ A Revision of uterus .............................................. 14.64 NA 6.89 1.42 NA 22.95 090

58600 ............ A Division of fallopian tube .................................... 3.84 NA 2.46 1.38 NA 7.68 090

58605 ............ A Division of fallopian tube .................................... 3.34 NA 2.26 1.01 NA 6.61 090

58611 ............ A Ligate oviduct(s) ................................................. 0.63 NA 0.40 0.10 NA 1.13 ZZZ

58615 ............ A Occlude fallopian tube(s) ................................... 3.90 NA 5.53 0.35 NA 9.78 010

58700 ............ A Removal of fallopian tube .................................. 6.49 NA 3.56 1.31 NA 11.36 090

58720 ............ A Removal of ovary/tube(s) ................................... 11.36 NA 5.58 1.63 NA 18.57 090

58740 ............ A Revise fallopian tube(s) ..................................... 5.83 NA 3.47 1.88 NA 11.18 090

58750 ............ A Repair oviduct .................................................... 14.84 NA 7.09 1.46 NA 23.39 090

58752 ............ A Revise ovarian tube(s) ....................................... 14.84 NA 7.36 0.93 NA 23.13 090

58760 ............ A Remove tubal obstruction .................................. 13.13 NA 6.43 1.19 NA 20.75 090

58770 ............ A Create new tubal opening .................................. 13.97 NA 6.88 1.11 NA 21.96 090

58800 ............ A Drainage of ovarian cyst(s) ................................ 4.14 3.67 3.33 0.53 8.34 8.00 090

58805 ............ A Drainage of ovarian cyst(s) ................................ 5.88 NA 3.27 1.36 NA 10.51 090

58820 ............ A Open drain ovary abscess ................................. 4.22 NA 2.85 0.49 NA 7.56 090

58822 ............ A Percut drain ovary abscess ............................... 10.13 NA 4.89 0.81 NA 15.83 090

58823 ............ A Percut drain pelvic abscess ............................... 3.38 NA 2.46 0.30 NA 6.14 000

58825 ............ A Transposition, ovary(s) ....................................... 6.13 NA 3.69 0.93 NA 10.75 090

58900 ............ A Biopsy of ovary(s) .............................................. 5.99 NA 3.29 1.07 NA 10.35 090

58920 ............ A Partial removal of ovary(s) ................................. 6.78 NA 3.66 1.41 NA 11.85 090

58925 ............ A Removal of ovarian cyst(s) ................................ 11.36 NA 5.46 1.38 NA 18.20 090

58940 ............ A Removal of ovary(s) ........................................... 7.29 NA 3.76 1.33 NA 12.38 090

58943 ............ A Removal of ovary(s) ........................................... 18.43 NA 9.07 2.63 NA 30.13 090

58950 ............ A Resect ovarian malignancy ................................ 15.27 NA 7.83 2.38 NA 25.48 090

58951 ............ A Resect ovarian malignancy ................................ 21.81 NA 10.61 3.93 NA 36.35 090

58952 ............ A Resect ovarian malignancy ................................ 25.01 NA 11.86 3.92 NA 40.79 090

58960 ............ A Exploration of abdomen ..................................... 14.65 NA 7.59 2.95 NA 25.19 090

58970 ............ A Retrieval of oocyte ............................................. 3.53 6.04 1.90 0.58 10.15 6.01 000

58976 ............ A Transfer of embryo ............................................. 3.83 4.93 4.62 0.63 9.39 9.08 000

59000 ............ A Amniocentesis .................................................... 1.30 1.36 0.53 0.18 2.84 2.01 000

59012 ............ A Fetal cord puncture, prenatal ............................. 3.45 NA 1.53 0.31 NA 5.29 000

59015 ............ A Chorion biopsy ................................................... 2.20 1.25 0.91 0.10 3.55 3.21 000

59020 ............ A Fetal contract stress test .................................... 0.66 1.15 1.15 0.29 2.10 2.10 000

59020 26 A Fetal contract stress test .................................... 0.66 NA 0.21 0.19 NA 1.06 000

59020 TC A Fetal contract stress test .................................... 0.00 0.94 0.94 0.10 1.04 1.04 000

59025 ............ A Fetal non-stress test .......................................... 0.53 0.61 0.61 0.12 1.26 1.26 000

59025 26 A Fetal non-stress test .......................................... 0.53 NA 0.21 0.08 NA 0.82 000

59025 TC A Fetal non-stress test .......................................... 0.00 0.40 0.40 0.04 0.44 0.44 000

59030 ............ A Fetal scalp blood sample ................................... 1.99 NA 1.00 0.21 NA 3.20 000

59050 ............ A Fetal monitor w/report ........................................ 0.89 NA 0.37 0.15 NA 1.41 XXX

59051 ............ A Fetal monitor/interpret only ................................ 0.74 NA 0.31 0.15 NA 1.20 XXX

59100 ............ A Remove uterus lesion ........................................ 12.35 NA 6.27 0.96 NA 19.58 090

59120 ............ A Treat ectopic pregnancy .................................... 11.49 NA 5.88 1.50 NA 18.87 090

59121 ............ A Treat ectopic pregnancy .................................... 11.67 NA 5.63 1.07 NA 18.37 090

59130 ............ A Treat ectopic pregnancy .................................... 14.22 NA 16.39 0.70 NA 31.31 090

59135 ............ A Treat ectopic pregnancy .................................... 13.88 NA 6.08 1.15 NA 21.11 090

59136 ............ A Treat ectopic pregnancy .................................... 13.18 NA 6.67 1.44 NA 21.29 090

59140 ............ A Treat ectopic pregnancy .................................... 5.46 NA 2.97 0.29 NA 8.72 090

59150 ............ A Treat ectopic pregnancy .................................... 6.89 NA 4.30 1.05 NA 12.24 090

59151 ............ A Treat ectopic pregnancy .................................... 7.86 NA 4.21 0.64 NA 12.71 090
30956

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

59160 ............ A D&C after delivery .............................................. 2.71 2.93 1.99 0.52 6.16 5.22 010

59200 ............ A Insert cervical dilator .......................................... 0.79 1.03 0.31 0.11 1.93 1.21 000

59300 ............ A Episiotomy or vaginal repair .............................. 2.41 1.54 0.97 0.10 4.05 3.48 000

59320 ............ A Revision of cervix ............................................... 2.48 NA 1.36 0.41 NA 4.25 000

59325 ............ A Revision of cervix ............................................... 4.07 NA 2.35 0.29 NA 6.71 000

59350 ............ A Repair of uterus ................................................. 4.95 NA 2.11 0.82 NA 7.88 000

59400 ............ A Obstetrical care .................................................. 23.06 NA 12.94 3.47 NA 39.47 MMM

59409 ............ A Obstetrical care .................................................. 13.50 NA 5.47 2.20 NA 21.17 MMM

59410 ............ A Obstetrical care .................................................. 14.78 NA 6.52 2.39 NA 23.69 MMM

59412 ............ A Antepartum manipulation ................................... 1.71 1.29 0.70 0.29 3.29 2.70 MMM

59414 ............ A Deliver placenta ................................................. 1.61 NA 1.07 0.27 NA 2.95 MMM

59425 ............ A Antepartum care only ......................................... 4.81 4.02 4.05 0.66 9.49 9.52 MMM

59426 ............ A Antepartum care only ......................................... 8.28 6.86 6.89 1.14 16.28 16.31 MMM

59430 ............ A Care after delivery .............................................. 2.13 1.11 1.10 0.07 3.31 3.30 MMM

59510 ............ A Cesarean delivery .............................................. 26.22 NA 14.88 3.92 NA 45.02 MMM

59514 ............ A Cesarean delivery only ...................................... 15.97 NA 6.48 2.55 NA 25.00 MMM

59515 ............ A Cesarean delivery .............................................. 17.37 NA 7.92 2.73 NA 28.02 MMM

59525 ............ A Remove uterus after cesarean .......................... 8.54 NA 3.67 0.88 NA 13.09 MMM

59610 ............ A Vbac delivery ...................................................... 24.62 NA 10.06 3.47 NA 38.15 MMM

59612 ............ A Vbac delivery only .............................................. 15.06 NA 6.06 2.20 NA 23.32 MMM

59614 ............ A Vbac care after delivery ..................................... 16.34 NA 6.41 2.39 NA 25.14 MMM

59618 ............ A Attempted vbac delivery ..................................... 27.78 NA 11.13 3.92 NA 42.83 MMM

59620 ............ A Attempted vbac delivery only ............................. 17.53 NA 17.55 2.55 NA 37.63 MMM

59622 ............ A Attempted vbac after care .................................. 18.93 NA 7.86 2.73 NA 29.52 MMM

59812 ............ A Treatment of miscarriage ................................... 3.25 3.59 2.21 0.77 7.61 6.23 090

59820 ............ A Care of miscarriage ............................................ 4.01 3.93 2.50 0.77 8.71 7.28 090

59821 ............ A Treatment of miscarriage ................................... 4.47 4.13 2.67 0.62 9.22 7.76 090

59830 ............ A Treat uterus infection ......................................... 6.11 NA 3.64 0.52 NA 10.27 090

59840 ............ A Abortion .............................................................. 3.01 3.85 2.08 0.69 7.55 5.78 010

59841 ............ A Abortion .............................................................. 5.24 5.30 3.28 0.76 11.30 9.28 010

59850 ............ A Abortion .............................................................. 5.91 NA 2.77 0.85 NA 9.53 090

59851 ............ A Abortion .............................................................. 5.93 NA 3.07 0.88 NA 9.88 090

59852 ............ A Abortion .............................................................. 8.24 NA 4.05 1.27 NA 13.56 090

59855 ............ A Abortion .............................................................. 6.12 NA 3.12 0.96 NA 10.20 090

59856 ............ A Abortion .............................................................. 7.48 NA 3.75 1.19 NA 12.42 090

59857 ............ A Abortion .............................................................. 9.29 NA 10.55 1.44 NA 21.28 090

59866 ............ A Abortion .............................................................. 4.00 NA 4.69 0.66 NA 9.35 000

59870 ............ A Evacuate mole of uterus .................................... 4.28 NA 2.99 0.67 NA 7.94 090

59871 ............ A Remove cerclage suture .................................... 2.13 3.59 2.17 0.41 6.13 4.71 000

60000 ............ A Drain thyroid/tongue cyst ................................... 1.76 1.56 1.65 0.09 3.41 3.50 010

60001 ............ A Aspirate/inject thyriod cyst ................................. 0.97 1.47 0.36 0.12 2.56 1.45 000

60100 ............ A Biopsy of thyroid ................................................ 0.97 1.88 0.72 0.12 2.97 1.81 000

60200 ............ A Remove thyroid lesion ....................................... 9.55 NA 6.23 1.04 NA 16.82 090

60210 ............ A Partial excision thyroid ....................................... 10.88 NA 6.20 1.65 NA 18.73 090

60212 ............ A Parital thyroid excision ....................................... 16.03 NA 8.19 1.74 NA 25.96 090

60220 ............ A Partial removal of thyroid ................................... 10.53 NA 6.31 1.61 NA 18.45 090

60225 ............ A Partial removal of thyroid ................................... 14.19 NA 8.08 1.92 NA 24.19 090

60240 ............ A Removal of thyroid ............................................. 16.06 NA 9.13 1.96 NA 27.15 090

60252 ............ A Removal of thyroid ............................................. 18.20 NA 10.75 2.55 NA 31.50 090

60254 ............ A Extensive thyroid surgery ................................... 23.88 NA 14.70 3.08 NA 41.66 090

60260 ............ A Repeat thyroid surgery ....................................... 15.46 NA 9.42 0.34 NA 25.22 090

60270 ............ A Removal of thyroid ............................................. 17.94 NA 10.61 2.54 NA 31.09 090

60271 ............ A Removal of thyroid ............................................. 14.89 NA 8.98 2.25 NA 26.12 090

60280 ............ A Remove thyroid duct lesion ............................... 6.08 NA 4.89 1.11 NA 12.08 090

60281 ............ A Remove thyroid duct lesion ............................... 8.53 NA 5.94 0.95 NA 15.42 090

60500 ............ A Explore parathyroid glands ................................ 16.23 NA 8.14 2.31 NA 26.68 090

60502 ............ A Re-explore parathyroids ..................................... 20.35 NA 10.27 2.33 NA 32.95 090

60505 ............ A Explore parathyroid glands ................................ 21.49 NA 11.63 2.56 NA 35.68 090

60512 ............ A Autotransplant, parathyroid ................................ 4.45 NA 2.04 0.54 NA 7.03 ZZZ

60520 ............ A Removal of thymus gland .................................. 16.81 NA 9.26 2.46 NA 28.53 090

60521 ............ A Removal thymus gland ...................................... 18.87 NA 10.85 2.46 NA 32.18 090

60522 ............ A Removal of thymus gland .................................. 23.09 NA 12.72 2.46 NA 38.27 090

60540 ............ A Explore adrenal gland ........................................ 17.03 NA 8.46 2.08 NA 27.57 090

60545 ............ A Explore adrenal gland ........................................ 19.88 NA 9.89 2.34 NA 32.11 090

60600 ............ A Remove carotid body lesion .............................. 17.93 NA 12.24 1.88 NA 32.05 090

60605 ............ A Remove carotid body lesion .............................. 20.24 NA 17.68 2.21 NA 40.13 090

61000 ............ A Remove cranial cavity fluid ................................ 1.58 1.26 1.30 0.17 3.01 3.05 000

61001 ............ A Remove cranial cavity fluid ................................ 1.49 1.24 1.27 0.17 2.90 2.93 000

61020 ............ A Remove brain cavity fluid ................................... 1.51 1.30 1.23 0.20 3.01 2.94 000

61026 ............ A Injection into brain canal .................................... 1.69 1.33 1.28 0.22 3.24 3.19 000

61050 ............ A Remove brain canal fluid ................................... 1.51 NA 1.34 0.15 NA 3.00 000

61055 ............ A Injection into brain canal .................................... 2.10 NA 1.45 0.19 NA 3.74 000

61070 ............ A Brain canal shunt procedure .............................. 0.89 3.37 0.84 0.03 4.29 1.76 000

61105 ............ A Drill skull for examination ................................... 5.14 NA 3.51 1.24 NA 9.89 090
30957

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

61106 ............ A Drill skull for exam/surgery ................................ 4.62 NA 2.67 1.15 NA 8.44 ZZZ

61107 ............ A Drill skull for implantation ................................... 5.00 NA 3.13 1.26 NA 9.39 000

61108 ............ A Drill skull for drainage ........................................ 10.19 NA 6.82 2.22 NA 19.23 090

61120 ............ A Pierce skull for examination ............................... 8.76 NA 5.73 1.08 NA 15.57 090

61130 ............ A Pierce skull, exam/surgery ................................. 6.37 NA 3.71 0.96 NA 11.04 ZZZ

61140 ............ A Pierce skull for biopsy ........................................ 15.90 NA 10.04 2.56 NA 28.50 090

61150 ............ A Pierce skull for drainage .................................... 17.57 NA 10.62 2.63 NA 30.82 090

61151 ............ A Pierce skull for drainage .................................... 12.42 NA 8.03 0.37 NA 20.82 090

61154 ............ A Pierce skull, remove clot .................................... 14.99 NA 9.45 3.27 NA 27.71 090

61156 ............ A Pierce skull for drainage .................................... 16.32 NA 10.26 3.05 NA 29.63 090

61210 ............ A Pierce skull; implant device ............................... 5.84 NA 3.67 1.53 NA 11.04 000

61215 ............ A Insert brain-fluid device ...................................... 4.89 NA 3.87 1.63 NA 10.39 090

61250 ............ A Pierce skull & explore ........................................ 10.42 NA 6.74 1.44 NA 18.60 090

61253 ............ A Pierce skull & explore ........................................ 12.36 NA 7.87 1.69 NA 21.92 090

61304 ............ A Open skull for exploration .................................. 21.96 NA 13.26 4.78 NA 40.00 090

61305 ............ A Open skull for exploration .................................. 26.61 NA 15.78 5.05 NA 47.44 090

61312 ............ A Open skull for drainage ...................................... 24.57 NA 14.75 4.46 NA 43.78 090

61313 ............ A Open skull for drainage ...................................... 24.93 NA 15.30 4.38 NA 44.61 090

61314 ............ A Open skull for drainage ...................................... 24.23 NA 14.74 4.68 NA 43.65 090

61315 ............ A Open skull for drainage ...................................... 27.68 NA 17.03 4.47 NA 49.18 090

61320 ............ A Open skull for drainage ...................................... 25.62 NA 15.91 3.41 NA 44.94 090

61321 ............ A Open skull for drainage ...................................... 28.50 NA 17.28 3.54 NA 49.32 090

61330 ............ A Decompress eye socket ..................................... 23.32 NA 18.40 1.22 NA 42.94 090

61332 ............ A Explore/biopsy eye socket ................................. 27.28 NA 20.32 2.76 NA 50.36 090

61333 ............ A Explore orbit; remove lesion .............................. 27.95 NA 19.48 3.26 NA 50.69 090

61334 ............ A Explore orbit; remove object .............................. 18.27 NA 11.98 1.82 NA 32.07 090

61340 ............ A Relieve cranial pressure .................................... 18.66 NA 11.75 2.54 NA 32.95 090

61343 ............ A Incise skull, pressure relief ................................ 29.77 NA 18.69 5.28 NA 53.74 090

61345 ............ A Relieve cranial pressure .................................... 27.20 NA 16.48 3.45 NA 47.13 090

61440 ............ A Incise skull for surgery ....................................... 26.63 NA 14.53 3.00 NA 44.16 090

61450 ............ A Incise skull for surgery ....................................... 25.95 NA 15.66 3.43 NA 45.04 090

61458 ............ A Incise skull for brain wound ............................... 27.29 NA 16.70 4.87 NA 48.86 090

61460 ............ A Incise skull for surgery ....................................... 28.39 NA 17.74 3.98 NA 50.11 090

61470 ............ A Incise skull for surgery ....................................... 26.06 NA 16.40 2.53 NA 44.99 090

61480 ............ A Incise skull for surgery ....................................... 26.49 NA 32.47 1.78 NA 60.74 090

61490 ............ A Incise skull for surgery ....................................... 25.66 NA 15.39 2.16 NA 43.21 090

61500 ............ A Removal of skull lesion ...................................... 17.92 NA 11.45 3.58 NA 32.95 090

61501 ............ A Remove infected skull bone ............................... 14.84 NA 9.58 3.33 NA 27.75 090

61510 ............ A Removal of brain lesion ..................................... 28.45 NA 17.40 4.90 NA 50.75 090

61512 ............ A Remove brain lining lesion ................................. 35.09 NA 21.10 5.28 NA 61.47 090

61514 ............ A Removal of brain abscess ................................. 25.26 NA 15.37 4.74 NA 45.37 090

61516 ............ A Removal of brain lesion ..................................... 24.61 NA 15.37 4.57 NA 44.55 090

61518 ............ A Removal of brain lesion ..................................... 37.32 NA 23.03 5.46 NA 65.81 090

61519 ............ A Remove brain lining lesion ................................. 41.39 NA 25.28 5.77 NA 72.44 090

61520 ............ A Removal of brain lesion ..................................... 54.84 NA 33.94 5.89 NA 94.67 090

61521 ............ A Removal of brain lesion ..................................... 44.48 NA 27.27 5.85 NA 77.60 090

61522 ............ A Removal of brain abscess ................................. 29.45 NA 19.01 3.79 NA 52.25 090

61524 ............ A Removal of brain lesion ..................................... 27.86 NA 17.28 5.15 NA 50.29 090

61526 ............ A Removal of brain lesion ..................................... 52.17 NA 33.40 4.79 NA 90.36 090

61530 ............ A Removal of brain lesion ..................................... 43.86 NA 29.39 4.79 NA 78.04 090

61531 ............ A Implant brain electrodes ..................................... 14.63 NA 9.56 1.75 NA 25.94 090

61533 ............ A Implant brain electrodes ..................................... 19.71 NA 12.33 3.33 NA 35.37 090

61534 ............ A Removal of brain lesion ..................................... 20.97 NA 13.26 2.01 NA 36.24 090

61535 ............ A Remove brain electrodes ................................... 11.63 NA 8.05 1.25 NA 20.93 090

61536 ............ A Removal of brain lesion ..................................... 35.52 NA 21.77 3.99 NA 61.28 090

61538 ............ A Removal of brain tissue ..................................... 26.81 NA 17.07 4.97 NA 48.85 090

61539 ............ A Removal of brain tissue ..................................... 32.08 NA 18.98 4.07 NA 55.13 090

61541 ............ A Incision of brain tissue ....................................... 28.85 NA 18.26 3.78 NA 50.89 090

61542 ............ A Removal of brain tissue ..................................... 31.02 NA 17.53 3.90 NA 52.45 090

61543 ............ A Removal of brain tissue ..................................... 29.22 NA 18.17 2.49 NA 49.88 090

61544 ............ A Remove & treat brain lesion .............................. 25.50 NA 16.41 2.11 NA 44.02 090

61545 ............ A Excision of brain tumor ...................................... 43.80 NA 26.55 4.80 NA 75.15 090

61546 ............ A Removal of pituitary gland ................................. 31.30 NA 19.32 4.78 NA 55.40 090

61548 ............ A Removal of pituitary gland ................................. 21.53 NA 14.40 4.03 NA 39.96 090

61550 ............ A Release of skull seams ...................................... 14.65 NA 6.61 1.11 NA 22.37 090

61552 ............ A Release of skull seams ...................................... 19.56 NA 10.26 2.70 NA 32.52 090

61556 ............ A Incise skull/sutures ............................................. 22.26 NA 11.78 3.04 NA 37.08 090

61557 ............ A Incise skull/sutures ............................................. 22.38 NA 11.40 3.05 NA 36.83 090

61558 ............ A Excision of skull/sutures ..................................... 25.58 NA 16.83 3.47 NA 45.88 090

61559 ............ A Excision of skull/sutures ..................................... 32.79 NA 21.49 4.50 NA 58.78 090

61563 ............ A Excision of skull tumor ....................................... 26.83 NA 17.62 3.68 NA 48.13 090

61564 ............ A Excision of skull tumor ....................................... 33.83 NA 22.16 4.64 NA 60.63 090

61570 ............ A Remove brain foreign body ................................ 24.60 NA 14.66 3.06 NA 42.32 090

61571 ............ A Incise skull for brain wound ............................... 26.39 NA 16.46 3.21 NA 46.06 090
30958

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

61575 ............ A Skull base/brainstem surgery ............................. 34.36 NA 23.04 5.05 NA 62.45 090

61576 ............ A Skull base/brainstem surgery ............................. 52.43 NA 36.28 3.91 NA 92.62 090

61580 ............ A Craniofacial approach, skull ............................... 30.35 NA 20.42 4.10 NA 54.87 090

61581 ............ A Craniofacial approach, skull ............................... 34.60 NA 23.59 4.66 NA 62.85 090

61582 ............ A Craniofacial approach, skull ............................... 31.66 NA 19.47 4.22 NA 55.35 090

61583 ............ A Craniofacial approach, skull ............................... 36.21 NA 22.95 4.83 NA 63.99 090

61584 ............ A Orbitocranial approach/skull ............................... 34.65 NA 21.45 4.68 NA 60.78 090

61585 ............ A Orbitocranial approach/skull ............................... 38.61 NA 25.32 5.23 NA 69.16 090

61586 ............ A Resect nasopharynx, skull ................................. 25.10 NA 18.73 2.32 NA 46.15 090

61590 ............ A Infratemporal approach/skull .............................. 41.78 NA 28.03 5.68 NA 75.49 090

61591 ............ A Infratemporal approach/skull .............................. 43.68 NA 29.19 5.96 NA 78.83 090

61592 ............ A Orbitocranial approach/skull ............................... 39.64 NA 24.66 5.41 NA 69.71 090

61595 ............ A Transtemporal approach/skull ............................ 29.57 NA 20.52 4.00 NA 54.09 090

61596 ............ A Transcochlear approach/skull ............................ 35.63 NA 24.72 4.86 NA 65.21 090

61597 ............ A Transcondylar approach/skull ............................ 37.96 NA 22.85 5.13 NA 65.94 090

61598 ............ A Transpetrosal approach/skull ............................. 33.41 NA 22.09 4.52 NA 60.02 090

61600 ............ A Resect/excise cranial lesion ............................... 25.85 NA 18.10 3.46 NA 47.41 090

61601 ............ A Resect/excise cranial lesion ............................... 27.89 NA 17.64 3.72 NA 49.25 090

61605 ............ A Resect/excise cranial lesion ............................... 29.33 NA 19.91 3.93 NA 53.17 090

61606 ............ A Resect/excise cranial lesion ............................... 38.83 NA 23.98 5.25 NA 68.06 090

61607 ............ A Resect/excise cranial lesion ............................... 36.27 NA 22.45 4.91 NA 63.63 090

61608 ............ A Resect/excise cranial lesion ............................... 42.10 NA 25.98 5.71 NA 73.79 090

61609 ............ A Transect, artery, sinus ....................................... 9.89 NA 5.36 1.40 NA 16.65 ZZZ

61610 ............ A Transect, artery, sinus ....................................... 29.67 NA 16.40 4.21 NA 50.28 ZZZ

61611 ............ A Transect, artery, sinus ....................................... 7.42 NA 8.99 1.06 NA 17.47 ZZZ

61612 ............ A Transect, artery, sinus ....................................... 27.88 NA 15.35 3.96 NA 47.19 ZZZ

61613 ............ A Remove aneurysm, sinus .................................. 40.86 NA 24.84 5.61 NA 71.31 090

61615 ............ A Resect/excise lesion, skull ................................. 32.07 NA 21.56 4.31 NA 57.94 090

61616 ............ A Resect/excise lesion, skull ................................. 43.33 NA 27.06 5.86 NA 76.25 090

61618 ............ A Repair dura ........................................................ 16.99 NA 11.54 2.22 NA 30.75 090

61619 ............ A Repair dura ........................................................ 20.71 NA 14.37 2.77 NA 37.85 090

61624 ............ A Occlusion/embolization cath .............................. 20.15 NA 12.30 1.79 NA 34.24 000

61626 ............ A Occlusion/embolization cath .............................. 16.62 NA 9.57 1.47 NA 27.66 000

61680 ............ A Intracranial vessel surgery ................................. 30.71 NA 18.58 5.79 NA 55.08 090

61682 ............ A Intracranial vessel surgery ................................. 61.57 NA 36.19 6.36 NA 104.12 090

61684 ............ A Intracranial vessel surgery ................................. 39.81 NA 24.39 3.47 NA 67.67 090

61686 ............ A Intracranial vessel surgery ................................. 64.49 NA 36.48 4.20 NA 105.17 090

61690 ............ A Intracranial vessel surgery ................................. 29.31 NA 18.15 4.09 NA 51.55 090

61692 ............ A Intracranial vessel surgery ................................. 51.87 NA 31.20 3.36 NA 86.43 090

61700 ............ A Inner skull vessel surgery .................................. 50.52 NA 29.37 5.67 NA 85.56 090

61702 ............ A Inner skull vessel surgery .................................. 48.41 NA 28.26 6.61 NA 83.28 090

61703 ............ A Clamp neck artery .............................................. 17.47 NA 11.29 2.24 NA 31.00 090

61705 ............ A Revise circulation to head .................................. 36.20 NA 20.67 5.25 NA 62.12 090

61708 ............ A Revise circulation to head .................................. 35.30 NA 15.87 2.32 NA 53.49 090

61710 ............ A Revise circulation to head .................................. 29.67 NA 14.80 1.75 NA 46.22 090

61711 ............ A Fusion of skull arteries ....................................... 36.33 NA 21.45 6.20 NA 63.98 090

61712 ............ A Skull or spine microsurgery ............................... 3.49 NA 2.21 0.93 NA 6.63 ZZZ

61720 ............ A Incise skull/brain surgery ................................... 16.77 NA 10.55 4.05 NA 31.37 090

61735 ............ A Incise skull/brain surgery ................................... 20.43 NA 12.95 1.51 NA 34.89 090

61750 ............ A Incise skull; brain biopsy .................................... 18.20 NA 11.26 4.31 NA 33.77 090

61751 ............ A Brain biopsy with cat scan ................................. 17.62 NA 10.82 4.44 NA 32.88 090

61760 ............ A Implant brain electrodes ..................................... 22.27 NA 13.31 1.75 NA 37.33 090

61770 ............ A Incise skull for treatment .................................... 21.44 NA 13.67 3.43 NA 38.54 090

61790 ............ A Treat trigeminal nerve ........................................ 10.86 NA 6.57 3.03 NA 20.46 090

61791 ............ A Treat trigeminal tract .......................................... 14.61 NA 9.51 3.16 NA 27.28 090

61793 ............ A Focus radiation beam ........................................ 17.24 NA 11.21 1.96 NA 30.41 090

61795 ............ A Brain surgery using computer ............................ 4.04 NA 2.61 1.55 NA 8.20 000

61850 ............ A Implant neuroelectrodes ..................................... 12.39 NA 8.25 2.26 NA 22.90 090

61855 ............ A Implant neuroelectrodes ..................................... 13.39 NA 8.95 1.47 NA 23.81 090

61860 ............ A Implant neuroelectrodes ..................................... 20.87 NA 13.11 1.59 NA 35.57 090

61865 ............ A Implant neuroelectrodes ..................................... 22.97 NA 13.68 3.09 NA 39.74 090

61870 ............ A Implant neuroelectrodes ..................................... 14.94 NA 10.21 0.82 NA 25.97 090

61875 ............ A Implant neuroelectrodes ..................................... 15.06 NA 21.03 1.31 NA 37.40 090

61880 ............ A Revise/remove neuroelectrode .......................... 6.29 NA 4.64 0.66 NA 11.59 090

61885 ............ A Implant neuroreceiver ........................................ 5.85 NA 4.42 0.29 NA 10.56 090

61888 ............ A Revise/remove neuroreceiver ............................ 5.07 NA 3.60 0.44 NA 9.11 010

62000 ............ A Repair of skull fracture ....................................... 12.53 NA 6.11 0.95 NA 19.59 090

62005 ............ A Repair of skull fracture ....................................... 16.17 NA 9.71 1.97 NA 27.85 090

62010 ............ A Treatment of head injury .................................... 19.81 NA 12.24 3.39 NA 35.44 090

62100 ............ A Repair brain fluid leakage .................................. 22.03 NA 14.47 3.72 NA 40.22 090

62115 ............ A Reduction of skull defect .................................... 21.66 NA 13.85 1.82 NA 37.33 090

62116 ............ A Reduction of skull defect .................................... 23.59 NA 15.13 1.99 NA 40.71 090

62117 ............ A Reduction of skull defect .................................... 26.60 NA 16.82 2.25 NA 45.67 090

62120 ............ A Repair skull cavity lesion ................................... 23.35 NA 16.32 1.98 NA 41.65 090
30959

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

62121 ............ A Incise skull repair ............................................... 21.58 NA 14.65 3.41 NA 39.64 090

62140 ............ A Repair of skull defect ......................................... 13.51 NA 8.88 2.39 NA 24.78 090

62141 ............ A Repair of skull defect ......................................... 14.91 NA 9.90 3.28 NA 28.09 090

62142 ............ A Remove skull plate/flap ...................................... 10.79 NA 7.19 2.64 NA 20.62 090

62143 ............ A Replace skull plate/flap ...................................... 13.05 NA 8.77 1.65 NA 23.47 090

62145 ............ A Repair of skull & brain ....................................... 18.82 NA 12.41 2.29 NA 33.52 090

62146 ............ A Repair of skull with graft .................................... 16.12 NA 10.41 2.15 NA 28.68 090

62147 ............ A Repair of skull with graft .................................... 19.34 NA 12.51 2.57 NA 34.42 090

62180 ............ A Establish brain cavity shunt ............................... 21.06 NA 13.51 2.70 NA 37.27 090

62190 ............ A Establish brain cavity shunt ............................... 11.07 NA 7.75 3.21 NA 22.03 090

62192 ............ A Establish brain cavity shunt ............................... 12.25 NA 8.28 2.74 NA 23.27 090

62194 ............ A Replace/irrigate catheter .................................... 5.03 NA 2.49 0.29 NA 7.81 010

62200 ............ A Establish brain cavity shunt ............................... 18.32 NA 11.85 3.09 NA 33.26 090

62201 ............ A Establish brain cavity shunt ............................... 14.86 NA 10.10 1.72 NA 26.68 090

62220 ............ A Establish brain cavity shunt ............................... 13.00 NA 8.29 3.12 NA 24.41 090

62223 ............ A Establish brain cavity shunt ............................... 12.87 NA 8.36 3.02 NA 24.25 090

62225 ............ A Replace/irrigate catheter .................................... 5.41 NA 3.93 0.58 NA 9.92 090

62230 ............ A Replace/revise brain shunt ................................ 10.54 NA 6.77 1.82 NA 19.13 090

62256 ............ A Remove brain cavity shunt ................................ 6.60 NA 4.90 1.17 NA 12.67 090

62258 ............ A Replace brain cavity shunt ................................. 14.54 NA 9.12 2.55 NA 26.21 090

62268 ............ A Drain spinal cord cyst ........................................ 4.74 NA 2.47 0.36 NA 7.57 000

62269 ............ A Needle biopsy spinal cord .................................. 5.02 NA 2.43 0.28 NA 7.73 000

62270 ............ A Spinal fluid tap, diagnostic ................................. 1.13 0.64 0.40 0.06 1.83 1.59 000

62272 ............ A Drain spinal fluid ................................................ 1.35 0.79 0.58 0.12 2.26 2.05 000

62273 ............ A Treat lumbar spine lesion .................................. 2.15 1.24 0.82 0.26 3.65 3.23 000

62274 ............ A Inject spinal anesthetic ....................................... 1.78 2.37 1.22 0.17 4.32 3.17 000

62275 ............ A Inject spinal anesthetic ....................................... 1.79 2.14 1.21 0.19 4.12 3.19 000

62276 ............ A Inject spinal anesthetic ....................................... 2.04 1.89 1.46 0.23 4.16 3.73 000

62277 ............ A Inject spinal anesthetic ....................................... 2.15 3.63 1.26 0.23 6.01 3.64 000

62278 ............ A Inject spinal anesthetic ....................................... 1.51 1.52 2.16 0.26 3.29 3.93 000

62279 ............ A Inject spinal anesthetic ....................................... 1.58 1.80 1.13 0.24 3.62 2.95 000

62280 ............ A Treat spinal cord lesion ...................................... 2.63 2.29 1.49 0.14 5.06 4.26 010

62281 ............ A Treat spinal cord lesion ...................................... 2.66 2.36 1.39 0.28 5.30 4.33 010

62282 ............ A Treat spinal canal lesion .................................... 2.33 3.74 1.41 0.40 6.47 4.14 010

62284 ............ A Injection for myelogram ...................................... 1.54 2.27 0.78 0.34 4.15 2.66 000

62287 ............ A Percutaneous diskectomy .................................. 8.08 NA 4.98 2.65 NA 15.71 090

62288 ............ A Injection into spinal canal ................................... 1.74 2.48 1.36 0.24 4.46 3.34 000

62289 ............ A Injection into spinal canal ................................... 1.64 2.43 1.19 0.29 4.36 3.12 000

62290 ............ A Inject for spine disk x-ray ................................... 3.00 2.84 1.48 0.24 6.08 4.72 000

62291 ............ A Inject for spine disk x-ray ................................... 2.91 2.96 1.17 0.39 6.26 4.47 000

62292 ............ A Injection into disk lesion ..................................... 7.86 NA 4.91 2.13 NA 14.90 090

62294 ............ A Injection into spinal artery .................................. 11.83 NA 6.64 0.68 NA 19.15 090

62298 ............ A Injection into spinal canal ................................... 2.20 2.45 1.25 0.13 4.78 3.58 000

62350 ............ A Implant spinal catheter ....................................... 6.87 NA 3.29 1.02 NA 11.18 090

62351 ............ A Implant spinal catheter ....................................... 10.00 NA 6.04 1.50 NA 17.54 090

62355 ............ A Remove spinal canal catheter ........................... 5.45 NA 2.26 0.68 NA 8.39 090

62360 ............ A Insert spine infusion device ............................... 2.62 NA 2.18 0.33 NA 5.13 090

62361 ............ A Implant spine infusion pump .............................. 5.42 NA 2.63 0.78 NA 8.83 090

62362 ............ A Implant spine infusion pump .............................. 7.04 NA 3.87 1.02 NA 11.93 090

62365 ............ A Remove spine infusion device ........................... 5.42 NA 2.88 0.68 NA 8.98 090

62367 26 A Analyze spine infusion pump ............................. 0.48 0.10 0.10 0.07 0.65 0.65 XXX

62368 26 A Analyze spine infusion pump ............................. 0.75 0.16 0.16 0.11 1.02 1.02 XXX

63001 ............ A Removal of spinal lamina ................................... 15.82 NA 10.73 3.42 NA 29.97 090

63003 ............ A Removal of spinal lamina ................................... 15.95 NA 10.73 3.23 NA 29.91 090

63005 ............ A Removal of spinal lamina ................................... 14.92 NA 10.60 3.10 NA 28.62 090

63011 ............ A Removal of spinal lamina ................................... 14.52 NA 10.02 1.87 NA 26.41 090

63012 ............ A Removal of spinal lamina ................................... 15.40 NA 10.51 3.15 NA 29.06 090

63015 ............ A Removal of spinal lamina ................................... 19.35 NA 12.63 4.18 NA 36.16 090

63016 ............ A Removal of spinal lamina ................................... 19.20 NA 12.90 4.11 NA 36.21 090

63017 ............ A Removal of spinal lamina ................................... 15.94 NA 11.18 4.00 NA 31.12 090

63020 ............ A Neck spine disk surgery ..................................... 14.81 NA 10.25 3.38 NA 28.44 090

63030 ............ A Low back disk surgery ....................................... 12.00 NA 8.73 2.81 NA 23.54 090

63035 ............ A Added spinal disk surgery .................................. 3.15 NA 2.10 0.76 NA 6.01 ZZZ

63040 ............ A Neck spine disk surgery ..................................... 18.81 NA 12.81 4.30 NA 35.92 090

63042 ............ A Low back disk surgery ....................................... 17.47 NA 11.99 4.38 NA 33.84 090

63045 ............ A Removal of spinal lamina ................................... 16.50 NA 11.21 4.38 NA 32.09 090

63046 ............ A Removal of spinal lamina ................................... 15.80 NA 10.99 4.58 NA 31.37 090

63047 ............ A Removal of spinal lamina ................................... 14.61 NA 10.46 4.48 NA 29.55 090

63048 ............ A Removal of spinal lamina ................................... 3.26 NA 2.23 1.03 NA 6.52 ZZZ

63055 ............ A Decompress spinal cord .................................... 21.99 NA 14.35 4.18 NA 40.52 090

63056 ............ A Decompress spinal cord .................................... 20.36 NA 13.92 3.76 NA 38.04 090

63057 ............ A Decompress spinal cord .................................... 5.26 NA 3.19 0.85 NA 9.30 ZZZ

63064 ............ A Decompress spinal cord .................................... 24.61 NA 16.30 4.09 NA 45.00 090

63066 ............ A Decompress spinal cord .................................... 3.26 NA 2.18 0.45 NA 5.89 ZZZ
30960

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

63075 ............ A Neck spine disk surgery ..................................... 19.41 NA 12.78 3.21 NA 35.40 090

63076 ............ A Neck spine disk surgery ..................................... 4.05 NA 2.73 0.97 NA 7.75 ZZZ

63077 ............ A Spine disk surgery, thorax ................................. 21.44 NA 14.91 3.17 NA 39.52 090

63078 ............ A Spine disk surgery, thorax ................................. 3.28 NA 2.34 0.45 NA 6.07 ZZZ

63081 ............ A Removal of vertebral body ................................. 23.73 NA 15.84 4.50 NA 44.07 090

63082 ............ A Removal of vertebral body ................................. 4.37 NA 2.96 1.22 NA 8.55 ZZZ

63085 ............ A Removal of vertebral body ................................. 26.92 NA 17.86 4.69 NA 49.47 090

63086 ............ A Removal of vertebral body ................................. 3.19 NA 1.35 1.07 NA 5.61 ZZZ

63087 ............ A Removal of vertebral body ................................. 35.57 NA 22.64 4.85 NA 63.06 090

63088 ............ A Removal of vertebral body ................................. 4.33 NA 2.98 1.18 NA 8.49 ZZZ

63090 ............ A Removal of vertebral body ................................. 28.16 NA 18.37 4.92 NA 51.45 090

63091 ............ A Removal of vertebral body ................................. 3.03 NA 2.10 0.46 NA 5.59 ZZZ

63170 ............ A Incise spinal cord tract(s) ................................... 19.83 NA 13.17 3.28 NA 36.28 090

63172 ............ A Drainage of spinal cyst ...................................... 17.66 NA 12.04 4.26 NA 33.96 090

63173 ............ A Drainage of spinal cyst ...................................... 21.99 NA 14.50 1.81 NA 38.30 090

63180 ............ A Revise spinal cord ligaments ............................. 18.27 NA 11.80 2.05 NA 32.12 090

63182 ............ A Revise spinal cord ligaments ............................. 20.50 NA 13.00 2.21 NA 35.71 090

63185 ............ A Incise spinal column/nerves ............................... 15.04 NA 9.89 2.93 NA 27.86 090

63190 ............ A Incise spinal column/nerves ............................... 17.45 NA 11.57 3.91 NA 32.93 090

63191 ............ A Incise spinal column/nerves ............................... 17.54 NA 12.16 2.21 NA 31.91 090

63194 ............ A Incise spinal column & cord ............................... 19.19 NA 13.04 2.33 NA 34.56 090

63195 ............ A Incise spinal column & cord ............................... 18.84 NA 12.24 2.11 NA 33.19 090

63196 ............ A Incise spinal column & cord ............................... 22.30 NA 12.39 1.83 NA 36.52 090

63197 ............ A Incise spinal column & cord ............................... 21.11 NA 13.78 2.62 NA 37.51 090

63198 ............ A Incise spinal column & cord ............................... 25.38 NA 33.47 3.19 NA 62.04 090

63199 ............ A Incise spinal column & cord ............................... 26.89 NA 12.16 2.61 NA 41.66 090

63200 ............ A Release of spinal cord ....................................... 19.18 NA 12.21 1.83 NA 33.22 090

63250 ............ A Revise spinal cord vessels ................................ 40.76 NA 23.31 5.22 NA 69.29 090

63251 ............ A Revise spinal cord vessels ................................ 41.20 NA 24.91 4.32 NA 70.43 090

63252 ............ A Revise spinal cord vessels ................................ 41.19 NA 22.74 5.52 NA 69.45 090

63265 ............ A Excise intraspinal lesion ..................................... 21.56 NA 13.88 3.90 NA 39.34 090

63266 ............ A Excise intraspinal lesion ..................................... 22.30 NA 14.16 4.43 NA 40.89 090

63267 ............ A Excise intraspinal lesion ..................................... 17.95 NA 11.93 4.20 NA 34.08 090

63268 ............ A Excise intraspinal lesion ..................................... 18.52 NA 11.63 2.46 NA 32.61 090

63270 ............ A Excise intraspinal lesion ..................................... 26.80 NA 16.57 3.42 NA 46.79 090

63271 ............ A Excise intraspinal lesion ..................................... 26.92 NA 16.80 4.79 NA 48.51 090

63272 ............ A Excise intraspinal lesion ..................................... 25.32 NA 15.72 4.26 NA 45.30 090

63273 ............ A Excise intraspinal lesion ..................................... 24.29 NA 15.41 3.12 NA 42.82 090

63275 ............ A Biopsy/excise spinal tumor ................................ 23.68 NA 14.78 5.09 NA 43.55 090

63276 ............ A Biopsy/excise spinal tumor ................................ 23.45 NA 14.78 4.62 NA 42.85 090

63277 ............ A Biopsy/excise spinal tumor ................................ 20.83 NA 13.44 4.25 NA 38.52 090

63278 ............ A Biopsy/excise spinal tumor ................................ 20.56 NA 13.18 4.32 NA 38.06 090

63280 ............ A Biopsy/excise spinal tumor ................................ 28.35 NA 17.77 4.99 NA 51.11 090

63281 ............ A Biopsy/excise spinal tumor ................................ 28.05 NA 17.40 4.96 NA 50.41 090

63282 ............ A Biopsy/excise spinal tumor ................................ 26.39 NA 16.53 4.44 NA 47.36 090

63283 ............ A Biopsy/excise spinal tumor ................................ 25.00 NA 15.98 3.44 NA 44.42 090

63285 ............ A Biopsy/excise spinal tumor ................................ 36.00 NA 21.55 4.49 NA 62.04 090

63286 ............ A Biopsy/excise spinal tumor ................................ 35.63 NA 21.97 4.92 NA 62.52 090

63287 ............ A Biopsy/excise spinal tumor ................................ 36.70 NA 22.55 4.53 NA 63.78 090

63290 ............ A Biopsy/excise spinal tumor ................................ 37.38 NA 22.74 4.65 NA 64.77 090

63300 ............ A Removal of vertebral body ................................. 24.43 NA 15.51 2.02 NA 41.96 090

63301 ............ A Removal of vertebral body ................................. 27.60 NA 17.36 3.58 NA 48.54 090

63302 ............ A Removal of vertebral body ................................. 27.81 NA 18.00 3.02 NA 48.83 090

63303 ............ A Removal of vertebral body ................................. 30.50 NA 18.91 3.39 NA 52.80 090

63304 ............ A Removal of vertebral body ................................. 30.33 NA 18.67 2.49 NA 51.49 090

63305 ............ A Removal of vertebral body ................................. 32.03 NA 19.28 3.75 NA 55.06 090

63306 ............ A Removal of vertebral body ................................. 32.22 NA 19.95 2.65 NA 54.82 090

63307 ............ A Removal of vertebral body ................................. 31.63 NA 17.92 2.98 NA 52.53 090

63308 ............ A Removal of vertebral body ................................. 5.25 NA 3.17 0.73 NA 9.15 ZZZ

63600 ............ A Remove spinal cord lesion ................................. 14.02 NA 5.15 2.63 NA 21.80 090

63610 ............ A Stimulation of spinal cord ................................... 8.73 NA 2.31 2.06 NA 13.10 000

63615 ............ A Remove lesion of spinal cord ............................ 16.28 NA 10.48 2.03 NA 28.79 090

63650 ............ A Implant neuroelectrodes ..................................... 6.74 NA 2.48 2.13 NA 11.35 090

63655 ............ A Implant neuroelectrodes ..................................... 10.29 NA 7.28 3.64 NA 21.21 090

63660 ............ A Revise/remove neuroelectrode .......................... 6.16 NA 3.22 1.56 NA 10.94 090

63685 ............ A Implant neuroreceiver ........................................ 7.04 NA 3.67 1.46 NA 12.17 090

63688 ............ A Revise/remove neuroreceiver ............................ 5.39 NA 3.27 1.26 NA 9.92 090

63690 ............ A Analysis of neuroreceiver ................................... 0.45 0.31 0.24 0.12 0.88 0.81 XXX

63691 ............ A Analysis of neuroreceiver ................................... 0.65 0.41 0.35 0.11 1.17 1.11 XXX

63700 ............ A Repair of spinal herniation ................................. 16.53 NA 10.92 2.22 NA 29.67 090

63702 ............ A Repair of spinal herniation ................................. 18.48 NA 11.93 2.49 NA 32.90 090

63704 ............ A Repair of spinal herniation ................................. 21.18 NA 14.82 2.77 NA 38.77 090

63706 ............ A Repair of spinal herniation ................................. 24.11 NA 15.25 3.18 NA 42.54 090

63707 ............ A Repair spinal fluid leakage ................................. 11.26 NA 8.05 2.56 NA 21.87 090
30961

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

63709 ............ A Repair spinal fluid leakage ................................. 14.32 NA 10.23 3.30 NA 27.85 090

63710 ............ A Graft repair of spine defect ................................ 14.07 NA 9.67 1.58 NA 25.32 090

63740 ............ A Install spinal shunt ............................................. 11.36 NA 7.83 2.99 NA 22.18 090

63741 ............ A Install spinal shunt ............................................. 8.25 NA 4.93 2.39 NA 15.57 090

63744 ............ A Revision of spinal shunt ..................................... 8.10 NA 4.95 1.68 NA 14.73 090

63746 ............ A Removal of spinal shunt .................................... 6.43 NA 3.39 1.08 NA 10.90 090

64400 ............ A Injection for nerve block ..................................... 1.11 1.44 1.03 0.05 2.60 2.19 000

64402 ............ A Injection for nerve block ..................................... 1.25 2.85 1.19 0.09 4.19 2.53 000

64405 ............ A Injection for nerve block ..................................... 1.32 1.49 0.99 0.07 2.88 2.38 000

64408 ............ A Injection for nerve block ..................................... 1.41 1.68 1.36 0.11 3.20 2.88 000

64410 ............ A Injection for nerve block ..................................... 1.43 1.56 1.12 0.15 3.14 2.70 000

64412 ............ A Injection for nerve block ..................................... 1.18 1.52 0.96 0.08 2.78 2.22 000

64413 ............ A Injection for nerve block ..................................... 1.40 1.74 1.17 0.08 3.22 2.65 000

64415 ............ A Injection for nerve block ..................................... 1.48 1.52 1.12 0.07 3.07 2.67 000

64417 ............ A Injection for nerve block ..................................... 1.44 1.44 1.09 0.15 3.03 2.68 000

64418 ............ A Injection for nerve block ..................................... 1.32 1.42 0.98 0.10 2.84 2.40 000

64420 ............ A Injection for nerve block ..................................... 1.18 1.47 0.98 0.07 2.72 2.23 000

64421 ............ A Injection for nerve block ..................................... 1.68 1.62 1.16 0.17 3.47 3.01 000

64425 ............ A Injection for nerve block ..................................... 1.75 1.43 1.07 0.10 3.28 2.92 000

64430 ............ A Injection for nerve block ..................................... 1.46 2.10 1.16 0.12 3.68 2.74 000

64435 ............ A Injection for nerve block ..................................... 1.45 2.24 1.58 0.09 3.78 3.12 000

64440 ............ A Injection for nerve block ..................................... 1.34 2.16 1.20 0.09 3.59 2.63 000

64441 ............ A Injection for nerve block ..................................... 1.79 2.29 1.25 0.12 4.20 3.16 000

64442 ............ A Injection for nerve block ..................................... 1.41 2.40 1.33 0.16 3.97 2.90 000

64443 ............ A Injection for nerve block ..................................... 0.98 2.18 1.34 0.12 3.28 2.44 ZZZ

64445 ............ A Injection for nerve block ..................................... 1.48 2.00 1.19 0.06 3.54 2.73 000

64450 ............ A Injection for nerve block ..................................... 1.27 1.00 1.00 0.05 2.32 2.32 000

64505 ............ A Injection for nerve block ..................................... 1.36 1.57 1.14 0.06 2.99 2.56 000

64508 ............ A Injection for nerve block ..................................... 1.12 1.69 1.42 0.08 2.89 2.62 000

64510 ............ A Injection for nerve block ..................................... 1.22 1.43 1.05 0.18 2.83 2.45 000

64520 ............ A Injection for nerve block ..................................... 1.35 2.03 1.10 0.17 3.55 2.62 000

64530 ............ A Injection for nerve block ..................................... 1.58 3.11 1.30 0.28 4.97 3.16 000

64550 ............ A Apply neurostimulator ........................................ 0.18 0.25 0.04 0.04 0.47 0.26 000

64553 ............ A Implant neuroelectrodes ..................................... 2.31 1.19 1.50 0.10 3.60 3.91 010

64555 ............ A Implant neuroelectrodes ..................................... 2.27 1.75 0.91 0.10 4.12 3.28 010

64560 ............ A Implant neuroelectrodes ..................................... 2.36 1.13 1.05 0.24 3.73 3.65 010

64565 ............ A Implant neuroelectrodes ..................................... 1.76 1.77 0.73 0.08 3.61 2.57 010

64573 ............ A Implant neuroelectrodes ..................................... 4.43 NA 2.77 0.61 NA 7.81 090

64575 ............ A Implant neuroelectrodes ..................................... 4.35 NA 3.07 0.40 NA 7.82 090

64577 ............ A Implant neuroelectrodes ..................................... 4.62 NA 3.02 0.45 NA 8.09 090

64580 ............ A Implant neuroelectrodes ..................................... 4.12 NA 2.55 0.20 NA 6.87 090

64585 ............ A Revise/remove neuroelectrode .......................... 2.06 1.66 1.54 0.09 3.81 3.69 010

64590 ............ A Implant neuroreceiver ........................................ 2.40 NA 2.18 0.35 NA 4.93 010

64595 ............ A Revise/remove neuroreceiver ............................ 1.73 NA 1.55 0.21 NA 3.49 010

64600 ............ A Injection treatment of nerve ............................... 3.45 2.22 1.88 0.17 5.84 5.50 010

64605 ............ A Injection treatment of nerve ............................... 5.61 4.38 2.31 0.33 10.32 8.25 010

64610 ............ A Injection treatment of nerve ............................... 7.16 NA 4.22 1.35 NA 12.73 010

64612 ............ A Destroy nerve, face muscle ............................... 1.96 2.41 2.10 0.17 4.54 4.23 010

64613 ............ A Destroy nerve, spine muscle ............................. 1.96 1.23 1.18 0.17 3.36 3.31 010

64620 ............ A Injection treatment of nerve ............................... 2.84 1.87 1.47 0.19 4.90 4.50 010

64622 ............ A Injection treatment of nerve ............................... 3.00 3.33 1.56 0.35 6.68 4.91 010

64623 ............ A Injection treatment of nerve ............................... 0.99 2.08 1.13 0.17 3.24 2.29 ZZZ

64630 ............ A Injection treatment of nerve ............................... 3.00 2.29 1.43 0.38 5.67 4.81 010

64640 ............ A Injection treatment of nerve ............................... 2.76 2.52 1.94 0.09 5.37 4.79 010

64680 ............ A Injection treatment of nerve ............................... 2.62 1.56 1.55 0.41 4.59 4.58 010

64702 ............ A Revise finger/toe nerve ...................................... 4.23 NA 3.52 0.70 NA 8.45 090

64704 ............ A Revise hand/foot nerve ...................................... 4.57 NA 2.92 0.74 NA 8.23 090

64708 ............ A Revise arm/leg nerve ......................................... 6.12 NA 4.82 1.26 NA 12.20 090

64712 ............ A Revision of sciatic nerve .................................... 7.75 NA 4.87 1.68 NA 14.30 090

64713 ............ A Revision of arm nerve(s) .................................... 11.00 NA 6.33 1.72 NA 19.05 090

64714 ............ A Revise low back nerve(s) ................................... 10.33 NA 4.61 1.41 NA 16.35 090

64716 ............ A Revision of cranial nerve ................................... 6.31 NA 4.82 0.67 NA 11.80 090

64718 ............ A Revise ulnar nerve at elbow .............................. 5.99 NA 4.90 1.13 NA 12.02 090

64719 ............ A Revise ulnar nerve at wrist ................................ 4.85 NA 4.10 0.85 NA 9.80 090

64721 ............ A Carpal tunnel surgery ......................................... 4.29 4.68 6.98 0.83 9.80 12.10 090

64722 ............ A Relieve pressure on nerve(s) ............................. 4.70 NA 3.06 1.11 NA 8.87 090

64726 ............ A Release foot/toe nerve ....................................... 4.18 NA 2.49 0.07 NA 6.74 090

64727 ............ A Internal nerve revision ........................................ 3.10 NA 2.10 0.55 NA 5.75 ZZZ

64732 ............ A Incision of brow nerve ........................................ 4.41 NA 3.16 0.72 NA 8.29 090

64734 ............ A Incision of cheek nerve ...................................... 4.92 NA 3.23 0.67 NA 8.82 090

64736 ............ A Incision of chin nerve ......................................... 4.60 NA 2.70 0.42 NA 7.72 090

64738 ............ A Incision of jaw nerve .......................................... 5.73 NA 3.22 0.61 NA 9.56 090

64740 ............ A Incision of tongue nerve ..................................... 5.59 NA 3.55 0.62 NA 9.76 090

64742 ............ A Incision of facial nerve ....................................... 6.22 NA 4.72 0.44 NA 11.38 090
30962

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

64744 ............ A Incise nerve, back of head ................................. 5.24 NA 3.43 1.10 NA 9.77 090

64746 ............ A Incise diaphragm nerve ...................................... 5.93 NA 3.88 0.77 NA 10.58 090

64752 ............ A Incision of vagus nerve ...................................... 7.06 NA 4.07 0.85 NA 11.98 090

64755 ............ A Incision of stomach nerves ................................ 13.52 NA 6.43 2.27 NA 22.22 090

64760 ............ A Incision of vagus nerve ...................................... 6.96 NA 3.72 1.50 NA 12.18 090

64761 ............ A Incision of pelvis nerve ...................................... 6.41 NA 3.66 0.50 NA 10.57 090

64763 ............ A Incise hip/thigh nerve ......................................... 6.93 NA 5.70 0.92 NA 13.55 090

64766 ............ A Incise hip/thigh nerve ......................................... 8.67 NA 4.91 1.20 NA 14.78 090

64771 ............ A Sever cranial nerve ............................................ 7.35 NA 5.16 0.73 NA 13.24 090

64772 ............ A Incision of spinal nerve ...................................... 7.21 NA 4.03 1.30 NA 12.54 090

64774 ............ A Remove skin nerve lesion .................................. 5.17 NA 3.43 0.45 NA 9.05 090

64776 ............ A Remove digit nerve lesion ................................. 5.12 NA 3.59 0.41 NA 9.12 090

64778 ............ A Added digit nerve surgery .................................. 3.11 NA 1.95 0.43 NA 5.49 ZZZ

64782 ............ A Remove limb nerve lesion ................................. 6.23 NA 3.40 0.46 NA 10.09 090

64783 ............ A Added limb nerve surgery .................................. 3.72 NA 2.42 0.47 NA 6.61 ZZZ

64784 ............ A Remove nerve lesion ......................................... 9.82 NA 6.55 0.96 NA 17.33 090

64786 ............ A Remove sciatic nerve lesion .............................. 15.46 NA 10.12 2.14 NA 27.72 090

64787 ............ A Implant nerve end .............................................. 4.30 NA 2.51 0.60 NA 7.41 ZZZ

