63124 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 400, 405, 410, 411, 412,

413, 414, 415, 417, and 489

[BPD–827–FC]

RIN 0938–AG96

Medicare Program; Revisions to

Payment Policies and Adjustments to

the Relative Value Units Under the

Physician Fee Schedule for Calendar

Year 1996

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Final rule with comment period.

SUMMARY: This final rule revises various

policies affecting payment for physician

services including Medicare payment

for physician services in teaching

settings, the relative value units (RVUs)

for certain existing procedure codes,

and establishes interim RVUs for new

and revised procedure codes. The rule

also includes the final revised 1996

geographic practice cost indices.

The rule redesignates current

regulations on teaching hospitals, on the

services of physicians to providers, on

the services of physicians in providers,

and on the services of interns and

residents. This redesignation

consolidates related rules affecting a

specific audience in a separate part and,

thereby, makes them easier to use.

DATES: Effective Date: This final rule is

effective January 1, 1996, except part

415 which is effective July 1, 1996.

Comment Date: We will accept

comments on interim RVUs for new or

revised procedure codes identified in

Addendum C. Comments will be

considered if we receive them at the

appropriate addresses, as provided

below, no later than 5 p.m., February 6,

1996.

ADDRESSES: Mail written comments (1

original and 3 copies) to the following

address: Health Care Financing

Administration, Department of Health

and Human Services, Attention: BPD–

827–FC, P.O. Box 7519, Baltimore, MD

21207–0519.

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

BPD–827–FC. 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).

For comments that relate to

information collection requirements,

mail a copy of comments to: Allison

Herron Eydt, HCFA Desk Officer, Office

of Information and Regulatory Affairs,

Rm. 10235, New Executive Office Bldg.,

Washington, DC 20530.

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 stock number 069–001–00090–4

and enclose a check or money order

payable to the Superintendent of

Documents, or enclose your Visa or

MasterCard 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.

Copies of the source files for this

document can also be purchased on

high density 3.5 inch personal computer

diskettes for $20.00. Send your request

to: Superintendent of Documents,

Attention: Electronic Products, P.O. Box

37082, Washington, DC 20013–7082.

Enclose a check or money order payable

to the Superintendent of Documents, or

enclose your Visa or MasterCard

number and expiration date. Credit card

orders for the diskettes can also be

placed by calling (202) 512–1530 or by

faxing to (202) 512–1262. The file

format on the diskettes is comma

delimited ASCII, Lotus 123, and

WordPerfect 5.1.

FOR FURTHER INFORMATION CONTACT:

Shana Olshan, (410) 786–5714 (for all

issues except those related to physician

services in teaching settings). William

Morse, (410) 786–4520 (for issues

related to physician services in teaching

settings).

SUPPLEMENTARY INFORMATION: In this

final rule, we provide background on

the statutory authority for and

development of the physician fee

schedule. We also explain in detail the

process by which certain interim work

RVUs are reviewed and, in some cases,

revised.

Section 1848(c)(2)(B) of the Social

Security Act (the Act) provides that

adjustments in RVUs resulting from an

annual 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. Thus, the statute allows a $20

million tolerance for increasing or

reducing total expenditures under the

physician fee schedule. We have

determined that net increases because of

changes in RVUs for codes reviewed as

part of a refinement process, the

addition of new codes to the fee

schedule, and the revisions in payment

policies would have added to projected

expenditures in calendar year 1996 by

approximately $140 million. Therefore,

it is necessary to adjust the physician

fee schedule conversion factors (CFs).

We have made the adjustments in such

a manner as to achieve budget neutrality

as we were best able to estimate. As a

result, the total projected expenditures

from the revised fee schedule are

estimated to be the same as they would

have been had we not changed the

RVUs for any individual codes or added

new codes to the fee schedule. We have

adjusted all CFs by a uniform

adjustment factor of 0.9964, which

results in a uniform reduction of 0.36

percent to the CFs for all services.

The CF is a national value that

converts RVUs into payment amounts.

There are three separate CFs: one for

surgical services, one for primary care

services, and one for nonsurgical

services other than primary care. The

CFs are updated annually.

Anesthesia services are paid

differently from other physicians’

services under the fee schedule.

Payment for anesthesia services is based

on base unit RVUs that are assigned to

each service and on time units that can

vary by procedure. The base and time

units are multiplied by an anesthesiaspecific CF, not the CFs used for

surgical, nonsurgical, or primary care

services.

This final rule also contains the

second half of the revisions to the

geographic practice cost indices (GPCIs).

Section 1848(e)(1)(c) of the Act requires

that the GPCIs be reviewed and, if

necessary, revised at least every 3 years.

The first review was required by 1995.

The first-half of the revision was

implemented in 1995. The second half,
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63125

published in Addendum D, is effective

January 1, 1996.

Addenda to this rule provide the

following information:

Addendum A—Explanation and Use of

Addenda B through E.

Addendum B—1996 Relative Value

Units and Related Information Used

in Determining Medicare Payments

for 1996.

Addendum C—Codes with Interim

Relative Value Units.

Addendum D—1996 Geographic

Practice Cost Indices by Medicare

Carrier and Locality.

Addendum E—Procedure Codes Subject

to the Site-of-Service Differential.

The RVUs and revisions to payment

policies in this final rule apply to

physicians’ services furnished on or

after January 1, 1996.

For those codes identified in

Addendum C of this final rule as new

or revised codes, the RVUs and update

indicators are considered to be interim

as they have not been published before

this final rule. Therefore, we will accept

comments on these interim RVUs and

update indicators if they are received no

later than 5 p.m. February 6, 1996. The

RVUs for the remaining codes are final.

To assist readers in referencing

sections contained in this final rule, we

are providing the following table of

contents. Some of the issues discussed

in this final rule affect the payment

policies but do not require changes to

the regulations in the Code of Federal

Regulations.

Table of Contents

I. Background

A. Legislative Requirements

B. Published Changes to the Fee Schedule

C. Components of the Fee Schedule

Payment Amounts

D. Summary of the Development of the

Relative Value Units

1. Work Relative Value Units

2. Practice Expense and Malpractice

Expense Relative Value Units

II. Specific Proposals for Calendar Year 1996

and Responses to Public Comments

A. Budget-Neutrality Adjustments for

Relative Value Units

B. Bundled Services

1. Hydration Therapy and Chemotherapy

2. Evaluation of Psychiatric Records and

Reports and Family Counseling Services

3. Fitting of Spectacles

C. X-Rays and Electrocardiograms Taken in

the Emergency Room

D. Extension of Site-of-Service Payment

Differential to Services in Ambulatory

Surgical Centers

E. Services of Teaching Physicians

1. General Background

2. Payment for Physician Services

Furnished in Teaching Settings

3. Payments for Supervising Physicians in

Teaching Settings and for Residents in

Certain Settings

4. Public Comments on the Teaching

Physician Proposal in the Proposed Rule

and Our Responses

F. Unspecified Physical and Occupational

Therapy Services (HCFA Common

Procedure Coding System Codes M0005

Through M0008 and H5300)

G. Transportation in Connection With

Furnishing Diagnostic Tests

H. Maxillofacial Prosthetic Services

I. Coverage of Mammography Services

III. Anesthesia Issues

A. Modifier Units for Anesthesia Services

B. Issue for Change in Calendar Year

1998—Two Anesthesia Providers

Involved in One Procedure

IV. Refinement of Relative Value Units for

Calendar Year 1996 and Responses to

Public Comments on Interim Relative

Value Units for 1995

A. Summary of Issues Discussed Related to

the Adjustment of Relative Value Units

B. Process for Establishing Work Relative

Value Units for the 1996 Fee Schedule

1. Work Relative Value Unit Refinements

of Interim and Related Relative Value

Units

2. Establishment of Interim Work Relative

Value Units for New and Revised Codes

for 1996

V. Issues for Discussion

A. Five-Year Refinement of Relative Value

Units

B. Resource-Based Practice Expense

Relative Value Units

C. Case Management in a Fee-for-Service

System

VI. Provisions of the Final Rule

VII. Collection of Information Requirements

VIII.Response to Comments

IX. Regulatory Impact Analysis

A. Regulatory Flexibility Act

B. Budget-Neutrality Adjustments

C. Bundled Services

1. Hydration Therapy and Chemotherapy

2. Evaluation of Psychiatric Records and

Reports and Family Counseling Services

3. Fitting of Spectacles

D. X-Rays and Electrocardiograms Taken in

the Emergency Room

E. Extension of Site-of-Service Payment

Differential to Services in Ambulatory

Surgical Centers

F. Services of Teaching Physicians

G. Unspecified Physical and Occupational

Therapy Services (HCFA Common

Procedure Coding System Codes M0005

Through M0008 and H5300)

H. Transportation in Connection With

Furnishing Diagnostic Tests

I. Maxillofacial Prosthetic Services

J. Coverage of Mammography Services

K. Two Anesthesia Providers Involved in

One Procedure

L. Rural Hospital Impact Statement

Text of the Final Regulations

Addenda

Addendum A—Explanation and Use of

Addenda B through E

Addendum B—1996 Relative Value Units

and Related Information Used in

Determining Medicare Payments for

1996

Addendum C—Codes with Interim Relative

Value Units

Addendum D—1996 Geographic Practice

Cost Indices by Medicare Carrier and

Locality

Addendum E—Procedure Codes Subject to

the Site-of-Service Differential

In addition, because of the many

organizations and terms to which we

refer by acronym in this final rule, we

are listing these acronyms and their

corresponding terms in alphabetical

order below:

ASC Ambulatory surgical center

CF Conversion factor

CFR Code of Federal Regulations

CPT [Physicians’] Current Procedural

Terminology [4th Edition, 1994,

copyrighted by the American

Medical Association] DEFRA

Deficit Reduction Act

EKG Electrocardiogram

GPCI Geographic Practice Cost Index

GME Graduate Medical Education

HCFA Health Care Financing

Administration

HCPCS HCFA Common Procedure

Coding System

OBRA Omnibus Budget Reconciliation

Act

ORA Omnibus Reconciliation Act

RUC [American Medical Association

Specialty Society] Relative [Value]

Update Committee

RVU Relative Value Unit

TEFRA Tax Equity and Fiscal

Responsibility Act

I. Background

A. Legislative Requirements

The Medicare program was

established in 1965 by the addition of

title XVIII to the Social Security Act (the

Act). Since January 1, 1992, Medicare

pays for physician services under

section 1848 of the Act, ‘‘Payment for

Physicians’ Services.’’ This section

contains three major elements: (1) A fee

schedule for the payment of physician

services; (2) a Medicare volume

performance standard 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(e)(1)(c) of the Act

requires us to review and, if necessary,

adjust the geographic practice cost

indices at least every 3 years. This

section of the Act also requires us to

phase in the adjustment over 2 years

and implement only one half of any
63126 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

adjustment if more than 1 year has

elapsed since the last geographic

practice cost index revision. The

geographic practice cost indices were

first implemented in 1992 and were not

reviewed until 1994. We implemented

one half of the adjustment in 1995 and

will implement the second half of the

adjustment in 1996.

The Act requires that payments vary

among fee schedule areas according to

geographic indices. In general, the fee

schedule areas that existed under the

prior reasonable charge system were

retained under the fee schedule. A

detailed discussion of fee schedule areas

can be found in the June 5, 1991

proposed rule (56 FR 25832) and in the

November 25, 1991 final rule (56 FR

59514). We are required by section

1848(e)(1)(A) of the Act to develop

separate indices to measure relative cost

differences among fee schedule areas

compared to the national average for

each of the three fee schedule

components. While requiring that the

practice expense geographic practice

cost indices and malpractice geographic

practice cost indices reflect the full

relative cost differences, the Act

requires that the work indices reflect

only one-quarter of the relative cost

differences compared to the national

average.

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 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)

announcing revised payment policies

and RVUs for 1994. (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

values, fee schedule payment areas, and

payment policies and RVUs for 1995.

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.

Prior Federal Register Documents

The information in this final rule with

comment period updates information in

the following Federal Register

documents:

• June 5, 1991, proposed rule entitled

‘‘Fee Schedule for Physicians’ Services’’

(56 FR 25792).

• November 25, 1991, final rule

entitled ‘‘Fee Schedule for Physicians’

Services’’ (56 FR 59502).

• September 15, 1992, correction

notice for the 1992 fee schedule (57 FR

42491).

• November 25, 1992, final notice

with comment period entitled ‘‘Fee

Schedule for Physicians’ Services for CY

1993’’ (57 FR 55914).

• June 7, 1993, correction notice for

the 1993 fee schedule (58 FR 31964).

• July 14, 1993, proposed rule

entitled ‘‘Revisions to Payment Policies

Under the Physician Fee Schedule’’ (58

FR 37994).

• December 2, 1993, final rule with

comment period entitled ‘‘Revisions to

Payment Policies and Adjustments to

the Relative Value Units under the

Physician Fee Schedule for Calendar

Year 1994’’ (58 FR 63626). (There were

two correction notices published for the

1994 physician fee schedule (July 15,

1994, 59 FR 36069) and (August 4, 1994,

59 FR 39828).)

• June 24, 1994, proposed rule

entitled ‘‘Refinements to Geographic

Adjustment Factor Values and Other

Policies Under the Physician Fee

Schedule’’ (58 FR 32754).

• December 8, 1994, final rule with

comment period entitled ‘‘Refinements

to Geographic Adjustment Factor

Values, Revisions to Payment Policies,

Adjustments to the Relative Value Units

(RVUs) Under the Physician Fee

Schedule for Calendar Year 1995, and

the 5–Year Refinement of RVUs’’ (59 FR

63410). (There were two correction

notices published for the 1995

physician fee schedule (January 3, 1995,

60 FR 46) and (July 18, 1995, 60 FR

36733).)

• July 26, 1995, proposed rule

entitled ‘‘Revisions to Payment Policies

Under the Physician Fee Schedule for

Calendar Year 1996 (60 FR 38400).

This final rule would affect the

regulations set forth at 42 CFR part 400,

which consists of an introduction to,

and definitions for, the Medicare and

Medicaid programs; part 405, which

encompasses regulations on Federal

health insurance for the aged and

disabled; part 410, which consists of

regulations on supplementary medical

insurance benefits; part 414, which

covers regulations on payment for Part

B medical and other health services; and

new part 415, which contains

regulations on services of physicians in

providers, supervising physicians in

teaching settings, and residents in

certain settings. We are making

technical and conforming amendments

to parts 411, 412, 413, 417, and 489.

C. Components of the Fee Schedule

Payment Amounts

Under the formula set forth in section

1848(b)(1) of the Act, the payment

amount for each service paid for under

the physician fee schedule is the

product of three factors: (1) A nationally

uniform relative value for the service;

(2) a geographic adjustment factor for

each physician fee schedule area; and

(3) a nationally uniform conversion

factor for the service. There are three

conversion factors (CFs)—one for

surgical services, one for nonsurgical

services, and one for primary care

services. The conversion factors convert

the relative values into payment

amounts.

For each physician fee schedule

service, there are three relative values:

(1) An RVU for physician work; (2) an

RVU for practice expense; and (3) an

RVU for malpractice expense. For each

of these components of the fee schedule

there is a geographic practice cost index

for each fee schedule area. The

geographic practice cost indices reflect

the relative costs of practice expenses,

malpractice insurance, and physician

work in an area compared to the

national average.

The general formula for calculating

the Medicare fee schedule amount for a

given service in a given fee schedule

area can be expressed as:

Payment=[(RVUwork × GPCIwork) +

(RVUpractice expense × GPCIpractice

expense) + (RVUmalpractice ×

GPCImalpractice)] × CF

The conversion factors for calendar year

1996 appear in Addendum A. The RVUs

for calendar year 1996 are in Addendum

B. The GPCIs are in Addendum D.

Section 1848(e) of the Act requires the

Secretary to develop geographic

adjustment factors for all physician fee

schedule areas. The total geographic

adjustment factor for a fee schedule area

is equal to a weighted average of the

individual GPCIs for each of the three

components of the service. Thus, the

geographic practice cost indices reflect

the relative costs of practice expenses,

malpractice insurance, and physician

work in an area compared to the

national average. In accordance with the

law, however, the geographic

adjustment factor for the physician’s
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63127

work reflects one-quarter of the relative

cost of physician’s work compared to

the national average.

For the first year of the fee schedule,

the law required a base-year CF that was

budget-neutral relative to 1991

estimated expenditures. The Secretary is

required to recommend to the Congress

updates to the CFs by April 15 of each

year as part of the Medicare volume

performance standards and annual fee

schedule update process. The Congress

may choose to enact the Secretary’s

recommendation, enact another update

amount, or not act at all. If the Congress

does not act, the annual fee schedule

update is set according to a ‘‘default’’

mechanism in the law. Under this

mechanism, the update will equal the

Medicare Economic Index adjusted by

the amount actual expenditures for the

second previous fiscal year (FY) were

greater or less than the performance

standard rate of increase for that FY.

(The Medicare Economic Index is a

physician input price index, in which

the annual percent changes for the

direct-labor price component are

adjusted by an annual percent change in

a 10-year moving average index of labor

productivity in the nonfarm business

sector.) The Medicare volume

performance standard for FY 1996 and

the physician fee schedule update for

CY 1996 are published elsewhere in this

Federal Register issue as a final notice

(BPD–828–FN).

D. Summary of the Development of the

Relative Value Units

1. Work Relative Value Units

Approximately 7,500 codes represent

services included in the physician fee

schedule. The work RVUs established

for the implementation of the fee

schedule in January 1992 were

developed with extensive input from

the physician community. The original

work RVUs for most codes were

developed by a research team at the

Harvard School of Public Health in a

cooperative agreement with us. In

constructing the vignettes for the

original RVUs, Harvard worked with

panels of expert physicians and

obtained input from physicians from

numerous specialties.

The RVUs for radiology services are

based on the American College of

Radiology (ACR) relative value scale,

which we integrated into the overall

physician fee schedule. The RVUs for

anesthesia services are based on RVUs

from a uniform relative value guide. We

established a separate CF for anesthesia

services because we continue to

recognize time as a factor in

determining payment for these services.

Proposed RVUs for services were

published in a proposed rule in the

Federal Register on June 5, 1991 (56 FR

25792). We responded to the comments

in the November 1991 final rule. Since

many of the RVUs were published for

the first time in the final rule, we

considered the RVUs to be interim

during the first year of the fee schedule

and gave the public 120 days to

comment on all work RVUs. In response

to the final rule, we received comments

on approximately 1,000 services. We

responded to those comments and listed

the new RVUs in the November 1992

notice for the 1993 fee schedule for

physicians’ services. We considered

these RVUs to be final and did not

request comments on them.

The November 1992 notice (57 FR

55914) also discussed the process used

to establish work RVUs for codes that

were new or revised in 1993. The RVUs

for these codes, which were listed in

Addendum C of the November 1992

notice, were considered interim in 1993

and open to comment through January

26, 1993.

We responded to comments received

on RVUs listed in Addendum C of the

November 1992 notice (57 FR 56152) in

the December 1993 final rule (58 FR

63647) for the 1994 physician fee

schedule. The December 1993 final rule

discussed the process used to establish

RVUs for codes that were new or revised

for 1994. The RVUs for these codes,

which are listed in Addendum C of the

December 1993 final rule (58 FR 63842),

were considered interim in 1994 and

open to comment through January 31,

1994. We proposed RVUs for some nonMedicare and carrier-priced codes in

our June 1994 proposed rule (59 FR

32760). Codes listed in Table 1 of the

June 1994 proposed rule were open to

comment. These comments, in addition

to comments on RVUs published as

interim in the December 1993 final rule

were addressed in the December 1994

final rule (59 FR 63432). In addition, the

December 1994 final rule discussed the

process used to establish RVUs for

codes that were new or revised for 1995.

Interim RVUs for new or revised

procedure codes were open to comment.

Comments were also accepted on all

RVUs considered under the 5-year

refinement process. The comment

period closed on February 6, 1995.

2. Practice Expense and Malpractice

Expense Relative Value Units

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

requires that the practice expense and

malpractice expense RVUs equal the

product of the base allowed charges and

the practice expense and malpractice

percentages for the service. Base

allowed charges are defined as the

national average allowed charges for the

service furnished during 1991, as

estimated using the most recent data

available. For most services, we used

1989 charge data ‘‘aged’’ to reflect the

1991 payment rules, since those were

the most recent data available for the

1992 fee schedule.

If charge data were unavailable or

insufficient, we imputed the practice

expense and malpractice expense RVUs

from the work RVUs. For example, if a

procedure has work RVUs of 6.00, and

the specialty practice cost percentages

for the specialty furnishing the service

is 60 percent work, 30 percent practice

expense, and 10 percent malpractice

expense, then the total RVUs would be

10.00 (6.00/.60), the practice expense

RVUs would be 3.00 (10 × .30), and the

malpractice expense RVUs would be

1.00 (10 × .10).

II. Specific Proposals for Calendar Year

1996 and Responses to Public

Comments

In response to the publication of the

July 26, 1995 proposed rule, we

received approximately 9,500

comments. We received comments from

individual physicians and health care

workers and professional associations

and societies. The majority of the

comments addressed two proposals: (1)

Revising Medicare payment for

physician services in teaching settings;

and (2) paying for only one

interpretation of an electrocardiogram or

an x-ray procedure furnished to an

emergency room patient except in

unusual circumstances.

The proposed rule discussed policies

that affect the number of RVUs on

which payment for certain services

would be based. Any changes

implemented through this final rule are

subject to the $20 million limitation on

annual adjustments as contained in

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

After reviewing the comments and

determining the policies we will

implement, we have estimated the costs

and savings of these policies and added

those costs and savings to the estimated

costs associated with any other changes

in RVUs for 1996, including RVU

changes necessitated by the 1995 CPT

coding changes. We discuss in detail the

effects of these changes in the

Regulatory Impact Analysis (section IX).

In the July 1995 proposed rule (60 FR

38416), we invited public comments on

a proposal to calculate the Medicare

volume performance standard for fiscal

year 1996 and all future years based on

estimates of the average volume and

intensity growth specific to each

category of physician service. We are
63128 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

responding to the comments we

received on this issue in the final notice

entitled ‘‘Physician Fee Schedule

Update for Calendar Year 1996 and

Physician Volume Performance

Standard Rates of Increase for Federal

Fiscal Year 1996 (BPD–828–FN)

published elsewhere in this Federal

Register issue.

For the convenience of the reader, the

headings for the policy issues in

sections II, III, and IV, for the most part,

correspond to the headings used in the

July 1995 proposed rule. More detailed

background information for each issue

can be found in the July 1995 proposed

rule (60 FR 38400).

A. Budget-Neutrality Adjustments for

Relative Value Units

We make annual adjustments to RVUs

for the physician fee schedule to reflect

changes in CPT codes and changes in

estimated physician work. The statute

requires that these revisions may not

change physician expenditures by more

than $20 million compared to estimated

expenditures that would have occurred

if the RVU adjustments had not been

made. In the past, we have made an

adjustment across all RVUs in the

physician fee schedule to maintain this

statutorily-mandated budget neutrality.

We recognize that many other payers,

including several Medicaid programs,

use the Medicare physician fee

schedule. To reduce the number of

system changes required by the annual

revisions to the physician fee schedule,

we proposed to apply these budgetneutrality adjustments to the physician

fee schedule conversion factors (CFs)

rather than across all RVUs.

The impact of this proposal on

payment amounts would be minimal

(slight differences could be caused by

rounding). This alternative approach

would be administratively simpler for

Medicare and other payers that base

payment on the Medicare RVUs,

including many State Medicaid

programs. In addition, this change

would provide for consistent RVUs from

year to year (for those codes with no

other changes), thus making it easier to

analyze payment and policy changes.

Comment: An overwhelming majority

of commenters strongly supported our

decision to apply the annual budgetneutrality adjustments to the physician

fee schedule CFs rather than across all

RVUs, beginning with the publication of

this final rule in the Federal Register;

however, a few commenters suggested

that we apply this change retroactively

by converting all RVUs, which were

altered for budget-neutrality reasons,

back to their original 1992 levels.

Response: For the sake of

administrative simplicity, we will not

readjust RVUs from periods before the

current period. In addition, we believe

that retroactively adjusting the RVUs

would cause unnecessary programming

costs for those who electronically

maintain systems containing the RVU

data.

Comment: A few commenters

suggested the use of a separate budgetneutrality factor rather than the

adjustment of the physician fee

schedule CFs to achieve budget

neutrality. They stated that private

payers who use the Medicare fee

schedule CFs would then be able to

decide whether to apply the budget

neutrality adjustment. This particularly

could be an issue for any adjustments

needed for the five-year review of all

work RVUs, depending on the

magnitude of the adjustments.

Response: We prefer to adjust the

existing CFs rather than add an

additional factor to adjust for budget

neutrality. Because we explicitly

identify the magnitude of the annual

budget-neutrality adjustment, other

payers can decide whether to apply the

adjustment to their CFs. However, we

may reconsider this issue in the future

for issues such as the 5-year review of

RVUs or congressional action.

Final Decision: Beginning with the

publication of this final rule, we will

apply annual budget-neutrality

adjustments to physician fee schedule

CFs rather than across all RVUs.

However, if the Congress explicitly sets

a conversion factor at a fixed dollar

amount for a given year, we will

consider establishing a separate budgetneutrality adjustor.

B. Bundled Services

1. Hydration Therapy and

Chemotherapy

We proposed not paying separately

for hydration therapy infusion (CPT

codes 90780 and 90781) when billed on

the same day as chemotherapy infusion,

CPT codes (96410, 96412, and 96414).

Frequently, hydration therapy and

chemotherapy are performed at the

same time. We believe paying for both

would be duplicative. We would

continue to pay separately for both the

hydration therapy solution and the

chemotherapy drug. This reflects a

policy change that is not explicitly

addressed in our regulations.

Comment: Commenters objected to

our proposal stating that the

administration of saline for hydration

therapy infusion at the same time as

chemotherapy infusion requires

significant additional work and

supplies.

Response: We disagree. The saline

and the chemotherapy drug are usually

administered through the same port or

site. In some cases, the solutions may

even be mixed. We see no significant

additional work or expense involved in

these cases, and we believe that paying

separately for hydration therapy

infusion administered at the same time

as chemotherapy infusion represents

duplicate payment.

Comment: A commenter agreed with

our proposal stating that the same

access port or site is used for

administering the chemotherapy drug

and the hydration therapy solution. The

commenter requested clarification as to

whether the policy would apply to other

drugs, such as antiemetics and

corticosteroids, which are often

administered with chemotherapy and,

like hydration therapy, billed using CPT

codes 90780 and 90781. The commenter

suggested that a logical extension of our

proposal is to cover the administration

of these drugs as well as hydration

therapy.

Response: We agree with this

comment. CPT codes 90780 and 90781

for the administration of saline or drugs

such as antiemetics and corticosteriods

will not be paid separately when

furnished at the same time as CPT codes

96410, 96412, and 96414 for

chemotherapy infusion. However, we

will pay separately for the drugs.

Comment: Most commenters agreed

that for any given segment of time it

would be duplicative to pay for both

chemotherapy infusion and hydration

therapy infusion. These commenters

noted that the course of treatment for

many chemotherapy drugs, for example,

cisplatin, ifosmamide, and

methotrexate, require hydration therapy

or the infusion of an antiemetic on the

same day, but either before or after the

chemotherapy. The commenters

believed that in these cases, the work is

not duplicative, and they should be

allowed to bill for the infusion of the

saline or antiemetic.

Response: We agree. We are revising

our proposal to allow payment for

hydration therapy or the infusion of an

antiemetic or other nonchemotherapy

drug on the same day as chemotherapy

infusion when the nonchemotherapy

drug is administered sequentially rather

than at the same time as the

chemotherapy infusion.

Final Decision: We will not pay for

the infusion of saline, an antiemetic, or

any other nonchemotherapy drug under

CPT codes 90780 and 90781 when these

drugs are administered at the same time

as chemotherapy infusion (CPT codes
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63129

96410, 96412, or 96414). However, we

will pay for the infusion of saline,

antiemetics, or any other

nonchemotherapy drug under CPT

codes 90780 and 90781 when these

drugs are administered on the same day

but sequentially to rather than at the

same time as chemotherapy infusion,

under CPT codes 96410, 96412, and

96414. Physicians should use the new

modifier ‘‘–GB’’ to indicate when CPT

codes 90780 and 90781 are provided

sequentially rather than

contemporaneously with CPT codes

96410, 96412, and 96414.

This policy change is not explicitly

addressed in our regulations.

2. Evaluation of Psychiatric Records and

Reports and Family Counseling Services

At present, we allow separate

payment for CPT codes 90825 and

90887. However, we believe that the

activities described by these codes are

generally performed as part of the

prework and postwork of other

physician services. The RVUs for

psychiatric services (CPT codes 90801

and 90835 through 90857) include the

prework and postwork activities

described by CPT codes 90825 and

90887. Thus, continuing to allow

separate payment for these codes, in

addition to payment for other

psychiatric services, results in duplicate

payments and is inconsistent with our

policy for other services.

Counseling of the family is part of the

work of all other evaluation and

management services. Medicare has a

long-standing policy of covering these

services if they relate to the

management of the beneficiary’s

problems and not to the problems of the

family member. We believe it is

appropriate to bundle covered family

counseling procedures into the other

psychiatric codes so that our policy is

consistent with our policy on services

furnished by other physician specialties.

Therefore, we proposed to change the

status indicator for CPT codes 90825

and 90887 to ‘‘B’’ to show that payment

for these codes is bundled into the

payment for another service, and

separate payment would not be allowed.

We proposed to implement this change

in a budget-neutral manner by

redistributing the RVUs for CPT codes

90825 and 90887 across the following

psychiatric codes: 90801, 90820, 90835,

90842 through 90847, and 90853

through 90857.

Comment: Several commenters

questioned our claim that the work

involved in CPT codes 90825 and 90887

is a fundamental element of the pre- and

postwork of other physician or other

psychiatric services, stating that medical

psychotherapy is a specific procedure,

distinct from evaluation and

management, and that these procedures

(CPT codes 90825 and 90887) are

characteristically excluded from

psychotherapy. Some commenters

believed this payment change would be

inherently unfair to providers who

furnish services under CPT codes 90825

and 90887.

Response: In addressing the concern

that CPT codes 90825 and 90887 are

excluded from psychotherapy and

represent distinct and different services,

we note that in the CPT chapter on

Psychiatry, General Clinical Psychiatric

Diagnostic or Evaluative Interview

Procedures, CPT code 90801

(Psychiatric Interview) refers to both

communication with family or other

sources, as well as the ordering and

medical interpretation of laboratory or

other medical diagnostic studies.

Further, the definition includes the

history and the exchange of information

with family members and other

informants. Additionally, the final

report by Harvard researchers

(‘‘Refinement of the Development of a

Resource-Based Relative Value Scale for

Psychiatrist Services; National Institute

of Mental Health Contract No. 278–87–

0024’’) defines physician work as

encompassing work while with the

patient and work before and after the

service, defined as reviewing records as

well as communicating with the patient,

the patient’s family, and other

professionals. We believe these

definitions clearly indicate that the

evaluation of other records and family

counseling fall within the scope of

medical psychotherapy and, thus, do

not represent distinct services.

Therefore, we believe it is appropriate to

bundle payment for these services.

Comment: Several commenters

specifically addressed CPT code 90887.

One commenter agreed that the services

encompassed by CPT code 90825 are

usually performed as part of the preand postwork for other physician

services, but expressed concern this was

not true for CPT code 90887, which is

typically the exclusive service being

furnished. Another commenter

questioned the redistribution of the

RVUs for CPT code 90887. The

commenter believed that if, as stated,

family counseling is part of the

postwork of evaluation and management

services, the RVUs for this service

should be distributed across all

evaluation and management codes, not

just the psychiatric codes.

Response: Family counseling must be

related to the patient. The fact that this

service occurs on different days or times

does not preclude it from being part of

the pre- and postwork. Although we

recognize that the services described by

CPT code 90887 may be provided on

different dates of service from when the

patient received psychiatric service,

they are still considered part of the

postwork service associated with that

code. We note, also, that the evaluation

and management services cannot be

billed by clinical psychologists and,

thus, have been included in other

service codes.

If the RVUs for CPT code 90887 were

distributed across all evaluation and

management codes as well as the

psychiatric codes for this service, the

impact would be negligible. That is, the

amount to be distributed is not of

sufficient magnitude to have any

noticeable effect.

Comment: One commenter requested

that we also consider changing the

status indicator for CPT code 90862

(Pharmacologic management) to ‘‘B’’

because, according to the commenter,

pharmacological management is part of

evaluation and management services.

Response: Separate payment for

pharmacological management is not

permitted on the same day as

psychotherapy as this service is already

included in the codes for

psychotherapy. To distinguish services

to Medicare beneficiaries for the sole

purpose of drug management from those

that include some psychotherapy, HCFA

developed HCPCS code M0064. This

code is defined as a brief office visit for

the sole purpose of monitoring or

changing drug prescriptions used in the

treatment of mental, psychoneurotic,

and personality disorders.

Comment: According to one

commenter, since the original survey of

psychiatric work conducted by Harvard

researchers, managed care has

increased. With the rise in managed

care, there is a decrease in mental health

benefits. Therefore, the patients that

psychiatrists treat, especially in the feefor-service setting, are much more

complex. The commenter believed this

additional work is not currently

included in the RVUs for psychiatric

services. In addition, this commenter

has found that psychiatrists are

spending a greater amount of time

responding to review requests,

developing treatment plans for managed

care, managing and supervising

nonphysician mental health providers,

and documenting and coding work.

Response: Section 1848(c)(2)(B) of the

Act requires that all RVUs be reviewed

not less frequently than every 5 years to

account for changes in medical practice,

coding changes, new data, and new

procedures. Thus, the issues of

psychiatric work time, as well as the
63130 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

issue of psychiatric services delivered in

a managed care setting, will be

addressed as part of the 5-year review

process.

Final Decision: We will bundle the

payment for CPT codes 90825 and

90887 into the payment for other

psychiatric services. Therefore, separate

payment for CPT codes 90825 and

90887 is not allowed.

This policy change is not explicitly

addressed in our regulations.

3. Fitting of Spectacles

We proposed to cease paying

separately for the fitting of glasses and

low vision systems. The payment for the

fitting of spectacles is included in the

payment for the spectacles in the same

way that payment for other prosthetic

fitting services is included in the

payment for the prosthetic device.

We proposed to assign a ‘‘B’’ status

indicator to CPT codes 92352, 92353,

92354, 92355, 92358, and 92371 to

indicate that the services are covered

under Medicare but that payment for

them is bundled into the payment for

the spectacles. We proposed to

implement this in a budget-neutral

manner by redistributing the current

RVUs for these services across all RVUs.

This reflects a policy change that is

not explicitly addressed in our

regulations.

Comment: A commenter believed that

these fitting services should continue to

be paid separately because of the time

and expertise required to fit glasses for

aphakic patients and low vision aids.

Response: The fitting of spectacles is

covered under section 1861(s)(8) of the

Act. Services under this section are not

included in the definition of physician

services as defined in section 1848(j)(3)

of the Act and are not payable under the

physician fee schedule. Although we

have been allowing payment, the fitting

of spectacles is included in the payment

for the spectacles in the same way that

payment for other prosthetic fitting

services are included in the payment for

the device. Under the current system,

duplicate payment has been made for

the aforementioned procedure codes.

Final Decision: We will no longer pay

separately for CPT codes 92352, 92353,

92354, 92355, 92358, and 92371.

Beginning January 1, 1996, these codes

will be assigned a ‘‘B’’ status indicator

to indicate that the services are covered

under Medicare, but payment for them

is bundled into the payment for the

spectacles.

This policy change is not explicitly

addressed in our regulations.

C. X-Rays and Electrocardiograms

Taken in the Emergency Room

We proposed to pay for the x-ray and/

or electrocardiogram (EKG)

interpretation that contributes to the

diagnosis or treatment of the patient in

the emergency room. We will pay for

only one x-ray and/or EKG

interpretation except under unusual

circumstances.

Comment: The comments from

radiologists opposed every aspect of the

proposal. The primary point raised by

virtually all of these commenters was

that, by training and experience, they

were more qualified than emergency

physicians or other nonradiologists to

furnish these interpretations. Some

radiologists commented that we should

require board certification as a

requirement to bill for the interpretation

of x-rays.

Response: In paying for physicians’

services under the Act, we are charged

with determining the following:

• Is the service covered under

Medicare?

• Is the service reasonable and

necessary for the individual beneficiary?

• Is the physician licensed to perform

the service in the State in which it is

furnished?

In the case of a licensed physician

who has furnished a covered service

(that is not payable through another

code) to a Medicare beneficiary in an

emergency room, it is not readily

apparent to us upon what basis the

claim can be denied. There is no portion

of the Act upon which to base a

decision that only board-certified

radiologists can furnish x-ray

interpretations or board-certified

cardiologists can furnish EKG

interpretations. (Where the Congress has

determined that there should be special

qualifications in order to furnish a

service, as in the case of mammography,

a provision was made in the statute.)

Our proposed policy for x-ray and EKG

interpretation is consistent with how we

generally treat other physician services.

Comment: Emergency room

physicians supported the direction of

the proposal but requested clarification

of the proposal including its effect on

payments for second interpretations.

Many commended us for proposing to

change the existing policy but criticized

the agency for not going far enough.

Several emergency physicians

commented that it was unethical for us

to withhold compensation from

physicians who make life-saving

decisions every day based on x-ray and

EKG interpretations.

Response: Our proposal addressed

situations in which both the emergency

physician and the radiologist/

cardiologist billed for the same

interpretation. It is that situation in

which a determination needs to be made

of which interpretation contributed to

the diagnosis and treatment of the

individual patient. If an emergency

physician does not bill for the

interpretation, there would be no

change from existing policy. We would

like to stress that if the only bill

received is from the radiologist or

cardiologist, it is paid on the same basis

as current claims.

Comment: We received relatively few

comments from physicians and other

entities specializing in cardiology

procedures. Their comments focused on

the cardiologists’ greater qualifications

to interpret EKGs based on their training

and experience.

Response: The discussion above about

the qualifications of the interpreting

radiologist would also apply here. The

situation with EKGs is somewhat

different than with x-rays because

section 13514 of OBRA 1993, Public

Law 103–66, enacted August 10, 1993,

requires us to make separate payment

for EKG interpretations and to exclude

the RVUs for EKG interpretations from

the RVUs for visits and consultations,

making the EKG portion of the current

policy as set forth in section 2020G of

the Medicare Carriers Manual obsolete.

Comment: We proposed that the

radiologist or cardiologist should be

paid for the interpretation when it is

performed contemporaneously with the

diagnosis and treatment of the

emergency room patient. This standard

would be met if an interpretation were

initially conveyed to the treating

physician verbally. Nearly all

commenters seemed to be troubled by

the use of the term ‘‘contemporaneous’’

and requested clarification of the term.

Some radiologists indicated that their

interpretation is furnished

contemporaneously if it is provided

timely, which commenters variously

defined as 12–24 hours. Other

radiologists indicated that there are

teleradiology hook-ups to radiologists,

homes which should satisfy the need for

contemporaneous interpretations.

Several emergency room specialists

indicated that the circumstances under

which a radiologist or cardiologist

furnishes a contemporaneous

interpretation as discussed in the

proposal should be clarified. They

expressed concern that the provision of

a verbal interpretation by the specialist

to the emergency room physician could

be used to circumvent the stated

intention to pay for the interpretation

used in the diagnosis and treatment of

the beneficiary.
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63131

Response: When we used the term

contemporaneous, we meant that the

interpretation of the procedure by the

radiologist or cardiologist and the

diagnosis and treatment of the

beneficiary by the physician in the

emergency room occur at the same time,

as opposed to an interpretation

performed hours or days after the

beneficiary is sent home. While the

argument that the carrier should pay for

any interpretation furnished timely

sounds reasonable, it does not reflect

the realities of claims processing. It

would be impossible for a reviewer to

make an assessment in every individual

case as to whether the second

interpretation was furnished ‘‘timely.’’

In situations in which both physicians

bill for the interpretation, the question

to be resolved is whether the radiologist

or cardiologist performed the

interpretation in time to be used in the

diagnosis and treatment of the patient.

As set forth in the proposal, we believe

that in any case in which the radiologist

or cardiologist furnishes the

interpretation (a written interpretation

or a verbal interpretation that will be

written later), the emergency room

physician should not bill for the

interpretation, and the carrier should

pay for the claim submitted by the

radiologist or cardiologist. The

comments we received from the

emergency room physicians did not

seem to be requesting payment for

interpretations furnished under these

conditions. We agree that an

interpretation furnished via

teleradiology meets the requirement

when the interpretation is used in the

diagnosis and treatment of the patient.

Comment: Several commenters

indicated that emergency room

physicians without formal training in

interpreting computerized axial

tomography (CT) scans will miss subtle

changes which could lead to permanent

injuries to patients. They also stated that

there were problems with the

application of the proposal to other

diagnostic procedures such as

mammography, ultrasound, and upper

and lower gastrointestinal series.

Response: This proposal applies only

to x-ray procedures and EKGs furnished

in emergency rooms.

Comment: Many radiologists

indicated that the proposal will increase

the Medicare program costs

‘‘tremendously’’ because of the potential

for self-referral abuse. The commenters

believed that physicians who see

patients in the emergency room will

order unnecessary tests if they know

that they will be able to bill for the

interpretations of these tests.

Response: We would be interested in

reviewing any evidence the radiologists

have that emergency room physicians

order additional tests that are not

medically necessary when they are

permitted to bill for x-ray and EKG

interpretations. We are also interested in

any suggestions we might offer to the

carriers on how to identify such

unnecessary testing. We will address

any self referral prohibitions within our

Stark regulations.

Comment: Several radiologists

pointed out that a proper interpretation

does not really mean a ‘‘check’’ or a few

words on the chart, but requires a full

written report.

Response: We agree completely. The

requirement for a written report of the

interpretation of an x-ray or EKG is an

integral part of our proposal. We would

point out that less extensive ‘‘reviews’’

by emergency room physicians are not

separately billable because payment for

such reviews is included in the payment

for the evaluation and management

services rendered in an emergency

room.

Comment: Many radiologists

commented that, while some emergency

medicine specialists are very proficient

at reading trauma films, they lack the

necessary training to identify subtle

changes. For example, a patient is

brought into the emergency room with

chest trauma. The commenter indicated

that the emergency physician would

identify the broken ribs but miss a lung

tumor. Several other commenters were

concerned that a missed early diagnosis

could result from an interpretation

performed by a nonradiologist

emergency room physician while a

radiologist would review the total film

rather than just the area of clinical

concern.

Response: It seems to us that the

major purpose of the emergency room xray in this instance would be to

diagnose the degree of chest trauma.

However, in this circumstance, if the

emergency physician billed for the

interpretation and a radiologist made an

additional finding of a lung tumor, it

would be appropriate for the carrier to

pay for both interpretations.

Comment: One radiologist indicated

that all too often the emergency room

preliminary interpretation is made by a

nurse or medical student and the films

are never reviewed by a staff emergency

room physician.

Response: It is difficult to see how

such an observation relates to our

proposal. A physician could not provide

a written interpretation of an x-ray

unless he or she personally viewed it. A

written report of interpretation is an

integral part of our proposal.

Comment: Many commenters objected

to the hospital playing a role in

determining which physician should

bill for the interpretation of these

procedures. The following comments

were received:

• Hospitals are not capable of making

such determinations.

• It would be in the financial interest

of the hospital for the interpretation to

be paid to those physicians who order

the most tests.

• The medical staff is usually a

legally separate and independent body

from the hospital, and hospitals have no

authority to become involved in such

matters.

• Such decisions should be left to

peer review.

• Hospitals should be encouraged to

ensure that the billed interpretation is

the one upon which treatment is based.

• The concept of a hospital making a

policy decision as to which physician

should get paid for interpretations will

be a regulatory nightmare and the time

and money carriers will have to expend

to monitor the situations will be

enormous. However, one emergency

room physician commented that he

hoped the proposal would encourage

radiologists and cardiologists to furnish

these interpretations in a more timely

fashion.

Response: In developing our proposal,

we considered requiring hospitals to

notify their local carrier of the identity

of the physician who would be

performing these interpretations for

their patients. We determined that such

a requirement would have had an effect

as indicated by one of the commenters

and that our authority to impose such a

requirement was questionable.

However, under our proposal, we

suggested that hospitals act to ensure

that only one interpretation is billed.

(Hospitals could do this now; we are not

mandating an additional duty.) If a

carrier receives only one claim, there

will be no problem. The problem will

arise when hospitals do not take action

and the carrier receives two claims for

each interpretation and then must make

a determination about which claim to

pay. It seems reasonable to us for

hospitals to work with their medical

staffs to establish guidelines for the

billing of x-ray and EKG interpretations

for emergency room patients.

Comment: Some commenters

expressed concern about the effect of

the proposal on small, rural hospitals in

which there are an insufficient number

of radiologists to cover the emergency

room 24 hours a day. It was pointed out

that many of these hospitals either go

without any service at all and ship films

to radiologists for interpretation or
63132 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

receive direct radiologist’s services on

an infrequent basis each week. One

commenter indicated that consideration

should be given to the size of the

hospital, the definition of what

constitutes an emergency room, and the

availability of radiologic services.

Response: Since our proposal is

limited to emergency room services, if a

hospital does not have an emergency

room and no claims with a place of

service indicator of emergency room are

received, there does not appear to be a

problem. Likewise, if there is an

emergency room in a hospital but no

emergency room physician bills for an

interpretation of the test, there is also no

problem. We indicated in our proposal

that if a carrier receives only one claim

for a reasonable and necessary

interpretation of an x-ray or EKG, it

would pay the claim, generally without

further development.

Comment: One commenter indicated

that the proposal was inappropriate

because emergency room physicians are

thankful that radiologists will interpret

the overnight x-rays the next morning in

view of the harried circumstances under

which services are furnished in the

emergency room.

Response: Our proposal does not

require emergency room physicians to

bill for these interpretations. If the

emergency room physicians do not bill

for these interpretations, the radiologist

and cardiologist may continue to be

paid for the interpretations. Our

proposal has no effect on situations in

which the emergency physician does

not wish to bill for the interpretation.

Comment: A carrier medical director

expressed concern that it will be

impossible to determine from a claim

whether the emergency physician has

submitted written documentation of the

x-ray or EKG interpretation for the

medical record. The carrier medical

director went on to indicate that

encouraging hospitals to exercise their

authority to ensure that only one claim

for interpretation is received will not

work and recommended that the current

policy should be maintained.

Response: By submitting a claim for

the interpretation of an x-ray or EKG,

the emergency room physician is stating

that he or she has prepared a written

interpretation of the procedure for

inclusion in the patient’s medical

record. We do not agree that the current

manual policy works well since it

became partially obsolete by the

physician fee schedule.

Comment: Another carrier medical

director indicated that the requirement

for a written report be strengthened to

indicate that Medicare is requiring a

separately written report which meets

the hospital’s requirement for an official

report.

Response: We agree and will include

such a written report requirement in the

revised manual instructions.

Comment: Some emergency room

physicians commented that they should

be paid for the x-ray and EKG

interpretation in almost every case since

it is they who furnish the real-time

service.

Response: We believe that our

proposal is a better approach. There is

no question that the cardiologist or

radiologist should be paid for the

interpretation when that physician

furnishes the service in time to be used

in the diagnosis and treatment of the

patient. Further, we believe that there

are physicians who work in emergency

rooms who prefer to defer to a

cardiologist or radiologist for the final

interpretation and do not wish to

prepare written reports or bill for

interpretations. However, our proposal

provides for payment when the

emergency room physician provides a

written interpretation that contributed

to the diagnosis and treatment of the

patient.

Comment: One commenter indicated

that, in their community hospital, the

radiologist is summoned at the time of

the initial diagnosis and treatment for

the most serious cases, whereas, for less

urgent examinations, the formal

interpretation is made the following

morning. The commenter went on to say

that the issue should be the

responsiveness of the radiologist when

his or her input will affect care, and that

having x-rays read by nonradiologists is

moving in the wrong direction.

Response: As indicated previously,

interpretations by radiologists used for

the diagnosis and treatment of the

patient would be payable.

Comment: A few commenters

suggested that the appropriate approach

is to split the fee for the interpretation

between the radiologist and the ER

physician.

Response: We do not believe that this

would be a workable approach since the

carrier would not know when or if it

would receive the second claim.

Comment: Radiologists made the

following additional comments:

• The majority of carrier medical

directors do not support the proposal.

• The changes do not reflect the

findings of the July 1993 report of the

Department of Health and Human

Services, Office of Inspector General,

entitled ‘‘Medicare’s Reimbursement for

Interpretations of Hospital Emergency

Room X-Rays.’’

Response: We did present the

proposal to a committee of carrier

medical directors during a monthly

conference call on operational issues

and the views were mixed. The major

impression we drew from their

comments was that they were most

concerned with enforcement issues. We

will continue to seek the guidance of the

carrier medical directors and other

interested parties in developing

instructions to implement this policy.

The recommendation of the OIG

report was to pay for reinterpretations of

x-rays only when attending physicians

specifically request a second physician’s

interpretation in order to render

appropriate medical care before the

patient is discharged. Any other

reinterpretation of the attending

physician’s original interpretation

should be treated and reimbursed as

part of the hospital’s quality assurance

program.

Using 1990 data, the OIG projected

savings of $20.4 million based on a

cessation on payments for radiologists’

interpretations of x-rays if its

recommendation were implemented.

We believe that the OIG

recommendation would result in no

payment for interpretations of these

services in many cases; therefore, we

reject that portion of the

recommendation. In other words, we

believe that one physician should be

paid for the interpretation of an x-ray.

Comment: One commenter suggested

that the solution to this problem be

developed through the CPT system. The

commenter suggested that we propose

separate codes for the emergent reading

of the test and a second, different code

for the over-read. This commenter and

some others indicated that payment for

these interpretations be evenly divided

between the two codes.

Response: The commenter may want

to refer this proposal to the CPT

Editorial Panel.

Final Decision: We are adopting the

policy as set forth in the proposed rule

for services furnished on or after

January 1, 1996.

Listed below are the elements of our

policy.

• The carrier will pay separately for

only one interpretation of an EKG or xray procedure furnished to an

emergency room patient. However, there

is a provision for payment of second

interpretation under unusual

circumstances such as a questionable

finding for which the physician

performing the initial interpretation

believes another physician’s expertise is

needed.

• The professional component of a

diagnostic procedure furnished to a

beneficiary in a hospital includes an

interpretation and written report for
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63133

inclusion in the beneficiary’s medical

record maintained by the hospital. We

have placed this requirement in the

radiology section of the regulations on

services of physicians in providers at

§ 405.554(a). (Under the recodification,

this section becomes 415.120(a)).

• We distinguish between an

‘‘interpretation and report’’ of an x-ray

or an EKG procedure and a ‘‘review’’ of

the procedure. An interpretation and

report of the procedure is separately

payable by the carrier. A review of the

findings of these procedures, without a

written report, does not meet the

conditions for separate payment of the

service since the review is already

included in the emergency room visit

payment.

• In the case of multiple bills for the

same interpretation and report, we will

instruct the carriers to adopt the

following procedures:

+ Cease consideration of physician

specialty in deciding which

interpretation and report to pay

regardless of when the service is

performed.

+ Pay for the interpretation and

report that directly contributed to the

diagnosis and treatment of the

individual patient.

+ Pay for the interpretation billed by

the cardiologist or radiologist if the

interpretation of the procedure is

performed at the same time as the

diagnosis and treatment of the

beneficiary. (This interpretation may be

a verbal report conveyed to the treating

physician that will be written in a report

at a later time.)

• We will minimize the carrier’s need

to make decisions about which claim to

pay when multiple claims for the

interpretation and report of the same

procedure are received by—

+ Encouraging hospitals to work with

their medical staffs to ensure that only

one claim per interpretation is

submitted;

+ Advising hospitals that if they

allow a physician to perform and bill for

a medically necessary service (the

interpretation and report) in an

emergency room and permit another

physician to perform and bill for the

same service, the Medicare carrier will

not pay two claims;

+ Advising hospitals that the

Medicare carrier may determine that the

hospital’s ‘‘official interpretation’’ is for

quality control and liability purposes

only and is a service to the hospital

rather than to an individual beneficiary;

and

+ Advising hospitals that Medicare

fiscal intermediaries consider costs

incurred for quality control activities in

determining payments to hospitals.

• When the Medicare carrier receives

only one claim for an interpretation and

the procedure is reasonable and

necessary, the carrier will pay the claim.

We will presume that the one service

billed was a service to the individual

beneficiary and not a quality control

measure.

Manual instructions to the carriers

will be issued as soon as possible.

This policy change is not explicitly

addressed in our regulations.

D. Extension of Site-of-Service Payment

Differential to Services in Ambulatory

Surgical Centers

We proposed extending the site-ofservice payment differential to services

on the ambulatory surgical center (ASC)

covered list of procedures that are

predominantly performed in an office

setting. We see no reason for exempting

these procedures from the site-of-service

payment differential. The practice

expense RVUs duplicate many of the

overhead expenses included in the ASC

facility and hospital payment rates. As

such, when a service is provided in an

ASC or a hospital, the physician does

not bear the same level of practice costs

as when the same service is furnished

in the office. Therefore, in § 414.32

(‘‘Determining payments for certain

physician services furnished in facility

settings’’), we proposed to modify in

paragraph (d) (‘‘Services excluded from

the reduction’’) the subordinate

paragraph (d)(2), which would have the

effect of applying the site-of-service

payment differential to ASC services.

The payment differential does not apply

to procedures performed in an ASC that

are not on the ASC list because no

facility payment is made.

Comment: Many commenters stated

that the Act provides that procedures

included on the ASC list, by definition,

are not office-based procedures.

Commenters indicated that we had

concluded in previously published

regulations on ASCs that certain

procedures, such as cystoscopies,

prostate biopsies, and skin lesion

excisions, are not office-based

procedures.

Response: Historically, the ASC list

included only procedures that were

performed less than half of the time in

an office setting. Consequently, the ASC

list and the site-of-service payment

differential lists were mutually

exclusive. Over time, many procedures

shifted from being performed

predominately in ASCs to being

performed predominately in offices.

However, in many cases the procedures

were retained on the ASC list because

we were persuaded by arguments that

while the procedure may usually be

done in an office, there were

circumstances justifying using an ASC.

Therefore, the two lists are no longer

mutually exclusive. Retention of certain

procedures on the ASC list does not

imply that they cannot appropriately be

performed in an office. In fact, the only

procedures proposed for addition to the

site-of-service differential payment list

are those that are performed in an office

setting the majority of the time.

Comment: Several commenters

questioned the accuracy of data or

indicated that they could not fully

evaluate the proposals because we did

not publish data on which the site-ofservice list is based. Some stated we

should use clinically-based criteria

instead of purely objective, arithmetic

data.

Many commenters indicated that

many of the procedures added to the

site-of-service differential list were

inappropriate and unlikely to be officebased procedures because they are

extraordinarily complicated procedures,

require anesthesia or sophisticated

equipment, or need to be evaluated on

a case by case basis. Several

commenters believed the list to be

arbitrary and unfair. Others indicated

that physicians should not be punished

for selecting the medically appropriate

site for certain procedures on the list.

One commenter agreed that we should

encourage physicians to perform

procedures in an office when it is safe

and effective.

Another commenter stated that we

should pay urologists for supplies and

a small facility fee to shift procedures to

the less costly office setting.

Some commenters stated that because

nasal/sinus endoscopy codes were

added to the ASC list effective January

1, 1994 the site-of-service data are likely

to be skewed toward the physician’s

office setting. Other commenters stated

the CPT description for breast biopsy

(CPT code 19100) was recently changed

to include only core needle aspiration

while fine needle aspiration is now

reported using code CPT code 88170.

One commenter agreed that breast

biopsy should be on the list. Other

commenters argued that the data do not

distinguish between techniques

employed. Many commenters indicated

that the policy does not account for

gender differences. For example,

cystoscopies performed on males are

more difficult and painful and are

inappropriate for an office setting.

Response: According to our data, the

procedures on the site-of-service

payment differential list are performed

in a physician’s office more than 50

percent of the time. Inclusion of

procedures on the list is not intended to
63134 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

reflect a judgment regarding the

appropriateness of the site where the

service is performed or to encourage

performance of procedures in the less

costly office setting or to create a

financial disincentive for the physician

to select the most appropriate site.

Inclusion on this list merely recognizes

where the service is being furnished the

majority of the time. We recognize that

although the majority of the procedures

we proposed to add to the site-of-service

list are performed in a physician’s

office, the ASC setting is sometimes

appropriate. That is the reason they

remain on the ASC list. It is not the

purpose of this policy to dictate where

a physician should perform the service.

The policy reflects the lower practice

costs incurred by physicians when these

services are performed in an ASC or a

hospital.

Comment: One commenter objected to

including urodynamic evaluation CPT

codes 51725, 51726, and 51772 on the

site-of-service payment differential list.

Another commenter provided

information demonstrating that 21 other

proposed procedures should not be on

the list because more recent data

indicate that the procedures are not

performed in the office more than 50

percent of the time.

Response: We agree with the

comment that urodynamic evaluation

codes do not belong on the list and have

removed CPT codes 51725, 51726,

51772, and 51785 from the list. We also

agree with the comment that some of the

proposed procedures are not performed

in the office setting more than 50

percent of the time based on the most

current data available. Therefore, we

have removed the following CPT codes

from the list: 13150, 14020, 14060,

15740, 21208, 21440, 23066, 26645,

28030, 28043, 28092, 28261, 40510,

41805, 42408, 46220, 46610, 63600,

64420, 65270, and 67921.

Comment: Some commenters stated

that the site-of-service payment

differential should not apply to services

furnished in an ASC for which no

facility payment is made. Another

commenter said that many ASCs are

considered extensions of a physician’s

office, not a free-standing facility, and

physicians are responsible for ASC

overhead.

Response: We agree with these

comments. Therefore, we have clarified

the proposal to state that when a service

that is not on the ASC list is performed

in an ASC, the site-of-service payment

differential does not apply. In this case,

we view the ASC as an extension of the

physician’s office and, for purposes of

this provision, view this as an office

service.

Comment: Some commenters said that

there is no difference in practice costs

between the office setting and the ASC.

In some cases, costs may be higher in

the ASC because of more complicated

cases, the delivery of anesthesia

services, and physician travel costs.

Other commenters said it is unjustified

to conclude that there is no office

overhead for physicians performing

procedures in another setting.

Some commenters recommended that

we make no changes to the site-ofservice payment differential before the

implementation of resource-based

practice expense RVUs in 1998. One

commenter requested that we suspend

the site-of-service payment differential

altogether. Others recommended

increasing practice expense payments

for procedures performed in the office to

discourage physicians from using

hospital ASCs. Other commenters said

we should exempt codes that are

reduced by the interim practice expense

reduction of OBRA 1993.

Response: The site-of-service payment

differential is a long established policy

that aims to avoid duplicate payments

for overhead while, at the same time,

recognizes that some office overhead is

incurred when physicians perform

procedures outside the office setting.

For this reason, the practice expense

RVUs are reduced by only 50 percent.

While we will implement resourcebased practice expense RVUs in 1998,

we see no reason to postpone applying

the payment differential to ASCs until

then. The site-of-service policy

currently applies to both inpatient and

outpatient hospital settings. We see no

justification for continuing to exempt

services provided in ASCs.

Section 13513 of OBRA 1993

provided for reductions in practice

expense RVUs for services for which

practice expense RVUs exceeded 128

percent of the work RVUs and that are

performed less than 75 percent of the

time in an office setting. This reduction

was based on the Congress’

determination that practice expense

RVUs were too high for some

procedures. This reduction is

independent of the long standing site-ofservice payment differential.

Comment: Many commenters stated

that the proposal would result in

reduced quality of care. Other

commenters said it did not encourage

placement of patients in the most

appropriate and cost-effective setting to

address the patient’s medical needs.

Several commenters indicated that since

we have determined that the proposed

procedures are appropriate for ASCs

based on medical review and patient

safety outcome data, it would be

inconsistent to apply the site-of-service

payment differential.

Some commenters indicated that

many of the proposed procedures

cannot be performed safely in an office.

They indicated that offices are not

certified to meet the same standards of

care or health care outcomes as ASCs,

which are generally safer places to

perform procedures. They believed the

proposal creates a disincentive for

physicians to use ASCs even when it is

in the patient’s best interest to do so.

Other commenters said procedures are

performed in an ASC because of patient

choice or for a patient’s safety and

comfort. They believed that paying less

for the most complicated cases will

discourage doctors from doing such

cases, thereby creating serious access

problems for patients.

Response: We disagree that

application of the site-of-service

payment differential will penalize a

physician who has valid clinical reasons

for performing a procedure in an ASC.

Rather, we believe the payment

differential will appropriately reflect

that the physician incurs fewer costs

when furnishing service in an ASC. We

believe that physicians consider the

welfare of the beneficiary in selecting

the appropriate site to perform the

service. We do not believe that

physicians will make inappropriate

decisions regarding the health and well

being of their patients because of a

reduction in their payment.

Comment: Many commenters said

that the proposal will encourage

physicians to buy costly equipment for

their offices, such as that required for

urologic and arthroscopic procedures,

which most do not have.

Response: We believe the payment

differential is incentive neutral with

regard to selecting a practice site. That

is, we do not believe that the payment

differential will induce physicians to

purchase additional equipment to

enable them to furnish services in the

office.

Comment: One commenter stated that

a large number of procedures proposed

for addition to the site-of-service list

were originally exempt from the list

because they were performed less than

50 percent of the time in a physician’s

office. Therefore, the practice expense

values already reflect the costs of

furnishing the procedures outside the

office setting.

Response: Physicians shift the place

of service for procedures from the

hospital setting to the office setting for

various reasons. Two reasons are (1) that

advances in technology, technique, or

other factors make it now feasible to do

many services in the office setting that
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63135

historically were furnished in a hospital

setting; and (2) physicians believe that

it is cost-effective and efficient to shift

the place of service. We believe that the

direct costs of providing the service

(staff, supplies, equipment, and space)

are reflected in the practice expense

relative values based on the

predominant place of service. Therefore,

we believe it is appropriate to apply the

site-of-service reduction to these

services when they are performed in a

setting where we make a payment for

the direct costs of providing the service;

for example, hospitals and ASCs.

However, this issue will be further

examined as part of the development of

practice expense RVUs for 1998.

Comment: Several commenters

misunderstood the proposal. Some

implied that we were proposing a

reduction in the ASC facility payment

rate or reducing payments for office

based procedures. One objected to

applying the site-of-service payment

differential to the hospital setting. One

commenter was not convinced the

proposal will save money.

Several comments concerned issues

not covered under this proposal, for

example, objections to removing certain

codes from the ASC approved list and

requests that particular codes be added

or deleted from the ASC list. Another

commenter suggested that new criteria

are needed for procedures on the ASC

list. Another thought we were proposing

removing the codes from the ASC list.

Response: The proposal does not

affect ASC facility payment rates or

physician payments for procedures

performed in an office setting. The siteof-service payment differential already

applies to the hospital outpatient

setting. The proposal is budget neutral

and is not intended to reduce Medicare

payments. The proposal does not revise

procedures on the approved ASC list.

Final Decision: We will extend the

site-of-service payment differential to

office-based services on the ASC list if

those services are performed in an ASC

or in a hospital setting. However, when

a service that is not on the ASC list is

performed in an ASC, the site-of-service

payment differential will not apply. The

site-of-service list for 1996 appears in

Addendum E of this final rule. All

additions to the list are identified by an

asterisk.

E. Services of Teaching Physicians

1. General Background

Our July 26, 1995 proposed rule (60

FR 38405) discussed Medicare payment

for those services furnished under

graduate medical education (GME)

programs that are not payable through

the mechanisms established for direct

GME costs by section 1886(h) of the Act.

Section 1886(h) addresses Medicare

payments to hospitals and hospitalbased providers for the costs of

approved GME programs in medicine,

osteopathy, dentistry, and podiatry.

Those costs include residents’ salaries

and fringe benefits, physician

compensation costs for GME program

activities that are not payable on a fee

schedule basis, and other GME program

costs.

Medicare intermediary expenditures

under section 1886(h) of the Act for

fiscal year 1996 are estimated to be

approximately $1.9 billion. In addition,

under section 1886(d)(5)(B) of the Act,

Medicare makes additional payments to

teaching hospitals under the prospective

payment system for the higher indirect

operating costs hospitals incur by

having GME programs. (These are costs

other than direct GME costs.) Medicare

indirect GME payments for fiscal year

1996 are estimated to be approximately

$4.9 billion. Medicare also supports

GME programs in teaching hospitals

through billings for the services of

attending physicians who involve

residents in the care of their patients.

The amount of Medicare expenditures

for these services is not known since

attending physicians are not required to

distinguish between services they

personally furnish and those they

furnish as attending physicians in

claims submitted to the Part B carriers.

Our proposal addressed services of

teaching physicians that are payable on

a fee schedule basis, services of

residents in settings that are not payable

under section 1886(h), and services of

moonlighting residents. In addition, the

proposed rule addressed, but did not

substantially change, existing rules on

related issues on Medicare payments for

the services of residents in approved

GME programs furnished in certain

freestanding skilled nursing facilities

and home health agencies, and services

of residents who are not in approved

GME programs. We referred to the

section 1886(h) mechanisms to

distinguish between that payment

methodology and other payment

mechanisms.

Title XVIII of the Act provides

separate coverage and payment bases for

provider services and physician

services. Under Medicare, provider

services, such as inpatient hospital

services and skilled nursing facility

services, are covered under Hospital

Insurance (Part A) and are paid from the

Part A Trust Fund. Outpatient hospital

services are covered under

Supplementary Medical Insurance (Part

B) and are paid from the Part B Trust

Fund. Provider services are paid on a

prospective payment, reasonable cost, or

other payment mechanism through

Medicare contractors called ‘‘fiscal

intermediaries.’’ Physician services and

other ‘‘medical and other health

services,’’ as defined in section 1861(s)

of the Act, are generally paid under Part

B through Medicare contractors called

‘‘carriers.’’ To administer the Medicare

program, we must distinguish clearly

between provider services and

physician services to determine the

appropriate payment methodology and

the appropriate Trust Fund that is liable

for payment.

As discussed in the proposed rule, in

part 405 (‘‘Federal Health Insurance for

the Aged and Disabled’’), subpart D

(‘‘Principles of Reimbursement for

Services by Hospital-Based

Physicians’’), current regulations

beginning with § 405.480 set forth the

basic principles regarding payment for

services of physicians who practice in

providers. Additional principles

applicable to payment for physician

services in teaching hospitals appeared

in subpart E (‘‘Criteria for Determination

of Reasonable Charges; Payment for

Services of Hospital Interns, Residents,

and Supervising Physicians’’) in

§§ 405.520 and 405.521. Principles

applicable to services of interns and

residents appeared in §§ 405.522

through 405.525. Sections 405.465 and

405.466 addressed the payment

methodology for teaching hospitals that

elect reasonable cost payments for

physician services. (See sections

1832(a)(2)(B)(i)(II) and 1861(b)(7) of the

Act.) Since the publication of those

regulations, the Congress enacted a

series of legislative changes that affected

payments for these services, and we

proposed to revise the regulations to

conform to those statutory changes and

to clarify current policy.

Section 948 of the Omnibus

Reconciliation Act of 1980 (ORA 1980)

(Pub. L. 96–499), enacted on December

5, 1980, as amended by section 2307 of

the Deficit Reduction Act of 1984

(DEFRA 1984) (Pub. L. 98–369), enacted

on July 18, 1984, addressed payments

for physician services in teaching

settings. (See section 1842(b)(7) of the

Act.) Another pertinent legislative

change, section 108 of the Tax Equity

and Fiscal Responsibility Act of 1982

(TEFRA 1982) (Pub. L. 97–248), enacted

on September 3, 1982, added a new

section 1887 to the Act. That legislation

dealt explicitly with distinguishing

between the professional services

physicians furnish to individual

patients in a provider and services

physicians furnish to the provider itself.

While section 1887 of the Act does not
63136 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

specifically address teaching physicians

or GME issues, it is consistent with

Medicare policy on classifying the

activities in which physicians in

teaching hospitals are engaged.

We published a final rule with

comment period in the Federal Register

on March 2, 1983 (48 FR 8902), which

implemented the provisions of section

1887 of the Act. That final rule revised

the regulations that govern Medicare

payment for services of physicians who

practice in providers such as hospitals,

skilled nursing facilities, and

comprehensive outpatient rehabilitation

facilities. As a part of that final rule, we

revised §§ 405.480 through 405.482,

removed §§ 405.483 through 405.488,

and added new §§ 405.550 through

405.557. Those regulations—

• Set forth basic criteria for

distinguishing those physician services

furnished in providers that are payable

by Part B carriers as physician services

to individual patients from those

services that are payable by fiscal

intermediaries as physician services to

the provider itself;

• Set limits on the amounts payable

on a reasonable cost basis to providers

for physician services to the provider;

and

• Established more specific criteria

for determining the basis and amount of

payment for physician services in the

specialties of anesthesiology, radiology,

and pathology.

In the preamble to the March 1983

final rule (48 FR 8906), we stated that

because of problems related to applying

portions of the revised regulations to

teaching hospitals and to implement

sections 1842(b)(6) and 1861(b)(7) of the

Act for physician payment (as amended

by section 948 of ORA 1980), we

planned to publish, in a separate

document, proposed regulations that

would establish special rules governing

payment for services of physicians in

teaching hospitals. Those rules would

have superseded §§ 405.520 and

405.521 if they became effective.

Subsequently, however, the Congress

passed DEFRA 1984, which further

amended section 1842(b)(6) of the Act

and redesignated it as section

1842(b)(7).

Another statutory change that affected

payments to teaching hospitals was

section 9202 of the Consolidated

Omnibus Budget Reconciliation Act of

1985 (Pub. L. 99–272), enacted on April

7, 1986, as amended by section 9314 of

the Omnibus Budget Reconciliation Act

of 1986 (Pub. L. 99–509), enacted on

October 21, 1986, which added a new

section 1886(h) to the Act. Section

1886(h) of the Act revised the method

of calculating Medicare payment for the

direct costs of approved GME activities

such as residents’ salaries and fringe

benefits, from reasonable cost payment

to payments based on hospital-specific

per-resident amounts multiplied by the

number of full-time equivalent residents

working in the hospital during a

hospital’s cost reporting period.

A major change in the Medicare

payment rules for physician services in

general was enacted as part of the

Omnibus Budget Reconciliation Act of

1989 (OBRA 1989) (Pub. L. 101–239),

enacted on December 19, 1989, which

added section 1848 to the Act. Section

1848 replaced the reasonable charge

payment mechanism with a fee

schedule for physician services. The

Omnibus Budget Reconciliation Act of

1990 (OBRA 1990) (Pub. L. 101–508),

enacted on November 5, 1990,

contained several modifications and

clarifications to the OBRA 1989

provisions that established the

physician fee schedule.

2. Payment for Physician Services

Furnished in Teaching Settings

a. Current Practices

In our proposed rule (60 FR 38406),

we stated that of the nearly 7,000

hospitals that participate in Medicare,

approximately 1,200 have GME

programs that are approved for

residency training by the appropriate

accrediting organization. (We used the

term ‘‘residents’’ in the preamble of the

proposed rule to include residents,

interns, and fellows who are in formally

organized and approved GME

programs.)

For hospital cost reporting periods

beginning on or after July 1, 1985, the

costs of residents’ compensation

(representing payment for the residents’

services), certain physician

compensation costs related to GME

programs, and other GME program costs

are payable based on hospital-specific

per-resident amounts as described in

§ 413.86, in accordance with section

1886(h) of the Act. Physician

compensation costs for administrative

and supervisory services unrelated to

the GME program or other approved

educational activities are payable as

operating costs through diagnosisrelated group payments under the

prospective payment system for

inpatient services and on a reasonable

cost basis for inpatient services in

hospitals excluded from the prospective

payment system and for outpatient

services.

In the case of those few teaching

hospitals that elect reasonable cost

payments for physician direct medical

and surgical services under section

1861(b)(7) of the Act instead of billing

for services to Medicare beneficiaries on

a fee-for-service basis, the election and

payment mechanisms described in

former §§ 405.465 and 405.466 were set

forth in the proposed rule in new

§ 415.160 and in redesignated

§§ 415.162 and 415.164.

Practices vary widely among and

within teaching hospitals with respect

to the degree of physician involvement

in the care of patients. In some cases,

teaching physicians personally direct

residents in furnishing patient care

services. In others, residents assume a

greater degree of responsibility for the

care patients receive, and the teaching

physicians exercise only general control

over the residents’ activities.

b. Statutory and Other Developments

Pertaining to Teaching Physician

Services

(1) Original Medicare Law and

Regulations

As originally enacted, title XVIII of

the Act excluded the services of

physicians, interns, and residents from

the definition of ‘‘inpatient hospital

services,’’ except for the services of

interns and residents in approved

training programs. The services of

residents in an approved program of a

hospital with which a skilled nursing

facility has a transfer agreement are

included in the definition of ‘‘extended

care services’’ and in the definition of

‘‘home health services’’ in the case of a

home health agency that is affiliated

with or under common control of a

hospital having the program. These

provisions established the costs of

approved GME programs for provider

services payable by intermediaries on a

reasonable cost basis. The Act did not

include special rules for payment of

physician services in teaching hospitals.

At the time of the publication of the

proposed rule, under §§ 405.520 and

405.521 for teaching physician services,

and §§ 405.522 through 405.525 for

residents’ services, a physician in a

teaching setting was considered the

attending physician for a Medicare

patient, and thereby qualified for Part B

payment, only if he or she furnished

‘‘personal and identifiable direction’’ to

the interns and residents who provided

the actual services to the patient. Before

January 1, 1992, Part B physician

services were paid under the reasonable

charge payment system. As of January 1,

1992, these physician services are paid

under the physician fee schedule set

forth in part 414 (56 FR 59502).

Although former § 405.521(b) listed

examples that illustrated the types of

responsibilities attending physicians
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63137

typically carry out, the list was not

exhaustive. In individual cases, it might

be difficult to determine, by referring to

§ 405.521, whether a physician in a

teaching setting is the ‘‘attending

physician’’ for a Medicare patient. It

might be necessary for the carrier to

review hospital charts to see if the

attending physician requirements were

met; however, the involvement of the

teaching physician in individual

services was often unclear from a review

of the charts.

It became apparent, shortly after the

former §§ 405.520 and 405.521 were

issued, that some Medicare carriers

were paying charges for physician

services in some teaching hospitals,

even though interns and residents were

primarily responsible for the care of the

patients. The physicians who were

billing for these services were often

assuming only limited responsibility for

the medical management of the patients’

treatment. It also became clear that some

physicians were submitting charges for

services furnished to Medicare patients

even though non-Medicare patients

were not billed for similar services, and

patients generally were not obligated to

pay for those physician services.

In April 1969, those problems led to

the issuance of Intermediary Letter 372,

which set forth specific conditions that

physicians in teaching settings were

required to meet to be considered

attending physicians and, thus, qualify

to charge the carrier for services in

which they involved residents. It also

specified how carriers were required to

determine the reasonable charges for

these services. Although Intermediary

Letter 372, which was still in effect at

the time of the publication of the

proposed rule, provided guidance to

Medicare carriers and intermediaries on

payment for these services, it was not

applied uniformly by all Medicare

carriers.

(2) 1972 Amendments

On October 30, 1972, the Congress

amended the Act to provide rules on

payment for physician services (as

distinguished from the services of

interns and residents) furnished in

teaching hospitals. Section 227 of the

Social Security Amendments of 1972

(Pub. L. 92–603) amended section

1861(b) of the Act to require that

Medicare treat those services as hospital

services and pay for them on a

reasonable cost basis, except under

certain specific circumstances. Section

227 also made certain incentives

available to hospitals that elected to be

paid for physician services on a

reasonable cost basis.

In subsequent legislation (section 15

of Pub. L. 93–233, enacted on December

31, 1973, and section 7 of the End-Stage

Renal Disease Program Amendments of

1978 (Pub. L. 95–292), enacted on June

13, 1978), the Congress deferred

implementation of all provisions of

section 227 of the 1972 amendments

except for the incentives to elect

reasonable cost payment for physician

direct medical and surgical services.

The cost reimbursement provisions

were implemented through former

§ 405.465, as published in a final rule on

August 8, 1975 (40 FR 33440). The

statutory provisions for which the

Congress deferred implementation were

eventually replaced by new provisions

passed by the Congress in ORA 1980.

ORA 1980 reaffirmed, but did not

otherwise affect, the provisions of

section 227 of the 1972 amendments

authorizing cost reimbursement

incentives.

(3) ORA 1980

Section 948 of ORA 1980 made

several important changes in the

sections of the Medicare statute that

address payment for physician services

in teaching hospitals. Specifically,

section 948—

• Repealed the provisions of the 1972

Amendments that required Medicare to

pay for those services (with certain

exceptions) on a reasonable cost basis;

• Amended section 1861(b) of the Act

to allow hospitals with approved

teaching programs to elect to be paid on

a reasonable cost basis for physician

direct medical and surgical services

furnished to their Medicare patients and

for the supervision of interns and

residents in the care of individual

patients if all physicians in the hospital

agree not to bill charges for their

services furnished to Medicare patients;

and

• Added section 1842(b)(6) of the Act

(now section 1842(b)(7)) to specify the

conditions that must be met to permit

payment under Part B for physician

services in teaching hospitals that do

not elect cost reimbursement, and to

provide special payment rules for

determining the customary charges

applicable in this situation.

In the Conference Report

accompanying ORA 1980 (H.R. Rep. No.

1479, 96th Cong., 2d Sess. 145 (1980)),

the Conference Committee stated that its

intention was to permit payment for

physician services in a teaching hospital

on a reasonable charge basis only if the

physician is the patient’s ‘‘attending

physician.’’ The conferees also endorsed

the attending physician criteria in

Intermediary Letter 372.

The Conference Report further stated

that ‘‘[t]he conferees intend (without

precluding reasonable changes in the

future) that in determining the amount

payable on a charge basis under

Medicare Part B for services of

physicians in teaching hospitals, the

policies contained in Intermediary

Letter 372 should be generally followed

where these are not inconsistent with

the provisions of the conference

agreement.’’ Ibid. p. 146.

(4) DEFRA 1984

Subsequently, section 2307(a) of

DEFRA 1984 further amended section

1842(b)(7) of the Act concerning

conditions for payment for physician

services furnished in teaching hospitals

that do not elect cost reimbursement.

Section 2307(a) was later amended by

sections 3(b) (5) and (6) of the DEFRA

Technical Amendments (Public Law

98–617), enacted on November 8, 1984.

As revised, section 1842(b)(7) of the Act

(which was redesignated from section

1842(b)(6) of the Act by section 2306 of

DEFRA ’84) provided that—

• The customary charge of a

physician qualifying as a teaching

physician is set no lower than 85

percent of the prevailing charge paid for

similar services in the same locality;

and

• If all the teaching physicians in a

teaching hospital agree to accept

assignment for all the services they

furnish to Medicare patients in that

hospital, the customary charge is set at

90 percent of the prevailing charge paid

for similar services in the same locality.

(5) 1989 Proposed Rule

On February 7, 1989, we published a

proposed rule that would have

implemented the teaching physician

payment provisions of both ORA 1980

and DEFRA 1984 (54 FR 5946). In that

document, we proposed the following

changes relating to teaching physicians:

• Revise the regulations governing the

conditions under which Medicare

payment is made for the services of

physicians in teaching settings and

implement a special methodology for

determining customary charges for the

services of teaching physicians.

• Revise the regulations governing

Medicare payment to providers for

compensation paid to physicians who

furnish services that are of general

benefit to patients in the provider.

That proposed rule was never

published in final because legislation

enacted in 1989 and 1990 that mandated

the implementation of the Medicare

physician fee schedule had the effect of

replacing the payment methodology of

the proposed rule.
63138 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

3. Payments for Supervising Physicians

in Teaching Settings and for Residents

in Certain Settings

In our July 26, 1995 proposed rule, we

proposed to revise the regulations

because of the substantial changes that

have taken place in the way Medicare

payments for physician services are

determined (that is, the replacement of

the reasonable charge system with the

physician fee schedule); the length of

time since the publication of the

February 1989 proposed rule; and our

decision to propose to replace the

attending physician criteria of the

February 1989 proposed rule. The

details of the attending physician policy

had been set forth earlier in

Intermediary Letter 372, published in

April 1969.

We proposed to change the attending

physician criteria from those of

Intermediary Letter 372 to make the

criteria more flexible in terms of the

individual teaching physician who may

serve as the responsible physician for a

particular service while ensuring that a

teaching physician is present during at

least some portion of each service

payable by the carrier. We also proposed

rules based on other Medicare policies

that had been in effect for years but had

never been explicitly addressed in the

regulations.

a. Distinction Between Teaching

Hospital and Teaching Setting

We proposed to distinguish between

‘‘teaching hospital’’ and ‘‘teaching

setting,’’ because the former is more

directly related to intermediary

payments, and the latter (although

defined in terms of intermediary

payments) is more directly related to

carrier payments. We proposed to define

‘‘teaching hospital’’ as a hospital

engaged in an approved GME residency

program in medicine, osteopathy,

dentistry, or podiatry. We proposed to

define ‘‘teaching setting’’ as a provider

or freestanding setting for which

Medicare payment for the services of

residents is made under the direct GME

payment provisions of § 413.86

(hospitals, hospital-based providers, and

settings, including nonprovider settings,

meeting the requirements for residents

in § 413.86(f)(1)(iii)), or on a reasonable

cost basis under the provisions of

§ 409.26 or § 409.40(f) for residents’

services furnished in freestanding

skilled nursing facilities or home health

agencies, respectively.

b. Statutory Requirements for Payment

in Teaching Hospitals Not Electing

Reasonable Costs for Physician Services

to Individual Patients

Section 1842(b)(7) of the Act is

generally premised on the use of

customary charges, that is, the

reasonable charge system, as the basis

for Medicare payments for the services

of physicians in teaching hospitals.

Section 1848 of the Act, however,

established the physician fee schedule

as the payment methodology for

physician services furnished beginning

January 1, 1992 without any exception

for physician services furnished in

teaching settings. Therefore, we based

the policies in the July 26, 1995

proposed rule on principles established

in legislation on payment for physician

services generally under the physician

fee schedule, on payment for physician

services furnished in providers, and on

payment to hospitals for GME programs.

With regard to payment to hospitals for

GME programs, the proposal addressed

activities associated with GME programs

that were not payable through fiscal

intermediary payment mechanisms.

c. Intermediary Letter 372 Attending

Physician Criteria

The Intermediary Letter 372 attending

physician criteria and related policy

were developed by Medicare in 1969 as

a means of documenting the

involvement of teaching physicians in

patient care services furnished in

teaching hospitals and have been

controversial ever since. It was

recognized then and now that residents

must furnish patient care services to

develop their skills as physicians or

other types of practitioners. The

‘‘attending physician’’ policy was

developed as a mechanism to make Part

B fee schedule payments for services in

which residents were involved. The

main requirement of the policy was that

there would be a single attending

physician who personally examined the

beneficiary within a reasonable time

after admission, confirmed the diagnosis

and course of treatment, and was

continuously involved in the care of the

beneficiary throughout the stay. The

attending physician policy as set forth

in Intermediary Letter 372 and related

issuances specifically stated that the

attending physician had to be present

when a major surgical procedure or a

complex or dangerous medical

procedure was performed, but was

vague, perhaps necessarily, on the

matter of the presence of the physician

during other occasions of inpatient

service. There was less ambiguity with

regard to hospital outpatients. Part A

Intermediary Letter No. 70–7/Part B

Intermediary Letter No. 70–2 (issued in

January 1970), a question-and-answer

on Intermediary Letter 372, indicated

that the supervising physician must

either personally perform the service or

function as the attending physician and

be present while a service is being

furnished (question 14).

Medicare carriers were directed to

periodically review the hospital charts

for verification of the establishment of

attending physician relationships and

their involvement in individual

services. If the chart did not substantiate

a sufficient level of involvement in the

care furnished, the teaching physician

role was seen as supervisory in nature,

rather than as an attending physician,

even though the teaching physician may

have had legal responsibility for the care

furnished to the patient. Consequently,

the fiscal intermediary for the hospital

would pay Medicare’s share of the

salary costs of the teaching physician

attributable to the supervision of

residents, but the Medicare carrier

would not make payment for the

physician services on the basis of

reasonable charges.

We believe, after years of working

experience with the Intermediary Letter

372 attending physician policy, that we

should replace it. The amount of

postpayment review necessary to verify

the establishment and continuity of the

attending physician relationship from

patient charts had become impractical

given reductions in contractor budgets

and was inconsistent with more recent

congressional action. While the

Congress endorsed the attending

physician policy in the Conference

Report accompanying ORA 1980, the

Intermediary Letter 372 policy might be

viewed as not entirely consistent with

the payment mechanism enacted in

OBRA ’86 under section 1886(h) of the

Act for payment of direct GME costs in

teaching hospitals. For example,

Intermediary Letter 372 indicated that,

if a physician was not an attending

physician but supervised a resident who

furnished a service, the costs of the

physician services were payable by the

intermediary. Under section 1886(h) of

the Act, if a service was determined not

to be an attending physician service

billable under Part B, the service could

not become a provider service for

purposes of additional payments made

under Part A since the GME payments

were prospectively determined amounts

that could not be adjusted based on the

individual circumstances of the delivery

of individual services. Further,

allocation agreements between

physicians and hospitals identifying the

various activities in which the
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63139

physicians were involved for purposes

of determining the appropriate payment

amounts had no effect on GME

payments in an individual hospital cost

reporting period. The costs that were

allocated during the GME base period

were carried forward regardless of

changes in the physician activities.

Moreover, the Intermediary Letter 372

policy left it to individual carriers to

determine coverage of the services based

on customary practices in the area or on

the competence of individual residents.

For example, a sentence in Intermediary

Letter 372.A. reads as follows:

If the supervising physician was present at

surgery, and the surgery was performed by a

resident acting under his close supervision

and instruction, he would not be the

attending surgeon unless it were customary

in the community for such services to be

performed in a similar fashion to private

patients who pay for services rendered by a

private physician.

While this policy might have been

appropriate 30 years ago in the early

days of Medicare, we stated in our

proposed rule (60 FR 38409) that we

believe it is inappropriate to base the

determination of whether a carrier will

pay several thousand dollars or zero

dollars for a surgical procedure on this

standard, which could result in a wide

disparity of policy from area to area

regarding when payment is made.

Another problem with the

Intermediary Letter 372 policy was

reliance on a single physician to be the

attending physician for the beneficiary

throughout the inpatient stay. The only

exception permitting an attending

physician relationship for only a portion

of a stay was if the portion was a

distinct segment of the patient’s course

of treatment, such as the postoperative

period. Another example from

Intermediary Letter 372 reads as

follows:

A group of physicians share the teaching and

supervision of the house staff on a rotating

basis. Each physician sees patients every

third day as he makes rounds. No physician

can be held to be one of these patients’

attending physician for any portion of the

hospital care although consultations and

other services they personally perform for the

patient might be covered.

We stated in our proposed rule (60 FR

38409) that we believe that this

emphasis on a single teaching physician

serving as the attending physician

through the stay was no longer

necessary, and that we should provide

teaching hospitals and GME programs

with flexibility in the determination of

the responsible teaching physician in an

individual case. We no longer believe

the Intermediary Letter 372 requirement

that a single physician be recognized by

the beneficiary as his or her personal

physician through a period of

hospitalization reflects current realities.

Further, the existing attending

physician regulation might operate at

cross-purposes with managed care

arrangements that often employ

treatment teams.

The Intermediary Letter 372

requirements for continuity of care

might be difficult for carriers to verify

from reviews of medical records, might

be interpreted in different ways by

different carriers, and might be

counterproductive and burdensome in

the delivery of services to the patient.

We believe the proposed policy would

address potential sources of

misunderstanding and abuse that have

been longstanding Medicare program

concerns. For example, Intermediary

Letter 372 required the attending

physician to personally examine the

patient, review the history and record of

test results, etc. From discussions with

carrier medical directors, it is our

understanding that some carriers

considered the requirements to be met

if the teaching physician first saw the

patient 1 or 2 days after admission. In

those situations, the carrier might pay

for an admission history and physical

performed by a resident on Saturday

while the teaching physician did not

actually see and examine the patient

until Monday. Other carriers would

maintain that, to pay for the admission

history and physical as an attending

physician, the teaching physician would

have to see the patient on the day the

service was performed.

We believe that the most important

consideration should be the presence of

the teaching physician during the key

portion of the service or procedure

being furnished by the resident, and that

requiring both an attending physician

relationship and the presence of that

same physician during every billable

service is no longer warranted. Thus,

under our proposal, carriers would no

longer pay for services such as

admission evaluation and management

services unless a teaching physician was

present during the key portion of the

service.

d. Carrier Payment for Services of

Teaching Physicians—General

We proposed to eliminate the

Intermediary Letter 372 attending

physician criteria from the

determination of whether payment

should be made for the services of

physicians in teaching settings. We

recognize that the term ‘‘attending

physician’’ is used in academic

medicine to denote the responsible

physician, and we believe that hospitals

and GME programs should be free to

designate any physician to be the

attending physician of the patients in

the teaching setting. We proposed to

require the following conditions for

services of teaching physicians

(physicians who involve residents in the

care of their patients) in both inpatient

and outpatient settings to be payable

under the physician fee schedule:

• A teaching physician (a physician

other than a resident or fellow in an

approved program) must be present for

a key portion of the time during the

performance of the service for which

payment is sought.