64788 ............ A Remove skin nerve lesion .................................. 4.61 NA 2.99 0.50 NA 8.10 090

64790 ............ A Removal of nerve lesion .................................... 11.31 NA 7.35 1.22 NA 19.88 090

64792 ............ A Removal of nerve lesion .................................... 14.92 NA 9.11 1.66 NA 25.69 090

64795 ............ A Biopsy of nerve .................................................. 3.01 NA 1.73 0.39 NA 5.13 000

64802 ............ A Remove sympathetic nerves .............................. 9.15 NA 5.06 1.10 NA 15.31 090

64804 ............ A Remove sympathetic nerves .............................. 14.64 NA 8.06 2.44 NA 25.14 090

64809 ............ A Remove sympathetic nerves .............................. 13.67 NA 6.18 2.04 NA 21.89 090

64818 ............ A Remove sympathetic nerves .............................. 10.30 NA 5.49 1.72 NA 17.51 090

64820 ............ A Remove sympathetic nerves .............................. 10.37 NA 7.87 1.42 NA 19.66 090

64830 ............ A Microrepair of nerve ........................................... 3.10 NA 2.09 0.38 NA 5.57 ZZZ

64831 ............ A Repair of digit nerve ........................................... 9.44 NA 6.91 0.56 NA 16.91 090

64832 ............ A Repair additional nerve ...................................... 5.66 NA 3.63 0.24 NA 9.53 ZZZ

64834 ............ A Repair of hand or foot nerve .............................. 10.19 NA 7.05 0.56 NA 17.80 090

64835 ............ A Repair of hand or foot nerve .............................. 10.94 NA 7.57 1.03 NA 19.54 090

64836 ............ A Repair of hand or foot nerve .............................. 10.94 NA 7.50 1.22 NA 19.66 090

64837 ............ A Repair additional nerve ...................................... 6.26 NA 3.93 0.85 NA 11.04 ZZZ

64840 ............ A Repair of leg nerve ............................................ 13.02 NA 9.09 0.53 NA 22.64 090

64856 ............ A Repair/transpose nerve ...................................... 13.80 NA 9.82 1.46 NA 25.08 090

64857 ............ A Repair arm/leg nerve ......................................... 14.49 NA 10.20 1.54 NA 26.23 090

64858 ............ A Repair sciatic nerve ........................................... 16.49 NA 10.05 2.11 NA 28.65 090

64859 ............ A Additional nerve surgery .................................... 4.26 NA 2.55 0.58 NA 7.39 ZZZ

64861 ............ A Repair of arm nerves ......................................... 19.24 NA 14.22 1.38 NA 34.84 090

64862 ............ A Repair of low back nerves ................................. 19.44 NA 8.00 1.61 NA 29.05 090

64864 ............ A Repair of facial nerve ......................................... 12.55 NA 8.83 1.16 NA 22.54 090

64865 ............ A Repair of facial nerve ......................................... 15.24 NA 10.67 1.50 NA 27.41 090

64866 ............ A Fusion of facial/other nerve ............................... 15.74 NA 10.75 1.84 NA 28.33 090

64868 ............ A Fusion of facial/other nerve ............................... 14.04 NA 9.67 1.47 NA 25.18 090

64870 ............ A Fusion of facial/other nerve ............................... 15.99 NA 20.77 1.70 NA 38.46 090

64872 ............ A Subsequent repair of nerve ............................... 1.99 NA 1.29 0.29 NA 3.57 ZZZ

64874 ............ A Repair & revise nerve ........................................ 2.98 NA 1.80 0.43 NA 5.21 ZZZ

64876 ............ A Repair nerve; shorten bone ............................... 3.38 NA 2.25 0.48 NA 6.11 ZZZ

64885 ............ A Nerve graft, head or neck .................................. 17.53 NA 11.64 1.48 NA 30.65 090

64886 ............ A Nerve graft, head or neck .................................. 20.75 NA 13.57 1.77 NA 36.09 090

64890 ............ A Nerve graft, hand or foot .................................... 15.15 NA 10.74 2.12 NA 28.01 090

64891 ............ A Nerve graft, hand or foot .................................... 16.14 NA 11.69 1.73 NA 29.56 090

64892 ............ A Nerve graft, arm or leg ....................................... 14.65 NA 10.55 1.69 NA 26.89 090

64893 ............ A Nerve graft, arm or leg ....................................... 15.60 NA 10.68 2.27 NA 28.55 090

64895 ............ A Nerve graft, hand or foot .................................... 19.25 NA 11.82 2.55 NA 33.62 090

64896 ............ A Nerve graft, hand or foot .................................... 20.49 NA 14.75 1.90 NA 37.14 090

64897 ............ A Nerve graft, arm or leg ....................................... 18.24 NA 11.06 2.47 NA 31.77 090

64898 ............ A Nerve graft, arm or leg ....................................... 19.50 NA 13.66 2.35 NA 35.51 090

64901 ............ A Additional nerve graft ......................................... 10.22 NA 6.60 0.87 NA 17.69 ZZZ

64902 ............ A Additional nerve graft ......................................... 11.83 NA 8.07 0.99 NA 20.89 ZZZ

64905 ............ A Nerve pedicle transfer ........................................ 14.02 NA 10.13 0.70 NA 24.85 090

64907 ............ A Nerve pedicle transfer ........................................ 18.83 NA 13.77 2.55 NA 35.15 090

65091 ............ A Revise eye ......................................................... 6.46 NA 8.43 0.45 NA 15.34 090

65093 ............ A Revise eye with implant ..................................... 6.87 NA 9.14 0.52 NA 16.53 090

65101 ............ A Removal of eye .................................................. 7.03 NA 9.28 0.47 NA 16.78 090

65103 ............ A Remove eye/insert implant ................................ 7.57 NA 9.63 0.50 NA 17.70 090

65105 ............ A Remove eye/attach implant ............................... 8.49 NA 10.38 0.55 NA 19.42 090

65110 ............ A Removal of eye .................................................. 13.95 NA 13.66 1.14 NA 28.75 090

65112 ............ A Remove eye, revise socket ................................ 16.38 NA 15.14 1.09 NA 32.61 090

65114 ............ A Remove eye, revise socket ................................ 17.53 NA 16.81 1.65 NA 35.99 090

65125 ............ A Revise ocular implant ......................................... 3.12 4.05 1.78 0.13 7.30 5.03 090

65130 ............ A Insert ocular implant ........................................... 7.15 NA 8.87 0.50 NA 16.52 090

65135 ............ A Insert ocular implant ........................................... 7.33 NA 9.07 0.35 NA 16.75 090
30963

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

65140 ............ A Attach ocular implant ......................................... 8.02 NA 9.49 0.33 NA 17.84 090

65150 ............ A Revise ocular implant ......................................... 6.26 NA 8.41 0.56 NA 15.23 090

65155 ............ A Reinsert ocular implant ...................................... 8.66 NA 10.02 0.90 NA 19.58 090

65175 ............ A Removal of ocular implant ................................. 6.28 NA 8.25 0.40 NA 14.93 090

65205 ............ A Remove foreign body from eye ......................... 0.71 3.17 0.23 0.02 3.90 0.96 000

65210 ............ A Remove foreign body from eye ......................... 0.84 3.18 0.26 0.03 4.05 1.13 000

65220 ............ A Remove foreign body from eye ......................... 0.71 4.56 0.22 0.04 5.31 0.97 000

65222 ............ A Remove foreign body from eye ......................... 0.93 3.17 0.23 0.03 4.13 1.19 000

65235 ............ A Remove foreign body from eye ......................... 7.57 NA 7.08 0.30 NA 14.95 090

65260 ............ A Remove foreign body from eye ......................... 10.96 NA 11.16 0.45 NA 22.57 090

65265 ............ A Remove foreign body from eye ......................... 12.59 NA 13.18 0.51 NA 26.28 090

65270 ............ A Repair of eye wound .......................................... 1.90 2.72 2.29 0.07 4.69 4.26 010

65272 ............ A Repair of eye wound .......................................... 3.82 4.32 4.04 0.10 8.24 7.96 090

65273 ............ A Repair of eye wound .......................................... 4.36 NA 4.39 0.21 NA 8.96 090

65275 ............ A Repair of eye wound .......................................... 5.34 4.47 4.28 0.04 9.85 9.66 090

65280 ............ A Repair of eye wound .......................................... 7.66 NA 8.10 0.49 NA 16.25 090

65285 ............ A Repair of eye wound .......................................... 12.90 NA 14.06 0.64 NA 27.60 090

65286 ............ A Repair of eye wound .......................................... 5.51 6.60 6.30 0.25 12.36 12.06 090

65290 ............ A Repair of eye socket wound .............................. 5.41 NA 6.59 0.37 NA 12.37 090

65400 ............ A Removal of eye lesion ....................................... 6.06 7.42 6.99 0.35 13.83 13.40 090

65410 ............ A Biopsy of cornea ................................................ 1.47 1.50 1.16 0.11 3.08 2.74 000

65420 ............ A Removal of eye lesion ....................................... 4.17 5.78 5.53 0.23 10.18 9.93 090

65426 ............ A Removal of eye lesion ....................................... 5.25 6.83 6.54 0.38 12.46 12.17 090

65430 ............ A Corneal smear .................................................... 1.47 3.62 1.03 0.03 5.12 2.53 000

65435 ............ A Curette/treat cornea ........................................... 0.92 1.16 0.48 0.04 2.12 1.44 000

65436 ............ A Curette/treat cornea ........................................... 4.19 4.51 4.25 0.08 8.78 8.52 090

65450 ............ A Treatment of corneal lesion ............................... 3.27 5.32 5.02 0.17 8.76 8.46 090

65600 ............ A Revision of cornea ............................................. 3.40 4.03 1.45 0.14 7.57 4.99 090

65710 ............ A Corneal transplant .............................................. 12.35 NA 13.50 1.13 NA 26.98 090

65730 ............ A Corneal transplant .............................................. 14.25 NA 14.30 1.29 NA 29.84 090

65750 ............ A Corneal transplant .............................................. 15.00 NA 14.90 1.33 NA 31.23 090

65755 ............ A Corneal transplant .............................................. 14.89 NA 14.73 1.39 NA 31.01 090

65770 ............ A Revise cornea with implant ................................ 17.56 NA 16.78 0.71 NA 35.05 090

65772 ............ A Correction of astigmatism .................................. 4.29 5.25 4.98 0.31 9.85 9.58 090

65775 ............ A Correction of astigmatism .................................. 5.79 NA 7.85 0.50 NA 14.14 090

65800 ............ A Drainage of eye .................................................. 1.91 1.98 1.73 0.10 3.99 3.74 000

65805 ............ A Drainage of eye .................................................. 1.91 1.99 1.74 0.10 4.00 3.75 000

65810 ............ A Drainage of eye .................................................. 4.87 NA 6.59 0.30 NA 11.76 090

65815 ............ A Drainage of eye .................................................. 5.05 6.67 6.36 0.24 11.96 11.65 090

65820 ............ A Relieve inner eye pressure ................................ 8.13 NA 8.81 0.51 NA 17.45 090

65850 ............ A Incision of eye .................................................... 10.52 NA 9.81 0.69 NA 21.02 090

65855 ............ A Laser surgery of eye .......................................... 4.30 4.61 3.88 0.52 9.43 8.70 090

65860 ............ A Incise inner eye adhesions ................................ 3.55 3.56 2.91 0.37 7.48 6.83 090

65865 ............ A Incise inner eye adhesions ................................ 5.60 NA 6.64 0.41 NA 12.65 090

65870 ............ A Incise inner eye adhesions ................................ 6.27 NA 7.02 0.31 NA 13.60 090

65875 ............ A Incise inner eye adhesions ................................ 6.54 NA 7.18 0.34 NA 14.06 090

65880 ............ A Incise inner eye adhesions ................................ 7.09 NA 7.56 0.37 NA 15.02 090

65900 ............ A Remove eye lesion ............................................ 10.93 NA 11.93 0.92 NA 23.78 090

65920 ............ A Remove implant from eye .................................. 8.40 NA 8.40 0.44 NA 17.24 090

65930 ............ A Remove blood clot from eye .............................. 7.44 NA 8.40 0.41 NA 16.25 090

66020 ............ A Injection treatment of eye .................................. 1.59 1.98 1.72 0.14 3.71 3.45 010

66030 ............ A Injection treatment of eye .................................. 1.25 1.77 1.32 0.03 3.05 2.60 010

66130 ............ A Remove eye lesion ............................................ 7.69 6.54 6.27 0.28 14.51 14.24 090

66150 ............ A Glaucoma surgery .............................................. 8.30 NA 9.01 0.59 NA 17.90 090

66155 ............ A Glaucoma surgery .............................................. 8.29 NA 9.00 0.50 NA 17.79 090

66160 ............ A Glaucoma surgery .............................................. 10.17 NA 10.01 0.55 NA 20.73 090

66165 ............ A Glaucoma surgery .............................................. 8.01 NA 8.86 0.57 NA 17.44 090

66170 ............ A Glaucoma surgery .............................................. 12.16 10.57 15.51 0.63 23.36 28.30 090

66172 ............ A Incision of eye .................................................... 15.04 NA 12.81 0.63 NA 28.48 090

66180 ............ A Implant eye shunt ............................................... 14.55 NA 13.02 1.03 NA 28.60 090

66185 ............ A Revise eye shunt ............................................... 8.14 NA 9.00 0.58 NA 17.72 090

66220 ............ A Repair eye lesion ............................................... 7.77 NA 9.21 0.34 NA 17.32 090

66225 ............ A Repair/graft eye lesion ....................................... 11.05 NA 10.47 0.86 NA 22.38 090

66250 ............ A Follow-up surgery of eye ................................... 5.98 7.38 6.96 0.38 13.74 13.32 090

66500 ............ A Incision of iris ..................................................... 3.71 NA 4.02 0.27 NA 8.00 090

66505 ............ A Incision of iris ..................................................... 4.08 NA 4.20 0.17 NA 8.45 090

66600 ............ A Remove iris and lesion ...................................... 8.68 NA 8.72 0.51 NA 17.91 090

66605 ............ A Removal of iris ................................................... 12.79 NA 13.29 0.67 NA 26.75 090

66625 ............ A Removal of iris ................................................... 5.13 6.70 6.41 0.48 12.31 12.02 090

66630 ............ A Removal of iris ................................................... 6.16 NA 7.33 0.45 NA 13.94 090

66635 ............ A Removal of iris ................................................... 6.25 NA 7.04 0.49 NA 13.78 090

66680 ............ A Repair iris & ciliary body .................................... 5.44 NA 6.63 0.35 NA 12.42 090

66682 ............ A Repair iris and ciliary body ................................ 6.21 NA 7.35 0.38 NA 13.94 090

66700 ............ A Destruction, ciliary body ..................................... 4.78 6.17 5.89 0.35 11.30 11.02 090
30964

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

66710 ............ A Destruction, ciliary body ..................................... 4.78 6.36 5.87 0.41 11.55 11.06 090

66720 ............ A Destruction, ciliary body ..................................... 4.78 6.07 5.85 0.38 11.23 11.01 090

66740 ............ A Destruction, ciliary body ..................................... 4.78 NA 6.35 0.39 NA 11.52 090

66761 ............ A Revision of iris .................................................... 4.07 3.83 3.19 0.47 8.37 7.73 090

66762 ............ A Revision of iris .................................................... 4.58 4.11 3.47 0.55 9.24 8.60 090

66770 ............ A Removal of inner eye lesion .............................. 5.18 4.46 3.81 0.45 10.09 9.44 090

66820 ............ A Incision, secondary cataract .............................. 3.89 NA 6.03 0.29 NA 10.21 090

66821 ............ A After cataract laser surgery ................................ 2.35 2.80 2.56 0.37 5.52 5.28 090

66825 ............ A Reposition intraocular lens ................................. 8.23 NA 8.49 0.38 NA 17.10 090

66830 ............ A Removal of lens lesion ....................................... 8.20 8.47 13.09 0.40 17.07 21.69 090

66840 ............ A Removal of lens material ................................... 7.91 NA 7.95 0.54 NA 16.40 090

66850 ............ A Removal of lens material ................................... 9.11 NA 8.58 0.70 NA 18.39 090

66852 ............ A Removal of lens material ................................... 9.97 NA 9.18 0.90 NA 20.05 090

66920 ............ A Extraction of lens ............................................... 8.86 NA 8.48 0.60 NA 17.94 090

66930 ............ A Extraction of lens ............................................... 10.18 NA 9.27 0.57 NA 20.02 090

66940 ............ A Extraction of lens ............................................... 8.93 NA 8.54 0.62 NA 18.09 090

66983 ............ A Remove cataract, insert lens ............................. 8.99 NA 5.94 0.95 NA 15.88 090

66984 ............ A Remove cataract, insert lens ............................. 10.28 NA 8.36 0.94 NA 19.58 090

66985 ............ A Insert lens prosthesis ......................................... 8.39 NA 7.24 0.63 NA 16.26 090

66986 ............ A Exchange lens prosthesis .................................. 12.28 NA 10.45 0.63 NA 23.36 090

67005 ............ A Partial removal of eye fluid ................................ 5.70 NA 3.42 1.13 NA 10.25 090

67010 ............ A Partial removal of eye fluid ................................ 6.87 NA 4.34 1.04 NA 12.25 090

67015 ............ A Release of eye fluid ........................................... 6.92 NA 7.55 0.35 NA 14.82 090

67025 ............ A Replace eye fluid ............................................... 6.84 10.75 7.07 0.36 17.95 14.27 090

67027 ............ A Implant eye drug system .................................... 10.85 24.75 15.60 0.47 36.07 26.92 090

67028 ............ A Injection eye drug ............................................... 2.52 5.37 1.68 0.18 8.07 4.38 000

67030 ............ A Incise inner eye strands ..................................... 4.84 NA 5.99 0.50 NA 11.33 090

67031 ............ A Laser surgery, eye strands ................................ 3.67 3.63 2.98 0.75 8.05 7.40 090

67036 ............ A Removal of inner eye fluid ................................. 11.89 NA 9.91 1.49 NA 23.29 090

67038 ............ A Strip retinal membrane ....................................... 21.24 NA 17.55 1.80 NA 40.59 090

67039 ............ A Laser treatment of retina .................................... 14.52 NA 12.59 1.68 NA 28.79 090

67040 ............ A Laser treatment of retina .................................... 17.23 NA 14.64 1.75 NA 33.62 090

67101 ............ A Repair, detached retina ...................................... 7.53 9.23 8.73 0.66 17.42 16.92 090

67105 ............ A Repair, detached retina ...................................... 7.41 7.17 5.67 0.80 15.38 13.88 090

67107 ............ A Repair detached retina ....................................... 14.84 NA 13.64 1.10 NA 29.58 090

67108 ............ A Repair detached retina ....................................... 20.82 NA 18.57 1.76 NA 41.15 090

67110 ............ A Repair detached retina ....................................... 8.81 13.73 10.00 0.97 23.51 19.78 090

67112 ............ A Re-repair detached retina .................................. 16.86 NA 15.75 0.86 NA 33.47 090

67115 ............ A Release, encircling material ............................... 4.99 NA 5.99 0.44 NA 11.42 090

67120 ............ A Remove eye implant material ............................ 5.98 10.12 6.53 0.38 16.48 12.89 090

67121 ............ A Remove eye implant material ............................ 10.67 NA 11.52 0.49 NA 22.68 090

67141 ............ A Treatment of retina ............................................. 5.20 6.47 6.18 0.48 12.15 11.86 090

67145 ............ A Treatment of retina ............................................. 5.37 5.01 4.15 0.49 10.87 10.01 090

67208 ............ A Treatment of retinal lesion ................................. 6.70 7.13 6.73 0.52 14.35 13.95 090

67210 ............ A Treatment of retinal lesion ................................. 10.05 7.98 6.80 0.47 18.50 17.32 090

67218 ............ A Treatment of retinal lesion ................................. 13.52 NA 13.52 0.70 NA 27.74 090

67227 ............ A Treatment of retinal lesion ................................. 6.58 7.23 6.94 0.51 14.32 14.03 090

67228 ............ A Treatment of retinal lesion ................................. 12.74 10.02 8.11 0.48 23.24 21.33 090

67250 ............ A Reinforce eye wall .............................................. 8.66 NA 9.58 0.40 NA 18.64 090

67255 ............ A Reinforce/graft eye wall ..................................... 8.90 NA 9.96 0.87 NA 19.73 090

67311 ............ A Revise eye muscle ............................................. 6.65 NA 6.99 0.47 NA 14.11 090

67312 ............ A Revise two eye muscles .................................... 8.54 NA 8.28 0.53 NA 17.35 090

67314 ............ A Revise eye muscle ............................................. 7.52 NA 7.48 0.58 NA 15.58 090

67316 ............ A Revise two eye muscles .................................... 9.66 NA 8.78 0.67 NA 19.11 090

67318 ............ A Revise eye muscle(s) ......................................... 7.85 NA 7.92 0.33 NA 16.10 090

67320 ............ A Revise eye muscle(s) ......................................... 8.66 NA 9.44 0.69 NA 18.79 090

67331 ............ A Eye surgery follow-up ........................................ 8.12 NA 8.00 0.54 NA 16.66 090

67332 ............ A Rerevise eye muscles ........................................ 8.99 NA 9.20 0.58 NA 18.77 090

67334 ............ A Revise eye muscle w/suture .............................. 7.96 NA 7.99 0.33 NA 16.28 090

67335 ............ A Eye suture during surgery .................................. 2.49 NA 3.31 0.43 NA 6.23 ZZZ

67340 ............ A Revise eye muscle ............................................. 9.85 NA 10.06 0.41 NA 20.32 090

67343 ............ A Release eye tissue ............................................. 7.35 NA 7.65 0.31 NA 15.31 090

67345 ............ A Destroy nerve of eye muscle ............................. 2.96 3.29 1.51 0.26 6.51 4.73 010

67350 ............ A Biopsy eye muscle ............................................. 2.87 NA 3.23 0.13 NA 6.23 000

67400 ............ A Explore/biopsy eye socket ................................. 9.76 NA 10.78 0.62 NA 21.16 090

67405 ............ A Explore/drain eye socket .................................... 7.93 NA 9.75 0.67 NA 18.35 090

67412 ............ A Explore/treat eye socket .................................... 9.50 NA 12.50 0.67 NA 22.67 090

67413 ............ A Explore/treat eye socket .................................... 10.00 NA 11.17 0.57 NA 21.74 090

67414 ............ A Explore/decompress eye socket ........................ 11.13 NA 13.33 0.44 NA 24.90 090

67415 ............ A Aspiration orbital contents .................................. 1.76 NA 1.52 0.12 NA 3.40 000

67420 ............ A Explore/treat eye socket .................................... 20.06 NA 18.62 1.11 NA 39.79 090

67430 ............ A Explore/treat eye socket .................................... 13.39 NA 14.77 0.54 NA 28.70 090

67440 ............ A Explore/drain eye socket .................................... 13.09 NA 14.66 0.97 NA 28.72 090

67445 ............ A Explore/decompress eye socket ........................ 14.42 NA 15.53 0.57 NA 30.52 090
30965

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

67450 ............ A Explore/biopsy eye socket ................................. 13.51 NA 14.67 0.87 NA 29.05 090

67500 ............ A Inject/treat eye socket ........................................ 0.79 4.27 0.82 0.06 5.12 1.67 000

67505 ............ A Inject/treat eye socket ........................................ 0.82 3.21 0.32 0.06 4.09 1.20 000

67515 ............ A Inject/treat eye socket ........................................ 0.61 3.07 0.56 0.03 3.71 1.20 000

67550 ............ A Insert eye socket implant ................................... 10.19 NA 10.57 0.70 NA 21.46 090

67560 ............ A Revise eye socket implant ................................. 10.60 NA 10.68 0.48 NA 21.76 090

67570 ............ A Decompress optic nerve .................................... 13.58 NA 14.66 0.39 NA 28.63 090

67700 ............ A Drainage of eyelid abscess ................................ 1.35 4.33 0.65 0.03 5.71 2.03 010

67710 ............ A Incision of eyelid ................................................ 1.02 4.42 1.59 0.06 5.50 2.67 010

67715 ............ A Incision of eyelid fold ......................................... 1.22 NA 1.74 0.09 NA 3.05 010

67800 ............ A Remove eyelid lesion ......................................... 1.38 4.52 0.78 0.05 5.95 2.21 010

67801 ............ A Remove eyelid lesions ....................................... 1.88 2.96 2.30 0.08 4.92 4.26 010

67805 ............ A Remove eyelid lesions ....................................... 2.22 6.30 2.60 0.08 8.60 4.90 010

67808 ............ A Remove eyelid lesion(s) ..................................... 3.80 NA 4.12 0.13 NA 8.05 090

67810 ............ A Biopsy of eyelid .................................................. 1.48 3.62 0.84 0.05 5.15 2.37 000

67820 ............ A Revise eyelashes ............................................... 0.89 3.26 0.49 0.02 4.17 1.40 000

67825 ............ A Revise eyelashes ............................................... 1.38 4.39 1.78 0.05 5.82 3.21 010

67830 ............ A Revise eyelashes ............................................... 1.70 5.26 2.16 0.17 7.13 4.03 010

67835 ............ A Revise eyelashes ............................................... 5.56 NA 5.13 0.45 NA 11.14 090

67840 ............ A Remove eyelid lesion ......................................... 2.04 5.86 2.80 0.07 7.97 4.91 010

67850 ............ A Treat eyelid lesion .............................................. 1.69 4.51 2.12 0.05 6.25 3.86 010

67875 ............ A Closure of eyelid by suture ................................ 1.35 5.70 2.47 0.13 7.18 3.95 000

67880 ............ A Revision of eyelid ............................................... 3.80 7.02 3.83 0.23 11.05 7.86 090

67882 ............ A Revision of eyelid ............................................... 5.07 8.66 4.86 0.37 14.10 10.30 090

67900 ............ A Repair brow defect ............................................. 6.14 8.06 6.72 0.20 14.40 13.06 090

67901 ............ A Repair eyelid defect ........................................... 6.97 NA 7.07 0.64 NA 14.68 090

67902 ............ A Repair eyelid defect ........................................... 7.03 NA 7.32 0.72 NA 15.07 090

67903 ............ A Repair eyelid defect ........................................... 6.37 7.89 6.78 0.73 14.99 13.88 090

67904 ............ A Repair eyelid defect ........................................... 6.26 10.24 7.81 0.71 17.21 14.78 090

67906 ............ A Repair eyelid defect ........................................... 6.79 8.01 7.07 0.36 15.16 14.22 090

67908 ............ A Repair eyelid defect ........................................... 5.13 7.35 6.24 0.54 13.02 11.91 090

67909 ............ A Revise eyelid defect ........................................... 5.40 7.53 6.35 0.48 13.41 12.23 090

67911 ............ A Revise eyelid defect ........................................... 5.27 NA 6.44 0.79 NA 12.50 090

67914 ............ A Repair eyelid defect ........................................... 3.68 7.24 4.03 0.39 11.31 8.10 090

67915 ............ A Repair eyelid defect ........................................... 3.18 9.88 3.11 0.07 13.13 6.36 090

67916 ............ A Repair eyelid defect ........................................... 5.31 9.05 5.26 0.38 14.74 10.95 090

67917 ............ A Repair eyelid defect ........................................... 6.02 8.08 6.91 0.47 14.57 13.40 090

67921 ............ A Repair eyelid defect ........................................... 3.40 7.03 3.86 0.20 10.63 7.46 090

67922 ............ A Repair eyelid defect ........................................... 3.06 5.76 3.05 0.07 8.89 6.18 090

67923 ............ A Repair eyelid defect ........................................... 5.88 9.31 5.60 0.38 15.57 11.86 090

67924 ............ A Repair eyelid defect ........................................... 5.79 7.64 6.50 0.43 13.86 12.72 090

67930 ............ A Repair eyelid wound .......................................... 3.61 7.30 3.72 0.08 10.99 7.41 010

67935 ............ A Repair eyelid wound .......................................... 6.22 9.27 5.41 0.24 15.73 11.87 090

67938 ............ A Remove eyelid foreign body .............................. 1.33 4.21 0.52 0.03 5.57 1.88 010

67950 ............ A Revision of eyelid ............................................... 5.82 6.42 9.88 0.45 12.69 16.15 090

67961 ............ A Revision of eyelid ............................................... 5.69 6.37 6.29 0.50 12.56 12.48 090

67966 ............ A Revision of eyelid ............................................... 6.57 6.92 9.56 0.66 14.15 16.79 090

67971 ............ A Reconstruction of eyelid ..................................... 9.79 NA 8.88 0.64 NA 19.31 090

67973 ............ A Reconstruction of eyelid ..................................... 12.87 NA 10.87 0.91 NA 24.65 090

67974 ............ A Reconstruction of eyelid ..................................... 12.84 NA 10.76 0.87 NA 24.47 090

67975 ............ A Reconstruction of eyelid ..................................... 9.13 NA 8.31 0.24 NA 17.68 090

68020 ............ A Incise/drain eyelid lining ..................................... 1.37 4.39 0.77 0.03 5.79 2.17 010

68040 ............ A Treatment of eyelid lesions ................................ 0.85 3.48 0.47 0.02 4.35 1.34 000

68100 ............ A Biopsy of eyelid lining ........................................ 1.35 4.02 1.09 0.06 5.43 2.50 000

68110 ............ A Remove eyelid lining lesion ............................... 1.77 4.74 2.01 0.07 6.58 3.85 010

68115 ............ A Remove eyelid lining lesion ............................... 2.36 5.69 2.53 0.11 8.16 5.00 010

68130 ............ A Remove eyelid lining lesion ............................... 4.93 NA 5.74 0.22 NA 10.89 090

68135 ............ A Remove eyelid lining lesion ............................... 1.84 4.77 2.06 0.04 6.65 3.94 010

68200 ............ A Treat eyelid by injection ..................................... 0.49 3.00 0.49 0.03 3.52 1.01 000

68320 ............ A Revise/graft eyelid lining .................................... 5.37 4.91 5.81 0.42 10.70 11.60 090

68325 ............ A Revise/graft eyelid lining .................................... 7.36 NA 6.86 0.62 NA 14.84 090

68326 ............ A Revise/graft eyelid lining .................................... 7.15 NA 6.88 0.49 NA 14.52 090

68328 ............ A Revise/graft eyelid lining .................................... 8.18 NA 7.39 0.82 NA 16.39 090

68330 ............ A Revise eyelid lining ............................................ 4.83 6.09 5.65 0.35 11.27 10.83 090

68335 ............ A Revise/graft eyelid lining .................................... 7.19 NA 5.70 0.68 NA 13.57 090

68340 ............ A Separate eyelid adhesions ................................. 4.17 8.46 4.33 0.17 12.80 8.67 090

68360 ............ A Revise eyelid lining ............................................ 4.37 5.79 5.39 0.33 10.49 10.09 090

68362 ............ A Revise eyelid lining ............................................ 7.34 NA 7.77 0.42 NA 15.53 090

68400 ............ A Incise/drain tear gland ........................................ 1.69 5.80 2.63 0.06 7.55 4.38 010

68420 ............ A Incise/drain tear sac ........................................... 2.30 6.09 2.95 0.06 8.45 5.31 010

68440 ............ A Incise tear duct opening ..................................... 0.94 4.28 1.55 0.04 5.26 2.53 010

68500 ............ A Removal of tear gland ........................................ 11.02 NA 9.77 0.75 NA 21.54 090

68505 ............ A Partial removal tear gland .................................. 10.94 NA 10.06 0.49 NA 21.49 090

68510 ............ A Biopsy of tear gland ........................................... 4.61 7.41 3.32 0.28 12.30 8.21 000
30966

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

68520 ............ A Removal of tear sac ........................................... 7.51 NA 7.37 0.51 NA 15.39 090

68525 ............ A Biopsy of tear sac .............................................. 4.43 NA 3.24 0.23 NA 7.90 000

68530 ............ A Clearance of tear duct ....................................... 3.66 7.39 3.45 0.17 11.22 7.28 010

68540 ............ A Remove tear gland lesion .................................. 10.60 NA 9.51 0.50 NA 20.61 090

68550 ............ A Remove tear gland lesion .................................. 13.26 NA 11.83 0.74 NA 25.83 090

68700 ............ A Repair tear ducts ................................................ 6.60 NA 6.79 0.15 NA 13.54 090

68705 ............ A Revise tear duct opening ................................... 2.06 4.94 2.18 0.05 7.05 4.29 010

68720 ............ A Create tear sac drain ......................................... 8.96 NA 8.39 0.74 NA 18.09 090

68745 ............ A Create tear duct drain ........................................ 8.63 NA 7.87 0.45 NA 16.95 090

68750 ............ A Create tear duct drain ........................................ 8.66 NA 8.38 0.83 NA 17.87 090

68760 ............ A Close tear duct opening ..................................... 1.73 4.63 0.98 0.04 6.40 2.75 010

68761 ............ A Close tear duct opening ..................................... 1.36 3.31 0.76 0.04 4.71 2.16 010

68770 ............ A Close tear system fistula .................................... 7.02 10.08 6.07 0.23 17.33 13.32 090

68801 ............ A Dilate tear duct opening ..................................... 0.94 3.99 0.51 0.02 4.95 1.47 010

68810 ............ A Probe nasolacrimal duct .................................... 1.90 5.34 2.26 0.03 7.27 4.19 010

68811 ............ A Probe nasolacrimal duct .................................... 2.35 NA 2.51 0.09 NA 4.95 010

68815 ............ A Probe nasolacrimal duct .................................... 3.20 6.01 3.16 0.10 9.31 6.46 010

68840 ............ A Explore/irrigate tear ducts .................................. 1.25 4.43 0.69 0.03 5.71 1.97 010

68850 ............ A Injection for tear sac x-ray ................................. 0.80 8.95 0.33 0.04 9.79 1.17 000

69000 ............ A Drain external ear lesion .................................... 1.45 1.35 0.59 0.03 2.83 2.07 010

69005 ............ A Drain external ear lesion .................................... 2.11 1.83 1.62 0.13 4.07 3.86 010

69020 ............ A Drain outer ear canal lesion ............................... 1.48 1.48 0.71 0.04 3.00 2.23 010

69100 ............ A Biopsy of external ear ........................................ 0.81 0.92 0.45 0.07 1.80 1.33 000

69105 ............ A Biopsy of external ear canal .............................. 0.85 0.95 0.71 0.09 1.89 1.65 000

69110 ............ A Partial removal external ear ............................... 3.44 2.58 2.33 0.37 6.39 6.14 090

69120 ............ A Removal of external ear ..................................... 4.05 NA 4.35 0.07 NA 8.47 090

69140 ............ A Remove ear canal lesion(s) ............................... 7.97 NA 7.56 0.88 NA 16.41 090

69145 ............ A Remove ear canal lesion(s) ............................... 2.62 2.43 2.01 0.28 5.33 4.91 090

69150 ............ A Extensive ear canal surgery .............................. 13.43 NA 10.95 1.25 NA 25.63 090

69155 ............ A Extensive ear/neck surgery ................................ 20.80 NA 14.75 1.61 NA 37.16 090

69200 ............ A Clear outer ear canal ......................................... 0.77 0.89 0.34 0.04 1.70 1.15 000

69205 ............ A Clear outer ear canal ......................................... 1.20 NA 1.03 0.11 NA 2.34 010

69210 ............ A Remove impacted ear wax ................................ 0.61 0.79 0.22 0.02 1.42 0.85 000

69220 ............ A Clean out mastoid cavity .................................... 0.83 0.95 0.52 0.05 1.83 1.40 000

69222 ............ A Clean out mastoid cavity .................................... 1.40 1.45 1.20 0.08 2.93 2.68 010

69300 ............ R Revise external ear ............................................ 6.36 NA 5.44 0.28 NA 12.08 YYY

69310 ............ A Rebuild outer ear canal ...................................... 10.79 NA 9.33 1.08 NA 21.20 090

69320 ............ A Rebuild outer ear canal ...................................... 16.96 NA 13.20 1.66 NA 31.82 090

69400 ............ A Inflate middle ear canal ...................................... 0.83 0.94 0.38 0.05 1.82 1.26 000

69401 ............ A Inflate middle ear canal ...................................... 0.63 0.82 0.39 0.03 1.48 1.05 000

69405 ............ A Catheterize middle ear canal ............................. 2.63 2.26 1.19 0.04 4.93 3.86 010

69410 ............ A Inset middle ear baffle ....................................... 0.33 0.66 0.19 0.07 1.06 0.59 000

69420 ............ A Incision of eardrum ............................................ 1.33 1.44 0.79 0.08 2.85 2.20 010

69421 ............ A Incision of eardrum ............................................ 1.73 1.68 1.43 0.13 3.54 3.29 010

69424 ............ A Remove ventilating tube .................................... 0.85 1.00 0.59 0.06 1.91 1.50 000

69433 ............ A Create eardrum opening .................................... 1.52 1.53 0.96 0.15 3.20 2.63 010

69436 ............ A Create eardrum opening .................................... 1.96 NA 1.56 0.23 NA 3.75 010

69440 ............ A Exploration of middle ear ................................... 7.57 NA 7.13 0.93 NA 15.63 090

69450 ............ A Eardrum revision ................................................ 5.57 NA 5.87 1.15 NA 12.59 090

69501 ............ A Mastoidectomy ................................................... 9.07 NA 8.01 1.17 NA 18.25 090

69502 ............ A Mastoidectomy ................................................... 12.38 NA 10.43 1.45 NA 24.26 090

69505 ............ A Remove mastoid structures ............................... 12.99 NA 10.68 1.79 NA 25.46 090

69511 ............ A Extensive mastoid surgery ................................. 13.52 NA 11.17 1.84 NA 26.53 090

69530 ............ A Extensive mastoid surgery ................................. 19.19 NA 14.85 1.72 NA 35.76 090

69535 ............ A Remove part of temporal bone .......................... 36.14 NA 25.22 2.85 NA 64.21 090

69540 ............ A Remove ear lesion ............................................. 1.20 1.35 1.07 0.14 2.69 2.41 010

69550 ............ A Remove ear lesion ............................................. 10.99 NA 9.30 2.00 NA 22.29 090

69552 ............ A Remove ear lesion ............................................. 19.46 NA 14.98 1.86 NA 36.30 090

69554 ............ A Remove ear lesion ............................................. 33.16 NA 23.94 2.63 NA 59.73 090

69601 ............ A Mastoid surgery revision .................................... 13.24 NA 11.10 1.55 NA 25.89 090

69602 ............ A Mastoid surgery revision .................................... 13.58 NA 11.23 1.75 NA 26.56 090

69603 ............ A Mastoid surgery revision .................................... 14.02 NA 11.38 1.88 NA 27.28 090

69604 ............ A Mastoid surgery revision .................................... 14.02 NA 11.25 2.70 NA 27.97 090

69605 ............ A Mastoid surgery revision .................................... 18.49 NA 14.22 1.86 NA 34.57 090

69610 ............ A Repair of eardrum .............................................. 4.43 3.46 3.10 0.10 7.99 7.63 010

69620 ............ A Repair of eardrum .............................................. 5.89 5.11 3.79 1.16 12.16 10.84 090

69631 ............ A Repair eardrum structures ................................. 9.86 NA 8.81 1.61 NA 20.28 090

69632 ............ A Rebuild eardrum structures ................................ 12.75 NA 10.85 1.73 NA 25.33 090

69633 ............ A Rebuild eardrum structures ................................ 12.10 NA 10.47 1.78 NA 24.35 090

69635 ............ A Repair eardrum structures ................................. 13.33 NA 11.05 1.91 NA 26.29 090

69636 ............ A Rebuild eardrum structures ................................ 15.22 NA 12.59 2.11 NA 29.92 090

69637 ............ A Rebuild eardrum structures ................................ 15.11 NA 12.49 2.22 NA 29.82 090

69641 ............ A Revise middle ear & mastoid ............................. 12.71 NA 10.64 1.87 NA 25.22 090

69642 ............ A Revise middle ear & mastoid ............................. 16.84 NA 13.41 2.21 NA 32.46 090
30967

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

69643 ............ A Revise middle ear & mastoid ............................. 15.32 NA 12.50 2.51 NA 30.33 090

69644 ............ A Revise middle ear & mastoid ............................. 16.97 NA 13.65 2.70 NA 33.32 090

69645 ............ A Revise middle ear & mastoid ............................. 16.38 NA 13.21 2.51 NA 32.10 090

69646 ............ A Revise middle ear & mastoid ............................. 17.99 NA 14.31 2.40 NA 34.70 090

69650 ............ A Release middle ear bone ................................... 9.66 NA 8.44 1.33 NA 19.43 090

69660 ............ A Revise middle ear bone ..................................... 11.90 NA 9.85 1.82 NA 23.57 090

69661 ............ A Revise middle ear bone ..................................... 15.74 NA 12.46 1.93 NA 30.13 090

69662 ............ A Revise middle ear bone ..................................... 15.44 NA 12.39 1.94 NA 29.77 090

69666 ............ A Repair middle ear structures .............................. 9.75 NA 8.52 1.77 NA 20.04 090

69667 ............ A Repair middle ear structures .............................. 9.76 NA 8.54 1.66 NA 19.96 090

69670 ............ A Remove mastoid air cells ................................... 11.51 NA 9.98 1.08 NA 22.57 090

69676 ............ A Remove middle ear nerve .................................. 9.52 NA 8.60 0.86 NA 18.98 090

69700 ............ A Close mastoid fistula .......................................... 8.23 NA 5.34 0.84 NA 14.41 090

69711 ............ A Remove/repair hearing aid ................................. 10.44 NA 9.25 0.44 NA 20.13 090

69720 ............ A Release facial nerve .......................................... 14.38 NA 11.86 2.27 NA 28.51 090

69725 ............ A Release facial nerve .......................................... 25.38 NA 18.41 1.51 NA 45.30 090

69740 ............ A Repair facial nerve ............................................. 15.96 NA 11.67 1.69 NA 29.32 090

69745 ............ A Repair facial nerve ............................................. 16.69 NA 13.17 1.53 NA 31.39 090

69801 ............ A Incise inner ear .................................................. 8.56 NA 7.69 1.84 NA 18.09 090

69802 ............ A Incise inner ear .................................................. 13.10 NA 10.98 1.22 NA 25.30 090

69805 ............ A Explore inner ear ................................................ 13.82 NA 11.15 2.00 NA 26.97 090

69806 ............ A Explore inner ear ................................................ 12.35 NA 10.47 2.54 NA 25.36 090

69820 ............ A Establish inner ear window ................................ 10.34 NA 8.82 1.00 NA 20.16 090

69840 ............ A Revise inner ear window .................................... 10.26 NA 12.01 0.51 NA 22.78 090

69905 ............ A Remove inner ear .............................................. 11.10 NA 9.53 2.07 NA 22.70 090

69910 ............ A Remove inner ear & mastoid ............................. 13.63 NA 11.12 2.34 NA 27.09 090

69915 ............ A Incise inner ear nerve ........................................ 21.23 NA 16.10 2.02 NA 39.35 090

69930 ............ A Implant cochlear device ..................................... 16.81 NA 12.89 3.34 NA 33.04 090

69950 ............ A Incise inner ear nerve ........................................ 25.64 NA 17.75 2.31 NA 45.70 090

69955 ............ A Release facial nerve .......................................... 27.04 NA 20.01 2.25 NA 49.30 090

69960 ............ A Release inner ear canal ..................................... 27.04 NA 18.59 1.93 NA 47.56 090

69970 ............ A Remove inner ear lesion .................................... 30.04 NA 21.22 2.26 NA 53.52 090

70010 ............ A Contrast x-ray of brain ....................................... 1.19 3.46 3.46 0.34 4.99 4.99 XXX

70010 26 A Contrast x-ray of brain ....................................... 1.19 0.39 0.39 0.08 1.66 1.66 XXX

70010 TC A Contrast x-ray of brain ....................................... 0.00 3.07 3.07 0.26 3.33 3.33 XXX

70015 ............ A Contrast x-ray of brain ....................................... 1.19 1.35 1.35 0.17 2.71 2.71 XXX

70015 26 A Contrast x-ray of brain ....................................... 1.19 0.39 0.39 0.08 1.66 1.66 XXX

70015 TC A Contrast x-ray of brain ....................................... 0.00 0.96 0.96 0.09 1.05 1.05 XXX

70030 ............ A X-ray eye for foreign body ................................. 0.17 0.36 0.36 0.04 0.57 0.57 XXX

70030 26 A X-ray eye for foreign body ................................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX

70030 TC A X-ray eye for foreign body ................................. 0.00 0.30 0.30 0.03 0.33 0.33 XXX

70100 ............ A X-ray exam of jaw .............................................. 0.18 0.44 0.44 0.04 0.66 0.66 XXX

70100 26 A X-ray exam of jaw .............................................. 0.18 0.07 0.07 0.01 0.26 0.26 XXX

70100 TC A X-ray exam of jaw .............................................. 0.00 0.37 0.37 0.03 0.40 0.40 XXX

70110 ............ A X-ray exam of jaw .............................................. 0.25 0.53 0.53 0.06 0.84 0.84 XXX

70110 26 A X-ray exam of jaw .............................................. 0.25 0.09 0.09 0.02 0.36 0.36 XXX

70110 TC A X-ray exam of jaw .............................................. 0.00 0.44 0.44 0.04 0.48 0.48 XXX

70120 ............ A X-ray exam of mastoids ..................................... 0.18 0.51 0.51 0.05 0.74 0.74 XXX

70120 26 A X-ray exam of mastoids ..................................... 0.18 0.07 0.07 0.01 0.26 0.26 XXX

70120 TC A X-ray exam of mastoids ..................................... 0.00 0.44 0.44 0.04 0.48 0.48 XXX

70130 ............ A X-ray exam of mastoids ..................................... 0.34 0.68 0.68 0.07 1.09 1.09 XXX

70130 26 A X-ray exam of mastoids ..................................... 0.34 0.12 0.12 0.02 0.48 0.48 XXX

70130 TC A X-ray exam of mastoids ..................................... 0.00 0.56 0.56 0.05 0.61 0.61 XXX

70134 ............ A X-ray exam of middle ear .................................. 0.34 0.64 0.64 0.07 1.05 1.05 XXX

70134 26 A X-ray exam of middle ear .................................. 0.34 0.12 0.12 0.02 0.48 0.48 XXX

70134 TC A X-ray exam of middle ear .................................. 0.00 0.52 0.52 0.05 0.57 0.57 XXX

70140 ............ A X-ray exam of facial bones ................................ 0.19 0.51 0.51 0.05 0.75 0.75 XXX

70140 26 A X-ray exam of facial bones ................................ 0.19 0.07 0.07 0.01 0.27 0.27 XXX

70140 TC A X-ray exam of facial bones ................................ 0.00 0.44 0.44 0.04 0.48 0.48 XXX

70150 ............ A X-ray exam of facial bones ................................ 0.26 0.65 0.65 0.07 0.98 0.98 XXX

70150 26 A X-ray exam of facial bones ................................ 0.26 0.09 0.09 0.02 0.37 0.37 XXX

70150 TC A X-ray exam of facial bones ................................ 0.00 0.56 0.56 0.05 0.61 0.61 XXX

70160 ............ A X-ray exam of nasal bones ................................ 0.17 0.43 0.43 0.04 0.64 0.64 XXX

70160 26 A X-ray exam of nasal bones ................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX

70160 TC A X-ray exam of nasal bones ................................ 0.00 0.37 0.37 0.03 0.40 0.40 XXX

70170 ............ A X-ray exam of tear duct ..................................... 0.30 0.77 0.77 0.08 1.15 1.15 XXX

70170 26 A X-ray exam of tear duct ..................................... 0.30 0.10 0.10 0.02 0.42 0.42 XXX

70170 TC A X-ray exam of tear duct ..................................... 0.00 0.67 0.67 0.06 0.73 0.73 XXX

70190 ............ A X-ray exam of eye sockets ................................ 0.21 0.51 0.51 0.05 0.77 0.77 XXX

70190 26 A X-ray exam of eye sockets ................................ 0.21 0.07 0.07 0.01 0.29 0.29 XXX

70190 TC A X-ray exam of eye sockets ................................ 0.00 0.44 0.44 0.04 0.48 0.48 XXX

70200 ............ A X-ray exam of eye sockets ................................ 0.28 0.65 0.65 0.07 1.00 1.00 XXX

70200 26 A X-ray exam of eye sockets ................................ 0.28 0.10 0.10 0.02 0.40 0.40 XXX

70200 TC A X-ray exam of eye sockets ................................ 0.00 0.56 0.56 0.05 0.61 0.61 XXX
30968

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

70210 ............ A X-ray exam of sinuses ....................................... 0.17 0.50 0.50 0.05 0.72 0.72 XXX

70210 26 A X-ray exam of sinuses ....................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX

70210 TC A X-ray exam of sinuses ....................................... 0.00 0.44 0.44 0.04 0.48 0.48 XXX

70220 ............ A X-ray exam of sinuses ....................................... 0.25 0.65 0.65 0.07 0.97 0.97 XXX

70220 26 A X-ray exam of sinuses ....................................... 0.25 0.09 0.09 0.02 0.36 0.36 XXX

70220 TC A X-ray exam of sinuses ....................................... 0.00 0.56 0.56 0.05 0.61 0.61 XXX

70240 ............ A X-ray exam pituitary saddle ............................... 0.19 0.36 0.36 0.04 0.59 0.59 XXX

70240 26 A X-ray exam pituitary saddle ............................... 0.19 0.07 0.07 0.01 0.27 0.27 XXX

70240 TC A X-ray exam pituitary saddle ............................... 0.00 0.30 0.30 0.03 0.33 0.33 XXX

70250 ............ A X-ray exam of skull ............................................ 0.24 0.52 0.52 0.06 0.82 0.82 XXX

70250 26 A X-ray exam of skull ............................................ 0.24 0.08 0.08 0.02 0.34 0.34 XXX

70250 TC A X-ray exam of skull ............................................ 0.00 0.44 0.44 0.04 0.48 0.48 XXX

70260 ............ A X-ray exam of skull ............................................ 0.34 0.75 0.75 0.08 1.17 1.17 XXX

70260 26 A X-ray exam of skull ............................................ 0.34 0.12 0.12 0.02 0.48 0.48 XXX

70260 TC A X-ray exam of skull ............................................ 0.00 0.63 0.63 0.06 0.69 0.69 XXX

70300 ............ A X-ray exam of teeth ........................................... 0.10 0.22 0.22 0.03 0.35 0.35 XXX

70300 26 A X-ray exam of teeth ........................................... 0.10 0.04 0.04 0.01 0.15 0.15 XXX

70300 TC A X-ray exam of teeth ........................................... 0.00 0.19 0.19 0.02 0.21 0.21 XXX

70310 ............ A X-ray exam of teeth ........................................... 0.16 0.35 0.35 0.04 0.55 0.55 XXX

70310 26 A X-ray exam of teeth ........................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX

70310 TC A X-ray exam of teeth ........................................... 0.00 0.30 0.30 0.03 0.33 0.33 XXX

70320 ............ A Full mouth x-ray of teeth .................................... 0.22 0.63 0.63 0.07 0.92 0.92 XXX

70320 26 A Full mouth x-ray of teeth .................................... 0.22 0.07 0.07 0.02 0.31 0.31 XXX

70320 TC A Full mouth x-ray of teeth .................................... 0.00 0.56 0.56 0.05 0.61 0.61 XXX

70328 ............ A X-ray exam of jaw joint ...................................... 0.18 0.42 0.42 0.04 0.64 0.64 XXX

70328 26 A X-ray exam of jaw joint ...................................... 0.18 0.07 0.07 0.01 0.26 0.26 XXX

70328 TC A X-ray exam of jaw joint ...................................... 0.00 0.35 0.35 0.03 0.38 0.38 XXX

70330 ............ A X-ray exam of jaw joints .................................... 0.24 0.68 0.68 0.07 0.99 0.99 XXX

70330 26 A X-ray exam of jaw joints .................................... 0.24 0.08 0.08 0.02 0.34 0.34 XXX

70330 TC A X-ray exam of jaw joints .................................... 0.00 0.60 0.60 0.05 0.65 0.65 XXX

70332 ............ A X-ray exam of jaw joint ...................................... 0.54 1.67 1.67 0.17 2.38 2.38 XXX

70332 26 A X-ray exam of jaw joint ...................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

70332 TC A X-ray exam of jaw joint ...................................... 0.00 1.49 1.49 0.13 1.62 1.62 XXX

70336 ............ A Magnetic image jaw joint ................................... 1.48 8.27 8.27 0.73 10.48 10.48 XXX

70336 26 A Magnetic image jaw joint ................................... 1.48 0.32 0.32 0.06 1.86 1.86 XXX

70336 TC A Magnetic image jaw joint ................................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

70350 ............ A X-ray head for orthodontia ................................. 0.17 0.33 0.33 0.03 0.53 0.53 XXX

70350 26 A X-ray head for orthodontia ................................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX

70350 TC A X-ray head for orthodontia ................................. 0.00 0.27 0.27 0.02 0.29 0.29 XXX

70355 ............ A Panoramic x-ray of jaws .................................... 0.20 0.47 0.47 0.05 0.72 0.72 XXX

70355 26 A Panoramic x-ray of jaws .................................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX

70355 TC A Panoramic x-ray of jaws .................................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

70360 ............ A X-ray exam of neck ............................................ 0.17 0.36 0.36 0.04 0.57 0.57 XXX

70360 26 A X-ray exam of neck ............................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX

70360 TC A X-ray exam of neck ............................................ 0.00 0.30 0.30 0.03 0.33 0.33 XXX

70370 ............ A Throat x-ray & fluoroscopy ................................. 0.32 1.03 1.03 0.10 1.45 1.45 XXX

70370 26 A Throat x-ray & fluoroscopy ................................. 0.32 0.11 0.11 0.02 0.45 0.45 XXX

70370 TC A Throat x-ray & fluoroscopy ................................. 0.00 0.92 0.92 0.08 1.00 1.00 XXX

70371 ............ A Speech evaluation, complex .............................. 0.84 1.77 1.77 0.19 2.80 2.80 XXX

70371 26 A Speech evaluation, complex .............................. 0.84 0.28 0.28 0.06 1.18 1.18 XXX

70371 TC A Speech evaluation, complex .............................. 0.00 1.49 1.49 0.13 1.62 1.62 XXX

70373 ............ A Contrast x-ray of larynx ...................................... 0.44 1.41 1.41 0.14 1.99 1.99 XXX

70373 26 A Contrast x-ray of larynx ...................................... 0.44 0.15 0.15 0.03 0.62 0.62 XXX

70373 TC A Contrast x-ray of larynx ...................................... 0.00 1.27 1.27 0.11 1.38 1.38 XXX

70380 ............ A X-ray exam of salivary gland ............................. 0.17 0.54 0.54 0.05 0.76 0.76 XXX

70380 26 A X-ray exam of salivary gland ............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX

70380 TC A X-ray exam of salivary gland ............................. 0.00 0.48 0.48 0.04 0.52 0.52 XXX

70390 ............ A X-ray exam of salivary duct ............................... 0.38 1.39 1.39 0.14 1.91 1.91 XXX

70390 26 A X-ray exam of salivary duct ............................... 0.38 0.13 0.13 0.03 0.54 0.54 XXX

70390 TC A X-ray exam of salivary duct ............................... 0.00 1.27 1.27 0.11 1.38 1.38 XXX

70450 ............ A CAT scan of head or brain ................................ 0.85 3.63 3.63 0.35 4.83 4.83 XXX

70450 26 A CAT scan of head or brain ................................ 0.85 0.28 0.28 0.06 1.19 1.19 XXX

70450 TC A CAT scan of head or brain ................................ 0.00 3.35 3.35 0.29 3.64 3.64 XXX

70460 ............ A Contrast CAT scan of head ............................... 1.13 4.38 4.38 0.43 5.94 5.94 XXX

70460 26 A Contrast CAT scan of head ............................... 1.13 0.37 0.37 0.08 1.58 1.58 XXX

70460 TC A Contrast CAT scan of head ............................... 0.00 4.01 4.01 0.35 4.36 4.36 XXX

70470 ............ A Contrast CAT scans of head ............................. 1.27 5.43 5.43 0.52 7.22 7.22 XXX

70470 26 A Contrast CAT scans of head ............................. 1.27 0.42 0.42 0.09 1.78 1.78 XXX

70470 TC A Contrast CAT scans of head ............................. 0.00 5.02 5.02 0.43 5.45 5.45 XXX

70480 ............ A CAT scan of skull ............................................... 1.28 3.77 3.77 0.38 5.43 5.43 XXX

70480 26 A CAT scan of skull ............................................... 1.28 0.42 0.42 0.09 1.79 1.79 XXX

70480 TC A CAT scan of skull ............................................... 0.00 3.35 3.35 0.29 3.64 3.64 XXX

70481 ............ A Contrast CAT scan of skull ................................ 1.38 4.47 4.47 0.44 6.29 6.29 XXX

70481 26 A Contrast CAT scan of skull ................................ 1.38 0.45 0.45 0.09 1.92 1.92 XXX
30969

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

70481 TC A Contrast CAT scan of skull ................................ 0.00 4.01 4.01 0.35 4.36 4.36 XXX

70482 ............ A Contrast CAT scans of skull .............................. 1.45 5.49 5.49 0.53 7.47 7.47 XXX

70482 26 A Contrast CAT scans of skull .............................. 1.45 0.48 0.48 0.10 2.03 2.03 XXX

70482 TC A Contrast CAT scans of skull .............................. 0.00 5.02 5.02 0.43 5.45 5.45 XXX

70486 ............ A CAT scan of face, jaw ........................................ 1.14 3.72 3.72 0.37 5.23 5.23 XXX

70486 26 A CAT scan of face, jaw ........................................ 1.14 0.37 0.37 0.08 1.59 1.59 XXX

70486 TC A CAT scan of face, jaw ........................................ 0.00 3.35 3.35 0.29 3.64 3.64 XXX

70487 ............ A Contrast CAT scan, face/jaw ............................. 1.30 4.44 4.44 0.44 6.18 6.18 XXX

70487 26 A Contrast CAT scan, face/jaw ............................. 1.30 0.42 0.42 0.09 1.81 1.81 XXX

70487 TC A Contrast CAT scan, face/jaw ............................. 0.00 4.01 4.01 0.35 4.36 4.36 XXX

70488 ............ A Contrast CAT scans face/jaw ............................ 1.42 5.49 5.49 0.53 7.44 7.44 XXX

70488 26 A Contrast CAT scans face/jaw ............................ 1.42 0.47 0.47 0.10 1.99 1.99 XXX

70488 TC A Contrast CAT scans face/jaw ............................ 0.00 5.02 5.02 0.43 5.45 5.45 XXX

70490 ............ A CAT scan of neck tissue .................................... 1.28 3.77 3.77 0.38 5.43 5.43 XXX

70490 26 A CAT scan of neck tissue .................................... 1.28 0.42 0.42 0.09 1.79 1.79 XXX

70490 TC A CAT scan of neck tissue .................................... 0.00 3.35 3.35 0.29 3.64 3.64 XXX

70491 ............ A Contrast CAT of neck tissue .............................. 1.38 4.47 4.47 0.44 6.29 6.29 XXX

70491 26 A Contrast CAT of neck tissue .............................. 1.38 0.45 0.45 0.09 1.92 1.92 XXX

70491 TC A Contrast CAT of neck tissue .............................. 0.00 4.01 4.01 0.35 4.36 4.36 XXX

70492 ............ A Contrast CAT of neck tissue .............................. 1.45 5.49 5.49 0.53 7.47 7.47 XXX

70492 26 A Contrast CAT of neck tissue .............................. 1.45 0.48 0.48 0.10 2.03 2.03 XXX

70492 TC A Contrast CAT of neck tissue .............................. 0.00 5.02 5.02 0.43 5.45 5.45 XXX

70540 ............ A Magnetic image, face, neck ............................... 1.48 8.44 8.44 0.77 10.69 10.69 XXX

70540 26 A Magnetic image, face, neck ............................... 1.48 0.49 0.49 0.10 2.07 2.07 XXX

70540 TC A Magnetic image, face, neck ............................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

70541 ............ R Magnetic image, head (MRA) ............................ 1.81 8.44 8.44 0.77 11.02 11.02 XXX

70541 26 R Magnetic image, head (MRA) ............................ 1.81 0.49 0.49 0.10 2.40 2.40 XXX

70541 TC R Magnetic image, head (MRA) ............................ 0.00 7.95 7.95 0.67 8.62 8.62 XXX

70551 ............ A Magnetic image, brain (MRI) ............................. 1.48 8.44 8.44 0.77 10.69 10.69 XXX

70551 26 A Magnetic image, brain (MRI) ............................. 1.48 0.49 0.49 0.10 2.07 2.07 XXX

70551 TC A Magnetic image, brain (MRI) ............................. 0.00 7.95 7.95 0.67 8.62 8.62 XXX

70552 ............ A Magnetic image, brain (MRI) ............................. 1.78 10.13 10.13 0.93 12.84 12.84 XXX

70552 26 A Magnetic image, brain (MRI) ............................. 1.78 0.60 0.60 0.12 2.50 2.50 XXX

70552 TC A Magnetic image, brain (MRI) ............................. 0.00 9.53 9.53 0.81 10.34 10.34 XXX

70553 ............ A Magnetic image, brain ........................................ 2.36 18.45 18.45 1.65 22.46 22.46 XXX

70553 26 A Magnetic image, brain ........................................ 2.36 0.80 0.80 0.16 3.32 3.32 XXX

70553 TC A Magnetic image, brain ........................................ 0.00 17.65 17.65 1.49 19.14 19.14 XXX

71010 ............ A Chest x-ray ......................................................... 0.18 0.39 0.39 0.04 0.61 0.61 XXX

71010 26 A Chest x-ray ......................................................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX

71010 TC A Chest x-ray ......................................................... 0.00 0.33 0.33 0.03 0.36 0.36 XXX

71015 ............ A X-ray exam of chest ........................................... 0.21 0.45 0.45 0.04 0.70 0.70 XXX

71015 26 A X-ray exam of chest ........................................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX

71015 TC A X-ray exam of chest ........................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

71020 ............ A Chest x-ray ......................................................... 0.22 0.51 0.51 0.05 0.78 0.78 XXX

71020 26 A Chest x-ray ......................................................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX

71020 TC A Chest x-ray ......................................................... 0.00 0.44 0.44 0.04 0.48 0.48 XXX

71021 ............ A Chest x-ray ......................................................... 0.27 0.61 0.61 0.07 0.95 0.95 XXX

71021 26 A Chest x-ray ......................................................... 0.27 0.09 0.09 0.02 0.38 0.38 XXX

71021 TC A Chest x-ray ......................................................... 0.00 0.52 0.52 0.05 0.57 0.57 XXX

71022 ............ A Chest x-ray ......................................................... 0.31 0.63 0.63 0.07 1.01 1.01 XXX

71022 26 A Chest x-ray ......................................................... 0.31 0.10 0.10 0.02 0.43 0.43 XXX

71022 TC A Chest x-ray ......................................................... 0.00 0.52 0.52 0.05 0.57 0.57 XXX

71023 ............ A Chest x-ray and fluoroscopy .............................. 0.38 0.68 0.68 0.08 1.14 1.14 XXX

71023 26 A Chest x-ray and fluoroscopy .............................. 0.38 0.13 0.13 0.03 0.54 0.54 XXX

71023 TC A Chest x-ray and fluoroscopy .............................. 0.00 0.56 0.56 0.05 0.61 0.61 XXX

71030 ............ A Chest x-ray ......................................................... 0.31 0.66 0.66 0.07 1.04 1.04 XXX

71030 26 A Chest x-ray ......................................................... 0.31 0.10 0.10 0.02 0.43 0.43 XXX

71030 TC A Chest x-ray ......................................................... 0.00 0.56 0.56 0.05 0.61 0.61 XXX

71034 ............ A Chest x-ray & fluoroscopy .................................. 0.46 1.18 1.18 0.12 1.76 1.76 XXX

71034 26 A Chest x-ray & fluoroscopy .................................. 0.46 0.16 0.16 0.03 0.65 0.65 XXX

71034 TC A Chest x-ray & fluoroscopy .................................. 0.00 1.02 1.02 0.09 1.11 1.11 XXX

71035 ............ A Chest x-ray ......................................................... 0.18 0.43 0.43 0.04 0.65 0.65 XXX

71035 26 A Chest x-ray ......................................................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX

71035 TC A Chest x-ray ......................................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

71036 ............ A X-ray guidance for biopsy .................................. 0.54 1.30 1.30 0.14 1.98 1.98 XXX

71036 26 A X-ray guidance for biopsy .................................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX

71036 TC A X-ray guidance for biopsy .................................. 0.00 1.12 1.12 0.10 1.22 1.22 XXX

71038 ............ A X-ray guidance for biopsy .................................. 0.54 1.38 1.38 0.15 2.07 2.07 XXX

71038 26 A X-ray guidance for biopsy .................................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX

71038 TC A X-ray guidance for biopsy .................................. 0.00 1.19 1.19 0.11 1.30 1.30 XXX

71040 ............ A Contrast x-ray of bronchi ................................... 0.58 1.24 1.24 0.13 1.95 1.95 XXX

71040 26 A Contrast x-ray of bronchi ................................... 0.58 0.20 0.20 0.04 0.82 0.82 XXX

71040 TC A Contrast x-ray of bronchi ................................... 0.00 1.03 1.03 0.09 1.12 1.12 XXX

71060 ............ A Contrast x-ray of bronchi ................................... 0.74 1.82 1.82 0.19 2.75 2.75 XXX
30970

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

71060 26 A Contrast x-ray of bronchi ................................... 0.74 0.25 0.25 0.05 1.04 1.04 XXX

71060 TC A Contrast x-ray of bronchi ................................... 0.00 1.56 1.56 0.14 1.70 1.70 XXX

71090 ............ A X-ray & pacemaker insertion ............................. 0.54 1.38 1.38 0.15 2.07 2.07 XXX

71090 26 A X-ray & pacemaker insertion ............................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX

71090 TC A X-ray & pacemaker insertion ............................. 0.00 1.19 1.19 0.11 1.30 1.30 XXX

71100 ............ A X-ray exam of ribs .............................................. 0.22 0.48 0.48 0.06 0.76 0.76 XXX

71100 26 A X-ray exam of ribs .............................................. 0.22 0.07 0.07 0.02 0.31 0.31 XXX

71100 TC A X-ray exam of ribs .............................................. 0.00 0.40 0.40 0.04 0.44 0.44 XXX

71101 ............ A X-ray exam of ribs, chest ................................... 0.27 0.57 0.57 0.06 0.90 0.90 XXX

71101 26 A X-ray exam of ribs, chest ................................... 0.27 0.10 0.10 0.02 0.39 0.39 XXX

71101 TC A X-ray exam of ribs, chest ................................... 0.00 0.48 0.48 0.04 0.52 0.52 XXX

71110 ............ A X-ray exam of ribs .............................................. 0.27 0.65 0.65 0.07 0.99 0.99 XXX

71110 26 A X-ray exam of ribs .............................................. 0.27 0.10 0.10 0.02 0.39 0.39 XXX

71110 TC A X-ray exam of ribs .............................................. 0.00 0.56 0.56 0.05 0.61 0.61 XXX

71111 ............ A X-ray exam of ribs, chest ................................... 0.32 0.74 0.74 0.08 1.14 1.14 XXX

71111 26 A X-ray exam of ribs, chest ................................... 0.32 0.11 0.11 0.02 0.45 0.45 XXX

71111 TC A X-ray exam of ribs, chest ................................... 0.00 0.63 0.63 0.06 0.69 0.69 XXX

71120 ............ A X-ray exam of breastbone ................................. 0.20 0.53 0.53 0.05 0.78 0.78 XXX

71120 26 A X-ray exam of breastbone ................................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX

71120 TC A X-ray exam of breastbone ................................. 0.00 0.46 0.46 0.04 0.50 0.50 XXX

71130 ............ A X-ray exam of breastbone ................................. 0.22 0.57 0.57 0.05 0.84 0.84 XXX

71130 26 A X-ray exam of breastbone ................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX

71130 TC A X-ray exam of breastbone ................................. 0.00 0.50 0.50 0.04 0.54 0.54 XXX

71250 ............ A Cat scan of chest ............................................... 1.16 4.57 4.57 0.44 6.17 6.17 XXX

71250 26 A Cat scan of chest ............................................... 1.16 0.38 0.38 0.08 1.62 1.62 XXX

71250 TC A Cat scan of chest ............................................... 0.00 4.19 4.19 0.36 4.55 4.55 XXX

71260 ............ A Contrast CAT scan of chest ............................... 1.24 5.43 5.43 0.51 7.18 7.18 XXX

71260 26 A Contrast CAT scan of chest ............................... 1.24 0.41 0.41 0.08 1.73 1.73 XXX

71260 TC A Contrast CAT scan of chest ............................... 0.00 5.02 5.02 0.43 5.45 5.45 XXX

71270 ............ A Contrast CAT scans of chest ............................. 1.38 6.73 6.73 0.61 8.72 8.72 XXX

71270 26 A Contrast CAT scans of chest ............................. 1.38 0.45 0.45 0.09 1.92 1.92 XXX

71270 TC A Contrast CAT scans of chest ............................. 0.00 6.27 6.27 0.52 6.79 6.79 XXX

71550 ............ A Magnetic image, chest ....................................... 1.60 8.48 8.48 0.78 10.86 10.86 XXX

71550 26 A Magnetic image, chest ....................................... 1.60 0.54 0.54 0.11 2.25 2.25 XXX

71550 TC A Magnetic image, chest ....................................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

71555 ............ N Magnetic imaging/chest (MRA) .......................... +1.81 8.48 8.48 0.78 11.07 11.07 XXX

71555 26 N Magnetic imaging/chest (MRA) .......................... +1.81 0.54 0.54 0.11 2.46 2.46 XXX

71555 TC N Magnetic imaging/chest (MRA) .......................... +0.00 7.95 7.95 0.67 8.62 8.62 XXX

72010 ............ A X-ray exam of spine ........................................... 0.45 0.88 0.88 0.09 1.42 1.42 XXX

72010 26 A X-ray exam of spine ........................................... 0.45 0.15 0.15 0.03 0.63 0.63 XXX

72010 TC A X-ray exam of spine ........................................... 0.00 0.73 0.73 0.06 0.79 0.79 XXX

72020 ............ A X-ray exam of spine ........................................... 0.15 0.35 0.35 0.04 0.54 0.54 XXX

72020 26 A X-ray exam of spine ........................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX

72020 TC A X-ray exam of spine ........................................... 0.00 0.30 0.30 0.03 0.33 0.33 XXX

72040 ............ A X-ray exam of neck spine .................................. 0.22 0.50 0.50 0.05 0.77 0.77 XXX

72040 26 A X-ray exam of neck spine .................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX

72040 TC A X-ray exam of neck spine .................................. 0.00 0.42 0.42 0.04 0.46 0.46 XXX

72050 ............ A X-ray exam of neck spine .................................. 0.31 0.74 0.74 0.08 1.13 1.13 XXX

72050 26 A X-ray exam of neck spine .................................. 0.31 0.10 0.10 0.02 0.43 0.43 XXX

72050 TC A X-ray exam of neck spine .................................. 0.00 0.63 0.63 0.06 0.69 0.69 XXX

72052 ............ A X-ray exam of neck spine .................................. 0.36 0.93 0.93 0.09 1.38 1.38 XXX

72052 26 A X-ray exam of neck spine .................................. 0.36 0.13 0.13 0.02 0.51 0.51 XXX

72052 TC A X-ray exam of neck spine .................................. 0.00 0.80 0.80 0.07 0.87 0.87 XXX

72069 ............ A X-ray exam of trunk spine .................................. 0.22 0.42 0.42 0.04 0.68 0.68 XXX

72069 26 A X-ray exam of trunk spine .................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX

72069 TC A X-ray exam of trunk spine .................................. 0.00 0.35 0.35 0.03 0.38 0.38 XXX

72070 ............ A X-ray exam of thorax spine ................................ 0.22 0.54 0.54 0.05 0.81 0.81 XXX

72070 26 A X-ray exam of thorax spine ................................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX

72070 TC A X-ray exam of thorax spine ................................ 0.00 0.46 0.46 0.04 0.50 0.50 XXX

72072 ............ A X-ray exam of thoracic spine ............................. 0.22 0.60 0.60 0.06 0.88 0.88 XXX

72072 26 A X-ray exam of thoracic spine ............................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX

72072 TC A X-ray exam of thoracic spine ............................. 0.00 0.52 0.52 0.05 0.57 0.57 XXX

72074 ............ A X-ray exam of thoracic spine ............................. 0.22 0.72 0.72 0.07 1.01 1.01 XXX

72074 26 A X-ray exam of thoracic spine ............................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX

72074 TC A X-ray exam of thoracic spine ............................. 0.00 0.65 0.65 0.06 0.71 0.71 XXX

72080 ............ A X-ray exam of trunk spine .................................. 0.22 0.55 0.55 0.05 0.82 0.82 XXX

72080 26 A X-ray exam of trunk spine .................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX

72080 TC A X-ray exam of trunk spine .................................. 0.00 0.48 0.48 0.04 0.52 0.52 XXX

72090 ............ A X-ray exam of trunk spine .................................. 0.28 0.57 0.57 0.06 0.91 0.91 XXX

72090 26 A X-ray exam of trunk spine .................................. 0.28 0.10 0.10 0.02 0.40 0.40 XXX

72090 TC A X-ray exam of trunk spine .................................. 0.00 0.48 0.48 0.04 0.52 0.52 XXX

72100 ............ A X-ray exam of lower spine ................................. 0.22 0.55 0.55 0.05 0.82 0.82 XXX

72100 26 A X-ray exam of lower spine ................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX

72100 TC A X-ray exam of lower spine ................................. 0.00 0.48 0.48 0.04 0.52 0.52 XXX
30971

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

72110 ............ A X-ray exam of lower spine ................................. 0.31 0.75 0.75 0.08 1.14 1.14 XXX

72110 26 A X-ray exam of lower spine ................................. 0.31 0.10 0.10 0.02 0.43 0.43 XXX

72110 TC A X-ray exam of lower spine ................................. 0.00 0.65 0.65 0.06 0.71 0.71 XXX

72114 ............ A X-ray exam of lower spine ................................. 0.36 0.97 0.97 0.09 1.42 1.42 XXX

72114 26 A X-ray exam of lower spine ................................. 0.36 0.13 0.13 0.02 0.51 0.51 XXX

72114 TC A X-ray exam of lower spine ................................. 0.00 0.84 0.84 0.07 0.91 0.91 XXX

72120 ............ A X-ray exam of lower spine ................................. 0.22 0.71 0.71 0.07 1.00 1.00 XXX

72120 26 A X-ray exam of lower spine ................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX

72120 TC A X-ray exam of lower spine ................................. 0.00 0.63 0.63 0.06 0.69 0.69 XXX

72125 ............ A CAT scan of neck spine ..................................... 1.16 4.57 4.57 0.44 6.17 6.17 XXX

72125 26 A CAT scan of neck spine ..................................... 1.16 0.38 0.38 0.08 1.62 1.62 XXX

72125 TC A CAT scan of neck spine ..................................... 0.00 4.19 4.19 0.36 4.55 4.55 XXX

72126 ............ A Contrast CAT scan of neck ................................ 1.22 5.41 5.41 0.51 7.14 7.14 XXX

72126 26 A Contrast CAT scan of neck ................................ 1.22 0.39 0.39 0.08 1.69 1.69 XXX

72126 TC A Contrast CAT scan of neck ................................ 0.00 5.02 5.02 0.43 5.45 5.45 XXX

72127 ............ A Contrast CAT scans of neck .............................. 1.27 6.69 6.69 0.61 8.57 8.57 XXX

72127 26 A Contrast CAT scans of neck .............................. 1.27 0.42 0.42 0.09 1.78 1.78 XXX

72127 TC A Contrast CAT scans of neck .............................. 0.00 6.27 6.27 0.52 6.79 6.79 XXX

72128 ............ A CAT scan of thorax spine .................................. 1.16 4.57 4.57 0.44 6.17 6.17 XXX

72128 26 A CAT scan of thorax spine .................................. 1.16 0.38 0.38 0.08 1.62 1.62 XXX

72128 TC A CAT scan of thorax spine .................................. 0.00 4.19 4.19 0.36 4.55 4.55 XXX

72129 ............ A Contrast CAT scan of thorax ............................. 1.22 5.41 5.41 0.51 7.14 7.14 XXX

72129 26 A Contrast CAT scan of thorax ............................. 1.22 0.39 0.39 0.08 1.69 1.69 XXX

72129 TC A Contrast CAT scan of thorax ............................. 0.00 5.02 5.02 0.43 5.45 5.45 XXX

72130 ............ A Contrast CAT scans of thorax ........................... 1.27 6.69 6.69 0.61 8.57 8.57 XXX

72130 26 A Contrast CAT scans of thorax ........................... 1.27 0.42 0.42 0.09 1.78 1.78 XXX

72130 TC A Contrast CAT scans of thorax ........................... 0.00 6.27 6.27 0.52 6.79 6.79 XXX

72131 ............ A CAT scan of lower spine .................................... 1.16 4.57 4.57 0.44 6.17 6.17 XXX

72131 26 A CAT scan of lower spine .................................... 1.16 0.38 0.38 0.08 1.62 1.62 XXX

72131 TC A CAT scan of lower spine .................................... 0.00 4.19 4.19 0.36 4.55 4.55 XXX

72132 ............ A Contrast CAT of lower spine .............................. 1.22 5.41 5.41 0.51 7.14 7.14 XXX

72132 26 A Contrast CAT of lower spine .............................. 1.22 0.39 0.39 0.08 1.69 1.69 XXX

72132 TC A Contrast CAT of lower spine .............................. 0.00 5.02 5.02 0.43 5.45 5.45 XXX

72133 ............ A Contrast CAT scans, low spine ......................... 1.27 6.69 6.69 0.61 8.57 8.57 XXX

72133 26 A Contrast CAT scans, low spine ......................... 1.27 0.42 0.42 0.09 1.78 1.78 XXX

72133 TC A Contrast CAT scans, low spine ......................... 0.00 6.27 6.27 0.52 6.79 6.79 XXX

72141 ............ A Magnetic image, neck spine .............................. 1.60 8.48 8.48 0.78 10.86 10.86 XXX

72141 26 A Magnetic image, neck spine .............................. 1.60 0.54 0.54 0.11 2.25 2.25 XXX

72141 TC A Magnetic image, neck spine .............................. 0.00 7.95 7.95 0.67 8.62 8.62 XXX

72142 ............ A Magnetic image, neck spine .............................. 1.92 10.17 10.17 0.94 13.03 13.03 XXX

72142 26 A Magnetic image, neck spine .............................. 1.92 0.64 0.64 0.13 2.69 2.69 XXX

72142 TC A Magnetic image, neck spine .............................. 0.00 9.53 9.53 0.81 10.34 10.34 XXX

72146 ............ A Magnetic image, chest spine ............................. 1.60 9.36 9.36 0.85 11.81 11.81 XXX

72146 26 A Magnetic image, chest spine ............................. 1.60 0.54 0.54 0.11 2.25 2.25 XXX

72146 TC A Magnetic image, chest spine ............................. 0.00 8.83 8.83 0.74 9.57 9.57 XXX

72147 ............ A Magnetic image, chest spine ............................. 1.92 10.17 10.17 0.94 13.03 13.03 XXX

72147 26 A Magnetic image, chest spine ............................. 1.92 0.64 0.64 0.13 2.69 2.69 XXX

72147 TC A Magnetic image, chest spine ............................. 0.00 9.53 9.53 0.81 10.34 10.34 XXX

72148 ............ A Magnetic image, lumbar spine ........................... 1.48 9.32 9.32 0.84 11.64 11.64 XXX

72148 26 A Magnetic image, lumbar spine ........................... 1.48 0.49 0.49 0.10 2.07 2.07 XXX

72148 TC A Magnetic image, lumbar spine ........................... 0.00 8.83 8.83 0.74 9.57 9.57 XXX

72149 ............ A Magnetic image, lumbar spine ........................... 1.78 10.13 10.13 0.93 12.84 12.84 XXX

72149 26 A Magnetic image, lumbar spine ........................... 1.78 0.60 0.60 0.12 2.50 2.50 XXX

72149 TC A Magnetic image, lumbar spine ........................... 0.00 9.53 9.53 0.81 10.34 10.34 XXX

72156 ............ A Magnetic image, neck spine .............................. 2.57 18.51 18.51 1.66 22.74 22.74 XXX

72156 26 A Magnetic image, neck spine .............................. 2.57 0.86 0.86 0.17 3.60 3.60 XXX

72156 TC A Magnetic image, neck spine .............................. 0.00 17.65 17.65 1.49 19.14 19.14 XXX

72157 ............ A Magnetic image, chest spine ............................. 2.57 18.51 18.51 1.66 22.74 22.74 XXX

72157 26 A Magnetic image, chest spine ............................. 2.57 0.86 0.86 0.17 3.60 3.60 XXX

72157 TC A Magnetic image, chest spine ............................. 0.00 17.65 17.65 1.49 19.14 19.14 XXX

72158 ............ A Magnetic image, lumbar spine ........................... 2.36 18.45 18.45 1.65 22.46 22.46 XXX

72158 26 A Magnetic image, lumbar spine ........................... 2.36 0.80 0.80 0.16 3.32 3.32 XXX

72158 TC A Magnetic image, lumbar spine ........................... 0.00 17.65 17.65 1.49 19.14 19.14 XXX

72159 ............ N Magnetic imaging/spine (MRA) .......................... +1.80 9.32 9.32 0.84 11.96 11.96 XXX

72159 26 N Magnetic imaging/spine (MRA) .......................... +1.80 0.49 0.49 0.10 2.39 2.39 XXX

72159 TC N Magnetic imaging/spine (MRA) .......................... +0.00 8.83 8.83 0.74 9.57 9.57 XXX

72170 ............ A X-ray exam of pelvis .......................................... 0.17 0.42 0.42 0.04 0.63 0.63 XXX

72170 26 A X-ray exam of pelvis .......................................... 0.17 0.05 0.05 0.01 0.23 0.23 XXX

72170 TC A X-ray exam of pelvis .......................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

72190 ............ A X-ray exam of pelvis .......................................... 0.21 0.55 0.55 0.05 0.81 0.81 XXX

72190 26 A X-ray exam of pelvis .......................................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX

72190 TC A X-ray exam of pelvis .......................................... 0.00 0.48 0.48 0.04 0.52 0.52 XXX

72192 ............ A CAT scan of pelvis ............................................. 1.09 4.55 4.55 0.43 6.07 6.07 XXX

72192 26 A CAT scan of pelvis ............................................. 1.09 0.36 0.36 0.07 1.52 1.52 XXX
30972

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

72192 TC A CAT scan of pelvis ............................................. 0.00 4.19 4.19 0.36 4.55 4.55 XXX

72193 ............ A Contrast CAT scan of pelvis .............................. 1.16 5.23 5.23 0.49 6.88 6.88 XXX

72193 26 A Contrast CAT scan of pelvis .............................. 1.16 0.38 0.38 0.08 1.62 1.62 XXX

72193 TC A Contrast CAT scan of pelvis .............................. 0.00 4.85 4.85 0.41 5.26 5.26 XXX

72194 ............ A Contrast CAT scans of pelvis ............................ 1.22 6.42 6.42 0.58 8.22 8.22 XXX

72194 26 A Contrast CAT scans of pelvis ............................ 1.22 0.39 0.39 0.08 1.69 1.69 XXX

72194 TC A Contrast CAT scans of pelvis ............................ 0.00 6.02 6.02 0.50 6.52 6.52 XXX

72196 ............ A Magnetic image, pelvis ...................................... 1.60 8.48 8.48 0.78 10.86 10.86 XXX

72196 26 A Magnetic image, pelvis ...................................... 1.60 0.54 0.54 0.11 2.25 2.25 XXX

72196 TC A Magnetic image, pelvis ...................................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

72198 ............ N Magnetic imaging/pelvis (MRA) ......................... +1.80 8.48 8.48 0.78 11.06 11.06 XXX

72198 26 N Magnetic imaging/pelvis (MRA) ......................... +1.80 0.54 0.54 0.11 2.45 2.45 XXX

72198 TC N Magnetic imaging/pelvis (MRA) ......................... +0.00 7.95 7.95 0.67 8.62 8.62 XXX

72200 ............ A X-ray exam sacroiliac joints ............................... 0.17 0.43 0.43 0.04 0.64 0.64 XXX

72200 26 A X-ray exam sacroiliac joints ............................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX

72200 TC A X-ray exam sacroiliac joints ............................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

72202 ............ A X-ray exam sacroiliac joints ............................... 0.19 0.51 0.51 0.05 0.75 0.75 XXX

72202 26 A X-ray exam sacroiliac joints ............................... 0.19 0.07 0.07 0.01 0.27 0.27 XXX

72202 TC A X-ray exam sacroiliac joints ............................... 0.00 0.44 0.44 0.04 0.48 0.48 XXX

72220 ............ A X-ray exam of tailbone ....................................... 0.17 0.46 0.46 0.05 0.68 0.68 XXX

72220 26 A X-ray exam of tailbone ....................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX

72220 TC A X-ray exam of tailbone ....................................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

72240 ............ A Contrast x-ray of neck spine .............................. 0.91 3.67 3.67 0.35 4.93 4.93 XXX

72240 26 A Contrast x-ray of neck spine .............................. 0.91 0.31 0.31 0.06 1.28 1.28 XXX

72240 TC A Contrast x-ray of neck spine .............................. 0.00 3.36 3.36 0.29 3.65 3.65 XXX

72255 ............ A Contrast x-ray thorax spine ................................ 0.91 3.38 3.38 0.32 4.61 4.61 XXX

72255 26 A Contrast x-ray thorax spine ................................ 0.91 0.31 0.31 0.06 1.28 1.28 XXX

72255 TC A Contrast x-ray thorax spine ................................ 0.00 3.07 3.07 0.26 3.33 3.33 XXX

72265 ............ A Contrast x-ray lower spine ................................. 0.83 3.17 3.17 0.31 4.31 4.31 XXX

72265 26 A Contrast x-ray lower spine ................................. 0.83 0.28 0.28 0.06 1.17 1.17 XXX

72265 TC A Contrast x-ray lower spine ................................. 0.00 2.89 2.89 0.25 3.14 3.14 XXX

72270 ............ A Contrast x-ray of spine ....................................... 1.33 4.76 4.76 0.46 6.55 6.55 XXX

72270 26 A Contrast x-ray of spine ....................................... 1.33 0.44 0.44 0.09 1.86 1.86 XXX

72270 TC A Contrast x-ray of spine ....................................... 0.00 4.32 4.32 0.37 4.69 4.69 XXX

72285 ............ A X-ray of neck spine disk .................................... 0.83 6.23 6.23 0.56 7.62 7.62 XXX

72285 26 A X-ray of neck spine disk .................................... 0.83 0.28 0.28 0.06 1.17 1.17 XXX

72285 TC A X-ray of neck spine disk .................................... 0.00 5.95 5.95 0.50 6.45 6.45 XXX

72295 ............ A X-ray of lower spine disk ................................... 0.83 5.86 5.86 0.52 7.21 7.21 XXX

72295 26 A X-ray of lower spine disk ................................... 0.83 0.28 0.28 0.06 1.17 1.17 XXX

72295 TC A X-ray of lower spine disk ................................... 0.00 5.57 5.57 0.46 6.03 6.03 XXX

73000 ............ A X-ray exam of collarbone ................................... 0.16 0.42 0.42 0.04 0.62 0.62 XXX

73000 26 A X-ray exam of collarbone ................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73000 TC A X-ray exam of collarbone ................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

73010 ............ A X-ray exam of shoulder blade ............................ 0.17 0.43 0.43 0.04 0.64 0.64 XXX

73010 26 A X-ray exam of shoulder blade ............................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73010 TC A X-ray exam of shoulder blade ............................ 0.00 0.37 0.37 0.03 0.40 0.40 XXX

73020 ............ A X-ray exam of shoulder ...................................... 0.15 0.39 0.39 0.04 0.58 0.58 XXX

73020 26 A X-ray exam of shoulder ...................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX

73020 TC A X-ray exam of shoulder ...................................... 0.00 0.33 0.33 0.03 0.36 0.36 XXX

73030 ............ A X-ray exam of shoulder ...................................... 0.18 0.46 0.46 0.05 0.69 0.69 XXX

73030 26 A X-ray exam of shoulder ...................................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX

73030 TC A X-ray exam of shoulder ...................................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

73040 ............ A Contrast x-ray of shoulder ................................. 0.54 1.67 1.67 0.17 2.38 2.38 XXX

73040 26 A Contrast x-ray of shoulder ................................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX

73040 TC A Contrast x-ray of shoulder ................................. 0.00 1.49 1.49 0.13 1.62 1.62 XXX

73050 ............ A X-ray exam of shoulders .................................... 0.20 0.54 0.54 0.05 0.79 0.79 XXX

73050 26 A X-ray exam of shoulders .................................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX

73050 TC A X-ray exam of shoulders .................................... 0.00 0.48 0.48 0.04 0.52 0.52 XXX

73060 ............ A X-ray exam of humerus ..................................... 0.17 0.46 0.46 0.05 0.68 0.68 XXX

73060 26 A X-ray exam of humerus ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73060 TC A X-ray exam of humerus ..................................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

73070 ............ A X-ray exam of elbow .......................................... 0.15 0.42 0.42 0.04 0.61 0.61 XXX

73070 26 A X-ray exam of elbow .......................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX

73070 TC A X-ray exam of elbow .......................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

73080 ............ A X-ray exam of elbow .......................................... 0.17 0.46 0.46 0.05 0.68 0.68 XXX

73080 26 A X-ray exam of elbow .......................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73080 TC A X-ray exam of elbow .......................................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

73085 ............ A Contrast x-ray of elbow ...................................... 0.54 1.67 1.67 0.17 2.38 2.38 XXX

73085 26 A Contrast x-ray of elbow ...................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

73085 TC A Contrast x-ray of elbow ...................................... 0.00 1.49 1.49 0.13 1.62 1.62 XXX

73090 ............ A X-ray exam of forearm ....................................... 0.16 0.42 0.42 0.04 0.62 0.62 XXX

73090 26 A X-ray exam of forearm ....................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73090 TC A X-ray exam of forearm ....................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

73092 ............ A X-ray exam of arm, infant .................................. 0.16 0.40 0.40 0.04 0.60 0.60 XXX
30973

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

73092 26 A X-ray exam of arm, infant .................................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73092 TC A X-ray exam of arm, infant .................................. 0.00 0.35 0.35 0.03 0.38 0.38 XXX

73100 ............ A X-ray exam of wrist ............................................ 0.16 0.40 0.40 0.04 0.60 0.60 XXX

73100 26 A X-ray exam of wrist ............................................ 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73100 TC A X-ray exam of wrist ............................................ 0.00 0.35 0.35 0.03 0.38 0.38 XXX

73110 ............ A X-ray exam of wrist ............................................ 0.17 0.44 0.44 0.04 0.65 0.65 XXX

73110 26 A X-ray exam of wrist ............................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73110 TC A X-ray exam of wrist ............................................ 0.00 0.38 0.38 0.03 0.41 0.41 XXX

73115 ............ A Contrast x-ray of wrist ........................................ 0.54 1.30 1.30 0.14 1.98 1.98 XXX

73115 26 A Contrast x-ray of wrist ........................................ 0.54 0.19 0.19 0.04 0.77 0.77 XXX

73115 TC A Contrast x-ray of wrist ........................................ 0.00 1.12 1.12 0.10 1.22 1.22 XXX

73120 A X-ray exam of hand ........................................... 0.16 0.40 0.40 0.04 0.60 0.60 XXX

73120 26 ....... A X-ray exam of hand ........................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73120 TC A X-ray exam of hand ........................................... 0.00 0.35 0.35 0.03 0.38 0.38 XXX

73130 ............ A X-ray exam of hand ........................................... 0.17 0.44 0.44 0.04 0.65 0.65 XXX

73130 26 A X-ray exam of hand ........................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73130 TC A X-ray exam of hand ........................................... 0.00 0.38 0.38 0.03 0.41 0.41 XXX

73140 ............ A X-ray exam of finger(s) ...................................... 0.13 0.34 0.34 0.04 0.51 0.51 XXX

73140 26 A X-ray exam of finger(s) ...................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX

73140 TC A X-ray exam of finger(s) ...................................... 0.00 0.30 0.30 0.03 0.33 0.33 XXX

73200 ............ A CAT scan of arm ................................................ 1.09 3.88 3.88 0.37 5.34 5.34 XXX

73200 26 A CAT scan of arm ................................................ 1.09 0.36 0.36 0.07 1.52 1.52 XXX

73200 TC A CAT scan of arm ................................................ 0.00 3.52 3.52 0.30 3.82 3.82 XXX

73201 ............ A Contrast CAT scan of arm ................................. 1.16 4.57 4.57 0.44 6.17 6.17 XXX

73201 26 A Contrast CAT scan of arm ................................. 1.16 0.38 0.38 0.08 1.62 1.62 XXX

73201 TC A Contrast CAT scan of arm ................................. 0.00 4.19 4.19 0.36 4.55 4.55 XXX

73202 ............ A Contrast CAT scans of arm ............................... 1.22 5.66 5.66 0.53 7.41 7.41 XXX

73202 26 A Contrast CAT scans of arm ............................... 1.22 0.39 0.39 0.08 1.69 1.69 XXX

73202 TC A Contrast CAT scans of arm ............................... 0.00 5.27 5.27 0.45 5.72 5.72 XXX

73220 ............ A Magnetic image, arm, hand ............................... 1.48 8.44 8.44 0.77 10.69 10.69 XXX

73220 26 A Magnetic image, arm, hand ............................... 1.48 0.49 0.49 0.10 2.07 2.07 XXX

73220 TC A Magnetic image, arm, hand ............................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

73221 ............ A Magnetic image, joint of arm ............................. 1.48 8.27 8.27 0.73 10.48 10.48 XXX

73221 26 A Magnetic image, joint of arm ............................. 1.48 0.32 0.32 0.06 1.86 1.86 XXX

73221 TC A Magnetic image, joint of arm ............................. 0.00 7.95 7.95 0.67 8.62 8.62 XXX

73225 ............ N Magnetic imaging/upper (MRA) ......................... +1.73 8.44 8.44 0.77 10.94 10.94 XXX

73225 26 N Magnetic imaging/upper (MRA) ......................... +1.73 0.49 0.49 0.10 2.32 2.32 XXX

73225 TC N Magnetic imaging/upper (MRA) ......................... +0.00 7.95 7.95 0.67 8.62 8.62 XXX

73500 ............ A X-ray exam of hip ............................................... 0.17 0.39 0.39 0.04 0.60 0.60 XXX

73500 26 A X-ray exam of hip ............................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73500 TC A X-ray exam of hip ............................................... 0.00 0.33 0.33 0.03 0.36 0.36 XXX

73510 ............ A X-ray exam of hip ............................................... 0.21 0.48 0.48 0.05 0.74 0.74 XXX

73510 26 A X-ray exam of hip ............................................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX

73510 TC A X-ray exam of hip ............................................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

73520 ............ A X-ray exam of hips ............................................. 0.26 0.57 0.57 0.06 0.89 0.89 XXX

73520 26 A X-ray exam of hips ............................................. 0.26 0.09 0.09 0.02 0.37 0.37 XXX

73520 TC A X-ray exam of hips ............................................. 0.00 0.48 0.48 0.04 0.52 0.52 XXX

73525 ............ A Contrast x-ray of hip .......................................... 0.54 1.67 1.67 0.17 2.38 2.38 XXX

73525 26 A Contrast x-ray of hip .......................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

73525 TC A Contrast x-ray of hip .......................................... 0.00 1.49 1.49 0.13 1.62 1.62 XXX

73530 ............ A X-ray exam of hip ............................................... 0.29 0.47 0.47 0.05 0.81 0.81 XXX

73530 26 A X-ray exam of hip ............................................... 0.29 0.10 0.10 0.02 0.41 0.41 XXX

73530 TC A X-ray exam of hip ............................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

73540 ............ A X-ray exam of pelvis & hips ............................... 0.20 0.48 0.48 0.05 0.73 0.73 XXX

73540 26 A X-ray exam of pelvis & hips ............................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX

73540 TC A X-ray exam of pelvis & hips ............................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

73550 ............ A X-ray exam of thigh ............................................ 0.17 0.46 0.46 0.05 0.68 0.68 XXX

73550 26 A X-ray exam of thigh ............................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73550 TC A X-ray exam of thigh ............................................ 0.00 0.40 0.40 0.04 0.44 0.44 XXX

73560 ............ A X-ray exam of knee ............................................ 0.17 0.42 0.42 0.04 0.63 0.63 XXX

73560 26 A X-ray exam of knee ............................................ 0.17 0.05 0.05 0.01 0.23 0.23 XXX

73560 TC A X-ray exam of knee ............................................ 0.00 0.37 0.37 0.03 0.40 0.40 XXX

73562 ............ A X-ray exam of knee ............................................ 0.18 0.47 0.47 0.05 0.70 0.70 XXX

73562 26 A X-ray exam of knee ............................................ 0.18 0.07 0.07 0.01 0.26 0.26 XXX

73562 TC A X-ray exam of knee ............................................ 0.00 0.40 0.40 0.04 0.44 0.44 XXX

73564 ............ A X-ray exam of knee ............................................ 0.22 0.51 0.51 0.06 0.79 0.79 XXX

73564 26 A X-ray exam of knee ............................................ 0.22 0.07 0.07 0.02 0.31 0.31 XXX

73564 TC A X-ray exam of knee ............................................ 0.00 0.44 0.44 0.04 0.48 0.48 XXX

73565 ............ A X-ray exam of knee ............................................ 0.17 0.40 0.40 0.04 0.61 0.61 XXX

73565 26 A X-ray exam of knee ............................................ 0.17 0.05 0.05 0.01 0.23 0.23 XXX

73565 TC A X-ray exam of knee ............................................ 0.00 0.35 0.35 0.03 0.38 0.38 XXX

73580 ............ A Contrast x-ray of knee joint ................................ 0.54 2.05 2.05 0.21 2.80 2.80 XXX

73580 26 A Contrast x-ray of knee joint ................................ 0.54 0.19 0.19 0.04 0.77 0.77 XXX

73580 TC A Contrast x-ray of knee joint ................................ 0.00 1.86 1.86 0.17 2.03 2.03 XXX
30974

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

73590 ............ A X-ray exam of lower leg ..................................... 0.17 0.42 0.42 0.04 0.63 0.63 XXX

73590 26 A X-ray exam of lower leg ..................................... 0.17 0.05 0.05 0.01 0.23 0.23 XXX

73590 TC A X-ray exam of lower leg ..................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

73592 ............ A X-ray exam of leg, infant .................................... 0.16 0.40 0.40 0.04 0.60 0.60 XXX

73592 26 A X-ray exam of leg, infant .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73592 TC A X-ray exam of leg, infant .................................... 0.00 0.35 0.35 0.03 0.38 0.38 XXX

73600 ............ A X-ray exam of ankle ........................................... 0.16 0.40 0.40 0.04 0.60 0.60 XXX

73600 26 A X-ray exam of ankle ........................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73600 TC A X-ray exam of ankle ........................................... 0.00 0.35 0.35 0.03 0.38 0.38 XXX

73610 ............ A X-ray exam of ankle ........................................... 0.17 0.44 0.44 0.04 0.65 0.65 XXX

73610 26 A X-ray exam of ankle ........................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73610 TC A X-ray exam of ankle ........................................... 0.00 0.38 0.38 0.03 0.41 0.41 XXX

73615 ............ A Contrast x-ray of ankle ....................................... 0.54 1.67 1.67 0.17 2.38 2.38 XXX

73615 26 A Contrast x-ray of ankle ....................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

73615 TC A Contrast x-ray of ankle ....................................... 0.00 1.49 1.49 0.13 1.62 1.62 XXX

73620 ............ A X-ray exam of foot ............................................. 0.16 0.40 0.40 0.04 0.60 0.60 XXX

73620 26 A X-ray exam of foot ............................................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73620 TC A X-ray exam of foot ............................................. 0.00 0.35 0.35 0.03 0.38 0.38 XXX

73630 ............ A X-ray exam of foot ............................................. 0.17 0.44 0.44 0.04 0.65 0.65 XXX

73630 26 A X-ray exam of foot ............................................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX

73630 TC A X-ray exam of foot ............................................. 0.00 0.38 0.38 0.03 0.41 0.41 XXX

73650 ............ A X-ray exam of heel ............................................. 0.16 0.39 0.39 0.04 0.59 0.59 XXX

73650 26 A X-ray exam of heel ............................................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX

73650 TC A X-ray exam of heel ............................................. 0.00 0.33 0.33 0.03 0.36 0.36 XXX

73660 ............ A X-ray exam of toe(s) .......................................... 0.13 0.34 0.34 0.04 0.51 0.51 XXX

73660 26 A X-ray exam of toe(s) .......................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX

73660 TC A X-ray exam of toe(s) .......................................... 0.00 0.30 0.30 0.03 0.33 0.33 XXX

73700 ............ A CAT scan of leg ................................................. 1.09 3.88 3.88 0.37 5.34 5.34 XXX

73700 26 A CAT scan of leg ................................................. 1.09 0.36 0.36 0.07 1.52 1.52 XXX

73700 TC A CAT scan of leg ................................................. 0.00 3.52 3.52 0.30 3.82 3.82 XXX

73701 ............ A Contrast CAT scan of leg .................................. 1.16 4.57 4.57 0.44 6.17 6.17 XXX

73701 26 A Contrast CAT scan of leg .................................. 1.16 0.38 0.38 0.08 1.62 1.62 XXX

73701 TC A Contrast CAT scan of leg .................................. 0.00 4.19 4.19 0.36 4.55 4.55 XXX

73702 ............ A Contrast CAT scans of leg ................................. 1.22 5.66 5.66 0.53 7.41 7.41 XXX

73702 26 A Contrast CAT scans of leg ................................. 1.22 0.39 0.39 0.08 1.69 1.69 XXX

73702 TC A Contrast CAT scans of leg ................................. 0.00 5.27 5.27 0.45 5.72 5.72 XXX

73720 ............ A Magnetic image, leg, foot ................................... 1.48 8.44 8.44 0.77 10.69 10.69 XXX

73720 26 A Magnetic image, leg, foot ................................... 1.48 0.49 0.49 0.10 2.07 2.07 XXX

73720 TC A Magnetic image, leg, foot ................................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

73721 ............ A Magnetic image, joint of leg ............................... 1.48 8.27 8.27 0.73 10.48 10.48 XXX

73721 26 A Magnetic image, joint of leg ............................... 1.48 0.32 0.32 0.06 1.86 1.86 XXX

73721 TC A Magnetic image, joint of leg ............................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

73725 ............ R Magnetic imaging/lower (MRA) .......................... 1.82 8.44 8.44 0.77 11.03 11.03 XXX

73725 26 R Magnetic imaging/lower (MRA) .......................... 1.82 0.49 0.49 0.10 2.41 2.41 XXX

73725 TC R Magnetic imaging/lower (MRA) .......................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

74000 ............ A X-ray exam of abdomen .................................... 0.18 0.43 0.43 0.04 0.65 0.65 XXX

74000 26 A X-ray exam of abdomen .................................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX

74000 TC A X-ray exam of abdomen .................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

74010 ............ A X-ray exam of abdomen .................................... 0.23 0.48 0.48 0.06 0.77 0.77 XXX

74010 26 A X-ray exam of abdomen .................................... 0.23 0.08 0.08 0.02 0.33 0.33 XXX

74010 TC A X-ray exam of abdomen .................................... 0.00 0.40 0.40 0.04 0.44 0.44 XXX

74020 ............ A X-ray exam of abdomen .................................... 0.27 0.54 0.54 0.06 0.87 0.87 XXX

74020 26 A X-ray exam of abdomen .................................... 0.27 0.10 0.10 0.02 0.39 0.39 XXX

74020 TC A X-ray exam of abdomen .................................... 0.00 0.44 0.44 0.04 0.48 0.48 XXX

74022 ............ A X-ray exam series, abdomen ............................. 0.32 0.63 0.63 0.07 1.02 1.02 XXX

74022 26 A X-ray exam series, abdomen ............................. 0.32 0.11 0.11 0.02 0.45 0.45 XXX

74022 TC A X-ray exam series, abdomen ............................. 0.00 0.52 0.52 0.05 0.57 0.57 XXX

74150 ............ A CAT scan of abdomen ....................................... 1.19 4.40 4.40 0.43 6.02 6.02 XXX

74150 26 A CAT scan of abdomen ....................................... 1.19 0.39 0.39 0.08 1.66 1.66 XXX

74150 TC A CAT scan of abdomen ....................................... 0.00 4.01 4.01 0.35 4.36 4.36 XXX

74160 ............ A Contrast CAT scan of abdomen ........................ 1.27 5.27 5.27 0.50 7.04 7.04 XXX

74160 26 A Contrast CAT scan of abdomen ........................ 1.27 0.42 0.42 0.09 1.78 1.78 XXX

74160 TC A Contrast CAT scan of abdomen ........................ 0.00 4.85 4.85 0.41 5.26 5.26 XXX

74170 ............ A Contrast CAT scans, abdomen .......................... 1.40 6.48 6.48 0.60 8.48 8.48 XXX

74170 26 A Contrast CAT scans, abdomen .......................... 1.40 0.46 0.46 0.10 1.96 1.96 XXX

74170 TC A Contrast CAT scans, abdomen .......................... 0.00 6.02 6.02 0.50 6.52 6.52 XXX

74181 ............ A Magnetic image, abdomen (MRI) ...................... 1.60 8.48 8.48 0.78 10.86 10.86 XXX

74181 26 A Magnetic image, abdomen (MRI) ...................... 1.60 0.54 0.54 0.11 2.25 2.25 XXX

74181 TC A Magnetic image, abdomen (MRI) ...................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

74185 ............ N Magnetic image/abdomen (MRA) ...................... +1.80 8.48 8.48 0.78 11.06 11.06 XXX

74185 26 N Magnetic image/abdomen (MRA) ...................... +1.80 0.54 0.54 0.11 2.45 2.45 XXX

74185 TC N Magnetic image/abdomen (MRA) ...................... +0.00 7.95 7.95 0.67 8.62 8.62 XXX

74190 ............ A X-ray exam of peritoneum ................................. 0.48 1.02 1.02 0.10 1.60 1.60 XXX

74190 26 A X-ray exam of peritoneum ................................. 0.48 0.10 0.10 0.02 0.60 0.60 XXX
30975

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

74190 TC A X-ray exam of peritoneum ................................. 0.00 0.92 0.92 0.08 1.00 1.00 XXX

74210 ............ A Contrast xray exam of throat ............................. 0.36 0.96 0.96 0.09 1.41 1.41 XXX

74210 26 A Contrast xray exam of throat ............................. 0.36 0.12 0.12 0.02 0.50 0.50 XXX

74210 TC A Contrast xray exam of throat ............................. 0.00 0.84 0.84 0.07 0.91 0.91 XXX

74220 ............ A Contrast xray exam, esophagus ........................ 0.46 1.00 1.00 0.10 1.56 1.56 XXX

74220 26 A Contrast xray exam, esophagus ........................ 0.46 0.16 0.16 0.03 0.65 0.65 XXX

74220 TC A Contrast xray exam, esophagus ........................ 0.00 0.84 0.84 0.07 0.91 0.91 XXX

74230 ............ A Cinema xray throat/esophagus .......................... 0.53 1.11 1.11 0.12 1.76 1.76 XXX

74230 26 A Cinema xray throat/esophagus .......................... 0.53 0.19 0.19 0.04 0.76 0.76 XXX

74230 TC A Cinema xray throat/esophagus .......................... 0.00 0.92 0.92 0.08 1.00 1.00 XXX

74235 ............ A Remove esophagus obstruction ........................ 1.19 2.25 2.25 0.25 3.69 3.69 XXX

74235 26 A Remove esophagus obstruction ........................ 1.19 0.39 0.39 0.08 1.66 1.66 XXX

74235 TC A Remove esophagus obstruction ........................ 0.00 1.86 1.86 0.17 2.03 2.03 XXX

74240 ............ A X-ray exam upper GI tract ................................. 0.69 1.27 1.27 0.14 2.10 2.10 XXX

74240 26 A X-ray exam upper GI tract ................................. 0.69 0.24 0.24 0.05 0.98 0.98 XXX

74240 TC A X-ray exam upper GI tract ................................. 0.00 1.03 1.03 0.09 1.12 1.12 XXX

74241 ............ A X-ray exam upper GI tract ................................. 0.69 1.30 1.30 0.14 2.13 2.13 XXX

74241 26 A X-ray exam upper GI tract ................................. 0.69 0.24 0.24 0.05 0.98 0.98 XXX

74241 TC A X-ray exam upper GI tract ................................. 0.00 1.06 1.06 0.09 1.15 1.15 XXX

74245 ............ A X-ray exam upper GI tract ................................. 0.91 1.99 1.99 0.21 3.11 3.11 XXX

74245 26 A X-ray exam upper GI tract ................................. 0.91 0.31 0.31 0.06 1.28 1.28 XXX

74245 TC A X-ray exam upper GI tract ................................. 0.00 1.69 1.69 0.15 1.84 1.84 XXX

74246 ............ A Contrast xray upper GI tract .............................. 0.69 1.41 1.41 0.15 2.25 2.25 XXX

74246 26 A Contrast xray upper GI tract .............................. 0.69 0.24 0.24 0.05 0.98 0.98 XXX

74246 TC A Contrast xray upper GI tract .............................. 0.00 1.17 1.17 0.10 1.27 1.27 XXX

74247 ............ A Contrast xray upper GI tract .............................. 0.69 1.43 1.43 0.16 2.28 2.28 XXX

74247 26 A Contrast xray upper GI tract .............................. 0.69 0.24 0.24 0.05 0.98 0.98 XXX

74247 TC A Contrast xray upper GI tract .............................. 0.00 1.19 1.19 0.11 1.30 1.30 XXX

74249 ............ A Contrast xray upper GI tract .............................. 0.91 2.13 2.13 0.22 3.26 3.26 XXX

74249 26 A Contrast xray upper GI tract .............................. 0.91 0.31 0.31 0.06 1.28 1.28 XXX

74249 TC A Contrast xray upper GI tract .............................. 0.00 1.82 1.82 0.16 1.98 1.98 XXX

74250 ............ A X-ray exam of small bowel ................................ 0.47 1.08 1.08 0.11 1.66 1.66 XXX

74250 26 A X-ray exam of small bowel ................................ 0.47 0.16 0.16 0.03 0.66 0.66 XXX

74250 TC A X-ray exam of small bowel ................................ 0.00 0.92 0.92 0.08 1.00 1.00 XXX

74251 ............ A X-ray exam of small bowel ................................ 0.69 1.08 1.08 0.11 1.88 1.88 XXX

74251 26 A X-ray exam of small bowel ................................ 0.69 0.16 0.16 0.03 0.88 0.88 XXX

74251 TC A X-ray exam of small bowel ................................ 0.00 0.92 0.92 0.08 1.00 1.00 XXX

74260 ............ A X-ray exam of small bowel ................................ 0.50 1.23 1.23 0.12 1.85 1.85 XXX

74260 26 A X-ray exam of small bowel ................................ 0.50 0.17 0.17 0.03 0.70 0.70 XXX

74260 TC A X-ray exam of small bowel ................................ 0.00 1.06 1.06 0.09 1.15 1.15 XXX

74270 ............ A Contrast x-ray exam of colon ............................. 0.69 1.44 1.44 0.16 2.29 2.29 XXX

74270 26 A Contrast x-ray exam of colon ............................. 0.69 0.24 0.24 0.05 0.98 0.98 XXX

74270 TC A Contrast x-ray exam of colon ............................. 0.00 1.21 1.21 0.11 1.32 1.32 XXX

74280 ............ A Contrast x-ray exam of colon ............................. 0.99 1.92 1.92 0.21 3.12 3.12 XXX

74280 26 A Contrast x-ray exam of colon ............................. 0.99 0.33 0.33 0.07 1.39 1.39 XXX

74280 TC A Contrast x-ray exam of colon ............................. 0.00 1.59 1.59 0.14 1.73 1.73 XXX

74283 ............ A Contrast x-ray exam of colon ............................. 2.02 2.49 2.49 0.30 4.81 4.81 XXX

74283 26 A Contrast x-ray exam of colon ............................. 2.02 0.67 0.67 0.14 2.83 2.83 XXX

74283 TC A Contrast x-ray exam of colon ............................. 0.00 1.82 1.82 0.16 1.98 1.98 XXX

74290 ............ A Contrast x-ray, gallbladder ................................. 0.32 0.63 0.63 0.07 1.02 1.02 XXX

74290 26 A Contrast x-ray, gallbladder ................................. 0.32 0.11 0.11 0.02 0.45 0.45 XXX

74290 TC A Contrast x-ray, gallbladder ................................. 0.00 0.52 0.52 0.05 0.57 0.57 XXX

74291 ............ A Contrast x-rays, gallbladder ............................... 0.20 0.36 0.36 0.04 0.60 0.60 XXX

74291 26 A Contrast x-rays, gallbladder ............................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX

74291 TC A Contrast x-rays, gallbladder ............................... 0.00 0.30 0.30 0.03 0.33 0.33 XXX

74300 26 A X-ray bile ducts, pancreas ................................. 0.36 0.13 0.13 0.02 0.51 0.51 XXX

74301 26 A Additional x-rays at surgery ............................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX

74305 ............ A X-ray bile ducts, pancreas ................................. 0.42 0.70 0.70 0.08 1.20 1.20 XXX

74305 26 A X-ray bile ducts, pancreas ................................. 0.42 0.14 0.14 0.03 0.59 0.59 XXX

74305 TC A X-ray bile ducts, pancreas ................................. 0.00 0.56 0.56 0.05 0.61 0.61 XXX

74320 ............ A Contrast x-ray of bile ducts ................................ 0.54 2.42 2.42 0.23 3.19 3.19 XXX

74320 26 A Contrast x-ray of bile ducts ................................ 0.54 0.19 0.19 0.04 0.77 0.77 XXX

74320 TC A Contrast x-ray of bile ducts ................................ 0.00 2.23 2.23 0.19 2.42 2.42 XXX

74327 ............ A X-ray for bile stone removal ............................... 0.70 1.49 1.49 0.16 2.35 2.35 XXX

74327 26 A X-ray for bile stone removal ............................... 0.70 0.24 0.24 0.05 0.99 0.99 XXX

74327 TC A X-ray for bile stone removal ............................... 0.00 1.25 1.25 0.11 1.36 1.36 XXX

74328 ............ A X-ray for bile duct endoscopy ............................ 0.70 2.47 2.47 0.24 3.41 3.41 XXX

74328 26 A X-ray for bile duct endoscopy ............................ 0.70 0.24 0.24 0.05 0.99 0.99 XXX

74328 TC A X-ray for bile duct endoscopy ............................ 0.00 2.23 2.23 0.19 2.42 2.42 XXX

74329 ............ A X-ray for pancreas endoscopy ........................... 0.70 2.47 2.47 0.24 3.41 3.41 XXX

74329 26 A X-ray for pancreas endoscopy ........................... 0.70 0.24 0.24 0.05 0.99 0.99 XXX

74329 TC A X-ray for pancreas endoscopy ........................... 0.00 2.23 2.23 0.19 2.42 2.42 XXX

74330 ............ A Xray, bile/pancreas endoscopy .......................... 0.90 2.47 2.47 0.24 3.61 3.61 XXX

74330 26 A Xray, bile/pancreas endoscopy .......................... 0.90 0.24 0.24 0.05 1.19 1.19 XXX
30976

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

74330 TC A Xray, bile/pancreas endoscopy .......................... 0.00 2.23 2.23 0.19 2.42 2.42 XXX

74340 ............ A X-ray guide for GI tube ...................................... 0.54 2.05 2.05 0.21 2.80 2.80 XXX

74340 26 A X-ray guide for GI tube ...................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

74340 TC A X-ray guide for GI tube ...................................... 0.00 1.86 1.86 0.17 2.03 2.03 XXX

74350 ............ A X-ray guide, stomach tube ................................. 0.76 2.49 2.49 0.24 3.49 3.49 XXX