• In the case of surgery or a

dangerous or complex procedure, the

teaching physician must be present

during all critical portions of the

procedure and must be immediately

available to furnish services during the

entire service or procedure. We

specified that the teaching physician

presence requirement is not met when

the presence of a teaching physician is

required in two places for concurrent

major surgeries. The operative notes

must indicate when the teaching

physician presence in individual

procedures began and ended. In the case

of procedures, such as an endoscopy, in

which a body area, rather than a

representation, is viewed, we would not

make payment if the teaching physician

was not present during the viewing. A

discussion of the findings with a

resident would not be sufficient. The

situation is contrasted with a diagnostic

procedure, such as an x-ray, in which

the physician would not be expected to

be present during the performance of a

test and could bill for an interpretation

by reviewing the film with the resident

(or by performing an independent

interpretation).

• In the case of services such as

evaluation and management services

(for example, visits and consultations),

for which there are several levels of

service available for reporting purposes,

the appropriate payment level must

reflect the extent and complexity of the

service if the service had been fully

furnished by the teaching physician. In

other words, if the medical decisionmaking in an individual service is

highly complex to an inexperienced

resident, but straightforward to the

teaching physician, payment is made at

the lower payment level reflecting the

involvement of the teaching physician

in the service. We intend to promote

flexibility and leave the decision to the

teaching physician as to whether the

teaching physician should perform

hands-on care, in addition to the care

furnished by the resident in the

presence of the teaching physician.
63140 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

However, in the case of both hospital

inpatient and outpatient evaluation and

management services, the teaching

physician must be present during the

key portion of the visit.

• The presence of the physician

during the service or procedure must be

documented in the medical records.

The proposal eliminated the

Intermediary Letter 372 requirement

that the attending physician personally

examine the patient and left the

decision to the teaching physician as to

whether he or she should perform an

examination in addition to the

resident’s examination based on

medical and risk management

considerations rather than Medicare

payment rules. For example, a

beneficiary might be admitted to the

hospital on a Saturday and be examined

by a resident in the presence of a

teaching physician on duty at the time.

On Monday, another teaching physician

might be designated to be the attending

physician in the case. Under the

proposal to eliminate the Intermediary

Letter 372 attending physician criteria,

the services of both teaching physicians

in this example would be payable (as

long as distinct services are furnished).

Under our proposal, we clarified that

services of teaching physicians that

involve the supervision of residents in

the care of individual patients are

payable under the physician fee

schedule only if the teaching physician

is present during the key portion of the

service. If a teaching physician is

engaged in such activities as discussions

of the patient’s treatment with a resident

but is not present during any portion of

the session with the patient, we believe

that the supervisory service furnished is

a teaching service as distinguished from

a physician service to an individual

patient.

We believe that this clarification is

consistent with existing policy. Part A

Intermediary Letter No. 70–7/Part B

Intermediary Letter No. 70–2, issued in

January 1970, contained a series of

questions and answers about the

attending physician policy set forth in

Intermediary Letter No. 372. Question

14 of that issuance addressed services

furnished in emergency rooms and

outpatient departments and states the

following:

Q. Intermediary letter No. 372 states,

‘‘An emergency room supervising

physician may not customarily be

considered to be the attending physician

of patients cared for by the house staff,

etc.’’ Is this also true in the hospital’s

outpatient department?

A. Yes, because an attending

physician relationship is not normally

established with anyone other than the

treating physician in an outpatient

department. If the Part B bills are

submitted for services performed by a

physician in either the emergency room

or in any part of the outpatient

department, the hospital records should

clearly indicate either that: the

supervising physician personally

performed the service; or he functioned

as the patient’s attending physician and

was present at the furnishing of the

service for which payment is claimed.

At the same time we were concerned

about the integrity of the Medicare

payment process, we recognized that

application of this policy to the

reimbursement of teaching physicians

in family practice residency programs

raised special concerns about the

viability of these programs. Family

practice residency programs are

different from other programs because

training occurs primarily in an

outpatient setting, known as a family

practice center. In these centers,

residents are assigned a panel of

patients for whom they will provide

care throughout their 3 years of training.

While teaching physicians supervise

this care and, indeed, are present during

the actual furnishing of services in some

circumstances (most notably with first

year residents and for more complex

patient cases), a general requirement

that teaching physicians be physically

present during all visits to the family

practice center would undermine the

development of this physician/patient

relationship. This requirement also

would be incompatible with the way

family practice centers are organized

and staffed and could require the hiring

of additional teaching physicians when

the faculty are already in short supply.

We stated in our July 26, 1995

proposed rule (60 FR 38410) that we

would be willing to develop a special

rule for paying teaching family

physicians that takes into account the

unique nature of these training

programs while clarifying the

appropriate level of involvement of the

teaching physician in patient care in

family practice centers. We invited

comments on the structure and content

of such a rule, or a legislative proposal,

along with any supportive data. We also

invited comments on whether and how

such a rule might be applied to other

primary care training programs.

e. Special Treatment—Psychiatric

Services

During the period in which we were

developing the February 1989 proposed

rule, we met with representatives of

psychiatric GME programs who

indicated that it was inappropriate for a

physician other than the treating

resident to be viewed by psychiatric

patients as their physician. In

psychiatric programs, the teaching

physician may observe a resident’s

treatment of patients only through oneway mirrors or video equipment. We

accepted this position and proposed

that, with respect to psychiatric services

(including evaluation and management

services) furnished under an approved

psychiatric GME program, the teaching

physician would be considered to be

‘‘present’’ during each visit for which

payment is sought as long as the

teaching physician observes the visit

through visual devices and meets with

the patient after the visit.

f. Physician Services Furnished to Renal

Dialysis Patients in Teaching Hospitals

Effective for services furnished on or

after August 1, 1983, Medicare pays for

physician services to end-stage renal

disease patients on the basis of the

physician monthly capitation payment

method described in § 414.314. This

payment method generally applies to

renal-related physician services

furnished to outpatient maintenance

dialysis patients, regardless of where the

services are furnished (that is, in an

independent end-stage renal disease

facility, a hospital-based end-stage renal

disease facility, or in the patient’s

home). Physician services furnished to

end-stage renal disease patients on or

after August 7, 1990 may also be paid

on the basis of the initial method as

described in § 414.313. We would

continue application of these physician

payment methods to teaching hospitals

with end-stage renal disease facilities.

We would not impose any special

medical record documentation

requirements solely because the endstage renal disease facility is based in a

teaching hospital.

Physician fee schedule payments for

covered physician services furnished to

inpatients in a hospital by a physician

who elects not to continue to receive

payment on a monthly capitation basis

through the period of the inpatient stay,

or who is paid based on the initial

method, would be determined according

to the rules described in proposed

§ 415.170. Physicians would have to

either personally furnish the services, or

furnish the services as a teaching

physician as described in proposed

§ 415.172.

g. Special Criteria for Anesthesia

Services and Interpretation of

Diagnostic Tests

Special criteria for anesthesia services

involving residents appear in § 415.178.

In the case of diagnostic radiology and

other diagnostic tests, we make payment
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63141

for the interpretation if the physician

either personally performs the

interpretation or reviews the resident’s

interpretation.

h. Services of Residents

We proposed to incorporate into the

regulations longstanding Medicare

coverage and payment policy regarding

the circumstances under which the

services of residents are payable as

physician services. These policies are in

operating instructions and other

issuances.

Generally, the services of residents in

approved GME programs furnished in

hospitals and hospital-based providers

are payable through the direct GME

payment methodology in § 413.86. For

hospital cost reporting periods

beginning on or after July 1, 1985, a

teaching hospital is entitled to include

residents working in the hospital and

hospital-based providers in the full-time

equivalency count used to compute

direct GME payments. These payments

are based on per-resident amounts

reflecting GME costs incurred during a

base period and updated by the

Consumer Price Index. Further, effective

July 1, 1987, under the conditions set

forth in § 413.86(f)(1)(iii), a teaching

hospital may elect to enter into a written

agreement with another entity for the

purpose of including the time spent by

residents in furnishing patient care

services in a setting outside the hospital

in the hospital’s full-time equivalency

count of residents for GME purposes.

The agreement must specify that the

hospital compensate the resident for the

services in the nonhospital setting.

When an agreement is in effect, the

teaching setting guidelines of proposed

§§ 415.170 through 415.184 would

apply to services in which physicians

involve residents in the nonhospital

setting. The services of residents in

these settings are payable as hospital

services rather than physician services.

We stated that proposed § 415.200

would replace current § 405.522.

Current § 405.523 addressed payment

for the services of residents who are not

in approved programs. The section was

applicable to the services of a physician

employed by a hospital who is

authorized to practice only in a hospital

setting and to residents in an

unapproved program. We proposed to

replace this rule with new § 415.202.

The proposed rule incorporated the

policy currently in section 404.1.B of

the Provider Reimbursement Manual

(HCFA Pub. 15–1), which provides that

only the costs of the residents’ services

are allowable as Part B costs, and that

other costs, such as teaching costs, of an

unapproved program are not allowable.

Current § 405.524 (‘‘Interns’ and

residents’ services outside the hospital’’)

provided for reasonable cost payments

for the services of residents in

freestanding skilled nursing facilities

and home health agencies. We proposed

to rename this section to clarify that its

scope is limited to these types of

providers and to include it with only

minor changes into a new § 415.204.

We proposed to establish a new

§ 415.206 to address payment issues

relating to the services of residents in

nonprovider settings, such as

freestanding clinics that are not part of

a hospital. Paragraph (a) addresses

situations when a teaching hospital and

another entity have entered into a

written agreement under which the time

the residents spend in patient care

activities in these nonhospital settings is

included in the hospital’s full-time

equivalency count used to compute

direct GME payments. If an agreement is

in force, the carrier would make

payments for teaching physician and

other physician services under the rules

in §§ 415.170 through 415.190.

If a nonprovider entity, such as a

freestanding family practice or

multispecialty clinic, does not enter into

this type of agreement for residency

training with a teaching hospital, the

payment mechanism in proposed

§ 415.206(b) would apply in the case of

services furnished by certain residents.

We modified the policy on Part B

billings for services furnished by

licensed residents in the late 1970’s in

an action designed to enhance the

ability of primary care residency

programs to finance their training

activities outside the teaching hospital

setting. We revised the Medicare

Carriers Manual (HCFA Pub. 14–3) to

cover residents’ services furnished in a

setting that is not part of a hospital as

physician services if the resident was

fully licensed to practice by the State in

which the service was performed. This

policy applies whether or not the

residents are functioning within the

scope of their approved GME program.

Under these circumstances, the resident

is functioning in the capacity of a

physician, and the teaching physician

guidelines do not apply.

Additionally, the services of residents

practicing in freestanding federally

qualified health centers and rural health

clinics who meet the requirements of

proposed § 415.206(b) would be eligible

for payment under the payment

methodology for federally qualified

health centers. (We would make

payments for residents’ services in a

hospital-based entity under the

provisions of § 413.86 for direct GME

payments.) We proposed to allow

freestanding federally qualified health

centers and rural health clinics to

include the costs of a service performed

by a resident meeting those

requirements as an allowable cost on the

entity’s cost report. We proposed to

amend § 405.2468(b)(1), which sets forth

allowable costs for federally qualified

health centers and rural health clinic

services, to recognize these costs.

Further, a resident is considered to be

a physician as defined in revised

§ 405.2401(b) for the purpose of

determining payments to the federally

qualified health centers and rural health

clinics. Consistent with the payment

method for federally qualified health

centers and rural health clinics,

payments for services furnished by

residents in federally qualified health

centers and rural health clinics would

be paid under § 405.2462 rather than

under the physician fee schedule. In

other words, services of the resident

would be treated in exactly the same

manner as services of other physicians

who are not residents in the federally

qualified health center or rural health

clinic. We believe that recognizing the

costs of these residents in federally

qualified health centers and rural health

clinic settings would create more

uniformity in the way these costs are

treated by the Medicare program.

We proposed to establish a new

§ 415.208 to address carrier payments

for the services of ‘‘moonlighting’’

residents. Paragraph (a) defines these

services as referring to services that

licensed residents perform that are

outside the scope of an approved GME

program. Paragraph (b) reflects the

policy set forth in section 2020.8.C. of

the Medicare Carriers Manual under

which carriers may pay under the

physician fee schedule for the services

of moonlighting residents in the

outpatient department or emergency

department of a hospital in which they

have their training program if there is a

contract between the resident and the

hospital indicating that the following

criteria are met:

• The services are identifiable

physician services and meet the criteria

in § 415.102(a) (formerly § 405.550(b)).

• The resident is fully licensed to

practice medicine, osteopathy,

dentistry, or podiatry in the State in

which the services are performed.

• The services can be separately

identified from those services that are

required as part of the approved GME

program.

Paragraph (c) indicates that the

moonlighting services of a resident

furnished outside the scope of an

approved GME program in a hospital or

other setting that does not participate in
63142 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

the GME program are payable as

physician services under the physician

fee schedule.

i. Redesignation of Regulations on

Teaching Hospitals, Teaching

Physicians, and Physicians Who

Practice in Providers

As a part of this rulemaking process,

we proposed to redesignate the

regulations currently set forth in

§§ 405.465 and 405.466, 405.480

through 405.482, 405.522 through

405.524, 405.550, 405.551, 405.554,

405.556, and 405.580 into a new part

415, along with the new regulations

proposed in this rule. The redesignation

is part of our continuing effort to

improve the overall organization of title

42 of the Code of Federal Regulations

and, in this case, specifically, the

organization of the regulations on

teaching hospitals, teaching physicians,

and physicians who practice in

providers.

Except as indicated below, we

proposed only technical changes to

conform cross-references, and no

substantive changes were included. We

proposed to remove §§ 405.520 and

405.521 because the applicable rules for

payment of services are obsolete. We

also proposed to remove the chart for

payment to interns and residents in

§ 405.525 as obsolete. In addition, we

proposed to remove § 405.552 because

the applicable payment rules for

anesthesia services are set forth in

§ 414.46. The proposed deletion of

§ 405.552 was an error; we are

redesignating this section as § 415.110.

We intended the redesignation to

make these regulations easier to use.

Following is a distribution table that

indicates the new section numbers that

will result from the redesignation or the

removal of the section:

DISTRIBUTION TABLE

Old section New section

405.465 ....... 415.162

405.466 ....... 415.164

405.480 ....... 415.55

405.481 ....... 415.60

405.482 ....... 415.70

405.520 ....... Removed.

405.521 ....... Removed.

405.522 ....... 415.200

405.523 ....... 415.202

405.524 ....... 415.204

405.525 ....... Removed.

405.550 ....... 415.100, 415.102

405.551 ....... 415.105

405.552 ....... 415.110

405.554 ....... 415.120

405.556 ....... 415.130

405.580 ....... 415.190

Following is a derivation table that

shows the origin of each section of the

new material:

DERIVATION TABLE

New section Old section

415.1 .......................................

415.50 .....................................

415.55 ..................................... 405.480

415.60 ..................................... 405.481

415.70 ..................................... 405.482

415.100, 415.102 .................... 405.550

415.105 ................................... 405.551

415.110 ................................... 405.552

415.120 ................................... 405.554

415.130 ................................... 405.556

415.150 ...................................

415.152 ...................................

415.160 ...................................

415.162 ................................... 405.465

415.164 ................................... 405.466

415.170 ...................................

415.172 ...................................

415.174 ...................................

415.176 ...................................

415.178 ...................................

415.180 ...................................

415.184 ...................................

415.190 ................................... 405.580

415.200 ................................... 405.522

415.202 ................................... 405.523

415.204 ................................... 405.524

415.206 ...................................

415.208 ...................................

4. Public Comments on the Teaching

Physician Proposal in the Proposed Rule

and Our Responses

We received several thousand

comments on the teaching physician

proposal in our July 26, 1995 proposed

rule. Almost all of the comments came

from medical schools, residency

programs, and other entities that bill for

physicians’ services in teaching

hospitals and GME programs. The

comments and our responses to them

follow.

Comment: Most commenters argued

that the requirement of teaching

physician presence during individual

services was a significant departure

from the current practice, and that a

teaching setting would need a great deal

of time to implement the requirement.

They requested a delay in the effective

date of any new policy. They believed

that January 1 would be a particular

problem since it falls in the middle of

the cost reporting period for most

teaching hospitals.

Response: We do not believe that the

physical presence requirement is a

significant departure from current

practice. Instead, as we have indicated

in the proposed rule and in this final

rule, the proposed rule requiring

physical presence clarifies current

policy. Under the criteria in

Intermediary Letter 372, Part B payment

should be made only when a

supervising physician either personally

performed the service or functioned as

the attending physician and was present

while the service was furnished. It has

always been our intent that, at a

minimum, a teaching physician must be

present during a service furnished by an

intern or resident in order for the

teaching physician to receive Part B

payment.

We proposed to clarify our policy

because it has not been enforced

consistently across carriers. More

specifically, we have learned that some

teaching physicians are billing Medicare

and receiving Part B payment for

services even when the service is

performed by an intern or resident

outside the presence of the teaching

physician and the teaching physician

has minimal involvement, or no

involvement, in the service. Under the

physician fee schedule, payment

amounts are intended to reflect the

amount of resources required for a

particular service, and we believe a

teaching physician should not receive a

resource-based fee schedule amount

when the physician has expended little

or no resources with respect to the

service. It would be particularly

inequitable to make a resource-based

payment to some teaching physicians

when other teaching physicians receive

no payment because a carrier is properly

applying the physical presence

requirement in Intermediary Letter 372.

Thus, the proposed rule would clarify

the physical presence requirement

reflected in Intermediary Letter 372. At

the same time, the proposed rule

increases flexibility for billing. The

criteria in Intermediary Letter 372 were

premised in part on the notion that the

same physician served as the attending

physician throughout the entire

inpatient stay; therefore, only that

physician could bill Medicare Part B.

Accordingly, under Intermediary Letter

372, if a patient receives a service from

the attending physician soon after

admission, and receives services from

other physicians during the course of

the inpatient stay, the other physicians

cannot bill Medicare Part B for services

furnished by a resident. The proposed

rule deletes the requirement of a single

attending physician, and allows more

than one teaching physician to receive

Medicare Part B payment with respect

to a particular inpatient stay.

Although the physical presence

requirement merely clarifies current

policy, we are nevertheless willing to

delay the effective date of the provisions

of this final rule concerning teaching

physicians until July 1, 1996 to give our
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63143

contractors adequate time to educate all

affected parties. This delay will apply to

all provisions of the regulation

concerning teaching physicians,

including those that state the new

policies relating to the elimination of

the single attending physician

requirement and the exception for

residency programs in certain centers.

Comment: One commenter stated that

section 948 of the Omnibus

Reconciliation Act of 1980, as amended

by section 2307 of the Deficit Reduction

Act of 1984, requires only that—

The physician renders sufficient personal

and identifiable physicians’ services to the

patient and exercises full, personal control

over the management of the portion of the

case for which payment is sought.

The commenter believed that these

legislative provisions contain no

physician presence requirement and

questioned our authority to change 25

years of policy without a Congressional

mandate to do so.

Response: We believe that the

physical presence requirement is

entirely consistent with our statutory

authority. Under section 1887 of the

Act, we are authorized to establish

criteria to distinguish between services

furnished for an individual patient,

which may be paid for by carriers as

physician services, and services that are

furnished for the general benefit to

patients in a hospital, which are paid for

by intermediaries.

In addition, we do not view the

proposed policy as inconsistent with the

statutory provision cited by the

commenter. In the first place, we note

that section 1842(b)(7) of the Act is

largely premised on the use of charges

as a basis for payment, and the chargebased system for physicians’ services

has been superseded by the enactment

of the physician fee schedule.

Nevertheless, the requirements stated in

that section are not in conflict with the

physical presence requirement. Section

1842(b)(7) provides that Part B payment

may not be made for the services of

teaching physicians unless, among other

things, ‘‘The physician renders

sufficient personal and identifiable

services to the patient and exercises full

personal control over the management

of the portion of the case for which

payment is sought.’’ (Emphasis added.)

We believe we have ample authority

under these provisions, as well as

section 1848 of the Act, to determine the

circumstances under which a teaching

physician has performed a service for a

patient, and thus has furnished a

‘‘physician’s service’’ that warrants Part

B payment under the physician fee

schedule. Currently, despite the criteria

in Intermediary Letter 372, many

teaching physicians are billing Medicare

and receiving Part B payment in

situations when they have minimal, if

any, involvement in the care of an

individual patient. For example, the

teaching physician may have medical

and legal responsibility for the care a

resident furnishes to a patient but may

never actually see the patient after

admission to the hospital. We believe it

is inappropriate to make Part B payment

in these cases, particularly because the

amount of payment is resource-based.

Of course, it is often difficult, and

quite time-consuming, to determine

when a physician is ‘‘sufficiently

involved’’ in a particular patient care

service so that Part B payment is

warranted. As indicated in the proposed

rule (60 FR 38409), the amount of

postpayment review necessary to verify

the involvement of teaching physicians

in the care of individual patients would

be enormous, and the use of scarce

carrier resources in that effort would be

impractical. Therefore, consistent with

our authority to establish standards for

determining when a service is furnished

for a patient, as a general matter we

believe the most appropriate and

feasible manner to determine when Part

B payment may be made is to require

that the teaching physician must be

present for the service for which

payment is sought. The physical

presence requirement identifies

situations when the teaching physician

is sufficiently involved in the service,

and at the same time it provides a

standard that can be readily

documented and verified.

Comment: One commenter argued

that, under the proposed rule, teaching

physicians would not be reimbursed in

any manner under Medicare for certain

teaching activities that were previously

paid for under Part B. According to the

commenter, Part A payment reflects

base year costs that include only

teaching physician costs related to the

administration of the teaching program,

and ‘‘Teaching physician time was not

allocable to Part A if attributable to

patient care, whether the service was

personally performed by the physician,

or furnished in the context of the

attending physician relationship.’’ The

commenter argued that teaching

activities related to services to

individual patients could not be

included in base year costs and thus

would never be reimbursed under Part

A. The commenter concluded that,

under the physical presence

requirement, teaching activities related

to the care of individual patients would

not be reimbursed under either Part A

or Part B.

Response: We believe the policies

reflected in this final rule fairly

reimburse hospitals and physicians for

the activities of teaching physicians. As

we have indicated, currently many

teaching physicians are billing Medicare

and receiving Part B payment even

when they have little or no involvement

in a service furnished by an intern or

resident. We believe it is not

appropriate for teaching physicians to

receive physician fee schedule payment

in these situations as if the teaching

physician had personally performed the

service, particularly since fee schedule

payments are intended to reflect the

amount of resources expended by the

physician. In order to address this

problem, and to ensure that Part B

payment is made only when the

situation warrants, this final rule

clarifies the physical presence

requirement reflected in Intermediary

Letter 372. We believe the requirement

is reasonable and necessary because it

ensures that Part B payment is made

only when a teaching physician is

sufficiently involved in the service and

does so in a manner that can be readily

documented.

We recognize that there may be some

inherent tension between policies for

carrier payments under Part B and

policies for intermediary payments

under Part A or Part B. If a service or

activity is payable under Medicare, and

it is not payable under Part B, then

presumably the service or activity is

encompassed in the Part A payment.

Therefore, any ‘‘change’’ in (or

clarification of) Part B policy may, at

least arguably, implicate Part A policy.

The commenter argued that, despite this

relationship between Part A and Part B,

under the proposed policies, some

services might not be reimbursed at all

under Medicare.

We believe that the commenter’s

arguments are misguided. We note

initially that, as a general matter,

payment for the costs of direct GME

under Part A, like any system that uses

base year costs, necessarily reflects

conditions in the base year, and any

number of conditions might change after

the base year (these changes might

benefit or hurt the hospital). However,

the use of base years for purposes of

making these Part A payments is

required by statute. We do not believe

we should necessarily perpetuate

inappropriate payments under Part B

simply because payments under Part A

cannot be adjusted.

Moreover, and more significantly, we

believe that the policies reflected in this

final rule taken as a whole reasonably

reconcile any tension that there might

be between Part A payment policies and
63144 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

Part B payment policies. The

commenter seemed to suggest that, in

conducting the Part A base year audits,

the agency excluded all costs associated

with teaching activities that were

related to patient care. This suggestion,

however, is incorrect. Indeed, as the

commenter acknowledged, time spent

supervising residents in patient care

was allocable to Part A under the audits

if there was no attending physician

relationship. Furthermore, although the

commenter also asserted that 100

percent of a physician’s time was

allocable to Part B ‘‘in the absence of

appropriate documentation,’’ it follows

that time spent supervising residents

could have been allocated to Part A if

the hospital or the physician provided

appropriate documentation. Thus,

contrary to the commenter’s suggestion,

teaching activities related to patient care

were, or could have been, included in

the Part A base year costs. We believe

we should not perpetuate inappropriate

Part B policies simply because hospitals

and physicians failed to properly claim

or document Part A costs in the base

year.

The commenter also indicated that,

under the proposed rule, certain

teaching activities would not be

reimbursed under Part B even though

they were reimbursed under Part B

previously (incorrectly or otherwise).

This might relate to activities such as

discussions about patient charts with a

resident when the teaching physician

was not present during the visit itself.

The commenter stated that, in the

proposed rule, we claimed incorrectly

that lost Part B revenues could be

collected through Part A. Contrary to the

commenter’s suggestion, we did not

mean to suggest that services that were

previously, but no longer, paid for

under Part B would be paid for through

increased payments under Part A.

Rather, we meant to indicate that, at

times in the past, improper payments

may have been made.

We believe that our policies

adequately reimburse hospitals and

teaching physicians for the activities of

teaching physicians. First, the services

of the interns or residents themselves

are payable under separate mechanisms.

Thus, to the extent that services are

provided by interns and residents who

are largely unsupervised, Medicare pays

for the direct costs of those services

through GME payments. Second,

consistent with the criteria in

Intermediary Letter 372, the teaching

physician may receive Part B payment

as long as the physician is present for

the service. Finally, we are providing

further flexibility for billing in this final

rule, so that services may now be paid

for under Part B even though the same

services could not previously be

properly billed to Part B; specifically,

under this final rule, more than one

teaching physician may bill Part B with

respect to a particular hospital inpatient

stay, whereas under Intermediary Letter

372, only a single attending physician

could properly bill Part B.

In short, hospitals and physicians will

not, as alleged, be systematically

underreimbursed under the policies

reflected in this final rule. The Part A

payment encompasses costs of

supervising residents that were (or

could have been) properly allocated and

substantiated for the base year. Teaching

physicians may continue to receive Part

B payment under the physical presence

requirement reflected in Intermediary

Letter 372. And Part B payment may

now be made under circumstances in

which payment could not properly be

made under Intermediary Letter 372.

Comment: Many commenters believed

that we developed the teaching

physician proposal because we had

concluded that beneficiaries in teaching

hospitals receive substandard care when

the teaching physician is not present

during the service or procedure.

Response: The policy was not

intended to specifically address quality

concerns. Rather, the policy addresses

payment issues, in particular,

identifying when it is appropriate to

make Medicare Part B payment to

teaching physicians who oversee the

services of interns and residents.

It is important to distinguish between

the services of interns and residents and

the services of teaching physicians.

Medicare fiscal intermediaries pay

teaching hospitals for the services of

interns and residents. Those services are

described in sections 1861(b) and

1832(a) of the Act and are paid under

the methodology established by section

1886(h) of the Act. Thus, the fiscal

intermediaries are already paying

teaching hospitals for services furnished

to beneficiaries by residents. The

graduate medical education costs

payable through the section 1886(h)

methodology also encompass any costs

associated with the supervisory services

of teaching physicians that were

appropriately allocated during the base

period for that methodology (fiscal year

1984).

Particularly in light of these other

payments, we believe that, if we are to

pay a fee to another physician who is

medically responsible for the services

the resident is furnishing to the

beneficiary, it is entirely appropriate to

require as a condition of payment that

the supervising physician furnish a

direct, personal physician service to the

beneficiary. This is the basis for the

payment of physician services under

Medicare. If the resident has personally

furnished the service to the beneficiary

and the intermediary is paying the

teaching hospital for Medicare’s share of

the services performed by the resident,

we believe it is appropriate not to pay

a full fee to a supervising physician who

was not present when the service was

furnished. Furthermore, the Medicare

beneficiary is responsible for a 20

percent coinsurance amount for that

physician’s services as well as any

deductible liability. We believe it is

fully consistent with a resource-based

fee schedule that the physician in

whose name the service is billed

furnishes a service to the beneficiary.

Comment: Many commenters stated

that residency programs cannot afford to

furnish services to Medicare

beneficiaries without Medicare

payment.

Response: Medicare fiscal

intermediaries pay approximately $7

billion annually in direct and indirect

medical expenses to teaching hospitals

for the costs associated with approved

GME programs.

Comment: Some commenters

expressed concern about the term ‘‘key

portion’’ in determining when the

teaching physician should be present.

They stated that it is often difficult to

define the key portion of a service or

procedure. Many commenters expressed

their concern with the lack of a clear

definition of what constitutes the key

portion of every service or procedure.

Many other commenters contended that

the key portion of the teaching

physician’s services takes place during

the teaching physician’s discussions of

the case with the resident before and

after a visit or procedures. This

argument was made by physicians in

both medical and surgical specialties.

Response: We proposed the concept

of the key portion of a service or

procedure to provide flexibility and to

avoid requiring the presence of the

teaching physician for the duration of

every service or procedure billed in his

or her name. Many of the commenters

expressed the view that the key

portion—and the most meaningful

portion—of the teaching physician’s

service to the beneficiary actually takes

place in the absence of the beneficiary.

We do not agree with this interpretation

of key portion because it blurs the

distinction between teaching oversight

and actually furnishing an identifiable

service to the beneficiary.

While we recognize the concern that

it may be difficult to determine the key

portion for a particular service, this

concept is necessarily general because it
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63145

is not feasible to define the key portion

for each and every billable service. In

order to provide guidance, we stated

some general guidelines in the proposed

rule. Thus, in the case of surgical, highrisk, or other complex procedures, the

teaching physician must be present

during all critical portions of the

procedure and immediately available to

furnish services during the entire

service or procedure. In the case of

surgery, the teaching physician’s

presence is not required during opening

and closing of the surgical field. In the

case of procedures performed through

an endoscope, the teaching physician

must be present during the entire

viewing.

In the case of evaluation and

management services, the teaching

physician must be present during the

portion of the service that determines

the level of service billed. The factors to

be considered are complexity of medical

decision-making, extent of history

obtained, and extent of examination

performed. We believe that the teaching

physician should have considerable

discretion in determining the key

portion of the service, and we do not

anticipate that carriers will deny claims

submitted based on this discretion, as

long as the claims are documented and

in accord with our guidelines. If the

teaching physician believes that a key

portion of an entire evaluation and

management service cannot be

identified, the teaching physician

should be present for the entire service.

We plan to address this matter further

in carrier manual instructions.

Comment: Some commenters objected

to the requirement of the proposed rule

that the teaching physician be present

during the viewing portion of a

procedure such as an endoscopy. The

commenters believed that the presence

of the physician should be determined

by the teaching physician based on the

competence of the resident.

Response: In those situations, we

believe that the carrier should pay for

the interpretation of the viewed area by

the teaching physician rather than by

the resident. As indicated earlier, the

viewing by the resident is not payable

as a physician service; this service by

the resident is paid under direct GME.

Comment: The majority of the

commenters identified themselves as

representatives of family practice

residency programs. The commenters

made the following points:

• Many appreciated the preamble

language of the proposed rule indicating

our willingness to consider adopting

special rules for family practice

programs.

• Many claimed that hospitals and

health care delivery systems would

cease residency training for family

practice programs if the proposal went

into effect without an exception.

• In a family practice program, the

resident is the primary care-giver, and

the faculty physician sees the patient

only in a consultative role.

• It is beneficial for family practice

residents to see patients alone in order

to learn medical decision-making and to

recognize their own limitations.

• A resident cannot be educated in

the art and practice of medicine without

unsupervised patient contact; the

proposed policy would interfere with

the development of a resident’s bedside

manner.

• One family practice resident

objected to the low levels of fee

payments for his services under

Medicare and Medicaid.

• The teaching physician presence

requirement intrudes upon the

relationship between the resident and

the patient and, in the view of some,

would cause Medicare beneficiaries to

lose confidence in the competence of

their resident physician.

• The requirement would necessitate

the hiring of more teaching physicians

and inhibit the ability to finance family

practice programs through patient care

billings.

• In many cases, the presence of the

teaching physician is superfluous.

• The proposal does not adequately

recognize the way medicine is practiced

in this country.

• The family practice teaching

physician is responsible for supervising

four or more residents and medical

students who are seeing patients

simultaneously. Since the teaching

physician must remain with the medical

students during patient care visits, he or

she does not have time to be involved

in services furnished by the residents.

• The family practice preceptors are

responsible for signing the medical

records after the residents have dictated

their entries which, in the view of some,

guarantees mandatory supervision for

each and every visit.

• Some residents are experienced

physicians who have been in private

practice for years and are in the

residency program only to obtain board

certification. The proposal does not

adequately address those residents.

• If the proposed policy is

implemented, family practice clinics

will refuse to treat Medicare

beneficiaries. Thus, the beneficiaries

will be forced to go to medical

assistance clinics.

• The proposal would put the

resident in the position of being a clerk

rather than a physician.

• Care furnished in family practice

programs is more cost-effective than

care furnished in established practices;

therefore, total Medicare costs are lower

when services are provided by these

programs.

• The physician presence

requirement would inhibit the ability of

family practice clinics to compete with

managed care programs in the

community.

In addition, the American Academy of

Family Practice proposed a specific

limited exception to the physician

presence requirement that we have

adopted in large part as set forth below.

Response: As we have discussed, we

believe the physical presence

requirement is necessary and

appropriate as a general rule to ensure

that Part B payment is not made when

a teaching physician does not furnish a

service for a patient; we also believe that

hospitals and teaching physicians

generally can, as a practical matter,

reasonably meet the presence

requirement and that Part B payment

will be made as appropriate for the

services and activities of teaching

physicians. At the same time, we

believe that, if the nature of a residency

program is fundamentally incompatible

with a physical presence requirement, it

may be appropriate to make Part B

payment if the teaching physicians

satisfy certain conditions that

demonstrate that they are sufficiently

involved in the care of individual

patients to warrant Medicare Part B

payment. As reflected in the proposed

rule, we believe a requirement of

physical presence would be inherently

incompatible with the nature of family

practice residency programs, and thus

unfairly deny reimbursement for the

activities of teaching physicians in these

programs and endanger the financial

viability of these programs. Because of

these considerations, we proposed a

limited exception for family practice

residency programs.

In light of the comments, we have

concluded that an exception should not

be limited to family practice programs,

but instead should apply to any program

that satisfies certain specified criteria.

The criteria are designed to capture

those residency programs with

requirements that are incompatible with

a physical presence requirement. Thus,

in this final rule, we have decided to

establish an exception to the physician

presence requirement for certain

evaluation and management services

furnished in certain centers within the

context of certain types of residency
63146 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

training programs. The exception is set

forth in a new § 415.174 of this final

rule.

Under the exception, carriers may

make physician fee schedule payment

for reasonable and necessary low to

mid-level evaluation and management

services when furnished by a resident

without the presence of a teaching

physician if all of the following

conditions are met:

• Services must be furnished in a

center located in the outpatient

department of a hospital or another

ambulatory care entity in which the

time spent by residents in patient care

activities is included in determining

intermediary payments to a hospital

under § 413.86.

• Any resident furnishing the service

without the presence of a teaching

physician must have completed more

than 6 months of an approved residency

program. The center is responsible for

furnishing this information to the

carrier. The family practice groups

recommended the 6-month requirement,

and we believe it is an appropriate

safeguard.

• The teaching physician may not

supervise more than four residents at

any given time and must direct the care

from such proximity as to constitute

immediate availability. The teaching

physician must—

+ Have no other responsibilities at the

time of the service for which payment

is sought;

+ Assume management responsibility

for those beneficiaries seen by the

residents;

+ Ensure that the services furnished

are appropriate;

+ Review with each resident during or

immediately after each visit, the

beneficiary’s medical history, physical

examination, diagnosis, and record of

tests and therapies; and

+ Document the extent of his or her

own participation in the review and

direction of the services furnished to

each beneficiary.

• The patients seen must be an

identifiable group of individuals who

consider the center to be the continuing

source of their health care and in which

services are furnished by residents

under the medical direction of teaching

physicians. The residents must

generally follow the same group of

patients throughout the course of their

residency program. We are not requiring

that the teaching physicians remain the

same over any period of time.

• The range of services furnished by

residents includes:

+ Acute care for undifferentiated

problems or chronic care for ongoing

conditions.

+ Coordination of care furnished by

other physicians and providers.

+ Comprehensive care not limited by

organ system, diagnosis, or gender.

We believe that the types of GME

programs most likely to qualify for this

exception include: family practice and

some programs in general internal

medicine, geriatrics, and pediatrics.

• The center must be located in a

setting in which the resident’s time is

included in the full-time equivalency

count used by the intermediary to make

direct GME payments to a hospital for

services of residents in that setting. In

a freestanding setting in which residents

are not counted for the purpose of

making these payments, the services of

licensed residents are already covered

as physician services.

This exception to the teaching

physician presence applies only to

specific low- and mid-level evaluation

and management codes for office or

other outpatient visits for both new and

established patients. The established

patient codes to which the exception

applies are CPT codes 99211, 99212,

and 99213 (and their successor codes).

New patient codes to which the

exception applies are CPT codes 99201,

99202, and 99203 (and their successor

codes). The teaching physician must be

present for higher level evaluation and

management codes and all invasive

procedures.

In paragraph (b) of new § 415.174, we

clarify that the exception may not be

construed as providing a basis for the

coverage of otherwise noncovered

services under Medicare, such as

routine physical checkups. Further, this

special treatment for certain training

situations does not apply to services

involving medical school students. A

service furnished by a medical school

student is a noncovered service under

Medicare even if the teaching physician

is in the room. We will publish further

instructions on the new policy in the

Medicare Carriers Manual.

Comment: Some commenters who

represent physician specialty

organizations stated that they were

opposed to any exception to the

physician presence requirement if it was

limited to a particular specialty. They

believed that the same rules on

physician presence should apply to all

specialties. Some commenters indicated

that special treatment for family practice

programs ‘‘devalued’’ the importance of

residency training in other programs.

Many commenters argued that any

special treatment given to family

practice programs should apply to their

programs as well. These include

psychiatry, physical medicine, internal

medicine, and obstetrics-gynecology.

For example, several commenters

believed that psychiatric residency

programs should be given the same

special treatment in the final rule as

might be afforded to family practice

programs. Some indicated that the costs

of purchasing video equipment or oneway mirrors would be too great.

Response: The exception we are

establishing at new § 415.174 is not

limited to family practice programs; it

applies to the indicated evaluation and

management codes when furnished

under the specified conditions. We are

continuing to provide an additional,

special exception for psychiatric

programs in § 415.184 as originally

proposed.

Comment: Some commenters

indicated that their family practice

clinics are not under the sponsorship of

a hospital, and that their programs do

not receive Medicare funds from a

hospital for the time the resident is in

the clinic.

Response: If the family practice clinic

is freestanding (that is, not part of a

hospital) and the residents are not

included in any hospital’s full-time

equivalent count of residents, the

services of licensed residents are

payable under the physician fee

schedule on the same basis as any other

physician’s services. This longstanding

policy applies regardless of whether or

not the resident’s services are furnished

within the scope of an approved GME

training program.

Comment: Several commenters

expressed concern that the same

residents for whom we are requiring the

presence of a teaching physician are not

supervised by a teaching physician

when they ‘‘moonlight’’ outside of their

training programs.

Response: We recognize moonlighting

situations and addressed the subject in

the proposed rule. When licensed

residents moonlight outside of their

training program, Medicare pays for

their services as physician services.

Medicare does not pay a teaching

hospital for these services through the

direct GME payment mechanism or

through the indirect medical education

payment mechanism. In other words, in

moonlighting situations, the Medicare

program pays for the service only once.

Comment: One organization

supported the proposed rule on

‘‘moonlighting residents’’ but sought

clarification as to the impact of the

proposal on inpatient services. Another

commenter sought clarification of the

policy when a licensed resident

moonlights in another teaching hospital.

Response: The proposal reflects

longstanding policy outlined in section

2020.8 of the Medicare Carriers Manual.
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63147

The policy does not encompass

Medicare payment for moonlighting

services furnished to inpatients in the

hospital in which the resident has his or

her program since we believe these

services are virtually indistinguishable

from the services the resident furnishes

within the scope of the training

program. However, when a licensed

resident moonlights in another teaching

hospital, the carrier must be furnished

sufficient information to be sure that the

moonlighting resident is not being

included in the residency count (used to

determine direct and indirect medical

education payments) of either hospital

for the period of time in question.

Moreover, in this final rule, we are

revising proposed § 415.202 (‘‘Services

of residents not in approved GME

programs’’) (formerly § 405.523) to

clarify that, when an intern or resident

is in an approved GME program at one

hospital and is concurrently furnishing

moonlighting services in another

hospital that lacks an approved GME

program, the services in the second

hospital may be reimbursed only

pursuant to 42 CFR part 414 or section

2109 of the Provider Reimbursement

Manual.

Comment: Some commenters

suggested that we should discard the

current proposal and implement the

‘‘philosophy’’ of teaching physician

immediate availability rather than

presence as proposed in the February 7,

1989 proposed rule.

Response: The exception that we have

added to the policy we are adopting is

consistent with the philosophy to which

the commenters referred.

Comment: Some commenters stated

that documentation of a teaching

physician’s presence during a procedure

would add costs to an already

burdensome, bureaucratic process.

Response: The policy we are adopting

cannot be enforced without some

documentation of the presence of the

teaching physician during procedures

and the personal involvement of the

teaching physician in evaluation and

management services.

Comment: A few physician specialty

organizations supported the proposal. In

addition, a few physicians stated that

the physician presence requirements

reflected their standard practice. Some

commenters representing surgeons

stated that, while they generally

supported the physician presence

proposal, they objected to the

requirement that the surgeons have to

indicate in their operative notes when

their presence began and ended since

the anesthesiologist and nurses already

record this information. Many other

commenters objected to any restriction

in the involvement of teaching surgeons

in concurrent cases. Some commenters

believed that third or fourth year

residents were capable of performing

surgical procedures with the teaching

physician in the operating suite rather

than in the operating room.

Response: As we stated in the

proposed rule, the notation in the

nurse’s notes is sufficient

documentation of the teaching

physician’s presence during surgical

procedures. There is no requirement

that the teaching physician personally

record the information if it duplicates

information available elsewhere. If the

teaching physician believes the third or

fourth year resident is capable of

performing surgical procedures without

supervision, the teaching physician

should not bill Part B for the surgical

services furnished by the resident.

Comment: One commenter

recommended that the teaching

physician be able to indicate the

following general statement on all

records:

I have interviewed and examined the

patient, and I agree with the history and

physical findings as recorded by Dr.

(Resident) in his/her note of (date).

The commenter believed that this

would clarify that the physician

participated in the care of the patient,

but not require that he or she spend

valuable time repeating all of the

documentation already present in the

record.

Response: This statement, by itself,

would not be sufficient for Part B

payment if the physician was not

present during the service. If the

physician was present, it is not

necessary for the teaching physician to

repeat all of the documentation entered

into the medical records by the resident.

The teaching physician may countersign

the resident’s entries and enter

additional notes as necessary to indicate

his or her involvement in the service.

We will address these matters in more

detail in manual instructions.

Comment: One commenter believed

that we should pay teaching physicians

under case management CPT codes

99361 through 99373 and care plan

oversight codes (CPT codes 99375 and

99376). These services include care

team conferences and telephone calls

for consultation or medical management

with other health care professionals. In

addition, the commenter suggested that

we undertake a demonstration project to

test the feasibility and cost-effectiveness

of these payments with the goal of

implementing a budget-neutral policy

for the payments. The same commenter

also suggested a policy under which the

teaching physician could bill Medicare

for each visit if the physician were

present to observe every third visit

furnished by the resident to the patient.

Response: Medicare does not allow

separate payment for the case

management codes. We consider case

management services to be included in

the prework and postwork of the

evaluation and management codes. The

suggestion seems to be a way of

removing the teaching physician further

from the actual performance of the

service, and we do not support this

outcome.

Comment: Under current policy in

§ 414.46(c)(1)(iii), if a teaching

anesthesiologist is involved in

concurrent cases, the medical direction

payment rules apply, and a reduced

allowance is recognized for the

physician service in each concurrent

case. Commenters argued that this

standard is inconsistent with the

standard for teaching surgical services.

They indicated their understanding that

the teaching surgeon can be involved in

concurrent procedures and receive a full

allowance for each surgical procedure.

Response: We intend to apply the

physician presence standard for both

surgical and anesthesia teaching

services and have revised § 415.178

(‘‘Anesthesia services’’) accordingly.

Under the policy we are adopting, while

we require the teaching surgeon’s

presence during the critical portion of

the service, we do not require the

surgeon’s presence during the opening

and closing of the patient. However,

during this period, the teaching surgeon

may not be involved in surgical services

for other patients since this would

preclude his or her return to the original

case. We believe that this policy is

analogous to the teaching

anesthesiologist policy under which, in

order to receive an unreduced fee, the

anesthesiologist must be present during

all critical portions of the procedure and

immediately available to furnish

services during the entire procedure.

Comment: A carrier medical director

commented that there should be a

national standard on documentation of

what the teaching physician actually

does. The carrier medical director

believed that physicians in nonteaching

settings have to provide considerably

more documentation than a countersignature, and that the teaching

physician should make a brief notation

documenting his or her involvement in

support of the level of evaluation and

management code billed.

Response: We plan to address this

matter in billing instructions to

implement the new policy.

Final decision: We are going forward

with the policy we proposed but have
63148 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

included an exception to the teaching

physician presence requirement for

certain evaluation and management

services furnished in certain centers

within the context of certain types of

residency training programs. The new

exception is found in § 415.174

(‘‘Exception: Evaluation and

management services furnished in

certain centers’’). The effective date of

the regulations concerning teaching

physicians will be July 1, 1996.

F. Unspecified Physical and

Occupational Therapy Services (HCFA

Common Procedure Coding System

Codes M0005 Through M0008 and

H5300)

We proposed to eliminate HCFA

Common Procedure Coding System

(HCPCS) codes M0005 through M0008

and H5300 and to redistribute the RVUs

to the codes in the physical medicine

section of the CPT (CPT codes 97010

through 97799). This policy change

requires a single way of reporting and

paying for a service for which there are

now two ways to report. We proposed

no change regarding what services may

be covered, only as to how covered

services would be billed and paid.

Comment: All the comments we

received expressed agreement with our

proposal to eliminate the HCPCS codes

M0005 through M0008 and H5300. The

commenters stated that these services

can be accurately reported using the

new and revised physical medicine and

rehabilitation codes in the CPT. They

considered the decision to delete these

codes to be appropriate and long

overdue. The commenters cited the

opportunity for unnecessary

duplications of service codes and the

misuse or overuse of the ‘‘M’’ codes in

billing by physical therapists to support

eliminating the HCPCS codes.

However, some commenters were

concerned that carriers might be

reluctant to follow billing rules under

the CPT for occupational and physical

therapists in the same manner as is

accepted for physicians. One

commenter had encountered problems

in the past with carrier refusals to

accept the range of codes allowed under

the scope of practice, to allow payment

for both physical therapy and

occupational therapy services required

by the same patient, or to reimburse for

more than one code per visit. Another

commenter questioned whether

occupational therapists in independent

practice could report the full range of

codes or if some codes were appropriate

only to physical therapists in

independent practice. The commenter

also observed that some procedures can

be considered either a physical therapy

service or an occupational therapy

service based solely on the specialty of

the provider performing the service.

Because of the coding flexibility, a

beneficiary who has met his or her

outpatient limit for physical therapy can

continue to receive some of the same

services under the occupational therapy

outpatient limit if the service is

furnished by an occupational therapist

and vice versa.

Response: Physical therapy and

occupational therapy services required

by the same patient are permitted, as is

payment for more than one code per

visit, subject to statutory requirements

and limitations. That is, the provider of

a service must be qualified within the

State’s scope of practice to furnish the

service. According to § 410.60

(‘‘Outpatient physical therapy services:

Conditions.’’), the services must be

furnished under a written plan of

treatment established by the physician

or therapist caring for the patient. The

services also must be medically

necessary and reasonable for the

diagnosis or treatment of an illness or

injury, as mandated by section 1862(a)

of the Act. Occupational and physical

therapy services furnished to the same

patient on the same day would

necessitate two separate treatment

plans, two separate physician orders,

and both must be medically necessary.

The current Medicare coding

limitations apply when both physical

therapists and occupational therapists

furnish services to the same patient.

Specifically, we do not allow separate

payment for CPT code 97250

(Myofascial release/soft tissue

mobilization, one or more regions) for

the same patient, on the same date of

service as CPT codes 97265 (Joint

mobilization), 97260 (Manipulation

(cervical, thoracic, lumbosacral,

sacroiliac, hand, wrist) (separate

procedure)), or 97261 (each additional

area) because these services overlap.

Because of the duplication of services

represented by the codes for manual

manipulation (CPT codes 97260 and

97261), soft tissue mobilization (CPT

code 97250), joint mobilization (CPT

code 97265), or osteopathic

manipulation (CPT codes 98925 through

98929), we do not permit separate

payment if any of these codes are

reported for the same patient, on the

same date of service. Aside from these

limitations, there is nothing that

precludes the payment for both physical

therapy and occupational therapy

services for the same patient on the

same date of service.

The full range of CPT codes 97010

through 97799 may be reported by

occupational therapists in independent

practice as well as by physical

therapists in independent practice if the

service is within the scope of practice.

We have no national payment policy

that prevents occupational therapists in

independent practice from billing and

being paid for any CPT code that

describes a service they furnish that

may be covered. We do not allow

payment for evaluation and

management services billed by physical

therapists in independent practice and

occupational therapists in independent

practice because the work RVUs for

these services include work that they

are not trained to perform (for example,

evaluation for and prescription of drug

therapy and evaluation for and

prescription of surgical or other

therapy). Otherwise, occupational

therapists in independent practice may

bill using any CPT code the carrier

determines describes the covered

services, not just the codes in the

physical medicine section of the CPT.

It follows, therefore, that the same

procedure code may be used to bill for

an occupational therapy service or a

physical therapy service. The covered

outpatient limit applies to both

specialties individually.

Comment: We were requested to

clarify whether carriers allow payment

for therapists’ bills submitted under the

physician fee schedule in the same

manner as physicians’ bills for similar

services.

Response: Section 1848(j)(3) of the

Act defines physicians’ services to

include outpatient physical therapy and

occupational therapy for physician fee

schedule payment and, therefore, bills

of physical therapists and occupational

therapists in independent practice are

treated in the same manner as bills of a

physician for covered services.

Comment: We received one comment

asking if RVUs will be established for

CPT codes 97545 and 97546, which are

currently carrier priced.

Response: We reviewed the RUC

recommendations and decided to defer

assigning RVUs for these codes until

there is a better definition of the

services. It is unclear whether the time

specified in the codes (CPT 97545, work

hardening/conditioning, initial 2 hours

and CPT code 97546, each additional

hour) describes the time of the patient

or the practitioner. It is our belief that

it is possible for physical therapists in

independent practice to do work

hardening for four patients

simultaneously, rotating from patient to

patient located within the same room.

Moreover, we believe that there is more

work (that is, higher intensity and oneon-one attention) in the first 2 or more

hours of service, not the initial 2 hours
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63149

of care in a given day, as these codes are

defined. We believe that the intensity

and amount of work drops off quickly

in the process and that it would be

impossible to value the services

correctly under its current definition.

Comment: As noted in the proposed

rule, the Health Care Professional

Advisory Committee will be considering

the creation of evaluation and

management codes for physical

therapists in independent practice and

occupational therapists in independent

practice. One commenter expressed

hope that these codes would be

developed by 1997.

Response: We anticipate these codes

will be developed for use in 1997.

Final Decision: We will eliminate

HCPCS codes M0005 through M0008

and H5300 and redistribute the RVUs

across CPT codes 97010 through 97799.

This policy change is not explicitly

addressed in our regulations.

G. Transportation in Connection with

Furnishing Diagnostic Tests

The general physician fee schedule

policy regarding additional payments

for travel expenses is that travel is

included in the practice expense RVUs

for a service. However, we have not

specifically applied that policy to the

transportation of equipment used to

perform diagnostic tests. In the absence

of specific instructions from us, separate

payment for the transportation of

diagnostic equipment has been at the

Medicare carriers’ discretion. We

proposed to standardize payment for

transportation of diagnostic equipment

by applying the general physician fee

schedule policy regarding payment for

travel expenses to transportation

services except in some cases of

transporting portable x-ray and EKG

equipment.

The exceptions are based on

longstanding specific instructions. In

the case of x-ray services furnished by

approved suppliers, section 1861(s)(3)

of the Act establishes the coverage of

diagnostic x-rays furnished in a place of

residence used as the patient’s home.

Although the Congress did not

explicitly so state, we determined that,

because there were increased costs

associated with transporting the x-ray

equipment to the beneficiary, the

Congress intended for us to pay an

additional amount for the transportation

service. Thus, we established codes for

use in billing for a transportation

component of these services. Nothing in

our proposal affects the payment of a

transportation component in connection

with the x-ray procedures furnished by

approved portable x-ray suppliers listed

in section 2070.4.C of the Medicare

Carriers Manual.

We later added the taking of an EKG

tracing to the list of services approved

suppliers of portable x-ray services may

furnish (section 2070.4.F of the

Medicare Carriers Manual) and

established HCPCS code R0076 to pay

for the transportation of EKG

equipment. Under our proposal, we

would continue to pay for the

transportation of EKG equipment by

approved suppliers of portable x-ray

equipment although we did clarify that

the policy applied only to standard EKG

procedures described by CPT code

93005 (or CPT code 93000 if the

interpretation is billed with the tracing).

Many Medicare carriers have limited

the use of HCPCS code R0076 to

approved portable x-ray suppliers, but

some Medicare carriers permit other

types of entities, such as independent

physiological laboratories to use the

code. Section 2070.1.G of the Medicare

Carriers Manual provides for the

coverage of an EKG tracing by an

independent laboratory in the following

situations:

• In a home if the beneficiary is a

homebound patient.

• In an institution used as a place of

residence if the patient is confined to

the facility and the facility does not

have on-duty personnel qualified to

perform the service.

Under our proposal, we would

remove the requirement that the

beneficiary be confined to his or her

home or to an institution for the EKG

tracing to be a covered service since this

requirement does not apply to EKG

tracings taken by portable x-ray

suppliers.

For all other types of diagnostic tests

payable under the physician fee

schedule, Medicare carriers would pay

for the transportation of equipment only

on a ‘‘by report’’ basis under CPT code

99082 if a physician submits

documentation to justify the ‘‘very

unusual’’ travel set forth in section

15026 of the Medicare Carriers Manual.

Comment: One commenter,

representing a mobile independent

physiological laboratory, indicated that

the laboratory currently furnished

several types of diagnostic procedures to

patients in various settings without any

separate payment for transportation.

The commenter appreciated the fact

that, under the proposal, the laboratory

would now receive a transportation

payment for CPT code 93005 (a 12-lead

EKG) and suggested that the exceptions

to the transportation payment proposal

be extended to include CPT code 93225

(holter monitoring) and HCPCS code

G0005 (patient activated event recording

procedures). The commenter suggested

that HCPCS code R0076 be revised to

specifically include the transportation

of holter monitoring and patient

activated event recorder equipment to

patients upon physician order.

Response: We were not seeking to

expand the list of services independent

physiological laboratories may furnish

for which carriers will make separate

transportation payments. Since the law

does not provide for coverage of any

diagnostic tests payable under the

physician fee schedule furnished to

beneficiaries in their place of residence

other than x-ray services furnished

under conditions we have approved, we

will not provide for transportation

payments in connection with other

diagnostic tests furnished by

independent physiological laboratories.

Under our proposal, Medicare carriers

would make transportation payments

under HCPCS code R0076 in connection

with standard EKG procedures (CPT

code 93005) furnished by an

independent physiological laboratory

when the coverage conditions of section

2070.5 of the Medicare Carriers Manual

are met. We made this exception to the

general policy on transportation of

diagnostic equipment because of the

longstanding nature of the Medicare

Carriers Manual policy on furnishing

EKGs to patients in their residences or

in nursing homes by ‘‘independent’’

laboratories. We have some concerns

about making this exception because it

is our understanding that some

Medicare carriers are not currently

making such payments. However, we

anticipate that this additional cost will

be offset, to some degree, nationally by

the discontinuation of transportation

payments to independent physiological

laboratories for other types of diagnostic

tests that Medicare carriers may

currently allow. In addition, we are

modifying our proposal in that we are

maintaining section 2070.1.G of the

Medicare Carriers Manual regarding the

homebound status of the beneficiary

receiving the service.

Comment: A carrier medical director

questioned why the proposal did not

address whether the diagnostic

procedure itself was payable when

furnished by an independent

physiological laboratory in settings such

as a nursing home and whether we were

suggesting that such procedures should

not be done in nursing homes. The

commenter noted that it would be

useful for us to establish a list of

‘‘physiological’’ tests that can be

furnished by an independent

physiological laboratory.

Response: Our proposal does not

address the coverage for procedures
63150 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

furnished by independent physiological

laboratories. In the absence of a national

policy on the payment for the services,

the coverage for independent

physiological laboratory services

remains within the authority of the

carrier and must be consistent with any

applicable State or local laws.

Comment: A national organization of

suppliers of portable x-ray services

commented that portable x-ray suppliers

should be the only entities paid under

the physician fee schedule who may bill

for transportation of diagnostic

equipment under HCPCS codes R0070,

R0075, and R0076.

Response: Under the policy we are

adopting, approved suppliers of

portable x-ray services are the only

entities who may bill HCPCS codes

R0070 and R0075 under the physician

fee schedule. Portable x-ray suppliers

and independent physiological

laboratories may bill HCPCS code R0076

for the transportation of EKG equipment

used to furnish standard EKGs (CPT

codes 93000 and 93005).

Comment: A national organization

whose membership includes primary

care physicians opposed the proposal

because it would adversely affect the

availability of portable diagnostic

equipment for small hospitals and for

patients in home care and skilled

nursing facilities. The commenter noted

that it was not in the best interest of

patient care to force patients to travel to

medical facilities outside their

communities to receive the testing and

that Medicare carriers should ensure

that transportation payments do not

exceed transportation costs.

Response: We believe there is no

problem with respect to the

transportation of diagnostic equipment

to small hospitals. The hospital must

purchase the service ‘‘under

arrangements’’ if the service is provided

to its patients. When a hospital

purchases services ‘‘under

arrangement,’’ it assumes responsibility

for the service furnished, and Medicare

intermediary payment is made for this

service through one of several payment

mechanisms applicable to payment for

hospital services.

Comment: Several commenters

indicated that home and facility bound

patients would benefit from expanded

coverage of portable ultrasound

services. One commenter indicated that

these services offer the patient a top

quality examination while eliminating

the trauma and expense of an

ambulance ride and emergency room

stay. The commenter requested a mobile

ultrasound transport code and a mobile

ultrasound set-up code.

Response: Our proposal does not

affect the furnishing of these procedures

in homes or facilities; it merely affects

any additional payment for the

transportation of the diagnostic

equipment. We can find no basis in the

statute to support separate payments for

the transportation of the equipment

used to furnish these services.

Comment: A national physicians’

organization recommended we establish

a list of diagnostic services for which

transportation payment will be made. It

suggested the list include transportation

of diagnostic equipment used to perform

the following:

• Frozen section diagnosis in

hospitals and other facilities in which

surgery is provided.

• Therapeutic apheresis furnished to

patients in sites where the equipment is

not available.

Response: The frozen section

diagnostic equipment should be

purchased ‘‘under arrangement’’ by the

hospital and is payable through

Medicare intermediary payment

mechanisms. Therapeutic apheresis

services are outside the scope of this

proposal, which only relates to

diagnostic tests.

Comment: We received several

comments requesting the following:

• The definition of an independent

physiological laboratory be extended to

include diagnostic and screening

mammograms furnished by certified

facilities.

• Transportation payments be made

to mobile facilities providing

mammography services.

• Diagnostic and screening

mammography services be added to the

list of covered portable x-ray services.

Response: As indicated in an earlier

response, the coverage of services

furnished by independent physiological

laboratories is beyond the scope of this

proposal. Furthermore, the Congress has

placed the authority for setting

standards for entities furnishing both

diagnostic and screening mammograms

with the Food and Drug Administration.

If an independent physiological

laboratory were to receive certification

from the Food and Drug Administration,

it may furnish these services to

Medicare beneficiaries.

Under the policy we are adopting, the

only service furnished by an

independent physiological laboratory

for which a separate transportation

payment may be made is a standard

EKG.

Under our proposal, we were not

planning to make any changes in the

services an approved supplier of

portable x-ray services may furnish;

however, the commenter has made a

good point about mammography

services. Under the changes made to

section 1861(s)(3) of the Act by section

145(b) of the Social Security Act

Amendments of 1994, Public Law 103–

432, enacted on October 31, 1994, we

believe that the Congress has added

diagnostic mammography as part of the

portable x-ray benefit. We will issue

instructions to Medicare carriers

regarding payments (including

transportation payments) for

mammograms furnished by approved

portable x-ray suppliers.

Final Decision: We are adopting the

proposal to preclude separate payment

for the transportation of diagnostic

equipment except under the following

circumstances:

• Transportation services billed

under HCPCS codes R0070, R0075, or

R0076 in connection with services

furnished by approved suppliers of

portable x-ray services as set forth in

section 2070.4 of the Medicare Carriers

Manual.

• Transportation services billed by an

independent physiological laboratory

under HCPCS code R0076 in connection

with the provision of the CPT codes

93000 or 93005 (a 12-lead EKG with

interpretation and report or a 12-lead

EKG, tracing only, without

interpretation and report, respectively)

furnished under the conditions set forth

in section 2070.1.G. of the Medicare

Carriers Manual.

• Transportation services billed on a

‘‘by report’’ basis under CPT code 99082

(unusual travel) if a physician submits

documentation to justify ‘‘very unusual’’

travel as set forth in section 15026 of the

Medicare Carriers Manual.

Payment for expenses associated with

the transportation of diagnostic

equipment under conditions that do not

meet any of the above criteria is

included in the practice expense RVUs

assigned to the service or procedure and

is not separately payable. In addition,

we plan to develop a proposal related to

the transportation of EKG equipment

furnished by any supplier as part of next

year’s physician fee schedule regulation.

H. Maxillofacial Prosthetic Services

We proposed to eliminate the carrierpriced status and establish RVUs for

maxillofacial prosthetic services

effective for services performed on or

after January 1, 1996. We proposed

RVUs for CPT codes 21079 through

21087 and HCPCS codes G0020 and

G0021.

The work RVUs that we proposed

were developed by the American

Academy of Maxillofacial Prosthetics.

We believe they appropriately represent

the work involved in these procedures.
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63151

Because the CPT codes were introduced

in 1991 and the HCPCS codes in 1995,

we have little or no charge data on

which to base practice expense and

malpractice expense RVUs in

accordance with section 1848(c)(2)(C) of

the Act. Therefore, we imputed the

practice expense and malpractice

expense RVUs from the work RVUs

based on the practice cost shares

provided by the American Association

of Oral and Maxillofacial Surgeons.

Those shares are 54.7 percent for

practice expense and 4.4 percent for

malpractice expense.

Comment: We received numerous

comments in response to the RVUs

assigned to maxillofacial prosthetic

services. Although there was some

support for eliminating the carrierpriced status of these services and at

least one commenter expressed

appreciation of the work RVUs, the

commenters were unanimous in

objecting to our use of the American

Association of Oral and Maxillofacial

Surgeons’ practice cost shares. These

commenters stated that the practice and

malpractice expenses for the subspecialty of maxillofacial prosthetics

differ substantially from those of

maxillofacial surgery, primarily due to

increased laboratory, supply, and

maxillofacial material costs. The

commenters believed that the RVUs

imputed for practice expense are too

low and should be between 65 and 70

percent to accurately reflect the practice

expenses incurred by the

prosthodontist. According to the

commenters, the RVUs we proposed for

malpractice expense are too high and

should be in the range of 1 percent to

3.5 percent of the total RVUs.

Because maxillofacial prosthodontic

practice expenses include laboratory

charges (including precious metals and

impression materials) that are rarely

seen in oral and maxillofacial surgery

and include significantly higher practice

expenses, the commenters requested

that we revise the RVUs for

maxillofacial prosthetic procedures to

account for the higher practice cost

shares.

Response: In the absence of charge

data, we use the best available data to

impute practice expense and

malpractice expense RVUs.

Maxillofacial surgery represented the

specialty for which we had available

data that used comparable survey

methods. We note, also, that we are

currently working on a resource-based

practice expense study and, as part of

this effort, hope to have more definitive

data in the future. At that time, we will

reevaluate all maxillofacial practice

expense RVUs.

Final Decision: We are recommending

no additional modifications to the RVUs

for maxillofacial codes at this time. The

proposed RVUs for CPT codes 21079

through 21087 are accepted as final.

HCPCS code G0020 has been replaced

by new CPT code 21076, and G0021 has

been replaced by new CPT code 21077.

Because these new CPT codes describe

the same services as the HCPCS codes,

the assigned RVUs will not change.

Therefore, the proposed relative values

for G0020 and G0021 are accepted as

final but are assigned to CPT codes

21076 and 21077, respectively. G0020

and G0021 are deleted effective January

1, 1996. All RVUs for oral maxillofacial

prosthetic services are published in

Addendum B.

I. Coverage of Mammography Services

Based on recommendations from the

Food and Drug Administration, the

National Cancer Institute, and a carrier

medical directors’ workgroup, we

proposed to revise the definitions of

‘‘diagnostic’’ and ‘‘screening’’

mammography in § 410.34 to make them

consistent with previous Medicare

coverage policy regarding ‘‘diagnostic’’

mammography and with the way these

terms are used in general clinical

practice in the United States.

Specifically, we proposed to expand the

definition of ‘‘diagnostic’’

mammography in § 410.34(a)(1) to

include as candidates for this service

asymptomatic men or women who have

a personal history of biopsy-proven

breast disease. However, we proposed to

retain the substance of the present

definition of ‘‘screening’’ mammography

in § 410.34(a)(2) so that patients with a

personal history of breast disease can be

considered candidates for the

‘‘screening’’ examination, if the

woman’s attending physician

determines that this is appropriate.

Comment: One commenter indicated

that, because of the overlap in the

definitions for ‘‘screening’’ and

‘‘diagnostic’’ mammograms, the

proposal would lead to allowing almost

every mammogram furnished to a

Medicare beneficiary to be covered as a

diagnostic mammogram, thereby

increasing Medicare costs for

mammograms.

Response: We do not believe the

revised definitions will significantly

increase the total number of diagnostic

mammography services furnished.

Information from the Medicare carriers

indicates that most asymptomatic

patients with a personal history of

biopsy-proven breast disease are already

receiving diagnostic mammograms

rather than screening mammograms.

This final rule is consistent with general

clinical practice in the United States

and falls within the parameters of

Medicare statutory coverage for

diagnostic and screening mammograms.

Comment: Two commenters

recommended that we clarify the term

‘‘a personal history of biopsy-proven

breast disease.’’ One commenter

assumed that both benign (for example,

fibroadenomas) and malignant

neoplasms would fall in that category.

The other commenter suggested that we

make a distinction between ‘‘a personal

history of breast cancer’’ and ‘‘a

personal history of biopsy-proven breast

disease.’’

Response: We agree that this point

needs to be clarified. The intent of the

proposal was to include both benign

and malignant neoplasms within the

meaning of the term ‘‘a personal history

of biopsy-proven breast disease.’’ Breast

diseases, including both benign and

malignant neoplasms, that require a

biopsy and subsequently demonstrate a

pathologic process, establish a history of

biopsy-proven breast disease. In the

final rule, we are clarifying this by

revising the term ‘‘a personal history of

biopsy-proven breast disease’’ to read ‘‘a

personal history of breast cancer or a

personal history of biopsy-proven

benign breast disease.’’

Comment: One commenter expressed

the opinion that the term ‘‘fibrocystic

disease’’ referred to in the preamble of

the proposed rule should be more

appropriately referenced as ‘‘fibrocystic

changes.’’

Response: The terms ‘‘fibrocystic

disease’’ and ‘‘fibrocystic changes’’ are

often used synonymously. We agree

that, in our discussion of this subject in

the preamble to the proposed rule, the

preferred term is ‘‘fibrocystic changes.’’

Comment: One commenter suggested

that the proposal should be revised to

include, as candidates for diagnostic

mammography, women who have a

family history of breast disease (within

one generation).

Response: While there is a growing

consensus among clinicians and

mammography experts that family

history is an important etiologic factor

that places women at high risk of

developing breast cancer, and thus

eligible for screening mammography at

frequent intervals, the data are not

sufficiently definitive at present to

consider these women to be candidates

for diagnostic mammography.

Comment: One commenter suggested

that we discuss whether women who

have tested positive for any of the

recently identified breast cancer genes,

such as BRCA1, should be considered to

have a personal history of breast cancer
63152 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

within the meaning of this term in the

regulations.

Response: As we stated in the final

rule concerning Medicare coverage of

screening mammography that was

published in the Federal Register on

September 30, 1994 (59 FR 49826), the

term ‘‘a personal history of breast

cancer’’ in § 410.34(b)(4) of the

regulations was intended to mean that

there is documented evidence in the

woman’s medical record that she has

tested positive for breast cancer. While

the development of screening tests in

this area is promising, we do not believe

that the inclusion of these tests as

specific criteria for coverage of

screening mammograms is warranted at

this time. However, as new information

becomes available, we will reconsider

this issue.

Final Decision: We are adopting our

proposal to revise the definitions of the

terms diagnostic and screening

mammography in § 410.34. As requested

by several commenters, we are

clarifying the final regulations text by

revising the term ‘‘a personal history of

biopsy-proven breast disease’’ to read ‘‘a

personal history of breast cancer or a

personal history of biopsy-proven

benign breast disease.’’

III. Anesthesia Issues

A. Modifier Units for Anesthesia

Services

In the January 26, 1989 proposed rule

(54 FR 3794) and the August 7, 1990

final rule implementing the uniform

relative value guide for physician

anesthesia services, we stated our

national policy that Medicare carriers

cannot recognize payments for

anesthesia modifiers. Anesthesia

modifiers represent additional units

charged by physicians because of the

patient’s advanced age, poor physical

health status, or unusual circumstances

including the performance of anesthesia

under emergency circumstances or

anesthesia complicated by the use of

controlled hypotension.

For the 3 years preceding the

physician fee schedule, Medicare

carriers had uniformly implemented the

policy of not allowing modifier units in

determining payment for physician

anesthesia services.

The physician fee schedule legislation

required us to use the uniform relative

value guide to the extent feasible and to

make any necessary adjustments to the

anesthesia CF. In the November 1991

final rule (56 FR 59509) to implement

the physician fee schedule, we stated

that we were continuing to use the

uniform relative value guide to

determine payment for physician

anesthesia services under the physician

fee schedule. Since it was the

established uniform practice for

Medicare carriers not to recognize

modifier units, we believed it was

sufficient to write the regulations to

explain only those elements that the

Medicare carrier would recognize in

calculating anesthesia payments,

namely anesthesia base and time units.

Thus, in the final rule to implement the

physician fee schedule, we did not

include specific regulatory language

prohibiting anesthesia modifier units.

Some administrative law judges have

interpreted the absence of language

expressly prohibiting the use of

modifier units under the physician fee

schedule to mean that modifier units

can be allowed. This is clearly an

incorrect interpretation of our

regulations, and we have chosen to

clarify this matter by including a

specific reference in the regulations

stating that modifier units are not

allowed. We have revised § 414.46 to

reflect this policy. Because this

clarification of the regulations is an

interpretive change, the law does not

require prior notice and comment.

However, we will accept comments on

this change in the regulations.

B. Issue for Change in Calendar Year

1998—Two Anesthesia Providers

Involved in One Procedure

As a result of the revised payment

methodology for the anesthesia care

team established by section 13516 of

OBRA 1993, we proposed to apply the

medical direction payment policy to the

single procedure involving both the

physician and the certified registered

nurse anesthetist. Thus, in § 414.46 we

proposed to revise paragraphs (c) and

(d) to state that, in this situation, the

payment allowance for the medical

direction service of the physician and

the medically directed service of the

certified registered nurse anesthetist or

the anesthesiologist assistant is based on

the specified percentage of the payment

allowance in § 414.46(d)(3). In addition,

we proposed that in 1998 and later

years, this payment allowance is equal

to 50 percent of the allowance for

personally performed procedures.

We proposed to implement this policy

on January 1, 1998. At that time, the

change in policy will be done in a

budget-neutral manner.

Comment: Commenters referred to

those complicated anesthesia cases

when it may be medically necessary for

two anesthesia care providers to be

involved. The anesthesia providers

could be an anesthesiologist and a

certified registered nurse anesthetist or

two anesthesiologists. They asked

whether we would permit full payment

for each of these providers or subject

these providers to the new proposal in

which case each provider would receive

only 50 percent of the allowance

recognized for the anesthesia case

personally performed by a single

anesthesiologist.

Response: We are not changing the

current policy under which the

Medicare carriers can, on the basis of

medical necessity, recognize full

payment for the services of each of two

anesthesia providers if both providers

are needed in a single anesthesia case.

Thus, the Medicare carriers can

continue, based on medical necessity, to

allow full payment for the service

furnished by each anesthesia provider

in a single case.

Comment: A commenter offered an

alternative proposal that would achieve

budget neutrality but allow

implementation beginning in 1996.

Under the commenter’s proposal, which

would take effect in 1996, the payment

allowance for both the certified

registered nurse anesthetist and the

anesthesiologist involved in the single

case would be 50 percent of the

allowance recognized for the single

anesthesiologist.

Response: The law recognizes that an

anesthesia service is either personally

performed by a physician (or

nonmedically directed certified

registered nurse anesthetist) or the case

is medically directed. We have

implemented the medical direction

policy as applying only to two, three, or

four concurrent procedures. Therefore,

we deemed the case involving both the

anesthesiologist and the certified

registered nurse anesthetist to be

personally performed by the physician.

In the July 26, 1995 proposed rule, we

proposed to modify the definition of

medical direction to include a single

procedure in addition to concurrent

procedures. The statutory provisions

governing medical direction provide

that, in 1996, the payment allowance for

both the certified registered nurse

anesthetist and the physician are equal

to 55 percent of the single

anesthesiologist payment allowance.

Thus, there is no direct authority in the

law to recognize a payment allowance

that is 50 percent of the single

anesthesiologist payment allowance for

both the certified registered nurse

anesthetist and the physician.

Final Decision: We will apply the

medical direction payment policy to the

single procedure involving both the

physician and the certified registered

nurse anesthetist. We will implement

this policy on January 1, 1998. At that
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63153

time, the change in policy will be done

in a budget-neutral manner.

IV. Refinement of Relative Value Units

for Calendar Year 1996 and Responses

to Public Comments on Interim Relative

Value Units for 1995

A. Summary of Issues Discussed Related

to the Adjustment of Relative Value

Units

Section IV.B. of this final rule

describes the methodology used to

review the comments received on the

relative value units (RVUs) for

physician work and the process used to

establish RVUs for new and revised CPT

codes. (The CPT, which is published

annually by the American Medical

Association, is a listing of descriptive

terms and identifying codes for

reporting medical services and

procedures performed by physicians.)

Changes to codes on the physician fee

schedule reflected in Addendum B are

effective for services furnished

beginning January 1, 1996.

B. Process for Establishing Work

Relative Value Units for the 1996 Fee

Schedule

Our December 8, 1994 final rule on

the 1995 physician fee schedule (59 FR

63410) announced the final RVUs for

Medicare payment for existing

procedure codes under the physician fee

schedule and interim RVUs for new and

revised codes. The RVUs contained in

the rule apply to physician services

furnished beginning January 1, 1995.

We announced that we would accept

comments on interim RVUs for new or

revised codes. We announced that we

considered the RVUs for the remaining

codes to be subject to public comment

under the 5-year refinement process. In

this section, we summarize the

refinements to the interim work RVUs

that have occurred since publication of

the December 1994 final rule and our

establishment of the work RVUs for new

and revised codes for the 1996 fee

schedule.

1. Work Relative Value Unit

Refinements of Interim and Related

Relative Value Units

a. Methodology (Includes Table 1—

Work Relative Value Unit Refinements

of Interim and Related Relative Value

Units).

Although the RVUs in the December

1994 final rule were used to calculate

1995 payment amounts, we considered

the RVUs for the new or revised codes

to be interim. We accepted comments

for a period of 60 days. We received

approximately 100 substantive

comments from 24 specialty societies on

approximately 83 CPT codes with

interim RVUs.

Only comments received on codes

listed in Addendum C of the December

1994 final rule were considered this

year. We will consider comments we

received on other codes under the 5-

year refinement process. We convened a

multispecialty panel of physicians to

assist us in the review of the comments

with certain exceptions. The comments

that we did not submit to panel review

are discussed at the end of this section.

The panel was moderated by our

medical staff and consisted of the

following groups:

• A clinician representing each of the

specialties most identified with the

procedures in question. Each specialist

on the panel was nominated by the

specialty society that submitted the

comments. Eleven specialty societies,

including primary care, were

represented on the panel.

• Primary care clinicians nominated

by the American Academy of Family

Physicians, the American Society of

Internal Medicine, the American College

of Physicians, and the American

Academy of Pediatrics.

• Carrier medical directors.

After eliminating the codes with final

RVUs and certain codes that are

discussed at the end of this section, we

submitted comments on 18 codes for

evaluation by the panel. The panel

discussed the work involved in each

procedure under review in comparison

to the work associated with other

services on the fee schedule. We had

assembled a set of reference services

and asked specialty societies to compare

clinical aspects of the work of services

they believed were incorrectly valued to

one or more of the reference services. In

compiling the set, we attempted to

include: (1) Services that are commonly

performed whose work RVUs are not

controversial; (2) services that span the

entire spectrum from the easiest to the

most difficult; and (3) at least three

services performed by each of the major

specialties so that each specialty would

be represented. The set listed

approximately 120 services. Panelists

were encouraged to make comparisons

to reference services.

The intent of the panel process was to

capture each participant’s independent

judgment based on the discussion and

his or her clinical experience. Following

each discussion, each participant rated

the work for the procedure. Ratings

were individual and confidential, and

there was no attempt to achieve

consensus among the panel members.

We then analyzed the ratings based on

a presumption that the final rule RVUs

were correct. To overcome this

presumption, the inaccuracy of the

interim RVUs had to be apparent to the

broad range of physicians participating

in each panel.

Ratings of work were analyzed for

consistency among the groups

represented on each panel. In general

terms, we used statistical tests to

determine whether there was enough

agreement among the groups of the

panel and whether the agreed-upon

RVUs were significantly different from

the interim RVUs published in

Addendum C of the December 1994

final rule. We did not modify the RVUs

unless there was clear indication for a

change. If there was agreement across

groups for change, but the groups did

not agree on what the new RVUs should

be, we eliminated the outlier group and

looked for agreement among the two

remaining groups as the basis for new

RVUs. We used the same methodology

in analyzing the ratings that we used in

the refinement process for the 1993 fee

schedule. The statistical tests were

described in detail in the November 25,

1992 final notice (57 FR 55938).

Our decision to convene

multispecialty panels of physicians and

to apply the statistical tests described

above was based on our need to balance

the interests of those who commented

on the work RVUs against the

redistributive effects that would occur

in other specialties, particularly the

potential adverse effect on primary care

services. Of the 18 codes reviewed by

our multispecialty panel, all of the

requests were for increased values.

We also received comments on RVUs

that were interim for 1995 but which we

did not submit to the panel for review

for a variety of reasons. These comments

and our decisions on those comments

are discussed in further detail in section

VI.B.1.c. of this final rule. Of the 44

interim work RVUs that were reviewed,

approximately 41 percent were

increased, and approximately 59

percent were not changed.

Table 1—Work Relative Value Unit

Refinements of Interim Relative Value

Units

Table 1 lists the interim and related

codes reviewed during the 1995

refinement process described in this

section. This table includes the

following information:

• CPT code. This is the CPT code for

a service.

• Modifier. A ‘‘26’’ in this column

indicates that the RVUs are for the

professional component of the code.

• Description. This is an abbreviated

version of the narrative description of

the code.
63154

• 1995 work RVUs. The work RVUs

that appeared in the December 1994 rule

are shown for each reviewed code.

• Requested work RVUs. This column

identifies the work RVUs requested by

commenters. We received more than

one comment on some codes, and, in a

few of these cases, the commenters

requested different RVUs. The table lists

the highest requested RVUs. For some

codes, we received recommendations

for an increase or decrease but no

specific RVU recommendations.

• 1996 work RVUs. This column

contains the final RVUs for physician

work.

• Basis for decision. This column

indicates whether:

—The recommendations of the

refinement panel were the basis upon

which we determined that the interim

work RVUs published in the

December 1994 final rule should be

retained (indicator 1);

—A new value emerged from our

analysis of the refinement panel

ratings (indicator 2); or

—A new or retained value emerged from

some other source (indicator 3). Codes

with an indicator of 3 are discussed

following Table 1, in section VI.B.1.c.

—New or retained values emerged

through a combination of the panel

ratings and code descriptor

interpretation (indicator 4). Codes

with an indicator of 4 are discussed

following Table 1, in section VI.B.1.b.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

TABLE 1.—WORK RVU REFINEMENTS OF INTERIM AND RELATED RVUS

CPT* Mod Description

1995

work

RVU

Requested

work

RVU

1996

work

RVU

Basis for

decision

11977 ................ Removal/reinsert contra cap .................................................................... 2.52 3.30 3.30 3

19367 ................ Breast reconstruction ............................................................................... 24.73 26.50 24.73 3

20955 ................ Microvascular fibula graft ......................................................................... 37.58 43.00 37.58 3

25337 ................ Reconstruct ulna/radioulna ...................................................................... 9.10 9.50 9.50 3

25830 ................ Fusion radioulnar jnt/ulna ......................................................................... 9.10 9.50 9.50 3

26580 ................ Repair hand deformity .............................................................................. 15.81 17.71 17.71 3

29445 ................ Apply rigid leg cast ................................................................................... 1.78 0.57 1.78 3

31276 ................ Sinus surgical endoscopy ........................................................................ 7.42 8.85 8.85 3

37209 ................ Exchange arterial catheter ....................................................................... 1.48 3.66 2.27 2

41822 ................ Excision of gum lesion ............................................................................. 2.26 4.20 2.26 1

41823 ................ Excision of gum lesion ............................................................................. 3.15 4.60 3.15 1

41828 ................ Excision of gum lesion ............................................................................. 1.26 4.44 3.04 2

41830 ................ Removal of gum tissue ............................................................................ 1.12 5.00 3.30 2

43842 ................ Gastroplasty for obesity ........................................................................... 13.76 17.47 13.76 3

43843 ................ Gastroplasty for obesity ........................................................................... 13.76 17.47 13.76 3

43846 ................ Gastric bypass for obesity ....................................................................... 17.84 20.87 17.84 3

43847 ................ Gastric bypass for obesity ....................................................................... 19.87 23.24 19.87 3

43848 ................ Revision gastroplasty ............................................................................... 22.10 24.75 22.10 3

52647 ................ Laser surgery of prostate ......................................................................... 7.42 11.51 9.84 2

52648 ................ Laser surgery of prostate ......................................................................... 8.65 11.51 10.69 2

59855 ................ Abortion .................................................................................................... 4.75 5.80 5.80 3

64820 ................ Remove sympathetic nerves .................................................................... 9.10 10.00 10.00 3

76093 26 Magnetic image, breast ............................................................................ 1.63 1.94 1.63 1

76094 26 Magnetic image, both breasts .................................................................. 1.63 1.94 1.63 1

76936 26 Echo guide for artery repair ..................................................................... 1.31 2.64 1.99 2

90849 ................ Special family therapy .............................................................................. 0.59 0.78 0.59 3

90918 ................ ESRD related services, month ................................................................. 9.77 13.27 11.18 4

90919 ................ ESRD related services, month ................................................................. 7.13 9.13 8.54 4

90920 ................ ESRD related services, month ................................................................. 5.86 6.64 7.27 4

90921 ................ ESRD related services, month ................................................................. 3.06 5.06 4.47 4

92587 26 Evoked auditory test ................................................................................ 0.13 1.40 0.13 3

92588 26 Evoked auditory test ................................................................................ 0.36 1.70 0.36 3

93350 26 Echo exam of heart .................................................................................. 0.78 Increase 0.78 3

93990 26 Doppler flow testing ................................................................................. 0.25 1.18 0.25 1

95812 26 Electroencephalogram (EEG) .................................................................. 1.08 1.75 1.08 4

95813 26 Electroencephalogram (EEG) .................................................................. 1.73 2.50 1.73 4

96913 ................ Photochemotherapy, UV–A or B .............................................................. 0.00 Increase 0.00 3

97124 ................ Massage therapy ...................................................................................... 0.35 Decrease 0.35 3

97265 ................ Joint mobilization ...................................................................................... 0.45 Decrease 0.45 3

99354 ................ Prolonged service, office .......................................................................... 1.51 2.33 1.51 3

99355 ................ Prolonged service, office .......................................................................... 1.51 1.20 1.51 3

99356 ................ Prolonged service, inpatient ..................................................................... 1.44 3.00 1.44 3

99357 ................ Prolonged service, inpatient ..................................................................... 1.44 1.50 1.44 3

99375 ................ Care plan oversight/30–60 ....................................................................... 1.06 2.65 1.73 2

b. Discussion of codes reviewed by the

panel for which clarification of the

description of the service is required.

For several of the codes reviewed by

the refinement panel, it was necessary

to reach agreement on the meaning of

the codes before individual ratings of

work could be provided. In the

following paragraphs, we summarize the
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63155

panel’s understanding of the nature and

extent of the services included in the

codes for which extensive discussion

was required.

End-stage renal disease services, per

full month (CPT codes 90918 through

90921).

Before rating the work of CPT codes

90918 through 90921, the refinement

panel discussed the definition of the

monthly capitation payment and the list

of services included in and excluded

from the monthly capitation payment

that was developed by the Renal

Physicians Association and presented to

the RUC and the refinement panel. The

refinement panel also reviewed HCFA

regulations regarding the monthly

capitation payment and agreed to rate

the work of the codes based on the

following definition and list of services

included in and excluded from the

monthly capitation payment.

The monthly capitation payment for

maintenance dialysis is defined as a

comprehensive monthly payment that

covers all physician services associated

with the continuing medical

management of a maintenance dialysis

patient.

The following physician services are

included in the monthly capitation

payment:

• Assessment and determination of

the need for outpatient chronic dialysis

therapy.

• Assessment of the need for a

specified diet and the need for

nutritional supplementation for the

control of chronic renal failure.

Specification of the quantity of total

protein, high biologic protein, sodium,

potassium, and amount of fluids to be

allowed during a given time period. For

diabetic patients with chronic renal

failure, the prescription usually

includes specification of the number of

calories in the diet.

• Assessment of which mode(s) of

chronic dialysis (types of hemodialysis

or peritoneal dialysis) are suitable for a

given patient and recommendation of

the type(s) of therapy for a given patient.

• Assessment and determination of

which type of dialysis access is best

suited for a given patient and

arrangement for creation of dialysis

access.

• Assessment of whether the patient

meets preliminary criteria as a renal

transplant candidate and presentation of

this assessment to the patient and

family.

• Prescription of the parameters of

intradialytic management. For chronic

hemodialysis therapies, this includes

the type of dialysis access, the type and

amount of anticoagulant to be

employed, blood flow rates, dialysate

flow rate, ultrafiltration rate, dialysate

temperature, type of dialysate (acetate

versus bicarbonate) and composition of

the electrolytes in the dialysate, size of

hemodialyzer (surface area) and

composition of the dialyzer membrane

(conventional versus high flux),

duration and frequency of treatments,

the type and frequency of measuring

indices of clearance, and intradialytic

medications to be administered. For

chronic peritoneal dialysis therapies,

this includes the type of peritoneal

dialysis, the volume of dialysate,

concentration of dextrose in the

dialysate electrolyte composition of the

dialysate, duration of each exchange,

and addition of medication to the

dialysate, such as heparin, and the type

and frequency of measuring indices of

clearance. For diabetics, the quantity of

insulin to be added to each exchange is

prescribed.

• Assessment of whether the patient

has significant renal failure-related

anemia, determination of the

etiology(ies) for the anemia based on

diagnostic tests, and prescription of

therapy for correction of the anemia,

such as vitamins, oral or parenteral iron,

and hormonal therapy such as

erythropoietin.