74350 26 A X-ray guide, stomach tube ................................. 0.76 0.26 0.26 0.05 1.07 1.07 XXX

74350 TC A X-ray guide, stomach tube ................................. 0.00 2.23 2.23 0.19 2.42 2.42 XXX

74355 ............ A X-ray guide, intestinal tube ................................ 0.76 2.12 2.12 0.22 3.10 3.10 XXX

74355 26 A X-ray guide, intestinal tube ................................ 0.76 0.26 0.26 0.05 1.07 1.07 XXX

74355 TC A X-ray guide, intestinal tube ................................ 0.00 1.86 1.86 0.17 2.03 2.03 XXX

74360 ............ A X-ray guide, GI dilation ...................................... 0.54 2.42 2.42 0.23 3.19 3.19 XXX

74360 26 A X-ray guide, GI dilation ...................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

74360 TC A X-ray guide, GI dilation ...................................... 0.00 2.23 2.23 0.19 2.42 2.42 XXX

74363 ............ A X-ray, bile duct dilation ...................................... 0.88 4.62 4.62 0.43 5.93 5.93 XXX

74363 26 A X-ray, bile duct dilation ...................................... 0.88 0.30 0.30 0.06 1.24 1.24 XXX

74363 TC A X-ray, bile duct dilation ...................................... 0.00 4.32 4.32 0.37 4.69 4.69 XXX

74400 ............ A Contrast x-ray urinary tract ................................ 0.49 1.35 1.35 0.14 1.98 1.98 XXX

74400 26 A Contrast x-ray urinary tract ................................ 0.49 0.16 0.16 0.03 0.68 0.68 XXX

74400 TC A Contrast x-ray urinary tract ................................ 0.00 1.19 1.19 0.11 1.30 1.30 XXX

74405 ............ A Contrast x-ray urinary tract ................................ 0.49 1.57 1.57 0.16 2.22 2.22 XXX

74405 26 A Contrast x-ray urinary tract ................................ 0.49 0.16 0.16 0.03 0.68 0.68 XXX

74405 TC A Contrast x-ray urinary tract ................................ 0.00 1.41 1.41 0.13 1.54 1.54 XXX

74410 ............ A Contrast x-ray urinary tract ................................ 0.49 1.55 1.55 0.15 2.19 2.19 XXX

74410 26 A Contrast x-ray urinary tract ................................ 0.49 0.16 0.16 0.03 0.68 0.68 XXX

74410 TC A Contrast x-ray urinary tract ................................ 0.00 1.38 1.38 0.12 1.50 1.50 XXX

74415 ............ A Contrast x-ray urinary tract ................................ 0.49 1.67 1.67 0.16 2.32 2.32 XXX

74415 26 A Contrast x-ray urinary tract ................................ 0.49 0.16 0.16 0.03 0.68 0.68 XXX

74415 TC A Contrast x-ray urinary tract ................................ 0.00 1.50 1.50 0.13 1.63 1.63 XXX

74420 ............ A Contrast x-ray urinary tract ................................ 0.36 1.98 1.98 0.19 2.53 2.53 XXX

74420 26 A Contrast x-ray urinary tract ................................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX

74420 TC A Contrast x-ray urinary tract ................................ 0.00 1.86 1.86 0.17 2.03 2.03 XXX

74425 ............ A Contrast x-ray urinary tract ................................ 0.36 1.04 1.04 0.10 1.50 1.50 XXX

74425 26 A Contrast x-ray urinary tract ................................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX

74425 TC A Contrast x-ray urinary tract ................................ 0.00 0.92 0.92 0.08 1.00 1.00 XXX

74430 ............ A Contrast x-ray of bladder ................................... 0.32 0.86 0.86 0.09 1.27 1.27 XXX

74430 26 A Contrast x-ray of bladder ................................... 0.32 0.11 0.11 0.02 0.45 0.45 XXX

74430 TC A Contrast x-ray of bladder ................................... 0.00 0.74 0.74 0.07 0.81 0.81 XXX

74440 ............ A X-ray exam male genital tract ............................ 0.38 0.93 0.93 0.10 1.41 1.41 XXX

74440 26 A X-ray exam male genital tract ............................ 0.38 0.13 0.13 0.03 0.54 0.54 XXX

74440 TC A X-ray exam male genital tract ............................ 0.00 0.80 0.80 0.07 0.87 0.87 XXX

74445 ............ A X-ray exam of penis ........................................... 1.14 1.18 1.18 0.15 2.47 2.47 XXX

74445 26 A X-ray exam of penis ........................................... 1.14 0.37 0.37 0.08 1.59 1.59 XXX

74445 TC A X-ray exam of penis ........................................... 0.00 0.80 0.80 0.07 0.87 0.87 XXX

74450 ............ A X-ray exam urethra/bladder ............................... 0.33 1.15 1.15 0.11 1.59 1.59 XXX

74450 26 A X-ray exam urethra/bladder ............................... 0.33 0.11 0.11 0.02 0.46 0.46 XXX

74450 TC A X-ray exam urethra/bladder ............................... 0.00 1.03 1.03 0.09 1.12 1.12 XXX

74455 ............ A X-ray exam urethra/bladder ............................... 0.33 1.23 1.23 0.12 1.68 1.68 XXX

74455 26 A X-ray exam urethra/bladder ............................... 0.33 0.11 0.11 0.02 0.46 0.46 XXX

74455 TC A X-ray exam urethra/bladder ............................... 0.00 1.12 1.12 0.10 1.22 1.22 XXX

74470 ............ A X-ray exam of kidney lesion .............................. 0.54 1.07 1.07 0.12 1.73 1.73 XXX

74470 26 A X-ray exam of kidney lesion .............................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX

74470 TC A X-ray exam of kidney lesion .............................. 0.00 0.89 0.89 0.08 0.97 0.97 XXX

74475 ............ A X-ray control catheter insert ............................... 0.54 3.07 3.07 0.29 3.90 3.90 XXX

74475 26 A X-ray control catheter insert ............................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

74475 TC A X-ray control catheter insert ............................... 0.00 2.89 2.89 0.25 3.14 3.14 XXX

74480 ............ A X-ray control catheter insert ............................... 0.54 3.07 3.07 0.29 3.90 3.90 XXX

74480 26 A X-ray control catheter insert ............................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

74480 TC A X-ray control catheter insert ............................... 0.00 2.89 2.89 0.25 3.14 3.14 XXX

74485 ............ A X-ray guide, GU dilation ..................................... 0.54 2.42 2.42 0.23 3.19 3.19 XXX

74485 26 A X-ray guide, GU dilation ..................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

74485 TC A X-ray guide, GU dilation ..................................... 0.00 2.23 2.23 0.19 2.42 2.42 XXX

74710 ............ A X-ray measurement of pelvis ............................. 0.34 0.86 0.86 0.09 1.29 1.29 XXX

74710 26 A X-ray measurement of pelvis ............................. 0.34 0.12 0.12 0.02 0.48 0.48 XXX

74710 TC A X-ray measurement of pelvis ............................. 0.00 0.74 0.74 0.07 0.81 0.81 XXX

74740 ............ A X-ray female genital tract ................................... 0.38 1.05 1.05 0.11 1.54 1.54 XXX

74740 26 A X-ray female genital tract ................................... 0.38 0.13 0.13 0.03 0.54 0.54 XXX

74740 TC A X-ray female genital tract ................................... 0.00 0.92 0.92 0.08 1.00 1.00 XXX

74742 ............ A X-ray fallopian tube ............................................ 0.61 2.42 2.42 0.23 3.26 3.26 XXX

74742 26 A X-ray fallopian tube ............................................ 0.61 0.19 0.19 0.04 0.84 0.84 XXX

74742 TC A X-ray fallopian tube ............................................ 0.00 2.23 2.23 0.19 2.42 2.42 XXX

74775 ............ A X-ray exam of perineum .................................... 0.62 1.25 1.25 0.13 2.00 2.00 XXX

74775 26 A X-ray exam of perineum .................................... 0.62 0.22 0.22 0.04 0.88 0.88 XXX

74775 TC A X-ray exam of perineum .................................... 0.00 1.03 1.03 0.09 1.12 1.12 XXX

75552 ............ A Magnetic image, myocardium ............................ 1.60 8.48 8.48 0.78 10.86 10.86 XXX
30977

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

75552 26 A Magnetic image, myocardium ............................ 1.60 0.54 0.54 0.11 2.25 2.25 XXX

75552 TC A Magnetic image, myocardium ............................ 0.00 7.95 7.95 0.67 8.62 8.62 XXX

75553 ............ A Magnetic image, myocardium ............................ 2.00 8.48 8.48 0.78 11.26 11.26 XXX

75553 26 A Magnetic image, myocardium ............................ 2.00 0.54 0.54 0.11 2.65 2.65 XXX

75553 TC A Magnetic image, myocardium ............................ 0.00 7.95 7.95 0.67 8.62 8.62 XXX

75554 ............ A Cardiac MRI/function .......................................... 1.83 8.48 8.48 0.78 11.09 11.09 XXX

75554 26 A Cardiac MRI/function .......................................... 1.83 0.54 0.54 0.11 2.48 2.48 XXX

75554 TC A Cardiac MRI/function .......................................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

75555 ............ A Cardiac MRI/limited study .................................. 1.74 8.48 8.48 0.78 11.00 11.00 XXX

75555 26 A Cardiac MRI/limited study .................................. 1.74 0.54 0.54 0.11 2.39 2.39 XXX

75555 TC A Cardiac MRI/limited study .................................. 0.00 7.95 7.95 0.67 8.62 8.62 XXX

75600 ............ A Contrast x-ray exam of aorta ............................. 0.49 9.10 9.10 0.78 10.37 10.37 XXX

75600 26 A Contrast x-ray exam of aorta ............................. 0.49 0.16 0.16 0.03 0.68 0.68 XXX

75600 TC A Contrast x-ray exam of aorta ............................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75605 ............ A Contrast x-ray exam of aorta ............................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75605 26 A Contrast x-ray exam of aorta ............................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75605 TC A Contrast x-ray exam of aorta ............................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75625 ............ A Contrast x-ray exam of aorta ............................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75625 26 A Contrast x-ray exam of aorta ............................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75625 TC A Contrast x-ray exam of aorta ............................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75630 ............ A X-ray aorta, leg arteries ..................................... 1.79 9.74 9.74 0.88 12.41 12.41 XXX

75630 26 A X-ray aorta, leg arteries ..................................... 1.79 0.43 0.43 0.09 2.31 2.31 XXX

75630 TC A X-ray aorta, leg arteries ..................................... 0.00 9.31 9.31 0.79 10.10 10.10 XXX

75650 ............ A Artery x-rays, head & neck ................................ 1.49 9.43 9.43 0.85 11.77 11.77 XXX

75650 26 A Artery x-rays, head & neck ................................ 1.49 0.49 0.49 0.10 2.08 2.08 XXX

75650 TC A Artery x-rays, head & neck ................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75658 ............ A X-ray exam of arm arteries ................................ 1.31 9.37 9.37 0.84 11.52 11.52 XXX

75658 26 A X-ray exam of arm arteries ................................ 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75658 TC A X-ray exam of arm arteries ................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75660 ............ A Artery x-rays, head & neck ................................ 1.31 9.37 9.37 0.84 11.52 11.52 XXX

75660 26 A Artery x-rays, head & neck ................................ 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75660 TC A Artery x-rays, head & neck ................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75662 ............ A Artery x-rays, head & neck ................................ 1.66 9.49 9.49 0.86 12.01 12.01 XXX

75662 26 A Artery x-rays, head & neck ................................ 1.66 0.55 0.55 0.11 2.32 2.32 XXX

75662 TC A Artery x-rays, head & neck ................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75665 ............ A Artery x-rays, head & neck ................................ 1.31 9.37 9.37 0.84 11.52 11.52 XXX

75665 26 A Artery x-rays, head & neck ................................ 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75665 TC A Artery x-rays, head & neck ................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75671 ............ A Artery x-rays, head & neck ................................ 1.66 9.49 9.49 0.86 12.01 12.01 XXX

75671 26 A Artery x-rays, head & neck ................................ 1.66 0.55 0.55 0.11 2.32 2.32 XXX

75671 TC A Artery x-rays, head & neck ................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75676 ............ A Artery x-rays, neck ............................................. 1.31 9.37 9.37 0.84 11.52 11.52 XXX

75676 26 A Artery x-rays, neck ............................................. 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75676 TC A Artery x-rays, neck ............................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75680 ............ A Artery x-rays, neck ............................................. 1.66 9.49 9.49 0.86 12.01 12.01 XXX

75680 26 A Artery x-rays, neck ............................................. 1.66 0.55 0.55 0.11 2.32 2.32 XXX

75680 TC A Artery x-rays, neck ............................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75685 ............ A Artery x-rays, spine ............................................ 1.31 9.37 9.37 0.84 11.52 11.52 XXX

75685 26 A Artery x-rays, spine ............................................ 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75685 TC A Artery x-rays, spine ............................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75705 ............ A Artery x-rays, spine ............................................ 2.18 9.67 9.67 0.90 12.75 12.75 XXX

75705 26 A Artery x-rays, spine ............................................ 2.18 0.73 0.73 0.15 3.06 3.06 XXX

75705 TC A Artery x-rays, spine ............................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75710 ............ A Artery x-rays, arm/leg ......................................... 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75710 26 A Artery x-rays, arm/leg ......................................... 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75710 TC A Artery x-rays, arm/leg ......................................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75716 ............ A Artery x-rays, arms/legs ..................................... 1.31 9.37 9.37 0.84 11.52 11.52 XXX

75716 26 A Artery x-rays, arms/legs ..................................... 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75716 TC A Artery x-rays, arms/legs ..................................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75722 ............ A Artery x-rays, kidney .......................................... 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75722 26 A Artery x-rays, kidney .......................................... 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75722 TC A Artery x-rays, kidney .......................................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75724 ............ A Artery x-rays, kidneys ........................................ 1.49 9.43 9.43 0.85 11.77 11.77 XXX

75724 26 A Artery x-rays, kidneys ........................................ 1.49 0.49 0.49 0.10 2.08 2.08 XXX

75724 TC A Artery x-rays, kidneys ........................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75726 ............ A Artery x-rays, abdomen ...................................... 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75726 26 A Artery x-rays, abdomen ...................................... 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75726 TC A Artery x-rays, abdomen ...................................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75731 ............ A Artery x-rays, adrenal gland ............................... 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75731 26 A Artery x-rays, adrenal gland ............................... 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75731 TC A Artery x-rays, adrenal gland ............................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75733 ............ A Artery x-rays, adrenal glands ............................. 1.31 9.37 9.37 0.84 11.52 11.52 XXX

75733 26 A Artery x-rays, adrenal glands ............................. 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75733 TC A Artery x-rays, adrenal glands ............................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX
30978

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

75736 ............ A Artery x-rays, pelvis ........................................... 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75736 26 A Artery x-rays, pelvis ........................................... 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75736 TC A Artery x-rays, pelvis ........................................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75741 ............ A Artery x-rays, lung .............................................. 1.31 9.37 9.37 0.84 11.52 11.52 XXX

75741 26 A Artery x-rays, lung .............................................. 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75741 TC A Artery x-rays, lung .............................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75743 ............ A Artery x-rays, lungs ............................................ 1.66 9.49 9.49 0.86 12.01 12.01 XXX

75743 26 A Artery x-rays, lungs ............................................ 1.66 0.55 0.55 0.11 2.32 2.32 XXX

75743 TC A Artery x-rays, lungs ............................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75746 ............ A Artery x-rays, lung .............................................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75746 26 A Artery x-rays, lung .............................................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75746 TC A Artery x-rays, lung .............................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75756 ............ A Artery x-rays, chest ............................................ 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75756 26 A Artery x-rays, chest ............................................ 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75756 TC A Artery x-rays, chest ............................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75774 ............ A Artery x-ray, each vessel ................................... 0.36 9.06 9.06 0.77 10.19 10.19 XXX

75774 26 A Artery x-ray, each vessel ................................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX

75774 TC A Artery x-ray, each vessel ................................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75790 ............ A Visualize A–V shunt ........................................... 1.84 1.58 1.58 0.21 3.63 3.63 XXX

75790 26 A Visualize A–V shunt ........................................... 1.84 0.62 0.62 0.12 2.58 2.58 XXX

75790 TC A Visualize A–V shunt ........................................... 0.00 0.96 0.96 0.09 1.05 1.05 XXX

75801 ............ A Lymph vessel x-ray, arm/leg .............................. 0.81 4.12 4.12 0.38 5.31 5.31 XXX

75801 26 A Lymph vessel x-ray, arm/leg .............................. 0.81 0.28 0.28 0.05 1.14 1.14 XXX

75801 TC A Lymph vessel x-ray, arm/leg .............................. 0.00 3.84 3.84 0.33 4.17 4.17 XXX

75803 ............ A Lymph vessel x-ray, arms/legs .......................... 1.17 4.22 4.22 0.41 5.80 5.80 XXX

75803 26 A Lymph vessel x-ray, arms/legs .......................... 1.17 0.38 0.38 0.08 1.63 1.63 XXX

75803 TC A Lymph vessel x-ray, arms/legs .......................... 0.00 3.84 3.84 0.33 4.17 4.17 XXX

75805 ............ A Lymph vessel x-ray, trunk .................................. 0.81 4.60 4.60 0.42 5.83 5.83 XXX

75805 26 A Lymph vessel x-ray, trunk .................................. 0.81 0.28 0.28 0.05 1.14 1.14 XXX

75805 TC A Lymph vessel x-ray, trunk .................................. 0.00 4.32 4.32 0.37 4.69 4.69 XXX

75807 ............ A Lymph vessel x-ray, trunk .................................. 1.17 4.70 4.70 0.45 6.32 6.32 XXX

75807 26 A Lymph vessel x-ray, trunk .................................. 1.17 0.38 0.38 0.08 1.63 1.63 XXX

75807 TC A Lymph vessel x-ray, trunk .................................. 0.00 4.32 4.32 0.37 4.69 4.69 XXX

75809 ............ A Nonvascular shunt, x-ray ................................... 0.47 0.70 0.70 0.08 1.25 1.25 XXX

75809 26 A Nonvascular shunt, x-ray ................................... 0.47 0.14 0.14 0.03 0.64 0.64 XXX

75809 TC A Nonvascular shunt, x-ray ................................... 0.00 0.56 0.56 0.05 0.61 0.61 XXX

75810 ............ A Vein x-ray, spleen/liver ....................................... 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75810 26 A Vein x-ray, spleen/liver ....................................... 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75810 TC A Vein x-ray, spleen/liver ....................................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75820 ............ A Vein x-ray, arm/leg ............................................. 0.70 0.91 0.91 0.11 1.72 1.72 XXX

75820 26 A Vein x-ray, arm/leg ............................................. 0.70 0.24 0.24 0.05 0.99 0.99 XXX

75820 TC A Vein x-ray, arm/leg ............................................. 0.00 0.67 0.67 0.06 0.73 0.73 XXX

75822 ............ A Vein x-ray, arms/legs ......................................... 1.06 1.40 1.40 0.16 2.62 2.62 XXX

75822 26 A Vein x-ray, arms/legs ......................................... 1.06 0.35 0.35 0.07 1.48 1.48 XXX

75822 TC A Vein x-ray, arms/legs ......................................... 0.00 1.05 1.05 0.09 1.14 1.14 XXX

75825 ............ A Vein x-ray, trunk ................................................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75825 26 A Vein x-ray, trunk ................................................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75825 TC A Vein x-ray, trunk ................................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75827 ............ A Vein x-ray, chest ................................................ 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75827 26 A Vein x-ray, chest ................................................ 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75827 TC A Vein x-ray, chest ................................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75831 ............ A Vein x-ray, kidney .............................................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75831 26 A Vein x-ray, kidney .............................................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75831 TC A Vein x-ray, kidney .............................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75833 ............ A Vein x-ray, kidneys ............................................. 1.49 9.43 9.43 0.85 11.77 11.77 XXX

75833 26 A Vein x-ray, kidneys ............................................. 1.49 0.49 0.49 0.10 2.08 2.08 XXX

75833 TC A Vein x-ray, kidneys ............................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75840 ............ A Vein x-ray, adrenal gland ................................... 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75840 26 A Vein x-ray, adrenal gland ................................... 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75840 TC A Vein x-ray, adrenal gland ................................... 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75842 ............ A Vein x-ray, adrenal glands ................................. 1.49 9.43 9.43 0.85 11.77 11.77 XXX

75842 26 A Vein x-ray, adrenal glands ................................. 1.49 0.49 0.49 0.10 2.08 2.08 XXX

75842 TC A Vein x-ray, adrenal glands ................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75860 ............ A Vein x-ray, neck ................................................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75860 26 A Vein x-ray, neck ................................................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75860 TC A Vein x-ray, neck ................................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75870 ............ A Vein x-ray, skull .................................................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75870 26 A Vein x-ray, skull .................................................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75870 TC A Vein x-ray, skull .................................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75872 ............ A Vein x-ray, skull .................................................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75872 26 A Vein x-ray, skull .................................................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75872 TC A Vein x-ray, skull .................................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75880 ............ A Vein x-ray, eye socket ....................................... 0.70 0.91 0.91 0.11 1.72 1.72 XXX

75880 26 A Vein x-ray, eye socket ....................................... 0.70 0.24 0.24 0.05 0.99 0.99 XXX
30979

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

75880 TC A Vein x-ray, eye socket ....................................... 0.00 0.67 0.67 0.06 0.73 0.73 XXX

75885 ............ A Vein x-ray, liver .................................................. 1.44 9.42 9.42 0.85 11.71 11.71 XXX

75885 26 A Vein x-ray, liver .................................................. 1.44 0.48 0.48 0.10 2.02 2.02 XXX

75885 TC A Vein x-ray, liver .................................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75887 ............ A Vein x-ray, liver .................................................. 1.44 9.42 9.42 0.85 11.71 11.71 XXX

75887 26 A Vein x-ray, liver .................................................. 1.44 0.48 0.48 0.10 2.02 2.02 XXX

75887 TC A Vein x-ray, liver .................................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75889 ............ A Vein x-ray, liver .................................................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75889 26 A Vein x-ray, liver .................................................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75889 TC A Vein x-ray, liver .................................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75891 ............ A Vein x-ray, liver .................................................. 1.14 9.31 9.31 0.83 11.28 11.28 XXX

75891 26 A Vein x-ray, liver .................................................. 1.14 0.37 0.37 0.08 1.59 1.59 XXX

75891 TC A Vein x-ray, liver .................................................. 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75893 ............ A Venous sampling by catheter ............................ 0.54 9.12 9.12 0.79 10.45 10.45 XXX

75893 26 A Venous sampling by catheter ............................ 0.54 0.19 0.19 0.04 0.77 0.77 XXX

75893 TC A Venous sampling by catheter ............................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75894 ............ A X-rays, transcatheter therapy ............................. 1.31 17.55 17.55 1.53 20.39 20.39 XXX

75894 26 A X-rays, transcatheter therapy ............................. 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75894 TC A X-rays, transcatheter therapy ............................. 0.00 17.12 17.12 1.44 18.56 18.56 XXX

75896 ............ A X-rays, transcatheter therapy ............................. 1.31 15.32 15.32 1.34 17.97 17.97 XXX

75896 26 A X-rays, transcatheter therapy ............................. 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75896 TC A X-rays, transcatheter therapy ............................. 0.00 14.89 14.89 1.25 16.14 16.14 XXX

75898 ............ A Follow-up angiogram .......................................... 1.65 1.30 1.30 0.18 3.13 3.13 XXX

75898 26 A Follow-up angiogram .......................................... 1.65 0.55 0.55 0.11 2.31 2.31 XXX

75898 TC A Follow-up angiogram .......................................... 0.00 0.74 0.74 0.07 0.81 0.81 XXX

75900 ............ A Arterial catheter exchange ................................. 0.49 15.05 15.05 1.29 16.83 16.83 XXX

75900 26 A Arterial catheter exchange ................................. 0.49 0.17 0.17 0.03 0.69 0.69 XXX

75900 TC A Arterial catheter exchange ................................. 0.00 14.88 14.88 1.26 16.14 16.14 XXX

75940 ............ A X-ray placement, vein filter ................................ 0.54 9.12 9.12 0.79 10.45 10.45 XXX

75940 26 A X-ray placement, vein filter ................................ 0.54 0.19 0.19 0.04 0.77 0.77 XXX

75940 TC A X-ray placement, vein filter ................................ 0.00 8.94 8.94 0.75 9.69 9.69 XXX

75945 ............ A Intravascular us .................................................. 0.40 NA 3.40 0.31 NA 4.11 XXX

75945 26 A Intravascular us .................................................. 0.40 NA 0.16 0.03 NA 0.59 XXX

75945 TC A Intravascular us .................................................. 0.00 NA 3.24 0.28 NA 3.52 XXX

75946 ............ A Intravascular us .................................................. 0.40 NA 1.79 0.17 NA 2.36 XXX

75946 26 A Intravascular us .................................................. 0.40 NA 0.16 0.03 NA 0.59 XXX

75946 TC A Intravascular us .................................................. 0.00 NA 1.62 0.14 NA 1.76 XXX

75960 ............ A Transcatheter intro, stent ................................... 0.82 10.84 10.84 0.94 12.60 12.60 XXX

75960 26 A Transcatheter intro, stent ................................... 0.82 0.28 0.28 0.06 1.16 1.16 XXX

75960 TC A Transcatheter intro, stent ................................... 0.00 10.57 10.57 0.88 11.45 11.45 XXX

75961 ............ A Retrieval, broken catheter .................................. 4.25 8.86 8.86 0.90 14.01 14.01 XXX

75961 26 A Retrieval, broken catheter .................................. 4.25 1.41 1.41 0.28 5.94 5.94 XXX

75961 TC A Retrieval, broken catheter .................................. 0.00 7.45 7.45 0.62 8.07 8.07 XXX

75962 ............ A Repair arterial blockage ..................................... 0.54 11.35 11.35 0.98 12.87 12.87 XXX

75962 26 A Repair arterial blockage ..................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

75962 TC A Repair arterial blockage ..................................... 0.00 11.16 11.16 0.94 12.10 12.10 XXX

75964 ............ A Repair artery blockage, each ............................. 0.36 6.07 6.07 0.52 6.95 6.95 XXX

75964 26 A Repair artery blockage, each ............................. 0.36 0.12 0.12 0.02 0.50 0.50 XXX

75964 TC A Repair artery blockage, each ............................. 0.00 5.95 5.95 0.50 6.45 6.45 XXX

75966 ............ A Repair arterial blockage ..................................... 1.31 11.60 11.60 1.03 13.94 13.94 XXX

75966 26 A Repair arterial blockage ..................................... 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75966 TC A Repair arterial blockage ..................................... 0.00 11.16 11.16 0.94 12.10 12.10 XXX

75968 ............ A Repair artery blockage, each ............................. 0.36 6.07 6.07 0.52 6.95 6.95 XXX

75968 26 A Repair artery blockage, each ............................. 0.36 0.12 0.12 0.02 0.50 0.50 XXX

75968 TC A Repair artery blockage, each ............................. 0.00 5.95 5.95 0.50 6.45 6.45 XXX

75970 ............ A Vascular biopsy .................................................. 0.83 8.47 8.47 0.75 10.05 10.05 XXX

75970 26 A Vascular biopsy .................................................. 0.83 0.28 0.28 0.06 1.17 1.17 XXX

75970 TC A Vascular biopsy .................................................. 0.00 8.19 8.19 0.69 8.88 8.88 XXX

75978 ............ A Repair venous blockage .................................... 0.54 11.52 11.52 0.98 13.04 13.04 XXX

75978 26 A Repair venous blockage .................................... 0.54 0.36 0.36 0.04 0.94 0.94 XXX

75978 TC A Repair venous blockage .................................... 0.00 11.16 11.16 0.94 12.10 12.10 XXX

75980 ............ A Contrast xray exam bile duct ............................. 1.44 4.32 4.32 0.43 6.19 6.19 XXX

75980 26 A Contrast xray exam bile duct ............................. 1.44 0.48 0.48 0.10 2.02 2.02 XXX

75980 TC A Contrast xray exam bile duct ............................. 0.00 3.84 3.84 0.33 4.17 4.17 XXX

75982 ............ A Contrast xray exam bile duct ............................. 1.44 4.80 4.80 0.47 6.71 6.71 XXX

75982 26 A Contrast xray exam bile duct ............................. 1.44 0.48 0.48 0.10 2.02 2.02 XXX

75982 TC A Contrast xray exam bile duct ............................. 0.00 4.32 4.32 0.37 4.69 4.69 XXX

75984 ............ A X-ray control catheter change ............................ 0.72 1.63 1.63 0.17 2.52 2.52 XXX

75984 26 A X-ray control catheter change ............................ 0.72 0.25 0.25 0.05 1.02 1.02 XXX

75984 TC A X-ray control catheter change ............................ 0.00 1.38 1.38 0.12 1.50 1.50 XXX

75989 ............ A Abscess drainage under x-ray ........................... 1.19 2.62 2.62 0.27 4.08 4.08 XXX

75989 26 A Abscess drainage under x-ray ........................... 1.19 0.39 0.39 0.08 1.66 1.66 XXX

75989 TC A Abscess drainage under x-ray ........................... 0.00 2.23 2.23 0.19 2.42 2.42 XXX

75992 ............ A Atherectomy, x-ray exam ................................... 0.54 11.35 11.35 0.98 12.87 12.87 XXX
30980

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

75992 26 A Atherectomy, x-ray exam ................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

75992 TC A Atherectomy, x-ray exam ................................... 0.00 11.16 11.16 0.94 12.10 12.10 XXX

75993 ............ A Atherectomy, x-ray exam ................................... 0.36 6.07 6.07 0.52 6.95 6.95 XXX

75993 26 A Atherectomy, x-ray exam ................................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX

75993 TC A Atherectomy, x-ray exam ................................... 0.00 5.95 5.95 0.50 6.45 6.45 XXX

75994 ............ A Atherectomy, x-ray exam ................................... 1.31 11.60 11.60 1.03 13.94 13.94 XXX

75994 26 A Atherectomy, x-ray exam ................................... 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75994 TC A Atherectomy, x-ray exam ................................... 0.00 11.16 11.16 0.94 12.10 12.10 XXX

75995 ............ A Atherectomy, x-ray exam ................................... 1.31 11.60 11.60 1.03 13.94 13.94 XXX

75995 26 A Atherectomy, x-ray exam ................................... 1.31 0.43 0.43 0.09 1.83 1.83 XXX

75995 TC A Atherectomy, x-ray exam ................................... 0.00 11.16 11.16 0.94 12.10 12.10 XXX

75996 ............ A Atherectomy, x-ray exam ................................... 0.36 6.07 6.07 0.52 6.95 6.95 XXX

75996 26 A Atherectomy, x-ray exam ................................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX

75996 TC A Atherectomy, x-ray exam ................................... 0.00 5.95 5.95 0.50 6.45 6.45 XXX

76000 ............ A Fluoroscope examination ................................... 0.17 0.98 0.98 0.09 1.24 1.24 XXX

76000 26 A Fluoroscope examination ................................... 0.17 0.05 0.05 0.01 0.23 0.23 XXX

76000 TC A Fluoroscope examination ................................... 0.00 0.92 0.92 0.08 1.00 1.00 XXX

76001 ............ A Fluoroscope exam, extensive ............................ 0.67 2.09 2.09 0.22 2.98 2.98 XXX

76001 26 A Fluoroscope exam, extensive ............................ 0.67 0.23 0.23 0.05 0.95 0.95 XXX

76001 TC A Fluoroscope exam, extensive ............................ 0.00 1.86 1.86 0.17 2.03 2.03 XXX

76003 ............ A Needle localization by x-ray ............................... 0.54 1.11 1.11 0.12 1.77 1.77 XXX

76003 26 A Needle localization by x-ray ............................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

76003 TC A Needle localization by x-ray ............................... 0.00 0.92 0.92 0.08 1.00 1.00 XXX

76010 ............ A X-ray, nose to rectum ........................................ 0.18 0.43 0.43 0.04 0.65 0.65 XXX

76010 26 A X-ray, nose to rectum ........................................ 0.18 0.06 0.06 0.01 0.25 0.25 XXX

76010 TC A X-ray, nose to rectum ........................................ 0.00 0.37 0.37 0.03 0.40 0.40 XXX

76020 ............ A X-rays for bone age ........................................... 0.19 0.44 0.44 0.04 0.67 0.67 XXX

76020 26 A X-rays for bone age ........................................... 0.19 0.07 0.07 0.01 0.27 0.27 XXX

76020 TC A X-rays for bone age ........................................... 0.00 0.37 0.37 0.03 0.40 0.40 XXX

76040 ............ A X-rays, bone evaluation ..................................... 0.27 0.65 0.65 0.07 0.99 0.99 XXX

76040 26 A X-rays, bone evaluation ..................................... 0.27 0.10 0.10 0.02 0.39 0.39 XXX

76040 TC A X-rays, bone evaluation ..................................... 0.00 0.56 0.56 0.05 0.61 0.61 XXX

76061 ............ A X-rays, bone survey ........................................... 0.45 0.86 0.86 0.09 1.40 1.40 XXX

76061 26 A X-rays, bone survey ........................................... 0.45 0.15 0.15 0.03 0.63 0.63 XXX

76061 TC A X-rays, bone survey ........................................... 0.00 0.71 0.71 0.06 0.77 0.77 XXX

76062 ............ A X-rays, bone survey ........................................... 0.54 1.21 1.21 0.13 1.88 1.88 XXX

76062 26 A X-rays, bone survey ........................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

76062 TC A X-rays, bone survey ........................................... 0.00 1.02 1.02 0.09 1.11 1.11 XXX

76065 ............ A X-rays, bone evaluation ..................................... 0.28 0.62 0.62 0.07 0.97 0.97 XXX

76065 26 A X-rays, bone evaluation ..................................... 0.28 0.10 0.10 0.02 0.40 0.40 XXX

76065 TC A X-rays, bone evaluation ..................................... 0.00 0.52 0.52 0.05 0.57 0.57 XXX

76066 ............ A Joint(s) survey, single film ................................. 0.31 0.89 0.89 0.09 1.29 1.29 XXX

76066 26 A Joint(s) survey, single film ................................. 0.31 0.10 0.10 0.02 0.43 0.43 XXX

76066 TC A Joint(s) survey, single film ................................. 0.00 0.79 0.79 0.07 0.86 0.86 XXX

76070 ............ A CT scan, bone density study ............................. 0.25 2.18 2.18 0.20 2.63 2.63 XXX

76070 26 A CT scan, bone density study ............................. 0.25 0.09 0.09 0.02 0.36 0.36 XXX

76070 TC A CT scan, bone density study ............................. 0.00 2.09 2.09 0.18 2.27 2.27 XXX

76075 ............ A Dual energy x-ray study ..................................... 0.30 2.28 2.28 0.21 2.79 2.79 XXX

76075 26 A Dual energy x-ray study ..................................... 0.30 0.09 0.09 0.02 0.41 0.41 XXX

76075 TC A Dual energy x-ray study ..................................... 0.00 2.20 2.20 0.19 2.39 2.39 XXX

76076 ............ A Dual energy x-ray study ..................................... 0.22 0.61 0.61 0.07 0.90 0.90 XXX

76076 26 A Dual energy x-ray study ..................................... 0.22 0.07 0.07 0.02 0.31 0.31 XXX

76076 TC A Dual energy x-ray study ..................................... 0.00 0.54 0.54 0.05 0.59 0.59 XXX

76078 ............ A Photodensitometry ............................................. 0.20 0.61 0.61 0.07 0.88 0.88 XXX

76078 26 A Photodensitometry ............................................. 0.20 0.07 0.07 0.02 0.29 0.29 XXX

76078 TC A Photodensitometry ............................................. 0.00 0.54 0.54 0.05 0.59 0.59 XXX

76080 ............ A X-ray exam of fistula .......................................... 0.54 0.93 0.93 0.11 1.58 1.58 XXX

76080 26 A X-ray exam of fistula .......................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

76080 TC A X-ray exam of fistula .......................................... 0.00 0.74 0.74 0.07 0.81 0.81 XXX

76086 ............ A X-ray of mammary duct ..................................... 0.36 1.99 1.99 0.19 2.54 2.54 XXX

76086 26 A X-ray of mammary duct ..................................... 0.36 0.13 0.13 0.02 0.51 0.51 XXX

76086 TC A X-ray of mammary duct ..................................... 0.00 1.86 1.86 0.17 2.03 2.03 XXX

76088 ............ A X-ray of mammary ducts .................................... 0.45 2.75 2.75 0.25 3.45 3.45 XXX

76088 26 A X-ray of mammary ducts .................................... 0.45 0.15 0.15 0.03 0.63 0.63 XXX

76088 TC A X-ray of mammary ducts .................................... 0.00 2.60 2.60 0.22 2.82 2.82 XXX

76090 ............ A Mammogram, one breast ................................... 0.58 0.83 0.83 0.09 1.50 1.50 XXX

76090 26 A Mammogram, one breast ................................... 0.58 0.09 0.09 0.02 0.69 0.69 XXX

76090 TC A Mammogram, one breast ................................... 0.00 0.74 0.74 0.07 0.81 0.81 XXX

76091 ............ A Mammogram, both breasts ................................ 0.69 1.06 1.06 0.11 1.86 1.86 XXX

76091 26 A Mammogram, both breasts ................................ 0.69 0.13 0.13 0.03 0.85 0.85 XXX

76091 TC A Mammogram, both breasts ................................ 0.00 0.92 0.92 0.08 1.00 1.00 XXX

76093 ............ A Magnetic image, breast ...................................... 1.63 13.04 13.04 1.16 15.83 15.83 XXX

76093 26 A Magnetic image, breast ...................................... 1.63 0.54 0.54 0.11 2.28 2.28 XXX

76093 TC A Magnetic image, breast ...................................... 0.00 12.50 12.50 1.05 13.55 13.55 XXX
30981

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

76094 ............ A Magnetic image, both breasts ............................ 1.63 17.50 17.50 1.53 20.66 20.66 XXX

76094 26 A Magnetic image, both breasts ............................ 1.63 0.54 0.54 0.11 2.28 2.28 XXX

76094 TC A Magnetic image, both breasts ............................ 0.00 16.96 16.96 1.42 18.38 18.38 XXX

76095 ............ A Stereotactic breast biopsy .................................. 1.59 5.61 5.61 0.54 7.74 7.74 XXX

76095 26 A Stereotactic breast biopsy .................................. 1.59 0.53 0.53 0.11 2.23 2.23 XXX

76095 TC A Stereotactic breast biopsy .................................. 0.00 5.08 5.08 0.43 5.51 5.51 XXX

76096 ............ A X-ray of needle wire, breast ............................... 0.56 1.12 1.12 0.12 1.80 1.80 XXX

76096 26 A X-ray of needle wire, breast ............................... 0.56 0.19 0.19 0.04 0.79 0.79 XXX

76096 TC A X-ray of needle wire, breast ............................... 0.00 0.92 0.92 0.08 1.00 1.00 XXX

76098 ............ A X-ray exam, breast specimen ............................ 0.16 0.35 0.35 0.04 0.55 0.55 XXX

76098 26 A X-ray exam, breast specimen ............................ 0.16 0.05 0.05 0.01 0.22 0.22 XXX

76098 TC A X-ray exam, breast specimen ............................ 0.00 0.30 0.30 0.03 0.33 0.33 XXX

76100 ............ A X-ray exam of body section ............................... 0.58 1.09 1.09 0.12 1.79 1.79 XXX

76100 26 A X-ray exam of body section ............................... 0.58 0.20 0.20 0.04 0.82 0.82 XXX

76100 TC A X-ray exam of body section ............................... 0.00 0.89 0.89 0.08 0.97 0.97 XXX

76101 ............ A Complex body section x-ray .............................. 0.58 1.21 1.21 0.13 1.92 1.92 XXX

76101 26 A Complex body section x-ray .............................. 0.58 0.20 0.20 0.04 0.82 0.82 XXX

76101 TC A Complex body section x-ray .............................. 0.00 1.00 1.00 0.09 1.09 1.09 XXX

76102 ............ A Complex body section x-rays ............................. 0.58 1.43 1.43 0.15 2.16 2.16 XXX

76102 26 A Complex body section x-rays ............................. 0.58 0.20 0.20 0.04 0.82 0.82 XXX

76102 TC A Complex body section x-rays ............................. 0.00 1.23 1.23 0.11 1.34 1.34 XXX

76120 ............ A Cinematic x-rays ................................................ 0.38 0.87 0.87 0.10 1.35 1.35 XXX

76120 26 A Cinematic x-rays ................................................ 0.38 0.13 0.13 0.03 0.54 0.54 XXX

76120 TC A Cinematic x-rays ................................................ 0.00 0.74 0.74 0.07 0.81 0.81 XXX

76125 ............ A Cinematic x-rays ................................................ 0.27 0.65 0.65 0.07 0.99 0.99 XXX

76125 26 A Cinematic x-rays ................................................ 0.27 0.09 0.09 0.02 0.38 0.38 XXX

76125 TC A Cinematic x-rays ................................................ 0.00 0.56 0.56 0.05 0.61 0.61 XXX

76150 ............ A X-ray exam, dry process .................................... 0.00 0.30 0.30 0.03 0.33 0.33 XXX

76355 ............ A CAT scan for localization ................................... 1.21 6.25 6.25 0.57 8.03 8.03 XXX

76355 26 A CAT scan for localization ................................... 1.21 0.39 0.39 0.08 1.68 1.68 XXX

76355 TC A CAT scan for localization ................................... 0.00 5.86 5.86 0.49 6.35 6.35 XXX

76360 ............ A CAT scan for needle biopsy .............................. 1.16 6.23 6.23 0.57 7.96 7.96 XXX

76360 26 A CAT scan for needle biopsy .............................. 1.16 0.37 0.37 0.08 1.61 1.61 XXX

76360 TC A CAT scan for needle biopsy .............................. 0.00 5.86 5.86 0.49 6.35 6.35 XXX

76365 ............ A CAT scan for cyst aspiration .............................. 1.16 6.23 6.23 0.57 7.96 7.96 XXX

76365 26 A CAT scan for cyst aspiration .............................. 1.16 0.37 0.37 0.08 1.61 1.61 XXX

76365 TC A CAT scan for cyst aspiration .............................. 0.00 5.86 5.86 0.49 6.35 6.35 XXX

76370 ............ A CAT scan for therapy guide ............................... 0.85 2.37 2.37 0.24 3.46 3.46 XXX

76370 26 A CAT scan for therapy guide ............................... 0.85 0.28 0.28 0.06 1.19 1.19 XXX

76370 TC A CAT scan for therapy guide ............................... 0.00 2.09 2.09 0.18 2.27 2.27 XXX

76375 ............ A 3d/holograph reconstr add-on ............................ 0.16 2.56 2.56 0.22 2.94 2.94 XXX

76375 26 A 3d/holograph reconstr add-on ............................ 0.16 0.05 0.05 0.01 0.22 0.22 XXX

76375 TC A 3d/holograph reconstr add-on ............................ 0.00 2.51 2.51 0.21 2.72 2.72 XXX

76380 ............ A CAT scan follow-up study .................................. 0.98 2.81 2.81 0.28 4.07 4.07 XXX

76380 26 A CAT scan follow-up study .................................. 0.98 0.33 0.33 0.07 1.38 1.38 XXX

76380 TC A CAT scan follow-up study .................................. 0.00 2.49 2.49 0.21 2.70 2.70 XXX

76390 ............ A Mr spectroscopy ................................................. 1.40 8.44 8.44 0.77 10.61 10.61 XXX

76390 26 A Mr spectroscopy ................................................. 1.40 0.49 0.49 0.10 1.99 1.99 XXX

76390 TC A Mr spectroscopy ................................................. 0.00 7.95 7.95 0.67 8.62 8.62 XXX

76400 ............ A Magnetic image, bone marrow .......................... 1.60 8.48 8.48 0.78 10.86 10.86 XXX

76400 26 A Magnetic image, bone marrow .......................... 1.60 0.54 0.54 0.11 2.25 2.25 XXX

76400 TC A Magnetic image, bone marrow .......................... 0.00 7.95 7.95 0.67 8.62 8.62 XXX

76506 ............ A Echo exam of head ............................................ 0.63 1.22 1.22 0.13 1.98 1.98 XXX

76506 26 A Echo exam of head ............................................ 0.63 0.22 0.22 0.04 0.89 0.89 XXX

76506 TC A Echo exam of head ............................................ 0.00 1.00 1.00 0.09 1.09 1.09 XXX

76511 ............ A Echo exam of eye .............................................. 0.94 1.07 1.07 0.12 2.13 2.13 XXX

76511 26 A Echo exam of eye .............................................. 0.94 0.19 0.19 0.04 1.17 1.17 XXX

76511 TC A Echo exam of eye .............................................. 0.00 0.89 0.89 0.08 0.97 0.97 XXX

76512 ............ A Echo exam of eye .............................................. 0.66 1.30 1.30 0.15 2.11 2.11 XXX

76512 26 A Echo exam of eye .............................................. 0.66 0.22 0.22 0.05 0.93 0.93 XXX

76512 TC A Echo exam of eye .............................................. 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76513 ............ A Echo exam of eye, water bath ........................... 0.66 1.30 1.30 0.15 2.11 2.11 XXX

76513 26 A Echo exam of eye, water bath ........................... 0.66 0.22 0.22 0.05 0.93 0.93 XXX

76513 TC A Echo exam of eye, water bath ........................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76516 ............ A Echo exam of eye .............................................. 0.54 1.07 1.07 0.12 1.73 1.73 XXX

76516 26 A Echo exam of eye .............................................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX

76516 TC A Echo exam of eye .............................................. 0.00 0.89 0.89 0.08 0.97 0.97 XXX

76519 ............ A Echo exam of eye .............................................. 0.54 1.07 1.07 0.12 1.73 1.73 XXX

76519 26 A Echo exam of eye .............................................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX

76519 TC A Echo exam of eye .............................................. 0.00 0.89 0.89 0.08 0.97 0.97 XXX

76529 ............ A Echo exam of eye .............................................. 0.57 1.16 1.16 0.13 1.86 1.86 XXX

76529 26 A Echo exam of eye .............................................. 0.57 0.19 0.19 0.04 0.80 0.80 XXX

76529 TC A Echo exam of eye .............................................. 0.00 0.97 0.97 0.09 1.06 1.06 XXX

76536 ............ A Echo exam of head and neck ............................ 0.56 1.20 1.20 0.13 1.89 1.89 XXX
30982

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

76536 26 A Echo exam of head and neck ............................ 0.56 0.19 0.19 0.04 0.79 0.79 XXX

76536 TC A Echo exam of head and neck ............................ 0.00 1.00 1.00 0.09 1.09 1.09 XXX

76604 ............ A Echo exam of chest ........................................... 0.55 1.12 1.12 0.12 1.79 1.79 XXX

76604 26 A Echo exam of chest ........................................... 0.55 0.19 0.19 0.04 0.78 0.78 XXX

76604 TC A Echo exam of chest ........................................... 0.00 0.92 0.92 0.08 1.00 1.00 XXX

76645 ............ A Echo exam of breast .......................................... 0.54 0.93 0.93 0.11 1.58 1.58 XXX

76645 26 A Echo exam of breast .......................................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX

76645 TC A Echo exam of breast .......................................... 0.00 0.74 0.74 0.07 0.81 0.81 XXX

76700 ............ A Echo exam of abdomen ..................................... 0.81 1.67 1.67 0.17 2.65 2.65 XXX

76700 26 A Echo exam of abdomen ..................................... 0.81 0.28 0.28 0.05 1.14 1.14 XXX

76700 TC A Echo exam of abdomen ..................................... 0.00 1.40 1.40 0.12 1.52 1.52 XXX

76705 ............ A Echo exam of abdomen ..................................... 0.59 1.21 1.21 0.13 1.93 1.93 XXX

76705 26 A Echo exam of abdomen ..................................... 0.59 0.20 0.20 0.04 0.83 0.83 XXX

76705 TC A Echo exam of abdomen ..................................... 0.00 1.00 1.00 0.09 1.09 1.09 XXX

76770 ............ A Echo exam abdomen back wall ......................... 0.74 1.65 1.65 0.17 2.56 2.56 XXX

76770 26 A Echo exam abdomen back wall ......................... 0.74 0.25 0.25 0.05 1.04 1.04 XXX

76770 TC A Echo exam abdomen back wall ......................... 0.00 1.40 1.40 0.12 1.52 1.52 XXX

76775 ............ A Echo exam abdomen back wall ......................... 0.58 1.21 1.21 0.13 1.92 1.92 XXX

76775 26 A Echo exam abdomen back wall ......................... 0.58 0.20 0.20 0.04 0.82 0.82 XXX

76775 TC A Echo exam abdomen back wall ......................... 0.00 1.00 1.00 0.09 1.09 1.09 XXX

76778 ............ A Echo exam kidney transplant ............................. 0.74 1.65 1.65 0.17 2.56 2.56 XXX

76778 26 A Echo exam kidney transplant ............................. 0.74 0.25 0.25 0.05 1.04 1.04 XXX

76778 TC A Echo exam kidney transplant ............................. 0.00 1.40 1.40 0.12 1.52 1.52 XXX

76800 ............ A Echo exam spinal canal ..................................... 1.13 1.38 1.38 0.17 2.68 2.68 XXX

76800 26 A Echo exam spinal canal ..................................... 1.13 0.37 0.37 0.08 1.58 1.58 XXX

76800 TC A Echo exam spinal canal ..................................... 0.00 1.00 1.00 0.09 1.09 1.09 XXX

76805 ............ A Echo exam of pregnant uterus .......................... 0.99 1.82 1.82 0.20 3.01 3.01 XXX

76805 26 A Echo exam of pregnant uterus .......................... 0.99 0.33 0.33 0.07 1.39 1.39 XXX

76805 TC A Echo exam of pregnant uterus .......................... 0.00 1.49 1.49 0.13 1.62 1.62 XXX

76810 ............ A Echo exam of pregnant uterus .......................... 1.97 3.63 3.63 0.38 5.98 5.98 XXX

76810 26 A Echo exam of pregnant uterus .......................... 1.97 0.65 0.65 0.13 2.75 2.75 XXX

76810 TC A Echo exam of pregnant uterus .......................... 0.00 2.98 2.98 0.25 3.23 3.23 XXX

76815 ............ A Echo exam of pregnant uterus .......................... 0.65 1.23 1.23 0.13 2.01 2.01 XXX

76815 26 A Echo exam of pregnant uterus .......................... 0.65 0.22 0.22 0.04 0.91 0.91 XXX

76815 TC A Echo exam of pregnant uterus .......................... 0.00 1.00 1.00 0.09 1.09 1.09 XXX

76816 ............ A Echo exam followup or repeat ........................... 0.57 0.98 0.98 0.11 1.66 1.66 XXX

76816 26 A Echo exam followup or repeat ........................... 0.57 0.19 0.19 0.04 0.80 0.80 XXX

76816 TC A Echo exam followup or repeat ........................... 0.00 0.79 0.79 0.07 0.86 0.86 XXX

76818 ............ A Fetal biophysical profile ..................................... 0.77 1.41 1.41 0.15 2.33 2.33 XXX

76818 26 A Fetal biophysical profile ..................................... 0.77 0.26 0.26 0.05 1.08 1.08 XXX

76818 TC A Fetal biophysical profile ..................................... 0.00 1.15 1.15 0.10 1.25 1.25 XXX

76825 ............ A Echo exam of fetal heart .................................... 1.67 1.66 1.66 0.17 3.50 3.50 XXX

76825 26 A Echo exam of fetal heart .................................... 1.67 0.26 0.26 0.05 1.98 1.98 XXX

76825 TC A Echo exam of fetal heart .................................... 0.00 1.40 1.40 0.12 1.52 1.52 XXX

76826 ............ A Echo exam of fetal heart .................................... 0.83 1.00 1.00 0.10 1.93 1.93 XXX

76826 26 A Echo exam of fetal heart .................................... 0.83 0.51 0.51 0.05 1.39 1.39 XXX

76826 TC A Echo exam of fetal heart .................................... 0.00 0.50 0.50 0.05 0.55 0.55 XXX

76827 ............ A Echo exam of fetal heart .................................... 0.58 1.70 1.70 0.18 2.46 2.46 XXX

76827 26 A Echo exam of fetal heart .................................... 0.58 0.48 0.48 0.05 1.11 1.11 XXX

76827 TC A Echo exam of fetal heart .................................... 0.00 1.22 1.22 0.13 1.35 1.35 XXX

76828 ............ A Echo exam of fetal heart .................................... 0.56 1.00 1.00 0.11 1.67 1.67 XXX

76828 26 A Echo exam of fetal heart .................................... 0.56 0.21 0.21 0.02 0.79 0.79 XXX

76828 TC A Echo exam of fetal heart .................................... 0.00 0.79 0.79 0.09 0.88 0.88 XXX

76830 ............ A Echo exam, transvaginal .................................... 0.69 1.32 1.32 0.15 2.16 2.16 XXX

76830 26 A Echo exam, transvaginal .................................... 0.69 0.24 0.24 0.05 0.98 0.98 XXX

76830 TC A Echo exam, transvaginal .................................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76831 ............ A Echo exam, uterus ............................................. 0.72 1.32 1.32 0.15 2.19 2.19 XXX

76831 26 A Echo exam, uterus ............................................. 0.72 0.24 0.24 0.05 1.01 1.01 XXX

76831 TC A Echo exam, uterus ............................................. 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76856 ............ A Echo exam of pelvis ........................................... 0.69 1.32 1.32 0.15 2.16 2.16 XXX

76856 26 A Echo exam of pelvis ........................................... 0.69 0.24 0.24 0.05 0.98 0.98 XXX

76856 TC A Echo exam of pelvis ........................................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76857 ............ A Echo exam of pelvis ........................................... 0.38 0.87 0.87 0.10 1.35 1.35 XXX

76857 26 A Echo exam of pelvis ........................................... 0.38 0.13 0.13 0.03 0.54 0.54 XXX

76857 TC A Echo exam of pelvis ........................................... 0.00 0.74 0.74 0.07 0.81 0.81 XXX

76870 ............ A Echo exam of scrotum ....................................... 0.64 1.30 1.30 0.14 2.08 2.08 XXX

76870 26 A Echo exam of scrotum ....................................... 0.64 0.22 0.22 0.04 0.90 0.90 XXX

76870 TC A Echo exam of scrotum ....................................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76872 ............ A Echo exam, transrectal ...................................... 0.69 1.32 1.32 0.15 2.16 2.16 XXX

76872 26 A Echo exam, transrectal ...................................... 0.69 0.24 0.24 0.05 0.98 0.98 XXX

76872 TC A Echo exam, transrectal ...................................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76880 ............ A Echo exam of extremity ..................................... 0.59 1.21 1.21 0.13 1.93 1.93 XXX

76880 26 A Echo exam of extremity ..................................... 0.59 0.20 0.20 0.04 0.83 0.83 XXX

76880 TC A Echo exam of extremity ..................................... 0.00 1.00 1.00 0.09 1.09 1.09 XXX
30983

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

76885 ............ A Echo exam, infant hips ...................................... 0.74 1.32 1.32 0.15 2.21 2.21 XXX

76885 26 A Echo exam, infant hips ...................................... 0.74 0.24 0.24 0.05 1.03 1.03 XXX

76885 TC A Echo exam, infant hips ...................................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76886 ............ A Echo exam, infant hips ...................................... 0.62 1.21 1.21 0.13 1.96 1.96 XXX

76886 26 A Echo exam, infant hips ...................................... 0.62 0.20 0.20 0.04 0.86 0.86 XXX

76886 TC A Echo exam, infant hips ...................................... 0.00 1.00 1.00 0.09 1.09 1.09 XXX

76930 ............ A Echo guide for heart sac tap ............................. 0.67 1.31 1.31 0.15 2.13 2.13 XXX

76930 26 A Echo guide for heart sac tap ............................. 0.67 0.23 0.23 0.05 0.95 0.95 XXX

76930 TC A Echo guide for heart sac tap ............................. 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76932 ............ A Echo guide for heart biopsy ............................... 0.67 1.31 1.31 0.15 2.13 2.13 XXX

76932 26 A Echo guide for heart biopsy ............................... 0.67 0.23 0.23 0.05 0.95 0.95 XXX

76932 TC A Echo guide for heart biopsy ............................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76934 ............ A Echo guide for chest tap .................................... 0.67 1.31 1.31 0.15 2.13 2.13 XXX

76934 26 A Echo guide for chest tap .................................... 0.67 0.23 0.23 0.05 0.95 0.95 XXX

76934 TC A Echo guide for chest tap .................................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76936 ............ A Echo guide for artery repair ............................... 1.99 5.39 5.39 0.48 7.86 7.86 XXX

76936 26 A Echo guide for artery repair ............................... 1.99 0.92 0.92 0.10 3.01 3.01 XXX

76936 TC A Echo guide for artery repair ............................... 0.00 4.47 4.47 0.38 4.85 4.85 XXX

76938 ............ A Echo exam for drainage ..................................... 0.67 1.31 1.31 0.15 2.13 2.13 XXX

76938 26 A Echo exam for drainage ..................................... 0.67 0.23 0.23 0.05 0.95 0.95 XXX

76938 TC A Echo exam for drainage ..................................... 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76941 ............ A Echo guide for transfusion ................................. 1.34 1.54 1.54 0.19 3.07 3.07 XXX

76941 26 A Echo guide for transfusion ................................. 1.34 0.45 0.45 0.10 1.89 1.89 XXX

76941 TC A Echo guide for transfusion ................................. 0.00 1.09 1.09 0.09 1.18 1.18 XXX

76942 ............ A Echo guide for biopsy ........................................ 0.67 1.31 1.31 0.15 2.13 2.13 XXX

76942 26 A Echo guide for biopsy ........................................ 0.67 0.23 0.23 0.05 0.95 0.95 XXX

76942 TC A Echo guide for biopsy ........................................ 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76945 ............ A Echo guide, villus sampling ............................... 0.67 1.54 1.54 0.19 2.40 2.40 XXX

76945 26 A Echo guide, villus sampling ............................... 0.67 0.45 0.45 0.10 1.22 1.22 XXX

76945 TC A Echo guide, villus sampling ............................... 0.00 1.09 1.09 0.09 1.18 1.18 XXX

76946 ............ A Echo guide for amniocentesis ............................ 0.38 1.21 1.21 0.13 1.72 1.72 XXX

76946 26 A Echo guide for amniocentesis ............................ 0.38 0.13 0.13 0.03 0.54 0.54 XXX

76946 TC A Echo guide for amniocentesis ............................ 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76948 ............ A Echo guide, ova aspiration ................................ 0.38 1.21 1.21 0.13 1.72 1.72 XXX

76948 26 A Echo guide, ova aspiration ................................ 0.38 0.13 0.13 0.03 0.54 0.54 XXX

76948 TC A Echo guide, ova aspiration ................................ 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76950 ............ A Echo guidance radiotherapy .............................. 0.58 1.12 1.12 0.12 1.82 1.82 XXX

76950 26 A Echo guidance radiotherapy .............................. 0.58 0.20 0.20 0.04 0.82 0.82 XXX

76950 TC A Echo guidance radiotherapy .............................. 0.00 0.92 0.92 0.08 1.00 1.00 XXX

76960 ............ A Echo guidance radiotherapy .............................. 0.58 1.12 1.12 0.12 1.82 1.82 XXX

76960 26 A Echo guidance radiotherapy .............................. 0.58 0.20 0.20 0.04 0.82 0.82 XXX

76960 TC A Echo guidance radiotherapy .............................. 0.00 0.92 0.92 0.08 1.00 1.00 XXX

76965 ............ A Echo guidance radiotherapy .............................. 1.34 5.05 5.05 0.52 6.91 6.91 XXX

76965 26 A Echo guidance radiotherapy .............................. 1.34 1.09 1.09 0.19 2.62 2.62 XXX

76965 TC A Echo guidance radiotherapy .............................. 0.00 3.95 3.95 0.33 4.28 4.28 XXX

76970 ............ A Ultrasound exam follow-up ................................ 0.40 0.88 0.88 0.10 1.38 1.38 XXX

76970 26 A Ultrasound exam follow-up ................................ 0.40 0.13 0.13 0.03 0.56 0.56 XXX

76970 TC A Ultrasound exam follow-up ................................ 0.00 0.74 0.74 0.07 0.81 0.81 XXX

76975 ............ A GI endoscopic ultrasound .................................. 0.81 1.33 1.33 0.15 2.29 2.29 XXX

76975 26 A GI endoscopic ultrasound .................................. 0.81 0.25 0.25 0.05 1.11 1.11 XXX

76975 TC A GI endoscopic ultrasound .................................. 0.00 1.08 1.08 0.10 1.18 1.18 XXX

76986 ............ A Echo exam at surgery ........................................ 1.20 2.26 2.26 0.25 3.71 3.71 XXX

76986 26 A Echo exam at surgery ........................................ 1.20 0.39 0.39 0.08 1.67 1.67 XXX

76986 TC A Echo exam at surgery ........................................ 0.00 1.86 1.86 0.17 2.03 2.03 XXX

77261 ............ A Radiation therapy planning ................................ 1.39 0.46 0.46 0.09 1.94 1.94 XXX

77262 ............ A Radiation therapy planning ................................ 2.11 0.70 0.70 0.14 2.95 2.95 XXX

77263 ............ A Radiation therapy planning ................................ 3.14 1.04 1.04 0.20 4.38 4.38 XXX

77280 ............ A Set radiation therapy field .................................. 0.70 2.70 2.70 0.26 3.66 3.66 XXX

77280 26 A Set radiation therapy field .................................. 0.70 0.24 0.24 0.05 0.99 0.99 XXX

77280 TC A Set radiation therapy field .................................. 0.00 2.46 2.46 0.21 2.67 2.67 XXX

77285 ............ A Set radiation therapy field .................................. 1.05 4.29 4.29 0.41 5.75 5.75 XXX

77285 26 A Set radiation therapy field .................................. 1.05 0.34 0.34 0.07 1.46 1.46 XXX

77285 TC A Set radiation therapy field .................................. 0.00 3.95 3.95 0.34 4.29 4.29 XXX

77290 ............ A Set radiation therapy field .................................. 1.56 5.14 5.14 0.50 7.20 7.20 XXX

77290 26 A Set radiation therapy field .................................. 1.56 0.52 0.52 0.11 2.19 2.19 XXX

77290 TC A Set radiation therapy field .................................. 0.00 4.61 4.61 0.39 5.00 5.00 XXX

77295 ............ A Set radiation therapy field .................................. 4.57 21.35 21.35 1.93 27.85 27.85 XXX

77295 26 A Set radiation therapy field .................................. 4.57 1.53 1.53 0.23 6.33 6.33 XXX

77295 TC A Set radiation therapy field .................................. 0.00 19.81 19.81 1.70 21.51 21.51 XXX

77300 ............ A Radiation therapy dose plan .............................. 0.62 1.16 1.16 0.12 1.90 1.90 XXX

77300 26 A Radiation therapy dose plan .............................. 0.62 0.21 0.21 0.04 0.87 0.87 XXX

77300 TC A Radiation therapy dose plan .............................. 0.00 0.95 0.95 0.08 1.03 1.03 XXX

77305 ............ A Radiation therapy dose plan .............................. 0.70 1.56 1.56 0.17 2.43 2.43 XXX

77305 26 A Radiation therapy dose plan .............................. 0.70 0.24 0.24 0.05 0.99 0.99 XXX
30984

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

77305 TC A Radiation therapy dose plan .............................. 0.00 1.32 1.32 0.12 1.44 1.44 XXX

77310 ............ A Radiation therapy dose plan .............................. 1.05 1.99 1.99 0.22 3.26 3.26 XXX

77310 26 A Radiation therapy dose plan .............................. 1.05 0.34 0.34 0.07 1.46 1.46 XXX

77310 TC A Radiation therapy dose plan .............................. 0.00 1.65 1.65 0.15 1.80 1.80 XXX

77315 ............ A Radiation therapy dose plan .............................. 1.56 2.40 2.40 0.28 4.24 4.24 XXX

77315 26 A Radiation therapy dose plan .............................. 1.56 0.52 0.52 0.11 2.19 2.19 XXX

77315 TC A Radiation therapy dose plan .............................. 0.00 1.88 1.88 0.17 2.05 2.05 XXX

77321 ............ A Radiation therapy port plan ................................ 0.95 3.19 3.19 0.30 4.44 4.44 XXX

77321 26 A Radiation therapy port plan ................................ 0.95 0.32 0.32 0.06 1.33 1.33 XXX

77321 TC A Radiation therapy port plan ................................ 0.00 2.87 2.87 0.24 3.11 3.11 XXX

77326 ............ A Radiation therapy dose plan .............................. 0.93 1.99 1.99 0.21 3.13 3.13 XXX

77326 26 A Radiation therapy dose plan .............................. 0.93 0.31 0.31 0.06 1.30 1.30 XXX

77326 TC A Radiation therapy dose plan .............................. 0.00 1.67 1.67 0.15 1.82 1.82 XXX

77327 ............ A Radiation therapy dose plan .............................. 1.39 2.93 2.93 0.30 4.62 4.62 XXX

77327 26 A Radiation therapy dose plan .............................. 1.39 0.46 0.46 0.09 1.94 1.94 XXX

77327 TC A Radiation therapy dose plan .............................. 0.00 2.46 2.46 0.21 2.67 2.67 XXX

77328 ............ A Radiation therapy dose plan .............................. 2.09 4.21 4.21 0.44 6.74 6.74 XXX

77328 26 A Radiation therapy dose plan .............................. 2.09 0.69 0.69 0.14 2.92 2.92 XXX

77328 TC A Radiation therapy dose plan .............................. 0.00 3.52 3.52 0.30 3.82 3.82 XXX

77331 ............ A Special radiation dosimetry ................................ 0.87 0.65 0.65 0.09 1.61 1.61 XXX

77331 26 A Special radiation dosimetry ................................ 0.87 0.29 0.29 0.06 1.22 1.22 XXX

77331 TC A Special radiation dosimetry ................................ 0.00 0.36 0.36 0.03 0.39 0.39 XXX

77332 ............ A Radiation treatment aid(s) .................................. 0.54 1.14 1.14 0.12 1.80 1.80 XXX

77332 26 A Radiation treatment aid(s) .................................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX

77332 TC A Radiation treatment aid(s) .................................. 0.00 0.95 0.95 0.08 1.03 1.03 XXX

77333 ............ A Radiation treatment aid(s) .................................. 0.84 1.63 1.63 0.18 2.65 2.65 XXX

77333 26 A Radiation treatment aid(s) .................................. 0.84 0.28 0.28 0.06 1.18 1.18 XXX

77333 TC A Radiation treatment aid(s) .................................. 0.00 1.35 1.35 0.12 1.47 1.47 XXX

77334 ............ A Radiation treatment aid(s) .................................. 1.24 2.71 2.71 0.27 4.22 4.22 XXX

77334 26 A Radiation treatment aid(s) .................................. 1.24 0.40 0.40 0.08 1.72 1.72 XXX

77334 TC A Radiation treatment aid(s) .................................. 0.00 2.31 2.31 0.19 2.50 2.50 XXX

77336 ............ A Radiation physics consu .................................... 0.00 2.11 2.11 0.18 2.29 2.29 XXX

77370 ............ A Radiation physics consult .................................. 0.00 2.48 2.48 0.21 2.69 2.69 XXX

77401 ............ A Radiation treatment delivery .............................. 0.00 1.26 1.26 0.11 1.37 1.37 XXX

77402 ............ A Radiation treatment delivery .............................. 0.00 1.26 1.26 0.11 1.37 1.37 XXX

77403 ............ A Radiation treatment delivery .............................. 0.00 1.26 1.26 0.11 1.37 1.37 XXX

77404 ............ A Radiation treatment delivery .............................. 0.00 1.26 1.26 0.11 1.37 1.37 XXX

77406 ............ A Radiation treatment delivery .............................. 0.00 1.26 1.26 0.11 1.37 1.37 XXX

77407 ............ A Radiation treatment delivery .............................. 0.00 1.48 1.48 0.13 1.61 1.61 XXX

77408 ............ A Radiation treatment delivery .............................. 0.00 1.48 1.48 0.13 1.61 1.61 XXX

77409 ............ A Radiation treatment delivery .............................. 0.00 1.48 1.48 0.13 1.61 1.61 XXX

77411 ............ A Radiation treatment delivery .............................. 0.00 1.48 1.48 0.13 1.61 1.61 XXX

77412 ............ A Radiation treatment delivery .............................. 0.00 1.65 1.65 0.15 1.80 1.80 XXX

77413 ............ A Radiation treatment delivery .............................. 0.00 1.65 1.65 0.15 1.80 1.80 XXX

77414 ............ A Radiation treatment delivery .............................. 0.00 1.65 1.65 0.15 1.80 1.80 XXX

77416 ............ A Radiation treatment delivery .............................. 0.00 1.65 1.65 0.15 1.80 1.80 XXX

77417 ............ A Radiology port film(s) ......................................... 0.00 0.42 0.42 0.04 0.46 0.46 XXX

77419 ............ A Weekly radiation therapy ................................... 3.60 1.20 1.20 0.23 5.03 5.03 XXX

77420 ............ A Weekly radiation therapy ................................... 1.61 0.54 0.54 0.11 2.26 2.26 XXX

77425 ............ A Weekly radiation therapy ................................... 2.44 0.82 0.82 0.17 3.43 3.43 XXX

77430 ............ A Weekly radiation therapy ................................... 3.60 1.20 1.20 0.23 5.03 5.03 XXX

77431 ............ A Radiation therapy management ......................... 1.81 0.60 0.60 0.12 2.53 2.53 XXX

77432 ............ A Stereotactic radiation trmt .................................. 7.93 3.68 3.68 0.40 12.01 12.01 XXX

77470 ............ A Special radiation treatment ................................ 2.09 8.60 8.60 0.80 11.49 11.49 XXX

77470 26 A Special radiation treatment ................................ 2.09 0.69 0.69 0.14 2.92 2.92 XXX

77470 TC A Special radiation treatment ................................ 0.00 7.90 7.90 0.66 8.56 8.56 XXX

77600 ............ R Hyperthermia treatment ..................................... 1.56 2.68 2.68 0.29 4.53 4.53 ZZZ

77600 26 R Hyperthermia treatment ..................................... 1.56 0.52 0.52 0.11 2.19 2.19 ZZZ

77600 TC R Hyperthermia treatment ..................................... 0.00 2.16 2.16 0.18 2.34 2.34 ZZZ

77605 ............ R Hyperthermia treatment ..................................... 2.09 3.57 3.57 0.39 6.05 6.05 ZZZ

77605 26 R Hyperthermia treatment ..................................... 2.09 0.69 0.69 0.14 2.92 2.92 ZZZ

77605 TC R Hyperthermia treatment ..................................... 0.00 2.88 2.88 0.25 3.13 3.13 ZZZ

77610 ............ R Hyperthermia treatment ..................................... 1.56 2.68 2.68 0.29 4.53 4.53 ZZZ

77610 26 R Hyperthermia treatment ..................................... 1.56 0.52 0.52 0.11 2.19 2.19 ZZZ

77610 TC R Hyperthermia treatment ..................................... 0.00 2.16 2.16 0.18 2.34 2.34 ZZZ

77615 ............ R Hyperthermia treatment ..................................... 2.09 3.57 3.57 0.39 6.05 6.05 ZZZ

77615 26 R Hyperthermia treatment ..................................... 2.09 0.69 0.69 0.14 2.92 2.92 ZZZ

77615 TC R Hyperthermia treatment ..................................... 0.00 2.88 2.88 0.25 3.13 3.13 ZZZ

77620 ............ R Hyperthermia treatment ..................................... 1.56 2.68 2.68 0.29 4.53 4.53 ZZZ

77620 26 R Hyperthermia treatment ..................................... 1.56 0.52 0.52 0.11 2.19 2.19 ZZZ

77620 TC R Hyperthermia treatment ..................................... 0.00 2.16 2.16 0.18 2.34 2.34 ZZZ

77750 ............ A Infuse radioactive materials ............................... 4.91 2.47 2.47 0.38 7.76 7.76 090

77750 26 A Infuse radioactive materials ............................... 4.91 1.53 1.53 0.30 6.74 6.74 090

77750 TC A Infuse radioactive materials ............................... 0.00 0.95 0.95 0.08 1.03 1.03 090
30985

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

77761 ............ A Radioelement application ................................... 3.81 2.96 2.96 0.39 7.16 7.16 090

77761 26 A Radioelement application ................................... 3.81 1.18 1.18 0.23 5.22 5.22 090

77761 TC A Radioelement application ................................... 0.00 1.78 1.78 0.16 1.94 1.94 090

77762 ............ A Radioelement application ................................... 5.72 4.34 4.34 0.57 10.63 10.63 090

77762 26 A Radioelement application ................................... 5.72 1.78 1.78 0.35 7.85 7.85 090

77762 TC A Radioelement application ................................... 0.00 2.56 2.56 0.22 2.78 2.78 090

77763 ............ A Radioelement application ................................... 8.57 5.85 5.85 0.77 15.19 15.19 090

77763 26 A Radioelement application ................................... 8.57 2.66 2.66 0.50 11.73 11.73 090

77763 TC A Radioelement application ................................... 0.00 3.19 3.19 0.27 3.46 3.46 090

77776 ............ A Radioelement application ................................... 4.66 3.10 3.10 0.45 8.21 8.21 XXX

77776 26 A Radioelement application ................................... 4.66 1.56 1.56 0.31 6.53 6.53 XXX

77776 TC A Radioelement application ................................... 0.00 1.54 1.54 0.14 1.68 1.68 XXX

77777 ............ A Radioelement application ................................... 7.48 5.34 5.34 0.71 13.53 13.53 090

77777 26 A Radioelement application ................................... 7.48 2.33 2.33 0.45 10.26 10.26 090

77777 TC A Radioelement application ................................... 0.00 3.01 3.01 0.26 3.27 3.27 090

77778 ............ A Radioelement application ................................... 11.19 7.13 7.13 0.98 19.30 19.30 090

77778 26 A Radioelement application ................................... 11.19 3.49 3.49 0.67 15.35 15.35 090

77778 TC A Radioelement application ................................... 0.00 3.64 3.64 0.31 3.95 3.95 090

77781 ............ A High intensity brachytherapy .............................. 1.66 14.92 14.92 1.32 17.90 17.90 090

77781 26 A High intensity brachytherapy .............................. 1.66 0.51 0.51 0.11 2.28 2.28 090

77781 TC A High intensity brachytherapy .............................. 0.00 14.40 14.40 1.21 15.61 15.61 090

77782 ............ A High intensity brachytherapy .............................. 2.49 15.18 15.18 1.37 19.04 19.04 090

77782 26 A High intensity brachytherapy .............................. 2.49 0.78 0.78 0.16 3.43 3.43 090

77782 TC A High intensity brachytherapy .............................. 0.00 14.40 14.40 1.21 15.61 15.61 090

77783 ............ A High intensity brachytherapy .............................. 3.73 15.56 15.56 1.44 20.73 20.73 090

77783 26 A High intensity brachytherapy .............................. 3.73 1.15 1.15 0.23 5.11 5.11 090

77783 TC A High intensity brachytherapy .............................. 0.00 14.40 14.40 1.21 15.61 15.61 090

77784 ............ A High intensity brachytherapy .............................. 5.61 16.14 16.14 1.56 23.31 23.31 090

77784 26 A High intensity brachytherapy .............................. 5.61 1.74 1.74 0.35 7.70 7.70 090

77784 TC A High intensity brachytherapy .............................. 0.00 14.40 14.40 1.21 15.61 15.61 090

77789 ............ A Radioelement application ................................... 1.12 0.66 0.66 0.10 1.88 1.88 090

77789 26 A Radioelement application ................................... 1.12 0.34 0.34 0.07 1.53 1.53 090

77789 TC A Radioelement application ................................... 0.00 0.32 0.32 0.03 0.35 0.35 090

77790 ............ A Radioelement handling ...................................... 1.05 0.70 0.70 0.10 1.85 1.85 XXX

77790 26 A Radioelement handling ...................................... 1.05 0.34 0.34 0.07 1.46 1.46 XXX

77790 TC A Radioelement handling ...................................... 0.00 0.36 0.36 0.03 0.39 0.39 XXX

78000 ............ A Thyroid, single uptake ........................................ 0.19 0.75 0.75 0.07 1.01 1.01 XXX

78000 26 A Thyroid, single uptake ........................................ 0.19 0.07 0.07 0.01 0.27 0.27 XXX

78000 TC A Thyroid, single uptake ........................................ 0.00 0.68 0.68 0.06 0.74 0.74 XXX

78001 ............ A Thyroid, multiple uptakes ................................... 0.26 1.01 1.01 0.10 1.37 1.37 XXX

78001 26 A Thyroid, multiple uptakes ................................... 0.26 0.09 0.09 0.02 0.37 0.37 XXX

78001 TC A Thyroid, multiple uptakes ................................... 0.00 0.92 0.92 0.08 1.00 1.00 XXX

78003 ............ A Thyroid suppress/stimul ..................................... 0.33 0.80 0.80 0.08 1.21 1.21 XXX

78003 26 A Thyroid suppress/stimul ..................................... 0.33 0.11 0.11 0.02 0.46 0.46 XXX

78003 TC A Thyroid suppress/stimul ..................................... 0.00 0.68 0.68 0.06 0.74 0.74 XXX

78006 ............ A Thyroid,imaging with uptake .............................. 0.49 1.85 1.85 0.18 2.52 2.52 XXX

78006 26 A Thyroid,imaging with uptake .............................. 0.49 0.16 0.16 0.03 0.68 0.68 XXX

78006 TC A Thyroid,imaging with uptake .............................. 0.00 1.69 1.69 0.15 1.84 1.84 XXX

78007 ............ A Thyroid, image, mult uptakes ............................. 0.50 1.99 1.99 0.19 2.68 2.68 XXX

78007 26 A Thyroid, image, mult uptakes ............................. 0.50 0.17 0.17 0.03 0.70 0.70 XXX

78007 TC A Thyroid, image, mult uptakes ............................. 0.00 1.82 1.82 0.16 1.98 1.98 XXX

78010 ............ A Thyroid imaging .................................................. 0.39 1.41 1.41 0.14 1.94 1.94 XXX

78010 26 A Thyroid imaging .................................................. 0.39 0.13 0.13 0.03 0.55 0.55 XXX

78010 TC A Thyroid imaging .................................................. 0.00 1.29 1.29 0.11 1.40 1.40 XXX

78011 ............ A Thyroid imaging with flow .................................. 0.45 1.86 1.86 0.18 2.49 2.49 XXX

78011 26 A Thyroid imaging with flow .................................. 0.45 0.16 0.16 0.03 0.64 0.64 XXX

78011 TC A Thyroid imaging with flow .................................. 0.00 1.70 1.70 0.15 1.85 1.85 XXX

78015 ............ A Thyroid met imaging .......................................... 0.67 2.05 2.05 0.21 2.93 2.93 XXX

78015 26 A Thyroid met imaging .......................................... 0.67 0.23 0.23 0.05 0.95 0.95 XXX

78015 TC A Thyroid met imaging .......................................... 0.00 1.82 1.82 0.16 1.98 1.98 XXX

78016 ............ A Thyroid met imaging/studies .............................. 0.82 2.75 2.75 0.27 3.84 3.84 XXX

78016 26 A Thyroid met imaging/studies .............................. 0.82 0.28 0.28 0.06 1.16 1.16 XXX

78016 TC A Thyroid met imaging/studies .............................. 0.00 2.47 2.47 0.21 2.68 2.68 XXX

78017 ............ A Thyroid met imaging, mult ................................. 0.87 2.93 2.93 0.28 4.08 4.08 XXX

78017 26 A Thyroid met imaging, mult ................................. 0.87 0.29 0.29 0.06 1.22 1.22 XXX

78017 TC A Thyroid met imaging, mult ................................. 0.00 2.64 2.64 0.22 2.86 2.86 XXX

78018 ............ A Thyroid, met imaging, body ............................... 0.95 4.17 4.17 0.39 5.51 5.51 XXX

78018 26 A Thyroid, met imaging, body ............................... 0.95 0.32 0.32 0.06 1.33 1.33 XXX

78018 TC A Thyroid, met imaging, body ............................... 0.00 3.85 3.85 0.33 4.18 4.18 XXX

78070 ............ A Parathyroid nuclear imaging .............................. 0.82 1.46 1.46 0.15 2.43 2.43 XXX

78070 26 A Parathyroid nuclear imaging .............................. 0.82 0.17 0.17 0.04 1.03 1.03 XXX

78070 TC A Parathyroid nuclear imaging .............................. 0.00 1.29 1.29 0.11 1.40 1.40 XXX

78075 ............ A Adrenal nuclear imaging .................................... 0.74 4.10 4.10 0.38 5.22 5.22 XXX

78075 26 A Adrenal nuclear imaging .................................... 0.74 0.25 0.25 0.05 1.04 1.04 XXX
30986

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78075 TC A Adrenal nuclear imaging .................................... 0.00 3.85 3.85 0.33 4.18 4.18 XXX

78102 ............ A Bone marrow imaging, ltd .................................. 0.55 1.63 1.63 0.17 2.35 2.35 XXX

78102 26 A Bone marrow imaging, ltd .................................. 0.55 0.19 0.19 0.04 0.78 0.78 XXX

78102 TC A Bone marrow imaging, ltd .................................. 0.00 1.44 1.44 0.13 1.57 1.57 XXX

78103 ............ A Bone marrow imaging, mult ............................... 0.75 2.50 2.50 0.24 3.49 3.49 XXX

78103 26 A Bone marrow imaging, mult ............................... 0.75 0.25 0.25 0.05 1.05 1.05 XXX

78103 TC A Bone marrow imaging, mult ............................... 0.00 2.25 2.25 0.19 2.44 2.44 XXX

78104 ............ A Bone marrow imaging, body .............................. 0.80 3.16 3.16 0.30 4.26 4.26 XXX

78104 26 A Bone marrow imaging, body .............................. 0.80 0.28 0.28 0.05 1.13 1.13 XXX

78104 TC A Bone marrow imaging, body .............................. 0.00 2.89 2.89 0.25 3.14 3.14 XXX

78110 ............ A Plasma volume, single ....................................... 0.19 0.74 0.74 0.07 1.00 1.00 XXX

78110 26 A Plasma volume, single ....................................... 0.19 0.07 0.07 0.01 0.27 0.27 XXX

78110 TC A Plasma volume, single ....................................... 0.00 0.67 0.67 0.06 0.73 0.73 XXX

78111 ............ A Plasma volume, multiple .................................... 0.22 1.90 1.90 0.18 2.30 2.30 XXX

78111 26 A Plasma volume, multiple .................................... 0.22 0.07 0.07 0.02 0.31 0.31 XXX

78111 TC A Plasma volume, multiple .................................... 0.00 1.82 1.82 0.16 1.98 1.98 XXX

78120 ............ A Red cell mass, single ......................................... 0.23 1.31 1.31 0.13 1.67 1.67 XXX

78120 26 A Red cell mass, single ......................................... 0.23 0.08 0.08 0.02 0.33 0.33 XXX

78120 TC A Red cell mass, single ......................................... 0.00 1.23 1.23 0.11 1.34 1.34 XXX

78121 ............ A Red cell mass, multiple ...................................... 0.32 2.17 2.17 0.19 2.68 2.68 XXX

78121 26 A Red cell mass, multiple ...................................... 0.32 0.11 0.11 0.02 0.45 0.45 XXX

78121 TC A Red cell mass, multiple ...................................... 0.00 2.06 2.06 0.17 2.23 2.23 XXX

78122 ............ A Blood volume ..................................................... 0.45 3.42 3.42 0.31 4.18 4.18 XXX

78122 26 A Blood volume ..................................................... 0.45 0.15 0.15 0.03 0.63 0.63 XXX

78122 TC A Blood volume ..................................................... 0.00 3.27 3.27 0.28 3.55 3.55 XXX

78130 ............ A Red cell survival study ....................................... 0.61 2.23 2.23 0.21 3.05 3.05 XXX

78130 26 A Red cell survival study ....................................... 0.61 0.21 0.21 0.04 0.86 0.86 XXX

78130 TC A Red cell survival study ....................................... 0.00 2.02 2.02 0.17 2.19 2.19 XXX

78135 ............ A Red cell survival kinetics .................................... 0.64 3.67 3.67 0.34 4.65 4.65 XXX

78135 26 A Red cell survival kinetics .................................... 0.64 0.22 0.22 0.04 0.90 0.90 XXX

78135 TC A Red cell survival kinetics .................................... 0.00 3.45 3.45 0.30 3.75 3.75 XXX

78140 ............ A Red cell sequestration ....................................... 0.61 3.00 3.00 0.28 3.89 3.89 XXX

78140 26 A Red cell sequestration ....................................... 0.61 0.21 0.21 0.04 0.86 0.86 XXX

78140 TC A Red cell sequestration ....................................... 0.00 2.79 2.79 0.24 3.03 3.03 XXX

78160 ............ A Plasma iron turnover .......................................... 0.33 2.71 2.71 0.24 3.28 3.28 XXX

78160 26 A Plasma iron turnover .......................................... 0.33 0.11 0.11 0.02 0.46 0.46 XXX

78160 TC A Plasma iron turnover .......................................... 0.00 2.60 2.60 0.22 2.82 2.82 XXX

78162 ............ A Iron absorption exam ......................................... 0.45 2.42 2.42 0.22 3.09 3.09 XXX

78162 26 A Iron absorption exam ......................................... 0.45 0.15 0.15 0.03 0.63 0.63 XXX

78162 TC A Iron absorption exam ......................................... 0.00 2.27 2.27 0.19 2.46 2.46 XXX

78170 ............ A Red cell iron utilization ....................................... 0.41 3.90 3.90 0.35 4.66 4.66 XXX

78170 26 A Red cell iron utilization ....................................... 0.41 0.13 0.13 0.03 0.57 0.57 XXX

78170 TC A Red cell iron utilization ....................................... 0.00 3.77 3.77 0.32 4.09 4.09 XXX

78172 26 A Total body iron estimation .................................. 0.53 0.19 0.19 0.04 0.76 0.76 XXX

78185 ............ A Spleen imaging .................................................. 0.40 1.81 1.81 0.18 2.39 2.39 XXX

78185 26 A Spleen imaging .................................................. 0.40 0.13 0.13 0.03 0.56 0.56 XXX

78185 TC A Spleen imaging .................................................. 0.00 1.67 1.67 0.15 1.82 1.82 XXX

78190 ............ A Platelet survival, kinetics .................................... 1.09 4.41 4.41 0.42 5.92 5.92 XXX

78190 26 A Platelet survival, kinetics .................................... 1.09 0.36 0.36 0.07 1.52 1.52 XXX

78190 TC A Platelet survival, kinetics .................................... 0.00 4.06 4.06 0.35 4.41 4.41 XXX

78191 ............ A Platelet survival .................................................. 0.61 5.41 5.41 0.48 6.50 6.50 XXX

78191 26 A Platelet survival .................................................. 0.61 0.21 0.21 0.04 0.86 0.86 XXX

78191 TC A Platelet survival .................................................. 0.00 5.20 5.20 0.44 5.64 5.64 XXX

78195 ............ A Lymph system imaging ...................................... 1.20 3.13 3.13 0.30 4.63 4.63 XXX

78195 26 A Lymph system imaging ...................................... 1.20 0.24 0.24 0.05 1.49 1.49 XXX

78195 TC A Lymph system imaging ...................................... 0.00 2.89 2.89 0.25 3.14 3.14 XXX

78201 ............ A Liver imaging ...................................................... 0.44 1.82 1.82 0.18 2.44 2.44 XXX

78201 26 A Liver imaging ...................................................... 0.44 0.14 0.14 0.03 0.61 0.61 XXX

78201 TC A Liver imaging ...................................................... 0.00 1.67 1.67 0.15 1.82 1.82 XXX

78202 ............ A Liver imaging with flow ....................................... 0.51 2.22 2.22 0.21 2.94 2.94 XXX

78202 26 A Liver imaging with flow ....................................... 0.51 0.17 0.17 0.04 0.72 0.72 XXX

78202 TC A Liver imaging with flow ....................................... 0.00 2.05 2.05 0.17 2.22 2.22 XXX

78205 ............ A Liver imaging (3D) .............................................. 0.71 4.44 4.44 0.41 5.56 5.56 XXX

78205 26 A Liver imaging (3D) .............................................. 0.71 0.25 0.25 0.05 1.01 1.01 XXX

78205 TC A Liver imaging (3D) .............................................. 0.00 4.19 4.19 0.36 4.55 4.55 XXX

78215 ............ A Liver and spleen imaging ................................... 0.49 2.25 2.25 0.20 2.94 2.94 XXX

78215 26 A Liver and spleen imaging ................................... 0.49 0.16 0.16 0.03 0.68 0.68 XXX

78215 TC A Liver and spleen imaging ................................... 0.00 2.08 2.08 0.17 2.25 2.25 XXX

78216 ............ A Liver & spleen image, flow ................................. 0.57 2.66 2.66 0.25 3.48 3.48 XXX

78216 26 A Liver & spleen image, flow ................................. 0.57 0.19 0.19 0.04 0.80 0.80 XXX

78216 TC A Liver & spleen image, flow ................................. 0.00 2.47 2.47 0.21 2.68 2.68 XXX

78220 ............ A Liver function study ............................................ 0.49 2.81 2.81 0.25 3.55 3.55 XXX

78220 26 A Liver function study ............................................ 0.49 0.16 0.16 0.03 0.68 0.68 XXX

78220 TC A Liver function study ............................................ 0.00 2.64 2.64 0.22 2.86 2.86 XXX
30987

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78223 ............ A Hepatobiliary imaging ......................................... 0.84 2.88 2.88 0.28 4.00 4.00 XXX

78223 26 A Hepatobiliary imaging ......................................... 0.84 0.28 0.28 0.06 1.18 1.18 XXX

78223 TC A Hepatobiliary imaging ......................................... 0.00 2.60 2.60 0.22 2.82 2.82 XXX

78230 ............ A Salivary gland imaging ....................................... 0.45 1.70 1.70 0.17 2.32 2.32 XXX

78230 26 A Salivary gland imaging ....................................... 0.45 0.16 0.16 0.03 0.64 0.64 XXX

78230 TC A Salivary gland imaging ....................................... 0.00 1.54 1.54 0.14 1.68 1.68 XXX

78231 ............ A Serial salivary imaging ....................................... 0.52 2.43 2.43 0.23 3.18 3.18 XXX

78231 26 A Serial salivary imaging ....................................... 0.52 0.18 0.18 0.04 0.74 0.74 XXX

78231 TC A Serial salivary imaging ....................................... 0.00 2.25 2.25 0.19 2.44 2.44 XXX

78232 ............ A Salivary gland function exam ............................. 0.47 2.67 2.67 0.24 3.38 3.38 XXX

78232 26 A Salivary gland function exam ............................. 0.47 0.16 0.16 0.03 0.66 0.66 XXX

78232 TC A Salivary gland function exam ............................. 0.00 2.51 2.51 0.21 2.72 2.72 XXX

78258 ............ A Esophageal motility study .................................. 0.74 2.30 2.30 0.22 3.26 3.26 XXX

78258 26 A Esophageal motility study .................................. 0.74 0.25 0.25 0.05 1.04 1.04 XXX

78258 TC A Esophageal motility study .................................. 0.00 2.05 2.05 0.17 2.22 2.22 XXX

78261 ............ A Gastric mucosa imaging .................................... 0.69 3.15 3.15 0.30 4.14 4.14 XXX

78261 26 A Gastric mucosa imaging .................................... 0.69 0.24 0.24 0.05 0.98 0.98 XXX

78261 TC A Gastric mucosa imaging .................................... 0.00 2.91 2.91 0.25 3.16 3.16 XXX

78262 ............ A Gastroesophageal reflux exam .......................... 0.68 3.25 3.25 0.31 4.24 4.24 XXX

78262 26 A Gastroesophageal reflux exam .......................... 0.68 0.23 0.23 0.05 0.96 0.96 XXX

78262 TC A Gastroesophageal reflux exam .......................... 0.00 3.01 3.01 0.26 3.27 3.27 XXX

78264 ............ A Gastric emptying study ...................................... 0.78 3.19 3.19 0.30 4.27 4.27 XXX

78264 26 A Gastric emptying study ...................................... 0.78 0.27 0.27 0.05 1.10 1.10 XXX

78264 TC A Gastric emptying study ...................................... 0.00 2.93 2.93 0.25 3.18 3.18 XXX

78270 ............ A Vit B–12 absorption exam .................................. 0.20 1.17 1.17 0.11 1.48 1.48 XXX

78270 26 A Vit B–12 absorption exam .................................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX

78270 TC A Vit B–12 absorption exam .................................. 0.00 1.09 1.09 0.10 1.19 1.19 XXX

78271 ............ A Vit B–12 absorp exam, IF .................................. 0.20 1.24 1.24 0.11 1.55 1.55 XXX

78271 26 A Vit B–12 absorp exam, IF .................................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX

78271 TC A Vit B–12 absorp exam, IF .................................. 0.00 1.17 1.17 0.10 1.27 1.27 XXX

78272 ............ A Vit B–12 absorp, combined ................................ 0.27 1.74 1.74 0.17 2.18 2.18 XXX

78272 26 A Vit B–12 absorp, combined ................................ 0.27 0.10 0.10 0.02 0.39 0.39 XXX

78272 TC A Vit B–12 absorp, combined ................................ 0.00 1.64 1.64 0.15 1.79 1.79 XXX

78278 ............ A Acute GI blood loss imaging .............................. 0.99 3.79 3.79 0.37 5.15 5.15 XXX

78278 26 A Acute GI blood loss imaging .............................. 0.99 0.33 0.33 0.07 1.39 1.39 XXX

78278 TC A Acute GI blood loss imaging .............................. 0.00 3.45 3.45 0.30 3.75 3.75 XXX

78282 26 A GI protein loss exam .......................................... 0.38 0.13 0.13 0.03 0.54 0.54 XXX

78290 ............ A Meckel’s divert exam ......................................... 0.68 2.39 2.39 0.23 3.30 3.30 XXX

78290 26 A Meckel’s divert exam ......................................... 0.68 0.23 0.23 0.05 0.96 0.96 XXX

78290 TC A Meckel’s divert exam ......................................... 0.00 2.16 2.16 0.18 2.34 2.34 XXX

78291 ............ A Leveen/shunt patency exam .............................. 0.88 2.46 2.46 0.24 3.58 3.58 XXX

78291 26 A Leveen/shunt patency exam .............................. 0.88 0.29 0.29 0.06 1.23 1.23 XXX

78291 TC A Leveen/shunt patency exam .............................. 0.00 2.17 2.17 0.18 2.35 2.35 XXX

78300 ............ A Bone imaging, limited area ................................ 0.62 1.98 1.98 0.20 2.80 2.80 XXX

78300 26 A Bone imaging, limited area ................................ 0.62 0.22 0.22 0.04 0.88 0.88 XXX

78300 TC A Bone imaging, limited area ................................ 0.00 1.76 1.76 0.16 1.92 1.92 XXX

78305 ............ A Bone imaging, multiple areas ............................ 0.83 2.88 2.88 0.28 3.99 3.99 XXX

78305 26 A Bone imaging, multiple areas ............................ 0.83 0.28 0.28 0.06 1.17 1.17 XXX

78305 TC A Bone imaging, multiple areas ............................ 0.00 2.60 2.60 0.22 2.82 2.82 XXX

78306 ............ A Bone imaging, whole body ................................. 0.86 3.32 3.32 0.32 4.50 4.50 XXX

78306 26 A Bone imaging, whole body ................................. 0.86 0.29 0.29 0.06 1.21 1.21 XXX

78306 TC A Bone imaging, whole body ................................. 0.00 3.03 3.03 0.26 3.29 3.29 XXX

78315 ............ A Bone imaging, 3 phase ...................................... 1.02 3.72 3.72 0.36 5.10 5.10 XXX

78315 26 A Bone imaging, 3 phase ...................................... 1.02 0.33 0.33 0.07 1.42 1.42 XXX

78315 TC A Bone imaging, 3 phase ...................................... 0.00 3.39 3.39 0.29 3.68 3.68 XXX

78320 ............ A Bone imaging (3D) ............................................. 1.04 4.53 4.53 0.43 6.00 6.00 XXX

78320 26 A Bone imaging (3D) ............................................. 1.04 0.34 0.34 0.07 1.45 1.45 XXX

78320 TC A Bone imaging (3D) ............................................. 0.00 4.19 4.19 0.36 4.55 4.55 XXX

78350 ............ A Bone mineral, single photon .............................. 0.22 0.61 0.61 0.07 0.90 0.90 XXX

78350 26 A Bone mineral, single photon .............................. 0.22 0.07 0.07 0.02 0.31 0.31 XXX

78350 TC A Bone mineral, single photon .............................. 0.00 0.54 0.54 0.05 0.59 0.59 XXX

78351 ............ N Bone mineral, dual photon ................................. +0.30 0.14 0.14 0.02 0.46 0.46 XXX

78414 26 A Non-imaging heart function ................................ 0.45 0.15 0.15 0.03 0.63 0.63 XXX

78428 ............ A Cardiac shunt imaging ....................................... 0.78 1.87 1.87 0.19 2.84 2.84 XXX

78428 26 A Cardiac shunt imaging ....................................... 0.78 0.27 0.27 0.05 1.10 1.10 XXX

78428 TC A Cardiac shunt imaging ....................................... 0.00 1.60 1.60 0.14 1.74 1.74 XXX

78445 ............ A Vascular flow imaging ........................................ 0.49 1.50 1.50 0.15 2.14 2.14 XXX

78445 26 A Vascular flow imaging ........................................ 0.49 0.18 0.18 0.04 0.71 0.71 XXX

78445 TC A Vascular flow imaging ........................................ 0.00 1.32 1.32 0.11 1.43 1.43 XXX

78455 ............ A Venous thrombosis study ................................... 0.73 3.07 3.07 0.29 4.09 4.09 XXX

78455 26 A Venous thrombosis study ................................... 0.73 0.25 0.25 0.05 1.03 1.03 XXX

78455 TC A Venous thrombosis study ................................... 0.00 2.83 2.83 0.24 3.07 3.07 XXX

78457 ............ A Venous thrombosis imaging ............................... 0.77 2.14 2.14 0.22 3.13 3.13 XXX

78457 26 A Venous thrombosis imaging ............................... 0.77 0.26 0.26 0.05 1.08 1.08 XXX
30988

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78457 TC A Venous thrombosis imaging ............................... 0.00 1.88 1.88 0.17 2.05 2.05 XXX

78458 ............ A Ven thrombosis images, bilat ............................. 0.90 3.15 3.15 0.30 4.35 4.35 XXX

78458 26 A Ven thrombosis images, bilat ............................. 0.90 0.30 0.30 0.06 1.26 1.26 XXX

78458 TC A Ven thrombosis images, bilat ............................. 0.00 2.85 2.85 0.24 3.09 3.09 XXX

78459 26 I Heart muscle imaging (PET) .............................. +1.88 1.00 1.00 0.10 2.98 2.98 XXX

78460 ............ A Heart muscle blood single ................................. 0.86 1.96 1.96 0.21 3.03 3.03 XXX

78460 26 A Heart muscle blood single ................................. 0.86 0.29 0.29 0.06 1.21 1.21 XXX

78460 TC A Heart muscle blood single ................................. 0.00 1.67 1.67 0.15 1.82 1.82 XXX

78461 ............ A Heart muscle blood multiple .............................. 1.23 3.75 3.75 0.37 5.35 5.35 XXX

78461 26 A Heart muscle blood multiple .............................. 1.23 0.40 0.40 0.08 1.71 1.71 XXX

78461 TC A Heart muscle blood multiple .............................. 0.00 3.35 3.35 0.29 3.64 3.64 XXX

78464 ............ A Heart image (3D) single ..................................... 1.09 5.37 5.37 0.50 6.96 6.96 XXX

78464 26 A Heart image (3D) single ..................................... 1.09 0.36 0.36 0.07 1.52 1.52 XXX

78464 TC A Heart image (3D) single ..................................... 0.00 5.02 5.02 0.43 5.45 5.45 XXX

78465 ............ A Heart image (3D) multiple .................................. 1.46 8.85 8.85 0.80 11.11 11.11 XXX

78465 26 A Heart image (3D) multiple .................................. 1.46 0.48 0.48 0.10 2.04 2.04 XXX

78465 TC A Heart image (3D) multiple .................................. 0.00 8.37 8.37 0.70 9.07 9.07 XXX

78466 ............ A Heart infarct image ............................................. 0.69 2.10 2.10 0.22 3.01 3.01 XXX

78466 26 A Heart infarct image ............................................. 0.69 0.24 0.24 0.05 0.98 0.98 XXX

78466 TC A Heart infarct image ............................................. 0.00 1.86 1.86 0.17 2.03 2.03 XXX

78468 ............ A Heart infarct image, EF ...................................... 0.80 2.87 2.87 0.27 3.94 3.94 XXX

78468 26 A Heart infarct image, EF ...................................... 0.80 0.27 0.27 0.05 1.12 1.12 XXX

78468 TC A Heart infarct image, EF ...................................... 0.00 2.60 2.60 0.22 2.82 2.82 XXX

78469 ............ A Heart infarct image (3D) .................................... 0.92 4.01 4.01 0.38 5.31 5.31 XXX

78469 26 A Heart infarct image (3D) .................................... 0.92 0.31 0.31 0.06 1.29 1.29 XXX

78469 TC A Heart infarct image (3D) .................................... 0.00 3.71 3.71 0.32 4.03 4.03 XXX

78472 ............ A Gated heart, resting ........................................... 0.98 4.23 4.23 0.41 5.62 5.62 XXX

78472 26 A Gated heart, resting ........................................... 0.98 0.33 0.33 0.07 1.38 1.38 XXX

78472 TC A Gated heart, resting ........................................... 0.00 3.91 3.91 0.34 4.25 4.25 XXX

78473 ............ A Gated heart, multiple .......................................... 1.47 6.34 6.34 0.59 8.40 8.40 XXX

78473 26 A Gated heart, multiple .......................................... 1.47 0.48 0.48 0.10 2.05 2.05 XXX

78473 TC A Gated heart, multiple .......................................... 0.00 5.86 5.86 0.49 6.35 6.35 XXX

78478 ............ A Heart wall motion (add-on) ................................ 0.62 1.31 1.31 0.14 2.07 2.07 XXX

78478 26 A Heart wall motion (add-on) ................................ 0.62 0.21 0.21 0.04 0.87 0.87 XXX

78478 TC A Heart wall motion (add-on) ................................ 0.00 1.10 1.10 0.10 1.20 1.20 XXX

78480 ............ A Heart function, (add-on) ..................................... 0.62 1.31 1.31 0.14 2.07 2.07 XXX

78480 26 A Heart function, (add-on) ..................................... 0.62 0.21 0.21 0.04 0.87 0.87 XXX

78480 TC A Heart function, (add-on) ..................................... 0.00 1.10 1.10 0.10 1.20 1.20 XXX

78481 ............ A Heart first pass single ........................................ 0.98 4.03 4.03 0.39 5.40 5.40 XXX

78481 26 A Heart first pass single ........................................ 0.98 0.33 0.33 0.07 1.38 1.38 XXX

78481 TC A Heart first pass single ........................................ 0.00 3.71 3.71 0.32 4.03 4.03 XXX

78483 ............ A Heart first pass multiple ..................................... 1.47 6.07 6.07 0.57 8.11 8.11 XXX

78483 26 A Heart first pass multiple ..................................... 1.47 0.48 0.48 0.10 2.05 2.05 XXX

78483 TC A Heart first pass multiple ..................................... 0.00 5.58 5.58 0.47 6.05 6.05 XXX

78491 26 I Heart image (pet) single .................................... +1.50 1.00 1.00 0.10 2.60 2.60 XXX

78492 26 I Heart image (pet) multiple ................................. +1.87 1.00 1.00 0.10 2.97 2.97 XXX

78580 ............ A Lung perfusion imaging ...................................... 0.74 2.69 2.69 0.26 3.69 3.69 XXX

78580 26 A Lung perfusion imaging ...................................... 0.74 0.25 0.25 0.05 1.04 1.04 XXX

78580 TC A Lung perfusion imaging ...................................... 0.00 2.43 2.43 0.21 2.64 2.64 XXX

78584 ............ A Lung V/Q image single breath ........................... 0.99 2.60 2.60 0.26 3.85 3.85 XXX

78584 26 A Lung V/Q image single breath ........................... 0.99 0.33 0.33 0.07 1.39 1.39 XXX

78584 TC A Lung V/Q image single breath ........................... 0.00 2.27 2.27 0.19 2.46 2.46 XXX

78585 ............ A Lung V/Q imaging .............................................. 1.09 4.35 4.35 0.41 5.85 5.85 XXX

78585 26 A Lung V/Q imaging .............................................. 1.09 0.36 0.36 0.07 1.52 1.52 XXX

78585 TC A Lung V/Q imaging .............................................. 0.00 4.00 4.00 0.34 4.34 4.34 XXX

78586 ............ A Aerosol lung image, single ................................. 0.40 1.97 1.97 0.19 2.56 2.56 XXX

78586 26 A Aerosol lung image, single ................................. 0.40 0.13 0.13 0.03 0.56 0.56 XXX

78586 TC A Aerosol lung image, single ................................. 0.00 1.84 1.84 0.16 2.00 2.00 XXX

78587 ............ A Aerosol lung image, multiple .............................. 0.49 2.15 2.15 0.20 2.84 2.84 XXX

78587 26 A Aerosol lung image, multiple .............................. 0.49 0.16 0.16 0.03 0.68 0.68 XXX

78587 TC A Aerosol lung image, multiple .............................. 0.00 1.99 1.99 0.17 2.16 2.16 XXX

78591 ............ A Vent image, 1 breath, 1 proj .............................. 0.40 2.16 2.16 0.20 2.76 2.76 XXX

78591 26 A Vent image, 1 breath, 1 proj .............................. 0.40 0.13 0.13 0.03 0.56 0.56 XXX

78591 TC A Vent image, 1 breath, 1 proj .............................. 0.00 2.02 2.02 0.17 2.19 2.19 XXX

78593 ............ A Vent image, 1 proj, gas ...................................... 0.49 2.61 2.61 0.24 3.34 3.34 XXX

78593 26 A Vent image, 1 proj, gas ...................................... 0.49 0.16 0.16 0.03 0.68 0.68 XXX

78593 TC A Vent image, 1 proj, gas ...................................... 0.00 2.45 2.45 0.21 2.66 2.66 XXX

78594 ............ A Vent image, mult proj, gas ................................. 0.53 3.72 3.72 0.34 4.59 4.59 XXX

78594 26 A Vent image, mult proj, gas ................................. 0.53 0.19 0.19 0.04 0.76 0.76 XXX

78594 TC A Vent image, mult proj, gas ................................. 0.00 3.54 3.54 0.30 3.84 3.84 XXX

78596 ............ A Lung differential function .................................... 1.27 5.43 5.43 0.52 7.22 7.22 XXX

78596 26 A Lung differential function .................................... 1.27 0.42 0.42 0.09 1.78 1.78 XXX

78596 TC A Lung differential function .................................... 0.00 5.02 5.02 0.43 5.45 5.45 XXX

78600 ............ A Brain imaging, ltd static ...................................... 0.44 2.20 2.20 0.20 2.84 2.84 XXX
30989

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78600 26 A Brain imaging, ltd static ...................................... 0.44 0.15 0.15 0.03 0.62 0.62 XXX

78600 TC A Brain imaging, ltd static ...................................... 0.00 2.05 2.05 0.17 2.22 2.22 XXX

78601 ............ A Brain ltd imaging & flow ..................................... 0.51 2.59 2.59 0.24 3.34 3.34 XXX

78601 26 A Brain ltd imaging & flow ..................................... 0.51 0.18 0.18 0.04 0.73 0.73 XXX

78601 TC A Brain ltd imaging & flow ..................................... 0.00 2.41 2.41 0.20 2.61 2.61 XXX

78605 ............ A Brain imaging, complete .................................... 0.53 2.60 2.60 0.24 3.37 3.37 XXX

78605 26 A Brain imaging, complete .................................... 0.53 0.19 0.19 0.04 0.76 0.76 XXX

78605 TC A Brain imaging, complete .................................... 0.00 2.41 2.41 0.20 2.61 2.61 XXX

78606 ............ A Brain imaging comp & flow ................................ 0.64 2.96 2.96 0.27 3.87 3.87 XXX

78606 26 A Brain imaging comp & flow ................................ 0.64 0.22 0.22 0.04 0.90 0.90 XXX

78606 TC A Brain imaging comp & flow ................................ 0.00 2.75 2.75 0.23 2.98 2.98 XXX

78607 ............ A Brain imaging (3D) ............................................. 1.23 5.05 5.05 0.47 6.75 6.75 XXX

78607 26 A Brain imaging (3D) ............................................. 1.23 0.40 0.40 0.08 1.71 1.71 XXX

78607 TC A Brain imaging (3D) ............................................. 0.00 4.65 4.65 0.39 5.04 5.04 XXX

78610 ............ A Brain flow imaging only ...................................... 0.30 1.22 1.22 0.12 1.64 1.64 XXX

78610 26 A Brain flow imaging only ...................................... 0.30 0.10 0.10 0.02 0.42 0.42 XXX

78610 TC A Brain flow imaging only ...................................... 0.00 1.12 1.12 0.10 1.22 1.22 XXX

78615 ............ A Cerebral blood flow imaging .............................. 0.42 2.87 2.87 0.26 3.55 3.55 XXX

78615 26 A Cerebral blood flow imaging .............................. 0.42 0.14 0.14 0.03 0.59 0.59 XXX

78615 TC A Cerebral blood flow imaging .............................. 0.00 2.73 2.73 0.23 2.96 2.96 XXX

78630 ............ A Cerebrospinal fluid scan .................................... 0.68 3.80 3.80 0.36 4.84 4.84 XXX

78630 26 A Cerebrospinal fluid scan .................................... 0.68 0.23 0.23 0.05 0.96 0.96 XXX

78630 TC A Cerebrospinal fluid scan .................................... 0.00 3.57 3.57 0.31 3.88 3.88 XXX

78635 ............ A CSF ventriculography ......................................... 0.61 2.01 2.01 0.20 2.82 2.82 XXX

78635 26 A CSF ventriculography ......................................... 0.61 0.21 0.21 0.04 0.86 0.86 XXX

78635 TC A CSF ventriculography ......................................... 0.00 1.80 1.80 0.16 1.96 1.96 XXX

78645 ............ A CSF shunt evaluation ......................................... 0.57 2.63 2.63 0.25 3.45 3.45 XXX

78645 26 A CSF shunt evaluation ......................................... 0.57 0.19 0.19 0.04 0.80 0.80 XXX

78645 TC A CSF shunt evaluation ......................................... 0.00 2.43 2.43 0.21 2.64 2.64 XXX

78647 ............ A Cerebrospinal fluid scan .................................... 0.90 4.50 4.50 0.42 5.82 5.82 XXX

78647 26 A Cerebrospinal fluid scan .................................... 0.90 0.31 0.31 0.06 1.27 1.27 XXX

78647 TC A Cerebrospinal fluid scan .................................... 0.00 4.19 4.19 0.36 4.55 4.55 XXX

78650 ............ A CSF leakage imaging ......................................... 0.61 3.50 3.50 0.32 4.43 4.43 XXX

78650 26 A CSF leakage imaging ......................................... 0.61 0.21 0.21 0.04 0.86 0.86 XXX

78650 TC A CSF leakage imaging ......................................... 0.00 3.29 3.29 0.28 3.57 3.57 XXX

78660 ............ A Nuclear exam of tear flow .................................. 0.53 1.69 1.69 0.17 2.39 2.39 XXX

78660 26 A Nuclear exam of tear flow .................................. 0.53 0.19 0.19 0.04 0.76 0.76 XXX

78660 TC A Nuclear exam of tear flow .................................. 0.00 1.50 1.50 0.13 1.63 1.63 XXX

78700 ............ A Kidney imaging, static ........................................ 0.45 2.31 2.31 0.21 2.97 2.97 XXX

78700 26 A Kidney imaging, static ........................................ 0.45 0.15 0.15 0.03 0.63 0.63 XXX

78700 TC A Kidney imaging, static ........................................ 0.00 2.16 2.16 0.18 2.34 2.34 XXX

78701 ............ A Kidney imaging with flow ................................... 0.49 2.69 2.69 0.24 3.42 3.42 XXX

78701 26 A Kidney imaging with flow ................................... 0.49 0.16 0.16 0.03 0.68 0.68 XXX

78701 TC A Kidney imaging with flow ................................... 0.00 2.52 2.52 0.21 2.73 2.73 XXX

78704 ............ A Imaging renogram .............................................. 0.74 3.06 3.06 0.29 4.09 4.09 XXX

78704 26 A Imaging renogram .............................................. 0.74 0.25 0.25 0.05 1.04 1.04 XXX

78704 TC A Imaging renogram .............................................. 0.00 2.81 2.81 0.24 3.05 3.05 XXX

78707 ............ A Kidney flow & function image ............................ 0.96 3.48 3.48 0.33 4.77 4.77 XXX

78707 26 A Kidney flow & function image ............................ 0.96 0.31 0.31 0.06 1.33 1.33 XXX

78707 TC A Kidney flow & function image ............................ 0.00 3.17 3.17 0.27 3.44 3.44 XXX

78708 ............ A Kidney flow & function image ............................ 1.21 3.48 3.48 0.33 5.02 5.02 XXX

78708 26 A Kidney flow & function image ............................ 1.21 0.31 0.31 0.06 1.58 1.58 XXX

78708 TC A Kidney flow & function image ............................ 0.00 3.17 3.17 0.27 3.44 3.44 XXX

78709 ............ A Kidney flow & function image ............................ 1.41 3.48 3.48 0.33 5.22 5.22 XXX

78709 26 A Kidney flow & function image ............................ 1.41 0.31 0.31 0.06 1.78 1.78 XXX

78709 TC A Kidney flow & function image ............................ 0.00 3.17 3.17 0.27 3.44 3.44 XXX

78710 ............ A Kidney imaging (3D) .......................................... 0.66 4.41 4.41 0.41 5.48 5.48 XXX

78710 26 A Kidney imaging (3D) .......................................... 0.66 0.22 0.22 0.05 0.93 0.93 XXX

78710 TC A Kidney imaging (3D) .......................................... 0.00 4.19 4.19 0.36 4.55 4.55 XXX

78715 ............ A Renal vascular flow exam .................................. 0.30 1.22 1.22 0.12 1.64 1.64 XXX

78715 26 A Renal vascular flow exam .................................. 0.30 0.10 0.10 0.02 0.42 0.42 XXX

78715 TC A Renal vascular flow exam .................................. 0.00 1.12 1.12 0.10 1.22 1.22 XXX

78725 ............ A Kidney function study ......................................... 0.38 1.39 1.39 0.14 1.91 1.91 XXX

78725 26 A Kidney function study ......................................... 0.38 0.13 0.13 0.03 0.54 0.54 XXX

78725 TC A Kidney function study ......................................... 0.00 1.27 1.27 0.11 1.38 1.38 XXX

78730 ............ A Urinary bladder retention ................................... 0.36 1.15 1.15 0.11 1.62 1.62 XXX

78730 26 A Urinary bladder retention ................................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX

78730 TC A Urinary bladder retention ................................... 0.00 1.03 1.03 0.09 1.12 1.12 XXX

78740 ............ A Ureteral reflux study ........................................... 0.57 1.70 1.70 0.17 2.44 2.44 XXX

78740 26 A Ureteral reflux study ........................................... 0.57 0.19 0.19 0.04 0.80 0.80 XXX

78740 TC A Ureteral reflux study ........................................... 0.00 1.50 1.50 0.13 1.63 1.63 XXX

78760 ............ A Testicular imaging .............................................. 0.66 2.12 2.12 0.21 2.99 2.99 XXX

78760 26 A Testicular imaging .............................................. 0.66 0.22 0.22 0.04 0.92 0.92 XXX

78760 TC A Testicular imaging .............................................. 0.00 1.90 1.90 0.17 2.07 2.07 XXX
30990

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

78761 ............ A Testicular imaging & flow ................................... 0.71 2.52 2.52 0.24 3.47 3.47 XXX