• Assessment of whether the patient

has hyperparathyroidism and/or renal

osteodystrophy secondary to chronic

renal failure and prescription of

appropriate therapy, such as calcium

and phosphate binders for control of

hyperphosphatemia. Based upon

assessment of parahormone levels,

serum calcium levels, and evaluation for

the presence of metabolic bone disease,

the physician determines whether oral

or parenteral therapy with vitamin D or

its analogs is indicated, and prescribes

the appropriate therapy. Based upon

assessment and diagnosis of aluminum

bone disease, the physician may

prescribe specific chelation therapy

with deferoxamine and the use of

hemoperfusion for removal of

aluminum and the chelator.

• Assessment of whether the patient

has dialysis-related arthropathy or

neuropathy and adjustment of the

patient’s prescription accordingly.

Referral of the patient for any additional

needed specialist evaluation and

management of these end-organ

problems.

• Assessment of whether the patient

has fluid overload resulting from renal

failure and establishment of an

estimated ‘‘ideal (dry) weight.’’ The

physician determines the need for fluid

removal independent of the dialysis

prescription and implements these

measures when indicated.

• Determination of the need for and

prescription of anti-hypertensive

medications and their timing relative to

dialysis when the patient is

hypertensive in spite of correction of

fluid overload.

• Periodic review of the dialysis

records to ascertain whether the patient

is receiving the prescribed amount of

dialysis and ordering of indices of

clearance, such as urea kinetics, in order

to ascertain whether the dialysis

prescription is producing adequate

dialysis. If the indices of clearance

suggest that the prescription requires

alteration, the physician orders changes

in the hemodialysis prescription, such

as blood flow rate, dialyzer surface area,

dialysis frequency, and/or dialysis

duration (length of treatment). For

peritoneal dialysis patients, the

physician may order changes in the

volume of dialysate, dextrose

concentration of the dialysate, and

duration of the exchanges.

• Periodic visits to the patient during

dialysis to ascertain whether the

dialysis is working well and whether

the patient is tolerating the procedure

well (physiologically and

psychologically). During these visits, the

physician determines whether alteration

in any aspect of a given patient’s

prescription is indicated, such as

changes in the estimate of the patient’s

dry weight. Review of the treatment

with the nurse or technician performing

the therapy is also included. The

frequency of these visits will vary

depending upon the patient’s medical

status, complicating conditions, and

other determinants.

• Performance of periodic physical

assessments, based upon the patient’s

clinical stability, in order to determine

the necessity for alterations in various

aspects of the patient’s prescription.

Similarly, the physician reviews the

results of periodic laboratory testing in

order to determine the need for

alterations in the patient’s prescription,

such as changes in the amount and

timing of phosphate binders or dose of

erythropoietin.

• Periodic assessment of the

adequacy and function of the patient’s

dialysis access.

• Assessment of patients on

peritoneal dialysis for evidence of

peritonitis and the ordering of

appropriate tests and antibiotic therapy.
63156 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

• Periodic review and update of the

patient’s short-term and long-term care

plans with staff.

• Coordination and direction of the

care of patients by other professional

staff, such as dieticians and social

workers.

• Certification of the need for items

and services such as durable medical

equipment and home health care

services. Care plan oversight services

described by CPT code 99375 also are

included in the monthly capitation

payment and may not be separately

reported.

The following physician services are

excluded from the monthly capitation

payment:

• Surgical services such as—

—Temporary hemodialysis catheter

placement.

—Permanent hemodialysis catheter

placement.

—Temporary peritoneal dialysis

catheter placement.

—Permanent peritoneal dialysis catheter

placement.

—Repair of existing dialysis accesses.

—Placement of catheter(s) for

thrombolytic therapy.

—Thrombolytic therapy (systemic,

regional, or access catheter only;

hemodialysis or peritoneal dialysis).

—Thrombectomy of clotted cannula.

—Arthrocentesis.

—Bone marrow aspiration.

—Bone marrow biopsy.

• Interpretation of tests that have a

professional component such as:

—Electrocardiograms (12 lead, Holter

monitor, stress tests, etc.).

—Echocardiograms.

—24-hour blood pressure monitor.

—Nerve conduction velocity and

electromyography studies.

—Flow doppler studies.

—Bone densitometry studies.

—Biopsies.

—Spirometry and complete pulmonary

function tests.

• Complete evaluation for renal

transplantation. While the physician

assessment of whether the patient meets

preliminary criteria as a renal transplant

candidate is included under the

monthly capitation payment, the

complete evaluation for renal

transplantation is excluded from the

monthly capitation payment.

• Evaluation of potential living

transplant donors.

• The training of patients to perform

home hemodialysis, self hemodialysis,

and the various forms of self peritoneal

dialysis.

• Non-renal related physician’s

services. These services may be

furnished by the physician providing

renal care or by another physician. They

may not be incidental to services

furnished during a dialysis session or

office visit necessitated by the renal

condition. For example, the medical

management of diabetes mellitus that is

not related to the dialysis or furnished

during a dialysis session is excluded.

• Covered physician services

furnished to hospital inpatients,

including services related to inpatient

dialysis, by a physician who elects not

to continue to receive the monthly

capitation payment during the period of

inpatient stay. In these cases, the

physician receives a prorated portion of

the monthly capitation payment for that

month.

• All physician services that antedate

the initiation of outpatient dialysis.

While the refinement panel agreed to

rate the work of the monthly capitation

payment codes based on the above

definitions, it was unable to reach

consensus on whether the interpretation

of all tests that have a professional

component should be included in or

excluded from the monthly capitation

payment. Because the American

Medical Association Specialty Society

Relative Value Update Committee (RUC)

recommendations were based on the

Renal Physicians Association’s

definition, which excludes test

interpretations from the monthly

capitation payment, it was decided to

rate the physician work based on an

assumption that the physician work

associated with test interpretations was

excluded from the monthly capitation

payment and included in other codes

that would be reported separately. It

was also agreed that the Renal

Physicians Association and HCFA

would examine current utilization data

and that HCFA would consider

bundling the work of test interpretations

into the monthly capitation payment.

This would lead to adding additional

RVUs to the RVUs that emerged from

the panel ratings. The RVUs that

emerged from the statistical tests of the

refinement panel were 4.45.

Subsequent to the refinement panel,

we analyzed utilization data on test

interpretations provided to end-stage

renal disease patients by monthly

capitation payment physicians. In

general, most physicians who are paid

under the monthly capitation payment

method do not separately bill for test

interpretations. Based on our analysis,

we have bundled the work RVUs of the

test interpretations listed below into the

monthly capitation payment:

• Bone mineral density studies (CPT

codes 76070, 76075, 78350, and 78351).

• Non-invasive vascular diagnostic

studies of hemodialysis access (CPT

codes 93925, 93926, 93930, 93931, and

93990).

• Nerve conduction studies (CPT

codes 95900, 95903, 95904, 95925,

95926, 95927, 95934, 95935, and

95936).

• Electromyography studies (CPT

codes 95860, 95861, 95863, 95864,

95867, 95868, 95869, and 95872).

In performing our analysis, we took

into account the fact that the coding for

the four categories of services listed

above has changed in the past 2 years.

Thus, while we used all of the most

current utilization data, the specific

codes listed may be new, revised or

deleted from CPT 1996. When the

physician receiving the monthly

capitation payment payment performs

the services listed above, we will not

make separate payment. However, these

and other medically necessary services

that are included or bundled into the

monthly capitation payment are

separately payable when furnished by

physicians other than the monthly

capitation payment physician.

The bundling of these services leads

to the addition of 0.02 RVUs to the

refinement panel rating of 4.45 RVUs to

result in the assignment of 4.47 RVUs.

Medically necessary services that are

included or bundled into the monthly

capitation payment are separately

payable when furnished by physicians

other than the monthly capitation

payment physician.

We next increased the RVUs of the

pediatric monthly capitation payment

CPT codes (90918 through 90920) to

maintain the relationship of adult to

pediatric services that we established in

last year’s final rule. This led to the

assignment of 11.18 RVUs to CPT code

90918, 8.54 RVUs to CPT code 90919,

and 7.27 RVUs to CPT code 90920.

Electroencephalogram Codes

Before rating the work of CPT codes

95812 and 95813 (electroencephalogram

(EEG) extended monitoring), the panel

discussed extensively the work involved

in EEG monitoring compared to other

EEG and electrodiagnostic services on

the fee schedule. Subsequent to the

panel meeting, the American Academy

of Neurology provided us with the

following written definitions and

clinical vignettes to clarify the types of

services that should be coded using nine
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63157

common EEG diagnostic codes by

comparing and contrasting them. The

panel members discussed these

definitions of the EEG services before

they rated the work of extended EEG

monitoring.

Extended EEG; up to one hour (CPT

code 95812).

EEG recording is conducted for 45 to

60 minutes. Hyperventilation, photic

stimulation and/or oral sedation may be

used. The physician reviews in detail

the entire 45-to-60 minute record (270 to

360 pages of standard EEG paper).

The following is a vignette for CPT

code 95812: A 35-year-old woman

experiences episodic loss of

consciousness. Differential diagnosis

includes syncope and several types of

seizure disorder. The EEG is extended

because the EEG technologist detected

no epileptic abnormalities during the

first 20 to 30 minutes of recording, and

the physician had requested a longer

recording if needed to find

abnormalities. Bursts of epileptic

abnormalities are finally detected at 55

minutes into the recording. This helps

make the diagnosis of a seizure disorder.

The type of epileptic abnormalities seen

on the EEG guides the diagnosis and

choice of medications.

Extended EEG; greater than one hour

(CPT code 95813).

EEG recording is conducted

continuously for more than 1 hour.

Hyperventilation, photic stimulation

and/or oral sedation may be used. The

recording is continued until the events

sought are obtained, if possible. Typical

recording time is 2 to 3 hours. The

physician reviews the entire recording

in detail (typically equal to 360 to 1,000-

plus pages of standard EEG paper). The

entire continuous EEG recording is also

interpreted for additional diagnostic

information.

The following is a vignette for CPT

code 95813: A 55-year-old woman is

comatose in the intensive care unit with

multiple medical problems and is

having repeated episodes of movements

possibly representing epileptic seizures.

Continuous EEG recording is performed

for 3 hours, including recording during

two of her episodes. Four additional

subclinical ictal events were also

detected on the EEG beyond the two

events noted by the nurses. Events are

determined to be epileptic seizures, and

a treatment plan is developed

accordingly.

Awake EEG (CPT code 95816).

The test is conducted with the patient

awake. The patient often becomes

drowsy or may briefly fall asleep, but

the test is not run deliberately to obtain

sleep. Hyperventilation and/or photic

stimulation are usually obtained. The

minimum recording time is 20 minutes.

The typical recording time is 20 to 25

minutes. The physician reads in detail

the entire 20-to-25 minute record (120 to

150 pages of standard EEG paper).

The following is a vignette for CPT

code 95816: A 60-year-old man

complains of memory and other

cognitive impairment. Differential

diagnosis includes dementia and

depression. EEG seeks objective

evidence of organic impairment

supporting a diagnosis of a dementia.

EEG awake and asleep (CPT code

95819).

Sleep is deliberately sought during

the EEG record to identify specific

epileptic abnormalities. The patient may

be sleep-deprived before the recording

or given sedative medication to induce

sleep. The recording continues until at

least 5 minutes of Stage 2 sleep is

obtained. During the awake portion of

the recording, hyperventilation and/or

photic stimulation are usually obtained.

The minimum recording time is 20

minutes. The typical recording time is

30 to 35 minutes. The physician reads

in detail the entire 30-to-35 minute

record (180 to 210 pages of standard

EEG paper).

The following is a vignette for CPT

code 95819: A 25-year-old woman

experiences recent onset of lapses of

consciousness. The differential

diagnosis includes syncope and several

types of seizure disorders. A test is

conducted to look for evidence of a

seizure disorder and to help specify

which type of seizure disorder.

EEG; sleep only (CPT code 95822).

The EEG is conducted with the

patient asleep, stuporous, or comatose.

Little or no awake EEG is recorded.

Hyperventilation and photic stimulation

are generally not performed. Stuporous

or comatose patients may be stimulated

by the technologist to attempt to induce

state changes. The minimum recording

time is 20 minutes. The typical

recording time is 20 to 30 minutes. The

physician reads in detail the entire 20

to 30 minute record (120 to 180 pages

of standard EEG paper).

The following is a vignette for CPT

code 95822: A 45-year-old man is

comatose after a head injury. An EEG is

performed to assess the depth of the

coma, assist in assessing prognosis, and

evaluate for epileptic discharges or focal

cerebral abnormality.

EEG; all night sleep only (CPT code

95827).

Prolonged EEG recording is performed

by leaving equipment at the hospital

bedside. The recording may or may not

be continuous. If not continuous, the

recording is done periodically as

needed. The minimum time the EEG is

at the bedside is 8 hours. The physician

scans the hours-long records, reading in

detail selected or specific portions. The

minimum amount of the EEG actually

reviewed in detail is 20 minutes of

recording (120 pages of standard EEG

paper). The typical amount reviewed in

detail is 30 to 40 minutes.

The following is a vignette for CPT

code 95827: A 3-year-old boy is

comatose from near-drowning. The

patient is in a therapeutic barbiturate

coma. The EEG is used to titrate the

amount of barbiturate to keep the EEG

in burst-suppression. Incidental

observations are made of any epileptic

discharges or focal features. The EEG is

kept at the intensive care unit bedside

for 3 days. Each day, 50 to 90 minutes

of EEG are printed, of which 20 to 30

minutes (120 to 180 pages of standard

EEG paper) are reviewed in detail, and

other pages are scanned for relevant

events.

Electrocorticography (CPT code

95829).

The EEG is recorded in the operating

room from electrodes applied directly to

the surgically exposed cerebral cortex.

Many separate recording sites are used.

While it is being recorded in the

operating room, the EEG is interpreted

by the EEG physician, who is present in

the operating room for 60 minutes or

more. The EEG physician uses the EEG

features for determining the extent of

surgical resection of the cerebral cortex.

During this 60 minutes, 30 to 60

minutes of EEG recording (minimum 20

minutes) are made from various cortical

recording sites.

The following is a vignette for CPT

code 95829: A 25-year-old man,

disabled by medically refractory

epileptic seizures, undergoes a

craniotomy to resect a portion of his

temporal lobe. The EEG physician

interprets the record in the operating

room. Electrocorticography is used to

define the extent of epileptic spiking

and slowing, and the resection is

tailored to include regions of electrically

identified pathology. Follow-up

recording is made to check for any

remaining epileptic spiking after

resection.

Ambulatory EEG monitoring (CPT

code 95950).

The EEG is recorded onto a long-term

storage medium such as magnetic disc
63158 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

or tape, using a small portable recorder.

The patient is free to take this home,

returning to the laboratory one or

several days later. The recording is

continuous for 24 hours per day. The

patient, family, and friends write notes

about clinical events. The recorded EEG

is scanned to find these or other events

of clinical interest. Around the time of

each clinical event of interest, 5 to 10

minutes of the EEG is reviewed in

detail. The EEG is also surveyed for

other EEG findings of clinical

importance.

The following is a vignette for CPT

code 95950: A 12-year-old boy has

episodes of staring or daydreaming,

possibly representing nonconvulsive

seizures. Previous routine EEG

recording was normal. Ambulatory EEG

is conducted to search for signs of

epileptic abnormality. During 2 days of

ambulatory monitoring, 6 clinical

daydreaming events are noted by the

family. These demonstrate petit mal

seizures, as do 10 additional events not

noted by the family but found on EEG

review. A treatment plan is developed

accordingly.

Video EEG long-term monitoring (CPT

code 95951).

This daily procedure is used when

video and EEG are continuously

recorded for several days. Continuous

videotaping of the patient’s behavior is

made simultaneously with the EEG.

Monitoring is usually conducted in a

specialized inpatient epilepsy

evaluation and monitoring unit, with

the patient’s antiepileptic medications

reduced or withdrawn to induce

epileptic seizures. The physician

reviews the EEG and videotapes

recorded before, during, and after each

captured epileptic seizure. Typically,

several seizures may occur each day. In

some patients, no seizures may occur for

several days, whereas other patients

may have more than a dozen seizures

per day. Randomly selected recorded

segments are also chosen for review and

comparison to look for subclinical

seizures and isolated epileptic EEG

discharges. Monitoring generally is

continued until at least 5 seizures are

captured to characterize and to localize

the abnormality. The exact number of

seizures needed varies with the specific

clinical circumstances and the nature of

EEG findings.

The following is vignette number one

for CPT code 95951: A 25-year-old man

has become totally disabled as a result

of frequent medically refractory

epileptic seizures. Long-term video EEG

monitoring for 4 days captures 6

seizures and localizes the ictal onset

sufficiently to refer the patient for

surgical excision of the epileptic area.

Localization for surgical excision is

based primarily on this EEG

localization. After eventual surgical

excision, the patient becomes seizurefree, stops medication, and is no longer

disabled.

The following is vignette number two

for CPT code 95951: A 9-year-old boy

has frequent seizures not controlled by

medication, during some of which he

abruptly falls to the ground. Because of

the falls, he has lacerated his scalp on

several occasions, requiring trips to the

emergency room for x-rays, sutures, and

antibiotic treatment. His physicians are

considering corpus callosum section,

but some of the clinical data suggest that

the seizures may be originating from a

more localized area of one frontal lobe.

Forty seizures are recorded in 2 days,

some of which appear to originate from

this region. Analysis of the recordings

indicates, however, that the majority do

not, and he undergoes callosal section.

Following callosal section, he no longer

has ‘‘falling seizures’’ and no longer

needs to wear a helmet for protection.

He does continue to have focal seizures

of one arm.

We have finalized the interim RVUs

for the EEG CPT codes; we have not

changed any of the interim RVUs for

these codes. However, we have clarified

the descriptors for the CPT codes for the

services. We have assigned 1.08 RVUs to

CPT code 95812, 1.73 RVUs to CPT code

95813, 1.08 RVUs to CPT code 95816,

1.08 RVUs to CPT code 95819, 1.08

RVUs to CPT code 95822, 1.08 RVUs to

CPT code 95827, 6.21 RVUs to CPT code

95829, 1.51 RVUs to CPT code 95950,

and 3.80 RVUs to CPT code 95951.

c. Discussion of codes not reviewed by

the panel.

Codes listed in Table 1 with a basis

of decision of ‘‘3’’ fall into several

categories. For most of these codes, we

received comments that were not

considered by the multispecialty

refinement panel for a variety of

reasons. Those codes and our rationale

for the final work RVUs we have

established for the codes are discussed

below.

Removal with reinsertion, implantable

contraceptive capsules (CPT code

11977).

Comment: A commenter stated that

we erred in rejecting the RUC

recommendation of 3.30 RVUs for CPT

code 11977. The commenter

recommended that ‘‘Removal with

reinsertion’’ should be assigned the full

value of both CPT code 11975

(Insertion, implantable contraceptive

capsules) and CPT code 11976

(Removal, implantable contraceptive

capsules). Typically, the new capsules

are inserted at a different site than the

one from which the old capsules were

removed, thus requiring a second

incision and closure. In addition, the

amount of preservice and postservice

work associated with reinsertion is

similar to the preservice and postservice

work for the original insertion. The

physician must ascertain that the

patient has not undergone changes in

health status or experienced side effects

that would make her an unsuitable

candidate for this contraceptive method

and must instruct her about follow-up

care and potential complications.

Response: We agree with the

comment and have assigned 3.30 RVUs

to CPT code 11977, as recommended.

Breast reconstruction with a TRAM

flap (CPT code 19367).

Comment: A commenter

recommended that the RVUs of CPT

code 19367 be increased from 24.73 to

a minimum 26.50 RVUs. The

commenter stated that breast

reconstruction is similar to facial

fracture surgeries and that in

comparison to CPT code 21159 (Le Forte

III), with 40.99 RVUs, a TRAM flap

reconstruction is a much larger

procedure.

Response: We disagree with this

comment that we believe may have been

based on a misunderstanding of CPT

code 21159. This code is used to report

reconstruction of the midface. It is not

used to report the repair of facial

fractures. When compared to the RVUs

of codes for the open repair of a facial

fracture, for example, CPT code 21432,

which is assigned 8.05 RVUs, the RVUs

of the breast reconstruction code are

much higher. The 24.73 interim RVUs,

which were based on a RUC

recommendation, will be made final.

Microvascular fibula graft (CPT code

20955).

Comment: A commenter

recommended 43.00 RVUs for this

procedure, which was described as a

very delicate, labor-intensive procedure

particularly for mandible

reconstruction, multiple osteotomies,

and plate and wire fixation. The

commenter stated that the work and

postoperative care can be compared to

twice that of a breast reconstruction

with a TRAM flap (CPT code 19367),

with 24.73 RVUs. Because of the nature

of this delicate procedure, the risks for

malpractice are greater than for any
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63159

other bone procedure. These risks

include complications such as foot

drop, sensory loss of the lower

extremity, complications related to skin

graft healing, chronic pain, and wound

closure.

Response: We agree this is a complex

procedure as confirmed by our

acceptance of a RUC recommendation of

38.00 RVUs (see Table 4, ‘‘American

Medical Association RUC

Recommendations and HCFA’s

Decisions,’’ in our December 8, 1994

final rule with comment period (60 FR

63441)). We do not believe, however,

the arguments presented warrant an

increase to 43.00 RVUs, which would be

nearly 3.00 RVUs higher than the

reference code for repair of a

thoracoabdominal aortic aneurysm with

graft (CPT code 33877) valued at 40.29

RVUs. We have retained 38.00 RVUs for

CPT code 20955 (37.58 RVUs after

adjustment for budget neutrality).

Reconstruction for stabilization of

unstable distal ulna or distal radioulnar

joint (CPT code 25337).

Comment: A commenter disagreed

with our decision to value new CPT

code 25337 at 9.10 RVUs instead of 9.50

RVUs as the RUC recommended. The

commenter stated that the preservice

and postservice work is quite similar

between the new code and the reference

service, CPT code 25312. The

commenter also stated the intraservice

work requires more skill, effort, and

time because the new code may involve

a two-tendon transfer with two skin

incisions, hence, a larger surgical

exposure. The potential of injury to the

ulnar nerve is high. Confirmation of an

accurate reduction of the distal ulna

requires an intraoperative x-ray, and,

frequently, internal fixation with Kwires. Tunnels must be drilled into

bone to allow passage of the tendons.

Response: We agree with the

comment and have assigned 9.50 RVUs

to CPT code 25337, as recommended.

Distal radioulnar joint arthrodesis

and segmental resection of ulna (SauveKapandji procedure) (CPT code 25830).

Comment: A commenter stated that

the work of CPT code 25830 is equal to

the work of CPT code 25337 (Distal

radioulnar tenodesis) and recommended

that 9.50 RVUs are the most appropriate

RVUs for both codes. The commenter

also stated that the RUC accepted CPT

code 25390 (Osteoplasty, radius or ulna;

shortening), with 9.96 RVUs, as a

reference service for new CPT code

25830. This reference service involves

excising a carefully measured segment

of ulna followed by internal fixation

using a plate and screws. Preoperative

work is somewhat greater than the work

in new CPT code 25830. New CPT code

25830 is similar to the reference service

in that a small segment of ulna is

excised and then fused to the adjacent

radius using pins or screws. Plates are

not used and the amount of excised ulna

is less critical. For these clinical

reasons, the commenter recommended

9.50 RVUs for CPT code 25830.

Response: We agree with the

comment and have assigned 9.50 RVUs

to CPT code 25830, as recommended.

Repair of cleft hand (CPT code

26580).

Comment: A commenter disagreed

with our decision to value CPT code

26580 at 15.99 RVUs (15.81 RVUs

rescaled) instead of 17.71 RVUs, as the

RUC recommended (see Table 4 of our

December 8, 1994 final rule with

comment period (60 FR 63441)). The

commenter objected to the use of CPT

code 28360 (Repair of a cleft foot) as the

reference service. The commenter

argued that the choice of this code as a

reference service was inappropriate

because of its clinical dissimilarity to

the revised code. The commenter stated

that CPT code 26590 (Repair

macrodactylia), with 17.63 RVUs, is a

more appropriate reference service. This

code deals with a congenital anomaly of

the digits of the hand requiring exacting

microsurgical reconstruction of soft

tissue, nerves, and bone in an infant.

Revised CPT code 26580 requires

metacarpal alignment by soft tissue

dissection or metacarpal osteotomy

requiring internal fixation,

reconstruction of the deep transverse

metacarpal ligament, and a thumb realignment to allow opposition.

Mobilization of skin flaps may be

necessary to achieve skin closure. This

is a microsurgical procedure performed

in infants, with an amount of work

similar to the work involved in CPT

code 26590. For these clinical reasons,

the commenter recommended that

revised CPT code 26580 should have

17.71 RVUs.

Response: We agree with the

comment and have assigned 17.71 RVUs

to CPT code 26580, as recommended.

Application of rigid total contact leg

cast (CPT code 29445).

Comment: A commenter stated that

this service is overvalued compared to

the application of an Unna boot (CPT

code 29580), with 0.57 RVUs.

Response: We disagree that this

service is overvalued. The application of

a rigid total contact leg cast (CPT code

29445) involves more work than the

application of an Unna boot because it

requires the physician to custom make

and fabricate the walking surface for

each cast. The patient is usually diabetic

with a grade 1 or 2 foot ulcer. The use

of casts by these patients is risky

because they are at risk of developing

additional ulcers. Therefore, a great deal

of time is spent ensuring that the cast

will fit properly. Unlike Unna boots or

other casts, total contact casts are

always performed personally by a

physician who must hold the foot in

place while applying the cast.

Nasal/sinus endoscopy, surgical with

frontal sinus exploration, with or

without removal of tissue from frontal

sinus (CPT code 31276).

Comment: A commenter objected to

the assigned 7.42 RVUs and requested

an increase to 8.85 RVUs. The

commenter presented the following

description of the procedure. This

procedure is performed around the

middle turbinate anterior attachment in

the frontal recess at 90 degrees to the

line of sight. It requires the use of 70

and 30 degree telescopes, small-angled

forceps, curettes, and hooks. It requires

an exhaustive knowledge of frontal

recess anatomy, very delicate technique,

removal of tiny bone fragments,

preservation of mucosa, and a dry field.

It is very tedious and time-consuming.

The commenter believed that the overall

intensity and time is significantly

greater for the endoscopic frontal

sinustomy than either a total

ethmoidectomy (CPT code 31255), with

6.96 RVUs, or an external frontal

sinusotomy (CPT code 31075), with 8.85

RVUs.

Response: We agree with the

comment and have assigned 8.85 RVUs

to CPT code 31276, as recommended.

Gastroplasties and gastric bypass for

obesity (CPT codes 43842, 43843, 43846,

43847, and 43848).

Comment: A commenter requested a

re-evaluation of the entire family of

codes because of a lack of representation

of bariatric surgeons in the original

resource-based relative value scale

process. The commenter stated that the

modest increase in the RVUs we

assigned to these procedures still left a

deficit valuation of approximately 27

percent for CPT codes 43842 and 43843,

17 percent for CPT codes 43846 and

43847, and 12 percent for CPT code

43848.

Response: We have not revised the

interim RVUs because we do not believe

the commenter made a compelling

argument for change. We also disagree

that the increases in RVUs assigned to
63160 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

these codes were modest. As we

discussed in Table 4 of our December 8,

1994 final rule (59 FR 63444), the

increases were as follows: CPT code

43842 from 11.99 RVUs to 13.91 RVUs;

CPT code 43843 from 11.99 RVUs to

13.91 RVUs; CPT code 43846 from 12.90

RVUs to 18.04 RVUs; CPT code 43847

from 14.32 RVUs to 20.09 RVUs; and,

CPT code 43848 from 15.00 RVUs to

22.35 RVUs. When the RVUs were

adjusted for budget neutrality, the RVUs

were as follows: CPT code 43842,

assigned 13.76 RVUs; CPT code 43843,

assigned 13.76 RVUs; CPT code 43846,

assigned 17.84 RVUs; CPT code 43847,

assigned 19.87 RVUs; and, CPT code

43848 assigned 22.10 RVUs. We believe

that further increases would create rank

order anomalies with other abdominal

surgical procedures on the physician fee

schedule.

Induced abortion, by one or more

vaginal suppositories (eg.

prostaglandin) with or without cervical

dilation (eg. laminaria), including

hospital admission and visits (CPT code

59855).

Comment: A commenter

recommended that we assign the RUCrecommended 5.80 RVUs to CPT code

59855. The commenter believed that our

rationale for lowering the work RVUs to

4.80 (4.75 rescaled) was ‘‘the physician

work in placing suppositories is less

than the work in an amnioinjection,

regardless of the number of

suppositories needed’’ and that CPT

code 59855 requires less physician work

than CPT code 59850 (Induced abortion

by amnioinjection). The commenter

stated that while it is true that the

procedural work associated with placing

suppositories is less than the procedural

work associated with amnioinjection,

placement of the suppositories or

performance of the amnioinjection is

only one element of the total work of

each of these services. Use of

prostaglandin suppositories typically

results in more side effects that the

physician must manage over a period of

time that is longer than that associated

with the amnioinjection, increasing the

amount of evaluation and management

work for CPT code 59855. Overall, CPT

code 59855 requires a greater amount of

physician work than CPT code 59850.

Response: We agree with the

comment and have assigned 5.80 RVUs

to CPT code 59855, as recommended.

Sympathectomy, digital arteries (CPT

code 64820).

Comment: A commenter disagreed

with our decision to value CPT code

64820 at 9.20 RVUs (9.10 RVUs

rescaled) instead of 10.00 RVUs as the

RUC recommended. The commenter

objected to our determination that the

work involved in new CPT code 64820

is approximately the same as the repair

of a blood vessel of the hand or finger

(CPT code 35207). The commenter

stated that the work on the two vessels

involved in a digital sympathectomy is

not similar to the anastomosis of a

single vessel and offered the following

explanation. CPT code 35207 involves

the repair of a single injured vessel

through an existing skin laceration. CPT

code 35207 has less preservice and

intraservice work than new CPT code

64820. Digital sympathectomy is

performed in individuals with

vasospastic disease of the hand and

severe ischemic pain frequently with

ulceration of the finger tip. Two vessels

are always treated through an extensile

palmar incision on the radial and ulnar

side of a digit. Using an operating

microscope and jeweler’s forceps, a

tedious removal of the adventitia is

performed for a distance of 1.5 to 2.0

centimeters. Extraordinary care must be

taken to avoid perforating the vessel.

Damaging the vessel’s media or intima

will cause thrombosis and possible

gangrene of the finger. Considering the

clinical circumstances regarding the

patient indications and actual

intraservice work, digital

sympathectomy represents a greater

intensity of work than CPT code 35207,

as measured by increased mental effort

and judgment, greater technical skill,

and considerably more psychological

stress. Postservice work is similar for

both codes, however, with an average of

four office visits after the procedure. For

these clinical reasons, the commenter

recommended that new CPT code 64820

should have 10.00 RVUs.

Response: We agree with the

comment and have assigned 10.00 RVUs

to CPT code 64820, as recommended.

Multiple-family group medical

psychotherapy (CPT code 90849).

Comment: A commenter

recommended increases for all

psychiatric services in response to our

request for comments as part of the 5-

year refinement of RVUs under the

physician fee schedule. Included in that

comment was a recommendation to

increase the RVUs for CPT code 90849

from 0.59 to 0.78 to maintain the

relative value with the recommended

increases for the other psychiatric

codes.

Response: The RVUs assigned to this

code were based on a 1994 RUC

recommendation that we accepted. We

have not increased the RVUs this year

because we believe it is an issue for the

5-year refinement. We will consider the

recommended RVUs as part of that

process. In the meantime, we will

maintain the assigned 0.59 RVUs.

Evoked otoacoustic emissions testing

(CPT codes 92587 and 92588).

Comment: A commenter

recommended that we provide a tenfold increase in the RVUs for these

audiology services to ‘‘properly

compensate for the training, effort, and

time necessary to diagnose hearing loss

and related disorders.’’

Response: We have not accepted this

comment because it did not provide

enough clinical information about the

nature of the work to warrant a

reconsideration of the interim RVUs.

Stress echocardiography (CPT code

93350).

Comment: A commenter expressed

concern about the decrease in RVUs for

this service.

Response: The decrease in RVUs for

stress echocardiography occurred as a

result of a change in CPT reporting

instructions that now direct the user to

report the appropriate stress testing

code from the 93015 through 93018

series in addition to CPT code 93350.

The sum of the RVUs for these services

is equal to the RVUs that were assigned

to CPT code 93350 in the past when it

was the only code used to report stress

echocardiography.

Photochemotherapy (Goeckerman

and/or PUVA) for severe

photoresponsive dermatoses requiring

at least four to eight hours of care under

direct supervision of the physician

(includes application of medication and

dressings) (CPT code 96913).

Comment: A commenter objected to

our decision not to assign physician

work RVUs to this service. The

commenter stated that with the

availability of psoriasis day treatment

centers, much Goeckerman therapy is

now practical in a day treatment

program but that it is very different from

a simple office visit. The commenter

argued that there is considerable

professional judgment involved and

there is also an extraordinary quantity of

nursing time involved since the patient

is typically in a day treatment center for

6 hours or more a day. The treatment

requires bathing, scale removal, twice

daily application of tar over the total

body surface, shampoos, scale removal

from scalp, ultraviolet light, and

typically anthralin as well. The

treatment is extremely time-consuming

because the medication must be put on
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63161

each individual spot while avoiding

normal skin.

Response: We have not revised our

decision regarding this code. We have

not assigned any work RVUs to this

service because the commenter did not

persuade us that photochemotherapy

requires any physician work beyond

that already described by existing

evaluation and management codes. We

have assigned practice expense and

malpractice expense RVUs based on

historic charges for this code so that it

will no longer be carrier-priced. We

have categorized this service as an

‘‘incident to’’ code, which means that it

is covered incident to a physician’s

service when it is furnished by auxiliary

personnel employed by the physician

and working under his or her direct

supervision. Payment may not be made

for this service when it is furnished to

hospital inpatients or patients in a

hospital outpatient department.

Physicians may bill for evaluation and

management services in those settings.

Joint mobilization and massage (CPT

codes 97124 and 97265).

Comment: One commenter stated that

these codes may be overvalued relative

to osteopathic manipulative treatment

(CPT codes 98925 through 98929) and

evaluation and management services.

Response: The interim RVUs we

proposed for these codes were based on

our acceptance of recommendations we

received from the RUC Health Care

Professionals Advisory Committee

Review Board last year. The history and

functions of this board are described

below.

In 1992 the American Medical

Association recommended that a Health

Care Professionals Advisory Committee

be established to expand the CPT

Editorial Panel and the RUC processes

to all groups legally required to use the

CPT to report their services.

Organizations representing physician

assistants, nurses, occupational and

physical therapists, optometrists,

podiatrists, psychologists, social

workers, audiologists and speech

pathologists were invited to nominate

representatives to the CPT and RUC

Health Care Professionals Advisory

Committee. The CPT Health Care

Professionals Advisory Committee was

created to foster participation in and

solicit comments from these

professional organizations in coding

changes affecting their members, while

the RUC Health Care Professionals

Advisory Committee was formed to

allow participation in development of

RVUs for new and revised codes within

their scope of practice.

To further facilitate the decisionmaking process on issues of concern to

both medical doctors (MDs) and doctors

of osteopathy (DOs) and non-MDs and

non-DOs, CPT and RUC Health Care

Professionals Advisory Committee

Review Boards were also formed. The

review boards bring MDs and DOs and

non-MDs and non-DOs together to

discuss coding issues and RVU

proposals. The RUC Health Care

Professionals Advisory Committee

Review Board comprises all nine

members of the current RUC Health

Care Professionals Advisory Committee

and three RUC members. For codes used

only or predominantly by non-MDs and

non-DOs, the RUC Health Care

Professionals Advisory Committee

Review Board replaces the RUC as the

body responsible for developing

recommendations for HCFA.

We have decided to maintain the

RVUs for joint mobilization (CPT code

97265), with 0.45 RVUs, and massage

(CPT code 97124), with 0.35 RVUs, as

interim RVUs on the 1996 fee schedule

so that we will have additional time to

re-evaluate them. While we agree that

these services appropriately are

compared to other therapeutic

procedures in the physical medicine

section of CPT, our review of them in

light of the comment causes us to

believe that the interim RVUs we

assigned to the therapeutic procedures

services may have been too high relative

to other services on the fee schedule, for

example, osteopathic manipulative

treatments and evaluation and

management services.

While we acknowledge that we

accepted last year’s recommendations of

the RUC Health Care Professionals

Advisory Committee Review Board, we

now plan to refer these and all other

physical medicine and rehabilitation

codes (CPT codes 97010 through 97770)

back to the RUC Health Care

Professionals Advisory Committee

Review Board for its reconsideration.

We also will notify the RUC of our

concerns. In addition, we seek public

comments on this issue.

Prolonged physician services (CPT

codes 99354 through 99357).

Comment: A commenter provided

extensive arguments for an increase in

the RVUs of these codes based on the

premise that we have underestimated

the time involved in furnishing these

services. Because the RVUs for

evaluation and management services are

related to the time specified in the CPT

codes, the commenter believed that the

selection of the appropriate level of

service should be based solely on the

time spent providing the service. For

example, a consultation (CPT code

99253) typically assumes a 55-minute

time segment. The commenter stated

that if less time is spent, the

consultation would be coded at a lower

level as CPT code 99252 or 99251. The

commenter believed that the correct key

references for these prolonged physician

services are CPT codes 99245 (Office

consultation) and 99255 (Hospital

inpatient consultation) because the

times specified in those codes

correspond to the times specified in the

prolonged services codes.

Response: We have decided not to

accept this comment, which we believe

is based, in part, on a misunderstanding

of the relationship of the typical times

associated with the evaluation and

management codes and the RVUs

assigned to the codes. While it is true

that time is a key predictor of work, it

is not true that physicians are required

to report their evaluation and

management services based solely on

the amount of time spent furnishing the

service. CPT codes 99354 and 99356

both describe the ‘‘first hour’’ of

prolonged services. This terminology in

the code does not require that an entire

hour of service be furnished in order for

the code to be used. In fact, the CPT

directs the reader to use the code to

report 30 to 74 minutes of prolonged

services. In our discussion of these

codes in the December 8, 1994 Federal

Register (59 FR 63437 through 63440),

we indicated that we did not expect that

the typical use of the code would be to

report an hour of service. We assigned

RVUs that are equivalent to 40 minutes

of face-to-face or floor time.

Finally, for those specialties with very

prolonged encounters, we have assigned

the same RVUS to the ‘‘each additional

30 minutes’’ codes (CPT codes 99355

and 99357) that we assigned to the ‘‘first

hour’’ codes. This actually represents an

increase above the recommended RVUs

we received from the RUC for CPT

codes 99355 and 99357. We believe the

final RVUs for the prolonged service

codes appropriately recognize the work

associated with very prolonged services.

2. Establishment of Interim Work

Relative Value Units for New and

Revised Codes for 1996

a. Methodology (Includes Table 2—

American Medical Association

Specialty Society Relative Value Update
63162

Committee Recommendations and

HCFA’s Decisions).

The major aspect of establishing work

RVUs for 1996 was related to the

assignment of interim RVUs for all new

and revised CPT codes. As described in

our November 1992 notice on the 1993

fee schedule (57 FR 55938), we

established a process, based on

recommendations received from the

RUC, for establishing interim RVUs for

new and revised codes.

The RUC was formed in November

1991 and grew out of a series of

discussions between the American

Medical Association and the major

national medical specialty societies. The

RUC is comprised of 26 members; 22 are

representatives of major specialty

societies. The remaining members

represent the American Medical

Association, the American Osteopathic

Association, and the CPT Editorial

Panel. The work of the RUC is

supported by the RUC Advisory

Committee made up of representatives

of 65 specialty societies in the American

Medical Association House of Delegates.

The RUC used a small group survey

method to produce work RVUs that

were voted on by the RUC, with a twothirds vote required for acceptance. The

RUC then submitted to us those

accepted RVUs as recommended values.

We received work RVU

recommendations for approximately 140

new and revised codes from the RUC.

We also received RUC recommendations

for base units for two anesthesia codes,

CPT codes 00520 (Anesthesia, closed

chest procedures) and 00540

(Anesthesia, chest procedure) and have

accepted the recommendations of 6.00

and 13.00 base units, respectively.

Physician panels consisting of carrier

medical directors and our staff reviewed

the RUC recommendations by

comparing them to our reference set or

to other comparable services on the fee

schedule for which work RVUs had

been established previously, or to both

of these criteria. The panels also

considered the relationships among the

new and revised codes for which we

received the RUC recommendations. We

agreed with a majority of the

relationships reflected in the RUC

values. In some cases when we agreed

with the RUC relationships, we revised

the RVUs recommended by the RUC in

order to achieve work neutrality within

families of codes. For example, if CPT

revised an existing code by splitting it

into two or more new codes, we took

into account the RVUs assigned to the

existing code and the expected

utilization of the split codes in such a

way that the coding change would not

lead to an overall increase in RVUs

associated with services previously

described by a single code. For

approximately 90 percent of the RUC

recommendations, proposed RVUs were

accepted or increased, and for

approximately 10 percent, RVUs were

decreased.

We also received two

recommendations from specialty

societies and four recommendations

from the Health Care Professionals

Advisory Committee for new or revised

codes for which the RUC did not

provide a recommendation. The

specialty society recommendations were

also reviewed by the physician panels.

All of the proposed RVUs of the

specialty society recommendations were

accepted. All of the proposed RVUs of

the Health Care Professionals Advisory

Committee recommendations were

decreased.

Table 2 is a listing of those codes that

will be new or revised in 1996 for which

we received recommended work RVUs.

This table includes the following

information:

• A ‘‘#’’ identifies a new code for

1996.

• CPT code. This is the CPT code for

a service.

• Modifier. A ‘‘26’’ in this column

indicates that the RVUs are for the

professional component of the code.

• Description. This is an abbreviated

version of the narrative description of

the code.

• RUC-recommended work RVUs.

This column identifies the work RVUs

recommended by the RUC. If no

recommendation was received from the

RUC, this column shows ‘‘no rec.’’

• Health Care Professionals Advisory

Committee (HCPAC) recommendations.

This column identifies work RVUs

recommended by the Health Care

Professionals Advisory Committee.

• Specialty-recommended RVUs. This

column identifies work RVUs

recommended by a specialty society.

• HCFA decision. This column

indicates whether we agreed with the

RUC recommendation (‘‘agreed’’); we

established work RVUs that are higher

than the RUC recommendation

(‘‘increased’’); or we established work

RVUs that were less than the RUC

recommendation (‘‘decreased’’). Codes

for which we did not accept the RUC

recommendation are discussed in

greater detail following Table 2. A

discussion follows the table in section

VI.B.2.b. An (a) in the column indicates

that RVUs were not assigned.

• HCFA value. This column contains

the 1996 RVUs for physician work.

This table includes only those codes

that were reviewed by the full RUC or

for which we received a

recommendation from a specialty

society or Health Care Professionals

Advisory Committee.

444444444444

*All CPT codes and descriptors copyright 1995 American Medical Association.

a No work RVUs assumed.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

TABLE 2.—AMA RUC RECOMMENDATIONS AND HCFA’S DECISIONS

CPT* Mod Description RUC recommendations

HCPAC recommendationsSpecialty recommendationsHCFA

decision

1996 work

RVUs

17110 ................ Destruction of skin lesions .............. 0.55 ........................ ........................ Agreed ........ 0.55

#20100 ................ Explore wound, neck ...................... 9.50 ........................ ........................ Agreed ........ 9.50

#20101 ................ Explore wound, chest ..................... 3.00 ........................ ........................ Agreed ........ 3.00

#20102 ................ Explore wound, abdomen ............... 3.68 ........................ ........................ Agreed ........ 3.68

#20103 ................ Explore wound, extremity ............... 4.95 ........................ ........................ Agreed ........ 4.95

#20930 ................ Spinal bone allograft ....................... 0.00 ........................ ........................ Agreed ........ 0.00

#20931 ................ Spinal bone allograft ....................... 1.81 ........................ ........................ Agreed ........ 1.81

#20936 ................ Spinal bone autograft ..................... 0.00 ........................ ........................ Agreed ........ 0.00

#20937 ................ Spinal bone autograft ..................... 2.79 ........................ ........................ Agreed ........ 2.79

#20938 ................ Spinal bone autograft ..................... 3.02 ........................ ........................ Agreed ........ 3.02

#21076 ................ Prepare face/oral prosthesis ........... ........................ ........................ 12.54 Agreed ........ 12.54

#21077 ................ Prepare face/oral prosthesis ........... ........................ ........................ 31.54 Agreed ........ 31.54

#21141 ................ Reconstruct midface, lefort ............. 16.92 ........................ ........................ Agreed ........ 16.92

#21142 ................ Reconstruct midface, lefort ............. 17.58 ........................ ........................ Agreed ........ 17.58
63163

444444444444

*All CPT codes and descriptors copyright 1995 American Medical Association.

a No work RVUs assumed.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

TABLE 2.—AMA RUC RECOMMENDATIONS AND HCFA’S DECISIONS—Continued

CPT* Mod Description RUC recommendations

HCPAC recommendationsSpecialty recommendationsHCFA

decision

1996 work

RVUs

#21143 ................ Reconstruct midface, lefort ............. 18.30 ........................ ........................ Agreed ........ 18.30

21145 ................ Reconstruct midface, lefort ............. 18.92 ........................ ........................ Agreed ........ 18.92

21146 ................ Reconstruct midface, lefort ............. 19.58 ........................ ........................ Agreed ........ 19.58

21147 ................ Reconstruct midface, lefort ............. 20.30 ........................ ........................ Agreed ........ 20.30

22100 ................ Remove part of neck vertebra ........ 9.05 ........................ ........................ Agreed ........ 9.05

22101 ................ Remove part, thorax vertebra ......... 9.00 ........................ ........................ Agreed ........ 9.00

22102 ................ Remove part, lumbar vertebra ........ 9.00 ........................ ........................ Agreed ........ 9.00

#22103 ................ Remove extra spine segment ......... 2.34 ........................ ........................ Agreed ........ 2.34

22110 ................ Remove part of neck vertebra ........ 11.59 ........................ ........................ Agreed ........ 11.59

22112 ................ Remove part, thorax vertebra ......... 11.59 ........................ ........................ Agreed ........ 11.59

22114 ................ Remove part, lumbar vertebra ........ 11.59 ........................ ........................ Agreed ........ 11.59

#22116 ................ Remove extra spine segment ......... 2.32 ........................ ........................ Agreed ........ 2.32

22210 ................ Revision of neck spine ................... 22.51 ........................ ........................ Agreed ........ 22.51

22212 ................ Revision of thorax spine ................. 18.14 ........................ ........................ Agreed ........ 18.14

22214 ................ Revision of lumbar spine ................ 18.14 ........................ ........................ Agreed ........ 18.14

#22216 ................ Revise, extra spine segment .......... 6.04 ........................ ........................ Agreed ........ 6.04

22220 ................ Revision of neck spine ................... 20.15 ........................ ........................ Agreed ........ 20.15

22222 ................ Revision of thorax spine ................. 20.15 ........................ ........................ Agreed ........ 20.15

22224 ................ Revision of lumbar spine ................ 20.15 ........................ ........................ Agreed ........ 20.15

#22226 ................ Revise, extra spine segment .......... 6.04 ........................ ........................ Agreed ........ 6.04

22305 ................ Treat spine process fracture ........... 1.86 ........................ ........................ Agreed ........ 1.86

22310 ................ Treat spine fracture ........................ 1.86 ........................ ........................ Agreed ........ 1.86

22315 ................ Treat spine fracture ........................ 8.36 ........................ ........................ Agreed ........ 8.36

22325 ................ Repair of spine fracture .................. 17.19 ........................ ........................ Agreed ........ 17.19

22326 ................ Repair neck spine fracture ............. 18.43 ........................ ........................ Agreed ........ 18.43

22327 ................ Repair thorax spine fracture ........... 17.56 ........................ ........................ Agreed ........ 17.56

#22328 ................ Repair each add spine fx ............... 4.61 ........................ ........................ Agreed ........ 4.61

22548 ................ Neck spine fusion ........................... 24.08 ........................ ........................ Agreed ........ 24.08

22554 ................ Neck spine fusion ........................... 17.24 ........................ ........................ Agreed ........ 17.24

22556 ................ Thorax spine fusion ........................ 22.27 ........................ ........................ Agreed ........ 22.27

22558 ................ Lumbar spine fusion ....................... 21.22 ........................ ........................ Agreed ........ 21.22

22585 ................ Additional spinal fusion ................... 5.53 ........................ ........................ Agreed ........ 5.53

22590 ................ Spine & skull spinal fusion ............. 19.50 ........................ ........................ Agreed ........ 19.50

22595 ................ Neck spinal fusion .......................... 18.19 ........................ ........................ Agreed ........ 18.19

22600 ................ Neck spine fusion ........................... 14.74 ........................ ........................ Agreed ........ 14.74

22610 ................ Thorax spine fusion ........................ 14.62 ........................ ........................ Agreed ........ 14.62

22612 ................ Lumbar spine fusion ....................... 20.19 ........................ ........................ Agreed ........ 20.19

#22614 ................ Spine fusion, extra segment ........... 6.44 ........................ ........................ Agreed ........ 6.44

22630 ................ Lumbar spine fusion ....................... 20.03 ........................ ........................ Agreed ........ 20.03

#22632 ................ Spine fusion, extra segment ........... 5.23 ........................ ........................ Agreed ........ 5.23

22800 ................ Fusion of spine ............................... 16.92 ........................ ........................ Agreed ........ 16.92

22802 ................ Fusion of spine ............................... 29.74 ........................ ........................ Agreed ........ 29.74

#22804 ................ Fusion of spine ............................... 35.00 ........................ ........................ Agreed ........ 35.00

#22808 ................ Fusion of spine ............................... 25.00 ........................ ........................ Agreed ........ 25.00

22810 ................ Fusion of spine ............................... 29.00 ........................ ........................ Agreed ........ 29.00

22812 ................ Fusion of spine ............................... 31.00 ........................ ........................ Agreed ........ 31.00

22830 ................ Exploration of spinal fusion ............ 10.22 ........................ ........................ Agreed ........ 10.22

22840 ................ Insert spine fixation device ............. 6.27 ........................ ........................ Agreed ........ 6.27

#22841 ................ Insert spine fixation device ............. 0.00 ........................ ........................ Agreed ........ 0.00

#22842 ................ Insert spine fixation device ............. 7.19 ........................ ........................ Agreed ........ 7.19

#22843 ................ Insert spine fixation device ............. 8.97 ........................ ........................ Agreed ........ 8.97

#22844 ................ Insert spine fixation device ............. 10.96 ........................ ........................ Agreed ........ 10.96

22845 ................ Insert spine fixation device ............. 5.98 ........................ ........................ Agreed ........ 5.98

#22846 ................ Insert spine fixation device ............. 8.28 ........................ ........................ Agreed ........ 8.28

#22847 ................ Insert spine fixation device ............. 9.20 ........................ ........................ Agreed ........ 9.20

#22848 ................ Insert pelvic fixation device ............ 6.00 ........................ ........................ Agreed ........ 6.00

#22851 ................ Apply spine prosth device .............. 6.71 ........................ ........................ Agreed ........ 6.71

32095 ................ Biopsy through chest wall ............... 7.13 ........................ ........................ Agreed ........ 7.13

#32501 ................ Repair bronchus (add-on) ............... 4.69 ........................ ........................ Agreed ........ 4.69

#33253 ................ Reconstruct atria ............................. 30.00 ........................ ........................ Agreed ........ 30.00

#33924 ................ Remove pulmonary shunt ............... 5.50 ........................ ........................ Agreed ........ 5.50

#38231 ................ Stem cell collection ......................... 1.74 ........................ ........................ Decreased ... 1.50

38240 ................ Bone marrow/stem transplant ......... 2.24 ........................ ........................ Agreed ........ 2.24

38241 ................ Bone marrow/stem transplant ......... 2.24 ........................ ........................ Agreed ........ 2.24

47350 ................ Repair liver wound .......................... 11.29 ........................ ........................ Agreed ........ 11.29

47360 ................ Repair liver wound .......................... 15.34 ........................ ........................ Agreed ........ 15.34

#47361 ................ Repair liver wound .......................... 28.00 ........................ ........................ Agreed ........ 28.00

#47362 ................ Repair liver wound .......................... 10.00 ........................ ........................ Agreed ........ 10.00
63164

444444444444

*All CPT codes and descriptors copyright 1995 American Medical Association.

a No work RVUs assumed.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

TABLE 2.—AMA RUC RECOMMENDATIONS AND HCFA’S DECISIONS—Continued

CPT* Mod Description RUC recommendations

HCPAC recommendationsSpecialty recommendationsHCFA

decision

1996 work

RVUs

49000 ................ Exploration of abdomen .................. 8.99 ........................ ........................ Agreed ........ 8.99

49002 ................ Reopening of abdomen .................. 9.40 ........................ ........................ Agreed ........ 9.40

49010 ................ Exploration behind abdomen .......... 11.19 ........................ ........................ Agreed ........ 11.19

55859 ................ Percut/needle insert, pros ............... 14.00 ........................ ........................ Decreased ... 8.29

#56343 ................ Laparoscopic salpingostomy .......... 6.96 ........................ ........................ Agreed ........ 6.96

#56344 ................ Laparoscopic fimbrioplasty ............. 7.16 ........................ ........................ Agreed ........ 7.16

#57284 ................ Repair paravaginal defect ............... 12.10 ........................ ........................ Agreed ........ 12.10

#59610 ................ Vbac delivery .................................. 22.63 ........................ ........................ Decreased ... 22.55

#59612 ................ Vbac delivery only .......................... 15.00 ........................ ........................ Decreased ... 14.84

#59614 ................ Vbac care after delivery .................. 16.00 ........................ ........................ Decreased ... 15.96

#59618 ................ Attempted vbac delivery ................. 25.03 ........................ ........................ Increased .... 25.23

#59620 ................ Attempted vbac delivery only ......... 16.75 ........................ ........................ Increased .... 16.95

#59622 ................ Attempted vbac after care .............. 17.94 ........................ ........................ Increased .... 18.11

62274 ................ Inject spinal anesthetic ................... 1.78 ........................ ........................ Agreed ........ 1.78

62288 ................ Injection into spinal canal ............... 1.74 ........................ ........................ Agreed ........ 1.74

#62350 ................ Implant spinal catheter ................... 6.25 ........................ ........................ Agreed ........ 6.25

#62351 ................ Implant spinal catheter ................... 9.25 ........................ ........................ Agreed ........ 9.25

#62355 ................ Remove spinal canal catheter ........ 4.80 ........................ ........................ Agreed ........ 4.80

#62360 ................ Insert spine infusion device ............ 2.00 ........................ ........................ Agreed ........ 2.00

#62361 ................ Implant spine infusion pump ........... 4.80 ........................ ........................ Agreed ........ 4.80

#62362 ................ Implant spine infusion pump ........... 6.29 ........................ ........................ Agreed ........ 6.29

#62365 ................ Remove spine infusion device ........ 4.77 ........................ ........................ Agreed ........ 4.77

#62367 26 Analyze spine infusion pump .......... 0.48 ........................ ........................ Agreed ........ 0.48

#62368 26 Analyze spine infusion pump .......... 0.75 ........................ ........................ Agreed ........ 0.75

67107 ................ Repair detached retina ................... 13.99 ........................ ........................ Agreed ........ 13.99

67108 ................ Repair detached retina ................... 19.90 ........................ ........................ Agreed ........ 19.90

67112 ................ Re-repair detached retina ............... 16.15 ........................ ........................ Agreed ........ 16.15

# 76965 26 Echo guidance radiotherapy ........... 1.34 ........................ ........................ Agreed ........ 1.34

# 78459 26 Heart muscle imaging (PET) .......... 1.88 ........................ ........................ Agreed ........ 1.88

# 78810 26 Tumor imaging (PET) ..................... 1.93 ........................ ........................ Agreed ........ 1.93

# 90922 ................ ESRD related services, day ........... 0.44 ........................ ........................ Decreased ... 0.37

# 90923 ................ Esrd related services, day .............. 0.30 ........................ ........................ Decreased ... 0.28

# 90924 ................ Esrd related services, day .............. 0.22 ........................ ........................ Increased .... 0.24

# 90925 ................ Esrd related services, day .............. 0.17 ........................ ........................ Decreased ... 0.15

92506 ................ Speech & hearing evaluation ......... 0.86 ........................ ........................ Agreed ........ 0.86

92507 ................ Speech/hearing therapy .................. 0.52 ........................ ........................ Agreed ........ 0.52

92508 ................ Speech/hearing therapy .................. 0.26 ........................ ........................ Agreed ........ 0.26

# 92510 ................ Rehab for ear implant ..................... 1.50 ........................ ........................ Agreed ........ 1.50

92516 ................ Facial nerve function test ............... 0.43 ........................ ........................ Agreed ........ 0.43

# 92525 ................ Oral function evaluation .................. 1.61 ........................ ........................ Decreased ... 1.13

# 92526 ................ Oral function therapy ...................... 0.64 ........................ ........................ Decreased ... 0.52

92546 26 Sinusoidal rotational test ................ 0.29 ........................ ........................ Agreed ........ 0.29

# 92579 ................ Visual audiometry (vra) ................... ........................ ........................ ........................ (a) ................ ........................

# 92597 ................ Oral speech device eval ................. 1.50 ........................ ........................ Decreased ... 1.11

# 92598 ................ Modify oral speech device .............. 0.99 ........................ ........................ Decreased ... 0.73

# 92987 ................ Revision of mitral valve .................. 20.69 ........................ ........................ Agreed ........ 20.69

95872 26 Muscle test, one fiber ..................... 1.50 ........................ ........................ Agreed ........ 1.50

95900 26 Motor nerve conduction test ........... 0.42 ........................ ........................ Agreed ........ 0.42

# 95903 26 Motor nerve conduction test ........... 0.60 ........................ ........................ Agreed ........ 0.60

95904 26 Sense nerve conduction test .......... 0.34 ........................ ........................ Agreed ........ 0.34

95925 26 Somatosensory testing ................... 0.81 ........................ ........................ Decreased ... 0.54

# 95926 26 Somatosensory testing ................... 0.81 ........................ ........................ Decreased ... 0.54

# 95927 26 Somatosensory testing ................... 0.81 ........................ ........................ Decreased ... 0.54

# 95930 26 Visual evoked potential test ............ 0.35 ........................ ........................ Agreed ........ 0.35

# 95934 26 ‘H’ reflex test ................................... 0.51 ........................ ........................ Agreed ........ 0.51

# 95936 26 ‘H’ reflex test ................................... 0.55 ........................ ........................ Agreed ........ 0.55

97116 ................ Gait training therapy ....................... 0.40 ........................ ........................ Agreed ........ 0.40

# 97535 ................ Self care mngment training ............ ........................ 0.45 ........................ Decreased ... 0.33

# 97537 ................ Community/work reintegration ........ ........................ 0.45 ........................ Decreased ... 0.33

# 97542 ................ Wheelchair mngement training ....... ........................ 0.45 ........................ Decreased ... 0.25

# 97703 ................ Prosthetic checkout ........................ ........................ 0.45 ........................ Decreased ... 0.25

99238 ................ Hospital discharge day ................... 1.06 ........................ ........................ Agreed ........ 1.06

# 99239 ................ Hospital discharge day ................... 1.75 ........................ ........................ Agreed ........ 1.75

# 99435 ................ Hospital NB discharge day ............. 1.50 ........................ ........................ Agreed ........ 1.50
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63165

b. Discussion of codes for which the

recommendations were not accepted or

for which clarification of the code is

necessary.

The following is a summary of our

rationale for not accepting particular

recommendations. It is arranged by type

of service in CPT code order. We have

included in this section a clarification of

the intended use of one family of codes

for which we accepted the RUC

recommendations. This summary refers

only to work RVUs.

Exploration of penetrating wounds

(CPT codes 20100 through 20103).

We accepted the RUC

recommendations for these codes but

are concerned that they could be

inappropriately used to report the repair

of wounds. Therefore, we are providing

a clarification of the codes based on the

language that will be included in CPT

1996.

These codes are used to report the

treatment of wounds resulting from

penetrating trauma that require surgical

exploration and enlargement of the

wound, extension of dissection (to

determine penetration), debridement,

removal of foreign body(s), ligation or

coagulation of minor subcutaneous and/

or muscular blood vessel(s), of the

subcutaneous tissue, muscle fascia, and/

or muscle. If a repair is done to major

blood vessel(s) requiring thoracotomy or

laparotomy, those specific code(s)

would supersede the use of CPT codes

20100 through 20103. These codes

should not be used to report simple,

intermediate, or complex repair of

wound(s) that do not require

enlargement of the wound, extension of

dissection, etc., as stated above.

Blood-derived peripheral stem cell

harvesting for transplantation, per

collection (CPT code 38231).

The RUC recommended 1.74 RVUs

based on its determination that the work

is equivalent to the work of CPT code

36520 (Therapeutic apheresis). We

believe that the work associated with

this procedure is less than that for CPT

code 36520 in that the patients are less

ill and the risk of complications is much

less. In addition, patients require less

physician monitoring, and the

procedure is more likely to be

performed on an outpatient basis. We

believe the work is comparable to a

level-5 evaluation and management

service (CPT code 99215), which is

assigned 1.50 RVUs.

However, as with therapeutic

apheresis, we do not permit payment for

both harvesting and certain evaluation

and management codes on the same

date. Specifically, we do not allow

separate payment for CPT codes 99211

through 99215 (Established patient

office or other outpatient visits), 99231

through 99233 (Subsequent hospital

care), and 99261 through 99263 (Followup inpatient consultations) on the same

date that CPT code 38231 (Stem cell

harvesting) is furnished because it

would allow duplicate payment for the

evaluation and management service.

Physicians furnishing stem cell

harvesting services may choose to bill

for the appropriate evaluation and

management visit or consultation code

indicating the level of services

furnished rather than billing for the

stem cell harvesting. This will permit

physicians to be paid for the level of

service furnished.

Separate payment will be allowed for

physician services furnished to establish

the required vascular access if

performed by the physician and if the

criteria for payment under the

appropriate CPT code are satisfied. We

will also allow separate billing for CPT

codes 99221 through 99223 (Initial

hospital visit), CPT codes 99241 through

99245 and 99251 through 99255 (Initial

consultations), and CPT code 99238

(Hospital discharge service) when billed

on the same date as CPT code 38231

(Stem cell harvesting) because the work

associated with these evaluation and

management services is not included in

work RVUs assigned to the stem cell

harvesting. These policies are consistent

with the policies for therapeutic

apheresis that were established for the

1995 fee schedule.

Transperineal placement of needles

or catheters into prostate for interstitial

radioelement application, with or

without cystoscopy (CPT code 55859).

We received a RUC recommendation

of 14.00 RVUs based upon the use of

CPT code 61770 (Stereotactic

localization, any method, including burr

hole(s) with insertion of catheter(s) for

brachytherapy) as a reference procedure.

We believe that these RVUs are too high

and disagree with the RUC’s use of CPT

code 61770 as a reference procedure; we

view that procedure as requiring greater

technical skill, mental effort, and

judgment. The recommended 14.00

RVUs are higher than the RVUs assigned

to CPT code 55860 (Exposure of

prostate, any approach, for insertion of

radioactive substance), which is

assigned 13.33 RVUs. This is an open

surgical procedure with significantly

more postprocedure work than CPT

code 55859, which can be performed on

an outpatient basis.

The placement of needles or catheters

into the prostate is performed under

ultrasonic guidance, and the guidance is

separately reported by new CPT code

76965 for which we accepted the RUC

recommendation of 1.34 RVUs. In

addition, CPT also directs separate

reporting of the interstitial radioelement

application (CPT codes 77776 through

77778). CPT code 77778 (Interstitial

radioelement application, complex) is

the code most likely to be reported. We

assigned 10.46 RVUs to this code. Thus,

a physician performing all aspects of

this procedure would report all three

codes with 25.80 total RVUs if we

accepted the RUC recommendation of

14.00 for code 55859.

We believe it is possible that

urologists responding to the surveyed

vignette may have misunderstood that

this code is used to report only the

placement of the needles or catheters

into the prostate and that they

inadvertently included in their

estimates of work the separately

reported work of ultrasonic guidance

and application of the radioelements.

We believe that a more appropriate

reference procedure than a

neurosurgical procedure would be

another prostate procedure that can be

performed on an outpatient basis. We

selected CPT code 55700 (Biopsy,

prostate; needle or punch, single or

multiple, any approach), which is

assigned 1.57 RVUs. Because of the

increased intraoperative time and

complexity as well as the increased

surgical risk associated with CPT code

55859, we have increased the RVUs

four-fold to 6.28 RVUs. In addition we

added 2.01 RVUs, the RVUs assigned to

CPT code 52000, to reflect the added

work of the cystoscopy. This addition

results is the assignment of 8.29 RVUs

for CPT code 55859.

Vaginal birth after cesarean (CPT

codes 59610, 59612, 59614, 59618,

59620, and 59622).

The CPT has added a new section to

the 1996 edition for ‘‘delivery after

previous cesarean delivery.’’ Included

in this section are six new codes that are

used to report the services furnished to

patients who have had a previous

cesarean delivery and who present with

the expectation of a vaginal delivery. If

the patient has a successful vaginal

delivery after a previous cesarean

delivery (VBAC), then either CPT code

59610, 59612, or 59614 is reported. If

the attempt is unsuccessful and another

cesarean delivery is carried out, either
63166 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

CPT code 59618, 59620, or 59622 is

reported. The RUC-recommended RVUs

for all six codes that added varying

increments of work to the RVUs of the

six existing codes that are used to report

routine vaginal and cesarean deliveries.

The following table includes the RVUs

for the six existing codes, the RUC

recommendations for the six new VBAC

codes and the difference in RVUs for

each of the six pairs.

Existing delivery code

RVUs of existing delivery

code

Corresponding

new VBAC

code

RUC-Recommended

RVUs for new

VBAC code

RVU differenceHCFA

RVUs

59400 ............................................................................................... 20.99 59610 22.63 1.64 22.55

59409 ............................................................................................... 13.28 59612 15.00 1.72 14.84

59410 ............................................................................................... 14.44 59614 16.00 1.56 15.96

59510 ............................................................................................... 23.67 59618 25.03 1.36 25.23

59514 ............................................................................................... 15.39 59620 16.75 1.36 16.95

59515 ............................................................................................... 16.55 59622 17.94 1.39 18.11

While we accept the RUC conclusion

that VBAC services entail more

physician work and that the existing

delivery codes are appropriate reference

points, we disagree with the variable

and small differences in work from one

code to the next. We believe the

increased stress, mental effort, and

judgment associated with VBAC is the

same regardless of the particular

delivery service furnished. Therefore,

we are adding 1.56 RVUs (the median

RVUs of the above differences) to each

of the existing delivery codes. This

results in the interim RVUs identified in

the last column of the table as ‘‘HCFA

RVUs.’’

End-stage renal disease services, per

day (CPT codes 90922 through 90925).

CPT 1996 will include four codes for

the reporting of end-stage renal disease

services on a per day rather than per

month basis. We did not accept the RUC

recommendations for these codes that

were based on the RUC’s

recommendations for the monthly codes

(CPT codes 90918 through 90921). As

discussed in section VI.B.1.b. of this

final rule, new RVUs emerged from the

refinement panel ratings for these codes.

We calculated work RVUs for the four

‘‘per day’’ end-stage renal disease codes

by dividing the RVUs of the ‘‘per full

month’’ codes by 30. This led to the

assignment of 0.37 RVUs to CPT code

90922, 0.28 RVUs to CPT code 90923,

0.24 RVUs to CPT code 90924, and 0.15

RVUs to CPT code 90925.

Evaluation of swallowing and oral

function for feeding (CPT code 92525).

The RUC made its recommendation of

1.61 RVUs based on a clinical vignette

of an inpatient whose evaluation

included a barium swallow. The RUC

lowered the specialty’s recommendation

to better account for the times when the

barium swallow might not be done. We

believe the RVUs recommended, which

are between the RVUs of a level-3

inpatient consultation (CPT code

99253), with 1.56 RVUs, and a level-4

inpatient consultation (CPT code 99254)

with 2.27 RVUs, are too high. While we

believe that the intraservice work

determined by the survey for the

vignette may be reasonable, we do not

believe that the surveyed vignette

represented a typical patient.

Our data suggest that this procedure,

which was formerly reported by CPT

code 92506, is performed primarily in

the physician’s office. We took into

consideration that the procedure is

currently reported using CPT code

92506, which is assigned 0.86 RVUs. We

then took into account that the barium

swallow is probably included in at least

50 percent of the cases and that the

evaluation of the barium swallow is an

integral part of the procedure.

Therefore, we added half the value of

CPT code 74230 (Swallowing function,

pharynx and/or esophagus, with

cineradiography and/or video), which is

assigned 0.54 RVUs to the 0.86 RVUs for

CPT code 92506 resulting in an

assignment of 1.13 RVUs to CPT code

92525. These RVUs are slightly higher

than the RVUs of CPT code 99242,

which is the code for a level-2 office

consultation, the components of which

include an expanded problem-focused

history, an expanded problem-focused

examination, and straightforward

medical decision making.

Treatment of swallowing dysfunction

and/or oral function for feeding (CPT

code 92526).

The RUC recommended 0.64 RVUs

based on a clinical vignette of an

inpatient similar to the patient

described in the vignette used for CPT

code 92525 described above. Our data

suggest that this procedure, which is

currently reported using CPT code

92507, also is performed primarily in

physicians’ offices. Because we believe

the surveyed vignette does not describe

a typical patient, we reduced the RUC

recommendation for CPT code 92526 to

0.52 RVUs, which are the same RVUs as

those for CPT code 92507 (Speech,

language or hearing therapy, with

continuing medical supervision;

individual). These RVUs are slightly

less than the RVUs assigned to a midlevel office visit (CPT code 99213), with

0.55 RVUs, which typically requires 15

minutes of face-to-face time with a

physician.

Visual reinforcement audiometry

(VRA) (CPT code 92579).

The RUC made no recommendation

for RVUs for this procedure. As with

most of the audiologic function tests, we

do not believe this service requires

performance by a physician.

Consequently, we have not assigned

physician work RVUs to this code.

However, we have assigned 0.69

practice expense RVUs and 0.07

malpractice expense RVUs.

Evaluation for use and/or fitting of

voice prosthetic or augmentative/

alternative communication device to

supplement oral speech (CPT code

92597).

The RUC recommended 1.50 RVUs.

We believe the recommended RVUs are

too high because they are comparable to

the highest level established patient

office visit, CPT code 99215, the

components of which include a

comprehensive history, a

comprehensive examination, and

medical decision-making of high

complexity. We do not believe the work

of these two services is comparable.

Rather, we believe the work associated

with CPT code 92597 is slightly less

than the work associated with a level3 new patient office visit (CPT code

99203) with 1.14 RVUs and a level-2

inpatient consultation (CPT code 99252)

with 1.13 RVUs. Therefore, we have

assigned 1.11 RVUs to CPT code 92597.
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63167

Modification of voice prosthetic or

augmentative/alternative

communication device to supplement

oral speech (CPT code 92598).

The RUC recommended 0.99 RVUs,

which are higher than the RVUs

assigned to a level-4 established patient

office visit (CPT code 99214), with 0.94

RVUs. We believe that the

recommendation is too high. However,

we believe that the relative relationship

between this service and CPT code

92597, as established by the RUC,

should be maintained. Thus, we

calculated the interim RVUs by

multiplying the recommended 0.99

RVUs by 74 percent (0.99×1.11/1.5)

representing the percentage of the RUCrecommended RVUs, which we

accepted for the preceding code. This

calculation results in 0.73 interim RVUs

for CPT code 92598.

Short-latency somatosensory evoked

potential studies, stimulation of any/all

peripheral nerves or skin sites,

recording from the central nervous

system (CPT codes 95925 through

95927).

The existing code for the reporting of

somatosensory testing is CPT code

95925. The descriptor in CPT 1995 is

‘‘Somatosensory testing (e.g., cerebral

evoked potentials), one or more nerves.’’

CPT revised existing CPT code 95925 by

splitting it into three codes (95925,

95926, and 95927), which will be used

to report testing of the upper limbs,

lower limbs, and trunk or head,

respectively. Currently, 0.81 RVUs are

assigned to CPT code 95925. The RUC

viewed the coding change as editorial

and recommended 0.81 RVUs for each

of these codes. While we agree that the

same RVUs should be assigned to the

three codes, we have not accepted the

specific recommendation of 0.81 RVUs

because we do not view it as an editorial

change. We believe that the RUC failed

to take account of the fact that some

patients will require testing of both the

upper and lower limbs during an

encounter and that, under the existing

code, only one unit of service can be

reported regardless of the number of

nerves tested because the descriptor

specifies ‘‘one or more nerves.’’ We

estimate that the cases previously

reported with CPT code 95925 will be

reported under the new and revised

codes as follows: About 50 percent will

be reported with revised CPT code

95925; about 50 percent will be reported

as new CPT code 95926; about 1 percent

will be reported as CPT code 95927; and

50 percent of all testing will involve

both CPT codes 95925 and 95926 during

the same encounter. Using these

estimates, we adjusted the RVUs for the

three codes so that the total number of

RVUs under the new codes will be the

same as the total number of RVUs under

the old codes. This results in a decrease

of the RUC’s recommendation of 0.81

RVUs for each of the codes to 0.54 RVUs

for each of the codes.

ADDITIONAL CODES

CPT code Description

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.

97703 ..... Checkout for orthotic/prosthetic

use, established patient, each

15 minutes.

The RUC Health Care Professionals

Advisory Committee Review Board

recommended 0.45 RVUs for each of

these services on the basis of their

comparability to other physical

medicine codes, for example, CPT code

97110 (Therapeutic procedure, one or

more areas, each 15 minutes;

therapeutic exercises to develop

strength and endurance, range of motion

and flexibility). While we agree that

these new services appropriately are

compared to other therapeutic

procedures, our review of the new

services causes us to believe that the

interim RVUs we assigned to the

therapeutic procedures services may

have been too high relative to other

services on the fee schedule, for

example, evaluation and management

services.

We have decided to maintain the

interim RVUs for the physical medicine

and rehabilitation codes (CPT codes

97010 through 97770) as interim RVUs

on the 1996 fee schedule so that we will

have additional time to re-evaluate

them. While we acknowledge that we

accepted last year’s recommendations of

the Health Care Professionals Advisory

Committee Review Board to assign 0.45

RVUs to CPT code 97110 and several

other of the therapeutic procedures, we

now plan to refer these codes back to

the RUC Health Care Professionals

Advisory Committee Review Board for

its reconsideration, and we will notify

the RUC of our concerns. In addition,

we seek public comments on this issue.

For new CPT codes 97535 and 97537,

we believe the recommended 0.45 RVUs

are too high. Since they are currently

reported using CPT code 97540

(Training in activities of daily living

(self care skills and/or daily life

management skills); initial 30 minutes,

each visit), which has 0.44 RVUs, we

divided the RVUs for CPT code 97540

by 2 to arrive at RVUs for 15 minutes

and added 50 percent to account for the

prework and postwork inherent in the

service. This results in 0.33 RVUs for

CPT codes 97535 and 97537.

For new CPT codes 97542 and 97703,

we believe the recommended 0.45 RVUs

are too high. We believe these services

are comparable to attended modality

services such as manual electrical

stimulation (CPT code 97032), with 0.25

RVUs. Therefore, we have assigned 0.25

RVUs to both CPT codes 97542 and

97703.

CPT code Description

99238 ..... Hospital discharge day management; 30 minutes or less.

99239 ..... Hospital discharge day management; more than 30 minutes.

We agreed with the RUC

recommendation of 1.06 RVUs for CPT

code 99238 and 1.75 RVUs for CPT code

99239. The reporting of CPT code 99239

must be supported by documentation in

the patient’s medical record of the time

spent by the physician furnishing the

service as well as documentation of the

actual services furnished. Time spent by

individuals other than the physician

should not be considered in selecting

the appropriate hospital discharge day

management code.
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CPT code Description

99411 ..... Preventive medicine counseling

and/or risk factor reduction

intervention(s) provided to individuals in a group setting (separate procedure): approximately 30 minutes.

99412 ..... Preventive medicine counseling

and/or risk factor reduction

intervention(s) provided to individuals in a group setting (separate procedure): approximately 60 minutes.

We agreed with the RUC

recommendations of 0.15 RVUs for CPT

code 99411 and 0.25 RVUs for CPT code

99412. While these services are not

covered by Medicare, we believe it is

important to state the assumptions we

made in agreeing with the RUCrecommended RVUs. The intent of the

codes is to represent an interactive

service between the patient and the

physician. We expect that the

interaction will be documented in each

patient’s individual medical record. In

addition, since the RVUs are based on

physician work, the codes should not be

reported unless they are personally

performed by a physician; they should

not be used to report group preventive

medicine counseling furnished by

anyone other than a physician. Nor is

the service to be reported if it is

furnished in a place of service other

than the physician’s office. Finally, the

assigned RVUs are based on a group of

two to five persons for CPT code 99411

and a group of two to six persons for

CPT code 99412. Preventive medicine

furnished to groups larger than these

should be reported using code 99249

which is for the reporting of preventive

medicine services not listed in CPT.

c. Temporary alpha-numeric HCFA

Common Procedure Coding System

codes.

For the 1996 Medicare fee schedule

for physicians services, we have

established several new alpha-numeric

HCFA Common Procedure Coding

System (HCPCS) codes for the reporting

of certain new services that are not

clearly described by existing CPT codes.

In this section, we discuss our rationale

for establishing the codes as well as the

basis of the interim RVUs we have

assigned to them. We view these codes

as temporary since we will be referring

them to the CPT Editorial Panel for

possible inclusion in future editions of

the CPT.

Measurement of post-voiding residual

urine and/or bladder capacity by

ultrasound (HCPCS code G0050).

Measurement of postvoiding residual

(PVR) urine and/or bladder capacity can

be done by simple diagnostic

catheterization. It can also be done by

ultrasound using either traditional

sonographic equipment or smaller less

expensive equipment whose capacity is

limited only to bladder volume

determination. When done by

catheterization, CPT code 53670, with

0.74 RVUs, is reported. When done by

ultrasound, CPT code 76857, pelvic

echography, with 1.65 RVUs, is reported

whether done using traditional

equipment or the smaller bladder scan.

There is presently no separate CPT code

for a bladder scan only. Both individual

carriers and a manufacturer of bladder

scanning devices have recommended

that we establish a separate code to

distinguish bladder scans from general

pelvic scans because they believe that

payment for CPT code 76857 is too high

for only a bladder scan to determine

PVR. We agree with this

recommendation and are issuing the

new HCPCS code G0050.

HCPCS code Work

RVUs Practice RVUs MalpracticeRVUs

Total

RVUs

G0050 ....................................................................................................................................... 0.00 0.81 0.05 0.86

We believe that this bladder scan

performs the same function as a simple

diagnostic catheterization but without

the risk of infection. To recognize the

slightly higher equipment costs, we

have established interim total RVUs for

bladder scan of 0.86, or about 0.12 RVUs

higher than for catheterization. We have

not assigned physician work RVUs for a

bladder scan. We expect that the scan

will be performed after a physician has

examined the patient and determined

the medical necessity for a bladder scan.

Physician interpretation of the scan is

included in the associated evaluation

and management service.

Lung volume reduction surgery

(reduction pneumoplasty) eg, lung

shaving, lung contouring, unilateral or

bilateral (HCPCS code G0061).

Lung volume reduction surgery, also

termed reduction pneumoplasty, lung

shaving, or lung contouring is a

procedure performed to improve

pulmonary function in patients with

severe emphysema. Medicare has not

established that the procedure is

reasonable and necessary for the

diagnosis or treatment of illness or

injury. Therefore, we have excluded this

procedure from coverage under the

provisions of section 1862(a)(1)(A) of

the Act.

Although we have assigned a

noncoverage indicator of ‘‘N’’ to this

code, we are providing interim RVUs for

those who look to the Medicare fee

schedule for information on the relative

value of all physicians services

including those not covered by

Medicare.

We believe the procedure is most

often being reported as wedge

resection(s) of the lung using CPT code

32500, which has 13.10 work RVUs.

Based on discussions with carrier

medical directors, we believe that lung

volume reduction surgery is more

difficult than wedge resection(s). After

considering existing CPT codes for other

pulmonary procedures, we have

assigned 17.62 RVUs on an interim basis

to HCPCS code G0061. These are the

same RVUs assigned to total pulmonary

decortication (CPT code 32220), which

we believe is similar to lung reduction

surgery in terms of physician work.

V. Issues for Discussion

A. Five-Year Refinement of Relative

Value Units

Section 1848(c)(2)(B)(i) of the Act

requires that we review all RVUs no less

often than every 5 years. Since we

implemented the physician fee schedule

effective for services furnished

beginning January 1, 1992, we have

initiated the 5-year refinement of RVUs

that will be effective for services

furnished beginning January 1, 1997.

All work RVUs included in the

December 1994 final rule (59 FR 63617)

were subject to comment. During the

comment period, which closed on

February 6, 1995, we received

approximately 500 public comments on

approximately 1,100 procedure codes.

After review by our medical staff, we

forwarded comments on approximately

700 CPT codes for consideration by the
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63169

American Medical Association/

Specialty Society Relative Value Update

Committee (RUC).

After a thorough review of the RUC

recommendations, we will announce

any proposed changes to the work RVUs

in the Federal Register in early 1996

and provide an opportunity for the

public to comment before we finalize

the changes.

B. Resource-Based Practice Expense

Relative Value Units

With the exception of anesthesia

services, physician services and other

diagnostic services paid under the

physician fee schedule have practice

expense and malpractice expense RVUs.

Payments for practice expense RVUs

account for approximately 42 percent of

physician fee schedule payments.

The practice expense RVUs are

derived from historical allowed charge

data. The common criticism is that the

practice expense RVUs are not truly

resource-based because they are not

based on resource costs.

Section 121 of the Social Security Act

Amendments of 1994, Public Law 103–

432, enacted on October 31, 1994,

requires the Secretary to develop a

methodology for a resource-based

system for determining practice expense

RVUs for each physician service. In

developing the methodology, the

Secretary must consider the staff,

equipment, and supplies used in the

provision of medical and surgical

services in various settings. The

Secretary must report to the Congress on

the methodology by June 30, 1996. The

new payment methodology is effective

for services furnished in 1998. There is

no transition provision for these

services.

We awarded a contract to Abt

Associates in March 1995. Abt will

develop a uniform database that can be

used to support a number of analytical

methods (for example, microcosting or

economic cost functions) to estimate

practice expense per service. Abt will

also provide us with both direct and

indirect practice expense estimates for

all services paid under the physician fee

schedule. We expect that these

estimates will vary based on the site

where the service is furnished. For

example, the practice expense for a

physician service furnished in the

hospital outpatient department will

differ from the practice expense for the

same service performed in the

physician’s office.

As we pointed out in our July 26,

1995 proposed rule (60 FR 38400), Abt

will use information from two separate

processes to generate practice expense

RVUs for physician services (60 FR

38417). Through the use of Clinical

Practice Expert Panels, Abt will estimate

the expenses, including the cost of

clinical labor, supplies, and medical

equipment for specific physician

services. The Clinical Practice Expert

Panels will also consider whether

additional items, such as the cost of

administrative services, can be directly

assigned to individual services. The

remaining expenses for physician

services will be calculated from the

information obtained through the

practice expense survey.

Practice Expense Survey

Abt will obtain physician practice

specific information through a practice

expense survey. Abt expects to receive

responses from approximately 3,000

practices.

The survey instrument was sent to the

Office of the Secretary in the

Department of Health and Human

Services on August 7, 1995. Under

current procedures, the Department has

a 60-day period to review this survey.

After Departmental clearance, the

survey is sent to the Office of

Management and Budget where it will

undergo a 60-day clearance process.

Under the current schedule, the earliest

clearance on the survey will be in early

December.

We expect that Abt will send the

survey to individual practices starting in

January 1996. Abt estimates that it will

take approximately 7 months for its staff

to mail the survey, to compile the

completed responses, and to assemble

the data into a database.

As we stated in the July 26, 1995

proposed rule, one of the main

objectives of the practice expense

survey will be to collect indirect

practice expenses so that these expenses

can be related to individual CPT

procedure codes.

Clinical Practice Expert Panels

We furnished Abt with a list of all the

codes in the Medicare physician fee

schedule database for which practice

expense RVUs are to be estimated. As a

starting point, Abt used a classification

system that is a hybrid of the

Ambulatory Patient Groups system

developed by 3M and the BerensonEggers-Holahan (Urban Institute) system

to group the codes into similar families

of codes. The objective was to sort the

codes into families that are clinically

related and have relatively comparable

direct costs. This system was reviewed

by our medical staff, clinical

consultants, and the Clinical Practice

Expert Panel Technical Expert Group,

the advisory group for the overall design

of the project.

At a HCFA-sponsored public meeting

on August 18, 1995, a draft copy of this

classification system was provided to

various specialty groups. These groups

were given the opportunity to review

the families of codes and the Clinical

Practice Expert Panel to which the

family was assigned and to suggest one

or more reference codes for each family.

Abt considered these comments in the

development of the final classification

system.

At this time, Abt has grouped the

codes into 199 families. These families

have been assigned to 15 Clinical

Practice Expert Panels. Each Clinical

Practice Expert Panel is generally

assigned between 6 to 25 families. A

goal is to keep the number of service

families per Clinical Practice Expert

Panel manageable.

Each Clinical Practice Expert Panel

will be composed of up to 15 members.

Clinical Practice Expert Panel

membership is not restricted to

practicing physicians. Clinical Practice

Expert Panel members can be practice

managers and nonphysician clinicians

who are knowledgeable about physician

practice expenses. There will be a

primary care physician and surgeon on

every Clinical Practice Expert Panel.

The remainder of the Clinical Practice

Expert Panel members will be composed

of the primary providers of the services

in the Clinical Practice Expert Panel

families.

The Clinical Practice Expert Panel is

to reach consensus on the detailed

direct inputs for one reference

procedure per family. The following

four criteria were established to guide

the selection process of the reference

procedure:

• The service should be commonly

performed.

• The service should have a midrange level of resource usage relative to

the other codes in the family.

• The service should be a code whose

definition or coding application has not

changed in the last several years.

• The variation across physicians in

the way the service is performed should

be minimal.

A Clinical Practice Expert Panel

Technical Expert Group meeting was

held on September 7 and 8, 1995. The

Clinical Practice Expert Panel Technical

Expert Group devoted its attention to
63170 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

the following topics: service family

composition including criteria;

reference procedures per family;

composition of the Clinical Practice

Expert Panel; and the process for

conducting the Clinical Practice Expert

Panels, in particular, the worksheets to

be completed.

Future Scheduled Activities

A mock Clinical Practice Expert Panel

meeting will be held in January 1996.

The purpose of the mock Clinical

Practice Expert Panel meeting is to pretest the Clinical Practice Expert Panel

process and worksheets.

The first series of Clinical Practice

Expert Panel meetings will be

conducted beginning in late January

1996. Before the Clinical Practice Expert

Panel meetings, each Clinical Practice

Expert Panel member (and if it so

chooses, specialty group) will complete

the worksheets on the resource costs of

reference procedures. Abt will compile

these data and provide summary

information to each Clinical Practice

Expert Panel member. The Clinical

Practice Expert Panel members will use

a consensus approach to estimate the

direct inputs for the reference services.

The second series of Clinical Practice

Expert Panel meetings will be

conducted in the spring of 1996. The

Clinical Practice Expert Panel members

will use an extrapolation process to

estimate the direct costs of the other

nonreference procedures in the same

family.

Data collection on the practice

expense survey will be completed by

June 1996. Abt will deliver data files by

August 1, 1996. We expect to award

multiple contracts to analyze the data.

Abt’s report on the analysis of the data

is due by September 1996.

We expect to publish the proposed

rule in the Federal Register in the

spring of 1997 and the final rule in the

fall of 1997. We will implement the

resource-based practice expense RVUs

beginning January 1, 1998.

As we also stated in the July 26, 1995

proposed rule, this discussion of our

efforts to implement the requirement in

the statute to develop a resource-based

relative value scale is for informational

purposes and is not a formal proposal.

We were not soliciting comments on the

proposal. While we did receive several

comments, we are not providing a

summary of these comments nor

responses to them because it was not a

formal proposal. We will, however,

consider the comments.

C. Case Management in a Fee-forService System

In the July 26, 1995 proposed rule, we

solicited information,

recommendations, and suggestions from

the public on how we might apply case

management to the Medicare fee-forservice system. While the comments we

received addressed the issues we raised

in the proposed rule, we are now

seeking comments on some additional

issues.

We are currently interested in paying

physicians for the management of

patients with specific diagnoses. We

believe that physicians often provide

extensive case management to patients

with certain chronic conditions and that

these management activities may

maintain or improve health status. We

are interested in learning more about

which patients would benefit from this

case management.

We are also exploring various

managed care options within the

Medicare fee-for-service system. We are

interested in receiving public comment

about the appropriateness and

feasibility of creating periodic capitated

payments for comprehensive

management of medical cases.

Our intent at this time is to solicit

information, recommendations, and

suggestions from the public on how we

might create a capitated payment for

case management. We are particularly

interested in the following:

• What types of patients would

benefit from extensive case

management? We are considering

developing bundled payments for

physician services furnished to patients

with dementia and one or more comorbidities, diabetes, hypertension, or

congestive heart failure. We are seeking

comments on these and other types of

patients who would benefit from case

management. Any information about the

types of services that should be

included in a bundled payment for care

of these patients and data on the

prevalence of a given medical condition

or combination of conditions in the

Medicare population would be

appreciated.

• What is an appropriate periodicity

for a capitated payment? There is

precedent in the Medicare program for

monthly and weekly capitated

payments. (Medicare pays on a monthly

basis for physician services associated

with the continuing medical

management of a maintenance dialysis

patient and has a weekly radiation

therapy management payment.) Do

other schedules such as quarterly or

semiannually make more sense for

identifiable groups of patients?

VI. Provisions of the Final Rule

The provisions of this final rule, for

the most part, restate the provisions of

the July 1995 proposed rule. This

section includes the following changes

from the proposed rule:

• Adds a new statutory basis section

in § 405.500 for subpart E (‘‘Criteria for

Determining Reasonable Charges’’) in

part 405 and also revises the authority

citation for subpart E.

• Redesignates § 405.552

(‘‘Conditions for payment:

Anesthesiology services’’) as § 415.110.

• Adds a statutory basis section in

§ 405.2400 for subpart X (‘‘Health Clinic

and Federally Qualified Health Center

Services’’) of part 405 and also revises

the authority citation for subpart X.

• Revises § 405.2468 (‘‘Allowable

costs’’) to expand the definition of

physician services in rural health clinics

and Federally qualified health centers to

include services of residents as defined

in § 415.152 (‘‘Definitions’’) who meet

the requirements in § 415.206(b)

(concerning physician fee schedule

payment for services of residents in

nonprovider settings).

• Revises § 414.30 (‘‘Conversion

factor update’’) to incorporate a change

regarding the downward adjustment to

the conversion factor required by

section 13511 of OBRA 1993.

• Revises § 414.32 (‘‘Determining

payments for certain physicians’

services furnished in facility settings’’)

to state that when a service which is not

on the ASC list is performed in an ASC,

the site-of-service payment differential

does not apply.

• Removes the urodynamic

evaluation CPT codes 51725, 51726,

51772, 51785 and CPT codes 13150,

14020, 14060, 15740, 21208, 21440,

23066, 26645, 28030, 28043, 28092,

28261, 40510, 41805, 42408, 46220,

46610, 63600, 64420, 65270, and 67921

from the site-of-service payment

differential list as proposed.

• Revises § 414.46 (‘‘Additional rules

for payment of anesthesia services’’) to

state that anesthesia CPT modifier units

are not allowed for Medicare payment.

• Moves the ‘‘Scope’’ paragraph (a) in

§ 415.100 of subpart C (‘‘Part B Carrier

Payments for Physician Services to

Beneficiaries in Providers’’) of part 415

in the proposed rule into a separate

§ 415.100. Redesignates the remaining

paragraphs in proposed rule § 415.100

as § 415.102 (‘‘Conditions for fee
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63171

schedule payment for physician services

to beneficiaries in providers’’).

• Creates a limited exception to the

teaching physician presence

requirement for certain residency

programs in new § 415.174 (‘‘Exception:

Evaluation and management services

furnished in certain centers’’).

In addition, the final rule differs from

the proposed rule in that we have

revised our proposed payment policy

related to hydration therapy and

chemotherapy as a result of public

comments. We will allow separate

payment for hydration therapy or the

infusion of antiemetics or other

nonchemotherapy drug on the same

date of service as chemotherapy

infusion only when the

nonchemotherapy drug is administered

sequentially rather than at the same

time as the chemotherapy infusion.

However, as we proposed, we will not

pay for hydration therapy when

administered at the same time as

chemotherapy infusion.

VII. Collection of Information

Requirements

Under the Paperwork Reduction Act

of 1995, agencies are required to provide

60-day notice in the Federal Register

and solicit public comment before a

collection of information requirement is

submitted to the Office of Management

and Budget (OMB) for review and

approval. In order to fairly evaluate

whether an information collection

should be approved by OMB, section

3506(c)(2)(A) of the Paperwork

Reduction Act of 1995 requires that we

solicit comment on the following issues:

• Whether the information collection

is necessary and useful to carry out the

proper functions of the agency;

• The accuracy of the agency’s

estimate of the information collection

burden;

• The quality, utility, and clarity of

the information to be collected; and

• Recommendations to minimize the

information collection burden on the

affected public, including automated

collection techniques.

Therefore, we are soliciting public

comment on each of these issues for the

information collection requirements

discussed below.

The following sections of this

document contain information

collection requirements as described

below:

The information collection

requirements in § 415.60 (‘‘Allocation of

physician compensation costs’’), in

paragraph (f)(1), concern determination

and payment of allowable physician

compensation costs. The requirements

also concern the amounts of time the

physician spends in furnishing

physician services to the provider,

physician services to patients, and

services that are not paid under either

Part A or Part B of Medicare; and

assurance that the compensation is

reasonable in terms of the time devoted

to these services. The information

collection requirements in § 415.60(g)

concern recordkeeping requirements for

allocation of physician compensation

costs. They also concern time records

used to allocate physician

compensation, information on which

the physician compensation allocation

is based, and retention of this

information for a 4-year period after the

end of each cost reporting period to

which the allocation applies.

Respondents that will provide the

information are 7,091 hospitals, 10,630

freestanding skilled nursing facilities,

and 258 freestanding comprehensive

outpatient rehabilitation facilities. The

respondents will provide the

information in Exhibits 2 through 4 on

Form HCFA–339, ‘‘Provider Cost Report

Reimbursement Questionnaire.’’

The information collection

requirements in § 415.130 (‘‘Conditions

for payment: Physician pathology

services’’), paragraph (b)(3), concern a

written narrative report included in the

beneficiary’s medical record for clinical

consultation pathology services. The

services must be requested by the

beneficiary’s attending physician, relate

to a test result that lies outside the

clinically significant normal or expected

range in view of the condition of the

beneficiary, and require the exercise of

medical judgment by the consultant

physicians. Respondents who will

provide the information are physicians

furnishing clinical consultation

pathology services.

The information collection

requirements in § 415.162

(‘‘Determining payment for physician

services furnished to beneficiaries in

teaching hospitals’’) concern the

apportionment of compensation in the

case of teaching hospitals electing cost

reimbursement for direct medical and

surgical services furnished by

physicians to beneficiaries and

supervision of interns and residents

furnishing care to beneficiaries in a

teaching hospital. Respondents that will

provide the information are 40 cost

election teaching hospitals. The

respondents will provide the

information on Supplemental

Worksheet, Part I and Part II, of Form

HCFA–2552–92.

The information collection

requirements in § 415.172 (‘‘Physician

fee schedule payment for services of

teaching physicians’’), paragraph (b),

concern documentation in the medical

records that the teaching physician was

present at the time the service was

furnished, and, in the case of evaluation

and management services, personal

documentation by the teaching

physician in the medical records of his

or her participation in the service. The

information collection requirements

also concern, in the case of surgical,

high-risk, or other complex procedures,

the presence of the teaching physician

during all critical portions of the

procedure and immediate availability to

furnish services during the entire

service or procedure. In the case of

surgery, the teaching physician’s

presence is not required during opening

and closing of the surgical field. In the

case of procedures performed through

an endoscope, the teaching physician

must be present during the entire

viewing. In the case of evaluation and

management services, the teaching

physician must be present during the

portion of the service that determines

the level of service billed. Respondents

who will provide this information are

physicians, residents, or nurses;

however, in the case of evaluation and

management services, the teaching

physician must personally document in

the medical records his or her

participation in the service.

The information collection

requirements in § 415.174 (‘‘Exception:

Evaluation and management services

furnished in certain centers’’),

paragraph (a)(3)(v), concern

documentation of the extent of the

teaching physician’s participation in the

review and direction of the services

furnished to each beneficiary in an

outpatient department of a hospital or

another ambulatory care entity. The

information collection requirements

concern the conditions under which

carriers will make physician fee

schedule payment for certain evaluation

and management services of lower and

mid-level complexity furnished by a

resident without the presence of a

teaching physician. Respondents who

will provide this information are

teaching physicians.

The information collection

requirements in § 415.178 (‘‘Anesthesia

services’’), paragraph (b), concern
63172 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

documentation of the teaching

physician’s presence or participation in

the administration of the anesthesia and

a preoperative and postoperative visit

by the teaching physician. The teaching

physician must be present during all

critical portions of the procedure and

immediately available to furnish

services during the entire service or

procedure. The teaching physician

cannot receive an unreduced fee if he or

she performs services involving other

patients during the period the

anesthesia resident is furnishing

services in a single case. Respondents

who will provide this information are

teaching physicians.

The information collection

requirements in § 415.180 (‘‘Teaching

setting requirements for the

interpretation of diagnostic radiology

and other diagnostic tests’’), paragraph

(b), concern documentation that the

teaching physician personally

performed the interpretation or

reviewed the resident’s interpretation

with the resident. Physician fee

schedule payment will be made in those

situations. Respondents who will

provide this information are teaching

physicians.

The table below indicates the annual

number of responses for each regulation

section in this final rule containing

information collection requirements, the

average burden per response in minutes

or hours, and the total annual burden

hours.

ESTIMATED ANNUAL REPORTING AND RECORDKEEPING BURDEN

CFR sections Annual No. of

responses

Annual frequency

Average burden per response

Annual burden

hours

415.60 ................................................................................................................ 17,979 1 11 hours ....... 197,769

415.130 .............................................................................................................. 9,273 1 3 minutes ..... 464

415.162 .............................................................................................................. 40 1 2 hours ......... 80

415.172 .............................................................................................................. 3,200,232 1 1 minute ....... 53,337

415.174 .............................................................................................................. 1,237,516 1 1 minute ....... 20,625

415.178 .............................................................................................................. 106,819 1 1 minute ....... 1,780

415.180 .............................................................................................................. 1,000,107 1 1 minute ....... 16,668

The information collection

requirements were approved by OMB

for §§ 415.60 and 415.162 as §§ 405.481

and 405.465, respectively, under OMB

control number 0938–0301 and expire

August 31, 1998.

We have submitted a copy of this final

rule with comment period to OMB for

its review of the information collection

requirements in §§ 415.130, 415.172,

415.174, 415.178, and 415.180. These

requirements are not effective until they

have been approved by OMB. A

document will be published in the

Federal Register when OMB approval is

obtained.

Organizations and individuals

desiring to submit comments on the

information collection and

recordkeeping requirements should

send them to the Health Care Financing

Administration, Office of Financial and

Human Resources, Management

Planning and Analysis Staff, 7500

Security Boulevard, Baltimore,

Maryland, 21244–1850 and to the Office

of Management and Budget official

whose name appears in the ADDRESSES

section of this preamble.

VIII. 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.

IX. Regulatory Impact Analysis

A. Regulatory Flexibility Act

Consistent with the Regulatory

Flexibility Act (5 U.S.C. 601 through

612), we prepare a regulatory flexibility

analysis unless the Secretary certifies

that a rule will not have a significant

economic impact on a substantial

number of small entities. For purposes

of the Regulatory Flexibility Act, all

physicians are considered to be small

entities.

This final rule will not have a

significant economic impact on a

substantial number of small entities.

Nevertheless, we are preparing a

regulatory flexibility analysis because

the provisions of this rule are expected

to have varying effects on the

distribution of Medicare physician

payments across specialties and across

geographic areas. We anticipate that

virtually all of the approximately

500,000 physicians who furnish covered

services to Medicare beneficiaries will

be affected by one or more provisions of

this rule. In addition, physicians who

are paid by private insurers for nonMedicare services will be affected to the

extent that they are paid by private

insurers that choose to use the RVUs.

However, with few exceptions, we

expect that the impact on individual

medical practitioners will be limited.

In accordance with the provisions of

Executive Order 12866, this final rule

was reviewed by the Office of

Management and Budget.

B. Budget-Neutrality Adjustment

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

requires that adjustments to RVUs in a

year may not cause the amount of

expenditures for the year to differ by

more than $20 million from the amount

of expenditures that would have been

made if these adjustments had not been

made. We refer to this as the budgetneutrality adjustment.

In past years, we have made this

adjustment across all RVUs. This year,

as we proposed, we are making this

adjustment on the conversion factors

instead of the RVUs. This alternative

approach is administratively simpler,

and it facilitates policy and data

analysis of RVUs. It does not

significantly affect the final payments

that are made to physicians because any

changes to payments will be the result

of rounding and will be minimal.

The issues discussed in sections IX.C.

through IX.K. will have no impact on

Medicare program expenditures because

the effects of these changes have been

neutralized in the calculation of the

conversion factors for 1996.

We have estimated the net increase in

program costs in calendar year 1996
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63173

resulting from the adjustments to RVUs

and revisions in payment policies to be

approximately $140 million. This is a

net figure in that savings from the

reductions in RVUs for some services

partially offset the cost associated with

increases in the RVUs for other services.

This figure requires a reduction of 0.36

percent in the conversion factors for all

services to comply with the statutory

limitation on increases in expenditures.

Although a $20 million tolerance is

permitted under the law, this 0.36

percent reduction to all conversion

factors is designed to approximate

budget neutrality as closely as possible,

without creating any increase or

decrease in expenditures as a result of

RVU adjustments or revisions in

payment policies.

C. Bundled Services

1. Hydration Therapy and

Chemotherapy

Bundling of payment for CPT codes

90780 and 90781, (Therapeutic

infusions except for chemotherapy) into

CPT codes 96410, 96412, and 96414

(Chemotherapy infusion), when

nonchemotherapy drugs are infused at

the same time as chemotherapy drugs

means that in some cases, physicians

will no longer be paid for CPT codes

90780 and 90781. However, our policy

will allow physicians to continue to be

paid for CPT codes 90780 and 90781

when done on the same day as CPT

codes 96410, 96412, and 96414 if the

nonchemotherapy drugs are infused

sequentially rather than

contemporaneously with the

chemotherapy drugs. We are unable to

determine from our existing data which

portion of billings for CPT codes 90780

and 90781 that are currently furnished

on the same day as CPT codes 96410,

96412, and 96414 are for sequential or

contemporaneous services. Therefore, at

this time, we are unable to estimate the

impact of this policy. We expect that the

impact will be minor.

2. Evaluation of Psychiatric Records and

Reports and Family Counseling Services

Bundling of payment for CPT codes

90825 and 90887 into the payment for

other psychiatric codes means that

physicians who are currently billing for,

and receiving separate payment for,

these services may no longer do so.

Because we believe that the services

described by CPT codes 90825 and

90887 are captured in the prework and

postwork of other psychiatric services,

we will implement this change in policy

by redistributing the RVUs for CPT

codes 90825 and 90887 equally into the

following psychiatric procedure codes:

CPT codes 90801, 90820, 90835, 90842

through 90847, and 90853 through

90857. We estimate that this change will

increase the RVUs for the latter codes by

approximately 0.7 percent.

3. Fitting of Spectacles

We will cease making separate

payment under the physician fee

schedule for fitting of spectacles and

low vision systems (CPT codes 92352

through 92358 and 92371) beginning

January 1, 1996. Payment for these

services is already included in the

payment for the prosthetic device. We

will redistribute the payment currently

made for these CPT codes across all

physician services, which is what

would have occurred had we not

included these fees when the fee

schedule was created. Because the total

payment for spectacle fitting services is

relatively low (approximately $2.5

million in calendar year 1994)

compared to the total payment for all

physician services, we believe the

impact on RVUs for all physician

services is negligible.

Virtually all of the providers who

have been billing for the fitting of

spectacles as a professional service have

been optometrists. Under this revised

policy, they are no longer able to bill

separately for this service. The effect on

individual optometrists will depend

upon the amount of their income

derived from billing for spectacle fitting

services.

D. X-Rays and Electrocardiograms

Taken in the Emergency Room

Under policy issued in 1981, the

interpretation of an x-ray or EKG

furnished to an emergency room patient

by a radiologist or cardiologist,

respectively, ‘‘almost always’’

constituted a covered Part B service

payable by the carrier, regardless of

whether the test results had been

previously used in the diagnosis and

treatment of the patient by a physician

in the emergency room and regardless of

when the specialist furnished the

interpretation. A study completed by

the Office of Inspector General of the

Department of Health and Human

Services, dated July 1993, recommended

that we change this policy to indicate

that the second interpretation is

generally a quality control service to be

taken into account by intermediaries in

determining hospital reasonable costs.

Further, we understand that some

carriers are currently paying both the

emergency room physician and the

radiologist or cardiologist for the

interpretation of the same x-ray or EKG.

We will pay for only one

interpretation of an x-ray or EKG

furnished to an emergency room patient

except under unusual circumstances. In

situations in which both the emergency

room physician and the radiologist or

cardiologist bill for the interpretation,

we will instruct the carriers to pay for

the interpretation used in the diagnosis

and treatment of the patient. We will

consider the second interpretation to be

a quality control service. Under this

policy, we will reduce the incidence of

carriers’ paying twice for an

interpretation, but we have no estimate

of the number of duplicate payments

that will be eliminated. We believe that

the specialists will be affected

primarily. If hospitals want to ensure

that their specialists are paid for these

interpretations, they can make

arrangements to preclude the emergency

room physician from billing for the

same service.

E. Extension of Site-of-Service Payment

Differential to Services in Ambulatory

Surgical Centers

We are extending the site-of-service

payment limit to office-based services if

those services are performed in an

ambulatory surgical center, effective for

services furnished beginning January 1,

1996. We are adding 126 procedure

codes to the list. Were it not for budgetneutrality adjustments, we estimate that

these additions would result in a $24.6

million reduction in 1996 Medicare

payments.

F. Services of Teaching Physicians

This change removes the single

attending physician criteria for hospital

patients. It allows and promotes

supervision of the care by physician

group practices. We believe allowing for

more than one teaching physician per

beneficiary inpatient stay will result in

negligible additional cost, but the lack

of any data prevents us from quantifying

the effects of this change. In addition,

this rule will incorporate longstanding

Medicare coverage and payment policy

regarding the circumstances under

which the services of residents are

payable as physician services.

We will require the physical presence

of a teaching physician during the key

portion of the service in order for the

teaching physician to receive Part B

physician fee schedule payment for the

service. Details regarding the physical
63174 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

presence of a teaching physician during

different types of services and

procedures are discussed in section II.F.

of this preamble. Although we lack

specific data, we believe that the

provisions of this part of the final rule

have no budgetary effect because we

believe that the potential costs are offset

by the potential savings.

G. Unspecified Physical and

Occupational Therapy Services (HCFA

Common Procedure Coding System

Codes M0005 Through M0008 and

H5300)

We are eliminating HCPCS codes

M0005 through M0008 and H5300 and

redistributing the RVUs to codes in the

physical medicine and rehabilitation

section of the CPT (codes 97010 through

97799). The codes we are deleting are

general codes that do not describe

adequately the service being furnished.

Their use precludes effective review

necessary to ensure that the services

being paid are covered by Medicare. In

1995, the American Medical Association

revised the CPT codes in the Physical

Medicine and Rehabilitation section of

the CPT to better reflect the provision of

physical and occupational therapy

services.

We believe that each unit of service

currently billed under the codes we are

deleting will be billed under a CPT or

HCPCS code and that the total amount

of Medicare payment for physical

medicine services will not change

significantly as a result of the

elimination of these codes. Therefore,

we believe there will be no additional

costs or savings as a result of this

change in billing. Since the original

codes were not descriptive, we had no

way of comparing payments. However,

we believe that we are eliminating

potential manipulation of payment and

are improving the data collected by

requiring practitioners to use the more

specific codes when billing for these

services.

H. Transportation in Connection With

Furnishing Diagnostic Tests

Under the policy adopted in this final

rule, we are restricting the discretion of

carriers to make separate payments for

the transportation of diagnostic testing

equipment. Effective for services

furnished beginning January 1, 1996, the

general policy is that separate

transportation payments will be made

only in connection with the following

services:

• X-ray and standard EKG services

furnished by an approved portable x-ray

supplier; and

• Standard EKG services furnished by

an independent physiological laboratory

under special conditions.

For all other types of diagnostic tests

payable under the physician fee

schedule, travel expenses are

considered to be ‘‘bundled’’ into the

payment for the procedure, and

Medicare carriers will pay for the

transportation of equipment only on a

‘‘by report’’ basis under CPT code 99082

if a physician submits documentation to

justify the ‘‘very unusual’’ travel as set

forth in section 15026 of the Medicare

Carriers’ Manual.

We are unable to assess the impact of

this new national policy because

carriers have had such varying payment

policies on this issue. We had thought

that this might be a significant policy

change since we had received many

inquiries on the subject in recent years;

however, we received fewer than 10

comments on this policy as set forth in

the proposed rule, and we now

conclude that the national impact of the

new policy will not be significant. There

will likely be an impact on payments to

independent physiological laboratories

in some areas in which transportation

payments were made before January 1,

but it is not possible to assess these

reductions from the comments received.

I. Maxillofacial Prosthetic Services

We are establishing national RVUs for

these services and, therefore, are

discontinuing pricing by individual

carriers, effective January 1, 1996. We

estimate that total expenditures for CPT

codes 21079 through 21087 and codes

G0020 and G0021 (replaced by CPT

codes 21076 and 20177 in 1996), based

on the RVUs will be approximately $2.4

million in calendar year 1996. The 1994

Medicare expenditures for these codes

under the carrier pricing methodology

were approximately $1.5 million which,

if updated for 1995, would be

approximately $1.6 million. Thus, we

estimate an increase of approximately

$800,000 for these codes. However, total

expenditures for physician services will

not increase because we are

implementing this change in a budgetneutral manner in accordance with

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

These services are furnished most

frequently by oral surgeons (dentists

only) and by maxillofacial surgeons.

Because we estimate that the total

expenditures for these services will

increase slightly, we expect that, in

general, the physicians who perform

and bill for these procedures will realize

an increase in payment. However, in

some areas, the payment amounts based

on national RVUs may be lower than

those calculated by the local carrier.

J. Coverage of Mammography Services

We are expanding the definition of

‘‘diagnostic’’ mammography to include

as candidates for this service

asymptomatic men or women who have

a personal history of breast cancer or a

personal history of biopsy-proven

benign breast disease. We do not believe

this change will result in a significant

increase in the total number of

mammography services because

information from carriers indicates that

most asymptomatic patients in these

categories are already receiving

diagnostic mammography services.

K. Two Anesthesia Providers Involved in

One Procedure

We will apply the medical direction

payment policy to the single procedure

involving both the physician and the

CRNA. We will not implement this

policy until January 1, 1998, at which

time the proposal will be budgetneutral. In 1998, the allowance for the

medically-directed CRNA service and

the medical-direction service of the

anesthesiologist will be equivalent to 50

percent of the allowance recognized for

the service personally performed by the

anesthesiologist alone. Thus, payment

for both services will be no different

than what would be allowed for the

anesthesia service personally performed

by the anesthesiologist.

Although this proposal is budgetneutral, total payments to

anesthesiologists will decrease slightly

and payments to the CRNAs’ employers

will increase slightly. We cannot

quantify the amount of the losses to the

anesthesiologists or the gains to the

CRNAs’ employers. However,

anesthesiologists can lessen their losses

by actually personally performing as

many of these services as possible and

receiving the same allowance they

would have in the absence of this new

policy.

L. Rural Hospital Impact Statement

Section 1102(b) of the Act requires the

Secretary to prepare a regulatory impact

analysis if a rule may have a significant

impact on the operations of a substantial

number of small rural hospitals. This

analysis must conform to the provisions

of section 604 of the Regulatory

Flexibility Act. For purposes of section
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63175

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

rural hospital as a hospital that is

located outside of a Metropolitan

Statistical Area and has fewer than 50

beds.

This final rule will have little direct

effect on payments to rural hospitals

since this rule will change only

payments made to physicians and

certain other practitioners under Part B

of the Medicare program and will not

change payments to hospitals under Part

A. We do not believe the changes will

have a major, indirect effect on rural

hospitals.

Therefore, we are not preparing an

analysis for section 1102(b) of the Act

since we have determined, and the

Secretary certifies, that this rule will not

have a significant impact on the

operations of a substantial number of

small rural hospitals.

List of Subjects

42 CFR Part 400

Grant programs—health, Health

facilities, Health maintenance

organizations (HMO), Medicaid,

Medicare, Reporting and recordkeeping

requirements.

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 411

Kidney diseases, Medicare, Reporting

and recordkeeping requirements.

42 CFR Part 412

Administrative practice and

procedure, Health facilities, Medicare,

Puerto Rico, Reporting and

recordkeeping requirements.

42 CFR Part 413

Health facilities, Kidney diseases,

Medicare, Puerto Rico, Reporting and

recordkeeping requirements.

42 CFR Part 414

Administrative practice and

procedure, Health facilities, Health

professions, Kidney diseases, Medicare,

Reporting and recordkeeping

requirements, Rural areas, X-rays.

42 CFR Part 415

Health facilities, Health professions,

Medicare, Reporting and recordkeeping

requirements.

42 CFR Part 417

Administrative practice and

procedure, Grant programs—health,

Health care, Health facilities, Health

insurance, Health maintenance

organizations (HMO), Loan programs—

health, Medicare, Reporting and

recordkeeping requirements.

42 CFR Part 489

Health facilities, Medicare, Reporting

and recordkeeping requirements.

Under the authority of 42 U.S.C. 1302

and 1395hh, 42 CFR chapter IV is

amended as set forth below:

PART 400—INTRODUCTION;

DEFINITIONS

A. Part 400 is amended as set forth

below:

1. The authority citation for part 400

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh) and 44 U.S.C. Chapter 35.

2. In § 400.202, the introductory text

is republished and the definition of

GME is added in alphabetical order to

read as follows:

§ 400.202 Definitions specific to Medicare.

As used in connection with the

Medicare program, unless the context

indicates otherwise—

* * * * *

GME stands for graduate medical

education.

* * * * *

PART 405—FEDERAL HEALTH

INSURANCE FOR THE AGED AND

DISABLED

B. Part 405 is amended as set forth

below:

Subpart D—[Removed and Reserved]

1. Subpart D, consisting of §§ 405.465

through 405.482, is removed and

reserved.

2. Subpart E is amended as set forth

below:

a. The authority citation for subpart E

is revised to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh).

b. The heading for subpart E is revised

to read as follows:

Subpart E—Criteria for Determining

Reasonable Charges

c. A new § 405.500 is added to read

as follows:

§ 405.500 Basis.

Subpart E is based on the provisions

of the following sections of the Act:

Section 1814(b) provides for Part A

payment on the basis of the lesser of a

provider’s reasonable costs or customary

charges. Section 1832 establishes the

scope of benefits provided under the

Part B supplementary medical insurance

program. Section 1833(a) sets forth the

amounts of payment for supplementary

medical insurance services on the basis

of the lesser of a provider’s reasonable

costs or customary charges. Section

1834(a) specifies how payments are

made for the purchase or rental of new

and used durable medical equipment for

Medicare beneficiaries. Section 1834(b)

provides for payment for radiologist

services on a fee schedule basis. Section

1834(c) provides for payments and

standards for screening mammography.

Section 1842(b) sets forth the provisions

for a carrier to enter into a contract with

the Secretary and to make

determinations with respect to Part B

claims. Section 1842(h) sets forth the

requirements for a physician or supplier

to voluntarily enter into an agreement

with the Secretary to become a

participating physician or supplier.

Section 1842(i) sets forth the provisions

for the payment of Part B claims.

Section 1848 establishes a fee schedule

for payment of physician services.

Section 1861(b) sets forth the inpatient

hospital services covered by the

Medicare program. Section 1861(s) sets

forth medical and other health services

covered by the Medicare program.

Section 1861(v) sets forth the general

authority under which HCFA may

establish limits on provider costs

recognized as reasonable in determining

Medicare program payments. Section

1861(aa) sets forth the rural health clinic

services and Federally qualified health

center services covered by the Medicare

program. Section 1861(jj) defines the

term ‘‘covered osteoporosis drug.’’

Section 1862(a)(14) lists services that

are excluded from coverage. Section

1866(a) specifies the terms for provider

agreements. Section 1881 authorizes

special rules for the coverage of and

payment for services furnished to

patients with end-stage renal disease.

Section 1886 sets forth the requirements

for payment to hospitals for inpatient

hospital services. Section 1887 sets forth
63176 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

requirements for payment of providerbased physicians and payment under

certain percentage arrangements.

Section 1889 provides for Medicare and

Medigap information by telephone.

§ 405.501 [Amended]

d. In § 405.501, the following changes

are made:

i. Paragraphs (c) and (d) are removed,

and paragraphs (e) and (f) are

redesignated as paragraphs (c) and (d),

respectively.

ii. In newly redesignated paragraph

(c), the phrase ‘‘§§ 405.480 through

405.482 and §§ 405.550 through

405.557’’ is removed, and the phrase

‘‘§§ 415.55 through 415.70 and

§§ 415.100 through 415.130 of this

chapter’’ is added in its place.

iii. In newly redesignated paragraph

(d), the words ‘‘For services furnished

on or after January 1, 1989, payment’’

are removed, and the word ‘‘Payment’’

is added in their place.

§§ 405.520–405.525 [Removed]

e. Sections 405.520 through 405.525

are removed.

Subpart F—[Removed and Reserved]

3. Subpart F, consisting of §§ 405.550

through 405.580, is removed and

reserved.

Subpart X—Rural Health Clinic and

Federally Qualified Health Center

Services

4. Subpart X is amended as set forth

below:

a. The authority citation for subpart X

is revised to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh).

b. A new § 405.2400 is added to read

as follows:

§ 405.2400 Basis.

Subpart X is based on the provisions

of the following sections of the Act:

Section 1833 sets forth the amounts of

payment for supplementary medical

insurance services. Section 1861(aa) sets

forth the rural health clinic services and

Federally qualified health center

services covered by the Medicare

program.

c. In § 405.2401, paragraph (b), the

introductory text is republished, and the

definition for physician is revised to

read as follows:

§ 405.2401 Scope and definitions.

* * * * *

(b) Definitions. As used in this

subpart, unless the context indicates

otherwise:

* * * * *

Physician means the following:

(1) A doctor of medicine or

osteopathy legally authorized to practice

medicine and surgery by the State in

which the function is performed.

(2) Within limitations as to the

specific services furnished, a doctor of

dentistry or dental or oral surgery, a

doctor of optometry, a doctor of

podiatry or surgical chiropody or a

chiropractor. (See section 1861(r) of the

Act for specific limitations.)

(3) A resident (including residents as

defined in § 415.152 of this chapter who

meet the requirements in § 415.206(b) of

this chapter for payment under the

physician fee schedule).

* * * * *

d. In § 405.2468, the introductory text

of paragraph (b) is republished, and

paragraph (b)(1) is revised to read as

follows:

§ 405.2468 Allowable costs.

* * * * *

(b) Typical rural health clinic and

Federally qualified health center costs.

The following types and items of cost

are included in allowable costs to the

extent that they are covered and

reasonable:

(1) Compensation for the services of

physicians, (including residents as

defined in § 415.152 of this chapter who

meet the requirements in § 415.206(b) of

this chapter for payment under the

physician fee schedule), physician

assistants, nurse practitioners, nurse

midwives, specialized nurse

practitioners, visiting nurses, qualified

clinical psychologists, and clinical

social workers employed by the clinic or

center.

* * * * *

PART 410—SUPPLEMENTARY

MEDICAL INSURANCE (SMI)

BENEFITS

C. 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).

2. Section 410.34 is amended by

republishing the introductory text to

paragraph (a) and revising paragraphs

(a)(1), (a)(2), and (d) to read as follows:

§ 410.34 Mammography services:

Conditions for and limitations on coverage.

(a) Definitions. As used in this

section, the following definitions apply:

(1) Diagnostic mammography means a

radiologic procedure furnished to a man

or woman with signs or symptoms of

breast disease, or a personal history of

breast cancer, or a personal history of

biopsy-proven benign breast disease,

and includes a physician’s

interpretation of the results of the

procedure.

(2) Screening mammography means a

radiologic procedure furnished to a

woman without signs or symptoms of

breast disease, for the purpose of early

detection of breast cancer, and includes

a physician’s interpretation of the

results of the procedure.

* * * * *

(d) Limitations on coverage of

screening mammography services. The

following limitations apply to coverage

of screening mammography services as

described in paragraph (a)(2) of this

section:

(1) The service must be, at a minimum

a two-view exposure (that is, a craniocaudal and a medial lateral oblique

view) of each breast.

(2) Payment may not be made for

screening mammography performed on

a woman under age 35.

(3) Payment may be made for only 1

screening mammography performed on

a woman over age 34, but under age 40.

(4) For a woman over age 39, but

under age 50, the following limitations

apply:

(i) Payment may be made for a

screening mammography performed

after at least 11 months have passed

following the month in which the last

screening mammography was performed

if the woman has—

(A) A personal history of breast

cancer;

(B) A personal history of biopsyproven benign breast disease;

(C) A mother, sister, or daughter who

has had breast cancer; or

(D) Not given birth before age 30.

(ii) If the woman does not meet the

conditions described in paragraph

(d)(4)(i) of this section, payment may be

made for a screening mammography

performed after at least 23 months have

passed following the month in which

the last screening mammography was

performed.

(5) For a woman over age 49, but

under age 65, payment may be made for

a screening mammography performed

after at least 11 months have passed
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63177

following the month in which the last

screening mammography was

performed.

(6) For a woman over age 64, payment

may be made for a screening

mammography performed after at least

23 months have passed following the

month in which the last screening

mammography was performed.

PART 414—PAYMENT FOR PART B

MEDICAL AND OTHER HEALTH

SERVICES

D. 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 § 414.2, the following definitions

are added alphabetically:

§ 414.2 Definitions.

AA stands for anesthesiologist

assistant.

* * * * *

CRNA stands for certified registered

nurse anesthetist.

* * * * *

3. In § 414.28, the introductory text is

republished, and paragraph (b) is

revised to read as follows:

§ 414.28 Conversion factors.

HCFA establishes CFs in accordance

with section 1848(d) of the Act.

* * * * *

(b) Subsequent CFs. For calendar

years 1993 through 1995, the CF for

each year is equal to the CF for the

previous year, adjusted in accordance

with § 414.30. Beginning January 1,

1996, the CF for each calendar year may

be further adjusted so that adjustments

to the fee schedule in accordance with

section 1848(c)(2)(B)(ii) of the Act do

not cause total expenditures under the

fee schedule to differ by more than $20

million from the amount that would

have been spent if these adjustments

had not been made.

4. In § 414.30, the introductory text to

the section and the introductory text to

paragraph (b) are republished,

paragraph (b)(2) is revised, and

paragraph (c) is added to read as

follows:

§ 414.30 Conversion factor update.

Unless Congress acts in accordance

with section 1848(d)(3) of the Act—

* * * * *

(b) Downward adjustment. The

downward adjustment may not exceed

the following:

* * * * *

(2) For CY 1994, 2.5 percentage

points.

* * * * *

(c) For CYs 1995 and thereafter, 5

percentage points.

5. In § 414.32, the introductory text to

paragraph (d) is republished and

paragraph (d)(2) is revised to read as

follows:

§ 414.32 Determining payments for certain

physician services furnished in facility

settings.

* * * * *

(d) Services excluded from the

reduction. The reduction established

under this section does not apply to the

following:

* * * * *

(2) Surgical services not on the

ambulatory surgical center covered list

of procedures published under

§ 416.65(c) of this chapter when

furnished in an ambulatory surgical

center.

* * * * *

§ 414.46 [Amended]

6. In § 414.46, the following changes

are made:

a. The word ‘‘procedure’’ in paragraph

(g) is removed, and the word ‘‘service’’

is added in its place. The word

‘‘procedures’’ in paragraphs (a)(1), (e)

and (g) is removed, and the word

‘‘services’’ is added in its place.

b. Paragraphs (b), (c), and (d) are

revised to read as follows:

§ 414.46 Additional rules for payment of

anesthesia services.

* * * * *

(b) Determination of payment

amount—Basic rule. For anesthesia

services performed, medically directed,

or medically supervised by a physician,

HCFA pays the lesser of the actual

charge or the anesthesia fee schedule

amount.

(1) The physician fee schedule

amount for an anesthesia service is

based on the product of the allowable

base and time units and an anesthesiaspecific CF.

(2) The allowable base units are

determined by the uniform relative

value guide based on the 1988 American

Society of Anesthesiologists’ Relative

Value Guide except that the number of

base units recognized for anesthesia

services furnished during cataract or

iridectomy surgery is four units. The

uniform base units are identified in

program operating instructions.

(3) Modifier units are not allowed.

Modifier units include additional units

charged by a physician or a CRNA for

patient health status, risk, age, or

unusual circumstances.

(c) Physician personally performs the

anesthesia procedure.

(1) HCFA considers an anesthesia

service to be personally performed

under any of the following

circumstances:

(i) The physician performs the entire

anesthesia service alone.

(ii) The physician establishes an

attending physician relationship in one

or two concurrent cases involving an

intern or resident and the service was

furnished before January 1, 1994.

(iii) The physician establishes an

attending physician relationship in one

case involving an intern or resident and

the service was furnished on or after

January 1, 1994 but prior to January 1,

1996. For services on or after January 1,

1996, the physician must be the

teaching physician as defined in

§§ 415.170 through 415.184 of this

chapter.

(iv) The physician and the CRNA or

AA are involved in a single case and the

services of each are found to be

medically necessary.

(v) The physician is continuously

involved in a single case involving a

student nurse anesthetist.

(vi) The physician is continuously

involved in a single case involving a

CRNA or AA and the service was

furnished prior to January 1, 1998.

(2) HCFA determines the fee schedule

amount for an anesthesia service

personally performed by a physician on

the basis of an anesthesia-specific fee

schedule CF and unreduced base units

and anesthesia time units. One

anesthesia time unit is equivalent to 15

minutes of anesthesia time, and

fractions of a 15-minute period are

recognized as fractions of an anesthesia

time unit.

(d) Anesthesia services medically

directed by a physician. (1) HCFA

considers an anesthesia service to be

medically directed by a physician if:

(i) The physician performs the

activities described in § 415.110 of this

chapter.

(ii) The physician directs qualified

individuals involved in two, three, or

four concurrent cases.

(iii) Medical direction can occur for a

single case furnished on or after January

1, 1998 if the physician performs the

activities described in § 415.110 of this
63178 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

chapter and medically directs a single

CRNA or AA.

(2) The rules for medical direction

differ for certain time periods

depending on the nature of the qualified

individual who is directed by the

physician. If more than two procedures

are directed on or after January 1, 1994,

the qualified individuals could be AAs,

CRNAs, interns, or residents. The

medical direction rules apply to student

nurse anesthetists only if the physician

directs two concurrent cases, each of

which involves a student nurse

anesthetist or the physician directs one

case involving a student nurse

anesthetist and the other involving a

CRNA, AA, intern, or resident.

(3) Payment for medical direction is

based on a specific percentage of the

payment allowance recognized for the

anesthesia service personally performed

by a physician alone. The following

percentages apply for the years

specified:

(i) CY 1994—60 percent of the

payment allowance for personally

performed procedures.

(ii) CY 1995—57.5 percent of the

payment allowance for personally

performed services.

(iii) CY 1996—55 percent of the

payment allowance for personally

performed services.

(iv) CY 1997—52.5 percent of the

payment allowance for personally

performed services.

(v) CY 1998 and thereafter—50

percent of the payment allowance for

personally performed services.

* * * * *

7. Section 414.60 is revised to read as

follows:

§ 414.60 Payment for the services of

CRNAs.

(a) Basis for payment. Beginning with

CY 1994—

(1) The allowance for an anesthesia

service furnished by a medically

directed CRNA is based on a fixed

percentage of the allowance recognized

for the anesthesia service personally

performed by the physician alone, as

specified in § 414.46(d)(3); and

(2) The CF for an anesthesia service

furnished by a CRNA not directed by a

physician may not exceed the CF for a

service personally performed by a

physician.

(b) To whom payment may be made.

Payment for an anesthesia service

furnished by a CRNA may be made to

the CRNA or to any individual or entity

(such as a hospital, rural primary care

hospital, physician, group practice, or

ambulatory surgical center) with which

the CRNA has an employment or

contract relationship that provides for

payment to be made to the individual or

entity.

(c) Condition for payment. Payment

for the services of a CRNA may be made

only on an assignment related basis, and

any assignment accepted by a CRNA is

binding on any other person presenting

a claim or request for payment for the

service.

Subpart H—[Removed and Reserved]

8. Subpart H, consisting of §§ 414.450

through 414.453, is removed and

reserved.

E. A new part 415 is added to read as

follows:

PART 415—SERVICES FURNISHED BY

PHYSICIANS IN PROVIDERS,

SUPERVISING PHYSICIANS IN

TEACHING SETTINGS, AND

RESIDENTS IN CERTAIN SETTINGS

Subpart A—General Provisions

Sec.

415.1 Basis and scope.

Subpart B—Fiscal Intermediary Payments

to Providers for Physician Services

415.50 Scope.

415.55 General payment rules.

415.60 Allocation of physician

compensation costs.

415.70 Limits on compensation for

physician services in providers.

Subpart C—Part B Carrier Payments for

Physician Services to Beneficiaries in

Providers

415.100 Scope.

415.102 Conditions for fee schedule

payment for physician services to

beneficiaries in providers.

415.105 Amounts of payment for physician

services to beneficiaries in providers.

415.110 Conditions for payment:

Anesthesiology services.

415.120 Conditions for payment: Radiology

services.

415.130 Conditions for payment: Physician

pathology services.

Subpart D—Physician Services in Teaching

Settings

415.150 Scope.

415.152 Definitions.

415.160 Election of reasonable cost

payment for direct medical and surgical

services of physicians in teaching

hospitals: General provisions.

415.162 Determining payment for physician

services furnished to beneficiaries in

teaching hospitals.

415.164 Payment to a fund.

415.170 Conditions for payment on a fee

schedule basis for physician services in

a teaching setting.

415.172 Physician fee schedule payment for

services of teaching physicians.

415.174 Exception: Evaluation and

management services furnished in

certain centers.

415.176 Renal dialysis services.

415.178 Anesthesia services.

415.180 Teaching setting requirements for

the interpretation of diagnostic radiology

and other diagnostic tests.

415.184 Psychiatric services.

415.190 Conditions of payment: Assistants

at surgery in teaching hospitals.

Subpart E—Services of Residents

415.200 Services of residents in approved

GME programs.

415.202 Services of residents not in

approved GME programs.

415.204 Services of residents in skilled

nursing facilities and home health

agencies.

415.206 Services of residents in

nonprovider settings.

415.208 Services of moonlighting residents.

Authority: Secs. 1102 and 1871 of the

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

1395hh).

Subpart A—General Provisions

§ 415.1 Basis and scope.

(a) Basis. This part is based on the

provisions of the following sections of

the Act: Section 1848 establishes a fee

schedule for payment for physician

services. Section 1861(q) specifies what

is included in the term ‘‘physician

services’’ covered under Medicare.

Section 1862(a)(14) sets forth the

exclusion of nonphysician services

furnished to hospital patients under Part

B of Medicare. Section 1886(d)(5)(B)

provides for a payment adjustment

under the prospective payment system

for the operating costs of inpatient

hospital services furnished to Medicare

beneficiaries in cost reporting periods

beginning on or after October 1, 1983, to

account for the indirect costs of medical

education. Section 1886(h) establishes

the methodology for Medicare payment

of the cost of direct GME activities.

(b) Scope. This part sets forth rules for

fiscal intermediary payments to

providers for physician services, Part B

carrier payments for physician services

to beneficiaries in providers, physician

services in teaching settings, and

services of residents.

Subpart B—Fiscal Intermediary

Payments to Providers for Physician

Services

§ 415.50 Scope.

This subpart sets forth rules for

payment by fiscal intermediaries to

providers for services furnished by
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63179

physicians. Payment for covered

services is made either under the

prospective payment system (PPS) to

PPS-participating providers in

accordance with part 412 of this chapter

or under the reasonable cost method to

non-PPS participating providers in

accordance with part 413 of this

chapter.

§ 415.55 General payment rules.

(a) Allowable costs. Except as

specified otherwise in §§ 413.102 of this

chapter (concerning compensation of

owners), 415.60 (concerning allocation

of physician compensation costs), and

415.162 (concerning payment for

physician services furnished to

beneficiaries in teaching hospitals),

costs a provider incurs for services of

physicians are allowable only if the

following conditions are met:

(1) The services do not meet the

conditions in § 415.102(a) regarding fee

schedule payment for services of

physicians to a beneficiary in a

provider.

(2) The services include a surgeon’s

supervision of services of a qualified

anesthetist, but do not include

physician availability services, except

for reasonable availability services

furnished for emergency rooms and the

services of standby surgical team

physicians.

(3) The provider has incurred a cost

for salary or other compensation it

furnished the physician for the services.

(4) The costs incurred by the provider

for the services meet the requirements

in § 413.9 of this chapter regarding costs

related to patient care.

(5) The costs do not include

supervision of interns and residents

unless the provider elects reasonable

cost payment as specified in § 415.160,

or any other costs incurred in

connection with an approved GME

program that are payable under § 413.86

of this chapter.

(b) Allocation of allowable costs. The

provider must follow the rules in

§ 415.60 regarding allocation of

physician compensation costs to

determine its costs of services.

(c) Limits on allowable costs. The

intermediary must apply the limits on

compensation set forth in § 415.70 to

determine its payments to a provider for

the costs of services.

§ 415.60 Allocation of physician

compensation costs.

(a) Definition. For purposes of this

subpart, physician compensation costs

means monetary payments, fringe

benefits, deferred compensation, and

any other items of value (excluding

office space or billing and collection

services) that a provider or other

organization furnishes a physician in

return for the physician services. Other

organizations are entities related to the

provider within the meaning of § 413.17

of this chapter or entities that furnish

services for the provider under

arrangements within the meaning of the

Act.

(b) General rule. Except as provided

in paragraph (d) of this section, each

provider that incurs physician

compensation costs must allocate those

costs, in proportion to the percentage of

total time that is spent in furnishing

each category of services, among—

(1) Physician services to the provider

(as described in § 415.55);

(2) Physician services to patients (as

described in § 415.102); and

(3) Activities of the physician, such as

funded research, that are not paid under

either Part A or Part B of Medicare.

(c) Allowable physician compensation

costs. Only costs allocated to payable

physician services to the provider (as

described in § 415.55) are allowable

costs to the provider under this subpart.

(d) Allocation of all compensation to

services to the provider. Generally, the

total physician compensation received

by a physician is allocated among all

services furnished by the physician,

unless—

(1) The provider certifies that the

compensation is attributable solely to

the physician services furnished to the

provider; and

(2) The physician bills all patients for

the physician services he or she

furnishes to them and personally

receives the payment from or on behalf

of the patients. If returned directly or

indirectly to the provider or an

organization related to the provider

within the meaning of § 413.17 of this

chapter, these payments are not

compensation for physician services

furnished to the provider.

(e) Assumed allocation of all

compensation to beneficiary services. If

the provider and physician agree to

accept the assumed allocation of all the

physician services to direct services to

beneficiaries as described under

§ 415.102(a), HCFA does not require a

written allocation agreement between

the physician and the provider.

(f) Determination and payment of

allowable physician compensation

costs. (1) Except as provided under

paragraph (e) of this section, the

intermediary pays the provider for these

costs only if—

(i) The provider submits to the

intermediary a written allocation

agreement between the provider and the

physician that specifies the respective

amounts of time the physician spends in

furnishing physician services to the

provider, physician services to patients,

and services that are not payable under

either Part A or Part B of Medicare; and

(ii) The compensation is reasonable in

terms of the time devoted to these

services.

(2) In the absence of a written

allocation agreement, the intermediary

assumes, for purposes of determining

reasonable costs of the provider, that

100 percent of the physician

compensation cost is allocated to

services to beneficiaries as specified in

paragraph (b)(2) of this section.

(g) Recordkeeping requirements.

Except for services furnished in

accordance with the assumed allocation

under paragraph (e) of this section, each

provider that claims payment for

services of physicians under this

subpart must meet all of the following

requirements:

(1) Maintain the time records or other

information it used to allocate physician

compensation in a form that permits the

information to be validated by the

intermediary or the carrier.

(2) Report the information on which

the physician compensation allocation

is based to the intermediary or the

carrier on an annual basis and promptly

notify the intermediary or carrier of any

revisions to the compensation

allocation.

(3) Retain each physician

compensation allocation, and the

information on which it is based, for at

least 4 years after the end of each cost

reporting period to which the allocation

applies.

§ 415.70 Limits on compensation for

physician services in providers.

(a) Principle and scope. (1) Except as

provided in paragraphs (a)(2) and (a)(3)

of this section, HCFA establishes

reasonable compensation equivalency

limits on the amount of compensation

paid to physicians by providers. These

limits are applied to a provider’s costs

incurred in compensating physicians for

services to the provider, as described in

§ 415.55(a).

(2) Limits established under this

section do not apply to costs of

physician compensation attributable to

furnishing inpatient hospital services

that are paid for under the prospective
63180 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

payment system implemented under

part 412 of this chapter or to costs of

physician compensation attributable to

approved GME programs that are

payable under § 413.86 of this chapter.

(3) Compensation that a physician

receives for activities that may not be

paid for under either Part A or Part B

of Medicare is not considered in

applying these limits.

(b) Methodology for establishing

limits. HCFA establishes a methodology

for determining annual reasonable

compensation equivalency limits and, to

the extent possible, considers average

physician incomes by specialty and type

of location using the best available data.

(c) Application of limits. If the level

of compensation exceeds the limits

established under paragraph (b) of this

section, Medicare payment is based on

the level established by the limits.

(d) Adjustment of the limits. The

intermediary may adjust limits

established under paragraph (b) of this

section to account for costs incurred by

the physician or the provider related to

malpractice insurance, professional

memberships, and continuing medical

education.

(1) For the costs of membership in

professional societies and continuing

medical education, the intermediary

may adjust the limit by the lesser of—

(i) The actual cost incurred by the

provider or the physician for these

activities; or

(ii) Five percent of the appropriate

limit.

(2) For the cost of malpractice

expenses incurred by either the provider

or the physician, the intermediary may

adjust the reasonable compensation

equivalency limit by the cost of the

malpractice insurance expense related

to the physician service furnished to

patients in providers.

(e) Exception to limits. An

intermediary may grant a provider an

exception to the limits established

under paragraph (b) of this section only

if the provider can demonstrate to the

intermediary that it is unable to recruit

or maintain an adequate number of

physicians at a compensation level

within these limits.

(f) Notification of changes in

methodologies and payment limits. (1)

Before the start of a cost reporting

period to which limits established

under this section will be applied,

HCFA publishes a notice in the Federal

Register that sets forth the amount of

the limits and explains how it

calculated the limits.

(2) If HCFA proposes to revise the

methodology for establishing payment

limits under this section, HCFA

publishes a notice, with opportunity for

public comment, in the Federal

Register. The notice explains the

proposed basis and methodology for

setting limits, specifies the limits that

would result, and states the date of

implementation of the limits.

(3) If HCFA updates limits by

applying the most recent economic

index data without revising the limit

methodology, HCFA publishes the

revised limits in a notice in the Federal

Register without prior publication of a

proposal or public comment period.

Subpart C—Part B Carrier Payments

for Physician Services to Beneficiaries

in Providers

§ 415.100 Scope.

This subpart implements section

1887(a)(1)(A) of the Act by providing

general conditions that must be met in

order for services furnished by

physicians to beneficiaries in providers

to be paid for on the basis of the

physician fee schedule under part 414

of this chapter. Section 415.102 sets

forth the conditions for fee schedule

payment for physician services to

beneficiaries in providers. Section

415.105 sets forth general requirements

for determining the amounts of payment

for services that meet the conditions of

this section. Sections 415.120 and

415.130 set forth additional conditions

for payment for physician services in

the specialties of radiology and

pathology (laboratory services).

§ 415.102 Conditions for fee schedule

payment for physician services to

beneficiaries in providers.

(a) General rule. If the physician

furnishes services to beneficiaries in

providers, the carrier pays on a fee

schedule basis provided the following

requirements are met:

(1) The services are personally

furnished for an individual beneficiary

by a physician.

(2) The services contribute directly to

the diagnosis or treatment of an

individual beneficiary.

(3) The services ordinarily require

performance by a physician.

(4) In the case of radiology or

laboratory services, the additional

requirements in § 415.120 or § 415.130,

respectively, are met.

(b) Exception. If a physician furnishes

services in a provider that do not meet

the requirements in paragraph (a) of this

section, but are related to beneficiary

care furnished by the provider, the

intermediary pays for those services, if

otherwise covered. The intermediary

follows the rules in §§ 415.55 and

415.60 for payment on the basis of

reasonable cost or PPS, as appropriate.

(c) Effect of billing charges for

physician services to a provider.

(1) If a physician furnishes services

that may be paid under the reasonable

cost rules in § 415.55 or § 415.60, and

paid by the intermediary, or would be

paid under those rules except for the

PPS rules in part 412 of this chapter,

and under the payment rules for GME

established by § 413.86 of this chapter,

neither the provider nor the physician

may seek payment from the carrier,

beneficiary, or another insurer.

(2) If a physician furnishes services to

an individual beneficiary that do not

meet the applicable conditions in

§§ 415.120 (concerning conditions for

payment for radiology services) and

415.130 (concerning conditions for

payment for physician pathology

services), the carrier does not pay on a

fee schedule basis.

(3) If the physician, the provider, or

another entity bills the carrier or the

beneficiary or another insurer for

physician services furnished to the

provider, as described in § 415.55(a),

HCFA considers the provider to which

the services are furnished to have

violated its provider participation

agreement, and may terminate that

agreement. See part 489 of this chapter

for rules governing provider agreements.

(d) Effect of physician assumption of

operating costs. If a physician or other

entity enters into an agreement (such as

a lease or concession) with a provider,

and the physician (or entity) assumes

some or all of the operating costs of the

provider department in which the

physician furnishes physician services,

the following rules apply:

(1) If the conditions set forth in

paragraph (a) of this section are met, the

carrier pays for the physician services

under the physician fee schedule in part

414 of this chapter.

(2) To the extent the provider incurs

a cost payable on a reasonable cost basis

under part 413 of this chapter, the

intermediary pays the provider on a

reasonable cost basis for the costs

associated with producing these

services, including overhead, supplies,

equipment costs, and services furnished

by nonphysician personnel.

(3) The physician (or other entity) is

treated as being related to the provider

within the meaning of § 413.17 of this
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63181

chapter (concerning cost to related

organizations).

(4) The physician (or other entity)

must make its books and records

available to the provider and the

intermediary as necessary to verify the

nature and extent of the costs of the

services furnished by the physician (or

other entity).

§ 415.105 Amounts of payment for

physician services to beneficiaries in

providers.

(a) General rule. The carrier

determines amounts of payment for

physician services to beneficiaries in

providers in accordance with the

general rules governing the physician

fee schedule payment in part 414 of this

chapter, except as provided in

paragraph (b) of this section.

(b) Application in certain settings—(1)

Teaching hospitals. The carrier applies

the rules in subpart D of this part

(concerning physician services in

teaching settings), in addition to those

in this section, in determining whether

fee schedule payment should be made

for physician services to individual

beneficiaries in a teaching hospital.

(2) Hospital-based ESRD facilities.

The carrier applies §§ 414.310 through

414.314 of this chapter, which set forth

determination of reasonable charges

under the ESRD program, to determine

the amount of payment for physician

services furnished to individual

beneficiaries in a hospital-based ESRD

facility approved under part 405 subpart

U.

§ 415.110 Conditions for payment:

Anesthesiology services.

(a) Services furnished directly or

concurrently. The carrier pays a

physician for anesthesia services

furnished to patients in a provider on a

fee schedule basis only if the services

meet the conditions in § 415.102(a) and

the following additional conditions:

(1) For each patient, the physician—

(i) Performs a pre-anesthetic

examination and evaluation;

(ii) Prescribes the anesthesia plan;

(iii) Personally participates in the

most demanding procedures in the

anesthesia plan, including induction

and emergence;

(iv) 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;

(v) Monitors the course of anesthesia

administration at frequent intervals;

(vi) Remains physically present and

available for immediate diagnosis and

treatment of emergencies; and

(vii) Provides indicated postanesthesia care.

(2) The physician performs the

procedure personally or directs no more

than four anesthesia procedures

concurrently and does not perform any

other services while he or she is

directing the concurrent procedures.

(b) Supervision of more than four

procedures concurrently. If a physician

is involved in furnishing more than four

procedures concurrently, or is

performing other services while

directing the concurrent procedures, the

concurrent anesthesia services are

physician services to the provider in

which the procedures are performed. In

these cases, the physician is not

required to meet the criteria of

paragraphs (a)(1) (iii) and (vii) of this

section personally, but must ensure that

a qualified individual performs any

procedure in which the physician does

not personally participate. In these

cases, the intermediary pays for the

services under the rules in §§ 415.55

and 415.60 on reasonable cost payment

for physician services to providers or

under the rules in part 412 of this

chapter for payment under the

prospective payment system.

§ 415.120 Conditions for payment:

Radiology services.

(a) Services to beneficiaries. The

carrier pays for radiology services

furnished by a physician to a

beneficiary on a fee schedule basis only

if the services meet the conditions for

fee schedule payment in § 415.102(a)

and are identifiable, direct, and discrete

diagnostic or therapeutic services

furnished to an individual beneficiary,

such as interpretation of x-ray plates,

angiograms, myelograms, pyelograms, or

ultrasound procedures. The carrier pays

for interpretations only if there is a

written report prepared for inclusion in

the patient’s medical record maintained

by the hospital.

(b) Services to providers. The carrier

does not pay on a fee schedule basis for

physician services to the provider (for

example, administrative or supervisory

services) or for provider services needed

to produce the x-ray films or other items

that are interpreted by the radiologist.

However, the intermediary pays the

provider for these services in

accordance with § 415.55 for provider

costs; § 415.102(d)(2) for costs incurred

by a physician, such as under a lease or

concession agreement; or part 412 of

this chapter for payment under PPS.

§ 415.130 Conditions for payment:

Physician pathology services.

(a) Physician pathology services. The

carrier pays for pathology services

furnished by a physician to an

individual beneficiary on a fee schedule

basis only if the services meet the

conditions for payment in § 415.102(a)

and are one of the following services:

(1) Surgical pathology services.

(2) Specific cytopathology,

hematology, and blood banking services

that have been identified to require

performance by a physician and are

listed in program operating instructions.

(3) Clinical consultation services that

meet the requirements in paragraph (b)

of this section.

(4) Clinical laboratory interpretative

services that meet the requirements of

paragraphs (b)(1), (b)(3), and (b)(4) of

this section and that are specifically

listed in program operating instructions.

(b) Clinical consultation services. For

purposes of this section, clinical

consultation services must meet the

following requirements:

(1) Be requested by the beneficiary’s

attending physician.

(2) Relate to a test result that lies

outside the clinically significant normal

or expected range in view of the

condition of the beneficiary.

(3) Result in a written narrative report

included in the beneficiary’s medical

record.

(4) Require the exercise of medical

judgment by the consultant physician.

(c) Physician pathology services

furnished by an independent laboratory.

Laboratory services, including the

technical component of a service,

furnished to a hospital inpatient or

outpatient by an independent laboratory

are paid on a fee schedule basis under

this subpart only if they are physician

pathology services as described in

paragraph (a) of this section.

Subpart D—Physician Services in

Teaching Settings

§ 415.150 Scope.

This subpart sets forth the rules

governing payment for the services of

physicians in teaching settings and the

criteria for determining whether the

payments are made as one of the

following:

(a) Services to the hospital under the

reasonable cost election in §§ 415.160

through 415.164.
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(b) Provider services through the

direct GME payment mechanism in

§ 413.86 of this chapter.

(c) Physician services to beneficiaries

under the physician fee schedule as set

forth in part 414 of this chapter.

§ 415.152 Definitions.

As used in this subpart—

Approved graduate medical

education (GME) program means a

residency program approved by the

Accreditation Council for Graduate

Medical Education of the American

Medical Association, by the Committee

on Hospitals of the Bureau of

Professional Education of the American

Osteopathic Association, by the Council

on Dental Education of the American

Dental Association, or by the Council on

Podiatric Medicine Education of the

American Podiatric Medical

Association.

Direct medical and surgical services

means services to individual

beneficiaries that are either personally

furnished by a physician or furnished

by a resident under the supervision of

a physician in a teaching hospital

making the cost election described in

§§ 415.160 through 415.162.

Nonprovider setting means a setting

other than a hospital, skilled nursing

facility, home health agency, or

comprehensive outpatient rehabilitation

facility in which residents furnish

services. These include, but are not

limited to, family practice or

multispecialty clinics and physician

offices.

Resident means one of the following:

(1) An individual who participates in

an approved GME program, including

programs in osteopathy, dentistry, and

podiatry.

(2) A physician who is not in an

approved GME program, but who is

authorized to practice only in a hospital,

for example, individuals with temporary

or restricted licenses, or unlicensed

graduates of foreign medical schools.

For purposes of this subpart, the term

resident is synonymous with the terms

intern and fellow.

Teaching hospital means a hospital

engaged in an approved GME residency

program in medicine, osteopathy,

dentistry, or podiatry.

Teaching physician means a

physician (other than another resident)

who involves residents in the care of his

or her patients.

Teaching setting means any provider,

hospital-based provider, or nonprovider

settings in which Medicare payment for

the services of residents is made under

the direct GME payment provisions of

§ 413.86, or on a reasonable-cost basis

under the provisions of § 409.26 or

§ 409.40(f) for resident services

furnished in skilled nursing facilities or

home health agencies, respectively.

§ 415.160 Election of reasonable cost

payment for direct medical and surgical

services of physicians in teaching

hospitals: General provisions.

(a) Scope. A teaching hospital may

elect to receive payment on a reasonable

cost basis for the direct medical and

surgical services of its physicians in lieu

of fee schedule payments that might

otherwise be made for these services.

(b) Conditions. A teaching hospital

may elect to receive these payments

only if—

(1) The hospital notifies its

intermediary in writing of the election

and meets the conditions of either

paragraph (b)(2) or paragraph (b)(3) of

this section;

(2) All physicians who furnish

services to Medicare beneficiaries in the

hospital agree not to bill charges for

these services; or

(3) All physicians who furnish

services to Medicare beneficiaries in the

hospital are employees of the hospital

and, as a condition of employment, are

precluded from billing for these

services.

(c) Effect of election. If a teaching

hospital elects to receive reasonable cost

payment for physician direct medical

and surgical services furnished to

beneficiaries—

(1) Those services and the supervision

of interns and residents furnishing care

to individual beneficiaries are covered

as hospital services, and

(2) The intermediary pays the hospital

for those services on a reasonable cost

basis under the rules in § 415.162.

(Payment for other physician

compensation costs related to approved

GME programs is made as described in

§ 413.86 of this chapter.)

(d) Election declined. If the teaching

hospital does not make this election,

payment is made—

(1) For physician services furnished to

beneficiaries on a fee schedule basis as

described in part 414 subject to the rules

in this subpart, and

(2) For the supervision of interns and

residents as described in § 413.86.

§ 415.162 Determining payment for

physician services furnished to

beneficiaries in teaching hospitals.

(a) General rule. Payments for direct

medical and surgical services of

physicians furnished to beneficiaries

and supervision of interns and residents

furnishing care to beneficiaries is made

by Medicare on the basis of reasonable

cost if the hospital exercises the election

as provided for in § 415.160. If this

election is made, the following occurs:

(1) Physician services furnished to

beneficiaries and supervision of interns

and residents furnishing care to

beneficiaries are paid on a reasonablecost basis, as provided for in paragraph

(b) of this section.

(2) Payment for certain medical

school costs may be made as provided

for in paragraph (c) of this section.

(3) Payments for services donated by

volunteer physicians to beneficiaries are

made to a fund designated by the

organized medical staff of the teaching

hospital or medical school as provided

for in paragraph (d) of this section.

(b) Reasonable cost of physician

services and supervision of interns and

residents.

(1) Physician services furnished to

beneficiaries and supervision of interns

and residents furnishing care to

beneficiaries in a teaching hospital are

payable as provider services on a

reasonable-cost basis.

(2) For purposes of this paragraph,

reasonable cost is defined as the direct

salary paid to these physicians, plus

applicable fringe benefits.

(3) The costs must be allocated to the

services as provided by paragraph (j) of

this section and apportioned to program

beneficiaries as provided by paragraph

(g) of this section.

(4) Other allowable costs incurred by

the provider related to the services

described in this paragraph are payable

subject to the requirements applicable to

all other provider services.

(c) Reasonable costs for the services

furnished by a medical school or related

organization in a hospital. An amount is

payable to the hospital by HCFA under

the Medicare program provided that the

costs would be payable if incurred

directly by the hospital rather than

under the arrangement. The amount

must not be in excess of the reasonable

costs (as defined in paragraphs (c)(1)

and (c)(2) of this section) incurred by a

teaching hospital for services furnished

by a medical school or organization as

described in § 413.17 of this chapter for

certain costs to the medical school (or

a related organization) in furnishing

services in the hospital.

(1) Reasonable costs of physician

services.

(i) When the medical school and the

hospital are related organizations. If the
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63183

medical school (or organization related

to the medical school) and the hospital

are related by common ownership or

control as described in § 413.17 of this

chapter—

(A) The costs of these services are

allowable costs to the hospital under the

provisions of § 413.17 of this chapter;

and

(B) The reimbursable costs to the

hospital are determined under the

provisions of this section in the same

manner as the costs incurred for

physicians on the hospital staff and

without regard to payments made to the

medical school by the hospital.

(ii) When the medical school and the

hospital are not related organizations.

(A) If the medical school and the

hospital are not related organizations

under the provisions of § 413.17 of this

chapter and the hospital makes payment

to the medical school for the costs of

those services furnished to all patients,

payment is made by Medicare to the

hospital for the reasonable cost incurred

by the hospital for its payments to the

medical school for services furnished to

beneficiaries.

(B) Costs incurred under an

arrangement must be allocated to the

full range of services furnished to the

hospital by the medical school

physicians on the same basis as

provided for under paragraph (j) of this

section, and costs allocated to direct

medical and surgical services furnished

to hospital patients must be apportioned

to beneficiaries as provided for under

paragraph (g) of this section.

(C) If the medical school and the

hospital are not related organizations

under the provisions of § 413.17 of this

chapter and the hospital makes payment

to the medical school only for the costs

of those services furnished to

beneficiaries, costs of the medical

school not to exceed 105 percent of the

sum of physician direct salaries,

applicable fringe benefits, employer’s

portion of FICA taxes, Federal and State

unemployment taxes, and workmen’s

compensation paid by the medical

school or an organization related to the

medical school may be recognized as

allowable costs of the medical school.

(D) These allowable medical school

costs must be allocated to the full range

of services furnished by the physicians

of the medical school or organization

related as provided by paragraph (j) of

this section.

(E) Costs allocated to direct medical

and surgical services furnished to

hospital patients must be apportioned to

beneficiaries as provided by paragraph

(g) of this section.

(2) Reasonable costs of other than

direct medical and surgical services.

These costs are determined in

accordance with paragraph (c)(1) of this

section except that—

(i) If the hospital makes payment to

the medical school for other than direct

medical and surgical services furnished

to beneficiaries and supervision of

interns and residents furnishing care to

beneficiaries, these payments are subject

to the required cost-finding and

apportionment methods applicable to

the cost of other hospital services

(except for direct medical and surgical

services furnished to beneficiaries); or

(ii) If the hospital makes payment to

the medical school only for these

services furnished to beneficiaries, the

cost of these services is not subject to

cost-finding and apportionment as

otherwise provided by this subpart, and

the reasonable cost paid by Medicare

must be determined on the basis of the

health insurance ratio(s) used in the

apportionment of all other provider

costs (excluding physician direct

medical and surgical services furnished

to beneficiaries) applied to the

allowable medical school costs incurred

by the medical school for the services

furnished to all patients of the hospital.

(d) ‘‘Salary equivalent’’ payments for

direct medical and surgical services

furnished by physicians on the

voluntary staff of the hospital.

(1) HCFA makes payments under the

Medicare program to a fund as defined

in § 415.164 for direct medical and

surgical services furnished to

beneficiaries on a regularly scheduled

basis by physicians on the unpaid

voluntary medical staff of the hospital

(or medical school under arrangement

with the hospital).

(i) These payments represent

compensation for contributed medical

staff time which, if not contributed,

would have to be obtained through

employed staff on a payable basis.

(ii) Payments for volunteer services

are determined by applying to the

regularly scheduled contributed time an

hourly rate not to exceed the equivalent

of the average direct salary (exclusive of

fringe benefits) paid to all full-time,

salaried physicians (other than interns

and residents) on the hospital staff or,

if the number of full-time salaried

physicians is minimal in absolute terms

or in relation to the number of

physicians on the voluntary staff, to

physicians at like institutions in the

area.

(iii) This ‘‘salary equivalent’’ is a

single hourly rate covering all

physicians regardless of specialty and is

applied to the actual regularly

scheduled time contributed by the

physicians in furnishing direct medical

and surgical services to beneficiaries

including supervision of interns and

residents in that care.

(iv) A physician who receives any

compensation from the hospital or a

medical school related to the hospital by

common ownership or control (within

the meaning of § 413.17 of this chapter)

for direct medical and surgical services

furnished to any patient in the hospital

is not considered an unpaid voluntary

physician for purposes of this

paragraph.

(v) If, however, a physician receives

compensation from the hospital or

related medical school or organization

only for services that are other than

direct medical and surgical services, a

salary equivalent payment for the

physician’s regularly scheduled direct

medical and surgical services to

beneficiaries in the hospital may be

imputed. However, the sum of the

imputed value for volunteer services

and the physician’s actual

compensation from the hospital and the

related medical school (or organization)

may not exceed the amount that would

have been imputed if all of the

physician’s hospital and medical school

services (compensated and volunteer)

had been volunteer services, or paid at

the rate of $30,000 per year, whichever

is less.

(2) The following examples illustrate

how the allowable imputed value for

volunteer services is determined. In

each example, it has been assumed that

the average salary equivalent hourly rate

is equal to the hourly rate for the

individual physician’s compensated

services.

Example No: 1. Dr. Jones received $3,000

a year from Hospital X for services other than

direct medical services to all patients, for

example, utilization review and

administrative services. Dr. Jones also

voluntarily furnished direct medical services

to beneficiaries. The imputed value of the

volunteer services amounted to $10,000 for

the cost reporting period. The full imputed

value of Dr. Jones’ volunteer direct medical

services would be allowed since the total

amount of the imputed value ($10,000) and

the compensated services ($3,000) does not

exceed $30,000.

Example No: 2. Dr. Smith received $25,000

from Hospital X for services as a department

head in a teaching hospital. Dr. Smith also

voluntarily furnished direct medical services

to beneficiaries. The imputed value of the
63184 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

volunteer services amounted to $10,000.

Only $5,000 of the imputed value of

volunteer services would be allowed since

the total amount of the imputed value

($10,000) and the compensated services

($25,000) exceeds the $30,000 maximum

amount allowable for all of Dr. Smith’s

services.

Computation:

Maximum amount allowable for

all services performed by Dr.

Smith for purposes of this

computation ............................. $30,000

Less compensation received

from Hospital X for other than

direct medical services to individual patients ......................... $25,000

Allowable amount of imputed

value for the volunteer services furnished by Dr. Smith .... $5,000

Example No. 3. Dr. Brown is not

compensated by Hospital X for any services

furnished in the hospital. Dr. Brown

voluntarily furnished direct surgical services

to beneficiaries for a period of 6 months, and

the imputed value of these services

amounted to $20,000. The allowable amount

of the imputed value for volunteer services

furnished by Dr. Brown would be limited to

$15,000 ($30,000 x 6/12).

(3) The amount of the imputed value

for volunteer services applicable to

beneficiaries and payable to a fund is

determined in accordance with the

aggregate per diem method described in

paragraph (g) of this section.

(4) Medicare payments to a fund must

be used by the fund solely for

improvement of care of hospital patients

or for educational or charitable purposes

(which may include but are not limited

to medical and other scientific

research).

(i) No personal financial gain, either

direct or indirect, from benefits of the

fund may inure to any of the hospital

staff physicians, medical school faculty,

or physicians for whom Medicare

imputes costs for purposes of payment

into the fund.

(ii) Expenses met from contributions

made to the hospital from a fund are not

included as a reimbursable cost when

expended by the hospital, and

depreciation expense is not allowed

with respect to equipment or facilities

donated to the hospital by a fund or

purchased by the hospital from monies

in a fund.

(e) Requirements for payment—(1)

Physicians on the hospital staff. The

requirements under which the costs of

physician direct medical and surgical

services (including supervision of

interns and residents) to beneficiaries

are the same as those applicable to the

cost of all other covered provider

services except that the costs of these

services are separately determined as

provided by this section and are not

subject to cost-finding as described in

§ 413.24 of this chapter.

(2) Physicians on the medical school

faculty. Payment is made to a hospital

for the costs of services of physicians on

the medical school faculty, provided

that if the medical school is not related

to the hospital (within the meaning of

§ 413.17 of this chapter, concerning cost

to related organizations), the hospital

does not make payment to the medical

school for services furnished to all

patients and the following requirements

are met: If the hospital makes payment

to the medical school for services

furnished to all patients, these

requirements do not apply. (See

paragraph (c)(1)(ii) of this section.)

(i) There is a written agreement

between the hospital and the medical

school or organization, specifying the

types and extent of services to be

furnished by the medical school and

specifying that the hospital must pay to

the medical school an amount at least

equal to the reasonable cost (as defined

in paragraph (c) of this section) of

furnishing the services to beneficiaries.

(ii) The costs are paid to the medical

school by the hospital no later than the

date on which the cost report covering

the period in which the services were

furnished is due to HCFA.

(iii) Payment for the services

furnished under an arrangement would

have been made to the hospital had the

services been furnished directly by the

hospital.

(3) Physicians on the voluntary staff

of the hospital (or medical school under

arrangement with the hospital). If the

conditions for payment to a fund

outlined in § 415.164 are met, payments

are made on a ‘‘salary equivalent’’ basis

(as defined in paragraph (d) of this

section) to a fund.

(f) Requirements for payment for

medical school faculty services other

than physician direct medical and

surgical services. If the requirements for

payment for physician direct medical

and surgical services furnished to

beneficiaries in a teaching hospital

described in paragraph (e) of this

section are met, payment is made to a

hospital for the costs of medical school

faculty services other than physician

direct medical and surgical services

furnished in a teaching hospital.

(g) Aggregate per diem methods of

apportionment—(1) For the costs of

physician direct medical and surgical

services. The cost of physician direct

medical and surgical services furnished

in a teaching hospital to beneficiaries is

determined on the basis of an average

cost per diem as defined in paragraph

(h)(1) of this section for physician direct

medical and surgical services to all

patients (see §§ 415.172 through

415.184) for each of the following

categories of physicians:

(i) Physicians on the hospital staff.

(ii) Physicians on the medical school

faculty.

(2) For the imputed value of physician

volunteer direct medical and surgical

services. The imputed value of

physician direct medical and surgical

services furnished to beneficiaries in a

teaching hospital is determined on the

basis of an average per diem, as defined

in paragraph (h)(1) of this section, for

physician direct medical and surgical

services to all patients except that the

average per diem is derived from the

imputed value of the physician

volunteer direct medical and surgical

services furnished to all patients.

(h) Definitions. (1) Average cost per

diem for physician direct medical and

surgical services (including supervision

of interns and residents) furnished in a

teaching hospital to patients in each

category of physician services described

in paragraph (g)(1) of this section means

the amount computed by dividing total

reasonable costs of these services in

each category by the sum of—

(i) Inpatient days (as defined in

paragraph (h)(2) of this section); and

(ii) Outpatient visit days (as defined

in paragraph (h)(3) of this section).

(2) Inpatient days are determined by

counting the day of admission as 3.5

days and each day after a patient’s day

of admission, except the day of

discharge, as 1 day.

(3) Outpatient visit days are

determined by counting only one visit

day for each calendar day that a patient

visits an outpatient department or

multiple outpatient departments.

(i) Application. (1) The following

illustrates how apportionment based on

the aggregate per diem method for costs

of physician direct medical and surgical

services furnished in a teaching hospital

to patients is determined.

Teaching Hospital Y

Statistical and financial data:

Total inpatient days as defined in paragraph (h)(2) of

this section and outpatient

visit days as defined in

paragraph (h)(3) of this section ........................................ 75,000
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63185

Total inpatient Part A days ..... 20,000

Total inpatient Part B days

where Part A coverage is

not available ......................... 1,000

Total outpatient Part B visit

days ....................................... 5,000

Total cost of direct medical

and surgical services furnished to all patients by

physicians on the hospital

staff as determined in accordance with paragraph (i)

of this section ....................... $1,500,000

Total cost of direct medical

and surgical services furnished to all patients by

physicians on the medical

school faculty as determined in accordance with

paragraph (i) of this section $1,650,000

Computation of cost applicable to program

for physicians on the hospital staff:

Average cost per diem for direct medical

and surgical services to patients by

physicians on the hospital staff: $1,500,000 ÷

75,000 = $20 per diem.

Cost of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part

A: $20 per diem × 20,000 .... $400,000

Cost of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part

B: $20 per diem × 1,000 ...... $20,000

Cost of physician direct medical and surgical services furnished to outpatient beneficiaries covered under Part

B: $20 per diem × 5,000 ...... $100,000

Computation of cost applicable to program

for physicians on the medical school faculty:

Average cost per diem for direct medical

and surgical services to patients by

physicians on the medical school faculty:

$1,650,000 ÷ 75,000 = $22 per diem.

Cost of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part

A: $22 per diem × 20,000 .... $440,000

Cost of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part

B: $20 per diem × 1,000 ...... $22,000

Cost of physician direct medical and surgical services furnished to outpatient beneficiaries covered under Part

B: $22 per diem × 5,000 ...... $110,000

(2) The following illustrates how the

imputed value of physician volunteer direct

medical and surgical services furnished in a

teaching hospital to beneficiaries is

determined.

Example: The physicians on the medical

staff of Teaching Hospital Y donated a total

of 5,000 hours in furnishing direct medical

and surgical services to patients of the

hospital during a cost reporting period and

did not receive any compensation from either

the hospital or the medical school. Also, the

imputed value for any physician volunteer

services did not exceed the rate of $30,000

per year per physician.

Statistical and financial data:

Total salaries paid to the fulltime salaried physicians by

the hospital (excluding interns and residents) ............. $800,000

Total physicians who were

paid for an average of 40

hours per week or 2,080 (52

weeks x 40 hours per week)

hours per year ...................... 20

Average hourly rate equivalent: $800,000 ÷ 41,600

(2,080 × 20) ........................... $19.23

Computation of total imputed value of

physician volunteer services applicable to all

patients:

(Total donated hours × average hourly rate equivalent):

5,000 × $19.23 ...................... $96,150

Total inpatient days (as defined in paragraph (h)(2) of

this section) and outpatient

visit days (as defined in

paragraph (h)(3) of this section) ....................................... 75,000

Total inpatient Part A days ..... 20,000

Total inpatient Part B days if

Part A coverage is not available ........................................ 1,000

Total outpatient Part B visit

days ....................................... 5,000

Computation of imputed value of

physician volunteer direct medical and

surgical services furnished to Medicare

beneficiaries:

Average per diem for physician direct

medical and surgical services to all patients:

$96,150 ÷ 75,000 = $1.28 per diem

Imputed value of physician

direct medical and surgical

services furnished to inpatient beneficiaries covered

under Part A: $1.28 per

diem × 20,000 ....................... $25,600

Imputed value of physician

direct medical and surgical

services furnished to inpatient beneficiaries covered

under Part B: $1.28 per

diem × 1,000 ......................... $1,280

Imputed value of physician

direct medical and surgical

services furnished to outpatient beneficiaries covered

under Part B: $1.28 per

diem × 5,000 ......................... $6,400

Total ......................................... $33,280

(j) Allocation of compensation paid to

physicians in a teaching hospital.

(1) In determining reasonable cost

under this section, the compensation

paid by a teaching hospital, or a medical

school or related organization under

arrangement with the hospital, to

physicians in a teaching hospital must

be allocated to the full range of services

implicit in the physician compensation

arrangements. (However, see paragraph

(d) of this section for the computation

of the ‘‘salary equivalent’’ payments for

volunteer services furnished to

patients.)

(2) This allocation must be made and

must be capable of substantiation on the

basis of the proportion of each

physician’s time spent in furnishing

each type of service to the hospital or

medical school.

§ 415.164 Payment to a fund.

(a) General rules. Payment for certain

voluntary services by physicians in

teaching hospitals (as these services are

described in § 415.160) is made on a

salary equivalent basis (as described in

§ 415.162(d)) subject to the conditions

and limitations contained in parts 405

and 413 of this chapter and this part

415, to a single fund (as defined in

paragraph (b) of this section) designated

by the organized medical staff of the

hospital (or, if the services are furnished

in the hospital by the faculty of a

medical school, to a fund as may be

designated by the faculty), if the

following conditions are met:

(1) The hospital (or medical school

furnishing the services under

arrangement with the hospital) incurs

no actual cost in furnishing the services.

(2) The hospital has an agreement

with HCFA under part 489 of this

chapter.

(3) The intermediary, or HCFA as

appropriate, has received written

assurances that—

(i) The payment is used solely for the

improvement of care of hospital patients

or for educational or charitable

purposes; and

(ii) Neither the individuals who are

furnished the services nor any other

persons are charged for the services (and

if charged, provision is made for the

return of any monies incorrectly

collected).
63186 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

(b) Definition of a fund. For purposes

of paragraph (a) of this section, a fund

is an organization that meets either of

the following requirements:

(1) The organization has and retains

exemption, as a governmental entity or

under section 501(c)(3) of the Internal

Revenue Code (nonprofit educational,

charitable, and similar organizations),

from Federal taxation.

(2) The organization is an

organization of physicians who, under

the terms of their employment by an

entity that meets the requirements of

paragraph (b)(1) of this section, are

required to turn over to that entity all

income that the physician organization

derives from the physician services.

(c) Status of a fund. A fund approved

for payment under paragraph (a) of this

section has all the rights and

responsibilities of a provider under

Medicare except that it does not enter

into an agreement with HCFA under

part 489 of this chapter.

§ 415.170 Conditions for payment on a fee

schedule basis for physician services in a

teaching setting.

Services meeting the conditions for

payment in § 415.102(a) furnished in

teaching settings are payable under the

physician fee schedule if—

(a) The services are personally

furnished by a physician who is not a

resident; or

(b) The services are furnished by a

resident in the presence of a teaching

physician except as provided in

§ 415.172 (concerning physician fee

schedule payment for services of

teaching physicians), § 415.174

(concerning an exception for services

furnished in hospital outpatient and

certain other ambulatory settings),

§ 415.176 (concerning renal dialysis

services), and § 415.184 (concerning

psychiatric services), as applicable.

§ 415.172 Physician fee schedule payment

for services of teaching physicians.

(a) General rule. If a resident

participates in a service furnished in a

teaching setting, physician fee schedule

payment is made only if a teaching

physician is present during the key

portion of any service or procedure for

which payment is sought.

(1) In the case of surgical, high-risk,

or other complex procedures, the

teaching physician must be present

during all critical portions of the

procedure and immediately available to

furnish services during the entire

service or procedure.

(i) In the case of surgery, the teaching

physician’s presence is not required

during opening and closing of the

surgical field.

(ii) In the case of procedures

performed through an endoscope, the

teaching physician must be present

during the entire viewing.

(2) In the case of evaluation and

management services, the teaching

physician must be present during the

portion of the service that determines

the level of service billed. (However, in

the case of evaluation and management

services furnished in hospital outpatient

departments and certain other

ambulatory settings, the requirements of

§ 415.174 apply.)

(b) Documentation. Except for

services furnished as set forth in

§§ 415.174 (concerning an exception for

services furnished in hospital outpatient

and certain other ambulatory settings),

415.176 (concerning renal dialysis

services), and 415.184 (concerning

psychiatric services), the medical

records must document the teaching

physician was present at the time the

service is furnished. The presence of the

teaching physician during procedures

may be demonstrated by the notes in the

medical records made by a physician,

resident, or nurse. In the case of

evaluation and management procedures,

the teaching physician must personally

document his or her participation in the

service in the medical records.

(c) Payment level. In the case of

services such as evaluation and

management for which there are several

levels of service codes available for

reporting purposes, the appropriate

payment level must reflect the extent

and complexity of the service when

fully furnished by the teaching

physician.

§ 415.174 Exception: Evaluation and

management services furnished in certain

centers.

(a) In the case of certain evaluation

and management codes of lower and

mid-level complexity (as specified by

HCFA in program instructions), carriers

may make physician fee schedule

payment for a service furnished by a

resident without the presence of a

teaching physician. For the exception to

apply, all of the following conditions

must be met:

(1) The services must be furnished in

a center that is located in an outpatient

department of a hospital or another

ambulatory care entity in which the

time spent by residents in patient care

activities is included in determining

intermediary payments to a hospital

under § 413.86.

(2) Any resident furnishing the

service without the presence of a

teaching physician must have

completed more than 6 months of an

approved residency program.

(3) The teaching physician must not

direct the care of more than four

residents at any given time and must

direct the care from such proximity as

to constitute immediate availability. The

teaching physician must—

(i) Have no other responsibilities at

the time;

(ii) Assume management

responsibility for those beneficiaries

seen by the residents;

(iii) Ensure that the services furnished

are appropriate;

(iv) Review with each resident during

or immediately after each visit, the

beneficiary’s medical history, physical

examination, diagnosis, and record of

tests and therapies; and

(v) Document the extent of the

teaching physician’s participation in the

review and direction of the services

furnished to each beneficiary.

(4) The range of services furnished by

residents in the center includes all of

the following:

(i) Acute care for undifferentiated

problems or chronic care for ongoing

conditions.

(ii) Coordination of care furnished by

other physicians and providers.

(iii) Comprehensive care not limited

by organ system, diagnosis, or gender.

(5) The patients seen must be an

identifiable group of individuals who

consider the center to be the continuing

source of their health care and in which

services are furnished by residents

under the medical direction of teaching

physicians.

(b) Nothing in paragraph (a) of this

section may be construed as providing

a basis for the coverage of services not

determined to be covered under

Medicare, such as routine physical

checkups.

§ 415.176 Renal dialysis services.

In the case of renal dialysis services,

physicians who are not paid under the

physician monthly capitation payment

method (as described in § 414.314 of

this chapter) must meet the

requirements of §§ 415.170 and 415.172

(concerning physician fee schedule

payment for services of teaching

physicians).

§ 415.178 Anesthesia services.

(a) General rule. An unreduced

physician fee schedule payment may be

made if a physician is involved in a
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63187

single anesthesia procedure involving

an anesthesia resident. In the case of

anesthesia services, the teaching

physician must be present during all

critical portions of the procedure and

immediately available to furnish

services during the entire service or

procedure. The teaching physician

cannot receive an unreduced fee if he or

she performs services involving other

patients during the period the

anesthesia resident is furnishing

services in a single case. For additional

rules for payment of anesthesia services

involving residents, see

§ 414.46(c)(1)(iii)).

(b) Documentation. Documentation

must indicate the physician’s presence

or participation in the administration of

the anesthesia and a preoperative and

postoperative visit by the physician.

§ 415.180 Teaching setting requirements

for the interpretation of diagnostic

radiology and other diagnostic tests.

(a) General rule. Physician fee

schedule payment is made for the

interpretation of diagnostic radiology

and other diagnostic tests if the

interpretation is performed or reviewed

by a physician other than a resident.

(b) Documentation. Documentation

must indicate that the physician

personally performed the interpretation

or reviewed the resident’s interpretation

with the resident.

§ 415.184 Psychiatric services.

To qualify for physician fee schedule

payment for psychiatric services

furnished under an approved GME

program, the physician must meet the

requirements of §§ 415.170 and 415.172,

including documentation, except that

the requirement for the presence of the

teaching physician during the service in

which a resident is involved may be met

by observation of the service by use of

a one-way mirror, video equipment, or

similar device.

§ 415.190 Conditions of payment:

Assistants at surgery in teaching hospitals.

(a) Basis, purpose, and scope. This

section describes the conditions under

which Medicare pays on a fee schedule

basis for the services of an assistant at

surgery in a teaching hospital. This

section is based on section

1842(b)(7)(D)(I) of the Act and applies

only to hospitals with an approved GME

residency program. Except as specified

in paragraph (c) of this section, fee

schedule payment is not available for

assistants at surgery in hospitals with—

(1) A training program relating to the

medical specialty required for the

surgical procedure; and

(2) A resident in a training program

relating to the specialty required for the

surgery available to serve as an assistant

at surgery.

(b) Definition. Assistant at surgery

means a physician who actively assists

the physician in charge of a case in

performing a surgical procedure.

(c) Conditions for payment for

assistants at surgery. Payment on a fee

schedule basis is made for the services

of an assistant at surgery in a teaching

hospital only if the services meet one of

the following conditions:

(1) Are required as a result of

exceptional medical circumstances.

(2) Are complex medical procedures

performed by a team of physicians, each

performing a discrete, unique function

integral to the performance of a complex

medical procedure that requires the

special skills of more than one

physician.