78761 26 A Testicular imaging & flow ................................... 0.71 0.25 0.25 0.05 1.01 1.01 XXX

78761 TC A Testicular imaging & flow ................................... 0.00 2.27 2.27 0.19 2.46 2.46 XXX

78800 ............ A Tumor imaging, limited area .............................. 0.66 2.63 2.63 0.24 3.53 3.53 XXX

78800 26 A Tumor imaging, limited area .............................. 0.66 0.22 0.22 0.04 0.92 0.92 XXX

78800 TC A Tumor imaging, limited area .............................. 0.00 2.41 2.41 0.20 2.61 2.61 XXX

78801 ............ A Tumor imaging, mult areas ................................ 0.79 3.27 3.27 0.31 4.37 4.37 XXX

78801 26 A Tumor imaging, mult areas ................................ 0.79 0.27 0.27 0.05 1.11 1.11 XXX

78801 TC A Tumor imaging, mult areas ................................ 0.00 3.00 3.00 0.26 3.26 3.26 XXX

78802 ............ A Tumor imaging, whole body ............................... 0.86 4.21 4.21 0.40 5.47 5.47 XXX

78802 26 A Tumor imaging, whole body ............................... 0.86 0.29 0.29 0.06 1.21 1.21 XXX

78802 TC A Tumor imaging, whole body ............................... 0.00 3.92 3.92 0.34 4.26 4.26 XXX

78803 ............ A Tumor imaging (3D) ........................................... 1.09 5.01 5.01 0.46 6.56 6.56 XXX

78803 26 A Tumor imaging (3D) ........................................... 1.09 0.36 0.36 0.07 1.52 1.52 XXX

78803 TC A Tumor imaging (3D) ........................................... 0.00 4.65 4.65 0.39 5.04 5.04 XXX

78805 ............ A Abscess imaging, ltd area .................................. 0.73 2.66 2.66 0.25 3.64 3.64 XXX

78805 26 A Abscess imaging, ltd area .................................. 0.73 0.25 0.25 0.05 1.03 1.03 XXX

78805 TC A Abscess imaging, ltd area .................................. 0.00 2.41 2.41 0.20 2.61 2.61 XXX

78806 ............ A Abscess imaging, whole body ........................... 0.86 4.85 4.85 0.45 6.16 6.16 XXX

78806 26 A Abscess imaging, whole body ........................... 0.86 0.28 0.28 0.06 1.20 1.20 XXX

78806 TC A Abscess imaging, whole body ........................... 0.00 4.56 4.56 0.39 4.95 4.95 XXX

78807 ............ A Nuclear localization/abscess .............................. 1.09 5.01 5.01 0.46 6.56 6.56 XXX

78807 26 A Nuclear localization/abscess .............................. 1.09 0.36 0.36 0.07 1.52 1.52 XXX

78807 TC A Nuclear localization/abscess .............................. 0.00 4.65 4.65 0.39 5.04 5.04 XXX

78810 26 N Tumor imaging (PET) ......................................... +1.93 1.02 1.02 0.10 3.05 3.05 XXX

78890 ............ B Nuclear medicine data proc ............................... +0.05 0.94 0.94 0.08 1.07 1.07 XXX

78890 26 B Nuclear medicine data proc ............................... +0.05 0.01 0.01 0.00 0.06 0.06 XXX

78890 TC B Nuclear medicine data proc ............................... +0.00 0.92 0.92 0.08 1.00 1.00 XXX

78891 ............ B Nuclear med data proc ...................................... +0.10 1.90 1.90 0.18 2.18 2.18 XXX

78891 26 B Nuclear med data proc ...................................... +0.10 0.04 0.04 0.01 0.15 0.15 XXX

78891 TC B Nuclear med data proc ...................................... +0.00 1.86 1.86 0.17 2.03 2.03 XXX

79000 ............ A Intial hyperthyroid therapy .................................. 1.80 2.46 2.46 0.29 4.55 4.55 XXX

79000 26 A Intial hyperthyroid therapy .................................. 1.80 0.60 0.60 0.12 2.52 2.52 XXX

79000 TC A Intial hyperthyroid therapy .................................. 0.00 1.86 1.86 0.17 2.03 2.03 XXX

79001 ............ A Repeat hyperthyroid therapy .............................. 1.05 1.27 1.27 0.15 2.47 2.47 XXX

79001 26 A Repeat hyperthyroid therapy .............................. 1.05 0.34 0.34 0.07 1.46 1.46 XXX

79001 TC A Repeat hyperthyroid therapy .............................. 0.00 0.92 0.92 0.08 1.00 1.00 XXX

79020 ............ A Thyroid ablation .................................................. 1.81 2.46 2.46 0.29 4.56 4.56 XXX

79020 26 A Thyroid ablation .................................................. 1.81 0.60 0.60 0.12 2.53 2.53 XXX

79020 TC A Thyroid ablation .................................................. 0.00 1.86 1.86 0.17 2.03 2.03 XXX

79030 ............ A Thyroid ablation, carcinoma ............................... 2.10 2.56 2.56 0.31 4.97 4.97 XXX

79030 26 A Thyroid ablation, carcinoma ............................... 2.10 0.70 0.70 0.14 2.94 2.94 XXX

79030 TC A Thyroid ablation, carcinoma ............................... 0.00 1.86 1.86 0.17 2.03 2.03 XXX

79035 ............ A Thyroid metastatic therapy ................................. 2.52 2.70 2.70 0.34 5.56 5.56 XXX

79035 26 A Thyroid metastatic therapy ................................. 2.52 0.84 0.84 0.17 3.53 3.53 XXX

79035 TC A Thyroid metastatic therapy ................................. 0.00 1.86 1.86 0.17 2.03 2.03 XXX

79100 ............ A Hematopoetic nuclear therapy ........................... 1.32 2.29 2.29 0.26 3.87 3.87 XXX

79100 26 A Hematopoetic nuclear therapy ........................... 1.32 0.43 0.43 0.09 1.84 1.84 XXX

79100 TC A Hematopoetic nuclear therapy ........................... 0.00 1.86 1.86 0.17 2.03 2.03 XXX

79200 ............ A Intracavitary nuc treatment ................................ 1.99 2.52 2.52 0.31 4.82 4.82 XXX

79200 26 A Intracavitary nuc treatment ................................ 1.99 0.66 0.66 0.14 2.79 2.79 XXX

79200 TC A Intracavitary nuc treatment ................................ 0.00 1.86 1.86 0.17 2.03 2.03 XXX

79300 26 A Interstitial nuclear therapy .................................. 1.60 0.53 0.53 0.11 2.24 2.24 XXX

79400 ............ A Nonhemato nuclear therapy ............................... 1.96 2.51 2.51 0.30 4.77 4.77 XXX

79400 26 A Nonhemato nuclear therapy ............................... 1.96 0.65 0.65 0.13 2.74 2.74 XXX

79400 TC A Nonhemato nuclear therapy ............................... 0.00 1.86 1.86 0.17 2.03 2.03 XXX

79420 26 A Intravascular nuc therapy ................................... 1.51 0.50 0.50 0.10 2.11 2.11 XXX

79440 ............ A Nuclear joint therapy .......................................... 1.99 2.52 2.52 0.31 4.82 4.82 XXX

79440 26 A Nuclear joint therapy .......................................... 1.99 0.66 0.66 0.14 2.79 2.79 XXX

79440 TC A Nuclear joint therapy .......................................... 0.00 1.86 1.86 0.17 2.03 2.03 XXX

80500 ............ A Lab pathology consultation ................................ 0.37 0.20 0.18 0.01 0.58 0.56 XXX

80502 ............ A Lab pathology consultation ................................ 1.33 0.59 0.49 0.02 1.94 1.84 XXX

83020 26 A Assay hemoglobin .............................................. 0.37 0.24 0.23 0.01 0.62 0.61 XXX

83912 26 A Genetic examination .......................................... 0.37 0.20 0.23 0.01 0.58 0.61 XXX

84165 26 A Assay serum proteins ........................................ 0.37 0.24 0.23 0.01 0.62 0.61 XXX

84181 26 A Western blot test ................................................ 0.37 0.25 0.23 0.01 0.63 0.61 XXX

84182 26 A Protein, western blot test ................................... 0.37 0.30 0.22 0.01 0.68 0.60 XXX

85060 ............ A Blood smear interpretation ................................. 0.45 0.42 0.17 0.02 0.89 0.64 XXX

85095 ............ A Bone marrow aspiration ..................................... 1.08 1.74 0.48 0.05 2.87 1.61 XXX

85097 ............ A Bone marrow interpretation ................................ 0.94 1.41 0.35 0.04 2.39 1.33 XXX

85102 ............ A Bone marrow biopsy .......................................... 1.37 1.86 0.59 0.05 3.28 2.01 XXX

85390 26 A Fibrinolysins screen ........................................... 0.37 0.31 0.22 0.01 0.69 0.60 XXX

85576 26 A Blood platelet aggregation ................................. 0.37 0.32 0.23 0.01 0.70 0.61 XXX

86077 ............ A Physician blood bank service ............................ 0.94 0.44 0.35 0.02 1.40 1.31 XXX
30991

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

86078 ............ A Physician blood bank service ............................ 0.94 0.44 0.35 0.02 1.40 1.31 XXX

86079 ............ A Physician blood bank service ............................ 0.94 0.44 0.34 0.02 1.40 1.30 XXX

86255 26 A Fluorescent antibody; screen ............................. 0.37 0.33 0.25 0.01 0.71 0.63 XXX

86256 26 A Fluorescent antibody; titer .................................. 0.37 0.35 0.25 0.01 0.73 0.63 XXX

86320 26 A Serum immunoelectrophoresis .......................... 0.37 0.29 0.23 0.01 0.67 0.61 XXX

86325 26 A Other immunoelectrophoresis ............................ 0.37 0.27 0.23 0.01 0.65 0.61 XXX

86327 26 A Immunoelectrophoresis assay ........................... 0.42 0.35 0.25 0.01 0.78 0.68 XXX

86334 26 A Immunofixation procedure .................................. 0.37 0.28 0.23 0.01 0.66 0.61 XXX

86490 ............ A Coccidioidomycosis skin test ............................. 0.00 0.10 0.10 0.02 0.12 0.12 XXX

86510 ............ A Histoplasmosis skin test ..................................... 0.00 0.12 0.12 0.02 0.14 0.14 XXX

86580 ............ A TB intradermal test ............................................. 0.00 0.12 0.12 0.02 0.14 0.14 XXX

86585 ............ A TB tine test ......................................................... 0.00 0.14 0.14 0.01 0.15 0.15 XXX

87164 26 A Dark field examination ....................................... 0.37 0.21 0.22 0.01 0.59 0.60 XXX

87207 26 A Smear, stain & interpret ..................................... 0.37 0.30 0.27 0.01 0.68 0.65 XXX

88104 ............ A Cytopathology, fluids .......................................... 0.56 0.66 0.66 0.04 1.26 1.26 XXX

88104 26 A Cytopathology, fluids .......................................... 0.56 0.20 0.20 0.02 0.78 0.78 XXX

88104 TC A Cytopathology, fluids .......................................... 0.00 0.45 0.45 0.02 0.47 0.47 XXX

88106 ............ A Cytopathology, fluids .......................................... 0.56 0.62 0.62 0.03 1.21 1.21 XXX

88106 26 A Cytopathology, fluids .......................................... 0.56 0.26 0.26 0.01 0.83 0.83 XXX

88106 TC A Cytopathology, fluids .......................................... 0.00 0.36 0.36 0.02 0.38 0.38 XXX

88107 ............ A Cytopathology, fluids .......................................... 0.76 0.64 0.64 0.04 1.44 1.44 XXX

88107 26 A Cytopathology, fluids .......................................... 0.76 0.32 0.32 0.02 1.10 1.10 XXX

88107 TC A Cytopathology, fluids .......................................... 0.00 0.32 0.32 0.02 0.34 0.34 XXX

88108 ............ A Cytopath, concentrate tech ................................ 0.56 0.64 0.64 0.04 1.24 1.24 XXX

88108 26 A Cytopath, concentrate tech ................................ 0.56 0.23 0.23 0.02 0.81 0.81 XXX

88108 TC A Cytopath, concentrate tech ................................ 0.00 0.41 0.41 0.02 0.43 0.43 XXX

88125 ............ A Forensic cytopathology ...................................... 0.26 0.30 0.30 0.00 0.56 0.56 XXX

88125 26 A Forensic cytopathology ...................................... 0.26 0.07 0.07 0.00 0.33 0.33 XXX

88125 TC A Forensic cytopathology ...................................... 0.00 0.23 0.23 0.00 0.23 0.23 XXX

88141 ............ A Cytopath cerv/vag interpret ................................ 0.42 0.89 0.15 0.04 1.35 0.61 XXX

88160 ............ A Cytopath smear, other source ........................... 0.50 0.73 0.73 0.03 1.26 1.26 XXX

88160 26 A Cytopath smear, other source ........................... 0.50 0.15 0.15 0.01 0.66 0.66 XXX

88160 TC A Cytopath smear, other source ........................... 0.00 0.59 0.59 0.02 0.61 0.61 XXX

88161 ............ A Cytopath smear, other source ........................... 0.50 0.69 0.69 0.03 1.22 1.22 XXX

88161 26 A Cytopath smear, other source ........................... 0.50 0.18 0.18 0.01 0.69 0.69 XXX

88161 TC A Cytopath smear, other source ........................... 0.00 0.51 0.51 0.02 0.53 0.53 XXX

88162 ............ A Cytopath smear, other source ........................... 0.76 0.66 0.66 0.05 1.47 1.47 XXX

88162 26 A Cytopath smear, other source ........................... 0.76 0.31 0.31 0.03 1.10 1.10 XXX

88162 TC A Cytopath smear, other source ........................... 0.00 0.35 0.35 0.02 0.37 0.37 XXX

88170 ............ A Fine needle aspiration ........................................ 1.27 0.77 0.77 0.09 2.13 2.13 XXX

88170 26 A Fine needle aspiration ........................................ 1.27 0.57 0.57 0.05 1.89 1.89 XXX

88170 TC A Fine needle aspiration ........................................ 0.00 0.20 0.20 0.04 0.24 0.24 XXX

88171 ............ A Fine needle aspiration ........................................ 1.27 0.63 0.63 0.09 1.99 1.99 XXX

88171 26 A Fine needle aspiration ........................................ 1.27 0.49 0.49 0.05 1.81 1.81 XXX

88171 TC A Fine needle aspiration ........................................ 0.00 0.15 0.15 0.04 0.19 0.19 XXX

88172 ............ A Evaluation of smear ........................................... 0.60 0.72 0.72 0.05 1.37 1.37 XXX

88172 26 A Evaluation of smear ........................................... 0.60 0.24 0.24 0.03 0.87 0.87 XXX

88172 TC A Evaluation of smear ........................................... 0.00 0.48 0.48 0.02 0.50 0.50 XXX

88173 ............ A Interpretation of smear ....................................... 1.39 1.17 1.17 0.05 2.61 2.61 XXX

88173 26 A Interpretation of smear ....................................... 1.39 0.52 0.52 0.03 1.94 1.94 XXX

88173 TC A Interpretation of smear ....................................... 0.00 0.64 0.64 0.02 0.66 0.66 XXX

88180 ............ A Cell marker study ............................................... 0.36 0.38 0.38 0.03 0.77 0.77 XXX

88180 26 A Cell marker study ............................................... 0.36 0.13 0.13 0.01 0.50 0.50 XXX

88180 TC A Cell marker study ............................................... 0.00 0.25 0.25 0.02 0.27 0.27 XXX

88182 ............ A Cell marker study ............................................... 0.77 0.89 0.89 0.07 1.73 1.73 XXX

88182 26 A Cell marker study ............................................... 0.77 0.26 0.26 0.03 1.06 1.06 XXX

88182 TC A Cell marker study ............................................... 0.00 0.63 0.63 0.04 0.67 0.67 XXX

88300 ............ A Surg path, gross ................................................. 0.08 0.36 0.36 0.01 0.45 0.45 XXX

88300 26 A Surg path, gross ................................................. 0.08 0.03 0.03 0.01 0.12 0.12 XXX

88300 TC A Surg path, gross ................................................. 0.00 0.33 0.33 0.00 0.33 0.33 XXX

88302 ............ A Tissue exam by pathologist ............................... 0.13 0.63 0.63 0.04 0.80 0.80 XXX

88302 26 A Tissue exam by pathologist ............................... 0.13 0.06 0.06 0.02 0.21 0.21 XXX

88302 TC A Tissue exam by pathologist ............................... 0.00 0.58 0.58 0.02 0.60 0.60 XXX

88304 ............ A Tissue exam by pathologist ............................... 0.22 0.72 0.72 0.04 0.98 0.98 XXX

88304 26 A Tissue exam by pathologist ............................... 0.22 0.09 0.09 0.02 0.33 0.33 XXX

88304 TC A Tissue exam by pathologist ............................... 0.00 0.62 0.62 0.02 0.64 0.64 XXX

88305 ............ A Tissue exam by pathologist ............................... 0.75 1.06 1.06 0.08 1.89 1.89 XXX

88305 26 A Tissue exam by pathologist ............................... 0.75 0.31 0.31 0.04 1.10 1.10 XXX

88305 TC A Tissue exam by pathologist ............................... 0.00 0.75 0.75 0.04 0.79 0.79 XXX

88307 ............ A Tissue exam by pathologist ............................... 1.59 1.71 1.71 0.12 3.42 3.42 XXX

88307 26 A Tissue exam by pathologist ............................... 1.59 0.61 0.61 0.06 2.26 2.26 XXX

88307 TC A Tissue exam by pathologist ............................... 0.00 1.10 1.10 0.06 1.16 1.16 XXX

88309 ............ A Tissue exam by pathologist ............................... 2.28 2.49 2.49 0.13 4.90 4.90 XXX

88309 26 A Tissue exam by pathologist ............................... 2.28 0.89 0.89 0.07 3.24 3.24 XXX
30992

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

88309 TC A Tissue exam by pathologist ............................... 0.00 1.60 1.60 0.06 1.66 1.66 XXX

88311 ............ A Decalcify tissue .................................................. 0.24 0.15 0.15 0.01 0.40 0.40 XXX

88311 26 A Decalcify tissue .................................................. 0.24 0.09 0.09 0.01 0.34 0.34 XXX

88311 TC A Decalcify tissue .................................................. 0.00 0.06 0.06 0.00 0.06 0.06 XXX

88312 ............ A Special stains ..................................................... 0.54 1.11 1.11 0.01 1.66 1.66 XXX

88312 26 A Special stains ..................................................... 0.54 0.20 0.20 0.01 0.75 0.75 XXX

88312 TC A Special stains ..................................................... 0.00 0.91 0.91 0.00 0.91 0.91 XXX

88313 ............ A Special stains ..................................................... 0.24 0.73 0.73 0.01 0.98 0.98 XXX

88313 26 A Special stains ..................................................... 0.24 0.09 0.09 0.01 0.34 0.34 XXX

88313 TC A Special stains ..................................................... 0.00 0.65 0.65 0.00 0.65 0.65 XXX

88314 ............ A Histochemical stain ............................................ 0.45 1.30 1.30 0.04 1.79 1.79 XXX

88314 26 A Histochemical stain ............................................ 0.45 0.35 0.35 0.02 0.82 0.82 XXX

88314 TC A Histochemical stain ............................................ 0.00 0.95 0.95 0.02 0.97 0.97 XXX

88318 ............ A Chemical histochemistry .................................... 0.42 0.58 0.58 0.01 1.01 1.01 XXX

88318 26 A Chemical histochemistry .................................... 0.42 0.18 0.18 0.01 0.61 0.61 XXX

88318 TC A Chemical histochemistry .................................... 0.00 0.39 0.39 0.00 0.39 0.39 XXX

88319 ............ A Enzyme histochemistry ...................................... 0.53 2.53 2.53 0.04 3.10 3.10 XXX

88319 26 A Enzyme histochemistry ...................................... 0.53 0.31 0.31 0.02 0.86 0.86 XXX

88319 TC A Enzyme histochemistry ...................................... 0.00 2.21 2.21 0.02 2.23 2.23 XXX

88321 ............ A Microslide consultation ....................................... 1.30 0.81 0.48 0.03 2.14 1.81 XXX

88323 ............ A Microslide consultation ....................................... 1.35 1.20 1.20 0.05 2.60 2.60 XXX

88323 26 A Microslide consultation ....................................... 1.35 0.68 0.68 0.03 2.06 2.06 XXX

88323 TC A Microslide consultation ....................................... 0.00 0.52 0.52 0.02 0.54 0.54 XXX

88325 ............ A Comprehensive review of data .......................... 2.22 1.10 0.82 0.04 3.36 3.08 XXX

88329 ............ A Pathology consult in surgery .............................. 0.67 0.34 0.25 0.03 1.04 0.95 XXX

88331 ............ A Pathology consult in surgery .............................. 1.19 0.68 0.68 0.08 1.95 1.95 XXX

88331 26 A Pathology consult in surgery .............................. 1.19 0.45 0.45 0.04 1.68 1.68 XXX

88331 TC A Pathology consult in surgery .............................. 0.00 0.23 0.23 0.04 0.27 0.27 XXX

88332 ............ A Pathology consult in surgery .............................. 0.59 0.32 0.32 0.04 0.95 0.95 XXX

88332 26 A Pathology consult in surgery .............................. 0.59 0.22 0.22 0.02 0.83 0.83 XXX

88332 TC A Pathology consult in surgery .............................. 0.00 0.10 0.10 0.02 0.12 0.12 XXX

88342 ............ A Immunocytochemistry ........................................ 0.85 0.98 0.98 0.04 1.87 1.87 XXX

88342 26 A Immunocytochemistry ........................................ 0.85 0.31 0.31 0.02 1.18 1.18 XXX

88342 TC A Immunocytochemistry ........................................ 0.00 0.67 0.67 0.02 0.69 0.69 XXX

88346 ............ A Immunofluorescent study ................................... 0.86 1.00 1.00 0.04 1.90 1.90 XXX

88346 26 A Immunofluorescent study ................................... 0.86 0.30 0.30 0.02 1.18 1.18 XXX

88346 TC A Immunofluorescent study ................................... 0.00 0.70 0.70 0.02 0.72 0.72 XXX

88347 ............ A Immunofluorescent study ................................... 0.86 0.78 0.78 0.04 1.68 1.68 XXX

88347 26 A Immunofluorescent study ................................... 0.86 0.42 0.42 0.02 1.30 1.30 XXX

88347 TC A Immunofluorescent study ................................... 0.00 0.35 0.35 0.02 0.37 0.37 XXX

88348 ............ A Electron microscopy ........................................... 1.51 3.80 3.80 0.16 5.47 5.47 XXX

88348 26 A Electron microscopy ........................................... 1.51 0.34 0.34 0.08 1.93 1.93 XXX

88348 TC A Electron microscopy ........................................... 0.00 3.46 3.46 0.08 3.54 3.54 XXX

88349 ............ A Scanning electron microscopy ........................... 0.76 8.14 8.14 0.12 9.02 9.02 XXX

88349 26 A Scanning electron microscopy ........................... 0.76 0.17 0.17 0.06 0.99 0.99 XXX

88349 TC A Scanning electron microscopy ........................... 0.00 7.97 7.97 0.06 8.03 8.03 XXX

88355 ............ A Analysis, skeletal muscle ................................... 1.85 3.00 3.00 0.13 4.98 4.98 XXX

88355 26 A Analysis, skeletal muscle ................................... 1.85 0.81 0.81 0.07 2.73 2.73 XXX

88355 TC A Analysis, skeletal muscle ................................... 0.00 2.19 2.19 0.06 2.25 2.25 XXX

88356 ............ A Analysis, nerve ................................................... 3.02 4.19 4.19 0.18 7.39 7.39 XXX

88356 26 A Analysis, nerve ................................................... 3.02 0.84 0.84 0.10 3.96 3.96 XXX

88356 TC A Analysis, nerve ................................................... 0.00 3.35 3.35 0.08 3.43 3.43 XXX

88358 ............ A Analysis, tumor ................................................... 2.82 1.74 1.74 0.16 4.72 4.72 XXX

88358 26 A Analysis, tumor ................................................... 2.82 1.26 1.26 0.08 4.16 4.16 XXX

88358 TC A Analysis, tumor ................................................... 0.00 0.48 0.48 0.08 0.56 0.56 XXX

88362 ............ A Nerve teasing preparations ................................ 2.17 3.27 3.27 0.13 5.57 5.57 XXX

88362 26 A Nerve teasing preparations ................................ 2.17 0.50 0.50 0.07 2.74 2.74 XXX

88362 TC A Nerve teasing preparations ................................ 0.00 2.77 2.77 0.06 2.83 2.83 XXX

88365 ............ A Tissue hybridization ........................................... 0.93 1.82 1.82 0.05 2.80 2.80 XXX

88365 26 A Tissue hybridization ........................................... 0.93 0.39 0.39 0.03 1.35 1.35 XXX

88365 TC A Tissue hybridization ........................................... 0.00 1.43 1.43 0.02 1.45 1.45 XXX

88371 26 A Protein, western blot tissue ................................ 0.37 0.33 0.23 0.01 0.71 0.61 XXX

88372 26 A Protein analysis w/probe .................................... 0.37 0.33 0.23 0.01 0.71 0.61 XXX

89060 26 A Exam, synovial fluid crystals .............................. 0.37 0.31 0.24 0.01 0.69 0.62 XXX

89100 ............ A Sample intestinal contents ................................. 0.60 0.90 0.27 0.03 1.53 0.90 XXX

89105 ............ A Sample intestinal contents ................................. 0.50 1.93 0.23 0.03 2.46 0.76 XXX

89130 ............ A Sample stomach contents .................................. 0.45 0.93 0.17 0.03 1.41 0.65 XXX

89132 ............ A Sample stomach contents .................................. 0.19 1.21 0.11 0.02 1.42 0.32 XXX

89135 ............ A Sample stomach contents .................................. 0.79 1.31 0.31 0.04 2.14 1.14 XXX

89136 ............ A Sample stomach contents .................................. 0.21 0.51 0.14 0.02 0.74 0.37 XXX

89140 ............ A Sample stomach contents .................................. 0.94 0.98 0.29 0.07 1.99 1.30 XXX

89141 ............ A Sample stomach contents .................................. 0.85 1.59 0.28 0.06 2.50 1.19 XXX

89350 ............ A Sputum specimen collection .............................. 0.00 0.13 0.13 0.03 0.16 0.16 XXX

89360 ............ A Collect sweat for test ......................................... 0.00 0.03 0.03 0.03 0.06 0.06 XXX
30993

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

90780 ............ A IV infusion therapy, 1 hour ................................. 0.00 0.90 0.06 0.08 0.98 0.14 XXX

90781 ............ A IV infusion, additional hour ................................ 0.00 0.64 0.18 0.04 0.68 0.22 XXX

90782 ............ T Injection (SC)/(IM) .............................................. 0.00 0.12 0.03 0.01 0.13 0.04 XXX

90783 ............ T Injection (IA) ....................................................... 0.00 0.21 0.06 0.03 0.24 0.09 XXX

90784 ............ T Injection (IV) ....................................................... 0.00 0.22 0.06 0.04 0.26 0.10 XXX

90788 ............ T Injection of antibiotic .......................................... 0.00 0.11 0.03 0.01 0.12 0.04 XXX

90801 ............ A Psy dx interview ................................................. 2.80 1.09 1.05 0.09 3.98 3.94 XXX

90802 ............ A Intac psy dx interview ........................................ 3.01 1.24 1.15 0.05 4.30 4.21 XXX

90804 ............ A Psytx, office (20-30) ........................................... 1.11 0.45 0.40 0.05 1.61 1.56 XXX

90805 ............ A Psytx, office (20–30) w/e&m .............................. 1.47 0.58 0.52 0.05 2.10 2.04 XXX

90806 ............ A Psytx, office (45–50) .......................................... 1.73 0.71 0.61 0.08 2.52 2.42 XXX

90807 ............ A Psytx, office (45–50) w/e&m .............................. 2.00 0.81 0.70 0.08 2.89 2.78 XXX

90808 ............ A Psytx, office (75–80) .......................................... 2.76 1.11 1.06 0.15 4.02 3.97 XXX

90809 ............ A Psytx, office (75–80) w/e&m .............................. 3.15 1.26 1.20 0.15 4.56 4.50 XXX

90810 ............ A Intac psytx, office (20–30) .................................. 1.19 0.47 0.40 0.09 1.75 1.68 XXX

90811 ............ A Intac psytx, off 20–30 w/e&m ............................ 1.58 0.68 0.58 0.09 2.35 2.25 XXX

90812 ............ A Intac psytx, office (45–50) .................................. 1.86 0.69 0.61 0.09 2.64 2.56 XXX

90813 ............ A Intac psytx, off 45–50 w/e&m ............................ 2.15 0.87 0.75 0.09 3.11 2.99 XXX

90814 ............ A Intac psytx, office (75–80) .................................. 2.97 1.08 0.96 0.09 4.14 4.02 XXX

90815 ............ A Intac psytx, off 75–80 w/e&m ............................ 3.39 1.31 1.15 0.09 4.79 4.63 XXX

90816 ............ A Psytx, hosp (20–30) ........................................... 1.24 0.50 0.44 0.05 1.79 1.73 XXX

90817 ............ A Psytx, hosp (20–30) w/e&m ............................... 1.65 0.71 0.63 0.05 2.41 2.33 XXX

90818 ............ A Psytx, hosp (45–50) ........................................... 1.94 0.79 0.68 0.08 2.81 2.70 XXX

90819 ............ A Psytx, hosp (45–50) w/e&m ............................... 2.24 0.98 0.83 0.08 3.30 3.15 XXX

90821 ............ A Psytx, hosp (75–80) ........................................... 3.09 1.24 1.18 0.15 4.48 4.42 XXX

90822 ............ A Psytx, hosp (75–80) w/e&m ............................... 3.53 1.48 1.43 0.15 5.16 5.11 XXX

90823 ............ A Intac psytx, hosp (20–30) .................................. 1.33 0.51 0.44 0.09 1.93 1.86 XXX

90824 ............ A Intac psytx, hsp 20–30 w/e&m ........................... 1.77 0.74 0.63 0.09 2.60 2.49 XXX

90826 ............ A Intac psytx, hosp (45–50) .................................. 2.08 0.77 0.67 0.09 2.94 2.84 XXX

90827 ............ A Intac psytx, hsp 45–50 w/e&m ........................... 2.41 0.95 0.82 0.09 3.45 3.32 XXX

90828 ............ A Intac psytx, hosp (75–80) .................................. 3.32 1.20 1.07 0.09 4.61 4.48 XXX

90829 ............ A Intac psytx, hsp 75–80 w/e&m ........................... 3.80 1.44 1.27 0.09 5.33 5.16 XXX

90845 ............ A Psychoanalysis ................................................... 1.79 0.64 0.58 0.05 2.48 2.42 XXX

90846 ............ R Family psytx w/o patient .................................... 1.83 0.76 0.67 0.08 2.67 2.58 XXX

90847 ............ R Family psytx w/patient ........................................ 2.21 0.86 0.79 0.08 3.15 3.08 XXX

90849 ............ R Multiple family group psytx ................................ 0.59 0.31 0.30 0.03 0.93 0.92 XXX

90853 ............ A Group psychotherapy ......................................... 0.59 0.31 0.29 0.03 0.93 0.91 XXX

90857 ............ A Intac group psytx ................................................ 0.63 0.34 0.31 0.02 0.99 0.96 XXX

90862 ............ A Medication management .................................... 0.95 0.36 0.35 0.05 1.36 1.35 XXX

90865 ............ A Narcosynthesis ................................................... 2.84 5.14 0.88 0.07 8.05 3.79 XXX

90870 ............ A Electroconvulsive therapy .................................. 1.88 0.64 0.71 0.08 2.60 2.67 000

90871 ............ A Electroconvulsive therapy .................................. 2.72 NA 0.89 0.13 NA 3.74 000

90880 ............ A Hypnotherapy ..................................................... 2.19 0.88 0.80 0.07 3.14 3.06 XXX

90885 ............ B Psy evaluation of records .................................. +0.97 0.97 0.97 0.04 1.98 1.98 XXX

90887 ............ B Consultation with family ..................................... +1.48 1.82 1.73 0.04 3.34 3.25 XXX

90901 ............ A Biofeedback, any method .................................. 0.41 0.43 0.33 0.07 0.91 0.81 000

90911 ............ A Biofeedback peri/uro/rectal ................................ 0.89 0.60 0.59 0.27 1.76 1.75 000

90918 ............ A ESRD related services, month ........................... 11.18 4.46 4.46 0.14 15.78 15.78 XXX

90919 ............ A ESRD related services, month ........................... 8.54 3.59 3.59 0.14 12.27 12.27 XXX

90920 ............ A ESRD related services, month ........................... 7.27 2.98 2.98 0.14 10.39 10.39 XXX

90921 ............ A ESRD related services, month ........................... 4.47 2.02 2.02 0.14 6.63 6.63 XXX

90922 ............ A ESRD related services, day ............................... 0.37 0.13 0.13 0.01 0.51 0.51 XXX

90923 ............ A Esrd related services, day ................................. 0.28 0.12 0.12 0.01 0.41 0.41 XXX

90924 ............ A Esrd related services, day ................................. 0.24 0.10 0.10 0.01 0.35 0.35 XXX

90925 ............ A Esrd related services, day ................................. 0.15 0.07 0.07 0.01 0.23 0.23 XXX

90935 ............ A Hemodialysis, one evaluation ............................ 1.22 NA 0.58 0.10 NA 1.90 000

90937 ............ A Hemodialysis, repeated eval. ............................. 2.11 NA 0.86 0.18 NA 3.15 000

90945 ............ A Dialysis, one evaluation ..................................... 1.28 NA 0.60 0.08 NA 1.96 000

90947 ............ A Dialysis, repeated eval. ...................................... 2.16 NA 0.88 0.14 NA 3.18 000

90997 ............ A Hemoperfusion ................................................... 1.84 NA 0.77 0.16 NA 2.77 000

91000 ............ A Esophageal intubation ........................................ 0.73 1.47 1.47 0.06 2.26 2.26 000

91000 26 A Esophageal intubation ........................................ 0.73 0.15 0.15 0.05 0.93 0.93 000

91000 TC A Esophageal intubation ........................................ 0.00 1.33 1.33 0.01 1.34 1.34 000

91010 ............ A Esophagus motility study ................................... 1.25 1.38 1.38 0.17 2.80 2.80 000

91010 26 A Esophagus motility study ................................... 1.25 0.45 0.45 0.11 1.81 1.81 000

91010 TC A Esophagus motility study ................................... 0.00 0.94 0.94 0.06 1.00 1.00 000

91011 ............ A Esophagus motility study ................................... 1.50 2.81 2.81 0.18 4.49 4.49 000

91011 26 A Esophagus motility study ................................... 1.50 0.41 0.41 0.11 2.02 2.02 000

91011 TC A Esophagus motility study ................................... 0.00 2.40 2.40 0.07 2.47 2.47 000

91012 ............ A Esophagus motility study ................................... 1.46 2.29 2.29 0.23 3.98 3.98 000

91012 26 A Esophagus motility study ................................... 1.46 0.46 0.46 0.15 2.07 2.07 000

91012 TC A Esophagus motility study ................................... 0.00 1.83 1.83 0.08 1.91 1.91 000

91020 ............ A Gastric motility .................................................... 1.44 2.01 2.01 0.18 3.63 3.63 000

91020 26 A Gastric motility .................................................... 1.44 0.44 0.44 0.12 2.00 2.00 000
30994

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

91020 TC A Gastric motility .................................................... 0.00 1.57 1.57 0.06 1.63 1.63 000

91030 ............ A Acid perfusion of esophagus ............................. 0.91 2.27 2.27 0.05 3.23 3.23 000

91030 26 A Acid perfusion of esophagus ............................. 0.91 0.26 0.26 0.03 1.20 1.20 000

91030 TC A Acid perfusion of esophagus ............................. 0.00 2.01 2.01 0.02 2.03 2.03 000

91032 ............ A Esophagus, acid reflux test ................................ 1.21 2.08 2.08 0.16 3.45 3.45 000

91032 26 A Esophagus, acid reflux test ................................ 1.21 0.30 0.30 0.10 1.61 1.61 000

91032 TC A Esophagus, acid reflux test ................................ 0.00 1.78 1.78 0.06 1.84 1.84 000

91033 ............ A Prolonged acid reflux test .................................. 1.30 1.39 1.39 0.25 2.94 2.94 000

91033 26 A Prolonged acid reflux test .................................. 1.30 0.45 0.45 0.14 1.89 1.89 000

91033 TC A Prolonged acid reflux test .................................. 0.00 0.94 0.94 0.11 1.05 1.05 000

91052 ............ A Gastric analysis test ........................................... 0.79 1.68 1.68 0.07 2.54 2.54 000

91052 26 A Gastric analysis test ........................................... 0.79 0.16 0.16 0.04 0.99 0.99 000

91052 TC A Gastric analysis test ........................................... 0.00 1.52 1.52 0.03 1.55 1.55 000

91055 ............ A Gastric intubation for smear ............................... 0.94 2.06 2.06 0.06 3.06 3.06 000

91055 26 A Gastric intubation for smear ............................... 0.94 0.21 0.21 0.04 1.19 1.19 000

91055 TC A Gastric intubation for smear ............................... 0.00 1.85 1.85 0.02 1.87 1.87 000

91060 ............ A Gastric saline load test ...................................... 0.45 0.25 0.25 0.06 0.76 0.76 000

91060 26 A Gastric saline load test ...................................... 0.45 0.11 0.11 0.04 0.60 0.60 000

91060 TC A Gastric saline load test ...................................... 0.00 0.14 0.14 0.02 0.16 0.16 000

91065 ............ A Breath hydrogen test .......................................... 0.20 1.59 1.59 0.05 1.84 1.84 000

91065 26 A Breath hydrogen test .......................................... 0.20 0.08 0.08 0.03 0.31 0.31 000

91065 TC A Breath hydrogen test .......................................... 0.00 1.51 1.51 0.02 1.53 1.53 000

91100 ............ A Pass intestine bleeding tube .............................. 1.08 NA 0.26 0.05 NA 1.39 000

91105 ............ A Gastric intubation treatment ............................... 0.37 NA 0.11 0.04 NA 0.52 000

91122 ............ A Anal pressure record .......................................... 1.77 2.21 2.21 0.22 4.20 4.20 000

91122 26 A Anal pressure record .......................................... 1.77 0.80 0.80 0.13 2.70 2.70 000

91122 TC A Anal pressure record .......................................... 0.00 1.41 1.41 0.09 1.50 1.50 000

92002 ............ A Eye exam, new patient ...................................... 0.88 0.96 0.36 0.02 1.86 1.26 XXX

92004 ............ A Eye exam, new patient ...................................... 1.67 1.58 0.87 0.02 3.27 2.56 XXX

92012 ............ A Eye exam established pt .................................... 0.67 1.26 0.35 0.02 1.95 1.04 XXX

92014 ............ A Eye exam & treatment ....................................... 1.10 1.25 0.58 0.02 2.37 1.70 XXX

92015 ............ N Refraction ........................................................... +0.38 1.93 0.38 0.02 2.33 0.78 XXX

92018 ............ A New eye exam & treatment ............................... 1.51 NA 1.11 0.03 NA 2.65 XXX

92019 ............ A Eye exam & treatment ....................................... 1.31 NA 0.85 0.03 NA 2.19 XXX

92020 ............ A Special eye evaluation ....................................... 0.37 0.51 0.20 0.01 0.89 0.58 XXX

92060 ............ A Special eye evaluation ....................................... 0.69 1.34 1.34 0.02 2.05 2.05 XXX

92060 26 A Special eye evaluation ....................................... 0.69 0.32 0.32 0.01 1.02 1.02 XXX

92060 TC A Special eye evaluation ....................................... 0.00 1.02 1.02 0.01 1.03 1.03 XXX

92065 ............ A Orthoptic/pleoptic training .................................. 0.37 0.62 0.62 0.01 1.00 1.00 XXX

92065 26 A Orthoptic/pleoptic training .................................. 0.37 0.06 0.06 0.01 0.44 0.44 XXX

92065 TC A Orthoptic/pleoptic training .................................. 0.00 0.56 0.56 0.00 0.56 0.56 XXX

92070 ............ A Fitting of contact lens ......................................... 0.70 0.87 0.40 0.06 1.63 1.16 XXX

92081 ............ A Visual field examination(s) ................................. 0.36 0.80 0.80 0.01 1.17 1.17 XXX

92081 26 A Visual field examination(s) ................................. 0.36 0.16 0.16 0.01 0.53 0.53 XXX

92081 TC A Visual field examination(s) ................................. 0.00 0.64 0.64 0.00 0.64 0.64 XXX

92082 ............ A Visual field examination(s) ................................. 0.44 1.05 1.05 0.02 1.51 1.51 XXX

92082 26 A Visual field examination(s) ................................. 0.44 0.23 0.23 0.01 0.68 0.68 XXX

92082 TC A Visual field examination(s) ................................. 0.00 0.82 0.82 0.01 0.83 0.83 XXX

92083 ............ A Visual field examination(s) ................................. 0.50 1.33 1.33 0.04 1.87 1.87 XXX

92083 26 A Visual field examination(s) ................................. 0.50 0.28 0.28 0.03 0.81 0.81 XXX

92083 TC A Visual field examination(s) ................................. 0.00 1.05 1.05 0.01 1.06 1.06 XXX

92100 ............ A Serial tonometry exam(s) ................................... 0.92 0.73 0.26 0.01 1.66 1.19 XXX

92120 ............ A Tonography & eye evaluation ............................ 0.81 0.72 0.30 0.02 1.55 1.13 XXX

92130 ............ A Water provocation tonography ........................... 0.81 0.80 0.26 0.02 1.63 1.09 XXX

92140 ............ A Glaucoma provocative tests ............................... 0.50 0.77 0.27 0.01 1.28 0.78 XXX

92225 ............ A Special eye exam, initial .................................... 0.38 0.96 0.21 0.02 1.36 0.61 XXX

92226 ............ A Special eye exam, subsequent .......................... 0.33 1.01 0.19 0.02 1.36 0.54 XXX

92230 ............ A Eye exam with photos ........................................ 0.60 1.74 0.18 0.04 2.38 0.82 XXX

92235 ............ A Eye exam with photos ........................................ 0.81 2.67 2.67 0.09 3.57 3.57 XXX

92235 26 A Eye exam with photos ........................................ 0.81 0.49 0.49 0.03 1.33 1.33 XXX

92235 TC A Eye exam with photos ........................................ 0.00 2.18 2.18 0.06 2.24 2.24 XXX

92240 ............ A Icg angiography .................................................. 1.10 2.84 2.84 0.09 4.03 4.03 XXX

92240 26 A Icg angiography .................................................. 1.10 0.66 0.66 0.03 1.79 1.79 XXX

92240 TC A Icg angiography .................................................. 0.00 2.17 2.17 0.06 2.23 2.23 XXX

92250 ............ A Eye exam with photos ........................................ 0.44 1.38 1.38 0.02 1.84 1.84 XXX

92250 26 A Eye exam with photos ........................................ 0.44 0.24 0.24 0.01 0.69 0.69 XXX

92250 TC A Eye exam with photos ........................................ 0.00 1.14 1.14 0.01 1.15 1.15 XXX

92260 ............ A Ophthalmoscopy/dynamometry .......................... 0.20 0.18 0.09 0.03 0.41 0.32 XXX

92265 ............ A Eye muscle evaluation ....................................... 0.81 1.10 1.10 0.02 1.93 1.93 XXX

92265 26 A Eye muscle evaluation ....................................... 0.81 0.21 0.21 0.00 1.02 1.02 XXX

92265 TC A Eye muscle evaluation ....................................... 0.00 0.89 0.89 0.02 0.91 0.91 XXX

92270 ............ A Electro-oculography ........................................... 0.81 1.19 1.19 0.05 2.05 2.05 XXX

92270 26 A Electro-oculography ........................................... 0.81 0.41 0.41 0.03 1.25 1.25 XXX

92270 TC A Electro-oculography ........................................... 0.00 0.79 0.79 0.02 0.81 0.81 XXX
30995

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

92275 ............ A Electroretinography ............................................ 1.01 1.89 1.89 0.05 2.95 2.95 XXX

92275 26 A Electroretinography ............................................ 1.01 0.38 0.38 0.03 1.42 1.42 XXX

92275 TC A Electroretinography ............................................ 0.00 1.51 1.51 0.02 1.53 1.53 XXX

92283 ............ A Color vision examination .................................... 0.17 0.63 0.63 0.01 0.81 0.81 XXX

92283 26 A Color vision examination .................................... 0.17 0.05 0.05 0.01 0.23 0.23 XXX

92283 TC A Color vision examination .................................... 0.00 0.59 0.59 0.00 0.59 0.59 XXX

92284 ............ A Dark adaptation eye exam ................................. 0.24 1.66 1.66 0.02 1.92 1.92 XXX

92284 26 A Dark adaptation eye exam ................................. 0.24 0.09 0.09 0.01 0.34 0.34 XXX

92284 TC A Dark adaptation eye exam ................................. 0.00 1.57 1.57 0.01 1.58 1.58 XXX

92285 ............ A Eye photography ................................................ 0.20 1.26 1.26 0.01 1.47 1.47 XXX

92285 26 A Eye photography ................................................ 0.20 0.10 0.10 0.01 0.31 0.31 XXX

92285 TC A Eye photography ................................................ 0.00 1.16 1.16 0.00 1.16 1.16 XXX

92286 ............ A Internal eye photography ................................... 0.66 1.56 1.56 0.07 2.29 2.29 XXX

92286 26 A Internal eye photography ................................... 0.66 0.34 0.34 0.05 1.05 1.05 XXX

92286 TC A Internal eye photography ................................... 0.00 1.21 1.21 0.02 1.23 1.23 XXX

92287 ............ A Internal eye photography ................................... 0.81 2.65 0.38 0.08 3.54 1.27 XXX

92310 ............ N Contact lens fitting ............................................. +1.17 1.99 1.17 0.00 3.16 2.34 XXX

92311 ............ A Contact lens fitting ............................................. 1.08 0.93 0.41 0.03 2.04 1.52 XXX

92312 ............ A Contact lens fitting ............................................. 1.26 0.93 0.51 0.03 2.22 1.80 XXX

92313 ............ A Contact lens fitting ............................................. 0.92 0.86 0.40 0.03 1.81 1.35 XXX

92314 ............ N Prescription of contact lens ................................ +0.69 1.51 0.69 0.00 2.20 1.38 XXX

92315 ............ A Prescription of contact lens ................................ 0.45 0.60 0.07 0.03 1.08 0.55 XXX

92316 ............ A Prescription of contact lens ................................ 0.68 0.61 0.27 0.04 1.33 0.99 XXX

92317 ............ A Prescription of contact lens ................................ 0.45 0.76 0.25 0.02 1.23 0.72 XXX

92325 ............ A Modification of contact lens ............................... 0.00 0.33 0.12 0.01 0.34 0.13 XXX

92326 ............ A Replacement of contact lens ............................. 0.00 0.26 0.09 0.06 0.32 0.15 XXX

92330 ............ A Fitting of artificial eye ......................................... 1.08 0.83 0.33 0.09 2.00 1.50 XXX

92335 ............ A Fitting of artificial eye ......................................... 0.45 0.66 0.19 0.11 1.22 0.75 XXX

92340 ............ N Fitting of spectacles ........................................... +0.37 1.05 0.37 0.00 1.42 0.74 XXX

92341 ............ N Fitting of spectacles ........................................... +0.47 1.15 0.47 0.00 1.62 0.94 XXX

92342 ............ N Fitting of spectacles ........................................... +0.53 1.21 0.53 0.00 1.74 1.06 XXX

92352 ............ B Special spectacles fitting .................................... +0.37 1.05 0.37 0.01 1.43 0.75 XXX

92353 ............ B Special spectacles fitting .................................... +0.50 1.18 0.50 0.01 1.69 1.01 XXX

92354 ............ B Special spectacles fitting .................................... +0.00 0.81 0.41 0.10 0.91 0.51 XXX

92355 ............ B Special spectacles fitting .................................... +0.00 0.81 0.41 0.01 0.82 0.42 XXX

92358 ............ B Eye prosthesis service ....................................... +0.00 0.47 0.24 0.05 0.52 0.29 XXX

92370 ............ N Repair & adjust spectacles ................................ +0.32 0.79 0.32 0.00 1.11 0.64 XXX

92371 ............ B Repair & adjust spectacles ................................ +0.00 0.47 0.24 0.02 0.49 0.26 XXX

92392 ............ I Supply of low vision aids ................................... +0.00 0.47 0.24 0.02 0.49 0.26 XXX

92393 ............ I Supply of artificial eye ........................................ +0.00 0.47 0.24 0.67 1.14 0.91 XXX

92395 ............ I Supply of spectacles .......................................... +0.00 0.47 0.24 0.10 0.57 0.34 XXX

92396 ............ I Supply of contact lenses .................................... +0.00 0.47 0.24 0.08 0.55 0.32 XXX

92502 ............ A Ear and throat examination ................................ 1.51 NA 1.11 0.12 NA 2.74 000

92504 ............ A Ear microscopy examination .............................. 0.18 0.49 0.11 0.02 0.69 0.31 XXX

92506 ............ A Speech & hearing evaluation ............................. 0.86 0.89 0.86 0.05 1.80 1.77 XXX

92507 ............ A Speech/hearing therapy ..................................... 0.52 0.73 0.65 0.03 1.28 1.20 XXX

92508 ............ A Speech/hearing therapy ..................................... 0.26 0.70 0.56 0.02 0.98 0.84 XXX

92510 ............ A Rehab for ear implant ........................................ 1.50 1.35 1.35 0.15 3.00 3.00 XXX

92511 ............ A Nasopharyngoscopy ........................................... 0.84 0.79 0.49 0.09 1.72 1.42 000

92512 ............ A Nasal function studies ........................................ 0.55 0.62 0.20 0.05 1.22 0.80 XXX

92516 ............ A Facial nerve function test ................................... 0.43 0.54 0.21 0.04 1.01 0.68 XXX

92520 ............ A Laryngeal function studies ................................. 0.76 0.57 0.54 0.05 1.38 1.35 XXX

92525 ............ A Oral function evaluation ..................................... 1.50 1.23 1.20 0.11 2.84 2.81 XXX

92526 ............ A Oral function therapy .......................................... 0.55 0.69 0.70 0.05 1.29 1.30 XXX

92541 ............ A Spontaneous nystagmus test ............................. 0.40 0.75 0.75 0.07 1.22 1.22 XXX

92541 26 A Spontaneous nystagmus test ............................. 0.40 0.21 0.21 0.05 0.66 0.66 XXX

92541 TC A Spontaneous nystagmus test ............................. 0.00 0.54 0.54 0.02 0.56 0.56 XXX

92542 ............ A Positional nystagmus test .................................. 0.33 0.71 0.71 0.07 1.11 1.11 XXX

92542 26 A Positional nystagmus test .................................. 0.33 0.18 0.18 0.04 0.55 0.55 XXX

92542 TC A Positional nystagmus test .................................. 0.00 0.54 0.54 0.03 0.57 0.57 XXX

92543 ............ A Caloric vestibular test ......................................... 0.10 0.57 0.57 0.02 0.69 0.69 XXX

92543 26 A Caloric vestibular test ......................................... 0.10 0.05 0.05 0.01 0.16 0.16 XXX

92543 TC A Caloric vestibular test ......................................... 0.00 0.52 0.52 0.01 0.53 0.53 XXX

92544 ............ A Optokinetic nystagmus test ................................ 0.26 0.67 0.67 0.05 0.98 0.98 XXX

92544 26 A Optokinetic nystagmus test ................................ 0.26 0.13 0.13 0.03 0.42 0.42 XXX

92544 TC A Optokinetic nystagmus test ................................ 0.00 0.53 0.53 0.02 0.55 0.55 XXX

92545 ............ A Oscillating tracking test ...................................... 0.23 0.65 0.65 0.04 0.92 0.92 XXX

92545 26 A Oscillating tracking test ...................................... 0.23 0.12 0.12 0.02 0.37 0.37 XXX

92545 TC A Oscillating tracking test ...................................... 0.00 0.53 0.53 0.02 0.55 0.55 XXX

92546 ............ A Sinusoidal rotational test .................................... 0.29 1.17 1.17 0.05 1.51 1.51 XXX

92546 26 A Sinusoidal rotational test .................................... 0.29 0.15 0.15 0.03 0.47 0.47 XXX

92546 TC A Sinusoidal rotational test .................................... 0.00 1.02 1.02 0.02 1.04 1.04 XXX

92547 ............ A Supplemental electrical test ............................... 0.00 0.50 0.50 0.06 0.56 0.56 XXX

92548 ............ A Posturography .................................................... 0.50 1.41 1.41 0.19 2.10 2.10 XXX
30996

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

92548 26 A Posturography .................................................... 0.50 0.22 0.22 0.05 0.77 0.77 XXX

92548 TC A Posturography .................................................... 0.00 1.19 1.19 0.14 1.33 1.33 XXX

92552 ............ A Pure tone audiometry, air .................................. 0.00 0.50 0.50 0.04 0.54 0.54 XXX

92553 ............ A Audiometry, air & bone ...................................... 0.00 0.51 0.51 0.07 0.58 0.58 XXX

92555 ............ A Speech threshold audiometry ............................ 0.00 0.51 0.51 0.04 0.55 0.55 XXX

92556 ............ A Speech audiometry, complete ........................... 0.00 0.51 0.51 0.06 0.57 0.57 XXX

92557 ............ A Comprehensive hearing test .............................. 0.00 0.51 0.51 0.13 0.64 0.64 XXX

92561 ............ A Bekesy audiometry, diagnosis ........................... 0.00 0.45 0.45 0.07 0.52 0.52 XXX

92562 ............ A Loudness balance test ....................................... 0.00 0.53 0.53 0.04 0.57 0.57 XXX

92563 ............ A Tone decay hearing test .................................... 0.00 0.51 0.51 0.04 0.55 0.55 XXX

92564 ............ A Sisi hearing test ................................................. 0.00 0.51 0.51 0.05 0.56 0.56 XXX

92565 ............ A Stenger test, pure tone ...................................... 0.00 0.50 0.50 0.04 0.54 0.54 XXX

92567 ............ A Tympanometry ................................................... 0.00 0.44 0.44 0.06 0.50 0.50 XXX

92568 ............ A Acoustic reflex testing ........................................ 0.00 0.44 0.44 0.04 0.48 0.48 XXX

92569 ............ A Acoustic reflex decay test .................................. 0.00 0.44 0.44 0.04 0.48 0.48 XXX

92571 ............ A Filtered speech hearing test .............................. 0.00 0.51 0.51 0.04 0.55 0.55 XXX

92572 ............ A Staggered spondaic word test ........................... 0.00 0.51 0.51 0.01 0.52 0.52 XXX

92573 ............ A Lombard test ...................................................... 0.00 0.51 0.51 0.04 0.55 0.55 XXX

92575 ............ A Sensorineural acuity test .................................... 0.00 0.39 0.39 0.03 0.42 0.42 XXX

92576 ............ A Synthetic sentence test ...................................... 0.00 0.51 0.51 0.05 0.56 0.56 XXX

92577 ............ A Stenger test, speech .......................................... 0.00 0.51 0.51 0.08 0.59 0.59 XXX

92579 ............ A Visual audiometry (vra) ...................................... 0.00 1.00 1.00 0.07 1.07 1.07 XXX

92582 ............ A Conditioning play audiometry ............................. 0.00 0.99 0.99 0.07 1.06 1.06 XXX

92583 ............ A Select picture audiometry .................................. 0.00 1.23 1.23 0.09 1.32 1.32 XXX

92584 ............ A Electrocochleography ......................................... 0.00 0.72 0.72 0.25 0.97 0.97 XXX

92585 ............ A Auditory evoked potential ................................... 0.50 1.82 1.82 0.31 2.63 2.63 XXX

92585 26 A Auditory evoked potential ................................... 0.50 0.21 0.21 0.14 0.85 0.85 XXX

92585 TC A Auditory evoked potential ................................... 0.00 1.60 1.60 0.17 1.77 1.77 XXX

92587 ............ A Evoked auditory test .......................................... 0.13 0.54 0.54 0.13 0.80 0.80 XXX

92587 26 A Evoked auditory test .......................................... 0.13 0.07 0.07 0.01 0.21 0.21 XXX

92587 TC A Evoked auditory test .......................................... 0.00 0.48 0.48 0.12 0.60 0.60 XXX

92588 ............ A Evoked auditory test .......................................... 0.36 0.68 0.68 0.16 1.20 1.20 XXX

92588 26 A Evoked auditory test .......................................... 0.36 0.23 0.23 0.02 0.61 0.61 XXX

92588 TC A Evoked auditory test .......................................... 0.00 0.45 0.45 0.14 0.59 0.59 XXX

92589 ............ A Auditory function test(s) ..................................... 0.00 0.76 0.76 0.06 0.82 0.82 XXX

92596 ............ A Ear protector evaluation ..................................... 0.00 0.51 0.51 0.06 0.57 0.57 XXX

92597 ............ A Oral speech device eval .................................... 1.35 1.20 1.10 0.11 2.66 2.56 XXX

92598 ............ A Modify oral speech device ................................. 0.99 0.85 0.64 0.07 1.91 1.70 XXX

92950 ............ A Heart/lung resuscitation (CPR) .......................... 3.80 1.37 0.91 0.17 5.34 4.88 000

92953 ............ A Temporary external pacing ................................ 0.23 NA 0.18 0.15 NA 0.56 000

92960 ............ A Heart electroconversion ..................................... 2.25 1.54 2.11 0.16 3.95 4.52 000

92970 ............ A Cardioassist, internal .......................................... 3.52 NA 2.95 0.41 NA 6.88 000

92971 ............ A Cardioassist, external ......................................... 1.77 NA 0.82 0.08 NA 2.67 000

92975 ............ A Dissolve clot, heart vessel ................................. 7.25 NA 7.60 0.42 NA 15.27 000

92977 ............ A Dissolve clot, heart vessel ................................. 0.00 NA 0.05 0.54 NA 0.59 XXX