(3) Constitute concurrent medical care

relating to a medical condition that

requires the presence of, and active care

by, a physician of another specialty

during surgery.

(4) Are medically required and are

furnished by a physician who is

primarily engaged in the field of

surgery, and the primary surgeon does

not use interns and residents in the

surgical procedures that the surgeon

performs (including preoperative and

postoperative care).

(5) Are not related to a surgical

procedure for which HCFA determines

that assistants are used less than 5

percent of the time.

Subpart E—Services of Residents

§ 415.200 Services of residents in

approved GME programs.

(a) General rules. Services furnished

in hospitals by residents in approved

GME programs are specifically excluded

from being paid as ‘‘physician services’’

defined in § 414.2 of this chapter and

are payable as hospital services. This

exclusion applies whether or not the

resident is licensed to practice under

the laws of the State in which he or she

performs the service. The payment

methodology for services of residents in

hospitals and hospital-based providers

is set forth in § 413.86 of this chapter.

(b) Exception. For low and mid-level

evaluation and management services

furnished under certain conditions in

centers located in hospital outpatient

departments and other ambulatory

settings, see § 415.174.

(c) Definitions. See § 415.152 for

definitions of terms used in this subpart

E.

§ 415.202 Services of residents not in

approved GME programs.

(a) General rules. For services of a

physician employed by a hospital who

is authorized to practice only in a

hospital setting and for the services of

a resident who is not in any approved

GME program, payment is made to the

hospital on a Part B reasonable cost

basis regardless of whether the services

are furnished to hospital inpatients or

outpatients.

(b) Payment. For services described in

paragraph (a) of this section, payment is

made under Part B by reducing the

reasonable costs of furnishing the

services by the beneficiary deductible

and paying 80 percent of the remaining

amount. No payment is made for other

costs of unapproved programs, such as

administrative costs related to teaching

activities of physicians.

§ 415.204 Services of residents in skilled

nursing facilities and home health agencies.

(a) Medicare Part A payment.

Payment is made under Medicare Part A

for interns’ and residents’ services

furnished in the following settings that

meet the specified requirements:

(1) Skilled nursing facility. Payment to

a participating skilled nursing facility

may include the cost of services of an

intern or resident who is in an approved

GME program in a hospital with which

the skilled nursing facility has a transfer

agreement that provides, in part, for the

transfer of patients and the interchange

of medical records.

(2) Home health agency. A

participating home health agency may

receive payment for the cost of the

services of an intern or resident who is

under an approved GME program of a

hospital with which the home health

agency is affiliated or under common

control if these services are furnished as

part of the home health visits for a

Medicare beneficiary. (Nevertheless, see

§ 413.86 of this chapter for the costs of

approved GME programs in hospitalbased providers.)

(b) Medicare Part B payment. Medical

services of a resident of a hospital that

are furnished by a skilled nursing

facility or home health agency are paid

under Medicare Part B if payment is not

provided under Medicare Part A.

Payment is made under Part B for a

resident’s services by reducing the
63188 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

reasonable costs of furnishing the

services by the beneficiary deductible

and paying 80 percent of the remaining

amount.

§ 415.206 Services of residents in

nonprovider settings.

Patient care activities of residents in

approved GME programs that are

furnished in nonprovider settings are

payable in one of the following two

ways:

(a) Direct GME payments. If the

conditions in § 413.86(f)(1)(iii) regarding

patient care activities and training of

residents are met, the time residents

spend in nonprovider settings such as

clinics, nursing facilities, and physician

offices in connection with approved

GME programs is included in

determining the number of full-time

equivalency residents in the calculation

of a teaching hospital’s resident count.

The teaching physician rules on carrier

payments in §§ 415.170 through 415.184

apply in these teaching settings.

(b) Physician fee schedule. (1)

Services furnished by a resident in a

nonprovider setting are covered as

physician services and payable under

the physician fee schedule if the

following requirements are met:

(i) The resident is fully licensed to

practice medicine, osteopathy,

dentistry, or podiatry in the State in

which the service is performed.

(ii) The time spent in patient care

activities in the nonprovider setting is

not included in a teaching hospital’s

full-time equivalency resident count for

the purpose of direct GME payments.

(2) Payment may be made regardless

of whether a resident is functioning

within the scope of his or her GME

program in the nonprovider setting.

(3) If fee schedule payment is made

for the resident’s services in a

nonprovider setting, payment must not

be made for the services of a teaching

physician.

(4) The carrier must apply the

physician fee schedule payment rules

set forth in subpart A of part 414 of this

chapter to payments for services

furnished by a resident in a nonprovider

setting.

§ 415.208 Services of moonlighting

residents.

(a) Definition. For purposes of this

section, the term services of

moonlighting residents refers to services

that licensed residents perform that are

outside the scope of an approved GME

program.

(b) Services in GME program

hospitals. (1) The services of residents

to inpatients of hospitals in which the

residents have their approved GME

program are not covered as physician

services and are payable under § 413.86

regarding direct GME payments.

(2) Services of residents that are not

related to their approved GME programs

and are performed in an outpatient

department or emergency department of

a hospital in which they have their

training program are covered as

physician services and payable under

the physician fee schedule if all of the

following criteria are met:

(i) The services are identifiable

physician services and meet the

conditions for payment of physician

services to beneficiaries in providers in

§ 415.102(a).

(ii) The resident is fully licensed to

practice medicine, osteopathy,

dentistry, or podiatry by the State in

which the services are performed.

(iii) The services performed can be

separately identified from those services

that are required as part of the approved

GME program.

(3) If the criteria specified in

paragraph (b)(2) of this section are met,

the services of the moonlighting

resident are considered to have been

furnished by the individual in his or her

capacity as a physician, rather than in

the capacity of a resident. The carrier

must review the contracts and

agreements for these services to ensure

compliance with the criteria specified in

paragraph (b)(2) of this section.

(4) No payment is made for services

of a ‘‘teaching physician’’ associated

with moonlighting services, and the

time spent furnishing these services is

not included in the teaching hospital’s

full-time equivalency count for the

indirect GME payment (§ 412.105 of this

chapter) and for the direct GME

payment (§ 413.86 of this chapter).

(c) Other settings. Moonlighting

services of a licensed resident in an

approved GME program furnished

outside the scope of that program in a

hospital or other setting that does not

participate in the approved GME

program are payable under the

physician fee schedule as set forth in

§ 415.206(b)(1).

F. Technical Amendments

PART 400—[AMENDED]

1. In § 400.310, the following changes

are made:

a. The entries for §§ 405.481 and

405.552 are removed.

b. The table is amended by adding the

following entries:

§ 400.310 Display of currently valid OMB

control numbers.

Sections in 42 CFR that contain

collections of information

Current

OMB control numbers

* * * * *

415.60 ....................................... 0938–0301

415.162 ..................................... 0938–0301

* * * * *

PART 405—[AMENDED]

§ 405.502 [Amended]

2. In § 405.502(a)(10), the phrase

‘‘§ 405.580(c)(2) or (3)’’ is removed, and

the phrase ‘‘§ 415.190(c)(2) or (c)(3) of

this chapter’’ is added in its place.

PART 411—EXCLUSIONS FROM

MEDICARE AND LIMITATIONS ON

MEDICARE PAYMENT

3. The authority citation for part 411

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh).

§ 411.15 [Amended]

4. In § 411.15(m)(2)(i), ‘‘§ 405.550(b)’’

is removed, and ‘‘§ 415.102(a)’’ is added

in its place.

PART 412—PROSPECTIVE PAYMENT

SYSTEMS FOR INPATIENT HOSPITAL

SERVICES

5. The authority citation for part 412

continues to read as follows:

Authority: Secs. 1102, 1815(e), 1820, 1871,

and 1886 of the Social Security Act (42

U.S.C. 1302, 1395g(e), 1395i-4, 1395hh, and

1395ww).

§ 412.50 [Amended]

6. In § 412.50, the following changes

are made:

a. In paragraph (a), ‘‘§ 405.550(b)’’ is

removed, and ‘‘§ 415.102(a)’’ is added in

its place.

b. In paragraph (b), ‘‘§ 405.550(b)’’ is

removed, and ‘‘§ 415.102(a)’’ is added in

its place.

§ 412.71 [Amended]

7. In § 412.71(c)(1)(i), ‘‘§ 405.550(b)’’

is removed, and ‘‘§ 415.102(a)’’ is added

in its place.

§ 412.105 [Amended]

8. In § 412.105(g)(1)(i)(A),

‘‘§ 405.522(a)’’ is removed, and

‘‘§ 415.200(a)’’ is added in its place.
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63189

PART 413—[AMENDED]

9. 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).

§ 413.5 [Amended]

10. In § 413.5(c)(9), the phrase ‘‘(as

described in § 405.465 of this chapter)

where elected as provided for in

§ 405.521 of this chapter.’’ is removed,

and the phrase ‘‘(as described in

§ 415.162 of this chapter) if elected as

provided for in § 415.160 of this

chapter.’’ is added in its place.

§ 413.13 [Amended]

11. In § 413.13(g)(1)(i), the phrase

‘‘§§ 405.480 through 405.482’’ is

removed, and the phrase ‘‘§§ 415.55

through 415.70’’ is added in its place.

§ 413.80 [Amended]

12. In § 413.80(h), the phrase ‘‘, as

described in § 414.450 of this chapter,’’

is removed.

§ 413.86 [Amended]

13. In § 413.86, the following changes

are made:

a. In paragraph (b), in the definition

of ‘‘Approved medical residency

program’’ in paragraph (1),

‘‘§ 405.522(a)’’ is removed, and

‘‘§ 415.200(a)’’ is added in its place.

b. In paragraph (g)(1)(ii),

‘‘§ 405.522(a)’’ is removed, and

‘‘§ 415.200(a)’’ is added in its place.

§ 413.174 [Amended]

14. In § 413.174(b)(4)(iv), the phrase

‘‘§§ 405.465 through 405.482’’ is

removed, and the phrase ‘‘§§ 415.55

through 415.70, § 415.162, and

§ 415.164’’ is added in its place.

PART 414—[AMENDED]

§ 414.58 [Amended]

15. In § 414.58, the following changes

are made:

a. In paragraph (a), the phrase

‘‘§§ 405.550 through 405.580’’ is

removed, and the phrase ‘‘§§ 415.100

through 415.130, and § 415.190’’ is

added in its place.

b. In paragraph (b), the phrase

‘‘§ 405.465 of this chapter if the hospital

exercises the election described in

§ 405.521(c)(2) of this chapter’’ is

removed, and the phrase ‘‘§ 415.162 of

this chapter if the hospital exercises the

election described in § 415.160 of this

chapter’’ is added in its place.

PART 417—HEALTH MAINTENANCE

ORGANIZATIONS, COMPETITIVE

MEDICAL PLANS, AND HEALTH CARE

PREPAYMENT PLANS

16. The authority citation for part 417

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh), secs. 1301, 1306, and 1310 of the

Public Health Service Act (42 U.S.C. 300e,

300e–5, and 300e–9); and 31 U.S.C. 9701.

§ 417.554 [Amended]

17. In § 417.554, the phrase

‘‘§ 405.480, part 412 of this chapter, and

§§ 413.55 and 413.24’’ is removed, and

the phrase ‘‘part 412, §§ 413.24, 413.55,

and 415.55’’ is added in its place.

PART 489—PROVIDER AGREEMENTS

AND SUPPLIER APPROVAL

18. The authority citation for part 489

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh).

§ 489.20 [Amended]

19. In § 489.20(d)(1), ‘‘§ 405.550(b)’’ is

removed, and ‘‘§ 415.102(a)’’ is added in

its place.

§ 489.21 [Amended]

20. In § 489.21(f), ‘‘§ 405.550(b)’’ is

removed, and ‘‘§ 415.102(a)’’ is added in

its place.

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance; and Program No. 93.774,

Medicare—Supplementary Medical

Insurance Program)

Dated: November 28, 1995.

Bruce C. Vladeck,

Administrator, Health Care Financing

Administration.

Dated: December 1, 1995.

Donna E. Shalala,

Secretary.

Note: These addenda will not appear in the

Code of Federal Regulations.

Addendum A—Explanation and Use of

Addenda B Through E

The addenda on the following pages

provide various data pertaining to the

Medicare fee schedule for physician services

furnished in 1995. Addendum B contains the

RVUs for work, practice expense, and

malpractice expense, and other information

for all services included in the physician fee

schedule. Addendum C provides interim

RVUs and related information for codes that

are subject to comment. Each code listed in

Addendum C is also included in Addendum

B. Further explanations of the information in

these addenda are provided at the beginning

of each addendum.

To compute a fee schedule amount

according to the formula provided in the

final rule, use the RVUs listed in Addendum

B and the GPCIs for 1996 listed in

Addendum D of this final rule. In applying

the formula, use the appropriate CF: For

services designated as surgical, use a CF of

$40.7986. For primary care services, use a CF

of $35.4173. For other nonsurgical services,

use a CF of $34.6293.

Addendum D lists the GPCIs for 1996.

Addendum E lists the procedure codes

subject to the site-of-service differential.

Addendum B—1996 Relative Value Units

and Related Information Used in

Determining Medicare Payments for 1996

This addendum contains the following

information for each CPT code and

alphanumeric HCPCS code, except for

alphanumeric codes beginning with B

(enteral and parenteral therapy), E (durable

medical equipment), K (temporary codes for

nonphysician services or items), or L

(orthotics), and codes for anesthesiology.

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

alphanumeric HCPCS number for the service.

Alphanumeric HCPCS codes are included at

the end of this addendum.

2. Modifier. A modifier is shown if there

is a technical component (modifier TC) and

a professional component (PC) (modifier

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

TC for the service, Addendum B contains

three entries for the code: One for the global

values (both professional and technical); one

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

TC. The global service is not designated by

a modifier, and physicians must bill using

the code without a modifier if the physician

furnishes both the PC and the TC of the

service.

3. Status indicator. This indicator shows

whether the CPT/HCPCS code is in the

physician fee schedule and whether it is

separately payable if the service is covered.

A = Active code. These codes are

separately payable under the fee schedule if

covered. There will be RVUs for codes with

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

does not mean that Medicare has made a

national decision regarding the coverage of

the service. Carriers remain responsible for

coverage decisions in the absence of a

national Medicare policy.

B = Bundled code. Payment for covered

services is always bundled into payment for

other services not specified. If RVUs are

shown, they are not used for Medicare

payment. If these services are covered,

payment for them is subsumed by the

payment for the services to which they are

incident. (An example is a telephone call

from a hospital nurse regarding care of a

patient.)

C = Carrier-priced code. Carriers will

establish RVUs and payment amounts for

these services, generally on a case-by-case

basis following review of documentation,

such as an operative report.

D = Deleted code. These codes are deleted

effective with the beginning of the calendar

year.
63190

E = Excluded from physician fee schedule

by regulation. These codes are for items or

services that we chose to exclude from the

physician fee schedule payment by

regulation. No RVUs are shown, and no

payment may be made under the physician

fee schedule for these codes. Payment for

them, if they are covered, continues under

reasonable charge or other payment

procedures.

G = Code not valid for Medicare purposes.

Medicare does not recognize codes assigned

this status. Medicare uses another code for

reporting of, and payment for, these services.

H = Deleted modifier. This code had TC

and PC components in 1995. For 1996, these

components are deleted.

N = Noncovered service. These codes are

noncovered services. Medicare payment may

not be made for these codes. If RVUs are

shown, they are not used for Medicare

payment.

P = Bundled or excluded code. There are

no RVUs for these services. No separate

payment should be made for them under the

physician fee schedule.

—If the item or service is covered as incident

to a physician service and is furnished on

the same day as a physician service,

payment for it is bundled into the payment

for the physician service to which it is

incident (an example is an elastic bandage

furnished by a physician incident to a

physician service).

—If the item or service is covered as other

than incident to a physician service, it is

excluded from the physician fee schedule

(for example, colostomy supplies) and is

paid under the other payment provisions of

the Act.

R = Restricted coverage. Special coverage

instructions apply. If the service is covered

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

T = Injections. There are RVUs for these

services, but they are only paid if there are

no other services payable under the

physician fee schedule billed on the same

date by the same provider. If any other

services payable under the physician fee

schedule are billed on the same date by the

same provider, these services are bundled

into the service(s) for which payment is

made.

X = Exclusion by law. These codes

represent an item or service that is not within

the definition of ‘‘physician services’’ for

physician fee schedule payment purposes.

No RVUs are shown for these codes, and no

payment may be made under the physician

fee schedule. (Examples are ambulance

services and clinical diagnostic laboratory

services.)

4. Description of code. This is an

abbreviated version of the narrative

description of the code.

5. Physician work RVUs. These are the

RVUs for the physician work for this service

in 1996. Codes that are not used for Medicare

payment are identified with a ‘‘#.’’

6. Practice expense RVUs. These are the

RVUs for the practice expense for the service

for 1996. Codes that are subject to the OBRA

1993 practice expense reduction are

identified by an asterisk in this column.

7. Malpractice expense RVUs. These are

the RVUs for the malpractice expense for the

service for 1996.

8. Total RVUs. This is the sum of the work,

practice expense, and malpractice expense

RVUs for 1996.

9. Global period. This indicator shows the

number of days in the global period for the

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

the alpha codes follows:

MMM = The code describes a service

furnished in uncomplicated maternity cases

including antepartum care, delivery, and

postpartum care. The usual global surgical

concept does not apply. See the 1996

Physicians’ Current Procedural Terminology

for specific definitions.

XXX = The global concept does not apply.

YYY = The global period is to be set by the

carrier (for example, unlisted surgery codes).

ZZZ = The code is part of another service

and falls within the global period for the

other service.

10. Update indicator. This column

indicates whether the update for surgical

procedures, primary care services, or other

nonsurgical services applies to the CPT/

HCPCS code in column 1. A ‘‘0’’ appears in

this field for codes that are deleted in 1996

or are not paid under the physician fee

schedule. A ‘‘P’’ in this column indicates that

the update and CF for primary care services

applies to this code. An ‘‘N’’ in this column

indicates that the update and CF for other

nonsurgical services applies to this code. An

‘‘S’’ in this column indicates that the separate

update and CF for surgical procedures

applies.

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

10040 ............. A Acne surgery of skin abscess ......................... 1.34 0.32 0.03 1.69 010 S

10060 ............. A Drainage of skin abscess ............................... 1.12 0.44 0.04 1.60 010 S

10061 ............. A Drainage of skin abscess ............................... 2.48 0.64 0.06 3.18 010 S

10080 ............. A Drainage of pilonidal cyst ............................... 1.62 0.50 0.05 2.17 010 N

10081 ............. A Drainage of pilonidal cyst ............................... 2.40 1.11 0.16 3.67 010 S

10120 ............. A Remove foreign body ..................................... 1.19 0.46 0.05 1.70 010 S

10121 ............. A Remove foreign body ..................................... 2.64 1.00 0.12 3.76 010 S

10140 ............. A Drainage of hematoma/fluid ........................... 1.48 0.48 0.05 2.01 010 S

10160 ............. A Puncture drainage of lesion ............................ 1.15 0.38 0.05 1.58 010 S

10180 ............. A Complex drainage, wound .............................. 2.20 1.05 0.18 3.43 010 S

11000 ............. A Surgical cleansing of skin ............................... 0.91 0.40 0.04 1.35 000 S

11001 ............. A Additional cleansing of skin ............................ 0.45 0.26 0.02 0.73 ZZZ S

11040 ............. A Surgical cleansing, abrasion ........................... 0.50 0.40 0.04 0.94 000 S

11041 ............. A Surgical cleansing of skin ............................... 0.82 0.56 0.06 1.44 000 S

11042 ............. A Cleansing of skin/tissue .................................. 1.12 0.65 0.08 1.85 000 S

11043 ............. A Cleansing of tissue/muscle ............................. 1.83 1.81 0.34 3.98 010 S

11044 ............. A Cleansing tissue/muscle/bone ........................ 2.28 2.82 0.49 5.59 010 S

11050 ............. A Trim skin lesion ............................................... 0.43 0.37 0.03 0.83 000 S

11051 ............. A Trim 2 to 4 skin lesions .................................. 0.66 0.50 0.05 1.21 000 S

11052 ............. A Trim over 4 skin lesions .................................. 0.86 0.41 0.04 1.31 000 S

11100 ............. A Biopsy of skin lesion ....................................... 0.81 0.51 0.04 1.36 000 S

11101 ............. A Biopsy, each added lesion ............................. 0.41 0.29 0.02 0.72 ZZZ S

11200 ............. A Removal of skin tags ...................................... 0.69 0.43 0.04 1.16 010 S

11201 ............. A Removal of added skin tags ........................... 0.26 0.17 0.02 0.45 ZZZ S

11300 ............. A Shave skin lesion ............................................ 0.51 0.53 0.05 1.09 000 S

11301 ............. A Shave skin lesion ............................................ 0.85 0.67 0.06 1.58 000 S
63191

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

11302 ............. A Shave skin lesion ............................................ 1.05 0.89 0.09 2.03 000 S

11303 ............. A Shave skin lesion ............................................ 1.24 1.36 0.17 2.77 000 S

11305 ............. A Shave skin lesion ............................................ 0.67 0.52 0.05 1.24 000 S

11306 ............. A Shave skin lesion ............................................ 0.99 0.71 0.07 1.77 000 S

11307 ............. A Shave skin lesion ............................................ 1.14 0.94 0.10 2.18 000 S

11308 ............. A Shave skin lesion ............................................ 1.41 1.40 0.17 2.98 000 S

11310 ............. A Shave skin lesion ............................................ 0.73 0.69 0.06 1.48 000 S

11311 ............. A Shave skin lesion ............................................ 1.05 0.85 0.08 1.98 000 S

11312 ............. A Shave skin lesion ............................................ 1.20 1.12 0.11 2.43 000 S

11313 ............. A Shave skin lesion ............................................ 1.62 1.49 0.15 3.26 000 S

11400 ............. A Removal of skin lesion ................................... 0.86 0.53 0.05 1.44 010 S

11401 ............. A Removal of skin lesion ................................... 1.27 0.67 0.06 2.00 010 S

11402 ............. A Removal of skin lesion ................................... 1.56 0.89 0.09 2.54 010 S

11403 ............. A Removal of skin lesion ................................... 1.87 1.17 0.13 3.17 010 S

11404 ............. A Removal of skin lesion ................................... 2.15 1.38 0.17 3.70 010 S

11406 ............. A Removal of skin lesion ................................... 2.71 1.88 0.33 4.92 010 S

11420 ............. A Removal of skin lesion ................................... 1.01 0.52 0.05 1.58 010 S

11421 ............. A Removal of skin lesion ................................... 1.48 0.71 0.07 2.26 010 S

11422 ............. A Removal of skin lesion ................................... 1.71 0.94 0.10 2.75 010 S

11423 ............. A Removal of skin lesion ................................... 2.12 1.31 0.15 3.58 010 S

11424 ............. A Removal of skin lesion ................................... 2.57 1.39 0.16 4.12 010 S

11426 ............. A Removal of skin lesion ................................... 3.73 1.83 0.29 5.85 010 S

11440 ............. A Removal of skin lesion ................................... 1.10 0.69 0.06 1.85 010 S

11441 ............. A Removal of skin lesion ................................... 1.56 0.85 0.08 2.49 010 S

11442 ............. A Removal of skin lesion ................................... 1.82 1.12 0.11 3.05 010 S

11443 ............. A Removal of skin lesion ................................... 2.44 1.45 0.15 4.04 010 S

11444 ............. A Removal of skin lesion ................................... 3.37 1.47 0.14 4.98 010 S

11446 ............. A Removal of skin lesion ................................... 4.44 1.78 0.18 6.40 010 S

11450 ............. A Removal, sweat gland lesion .......................... 2.58 2.68 0.44 5.70 090 S

11451 ............. A Removal, sweat gland lesion .......................... 3.80 2.90 0.46 7.16 090 S

11462 ............. A Removal, sweat gland lesion .......................... 2.36 2.41 0.36 5.13 090 S

11463 ............. A Removal, sweat gland lesion .......................... 3.80 2.00 0.34 6.14 090 S

11470 ............. A Removal, sweat gland lesion .......................... 3.10 2.78 0.45 6.33 090 S

11471 ............. A Removal, sweat gland lesion .......................... 4.26 2.46 0.48 7.20 090 S

11600 ............. A Removal of skin lesion ................................... 1.36 1.13 0.10 2.59 010 S

11601 ............. A Removal of skin lesion ................................... 1.88 1.39 0.12 3.39 010 S

11602 ............. A Removal of skin lesion ................................... 2.04 1.82 0.16 4.02 010 S

11603 ............. A Removal of skin lesion ................................... 2.30 2.25 0.21 4.76 010 S

11604 ............. A Removal of skin lesion ................................... 2.53 2.59 0.26 5.38 010 S

11606 ............. A Removal of skin lesion ................................... 3.38 3.11 0.49 6.98 010 S

11620 ............. A Removal of skin lesion ................................... 1.29 1.34 0.12 2.75 010 S

11621 ............. A Removal of skin lesion ................................... 1.92 1.75 0.16 3.83 010 S

11622 ............. A Removal of skin lesion ................................... 2.29 2.20 0.19 4.68 010 S

11623 ............. A Removal of skin lesion ................................... 2.88 2.58 0.25 5.71 010 S

11624 ............. A Removal of skin lesion ................................... 3.38 3.21 0.32 6.91 010 S

11626 ............. A Removal of skin lesion ................................... 4.20 3.41 0.51 8.12 010 S

11640 ............. A Removal of skin lesion ................................... 1.48 1.65 0.15 3.28 010 S

11641 ............. A Removal of skin lesion ................................... 2.39 2.09 0.18 4.66 010 S

11642 ............. A Removal of skin lesion ................................... 2.88 2.57 0.23 5.68 010 S

11643 ............. A Removal of skin lesion ................................... 3.45 3.01 0.28 6.74 010 S

11644 ............. A Removal of skin lesion ................................... 4.50 3.51 0.33 8.34 010 S

11646 ............. A Removal of skin lesion ................................... 5.85 4.32 0.60 10.77 010 S

11700 ............. A Scraping of 1–5 nails ...................................... 0.32 0.32 0.03 0.67 000 S

11701 ............. A Scraping of additional nails ............................ 0.23 0.23 0.02 0.48 ZZZ S

11710 ............. A Scraping of 1–5 nails ...................................... 0.32 0.32 0.03 0.67 000 S

11711 ............. A Scraping of additional nails ............................ 0.20 0.19 0.02 0.41 ZZZ S

11730 ............. A Removal of nail plate ...................................... 1.13 0.45 0.04 1.62 000 S

11731 ............. A Removal of second nail plate ......................... 0.55 0.51 0.05 1.11 ZZZ S

11732 ............. A Remove additional nail plate .......................... 0.38 0.25 0.02 0.65 ZZZ S

11740 ............. A Drain blood from under nail ............................ 0.37 0.39 0.04 0.80 000 S

11750 ............. A Removal of nail bed ........................................ 1.66 2.10 0.19 3.95 010 S

11752 ............. A Remove nail bed/finger tip .............................. 2.37 2.82 0.36 5.55 010 S

11755 ............. A Biopsy, nail unit .............................................. 1.31 0.99 0.12 2.42 000 S

11760 ............. A Reconstruction of nail bed .............................. 1.53 0.93 0.09 2.55 010 S

11762 ............. A Reconstruction of nail bed .............................. 2.84 2.57 0.24 5.65 010 S

11765 ............. A Excision of nail fold, toe ................................. 0.64 0.51 0.05 1.20 010 S
63192

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

11770 ............. A Removal of pilonidal lesion ............................. 2.56 2.67 0.44 5.67 010 S

11771 ............. A Removal of pilonidal lesion ............................. 5.15 4.52 0.92 10.59 090 S

11772 ............. A Removal of pilonidal lesion ............................. 6.36 4.82 1.01 12.19 090 S

11900 ............. A Injection into skin lesions ................................ 0.52 0.25 0.02 0.79 000 S

11901 ............. A Added skin lesions injection ........................... 0.80 0.41 0.03 1.24 000 S

11920 ............. R Correct skin color defects ............................... 1.61 1.18 0.23 3.02 000 S

11921 ............. R Correct skin color defects ............................... 1.93 1.40 0.28 3.61 000 S

11922 ............. R Correct skin color defects ............................... 0.49 0.36 0.07 0.92 ZZZ S

11950 ............. R Therapy for contour defects ........................... 0.84 1.19 0.11 2.14 000 S

11951 ............. R Therapy for contour defects ........................... 1.19 1.19 0.11 2.49 000 S

11952 ............. R Therapy for contour defects ........................... 1.69 1.19 0.11 2.99 000 S

11954 ............. R Therapy for contour defects ........................... 1.85 1.19 0.11 3.15 000 S

11960 ............. A Insert tissue expander(s) ................................ 6.04 *7.73 1.48 15.25 090 S

11970 ............. A Replace tissue expander ................................ 6.65 *8.51 1.61 16.77 090 S

11971 ............. A Remove tissue expander(s) ............................ 1.51 *2.30 0.82 4.63 090 S

11975 ............. N Insert contraceptive cap ................................. #1.48 1.06 0.25 2.79 XXX 0

11976 ............. R Removal of contraceptive cap ........................ 1.78 1.28 0.30 3.36 XXX N

11977 ............. N Removal/reinsert contra cap ........................... #3.30 2.36 0.55 6.21 XXX 0

12001 ............. A Repair superficial wound(s) ............................ 1.65 0.57 0.05 2.27 010 N

12002 ............. A Repair superficial wound(s) ............................ 1.81 0.79 0.07 2.67 010 N

12004 ............. A Repair superficial wound(s) ............................ 2.19 1.14 0.10 3.43 010 N

12005 ............. A Repair superficial wound(s) ............................ 2.81 1.47 0.14 4.42 010 N

12006 ............. A Repair superficial wound(s) ............................ 3.62 1.78 0.19 5.59 010 N

12007 ............. A Repair superficial wound(s) ............................ 4.07 1.80 0.19 6.06 010 S

12011 ............. A Repair superficial wound(s) ............................ 1.71 0.74 0.06 2.51 010 N

12013 ............. A Repair superficial wound(s) ............................ 1.94 1.03 0.08 3.05 010 N

12014 ............. A Repair superficial wound(s) ............................ 2.41 1.19 0.10 3.70 010 N

12015 ............. A Repair superficial wound(s) ............................ 3.14 1.62 0.14 4.90 010 N

12016 ............. A Repair superficial wound(s) ............................ 3.88 2.26 0.19 6.33 010 N

12017 ............. A Repair superficial wound(s) ............................ 4.66 3.36 0.31 8.33 010 N

12018 ............. A Repair superficial wound(s) ............................ 5.48 5.15 0.48 11.11 010 S

12020 ............. A Closure of split wound .................................... 2.57 1.19 0.18 3.94 010 S

12021 ............. A Closure of split wound .................................... 1.79 0.62 0.11 2.52 010 S

12031 ............. A Layer closure of wound(s) .............................. 2.10 0.72 0.07 2.89 010 S

12032 ............. A Layer closure of wound(s) .............................. 2.42 1.05 0.10 3.57 010 S

12034 ............. A Layer closure of wound(s) .............................. 2.87 1.47 0.15 4.49 010 S

12035 ............. A Layer closure of wound(s) .............................. 3.38 1.92 0.23 5.53 010 S

12036 ............. A Layer closure of wound(s) .............................. 4.00 2.32 0.37 6.69 010 S

12037 ............. A Layer closure of wound(s) .............................. 4.62 3.09 0.48 8.19 010 S

12041 ............. A Layer closure of wound(s) .............................. 2.32 0.84 0.08 3.24 010 N

12042 ............. A Layer closure of wound(s) .............................. 2.69 1.17 0.12 3.98 010 N

12044 ............. A Layer closure of wound(s) .............................. 3.09 1.62 0.17 4.88 010 N

12045 ............. A Layer closure of wound(s) .............................. 3.59 2.13 0.23 5.95 010 N

12046 ............. A Layer closure of wound(s) .............................. 4.20 2.82 0.37 7.39 010 S

12047 ............. A Layer closure of wound(s) .............................. 4.60 4.02 0.56 9.18 010 N

12051 ............. A Layer closure of wound(s) .............................. 2.42 1.01 0.10 3.53 010 S

12052 ............. A Layer closure of wound(s) .............................. 2.72 1.47 0.14 4.33 010 S

12053 ............. A Layer closure of wound(s) .............................. 3.07 1.76 0.17 5.00 010 S

12054 ............. A Layer closure of wound(s) .............................. 3.41 2.60 0.25 6.26 010 S

12055 ............. A Layer closure of wound(s) .............................. 4.38 3.24 0.37 7.99 010 S

12056 ............. A Layer closure of wound(s) .............................. 5.19 4.74 0.52 10.45 010 S

12057 ............. A Layer closure of wound(s) .............................. 5.91 5.57 0.48 11.96 010 S

13100 ............. A Repair of wound or lesion .............................. 3.07 1.14 0.13 4.34 010 S

13101 ............. A Repair of wound or lesion .............................. 3.87 2.08 0.21 6.16 010 S

13120 ............. A Repair of wound or lesion .............................. 3.25 1.35 0.17 4.77 010 S

13121 ............. A Repair of wound or lesion .............................. 4.28 2.65 0.33 7.26 010 S

13131 ............. A Repair of wound or lesion .............................. 3.74 1.98 0.23 5.95 010 S

13132 ............. A Repair of wound or lesion .............................. 4.21 4.57 0.44 9.22 010 S

13150 ............. A Repair of wound or lesion .............................. 3.76 1.76 0.23 5.75 010 S

13151 ............. A Repair of wound or lesion .............................. 4.40 2.45 0.35 7.20 010 S

13152 ............. A Repair of wound or lesion .............................. 6.28 5.13 0.68 12.09 010 S

13160 ............. A Late closure of wound .................................... 9.53 3.33 0.58 13.44 090 S

13300 ............. A Repair of wound or lesion .............................. 5.11 5.71 0.86 11.68 010 S

14000 ............. A Skin tissue rearrangement .............................. 5.43 3.41 0.38 9.22 090 S

14001 ............. A Skin tissue rearrangement .............................. 7.78 4.75 0.76 13.29 090 S

14020 ............. A Skin tissue rearrangement .............................. 6.08 4.90 0.49 11.47 090 S
63193

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

14021 ............. A Skin tissue rearrangement .............................. 9.37 6.21 0.94 16.52 090 S

14040 ............. A Skin tissue rearrangement .............................. 7.18 6.77 0.65 14.60 090 S

14041 ............. A Skin tissue rearrangement .............................. 10.74 7.88 1.02 19.64 090 S

14060 ............. A Skin tissue rearrangement .............................. 8.05 7.75 1.04 16.84 090 S

14061 ............. A Skin tissue rearrangement .............................. 11.42 10.49 1.27 23.18 090 S

14300 ............. A Skin tissue rearrangement .............................. 10.76 11.31 1.84 23.91 090 S

14350 ............. A Skin tissue rearrangement .............................. 9.05 6.07 1.05 16.17 090 S

15000 ............. A Skin graft procedure ....................................... 1.95 *2.49 0.53 4.97 ZZZ S

15050 ............. A Skin pinch graft procedure ............................. 3.90 1.79 0.30 5.99 090 S

15100 ............. A Skin split graft procedure ................................ 8.05 4.54 0.89 13.48 090 S

15101 ............. A Skin split graft procedure ................................ 1.72 1.59 0.33 3.64 ZZZ S

15120 ............. A Skin split graft procedure ................................ 9.14 6.05 0.94 16.13 090 S

15121 ............. A Skin split graft procedure ................................ 2.67 2.91 0.53 6.11 ZZZ S

15200 ............. A Skin full graft procedure ................................. 7.46 4.13 0.69 12.28 090 S

15201 ............. A Skin full graft procedure ................................. 1.32 *1.68 0.50 3.50 ZZZ S

15220 ............. A Skin full graft procedure ................................. 7.42 4.84 0.85 13.11 090 S

15221 ............. A Skin full graft procedure ................................. 1.19 *1.59 0.50 3.28 ZZZ S

15240 ............. A Skin full graft procedure ................................. 8.30 6.10 1.03 15.43 090 S

15241 ............. A Skin full graft procedure ................................. 1.86 *2.38 0.58 4.82 ZZZ S

15260 ............. A Skin full graft procedure ................................. 9.56 7.46 0.99 18.01 090 S

15261 ............. A Skin full graft procedure ................................. 2.23 *2.85 0.60 5.68 ZZZ S

15350 ............. A Skin homograft procedure .............................. 3.89 2.15 0.42 6.46 090 S

15400 ............. A Skin heterograft procedure ............................. 4.91 1.06 0.17 6.14 090 S

15570 ............. A Form skin pedicle flap .................................... 3.75 *5.50 2.08 11.33 090 S

15572 ............. A Form skin pedicle flap .................................... 3.80 *5.38 1.86 11.04 090 S

15574 ............. A Form skin pedicle flap .................................... 3.85 *5.40 1.66 10.91 090 S

15576 ............. A Form skin pedicle flap .................................... 4.27 3.12 0.60 7.99 090 S

15580 ............. A Attach skin pedicle graft ................................. 3.30 *4.31 1.30 8.91 090 S

15600 ............. A Skin graft procedure ....................................... 1.70 *2.51 0.88 5.09 090 S

15610 ............. A Skin graft procedure ....................................... 2.21 *2.82 0.80 5.83 090 S

15620 ............. A Skin graft procedure ....................................... 2.69 *3.44 0.86 6.99 090 S

15625 ............. A Skin graft procedure ....................................... 1.81 *2.41 0.78 5.00 090 S

15630 ............. A Skin graft procedure ....................................... 3.02 *3.86 0.90 7.78 090 S

15650 ............. A Transfer skin pedicle flap ............................... 3.61 *4.62 0.93 9.16 090 S

15732 ............. A Muscle-skin graft, head/neck .......................... 12.10 *15.48 3.46 31.04 090 S

15734 ............. A Muscle-skin graft, trunk .................................. 16.52 19.01 3.24 38.77 090 S

15736 ............. A Muscle-skin graft, arm .................................... 15.26 16.21 3.02 34.49 090 S

15738 ............. A Muscle-skin graft, leg ...................................... 10.07 *12.89 3.29 26.25 090 S

15740 ............. A Island pedicle flap graft .................................. 9.45 10.39 1.62 21.46 090 S

15750 ............. A Neurovascular pedicle graft ............................ 10.61 11.96 2.03 24.60 090 S

15755 ............. A Microvascular flap graft .................................. 28.33 30.09 5.33 63.75 090 S

15760 ............. A Composite skin graft ....................................... 8.28 7.29 1.11 16.68 090 S

15770 ............. A Derma-fat-fascia graft ..................................... 6.85 7.46 0.95 15.26 090 S

15775 ............. R Hair transplant punch grafts ........................... 3.96 2.88 0.56 7.40 000 S

15776 ............. R Hair transplant punch grafts ........................... 5.54 4.03 0.79 10.36 000 S

15780 ............. A Abrasion treatment of skin .............................. 6.73 1.53 0.13 8.39 090 S

15781 ............. A Abrasion treatment of skin .............................. 4.67 3.77 0.39 8.83 090 S

15782 ............. A Abrasion treatment of skin .............................. 4.19 1.19 0.13 5.51 090 S

15783 ............. A Abrasion treatment of skin .............................. 4.16 1.85 0.19 6.20 090 S

15786 ............. A Abrasion treatment of lesion ........................... 1.98 0.62 0.06 2.66 010 S

15787 ............. A Abrasion, added skin lesions .......................... 0.33 0.23 0.03 0.59 ZZZ S

15788 ............. R Chemical peel, face, epiderm ......................... 1.96 1.48 0.12 3.56 090 S

15789 ............. R Chemical peel, face, dermal ........................... 4.69 1.48 0.12 6.29 090 S

15792 ............. R Chemical peel, nonfacial ................................ 1.73 0.50 0.05 2.28 090 S

15793 ............. A Chemical peel, nonfacial ................................ 3.51 0.50 0.05 4.06 090 S

15810 ............. A Salabrasion ..................................................... 4.49 3.80 0.29 8.58 090 S

15811 ............. A Salabrasion ..................................................... 5.14 3.74 0.73 9.61 090 S

15819 ............. A Plastic surgery, neck ...................................... 8.87 8.01 0.87 17.75 090 S

15820 ............. A Revision of lower eyelid .................................. 4.80 *6.14 0.64 11.58 090 S

15821 ............. A Revision of lower eyelid .................................. 5.37 *6.87 0.68 12.92 090 S

15822 ............. A Revision of upper eyelid ................................. 4.27 *5.47 0.56 10.30 090 S

15823 ............. A Revision of upper eyelid ................................. 6.65 7.71 0.61 14.97 090 S

15824 ............. R Removal of forehead wrinkles ........................ 0.00 0.00 0.00 0.00 XXX S

15825 ............. R Removal of neck wrinkles ............................... 0.00 0.00 0.00 0.00 XXX S

15826 ............. R Removal of brow wrinkles ............................... 0.00 0.00 0.00 0.00 XXX S

15828 ............. R Removal of face wrinkles ............................... 0.00 0.00 0.00 0.00 XXX S
63194

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

15829 ............. R Removal of skin wrinkles ................................ 0.00 0.00 0.00 0.00 XXX S

15831 ............. A Excise excessive skin tissue .......................... 11.66 9.84 2.01 23.51 090 S

15832 ............. A Excise excessive skin tissue .......................... 10.97 8.29 1.33 20.59 090 S

15833 ............. A Excise excessive skin tissue .......................... 10.02 6.22 1.12 17.36 090 S

15834 ............. A Excise excessive skin tissue .......................... 10.16 7.18 1.22 18.56 090 S

15835 ............. A Excise excessive skin tissue .......................... 10.98 7.00 1.22 19.20 090 S

15836 ............. A Excise excessive skin tissue .......................... 8.83 5.80 1.10 15.73 090 S

15837 ............. A Excise excessive skin tissue .......................... 8.08 5.97 0.85 14.90 090 S

15838 ............. A Excise excessive skin tissue .......................... 6.78 5.88 0.73 13.39 090 S

15839 ............. A Excise excessive skin tissue .......................... 8.92 2.44 0.46 11.82 090 S

15840 ............. A Graft for face nerve palsy ............................... 12.26 15.54 2.28 30.08 090 S

15841 ............. A Graft for face nerve palsy ............................... 21.53 16.87 2.76 41.16 090 S

15842 ............. A Graft for face nerve palsy ............................... 35.98 29.00 2.68 67.66 090 S

15845 ............. A Skin and muscle repair, face .......................... 11.80 *15.10 2.54 29.44 090 S

15850 ............. B Removal of sutures ......................................... #0.78 0.36 0.04 1.18 XXX 0

15851 ............. A Removal of sutures ......................................... 0.86 0.30 0.03 1.19 000 N

15852 ............. A Dressing change, not for burn ........................ 0.86 0.44 0.07 1.37 000 N

15860 ............. A Test for blood flow in graft .............................. 1.95 1.35 0.25 3.55 000 S

15876 ............. R Suction assisted lipectomy ............................. 0.00 0.00 0.00 0.00 XXX S

15877 ............. R Suction assisted lipectomy ............................. 0.00 0.00 0.00 0.00 XXX S

15878 ............. R Suction assisted lipectomy ............................. 0.00 0.00 0.00 0.00 XXX S

15879 ............. R Suction assisted lipectomy ............................. 0.00 0.00 0.00 0.00 XXX S

15920 ............. A Removal of tail bone ulcer .............................. 7.37 2.95 0.63 10.95 090 S

15922 ............. A Removal of tail bone ulcer .............................. 9.17 5.98 1.19 16.34 090 S

15931 ............. A Remove sacrum pressure sore ...................... 8.13 2.93 0.55 11.61 090 S

15933 ............. A Remove sacrum pressure sore ...................... 9.64 6.92 1.43 17.99 090 S

15934 ............. A Remove sacrum pressure sore ...................... 11.40 7.46 1.50 20.36 090 S

15935 ............. A Remove sacrum pressure sore ...................... 13.05 11.24 2.27 26.56 090 S

15936 ............. A Remove sacrum pressure sore ...................... 11.31 10.27 2.05 23.63 090 S

15937 ............. A Remove sacrum pressure sore ...................... 12.98 13.47 2.67 29.12 090 S

15940 ............. A Removal of pressure sore .............................. 8.19 3.55 0.73 12.47 090 S

15941 ............. A Removal of pressure sore .............................. 10.15 7.05 1.39 18.59 090 S

15944 ............. A Removal of pressure sore .............................. 10.18 9.26 1.82 21.26 090 S

15945 ............. A Removal of pressure sore .............................. 11.32 11.14 2.09 24.55 090 S

15946 ............. A Removal of pressure sore .............................. 19.81 16.61 3.24 39.66 090 S

15950 ............. A Remove thigh pressure sore .......................... 6.79 3.01 0.58 10.38 090 S

15951 ............. A Remove thigh pressure sore .......................... 9.57 7.65 1.58 18.80 090 S

15952 ............. A Remove thigh pressure sore .......................... 10.18 7.13 1.37 18.68 090 S

15953 ............. A Remove thigh pressure sore .......................... 11.39 9.08 1.87 22.34 090 S

15956 ............. A Remove thigh pressure sore .......................... 13.93 17.17 3.39 34.49 090 S

15958 ............. A Remove thigh pressure sore .......................... 13.89 *17.77 3.76 35.42 090 S

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

16000 ............. A Initial treatment of burn(s) .............................. 0.89 0.35 0.03 1.27 000 N

16010 ............. A Treatment of burn(s) ....................................... 0.87 0.32 0.03 1.22 000 N

16015 ............. A Treatment of burn(s) ....................................... 2.35 2.04 0.38 4.77 000 S

16020 ............. A Treatment of burn(s) ....................................... 0.80 0.34 0.03 1.17 000 N

16025 ............. A Treatment of burn(s) ....................................... 1.85 0.45 0.05 2.35 000 S

16030 ............. A Treatment of burn(s) ....................................... 2.08 0.52 0.08 2.68 000 S

16035 ............. A Incision of burn scab ...................................... 4.53 1.88 0.34 6.75 090 S

16040 ............. A Burn wound excision ...................................... 1.02 *1.56 0.53 3.11 000 S

16041 ............. A Burn wound excision ...................................... 2.70 3.16 0.53 6.39 000 S

16042 ............. A Burn wound excision ...................................... 2.35 *3.02 0.53 5.90 000 S

17000 ............. A Destroy benign/premal lesion ......................... 0.64 0.42 0.03 1.09 010 S

17001 ............. A Destruction of add’l lesions ............................ 0.19 0.19 0.02 0.40 ZZZ S

17002 ............. A Destruction of add’l lesions ............................ 0.19 0.10 0.01 0.30 ZZZ S

17010 ............. A Destruction skin lesion(s) ............................... 1.01 0.48 0.04 1.53 010 S

17100 ............. A Destruction of skin lesion ............................... 0.53 0.37 0.03 0.93 010 S

17101 ............. A Destruction of 2nd lesion ................................ 0.11 0.18 0.02 0.31 ZZZ S

17102 ............. A Destruction of add’l lesions ............................ 0.11 0.08 0.01 0.20 ZZZ S

17104 ............. A Destruction of skin lesions .............................. 2.01 0.07 0.01 2.09 010 S

17105 ............. A Destruction of skin lesions .............................. 0.76 0.31 0.03 1.10 010 S

17106 ............. A Destruction of skin lesions .............................. 4.54 1.93 0.18 6.65 090 S

17107 ............. A Destruction of skin lesions .............................. 9.06 3.70 0.39 13.15 090 S

17108 ............. A Destruction of skin lesions .............................. 13.10 9.32 0.69 23.11 090 S

17110 ............. A Destruction of skin lesions .............................. 0.55 0.40 0.03 0.98 010 S

17200 ............. A Electrocautery of skin tags ............................. 0.59 0.41 0.04 1.04 010 S
63195

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

17201 ............. A Electrocautery added lesions ......................... 0.38 0.15 0.01 0.54 ZZZ S

17250 ............. A Chemical cautery, tissue ................................ 0.50 0.34 0.04 0.88 000 S

17260 ............. A Destruction of skin lesions .............................. 0.86 1.13 0.10 2.09 010 S

17261 ............. A Destruction of skin lesions .............................. 1.12 1.39 0.12 2.63 010 S

17262 ............. A Destruction of skin lesions .............................. 1.53 1.82 0.16 3.51 010 S

17263 ............. A Destruction of skin lesions .............................. 1.74 2.25 0.21 4.20 010 S

17264 ............. A Destruction of skin lesions .............................. 1.89 2.59 0.26 4.74 010 S

17266 ............. A Destruction of skin lesions .............................. 2.29 3.11 0.49 5.89 010 S

17270 ............. A Destruction of skin lesions .............................. 1.27 1.34 0.12 2.73 010 S

17271 ............. A Destruction of skin lesions .............................. 1.44 1.75 0.16 3.35 010 S

17272 ............. A Destruction of skin lesions .............................. 1.72 2.20 0.19 4.11 010 S

17273 ............. A Destruction of skin lesions .............................. 2.00 2.58 0.25 4.83 010 S

17274 ............. A Destruction of skin lesions .............................. 2.54 3.21 0.32 6.07 010 S

17276 ............. A Destruction of skin lesions .............................. 3.15 3.41 0.51 7.07 010 S

17280 ............. A Destruction of skin lesions .............................. 1.12 1.65 0.15 2.92 010 S

17281 ............. A Destruction of skin lesions .............................. 1.67 2.09 0.18 3.94 010 S

17282 ............. A Destruction of skin lesions .............................. 1.99 2.57 0.23 4.79 010 S

17283 ............. A Destruction of skin lesions .............................. 2.59 3.01 0.28 5.88 010 S

17284 ............. A Destruction of skin lesions .............................. 3.16 3.51 0.33 7.00 010 S

17286 ............. A Destruction of skin lesions .............................. 4.39 4.32 0.60 9.31 010 S

17304 ............. A Chemosurgery of skin lesion .......................... 7.60 4.02 0.31 11.93 000 S

17305 ............. A 2nd stage chemosurgery ................................ 2.85 2.26 0.17 5.28 000 S

17306 ............. A 3rd stage chemosurgery ................................. 2.85 1.40 0.11 4.36 000 S

17307 ............. A Followup skin lesion therapy .......................... 2.85 1.47 0.12 4.44 000 S

17310 ............. A Extensive skin chemosurgery ......................... 0.95 0.13 0.01 1.09 000 S

17340 ............. A Cryotherapy of skin ......................................... 0.73 0.28 0.02 1.03 010 S

17360 ............. A Skin peel therapy ............................................ 1.40 0.27 0.02 1.69 010 S

17380 ............. R Hair removal by electrolysis ............................ 0.00 0.00 0.00 0.00 XXX S

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

19000 ............. A Drainage of breast lesion ............................... 0.84 0.38 0.07 1.29 000 S

19001 ............. A Drain added breast lesion .............................. 0.42 0.24 0.05 0.71 ZZZ S

19020 ............. A Incision of breast lesion .................................. 3.37 1.40 0.28 5.05 090 S

19030 ............. A Injection for breast x-ray ................................. 1.53 0.49 0.04 2.06 000 N

19100 ............. A Biopsy of breast .............................................. 1.27 0.64 0.13 2.04 000 S

19101 ............. A Biopsy of breast .............................................. 3.13 2.34 0.45 5.92 010 S

19110 ............. A Nipple exploration ........................................... 4.15 2.46 0.51 7.12 090 S

19112 ............. A Excise breast duct fistula ................................ 3.52 2.34 0.35 6.21 090 S

19120 ............. A Removal of breast lesion ................................ 4.84 2.90 0.60 8.34 090 S

19125 ............. A Excision, breast lesion .................................... 5.85 2.90 0.60 9.35 090 S

19126 ............. A Excision, add’l breast lesion ........................... 2.93 1.45 0.31 4.69 ZZZ S

19140 ............. A Removal of breast tissue ................................ 4.90 4.29 0.91 10.10 090 S

19160 ............. A Removal of breast tissue ................................ 6.65 4.13 0.88 11.66 090 S

19162 ............. A Remove breast tissue, nodes ......................... 12.81 9.38 1.96 24.15 090 S

19180 ............. A Removal of breast .......................................... 8.15 5.61 1.17 14.93 090 S

19182 ............. A Removal of breast .......................................... 7.28 6.07 1.27 14.62 090 S

19200 ............. A Removal of breast .......................................... 14.23 10.22 2.15 26.60 090 S

19220 ............. A Removal of breast .......................................... 14.23 10.73 2.38 27.34 090 S

19240 ............. A Removal of breast .......................................... 14.71 9.44 1.99 26.14 090 S

19260 ............. A Removal of chest wall lesion .......................... 13.91 5.05 1.04 20.00 090 S

19271 ............. A Revision of chest wall ..................................... 17.07 13.95 2.77 33.79 090 S

19272 ............. A Extensive chest wall surgery .......................... 19.47 12.60 2.56 34.63 090 S

19290 ............. A Place needle wire, breast ............................... 1.27 0.44 0.07 1.78 000 S

19291 ............. A Place needle wire, breast ............................... 0.63 0.25 0.04 0.92 ZZZ S

19316 ............. A Suspension of breast ...................................... 10.07 12.84 2.43 25.34 090 S

19318 ............. A Reduction of large breast ............................... 11.08 *14.18 3.23 28.49 090 S

19324 ............. A Enlarge breast ................................................ 5.55 3.29 0.67 9.51 090 S

19325 ............. A Enlarge breast with implant ............................ 8.05 5.87 1.13 15.05 090 S

19328 ............. A Removal of breast implant .............................. 5.32 3.76 0.73 9.81 090 S

19330 ............. A Removal of implant material ........................... 7.18 3.88 0.75 11.81 090 S

19340 ............. A Immediate breast prosthesis .......................... 6.33 *8.10 2.06 16.49 ZZZ S

19342 ............. A Delayed breast prosthesis .............................. 10.64 10.81 2.03 23.48 090 S

19350 ............. A Breast reconstruction ...................................... 8.21 7.08 1.38 16.67 090 S

19355 ............. A Correct inverted nipple(s) ............................... 7.27 4.93 1.00 13.20 090 S

19357 ............. A Breast reconstruction ...................................... 16.72 12.15 2.37 31.24 090 S

19361 ............. A Breast reconstruction ...................................... 17.82 20.13 3.88 41.83 090 S

19364 ............. A Breast reconstruction ...................................... 27.60 16.68 3.58 47.86 090 S
63196

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

19366 ............. A Breast reconstruction ...................................... 19.84 16.40 3.18 39.42 090 S

19367 ............. A Breast reconstruction ...................................... 24.73 20.13 3.88 48.74 090 S

19368 ............. A Breast reconstruction ...................................... 31.15 20.13 3.88 55.16 090 S

19369 ............. A Breast reconstruction ...................................... 28.68 20.13 3.88 52.69 090 S

19370 ............. A Surgery of breast capsule .............................. 7.59 6.17 1.19 14.95 090 S

19371 ............. A Removal of breast capsule ............................. 8.84 7.91 1.54 18.29 090 S

19380 ............. A Revise breast reconstruction .......................... 8.63 8.11 1.57 18.31 090 S

19396 ............. A Design custom breast implant ........................ 2.17 1.57 0.31 4.05 000 S

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

20000 ............. A Incision of abscess ......................................... 1.85 0.85 0.08 2.78 010 S

20005 ............. A Incision of deep abscess ................................ 3.02 1.83 0.28 5.13 010 S

20100 ............. A Explore wound, neck ...................................... 9.50 4.97 1.16 15.63 010 S

20101 ............. A Explore wound, chest ..................................... 3.00 1.57 0.37 4.94 010 S

20102 ............. A Explore wound, abdomen ............................... 3.68 1.92 0.45 6.05 010 S

20103 ............. A Explore wound, extremity ............................... 4.95 2.59 0.60 8.14 010 S

20200 ............. A Muscle biopsy ................................................. 1.46 1.12 0.18 2.76 000 S

20205 ............. A Deep muscle biopsy ....................................... 2.35 1.88 0.33 4.56 000 S

20206 ............. A Needle biopsy, muscle ................................... 0.99 0.96 0.14 2.09 000 S

20220 ............. A Bone biopsy, trocar/needle ............................. 1.27 1.31 0.09 2.67 000 N

20225 ............. A Bone biopsy, trocar/needle ............................. 1.87 *2.39 0.28 4.54 000 N

20240 ............. A Bone biopsy, excisional .................................. 3.07 1.88 0.18 5.13 010 S

20245 ............. A Bone biopsy, excisional .................................. 3.68 3.58 0.44 7.70 010 S

20250 ............. A Open bone biopsy .......................................... 4.63 5.07 0.76 10.46 010 S

20251 ............. A Open bone biopsy .......................................... 5.16 5.84 0.92 11.92 010 S

20500 ............. A Injection of sinus tract ..................................... 1.18 0.36 0.04 1.58 010 N

20501 ............. A Inject sinus tract for x-ray ............................... 0.76 0.30 0.02 1.08 000 N

20520 ............. A Removal of foreign body ................................ 1.80 0.71 0.08 2.59 010 S

20525 ............. A Removal of foreign body ................................ 3.23 2.23 0.33 5.79 010 S

20550 ............. A Inj tendon/ligament/cyst .................................. 0.86 0.38 0.04 1.28 000 N

20600 ............. A Drain/inject joint/bursa .................................... 0.66 0.47 0.05 1.18 000 S

20605 ............. A Drain/inject joint/bursa .................................... 0.68 0.45 0.05 1.18 000 S

20610 ............. A Drain/inject joint/bursa .................................... 0.79 0.45 0.05 1.29 000 N

20615 ............. A Treatment of bone cyst ................................... 2.23 0.49 0.06 2.78 010 N

20650 ............. A Insert and remove bone pin ........................... 2.07 1.08 0.14 3.29 010 S

20660 ............. A Apply, remove fixation device ......................... 2.51 1.56 0.21 4.28 000 S

20661 ............. A Application of head brace ............................... 4.27 3.82 0.65 8.74 090 S

20662 ............. A Application of pelvis brace .............................. 5.52 6.54 1.03 13.09 090 S

20663 ............. A Application of thigh brace ............................... 4.88 4.64 0.76 10.28 090 S

20665 ............. A Removal of fixation device ............................. 1.26 0.50 0.07 1.83 010 S

20670 ............. A Removal of support implant ............................ 1.69 0.74 0.11 2.54 010 S

20680 ............. A Removal of support implant ............................ 3.25 3.33 0.51 7.09 090 S

20690 ............. A Apply bone fixation device .............................. 3.52 3.66 0.58 7.76 ZZZ S

20692 ............. A Apply bone fixation device .............................. 6.41 5.51 0.89 12.81 ZZZ S

20693 ............. A Adjust bone fixation device ............................. 5.42 2.49 0.42 8.33 090 S

20694 ............. A Remove bone fixation device ......................... 3.81 2.60 0.41 6.82 090 S

20802 ............. A Replantation, arm, complete ........................... 39.56 37.72 6.17 83.45 090 S

20804 ............. D Replantation, arm, partial ............................... 0.00 0.00 0.00 0.00 090 S

20805 ............. A Replant forearm, complete ............................. 48.41 46.17 7.56 102.14 090 S

20806 ............. D Replantation, forearm, partial ......................... 0.00 0.00 0.00 0.00 090 S

20808 ............. A Replantation, hand, complete ......................... 60.19 57.40 9.40 126.99 090 S

20812 ............. D Replantation, hand, partial .............................. 0.00 0.00 0.00 0.00 090 S

20816 ............. A Replantation digit, complete ........................... 29.67 28.30 4.63 62.60 090 S

20820 ............. D Replantation, digit, partial ............................... 0.00 0.00 0.00 0.00 090 S

20822 ............. A Replantation digit, complete ........................... 24.53 23.39 3.83 51.75 090 S

20823 ............. D Replantation, digit, partial ............................... 0.00 0.00 0.00 0.00 090 S

20824 ............. A Replantation thumb, complete ........................ 29.67 28.30 4.63 62.60 090 S

20826 ............. D Replantation, thumb, partial ............................ 0.00 0.00 0.00 0.00 090 S

20827 ............. A Replantation thumb, complete ........................ 25.22 24.05 3.94 53.21 090 S

20828 ............. D Replantation, thumb, partial ............................ 0.00 0.00 0.00 0.00 090 S

20832 ............. D Replantation, leg, complete ............................ 0.00 0.00 0.00 0.00 090 S

20834 ............. D Replantation, leg, partial ................................. 0.00 0.00 0.00 0.00 090 S

20838 ............. A Replantation, foot, complete ........................... 39.56 37.72 6.17 83.45 090 S

20840 ............. D Replantation, foot, partial ................................ 0.00 0.00 0.00 0.00 090 S

20900 ............. A Removal of bone for graft ............................... 5.03 2.80 0.45 8.28 090 S

20902 ............. A Removal of bone for graft ............................... 6.74 4.95 0.80 12.49 090 S

20910 ............. A Remove cartilage for graft .............................. 5.03 0.79 0.09 5.91 090 S
63197

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

20912 ............. A Remove cartilage for graft .............................. 6.04 4.62 0.64 11.30 090 S

20920 ............. A Removal of fascia for graft ............................. 4.87 3.93 0.50 9.30 090 S

20922 ............. A Removal of fascia for graft ............................. 6.04 4.39 0.71 11.14 090 S

20924 ............. A Removal of tendon for graft ............................ 6.04 5.45 0.85 12.34 090 S

20926 ............. A Removal of tissue for graft ............................. 5.03 2.59 0.39 8.01 090 S

20930 ............. B Spinal bone allograft ....................................... 0.00 0.00 0.00 0.00 XXX 0

20931 ............. A Spinal bone allograft ....................................... 1.81 1.73 0.28 3.82 ZZZ S

20936 ............. B Spinal bone autograft ..................................... 0.00 0.00 0.00 0.00 XXX 0

20937 ............. A Spinal bone autograft ..................................... 2.79 2.66 0.44 5.89 ZZZ S

20938 ............. A Spinal bone autograft ..................................... 3.02 2.88 0.47 6.37 ZZZ S

20950 ............. A Record fluid pressure, muscle ........................ 1.26 1.09 0.17 2.52 000 S

20955 ............. A Microvascular fibula graft ................................ 37.58 35.84 5.87 79.29 090 S

20960 ............. C Microvascular rib graft .................................... 0.00 0.00 0.00 0.00 090 S

20962 ............. C Microvascular bone graft ................................ 0.00 0.00 0.00 0.00 090 S

20969 ............. A Bone-skin graft ................................................ 42.08 40.13 6.57 88.78 090 S

20970 ............. A Bone-skin graft, pelvis .................................... 41.22 39.31 6.44 86.97 090 S

20971 ............. C Bone-skin graft, rib ......................................... 0.00 0.00 0.00 0.00 090 S

20972 ............. A Bone-skin graft, metatarsal ............................. 41.54 39.61 6.49 87.64 090 S

20973 ............. A Bone-skin graft, great toe ............................... 44.31 42.25 6.91 93.47 090 S

20974 ............. A Electrical bone stimulation .............................. 0.62 3.42 0.53 4.57 ZZZ S

20975 ............. A Electrical bone stimulation .............................. 2.60 *3.33 0.56 6.49 ZZZ S

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

21010 ............. A Incision of jaw joint ......................................... 9.06 10.24 0.93 20.23 090 S

21015 ............. A Resection of facial tumor ................................ 4.94 *6.32 1.13 12.39 090 S

21025 ............. A Excision of bone, lower jaw ............................ 5.03 4.14 0.38 9.55 090 S

21026 ............. A Excision of facial bone(s) ............................... 4.53 3.14 0.28 7.95 090 S

21029 ............. A Contour of face bone lesion ........................... 7.21 *9.23 0.78 17.22 090 S

21030 ............. A Removal of face bone lesion .......................... 7.05 3.35 0.29 10.69 090 S

21031 ............. A Remove exostosis, mandible .......................... 2.01 3.68 0.32 6.01 090 S

21032 ............. A Remove exostosis, maxilla ............................. 4.27 3.88 0.35 8.50 090 S

21034 ............. A Removal of face bone lesion .......................... 15.11 6.98 0.89 22.98 090 S

21040 ............. A Removal of jaw bone lesion ........................... 2.01 2.76 0.24 5.01 090 S

21041 ............. A Removal of jaw bone lesion ........................... 5.03 5.76 0.50 11.29 090 S

21044 ............. A Removal of jaw bone lesion ........................... 11.08 9.55 1.11 21.74 090 S

21045 ............. A Extensive jaw surgery ..................................... 15.11 13.83 1.58 30.52 090 S

21050 ............. A Removal of jaw joint ....................................... 10.07 12.33 1.08 23.48 090 S

21060 ............. A Remove jaw joint cartilage .............................. 9.56 11.59 1.04 22.19 090 S

21070 ............. A Remove coronoid process .............................. 7.66 6.81 0.82 15.29 090 S

21076 ............. A Prepare face/oral prosthesis ........................... 12.54 16.77 1.35 30.66 010 S

21077 ............. A Prepare face/oral prosthesis ........................... 31.54 42.18 3.39 77.11 090 S

21079 ............. A Prepare face/oral prosthesis ........................... 20.88 27.93 2.25 51.06 090 S

21080 ............. A Prepare face/oral prosthesis ........................... 23.46 31.38 2.52 57.36 090 S

21081 ............. A Prepare face/oral prosthesis ........................... 21.38 28.59 2.30 52.27 090 S

21082 ............. A Prepare face/oral prosthesis ........................... 19.50 26.08 2.10 47.68 090 S

21083 ............. A Prepare face/oral prosthesis ........................... 18.04 24.13 1.94 44.11 090 S

21084 ............. A Prepare face/oral prosthesis ........................... 21.04 28.14 2.28 51.46 090 S

21085 ............. A Prepare face/oral prosthesis ........................... 8.41 11.25 0.90 20.56 010 S

21086 ............. A Prepare face/oral prosthesis ........................... 23.29 31.15 2.51 56.95 090 S

21087 ............. A Prepare face/oral prosthesis ........................... 23.29 31.15 2.51 56.95 090 S

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

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

21100 ............. A Maxillofacial fixation ........................................ 4.04 1.06 0.11 5.21 090 S

21110 ............. A Interdental fixation .......................................... 5.03 5.53 0.46 11.02 090 S

21116 ............. A Injection, jaw joint x-ray .................................. 0.81 0.73 0.06 1.60 000 S

21120 ............. A Reconstruction of chin .................................... 4.75 3.59 0.42 8.76 090 S

21121 ............. A Reconstruction of chin .................................... 7.46 5.65 0.66 13.77 090 S

21122 ............. A Reconstruction of chin .................................... 8.21 6.23 0.73 15.17 090 S

21123 ............. A Reconstruction of chin .................................... 10.74 8.14 0.95 19.83 090 S

21125 ............. A Augmentation lower jaw bone ........................ 6.22 4.72 0.54 11.48 090 S

21127 ............. A Augmentation lower jaw bone ........................ 10.43 7.91 0.92 19.26 090 S

21137 ............. A Reduction of forehead .................................... 9.40 7.11 0.83 17.34 090 S

21138 ............. A Reduction of forehead .................................... 11.72 8.86 1.04 21.62 090 S

21139 ............. A Reduction of forehead .................................... 14.06 10.64 1.25 25.95 090 S

21141 ............. A Reconstruct midface, lefort ............................. 16.92 14.34 1.68 32.94 090 S

21142 ............. A Reconstruct midface, lefort ............................. 17.58 14.84 1.74 34.16 090 S

21143 ............. A Reconstruct midface, lefort ............................. 18.30 15.40 1.81 35.51 090 S
63198

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

21144 ............. D Reconstruct midface, lefort ............................. 0.00 0.00 0.00 0.00 090 S

21145 ............. A Reconstruct midface, lefort ............................. 18.92 14.34 1.68 34.94 090 S

21146 ............. A Reconstruct midface, lefort ............................. 19.58 14.84 1.74 36.16 090 S

21147 ............. A Reconstruct midface, lefort ............................. 20.30 15.40 1.81 37.51 090 S

21150 ............. A Reconstruct midface, lefort ............................. 24.41 18.46 2.17 45.04 090 S

21151 ............. A Reconstruct midface, lefort ............................. 27.34 20.68 2.42 50.44 090 S

21154 ............. A Reconstruct midface, lefort ............................. 29.28 22.15 2.59 54.02 090 S

21155 ............. A Reconstruct midface, lefort ............................. 33.19 25.11 2.94 61.24 090 S

21159 ............. A Reconstruct midface, lefort ............................. 40.99 31.02 3.63 75.64 090 S

21160 ............. A Reconstruct midface, lefort ............................. 44.90 33.96 3.98 82.84 090 S

21172 ............. A Reconstruct orbit/forehead ............................. 26.84 20.30 2.37 49.51 090 S

21175 ............. A Reconstruct orbit/forehead ............................. 32.21 24.37 2.85 59.43 090 S

21179 ............. A Reconstruct entire forehead ........................... 21.47 16.24 1.90 39.61 090 S

21180 ............. A Reconstruct entire forehead ........................... 24.41 18.46 2.17 45.04 090 S

21181 ............. A Contour cranial bone lesion ............................ 9.40 7.11 0.83 17.34 090 S

21182 ............. A Reconstruct cranial bone ................................ 31.23 23.63 2.77 57.63 090 S

21183 ............. A Reconstruct cranial bone ................................ 34.17 25.85 3.03 63.05 090 S

21184 ............. A Reconstruct cranial bone ................................ 37.10 28.06 3.28 68.44 090 S

21188 ............. A Reconstruction of midface .............................. 21.47 16.24 1.90 39.61 090 S

21193 ............. A Reconstruct lower jaw bone ........................... 16.23 12.31 1.44 29.98 090 S

21194 ............. A Reconstruct lower jaw bone ........................... 18.81 14.26 1.67 34.74 090 S

21195 ............. A Reconstruct lower jaw bone ........................... 16.27 12.34 1.44 30.05 090 S

21196 ............. A Reconstruct lower jaw bone ........................... 17.94 13.61 1.58 33.13 090 S

21198 ............. A Reconstruct lower jaw bone ........................... 13.36 14.82 1.74 29.92 090 S

21206 ............. A Reconstruct upper jaw bone ........................... 13.36 10.14 1.19 24.69 090 S

21208 ............. A Augmentation of facial bones ......................... 9.56 11.26 1.07 21.89 090 S

21209 ............. A Reduction of facial bones ............................... 6.28 4.59 0.76 11.63 090 S

21210 ............. A Face bone graft .............................................. 9.56 *12.24 1.29 23.09 090 S

21215 ............. A Lower jaw bone graft ...................................... 10.07 *12.89 1.42 24.38 090 S

21230 ............. A Rib cartilage graft ........................................... 10.07 10.37 1.69 22.13 090 S

21235 ............. A Ear cartilage graft ........................................... 6.28 *8.04 1.09 15.41 090 S

21240 ............. A Reconstruction of jaw joint ............................. 13.10 *16.77 2.09 31.96 090 S

21242 ............. A Reconstruction of jaw joint ............................. 12.10 *15.55 2.25 29.90 090 S

21243 ............. A Reconstruction of jaw joint ............................. 18.98 14.40 1.68 35.06 090 S

21244 ............. A Reconstruction of lower jaw ........................... 11.08 *14.18 1.93 27.19 090 S

21245 ............. A Reconstruction of jaw ..................................... 11.08 11.47 1.31 23.86 090 S

21246 ............. A Reconstruction of jaw ..................................... 11.65 8.83 1.04 21.52 090 S

21247 ............. A Reconstruct lower jaw bone ........................... 21.15 *27.08 2.27 50.50 090 S

21248 ............. A Reconstruction of jaw ..................................... 11.08 *14.18 1.75 27.01 090 S

21249 ............. A Reconstruction of jaw ..................................... 17.12 *23.10 3.29 43.51 090 S

21255 ............. A Reconstruct lower jaw bone ........................... 15.63 *20.00 1.68 37.31 090 S

21256 ............. A Reconstruction of orbit .................................... 15.13 *19.36 1.63 36.12 090 S

21260 ............. A Revise eye sockets ......................................... 15.44 *19.76 1.66 36.86 090 S

21261 ............. A Revise eye sockets ......................................... 29.43 17.78 1.65 48.86 090 S

21263 ............. A Revise eye sockets ......................................... 26.56 *34.00 2.86 63.42 090 S

21267 ............. A Revise eye sockets ......................................... 17.66 14.61 2.13 34.40 090 S

21268 ............. A Revise eye sockets ......................................... 22.88 15.35 3.13 41.36 090 S

21270 ............. A Augmentation cheek bone .............................. 12.10 9.60 1.41 23.11 090 S

21275 ............. A Revision orbitofacial bones ............................. 10.50 8.95 1.26 20.71 090 S

21280 ............. A Revision of eyelid ........................................... 5.64 7.19 0.61 13.44 090 S

21282 ............. A Revision of eyelid ........................................... 3.26 *4.52 0.79 8.57 090 S

21295 ............. A Revision of jaw muscle/bone .......................... 1.43 0.96 0.13 2.52 090 S

21296 ............. A Revision of jaw muscle/bone .......................... 3.97 3.62 0.22 7.81 090 S

21299 ............. C Cranio/maxillofacial surgery ............................ 0.00 0.00 0.00 0.00 YYY S

21300 ............. A Treatment of skull fracture .............................. 0.72 *0.92 0.11 1.75 000 S

21310 ............. A Treatment of nose fracture ............................. 0.58 *0.75 0.09 1.42 000 N

21315 ............. A Treatment of nose fracture ............................. 1.41 1.81 0.21 3.43 010 S

21320 ............. A Treatment of nose fracture ............................. 1.82 *2.33 0.34 4.49 010 S

21325 ............. A Repair of nose fracture ................................... 3.52 4.09 0.52 8.13 090 S

21330 ............. A Repair of nose fracture ................................... 5.03 *6.45 0.86 12.34 090 S

21335 ............. A Repair of nose fracture ................................... 8.05 *10.31 1.56 19.92 090 S

21336 ............. A Repair nasal septal fracture ........................... 5.35 4.09 0.52 9.96 090 S

21337 ............. A Repair nasal septal fracture ........................... 2.52 2.82 0.38 5.72 090 S

21338 ............. A Repair nasoethmoid fracture .......................... 6.04 5.01 0.66 11.71 090 S

21339 ............. A Repair nasoethmoid fracture .......................... 7.56 7.09 0.70 15.35 090 S

21340 ............. A Repair of nose fracture ................................... 10.07 8.91 1.04 20.02 090 S
63199

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

21343 ............. A Repair of sinus fracture .................................. 12.10 9.17 1.08 22.35 090 S

21344 ............. A Repair of sinus fracture .................................. 18.43 9.17 1.08 28.68 090 S

21345 ............. A Repair of nose/jaw fracture ............................ 7.63 7.90 0.81 16.34 090 S

21346 ............. A Repair of nose/jaw fracture ............................ 9.92 9.40 1.04 20.36 090 S

21347 ............. A Repair of nose/jaw fracture ............................ 11.86 10.36 1.36 23.58 090 S

21348 ............. A Repair of nose/jaw fracture ............................ 15.60 11.34 2.22 29.16 090 S

21355 ............. A Repair cheek bone fracture ............................ 3.52 1.56 0.17 5.25 010 S

21356 ............. A Repair cheek bone fracture ............................ 3.88 *4.96 0.89 9.73 010 S

21360 ............. A Repair cheek bone fracture ............................ 6.04 7.28 0.89 14.21 090 S

21365 ............. A Repair cheek bone fracture ............................ 13.97 12.35 1.63 27.95 090 S

21366 ............. A Repair cheek bone fracture ............................ 16.61 12.08 2.36 31.05 090 S

21385 ............. A Repair eye socket fracture ............................. 8.56 9.59 1.13 19.28 090 S

21386 ............. A Repair eye socket fracture ............................. 8.56 9.07 1.25 18.88 090 S

21387 ............. A Repair eye socket fracture ............................. 9.07 7.45 0.96 17.48 090 S

21390 ............. A Repair eye socket fracture ............................. 9.47 11.89 1.37 22.73 090 S

21395 ............. A Repair eye socket fracture ............................. 11.85 9.63 1.37 22.85 090 S

21400 ............. A Treat eye socket fracture ................................ 1.31 *1.67 0.17 3.15 090 N

21401 ............. A Repair eye socket fracture ............................. 3.05 2.58 0.32 5.95 090 S

21406 ............. A Repair eye socket fracture ............................. 6.55 5.21 0.74 12.50 090 S

21407 ............. A Repair eye socket fracture ............................. 8.05 7.09 0.78 15.92 090 S

21408 ............. A Repair eye socket fracture ............................. 11.57 8.49 0.99 21.05 090 S

21421 ............. A Treat mouth roof fracture ................................ 4.80 *6.14 0.62 11.56 090 S

21422 ............. A Repair mouth roof fracture ............................. 7.78 9.80 1.19 18.77 090 S

21423 ............. A Repair mouth roof fracture ............................. 9.72 9.80 1.19 20.71 090 S

21431 ............. A Treat craniofacial fracture ............................... 6.59 6.02 0.71 13.32 090 S

21432 ............. A Repair craniofacial fracture ............................. 8.05 6.76 0.84 15.65 090 S

21433 ............. A Repair craniofacial fracture ............................. 23.69 17.96 2.10 43.75 090 S

21435 ............. A Repair craniofacial fracture ............................. 16.12 13.25 1.88 31.25 090 S

21436 ............. A Repair craniofacial fracture ............................. 26.21 14.65 2.08 42.94 090 S

21440 ............. A Repair dental ridge fracture ............................ 2.52 3.07 0.28 5.87 090 S

21445 ............. A Repair dental ridge fracture ............................ 5.03 6.11 0.56 11.70 090 S

21450 ............. A Treat lower jaw fracture .................................. 2.78 2.84 0.26 5.88 090 S

21451 ............. A Treat lower jaw fracture .................................. 4.55 *5.83 0.74 11.12 090 S

21452 ............. A Treat lower jaw fracture .................................. 1.85 1.39 0.17 3.41 090 S

21453 ............. A Treat lower jaw fracture .................................. 5.18 *6.64 0.55 12.37 090 S

21454 ............. A Treat lower jaw fracture .................................. 6.04 *8.19 1.42 15.65 090 S

21461 ............. A Repair lower jaw fracture ................................ 7.56 *9.67 1.30 18.53 090 S

21462 ............. A Repair lower jaw fracture ................................ 9.15 *11.71 1.34 22.20 090 S

21465 ............. A Repair lower jaw fracture ................................ 11.13 8.44 0.99 20.56 090 S

21470 ............. A Repair lower jaw fracture ................................ 14.19 17.13 1.74 33.06 090 S

21480 ............. A Reset dislocated jaw ....................................... 0.61 *0.78 0.09 1.48 000 S

21485 ............. A Reset dislocated jaw ....................................... 3.73 2.19 0.20 6.12 090 S

21490 ............. A Repair dislocated jaw ..................................... 11.08 6.31 0.52 17.91 090 S

21493 ............. A Treat hyoid bone fracture ............................... 1.19 *1.52 0.13 2.84 090 S

21494 ............. A Repair hyoid bone fracture ............................. 5.87 *7.52 0.63 14.02 090 S

21495 ............. A Repair hyoid bone fracture ............................. 5.32 4.82 0.51 10.65 090 S

21497 ............. A Interdental wiring ............................................ 3.61 3.97 0.38 7.96 090 S

21499 ............. C Head surgery procedure ................................. 0.00 0.00 0.00 0.00 YYY S

21501 ............. A Drain neck/chest lesion .................................. 3.52 1.82 0.26 5.60 090 S

21502 ............. A Drain chest lesion ........................................... 6.44 4.22 0.75 11.41 090 S

21510 ............. A Drainage of bone lesion ................................. 5.03 3.82 0.50 9.35 090 S

21550 ............. A Biopsy of neck/chest ....................................... 2.01 0.85 0.12 2.98 010 S

21555 ............. A Remove lesion neck/chest .............................. 4.09 1.60 0.25 5.94 090 S

21556 ............. A Remove lesion neck/chest .............................. 5.28 3.80 0.64 9.72 090 S

21557 ............. A Remove tumor, neck or chest ........................ 8.56 8.50 1.41 18.47 090 S

21600 ............. A Partial removal of rib ...................................... 6.27 4.50 0.88 11.65 090 S

21610 ............. A Partial removal of rib ...................................... 8.54 5.17 0.76 14.47 090 S

21615 ............. A Removal of rib ................................................ 9.03 10.13 1.96 21.12 090 S

21616 ............. A Removal of rib and nerves ............................. 11.11 7.26 1.50 19.87 090 S

21620 ............. A Partial removal of sternum .............................. 6.04 6.85 1.23 14.12 090 S

21627 ............. A Sternal debridement ....................................... 6.06 5.03 0.90 11.99 090 S

21630 ............. A Extensive sternum surgery ............................. 15.77 12.89 2.40 31.06 090 S

21632 ............. A Extensive sternum surgery ............................. 16.62 11.54 2.22 30.38 090 S

21700 ............. A Revision of neck muscle ................................. 5.84 4.16 0.50 10.50 090 S

21705 ............. A Revision of neck muscle/rib ............................ 9.03 4.85 0.96 14.84 090 S

21720 ............. A Revision of neck muscle ................................. 5.44 3.84 0.52 9.80 090 S
63200

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

21725 ............. A Revision of neck muscle ................................. 6.55 4.84 0.74 12.13 090 S

21740 ............. A Reconstruction of sternum .............................. 15.42 8.99 1.64 26.05 090 S

21750 ............. A Repair of sternum separation ......................... 10.07 7.33 1.43 18.83 090 S

21800 ............. A Treatment of rib fracture ................................. 0.91 0.77 0.07 1.75 090 N

21805 ............. A Treatment of rib fracture ................................. 2.62 1.35 0.17 4.14 090 S

21810 ............. A Treatment of rib fracture(s) ............................. 6.68 7.33 0.61 14.62 090 N

21820 ............. A Treat sternum fracture .................................... 1.20 1.36 0.17 2.73 090 S

21825 ............. A Repair sternum fracture .................................. 6.82 6.90 1.12 14.84 090 S

21899 ............. C Neck/chest surgery procedure ........................ 0.00 0.00 0.00 0.00 YYY S

21920 ............. A Biopsy soft tissue of back ............................... 2.01 0.79 0.11 2.91 010 S

21925 ............. A Biopsy soft tissue of back ............................... 4.23 1.95 0.32 6.50 090 S

21930 ............. A Remove lesion, back or flank ......................... 6.55 2.72 0.49 9.76 090 S

21935 ............. A Remove tumor of back ................................... 17.12 6.59 1.30 25.01 090 S

22100 ............. A Remove part of neck vertebra ........................ 9.05 7.64 1.09 17.78 090 S

22101 ............. A Remove part, thorax vertebra ......................... 9.00 8.01 1.38 18.39 090 S

22102 ............. A Remove part, lumbar vertebra ........................ 9.00 4.50 0.67 14.17 090 S

22103 ............. A Remove extra spine segment ......................... 2.34 2.23 0.37 4.94 ZZZ S

22105 ............. D Remove part of neck vertebra ........................ 0.00 0.00 0.00 0.00 090 S

22106 ............. D Remove part, thorax vertebra ......................... 0.00 0.00 0.00 0.00 090 S

22107 ............. D Remove part, lumbar vertebra ........................ 0.00 0.00 0.00 0.00 090 S

22110 ............. A Remove part of neck vertebra ........................ 11.59 9.72 1.64 22.95 090 S

22112 ............. A Remove part, thorax vertebra ......................... 11.59 9.90 1.63 23.12 090 S

22114 ............. A Remove part, lumbar vertebra ........................ 11.59 7.25 1.17 20.01 090 S

22116 ............. A Remove extra spine segment ......................... 2.32 2.21 0.36 4.89 ZZZ S

22140 ............. D Reconstruct neck spine .................................. 0.00 0.00 0.00 0.00 090 S

22141 ............. D Reconstruct thorax spine ................................ 0.00 0.00 0.00 0.00 090 S

22142 ............. D Reconstruct lumbar spine ............................... 0.00 0.00 0.00 0.00 090 S

22145 ............. D Reconstruct vertebra(e) .................................. 0.00 0.00 0.00 0.00 ZZZ S

22148 ............. D Harvesting bone graft ..................................... 0.00 0.00 0.00 0.00 ZZZ S

22150 ............. D Reconstruct neck spine .................................. 0.00 0.00 0.00 0.00 090 S

22151 ............. D Reconstruct thorax spine ................................ 0.00 0.00 0.00 0.00 090 S

22152 ............. D Reconstruct lumbar spine ............................... 0.00 0.00 0.00 0.00 090 S

22210 ............. A Revision of neck spine ................................... 22.51 13.83 2.43 38.77 090 S

22212 ............. A Revision of thorax spine ................................. 18.14 17.29 2.83 38.26 090 S

22214 ............. A Revision of lumbar spine ................................ 18.14 15.11 2.68 35.93 090 S

22216 ............. A Revise, extra spine segment .......................... 6.04 5.07 0.89 12.00 ZZZ S

22220 ............. A Revision of neck spine ................................... 20.15 16.64 2.63 39.42 090 S

22222 ............. A Revision of thorax spine ................................. 20.15 13.61 1.58 35.34 090 S

22224 ............. A Revision of lumbar spine ................................ 20.15 14.68 2.66 37.49 090 S

22226 ............. A Revise, extra spine segment .......................... 6.04 5.07 0.89 12.00 ZZZ S

22230 ............. D Additional revision of spine ............................. 0.00 0.00 0.00 0.00 ZZZ S

22305 ............. A Treat spine process fracture ........................... 1.86 *2.38 0.37 4.61 090 S

22310 ............. A Treat spine fracture ........................................ 1.86 *2.52 0.69 5.07 090 S

22315 ............. A Treat spine fracture ........................................ 8.36 5.51 0.86 14.73 090 S

22325 ............. A Repair of spine fracture .................................. 17.19 8.32 1.34 26.85 090 S

22326 ............. A Repair neck spine fracture ............................. 18.43 15.93 2.74 37.10 090 S

22327 ............. A Repair thorax spine fracture ........................... 17.56 15.95 2.35 35.86 090 S

22328 ............. A Repair each add spine fx ............................... 4.61 4.40 0.72 9.73 ZZZ S

22505 ............. A Manipulation of spine ...................................... 1.77 1.31 0.17 3.25 010 N

22548 ............. A Neck spine fusion ........................................... 24.08 22.74 3.82 50.64 090 S

22554 ............. A Neck spine fusion ........................................... 17.24 19.81 3.52 40.57 090 S

22556 ............. A Thorax spine fusion ........................................ 22.27 21.68 3.58 47.53 090 S

22558 ............. A Lumbar spine fusion ....................................... 21.22 20.17 3.38 44.77 090 S

22585 ............. A Additional spinal fusion ................................... 5.53 5.40 0.93 11.86 ZZZ S

22590 ............. A Spine & skull spinal fusion ............................. 19.50 21.57 3.44 44.51 090 S

22595 ............. A Neck spinal fusion .......................................... 18.19 22.46 3.87 44.52 090 S

22600 ............. A Neck spine fusion ........................................... 14.74 19.36 3.32 37.42 090 S

22610 ............. A Thorax spine fusion ........................................ 14.62 17.87 2.75 35.24 090 S

22612 ............. A Lumbar spine fusion ....................................... 20.19 20.60 3.33 44.12 090 S

22614 ............. A Spine fusion, extra segment ........................... 6.44 5.65 0.92 13.01 ZZZ S

22625 ............. D Lumbar spine fusion ....................................... 0.00 0.00 0.00 0.00 090 S

22630 ............. A Lumbar spine fusion ....................................... 20.03 18.44 3.15 41.62 090 S

22632 ............. A Spine fusion, extra segment ........................... 5.23 4.99 0.82 11.04 ZZZ S

22650 ............. D Additional spinal fusion ................................... 0.00 0.00 0.00 0.00 ZZZ S

22800 ............. A Fusion of spine ............................................... 16.92 *21.66 3.58 42.16 090 S

22802 ............. A Fusion of spine ............................................... 29.74 28.32 4.61 62.67 090 S
63201

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

22804 ............. A Fusion of spine ............................................... 35.00 28.32 4.61 67.93 090 S

22808 ............. A Fusion of spine ............................................... 25.00 18.41 3.15 46.56 090 S

22810 ............. A Fusion of spine ............................................... 29.00 18.41 3.15 50.56 090 S

22812 ............. A Fusion of spine ............................................... 31.00 25.93 4.24 61.17 090 S

22820 ............. D Harvesting of bone ......................................... 0.00 0.00 0.00 0.00 ZZZ S

22830 ............. A Exploration of spinal fusion ............................ 10.22 *13.07 2.18 25.47 090 S

22840 ............. A Insert spine fixation device ............................. 6.27 5.98 0.98 13.23 ZZZ S

22841 ............. B Insert spine fixation device ............................. 0.00 0.00 0.00 0.00 XXX 0

22842 ............. A Insert spine fixation device ............................. 7.19 6.86 1.12 15.17 ZZZ S

22843 ............. A Insert spine fixation device ............................. 8.97 8.55 1.40 18.92 ZZZ S

22844 ............. A Insert spine fixation device ............................. 10.96 10.45 1.71 23.12 ZZZ S

22845 ............. A Insert spine fixation device ............................. 5.98 5.70 0.93 12.61 ZZZ S

22846 ............. A Insert spine fixation device ............................. 8.28 7.90 1.29 17.47 ZZZ S

22847 ............. A Insert spine fixation device ............................. 9.20 8.77 1.44 19.41 ZZZ S

22848 ............. A Insert pelvic fixation device ............................ 6.00 5.72 0.94 12.66 ZZZ S

22849 ............. A Reinsert spinal fixation ................................... 12.86 11.76 1.97 26.59 090 S

22850 ............. A Remove spine fixation device ......................... 8.98 9.17 1.50 19.65 090 S

22851 ............. A Apply spine prosth device .............................. 6.71 6.40 1.05 14.16 ZZZ S

22852 ............. A Remove spine fixation device ......................... 8.40 9.80 1.57 19.77 090 S

22855 ............. A Remove spine fixation device ......................... 9.10 7.46 1.25 17.81 090 S

22899 ............. C Spine surgery procedure ................................ 0.00 0.00 0.00 0.00 YYY S

22900 ............. A Remove abdominal wall lesion ....................... 6.56 3.03 0.60 10.19 090 S

22999 ............. C Abdomen surgery procedure .......................... 0.00 0.00 0.00 0.00 YYY S

23000 ............. A Removal of calcium deposits .......................... 4.12 3.24 0.47 7.83 090 S

23020 ............. A Release shoulder joint .................................... 8.25 7.27 1.09 16.61 090 S

23030 ............. A Drain shoulder lesion ...................................... 3.16 2.16 0.35 5.67 010 S

23031 ............. A Drain shoulder bursa ...................................... 2.69 0.50 0.05 3.24 010 S

23035 ............. A Drain shoulder bone lesion ............................. 7.80 6.22 1.04 15.06 090 S

23040 ............. A Exploratory shoulder surgery .......................... 8.39 9.27 1.47 19.13 090 S

23044 ............. A Exploratory shoulder surgery .......................... 6.40 6.91 1.18 14.49 090 S

23065 ............. A Biopsy shoulder tissues .................................. 2.24 0.66 0.09 2.99 010 S

23066 ............. A Biopsy shoulder tissues .................................. 4.01 1.18 0.10 5.29 090 S

23075 ............. A Removal of shoulder lesion ............................ 2.34 1.68 0.29 4.31 010 S

23076 ............. A Removal of shoulder lesion ............................ 7.12 3.54 0.65 11.31 090 S

23077 ............. A Remove tumor of shoulder ............................. 14.65 7.38 1.38 23.41 090 S

23100 ............. A Biopsy of shoulder joint .................................. 5.63 *7.20 1.24 14.07 090 S

23101 ............. A Shoulder joint surgery ..................................... 5.21 *6.68 1.21 13.10 090 S

23105 ............. A Remove shoulder joint lining .......................... 7.74 *9.91 1.73 19.38 090 S

23106 ............. A Incision of collarbone joint .............................. 5.56 4.75 0.80 11.11 090 S

23107 ............. A Explore, treat shoulder joint ............................ 8.13 9.59 1.60 19.32 090 S

23120 ............. A Partial removal, collar bone ............................ 6.65 4.61 0.74 12.00 090 S

23125 ............. A Removal of collarbone .................................... 8.90 8.49 1.27 18.66 090 S

23130 ............. A Partial removal, shoulder bone ....................... 7.10 7.05 1.14 15.29 090 S

23140 ............. A Removal of bone lesion .................................. 6.43 4.16 0.73 11.32 090 S

23145 ............. A Removal of bone lesion .................................. 8.54 8.13 1.33 18.00 090 S

23146 ............. A Removal of bone lesion .................................. 7.34 5.23 1.01 13.58 090 S

23150 ............. A Removal of humerus lesion ............................ 7.80 6.64 1.01 15.45 090 S

23155 ............. A Removal of humerus lesion ............................ 9.58 8.80 1.37 19.75 090 S

23156 ............. A Removal of humerus lesion ............................ 8.00 7.64 1.25 16.89 090 S

23170 ............. A Remove collarbone lesion .............................. 6.27 4.81 0.78 11.86 090 S

23172 ............. A Remove shoulder blade lesion ....................... 6.24 5.16 0.73 12.13 090 S

23174 ............. A Remove humerus lesion ................................. 8.71 8.55 1.21 18.47 090 S

23180 ............. A Remove collar bone lesion ............................. 7.82 4.30 0.67 12.79 090 S

23182 ............. A Remove shoulder blade lesion ....................... 7.44 6.57 1.13 15.14 090 S

23184 ............. A Remove humerus lesion ................................. 8.61 8.83 1.48 18.92 090 S

23190 ............. A Partial removal of scapula .............................. 6.78 6.07 0.98 13.83 090 S

23195 ............. A Removal of head of humerus ......................... 9.00 8.91 1.45 19.36 090 S

23200 ............. A Removal of collar bone ................................... 11.05 9.17 1.26 21.48 090 S

23210 ............. A Removal of shoulderblade .............................. 11.39 9.01 1.41 21.81 090 S

23220 ............. A Partial removal of humerus ............................ 13.31 12.05 2.03 27.39 090 S

23221 ............. A Partial removal of humerus ............................ 16.62 18.13 1.19 35.94 090 S

23222 ............. A Partial removal of humerus ............................ 16.64 15.02 2.30 33.96 090 S

23330 ............. A Remove shoulder foreign body ...................... 1.80 0.55 0.07 2.42 010 S

23331 ............. A Remove shoulder foreign body ...................... 6.89 2.26 0.38 9.53 090 S

23332 ............. A Remove shoulder foreign body ...................... 10.59 9.72 1.57 21.88 090 S

23350 ............. A Injection for shoulder x-ray ............................. 1.00 0.52 0.05 1.57 000 N
63202

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

23395 ............. A Muscle transfer, shoulder/arm ........................ 12.42 11.13 1.84 25.39 090 S

23397 ............. A Muscle transfers ............................................. 15.23 13.97 2.34 31.54 090 S

23400 ............. A Fixation of shoulder blade .............................. 12.96 9.84 1.68 24.48 090 S

23405 ............. A Incision of tendon & muscle ........................... 7.97 7.49 0.99 16.45 090 S

23406 ............. A Incise tendon(s) & muscle(s) .......................... 10.33 9.41 1.58 21.32 090 S

23410 ............. A Repair of tendon(s) ......................................... 11.90 10.94 1.75 24.59 090 S

23412 ............. A Repair of tendon(s) ......................................... 12.69 13.37 2.16 28.22 090 S

23415 ............. A Release of shoulder ligament ......................... 9.51 5.18 0.83 15.52 090 S

23420 ............. A Repair of shoulder .......................................... 12.60 14.68 2.34 29.62 090 S

23430 ............. A Repair biceps tendon ...................................... 9.56 7.34 1.19 18.09 090 S

23440 ............. A Removal/transplant tendon ............................. 10.08 7.17 1.17 18.42 090 S

23450 ............. A Repair shoulder capsule ................................. 12.85 12.75 2.04 27.64 090 S

23455 ............. A Repair shoulder capsule ................................. 13.82 15.56 2.50 31.88 090 S

23460 ............. A Repair shoulder capsule ................................. 14.66 14.07 2.24 30.97 090 S

23462 ............. A Repair shoulder capsule ................................. 14.62 15.13 2.48 32.23 090 S

23465 ............. A Repair shoulder capsule ................................. 15.14 14.15 2.27 31.56 090 S

23466 ............. A Repair shoulder capsule ................................. 13.65 16.53 2.67 32.85 090 S

23470 ............. A Reconstruct shoulder joint .............................. 16.12 16.76 2.65 35.53 090 S

23472 ............. A Reconstruct shoulder joint .............................. 16.09 *20.60 4.89 41.58 090 S

23480 ............. A Revision of collarbone .................................... 10.56 6.59 1.02 18.17 090 S

23485 ............. A Revision of collarbone .................................... 12.68 11.35 1.87 25.90 090 S

23490 ............. A Reinforce clavicle ............................................ 11.31 9.98 0.80 22.09 090 S

23491 ............. A Reinforce shoulder bones ............................... 13.63 12.70 2.11 28.44 090 S

23500 ............. A Treat clavicle fracture ..................................... 1.95 1.65 0.21 3.81 090 S

23505 ............. A Treat clavicle fracture ..................................... 3.54 2.57 0.38 6.49 090 S

23515 ............. A Repair clavicle fracture ................................... 7.01 6.93 1.12 15.06 090 S

23520 ............. A Treat clavicle dislocation ................................ 2.03 1.38 0.19 3.60 090 S

23525 ............. A Treat clavicle dislocation ................................ 3.40 1.98 0.27 5.65 090 S

23530 ............. A Repair clavicle dislocation .............................. 7.02 6.58 0.91 14.51 090 S

23532 ............. A Repair clavicle dislocation .............................. 7.59 7.23 1.19 16.01 090 S

23540 ............. A Treat clavicle dislocation ................................ 2.10 1.55 0.19 3.84 090 S

23545 ............. A Treat clavicle dislocation ................................ 3.07 1.98 0.29 5.34 090 S

23550 ............. A Repair clavicle dislocation .............................. 6.65 *8.51 1.46 16.62 090 S

23552 ............. A Repair clavicle dislocation .............................. 7.83 7.29 1.17 16.29 090 S

23570 ............. A Treat shoulderblade fracture .......................... 2.10 1.70 0.25 4.05 090 S

23575 ............. A Treat shoulderblade fracture .......................... 3.88 2.75 0.43 7.06 090 S

23585 ............. A Repair scapula fracture .................................. 8.41 7.70 1.29 17.40 090 S

23600 ............. A Treat humerus fracture ................................... 2.75 2.90 0.43 6.08 090 S

23605 ............. A Treat humerus fracture ................................... 4.56 4.76 0.76 10.08 090 S

23615 ............. A Repair humerus fracture ................................. 8.38 *10.72 1.78 20.88 090 S

23616 ............. A Repair humerus fracture ................................. 19.88 22.32 3.54 45.74 090 S

23620 ............. A Treat humerus fracture ................................... 2.25 *2.88 0.46 5.59 090 S

23625 ............. A Treat humerus fracture ................................... 3.64 3.82 0.60 8.06 090 S

23630 ............. A Repair humerus fracture ................................. 6.89 8.82 1.40 17.11 090 S

23650 ............. A Treat shoulder dislocation .............................. 3.24 2.10 0.24 5.58 090 S

23655 ............. A Treat shoulder dislocation .............................. 4.26 2.93 0.44 7.63 090 S

23660 ............. A Repair shoulder dislocation ............................ 7.09 9.07 1.40 17.56 090 S

23665 ............. A Treat dislocation/fracture ................................ 4.16 3.35 0.51 8.02 090 S

23670 ............. A Repair dislocation/fracture .............................. 7.44 *9.52 1.85 18.81 090 S

23675 ............. A Treat dislocation/fracture ................................ 5.60 3.93 0.61 10.14 090 S

23680 ............. A Repair dislocation/fracture .............................. 9.44 *12.09 2.13 23.66 090 S

23700 ............. A Fixation of shoulder ........................................ 2.47 2.09 0.34 4.90 010 S

23800 ............. A Fusion of shoulder joint .................................. 13.32 16.35 2.63 32.30 090 S

23802 ............. A Fusion of shoulder joint .................................. 14.67 14.07 2.24 30.98 090 S

23900 ............. A Amputation of arm & girdle ............................. 18.40 12.57 2.40 33.37 090 S

23920 ............. A Amputation at shoulder joint ........................... 13.60 13.85 2.54 29.99 090 S

23921 ............. A Amputation follow-up surgery ......................... 5.03 4.27 0.74 10.04 090 S

23929 ............. C Shoulder surgery procedure ........................... 0.00 0.00 0.00 0.00 YYY S

23930 ............. A Drainage of arm lesion ................................... 2.78 1.61 0.24 4.63 010 S

23931 ............. A Drainage of arm bursa .................................... 1.63 0.75 0.11 2.49 010 S

23935 ............. A Drain arm/elbow bone lesion .......................... 5.56 4.69 0.78 11.03 090 S

24000 ............. A Exploratory elbow surgery .............................. 5.32 *6.81 1.44 13.57 090 S

24006 ............. A Release elbow joint ........................................ 8.70 7.14 1.17 17.01 090 S

24065 ............. A Biopsy arm/elbow soft tissue .......................... 2.03 0.79 0.10 2.92 010 S

24066 ............. A Biopsy arm/elbow soft tissue .......................... 4.95 2.71 0.41 8.07 090 S

24075 ............. A Remove arm/elbow lesion .............................. 3.79 1.98 0.35 6.12 090 S
63203

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

24076 ............. A Remove arm/elbow lesion .............................. 6.01 3.68 0.67 10.36 090 S

24077 ............. A Remove tumor of arm/elbow .......................... 11.18 9.79 1.87 22.84 090 S

24100 ............. A Biopsy elbow joint lining ................................. 4.67 4.23 0.69 9.59 090 S

24101 ............. A Explore/treat elbow joint ................................. 5.84 *7.47 1.41 14.72 090 S

24102 ............. A Remove elbow joint lining ............................... 7.57 *9.68 1.81 19.06 090 S

24105 ............. A Removal of elbow bursa ................................. 3.43 3.77 0.63 7.83 090 S

24110 ............. A Remove humerus lesion ................................. 7.08 7.69 1.22 15.99 090 S

24115 ............. A Remove/graft bone lesion ............................... 8.88 7.68 1.33 17.89 090 S

24116 ............. A Remove/graft bone lesion ............................... 11.13 9.72 1.47 22.32 090 S

24120 ............. A Remove elbow lesion ..................................... 6.36 6.02 0.98 13.36 090 S

24125 ............. A Remove/graft bone lesion ............................... 7.40 5.79 0.61 13.80 090 S

24126 ............. A Remove/graft bone lesion ............................... 7.76 7.40 1.21 16.37 090 S

24130 ............. A Removal of head of radius ............................. 5.96 6.72 1.08 13.76 090 S

24134 ............. A Removal of arm bone lesion .......................... 8.98 8.69 1.24 18.91 090 S

24136 ............. A Remove radius bone lesion ............................ 7.33 8.78 0.92 17.03 090 S

24138 ............. A Remove elbow bone lesion ............................ 7.36 6.39 1.06 14.81 090 S

24140 ............. A Partial removal of arm bone ........................... 8.56 8.77 1.45 18.78 090 S

24145 ............. A Partial removal of radius ................................. 7.12 6.38 1.03 14.53 090 S

24147 ............. A Partial removal of elbow ................................. 7.00 6.61 1.08 14.69 090 S

24150 ............. A Extensive humerus surgery ............................ 12.43 14.08 2.24 28.75 090 S

24151 ............. A Extensive humerus surgery ............................ 14.65 13.83 2.11 30.59 090 S

24152 ............. A Extensive radius surgery ................................ 9.51 6.80 1.16 17.47 090 S

24153 ............. A Extensive radius surgery ................................ 10.96 10.44 1.71 23.11 090 S

24155 ............. A Removal of elbow joint ................................... 11.11 10.75 1.72 23.58 090 S

24160 ............. A Remove elbow joint implant ........................... 7.43 4.84 0.80 13.07 090 S

24164 ............. A Remove radius head implant .......................... 5.79 5.53 0.90 12.22 090 S

24200 ............. A Removal of arm foreign body ......................... 1.71 0.56 0.06 2.33 010 N

24201 ............. A Removal of arm foreign body ......................... 4.30 3.06 0.49 7.85 090 S

24220 ............. A Injection for elbow x-ray ................................. 1.31 0.51 0.05 1.87 000 N

24301 ............. A Muscle/tendon transfer ................................... 9.78 7.90 1.23 18.91 090 S

24305 ............. A Arm tendon lengthening ................................. 7.16 3.08 0.29 10.53 090 S

24310 ............. A Revision of arm tendon .................................. 5.72 2.95 0.48 9.15 090 S

24320 ............. A Repair of arm tendon ...................................... 10.01 9.20 1.29 20.50 090 S

24330 ............. A Revision of arm muscles ................................ 9.18 8.74 1.43 19.35 090 S

24331 ............. A Revision of arm muscles ................................ 10.10 9.62 1.57 21.29 090 S

24340 ............. A Repair of biceps tendon ................................. 7.58 7.00 1.13 15.71 090 S

24342 ............. A Repair of ruptured tendon .............................. 10.13 10.38 1.76 22.27 090 S

24350 ............. A Repair of tennis elbow .................................... 5.05 4.23 0.69 9.97 090 S

24351 ............. A Repair of tennis elbow .................................... 5.73 4.57 0.73 11.03 090 S

24352 ............. A Repair of tennis elbow .................................... 6.14 5.69 0.93 12.76 090 S

24354 ............. A Repair of tennis elbow .................................... 6.19 5.61 0.94 12.74 090 S

24356 ............. A Revision of tennis elbow ................................. 6.39 7.28 1.18 14.85 090 S

24360 ............. A Reconstruct elbow joint .................................. 11.76 *15.05 2.47 29.28 090 S

24361 ............. A Reconstruct elbow joint .................................. 13.50 13.13 2.00 28.63 090 S

24362 ............. A Reconstruct elbow joint .................................. 14.41 13.14 0.80 28.35 090 S

24363 ............. A Replace elbow joint ........................................ 17.66 *22.61 4.13 44.40 090 S

24365 ............. A Reconstruct head of radius ............................ 7.93 7.52 1.19 16.64 090 S

24366 ............. A Reconstruct head of radius ............................ 8.67 11.05 1.80 21.52 090 S

24400 ............. A Revision of humerus ....................................... 10.55 8.43 1.37 20.35 090 S

24410 ............. A Revision of humerus ....................................... 14.28 14.04 2.06 30.38 090 S

24420 ............. A Revision of humerus ....................................... 12.90 12.30 2.01 27.21 090 S

24430 ............. A Repair of humerus .......................................... 12.26 14.66 2.34 29.26 090 S

24435 ............. A Repair humerus with graft .............................. 12.19 *15.61 2.84 30.64 090 S

24470 ............. A Revision of elbow joint .................................... 8.32 7.92 1.30 17.54 090 S

24495 ............. A Decompression of forearm ............................. 7.59 5.75 1.10 14.44 090 S

24498 ............. A Reinforce humerus ......................................... 11.30 10.37 1.62 23.29 090 S

24500 ............. A Treat humerus fracture ................................... 3.01 2.54 0.36 5.91 090 S

24505 ............. A Treat humerus fracture ................................... 4.83 4.50 0.71 10.04 090 S

24515 ............. A Repair humerus fracture ................................. 10.92 9.65 1.54 22.11 090 S

24516 ............. A Repair humerus fracture ................................. 10.92 9.65 1.54 22.11 090 S

24530 ............. A Treat humerus fracture ................................... 3.30 2.73 0.42 6.45 090 S

24535 ............. A Treat humerus fracture ................................... 6.51 4.85 0.78 12.14 090 S

24538 ............. A Treat humerus fracture ................................... 8.85 7.98 1.26 18.09 090 S

24545 ............. A Repair humerus fracture ................................. 9.65 9.97 1.59 21.21 090 S

24546 ............. A Repair humerus fracture ................................. 14.66 9.97 1.59 26.22 090 S

24560 ............. A Treat humerus fracture ................................... 2.62 2.16 0.30 5.08 090 S
63204

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

24565 ............. A Treat humerus fracture ................................... 5.22 3.45 0.54 9.21 090 S

24566 ............. A Treat humerus fracture ................................... 7.17 6.06 0.96 14.19 090 S

24575 ............. A Repair humerus fracture ................................. 9.91 7.79 1.24 18.94 090 S

24576 ............. A Treat humerus fracture ................................... 2.66 2.16 0.33 5.15 090 S

24577 ............. A Treat humerus fracture ................................... 5.45 4.00 0.61 10.06 090 S

24579 ............. A Repair humerus fracture ................................. 10.85 8.37 1.35 20.57 090 S

24582 ............. A Treat humerus fracture ................................... 7.83 6.62 1.06 15.51 090 S

24586 ............. A Repair elbow fracture ..................................... 14.37 14.72 2.36 31.45 090 S

24587 ............. A Repair elbow fracture ..................................... 14.26 13.72 2.17 30.15 090 S

24600 ............. A Treat elbow dislocation ................................... 4.08 1.95 0.26 6.29 090 S

24605 ............. A Treat elbow dislocation ................................... 5.08 2.29 0.37 7.74 090 S

24615 ............. A Repair elbow dislocation ................................. 8.76 9.29 1.48 19.53 090 S

24620 ............. A Treat elbow fracture ........................................ 6.62 3.78 0.57 10.97 090 S

24635 ............. A Repair elbow fracture ..................................... 12.42 11.06 1.78 25.26 090 S

24640 ............. A Treat elbow dislocation ................................... 1.15 1.01 0.08 2.24 010 N

24650 ............. A Treat radius fracture ....................................... 2.01 2.25 0.33 4.59 090 S

24655 ............. A Treat radius fracture ....................................... 4.17 3.01 0.45 7.63 090 S

24665 ............. A Repair radius fracture ..................................... 7.69 7.13 1.14 15.96 090 S

24666 ............. A Repair radius fracture ..................................... 8.87 10.27 1.60 20.74 090 S

24670 ............. A Treatment of ulna fracture .............................. 2.39 1.95 0.27 4.61 090 S

24675 ............. A Treatment of ulna fracture .............................. 4.52 3.51 0.54 8.57 090 S

24685 ............. A Repair ulna fracture ........................................ 8.34 8.40 1.34 18.08 090 S

24800 ............. A Fusion of elbow joint ....................................... 10.75 10.59 1.55 22.89 090 S

24802 ............. A Fusion/graft of elbow joint .............................. 12.79 12.18 1.99 26.96 090 S

24900 ............. A Amputation of upper arm ................................ 8.76 7.68 1.39 17.83 090 S

24920 ............. A Amputation of upper arm ................................ 8.69 6.78 1.19 16.66 090 S

24925 ............. A Amputation follow-up surgery ......................... 6.61 6.27 0.75 13.63 090 S

24930 ............. A Amputation follow-up surgery ......................... 9.40 8.16 1.17 18.73 090 S

24931 ............. A Amputate upper arm & implant ...................... 11.71 11.17 1.84 24.72 090 S

24935 ............. A Revision of amputation ................................... 14.37 13.70 2.24 30.31 090 S

24940 ............. C Revision of upper arm .................................... 0.00 0.00 0.00 0.00 090 S

24999 ............. C Upper arm/elbow surgery ............................... 0.00 0.00 0.00 0.00 YYY S

25000 ............. A Incision of tendon sheath ............................... 3.20 3.94 0.62 7.76 090 S

25020 ............. A Decompression of forearm ............................. 5.55 4.35 0.77 10.67 090 S

25023 ............. A Decompression of forearm ............................. 11.80 5.44 0.94 18.18 090 S

25028 ............. A Drainage of forearm lesion ............................. 4.88 2.06 0.36 7.30 090 S

25031 ............. A Drainage of forearm bursa ............................. 3.90 0.66 0.09 4.65 090 S

25035 ............. A Treat forearm bone lesion .............................. 6.83 6.30 1.01 14.14 090 S

25040 ............. A Explore/treat wrist joint ................................... 6.61 5.69 0.90 13.20 090 S

25065 ............. A Biopsy forearm soft tissues ............................ 2.39 0.75 0.09 3.23 010 S

25066 ............. A Biopsy forearm soft tissues ............................ 3.87 1.54 0.22 5.63 090 S

25075 ............. A Removal of forearm lesion .............................. 3.61 2.19 0.37 6.17 090 S

25076 ............. A Removal of forearm lesion .............................. 4.77 3.77 0.67 9.21 090 S

25077 ............. A Remove tumor, forearm/wrist ......................... 9.25 8.48 1.67 19.40 090 S

25085 ............. A Incision of wrist capsule ................................. 5.13 4.62 0.71 10.46 090 S

25100 ............. A Biopsy of wrist joint ......................................... 3.66 *4.69 0.79 9.14 090 S

25101 ............. A Explore/treat wrist joint ................................... 4.43 5.61 0.98 11.02 090 S

25105 ............. A Remove wrist joint lining ................................. 5.56 *7.11 1.19 13.86 090 S

25107 ............. A Remove wrist joint cartilage ............................ 5.89 5.28 0.89 12.06 090 S

25110 ............. A Remove wrist tendon lesion ........................... 3.79 2.80 0.46 7.05 090 S

25111 ............. A Remove wrist tendon lesion ........................... 3.24 3.22 0.55 7.01 090 S

25112 ............. A Reremove wrist tendon lesion ........................ 4.38 3.72 0.66 8.76 090 S

25115 ............. A Remove wrist/forearm lesion .......................... 6.26 7.14 1.23 14.63 090 S

25116 ............. A Remove wrist/forearm lesion .......................... 6.44 8.17 1.38 15.99 090 S

25118 ............. A Excise wrist tendon sheath ............................. 4.11 *5.26 1.02 10.39 090 S

25119 ............. A Partial removal of ulna .................................... 5.64 *7.22 1.32 14.18 090 S

25120 ............. A Removal of forearm lesion .............................. 5.70 6.53 1.14 13.37 090 S

25125 ............. A Remove/graft forearm lesion .......................... 7.06 6.84 1.04 14.94 090 S

25126 ............. A Remove/graft forearm lesion .......................... 7.13 6.80 1.12 15.05 090 S

25130 ............. A Removal of wrist lesion ................................... 5.08 4.21 0.67 9.96 090 S

25135 ............. A Remove & graft wrist lesion ............................ 6.58 5.46 0.97 13.01 090 S

25136 ............. A Remove & graft wrist lesion ............................ 5.68 4.74 0.85 11.27 090 S

25145 ............. A Remove forearm bone lesion ......................... 5.97 5.95 0.75 12.67 090 S

25150 ............. A Partial removal of ulna .................................... 6.56 6.67 1.12 14.35 090 S

25151 ............. A Partial removal of radius ................................. 6.86 5.75 1.02 13.63 090 S

25170 ............. A Extensive forearm surgery .............................. 10.45 9.79 1.51 21.75 090 S
63205

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

25210 ............. A Removal of wrist bone .................................... 5.55 4.88 0.80 11.23 090 S

25215 ............. A Removal of wrist bones .................................. 7.40 8.68 1.42 17.50 090 S

25230 ............. A Partial removal of radius ................................. 4.86 5.57 0.85 11.28 090 S

25240 ............. A Partial removal of ulna .................................... 4.91 5.30 0.86 11.07 090 S

25246 ............. A Injection for wrist x-ray .................................... 1.45 0.50 0.05 2.00 000 N

25248 ............. A Remove forearm foreign body ........................ 4.96 2.18 0.37 7.51 090 S

25250 ............. A Removal of wrist prosthesis ............................ 6.31 5.63 0.91 12.85 090 S

25251 ............. A Removal of wrist prosthesis ............................ 9.08 8.25 1.39 18.72 090 S

25260 ............. A Repair forearm tendon/muscle ....................... 7.33 4.61 0.78 12.72 090 S

25263 ............. A Repair forearm tendon/muscle ....................... 7.37 5.77 1.03 14.17 090 S

25265 ............. A Repair forearm tendon/muscle ....................... 9.54 7.93 1.41 18.88 090 S

25270 ............. A Repair forearm tendon/muscle ....................... 5.71 3.36 0.55 9.62 090 S

25272 ............. A Repair forearm tendon/muscle ....................... 6.75 3.44 0.54 10.73 090 S

25274 ............. A Repair forearm tendon/muscle ....................... 8.44 6.62 1.13 16.19 090 S

25280 ............. A Revise wrist/forearm tendon ........................... 6.82 4.22 0.69 11.73 090 S

25290 ............. A Incise wrist/forearm tendon ............................ 5.03 2.47 0.41 7.91 090 S

25295 ............. A Release wrist/forearm tendon ......................... 6.26 3.05 0.52 9.83 090 S

25300 ............. A Fusion of tendons at wrist .............................. 8.46 7.36 1.19 17.01 090 S

25301 ............. A Fusion of tendons at wrist .............................. 8.09 6.77 1.18 16.04 090 S

25310 ............. A Transplant forearm tendon ............................. 7.68 7.14 1.17 15.99 090 S

25312 ............. A Transplant forearm tendon ............................. 9.08 7.63 1.31 18.02 090 S

25315 ............. A Revise palsy hand tendon(s) .......................... 9.45 8.06 1.34 18.85 090 S

25316 ............. A Revise palsy hand tendon(s) .......................... 11.49 10.58 1.78 23.85 090 S

25320 ............. A Repair/revise wrist joint ................................... 9.89 8.60 1.45 19.94 090 S

25330 ............. A Revise wrist joint ............................................. 10.85 9.23 1.50 21.58 090 S

25331 ............. A Revise wrist joint ............................................. 12.60 14.66 2.40 29.66 090 S

25332 ............. A Revise wrist joint ............................................. 10.83 9.98 1.61 22.42 090 S

25335 ............. A Realignment of hand ...................................... 12.11 11.41 1.56 25.08 090 S

25337 ............. A Reconstruct ulna/radioulnar ............................ 9.50 8.60 1.45 19.55 090 S

25350 ............. A Revision of radius ........................................... 8.23 7.61 1.26 17.10 090 S

25355 ............. A Revision of radius ........................................... 9.55 9.12 1.49 20.16 090 S

25360 ............. A Revision of ulna .............................................. 7.88 6.41 0.99 15.28 090 S

25365 ............. A Revise radius & ulna ...................................... 11.63 10.31 1.57 23.51 090 S

25370 ............. A Revise radius or ulna ...................................... 12.34 11.76 1.92 26.02 090 S

25375 ............. A Revise radius & ulna ...................................... 12.27 13.38 0.87 26.52 090 S

25390 ............. A Shorten radius/ulna ......................................... 9.85 8.82 1.50 20.17 090 S

25391 ............. A Lengthen radius/ulna ...................................... 12.75 11.25 1.93 25.93 090 S

25392 ............. A Shorten radius & ulna ..................................... 13.05 12.44 2.04 27.53 090 S

25393 ............. A Lengthen radius & ulna .................................. 14.90 14.21 2.32 31.43 090 S

25400 ............. A Repair radius or ulna ...................................... 10.30 10.78 1.75 22.83 090 S

25405 ............. A Repair/graft radius or ulna .............................. 13.48 12.42 2.02 27.92 090 S

25415 ............. A Repair radius & ulna ....................................... 12.64 11.42 1.92 25.98 090 S

25420 ............. A Repair/graft radius & ulna ............................... 15.34 14.70 2.28 32.32 090 S

25425 ............. A Repair/graft radius or ulna .............................. 12.44 12.02 1.87 26.33 090 S

25426 ............. A Repair/graft radius & ulna ............................... 14.92 11.72 2.13 28.77 090 S

25440 ............. A Repair/graft wrist bone ................................... 9.95 9.05 1.50 20.50 090 S

25441 ............. A Reconstruct wrist joint .................................... 12.26 11.36 1.89 25.51 090 S

25442 ............. A Reconstruct wrist joint .................................... 10.34 7.06 1.22 18.62 090 S

25443 ............. A Reconstruct wrist joint .................................... 9.88 9.38 1.52 20.78 090 S

25444 ............. A Reconstruct wrist joint .................................... 10.64 10.14 1.66 22.44 090 S

25445 ............. A Reconstruct wrist joint .................................... 9.27 10.36 1.72 21.35 090 S

25446 ............. A Wrist replacement ........................................... 15.52 *19.86 3.49 38.87 090 S

25447 ............. A Repair wrist joint(s) ......................................... 9.86 9.65 1.56 21.07 090 S

25449 ............. A Remove wrist joint implant .............................. 13.78 7.84 1.16 22.78 090 S

25450 ............. A Revision of wrist joint ...................................... 7.67 7.31 1.19 16.17 090 S

25455 ............. A Revision of wrist joint ...................................... 9.15 8.71 1.42 19.28 090 S

25490 ............. A Reinforce radius .............................................. 9.12 8.69 1.42 19.23 090 S

25491 ............. A Reinforce ulna ................................................. 9.54 9.10 1.49 20.13 090 S

25492 ............. A Reinforce radius and ulna .............................. 11.75 11.20 1.84 24.79 090 S

25500 ............. A Treat fracture of radius ................................... 2.30 2.33 0.29 4.92 090 S

25505 ............. A Treat fracture of radius ................................... 4.96 3.57 0.51 9.04 090 S

25515 ............. A Repair fracture of radius ................................. 8.63 7.63 1.22 17.48 090 S

25520 ............. A Repair fracture of radius ................................. 6.01 5.74 0.94 12.69 090 S

25525 ............. A Repair fracture of radius ................................. 11.69 11.15 1.83 24.67 090 S

25526 ............. A Repair fracture of radius ................................. 12.43 11.85 1.94 26.22 090 S

25530 ............. A Treat fracture of ulna ...................................... 1.94 2.44 0.35 4.73 090 S
63206

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

25535 ............. A Treat fracture of ulna ...................................... 4.91 3.57 0.54 9.02 090 S

25545 ............. A Repair fracture of ulna .................................... 8.35 7.58 1.20 17.13 090 S

25560 ............. A Treat fracture radius & ulna ............................ 2.29 2.27 0.27 4.83 090 S

25565 ............. A Treat fracture radius & ulna ............................ 5.29 4.66 0.70 10.65 090 S

25574 ............. A Treat fracture radius & ulna ............................ 6.03 *7.72 1.73 15.48 090 S

25575 ............. A Repair fracture radius/ulna ............................. 9.47 10.70 1.73 21.90 090 S

25600 ............. A Treat fracture radius/ulna ............................... 2.48 2.84 0.42 5.74 090 S

25605 ............. A Treat fracture radius/ulna ............................... 5.36 3.95 0.61 9.92 090 S

25611 ............. A Repair fracture radius/ulna ............................. 7.11 6.01 0.97 14.09 090 S

25620 ............. A Repair fracture radius/ulna ............................. 8.15 7.13 1.14 16.42 090 S

25622 ............. A Treat wrist bone fracture ................................ 2.43 2.28 0.33 5.04 090 S

25624 ............. A Treat wrist bone fracture ................................ 4.28 3.67 0.57 8.52 090 S

25628 ............. A Repair wrist bone fracture .............................. 7.81 7.13 1.16 16.10 090 S

25630 ............. A Treat wrist bone fracture ................................ 2.73 2.19 0.30 5.22 090 S

25635 ............. A Treat wrist bone fracture ................................ 4.16 3.36 0.50 8.02 090 S

25645 ............. A Repair wrist bone fracture .............................. 6.85 6.68 0.95 14.48 090 S

25650 ............. A Repair wrist bone fracture .............................. 2.87 2.66 0.36 5.89 090 S

25660 ............. A Treat wrist dislocation ..................................... 4.53 1.82 0.26 6.61 090 S

25670 ............. A Repair wrist dislocation ................................... 7.52 7.08 1.12 15.72 090 S

25675 ............. A Treat wrist dislocation ..................................... 4.44 2.28 0.34 7.06 090 S

25676 ............. A Repair wrist dislocation ................................... 7.55 7.32 1.11 15.98 090 S

25680 ............. A Treat wrist fracture .......................................... 5.63 2.44 0.36 8.43 090 S

25685 ............. A Repair wrist fracture ....................................... 9.23 8.79 1.44 19.46 090 S

25690 ............. A Treat wrist dislocation ..................................... 5.16 4.89 0.73 10.78 090 S

25695 ............. A Repair wrist dislocation ................................... 7.94 7.04 1.17 16.15 090 S

25800 ............. A Fusion of wrist joint ......................................... 9.21 10.94 1.80 21.95 090 S

25805 ............. A Fusion/graft of wrist joint ................................ 10.57 12.85 2.09 25.51 090 S

25810 ............. A Fusion/graft of wrist joint ................................ 9.79 *12.53 2.06 24.38 090 S

25820 ............. A Fusion of hand bones ..................................... 7.14 8.91 1.48 17.53 090 S

25825 ............. A Fusion hand bones with graft ......................... 8.60 *11.02 1.99 21.61 090 S

25830 ............. A Fusion radioulnar jnt/ulna ............................... 9.50 8.60 1.45 19.55 090 S

25900 ............. A Amputation of forearm .................................... 8.15 7.08 1.31 16.54 090 S

25905 ............. A Amputation of forearm .................................... 8.40 7.11 1.15 16.66 090 S

25907 ............. A Amputation follow-up surgery ......................... 7.27 5.74 1.00 14.01 090 S

25909 ............. A Amputation follow-up surgery ......................... 8.37 5.55 1.06 14.98 090 S

25915 ............. A Amputation of forearm .................................... 16.61 15.83 2.59 35.03 090 S

25920 ............. A Amputate hand at wrist ................................... 8.09 7.00 1.20 16.29 090 S

25922 ............. A Amputate hand at wrist ................................... 6.96 5.55 1.02 13.53 090 S

25924 ............. A Amputation follow-up surgery ......................... 7.87 7.50 1.22 16.59 090 S

25927 ............. A Amputation of hand ........................................ 8.27 6.29 1.22 15.78 090 S

25929 ............. A Amputation follow-up surgery ......................... 7.13 4.74 0.96 12.83 090 S

25931 ............. A Amputation follow-up surgery ......................... 7.35 4.54 0.90 12.79 090 S

25999 ............. C Forearm or wrist surgery ................................ 0.00 0.00 0.00 0.00 YYY S

26010 ............. A Drainage of finger abscess ............................. 1.49 0.48 0.05 2.02 010 N

26011 ............. A Drainage of finger abscess ............................. 2.14 1.54 0.24 3.92 010 S

26020 ............. A Drain hand tendon sheath .............................. 4.01 3.72 0.63 8.36 090 S

26025 ............. A Drainage of palm bursa .................................. 4.32 4.51 0.76 9.59 090 S

26030 ............. A Drainage of palm bursa(s) .............................. 5.36 5.73 0.98 12.07 090 S

26034 ............. A Treat hand bone lesion ................................... 5.59 4.23 0.71 10.53 090 S

26035 ............. A Decompress fingers/hand ............................... 8.38 5.17 0.86 14.41 090 S

26037 ............. A Decompress fingers/hand ............................... 6.68 6.37 1.05 14.10 090 S

26040 ............. A Release palm contracture ............................... 3.09 2.86 0.49 6.44 090 S

26045 ............. A Release palm contracture ............................... 5.27 4.83 0.81 10.91 090 S

26055 ............. A Incise finger tendon sheath ............................ 2.56 *3.28 0.56 6.40 090 S

26060 ............. A Incision of finger tendon ................................. 2.71 1.13 0.17 4.01 090 S

26070 ............. A Explore/treat hand joint ................................... 3.34 2.76 0.42 6.52 090 S

26075 ............. A Explore/treat finger joint .................................. 3.44 3.78 0.62 7.84 090 S

26080 ............. A Explore/treat finger joint .................................. 3.78 3.14 0.51 7.43 090 S

26100 ............. A Biopsy hand joint lining ................................... 3.54 2.99 0.45 6.98 090 S

26105 ............. A Biopsy finger joint lining .................................. 3.58 4.17 0.67 8.42 090 S

26110 ............. A Biopsy finger joint lining .................................. 3.40 2.93 0.50 6.83 090 S

26115 ............. A Removal of hand lesion .................................. 3.68 2.01 0.34 6.03 090 S

26116 ............. A Removal of hand lesion .................................. 5.19 3.71 0.62 9.52 090 S

26117 ............. A Remove tumor, hand/finger ............................ 8.24 5.07 0.91 14.22 090 S

26121 ............. A Release palm contracture ............................... 7.34 *9.40 1.61 18.35 090 S

26123 ............. A Release palm contracture ............................... 8.64 9.10 1.53 19.27 090 S
63207

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

26125 ............. A Release palm contracture ............................... 4.61 2.62 0.45 7.68 ZZZ S

26130 ............. A Remove wrist joint lining ................................. 5.13 5.01 0.86 11.00 090 S

26135 ............. A Revise finger joint, each ................................. 6.67 4.86 0.82 12.35 090 S

26140 ............. A Revise finger joint, each ................................. 5.88 4.40 0.75 11.03 090 S

26145 ............. A Tendon excision, palm/finger .......................... 6.03 4.71 0.80 11.54 090 S

26160 ............. A Remove tendon sheath lesion ........................ 3.00 2.32 0.40 5.72 090 S

26170 ............. A Removal of palm tendon, each ...................... 4.62 2.83 0.45 7.90 090 S

26180 ............. A Removal of finger tendon ............................... 5.00 4.01 0.71 9.72 090 S

26200 ............. A Remove hand bone lesion .............................. 5.25 4.48 0.72 10.45 090 S

26205 ............. A Remove/graft bone lesion ............................... 7.24 6.40 1.03 14.67 090 S

26210 ............. A Removal of finger lesion ................................. 4.97 3.90 0.64 9.51 090 S

26215 ............. A Remove/graft finger lesion .............................. 6.81 5.55 0.94 13.30 090 S

26230 ............. A Partial removal of hand bone ......................... 5.96 4.26 0.69 10.91 090 S

26235 ............. A Partial removal, finger bone ........................... 5.82 4.17 0.71 10.70 090 S

26236 ............. A Partial removal, finger bone ........................... 4.95 3.86 0.66 9.47 090 S

26250 ............. A Extensive hand surgery .................................. 7.26 6.00 1.07 14.33 090 S

26255 ............. A Extensive hand surgery .................................. 11.66 8.94 1.54 22.14 090 S

26260 ............. A Extensive finger surgery ................................. 6.74 5.73 0.97 13.44 090 S

26261 ............. A Extensive finger surgery ................................. 8.54 7.70 1.31 17.55 090 S

26262 ............. A Partial removal of finger ................................. 5.41 4.75 0.76 10.92 090 S

26320 ............. A Removal of implant from hand ....................... 3.74 3.54 0.57 7.85 090 S

26350 ............. A Repair finger/hand tendon .............................. 5.76 5.74 0.99 12.49 090 S

26352 ............. A Repair/graft hand tendon ................................ 7.26 6.60 1.10 14.96 090 S

26356 ............. A Repair finger/hand tendon .............................. 7.05 7.21 1.24 15.50 090 S

26357 ............. A Repair finger/hand tendon .............................. 8.16 6.58 1.19 15.93 090 S

26358 ............. A Repair/graft hand tendon ................................ 8.69 7.40 1.27 17.36 090 S

26370 ............. A Repair finger/hand tendon .............................. 6.71 6.71 1.13 14.55 090 S

26372 ............. A Repair/graft hand tendon ................................ 8.27 6.39 1.15 15.81 090 S

26373 ............. A Repair finger/hand tendon .............................. 7.67 6.85 1.11 15.63 090 S

26390 ............. A Revise hand/finger tendon .............................. 8.73 7.95 1.23 17.91 090 S

26392 ............. A Repair/graft hand tendon ................................ 9.77 8.61 1.26 19.64 090 S

26410 ............. A Repair hand tendon ........................................ 4.37 3.29 0.51 8.17 090 S

26412 ............. A Repair/graft hand tendon ................................ 5.91 6.01 0.97 12.89 090 S

26415 ............. A Excision, hand/finger tendon .......................... 8.05 6.75 0.90 15.70 090 S

26416 ............. A Graft hand or finger tendon ............................ 9.06 8.64 1.41 19.11 090 S

26418 ............. A Repair finger tendon ....................................... 4.02 3.58 0.59 8.19 090 S

26420 ............. A Repair/graft finger tendon ............................... 6.37 5.68 0.96 13.01 090 S

26426 ............. A Repair finger/hand tendon .............................. 5.86 6.31 1.07 13.24 090 S

26428 ............. A Repair/graft finger tendon ............................... 6.90 5.50 1.00 13.40 090 S

26432 ............. A Repair finger tendon ....................................... 3.87 3.15 0.51 7.53 090 S

26433 ............. A Repair finger tendon ....................................... 4.41 3.94 0.66 9.01 090 S

26434 ............. A Repair/graft finger tendon ............................... 5.80 4.95 0.84 11.59 090 S

26437 ............. A Realignment of tendons .................................. 5.53 4.05 0.68 10.26 090 S

26440 ............. A Release palm/finger tendon ............................ 4.76 3.57 0.59 8.92 090 S

26442 ............. A Release palm & finger tendon ........................ 6.10 3.37 0.59 10.06 090 S

26445 ............. A Release hand/finger tendon ........................... 4.16 3.25 0.54 7.95 090 S

26449 ............. A Release forearm/hand tendon ........................ 6.39 5.57 0.96 12.92 090 S

26450 ............. A Incision of palm tendon .................................. 3.54 2.28 0.36 6.18 090 S

26455 ............. A Incision of finger tendon ................................. 3.51 1.89 0.33 5.73 090 S

26460 ............. A Incise hand/finger tendon ............................... 3.33 1.72 0.30 5.35 090 S

26471 ............. A Fusion of finger tendons ................................. 5.55 4.15 0.67 10.37 090 S

26474 ............. A Fusion of finger tendons ................................. 5.14 4.61 0.75 10.50 090 S

26476 ............. A Tendon lengthening ........................................ 5.00 2.89 0.27 8.16 090 S

26477 ............. A Tendon shortening .......................................... 4.97 3.99 0.73 9.69 090 S

26478 ............. A Lengthening of hand tendon ........................... 5.62 4.30 0.72 10.64 090 S

26479 ............. A Shortening of hand tendon ............................. 5.56 5.29 0.86 11.71 090 S

26480 ............. A Transplant hand tendon .................................. 6.49 6.53 1.11 14.13 090 S

26483 ............. A Transplant/graft hand tendon ......................... 7.87 8.50 1.40 17.77 090 S

26485 ............. A Transplant palm tendon .................................. 7.28 6.50 1.08 14.86 090 S

26489 ............. A Transplant/graft palm tendon .......................... 9.00 3.40 0.51 12.91 090 S

26490 ............. A Revise thumb tendon ...................................... 7.99 7.80 1.28 17.07 090 S

26492 ............. A Tendon transfer with graft .............................. 9.17 8.75 1.21 19.13 090 S

26494 ............. A Hand tendon/muscle transfer ......................... 8.05 7.28 1.23 16.56 090 S

26496 ............. A Revise thumb tendon ...................................... 9.17 8.73 1.53 19.43 090 S

26497 ............. A Finger tendon transfer .................................... 9.15 8.02 1.38 18.55 090 S

26498 ............. A Finger tendon transfer .................................... 13.55 11.78 2.04 27.37 090 S
63208

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

26499 ............. A Revision of finger ............................................ 8.56 7.75 1.25 17.56 090 S

26500 ............. A Hand tendon reconstruction ........................... 5.67 3.49 0.60 9.76 090 S

26502 ............. A Hand tendon reconstruction ........................... 6.74 5.27 0.95 12.96 090 S

26504 ............. A Hand tendon reconstruction ........................... 7.05 6.72 1.11 14.88 090 S

26508 ............. A Release thumb contracture ............................ 5.61 4.15 0.72 10.48 090 S

26510 ............. A Thumb tendon transfer ................................... 5.03 4.15 0.68 9.86 090 S

26516 ............. A Fusion of knuckle joint .................................... 6.75 4.16 0.67 11.58 090 S

26517 ............. A Fusion of knuckle joints .................................. 8.34 7.07 1.23 16.64 090 S

26518 ............. A Fusion of knuckle joints .................................. 8.53 6.51 1.22 16.26 090 S

26520 ............. A Release knuckle contracture .......................... 5.01 4.48 0.71 10.20 090 S

26525 ............. A Release finger contracture ............................. 5.04 3.64 0.62 9.30 090 S

26530 ............. A Revise knuckle joint ........................................ 6.38 5.16 0.85 12.39 090 S

26531 ............. A Revise knuckle with implant ........................... 7.57 6.65 1.11 15.33 090 S

26535 ............. A Revise finger joint ........................................... 4.95 4.84 0.58 10.37 090 S

26536 ............. A Revise/implant finger joint .............................. 6.06 7.21 1.19 14.46 090 S

26540 ............. A Repair hand joint ............................................ 6.03 6.64 1.12 13.79 090 S

26541 ............. A Repair hand joint with graft ............................ 8.20 8.94 1.47 18.61 090 S

26542 ............. A Repair hand joint with graft ............................ 6.38 5.67 0.97 13.02 090 S

26545 ............. A Reconstruct finger joint ................................... 6.50 5.27 0.94 12.71 090 S

26548 ............. A Reconstruct finger joint ................................... 7.61 5.79 1.00 14.40 090 S

26550 ............. A Construct thumb replacement ........................ 20.77 19.81 3.24 43.82 090 S

26552 ............. C Construct thumb replacement ........................ 0.00 0.00 0.00 0.00 090 S

26555 ............. A Positional change of finger ............................. 16.16 15.41 2.52 34.09 090 S

26557 ............. C Construct finger replacement ......................... 0.00 0.00 0.00 0.00 090 S

26558 ............. C Added finger surgery ...................................... 0.00 0.00 0.00 0.00 090 S

26559 ............. C Added finger surgery ...................................... 0.00 0.00 0.00 0.00 090 S

26560 ............. A Repair of web finger ....................................... 5.23 4.65 0.66 10.54 090 S

26561 ............. A Repair of web finger ....................................... 10.50 8.89 1.56 20.95 090 S

26562 ............. A Repair of web finger ....................................... 9.23 10.97 0.82 21.02 090 S

26565 ............. A Correct metacarpal flaw .................................. 6.45 5.82 0.85 13.12 090 S

26567 ............. A Correct finger deformity .................................. 6.53 4.28 0.67 11.48 090 S

26568 ............. A Lengthen metacarpal/finger ............................ 8.66 8.45 1.06 18.17 090 S

26580 ............. A Repair hand deformity .................................... 17.71 16.89 2.76 37.36 090 S

26585 ............. A Repair finger deformity ................................... 13.58 12.95 2.12 28.65 090 S

26587 ............. C Reconstruct extra finger ................................. 0.00 0.00 0.00 0.00 090 S

26590 ............. A Repair finger deformity ................................... 17.44 16.63 2.72 36.79 090 S

26591 ............. A Repair muscles of hand .................................. 2.90 2.29 0.39 5.58 090 S

26593 ............. A Release muscles of hand ............................... 4.89 4.12 0.70 9.71 090 S

26596 ............. A Excision constricting tissue ............................. 8.64 8.24 1.35 18.23 090 S

26597 ............. A Release of scar contracture ........................... 9.37 8.02 1.37 18.76 090 S

26600 ............. A Treat metacarpal fracture ............................... 1.81 1.54 0.22 3.57 090 S

26605 ............. A Treat metacarpal fracture ............................... 2.67 2.29 0.36 5.32 090 S

26607 ............. A Treat metacarpal fracture ............................... 5.12 3.55 0.57 9.24 090 S

26608 ............. A Treat metacarpal fracture ............................... 5.12 3.55 0.57 9.24 090 S

26615 ............. A Repair metacarpal fracture ............................. 5.18 4.87 0.80 10.85 090 S

26641 ............. A Treat thumb dislocation .................................. 3.74 1.11 0.14 4.99 090 S

26645 ............. A Treat thumb fracture ....................................... 4.23 2.20 0.33 6.76 090 S

26650 ............. A Repair thumb fracture ..................................... 5.49 4.01 0.64 10.14 090 S

26665 ............. A Repair thumb fracture ..................................... 7.14 6.39 1.09 14.62 090 S

26670 ............. A Treat hand dislocation .................................... 3.54 0.96 0.10 4.60 090 S

26675 ............. A Treat hand dislocation .................................... 4.44 4.34 0.60 9.38 090 S

26676 ............. A Pin hand dislocation ....................................... 5.29 4.86 0.67 10.82 090 S

26685 ............. A Repair hand dislocation .................................. 6.54 5.76 0.91 13.21 090 S

26686 ............. A Repair hand dislocation .................................. 7.48 6.31 1.04 14.83 090 S

26700 ............. A Treat knuckle dislocation ................................ 3.54 0.88 0.10 4.52 090 S

26705 ............. A Treat knuckle dislocation ................................ 3.99 1.78 0.27 6.04 090 S

26706 ............. A Pin knuckle dislocation ................................... 4.92 4.68 0.75 10.35 090 S

26715 ............. A Repair knuckle dislocation .............................. 5.48 4.13 0.66 10.27 090 S

26720 ............. A Treat finger fracture, each .............................. 1.56 1.10 0.15 2.81 090 S

26725 ............. A Treat finger fracture, each .............................. 3.18 1.54 0.23 4.95 090 S

26727 ............. A Treat finger fracture, each .............................. 4.92 2.45 0.38 7.75 090 S

26735 ............. A Repair finger fracture, each ............................ 5.72 3.73 0.61 10.06 090 S

26740 ............. A Treat finger fracture, each .............................. 1.81 1.16 0.16 3.13 090 S

26742 ............. A Treat finger fracture, each .............................. 3.70 1.98 0.32 6.00 090 S

26746 ............. A Repair finger fracture, each ............................ 5.55 4.75 0.80 11.10 090 S

26750 ............. A Treat finger fracture, each .............................. 1.60 0.83 0.10 2.53 090 S
63209

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

26755 ............. A Treat finger fracture, each .............................. 2.97 1.08 0.15 4.20 090 S

26756 ............. A Pin finger fracture, each ................................. 4.19 1.90 0.33 6.42 090 S

26765 ............. A Repair finger fracture, each ............................ 4.04 2.66 0.45 7.15 090 S

26770 ............. A Treat finger dislocation ................................... 2.89 0.76 0.08 3.73 090 S

26775 ............. A Treat finger dislocation ................................... 3.51 1.13 0.17 4.81 090 S

26776 ............. A Pin finger dislocation ...................................... 4.60 2.08 0.35 7.03 090 S

26785 ............. A Repair finger dislocation ................................. 4.08 2.97 0.48 7.53 090 S

26820 ............. A Thumb fusion with graft .................................. 7.84 6.65 1.05 15.54 090 S

26841 ............. A Fusion of thumb .............................................. 6.79 6.17 1.00 13.96 090 S

26842 ............. A Thumb fusion with graft .................................. 7.75 8.58 1.37 17.70 090 S

26843 ............. A Fusion of hand joint ........................................ 7.21 6.37 1.10 14.68 090 S

26844 ............. A Fusion/graft of hand joint ................................ 8.24 7.35 1.19 16.78 090 S

26850 ............. A Fusion of knuckle ............................................ 6.57 4.63 0.76 11.96 090 S

26852 ............. A Fusion of knuckle with graft ............................ 7.97 5.72 1.00 14.69 090 S

26860 ............. A Fusion of finger joint ....................................... 4.49 4.30 0.68 9.47 090 S

26861 ............. A Fusion of finger joint, added ........................... 1.74 *2.23 0.43 4.40 ZZZ S

26862 ............. A Fusion/graft of finger joint ............................... 7.06 5.16 0.85 13.07 090 S

26863 ............. A Fuse/graft added joint ..................................... 3.90 3.37 0.57 7.84 ZZZ S

26910 ............. A Amputate metacarpal bone ............................ 7.18 5.16 0.93 13.27 090 S

26951 ............. A Amputation of finger/thumb ............................ 4.41 2.87 0.49 7.77 090 S

26952 ............. A Amputation of finger/thumb ............................ 6.02 4.00 0.69 10.71 090 S

26989 ............. C Hand/finger surgery ........................................ 0.00 0.00 0.00 0.00 YYY S

26990 ............. A Drainage of pelvis lesion ................................ 6.76 3.10 0.51 10.37 090 S

26991 ............. A Drainage of pelvis bursa ................................. 6.05 1.81 0.29 8.15 090 S

26992 ............. A Drainage of bone lesion ................................. 13.97 6.38 1.05 21.40 090 S

27000 ............. A Incision of hip tendon ..................................... 5.27 1.85 0.24 7.36 090 S

27001 ............. A Incision of hip tendon ..................................... 7.70 2.34 0.38 10.42 090 S

27003 ............. A Incision of hip tendon ..................................... 6.53 6.77 1.08 14.38 090 S

27005 ............. A Incision of hip tendon ..................................... 9.00 3.37 0.54 12.91 090 S

27006 ............. A Incision of hip tendons .................................... 9.50 4.64 0.77 14.91 090 S

27025 ............. A Incision of hip/thigh fascia .............................. 10.16 6.12 1.02 17.30 090 S

27030 ............. A Drainage of hip joint ....................................... 12.09 11.42 1.86 25.37 090 S

27033 ............. A Exploration of hip joint .................................... 12.38 11.52 1.85 25.75 090 S

27035 ............. A Denervation of hip joint ................................... 15.72 11.86 2.21 29.79 090 S

27040 ............. A Biopsy of soft tissues ...................................... 3.26 0.72 0.11 4.09 010 N

27041 ............. A Biopsy of soft tissues ...................................... 9.36 2.67 0.44 12.47 090 S

27047 ............. A Remove hip/pelvis lesion ................................ 7.16 1.89 0.32 9.37 090 S

27048 ............. A Remove hip/pelvis lesion ................................ 5.70 4.33 0.82 10.85 090 S

27049 ............. A Remove tumor, hip/pelvis ............................... 12.52 10.14 1.87 24.53 090 S

27050 ............. A Biopsy of sacroiliac joint ................................. 3.73 *4.78 0.90 9.41 090 S

27052 ............. A Biopsy of hip joint ........................................... 5.45 *6.97 1.59 14.01 090 S

27054 ............. A Removal of hip joint lining .............................. 7.60 *9.72 2.26 19.58 090 S

27060 ............. A Removal of ischial bursa ................................ 4.73 3.93 0.68 9.34 090 S

27062 ............. A Remove femur lesion/bursa ............................ 4.74 4.23 0.70 9.67 090 S

27065 ............. A Removal of hip bone lesion ............................ 4.98 5.59 0.90 11.47 090 S

27066 ............. A Removal of hip bone lesion ............................ 9.17 7.90 1.30 18.37 090 S

27067 ............. A Remove/graft hip bone lesion ......................... 12.64 11.63 1.93 26.20 090 S

27070 ............. A Partial removal of hip bone ............................ 9.58 7.41 1.21 18.20 090 S

27071 ............. A Partial removal of hip bone ............................ 10.23 8.50 1.45 20.18 090 S

27075 ............. A Extensive hip surgery ..................................... 15.85 13.54 2.32 31.71 090 S

27076 ............. A Extensive hip surgery ..................................... 17.93 16.37 2.61 36.91 090 S

27077 ............. A Extensive hip surgery ..................................... 21.29 18.98 3.24 43.51 090 S

27078 ............. A Extensive hip surgery ..................................... 11.86 9.20 1.67 22.73 090 S

27079 ............. A Extensive hip surgery ..................................... 12.11 8.64 1.66 22.41 090 S

27080 ............. A Removal of tail bone ....................................... 5.63 4.78 0.87 11.28 090 S

27086 ............. A Remove hip foreign body ............................... 1.82 0.58 0.07 2.47 010 S

27087 ............. A Remove hip foreign body ............................... 8.01 3.62 0.60 12.23 090 S

27090 ............. A Removal of hip prosthesis .............................. 12.00 9.09 1.46 22.55 090 S

27091 ............. A Removal of hip prosthesis .............................. 20.48 19.81 3.16 43.45 090 S

27093 ............. A Injection for hip x-ray ...................................... 1.30 0.82 0.11 2.23 000 S

27095 ............. A Injection for hip x-ray ...................................... 1.50 0.93 0.13 2.56 000 N

27097 ............. A Revision of hip tendon .................................... 8.08 7.71 1.26 17.05 090 S

27098 ............. A Transfer tendon to pelvis ................................ 8.08 7.71 1.26 17.05 090 S

27100 ............. A Transfer of abdominal muscle ........................ 10.57 7.68 1.42 19.67 090 S

27105 ............. A Transfer of spinal muscle ............................... 11.26 5.89 1.36 18.51 090 S

27110 ............. A Transfer of iliopsoas muscle ........................... 12.49 10.61 1.86 24.96 090 S
63210

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

27111 ............. A Transfer of iliopsoas muscle ........................... 11.44 11.63 1.65 24.72 090 S

27120 ............. A Reconstruction of hip socket .......................... 16.43 18.10 2.95 37.48 090 S

27122 ............. A Reconstruction of hip socket .......................... 13.56 *17.36 2.94 33.86 090 S

27125 ............. A Partial hip replacement ................................... 13.21 *16.91 3.01 33.13 090 S

27130 ............. A Total hip replacement ..................................... 18.68 *23.91 4.58 47.17 090 S

27132 ............. A Total hip replacement ..................................... 21.44 *27.44 5.09 53.97 090 S

27134 ............. A Revise hip joint replacement .......................... 24.54 *31.41 5.96 61.91 090 S

27137 ............. A Revise hip joint replacement .......................... 18.67 *23.90 4.82 47.39 090 S

27138 ............. A Revise hip joint replacement .......................... 18.93 *24.23 4.58 47.74 090 S

27140 ............. A Transplant of femur ridge ............................... 11.43 11.05 1.71 24.19 090 S

27146 ............. A Incision of hip bone ........................................ 13.72 10.88 1.35 25.95 090 S

27147 ............. A Revision of hip bone ....................................... 17.58 16.97 2.76 37.31 090 S

27151 ............. A Incision of hip bones ....................................... 18.58 17.71 2.90 39.19 090 S

27156 ............. A Revision of hip bones ..................................... 20.16 18.32 3.08 41.56 090 S

27158 ............. A Revision of pelvis ............................................ 18.10 14.42 2.64 35.16 090 S

27161 ............. A Incision of neck of femur ................................ 15.20 14.31 2.31 31.82 090 S

27165 ............. A Incision/fixation of femur ................................. 16.20 16.76 2.63 35.59 090 S

27170 ............. A Repair/graft femur head/neck ......................... 14.90 16.41 2.65 33.96 090 S

27175 ............. A Treat slipped epiphysis ................................... 7.24 1.18 0.18 8.60 090 S

27176 ............. A Treat slipped epiphysis ................................... 10.89 10.39 1.70 22.98 090 S

27177 ............. A Repair slipped epiphysis ................................. 13.76 12.39 2.05 28.20 090 S

27178 ............. A Repair slipped epiphysis ................................. 10.76 10.46 1.55 22.77 090 S

27179 ............. A Revise head/neck of femur ............................. 11.69 11.15 1.83 24.67 090 S

27181 ............. A Repair slipped epiphysis ................................. 13.80 13.14 2.16 29.10 090 S

27185 ............. A Revision of femur epiphysis ........................... 8.30 2.77 0.87 11.94 090 S

27187 ............. A Reinforce hip bones ........................................ 12.57 *16.09 2.76 31.42 090 S

27193 ............. A Treat pelvic ring fracture ................................. 4.64 2.41 0.39 7.44 090 S

27194 ............. A Treat pelvic ring fracture ................................. 8.73 3.90 0.50 13.13 090 S

27200 ............. A Treat tail bone fracture ................................... 1.76 1.49 0.17 3.42 090 S

27202 ............. A Repair tail bone fracture ................................. 6.52 6.15 0.89 13.56 090 S

27215 ............. A Pelvic fracture(s) treatment ............................ 9.39 *12.02 2.33 23.74 090 S

27216 ............. A Treat pelvic ring fracture ................................. 14.20 4.30 0.66 19.16 090 S

27217 ............. A Treat pelvic ring fracture ................................. 13.19 14.55 2.33 30.07 090 S

27218 ............. A Treat pelvic ring fracture ................................. 18.83 14.55 2.33 35.71 090 S

27220 ............. A Treat hip socket fracture ................................. 5.26 4.26 0.64 10.16 090 S

27222 ............. A Treat hip socket fracture ................................. 10.95 6.37 1.03 18.35 090 S

27226 ............. A Treat hip wall fracture ..................................... 13.93 15.78 2.52 32.23 090 S

27227 ............. A Treat hip fracture(s) ........................................ 15.39 *19.70 3.20 38.29 090 S

27228 ............. A Treat hip fracture(s) ........................................ 17.90 19.95 3.20 41.05 090 S

27230 ............. A Treat fracture of thigh ..................................... 4.95 3.30 0.41 8.66 090 S

27232 ............. A Treat fracture of thigh ..................................... 9.32 8.98 1.46 19.76 090 S

27235 ............. A Repair of thigh fracture ................................... 11.02 *14.10 2.60 27.72 090 S

27236 ............. A Repair of thigh fracture ................................... 14.14 16.91 2.71 33.76 090 S

27238 ............. A Treatment of thigh fracture ............................. 5.06 4.91 0.71 10.68 090 S

27240 ............. A Treatment of thigh fracture ............................. 10.86 9.70 1.53 22.09 090 S

27244 ............. A Repair of thigh fracture ................................... 14.35 16.30 2.62 33.27 090 S

27245 ............. A Repair of thigh fracture ................................... 18.72 16.30 2.62 37.64 090 S

27246 ............. A Treatment of thigh fracture ............................. 4.36 3.87 0.60 8.83 090 S

27248 ............. A Repair of thigh fracture ................................... 9.73 *12.46 2.11 24.30 090 S

27250 ............. A Treat hip dislocation ....................................... 6.31 3.19 0.45 9.95 090 S

27252 ............. A Treat hip dislocation ....................................... 9.47 4.34 0.68 14.49 090 S

27253 ............. A Repair of hip dislocation ................................. 11.98 13.14 2.11 27.23 090 S

27254 ............. A Repair of hip dislocation ................................. 17.29 13.47 2.27 33.03 090 S

27256 ............. A Treatment of hip dislocation ........................... 3.72 1.88 0.31 5.91 010 S

27257 ............. A Treatment of hip dislocation ........................... 4.82 4.62 0.73 10.17 010 S

27258 ............. A Repair of hip dislocation ................................. 14.40 13.73 2.25 30.38 090 S

27259 ............. A Repair of hip dislocation ................................. 18.03 17.20 2.82 38.05 090 S

27265 ............. A Treatment of hip dislocation ........................... 5.58 3.46 0.54 9.58 090 S

27266 ............. A Treatment of hip dislocation ........................... 7.73 4.45 0.71 12.89 090 S

27275 ............. A Manipulation of hip joint .................................. 2.00 1.88 0.30 4.18 010 S

27280 ............. A Fusion of sacroiliac joint ................................. 11.81 10.06 1.77 23.64 090 S

27282 ............. A Fusion of pubic bones .................................... 10.57 9.01 1.69 21.27 090 S

27284 ............. A Fusion of hip joint ........................................... 15.62 14.50 2.40 32.52 090 S

27286 ............. A Fusion of hip joint ........................................... 15.65 15.20 2.26 33.11 090 S

27290 ............. A Amputation of leg at hip ................................. 21.68 25.40 4.70 51.78 090 S

27295 ............. A Amputation of leg at hip ................................. 17.32 16.54 2.95 36.81 090 S
63211

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

27299 ............. C Pelvis/hip joint surgery .................................... 0.00 0.00 0.00 0.00 YYY S

27301 ............. A Drain thigh/knee lesion ................................... 5.96 2.46 0.40 8.82 090 S

27303 ............. A Drainage of bone lesion ................................. 7.69 5.86 0.96 14.51 090 S

27305 ............. A Incise thigh tendon & fascia ........................... 5.42 3.80 0.68 9.90 090 S

27306 ............. A Incision of thigh tendon .................................. 4.27 1.99 0.32 6.58 090 S

27307 ............. A Incision of thigh tendons ................................. 5.30 3.01 0.48 8.79 090 S

27310 ............. A Exploration of knee joint ................................. 8.26 9.60 1.51 19.37 090 S

27315 ............. A Partial removal, thigh nerve ............................ 6.51 5.38 0.96 12.85 090 S

27320 ............. A Partial removal, thigh nerve ............................ 5.90 5.18 0.73 11.81 090 S

27323 ............. A Biopsy thigh soft tissues ................................. 2.67 0.91 0.13 3.71 010 S

27324 ............. A Biopsy thigh soft tissues ................................. 4.53 2.63 0.45 7.61 090 S

27327 ............. A Removal of thigh lesion .................................. 4.32 2.29 0.40 7.01 090 S

27328 ............. A Removal of thigh lesion .................................. 5.31 4.07 0.73 10.11 090 S

27329 ............. A Remove tumor, thigh/knee ............................. 11.74 11.69 2.14 25.57 090 S

27330 ............. A Biopsy knee joint lining ................................... 4.71 *6.02 1.19 11.92 090 S

27331 ............. A Explore/treat knee joint ................................... 5.51 *7.05 1.49 14.05 090 S

27332 ............. A Removal of knee cartilage .............................. 7.85 *10.05 1.73 19.63 090 S

27333 ............. A Removal of knee cartilage .............................. 6.81 *9.01 2.52 18.34 090 S

27334 ............. A Remove knee joint lining ................................ 7.95 *10.18 1.77 19.90 090 S

27335 ............. A Remove knee joint lining ................................ 9.19 *11.76 2.05 23.00 090 S

27340 ............. A Removal of kneecap bursa ............................. 3.92 3.85 0.62 8.39 090 S

27345 ............. A Removal of knee cyst ..................................... 5.63 5.63 0.95 12.21 090 S

27350 ............. A Removal of kneecap ....................................... 7.42 *9.49 1.54 18.45 090 S

27355 ............. A Remove femur lesion ...................................... 7.06 7.58 1.23 15.87 090 S

27356 ............. A Remove femur lesion/graft ............................. 8.60 8.20 1.34 18.14 090 S

27357 ............. A Remove femur lesion/graft ............................. 9.63 8.80 1.43 19.86 090 S

27358 ............. A Remove femur lesion/fixation ......................... 4.74 4.55 0.72 10.01 ZZZ S

27360 ............. A Partial removal leg bone(s) ............................ 9.23 8.56 1.40 19.19 090 S

27365 ............. A Extensive leg surgery ..................................... 13.84 13.94 2.43 30.21 090 S

27370 ............. A Injection for knee x-ray ................................... 0.96 0.60 0.05 1.61 000 N

27372 ............. A Removal of foreign body ................................ 4.81 3.42 0.54 8.77 090 S

27380 ............. A Repair of kneecap tendon .............................. 6.63 7.94 1.29 15.86 090 S

27381 ............. A Repair/graft kneecap tendon .......................... 9.66 11.27 1.82 22.75 090 S

27385 ............. A Repair of thigh muscle .................................... 7.17 8.84 1.42 17.43 090 S

27386 ............. A Repair/graft of thigh muscle ........................... 9.72 *12.44 2.02 24.18 090 S

27390 ............. A Incision of thigh tendon .................................. 4.89 4.36 0.71 9.96 090 S

27391 ............. A Incision of thigh tendons ................................. 6.67 5.42 0.90 12.99 090 S

27392 ............. A Incision of thigh tendons ................................. 8.52 7.67 1.28 17.47 090 S

27393 ............. A Lengthening of thigh tendon ........................... 5.95 5.67 0.93 12.55 090 S

27394 ............. A Lengthening of thigh tendons ......................... 7.97 5.73 0.94 14.64 090 S

27395 ............. A Lengthening of thigh tendons ......................... 10.96 10.48 1.65 23.09 090 S

27396 ............. A Transplant of thigh tendon .............................. 7.33 7.06 1.11 15.50 090 S

27397 ............. A Transplants of thigh tendons .......................... 9.33 8.88 1.45 19.66 090 S

27400 ............. A Revise thigh muscles/tendons ........................ 8.47 7.89 1.24 17.60 090 S

27403 ............. A Repair of knee cartilage ................................. 7.80 8.79 1.44 18.03 090 S

27405 ............. A Repair of knee ligament ................................. 7.97 10.17 1.67 19.81 090 S

27407 ............. A Repair of knee ligament ................................. 9.44 8.87 1.42 19.73 090 S

27409 ............. A Repair of knee ligaments ................................ 11.80 *15.10 2.48 29.38 090 S

27418 ............. A Repair degenerated kneecap ......................... 9.82 12.23 1.85 23.90 090 S

27420 ............. A Revision of unstable kneecap ........................ 9.15 10.99 1.74 21.88 090 S

27422 ............. A Revision of unstable kneecap ........................ 9.10 11.45 1.83 22.38 090 S

27424 ............. A Revision/removal of kneecap ......................... 9.13 *11.68 1.89 22.70 090 S

27425 ............. A Lateral retinacular release .............................. 5.04 *6.46 1.08 12.58 090 S

27427 ............. A Reconstruction, knee ...................................... 8.68 *11.12 2.25 22.05 090 S

27428 ............. A Reconstruction, knee ...................................... 10.68 *13.67 2.71 27.06 090 S

27429 ............. A Reconstruction, knee ...................................... 11.86 11.27 1.83 24.96 090 S

27430 ............. A Revision of thigh muscles ............................... 8.92 9.36 1.50 19.78 090 S

27435 ............. A Incision of knee joint ....................................... 8.74 7.03 1.13 16.90 090 S

27437 ............. A Revise kneecap .............................................. 7.74 *9.91 1.55 19.20 090 S

27438 ............. A Revise kneecap with implant .......................... 10.29 13.13 2.14 25.56 090 S

27440 ............. A Revision of knee joint ..................................... 9.49 11.83 2.10 23.42 090 S

27441 ............. A Revision of knee joint ..................................... 9.81 9.14 1.51 20.46 090 S

27442 ............. A Revision of knee joint ..................................... 11.14 *14.25 3.05 28.44 090 S

27443 ............. A Revision of knee joint ..................................... 10.18 *13.03 3.34 26.55 090 S

27445 ............. A Revision of knee joint ..................................... 16.39 *20.98 4.21 41.58 090 S

27446 ............. A Revision of knee joint ..................................... 15.03 *19.25 3.87 38.15 090 S
63212

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

27447 ............. A Total knee replacement .................................. 19.69 *25.20 4.95 49.84 090 S

27448 ............. A Incision of thigh ............................................... 10.25 12.87 2.09 25.21 090 S

27450 ............. A Incision of thigh ............................................... 13.08 14.84 2.36 30.28 090 S

27454 ............. A Realignment of thigh bone ............................. 12.26 *15.70 2.82 30.78 090 S

27455 ............. A Realignment of knee ....................................... 12.01 12.01 1.95 25.97 090 S

27457 ............. A Realignment of knee ....................................... 12.60 13.30 2.14 28.04 090 S

27465 ............. A Shortening of thigh bone ................................ 12.84 12.24 2.00 27.08 090 S

27466 ............. A Lengthening of thigh bone .............................. 15.08 13.43 2.27 30.78 090 S

27468 ............. A Shorten/lengthen thighs .................................. 17.65 16.84 2.75 37.24 090 S

27470 ............. A Repair of thigh ................................................ 14.82 16.67 2.60 34.09 090 S

27472 ............. A Repair/graft of thigh ........................................ 16.40 19.87 3.16 39.43 090 S

27475 ............. A Surgery to stop leg growth ............................. 8.11 7.74 1.27 17.12 090 S

27477 ............. A Surgery to stop leg growth ............................. 9.32 *11.93 2.57 23.82 090 S

27479 ............. A Surgery to stop leg growth ............................. 12.18 11.63 1.89 25.70 090 S

27485 ............. A Surgery to stop leg growth ............................. 8.31 7.91 1.30 17.52 090 S

27486 ............. A Revise knee joint replace ............................... 16.63 *21.28 4.26 42.17 090 S

27487 ............. A Revise knee joint replace ............................... 21.69 *27.76 5.97 55.42 090 S

27488 ............. A Removal of knee prosthesis ........................... 14.48 16.16 2.58 33.22 090 S

27495 ............. A Reinforce thigh ................................................ 14.26 17.63 2.82 34.71 090 S

27496 ............. A Decompression of thigh/knee ......................... 4.75 4.53 0.74 10.02 090 S

27497 ............. A Decompression of thigh/knee ......................... 5.81 5.55 0.91 12.27 090 S

27498 ............. A Decompression of thigh/knee ......................... 6.63 6.32 1.04 13.99 090 S

27499 ............. A Decompression of thigh/knee ......................... 7.64 7.28 1.19 16.11 090 S

27500 ............. A Treatment of thigh fracture ............................. 5.29 5.41 0.82 11.52 090 S

27501 ............. A Treatment of thigh fracture ............................. 5.29 5.41 0.82 11.52 090 S

27502 ............. A Treatment of thigh fracture ............................. 9.51 7.67 1.21 18.39 090 S

27503 ............. A Treatment of thigh fracture ............................. 9.51 7.67 1.21 18.39 090 S

27506 ............. A Repair of thigh fracture ................................... 15.93 16.02 2.56 34.51 090 S

27507 ............. A Treatment of thigh fracture ............................. 12.85 16.02 2.56 31.43 090 S

27508 ............. A Treatment of thigh fracture ............................. 5.21 4.22 0.65 10.08 090 S

27509 ............. A Treatment of thigh fracture ............................. 6.77 4.22 0.65 11.64 090 S

27510 ............. A Treatment of thigh fracture ............................. 8.19 6.82 1.09 16.10 090 S

27511 ............. A Treatment of thigh fracture ............................. 12.50 *16.00 2.56 31.06 090 S

27513 ............. A Treatment of thigh fracture ............................. 16.78 16.02 2.56 35.36 090 S

27514 ............. A Repair of thigh fracture ................................... 15.98 15.76 2.53 34.27 090 S

27516 ............. A Repair of thigh growth plate ........................... 4.92 4.82 0.71 10.45 090 S

27517 ............. A Repair of thigh growth plate ........................... 8.20 7.82 1.28 17.30 090 S

27519 ............. A Repair of thigh growth plate ........................... 13.82 12.68 2.05 28.55 090 S

27520 ............. A Treat kneecap fracture ................................... 2.68 3.04 0.45 6.17 090 S

27524 ............. A Repair of kneecap fracture ............................. 9.38 10.34 1.65 21.37 090 S

27530 ............. A Treatment of knee fracture ............................. 3.23 3.40 0.51 7.14 090 S

27532 ............. A Treatment of knee fracture ............................. 6.81 5.68 0.91 13.40 090 S

27535 ............. A Treatment of knee fracture ............................. 10.36 11.69 1.88 23.93 090 S

27536 ............. A Repair of knee fracture ................................... 14.51 11.69 1.88 28.08 090 S

27538 ............. A Treat knee fracture(s) ..................................... 4.64 3.37 0.51 8.52 090 S

27540 ............. A Repair of knee fracture ................................... 12.38 10.95 1.74 25.07 090 S

27550 ............. A Treat knee dislocation .................................... 5.53 2.57 0.36 8.46 090 S

27552 ............. A Treat knee dislocation .................................... 7.39 3.43 0.53 11.35 090 S

27556 ............. A Repair of knee dislocation .............................. 13.47 12.48 1.95 27.90 090 S

27557 ............. A Repair of knee dislocation .............................. 15.80 14.60 2.43 32.83 090 S

27558 ............. A Repair of knee dislocation .............................. 16.75 14.60 2.43 33.78 090 S

27560 ............. A Treat kneecap dislocation ............................... 3.64 1.43 0.16 5.23 090 S

27562 ............. A Treat kneecap dislocation ............................... 5.48 5.18 0.76 11.42 090 S

27566 ............. A Repair kneecap dislocation ............................ 11.48 10.58 1.67 23.73 090 S

27570 ............. A Fixation of knee joint ...................................... 1.69 1.72 0.28 3.69 010 S

27580 ............. A Fusion of knee ................................................ 12.26 *15.70 2.56 30.52 090 S

27590 ............. A Amputate leg at thigh ..................................... 10.24 9.11 1.80 21.15 090 S

27591 ............. A Amputate leg at thigh ..................................... 11.09 11.77 2.11 24.97 090 S

27592 ............. A Amputate leg at thigh ..................................... 8.75 8.11 1.61 18.47 090 S

27594 ............. A Amputation follow-up surgery ......................... 6.30 3.65 0.68 10.63 090 S

27596 ............. A Amputation follow-up surgery ......................... 9.63 7.37 1.42 18.42 090 S

27598 ............. A Amputate lower leg at knee ............................ 9.56 10.04 1.78 21.38 090 S

27599 ............. C Leg surgery procedure ................................... 0.00 0.00 0.00 0.00 YYY S

27600 ............. A Decompression of lower leg ........................... 5.02 3.39 0.64 9.05 090 S

27601 ............. A Decompression of lower leg ........................... 4.98 3.38 0.67 9.03 090 S

27602 ............. A Decompression of lower leg ........................... 6.63 4.05 0.77 11.45 090 S
63213

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

27603 ............. A Drain lower leg lesion ..................................... 4.41 2.38 0.41 7.20 090 S

27604 ............. A Drain lower leg bursa ..................................... 4.23 1.02 0.14 5.39 090 S

27605 ............. A Incision of achilles tendon .............................. 2.82 1.18 0.14 4.14 010 S

27606 ............. A Incision of achilles tendon .............................. 3.87 2.12 0.35 6.34 010 S

27607 ............. A Treat lower leg bone lesion ............................ 7.05 6.01 0.98 14.04 090 S

27610 ............. A Explore/treat ankle joint .................................. 7.27 7.43 1.13 15.83 090 S

27612 ............. A Exploration of ankle joint ................................ 6.23 *7.97 1.30 15.50 090 S

27613 ............. A Biopsy lower leg soft tissue ............................ 2.12 0.67 0.10 2.89 010 S

27614 ............. A Biopsy lower leg soft tissue ............................ 5.29 2.26 0.38 7.93 090 S

27615 ............. A Remove tumor, lower leg ............................... 11.79 8.23 1.42 21.44 090 S

27618 ............. A Remove lower leg lesion ................................ 4.94 2.10 0.32 7.36 090 S

27619 ............. A Remove lower leg lesion ................................ 7.98 4.13 0.67 12.78 090 S

27620 ............. A Explore, treat ankle joint ................................. 5.69 6.03 0.96 12.68 090 S

27625 ............. A Remove ankle joint lining ............................... 7.88 8.71 1.27 17.86 090 S

27626 ............. A Remove ankle joint lining ............................... 8.49 *10.86 1.25 20.60 090 S

27630 ............. A Removal of tendon lesion ............................... 4.65 3.10 0.46 8.21 090 S

27635 ............. A Remove lower leg bone lesion ....................... 7.29 8.04 1.27 16.60 090 S

27637 ............. A Remove/graft leg bone lesion ......................... 9.14 8.47 1.40 19.01 090 S

27638 ............. A Remove/graft leg bone lesion ......................... 9.89 9.15 1.52 20.56 090 S

27640 ............. A Partial removal of tibia .................................... 10.21 9.81 1.57 21.59 090 S

27641 ............. A Partial removal of fibula .................................. 8.36 7.13 1.18 16.67 090 S

27645 ............. A Extensive lower leg surgery ........................... 13.14 11.64 1.98 26.76 090 S

27646 ............. A Extensive lower leg surgery ........................... 11.69 10.75 1.71 24.15 090 S

27647 ............. A Extensive ankle/heel surgery .......................... 11.21 9.95 1.35 22.51 090 S

27648 ............. A Injection for ankle x-ray .................................. 0.96 0.52 0.05 1.53 000 N

27650 ............. A Repair achilles tendon .................................... 9.07 8.98 1.41 19.46 090 S

27652 ............. A Repair/graft achilles tendon ............................ 9.62 10.41 1.56 21.59 090 S

27654 ............. A Repair of achilles tendon ................................ 9.34 10.93 1.65 21.92 090 S

27656 ............. A Repair leg fascia defect .................................. 4.31 3.18 0.54 8.03 090 S

27658 ............. A Repair of leg tendon, each ............................. 4.61 4.02 0.60 9.23 090 S

27659 ............. A Repair of leg tendon, each ............................. 6.28 5.87 0.86 13.01 090 S

27664 ............. A Repair of leg tendon, each ............................. 4.33 3.41 0.52 8.26 090 S

27665 ............. A Repair of leg tendon, each ............................. 5.11 4.95 0.76 10.82 090 S

27675 ............. A Repair lower leg tendons ................................ 6.78 6.40 0.94 14.12 090 S

27676 ............. A Repair lower leg tendons ................................ 7.87 7.56 1.14 16.57 090 S

27680 ............. A Release of lower leg tendon ........................... 5.37 4.12 0.61 10.10 090 S

27681 ............. A Release of lower leg tendons ......................... 6.36 5.97 0.86 13.19 090 S

27685 ............. A Revision of lower leg tendon .......................... 6.08 3.83 0.41 10.32 090 S

27686 ............. A Revise lower leg tendons ............................... 6.93 6.56 0.90 14.39 090 S

27687 ............. A Revision of calf tendon ................................... 5.84 5.45 0.76 12.05 090 S

27690 ............. A Revise lower leg tendon ................................. 8.09 6.74 0.88 15.71 090 S

27691 ............. A Revise lower leg tendon ................................. 9.25 7.89 1.23 18.37 090 S

27692 ............. A Revise additional leg tendon .......................... 1.87 2.03 0.29 4.19 ZZZ S

27695 ............. A Repair of ankle ligament ................................. 6.09 *7.79 1.32 15.20 090 S

27696 ............. A Repair of ankle ligaments ............................... 7.72 7.06 1.16 15.94 090 S

27698 ............. A Repair of ankle ligament ................................. 8.87 *11.35 1.86 22.08 090 S

27700 ............. A Revision of ankle joint .................................... 8.67 *11.11 1.51 21.29 090 S

27702 ............. A Reconstruct ankle joint ................................... 12.64 *16.18 3.99 32.81 090 S

27703 ............. A Reconstruction, ankle joint ............................. 14.49 13.82 2.25 30.56 090 S

27704 ............. A Removal of ankle implant ............................... 7.20 5.84 0.98 14.02 090 S

27705 ............. A Incision of tibia ................................................ 9.63 10.74 1.76 22.13 090 S

27707 ............. A Incision of fibula .............................................. 3.71 *4.75 0.79 9.25 090 S

27709 ............. A Incision of tibia & fibula .................................. 9.14 *11.70 2.14 22.98 090 S

27712 ............. A Realignment of lower leg ................................ 11.81 10.99 1.63 24.43 090 S

27715 ............. A Revision of lower leg ...................................... 12.97 12.61 1.88 27.46 090 S

27720 ............. A Repair of tibia ................................................. 10.95 13.97 2.25 27.17 090 S

27722 ............. A Repair/graft of tibia ......................................... 10.92 10.50 1.64 23.06 090 S

27724 ............. A Repair/graft of tibia ......................................... 12.11 *15.50 2.87 30.48 090 S

27725 ............. A Repair of lower leg ......................................... 11.04 10.43 1.53 23.00 090 S

27727 ............. A Repair of lower leg ......................................... 12.89 9.38 1.84 24.11 090 S

27730 ............. A Repair of tibia epiphysis ................................. 6.88 3.59 0.84 11.31 090 S

27732 ............. A Repair of fibula epiphysis ............................... 5.06 4.84 0.79 10.69 090 S

27734 ............. A Repair lower leg epiphyses ............................ 7.89 7.54 1.23 16.66 090 S

27740 ............. A Repair of leg epiphyses .................................. 8.75 8.36 1.36 18.47 090 S

27742 ............. A Repair of leg epiphyses .................................. 9.72 9.29 1.52 20.53 090 S

27745 ............. A Reinforce tibia ................................................. 9.39 8.97 1.39 19.75 090 S
63214

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

27750 ............. A Treatment of tibia fracture .............................. 2.90 3.45 0.50 6.85 090 S

27752 ............. A Treatment of tibia fracture .............................. 5.16 5.09 0.81 11.06 090 S

27756 ............. A Repair of tibia fracture .................................... 5.84 *7.48 1.70 15.02 090 S

27758 ............. A Repair of tibia fracture .................................... 10.51 *13.46 2.22 26.19 090 S

27759 ............. A Repair of tibia fracture .................................... 12.60 13.74 2.22 28.56 090 S

27760 ............. A Treatment of ankle fracture ............................ 2.81 2.58 0.37 5.76 090 S

27762 ............. A Treatment of ankle fracture ............................ 4.80 3.36 0.50 8.66 090 S

27766 ............. A Repair of ankle fracture .................................. 7.61 7.87 1.26 16.74 090 S

27780 ............. A Treatment of fibula fracture ............................ 2.47 1.97 0.26 4.70 090 S

27781 ............. A Treatment of fibula fracture ............................ 4.20 3.29 0.49 7.98 090 S

27784 ............. A Repair of fibula fracture .................................. 6.45 5.59 0.87 12.91 090 S

27786 ............. A Treatment of ankle fracture ............................ 2.66 2.52 0.38 5.56 090 S

27788 ............. A Treatment of ankle fracture ............................ 4.25 3.27 0.50 8.02 090 S

27792 ............. A Repair of ankle fracture .................................. 7.04 7.38 1.17 15.59 090 S

27808 ............. A Treatment of ankle fracture ............................ 2.63 2.79 0.39 5.81 090 S

27810 ............. A Treatment of ankle fracture ............................ 4.82 5.05 0.80 10.67 090 S

27814 ............. A Repair of ankle fracture .................................. 9.87 10.00 1.60 21.47 090 S

27816 ............. A Treatment of ankle fracture ............................ 2.71 *3.47 0.55 6.73 090 S

27818 ............. A Treatment of ankle fracture ............................ 5.08 *6.51 1.06 12.65 090 S

27822 ............. A Repair of ankle fracture .................................. 8.39 *10.73 1.88 21.00 090 S

27823 ............. A Repair of ankle fracture .................................. 10.90 12.79 2.05 25.74 090 S

27824 ............. A Treat lower leg fracture .................................. 2.71 *3.47 0.55 6.73 090 S

27825 ............. A Treat lower leg fracture .................................. 5.08 *6.51 1.06 12.65 090 S