92978 ............ A Intravas us, heart (add-on) ................................ 1.80 NA 3.53 0.36 NA 5.69 ZZZ

92978 26 A Intravas us, heart (add-on) ................................ 1.80 NA 1.80 0.08 NA 3.68 ZZZ

92978 TC A Intravas us, heart (add-on) ................................ 0.00 NA 1.73 0.28 NA 2.01 ZZZ

92979 ............ A Intravas us, heart (add-on) ................................ 1.44 NA 1.78 0.20 NA 3.42 ZZZ

92979 26 A Intravas us, heart (add-on) ................................ 1.44 NA 1.44 0.06 NA 2.94 ZZZ

92979 TC A Intravas us, heart (add-on) ................................ 0.00 NA 0.34 0.14 NA 0.48 ZZZ

92980 ............ A Insert intracoronary stent ................................... 14.84 NA 10.01 1.22 NA 26.07 000

92981 ............ A Insert intracoronary stent ................................... 4.17 NA 2.05 0.44 NA 6.66 ZZZ

92982 ............ A Coronary artery dilation ...................................... 10.98 NA 7.50 1.22 NA 19.70 000

92984 ............ A Coronary artery dilation ...................................... 2.97 NA 1.51 0.44 NA 4.92 ZZZ

92986 ............ A Revision of aortic valve ...................................... 21.80 NA 11.60 0.90 NA 34.30 090

92987 ............ A Revision of mitral valve ...................................... 22.70 NA 12.14 0.91 NA 35.75 090

92990 ............ A Revision of pulmonary valve .............................. 17.34 NA 9.28 0.71 NA 27.33 090

92995 ............ A Coronary atherectomy ........................................ 12.09 NA 8.11 1.22 NA 21.42 000

92996 ............ A Coronary atherectomy ........................................ 3.26 NA 1.55 0.44 NA 5.25 ZZZ

92997 ............ A Pul art balloon repair, perc ................................ 12.00 NA 17.22 1.22 NA 30.44 000

92998 ............ A Pul art balloon repair, perc ................................ 6.00 NA 6.16 0.44 NA 12.60 ZZZ

93000 ............ A Electrocardiogram, complete ............................. 0.17 0.24 0.24 0.04 0.45 0.45 XXX

93005 ............ A Electrocardiogram, tracing ................................. 0.00 0.16 0.16 0.03 0.19 0.19 XXX

93010 ............ A Electrocardiogram report .................................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX

93012 ............ A Transmission of ecg ........................................... 0.00 0.27 0.27 0.22 0.49 0.49 XXX

93014 ............ A Report on transmitted ecg ................................. 0.52 0.24 0.24 0.05 0.81 0.81 XXX

93015 ............ A Cardiovascular stress test .................................. 0.75 1.86 1.86 0.18 2.79 2.79 XXX

93016 ............ A Cardiovascular stress test .................................. 0.45 0.19 0.19 0.03 0.67 0.67 XXX

93017 ............ A Cardiovascular stress test .................................. 0.00 1.40 1.40 0.12 1.52 1.52 XXX

93018 ............ A Cardiovascular stress test .................................. 0.30 0.13 0.13 0.03 0.46 0.46 XXX

93024 ............ A Cardiac drug stress test ..................................... 1.17 1.38 1.38 0.23 2.78 2.78 XXX

93024 26 A Cardiac drug stress test ..................................... 1.17 0.58 0.58 0.14 1.89 1.89 XXX

93024 TC A Cardiac drug stress test ..................................... 0.00 0.80 0.80 0.09 0.89 0.89 XXX
30997

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

93040 ............ A Rhythm ECG with report .................................... 0.16 0.25 0.25 0.02 0.43 0.43 XXX

93041 ............ A Rhythm ECG, tracing ......................................... 0.00 0.04 0.04 0.01 0.05 0.05 XXX

93042 ............ A Rhythm ECG, report .......................................... 0.16 0.04 0.04 0.01 0.21 0.21 XXX

93224 ............ A ECG monitor/report, 24 hrs ................................ 0.52 0.54 0.54 0.31 1.37 1.37 XXX

93225 ............ A ECG monitor/record, 24 hrs ............................... 0.00 0.09 0.09 0.09 0.18 0.18 XXX

93226 ............ A ECG monitor/report, 24 hrs ................................ 0.00 0.25 0.25 0.16 0.41 0.41 XXX

93227 ............ A ECG monitor/review, 24 hrs ............................... 0.52 0.22 0.22 0.06 0.80 0.80 XXX

93230 ............ A ECG monitor/report, 24 hrs ................................ 0.52 0.51 0.51 0.34 1.37 1.37 XXX

93231 ............ A Ecg monitor/record, 24 hrs ................................ 0.00 0.09 0.09 0.11 0.20 0.20 XXX

93232 ............ A ECG monitor/report, 24 hrs ................................ 0.00 0.25 0.25 0.15 0.40 0.40 XXX

93233 ............ A ECG monitor/review, 24 hrs ............................... 0.52 0.22 0.22 0.08 0.82 0.82 XXX

93235 ............ A ECG monitor/report, 24 hrs ................................ 0.45 0.41 0.41 0.23 1.09 1.09 XXX

93236 ............ A ECG monitor/report, 24 hrs ................................ 0.00 0.26 0.26 0.17 0.43 0.43 XXX

93237 ............ A ECG monitor/review, 24 hrs ............................... 0.45 0.18 0.18 0.06 0.69 0.69 XXX

93268 ............ A ECG record/review ............................................. 0.52 0.66 0.66 0.36 1.54 1.54 XXX

93270 ............ A ECG recording ................................................... 0.00 0.14 0.14 0.09 0.23 0.23 XXX

93271 ............ A Ecg/monitoring and anaylysis ............................ 0.00 0.27 0.27 0.22 0.49 0.49 XXX

93272 ............ A Ecg/review, interpret only ................................... 0.52 0.23 0.23 0.05 0.80 0.80 XXX

93278 ............ A ECG/signal-averaged ......................................... 0.25 0.37 0.37 0.18 0.80 0.80 XXX

93278 26 A ECG/signal-averaged ......................................... 0.25 0.12 0.12 0.06 0.43 0.43 XXX

93278 TC A ECG/signal-averaged ......................................... 0.00 0.24 0.24 0.12 0.36 0.36 XXX

93303 ............ A Echo transthoracic ............................................. 1.30 2.23 2.23 0.36 3.89 3.89 XXX

93303 26 A Echo transthoracic ............................................. 1.30 0.63 0.63 0.09 2.02 2.02 XXX

93303 TC A Echo transthoracic ............................................. 0.00 1.60 1.60 0.27 1.87 1.87 XXX

93304 ............ A Echo transthoracic ............................................. 0.75 1.83 1.83 0.19 2.77 2.77 XXX

93304 26 A Echo transthoracic ............................................. 0.75 0.33 0.33 0.05 1.13 1.13 XXX

93304 TC A Echo transthoracic ............................................. 0.00 1.50 1.50 0.14 1.64 1.64 XXX

93307 ............ A Echo exam of heart ............................................ 0.92 1.65 1.65 0.36 2.93 2.93 XXX

93307 26 A Echo exam of heart ............................................ 0.92 0.47 0.47 0.09 1.48 1.48 XXX

93307 TC A Echo exam of heart ............................................ 0.00 1.18 1.18 0.27 1.45 1.45 XXX

93308 ............ A Echo exam of heart ............................................ 0.53 1.53 1.53 0.19 2.25 2.25 XXX

93308 26 A Echo exam of heart ............................................ 0.53 0.22 0.22 0.05 0.80 0.80 XXX

93308 TC A Echo exam of heart ............................................ 0.00 1.31 1.31 0.14 1.45 1.45 XXX

93312 ............ A Echo transesophageal ....................................... 2.20 6.02 6.02 0.45 8.67 8.67 XXX

93312 26 A Echo transesophageal ....................................... 2.20 0.84 0.84 0.12 3.16 3.16 XXX

93312 TC A Echo transesophageal ....................................... 0.00 5.18 5.18 0.33 5.51 5.51 XXX

93313 ............ A Echo transesophageal ....................................... 0.95 4.58 0.45 0.06 5.59 1.46 XXX

93314 ............ A Echo transesophageal ....................................... 1.25 4.32 4.32 0.39 5.96 5.96 XXX

93314 26 A Echo transesophageal ....................................... 1.25 0.60 0.60 0.06 1.91 1.91 XXX

93314 TC A Echo transesophageal ....................................... 0.00 3.72 3.72 0.33 4.05 4.05 XXX

93315 ............ A Echo transesophageal ....................................... 2.78 7.36 7.36 0.45 10.59 10.59 XXX

93315 26 A Echo transesophageal ....................................... 2.78 1.30 1.30 0.12 4.20 4.20 XXX

93315 TC A Echo transesophageal ....................................... 0.00 6.06 6.06 0.33 6.39 6.39 XXX

93316 ............ A Echo transesophageal ....................................... 0.95 0.79 0.46 0.06 1.80 1.47 XXX

93317 ............ A Echo transesophageal ....................................... 1.83 1.64 1.64 0.39 3.86 3.86 XXX

93317 26 A Echo transesophageal ....................................... 1.83 0.68 0.68 0.06 2.57 2.57 XXX

93317 TC A Echo transesophageal ....................................... 0.00 0.96 0.96 0.33 1.29 1.29 XXX

93320 ............ A Doppler echo exam, heart ................................. 0.38 0.81 0.81 0.18 1.37 1.37 ZZZ

93320 26 A Doppler echo exam, heart ................................. 0.38 0.21 0.21 0.05 0.64 0.64 ZZZ

93320 TC A Doppler echo exam, heart ................................. 0.00 0.60 0.60 0.13 0.73 0.73 ZZZ

93321 ............ A Doppler echo exam, heart ................................. 0.15 0.58 0.58 0.11 0.84 0.84 ZZZ

93321 26 A Doppler echo exam, heart ................................. 0.15 0.08 0.08 0.02 0.25 0.25 ZZZ

93321 TC A Doppler echo exam, heart ................................. 0.00 0.50 0.50 0.09 0.59 0.59 ZZZ

93325 ............ A Doppler color flow .............................................. 0.07 0.39 0.39 0.25 0.71 0.71 ZZZ

93325 26 A Doppler color flow .............................................. 0.07 0.04 0.04 0.01 0.12 0.12 ZZZ

93325 TC A Doppler color flow .............................................. 0.00 0.35 0.35 0.24 0.59 0.59 ZZZ

93350 ............ A Echo transthoracic ............................................. 0.78 7.46 7.46 0.24 8.48 8.48 XXX

93350 26 A Echo transthoracic ............................................. 0.78 0.43 0.43 0.10 1.31 1.31 XXX

93350 TC A Echo transthoracic ............................................. 0.00 7.04 7.04 0.14 7.18 7.18 XXX

93501 ............ A Right heart catheterization ................................. 3.02 17.41 17.41 1.54 21.97 21.97 000

93501 26 A Right heart catheterization ................................. 3.02 1.27 1.27 0.34 4.63 4.63 000

93501 TC A Right heart catheterization ................................. 0.00 16.13 16.13 1.20 17.33 17.33 000

93503 ............ A Insert/place heart catheter ................................. 2.91 1.14 0.72 0.36 4.41 3.99 000

93505 ............ A Biopsy of heart lining ......................................... 4.38 3.83 3.83 0.46 8.67 8.67 000

93505 26 A Biopsy of heart lining ......................................... 4.38 1.94 1.94 0.28 6.60 6.60 000

93505 TC A Biopsy of heart lining ......................................... 0.00 1.89 1.89 0.18 2.07 2.07 000

93508 ............ A Cath placement, angiography ............................ 4.10 16.13 16.13 0.98 21.21 21.21 000

93508 26 A Cath placement, angiography ............................ 4.10 4.11 4.11 0.23 8.44 8.44 000

93508 TC A Cath placement, angiography ............................ 0.00 12.03 12.03 0.75 12.78 12.78 000

93510 ............ A Left heart catheterization ................................... 4.33 37.21 37.21 2.86 44.40 44.40 000

93510 26 A Left heart catheterization ................................... 4.33 1.94 1.94 0.23 6.50 6.50 000

93510 TC A Left heart catheterization ................................... 0.00 35.27 35.27 2.63 37.90 37.90 000

93511 ............ A Left heart catheterization ................................... 5.03 36.62 36.62 2.76 44.41 44.41 000

93511 26 A Left heart catheterization ................................... 5.03 2.28 2.28 0.20 7.51 7.51 000
30998

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

93511 TC A Left heart catheterization ................................... 0.00 34.34 34.34 2.56 36.90 36.90 000

93514 ............ A Left heart catheterization ................................... 7.05 37.51 37.51 2.94 47.50 47.50 000

93514 26 A Left heart catheterization ................................... 7.05 3.17 3.17 0.38 10.60 10.60 000

93514 TC A Left heart catheterization ................................... 0.00 34.34 34.34 2.56 36.90 36.90 000

93524 ............ A Left heart catheterization ................................... 6.95 48.01 48.01 3.69 58.65 58.65 000

93524 26 A Left heart catheterization ................................... 6.95 3.15 3.15 0.34 10.44 10.44 000

93524 TC A Left heart catheterization ................................... 0.00 44.86 44.86 3.35 48.21 48.21 000

93526 ............ A Rt & Lt heart catheters ....................................... 5.99 48.77 48.77 3.83 58.59 58.59 000

93526 26 A Rt & Lt heart catheters ....................................... 5.99 2.67 2.67 0.39 9.05 9.05 000

93526 TC A Rt & Lt heart catheters ....................................... 0.00 46.10 46.10 3.44 49.54 49.54 000

93527 ............ A Rt & Lt heart catheters ....................................... 7.28 48.10 48.10 3.85 59.23 59.23 000

93527 26 A Rt & Lt heart catheters ....................................... 7.28 3.23 3.23 0.50 11.01 11.01 000

93527 TC A Rt & Lt heart catheters ....................................... 0.00 44.86 44.86 3.35 48.21 48.21 000

93528 ............ A Rt & Lt heart catheters ....................................... 9.00 48.89 48.89 3.68 61.57 61.57 000

93528 26 A Rt & Lt heart catheters ....................................... 9.00 4.02 4.02 0.33 13.35 13.35 000

93528 TC A Rt & Lt heart catheters ....................................... 0.00 44.86 44.86 3.35 48.21 48.21 000

93529 ............ A Rt, Lt heart catheterization ................................. 4.80 46.95 46.95 3.57 55.32 55.32 000

93529 26 A Rt, Lt heart catheterization ................................. 4.80 2.09 2.09 0.22 7.11 7.11 000

93529 TC A Rt, Lt heart catheterization ................................. 0.00 44.86 44.86 3.35 48.21 48.21 000

93530 ............ A Rt heart cath, congenital .................................... 4.23 17.84 17.84 1.54 23.61 23.61 000

93530 26 A Rt heart cath, congenital .................................... 4.23 1.70 1.70 0.34 6.27 6.27 000

93530 TC A Rt heart cath, congenital .................................... 0.00 16.13 16.13 1.20 17.33 17.33 000

93531 ............ A R & l heart cath, congenital ............................... 8.35 49.83 49.83 3.83 62.01 62.01 000

93531 26 A R & l heart cath, congenital ............................... 8.35 3.73 3.73 0.39 12.47 12.47 000

93531 TC A R & l heart cath, congenital ............................... 0.00 46.10 46.10 3.44 49.54 49.54 000

93532 ............ A R & l heart cath, congenital ............................... 10.00 49.02 49.02 3.85 62.87 62.87 000

93532 26 A R & l heart cath, congenital ............................... 10.00 4.15 4.15 0.50 14.65 14.65 000

93532 TC A R & l heart cath, congenital ............................... 0.00 44.86 44.86 3.35 48.21 48.21 000

93533 ............ A R & l heart cath, congenital ............................... 6.70 47.27 47.27 3.57 57.54 57.54 000

93533 26 A R & l heart cath, congenital ............................... 6.70 2.40 2.40 0.22 9.32 9.32 000

93533 TC A R & l heart cath, congenital ............................... 0.00 44.86 44.86 3.35 48.21 48.21 000

93536 ............ A Insert circulation assi ......................................... 4.85 NA 3.18 0.71 NA 8.74 000

93539 ............ A Injection, cardiac cath ........................................ 0.40 0.19 0.52 0.20 0.79 1.12 000

93540 ............ A Injection, cardiac cath ........................................ 0.43 0.20 0.53 0.20 0.83 1.16 000

93541 ............ A Injection for lung angiogram .............................. 0.29 NA 0.21 0.16 NA 0.66 000

93542 ............ A Injection for heart x-rays .................................... 0.29 NA 0.34 0.16 NA 0.79 000

93543 ............ A Injection for heart x-rays .................................... 0.29 0.35 0.55 0.11 0.75 0.95 000

93544 ............ A Injection for aortography .................................... 0.25 0.11 0.32 0.11 0.47 0.68 000

93545 ............ A Injection for coronary xrays ................................ 0.40 0.53 0.85 0.24 1.17 1.49 000

93555 ............ A Imaging, cardiac cath ......................................... 0.81 6.35 6.35 0.42 7.58 7.58 XXX

93555 26 A Imaging, cardiac cath ......................................... 0.81 0.36 0.36 0.04 1.21 1.21 XXX

93555 TC A Imaging, cardiac cath ......................................... 0.00 5.99 5.99 0.38 6.37 6.37 XXX

93556 ............ A Imaging, cardiac cath ......................................... 0.83 9.81 9.81 0.65 11.29 11.29 XXX

93556 26 A Imaging, cardiac cath ......................................... 0.83 0.37 0.37 0.07 1.27 1.27 XXX

93556 TC A Imaging, cardiac cath ......................................... 0.00 9.44 9.44 0.58 10.02 10.02 XXX

93561 ............ A Cardiac output measurement ............................. 0.50 0.64 0.64 0.16 1.30 1.30 000

93561 26 A Cardiac output measurement ............................. 0.50 0.14 0.14 0.09 0.73 0.73 000

93561 TC A Cardiac output measurement ............................. 0.00 0.50 0.50 0.07 0.57 0.57 000

93562 ............ A Cardiac output measurement ............................. 0.16 0.35 0.35 0.10 0.61 0.61 000

93562 26 A Cardiac output measurement ............................. 0.16 0.05 0.05 0.06 0.27 0.27 000

93562 TC A Cardiac output measurement ............................. 0.00 0.30 0.30 0.04 0.34 0.34 000

93600 ............ A Bundle of His recording ..................................... 2.12 2.18 2.18 0.38 4.68 4.68 000

93600 26 A Bundle of His recording ..................................... 2.12 0.86 0.86 0.24 3.22 3.22 000

93600 TC A Bundle of His recording ..................................... 0.00 1.32 1.32 0.14 1.46 1.46 000

93602 ............ A Intra-atrial recording ........................................... 2.12 2.39 2.39 0.22 4.73 4.73 000

93602 26 A Intra-atrial recording ........................................... 2.12 0.94 0.94 0.14 3.20 3.20 000

93602 TC A Intra-atrial recording ........................................... 0.00 1.45 1.45 0.08 1.53 1.53 000

93603 ............ A Right ventricular recording ................................. 2.12 1.75 1.75 0.28 4.15 4.15 000

93603 26 A Right ventricular recording ................................. 2.12 0.68 0.68 0.16 2.96 2.96 000

93603 TC A Right ventricular recording ................................. 0.00 1.07 1.07 0.12 1.19 1.19 000

93607 ............ A Right ventricular recording ................................. 3.26 2.86 2.86 0.28 6.40 6.40 000

93607 26 A Right ventricular recording ................................. 3.26 1.42 1.42 0.17 4.85 4.85 000

93607 TC A Right ventricular recording ................................. 0.00 1.44 1.44 0.11 1.55 1.55 000

93609 ............ A Mapping of tachycardia ...................................... 10.07 8.41 8.41 0.47 18.95 18.95 000

93609 26 A Mapping of tachycardia ...................................... 10.07 4.37 4.37 0.28 14.72 14.72 000

93609 TC A Mapping of tachycardia ...................................... 0.00 4.04 4.04 0.19 4.23 4.23 000

93610 ............ A Intra-atrial pacing ............................................... 3.02 3.91 3.91 0.27 7.20 7.20 000

93610 26 A Intra-atrial pacing ............................................... 3.02 1.31 1.31 0.17 4.50 4.50 000

93610 TC A Intra-atrial pacing ............................................... 0.00 2.60 2.60 0.10 2.70 2.70 000

93612 ............ A Intraventricular pacing ........................................ 3.02 4.00 4.00 0.29 7.31 7.31 000

93612 26 A Intraventricular pacing ........................................ 3.02 1.35 1.35 0.17 4.54 4.54 000

93612 TC A Intraventricular pacing ........................................ 0.00 2.65 2.65 0.12 2.77 2.77 000

93615 ............ A Esophageal recording ........................................ 0.99 0.98 0.98 0.04 2.01 2.01 000

93615 26 A Esophageal recording ........................................ 0.99 0.20 0.20 0.02 1.21 1.21 000
30999

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

93615 TC A Esophageal recording ........................................ 0.00 0.78 0.78 0.02 0.80 0.80 000

93616 ............ A Esophageal recording ........................................ 1.49 1.25 1.25 0.10 2.84 2.84 000

93616 26 A Esophageal recording ........................................ 1.49 0.43 0.43 0.08 2.00 2.00 000

93616 TC A Esophageal recording ........................................ 0.00 0.82 0.82 0.02 0.84 0.84 000

93618 ............ A Heart rhythm pacing ........................................... 4.26 3.90 3.90 0.72 8.88 8.88 000

93618 26 A Heart rhythm pacing ........................................... 4.26 1.87 1.87 0.44 6.57 6.57 000

93618 TC A Heart rhythm pacing ........................................... 0.00 2.03 2.03 0.28 2.31 2.31 000

93619 ............ A Electrophysiology evaluation .............................. 7.32 6.28 6.28 1.40 15.00 15.00 000

93619 26 A Electrophysiology evaluation .............................. 7.32 3.24 3.24 0.86 11.42 11.42 000

93619 TC A Electrophysiology evaluation .............................. 0.00 3.05 3.05 0.54 3.59 3.59 000

93620 ............ A Electrophysiology evaluation .............................. 11.59 6.65 6.65 1.55 19.79 19.79 000

93620 26 A Electrophysiology evaluation .............................. 11.59 5.10 5.10 0.95 17.64 17.64 000

93620 TC A Electrophysiology evaluation .............................. 0.00 1.55 1.55 0.60 2.15 2.15 000

93621 26 A Electrophysiology evaluation .............................. 12.66 5.66 5.66 1.11 19.43 19.43 000

93622 26 A Electrophysiology evaluation .............................. 12.74 5.71 5.71 1.07 19.52 19.52 000

93623 26 A Stimulation, pacing heart ................................... 2.85 1.27 1.27 0.20 4.32 4.32 000

93624 ............ A Electrophysiologic study ..................................... 4.81 4.05 4.05 0.35 9.21 9.21 000

93624 26 A Electrophysiologic study ..................................... 4.81 2.06 2.06 0.21 7.08 7.08 000

93624 TC A Electrophysiologic study ..................................... 0.00 1.99 1.99 0.14 2.13 2.13 000

93631 ............ A Heart pacing, mapping ....................................... 7.60 4.14 4.14 1.37 13.11 13.11 000

93631 26 A Heart pacing, mapping ....................................... 7.60 3.35 3.35 0.67 11.62 11.62 000

93631 TC A Heart pacing, mapping ....................................... 0.00 0.78 0.78 0.70 1.48 1.48 000

93640 ............ A Evaluation heart device ...................................... 3.52 3.38 3.38 1.09 7.99 7.99 000

93640 26 A Evaluation heart device ...................................... 3.52 1.58 1.58 0.61 5.71 5.71 000

93640 TC A Evaluation heart device ...................................... 0.00 1.80 1.80 0.48 2.28 2.28 000

93641 ............ A Electrophysiology evaluation .............................. 5.93 5.93 5.93 1.09 12.95 12.95 000

93641 26 A Electrophysiology evaluation .............................. 5.93 2.64 2.64 0.61 9.18 9.18 000

93641 TC A Electrophysiology evaluation .............................. 0.00 3.30 3.30 0.48 3.78 3.78 000

93642 ............ A Electrophysiology evaluation .............................. 4.89 3.97 3.97 1.09 9.95 9.95 000

93642 26 A Electrophysiology evaluation .............................. 4.89 2.17 2.17 0.61 7.67 7.67 000

93642 TC A Electrophysiology evaluation .............................. 0.00 1.80 1.80 0.48 2.28 2.28 000

93650 ............ A Ablate heart dysrhythm focus ............................ 10.51 NA 6.17 1.34 NA 18.02 000

93651 ............ A Ablate heart dysrhythm focus ............................ 16.25 NA 10.49 1.34 NA 28.08 000

93652 ............ A Ablate heart dysrhythm focus ............................ 17.68 NA 10.98 1.34 NA 30.00 000

93660 26 A Tilt table evaluation ............................................ 1.89 0.84 0.84 0.17 2.90 2.90 000

93720 ............ A Total body plethysmography .............................. 0.17 0.55 0.55 0.10 0.82 0.82 XXX

93721 ............ A Plethysmography tracing .................................... 0.00 0.55 0.55 0.07 0.62 0.62 XXX

93722 ............ A Plethysmography report ..................................... 0.17 0.05 0.05 0.03 0.25 0.25 XXX

93724 ............ A Analyze pacemaker system ............................... 4.89 2.85 2.85 0.50 8.24 8.24 000

93724 26 A Analyze pacemaker system ............................... 4.89 2.14 2.14 0.22 7.25 7.25 000

93724 TC A Analyze pacemaker system ............................... 0.00 0.71 0.71 0.28 0.99 0.99 000

93731 ............ A Analyze pacemaker system ............................... 0.45 0.59 0.59 0.07 1.11 1.11 XXX

93731 26 A Analyze pacemaker system ............................... 0.45 0.21 0.21 0.03 0.69 0.69 XXX

93731 TC A Analyze pacemaker system ............................... 0.00 0.38 0.38 0.04 0.42 0.42 XXX

93732 ............ A Analyze pacemaker system ............................... 0.92 0.85 0.85 0.08 1.85 1.85 XXX

93732 26 A Analyze pacemaker system ............................... 0.92 0.42 0.42 0.04 1.38 1.38 XXX

93732 TC A Analyze pacemaker system ............................... 0.00 0.44 0.44 0.04 0.48 0.48 XXX

93733 ............ A Telephone analysis, pacemaker ........................ 0.17 0.21 0.21 0.08 0.46 0.46 XXX

93733 26 A Telephone analysis, pacemaker ........................ 0.17 0.09 0.09 0.02 0.28 0.28 XXX

93733 TC A Telephone analysis, pacemaker ........................ 0.00 0.11 0.11 0.06 0.17 0.17 XXX

93734 ............ A Analyze pacemaker system ............................... 0.38 0.50 0.50 0.06 0.94 0.94 XXX

93734 26 A Analyze pacemaker system ............................... 0.38 0.18 0.18 0.03 0.59 0.59 XXX

93734 TC A Analyze pacemaker system ............................... 0.00 0.32 0.32 0.03 0.35 0.35 XXX

93735 ............ A Analyze pacemaker system ............................... 0.74 0.68 0.68 0.08 1.50 1.50 XXX

93735 26 A Analyze pacemaker system ............................... 0.74 0.33 0.33 0.04 1.11 1.11 XXX

93735 TC A Analyze pacemaker system ............................... 0.00 0.35 0.35 0.04 0.39 0.39 XXX

93736 ............ A Telephone analysis, pacemaker ........................ 0.15 0.20 0.20 0.09 0.44 0.44 XXX

93736 26 A Telephone analysis, pacemaker ........................ 0.15 0.09 0.09 0.03 0.27 0.27 XXX

93736 TC A Telephone analysis, pacemaker ........................ 0.00 0.11 0.11 0.06 0.17 0.17 XXX

93737 ............ A Analyze cardio/defibrillator ................................. 0.45 0.60 0.60 0.06 1.11 1.11 XXX

93737 26 A Analyze cardio/defibrillator ................................. 0.45 0.21 0.21 0.02 0.68 0.68 XXX

93737 TC A Analyze cardio/defibrillator ................................. 0.00 0.39 0.39 0.04 0.43 0.43 XXX

93738 ............ A Analyze cardio/defibrillator ................................. 0.92 0.86 0.86 0.07 1.85 1.85 XXX

93738 26 A Analyze cardio/defibrillator ................................. 0.92 0.43 0.43 0.03 1.38 1.38 XXX

93738 TC A Analyze cardio/defibrillator ................................. 0.00 0.43 0.43 0.04 0.47 0.47 XXX

93740 ............ A Temperature gradient studies ............................ 0.16 0.49 0.49 0.04 0.69 0.69 XXX

93740 26 A Temperature gradient studies ............................ 0.16 0.03 0.03 0.03 0.22 0.22 XXX

93740 TC A Temperature gradient studies ............................ 0.00 0.46 0.46 0.01 0.47 0.47 XXX

93770 ............ A Measure venous pressure ................................. 0.16 0.52 0.52 0.02 0.70 0.70 XXX

93770 26 A Measure venous pressure ................................. 0.16 0.09 0.09 0.02 0.27 0.27 XXX

93770 TC A Measure venous pressure ................................. 0.00 0.43 0.43 0.00 0.43 0.43 XXX

93797 ............ A Cardiac rehab ..................................................... 0.18 0.27 0.08 0.02 0.47 0.28 000

93798 ............ A Cardiac rehab/monitor ........................................ 0.28 0.41 0.12 0.04 0.73 0.44 000

93875 ............ A Extracranial study ............................................... 0.22 0.95 0.95 0.18 1.35 1.35 XXX
31000

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

93875 26 A Extracranial study ............................................... 0.22 0.11 0.11 0.06 0.39 0.39 XXX

93875 TC A Extracranial study ............................................... 0.00 0.84 0.84 0.12 0.96 0.96 XXX

93880 ............ A Extracranial study ............................................... 0.60 2.31 2.31 0.44 3.35 3.35 XXX

93880 26 A Extracranial study ............................................... 0.60 0.26 0.26 0.04 0.90 0.90 XXX

93880 TC A Extracranial study ............................................... 0.00 2.05 2.05 0.40 2.45 2.45 XXX

93882 ............ A Extracranial study ............................................... 0.40 2.02 2.02 0.29 2.71 2.71 XXX

93882 26 A Extracranial study ............................................... 0.40 0.20 0.20 0.03 0.63 0.63 XXX

93882 TC A Extracranial study ............................................... 0.00 1.82 1.82 0.26 2.08 2.08 XXX

93886 ............ A Intracranial study ................................................ 0.94 2.55 2.55 0.50 3.99 3.99 XXX

93886 26 A Intracranial study ................................................ 0.94 0.45 0.45 0.05 1.44 1.44 XXX

93886 TC A Intracranial study ................................................ 0.00 2.10 2.10 0.45 2.55 2.55 XXX

93888 ............ A Intracranial study ................................................ 0.62 1.85 1.85 0.34 2.81 2.81 XXX

93888 26 A Intracranial study ................................................ 0.62 0.26 0.26 0.03 0.91 0.91 XXX

93888 TC A Intracranial study ................................................ 0.00 1.60 1.60 0.31 1.91 1.91 XXX

93922 ............ A Extremity study ................................................... 0.25 1.22 1.22 0.19 1.66 1.66 XXX

93922 26 A Extremity study ................................................... 0.25 0.12 0.12 0.05 0.42 0.42 XXX

93922 TC A Extremity study ................................................... 0.00 1.10 1.10 0.14 1.24 1.24 XXX

93923 ............ A Extremity study ................................................... 0.45 1.50 1.50 0.35 2.30 2.30 XXX

93923 26 A Extremity study ................................................... 0.45 0.25 0.25 0.09 0.79 0.79 XXX

93923 TC A Extremity study ................................................... 0.00 1.25 1.25 0.26 1.51 1.51 XXX

93924 ............ A Extremity study ................................................... 0.50 2.30 2.30 0.39 3.19 3.19 XXX

93924 26 A Extremity study ................................................... 0.50 0.20 0.20 0.10 0.80 0.80 XXX

93924 TC A Extremity study ................................................... 0.00 2.10 2.10 0.29 2.39 2.39 XXX

93925 ............ A Lower extremity study ........................................ 0.58 2.47 2.47 0.44 3.49 3.49 XXX

93925 26 A Lower extremity study ........................................ 0.58 0.29 0.29 0.04 0.91 0.91 XXX

93925 TC A Lower extremity study ........................................ 0.00 2.18 2.18 0.40 2.58 2.58 XXX

93926 ............ A Lower extremity study ........................................ 0.39 1.86 1.86 0.30 2.55 2.55 XXX

93926 26 A Lower extremity study ........................................ 0.39 0.15 0.15 0.03 0.57 0.57 XXX

93926 TC A Lower extremity study ........................................ 0.00 1.72 1.72 0.27 1.99 1.99 XXX

93930 ............ A Upper extremity study ........................................ 0.46 2.31 2.31 0.47 3.24 3.24 XXX

93930 26 A Upper extremity study ........................................ 0.46 0.24 0.24 0.05 0.75 0.75 XXX

93930 TC A Upper extremity study ........................................ 0.00 2.07 2.07 0.42 2.49 2.49 XXX

93931 ............ A Upper extremity study ........................................ 0.31 1.56 1.56 0.31 2.18 2.18 XXX

93931 26 A Upper extremity study ........................................ 0.31 0.16 0.16 0.03 0.50 0.50 XXX

93931 TC A Upper extremity study ........................................ 0.00 1.40 1.40 0.28 1.68 1.68 XXX

93965 ............ A Extremity study ................................................... 0.35 1.05 1.05 0.19 1.59 1.59 XXX

93965 26 A Extremity study ................................................... 0.35 0.16 0.16 0.06 0.57 0.57 XXX

93965 TC A Extremity study ................................................... 0.00 0.88 0.88 0.13 1.01 1.01 XXX

93970 ............ A Extremity study ................................................... 0.68 2.30 2.30 0.51 3.49 3.49 XXX

93970 26 A Extremity study ................................................... 0.68 0.30 0.30 0.05 1.03 1.03 XXX

93970 TC A Extremity study ................................................... 0.00 2.01 2.01 0.46 2.47 2.47 XXX

93971 ............ A Extremity study ................................................... 0.45 1.57 1.57 0.34 2.36 2.36 XXX

93971 26 A Extremity study ................................................... 0.45 0.18 0.18 0.03 0.66 0.66 XXX

93971 TC A Extremity study ................................................... 0.00 1.39 1.39 0.31 1.70 1.70 XXX

93975 ............ A Vascular study .................................................... 1.80 3.03 3.03 0.55 5.38 5.38 XXX

93975 26 A Vascular study .................................................... 1.80 0.69 0.69 0.05 2.54 2.54 XXX

93975 TC A Vascular study .................................................... 0.00 2.34 2.34 0.50 2.84 2.84 XXX

93976 ............ A Vascular study .................................................... 1.21 1.94 1.94 0.37 3.52 3.52 XXX

93976 26 A Vascular study .................................................... 1.21 0.43 0.43 0.03 1.67 1.67 XXX

93976 TC A Vascular study .................................................... 0.00 1.52 1.52 0.34 1.86 1.86 XXX

93978 ............ A Vascular study .................................................... 0.65 2.62 2.62 0.47 3.74 3.74 XXX

93978 26 A Vascular study .................................................... 0.65 0.35 0.35 0.05 1.05 1.05 XXX

93978 TC A Vascular study .................................................... 0.00 2.28 2.28 0.42 2.70 2.70 XXX

93979 ............ A Vascular study .................................................... 0.44 1.69 1.69 0.31 2.44 2.44 XXX

93979 26 A Vascular study .................................................... 0.44 0.25 0.25 0.03 0.72 0.72 XXX

93979 TC A Vascular study .................................................... 0.00 1.44 1.44 0.28 1.72 1.72 XXX

93980 ............ A Penile vascular study ......................................... 1.25 2.84 2.84 0.45 4.54 4.54 XXX

93980 26 A Penile vascular study ......................................... 1.25 0.67 0.67 0.07 1.99 1.99 XXX

93980 TC A Penile vascular study ......................................... 0.00 2.17 2.17 0.38 2.55 2.55 XXX

93981 ............ A Penile vascular study ......................................... 0.44 2.27 2.27 0.39 3.10 3.10 XXX

93981 26 A Penile vascular study ......................................... 0.44 0.15 0.15 0.03 0.62 0.62 XXX

93981 TC A Penile vascular study ......................................... 0.00 2.12 2.12 0.36 2.48 2.48 XXX

93990 ............ A Doppler flow testing ........................................... 0.25 1.60 1.60 0.29 2.14 2.14 XXX

93990 26 A Doppler flow testing ........................................... 0.25 0.15 0.15 0.02 0.42 0.42 XXX

93990 TC A Doppler flow testing ........................................... 0.00 1.45 1.45 0.27 1.72 1.72 XXX

94010 ............ A Breathing capacity test ....................................... 0.17 0.45 0.45 0.05 0.67 0.67 XXX

94010 26 A Breathing capacity test ....................................... 0.17 0.06 0.06 0.02 0.25 0.25 XXX

94010 TC A Breathing capacity test ....................................... 0.00 0.39 0.39 0.03 0.42 0.42 XXX

94060 ............ A Evaluation of wheezing ...................................... 0.31 0.58 0.58 0.09 0.98 0.98 XXX

94060 26 A Evaluation of wheezing ...................................... 0.31 0.09 0.09 0.03 0.43 0.43 XXX

94060 TC A Evaluation of wheezing ...................................... 0.00 0.49 0.49 0.06 0.55 0.55 XXX

94070 ............ A Evaluation of wheezing ...................................... 0.60 2.56 2.56 0.13 3.29 3.29 XXX

94070 26 A Evaluation of wheezing ...................................... 0.60 0.18 0.18 0.03 0.81 0.81 XXX

94070 TC A Evaluation of wheezing ...................................... 0.00 2.38 2.38 0.10 2.48 2.48 XXX
31001

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

94150 ............ B Vital capacity test ............................................... +0.07 0.88 0.88 0.02 0.97 0.97 XXX

94150 26 B Vital capacity test ............................................... +0.07 0.07 0.07 0.01 0.15 0.15 XXX

94150 TC B Vital capacity test ............................................... +0.00 0.81 0.81 0.01 0.82 0.82 XXX

94200 ............ A Lung function test (MBC/MVV) .......................... 0.11 0.40 0.40 0.03 0.54 0.54 XXX

94200 26 A Lung function test (MBC/MVV) .......................... 0.11 0.03 0.03 0.01 0.15 0.15 XXX

94200 TC A Lung function test (MBC/MVV) .......................... 0.00 0.37 0.37 0.02 0.39 0.39 XXX

94240 ............ A Residual lung capacity ....................................... 0.26 1.31 1.31 0.07 1.64 1.64 XXX

94240 26 A Residual lung capacity ....................................... 0.26 0.08 0.08 0.02 0.36 0.36 XXX

94240 TC A Residual lung capacity ....................................... 0.00 1.23 1.23 0.05 1.28 1.28 XXX

94250 ............ A Expired gas collection ........................................ 0.11 0.41 0.41 0.02 0.54 0.54 XXX

94250 26 A Expired gas collection ........................................ 0.11 0.03 0.03 0.01 0.15 0.15 XXX

94250 TC A Expired gas collection ........................................ 0.00 0.37 0.37 0.01 0.38 0.38 XXX

94260 ............ A Thoracic gas volume .......................................... 0.13 0.31 0.31 0.06 0.50 0.50 XXX

94260 26 A Thoracic gas volume .......................................... 0.13 0.04 0.04 0.02 0.19 0.19 XXX

94260 TC A Thoracic gas volume .......................................... 0.00 0.28 0.28 0.04 0.32 0.32 XXX

94350 ............ A Lung nitrogen washout curve ............................. 0.26 1.37 1.37 0.05 1.68 1.68 XXX

94350 26 A Lung nitrogen washout curve ............................. 0.26 0.08 0.08 0.01 0.35 0.35 XXX

94350 TC A Lung nitrogen washout curve ............................. 0.00 1.29 1.29 0.04 1.33 1.33 XXX

94360 ............ A Measure airflow resistance ................................ 0.26 0.39 0.39 0.07 0.72 0.72 XXX

94360 26 A Measure airflow resistance ................................ 0.26 0.08 0.08 0.01 0.35 0.35 XXX

94360 TC A Measure airflow resistance ................................ 0.00 0.31 0.31 0.06 0.37 0.37 XXX

94370 ............ A Breath airway closing volume ............................ 0.26 1.58 1.58 0.03 1.87 1.87 XXX

94370 26 A Breath airway closing volume ............................ 0.26 0.09 0.09 0.01 0.36 0.36 XXX

94370 TC A Breath airway closing volume ............................ 0.00 1.49 1.49 0.02 1.51 1.51 XXX

94375 ............ A Respiratory flow volume loop ............................. 0.31 0.48 0.48 0.04 0.83 0.83 XXX

94375 26 A Respiratory flow volume loop ............................. 0.31 0.10 0.10 0.01 0.42 0.42 XXX

94375 TC A Respiratory flow volume loop ............................. 0.00 0.38 0.38 0.03 0.41 0.41 XXX

94400 ............ A CO2 breathing response curve .......................... 0.40 0.62 0.62 0.19 1.21 1.21 XXX

94400 26 A CO2 breathing response curve .......................... 0.40 0.13 0.13 0.13 0.66 0.66 XXX

94400 TC A CO2 breathing response curve .......................... 0.00 0.49 0.49 0.06 0.55 0.55 XXX

94450 ............ A Hypoxia response curve .................................... 0.40 0.91 0.91 0.05 1.36 1.36 XXX

94450 26 A Hypoxia response curve .................................... 0.40 0.42 0.42 0.02 0.84 0.84 XXX

94450 TC A Hypoxia response curve .................................... 0.00 0.49 0.49 0.03 0.52 0.52 XXX

94620 ............ A Pulmonary stress testing .................................... 0.88 2.00 2.00 0.15 3.03 3.03 XXX

94620 26 A Pulmonary stress testing .................................... 0.88 0.30 0.30 0.05 1.23 1.23 XXX

94620 TC A Pulmonary stress testing .................................... 0.00 1.70 1.70 0.10 1.80 1.80 XXX

94640 ............ A Airway inhalation treatment ................................ 0.00 0.35 0.02 0.03 0.38 0.05 XXX

94650 ............ A Pressure breathing (IPPB) ................................. 0.00 0.36 0.02 0.03 0.39 0.05 XXX

94651 ............ A Pressure breathing (IPPB) ................................. 0.00 0.36 0.02 0.03 0.39 0.05 XXX

94652 ............ A Pressure breathing (IPPB) ................................. 0.00 NA 0.02 0.08 NA 0.10 XXX

94656 ............ A Initial ventilator mgmt ......................................... 1.22 NA 0.37 0.12 NA 1.71 XXX

94657 ............ A Cont. ventilator ................................................... 0.83 NA 0.29 0.05 NA 1.17 XXX

94660 ............ A Pos airway pressure, CPAP .............................. 0.76 0.48 0.28 0.06 1.30 1.10 XXX

94662 ............ A Neg pressure ventilation,cnp ............................. 0.76 NA 0.30 0.02 NA 1.08 XXX

94664 ............ A Aerosol or vapor inhalations .............................. 0.00 0.27 0.02 0.04 0.31 0.06 XXX

94665 ............ A Aerosol or vapor inhalations .............................. 0.00 0.31 0.02 0.05 0.36 0.07 XXX

94667 ............ A Chest wall manipulation ..................................... 0.00 0.43 0.02 0.05 0.48 0.07 XXX

94668 ............ A Chest wall manipulation ..................................... 0.00 0.43 0.02 0.03 0.46 0.05 XXX

94680 ............ A Exhaled air analysis: O2 .................................... 0.26 1.12 1.12 0.10 1.48 1.48 XXX

94680 26 A Exhaled air analysis: O2 .................................... 0.26 0.06 0.06 0.03 0.35 0.35 XXX

94680 TC A Exhaled air analysis: O2 .................................... 0.00 1.05 1.05 0.07 1.12 1.12 XXX

94681 ............ A Exhaled air analysis: O2,CO2 ............................ 0.20 1.74 1.74 0.17 2.11 2.11 XXX

94681 26 A Exhaled air analysis: O2,CO2 ............................ 0.20 0.08 0.08 0.04 0.32 0.32 XXX

94681 TC A Exhaled air analysis: O2,CO2 ............................ 0.00 1.66 1.66 0.13 1.79 1.79 XXX

94690 ............ A Exhaled air analysis ........................................... 0.07 1.30 1.30 0.04 1.41 1.41 XXX

94690 26 A Exhaled air analysis ........................................... 0.07 0.03 0.03 0.00 0.10 0.10 XXX

94690 TC A Exhaled air analysis ........................................... 0.00 1.26 1.26 0.04 1.30 1.30 XXX

94720 ............ A Monoxide diffusing capacity ............................... 0.26 1.04 1.04 0.08 1.38 1.38 XXX

94720 26 A Monoxide diffusing capacity ............................... 0.26 0.07 0.07 0.02 0.35 0.35 XXX

94720 TC A Monoxide diffusing capacity ............................... 0.00 0.97 0.97 0.06 1.03 1.03 XXX

94725 ............ A Membrane diffusion capacity ............................. 0.26 1.88 1.88 0.14 2.28 2.28 XXX

94725 26 A Membrane diffusion capacity ............................. 0.26 0.09 0.09 0.01 0.36 0.36 XXX

94725 TC A Membrane diffusion capacity ............................. 0.00 1.79 1.79 0.13 1.92 1.92 XXX

94750 ............ A Pulmonary compliance study ............................. 0.23 2.78 2.78 0.06 3.07 3.07 XXX

94750 26 A Pulmonary compliance study ............................. 0.23 0.15 0.15 0.02 0.40 0.40 XXX

94750 TC A Pulmonary compliance study ............................. 0.00 2.63 2.63 0.04 2.67 2.67 XXX

94760 ............ A Measure blood oxygen level .............................. 0.00 0.04 0.04 0.02 0.06 0.06 XXX

94761 ............ A Measure blood oxygen level .............................. 0.00 0.09 0.09 0.06 0.15 0.15 XXX

94762 ............ A Measure blood oxygen level .............................. 0.00 0.11 0.11 0.10 0.21 0.21 XXX

94770 ............ A Exhaled carbon dioxide test ............................... 0.15 1.23 1.23 0.11 1.49 1.49 XXX

94770 26 A Exhaled carbon dioxide test ............................... 0.15 0.03 0.03 0.03 0.21 0.21 XXX

94770 TC A Exhaled carbon dioxide test ............................... 0.00 1.20 1.20 0.08 1.28 1.28 XXX

95004 ............ A Allergy skin tests ................................................ 0.00 0.11 0.04 0.01 0.12 0.05 XXX

95010 ............ A Sensitivity skin tests ........................................... 0.15 0.22 0.08 0.01 0.38 0.24 XXX
31002

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

95015 ............ A Sensitivity skin tests ........................................... 0.15 0.25 0.07 0.01 0.41 0.23 XXX

95024 ............ A Allergy skin tests ................................................ 0.00 0.13 0.05 0.01 0.14 0.06 XXX

95027 ............ A Skin end point titration ....................................... 0.00 0.17 0.17 0.01 0.18 0.18 XXX

95028 ............ A Allergy skin tests ................................................ 0.00 0.21 0.21 0.01 0.22 0.22 XXX

95044 ............ A Allergy patch tests .............................................. 0.00 0.11 0.04 0.01 0.12 0.05 XXX

95052 ............ A Photo patch test ................................................. 0.00 0.11 0.04 0.01 0.12 0.05 XXX

95056 ............ A Photosensitivity tests .......................................... 0.00 0.12 0.04 0.01 0.13 0.05 XXX

95060 ............ A Eye allergy tests ................................................. 0.00 0.48 0.48 0.02 0.50 0.50 XXX

95065 ............ A Nose allergy test ................................................ 0.00 0.33 0.33 0.01 0.34 0.34 XXX

95070 ............ A Bronchial allergy tests ........................................ 0.00 0.06 0.06 0.02 0.08 0.08 XXX

95071 ............ A Bronchial allergy tests ........................................ 0.00 0.13 0.13 0.02 0.15 0.15 XXX

95075 ............ A Ingestion challenge test ..................................... 0.95 0.72 0.45 0.02 1.69 1.42 XXX

95078 ............ A Provocative testing ............................................. 0.00 0.10 0.10 0.02 0.12 0.12 XXX

95115 ............ A Immunotherapy, one injection ............................ 0.00 0.28 0.09 0.02 0.30 0.11 000

95117 ............ A Immunotherapy injections .................................. 0.00 0.25 0.08 0.02 0.27 0.10 000

95144 ............ A Antigen therapy services .................................... 0.06 0.12 0.03 0.01 0.19 0.10 000

95145 ............ A Antigen therapy services .................................... 0.06 0.20 0.03 0.03 0.29 0.12 000

95146 ............ A Antigen therapy services .................................... 0.06 0.14 0.02 0.03 0.23 0.11 000

95147 ............ A Antigen therapy services .................................... 0.06 0.15 0.04 0.03 0.24 0.13 000

95148 ............ A Antigen therapy services .................................... 0.06 0.16 0.04 0.03 0.25 0.13 000

95149 ............ A Antigen therapy services .................................... 0.06 0.21 0.04 0.03 0.30 0.13 000

95165 ............ A Antigen therapy services .................................... 0.06 0.13 0.03 0.01 0.20 0.10 000

95170 ............ A Antigen therapy services .................................... 0.06 0.14 0.03 0.03 0.23 0.12 000

95180 ............ A Rapid desensitization ......................................... 2.01 1.37 1.06 0.01 3.39 3.08 000

95805 ............ A Multiple sleep latency test .................................. 1.88 6.89 6.89 0.45 9.22 9.22 XXX

95805 26 A Multiple sleep latency test .................................. 1.88 0.71 0.71 0.07 2.66 2.66 XXX

95805 TC A Multiple sleep latency test .................................. 0.00 6.18 6.18 0.38 6.56 6.56 XXX

95806 ............ A Sleep study, unattended .................................... 1.66 2.84 2.84 0.55 5.05 5.05 XXX

95806 26 A Sleep study, unattended .................................... 1.66 0.75 0.75 0.19 2.60 2.60 XXX

95806 TC A Sleep study, unattended .................................... 0.00 2.10 2.10 0.36 2.46 2.46 XXX

95807 ............ A Sleep study, attended ........................................ 1.66 10.24 10.24 0.67 12.57 12.57 XXX

95807 26 A Sleep study, attended ........................................ 1.66 0.59 0.59 0.19 2.44 2.44 XXX

95807 TC A Sleep study, attended ........................................ 0.00 9.65 9.65 0.48 10.13 10.13 XXX

95808 ............ A Polysomnography, 1–3 ...................................... 2.65 10.49 10.49 0.67 13.81 13.81 XXX

95808 26 A Polysomnography, 1–3 ...................................... 2.65 0.85 0.85 0.19 3.69 3.69 XXX

95808 TC A Polysomnography, 1–3 ...................................... 0.00 9.64 9.64 0.48 10.12 10.12 XXX

95810 ............ A Polysomnography, 4 or more ............................. 3.53 14.22 14.22 0.67 18.42 18.42 XXX

95810 26 A Polysomnography, 4 or more ............................. 3.53 1.39 1.39 0.19 5.11 5.11 XXX

95810 TC A Polysomnography, 4 or more ............................. 0.00 12.83 12.83 0.48 13.31 13.31 XXX

95811 ............ A Polysomnography w/cpap .................................. 3.80 14.68 14.68 0.70 19.18 19.18 XXX

95811 26 A Polysomnography w/cpap .................................. 3.80 1.53 1.53 0.20 5.53 5.53 XXX

95811 TC A Polysomnography w/cpap .................................. 0.00 13.15 13.15 0.50 13.65 13.65 XXX

95812 ............ A Electroencephalogram (EEG) ............................ 1.08 2.58 2.58 0.15 3.81 3.81 XXX

95812 26 A Electroencephalogram (EEG) ............................ 1.08 0.46 0.46 0.04 1.58 1.58 XXX

95812 TC A Electroencephalogram (EEG) ............................ 0.00 2.12 2.12 0.11 2.23 2.23 XXX

95813 ............ A Electroencephalogram (EEG) ............................ 1.73 3.93 3.93 0.15 5.81 5.81 XXX

95813 26 A Electroencephalogram (EEG) ............................ 1.73 0.79 0.79 0.04 2.56 2.56 XXX

95813 TC A Electroencephalogram (EEG) ............................ 0.00 3.14 3.14 0.11 3.25 3.25 XXX

95816 ............ A Electroencephalogram (EEG) ............................ 1.08 2.34 2.34 0.13 3.55 3.55 XXX

95816 26 A Electroencephalogram (EEG) ............................ 1.08 0.46 0.46 0.03 1.57 1.57 XXX

95816 TC A Electroencephalogram (EEG) ............................ 0.00 1.88 1.88 0.10 1.98 1.98 XXX

95819 ............ A Electroencephalogram (EEG) ............................ 1.08 2.42 2.42 0.14 3.64 3.64 XXX

95819 26 A Electroencephalogram (EEG) ............................ 1.08 0.46 0.46 0.04 1.58 1.58 XXX

95819 TC A Electroencephalogram (EEG) ............................ 0.00 1.97 1.97 0.10 2.07 2.07 XXX

95822 ............ A Sleep electroencephalogram ............................. 1.08 2.52 2.52 0.18 3.78 3.78 XXX

95822 26 A Sleep electroencephalogram ............................. 1.08 0.49 0.49 0.04 1.61 1.61 XXX

95822 TC A Sleep electroencephalogram ............................. 0.00 2.04 2.04 0.14 2.18 2.18 XXX

95824 ............ A Electroencephalography ..................................... 0.74 0.42 0.42 0.07 1.23 1.23 XXX

95824 26 A Electroencephalography ..................................... 0.74 0.31 0.31 0.04 1.09 1.09 XXX

95824 TC A Electroencephalography ..................................... 0.00 0.11 0.11 0.03 0.14 0.14 XXX

95827 ............ A Night electroencephalogram .............................. 1.08 6.64 6.64 0.24 7.96 7.96 XXX

95827 26 A Night electroencephalogram .............................. 1.08 0.42 0.42 0.07 1.57 1.57 XXX

95827 TC A Night electroencephalogram .............................. 0.00 6.22 6.22 0.17 6.39 6.39 XXX

95829 ............ A Surgery electrocorticogram ................................ 6.21 10.17 10.17 0.05 16.43 16.43 XXX

95829 26 A Surgery electrocorticogram ................................ 6.21 2.53 2.53 0.03 8.77 8.77 XXX

95829 TC A Surgery electrocorticogram ................................ 0.00 7.64 7.64 0.02 7.66 7.66 XXX

95830 ............ A Insert electrodes for EEG .................................. 1.70 2.27 0.70 0.07 4.04 2.47 XXX

95831 ............ A Limb muscle testing, manual ............................. 0.28 0.33 0.14 0.03 0.64 0.45 XXX

95832 ............ A Hand muscle testing, manual ............................ 0.29 0.27 0.12 0.02 0.58 0.43 XXX

95833 ............ A Body muscle testing, manual ............................. 0.47 0.41 0.22 0.05 0.93 0.74 XXX

95834 ............ A Body muscle testing, manual ............................. 0.60 0.51 0.30 0.06 1.17 0.96 XXX

95851 ............ A Range of motion measurements ........................ 0.16 0.27 0.08 0.02 0.45 0.26 XXX

95852 ............ A Range of motion measurements ........................ 0.11 0.25 0.06 0.02 0.38 0.19 XXX

95857 ............ A Tensilon test ....................................................... 0.53 0.50 0.23 0.04 1.07 0.80 XXX
31003

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

95858 ............ A Tensilon test & myogram ................................... 1.56 0.76 0.76 0.09 2.41 2.41 XXX

95858 26 A Tensilon test & myogram ................................... 1.56 0.43 0.43 0.05 2.04 2.04 XXX

95858 TC A Tensilon test & myogram ................................... 0.00 0.33 0.33 0.04 0.37 0.37 XXX

95860 ............ A Muscle test, one limb ......................................... 0.96 0.77 0.77 0.09 1.82 1.82 XXX

95860 26 A Muscle test, one limb ......................................... 0.96 0.46 0.46 0.06 1.48 1.48 XXX

95860 TC A Muscle test, one limb ......................................... 0.00 0.31 0.31 0.03 0.34 0.34 XXX

95861 ............ A Muscle test, two limbs ........................................ 1.54 1.11 1.11 0.16 2.81 2.81 XXX

95861 26 A Muscle test, two limbs ........................................ 1.54 0.72 0.72 0.10 2.36 2.36 XXX

95861 TC A Muscle test, two limbs ........................................ 0.00 0.39 0.39 0.06 0.45 0.45 XXX

95863 ............ A Muscle test, 3 limbs ........................................... 1.87 1.25 1.25 0.18 3.30 3.30 XXX

95863 26 A Muscle test, 3 limbs ........................................... 1.87 0.76 0.76 0.11 2.74 2.74 XXX

95863 TC A Muscle test, 3 limbs ........................................... 0.00 0.49 0.49 0.07 0.56 0.56 XXX

95864 ............ A Muscle test, 4 limbs ........................................... 1.99 1.27 1.27 0.27 3.53 3.53 XXX

95864 26 A Muscle test, 4 limbs ........................................... 1.99 0.92 0.92 0.14 3.05 3.05 XXX

95864 TC A Muscle test, 4 limbs ........................................... 0.00 0.35 0.35 0.13 0.48 0.48 XXX

95867 ............ A Muscle test, head or neck .................................. 0.79 0.71 0.71 0.09 1.59 1.59 XXX

95867 26 A Muscle test, head or neck .................................. 0.79 0.26 0.26 0.05 1.10 1.10 XXX

95867 TC A Muscle test, head or neck .................................. 0.00 0.46 0.46 0.04 0.50 0.50 XXX

95868 ............ A Muscle test, head or neck .................................. 1.18 0.93 0.93 0.15 2.26 2.26 XXX

95868 26 A Muscle test, head or neck .................................. 1.18 0.54 0.54 0.10 1.82 1.82 XXX