27826 ............. A Treat lower leg fracture .................................. 7.43 *9.50 1.88 18.81 090 S

27827 ............. A Treat lower leg fracture .................................. 9.90 11.71 1.88 23.49 090 S

27828 ............. A Treat lower leg fracture .................................. 12.33 12.79 2.05 27.17 090 S

27829 ............. A Treat lower leg joint ........................................ 4.87 *6.23 1.37 12.47 090 S

27830 ............. A Treat lower leg dislocation .............................. 3.50 3.25 0.46 7.21 090 S

27831 ............. A Treat lower leg dislocation .............................. 4.27 3.98 0.59 8.84 090 S

27832 ............. A Repair lower leg dislocation ........................... 5.96 5.70 0.89 12.55 090 S

27840 ............. A Treat ankle dislocation .................................... 4.27 1.87 0.21 6.35 090 S

27842 ............. A Treat ankle dislocation .................................... 5.72 2.22 0.34 8.28 090 S

27846 ............. A Repair ankle dislocation ................................. 9.04 8.59 1.37 19.00 090 S

27848 ............. A Repair ankle dislocation ................................. 10.45 8.36 1.32 20.13 090 S

27860 ............. A Fixation of ankle joint ...................................... 2.29 1.39 0.23 3.91 010 S

27870 ............. A Fusion of ankle joint ....................................... 10.42 *13.34 2.22 25.98 090 S

27871 ............. A Fusion of tibiofibular joint ................................ 8.55 7.79 1.21 17.55 090 S

27880 ............. A Amputation of lower leg .................................. 10.69 8.36 1.60 20.65 090 S

27881 ............. A Amputation of lower leg .................................. 10.89 10.82 1.87 23.58 090 S

27882 ............. A Amputation of lower leg .................................. 7.80 7.36 1.42 16.58 090 S

27884 ............. A Amputation follow-up surgery ......................... 7.40 3.37 0.61 11.38 090 S

27886 ............. A Amputation follow-up surgery ......................... 8.35 7.17 1.34 16.86 090 S

27888 ............. A Amputation of foot at ankle ............................ 8.70 9.49 1.65 19.84 090 S

27889 ............. A Amputation of foot at ankle ............................ 8.82 8.43 1.55 18.80 090 S

27892 ............. A Decompression of leg ..................................... 6.03 3.39 0.64 10.06 090 S

27893 ............. A Decompression of leg ..................................... 5.99 3.38 0.67 10.04 090 S

27894 ............. A Decompression of leg ..................................... 7.64 4.05 0.77 12.46 090 S

27899 ............. C Leg/ankle surgery procedure .......................... 0.00 0.00 0.00 0.00 YYY S

28001 ............. A Drainage of bursa of foot ................................ 2.68 0.52 0.05 3.25 010 S

28002 ............. A Treatment of foot infection .............................. 3.76 2.25 0.33 6.34 010 S

28003 ............. A Treatment of foot infection .............................. 7.49 3.50 0.59 11.58 090 S

28005 ............. A Treat foot bone lesion ..................................... 7.65 4.08 0.61 12.34 090 S

28008 ............. A Incision of foot fascia ...................................... 4.19 2.68 0.29 7.16 090 S

28010 ............. A Incision of toe tendon ..................................... 2.97 3.62 0.33 6.92 090 S

28011 ............. A Incision of toe tendons ................................... 3.99 1.77 0.19 5.95 090 S

28020 ............. A Exploration of a foot joint ................................ 4.75 4.40 0.56 9.71 090 S

28022 ............. A Exploration of a foot joint ................................ 4.41 2.74 0.31 7.46 090 S

28024 ............. A Exploration of a toe joint ................................. 4.12 2.39 0.24 6.75 090 S

28030 ............. A Removal of foot nerve .................................... 5.78 3.93 0.42 10.13 090 S

28035 ............. A Decompression of tibia nerve ......................... 4.83 *6.18 0.90 11.91 090 S

28043 ............. A Excision of foot lesion ..................................... 3.41 1.73 0.20 5.34 090 S

28045 ............. A Excision of foot lesion ..................................... 4.46 3.99 0.46 8.91 090 S

28046 ............. A Resection of tumor, foot ................................. 9.41 5.35 0.79 15.55 090 S

28050 ............. A Biopsy of foot joint lining ................................ 3.99 3.84 0.53 8.36 090 S

28052 ............. A Biopsy of foot joint lining ................................ 3.70 3.82 0.43 7.95 090 S

28054 ............. A Biopsy of toe joint lining ................................. 3.21 2.24 0.28 5.73 090 S
63215

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

28060 ............. A Partial removal foot fascia .............................. 5.05 4.22 0.53 9.80 090 S

28062 ............. A Removal of foot fascia .................................... 6.23 7.06 0.86 14.15 090 S

28070 ............. A Removal of foot joint lining ............................. 4.73 4.48 0.48 9.69 090 S

28072 ............. A Removal of foot joint lining ............................. 4.32 3.21 0.42 7.95 090 S

28080 ............. A Removal of foot lesion .................................... 3.18 *4.07 0.45 7.70 090 S

28086 ............. A Excise foot tendon sheath .............................. 4.52 3.12 0.46 8.10 090 S

28088 ............. A Excise foot tendon sheath .............................. 3.62 3.62 0.40 7.64 090 S

28090 ............. A Removal of foot lesion .................................... 4.26 3.02 0.29 7.57 090 S

28092 ............. A Removal of toe lesions ................................... 3.49 2.03 0.25 5.77 090 S

28100 ............. A Removal of ankle/heel lesion ......................... 5.37 4.58 0.56 10.51 090 S

28102 ............. A Remove/graft foot lesion ................................. 7.31 6.84 0.85 15.00 090 S

28103 ............. A Remove/graft foot lesion ................................. 6.10 5.61 0.69 12.40 090 S

28104 ............. A Removal of foot lesion .................................... 4.86 4.33 0.49 9.68 090 S

28106 ............. A Remove/graft foot lesion ................................. 6.74 6.42 0.79 13.95 090 S

28107 ............. A Remove/graft foot lesion ................................. 5.16 4.86 0.48 10.50 090 S

28108 ............. A Removal of toe lesions ................................... 4.01 4.20 0.38 8.59 090 S

28110 ............. A Part removal of metatarsal ............................. 3.82 3.48 0.39 7.69 090 S

28111 ............. A Part removal of metatarsal ............................. 4.64 5.04 0.65 10.33 090 S

28112 ............. A Part removal of metatarsal ............................. 4.23 3.96 0.45 8.64 090 S

28113 ............. A Part removal of metatarsal ............................. 4.09 4.44 0.48 9.01 090 S

28114 ............. A Removal of metatarsal heads ......................... 7.16 *9.17 1.42 17.75 090 S

28116 ............. A Revision of foot ............................................... 6.17 5.48 0.57 12.22 090 S

28118 ............. A Removal of heel bone .................................... 5.56 5.71 0.66 11.93 090 S

28119 ............. A Removal of heel spur ..................................... 5.10 5.44 0.57 11.11 090 S

28120 ............. A Part removal of ankle/heel .............................. 4.81 5.04 0.67 10.52 090 S

28122 ............. A Partial removal of foot bone ........................... 6.62 4.48 0.54 11.64 090 S

28124 ............. A Partial removal of toe ..................................... 4.39 4.11 0.37 8.87 090 S

28126 ............. A Partial removal of toe ..................................... 3.39 3.98 0.36 7.73 090 S

28130 ............. A Removal of ankle bone ................................... 7.33 7.03 0.88 15.24 090 S

28140 ............. A Removal of metatarsal .................................... 6.45 4.93 0.62 12.00 090 S

28150 ............. A Removal of toe ............................................... 3.83 3.29 0.38 7.50 090 S

28153 ............. A Partial removal of toe ..................................... 3.40 3.99 0.36 7.75 090 S

28160 ............. A Partial removal of toe ..................................... 3.59 4.12 0.38 8.09 090 S

28171 ............. A Extensive foot surgery .................................... 8.98 7.99 0.88 17.85 090 S

28173 ............. A Extensive foot surgery .................................... 8.18 5.74 0.74 14.66 090 S

28175 ............. A Extensive foot surgery .................................... 5.59 5.38 0.58 11.55 090 S

28190 ............. A Removal of foot foreign body ......................... 1.91 0.52 0.05 2.48 010 S

28192 ............. A Removal of foot foreign body ......................... 4.49 1.95 0.24 6.68 090 S

28193 ............. A Removal of foot foreign body ......................... 5.44 2.38 0.30 8.12 090 S

28200 ............. A Repair of foot tendon ...................................... 4.45 5.06 0.50 10.01 090 S

28202 ............. A Repair/graft of foot tendon .............................. 6.38 5.82 0.77 12.97 090 S

28208 ............. A Repair of foot tendon ...................................... 4.11 2.81 0.28 7.20 090 S

28210 ............. A Repair/graft of foot tendon .............................. 5.95 5.60 0.60 12.15 090 S

28220 ............. A Release of foot tendon ................................... 4.27 3.87 0.43 8.57 090 S

28222 ............. A Release of foot tendons ................................. 5.36 6.40 0.63 12.39 090 S

28225 ............. A Release of foot tendon ................................... 3.42 2.37 0.25 6.04 090 S

28226 ............. A Release of foot tendons ................................. 4.27 3.38 0.40 8.05 090 S

28230 ............. A Incision of foot tendon(s) ................................ 4.00 2.43 0.22 6.65 090 S

28232 ............. A Incision of toe tendon ..................................... 3.26 1.60 0.15 5.01 090 S

28234 ............. A Incision of foot tendon .................................... 3.19 1.53 0.14 4.86 090 S

28236 ............. D Transfer of foot tendon ................................... 0.00 0.00 0.00 0.00 090 S

28238 ............. A Revision of foot tendon ................................... 7.27 7.23 0.85 15.35 090 S

28240 ............. A Release of big toe .......................................... 4.12 2.13 0.23 6.48 090 S

28250 ............. A Revision of foot fascia .................................... 5.66 4.46 0.50 10.62 090 S

28260 ............. A Release of midfoot joint .................................. 7.50 4.43 0.48 12.41 090 S

28261 ............. A Revision of foot tendon ................................... 8.92 5.91 0.58 15.41 090 S

28262 ............. A Revision of foot and ankle .............................. 12.19 11.91 1.44 25.54 090 S

28264 ............. A Release of midfoot joint .................................. 9.80 9.56 1.17 20.53 090 S

28270 ............. A Release of foot contracture ............................ 4.58 2.63 0.23 7.44 090 S

28272 ............. A Release of toe joint, each ............................... 3.67 2.04 0.18 5.89 090 S

28280 ............. A Fusion of toes ................................................. 4.93 2.22 0.30 7.45 090 S

28285 ............. A Repair of hammertoe ...................................... 4.41 4.37 0.39 9.17 090 S

28286 ............. A Repair of hammertoe ...................................... 4.41 3.58 0.38 8.37 090 S

28288 ............. A Partial removal of foot bone ........................... 3.73 3.75 0.43 7.91 090 S

28290 ............. A Correction of bunion ....................................... 5.37 5.36 0.63 11.36 090 S

28292 ............. A Correction of bunion ....................................... 6.24 7.05 0.74 14.03 090 S
63216

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

28293 ............. A Correction of bunion ....................................... 8.25 9.55 0.98 18.78 090 S

28294 ............. A Correction of bunion ....................................... 8.14 9.16 0.86 18.16 090 S

28296 ............. A Correction of bunion ....................................... 8.69 8.81 0.98 18.48 090 S

28297 ............. A Correction of bunion ....................................... 8.69 9.02 1.05 18.76 090 S

28298 ............. A Correction of bunion ....................................... 7.52 8.89 0.79 17.20 090 S

28299 ............. A Correction of bunion ....................................... 8.46 10.14 1.08 19.68 090 S

28300 ............. A Incision of heel bone ...................................... 9.12 6.52 0.79 16.43 090 S

28302 ............. A Incision of ankle bone ..................................... 9.13 8.89 1.12 19.14 090 S

28304 ............. A Incision of midfoot bones ................................ 8.67 6.44 0.70 15.81 090 S

28305 ............. A Incise/graft midfoot bones .............................. 9.99 9.85 1.03 20.87 090 S

28306 ............. A Incision of metatarsal ...................................... 5.71 4.57 0.47 10.75 090 S

28307 ............. A Incision of metatarsal ...................................... 6.04 5.87 0.76 12.67 090 S

28308 ............. A Incision of metatarsal ...................................... 5.09 5.71 0.50 11.30 090 S

28309 ............. A Incision of metatarsals .................................... 8.83 6.87 1.00 16.70 090 S

28310 ............. A Revision of big toe .......................................... 5.06 4.17 0.42 9.65 090 S

28312 ............. A Revision of toe ................................................ 4.29 4.56 0.45 9.30 090 S

28313 ............. A Repair deformity of toe ................................... 4.75 2.57 0.31 7.63 090 S

28315 ............. A Removal of sesamoid bone ............................ 4.60 4.24 0.41 9.25 090 S

28320 ............. A Repair of foot bones ....................................... 8.76 8.69 1.03 18.48 090 S

28322 ............. A Repair of metatarsals ..................................... 8.03 4.67 0.52 13.22 090 S

28340 ............. A Resect enlarged toe tissue ............................. 6.58 6.34 0.91 13.83 090 S

28341 ............. A Resect enlarged toe ....................................... 7.86 7.66 0.96 16.48 090 S

28344 ............. A Repair extra toe(s) .......................................... 3.89 3.70 0.60 8.19 090 S

28345 ............. A Repair webbed toe(s) ..................................... 5.52 5.34 0.73 11.59 090 S

28360 ............. A Reconstruct cleft foot ...................................... 12.49 11.91 1.95 26.35 090 S

28400 ............. A Treatment of heel fracture .............................. 2.01 *2.57 0.40 4.98 090 S

28405 ............. A Treatment of heel fracture .............................. 4.28 3.90 0.58 8.76 090 S

28406 ............. A Treatment of heel fracture .............................. 5.82 6.09 0.93 12.84 090 S

28415 ............. A Repair of heel fracture .................................... 13.28 9.02 1.39 23.69 090 S

28420 ............. A Repair/graft heel fracture ................................ 15.80 10.89 1.63 28.32 090 S

28430 ............. A Treatment of ankle fracture ............................ 1.96 2.45 0.35 4.76 090 S

28435 ............. A Treatment of ankle fracture ............................ 3.25 3.36 0.50 7.11 090 S

28436 ............. A Treatment of ankle fracture ............................ 4.40 4.19 0.68 9.27 090 S

28445 ............. A Repair of ankle fracture .................................. 8.78 8.80 1.40 18.98 090 S

28450 ............. A Treat midfoot fracture, each ........................... 1.77 1.87 0.25 3.89 090 S

28455 ............. A Treat midfoot fracture, each ........................... 2.94 2.54 0.34 5.82 090 S

28456 ............. A Repair midfoot fracture ................................... 2.39 2.27 0.38 5.04 090 S

28465 ............. A Repair midfoot fracture, each ......................... 6.55 5.54 0.81 12.90 090 S

28470 ............. A Treat metatarsal fracture ................................ 1.76 1.80 0.23 3.79 090 S

28475 ............. A Treat metatarsal fracture ................................ 2.74 2.34 0.30 5.38 090 S

28476 ............. A Repair metatarsal fracture .............................. 3.15 3.37 0.45 6.97 090 S

28485 ............. A Repair metatarsal fracture .............................. 5.31 4.68 0.60 10.59 090 S

28490 ............. A Treat big toe fracture ...................................... 1.01 0.90 0.10 2.01 090 S

28495 ............. A Treat big toe fracture ...................................... 1.48 1.12 0.13 2.73 090 S

28496 ............. A Repair big toe fracture .................................... 2.18 2.07 0.31 4.56 090 S

28505 ............. A Repair big toe fracture .................................... 3.55 2.99 0.43 6.97 090 S

28510 ............. A Treatment of toe fracture ................................ 1.01 0.89 0.09 1.99 090 S

28515 ............. A Treatment of toe fracture ................................ 1.36 1.12 0.11 2.59 090 S

28525 ............. A Repair of toe fracture ...................................... 3.08 2.06 0.29 5.43 090 S

28530 ............. A Treat sesamoid bone fracture ........................ 1.01 1.00 0.10 2.11 090 S

28531 ............. A Treat sesamoid bone fracture ........................ 2.01 1.91 0.32 4.24 090 S

28540 ............. A Treat foot dislocation ...................................... 1.89 0.60 0.06 2.55 090 S

28545 ............. A Treat foot dislocation ...................................... 2.19 1.31 0.14 3.64 090 S

28546 ............. A Treat foot dislocation ...................................... 2.89 2.74 0.45 6.08 090 S

28555 ............. A Repair foot dislocation .................................... 5.84 5.58 0.73 12.15 090 S

28570 ............. A Treat foot dislocation ...................................... 1.56 1.59 0.17 3.32 090 S

28575 ............. A Treat foot dislocation ...................................... 2.91 2.77 0.42 6.10 090 S

28576 ............. A Treat foot dislocation ...................................... 3.75 2.77 0.42 6.94 090 S

28585 ............. A Repair foot dislocation .................................... 7.46 4.96 0.55 12.97 090 S

28600 ............. A Treat foot dislocation ...................................... 1.76 0.68 0.08 2.52 090 S

28605 ............. A Treat foot dislocation ...................................... 2.42 2.26 0.34 5.02 090 S

28606 ............. A Treat foot dislocation ...................................... 4.48 3.49 0.55 8.52 090 S

28615 ............. A Repair foot dislocation .................................... 5.12 4.96 0.78 10.86 090 S

28630 ............. A Treat toe dislocation ....................................... 1.65 1.03 0.11 2.79 010 S

28635 ............. A Treat toe dislocation ....................................... 1.86 1.45 0.18 3.49 010 S

28636 ............. A Treat toe dislocation ....................................... 2.67 2.56 0.42 5.65 010 S
63217

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

28645 ............. A Repair toe dislocation ..................................... 3.96 3.24 0.38 7.58 090 S

28660 ............. A Treat toe dislocation ....................................... 1.18 0.63 0.06 1.87 010 S

28665 ............. A Treat toe dislocation ....................................... 1.87 0.98 0.11 2.96 010 S

28666 ............. A Treat toe dislocation ....................................... 2.56 2.44 0.40 5.40 010 S

28675 ............. A Repair of toe dislocation ................................. 2.68 3.00 0.41 6.09 090 S

28705 ............. A Fusion of foot bones ....................................... 14.23 15.11 2.35 31.69 090 S

28715 ............. A Fusion of foot bones ....................................... 12.18 12.33 1.89 26.40 090 S

28725 ............. A Fusion of foot bones ....................................... 10.86 9.44 1.44 21.74 090 S

28730 ............. A Fusion of foot bones ....................................... 9.91 9.00 1.33 20.24 090 S

28735 ............. A Fusion of foot bones ....................................... 10.07 9.76 1.37 21.20 090 S

28737 ............. A Revision of foot bones .................................... 8.89 8.87 1.13 18.89 090 S

28740 ............. A Fusion of foot bones ....................................... 6.20 5.14 0.72 12.06 090 S

28750 ............. A Fusion of big toe joint ..................................... 4.77 5.32 0.82 10.91 090 S

28755 ............. A Fusion of big toe joint ..................................... 4.48 3.69 0.45 8.62 090 S

28760 ............. A Fusion of big toe joint ..................................... 5.47 5.40 0.65 11.52 090 S

28800 ............. A Amputation of midfoot ..................................... 7.37 6.65 1.19 15.21 090 S

28805 ............. A Amputation thru metatarsal ............................ 7.55 6.32 1.21 15.08 090 S

28810 ............. A Amputation toe & metatarsal .......................... 5.53 3.91 0.75 10.19 090 S

28820 ............. A Amputation of toe ........................................... 3.56 2.58 0.46 6.60 090 S

28825 ............. A Partial amputation of toe ................................ 3.13 2.40 0.41 5.94 090 S

28899 ............. C Foot/toes surgery procedure .......................... 0.00 0.00 0.00 0.00 YYY S

29000 ............. A Application of body cast ................................. 2.25 1.85 0.21 4.31 000 S

29010 ............. A Application of body cast ................................. 2.06 2.33 0.34 4.73 000 S

29015 ............. A Application of body cast ................................. 2.41 2.33 0.33 5.07 000 S

29020 ............. A Application of body cast ................................. 2.11 1.82 0.23 4.16 000 S

29025 ............. A Application of body cast ................................. 2.40 0.75 0.14 3.29 000 S

29035 ............. A Application of body cast ................................. 1.77 1.95 0.32 4.04 000 S

29040 ............. A Application of body cast ................................. 2.22 2.02 0.30 4.54 000 S

29044 ............. A Application of body cast ................................. 2.12 2.09 0.34 4.55 000 S

29046 ............. A Application of body cast ................................. 2.41 2.23 0.36 5.00 000 S

29049 ............. A Application of shoulder cast ........................... 0.89 0.42 0.06 1.37 000 S

29055 ............. A Application of shoulder cast ........................... 1.78 1.20 0.17 3.15 000 S

29058 ............. A Application of shoulder cast ........................... 1.31 0.65 0.09 2.05 000 S

29065 ............. A Application of long arm cast ........................... 0.87 0.80 0.13 1.80 000 S

29075 ............. A Application of forearm cast ............................. 0.77 0.61 0.10 1.48 000 S

29085 ............. A Apply hand/wrist cast ...................................... 0.87 0.50 0.08 1.45 000 S

29105 ............. A Apply long arm splint ...................................... 0.87 0.50 0.08 1.45 000 S

29125 ............. A Apply forearm splint ........................................ 0.59 0.37 0.05 1.01 000 S

29126 ............. A Apply forearm splint ........................................ 0.77 0.40 0.06 1.23 000 S

29130 ............. A Application of finger splint .............................. 0.50 0.17 0.02 0.69 000 S

29131 ............. A Application of finger splint .............................. 0.55 0.39 0.06 1.00 000 S

29200 ............. A Strapping of chest ........................................... 0.65 0.27 0.03 0.95 000 N

29220 ............. A Strapping of low back ..................................... 0.64 0.38 0.05 1.07 000 S

29240 ............. A Strapping of shoulder ..................................... 0.71 0.27 0.03 1.01 000 S

29260 ............. A Strapping of elbow or wrist ............................. 0.55 0.23 0.03 0.81 000 S

29280 ............. A Strapping of hand or finger ............................. 0.51 0.21 0.02 0.74 000 S

29305 ............. A Application of hip cast .................................... 2.03 1.88 0.31 4.22 000 S

29325 ............. A Application of hip casts ................................... 2.32 1.94 0.28 4.54 000 S

29345 ............. A Application of long leg cast ............................ 1.40 1.02 0.16 2.58 000 S

29355 ............. A Application of long leg cast ............................ 1.53 1.10 0.17 2.80 000 S

29358 ............. A Apply long leg cast brace ............................... 1.43 *1.84 0.33 3.60 000 S

29365 ............. A Application of long leg cast ............................ 1.18 0.86 0.14 2.18 000 S

29405 ............. A Apply short leg cast ........................................ 0.86 0.79 0.12 1.77 000 S

29425 ............. A Apply short leg cast ........................................ 1.01 0.97 0.14 2.12 000 S

29435 ............. A Apply short leg cast ........................................ 1.18 1.18 0.18 2.54 000 S

29440 ............. A Addition of walker to cast ............................... 0.57 0.23 0.03 0.83 000 S

29445 ............. A Apply rigid leg cast ......................................... 1.78 1.70 0.28 3.76 000 S

29450 ............. A Application of leg cast .................................... 1.02 0.39 0.04 1.45 000 S

29505 ............. A Application long leg splint ............................... 0.69 0.57 0.07 1.33 000 S

29515 ............. A Application lower leg splint ............................. 0.73 0.47 0.06 1.26 000 S

29520 ............. A Strapping of hip .............................................. 0.54 0.36 0.03 0.93 000 S

29530 ............. A Strapping of knee ........................................... 0.57 0.35 0.05 0.97 000 S

29540 ............. A Strapping of ankle ........................................... 0.51 0.30 0.03 0.84 000 S

29550 ............. A Strapping of toes ............................................ 0.47 0.28 0.03 0.78 000 S

29580 ............. A Application of paste boot ................................ 0.57 0.79 0.04 1.40 000 S

29590 ............. A Application of foot splint ................................. 0.76 0.28 0.03 1.07 000 S
63218

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

29700 ............. A Removal/revision of cast ................................ 0.88 0.32 0.05 1.25 000 S

29705 ............. A Removal/revision of cast ................................ 1.12 0.35 0.05 1.52 000 S

29710 ............. A Removal/revision of cast ................................ 1.34 0.45 0.07 1.86 000 S

29715 ............. A Removal/revision of cast ................................ 0.94 0.86 0.12 1.92 000 S

29720 ............. A Repair of body cast ........................................ 0.68 0.23 0.04 0.95 000 S

29730 ............. A Windowing of cast .......................................... 0.75 0.26 0.04 1.05 000 S

29740 ............. A Wedging of cast .............................................. 1.12 0.38 0.06 1.56 000 S

29750 ............. A Wedging of clubfoot cast ................................ 1.26 0.50 0.07 1.83 000 S

29799 ............. C Casting/strapping procedure ........................... 0.00 0.00 0.00 0.00 YYY S

29800 ............. A Jaw arthroscopy/surgery ................................. 5.28 4.01 0.46 9.75 090 S

29804 ............. A Jaw arthroscopy/surgery ................................. 7.99 *10.23 1.46 19.68 090 S

29815 ............. A Shoulder arthroscopy ...................................... 5.74 4.84 0.76 11.34 090 S

29819 ............. A Shoulder arthroscopy/surgery ......................... 7.33 *9.38 1.73 18.44 090 S

29820 ............. A Shoulder arthroscopy/surgery ......................... 6.81 *8.72 1.73 17.26 090 S

29821 ............. A Shoulder arthroscopy/surgery ......................... 7.43 *9.50 2.13 19.06 090 S

29822 ............. A Shoulder arthroscopy/surgery ......................... 7.14 *9.14 1.74 18.02 090 S

29823 ............. A Shoulder arthroscopy/surgery ......................... 7.86 *10.07 2.32 20.25 090 S

29825 ............. A Shoulder arthroscopy/surgery ......................... 7.33 *9.38 2.05 18.76 090 S

29826 ............. A Shoulder arthroscopy/surgery ......................... 8.70 *11.14 2.31 22.15 090 S

29830 ............. A Elbow arthroscopy .......................................... 5.63 5.32 0.83 11.78 090 S

29834 ............. A Elbow arthroscopy/surgery ............................. 6.13 5.84 0.96 12.93 090 S

29835 ............. A Elbow arthroscopy/surgery ............................. 6.33 6.03 0.99 13.35 090 S

29836 ............. A Elbow arthroscopy/surgery ............................. 7.37 7.03 1.15 15.55 090 S

29837 ............. A Elbow arthroscopy/surgery ............................. 6.72 6.40 1.06 14.18 090 S

29838 ............. A Elbow arthroscopy/surgery ............................. 7.42 7.05 1.14 15.61 090 S

29840 ............. A Wrist arthroscopy ............................................ 5.39 3.29 0.54 9.22 090 S

29843 ............. A Wrist arthroscopy/surgery ............................... 5.86 5.60 0.91 12.37 090 S

29844 ............. A Wrist arthroscopy/surgery ............................... 6.22 5.59 0.95 12.76 090 S

29845 ............. A Wrist arthroscopy/surgery ............................... 7.34 7.00 1.15 15.49 090 S

29846 ............. A Wrist arthroscopy/surgery ............................... 6.60 *8.45 2.20 17.25 090 S

29847 ............. A Wrist arthroscopy/surgery ............................... 6.93 6.78 0.97 14.68 090 S

29848 ............. A Wrist arthroscopy/surgery ............................... 4.04 3.85 0.62 8.51 090 S

29850 ............. A Knee arthroscopy/surgery ............................... 7.96 *10.19 1.74 19.89 090 S

29851 ............. A Knee arthroscopy/surgery ............................... 12.38 10.95 1.74 25.07 090 S

29855 ............. A Tibial arthroscopy/surgery .............................. 9.48 11.69 1.88 23.05 090 S

29856 ............. A Tibial arthroscopy/surgery .............................. 13.28 11.69 1.88 26.85 090 S

29870 ............. A Knee arthroscopy, diagnostic ......................... 4.94 4.02 0.64 9.60 090 S

29871 ............. A Knee arthroscopy/drainage ............................. 6.29 6.77 0.96 14.02 090 S

29874 ............. A Knee arthroscopy/surgery ............................... 6.79 *8.69 1.52 17.00 090 S

29875 ............. A Knee arthroscopy/surgery ............................... 6.16 *7.88 1.61 15.65 090 S

29876 ............. A Knee arthroscopy/surgery ............................... 7.51 *9.61 1.95 19.07 090 S

29877 ............. A Knee arthroscopy/surgery ............................... 7.05 *9.03 1.81 17.89 090 S

29879 ............. A Knee arthroscopy/surgery ............................... 7.63 *9.76 2.19 19.58 090 S

29880 ............. A Knee arthroscopy/surgery ............................... 8.09 *10.35 2.22 20.66 090 S

29881 ............. A Knee arthroscopy/surgery ............................... 7.46 *9.54 1.82 18.82 090 S

29882 ............. A Knee arthroscopy/surgery ............................... 8.24 *10.54 1.90 20.68 090 S

29883 ............. A Knee arthroscopy/surgery ............................... 9.00 *11.52 2.80 23.32 090 S

29884 ............. A Knee arthroscopy/surgery ............................... 6.92 *8.86 1.56 17.34 090 S

29885 ............. A Knee arthroscopy/surgery ............................... 8.63 8.23 1.35 18.21 090 S

29886 ............. A Knee arthroscopy/surgery ............................... 7.13 6.80 1.12 15.05 090 S

29887 ............. A Knee arthroscopy/surgery ............................... 8.58 10.52 1.71 20.81 090 S

29888 ............. A Knee arthroscopy/surgery ............................... 13.28 *17.00 3.18 33.46 090 S

29889 ............. A Knee arthroscopy/surgery ............................... 10.76 10.26 1.68 22.70 090 S

29894 ............. A Ankle arthroscopy/surgery .............................. 6.95 *8.90 1.47 17.32 090 S

29895 ............. A Ankle arthroscopy/surgery .............................. 6.73 *8.60 1.51 16.84 090 S

29897 ............. A Ankle arthroscopy/surgery .............................. 6.92 *8.86 1.77 17.55 090 S

29898 ............. A Ankle arthroscopy/surgery .............................. 8.03 *10.28 1.91 20.22 090 S

29909 ............. C Arthroscopy of joint ......................................... 0.00 0.00 0.00 0.00 YYY S

30000 ............. A Drainage of nose lesion .................................. 1.38 0.58 0.05 2.01 010 S

30020 ............. A Drainage of nose lesion .................................. 1.38 0.60 0.06 2.04 010 S

30100 ............. A Intranasal biopsy ............................................. 0.94 0.69 0.08 1.71 000 S

30110 ............. A Removal of nose polyp(s) ............................... 1.58 1.29 0.14 3.01 010 S

30115 ............. A Removal of nose polyp(s) ............................... 4.25 2.81 0.30 7.36 090 S

30117 ............. A Removal of intranasal lesion .......................... 3.06 2.84 0.31 6.21 090 S

30118 ............. A Removal of intranasal lesion .......................... 9.23 8.01 0.92 18.16 090 S

30120 ............. A Revision of nose ............................................. 5.14 *6.59 1.00 12.73 090 S
63219

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

30124 ............. A Removal of nose lesion .................................. 3.00 1.34 0.16 4.50 090 S

30125 ............. A Removal of nose lesion .................................. 6.79 5.55 0.73 13.07 090 S

30130 ............. A Removal of turbinate bones ........................... 3.17 1.67 0.17 5.01 090 S

30140 ............. A Removal of turbinate bones ........................... 3.28 3.04 0.34 6.66 090 S

30150 ............. A Partial removal of nose ................................... 8.48 7.92 1.07 17.47 090 S

30160 ............. A Removal of nose ............................................. 8.92 *11.42 1.73 22.07 090 S

30200 ............. A Injection treatment of nose ............................. 0.78 0.37 0.04 1.19 000 S

30210 ............. A Nasal sinus therapy ........................................ 1.03 0.26 0.03 1.32 010 S

30220 ............. A Insert nasal septal button ............................... 1.49 1.51 0.16 3.16 010 S

30300 ............. A Remove nasal foreign body ............................ 0.99 0.46 0.05 1.50 010 S

30310 ............. A Remove nasal foreign body ............................ 1.91 1.62 0.18 3.71 010 S

30320 ............. A Remove nasal foreign body ............................ 4.39 4.29 0.43 9.11 090 S

30400 ............. R Reconstruction of nose ................................... 9.24 9.97 1.36 20.57 090 S

30410 ............. R Reconstruction of nose ................................... 12.39 14.54 2.01 28.94 090 S

30420 ............. R Reconstruction of nose ................................... 15.40 17.78 2.22 35.40 090 S

30430 ............. R Revision of nose ............................................. 6.73 6.09 0.66 13.48 090 S

30435 ............. R Revision of nose ............................................. 11.23 10.17 1.10 22.50 090 S

30450 ............. R Revision of nose ............................................. 18.06 11.24 0.91 30.21 090 S

30460 ............. A Revision of nose ............................................. 9.48 8.58 0.93 18.99 090 S

30462 ............. A Revision of nose ............................................. 18.98 17.16 1.87 38.01 090 S

30520 ............. A Repair of nasal septum .................................. 5.55 *7.10 0.96 13.61 090 S

30540 ............. A Repair nasal defect ......................................... 7.46 6.63 0.70 14.79 090 S

30545 ............. A Repair nasal defect ......................................... 10.89 10.83 0.93 22.65 090 S

30560 ............. A Release of nasal adhesions ........................... 1.21 0.55 0.06 1.82 010 S

30580 ............. A Repair upper jaw fistula .................................. 6.49 6.24 0.57 13.30 090 S

30600 ............. A Repair mouth/nose fistula ............................... 5.87 3.77 0.36 10.00 090 S

30620 ............. A Intranasal reconstruction ................................ 5.55 *7.10 1.10 13.75 090 S

30630 ............. A Repair nasal septum defect ............................ 6.83 6.24 0.71 13.78 090 S

30801 ............. A Cauterization inner nose ................................. 1.02 0.47 0.05 1.54 010 S

30802 ............. A Cauterization inner nose ................................. 1.98 0.94 0.11 3.03 010 S

30901 ............. A Control of nosebleed ...................................... 1.21 0.56 0.06 1.83 000 S

30903 ............. A Control of nosebleed ...................................... 1.54 0.85 0.08 2.47 000 S

30905 ............. A Control of nosebleed ...................................... 1.97 1.79 0.17 3.93 000 S

30906 ............. A Repeat control of nosebleed .......................... 2.45 1.08 0.11 3.64 000 S

30915 ............. A Ligation nasal sinus artery .............................. 6.72 4.95 0.52 12.19 090 S

30920 ............. A Ligation upper jaw artery ................................ 7.46 *9.54 1.32 18.32 090 S

30930 ............. A Therapy fracture of nose ................................ 1.21 0.71 0.08 2.00 010 S

30999 ............. C Nasal surgery procedure ................................ 0.00 0.00 0.00 0.00 YYY N

31000 ............. A Irrigation maxillary sinus ................................. 1.10 0.43 0.05 1.58 010 S

31002 ............. A Irrigation sphenoid sinus ................................. 1.86 0.46 0.05 2.37 010 S

31020 ............. A Exploration maxillary sinus ............................. 2.81 2.66 0.29 5.76 090 S

31030 ............. A Exploration maxillary sinus ............................. 5.60 *7.16 0.86 13.62 090 S

31032 ............. A Explore sinus, remove polyps ......................... 6.22 *7.96 0.99 15.17 090 S

31040 ............. A Exploration behind upper jaw ......................... 8.83 7.98 0.86 17.67 090 S

31050 ............. A Exploration sphenoid sinus ............................. 5.07 5.96 0.64 11.67 090 S

31051 ............. A Sphenoid sinus surgery .................................. 6.85 8.12 0.85 15.82 090 S

31070 ............. A Exploration of frontal sinus ............................. 4.04 4.69 0.50 9.23 090 S

31075 ............. A Exploration of frontal sinus ............................. 8.57 10.51 1.10 20.18 090 S

31080 ............. A Removal of frontal sinus ................................. 10.73 9.21 1.12 21.06 090 S

31081 ............. A Removal of frontal sinus ................................. 11.93 10.32 1.30 23.55 090 S

31084 ............. A Removal of frontal sinus ................................. 12.69 14.79 1.62 29.10 090 S

31085 ............. A Removal of frontal sinus ................................. 13.38 15.65 1.76 30.79 090 S

31086 ............. A Removal of frontal sinus ................................. 11.98 10.87 1.15 24.00 090 S

31087 ............. A Removal of frontal sinus ................................. 12.14 10.39 1.33 23.86 090 S

31090 ............. A Exploration of sinuses .................................... 8.65 *11.32 2.12 22.09 090 S

31200 ............. A Removal of ethmoid sinus .............................. 4.68 4.62 0.48 9.78 090 S

31201 ............. A Removal of ethmoid sinus .............................. 7.91 7.01 0.75 15.67 090 S

31205 ............. A Removal of ethmoid sinus .............................. 9.65 8.03 0.81 18.49 090 S

31225 ............. A Removal of upper jaw ..................................... 15.19 *19.44 2.37 37.00 090 S

31230 ............. A Removal of upper jaw ..................................... 21.06 21.74 2.48 45.28 090 S

31231 ............. A Nasal endoscopy, dx ...................................... 1.10 1.37 0.15 2.62 000 S

31233 ............. A Nasal/sinus endoscopy, dx ............................. 2.18 *2.79 0.31 5.28 000 S

31235 ............. A Nasal/sinus endoscopy, dx ............................. 2.64 2.39 0.26 5.29 000 S

31237 ............. A Nasal/sinus endoscopy, surg .......................... 2.98 3.37 0.37 6.72 000 S

31238 ............. A Nasal/sinus endoscopy, surg .......................... 3.26 *4.17 0.45 7.88 000 S

31239 ............. A Nasal/sinus endoscopy, surg .......................... 8.50 *10.88 1.18 20.56 010 S
63220

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

31240 ............. A Nasal/sinus endoscopy, surg .......................... 2.61 *3.34 0.37 6.32 000 S

31254 ............. A Revision of ethmoid sinus .............................. 4.65 *5.95 0.69 11.29 000 S

31255 ............. A Removal of ethmoid sinus .............................. 6.96 *8.91 1.14 17.01 000 S

31256 ............. A Exploration maxillary sinus ............................. 3.29 3.77 0.41 7.47 000 S

31267 ............. A Endoscopy, maxillary sinus ............................ 5.46 5.23 0.81 11.50 000 S

31276 ............. A Sinus surgical endoscopy ............................... 8.85 6.72 0.73 16.30 000 S

31287 ............. A Nasal/sinus endoscopy, surg .......................... 3.92 *5.01 0.65 9.58 000 S

31288 ............. A Nasal/sinus endoscopy, surg .......................... 4.58 *5.86 0.78 11.22 000 S

31290 ............. A Nasal/sinus endoscopy, surg .......................... 12.87 *16.47 1.80 31.14 010 S

31291 ............. A Nasal/sinus endoscopy, surg .......................... 13.52 *17.31 1.88 32.71 010 S

31292 ............. A Nasal/sinus endoscopy, surg .......................... 10.45 *13.38 1.45 25.28 010 S

31293 ............. A Nasal/sinus endoscopy, surg .......................... 11.43 *14.64 1.59 27.66 010 S

31294 ............. A Nasal/sinus endoscopy, surg .......................... 13.06 *16.72 1.83 31.61 010 S

31299 ............. C Sinus surgery procedure ................................ 0.00 0.00 0.00 0.00 YYY S

31300 ............. A Removal of larynx lesion ................................ 13.28 11.58 1.28 26.14 090 S

31320 ............. A Diagnostic incision larynx ............................... 4.54 3.87 0.48 8.89 090 S

31360 ............. A Removal of larynx ........................................... 15.19 19.36 2.19 36.74 090 S

31365 ............. A Removal of larynx ........................................... 21.83 27.14 3.10 52.07 090 S

31367 ............. A Partial removal of larynx ................................. 18.98 17.22 1.88 38.08 090 S

31368 ............. A Partial removal of larynx ................................. 23.72 26.76 3.06 53.54 090 S

31370 ............. A Partial removal of larynx ................................. 18.50 17.18 1.88 37.56 090 S

31375 ............. A Partial removal of larynx ................................. 18.50 14.84 1.56 34.90 090 S

31380 ............. A Partial removal of larynx ................................. 18.50 17.27 1.88 37.65 090 S

31382 ............. A Partial removal of larynx ................................. 18.50 16.06 1.78 36.34 090 S

31390 ............. A Removal of larynx & pharynx ......................... 21.15 *27.08 4.05 52.28 090 S

31395 ............. A Reconstruct larynx & pharynx ......................... 26.19 *33.52 4.42 64.13 090 S

31400 ............. A Revision of larynx ........................................... 9.06 7.81 0.91 17.78 090 S

31420 ............. A Removal of epiglottis ...................................... 9.06 8.08 0.84 17.98 090 S

31500 ............. A Insert emergency airway ................................ 2.33 1.14 0.14 3.61 000 N

31502 ............. A Change of windpipe airway ............................ 0.65 0.58 0.07 1.30 000 S

31505 ............. A Diagnostic laryngoscopy ................................. 0.61 0.43 0.05 1.09 000 S

31510 ............. A Laryngoscopy with biopsy .............................. 1.92 0.55 0.07 2.54 000 S

31511 ............. A Remove foreign body, larynx .......................... 2.16 0.96 0.10 3.22 000 S

31512 ............. A Removal of larynx lesion ................................ 2.07 1.79 0.20 4.06 000 S

31513 ............. A Injection into vocal cord .................................. 2.10 *2.68 0.38 5.16 000 S

31515 ............. A Laryngoscopy for aspiration ........................... 1.80 1.13 0.14 3.07 000 S

31520 ............. A Diagnostic laryngoscopy ................................. 2.56 1.64 0.18 4.38 000 S

31525 ............. A Diagnostic laryngoscopy ................................. 2.63 2.20 0.23 5.06 000 S

31526 ............. A Diagnostic laryngoscopy ................................. 2.57 *3.29 0.38 6.24 000 S

31527 ............. A Laryngoscopy for treatment ............................ 3.27 2.99 0.30 6.56 000 S

31528 ............. A Laryngoscopy and dilatation ........................... 2.37 2.66 0.30 5.33 000 S

31529 ............. A Laryngoscopy and dilatation ........................... 2.68 2.46 0.25 5.39 000 S

31530 ............. A Operative laryngoscopy .................................. 3.39 3.63 0.39 7.41 000 S

31531 ............. A Operative laryngoscopy .................................. 3.73 *4.78 0.60 9.11 000 S

31535 ............. A Operative laryngoscopy .................................. 3.16 4.01 0.45 7.62 000 S

31536 ............. A Operative laryngoscopy .................................. 3.17 *4.06 0.59 7.82 000 S

31540 ............. A Operative laryngoscopy .................................. 4.13 *5.29 0.61 10.03 000 S

31541 ............. A Operative laryngoscopy .................................. 3.56 *4.56 0.75 8.87 000 S

31560 ............. A Operative laryngoscopy .................................. 5.46 4.99 0.51 10.96 000 S

31561 ............. A Operative laryngoscopy .................................. 4.90 *6.27 1.08 12.25 000 S

31570 ............. A Laryngoscopy with injection ............................ 3.87 *4.95 0.60 9.42 000 S

31571 ............. A Laryngoscopy with injection ............................ 3.52 *4.51 0.69 8.72 000 S

31575 ............. A Diagnostic laryngoscopy ................................. 1.10 1.56 0.17 2.83 000 S

31576 ............. A Laryngoscopy with biopsy .............................. 1.97 *2.52 0.33 4.82 000 S

31577 ............. A Remove foreign body, larynx .......................... 2.47 *3.16 0.37 6.00 000 S

31578 ............. A Removal of larynx lesion ................................ 2.84 *3.63 0.48 6.95 000 S

31579 ............. A Diagnostic laryngoscopy ................................. 2.26 2.33 0.26 4.85 000 S

31580 ............. A Revision of larynx ........................................... 11.01 *14.09 1.63 26.73 090 S

31582 ............. A Revision of larynx ........................................... 19.73 17.87 1.94 39.54 090 S

31584 ............. A Repair of larynx fracture ................................. 18.50 12.72 1.34 32.56 090 S

31585 ............. A Repair of larynx fracture ................................. 4.40 3.77 0.40 8.57 090 S

31586 ............. A Repair of larynx fracture ................................. 7.24 6.55 0.71 14.50 090 S

31587 ............. A Revision of larynx ........................................... 7.98 7.21 0.79 15.98 090 S

31588 ............. A Revision of larynx ........................................... 11.82 10.70 1.16 23.68 090 S

31590 ............. A Reinnervate larynx .......................................... 6.36 5.76 0.62 12.74 090 S

31595 ............. A Larynx nerve surgery ...................................... 7.58 6.84 0.74 15.16 090 S
63221

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

31599 ............. C Larynx surgery procedure ............................... 0.00 0.00 0.00 0.00 YYY S

31600 ............. A Incision of windpipe ........................................ 3.62 4.04 0.65 8.31 000 S

31601 ............. A Incision of windpipe ........................................ 4.45 5.03 0.66 10.14 000 S

31603 ............. A Incision of windpipe ........................................ 4.15 4.23 0.66 9.04 000 S

31605 ............. A Incision of windpipe ........................................ 3.58 4.19 0.50 8.27 000 S

31610 ............. A Incision of windpipe ........................................ 7.87 6.67 0.92 15.46 090 S

31611 ............. A Surgery/speech prosthesis ............................. 5.03 *6.45 1.04 12.52 090 S

31612 ............. A Puncture/clear windpipe ................................. 0.91 1.17 0.12 2.20 000 S

31613 ............. A Repair windpipe opening ................................ 4.24 2.21 0.28 6.73 090 S

31614 ............. A Repair windpipe opening ................................ 6.11 6.74 0.73 13.58 090 S

31615 ............. A Visualization of windpipe ................................ 2.09 1.95 0.22 4.26 000 S

31622 ............. A Diagnostic bronchoscopy ................................ 2.80 3.57 0.34 6.71 000 N

31625 ............. A Bronchoscopy with biopsy .............................. 3.37 3.83 0.35 7.55 000 N

31628 ............. A Bronchoscopy with biopsy .............................. 3.81 *4.88 0.38 9.07 000 N

31629 ............. A Bronchoscopy with biopsy .............................. 3.37 *4.31 0.34 8.02 000 N

31630 ............. A Bronchoscopy with repair ............................... 3.82 3.72 0.50 8.04 000 S

31631 ............. A Bronchoscopy with dilation ............................. 4.37 3.94 0.48 8.79 000 N

31635 ............. A Remove foreign body, airway ......................... 3.68 4.53 0.53 8.74 000 S

31640 ............. A Bronchoscopy & remove lesion ...................... 4.94 5.02 0.67 10.63 000 S

31641 ............. A Bronchoscopy, treat blockage ........................ 5.03 *6.45 0.85 12.33 000 N

31645 ............. A Bronchoscopy, clear airways .......................... 3.16 3.62 0.30 7.08 000 N

31646 ............. A Bronchoscopy, reclear airways ....................... 2.72 3.06 0.27 6.05 000 N

31656 ............. A Bronchoscopy, inject for x-ray ........................ 2.17 *2.77 0.31 5.25 000 N

31700 ............. A Insertion of airway catheter ............................ 1.34 1.38 0.17 2.89 000 N

31708 ............. A Instill airway contrast dye ............................... 1.41 0.77 0.09 2.27 000 N

31710 ............. A Insertion of airway catheter ............................ 1.30 0.90 0.12 2.32 000 N

31715 ............. A Injection for bronchus x-ray ............................ 1.11 0.48 0.04 1.63 000 N

31717 ............. A Bronchial brush biopsy ................................... 2.12 0.73 0.06 2.91 000 N

31720 ............. A Clearance of airways ...................................... 1.06 0.74 0.09 1.89 000 N

31725 ............. A Clearance of airways ...................................... 1.96 1.41 0.15 3.52 000 N

31730 ............. A Intro windpipe wire/tube .................................. 2.85 2.47 0.23 5.55 000 N

31750 ............. A Repair of windpipe .......................................... 9.05 8.88 1.09 19.02 090 S

31755 ............. A Repair of windpipe .......................................... 14.69 13.30 1.44 29.43 090 S

31760 ............. A Repair of windpipe .......................................... 20.89 10.92 2.55 34.36 090 S

31766 ............. A Reconstruction of windpipe ............................ 28.82 18.40 1.12 48.34 090 S

31770 ............. A Repair/graft of bronchus ................................. 21.15 15.07 2.08 38.30 090 S

31775 ............. A Reconstruct bronchus ..................................... 22.15 16.37 1.92 40.44 090 S

31780 ............. A Reconstruct windpipe ..................................... 16.14 17.33 2.08 35.55 090 S

31781 ............. A Reconstruct windpipe ..................................... 22.22 16.86 1.96 41.04 090 S

31785 ............. A Remove windpipe lesion ................................. 16.14 8.92 1.17 26.23 090 S

31786 ............. A Remove windpipe lesion ................................. 22.54 13.30 2.24 38.08 090 S

31800 ............. A Repair of windpipe injury ................................ 6.77 4.90 0.76 12.43 090 S

31805 ............. A Repair of windpipe injury ................................ 12.59 9.82 1.41 23.82 090 S

31820 ............. A Closure of windpipe lesion ............................. 4.10 3.58 0.46 8.14 090 S

31825 ............. A Repair of windpipe defect ............................... 6.31 5.00 0.58 11.89 090 S

31830 ............. A Revise windpipe scar ...................................... 4.26 3.66 0.42 8.34 090 S

31899 ............. C Airways surgical procedure ............................ 0.00 0.00 0.00 0.00 YYY S

32000 ............. A Drainage of chest ........................................... 1.54 0.90 0.08 2.52 000 N

32002 ............. A Treatment of collapsed lung ........................... 2.19 1.34 0.22 3.75 000 N

32005 ............. A Treat lung lining chemically ............................ 2.19 1.09 0.15 3.43 000 S

32020 ............. A Insertion of chest tube .................................... 3.98 2.63 0.43 7.04 000 S

32035 ............. A Exploration of chest ........................................ 6.55 6.76 1.25 14.56 090 S

32036 ............. A Exploration of chest ........................................ 7.56 7.13 1.32 16.01 090 S

32095 ............. A Biopsy through chest wall ............................... 7.13 8.25 1.45 16.83 090 S

32100 ............. A Exploration/biopsy of chest ............................. 10.07 11.24 2.10 23.41 090 S

32110 ............. A Explore/repair chest ........................................ 11.76 11.51 2.01 25.28 090 S

32120 ............. A Re-exploration of chest ................................... 9.62 9.45 1.72 20.79 090 S

32124 ............. A Explore chest, free adhesions ........................ 10.93 10.94 2.21 24.08 090 S

32140 ............. A Removal of lung lesion(s) ............................... 12.14 12.37 2.42 26.93 090 S

32141 ............. A Remove/treat lung lesions .............................. 12.14 13.42 2.53 28.09 090 S

32150 ............. A Removal of lung lesion(s) ............................... 12.42 10.34 2.01 24.77 090 S

32151 ............. A Remove lung foreign body ............................. 12.42 9.15 1.37 22.94 090 S

32160 ............. A Open chest heart massage ............................ 7.13 *9.13 1.52 17.78 090 S

32200 ............. A Drainage of lung lesion ................................... 13.10 6.89 0.93 20.92 090 S

32215 ............. A Treat chest lining ............................................ 10.07 7.62 1.28 18.97 090 S

32220 ............. A Release of lung ............................................... 17.62 15.81 3.01 36.44 090 S
63222

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

32225 ............. A Partial release of lung ..................................... 12.10 11.84 2.28 26.22 090 S

32310 ............. A Removal of chest lining .................................. 12.05 11.64 2.10 25.79 090 S

32320 ............. A Free/remove chest lining ................................ 19.15 18.10 3.40 40.65 090 S

32400 ............. A Needle biopsy chest lining .............................. 1.76 1.48 0.12 3.36 000 N

32402 ............. A Open biopsy chest lining ................................ 6.55 7.58 1.34 15.47 090 S

32405 ............. A Biopsy, lung or mediastinum .......................... 1.93 2.12 0.18 4.23 000 N

32420 ............. A Puncture/clear lung ......................................... 2.18 1.50 0.13 3.81 000 N

32440 ............. A Removal of lung .............................................. 19.15 18.56 3.55 41.26 090 S

32442 ............. A Sleeve pneumonectomy ................................. 24.68 17.94 3.50 46.12 090 S

32445 ............. A Removal of lung .............................................. 23.37 20.46 3.88 47.71 090 S

32480 ............. A Partial removal of lung .................................... 16.84 17.15 3.23 37.22 090 S

32482 ............. A Bilobectomy .................................................... 18.54 17.15 3.23 38.92 090 S

32484 ............. A Segmentectomy .............................................. 19.52 17.15 3.23 39.90 090 S

32485 ............. D Partial removal of lung .................................... 0.00 0.00 0.00 0.00 090 S

32486 ............. A Sleeve lobectomy ........................................... 22.75 16.54 3.23 42.52 090 S

32488 ............. A Completion pneumonectomy .......................... 24.41 17.74 3.46 45.61 090 S

32500 ............. A Partial removal of lung .................................... 13.10 13.47 2.56 29.13 090 S

32501 ............. A Repair bronchus (add-on) ............................... 4.69 4.31 0.70 9.70 ZZZ S

32520 ............. A Remove lung & revise chest .......................... 19.42 20.67 3.93 44.02 090 S

32522 ............. A Remove lung & revise chest .......................... 21.94 21.90 4.19 48.03 090 S

32525 ............. A Remove lung & revise chest .......................... 24.33 23.50 4.61 52.44 090 S

32540 ............. A Removal of lung lesion ................................... 13.31 11.67 2.05 27.03 090 S

32601 ............. A Thoracoscopy, diagnostic ............................... 5.46 3.47 0.57 9.50 000 S

32602 ............. A Thoracoscopy, diagnostic ............................... 5.96 3.87 0.64 10.47 000 S

32603 ............. A Thoracoscopy, diagnostic ............................... 7.81 3.47 0.57 11.85 000 S

32604 ............. A Thoracoscopy, diagnostic ............................... 8.78 3.87 0.64 13.29 000 S

32605 ............. A Thoracoscopy, diagnostic ............................... 6.93 3.47 0.57 10.97 000 S

32606 ............. A Thoracoscopy, diagnostic ............................... 8.40 3.87 0.64 12.91 000 S

32650 ............. A Thoracoscopy, surgical ................................... 10.07 7.62 1.28 18.97 090 S

32651 ............. A Thoracoscopy, surgical ................................... 12.10 11.84 2.28 26.22 090 S

32652 ............. A Thoracoscopy, surgical ................................... 17.62 15.81 3.01 36.44 090 S

32653 ............. A Thoracoscopy, surgical ................................... 12.42 10.34 2.01 24.77 090 S

32654 ............. A Thoracoscopy, surgical ................................... 11.76 11.51 2.01 25.28 090 S

32655 ............. A Thoracoscopy, surgical ................................... 12.42 13.42 2.53 28.37 090 S

32656 ............. A Thoracoscopy, surgical ................................... 12.10 13.36 2.36 27.82 090 S

32657 ............. A Thoracoscopy, surgical ................................... 13.10 13.47 2.56 29.13 090 S

32658 ............. A Thoracoscopy, surgical ................................... 11.08 13.26 2.52 26.86 090 S

32659 ............. A Thoracoscopy, surgical ................................... 10.91 *13.96 2.61 27.48 090 S

32660 ............. A Thoracoscopy, surgical ................................... 16.62 19.93 3.56 40.11 090 S

32661 ............. A Thoracoscopy, surgical ................................... 12.70 9.25 1.47 23.42 090 S

32662 ............. A Thoracoscopy, surgical ................................... 15.76 14.55 2.74 33.05 090 S

32663 ............. A Thoracoscopy, surgical ................................... 17.43 17.15 3.23 37.81 090 S

32664 ............. A Thoracoscopy, surgical ................................... 13.65 10.55 2.04 26.24 090 S

32665 ............. A Thoracoscopy, surgical ................................... 14.73 14.33 2.64 31.70 090 S

32800 ............. A Repair lung hernia .......................................... 12.10 8.28 1.58 21.96 090 S

32810 ............. A Close chest after drainage ............................. 11.59 6.50 1.19 19.28 090 S

32815 ............. A Close bronchial fistula .................................... 21.36 15.22 2.62 39.20 090 S

32820 ............. A Reconstruct injured chest ............................... 19.78 19.01 3.24 42.03 090 S

32850 ............. X Donor pneumonectomy .................................. 0.00 0.00 0.00 0.00 XXX 0

32851 ............. A Lung transplant, single ................................... 35.14 25.55 4.99 65.68 090 S

32852 ............. A Lung transplant w/bypass ............................... 38.11 27.71 5.41 71.23 090 S

32853 ............. A Lung transplant, double .................................. 43.93 31.94 6.24 82.11 090 S

32854 ............. A Lung transplant w/bypass ............................... 46.90 34.10 6.67 87.67 090 S

32900 ............. A Removal of rib(s) ............................................ 18.14 8.47 1.63 28.24 090 S

32905 ............. A Revise & repair chest wall .............................. 19.15 12.74 2.60 34.49 090 S

32906 ............. A Revise & repair chest wall .............................. 25.17 15.42 2.92 43.51 090 S

32940 ............. A Revision of lung .............................................. 18.14 11.37 1.75 31.26 090 S

32960 ............. A Therapeutic pneumothorax ............................. 1.84 0.93 0.13 2.90 000 N

32999 ............. C Chest surgery procedure ................................ 0.00 0.00 0.00 0.00 YYY S

33010 ............. A Drainage of heart sac ..................................... 2.24 1.54 0.14 3.92 000 N

33011 ............. A Repeat drainage of heart sac ......................... 2.24 1.11 0.12 3.47 000 N

33015 ............. A Incision of heart sac ....................................... 5.64 4.26 0.62 10.52 090 S

33020 ............. A Incision of heart sac ....................................... 11.08 13.26 2.52 26.86 090 S

33025 ............. A Incision of heart sac ....................................... 10.91 *13.96 2.61 27.48 090 S

33030 ............. A Partial removal of heart sac ........................... 16.62 21.02 3.92 41.56 090 S

33031 ............. A Partial removal of heart sac ........................... 19.64 13.25 2.50 35.39 090 S
63223

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

33050 ............. A Removal of heart sac lesion ........................... 12.70 9.25 1.47 23.42 090 S

33120 ............. A Removal of heart lesion .................................. 22.57 *28.89 5.17 56.63 090 S

33130 ............. A Removal of heart lesion .................................. 19.53 13.50 2.22 35.25 090 S

33200 ............. A Insertion of heart pacemaker .......................... 11.08 12.27 1.90 25.25 090 S

33201 ............. A Insertion of heart pacemaker .......................... 8.93 11.19 1.67 21.79 090 S

33206 ............. A Insertion of heart pacemaker .......................... 6.04 *7.73 1.34 15.11 090 S

33207 ............. A Insertion of heart pacemaker .......................... 7.28 9.01 1.33 17.62 090 S

33208 ............. A Insertion of heart pacemaker .......................... 7.28 *9.50 1.54 18.32 090 N

33210 ............. A Insertion of heart electrode ............................. 3.30 3.30 0.27 6.87 000 N

33211 ............. A Insertion of heart electrode ............................. 3.40 3.30 0.27 6.97 000 N

33212 ............. A Insertion of pulse generator ............................ 5.21 5.38 0.88 11.47 090 S

33213 ............. A Insertion of pulse generator ............................ 6.15 5.38 0.88 12.41 090 N

33214 ............. A Upgrade of pacemaker system ...................... 7.43 5.40 1.06 13.89 090 N

33216 ............. A Revision implanted electrode ......................... 5.07 5.02 0.55 10.64 090 N

33217 ............. A Insert/revise electrode .................................... 5.43 5.02 0.55 11.00 090 N

33218 ............. A Repair pacemaker electrodes ......................... 5.02 4.59 0.62 10.23 090 S

33220 ............. A Repair pacemaker electrode .......................... 5.10 4.59 0.62 10.31 090 N

33222 ............. A Pacemaker aicd pocket .................................. 4.59 5.70 1.01 11.30 090 S

33223 ............. A Pacemaker aicd pocket .................................. 6.14 5.70 1.01 12.85 090 S

33233 ............. A Removal of pacemaker system ...................... 2.97 2.64 0.05 5.66 090 N

33234 ............. A Removal of pacemaker system ...................... 8.69 4.74 0.38 13.81 090 S

33235 ............. A Removal pacemaker electrode ....................... 9.93 5.21 0.55 15.69 090 N

33236 ............. A Remove electrode/thoracotomy ...................... 11.71 3.98 0.62 16.31 090 S

33237 ............. A Remove electrode/thoracotomy ...................... 12.69 9.60 1.13 23.42 090 S

33238 ............. A Remove electrode/thoracotomy ...................... 14.15 10.29 2.01 26.45 090 S

33240 ............. A Insert/replace pulse gener .............................. 7.20 5.38 0.88 13.46 090 S

33241 ............. A Remove pulse generator only ........................ 2.97 2.16 0.43 5.56 090 S

33242 ............. A Repair pulse generator/leads ......................... 5.85 *7.50 1.54 14.89 090 S

33243 ............. A Remove generator/thoracotomy ..................... 21.47 9.02 1.54 32.03 090 S

33244 ............. A Remove generator .......................................... 8.34 9.02 1.54 18.90 090 S

33245 ............. A Implant heart defibrillator ................................ 12.57 *16.09 2.36 31.02 090 S

33246 ............. A Implant heart defibrillator ................................ 19.28 20.79 3.19 43.26 090 S

33247 ............. A Insert/replace leads ........................................ 9.76 *12.49 2.36 24.61 090 N

33249 ............. A Insert/replace leads/gener .............................. 12.83 *16.42 3.19 32.44 090 S

33250 ............. A Ablate heart dysrhythm focus ......................... 19.54 11.56 0.86 31.96 090 S

33251 ............. A Ablate heart dysrhythm focus ......................... 22.57 16.41 3.21 42.19 090 S

33253 ............. A Reconstruct atria ............................................. 30.00 21.81 4.26 56.07 090 S

33260 ............. D Ablate heart dysrhythm focus ......................... 0.00 0.00 0.00 0.00 090 S

33261 ............. A Ablate heart dysrhythm focus ......................... 22.57 13.96 2.73 39.26 090 S

33300 ............. A Repair of heart wound .................................... 16.19 14.36 2.60 33.15 090 S

33305 ............. A Repair of heart wound .................................... 19.22 17.40 3.07 39.69 090 S

33310 ............. A Exploratory heart surgery ............................... 17.12 11.28 1.93 30.33 090 S

33315 ............. A Exploratory heart surgery ............................... 20.15 14.48 2.57 37.20 090 S

33320 ............. A Repair major blood vessel(s) .......................... 15.39 14.14 2.51 32.04 090 S

33321 ............. A Repair major vessel ........................................ 18.74 21.75 3.61 44.10 090 S

33322 ............. A Repair major blood vessel(s) .......................... 18.40 21.75 3.61 43.76 090 S

33330 ............. A Insert major vessel graft ................................. 19.15 12.67 1.93 33.75 090 S

33332 ............. A Insert major vessel graft ................................. 22.50 15.07 2.39 39.96 090 S

33335 ............. A Insert major vessel graft ................................. 27.66 15.07 2.39 45.12 090 S

33350 ............. D Repair major blood vessel(s) .......................... 0.00 0.00 0.00 0.00 090 S

33400 ............. A Repair of aortic valve ...................................... 23.16 26.21 2.83 52.20 090 S

33401 ............. A Valvuloplasty, open ......................................... 22.45 26.21 2.83 51.49 090 S

33403 ............. A Valvuloplasty, w/cp bypass ............................. 23.43 26.21 2.83 52.47 090 S

33404 ............. A Prepare heart-aorta conduit ............................ 26.62 31.25 5.59 63.46 090 S

33405 ............. A Replacement of aortic valve ........................... 28.47 30.48 5.33 64.28 090 S

33406 ............. A Replacement, aortic valve .............................. 31.23 38.65 7.45 77.33 090 S

33411 ............. A Replacement of aortic valve ........................... 30.37 38.65 7.45 76.47 090 S

33412 ............. A Replacement of aortic valve ........................... 32.26 38.65 7.45 78.36 090 S

33413 ............. A Replacement, aortic valve .............................. 34.17 41.09 7.23 82.49 090 S

33414 ............. A Repair, aortic valve ......................................... 29.28 38.65 7.45 75.38 090 S

33415 ............. A Revision, subvalvular tissue ........................... 25.02 30.48 5.33 60.83 090 S

33416 ............. A Revise ventricle muscle .................................. 28.20 28.14 4.99 61.33 090 S

33417 ............. A Repair of aortic valve ...................................... 27.34 34.71 6.18 68.23 090 S

33420 ............. A Revision of mitral valve ................................... 20.69 19.82 2.45 42.96 090 S

33422 ............. A Revision of mitral valve ................................... 23.72 *30.35 6.45 60.52 090 S

33425 ............. A Repair of mitral valve ...................................... 25.57 31.27 5.42 62.26 090 S
63224

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

33426 ............. A Repair of mitral valve ...................................... 26.07 31.96 5.80 63.83 090 S

33427 ............. A Repair of mitral valve ...................................... 32.07 34.71 6.30 73.08 090 S

33430 ............. A Replacement of mitral valve ........................... 29.42 34.85 6.11 70.38 090 S

33460 ............. A Revision of tricuspid valve .............................. 21.60 26.07 4.73 52.40 090 S

33463 ............. A Valvuloplasty, tricuspid ................................... 24.16 32.67 5.95 62.78 090 S

33464 ............. A Valvuloplasty, tricuspid ................................... 25.87 32.67 5.95 64.49 090 S

33465 ............. A Replace tricuspid valve ................................... 26.57 32.67 5.95 65.19 090 S

33468 ............. A Revision of tricuspid valve .............................. 28.20 34.71 6.30 69.21 090 S

33470 ............. A Revision of pulmonary valve .......................... 19.52 19.82 2.45 41.79 090 S

33471 ............. A Valvotomy, pulmonary valve ........................... 21.13 26.21 2.83 50.17 090 S

33472 ............. A Revision of pulmonary valve .......................... 20.91 *28.70 2.83 52.44 090 S

33474 ............. A Revision of pulmonary valve .......................... 20.91 *28.70 2.83 52.44 090 S

33475 ............. A Replacement, pulmonary valve ...................... 27.34 34.85 6.11 68.30 090 S

33476 ............. A Revision of heart chamber ............................. 24.41 28.14 4.99 57.54 090 S

33478 ............. A Revision of heart chamber ............................. 25.38 31.27 5.42 62.07 090 S

33500 ............. A Repair heart vessel fistula .............................. 23.91 29.55 5.20 58.66 090 S

33501 ............. A Repair heart vessel fistula .............................. 16.14 14.14 2.51 32.79 090 S

33502 ............. A Coronary artery correction .............................. 19.80 14.14 2.51 36.45 090 S

33503 ............. A Coronary artery graft ...................................... 20.15 29.55 5.20 54.90 090 S

33504 ............. A Coronary artery graft ...................................... 23.16 29.55 5.20 57.91 090 S

33505 ............. A Repair artery w/tunnel .................................... 25.38 34.24 6.03 65.65 090 S

33506 ............. A Repair artery, translocation ............................ 25.38 34.24 6.03 65.65 090 S

33510 ............. A CABG, vein, single ......................................... 23.29 29.55 5.20 58.04 090 S

33511 ............. A CABG, vein, two ............................................. 25.57 32.44 5.71 63.72 090 S

33512 ............. A CABG, vein, three ........................................... 27.84 35.33 6.22 69.39 090 S

33513 ............. A CABG, vein, four ............................................. 30.12 38.21 6.73 75.06 090 S

33514 ............. A CABG, vein, five ............................................. 32.39 41.09 7.23 80.71 090 S

33516 ............. A CABG, vein, six+ ............................................ 34.66 43.97 7.74 86.37 090 S

33517 ............. A CABG, artery-vein, single ............................... 2.27 2.89 0.50 5.66 090 S

33518 ............. A CABG, artery-vein, two ................................... 4.55 5.77 1.02 11.34 090 S

33519 ............. A CABG, artery-vein, three ................................ 6.82 8.65 1.52 16.99 090 S

33521 ............. A CABG, artery-vein, four .................................. 9.10 11.54 2.03 22.67 090 S

33522 ............. A CABG, artery-vein, five ................................... 11.37 14.43 2.54 28.34 090 S

33523 ............. A CABG, artery-vein, six+ .................................. 13.65 17.32 3.05 34.02 090 S

33530 ............. A Coronary artery, bypass/reop ......................... 5.86 *7.51 2.18 15.55 ZZZ S

33533 ............. A CABG, arterial, single ..................................... 24.00 30.45 5.36 59.81 090 S

33534 ............. A CABG, arterial, two ......................................... 26.99 34.24 6.03 67.26 090 S

33535 ............. A CABG, arterial, three ...................................... 29.98 38.03 6.70 74.71 090 S

33536 ............. A CABG, arterial, four+ ...................................... 32.96 41.82 7.37 82.15 090 S

33542 ............. A Removal of heart lesion .................................. 26.57 30.73 5.53 62.83 090 S

33545 ............. A Repair of heart damage .................................. 33.96 34.92 6.28 75.16 090 S

33572 ............. A Open coronary endarterectomy ...................... 4.45 3.23 0.63 8.31 ZZZ S

33600 ............. A Closure of valve .............................................. 28.31 34.85 6.11 69.27 090 S

33602 ............. A Closure of valve .............................................. 27.34 30.48 5.33 63.15 090 S

33606 ............. A Anastomosis/artery-aorta ................................ 29.28 38.65 7.45 75.38 090 S

33608 ............. A Repair anomaly w/conduit .............................. 30.02 38.65 7.45 76.12 090 S

33610 ............. A Repair by enlargement ................................... 29.28 38.65 7.45 75.38 090 S

33611 ............. A Repair double ventricle ................................... 31.23 38.65 7.45 77.33 090 S

33612 ............. A Repair double ventricle ................................... 32.06 38.65 7.45 78.16 090 S

33615 ............. A Repair (simple fontan) .................................... 30.50 38.65 7.45 76.60 090 S

33617 ............. A Repair by modified fontan .............................. 32.21 38.65 7.45 78.31 090 S

33619 ............. A Repair single ventricle .................................... 35.39 44.30 8.04 87.73 090 S

33641 ............. A Repair heart septum defect ............................ 19.93 *25.51 4.87 50.31 090 S

33645 ............. A Revision of heart veins ................................... 22.78 27.61 4.87 55.26 090 S

33647 ............. A Repair heart septum defects .......................... 27.44 34.92 6.28 68.64 090 S

33660 ............. A Repair of heart defects ................................... 24.41 31.27 5.42 61.10 090 S

33665 ............. A Repair of heart defects ................................... 27.34 31.27 5.42 64.03 090 S

33670 ............. A Repair of heart chambers ............................... 31.23 38.65 7.45 77.33 090 S

33681 ............. A Repair heart septum defect ............................ 26.36 34.92 6.28 67.56 090 S

33684 ............. A Repair heart septum defect ............................ 28.31 34.92 6.28 69.51 090 S

33688 ............. A Repair heart septum defect ............................ 29.28 34.92 6.28 70.48 090 S

33690 ............. A Reinforce pulmonary artery ............................ 18.31 22.10 4.29 44.70 090 S

33692 ............. A Repair of heart defects ................................... 29.28 38.65 7.45 75.38 090 S

33694 ............. A Repair of heart defects ................................... 30.26 38.65 7.45 76.36 090 S

33696 ............. D Repair of heart defects ................................... 0.00 0.00 0.00 0.00 090 S

33697 ............. A Repair of heart defects ................................... 32.21 38.65 7.45 78.31 090 S
63225

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

33698 ............. D Repair of heart defects ................................... 0.00 0.00 0.00 0.00 090 S

33702 ............. A Repair of heart defects ................................... 25.38 30.48 5.33 61.19 090 S

33710 ............. A Repair of heart defects ................................... 28.35 34.92 6.28 69.55 090 S

33720 ............. A Repair of heart defect ..................................... 25.38 30.48 5.33 61.19 090 S

33722 ............. A Repair of heart defect ..................................... 27.34 30.48 5.33 63.15 090 S

33730 ............. A Repair heart-vein defect(s) ............................. 29.89 38.65 7.45 75.99 090 S

33732 ............. A Repair heart-vein defect ................................. 27.09 31.27 5.42 63.78 090 S

33735 ............. A Revision of heart chamber ............................. 19.97 25.69 4.87 50.53 090 S

33736 ............. A Revision of heart chamber ............................. 22.45 25.69 4.87 53.01 090 S

33737 ............. A Revision of heart chamber ............................. 20.50 25.69 4.87 51.06 090 S

33750 ............. A Major vessel shunt .......................................... 20.15 22.10 4.29 46.54 090 S

33755 ............. A Major vessel shunt .......................................... 20.50 22.10 4.29 46.89 090 S

33762 ............. A Major vessel shunt .......................................... 20.50 22.10 4.29 46.89 090 S

33764 ............. A Major vessel shunt & graft .............................. 20.50 22.10 4.29 46.89 090 S

33766 ............. A Major vessel shunt .......................................... 21.47 22.10 4.29 47.86 090 S

33767 ............. A Atrial septectomy/septostomy ......................... 23.43 25.69 4.87 53.99 090 S

33770 ............. A Repair great vessels defect ............................ 31.96 38.65 7.45 78.06 090 S

33771 ............. A Repair great vessels defect ............................ 33.19 38.65 7.45 79.29 090 S

33774 ............. A Repair great vessels defect ............................ 29.28 31.27 5.42 65.97 090 S

33775 ............. A Repair great vessels defect ............................ 30.50 31.27 5.42 67.19 090 S

33776 ............. A Repair great vessels defect ............................ 32.21 34.92 6.28 73.41 090 S

33777 ............. A Repair great vessels defect ............................ 31.73 31.27 5.42 68.42 090 S

33778 ............. A Repair great vessels defect ............................ 34.17 41.82 7.37 83.36 090 S

33779 ............. A Repair great vessels defect ............................ 34.41 41.82 7.37 83.60 090 S

33780 ............. A Repair great vessels defect ............................ 35.14 41.82 7.37 84.33 090 S

33781 ............. A Repair great vessels defect ............................ 34.65 41.82 7.37 83.84 090 S

33786 ............. A Repair arterial trunk ........................................ 33.19 38.65 7.45 79.29 090 S

33788 ............. A Revision of pulmonary artery .......................... 25.38 29.55 5.20 60.13 090 S

33800 ............. A Aortic suspension ........................................... 15.18 14.14 2.51 31.83 090 S

33802 ............. A Repair vessel defect ....................................... 16.60 22.10 4.29 42.99 090 S

33803 ............. A Repair vessel defect ....................................... 18.54 22.10 4.29 44.93 090 S

33813 ............. A Repair septal defect ........................................ 19.52 22.10 4.29 45.91 090 S

33814 ............. A Repair septal defect ........................................ 24.41 30.48 5.33 60.22 090 S

33820 ............. A Revise major vessel ....................................... 15.62 22.10 4.29 42.01 090 S

33822 ............. A Revise major vessel ....................................... 16.60 22.10 4.29 42.99 090 S

33824 ............. A Revise major vessel ....................................... 18.54 22.10 4.29 44.93 090 S

33840 ............. A Remove aorta constriction .............................. 19.52 31.25 5.59 56.36 090 S

33845 ............. A Remove aorta constriction .............................. 20.99 31.25 5.59 57.83 090 S

33851 ............. A Remove aorta constriction .............................. 20.01 31.25 5.59 56.85 090 S

33852 ............. A Repair septal defect ........................................ 22.45 31.25 5.59 59.29 090 S

33853 ............. A Repair septal defect ........................................ 30.26 38.65 7.45 76.36 090 S

33860 ............. A Ascending aorta graft ..................................... 31.23 34.71 6.18 72.12 090 S

33861 ............. A Ascending aorta graft ..................................... 33.19 34.71 6.18 74.08 090 S

33863 ............. A Ascending aorta graft ..................................... 35.14 34.71 6.18 76.03 090 S

33870 ............. A Transverse aortic arch graft ........................... 37.74 44.30 8.04 90.08 090 S

33875 ............. A Thoracic aorta graft ........................................ 26.94 31.25 5.59 63.78 090 S

33877 ............. A Thoracoabdominal graft .................................. 40.29 44.11 8.38 92.78 090 S

33910 ............. A Remove lung artery emboli ............................ 21.86 14.65 2.77 39.28 090 S

33915 ............. A Remove lung artery emboli ............................ 18.84 12.02 2.22 33.08 090 S

33916 ............. A Surgery of great vessel .................................. 24.17 17.57 3.43 45.17 090 S

33917 ............. A Repair pulmonary artery ................................. 23.43 34.71 6.30 64.44 090 S

33918 ............. A Repair pulmonary atresia ............................... 25.38 29.55 5.20 60.13 090 S

33919 ............. A Repair pulmonary atresia ............................... 31.11 38.65 7.45 77.21 090 S

33920 ............. A Repair pulmonary atresia ............................... 30.75 38.65 7.45 76.85 090 S

33922 ............. A Transect pulmonary artery .............................. 22.45 26.21 2.83 51.49 090 S

33924 ............. A Remove pulmonary shunt ............................... 5.50 4.00 0.78 10.28 ZZZ S

33930 ............. X Removal of donor heart/lung .......................... 0.00 0.00 0.00 0.00 XXX 0

33935 ............. R Transplantation, heart/lung ............................. 56.87 77.57 13.54 147.98 090 S

33940 ............. X Removal of donor heart .................................. 0.00 0.00 0.00 0.00 XXX 0

33945 ............. R Transplantation of heart .................................. 39.56 64.80 11.05 115.41 090 S

33960 ............. A External circulation assist ............................... 19.36 7.01 0.94 27.31 XXX S

33961 ............. A External circulation assist ............................... 10.93 7.01 0.94 18.88 XXX S

33970 ............. A Aortic circulation assist ................................... 8.05 7.54 1.00 16.59 000 S

33971 ............. A Aortic circulation assist ................................... 4.04 *5.16 0.91 10.11 090 S

33973 ............. A Insert balloon device ....................................... 9.76 7.54 1.00 18.30 000 S

33974 ............. A Remove intra-aortic balloon ............................ 12.69 5.56 0.91 19.16 090 S
63226

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

33975 ............. A Implant ventricular device ............................... 19.52 14.19 2.77 36.48 090 S

33976 ............. A Implant ventricular device ............................... 26.60 19.33 3.78 49.71 090 S

33977 ............. A Remove ventricular device ............................. 17.08 12.41 2.43 31.92 090 S

33978 ............. A Remove ventricular device ............................. 19.52 14.19 2.77 36.48 090 S

33999 ............. C Cardiac surgery procedure ............................. 0.00 0.00 0.00 0.00 YYY S

34001 ............. A Removal of artery clot .................................... 11.69 9.58 1.87 23.14 090 S

34051 ............. A Removal of artery clot .................................... 13.62 8.81 1.59 24.02 090 S

34101 ............. A Removal of artery clot .................................... 8.73 8.34 1.71 18.78 090 S

34111 ............. A Removal of arm artery clot ............................. 7.18 7.59 1.59 16.36 090 S

34151 ............. A Removal of artery clot .................................... 15.23 11.96 2.39 29.58 090 S

34201 ............. A Removal of artery clot .................................... 8.04 8.90 1.78 18.72 090 S

34203 ............. A Removal of leg artery clot ............................... 11.06 8.63 1.72 21.41 090 S

34401 ............. A Removal of vein clot ....................................... 11.64 8.07 1.39 21.10 090 S

34421 ............. A Removal of vein clot ....................................... 8.89 7.45 1.51 17.85 090 S

34451 ............. A Removal of vein clot ....................................... 13.13 10.69 2.14 25.96 090 S

34471 ............. A Removal of vein clot ....................................... 9.12 3.51 0.55 13.18 090 S

34490 ............. A Removal of vein clot ....................................... 6.51 7.27 1.54 15.32 090 S

34501 ............. A Repair valve, femoral vein .............................. 9.71 7.35 0.86 17.92 090 S

34502 ............. A Reconstruct, vena cava .................................. 25.65 18.65 3.64 47.94 090 S

34510 ............. A Transposition of vein valve ............................. 11.75 8.89 1.04 21.68 090 S

34520 ............. A Cross-over vein graft ...................................... 12.33 9.33 1.09 22.75 090 S

34530 ............. A Leg vein fusion ............................................... 16.33 12.35 1.44 30.12 090 S

35001 ............. A Repair defect of artery .................................... 18.14 15.90 3.18 37.22 090 S

35002 ............. A Repair artery rupture, neck ............................. 19.43 12.64 2.41 34.48 090 S

35005 ............. A Repair defect of artery .................................... 16.62 10.28 2.19 29.09 090 S

35011 ............. A Repair defect of artery .................................... 10.43 *13.35 2.76 26.54 090 S

35013 ............. A Repair artery rupture, arm .............................. 15.96 14.70 3.03 33.69 090 S

35021 ............. A Repair defect of artery .................................... 17.62 18.13 3.06 38.81 090 S

35022 ............. A Repair artery rupture, chest ............................ 21.15 14.78 2.80 38.73 090 S

35045 ............. A Repair defect of arm artery ............................ 9.98 12.35 2.50 24.83 090 S

35081 ............. A Repair defect of artery .................................... 22.15 21.45 4.18 47.78 090 S

35082 ............. A Repair artery rupture, aorta ............................ 28.82 22.91 4.59 56.32 090 S

35091 ............. A Repair defect of artery .................................... 28.10 22.67 4.25 55.02 090 S

35092 ............. A Repair artery rupture, aorta ............................ 36.06 26.27 5.21 67.54 090 S

35102 ............. A Repair defect of artery .................................... 23.44 22.15 4.32 49.91 090 S

35103 ............. A Repair artery rupture, groin ............................ 31.31 26.16 5.21 62.68 090 S

35111 ............. A Repair defect of artery .................................... 15.12 17.60 3.70 36.42 090 S

35112 ............. A Repair artery rupture,spleen ........................... 17.38 10.45 2.22 30.05 090 S

35121 ............. A Repair defect of artery .................................... 24.68 19.12 3.66 47.46 090 S

35122 ............. A Repair artery rupture, belly ............................. 32.08 17.92 3.96 53.96 090 S

35131 ............. A Repair defect of artery .................................... 17.00 15.88 3.15 36.03 090 S

35132 ............. A Repair artery rupture, groin ............................ 20.40 18.68 3.58 42.66 090 S

35141 ............. A Repair defect of artery .................................... 13.28 14.70 2.88 30.86 090 S

35142 ............. A Repair artery rupture, thigh ............................ 14.62 16.10 3.24 33.96 090 S

35151 ............. A Repair defect of artery .................................... 15.76 15.36 2.94 34.06 090 S

35152 ............. A Repair artery rupture, knee ............................ 15.46 9.27 1.95 26.68 090 S

35161 ............. A Repair defect of artery .................................... 17.45 15.88 3.15 36.48 090 S

35162 ............. A Repair artery rupture ...................................... 18.45 18.68 3.58 40.71 090 S

35180 ............. A Repair blood vessel lesion ............................. 12.16 7.37 1.48 21.01 090 S

35182 ............. A Repair blood vessel lesion ............................. 16.12 10.65 1.61 28.38 090 S

35184 ............. A Repair blood vessel lesion ............................. 10.79 9.73 1.96 22.48 090 S

35188 ............. A Repair blood vessel lesion ............................. 13.10 8.11 1.59 22.80 090 S

35189 ............. A Repair blood vessel lesion ............................. 17.12 11.33 2.21 30.66 090 S

35190 ............. A Repair blood vessel lesion ............................. 11.79 10.34 2.14 24.27 090 S

35201 ............. A Repair blood vessel lesion ............................. 8.90 10.07 1.94 20.91 090 S

35206 ............. A Repair blood vessel lesion ............................. 8.49 10.15 2.03 20.67 090 S

35207 ............. A Repair blood vessel lesion ............................. 9.06 10.80 1.93 21.79 090 S

35211 ............. A Repair blood vessel lesion ............................. 20.15 13.38 2.59 36.12 090 S

35216 ............. A Repair blood vessel lesion ............................. 17.12 10.68 2.08 29.88 090 S

35221 ............. A Repair blood vessel lesion ............................. 15.11 11.09 2.20 28.40 090 S

35226 ............. A Repair blood vessel lesion ............................. 8.17 10.28 1.95 20.40 090 S

35231 ............. A Repair blood vessel lesion ............................. 10.76 *13.78 2.91 27.45 090 S

35236 ............. A Repair blood vessel lesion ............................. 9.39 *12.02 2.56 23.97 090 S

35241 ............. A Repair blood vessel lesion ............................. 21.15 13.49 2.60 37.24 090 S

35246 ............. A Repair blood vessel lesion ............................. 18.14 16.95 2.15 37.24 090 S

35251 ............. A Repair blood vessel lesion ............................. 16.12 9.59 1.88 27.59 090 S
63227

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

35256 ............. A Repair blood vessel lesion ............................. 10.14 12.40 2.39 24.93 090 S

35261 ............. A Repair blood vessel lesion ............................. 10.39 13.16 2.66 26.21 090 S

35266 ............. A Repair blood vessel lesion ............................. 9.06 *11.59 2.41 23.06 090 S

35271 ............. A Repair blood vessel lesion ............................. 20.15 12.53 2.56 35.24 090 S

35276 ............. A Repair blood vessel lesion ............................. 17.12 10.85 2.26 30.23 090 S

35281 ............. A Repair blood vessel lesion ............................. 15.11 17.28 3.37 35.76 090 S

35286 ............. A Repair blood vessel lesion ............................. 10.78 11.71 2.33 24.82 090 S

35301 ............. A Rechanneling of artery ................................... 15.95 14.46 2.81 33.22 090 S

35311 ............. A Rechanneling of artery ................................... 22.61 22.06 4.61 49.28 090 S

35321 ............. A Rechanneling of artery ................................... 11.08 12.96 2.69 26.73 090 S

35331 ............. A Rechanneling of artery ................................... 22.15 13.34 2.66 38.15 090 S

35341 ............. A Rechanneling of artery ................................... 23.67 17.37 3.53 44.57 090 S

35351 ............. A Rechanneling of artery ................................... 19.15 14.95 2.97 37.07 090 S

35355 ............. A Rechanneling of artery ................................... 15.11 15.42 2.99 33.52 090 S

35361 ............. A Rechanneling of artery ................................... 22.15 19.37 3.88 45.40 090 S

35363 ............. A Rechanneling of artery ................................... 23.16 22.77 4.40 50.33 090 S

35371 ............. A Rechanneling of artery ................................... 10.49 12.51 2.50 25.50 090 S

35372 ............. A Rechanneling of artery ................................... 12.28 11.20 2.28 25.76 090 S

35381 ............. A Rechanneling of artery ................................... 14.50 13.67 2.71 30.88 090 S

35390 ............. A Reoperation, carotid ....................................... 3.19 1.67 0.39 5.25 ZZZ S

35450 ............. A Repair arterial blockage .................................. 10.07 *12.89 1.38 24.34 000 N

35452 ............. A Repair arterial blockage .................................. 6.91 4.35 0.61 11.87 000 S

35454 ............. A Repair arterial blockage .................................. 6.04 *7.73 1.53 15.30 000 S

35456 ............. A Repair arterial blockage .................................. 7.35 *9.41 1.69 18.45 000 S

35458 ............. A Repair arterial blockage .................................. 9.49 10.13 1.83 21.45 000 S

35459 ............. A Repair arterial blockage .................................. 8.63 10.39 1.69 20.71 000 S

35460 ............. A Repair venous blockage ................................. 6.04 3.16 0.74 9.94 000 S

35470 ............. A Repair arterial blockage .................................. 8.63 10.39 1.69 20.71 000 N

35471 ............. A Repair arterial blockage .................................. 10.07 *12.89 1.38 24.34 000 N

35472 ............. A Repair arterial blockage .................................. 6.91 3.61 0.85 11.37 000 N

35473 ............. A Repair arterial blockage .................................. 6.04 *7.73 1.53 15.30 000 N

35474 ............. A Repair arterial blockage .................................. 7.36 *9.42 1.69 18.47 000 N

35475 ............. R Repair arterial blockage .................................. 9.49 10.13 1.83 21.45 000 N

35476 ............. A Repair venous blockage ................................. 6.04 3.16 0.74 9.94 000 N

35480 ............. A Atherectomy, open .......................................... 11.08 13.43 1.38 25.89 000 S

35481 ............. A Atherectomy, open .......................................... 7.61 4.35 0.61 12.57 000 S

35482 ............. A Atherectomy, open .......................................... 6.65 *8.51 1.53 16.69 000 S