95868 TC A Muscle test, head or neck .................................. 0.00 0.39 0.39 0.05 0.44 0.44 XXX

95869 ............ A Muscle test, thor paraspinal ............................... 0.37 0.40 0.40 0.05 0.82 0.82 XXX

95869 26 A Muscle test, thor paraspinal ............................... 0.37 0.19 0.19 0.03 0.59 0.59 XXX

95869 TC A Muscle test, thor paraspinal ............................... 0.00 0.21 0.21 0.02 0.23 0.23 XXX

95870 ............ A Muscle test, non-paraspinal ............................... 0.37 0.87 0.87 0.05 1.29 1.29 XXX

95870 26 A Muscle test, non-paraspinal ............................... 0.37 0.37 0.37 0.03 0.77 0.77 XXX

95870 TC A Muscle test, non-paraspinal ............................... 0.00 0.50 0.50 0.02 0.52 0.52 XXX

95872 ............ A Muscle test, one fiber ......................................... 1.50 1.39 1.39 0.11 3.00 3.00 XXX

95872 26 A Muscle test, one fiber ......................................... 1.50 0.56 0.56 0.06 2.12 2.12 XXX

95872 TC A Muscle test, one fiber ......................................... 0.00 0.83 0.83 0.05 0.88 0.88 XXX

95875 ............ A Limb exercise test .............................................. 1.34 1.50 1.50 0.10 2.94 2.94 XXX

95875 26 A Limb exercise test .............................................. 1.34 0.49 0.49 0.04 1.87 1.87 XXX

95875 TC A Limb exercise test .............................................. 0.00 1.01 1.01 0.06 1.07 1.07 XXX

95900 ............ A Motor nerve conduction test .............................. 0.42 0.39 0.39 0.05 0.86 0.86 XXX

95900 26 A Motor nerve conduction test .............................. 0.42 0.20 0.20 0.03 0.65 0.65 XXX

95900 TC A Motor nerve conduction test .............................. 0.00 0.19 0.19 0.02 0.21 0.21 XXX

95903 ............ A Motor nerve conduction test .............................. 0.60 0.54 0.54 0.05 1.19 1.19 XXX

95903 26 A Motor nerve conduction test .............................. 0.60 0.26 0.26 0.03 0.89 0.89 XXX

95903 TC A Motor nerve conduction test .............................. 0.00 0.27 0.27 0.02 0.29 0.29 XXX

95904 ............ A Sense nerve conduction test ............................. 0.34 0.34 0.34 0.05 0.73 0.73 XXX

95904 26 A Sense nerve conduction test ............................. 0.34 0.15 0.15 0.03 0.52 0.52 XXX

95904 TC A Sense nerve conduction test ............................. 0.00 0.19 0.19 0.02 0.21 0.21 XXX

95920 ............ A Intraoperative nerve testing ............................... 2.11 NA 5.56 0.20 NA 7.87 XXX

95920 26 A Intraoperative nerve testing ............................... 2.11 NA 0.98 0.12 NA 3.21 XXX

95920 TC A Intraoperative nerve testing ............................... 0.00 NA 4.58 0.08 NA 4.66 XXX

95921 ............ A Autonomic nervous func test ............................. 0.90 5.48 5.48 0.05 6.43 6.43 XXX

95921 26 A Autonomic nervous func test ............................. 0.90 0.90 0.90 0.02 1.82 1.82 XXX

95921 TC A Autonomic nervous func test ............................. 0.00 4.58 4.58 0.03 4.61 4.61 XXX

95922 ............ A Autonomic nervous func test ............................. 0.96 5.54 5.54 0.06 6.56 6.56 XXX

95922 26 A Autonomic nervous func test ............................. 0.96 0.96 0.96 0.03 1.95 1.95 XXX

95922 TC A Autonomic nervous func test ............................. 0.00 4.58 4.58 0.03 4.61 4.61 XXX

95923 ............ A Autonomic nervous func test ............................. 0.90 5.48 5.48 0.05 6.43 6.43 XXX

95923 26 A Autonomic nervous func test ............................. 0.90 0.90 0.90 0.02 1.82 1.82 XXX

95923 TC A Autonomic nervous func test ............................. 0.00 4.58 4.58 0.03 4.61 4.61 XXX

95925 ............ A Somatosensory testing ....................................... 0.54 2.65 2.65 0.12 3.31 3.31 XXX

95925 26 A Somatosensory testing ....................................... 0.54 0.28 0.28 0.05 0.87 0.87 XXX

95925 TC A Somatosensory testing ....................................... 0.00 2.37 2.37 0.07 2.44 2.44 XXX

95926 ............ A Somatosensory testing ....................................... 0.54 2.57 2.57 0.12 3.23 3.23 XXX

95926 26 A Somatosensory testing ....................................... 0.54 0.28 0.28 0.05 0.87 0.87 XXX

95926 TC A Somatosensory testing ....................................... 0.00 2.29 2.29 0.07 2.36 2.36 XXX

95927 ............ A Somatosensory testing ....................................... 0.54 2.40 2.40 0.12 3.06 3.06 XXX

95927 26 A Somatosensory testing ....................................... 0.54 0.27 0.27 0.05 0.86 0.86 XXX

95927 TC A Somatosensory testing ....................................... 0.00 2.13 2.13 0.07 2.20 2.20 XXX

95930 ............ A Visual evoked potential test ............................... 0.35 1.34 1.34 0.05 1.74 1.74 XXX

95930 26 A Visual evoked potential test ............................... 0.35 0.16 0.16 0.04 0.55 0.55 XXX

95930 TC A Visual evoked potential test ............................... 0.00 1.18 1.18 0.01 1.19 1.19 XXX

95933 ............ A Blink reflex test ................................................... 0.59 0.44 0.44 0.10 1.13 1.13 XXX

95933 26 A Blink reflex test ................................................... 0.59 0.21 0.21 0.04 0.84 0.84 XXX

95933 TC A Blink reflex test ................................................... 0.00 0.24 0.24 0.06 0.30 0.30 XXX

95934 ............ A ‘h’ reflex test ....................................................... 0.51 0.50 0.50 0.05 1.06 1.06 XXX

95934 26 A ‘h’ reflex test ....................................................... 0.51 0.23 0.23 0.03 0.77 0.77 XXX

95934 TC A ‘h’ reflex test ....................................................... 0.00 0.27 0.27 0.02 0.29 0.29 XXX

95936 ............ A ‘h’ reflex test ....................................................... 0.55 0.50 0.50 0.05 1.10 1.10 XXX

95936 26 A ‘h’ reflex test ....................................................... 0.55 0.26 0.26 0.03 0.84 0.84 XXX
31004

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

95936 TC A ‘h’ reflex test ....................................................... 0.00 0.24 0.24 0.02 0.26 0.26 XXX

95937 ............ A Neuromuscular junction test .............................. 0.65 0.52 0.52 0.07 1.24 1.24 XXX

95937 26 A Neuromuscular junction test .............................. 0.65 0.24 0.24 0.04 0.93 0.93 XXX

95937 TC A Neuromuscular junction test .............................. 0.00 0.28 0.28 0.03 0.31 0.31 XXX

95950 ............ A Ambulatory eeg monitoring ................................ 1.51 4.32 4.32 0.60 6.43 6.43 XXX

95950 26 A Ambulatory eeg monitoring ................................ 1.51 0.66 0.66 0.10 2.27 2.27 XXX

95950 TC A Ambulatory eeg monitoring ................................ 0.00 3.65 3.65 0.50 4.15 4.15 XXX

95951 ............ A EEG monitoring/videorecord .............................. 6.00 18.23 18.23 0.64 24.87 24.87 XXX

95951 26 A EEG monitoring/videorecord .............................. 6.00 2.53 2.53 0.11 8.64 8.64 XXX

95951 TC A EEG monitoring/videorecord .............................. 0.00 15.70 15.70 0.53 16.23 16.23 XXX

95953 ............ A EEG monitoring/computer .................................. 3.08 3.79 3.79 0.60 7.47 7.47 XXX

95953 26 A EEG monitoring/computer .................................. 3.08 1.46 1.46 0.10 4.64 4.64 XXX

95953 TC A EEG monitoring/computer .................................. 0.00 2.33 2.33 0.50 2.83 2.83 XXX

95954 ............ A EEG monitoring/giving drugs ............................. 2.45 3.26 3.26 0.28 5.99 5.99 XXX

95954 26 A EEG monitoring/giving drugs ............................. 2.45 0.98 0.98 0.22 3.65 3.65 XXX

95954 TC A EEG monitoring/giving drugs ............................. 0.00 2.27 2.27 0.06 2.33 2.33 XXX

95955 ............ A EEG during surgery ........................................... 1.01 3.88 3.88 0.30 5.19 5.19 XXX

95955 26 A EEG during surgery ........................................... 1.01 0.35 0.35 0.11 1.47 1.47 XXX

95955 TC A EEG during surgery ........................................... 0.00 3.53 3.53 0.19 3.72 3.72 XXX

95956 ............ A EEG monitoring/cable/radio ............................... 3.08 44.02 44.02 0.61 47.71 47.71 XXX

95956 26 A EEG monitoring/cable/radio ............................... 3.08 1.08 1.08 0.11 4.27 4.27 XXX

95956 TC A EEG monitoring/cable/radio ............................... 0.00 42.94 42.94 0.50 43.44 43.44 XXX

95957 ............ A EEG digital analysis ........................................... 1.98 2.51 2.51 0.18 4.67 4.67 XXX

95957 26 A EEG digital analysis ........................................... 1.98 0.95 0.95 0.05 2.98 2.98 XXX

95957 TC A EEG digital analysis ........................................... 0.00 1.56 1.56 0.13 1.69 1.69 XXX

95958 ............ A EEG monitoring/function test ............................. 4.25 8.40 8.40 0.52 13.17 13.17 XXX

95958 26 A EEG monitoring/function test ............................. 4.25 1.63 1.63 0.38 6.26 6.26 XXX

95958 TC A EEG monitoring/function test ............................. 0.00 6.77 6.77 0.14 6.91 6.91 XXX

95961 ............ A Electrode stimulation, brain ................................ 2.97 4.99 4.99 0.20 8.16 8.16 XXX

95961 26 A Electrode stimulation, brain ................................ 2.97 1.17 1.17 0.12 4.26 4.26 XXX

95961 TC A Electrode stimulation, brain ................................ 0.00 3.82 3.82 0.08 3.90 3.90 XXX

95962 ............ A Electrode stimulation, brain ................................ 3.21 3.87 3.87 0.20 7.28 7.28 XXX

95962 26 A Electrode stimulation, brain ................................ 3.21 1.42 1.42 0.12 4.75 4.75 XXX

95962 TC A Electrode stimulation, brain ................................ 0.00 2.45 2.45 0.08 2.53 2.53 XXX

96100 ............ A Psychological testing .......................................... 0.00 0.40 0.37 0.20 0.60 0.57 XXX

96105 ............ A Assessment of aphasia ...................................... 0.00 0.49 0.38 0.20 0.69 0.58 XXX

96111 ............ A Developmental test, extend ............................... 0.00 0.54 0.41 0.20 0.74 0.61 XXX

96115 ............ A Neurobehavior status exam ............................... 0.00 0.70 0.54 0.20 0.90 0.74 XXX

96117 ............ A Neuropsych test battery ..................................... 0.00 0.54 0.49 0.20 0.74 0.69 XXX

96400 ............ A Chemotherapy, (SC)/(IM) ................................... 0.00 1.06 0.29 0.01 1.07 0.30 XXX

96405 ............ A Intralesional chemo admin ................................. 0.52 0.95 0.25 0.03 1.50 0.80 000

96406 ............ A Intralesional chemo admin ................................. 0.80 1.10 0.30 0.04 1.94 1.14 000

96408 ............ A Chemotherapy, push technique ......................... 0.00 1.04 0.31 0.06 1.10 0.37 XXX

96410 ............ A Chemotherapy, infusion method ........................ 0.00 1.16 0.34 0.09 1.25 0.43 XXX

96412 ............ A Chemotherapy, infusion method ........................ 0.00 0.52 0.15 0.08 0.60 0.23 XXX

96414 ............ A Chemotherapy, infusion method ........................ 0.00 1.16 0.35 0.09 1.25 0.44 XXX

96420 ............ A Chemotherapy, push technique ......................... 0.00 1.15 0.34 0.09 1.24 0.43 XXX

96422 ............ A Chemotherapy, infusion method ........................ 0.00 1.16 0.35 0.09 1.25 0.44 XXX

96423 ............ A Chemotherapy, infusion method ........................ 0.00 0.94 0.27 0.03 0.97 0.30 XXX

96425 ............ A Chemotherapy, infusion method ........................ 0.00 1.24 0.36 0.09 1.33 0.45 XXX

96440 ............ A Chemotherapy, intracavitary .............................. 2.37 2.83 1.03 0.06 5.26 3.46 000

96445 ............ A Chemotherapy, intracavitary .............................. 2.20 2.79 1.01 0.09 5.08 3.30 000

96450 ............ A Chemotherapy, into CNS ................................... 1.89 2.42 0.84 0.06 4.37 2.79 000

96520 ............ A Pump refilling, maintenance ............................... 0.00 0.85 0.25 0.06 0.91 0.31 XXX

96530 ............ A Pump refilling, maintenance ............................... 0.00 0.93 0.27 0.07 1.00 0.34 XXX

96542 ............ A Chemotherapy injection ..................................... 1.42 1.76 0.67 0.13 3.31 2.22 XXX

96900 ............ A Ultraviolet light therapy ...................................... 0.00 0.17 0.06 0.03 0.20 0.09 XXX

96902 ............ B Trichogram ......................................................... +0.41 0.54 0.54 0.02 0.97 0.97 XXX

96910 ............ A Photochemotherapy with UV–B ......................... 0.00 0.17 0.06 0.04 0.21 0.10 XXX

96912 ............ A Photochemotherapy with UV–A ......................... 0.00 0.23 0.08 0.05 0.28 0.13 XXX

96913 ............ A Photochemotherapy, UV–A or B ........................ 0.00 0.40 0.14 0.10 0.50 0.24 XXX

97001 ............ A Pt evaluation ...................................................... 1.20 0.34 0.47 0.11 1.65 1.78 XXX

97002 ............ A Pt re-evaluation .................................................. 0.60 0.25 0.23 0.01 0.86 0.84 XXX

97003 ............ A Ot evaluation ...................................................... 1.20 0.54 0.54 0.11 1.85 1.85 XXX

97004 ............ A Ot re-evaluation .................................................. 0.60 0.21 0.14 0.01 0.82 0.75 XXX

97010 ............ B Hot or cold packs therapy .................................. +0.06 0.13 0.02 0.02 0.21 0.10 XXX

97012 ............ A Mechanical traction therapy ............................... 0.25 0.14 0.03 0.02 0.41 0.30 XXX

97014 ............ A Electric stimulation therapy ................................ 0.18 0.13 0.02 0.02 0.33 0.22 XXX

97016 ............ A Vasopneumatic device therapy .......................... 0.18 0.13 0.02 0.02 0.33 0.22 XXX

97018 ............ A Paraffin bath therapy .......................................... 0.06 0.11 0.01 0.03 0.20 0.10 XXX

97020 ............ A Microwave therapy ............................................. 0.06 0.12 0.01 0.02 0.20 0.09 XXX

97022 ............ A Whirlpool therapy ............................................... 0.17 0.13 0.02 0.02 0.32 0.21 XXX

97024 ............ A Diathermy treatment ........................................... 0.06 0.12 0.01 0.02 0.20 0.09 XXX

97026 ............ A Infrared therapy .................................................. 0.06 0.11 0.01 0.02 0.19 0.09 XXX
31005

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

97028 ............ A Ultraviolet therapy .............................................. 0.08 0.11 0.01 0.01 0.20 0.10 XXX

97032 ............ A Electrical stimulation .......................................... 0.25 0.15 0.03 0.01 0.41 0.29 XXX

97033 ............ A Electric current therapy ...................................... 0.26 0.16 0.03 0.02 0.44 0.31 XXX

97034 ............ A Contrast bath therapy ........................................ 0.21 0.14 0.02 0.01 0.36 0.24 XXX

97035 ............ A Ultrasound therapy ............................................. 0.21 0.14 0.02 0.01 0.36 0.24 XXX

97036 ............ A Hydrotherapy ...................................................... 0.28 0.17 0.03 0.02 0.47 0.33 XXX

97039 ............ A Physical therapy treatment ................................ 0.20 0.14 0.02 0.03 0.37 0.25 XXX

97110 ............ A Therapeutic exercises ........................................ 0.45 0.18 0.05 0.02 0.65 0.52 XXX

97112 ............ A Neuromuscular reeducation ............................... 0.45 0.16 0.05 0.01 0.62 0.51 XXX

97113 ............ A Aquatic therapy/exercises .................................. 0.44 0.16 0.05 0.02 0.62 0.51 XXX

97116 ............ A Gait training therapy ........................................... 0.40 0.15 0.04 0.01 0.56 0.45 XXX

97122 ............ A Manual traction therapy ..................................... 0.42 0.15 0.04 0.01 0.58 0.47 XXX

97124 ............ A Massage therapy ................................................ 0.35 0.15 0.04 0.01 0.51 0.40 XXX

97139 ............ A Physical medicine procedure ............................. 0.21 0.13 0.02 0.02 0.36 0.25 XXX

97150 ............ A Group therapeutic procedures ........................... 0.27 0.14 0.03 0.02 0.43 0.32 XXX

97250 ............ A Myofascial release ............................................. 0.45 0.17 0.05 0.04 0.66 0.54 000

97260 ............ A Regional manipulation ........................................ 0.19 0.13 0.02 0.02 0.34 0.23 000

97261 ............ A Supplemental manipulations .............................. 0.12 0.15 0.01 0.01 0.28 0.14 000

97265 ............ A Joint mobilization ................................................ 0.45 0.16 0.05 0.04 0.65 0.54 XXX

97504 ............ A Orthotic training .................................................. 0.45 0.14 0.05 0.02 0.61 0.52 XXX

97520 ............ A Prosthetic training .............................................. 0.45 0.16 0.05 0.02 0.63 0.52 XXX

97530 ............ A Therapeutic activities ......................................... 0.44 0.16 0.05 0.02 0.62 0.51 XXX

97535 ............ A Self care mngment training ................................ 0.45 0.16 0.05 0.02 0.63 0.52 XXX

97537 ............ A Community/work reintegration ........................... 0.45 0.16 0.05 0.02 0.63 0.52 XXX

97542 ............ A Wheelchair mngement training .......................... 0.25 0.14 0.03 0.02 0.41 0.30 XXX

97703 ............ A Prosthetic checkout ............................................ 0.25 0.06 0.03 0.03 0.34 0.31 XXX

97750 ............ A Physical performance test .................................. 0.45 0.15 0.05 0.03 0.63 0.53 XXX

97770 ............ A Cognitive skills development .............................. 0.44 0.14 0.05 0.03 0.61 0.52 XXX

98925 ............ A Osteopathic manipulation ................................... 0.45 0.29 0.17 0.02 0.76 0.64 000

98926 ............ A Osteopathic manipulation ................................... 0.65 0.38 0.28 0.03 1.06 0.96 000

98927 ............ A Osteopathic manipulation ................................... 0.87 0.44 0.32 0.03 1.34 1.22 000

98928 ............ A Osteopathic manipulation ................................... 1.03 0.52 0.36 0.04 1.59 1.43 000

98929 ............ A Osteopathic manipulation ................................... 1.19 0.56 0.40 0.03 1.78 1.62 000

98940 ............ A Chiropractic manipulation ................................... 0.45 0.24 0.12 0.01 0.70 0.58 000

98941 ............ A Chiropractic manipulation ................................... 0.65 0.29 0.17 0.01 0.95 0.83 000

98942 ............ A Chiropractic manipulation ................................... 0.87 0.35 0.23 0.01 1.23 1.11 000

98943 ............ N Chiropractic manipulation ................................... +0.40 0.72 0.40 0.01 1.13 0.81 XXX

99141 ............ B Sedation, iv/im or inhalant ................................. +0.80 2.82 0.97 0.05 3.67 1.82 XXX

99142 ............ B Sedation, oral/rectal/nasal .................................. +0.60 2.62 0.77 0.04 3.26 1.41 XXX

99175 ............ A Induction of vomiting .......................................... 0.00 0.28 0.07 0.10 0.38 0.17 XXX

99183 ............ A Hyperbaric oxygen therapy ................................ 2.34 0.75 0.73 0.11 3.20 3.18 XXX

99185 ............ A Regional hypothermia ........................................ 0.00 NA 0.05 0.04 NA 0.09 XXX

99186 ............ A Total body hypothermia ..................................... 0.00 NA 0.05 0.52 NA 0.57 XXX

99195 ............ A Phlebotomy ........................................................ 0.00 1.26 0.11 0.03 1.29 0.14 XXX

99201 ............ A Office/outpatient visit, new ................................. 0.45 0.83 0.32 0.04 1.32 0.81 XXX

99202 ............ A Office/outpatient visit, new ................................. 0.88 1.11 0.50 0.05 2.04 1.43 XXX

99203 ............ A Office/outpatient visit, new ................................. 1.34 1.49 0.73 0.06 2.89 2.13 XXX

99204 ............ A Office/outpatient visit, new ................................. 2.00 2.00 1.00 0.08 4.08 3.08 XXX

99205 ............ A Office/outpatient visit, new ................................. 2.67 2.24 1.21 0.09 5.00 3.97 XXX

99211 ............ A Office/outpatient visit, est ................................... 0.17 0.32 0.16 0.02 0.51 0.35 XXX

99212 ............ A Office/outpatient visit, est ................................... 0.45 0.45 0.28 0.02 0.92 0.75 XXX

99213 ............ A Office/outpatient visit, est ................................... 0.67 0.55 0.35 0.03 1.25 1.05 XXX

99214 ............ A Office/outpatient visit, est ................................... 1.10 0.84 0.55 0.04 1.98 1.69 XXX

99215 ............ A Office/outpatient visit, est ................................... 1.77 1.12 0.80 0.07 2.96 2.64 XXX

99217 ............ A Observation care discharge ............................... 1.28 NA 0.55 0.04 NA 1.87 XXX

99218 ............ A Observation care ................................................ 1.28 NA 0.62 0.06 NA 1.96 XXX

99219 ............ A Observation care ................................................ 2.14 NA 0.92 0.09 NA 3.15 XXX

99220 ............ A Observation care ................................................ 2.99 NA 1.27 0.09 NA 4.35 XXX

99221 ............ A Initial hospital care ............................................. 1.28 NA 0.64 0.06 NA 1.98 XXX

99222 ............ A Initial hospital care ............................................. 2.14 NA 0.94 0.09 NA 3.17 XXX

99223 ............ A Initial hospital care ............................................. 2.99 NA 1.26 0.08 NA 4.33 XXX

99231 ............ A Subsequent hospital care .................................. 0.64 NA 0.28 0.03 NA 0.95 XXX

99232 ............ A Subsequent hospital care .................................. 1.06 NA 0.43 0.04 NA 1.53 XXX

99233 ............ A Subsequent hospital care .................................. 1.51 NA 0.60 0.05 NA 2.16 XXX

99234 ............ A Observ/hosp same date ..................................... 2.56 NA 1.09 0.06 NA 3.71 XXX

99235 ............ A Observ/hosp same date ..................................... 3.42 NA 1.38 0.09 NA 4.89 XXX

99236 ............ A Observ/hosp same date ..................................... 4.27 NA 1.72 0.09 NA 6.08 XXX

99238 ............ A Hospital discharge day ....................................... 1.28 NA 0.57 0.04 NA 1.89 XXX

99239 ............ A Hospital discharge day ....................................... 1.75 NA 0.73 0.04 NA 2.52 XXX

99241 ............ A Office consultation .............................................. 0.64 0.72 0.40 0.08 1.44 1.12 XXX

99242 ............ A Office consultation .............................................. 1.29 1.12 0.66 0.09 2.50 2.04 XXX

99243 ............ A Office consultation .............................................. 1.72 1.41 0.87 0.10 3.23 2.69 XXX

99244 ............ A Office consultation .............................................. 2.58 1.80 1.19 0.11 4.49 3.88 XXX

99245 ............ A Office consultation .............................................. 3.43 2.12 1.52 0.16 5.71 5.11 XXX
31006

444444444444 1 CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

2 Copyright 1994 American Dental Association. All rights reserved.

3+ Indicates RVUs are not for Medicare Payment.

Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

99251 ............ A Initial inpatient consult ........................................ 0.66 NA 0.40 0.08 NA 1.14 XXX

99252 ............ A Initial inpatient consult ........................................ 1.32 NA 0.71 0.09 NA 2.12 XXX

99253 ............ A Initial inpatient consult ........................................ 1.82 NA 0.94 0.10 NA 2.86 XXX

99254 ............ A Initial inpatient consult ........................................ 2.64 NA 1.26 0.11 NA 4.01 XXX

99255 ............ A Initial inpatient consult ........................................ 3.65 NA 1.66 0.14 NA 5.45 XXX

99261 ............ A Follow-up inpatient consult ................................ 0.42 NA 0.30 0.03 NA 0.75 XXX

99262 ............ A Follow-up inpatient consult ................................ 0.85 NA 0.48 0.04 NA 1.37 XXX

99263 ............ A Follow-up inpatient consult ................................ 1.27 NA 0.65 0.04 NA 1.96 XXX

99271 ............ A Confirmatory consultation .................................. 0.45 0.46 0.32 0.07 0.98 0.84 XXX

99272 ............ A Confirmatory consultation .................................. 0.84 0.65 0.50 0.09 1.58 1.43 XXX

99273 ............ A Confirmatory consultation .................................. 1.19 0.90 0.65 0.11 2.20 1.95 XXX

99274 ............ A Confirmatory consultation .................................. 1.73 1.19 0.85 0.11 3.03 2.69 XXX

99275 ............ A Confirmatory consultation .................................. 2.31 1.34 1.05 0.17 3.82 3.53 XXX

99281 ............ A Emergency dept visit .......................................... 0.33 NA 0.11 0.01 NA 0.45 XXX

99282 ............ A Emergency dept visit .......................................... 0.55 NA 0.15 0.03 NA 0.73 XXX

99283 ............ A Emergency dept visit .......................................... 1.24 NA 0.27 0.04 NA 1.55 XXX

99284 ............ A Emergency dept visit .......................................... 1.95 NA 0.39 0.06 NA 2.40 XXX

99285 ............ A Emergency dept visit .......................................... 3.06 NA 0.57 0.08 NA 3.71 XXX

99291 ............ A Critical care, first hour ........................................ 4.00 1.45 1.50 0.11 5.56 5.61 XXX

99292 ............ A Critical care, addl 30 min ................................... 2.00 0.78 0.79 0.04 2.82 2.83 XXX

99295 ............ A Neonatal critical care ......................................... 16.00 NA 5.32 1.55 NA 22.87 XXX

99296 ............ A Neonatal critical care ......................................... 8.00 NA 4.60 0.77 NA 13.37 XXX

99297 ............ A Neonatal critical care ......................................... 4.00 NA 3.54 0.38 NA 7.92 XXX

99301 ............ A Nursing facility care ............................................ 1.20 NA 0.69 0.03 NA 1.92 XXX

99302 ............ A Nursing facility care ............................................ 1.61 NA 0.89 0.04 NA 2.54 XXX

99303 ............ A Nursing facility care ............................................ 2.01 NA 1.05 0.07 NA 3.13 XXX

99311 ............ A Nursing facility care, subseq .............................. 0.60 NA 0.38 0.03 NA 1.01 XXX

99312 ............ A Nursing facility care, subseq .............................. 1.00 NA 0.52 0.03 NA 1.55 XXX

99313 ............ A Nursing facility care, subseq .............................. 1.42 NA 0.68 0.04 NA 2.14 XXX

99315 ............ A Nursing fac discharge day ................................. 1.13 NA 1.48 0.04 NA 2.65 XXX

99316 ............ A Nursing fac discharge day ................................. 1.50 NA 1.85 0.04 NA 3.39 XXX

99321 ............ A Rest home visit, new patient .............................. 0.71 0.36 0.61 0.03 1.10 1.35 XXX

99322 ............ A Rest home visit, new patient .............................. 1.01 0.55 0.89 0.05 1.61 1.95 XXX

99323 ............ A Rest home visit, new patient .............................. 1.28 0.70 0.97 0.06 2.04 2.31 XXX

99331 ............ A Rest home visit, estab pat ................................. 0.60 0.35 0.53 0.02 0.97 1.15 XXX

99332 ............ A Rest home visit, estab pat ................................. 0.80 0.45 0.60 0.03 1.28 1.43 XXX

99333 ............ A Rest home visit, estab pat ................................. 1.00 0.54 1.06 0.02 1.56 2.08 XXX

99341 ............ A Home visit, new patient ...................................... 1.01 0.48 0.60 0.05 1.54 1.66 XXX

99342 ............ A Home visit, new patient ...................................... 1.52 0.73 1.02 0.05 2.30 2.59 XXX

99343 ............ A Home visit, new patient ...................................... 2.27 1.07 1.45 0.06 3.40 3.78 XXX

99344 ............ A Home visit, new patient ...................................... 3.03 1.34 1.74 0.09 4.46 4.86 XXX

99345 ............ A Home visit, new patient ...................................... 3.79 1.61 2.04 0.09 5.49 5.92 XXX

99347 ............ A Home visit, estab patient ................................... 0.76 0.39 0.68 0.04 1.19 1.48 XXX

99348 ............ A Home visit, estab patient ................................... 1.26 0.61 0.86 0.04 1.91 2.16 XXX

99349 ............ A Home visit, estab patient ................................... 2.02 0.90 0.83 0.05 2.97 2.90 XXX

99350 ............ A Home visit, estab patient ................................... 3.03 1.24 1.06 0.07 4.34 4.16 XXX

99354 ............ A Prolonged service, office .................................... 1.77 1.03 0.73 0.07 2.87 2.57 XXX

99355 ............ A Prolonged service, office .................................... 1.77 0.92 0.66 0.07 2.76 2.50 XXX

99356 ............ A Prolonged service, inpatient ............................... 1.71 NA 0.63 0.08 NA 2.42 XXX

99357 ............ A Prolonged service, inpatient ............................... 1.71 NA 0.67 0.08 NA 2.46 XXX

99374 ............ B Home health care supervision ........................... +1.10 2.51 1.99 0.04 3.65 3.13 XXX

99375 ............ A Home health care supervision ........................... 1.73 1.03 0.87 0.04 2.80 2.64 XXX

99377 ............ B Hospice care supervision ................................... +1.10 2.51 1.99 0.04 3.65 3.13 XXX

99378 ............ A Hospice care supervision ................................... 1.73 1.03 0.87 0.04 2.80 2.64 XXX

99379 ............ B Nursing fac care supervision ............................. +1.10 2.51 1.99 0.04 3.65 3.13 XXX

99380 ............ B Nursing fac care supervision ............................. +1.73 3.14 2.62 0.04 4.91 4.39 XXX

99381 ............ N Preventive visit, new, infant ............................... +1.19 2.61 1.19 0.08 3.88 2.46 XXX

99382 ............ N Preventive visit, new, age 1–4 ........................... +1.36 2.74 1.36 0.09 4.19 2.81 XXX

99383 ............ N Preventive visit, new, age 5–11 ......................... +1.36 2.66 1.36 0.09 4.11 2.81 XXX

99384 ............ N Preventive visit, new, 12–17 .............................. +1.53 2.83 1.53 0.10 4.46 3.16 XXX

99385 ............ N Preventive visit, new, 18–39 .............................. +1.53 2.83 1.53 0.09 4.45 3.15 XXX

99386 ............ N Preventive visit, new, 40–64 .............................. +1.88 3.25 1.88 0.10 5.23 3.86 XXX

99387 ............ N Preventive visit, new, 65 & over ........................ +2.06 3.51 2.06 0.11 5.68 4.23 XXX

99391 ............ N Preventive visit, est, infant ................................. +1.02 1.86 1.02 0.07 2.95 2.11 XXX

99392 ............ N Preventive visit, est, age 1–4 ............................. +1.19 2.03 1.19 0.08 3.30 2.46 XXX

99393 ............ N Preventive visit, est, age 5–11 ........................... +1.19 1.99 1.19 0.08 3.26 2.46 XXX

99394 ............ N Preventive visit, est, 12–17 ................................ +1.36 2.18 1.36 0.09 3.63 2.81 XXX

99395 ............ N Preventive visit, est, 18–39 ................................ +1.36 2.23 1.98 0.08 3.67 3.42 XXX

99396 ............ N Preventive visit, est, 40–64 ................................ +1.53 2.43 2.15 0.09 4.05 3.77 XXX

99397 ............ N Preventive visit, est, 65 & over .......................... +1.71 2.65 2.33 0.10 4.46 4.14 XXX

99401 ............ N Preventive counseling, indiv .............................. +0.48 1.06 0.87 0.03 1.57 1.38 XXX

99402 ............ N Preventive counseling, indiv .............................. +0.98 1.63 1.37 0.05 2.66 2.40 XXX

99403 ............ N Preventive counseling, indiv .............................. +1.46 2.18 1.85 0.08 3.72 3.39 XXX

99404 ............ N Preventive counseling, indiv .............................. +1.95 2.73 2.34 0.11 4.79 4.40 XXX
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 31007

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Nonfacility

practice

expense

RVUs

Facility

practice

expense

RVUs

Malpractice

RVUs

Nonfacility

total

Facility

total Global

99411 ............ N Preventive counseling, group ............................. +0.15 0.31 0.25 0.01 0.47 0.41 XXX

99412 ............ N Preventive counseling, group ............................. +0.25 0.45 0.35 0.01 0.71 0.61 XXX

99431 ............ A Initial care, normal newborn ............................... 1.17 NA 0.55 0.08 NA 1.80 XXX

99432 ............ A Newborn care not in hospital ............................. 1.26 0.93 0.42 0.08 2.27 1.76 XXX

99433 ............ A Normal newborn care, hospital .......................... 0.62 NA 0.33 0.04 NA 0.99 XXX

99435 ............ A Hospital NB discharge day ................................ 1.50 NA 0.64 0.10 NA 2.24 XXX

99436 ............ A Attendance, birth ................................................ 1.50 2.89 2.55 0.10 4.49 4.15 XXX

99440 ............ A Newborn resuscitation ........................................ 2.93 NA 3.10 0.19 NA 6.22 XXX

A4263 ............ A Permanent tear duct plug .................................. 0.00 2.60 0.90 0.00 2.60 0.90 XXX

A4300 ............ A Cath impl vasc access portal ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX

A4550 ............ A Surgical trays ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

G0002 ............ A Temporary urinary catheter ................................ 0.50 2.34 0.19 0.02 2.86 0.71 000

G0004 ............ A ECG transm phys review & int .......................... 0.52 0.63 0.63 0.65 1.80 1.80 XXX

G0005 ............ A ECG 24 hour recording ...................................... 0.00 0.12 0.12 0.09 0.21 0.21 XXX

G0006 ............ A ECG transmission & analysis ............................ 0.00 0.32 0.32 0.51 0.83 0.83 XXX

G0007 ............ A ECG phy review & interpret ............................... 0.52 0.26 0.26 0.05 0.83 0.83 XXX

G0015 ............ A Post symptom ECG tracing ............................... 0.00 0.32 0.32 0.51 0.83 0.83 XXX

G0016 ............ A Post symptom ECG md review .......................... 0.52 0.48 0.48 0.05 1.05 1.05 XXX

G0025 ............ A Collagen skin test kit .......................................... 0.00 1.17 0.32 0.00 1.17 0.32 XXX

G0030 26 A PET imaging prev PET single ............................ 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0031 26 A PET imaging prev PET multple ......................... 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0032 26 A PET follow SPECT 78464 singl ......................... 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0033 26 A PET follow SPECT 78464 mult .......................... 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0034 26 A PET follow SPECT 76865 singl ......................... 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0035 26 A PET follow SPECT 78465 mult .......................... 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0036 26 A PET follow cornry angio sing ............................. 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0037 26 A PET follow cornry angio mult ............................. 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0038 26 A PET follow myocard perf sing ............................ 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0039 26 A PET follow myocard perf mult ............................ 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0040 26 A PET follow stress echo singl .............................. 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0041 26 A PET follow stress echo mult .............................. 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0042 26 A PET follow ventriculogm sing ............................. 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0043 26 A PET follow ventriculogm mult ............................ 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0044 26 A PET following rest ECG singl ............................ 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0045 26 A PET following rest ECG mult ............................. 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0046 26 A PET follow stress ECG singl .............................. 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0047 26 A PET follow stress ECG mult .............................. 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0050 ............ A Residual urine by ultrasound ............................. 0.00 0.60 0.60 0.05 0.65 0.65 XXX

G0101 ............ A CA screen; pelvic/breast exam .......................... 0.45 1.17 0.81 0.02 1.64 1.28 XXX

G0104 ............ A CA screen; flexi sigmoidscope ........................... 0.96 6.84 1.15 0.12 7.92 2.23 000

G0105 ............ A Colorectal scrn; hi risk ind ................................. 3.70 12.28 5.01 0.39 16.37 9.10 000

G0106 ............ A Colon CA screen; barium enema ...................... 0.99 1.92 1.92 0.21 3.12 3.12 XXX

G0106 26 A Colon CA screen; barium enema ...................... 0.99 0.33 0.33 0.07 1.39 1.39 XXX

G0106 TC A Colon CA screen; barium enema ...................... 0.00 1.59 1.59 0.14 1.73 1.73 XXX

G0110 ............ R Nett pulm-rehab educ; ind ................................. 0.90 1.70 0.90 0.04 2.64 1.84 XXX

G0111 ............ R Nett pulm-rehab educ; group ............................. 0.27 0.59 0.27 0.02 0.88 0.56 XXX

G0112 ............ R Nett; nutrition guid, initial ................................... 1.72 3.32 2.36 0.10 5.14 4.18 XXX

G0113 ............ R Nett; nutrition guid, subseqnt ............................. 1.29 2.77 1.86 0.09 4.15 3.24 XXX

G0114 ............ R Nett; psychosocial consult ................................. 1.20 1.36 1.20 0.11 2.67 2.51 XXX

G0115 ............ R Nett; psychological testing ................................. 1.20 1.53 1.20 0.11 2.84 2.51 XXX

G0116 ............ R Nett; psychosocial counsel ................................ 1.11 1.70 1.52 0.05 2.86 2.68 XXX

G0120 ............ A Colon ca scrn; barium enema ............................ 0.99 1.92 1.92 0.21 3.12 3.12 XXX

G0120 26 A Colon ca scrn; barium enema ............................ 0.99 0.33 0.33 0.07 1.39 1.39 XXX

G0120 TC A Colon ca scrn; barium enema ............................ 0.00 1.59 1.59 0.14 1.73 1.73 XXX

G0121 ............ N Colon ca scrn; barium enema ............................ +3.70 12.28 5.01 0.39 16.37 9.10 XXX

G0122 ............ N Colon ca scrn; barium enema ............................ +0.99 1.92 1.92 0.21 3.12 3.12 XXX

G0122 26 N Colon ca scrn; barium enema ............................ +0.99 0.33 0.33 0.07 1.39 1.39 XXX

G0122 TC N Colon ca scrn; barium enema ............................ +0.00 1.59 1.59 0.14 1.73 1.73 XXX

G0124 26 A Screen c/v thin layer by MD .............................. 0.42 1.70 0.42 0.04 2.16 0.88 XXX

G0125 26 A Lung image (PET) .............................................. 1.50 0.36 0.36 0.07 1.93 1.93 XXX

G0126 26 A Lung image (PET), staging ................................ 1.87 0.48 0.48 0.10 2.45 2.45 XXX

G0127 ............ R Trim nail(s) ......................................................... 0.11 1.59 0.11 0.02 1.72 0.24 000

M0064 ............ A Visit for drug monitoring ..................................... 0.37 0.19 0.23 0.03 0.59 0.63 XXX

M0101 ............ G Foot care hygienic/pm ........................................ 0.43 1.91 0.43 0.03 2.37 0.89 XXX

P3001 26 A Screening pap smear by phys ........................... 0.42 1.00 0.15 0.04 1.46 0.61 XXX

Q0035 ............ A Cardiokymography ............................................. 0.17 0.32 0.32 0.04 0.53 0.53 XXX

Q0035 26 A Cardiokymography ............................................. 0.17 0.10 0.10 0.01 0.28 0.28 XXX

Q0035 TC A Cardiokymography ............................................. 0.00 0.22 0.22 0.03 0.25 0.25 XXX

Q0068 ............ A Extracorpeal plasmapheresis ............................. 1.67 3.38 0.68 0.16 5.21 2.51 000

Q0091 ............ A Obtaining screen pap smear .............................. 0.37 0.58 0.14 0.03 0.98 0.54 XXX

Q0092 ............ A Set up port xray equipment ............................... 0.00 0.22 0.22 0.01 0.23 0.23 XXX

R0070 ............ A Transport portable x-ray ..................................... 0.00 0.77 0.77 0.01 0.78 0.78 XXX

R0075 ............ A Transport port x-ray multipl ................................ 0.00 0.19 0.19 0.01 0.20 0.20 XXX
31008 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

ADDENDUM D.—PHYSICIAN CODES ALWAYS SUBJECT TO THE OUTPATIENT REHABILITATION FINANCIAL LIMITATION

CPT 1

code Description

29126 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC

29131 APPLICATION OF FINGER SPLINT; DYNAMIC

64550 APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR

90901 BIOFEEDBACK TRAINING BY ANY MODALITY

90911 BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER, INCLUDING EMG AND/OR MANOMETRY

92506 EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AUDITORY PROCESSING, AND/OR AURAL REHABILITATION STATUS

92507 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER (INCLUDES AURAL REHABILITATION); INDIVIDUAL

92508 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER (INCLUDES AURAL REHABILITATION); GROUP, TWO OR MORE INDIVIDUALS

92510 AURAL REHABILITATION FOLLOWING COCHLEAR IMPLANT (INCLUDES EVALUATION OF AURAL REHABILITATION STATUS

AND HEARING, THERAPEUTIC SERVICES) WITH OR WITHOUT SPEECH PROCESSOR PROGRAMMING

92525 EVALUATION OF SWALLOWING AND ORAL FUNCTION FOR FEEDING

92526 TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING

92597 EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC OR AUGMENTATIVE/ ALTERNATIVE COMMUNICATION

DEVICE TO SUPPLEMENT ORAL SPEECH

92598 MODIFICATION OF VOICE PROSTHETIC OR AUGMENTATIVE/ALTERNATIVE COMMUNICATION DEVICE TO SUPPLEMENT

ORAL SPEECH

95831 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); EXTREMITY (EXCLUDING HAND) OR TRUNK, WITH REPORT

95832 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); HAND, WITH OR WITHOUT COMPARISON WITH NORMAL SIDE

95833 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION OF BODY, EXCLUDING HANDS

95834 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION OF BODY, INCLUDING HANDS

95851 RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); EACH EXTREMITY (EXCLUDING HAND)

OR EACH TRUNK SECTION (SPINE)

95852 RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); HAND, WITH OR WITHOUT COMPARISON

WITH NORMAL SIDE

96105 ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING, WRITING, EG, BY BOSTON

DIAGNOSTIC APHASIA EXAMINATION) WITH INTERPRETATION AND REPOR

97001 PHYSICAL THERAPY EVALUATION

97002 PHYSICAL THERAPY RE-EVALUATION

97003 OCCUPATIONAL THERAPY EVALUATION

97004 OCCUPATIONAL THERAPY RE-EVALUATION

97010 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HOT OR COLD PACKS

97012 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION, MECHANICAL

97014 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)

97016 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC DEVICES

97018 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH

97020 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; MICROWAVE

97022 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL

97024 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY

97026 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED

97028 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET

97032 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES

97033 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES

97034 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES

97035 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES

97036 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES

97039 UNLISTED MODALITY (SPECIFY TYPE AND TIME IF CONSTANT ATTENDANCE)

97110 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP

STRENGTH AND ENDURANCE, RANGE OF MOTION AND FLEXIBILITY

97112 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALANCE, COORDINATION, KINESTHETIC SENSE, POSTURE, AND PROPRIOCEPTION

97113 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH THERAPEUTIC EXERCISES

97116 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING)

97122 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; TRACTION, MANUAL

97124 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE,

PETRISSAGE AND/OR TAPOTEMENT (STROKING, COMPRESSION, PERCUSSION)

97139 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)

97150 THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)

97250 MYOFASCIAL RELEASE/SOFT TISSUE MOBILIZATION, ONE OR MORE REGIONS

97260 MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC, HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN; ONE AREA
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 31009

ADDENDUM D.—PHYSICIAN CODES ALWAYS SUBJECT TO THE OUTPATIENT REHABILITATION FINANCIAL LIMITATION—

Continued

CPT 1

code Description

97261 MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC, HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN; EACH ADDITIONAL AREA

97265 JOINT MOBILIZATION, ONE OR MORE AREAS (PERIPHERAL OR SPINAL)

97504 ORTHOTICS FITTING AND TRAINING, UPPER AND/OR LOWER EXTREMITIES, EACH 15 MINUTES

97520 PROSTHETIC TRAINING, UPPER AND/OR LOWER EXTREMITIES, EACH 15 MINUTES

97530 THERAPEUTIC ACTIVITIES, DIRECT (ONE ON ONE) PATIENT CONTACT BY THE PROVIDER (USE OF DYNAMIC ACTIVITIES

TO IMPROVE FUNCTIONAL PERFORMANCE), EACH 15 MINUTES

97535 SELF CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING,

MEAL PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ADAPTIVE EQUIPMENT) DIRECT ONE ON

ONE CONTACT BY PROVIDER, EACH 15 MINUTES

97537 COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING, TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/OR WORK ENVIRONMENT/MODIFICATION ANALYSIS, WORK TASK ANALYSIS), DIRECT ONE ON

ONE CONTACT BY PROVIDER, EACH 15 MINUTES

97542 WHEELCHAIR MANAGEMENT/PROPULSION TRAINING, EACH 15 MINUTES

97545 WORK HARDENING/CONDITIONING; INITIAL 2 HOURS

97546 WORK HARDENING/CONDITIONING; EACH ADDITIONAL HOUR

97703 CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT, EACH 15 MINUTES

97750 PHYSICAL PERFORMANCE TEST OR MEASUREMENT (EG, MUSCULOSKELETAL, FUNCTIONAL CAPACITY), WITH WRITTEN

REPORT, EACH 15 MINUTES

97770 DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING, INCLUDES COMPENSATORY TRAINING AND/OR SENSORY INTEGRATIVE ACTIVITIES, DIRECT (ONE ON ONE) PATIENT CONTACT BY THE

PROVIDER, EACH 15 MINUTES

97780 ACUPUNCTURE, ONE OR MORE NEEDLES; WITHOUT ELECTRICAL STIMULATION

97781 ACUPUNCTURE, ONE OR MORE NEEDLES; WITH ELECTRICAL STIMULATION

97799 UNLISTED PHYSICAL MEDICINE/REHABILITATION SERVICE OR PROCEDURE

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

2 Not all listed services are covered by the Medicare program.

ADDENDUM E.—PHYSICIAN CODES POTENTIALLY SUBJECT TO THE OUTPATIENT REHABILITATION FINANCIAL LIMITATION

CPT 1

code Description

29065 APPLICATION; SHOULDER TO HAND (LONG ARM)

29075 APPLICATION; ELBOW TO FINGER (SHORT ARM)

29085 APPLICATION; HAND AND LOWER FOREARM (GAUNTLET)

29105 APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)

29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC

29130 APPLICATION OF FINGER SPLINT; STATIC

29200 STRAPPING; THORAX

29220 STRAPPING; LOW BACK

29240 STRAPPING; SHOULDER (EG, VELPEAU)

29260 STRAPPING; ELBOW OR WRIST

29280 STRAPPING; HAND OR FINGER

29345 APPLICATION OF LONG LEG CAST (THIGH TO TOES);

29355 APPLICATION OF LONG LEG CAST (THIGH TO TOES); WALKER OR AMBULATORY TYPE

29358 APPLICATION OF LONG LEG CAST BRACE

29365 APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)

29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);

29425 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); WALKING OR AMBULATORY TYPE

29435 APPLICATION OF PATELLAR TENDON BEARING (PTB) CAST

29445 APPLICATION OF RIGID TOTAL CONTACT LEG CAST

29505 APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)

29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)

29520 STRAPPING; HIP

29530 STRAPPING; KNEE

29540 STRAPPING; ANKLE

29550 STRAPPING; TOES

29580 STRAPPING; UNNA BOOT

29590 DENIS-BROWNE SPLINT STRAPPING

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

2 Not all listed services are covered by the Medicare program.
31010 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

ADDENDUM F.—OUTPATIENT REHABILITATION THERAPY CODES

CPT1/

code Description

11040 DEBRIDEMENT; SKIN, PARTIAL THICKNESS

11041 DEBRIDEMENT; SKIN, FULL THICKNESS

11042 DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE

11043 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE

11044 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE

29065 APPLICATION; SHOULDER TO HAND (LONG ARM)

29075 APPLICATION; ELBOW TO FINGER (SHORT ARM)

29085 APPLICATION; HAND AND LOWER FOREARM (GAUNTLET)

29345 APPLICATION OF LONG LEG CAST (THIGH TO TOES);

29365 APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)

29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);

29445 APPLICATION OF RIGID TOTAL CONTACT LEG CAST

29105 APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)

29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC

29126 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC

29130 APPLICATION OF FINGER SPLINT; STATIC

29131 APPLICATION OF FINGER SPLINT; DYNAMIC

29200 STRAPPING; THORAX

29220 STRAPPING; LOW BACK

29240 STRAPPING; SHOULDER (EG, VELPEAU)

29260 STRAPPING; ELBOW OR WRIST

29280 STRAPPING; HAND OR FINGER

29505 APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)

29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)

29520 STRAPPING; HIP

29530 STRAPPING; KNEE

29540 STRAPPING; ANKLE

29550 STRAPPING; TOES

29580 STRAPPING; UNNA BOOT

29590 DENIS-BROWNE SPLINT STRAPPING

64550 APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR

90724 IMMUNIZATION, ACTIVE; INFLUENZA VIRUS VACCINE

90732 IMMUNIZATION, ACTIVE; PNEUMOCOCCAL VACCINE, POLYVALENT

90744 IMMUNIZATION, ACTIVE; HEPATITIS B VACCINE; NEWBORN TO 11 YEARS

90745 IMMUNIZATION, ACTIVE; HEPATITIS B VACCINE; 11–19 YEARS

90746 IMMUNIZATION, ACTIVE; HEPATITIS B VACCINE; 20 YEARS AND ABOVE

90747 IMMUNIZATION, ACTIVE; HEPATITIS B VACCINE; DIALYSIS OR IMMUNOSUPPRESSED PATIENT, ANY AGE

90804 INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR

OUTPATIENT FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACT-TO-FACE WITH THE PATIENT

90901 BIOFEEDBACK TRAINING BY ANY MODALITY

90911 BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER, INCLUDING EMG AND/OR MANOMETRY

92506 EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AUDITORY PROCESSING, AND/OR AURAL REHABILITATION STATUS

92507 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCESSING DISORDER (INCLUDES AURAL REHABILITATION); INDIVIDUAL

92508 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCESSING DISORDER (INCLUDES AURAL REHABILITATION); GROUP, TWO OR MORE INDIVIDUALS

92510 AURAL REHABILITATION FOLLOWING COCHLEAR IMPLANT (INCLUDES EVALUATION OF AURAL REHABILITATION STATUS

AND HEARING, THERAPEUTIC SERVICES) WITH OR WITHOUT SPEECH PROCESSOR PROGRAMMING

92525 EVALUATION OF SWALLOWING AND ORAL FUNCTION FOR FEEDING

92526 TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING

92597 EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC OR AUGMENTATIVE/ ALTERNATIVE COMMUNICATION

DEVICE TO SUPPLEMENT ORAL SPEECH

92598 MODIFICATION OF VOICE PROSTHETIC OR AUGMENTATIVE/ALTERNATIVE COMMUNICATION DEVICE TO SUPPLEMENT

ORAL SPEECH

94664 AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION, BRONCHODILATION, OR SPUTUM INDUCTION FOR DIAGNOSTIC PURPOSES; INITIAL DEMONSTRATION AND/OR EVALUATION

94665 AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION, BRONCHODILATION, OR SPUTUM INDUCTION FOR DIAGNOSTIC PURPOSES; SUBSEQUENT

94667 MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND VIBRATION TO FACILITATE LUNG FUNCTION; INITIAL DEMONSTRATION AND/OR EVALUATION

94668 MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND VIBRATION TO FACILITATE LUNG FUNCTION; SUBSEQUENT

95831 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); EXTREMITY (EXCLUDING HAND) OR TRUNK, WITH REPORT

95832 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); HAND, WITH OR WITHOUT COMPARISON WITH NORMAL SIDE

95833 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION OF BODY, EXCLUDING HANDS

95834 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION OF BODY, INCLUDING HANDS
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules 31011

ADDENDUM F.—OUTPATIENT REHABILITATION THERAPY CODES—Continued

CPT1/

code Description

95851 RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); EACH EXTREMITY (EXCLUDING HAND)

OR EACH TRUNK SECTION (SPINE)

95852 RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); HAND, WITH OR WITHOUT COMPARISON

WITH NORMAL SIDE

96105 ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING, WRITING, EG, BY BOSTON

DIAGNOSTIC APHASIA EXAMINATION) WITH INTERPRETATION AND REPOR

96110 DEVELOPMENT TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING TEST II, EARLY LANGUAGE MILESTONE SCREEN),

WITH INTERPRETATION AND REPORT

96111 DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE, SOCIAL, ADAPTIVE AND/OR

COGNITIVE FUNCTIONING BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS, EG, BAYLEY SCALES OF INFANT DEVELOPMENT) WITH INTERPRETATION AND REPORT, PER HOUR

96115 NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDGMENT, EG, ACQUIRED

KNOWLEDGE, ATTENTION,MEMORY, VISUAL SPATIAL ABILITIES, LANGUAGE FUNCTIONS, PLANNING) WITH INTERPRETATION AND REPORT, PER HOUR

97001 PHYSICAL THERAPY EVALUATION

97002 PHYSICAL THERAPY RE-EVALUATION

97003 OCCUPATIONAL THERAPY EVALUATION

97004 OCCUPATIONAL THERAPY RE-EVALUATION

97010 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HOT OR COLD PACKS

97012 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION, MECHANICAL

97014 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)

97016 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC DEVICES

97018 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH

97020 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; MICROWAVE

97022 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL

97024 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY

97026 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED

97028 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET

97032 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES

97033 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; IONTOPHORESIS, EACH 15 MINUTES

97034 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES

97035 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES

97036 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK, EACH 15 MINUTES

97039 UNLISTED MODALITY (SPECIFY TYPE AND TIME IF CONSTANT ATTENDANCE)

97110 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP

STRENGTH AND ENDURANCE, RANGE OF MOTION AND FLEXIBILITY

97112 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALANCE, COORDINATION, KINESTHETIC SENSE, POSTURE, AND PROPRIOCEPTION

97113 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH THERAPEUTIC EXERCISES

97116 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING)

97122 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; TRACTION, MANUAL

97124 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE,

PETRISSAGE AND/OR TAPOTEMENT (STROKING, COMPRESSION, PERCUSSION)

97139 THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)

97150 THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)

97250 MYOFASCIAL RELEASE/SOFT TISSUE MOBILIZATION, ONE OR MORE REGIONS

97260 MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC, HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN; ONE AREA

97261 MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC, HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN; EACH ADDITIONAL AREA

97265 JOINT MOBILIZATION, ONE OR MORE AREAS (PERIPHERAL OR SPINAL)

97504 ORTHOTICS FITTING AND TRAINING, UPPER AND/OR LOWER EXTREMITIES, EACH 15 MINUTES

97520 PROSTHETIC TRAINING, UPPER AND/OR LOWER EXTREMITIES, EACH 15 MINUTES

97530 THERAPEUTIC ACTIVITIES, DIRECT (ONE ON ONE) PATIENT CONTACT BY THE PROVIDER (USE OF DYNAMIC ACTIVITIES

TO IMPROVE FUNCTIONAL PERFORMANCE), EACH 15 MINUTES

97535 SELF CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING,

MEAL PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ADAPTIVE EQUIPMENT) DIRECT ONE ON

ONE CONTACT BY PROVIDER, EACH 15 MINUTES

97537 COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING, TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/OR WORK ENVIRONMENT/ MODIFICATION ANALYSIS, WORK TASK ANALYSIS), DIRECT ONE

ON ONE CONTACT BY PROVIDER, EACH 15 MINUTES

97542 WHEELCHAIR MANAGEMENT/PROPULSION TRAINING, EACH 15 MINUTES

97545 WORK HARDENING/CONDITIONING; INITIAL 2 HOURS

97546 WORK HARDENING/CONDITIONING; EACH ADDITIONAL HOUR

97703 CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT, EACH 15 MINUTES
31012 Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed Rules

ADDENDUM F.—OUTPATIENT REHABILITATION THERAPY CODES—Continued

CPT1/

code Description

97750 PHYSICAL PERFORMANCE TEST OR MEASUREMENT (EG, MUSCULOSKELETAL, FUNCTIONAL CAPACITY), WITH WRITTEN

REPORT, EACH 15 MINUTES

97770 DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING, INCLUDES COMPENSATORY TRAINING AND/OR SENSORY INTEGRATIVE ACTIVITIES, DIRECT (ONE ON ONE) PATIENT CONTACT BY THE

PROVIDER, EACH 15 MINUTES

97780 ACUPUNCTURE, ONE OR MORE NEEDLES; WITHOUT ELECTRICAL STIMULATION

97781 ACUPUNCTURE, ONE OR MORE NEEDLES; WITH ELECTRICAL STIMULATION

97799 UNLISTED PHYSICAL MEDICINE/REHABILITATION SERVICE OR PROCEDURE DESCRIPTION

V5362 SPEECH SCREENING

V5363 LANGUAGE SCREENING

V5364 DYSPHAGIA SCREENING

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

2 Not all listed services are covered by the Medical program.

[FR Doc. 98–14650 Filed 6–1–98; 9:59 am]

BILLING CODE 4120–03–P