35483 ............. A Atherectomy, open .......................................... 8.10 *10.36 1.69 20.15 000 S

35484 ............. A Atherectomy, open .......................................... 10.44 10.13 1.83 22.40 000 S

35485 ............. A Atherectomy, open .......................................... 9.49 4.52 1.06 15.07 000 S

35490 ............. A Atherectomy, percutaneous ............................ 11.08 13.43 1.38 25.89 000 N

35491 ............. A Atherectomy, percutaneous ............................ 7.61 4.35 0.61 12.57 000 N

35492 ............. A Atherectomy, percutaneous ............................ 6.65 *8.51 1.53 16.69 000 N

35493 ............. A Atherectomy, percutaneous ............................ 8.10 *10.36 1.69 20.15 000 N

35494 ............. A Atherectomy, percutaneous ............................ 10.44 10.13 1.83 22.40 000 N

35495 ............. A Atherectomy, percutaneous ............................ 9.49 4.52 1.06 15.07 000 N

35501 ............. A Artery bypass graft ......................................... 18.23 19.35 3.49 41.07 090 S

35506 ............. A Artery bypass graft ......................................... 18.23 19.17 3.64 41.04 090 S

35507 ............. A Artery bypass graft ......................................... 18.23 17.92 3.61 39.76 090 S

35508 ............. A Artery bypass graft ......................................... 17.21 18.11 3.43 38.75 090 S

35509 ............. A Artery bypass graft ......................................... 16.70 18.90 3.92 39.52 090 S

35511 ............. A Artery bypass graft ......................................... 15.39 10.40 1.92 27.71 090 S

35515 ............. A Artery bypass graft ......................................... 17.21 11.25 2.01 30.47 090 S

35516 ............. A Artery bypass graft ......................................... 14.88 17.37 3.54 35.79 090 S

35518 ............. A Artery bypass graft ......................................... 14.05 17.47 3.38 34.90 090 S

35521 ............. A Artery bypass graft ......................................... 14.80 17.53 3.34 35.67 090 S

35526 ............. A Artery bypass graft ......................................... 18.63 12.95 2.44 34.02 090 S

35531 ............. A Artery bypass graft ......................................... 24.17 20.25 3.90 48.32 090 S

35533 ............. A Artery bypass graft ......................................... 19.15 21.04 4.43 44.62 090 S

35536 ............. A Artery bypass graft ......................................... 21.65 21.37 4.17 47.19 090 S

35541 ............. A Artery bypass graft ......................................... 24.17 19.55 3.65 47.37 090 S

35546 ............. A Artery bypass graft ......................................... 24.17 21.39 4.26 49.82 090 S

35548 ............. A Artery bypass graft ......................................... 20.13 19.55 3.65 43.33 090 S

35549 ............. A Artery bypass graft ......................................... 21.91 21.39 4.26 47.56 090 S

35551 ............. A Artery bypass graft ......................................... 25.17 19.25 3.87 48.29 090 S

35556 ............. A Artery bypass graft ......................................... 15.47 18.71 3.71 37.89 090 S
63228

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

35558 ............. A Artery bypass graft ......................................... 12.82 *16.41 3.23 32.46 090 S

35560 ............. A Artery bypass graft ......................................... 22.12 20.22 3.93 46.27 090 S

35563 ............. A Artery bypass graft ......................................... 13.83 8.32 1.70 23.85 090 S

35565 ............. A Artery bypass graft ......................................... 13.83 *17.69 3.51 35.03 090 S

35566 ............. A Artery bypass graft ......................................... 20.21 20.62 4.08 44.91 090 S

35571 ............. A Artery bypass graft ......................................... 16.66 19.36 3.87 39.89 090 S

35582 ............. A Vein bypass graft ............................................ 25.69 23.74 4.89 54.32 090 S

35583 ............. A Vein bypass graft ............................................ 15.97 *20.44 4.13 40.54 090 S

35585 ............. A Vein bypass graft ............................................ 19.05 22.95 4.63 46.63 090 S

35587 ............. A Vein bypass graft ............................................ 17.07 21.51 4.13 42.71 090 S

35601 ............. A Artery bypass graft ......................................... 16.19 18.83 3.33 38.35 090 S

35606 ............. A Artery bypass graft ......................................... 17.40 17.55 3.51 38.46 090 S

35612 ............. A Artery bypass graft ......................................... 14.39 16.75 3.30 34.44 090 S

35616 ............. A Artery bypass graft ......................................... 14.39 16.79 3.42 34.60 090 S

35621 ............. A Artery bypass graft ......................................... 13.23 *16.94 3.80 33.97 090 S

35623 ............. A Bypass graft, not vein ..................................... 15.42 8.06 1.88 25.36 090 S

35626 ............. A Artery bypass graft ......................................... 22.26 20.51 4.08 46.85 090 S

35631 ............. A Artery bypass graft ......................................... 23.16 17.87 3.57 44.60 090 S

35636 ............. A Artery bypass graft ......................................... 21.15 13.50 2.45 37.10 090 S

35641 ............. A Artery bypass graft ......................................... 22.67 20.56 4.08 47.31 090 S

35642 ............. A Artery bypass graft ......................................... 16.70 10.33 2.20 29.23 090 S

35645 ............. A Artery bypass graft ......................................... 16.19 11.15 2.05 29.39 090 S

35646 ............. A Artery bypass graft ......................................... 24.00 23.78 4.73 52.51 090 S

35650 ............. A Artery bypass graft ......................................... 13.05 *16.71 3.56 33.32 090 S

35651 ............. A Artery bypass graft ......................................... 23.67 24.09 4.69 52.45 090 S

35654 ............. A Artery bypass graft ......................................... 17.62 22.10 4.42 44.14 090 S

35656 ............. A Artery bypass graft ......................................... 13.86 *17.73 3.60 35.19 090 S

35661 ............. A Artery bypass graft ......................................... 11.81 *15.11 3.30 30.22 090 S

35663 ............. A Artery bypass graft ......................................... 12.82 *16.41 3.80 33.03 090 S

35665 ............. A Artery bypass graft ......................................... 14.05 17.79 3.57 35.41 090 S

35666 ............. A Artery bypass graft ......................................... 15.97 20.06 4.00 40.03 090 S

35671 ............. A Artery bypass graft ......................................... 12.18 *15.60 4.08 31.86 090 S

35681 ............. A Artery bypass graft ......................................... 8.05 *10.42 3.52 21.99 ZZZ S

35691 ............. A Arterial transposition ....................................... 16.70 19.62 3.81 40.13 090 S

35693 ............. A Arterial transposition ....................................... 14.01 9.40 1.91 25.32 090 S

35694 ............. A Arterial transposition ....................................... 17.81 9.33 2.17 29.31 090 S

35695 ............. A Arterial transposition ....................................... 17.81 9.33 2.17 29.31 090 S

35700 ............. A Reoperation, bypass graft .............................. 3.08 1.61 0.38 5.07 ZZZ S

35701 ............. A Exploration, carotid artery ............................... 4.54 *5.82 1.25 11.61 090 S

35721 ............. A Exploration, femoral artery ............................. 4.54 5.56 1.11 11.21 090 S

35741 ............. A Exploration popliteal artery ............................. 4.54 5.73 1.15 11.42 090 S

35761 ............. A Exploration of artery/vein ................................ 4.54 5.81 1.14 11.49 090 S

35800 ............. A Explore neck vessels ...................................... 6.04 5.28 0.97 12.29 090 S

35820 ............. A Explore chest vessels ..................................... 11.64 7.92 1.43 20.99 090 S

35840 ............. A Explore abdominal vessels ............................. 8.63 7.23 1.44 17.30 090 S

35860 ............. A Explore limb vessels ....................................... 4.54 5.81 1.15 11.50 090 S

35870 ............. A Repair vessel graft defect ............................... 20.35 10.64 2.47 33.46 090 S

35875 ............. A Removal of clot in graft .................................. 9.07 8.21 1.65 18.93 090 S

35876 ............. A Removal of clot in graft .................................. 12.91 8.21 1.65 22.77 090 S

35901 ............. A Excision, graft, neck ....................................... 7.25 7.18 1.46 15.89 090 S

35903 ............. A Excision, graft, extremity ................................ 8.63 7.18 1.46 17.27 090 S

35905 ............. A Excision, graft, thorax ..................................... 16.89 7.18 1.46 25.53 090 S

35907 ............. A Excision, graft, abdomen ................................ 17.68 7.18 1.46 26.32 090 S

36000 ............. A Place needle in vein ....................................... 0.18 *0.24 0.04 0.46 XXX N

36005 ............. A Injection, venography ...................................... 0.95 0.47 0.04 1.46 000 N

36010 ............. A Place catheter in vein ..................................... 2.43 2.11 0.31 4.85 XXX N

36011 ............. A Place catheter in vein ..................................... 3.14 1.90 0.22 5.26 XXX N

36012 ............. A Place catheter in vein ..................................... 3.52 2.67 0.32 6.51 XXX N

36013 ............. A Place catheter in artery .................................. 2.52 2.11 0.31 4.94 XXX N

36014 ............. A Place catheter in artery .................................. 3.02 2.28 0.27 5.57 XXX N

36015 ............. A Place catheter in artery .................................. 3.52 2.67 0.32 6.51 XXX N

36100 ............. A Establish access to artery .............................. 3.02 2.59 0.32 5.93 XXX N

36120 ............. A Establish access to artery .............................. 2.01 2.32 0.30 4.63 XXX N

36140 ............. A Establish access to artery .............................. 2.01 1.41 0.24 3.66 XXX N

36145 ............. A Artery to vein shunt ........................................ 2.01 *2.57 0.49 5.07 XXX N

36160 ............. A Establish access to aorta ............................... 2.52 2.32 0.35 5.19 XXX S
63229

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

36200 ............. A Place catheter in aorta ................................... 3.02 2.73 0.28 6.03 XXX N

36215 ............. A Place catheter in artery .................................. 4.47 2.78 0.23 7.48 XXX N

36216 ............. A Place catheter in artery .................................. 5.28 3.29 0.27 8.84 XXX N

36217 ............. A Place catheter in artery .................................. 6.30 3.92 0.32 10.54 XXX N

36218 ............. A Place catheter in artery .................................. 1.01 0.62 0.05 1.68 XXX N

36245 ............. A Place catheter in artery .................................. 5.07 3.15 0.26 8.48 XXX N

36246 ............. A Place catheter in artery .................................. 5.28 3.29 0.27 8.84 XXX N

36247 ............. A Place catheter in artery .................................. 6.30 3.92 0.32 10.54 XXX N

36248 ............. A Place catheter in artery .................................. 1.01 0.62 0.05 1.68 XXX N

36260 ............. A Insertion of infusion pump .............................. 9.27 6.74 1.41 17.42 090 S

36261 ............. A Revision of infusion pump .............................. 5.04 2.23 0.42 7.69 090 S

36262 ............. A Removal of infusion pump .............................. 3.70 1.93 0.40 6.03 090 S

36299 ............. C Vessel injection procedure ............................. 0.00 0.00 0.00 0.00 YYY N

36400 ............. A Drawing blood ................................................. 0.18 0.09 0.01 0.28 XXX N

36405 ............. A Drawing blood ................................................. 0.18 0.45 0.03 0.66 XXX N

36406 ............. A Drawing blood ................................................. 0.18 0.16 0.01 0.35 XXX S

36410 ............. A Drawing blood ................................................. 0.18 0.22 0.02 0.42 XXX N

36415 ............. G Drawing blood ................................................. 0.00 0.00 0.00 0.00 XXX 0

36420 ............. A Establish access to vein ................................. 1.01 0.51 0.05 1.57 XXX N

36425 ............. A Establish access to vein ................................. 0.76 0.08 0.01 0.85 XXX N

36430 ............. A Blood transfusion service ............................... 0.00 0.96 0.07 1.03 XXX N

36440 ............. A Blood transfusion service ............................... 1.03 0.94 0.07 2.04 XXX S

36450 ............. A Exchange transfusion service ......................... 2.23 1.88 0.18 4.29 XXX N

36455 ............. A Exchange transfusion service ......................... 2.43 2.27 0.22 4.92 XXX N

36460 ............. A Transfusion service, fetal ................................ 6.59 4.71 1.09 12.39 XXX N

36468 ............. R Injection(s); spider veins ................................. 0.00 0.00 0.00 0.00 XXX S

36469 ............. R Injection(s); spider veins ................................. 0.00 0.00 0.00 0.00 XXX S

36470 ............. A Injection therapy of vein ................................. 1.02 0.27 0.04 1.33 010 S

36471 ............. A Injection therapy of veins ................................ 1.49 0.39 0.05 1.93 010 S

36481 ............. A Insertion of catheter, vein ............................... 6.99 5.30 0.61 12.90 000 S

36488 ............. A Insertion of catheter, vein ............................... 1.35 0.97 0.14 2.46 000 N

36489 ............. A Insertion of catheter, vein ............................... 1.22 1.12 0.17 2.51 000 N

36490 ............. A Insertion of catheter, vein ............................... 1.67 1.38 0.20 3.25 000 N

36491 ............. A Insertion of catheter, vein ............................... 1.43 1.71 0.32 3.46 000 N

36493 ............. A Repositioning of cvc ....................................... 1.21 0.63 0.16 2.00 000 N

36500 ............. A Insertion of catheter, vein ............................... 3.52 0.08 0.01 3.61 000 N

36510 ............. A Insertion of catheter, vein ............................... 1.09 0.34 0.02 1.45 000 N

36520 ............. A Plasma and/or cell exchange ......................... 1.74 1.92 0.12 3.78 000 N

36522 ............. A Photopheresis ................................................. 1.67 *2.48 0.37 4.52 000 S

36530 ............. R Insertion of infusion pump .............................. 4.83 4.82 1.02 10.67 010 S

36531 ............. R Revision of infusion pump .............................. 4.80 4.37 0.27 9.44 010 S

36532 ............. R Removal of infusion pump .............................. 3.23 1.77 0.37 5.37 010 S

36533 ............. A Insertion of access port .................................. 3.82 4.29 0.85 8.96 010 S

36534 ............. A Revision of access port .................................. 3.79 3.46 0.21 7.46 010 S

36535 ............. A Removal of access port .................................. 2.22 1.81 0.38 4.41 010 S

36600 ............. A Withdrawal of arterial blood ............................ 0.32 0.28 0.02 0.62 XXX N

36620 ............. A Insertion catheter, artery ................................. 1.15 0.66 0.14 1.95 000 N

36625 ............. A Insertion catheter, artery ................................. 2.11 0.86 0.18 3.15 000 N

36640 ............. A Insertion catheter, artery ................................. 2.10 2.32 0.40 4.82 000 N

36660 ............. A Insertion catheter, artery ................................. 1.40 0.49 0.04 1.93 000 N

36680 ............. A Insert needle, bone cavity .............................. 1.20 1.24 0.10 2.54 000 N

36800 ............. A Insertion of cannula ........................................ 2.43 2.22 0.28 4.93 000 N

36810 ............. A Insertion of cannula ........................................ 3.97 4.85 0.74 9.56 000 S

36815 ............. A Insertion of cannula ........................................ 2.62 *3.35 0.70 6.67 000 S

36821 ............. A Artery-vein fusion ............................................ 8.39 7.24 1.46 17.09 090 S

36822 ............. A Insertion of cannula(s) .................................... 5.03 5.60 0.77 11.40 090 S

36825 ............. A Artery-vein graft .............................................. 9.36 11.20 2.21 22.77 090 S

36830 ............. A Artery-vein graft .............................................. 7.78 *9.96 2.36 20.10 090 S

36832 ............. A Revise artery-vein fistula ................................ 5.84 *7.48 2.38 15.70 090 S

36834 ............. A Repair A-V aneurysm ..................................... 9.32 7.80 1.66 18.78 090 S

36835 ............. A Artery to vein shunt ........................................ 6.54 3.42 0.79 10.75 090 S

36860 ............. A Cannula declotting .......................................... 2.01 2.57 0.43 5.01 000 N

36861 ............. A Cannula declotting .......................................... 2.52 *3.22 1.01 6.75 000 S

37140 ............. A Revision of circulation ..................................... 22.15 16.29 3.34 41.78 090 S

37145 ............. A Revision of circulation ..................................... 23.16 17.13 1.72 42.01 090 S

37160 ............. A Revision of circulation ..................................... 20.15 17.74 3.79 41.68 090 S
63230

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

37180 ............. A Revision of circulation ..................................... 23.16 14.19 2.76 40.11 090 S

37181 ............. A Splice spleen/kidney veins ............................. 25.17 16.41 3.52 45.10 090 S

37200 ............. A Transcatheter biopsy ...................................... 4.56 1.59 0.13 6.28 000 N

37201 ............. A Transcatheter therapy infuse .......................... 7.25 5.50 0.64 13.39 000 N

37202 ............. A Transcatheter therapy infuse .......................... 5.68 4.30 0.50 10.48 000 N

37203 ............. A Transcatheter retrieval .................................... 5.03 3.82 0.45 9.30 000 N

37204 ............. A Transcatheter occlusion .................................. 18.14 13.76 1.60 33.50 000 N

37205 ............. A Transcatheter stent ......................................... 8.28 5.16 0.42 13.86 000 S

37206 ............. A Transcatheter stent ......................................... 4.13 2.58 0.21 6.92 ZZZ S

37207 ............. A Transcatheter stent ......................................... 8.28 5.16 0.42 13.86 000 S

37208 ............. A Transcatheter stent ......................................... 4.13 2.58 0.21 6.92 ZZZ S

37209 ............. A Exchange arterial catheter .............................. 2.27 1.41 0.11 3.79 000 N

37565 ............. A Ligation of neck vein ....................................... 3.90 3.79 0.74 8.43 090 S

37600 ............. A Ligation of neck artery .................................... 3.90 *4.98 0.80 9.68 090 S

37605 ............. A Ligation of neck artery .................................... 4.63 5.56 1.04 11.23 090 S

37606 ............. A Ligation of neck artery .................................... 4.63 *5.92 0.72 11.27 090 S

37607 ............. A Ligation of fistula ............................................. 5.84 3.06 0.71 9.61 090 S

37609 ............. A Temporal artery procedure ............................. 2.27 2.22 0.38 4.87 010 S

37615 ............. A Ligation of neck artery .................................... 4.39 *5.62 1.11 11.12 090 S

37616 ............. A Ligation of chest artery ................................... 14.69 4.21 0.83 19.73 090 S

37617 ............. A Ligation of abdomen artery ............................. 14.19 8.00 1.54 23.73 090 S

37618 ............. A Ligation of extremity artery ............................. 3.90 *4.98 1.06 9.94 090 S

37620 ............. A Revision of major vein .................................... 9.24 8.81 1.48 19.53 090 S

37650 ............. A Revision of major vein .................................... 4.39 4.02 0.52 8.93 090 S

37660 ............. A Revision of major vein .................................... 9.65 5.75 1.07 16.47 090 S

37700 ............. A Revise leg vein ............................................... 3.52 3.64 0.73 7.89 090 S

37720 ............. A Removal of leg vein ........................................ 5.22 5.11 1.04 11.37 090 S

37730 ............. A Removal of leg veins ...................................... 6.63 6.95 1.40 14.98 090 S

37735 ............. A Removal of leg veins/lesion ............................ 9.90 8.34 1.68 19.92 090 S

37760 ............. A Revision of leg veins ...................................... 9.90 7.48 1.52 18.90 090 S

37780 ............. A Revision of leg vein ........................................ 3.52 1.89 0.35 5.76 090 S

37785 ............. A Revise secondary varicosity ........................... 3.56 0.98 0.18 4.72 090 S

37788 ............. A Revascularization, penis ................................. 21.33 15.14 1.48 37.95 090 S

37790 ............. A Penile venous occlusion ................................. 8.02 5.70 0.55 14.27 090 S

37799 ............. C Vascular surgery procedure ........................... 0.00 0.00 0.00 0.00 YYY S

38100 ............. A Removal of spleen, total ................................. 11.99 8.55 1.81 22.35 090 S

38101 ............. A Removal of spleen, partial .............................. 12.59 6.99 1.51 21.09 090 S

38102 ............. A Removal of spleen, total ................................. 4.80 2.51 0.58 7.89 ZZZ S

38115 ............. A Repair of ruptured spleen ............................... 12.59 7.64 1.49 21.72 090 S

38200 ............. A Injection for spleen x-ray ................................ 2.64 1.71 0.15 4.50 000 S

38230 ............. A Bone marrow collection .................................. 3.16 2.78 0.21 6.15 010 N

38231 ............. A Stem cell collection ......................................... 1.50 1.37 0.08 2.95 000 N

38240 ............. A Bone marrow/stem transplant ......................... 2.24 2.08 0.14 4.46 XXX N

38241 ............. A Bone marrow/stem transplant ......................... 2.24 2.04 0.13 4.41 XXX N

38300 ............. A Drainage lymph node lesion ........................... 1.48 0.58 0.10 2.16 010 S

38305 ............. A Drainage lymph node lesion ........................... 4.24 1.96 0.36 6.56 090 S

38308 ............. A Incision of lymph channels ............................. 4.55 3.37 0.45 8.37 090 S

38380 ............. A Thoracic duct procedure ................................. 6.53 4.44 0.76 11.73 090 S

38381 ............. A Thoracic duct procedure ................................. 12.10 7.56 1.50 21.16 090 S

38382 ............. A Thoracic duct procedure ................................. 9.24 4.84 1.13 15.21 090 S

38500 ............. A Biopsy/removal, lymph node(s) ...................... 2.83 1.59 0.31 4.73 010 S

38505 ............. A Needle biopsy, lymph node(s) ........................ 1.14 1.12 0.17 2.43 000 S

38510 ............. A Biopsy/removal, lymph node(s) ...................... 3.90 2.54 0.45 6.89 090 S

38520 ............. A Biopsy/removal, lymph node(s) ...................... 4.86 2.99 0.56 8.41 090 S

38525 ............. A Biopsy/removal, lymph node(s) ...................... 4.37 2.59 0.53 7.49 090 S

38530 ............. A Biopsy/removal, lymph node(s) ...................... 5.82 3.17 0.65 9.64 090 S

38542 ............. A Explore deep node(s), neck ........................... 5.41 4.26 0.59 10.26 090 S

38550 ............. A Removal neck/armpit lesion ........................... 6.42 3.23 0.63 10.28 090 S

38555 ............. A Removal neck/armpit lesion ........................... 13.05 7.27 1.38 21.70 090 S

38562 ............. A Removal, pelvic lymph nodes ......................... 9.65 6.88 1.20 17.73 090 S

38564 ............. A Removal, abdomen lymph nodes ................... 10.00 7.39 1.51 18.90 090 S

38700 ............. A Removal of lymph nodes, neck ...................... 7.56 9.64 1.31 18.51 090 S

38720 ............. A Removal of lymph nodes, neck ...................... 12.29 *15.73 2.04 30.06 090 S

38724 ............. A Removal of lymph nodes, neck ...................... 13.22 14.36 2.00 29.58 090 S

38740 ............. A Remove armpit lymph nodes .......................... 6.28 4.72 1.00 12.00 090 S

38745 ............. A Remove armpits lymph nodes ........................ 8.08 8.28 1.76 18.12 090 S
63231

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

38746 ............. A Remove thoracic lymph nodes ....................... 4.39 2.29 0.53 7.21 ZZZ S

38747 ............. A Remove abdominal lymph nodes ................... 4.89 2.56 0.59 8.04 ZZZ S

38760 ............. A Remove groin lymph nodes ............................ 8.19 6.63 1.35 16.17 090 S

38765 ............. A Remove groin lymph nodes ............................ 14.98 12.67 2.42 30.07 090 S

38770 ............. A Remove pelvis lymph nodes .......................... 12.10 15.40 1.73 29.23 090 S

38780 ............. A Remove abdomen lymph nodes ..................... 15.17 16.06 3.13 34.36 090 S

38790 ............. A Injection for lymphatic xray ............................. 1.29 *1.64 0.19 3.12 000 N

38794 ............. A Access thoracic lymph duct ............................ 4.05 2.84 0.38 7.27 090 S

38999 ............. C Blood/lymph system procedure ...................... 0.00 0.00 0.00 0.00 YYY S

39000 ............. A Exploration of chest ........................................ 5.03 6.05 1.08 12.16 090 S

39010 ............. A Exploration of chest ........................................ 10.78 11.46 2.08 24.32 090 S

39200 ............. A Removal chest lesion ..................................... 12.40 11.58 2.14 26.12 090 S

39220 ............. A Removal chest lesion ..................................... 16.16 14.94 2.83 33.93 090 S

39400 ............. A Visualization of chest ...................................... 5.11 5.12 0.95 11.18 010 S

39499 ............. C Chest procedure ............................................. 0.00 0.00 0.00 0.00 YYY S

39501 ............. A Repair diaphragm laceration .......................... 12.10 10.66 2.10 24.86 090 S

39502 ............. A Repair paraesophageal hernia ....................... 15.18 11.93 2.45 29.56 090 S

39503 ............. A Repair of diaphragm hernia ............................ 33.22 25.18 2.94 61.34 090 S

39520 ............. A Repair of diaphragm hernia ............................ 15.18 12.53 2.46 30.17 090 S

39530 ............. A Repair of diaphragm hernia ............................ 14.22 14.06 2.71 30.99 090 S

39531 ............. A Repair of diaphragm hernia ............................ 15.23 10.00 1.80 27.03 090 S

39540 ............. A Repair of diaphragm hernia ............................ 12.10 11.98 2.51 26.59 090 S

39541 ............. A Repair of diaphragm hernia ............................ 13.10 12.16 2.37 27.63 090 S

39545 ............. A Revision of diaphragm .................................... 12.10 7.90 1.31 21.31 090 S

39599 ............. C Diaphragm surgery procedure ........................ 0.00 0.00 0.00 0.00 YYY S

40490 ............. A Biopsy of lip .................................................... 1.22 0.74 0.07 2.03 000 S

40500 ............. A Partial excision of lip ....................................... 4.08 *5.23 0.94 10.25 090 S

40510 ............. A Partial excision of lip ....................................... 4.57 *5.84 0.83 11.24 090 S

40520 ............. A Partial excision of lip ....................................... 4.54 4.50 0.68 9.72 090 S

40525 ............. A Reconstruct lip with flap ................................. 7.26 *9.30 1.43 17.99 090 S

40527 ............. A Reconstruct lip with flap ................................. 8.71 *11.16 1.65 21.52 090 S

40530 ............. A Partial removal of lip ....................................... 5.14 5.10 0.74 10.98 090 S

40650 ............. A Repair lip ......................................................... 3.49 *4.47 0.65 8.61 090 S

40652 ............. A Repair lip ......................................................... 4.08 *5.23 0.79 10.10 090 S

40654 ............. A Repair lip ......................................................... 5.13 *6.57 1.00 12.70 090 S

40700 ............. A Repair cleft lip/nasal ....................................... 12.04 8.46 1.28 21.78 090 S

40701 ............. A Repair cleft lip/nasal ....................................... 15.10 *19.33 1.62 36.05 090 S

40702 ............. A Repair cleft lip/nasal ....................................... 12.34 9.37 1.10 22.81 090 S

40720 ............. A Repair cleft lip/nasal ....................................... 12.91 9.59 1.79 24.29 090 S

40761 ............. A Repair cleft lip/nasal ....................................... 14.00 10.84 1.74 26.58 090 S

40799 ............. C Lip surgery procedure ..................................... 0.00 0.00 0.00 0.00 YYY S

40800 ............. A Drainage of mouth lesion ............................... 1.12 0.74 0.07 1.93 010 S

40801 ............. A Drainage of mouth lesion ............................... 2.48 1.70 0.16 4.34 010 S

40804 ............. A Removal foreign body, mouth ........................ 1.19 0.58 0.06 1.83 010 S

40805 ............. A Removal foreign body, mouth ........................ 2.64 2.50 0.30 5.44 010 S

40806 ............. A Incision of lip fold ............................................ 0.31 0.36 0.03 0.70 000 S

40808 ............. A Biopsy of mouth lesion ................................... 0.91 0.76 0.08 1.75 010 S

40810 ............. A Excision of mouth lesion ................................. 1.26 1.18 0.11 2.55 010 S

40812 ............. A Excise/repair mouth lesion ............................. 2.26 1.50 0.14 3.90 010 S

40814 ............. A Excise/repair mouth lesion ............................. 3.27 3.23 0.32 6.82 090 S

40816 ............. A Excision of mouth lesion ................................. 3.52 3.22 0.33 7.07 090 S

40818 ............. A Excise oral mucosa for graft ........................... 2.26 2.25 0.20 4.71 090 S

40819 ............. A Excise lip or cheek fold .................................. 2.26 1.23 0.14 3.63 090 S

40820 ............. A Treatment of mouth lesion .............................. 1.23 0.53 0.06 1.82 010 S

40830 ............. A Repair mouth laceration ................................. 1.71 0.67 0.07 2.45 010 S

40831 ............. A Repair mouth laceration ................................. 2.41 1.94 0.21 4.56 010 S

40840 ............. R Reconstruction of mouth ................................. 8.31 6.28 0.73 15.32 090 S

40842 ............. R Reconstruction of mouth ................................. 8.31 6.28 0.73 15.32 090 S

40843 ............. R Reconstruction of mouth ................................. 11.63 8.80 1.03 21.46 090 S

40844 ............. R Reconstruction of mouth ................................. 15.37 11.63 1.36 28.36 090 S

40845 ............. R Reconstruction of mouth ................................. 17.94 23.99 1.93 43.86 090 S

40899 ............. C Mouth surgery procedure ............................... 0.00 0.00 0.00 0.00 YYY S

41000 ............. A Drainage of mouth lesion ............................... 1.25 0.76 0.08 2.09 010 S

41005 ............. A Drainage of mouth lesion ............................... 1.21 0.62 0.07 1.90 010 S

41006 ............. A Drainage of mouth lesion ............................... 3.03 1.01 0.11 4.15 090 S

41007 ............. A Drainage of mouth lesion ............................... 2.89 2.90 0.30 6.09 090 S
63232

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

41008 ............. A Drainage of mouth lesion ............................... 3.16 1.06 0.11 4.33 090 S

41009 ............. A Drainage of mouth lesion ............................... 3.35 3.31 0.34 7.00 090 S

41010 ............. A Incision of tongue fold .................................... 1.19 0.37 0.04 1.60 010 S

41015 ............. A Drainage of mouth lesion ............................... 3.72 0.87 0.10 4.69 090 S

41016 ............. A Drainage of mouth lesion ............................... 3.72 3.69 0.38 7.79 090 S

41017 ............. A Drainage of mouth lesion ............................... 3.72 1.40 0.14 5.26 090 S

41018 ............. A Drainage of mouth lesion ............................... 4.75 3.93 0.38 9.06 090 S

41100 ............. A Biopsy of tongue ............................................. 1.58 0.80 0.08 2.46 010 S

41105 ............. A Biopsy of tongue ............................................. 1.37 1.03 0.12 2.52 010 S

41108 ............. A Biopsy of floor of mouth ................................. 1.00 0.85 0.09 1.94 010 S

41110 ............. A Excision of tongue lesion ................................ 1.46 1.30 0.15 2.91 010 S

41112 ............. A Excision of tongue lesion ................................ 2.63 2.39 0.23 5.25 090 S

41113 ............. A Excision of tongue lesion ................................ 3.09 3.41 0.37 6.87 090 S

41114 ............. A Excision of tongue lesion ................................ 7.88 6.39 0.73 15.00 090 S

41115 ............. A Excision of tongue fold ................................... 1.69 1.78 0.17 3.64 010 S

41116 ............. A Excision of mouth lesion ................................. 2.36 2.49 0.27 5.12 090 S

41120 ............. A Partial removal of tongue ............................... 8.83 7.28 0.88 16.99 090 S

41130 ............. A Partial removal of tongue ............................... 10.27 9.06 1.14 20.47 090 S

41135 ............. A Tongue and neck surgery ............................... 14.29 *18.30 2.64 35.23 090 S

41140 ............. A Removal of tongue ......................................... 23.46 18.89 2.45 44.80 090 S

41145 ............. A Tongue removal; neck surgery ....................... 27.58 22.79 2.95 53.32 090 S

41150 ............. A Tongue, mouth, jaw surgery ........................... 19.36 18.96 2.46 40.78 090 S

41153 ............. A Tongue, mouth, neck surgery ......................... 21.18 25.00 3.03 49.21 090 S

41155 ............. A Tongue, jaw, & neck surgery .......................... 23.40 *29.95 3.75 57.10 090 S

41250 ............. A Repair tongue laceration ................................ 1.86 1.07 0.11 3.04 010 S

41251 ............. A Repair tongue laceration ................................ 2.22 2.07 0.21 4.50 010 S

41252 ............. A Repair tongue laceration ................................ 2.92 2.35 0.26 5.53 010 S

41500 ............. A Fixation of tongue ........................................... 3.50 3.29 0.26 7.05 090 S

41510 ............. A Tongue to lip surgery ...................................... 3.32 2.53 0.45 6.30 090 S

41520 ............. A Reconstruction, tongue fold ............................ 2.63 2.88 0.28 5.79 090 S

41599 ............. C Tongue and mouth surgery ............................ 0.00 0.00 0.00 0.00 YYY S

41800 ............. A Drainage of gum lesion .................................. 1.12 0.69 0.07 1.88 010 S

41805 ............. A Removal foreign body, gum ........................... 1.19 0.84 0.08 2.11 010 S

41806 ............. A Removal foreign body, jawbone ..................... 2.64 1.64 0.15 4.43 010 S

41820 ............. R Excision, gum, each quadrant ........................ 0.00 0.00 0.00 0.00 XXX S

41821 ............. R Excision of gum flap ....................................... 0.00 0.00 0.00 0.00 XXX S

41822 ............. R Excision of gum lesion .................................... 2.26 3.03 0.25 5.54 010 S

41823 ............. R Excision of gum lesion .................................... 3.15 4.20 0.34 7.69 090 S

41825 ............. A Excision of gum lesion .................................... 1.26 1.49 0.14 2.89 010 S

41826 ............. A Excision of gum lesion .................................... 2.26 2.07 0.18 4.51 010 S

41827 ............. A Excision of gum lesion .................................... 3.27 3.78 0.38 7.43 090 S

41828 ............. R Excision of gum lesion .................................... 3.04 4.07 0.33 7.44 010 S

41830 ............. R Removal of gum tissue ................................... 3.30 4.41 0.36 8.07 010 S

41850 ............. R Treatment of gum lesion ................................. 0.00 0.00 0.00 0.00 XXX S

41870 ............. R Gum graft ........................................................ 0.00 0.00 0.00 0.00 XXX S

41872 ............. R Repair gum ..................................................... 2.44 3.26 0.27 5.97 090 S

41874 ............. R Repair tooth socket ......................................... 2.94 3.93 0.32 7.19 090 S

41899 ............. C Dental surgery procedure ............................... 0.00 0.00 0.00 0.00 YYY S

42000 ............. A Drainage mouth roof lesion ............................ 1.18 0.62 0.06 1.86 010 S

42100 ............. A Biopsy roof of mouth ...................................... 1.26 0.79 0.08 2.13 010 S

42104 ............. A Excision lesion, mouth roof ............................ 1.59 1.62 0.17 3.38 010 S

42106 ............. A Excision lesion, mouth roof ............................ 2.63 2.22 0.21 5.06 010 S

42107 ............. A Excision lesion, mouth roof ............................ 4.20 4.91 0.50 9.61 090 S

42120 ............. A Remove palate/lesion ..................................... 5.39 *6.90 1.01 13.30 090 S

42140 ............. A Excision of uvula ............................................. 1.54 1.35 0.15 3.04 090 S

42145 ............. A Repair, palate, pharynx/uvula ......................... 7.04 *9.01 1.45 17.50 090 S

42160 ............. A Treatment mouth roof lesion .......................... 1.75 1.53 0.16 3.44 010 S

42180 ............. A Repair palate .................................................. 2.45 2.24 0.26 4.95 010 S

42182 ............. A Repair palate .................................................. 3.78 3.47 0.38 7.63 010 S

42200 ............. A Reconstruct cleft palate .................................. 9.48 7.19 0.85 17.52 090 S

42205 ............. A Reconstruct cleft palate .................................. 8.96 10.82 0.79 20.57 090 S

42210 ............. A Reconstruct cleft palate .................................. 10.02 12.51 0.95 23.48 090 S

42215 ............. A Reconstruct cleft palate .................................. 8.42 7.68 0.86 16.96 090 S

42220 ............. A Reconstruct cleft palate .................................. 6.65 5.40 0.81 12.86 090 S

42225 ............. A Reconstruct cleft palate .................................. 9.08 6.90 1.08 17.06 090 S

42226 ............. A Lengthening of palate ..................................... 9.42 7.89 0.86 18.17 090 S
63233

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

42227 ............. A Lengthening of palate ..................................... 8.89 7.41 0.38 16.68 090 S

42235 ............. A Repair palate .................................................. 7.50 5.55 0.49 13.54 090 S

42260 ............. A Repair nose to lip fistula ................................. 4.17 3.98 0.44 8.59 090 S

42280 ............. A Preparation, palate mold ................................ 1.49 1.99 0.17 3.65 010 S

42281 ............. A Insertion, palate prosthesis ............................. 1.77 1.47 0.15 3.39 010 S

42299 ............. C Palate/uvula surgery ....................................... 0.00 0.00 0.00 0.00 YYY S

42300 ............. A Drainage of salivary gland .............................. 1.88 0.96 0.12 2.96 010 S

42305 ............. A Drainage of salivary gland .............................. 5.59 2.18 0.27 8.04 090 S

42310 ............. A Drainage of salivary gland .............................. 1.51 1.03 0.12 2.66 010 S

42320 ............. A Drainage of salivary gland .............................. 2.30 1.83 0.22 4.35 010 S

42325 ............. A Create salivary cyst drain ............................... 2.65 2.12 0.20 4.97 090 S

42326 ............. A Create salivary cyst drain ............................... 3.65 4.34 0.33 8.32 090 S

42330 ............. A Removal of salivary stone .............................. 2.16 1.10 0.12 3.38 010 S

42335 ............. A Removal of salivary stone .............................. 3.21 2.47 0.27 5.95 090 S

42340 ............. A Removal of salivary stone .............................. 4.47 4.25 0.45 9.17 090 S

42400 ............. A Biopsy of salivary gland .................................. 0.78 0.79 0.10 1.67 000 S

42405 ............. A Biopsy of salivary gland .................................. 3.24 1.54 0.19 4.97 010 S

42408 ............. A Excision of salivary cyst ................................. 4.41 3.24 0.38 8.03 090 S

42409 ............. A Drainage of salivary cyst ................................ 2.71 2.81 0.30 5.82 090 S

42410 ............. A Excise parotid gland/lesion ............................. 8.88 5.94 0.92 15.74 090 S

42415 ............. A Excise parotid gland/lesion ............................. 16.12 12.68 1.68 30.48 090 S

42420 ............. A Excise parotid gland/lesion ............................. 18.63 14.82 1.87 35.32 090 S

42425 ............. A Excise parotid gland/lesion ............................. 12.36 11.10 1.43 24.89 090 S

42426 ............. A Excise parotid gland/lesion ............................. 19.88 24.12 3.21 47.21 090 S

42440 ............. A Excision submaxillary gland ........................... 6.61 7.98 0.99 15.58 090 S

42450 ............. A Excision sublingual gland ............................... 4.38 3.42 0.35 8.15 090 S

42500 ............. A Repair salivary duct ........................................ 4.06 4.61 0.50 9.17 090 S

42505 ............. A Repair salivary duct ........................................ 5.92 7.34 0.86 14.12 090 S

42507 ............. A Parotid duct diversion ..................................... 5.96 4.65 0.67 11.28 090 S

42508 ............. A Parotid duct diversion ..................................... 8.64 7.61 0.94 17.19 090 S

42509 ............. A Parotid duct diversion ..................................... 11.08 7.31 1.23 19.62 090 S

42510 ............. A Parotid duct diversion ..................................... 7.71 7.65 0.84 16.20 090 S

42550 ............. A Injection for salivary x-ray ............................... 1.25 0.44 0.04 1.73 000 N

42600 ............. A Closure of salivary fistula ............................... 4.58 3.89 0.46 8.93 090 S

42650 ............. A Dilation of salivary duct .................................. 0.77 0.39 0.04 1.20 000 S

42660 ............. A Dilation of salivary duct .................................. 1.13 0.50 0.06 1.69 000 S

42665 ............. A Ligation of salivary duct .................................. 2.43 2.04 0.25 4.72 090 S

42699 ............. C Salivary surgery procedure ............................. 0.00 0.00 0.00 0.00 YYY S

42700 ............. A Drainage of tonsil abscess ............................. 1.57 0.85 0.10 2.52 010 S

42720 ............. A Drainage of throat abscess ............................ 2.61 1.89 0.22 4.72 010 S

42725 ............. A Drainage of throat abscess ............................ 7.60 4.45 0.53 12.58 090 S

42800 ............. A Biopsy of throat ............................................... 1.34 0.74 0.08 2.16 010 S

42802 ............. A Biopsy of throat ............................................... 1.49 1.02 0.12 2.63 010 S

42804 ............. A Biopsy of upper nose/throat ........................... 1.19 1.09 0.13 2.41 010 S

42806 ............. A Biopsy of upper nose/throat ........................... 1.53 1.40 0.16 3.09 010 S

42808 ............. A Excise pharynx lesion ..................................... 2.25 2.52 0.29 5.06 010 S

42809 ............. A Remove pharynx foreign body ....................... 1.76 0.82 0.08 2.66 010 S

42810 ............. A Excision of neck cyst ...................................... 3.20 3.14 0.47 6.81 090 S

42815 ............. A Excision of neck cyst ...................................... 6.75 8.47 1.12 16.34 090 S

42820 ............. A Remove tonsils and adenoids ........................ 3.59 3.15 0.32 7.06 090 S

42821 ............. A Remove tonsils and adenoids ........................ 4.10 3.93 0.46 8.49 090 S

42825 ............. A Removal of tonsils .......................................... 3.21 2.64 0.33 6.18 090 S

42826 ............. A Removal of tonsils .......................................... 3.19 3.86 0.43 7.48 090 S

42830 ............. A Removal of adenoids ...................................... 2.49 1.86 0.27 4.62 090 S

42831 ............. A Removal of adenoids ...................................... 2.61 2.36 0.25 5.22 090 S

42835 ............. A Removal of adenoids ...................................... 2.22 1.86 0.10 4.18 090 S

42836 ............. A Removal of adenoids ...................................... 3.10 2.79 0.31 6.20 090 S

42842 ............. A Extensive surgery of throat ............................. 8.13 6.69 0.73 15.55 090 S

42844 ............. A Extensive surgery of throat ............................. 12.73 10.85 1.27 24.85 090 S

42845 ............. A Extensive surgery of throat ............................. 21.88 18.62 2.22 42.72 090 S

42860 ............. A Excision of tonsil tags ..................................... 2.14 1.89 0.21 4.24 090 S

42870 ............. A Excision of lingual tonsil ................................. 5.16 2.32 0.26 7.74 090 S

42880 ............. A Excise nose/throat lesion ................................ 6.01 4.62 0.52 11.15 090 S

42890 ............. A Partial removal of pharynx .............................. 11.67 8.99 1.03 21.69 090 S

42892 ............. A Revision of pharyngeal walls .......................... 13.94 10.92 1.27 26.13 090 S

42894 ............. A Revision of pharyngeal walls .......................... 20.68 16.06 1.83 38.57 090 S
63234

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

42900 ............. A Repair throat wound ....................................... 4.98 4.26 0.48 9.72 010 S

42950 ............. A Reconstruction of throat ................................. 7.70 9.86 1.10 18.66 090 S

42953 ............. A Repair throat, esophagus ............................... 8.21 6.34 0.93 15.48 090 S

42955 ............. A Surgical opening of throat .............................. 6.50 3.32 0.43 10.25 090 S

42960 ............. A Control throat bleeding ................................... 2.28 1.08 0.12 3.48 010 S

42961 ............. A Control throat bleeding ................................... 5.18 1.75 0.19 7.12 090 S

42962 ............. A Control throat bleeding ................................... 6.64 5.98 0.68 13.30 090 S

42970 ............. A Control nose/throat bleeding .......................... 4.78 1.03 0.10 5.91 090 N

42971 ............. A Control nose/throat bleeding .......................... 5.56 2.90 0.34 8.80 090 S

42972 ............. A Control nose/throat bleeding .......................... 6.55 4.55 0.73 11.83 090 S

42999 ............. C Throat surgery procedure ............................... 0.00 0.00 0.00 0.00 YYY S

43020 ............. A Incision of esophagus ..................................... 7.72 6.58 0.71 15.01 090 S

43030 ............. A Throat muscle surgery .................................... 7.15 *9.15 1.21 17.51 090 S

43045 ............. A Incision of esophagus ..................................... 18.83 12.45 2.36 33.64 090 S

43100 ............. A Excision of esophagus lesion ......................... 8.47 6.19 0.95 15.61 090 S

43101 ............. A Excision of esophagus lesion ......................... 15.11 9.48 1.88 26.47 090 S

43107 ............. A Removal of esophagus ................................... 27.20 22.50 4.42 54.12 090 S

43108 ............. A Removal of esophagus ................................... 32.64 25.27 4.77 62.68 090 S

43112 ............. A Removal of esophagus ................................... 29.67 21.65 4.22 55.54 090 S

43113 ............. A Removal of esophagus ................................... 33.63 25.27 4.77 63.67 090 S

43116 ............. A Partial removal of esophagus ......................... 29.67 25.27 4.77 59.71 090 S

43117 ............. A Partial removal of esophagus ......................... 28.47 25.27 4.77 58.51 090 S

43118 ............. A Partial removal of esophagus ......................... 31.65 25.27 4.77 61.69 090 S

43121 ............. A Partial removal of esophagus ......................... 27.69 21.36 4.19 53.24 090 S

43122 ............. A Parital removal of esophagus ......................... 27.69 21.36 4.19 53.24 090 S

43123 ............. A Partial removal of esophagus ......................... 31.65 25.27 4.77 61.69 090 S

43124 ............. A Removal of esophagus ................................... 24.73 22.50 4.42 51.65 090 S

43130 ............. A Removal of esophagus pouch ........................ 10.68 10.51 1.60 22.79 090 S

43135 ............. A Removal of esophagus pouch ........................ 15.11 11.72 2.17 29.00 090 S

43200 ............. A Esophagus endoscopy ................................... 1.59 *2.04 0.26 3.89 000 S

43202 ............. A Esophagus endoscopy, biopsy ....................... 1.89 *2.41 0.31 4.61 000 N

43204 ............. A Esophagus endoscopy & inject ...................... 3.77 *4.83 0.36 8.96 000 N

43205 ............. A Esophagus endoscopy/ligation ....................... 3.79 2.70 0.18 6.67 000 N

43215 ............. A Esophagus endoscopy ................................... 2.60 *3.33 0.46 6.39 000 N

43216 ............. A Esophagus endoscopy/lesion ......................... 2.40 *3.58 0.37 6.35 000 N

43217 ............. A Esophagus endoscopy ................................... 2.90 *3.58 0.37 6.85 000 N

43219 ............. A Esophagus endoscopy ................................... 2.80 *3.58 0.34 6.72 000 N

43220 ............. A Esophagus endoscopy, dilation ...................... 2.10 *2.68 0.27 5.05 000 N

43226 ............. A Esophagus endoscopy, dilation ...................... 2.34 *3.00 0.26 5.60 000 N

43227 ............. A Esophagus endoscopy, repair ........................ 3.60 *4.61 0.34 8.55 000 N

43228 ............. A Esophagus endoscopy, ablation ..................... 3.77 4.79 0.38 8.94 000 N

43234 ............. A Upper GI endoscopy, exam ............................ 2.01 *2.57 0.30 4.88 000 N

43235 ............. A Upper GI endoscopy, diagnosis ..................... 2.39 *3.07 0.29 5.75 000 N

43239 ............. A Upper GI endoscopy, biopsy .......................... 2.69 *3.44 0.33 6.46 000 N

43241 ............. A Upper GI endoscopy with tube ....................... 2.59 *3.31 0.38 6.28 000 N

43243 ............. A Upper GI endoscopy & inject. ........................ 4.57 5.63 0.39 10.59 000 N

43244 ............. A Upper GI endoscopy/ligation .......................... 4.59 3.47 0.41 8.47 000 N

43245 ............. A Operative upper GI endoscopy ...................... 3.39 *4.34 0.40 8.13 000 N

43246 ............. A Place gastrostomy tube .................................. 4.33 *5.55 0.51 10.39 000 N

43247 ............. A Operative upper GI endoscopy ...................... 3.39 *4.34 0.38 8.11 000 N

43248 ............. A Upper GI endoscopy/guidewire ...................... 3.15 *4.03 0.35 7.53 000 N

43249 ............. A Esophagus endoscopy, dilation ...................... 2.90 3.73 0.30 6.93 000 N

43250 ............. A Upper GI endoscopy/tumor ............................ 3.20 *4.60 0.43 8.23 000 N

43251 ............. A Operative upper GI endoscopy ...................... 3.70 *4.60 0.43 8.73 000 N

43255 ............. A Operative upper GI endoscopy ...................... 4.40 5.63 0.38 10.41 000 N

43258 ............. A Operative upper GI endoscopy ...................... 4.55 5.41 0.38 10.34 000 N

43259 ............. A Endoscopic ultrasound exam ......................... 4.89 4.02 0.35 9.26 000 N

43260 ............. A Endoscopy,bile duct/pancreas ........................ 5.96 5.98 0.39 12.33 000 N

43261 ............. A Endoscopy,bile duct/pancreas ........................ 6.27 5.98 0.39 12.64 000 N

43262 ............. A Endoscopy,bile duct/pancreas ........................ 7.39 9.00 0.58 16.97 000 N

43263 ............. A Endoscopy,bile duct/pancreas ........................ 6.19 5.83 0.38 12.40 000 N

43264 ............. A Endoscopy,bile duct/pancreas ........................ 8.90 8.92 0.61 18.43 000 N

43265 ............. A Endoscopy,bile duct/pancreas ........................ 8.90 6.82 0.49 16.21 000 N

43267 ............. A Endoscopy,bile duct/pancreas ........................ 7.39 7.41 0.48 15.28 000 N

43268 ............. A Endoscopy,bile duct/pancreas ........................ 7.39 8.72 0.56 16.67 000 N

43269 ............. A Endoscopy,bile duct/pancreas ........................ 6.04 7.35 0.51 13.90 000 N
63235

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

43271 ............. A Endoscopy,bile duct/pancreas ........................ 7.39 7.63 0.50 15.52 000 N

43272 ............. A Endoscopy,bile duct/pancreas ........................ 7.39 5.60 0.42 13.41 000 N

43300 ............. A Repair of esophagus ...................................... 8.72 *11.17 1.70 21.59 090 S

43305 ............. A Repair esophagus and fistula ......................... 16.14 13.71 1.78 31.63 090 S

43310 ............. A Repair of esophagus ...................................... 24.20 16.99 3.23 44.42 090 S

43312 ............. A Repair esophagus and fistula ......................... 27.26 13.72 2.30 43.28 090 S

43320 ............. A Fuse esophagus & stomach ........................... 14.49 11.68 2.05 28.22 090 S

43324 ............. A Revise esophagus & stomach ........................ 15.18 11.88 2.53 29.59 090 S

43325 ............. A Revise esophagus & stomach ........................ 14.63 11.61 2.29 28.53 090 S

43326 ............. A Revise esophagus & stomach ........................ 14.37 7.52 1.75 23.64 090 S

43330 ............. A Repair of esophagus ...................................... 14.27 11.36 2.39 28.02 090 S

43331 ............. A Repair of esophagus ...................................... 14.73 14.33 2.64 31.70 090 S

43340 ............. A Fuse esophagus & intestine ........................... 14.16 12.44 2.52 29.12 090 S

43341 ............. A Fuse esophagus & intestine ........................... 15.26 9.90 1.56 26.72 090 S

43350 ............. A Surgical opening, esophagus ......................... 11.25 7.88 1.15 20.28 090 S

43351 ............. A Surgical opening, esophagus ......................... 13.42 8.77 1.53 23.72 090 S

43352 ............. A Surgical opening, esophagus ......................... 10.92 8.86 1.47 21.25 090 S

43360 ............. A Gastrointestinal repair ..................................... 26.06 21.36 4.19 51.61 090 S

43361 ............. A Gastrointestinal repair ..................................... 29.67 25.27 4.77 59.71 090 S

43400 ............. A Ligate esophagus veins .................................. 15.55 10.82 1.63 28.00 090 S

43401 ............. A Esophagus surgery for veins .......................... 16.26 9.59 1.93 27.78 090 S

43405 ............. A Ligate/staple esophagus ................................. 14.84 14.33 2.64 31.81 090 S

43410 ............. A Repair esophagus wound ............................... 9.61 8.90 1.54 20.05 090 S

43415 ............. A Repair esophagus wound ............................... 15.86 12.74 2.52 31.12 090 S

43420 ............. A Repair esophagus opening ............................. 10.19 5.88 0.78 16.85 090 S

43425 ............. A Repair esophagus opening ............................. 15.58 9.94 1.71 27.23 090 S

43450 ............. A Dilate esophagus ............................................ 1.38 0.68 0.05 2.11 000 N

43453 ............. A Dilate esophagus ............................................ 1.51 1.51 0.11 3.13 000 N

43456 ............. A Dilate esophagus ............................................ 3.52 2.47 0.24 6.23 000 N

43458 ............. A Dilation of esophagus ..................................... 3.06 *1.52 0.27 4.85 000 N

43460 ............. A Pressure treatment esophagus ...................... 3.80 1.67 0.15 5.62 000 N

43499 ............. C Esophagus surgery procedure ....................... 0.00 0.00 0.00 0.00 YYY N

43500 ............. A Surgical opening of stomach .......................... 7.60 6.13 1.20 14.93 090 S

43501 ............. A Surgical repair of stomach .............................. 13.85 8.58 1.83 24.26 090 S

43502 ............. A Surgical repair of stomach .............................. 15.82 8.58 1.83 26.23 090 S

43510 ............. A Surgical opening of stomach .......................... 9.27 8.29 0.94 18.50 090 N

43520 ............. A Incision of pyloric muscle ............................... 7.00 4.48 0.87 12.35 090 S

43600 ............. A Biopsy of stomach .......................................... 1.91 0.50 0.05 2.46 000 N

43605 ............. A Biopsy of stomach .......................................... 8.23 5.91 1.29 15.43 090 S

43610 ............. A Excision of stomach lesion ............................. 10.11 8.17 1.71 19.99 090 S

43611 ............. A Excision of stomach lesion ............................. 12.43 8.17 1.71 22.31 090 S

43620 ............. A Removal of stomach ....................................... 21.03 15.38 3.19 39.60 090 S

43621 ............. A Removal of stomach ....................................... 21.47 15.38 3.19 40.04 090 S

43622 ............. A Removal of stomach ....................................... 22.82 15.38 3.19 41.39 090 S

43631 ............. A Removal of stomach, partial ........................... 18.10 12.42 2.66 33.18 090 S

43632 ............. A Removal stomach, partial ............................... 18.10 12.42 2.66 33.18 090 S

43633 ............. A Removal stomach, partial ............................... 18.54 12.42 2.66 33.62 090 S

43634 ............. A Removal stomach, partial ............................... 19.89 20.83 4.57 45.29 090 S

43635 ............. A Partial removal of stomach ............................. 2.06 1.08 0.26 3.40 ZZZ S

43638 ............. A Partial removal of stomach ............................. 20.15 12.75 2.73 35.63 090 S

43639 ............. A Removal stomach, partial ............................... 20.64 12.75 2.73 36.12 090 S

43640 ............. A Vagotomy & pylorus repair ............................. 13.28 10.34 2.19 25.81 090 S

43641 ............. A Vagotomy & pylorus repair ............................. 13.28 10.34 2.18 25.80 090 S

43750 ............. A Place gastrostomy tube .................................. 5.71 4.35 0.56 10.62 010 N

43760 ............. A Change gastrostomy tube .............................. 1.10 0.69 0.09 1.88 000 N

43761 ............. A Reposition gastrostomy tube .......................... 2.01 1.06 0.25 3.32 000 N

43800 ............. A Reconstruction of pylorus ............................... 9.41 6.85 1.47 17.73 090 S

43810 ............. A Fusion of stomach and bowel ........................ 10.08 7.64 1.53 19.25 090 S

43820 ............. A Fusion of stomach and bowel ........................ 10.43 8.29 1.75 20.47 090 S

43825 ............. A Fusion of stomach and bowel ........................ 13.28 11.08 2.30 26.66 090 S

43830 ............. A Place gastrostomy tube .................................. 4.84 *6.19 1.19 12.22 090 S

43831 ............. A Place gastrostomy tube .................................. 6.41 5.20 0.93 12.54 090 S

43832 ............. A Place gastrostomy tube .................................. 10.68 7.95 1.36 19.99 090 S

43840 ............. A Repair of stomach lesion ................................ 10.45 7.84 1.66 19.95 090 S

43842 ............. A Gastroplasty for obesity .................................. 13.76 13.72 2.93 30.41 090 S

43843 ............. A Gastroplasty for obesity .................................. 13.76 13.72 2.93 30.41 090 S
63236

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

43846 ............. A Gastric bypass for obesity .............................. 17.84 14.80 3.30 35.94 090 S

43847 ............. A Gastric bypass for obesity .............................. 19.87 14.80 3.30 37.97 090 S

43848 ............. A Revision gastroplasty ...................................... 22.10 14.80 3.30 40.20 090 S

43850 ............. A Revise stomach-bowel fusion ......................... 18.14 11.64 2.25 32.03 090 S

43855 ............. A Revise stomach-bowel fusion ......................... 19.15 10.44 2.28 31.87 090 S

43860 ............. A Revise stomach-bowel fusion ......................... 18.14 11.46 2.51 32.11 090 S

43865 ............. A Revise stomach-bowel fusion ......................... 19.15 13.39 2.98 35.52 090 S

43870 ............. A Repair stomach opening ................................. 6.56 5.77 1.14 13.47 090 S

43880 ............. A Repair stomach-bowel fistula .......................... 18.14 8.25 1.76 28.15 090 S

43999 ............. C Stomach surgery procedure ........................... 0.00 0.00 0.00 0.00 YYY N

44005 ............. A Freeing of bowel adhesion ............................. 12.52 8.28 1.75 22.55 090 S

44010 ............. A Incision of small bowel ................................... 9.24 6.91 1.42 17.57 090 S

44015 ............. A Insert needle catheter, bowel ......................... 2.62 3.22 0.45 6.29 ZZZ S

44020 ............. A Exploration of small bowel .............................. 10.69 7.81 1.65 20.15 090 S

44021 ............. A Decompress small bowel ................................ 10.83 7.00 1.48 19.31 090 S

44025 ............. A Incision of large bowel .................................... 11.07 7.74 1.61 20.42 090 S

44050 ............. A Reduce bowel obstruction .............................. 10.05 7.77 1.64 19.46 090 S

44055 ............. A Correct malrotation of bowel .......................... 11.92 7.66 1.60 21.18 090 S

44100 ............. A Biopsy of bowel .............................................. 2.01 1.38 0.13 3.52 000 N

44110 ............. A Excision of bowel lesion(s) ............................. 9.01 7.67 1.58 18.26 090 S

44111 ............. A Excision of bowel lesion(s) ............................. 11.05 9.67 2.14 22.86 090 S

44120 ............. A Removal of small intestine .............................. 13.15 9.46 2.02 24.63 090 S

44121 ............. A Removal of small intestine .............................. 4.45 2.32 0.54 7.31 ZZZ S

44125 ............. A Removal of small intestine .............................. 13.15 10.75 2.28 26.18 090 S

44130 ............. A Bowel to bowel fusion ..................................... 11.09 8.67 1.86 21.62 090 S

44139 ............. A Mobilization of colon ....................................... 2.23 1.17 0.27 3.67 ZZZ S

44140 ............. A Partial removal of colon .................................. 16.97 11.37 2.40 30.74 090 S

44141 ............. A Partial removal of colon .................................. 17.36 11.86 2.55 31.77 090 S

44143 ............. A Partial removal of colon .................................. 15.00 12.26 2.62 29.88 090 S

44144 ............. A Partial removal of colon .................................. 15.00 12.06 2.53 29.59 090 S

44145 ............. A Partial removal of colon .................................. 21.29 13.25 2.78 37.32 090 S

44146 ............. A Partial removal of colon .................................. 22.22 14.98 3.14 40.34 090 S

44147 ............. A Partial removal of colon .................................. 16.23 15.34 3.30 34.87 090 S

44150 ............. A Removal of colon ............................................ 19.04 14.84 3.17 37.05 090 S

44151 ............. A Removal of colon/ileostomy ............................ 17.95 10.21 2.22 30.38 090 S

44152 ............. A Removal of colon/ileostomy ............................ 22.98 15.44 3.36 41.78 090 S

44153 ............. A Removal of colon/ileostomy ............................ 24.69 19.35 3.63 47.67 090 S

44155 ............. A Removal of colon ............................................ 22.09 16.65 3.50 42.24 090 S

44156 ............. A Removal of colon/ileostomy ............................ 20.48 11.40 2.52 34.40 090 S

44160 ............. A Removal of colon ............................................ 14.09 12.44 2.68 29.21 090 S

44300 ............. A Open bowel to skin ......................................... 7.77 6.03 1.29 15.09 090 S

44310 ............. A Ileostomy/jejunostomy .................................... 10.07 7.88 1.66 19.61 090 S

44312 ............. A Revision of ileostomy ...................................... 5.34 3.08 0.45 8.87 090 S

44314 ............. A Revision of ileostomy ...................................... 9.77 6.68 1.21 17.66 090 S

44316 ............. A Devise bowel pouch ....................................... 13.59 9.64 1.43 24.66 090 S

44320 ............. A Colostomy ....................................................... 11.39 7.46 1.57 20.42 090 S

44322 ............. A Colostomy with biopsies ................................. 10.31 9.07 1.88 21.26 090 S

44340 ............. A Revision of colostomy ..................................... 4.92 1.68 0.35 6.95 090 S

44345 ............. A Revision of colostomy ..................................... 10.05 4.84 1.03 15.92 090 S

44346 ............. A Revision of colostomy ..................................... 11.13 6.65 1.38 19.16 090 S

44360 ............. A Small bowel endoscopy .................................. 2.92 *3.74 0.32 6.98 000 N

44361 ............. A Small bowel endoscopy, biopsy ..................... 3.23 *4.14 0.34 7.71 000 N

44363 ............. A Small bowel endoscopy .................................. 3.94 2.99 0.36 7.29 000 N

44364 ............. A Small bowel endoscopy .................................. 4.22 4.73 0.72 9.67 000 N

44365 ............. A Small bowel endoscopy .................................. 3.73 4.73 0.72 9.18 000 N

44366 ............. A Small bowel endoscopy .................................. 4.97 5.86 0.45 11.28 000 N

44369 ............. A Small bowel endoscopy .................................. 5.09 *6.52 0.50 12.11 000 N

44372 ............. A Small bowel endoscopy .................................. 4.97 5.83 0.67 11.47 000 N

44373 ............. A Small bowel endoscopy .................................. 3.94 *5.03 0.50 9.47 000 N

44376 ............. A Small bowel endoscopy .................................. 5.69 4.05 0.26 10.00 000 N

44377 ............. A Small bowel endoscopy .................................. 5.98 4.26 0.28 10.52 000 N

44378 ............. A Small bowel endoscopy .................................. 7.71 5.27 0.35 13.33 000 N

44380 ............. A Small bowel endoscopy .................................. 1.51 *1.94 0.22 3.67 000 N

44382 ............. A Small bowel endoscopy .................................. 1.82 *2.33 0.29 4.44 000 N

44385 ............. A Endoscopy of bowel pouch ............................ 1.82 *2.33 0.34 4.49 000 S

44386 ............. A Endoscopy, bowel pouch, biopsy ................... 2.12 1.54 0.15 3.81 000 N
63237

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

44388 ............. A Colon endoscopy ............................................ 2.82 *3.61 0.50 6.93 000 S

44389 ............. A Colonoscopy with biopsy ................................ 3.13 *4.00 0.45 7.58 000 N

44390 ............. A Colonoscopy for foreign body ......................... 3.83 2.63 0.28 6.74 000 N

44391 ............. A Colonoscopy for bleeding ............................... 4.32 5.26 0.53 10.11 000 N

44392 ............. A Colonoscopy & polypectomy .......................... 3.82 *5.16 0.70 9.68 000 N

44393 ............. A Colonoscopy, lesion removal .......................... 4.84 5.41 0.70 10.95 000 N

44394 ............. A Colonoscopy w/snare ..................................... 4.43 *5.16 0.70 10.29 000 N

44500 ............. A Intro, gastrointestinal tube .............................. 0.49 0.36 0.02 0.87 000 N

44602 ............. A Suture, small intestine .................................... 9.72 7.65 1.62 18.99 090 S

44603 ............. A Suture, small intestine .................................... 12.94 9.09 1.96 23.99 090 S

44604 ............. A Suture, large intestine ..................................... 12.94 7.87 1.67 22.48 090 S

44605 ............. A Repair of bowel lesion .................................... 13.91 9.37 2.02 25.30 090 S

44615 ............. A Intestinal stricturoplasty .................................. 12.89 6.74 1.57 21.20 090 S

44620 ............. A Repair bowel opening ..................................... 9.65 5.97 1.26 16.88 090 S

44625 ............. A Repair bowel opening ..................................... 12.10 9.58 2.03 23.71 090 S

44640 ............. A Repair bowel-skin fistula ................................. 13.34 6.54 1.35 21.23 090 S

44650 ............. A Repair bowel fistula ........................................ 13.76 7.33 1.46 22.55 090 S

44660 ............. A Repair bowel-bladder fistula ........................... 13.14 8.34 1.21 22.69 090 S

44661 ............. A Repair bowel-bladder fistula ........................... 15.44 13.94 2.52 31.90 090 S

44680 ............. A Surgical revision, intestine .............................. 12.41 9.71 2.14 24.26 090 S

44799 ............. C Intestine surgery procedure ............................ 0.00 0.00 0.00 0.00 YYY S

44800 ............. A Excision of bowel pouch ................................. 10.12 5.24 1.08 16.44 090 S

44820 ............. A Excision of mesentery lesion .......................... 9.31 5.80 1.21 16.32 090 S

44850 ............. A Repair of mesentery ....................................... 8.64 5.60 1.18 15.42 090 S

44899 ............. C Bowel surgery procedure ................................ 0.00 0.00 0.00 0.00 YYY S

44900 ............. A Drainage of appendix abscess ....................... 7.86 4.28 0.88 13.02 090 S

44950 ............. A Appendectomy ................................................ 6.06 4.89 1.01 11.96 090 S

44955 ............. A Appendectomy ................................................ 1.53 *1.96 0.60 4.09 ZZZ S

44960 ............. A Appendectomy ................................................ 9.78 5.89 1.24 16.91 090 S

45000 ............. A Drainage of pelvic abscess ............................ 4.28 1.59 0.24 6.11 090 S

45005 ............. A Drainage of rectal abscess ............................. 1.96 1.29 0.21 3.46 010 S

45020 ............. A Drainage of rectal abscess ............................. 4.40 2.61 0.51 7.52 090 S

45100 ............. A Biopsy of rectum ............................................. 3.38 1.88 0.35 5.61 090 S

45108 ............. A Removal of anorectal lesion ........................... 4.28 2.66 0.53 7.47 090 S

45110 ............. A Removal of rectum ......................................... 21.68 16.32 3.43 41.43 090 S

45111 ............. A Partial removal of rectum ............................... 14.97 11.77 2.49 29.23 090 S

45112 ............. A Removal of rectum ......................................... 24.02 16.06 3.36 43.44 090 S

45113 ............. A Partial proctectomy ......................................... 24.69 16.06 3.36 44.11 090 S

45114 ............. A Partial removal of rectum ............................... 21.20 15.39 3.24 39.83 090 S

45116 ............. A Partial removal of rectum ............................... 19.09 10.77 2.34 32.20 090 S

45120 ............. A Removal of rectum ......................................... 22.78 16.39 3.54 42.71 090 S

45121 ............. A Removal of rectum and colon ......................... 24.96 10.79 2.01 37.76 090 S

45123 ............. A Partial proctectomy ......................................... 13.27 11.77 2.49 27.53 090 S

45130 ............. A Excision of rectal prolapse ............................. 13.03 8.92 1.79 23.74 090 S

45135 ............. A Excision of rectal prolapse ............................. 15.36 15.95 3.50 34.81 090 S

45150 ............. A Excision of rectal stricture ............................... 5.26 3.38 0.63 9.27 090 S

45160 ............. A Excision of rectal lesion .................................. 12.34 7.46 1.56 21.36 090 S

45170 ............. A Excision of rectal lesion .................................. 9.40 4.62 0.96 14.98 090 S

45190 ............. A Destruction, rectal tumor ................................ 7.91 5.09 1.06 14.06 090 S

45300 ............. A Proctosigmoidoscopy ...................................... 0.70 0.55 0.07 1.32 000 S

45303 ............. A Proctosigmoidoscopy ...................................... 0.50 *0.64 0.12 1.26 000 S

45305 ............. A Proctosigmoidoscopy; biopsy ......................... 1.01 0.84 0.14 1.99 000 S

45307 ............. A Proctosigmoidoscopy ...................................... 1.71 1.27 0.18 3.16 000 S

45308 ............. A Proctosigmoidoscopy ...................................... 1.51 1.13 0.20 2.84 000 S

45309 ............. A Proctosigmoidoscopy ...................................... 2.01 1.13 0.20 3.34 000 S

45315 ............. A Proctosigmoidoscopy ...................................... 2.54 1.19 0.18 3.91 000 S

45317 ............. A Proctosigmoidoscopy ...................................... 2.73 1.26 0.19 4.18 000 S

45320 ............. A Proctosigmoidoscopy ...................................... 2.88 1.87 0.34 5.09 000 S

45321 ............. A Proctosigmoidoscopy ...................................... 2.12 1.47 0.27 3.86 000 S

45330 ............. A Sigmoidoscopy, diagnostic ............................. 0.96 *1.23 0.12 2.31 000 N

45331 ............. A Sigmoidoscopy and biopsy ............................. 1.26 *1.61 0.15 3.02 000 N

45332 ............. A Sigmoidoscopy ................................................ 1.96 1.76 0.16 3.88 000 N

45333 ............. A Sigmoidoscopy & polypectomy ....................... 1.96 2.24 0.26 4.46 000 N

45334 ............. A Sigmoidoscopy for bleeding ........................... 2.99 2.71 0.23 5.93 000 N

45337 ............. A Sigmoidoscopy, decompression ..................... 2.36 *3.03 0.38 5.77 000 N

45338 ............. A Sigmoidoscopy ................................................ 2.57 2.24 0.26 5.07 000 N
63238

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

45339 ............. A Sigmoidoscopy ................................................ 3.14 3.24 0.31 6.69 000 N

45355 ............. A Surgical colonoscopy ...................................... 3.52 1.17 0.10 4.79 000 N

45378 ............. A Diagnostic colonoscopy .................................. 3.70 4.13 0.39 8.22 000 N

45379 ............. A Colonoscopy ................................................... 4.72 5.33 0.45 10.50 000 N

45380 ............. A Colonoscopy and biopsy ................................ 4.01 4.79 0.40 9.20 000 N

45382 ............. A Colonoscopy, control bleeding ....................... 5.73 5.87 0.41 12.01 000 N

45383 ............. A Colonoscopy, lesion removal .......................... 5.87 5.92 0.50 12.29 000 N

45384 ............. A Colonoscopy ................................................... 4.70 *6.65 0.58 11.93 000 N

45385 ............. A Colonoscopy, lesion removal .......................... 5.31 *6.65 0.58 12.54 000 N

45500 ............. A Repair of rectum ............................................. 6.59 5.95 1.21 13.75 090 S

45505 ............. A Repair of rectum ............................................. 5.54 6.29 1.23 13.06 090 S

45520 ............. A Treatment of rectal prolapse .......................... 0.55 0.61 0.10 1.26 000 N

45540 ............. A Correct rectal prolapse ................................... 11.98 9.89 2.10 23.97 090 S

45541 ............. A Correct rectal prolapse ................................... 9.79 10.17 2.04 22.00 090 S

45550 ............. A Repair rectum; remove sigmoid ...................... 13.38 11.49 2.38 27.25 090 S

45560 ............. A Repair of rectocele ......................................... 7.48 4.79 0.98 13.25 090 S

45562 ............. A Exploration/repair of rectum ........................... 11.13 8.09 1.58 20.80 090 S

45563 ............. A Exploration/repair of rectum ........................... 17.55 12.77 2.49 32.81 090 S

45800 ............. A Repair rectumbladder fistula ........................... 12.75 9.82 1.45 24.02 090 S

45805 ............. A Repair fistula; colostomy ................................ 15.08 12.32 2.39 29.79 090 S

45820 ............. A Repair rectourethral fistula ............................. 13.31 8.98 1.23 23.52 090 S

45825 ............. A Repair fistula; colostomy ................................ 15.45 9.87 1.66 26.98 090 S

45900 ............. A Reduction of rectal prolapse ........................... 1.68 0.58 0.11 2.37 010 S

45905 ............. A Dilation of anal sphincter ................................ 1.51 0.71 0.12 2.34 010 S

45910 ............. A Dilation of rectal narrowing ............................. 1.86 0.87 0.13 2.86 010 S

45915 ............. A Remove rectal obstruction .............................. 2.09 0.78 0.09 2.96 010 N

45999 ............. C Rectum surgery procedure ............................. 0.00 0.00 0.00 0.00 YYY N

46030 ............. A Removal of rectal marker ............................... 1.20 0.40 0.07 1.67 010 S

46040 ............. A Incision of rectal abscess ............................... 4.90 1.69 0.34 6.93 090 S

46045 ............. A Incision of rectal abscess ............................... 3.91 1.85 0.38 6.14 090 S

46050 ............. A Incision of anal abscess ................................. 1.14 0.60 0.11 1.85 010 S

46060 ............. A Incision of rectal abscess ............................... 5.03 5.35 1.12 11.50 090 S

46070 ............. A Incision of anal septum ................................... 2.63 1.37 0.33 4.33 090 S

46080 ............. A Incision of anal sphincter ................................ 2.35 2.13 0.43 4.91 010 S

46083 ............. A Incise external hemorrhoid ............................. 1.35 0.63 0.08 2.06 010 N

46200 ............. A Removal of anal fissure .................................. 3.02 3.29 0.66 6.97 090 S

46210 ............. A Removal of anal crypt ..................................... 2.52 0.77 0.14 3.43 090 S

46211 ............. A Removal of anal crypts ................................... 4.07 1.90 0.38 6.35 090 S

46220 ............. A Removal of anal tab ....................................... 1.51 0.63 0.12 2.26 010 S

46221 ............. A Ligation of hemorrhoid(s) ................................ 1.38 0.66 0.14 2.18 010 S

46230 ............. A Removal of anal tabs ...................................... 2.52 0.83 0.12 3.47 010 S

46250 ............. A Hemorrhoidectomy .......................................... 4.29 2.84 0.52 7.65 090 S

46255 ............. A Hemorrhoidectomy .......................................... 4.95 4.72 0.85 10.52 090 S

46257 ............. A Remove hemorrhoids & fissure ...................... 5.87 5.23 1.08 12.18 090 S

46258 ............. A Remove hemorrhoids & fistula ....................... 6.26 5.87 1.22 13.35 090 S

46260 ............. A Hemorrhoidectomy .......................................... 6.70 6.07 1.25 14.02 090 S

46261 ............. A Remove hemorrhoids & fissure ...................... 6.54 6.62 1.34 14.50 090 S

46262 ............. A Remove hemorrhoids & fistula ....................... 6.77 6.72 1.39 14.88 090 S

46270 ............. A Removal of anal fistula ................................... 3.51 1.87 0.37 5.75 090 S

46275 ............. A Removal of anal fistula ................................... 4.35 5.50 1.13 10.98 090 S

46280 ............. A Removal of anal fistula ................................... 5.63 6.08 1.24 12.95 090 S

46285 ............. A Removal of anal fistula ................................... 3.88 2.28 0.43 6.59 090 S

46288 ............. A Repair anal fistula ........................................... 6.83 3.57 0.83 11.23 090 S

46320 ............. A Removal of hemorrhoid clot ........................... 1.58 0.70 0.11 2.39 010 S

46500 ............. A Injection into hemorrhoids .............................. 1.53 0.32 0.06 1.91 010 S

46600 ............. A Diagnostic anoscopy ....................................... 0.50 0.28 0.03 0.81 000 N

46604 ............. A Anoscopy and dilation .................................... 1.31 0.38 0.06 1.75 000 S

46606 ............. A Anoscopy and biopsy ..................................... 0.81 0.36 0.06 1.23 000 S

46608 ............. A Anoscopy; remove foreign body ..................... 1.51 1.07 0.12 2.70 000 N

46610 ............. A Anoscopy; remove lesion ............................... 1.32 0.85 0.15 2.32 000 S

46611 ............. A Anoscopy ........................................................ 1.81 0.85 0.15 2.81 000 S

46612 ............. A Anoscopy; remove lesions .............................. 2.34 1.39 0.20 3.93 000 S

46614 ............. A Anoscopy; control bleeding ............................ 2.01 1.55 0.25 3.81 000 S

46615 ............. A Anoscopy ........................................................ 2.68 1.55 0.25 4.48 000 S

46700 ............. A Repair of anal stricture ................................... 6.40 6.14 1.24 13.78 090 S

46705 ............. A Repair of anal stricture ................................... 6.38 3.60 0.77 10.75 090 S
63239

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

46715 ............. A Repair of anovaginal fistula ............................ 6.73 3.51 0.82 11.06 090 S

46716 ............. A Repair of anovaginal fistula ............................ 11.58 6.05 1.40 19.03 090 S

46730 ............. A Construction of absent anus ........................... 20.54 10.74 2.50 33.78 090 S

46735 ............. A Construction of absent anus ........................... 24.91 13.04 3.04 40.99 090 S

46740 ............. A Construction of absent anus ........................... 22.08 11.55 2.68 36.31 090 S

46742 ............. A Repair, imperforated anus .............................. 27.82 19.75 1.93 49.50 090 S

46744 ............. A Repair, cloacal anomaly ................................. 31.23 22.17 2.17 55.57 090 S

46746 ............. A Repair, cloacal anomaly ................................. 34.17 24.26 2.37 60.80 090 S

46748 ............. A Repair, cloacal anomaly ................................. 38.07 27.03 2.64 67.74 090 S

46750 ............. A Repair of anal sphincter ................................. 7.35 6.00 1.22 14.57 090 S

46751 ............. A Repair of anal sphincter ................................. 7.78 4.07 0.95 12.80 090 S

46753 ............. A Reconstruction of anus ................................... 6.04 4.89 1.02 11.95 090 S

46754 ............. A Removal of suture from anus ......................... 1.51 1.48 0.30 3.29 010 S

46760 ............. A Repair of anal sphincter ................................. 10.61 6.80 1.41 18.82 090 S

46761 ............. A Repair of anal sphincter ................................. 10.16 6.83 1.35 18.34 090 S

46762 ............. A Implant artificial sphincter ............................... 9.26 5.72 1.21 16.19 090 S

46900 ............. A Destruction, anal lesion(s) .............................. 1.81 0.39 0.06 2.26 010 S

46910 ............. A Destruction, anal lesion(s) .............................. 1.81 0.64 0.08 2.53 010 S

46916 ............. A Cryosurgery, anal lesion(s) ............................. 1.81 0.67 0.06 2.54 010 S

46917 ............. A Laser surgery, anal lesion(s) .......................... 1.81 1.94 0.31 4.06 010 S

46922 ............. A Excision of anal lesion(s) ................................ 1.81 1.28 0.23 3.32 010 S

46924 ............. A Destruction, anal lesion(s) .............................. 2.71 2.56 0.46 5.73 010 S

46934 ............. A Destruction of hemorrhoids ............................ 3.84 1.19 0.17 5.20 090 N

46935 ............. A Destruction of hemorrhoids ............................ 2.40 1.62 0.22 4.24 010 N

46936 ............. A Destruction of hemorrhoids ............................ 4.17 2.29 0.24 6.70 090 N

46937 ............. A Cryotherapy of rectal lesion ............................ 2.66 2.35 0.45 5.46 010 S

46938 ............. A Cryotherapy of rectal lesion ............................ 4.42 2.50 0.52 7.44 090 S

46940 ............. A Treatment of anal fissure ................................ 2.29 0.51 0.09 2.89 010 S

46942 ............. A Treatment of anal fissure ................................ 2.01 0.46 0.08 2.55 010 S

46945 ............. A Ligation of hemorrhoids .................................. 3.06 0.63 0.12 3.81 090 S

46946 ............. A Ligation of hemorrhoids .................................. 4.04 0.94 0.17 5.15 090 S

46999 ............. C Anus surgery procedure ................................. 0.00 0.00 0.00 0.00 YYY S

47000 ............. A Needle biopsy of liver ..................................... 1.90 1.40 0.13 3.43 000 N

47001 ............. A Needle biopsy, liver ........................................ 1.90 1.40 0.13 3.43 ZZZ S

47010 ............. A Drainage of liver lesion ................................... 8.75 6.75 1.13 16.63 090 S

47015 ............. A Inject/aspirate liver cyst .................................. 8.78 6.75 1.13 16.66 090 S

47100 ............. A Wedge biopsy of liver ..................................... 6.75 3.29 0.67 10.71 090 S

47120 ............. A Partial removal of liver .................................... 19.99 12.00 2.48 34.47 090 S

47122 ............. A Extensive removal of liver ............................... 32.54 17.58 3.59 53.71 090 S

47125 ............. A Partial removal of liver .................................... 28.68 17.43 3.61 49.72 090 S

47130 ............. A Partial removal of liver .................................... 31.56 19.19 3.89 54.64 090 S

47133 ............. X Removal of donor liver ................................... 0.00 0.00 0.00 0.00 XXX 0

47134 ............. R Partial removal, donor liver ............................. 39.15 20.48 4.77 64.40 XXX S

47135 ............. R Transplantation of liver ................................... 77.61 54.48 8.49 140.58 090 S

47136 ............. R Transplantation of liver ................................... 64.04 33.50 7.79 105.33 090 S

47300 ............. A Surgery for liver lesion .................................... 8.75 7.67 1.59 18.01 090 S

47350 ............. A Repair liver wound .......................................... 11.29 7.46 1.49 20.24 090 S

47355 ............. D Repair liver wound .......................................... 0.00 0.00 0.00 0.00 090 S

47360 ............. A Repair liver wound .......................................... 15.34 10.93 2.18 28.45 090 S

47361 ............. A Repair liver wound .......................................... 28.00 14.64 3.41 46.05 090 S

47362 ............. A Repair liver wound .......................................... 10.00 5.23 1.22 16.45 090 S

47399 ............. C Liver surgery procedure .................................. 0.00 0.00 0.00 0.00 YYY S

47400 ............. A Incision of liver duct ........................................ 18.90 8.53 1.36 28.79 090 S

47420 ............. A Incision of bile duct ......................................... 15.31 9.48 1.99 26.78 090 S

47425 ............. A Incision of bile duct ......................................... 14.79 11.71 2.45 28.95 090 S

47460 ............. A Incise bile duct sphincter ................................ 14.41 15.54 1.82 31.77 090 N

47480 ............. A Incision of gallbladder ..................................... 8.05 7.60 1.59 17.24 090 S

47490 ............. A Incision of gallbladder ..................................... 6.04 3.57 0.38 9.99 090 N

47500 ............. A Injection for liver x-rays ................................... 1.96 1.51 0.14 3.61 000 N

47505 ............. A Injection for liver x-rays ................................... 0.76 *0.98 0.14 1.88 000 N

47510 ............. A Insert catheter, bile duct ................................. 7.39 2.87 0.25 10.51 090 N

47511 ............. A Insert bile duct drain ....................................... 9.91 2.87 0.25 13.03 090 N

47525 ............. A Change bile duct catheter .............................. 5.41 1.59 0.16 7.16 010 N

47530 ............. A Revise, reinsert bile tube ................................ 5.41 1.51 0.19 7.11 090 N

47550 ............. A Bile duct endoscopy ....................................... 3.02 1.56 0.35 4.93 000 S

47552 ............. A Biliary endoscopy, thru skin ............................ 6.04 1.36 0.21 7.61 000 S
63240

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

47553 ............. A Biliary endoscopy, thru skin ............................ 6.35 3.80 0.62 10.77 000 N

47554 ............. A Biliary endoscopy, thru skin ............................ 9.06 3.93 0.67 13.66 000 S

47555 ............. A Biliary endoscopy, thru skin ............................ 7.56 2.63 0.30 10.49 000 N

47556 ............. A Biliary endoscopy, thru skin ............................ 8.56 2.63 0.30 11.49 000 N

47600 ............. A Removal of gallbladder ................................... 10.68 7.53 1.58 19.79 090 S

47605 ............. A Removal of gallbladder ................................... 11.53 8.14 1.75 21.42 090 S

47610 ............. A Removal of gallbladder ................................... 13.86 9.37 2.00 25.23 090 S

47612 ............. A Removal of gallbladder ................................... 14.75 14.23 3.05 32.03 090 S

47620 ............. A Removal of gallbladder ................................... 15.79 11.23 2.36 29.38 090 S

47630 ............. A Remove bile duct stone .................................. 8.31 3.75 0.40 12.46 090 N

47700 ............. A Exploration of bile ducts ................................. 13.75 7.63 1.58 22.96 090 S

47701 ............. A Bile duct revision ............................................ 26.57 8.21 1.90 36.68 090 S

47711 ............. A Excision of bile duct tumor ............................. 18.16 12.06 2.46 32.68 090 S

47712 ............. A Excision of bile duct tumor ............................. 23.74 12.06 2.46 38.26 090 S

47715 ............. A Excision of bile duct cyst ................................ 14.50 8.22 1.71 24.43 090 S

47716 ............. A Fusion of bile duct cyst ................................... 12.53 6.56 1.53 20.62 090 S

47720 ............. A Fuse gallbladder & bowel ............................... 11.90 9.16 1.93 22.99 090 S

47721 ............. A Fuse upper gi structures ................................. 14.41 11.42 2.47 28.30 090 S

47740 ............. A Fuse gallbladder & bowel ............................... 13.93 10.21 2.14 26.28 090 S

47741 ............. A Fuse gallbladder & bowel ............................... 16.23 14.35 3.02 33.60 090 S

47760 ............. A Fuse bile ducts and bowel .............................. 19.93 11.61 2.53 34.07 090 S

47765 ............. A Fuse liver ducts & bowel ................................ 19.04 14.61 2.97 36.62 090 S

47780 ............. A Fuse bile ducts and bowel .............................. 20.40 13.07 2.73 36.20 090 S

47785 ............. A Fuse bile ducts and bowel .............................. 24.41 13.07 2.73 40.21 090 S

47800 ............. A Reconstruction of bile ducts ........................... 17.71 13.22 2.43 33.36 090 S

47801 ............. A Placement, bile duct support .......................... 11.28 5.48 0.81 17.57 090 S

47802 ............. A Fuse liver duct & intestine .............................. 16.01 10.27 1.75 28.03 090 S

47900 ............. A Suture bile duct injury ..................................... 15.63 13.22 2.43 31.28 090 S

47999 ............. C Bile tract surgery procedure ........................... 0.00 0.00 0.00 0.00 YYY S

48000 ............. A Drainage of abdomen ..................................... 13.10 7.05 1.40 21.55 090 S

48001 ............. A Placement of drain, pancreas ......................... 15.54 8.13 1.89 25.56 090 S

48005 ............. A Resect/debride pancreas ................................ 17.57 9.19 2.14 28.90 090 S

48020 ............. A Removal of pancreatic stone .......................... 12.98 6.78 1.57 21.33 090 S

48100 ............. A Biopsy of pancreas ......................................... 10.19 4.21 0.79 15.19 090 S

48102 ............. A Needle biopsy, pancreas ................................ 4.43 2.41 0.25 7.09 010 N

48120 ............. A Removal of pancreas lesion ........................... 12.79 9.72 2.07 24.58 090 S

48140 ............. A Partial removal of pancreas ............................ 18.27 13.29 2.83 34.39 090 S

48145 ............. A Partial removal of pancreas ............................ 19.09 15.71 3.16 37.96 090 S

48146 ............. A Pancreatectomy .............................................. 21.73 16.49 1.92 40.14 090 S

48148 ............. A Removal of pancreatic duct ............................ 14.41 8.23 1.68 24.32 090 S

48150 ............. A Partial removal of pancreas ............................ 40.25 22.54 4.75 67.54 090 S

48152 ............. A Pancreatectomy .............................................. 36.50 22.54 4.75 63.79 090 S

48153 ............. A Pancreatectomy .............................................. 40.25 22.54 4.75 67.54 090 S

48154 ............. A Pancreatectomy .............................................. 36.50 22.54 4.75 63.79 090 S

48155 ............. A Removal of pancreas ...................................... 19.43 20.40 4.26 44.09 090 S

48160 ............. N Pancreas removal, transplant ......................... 0.00 0.00 0.00 0.00 XXX 0

48180 ............. A Fuse pancreas and bowel .............................. 20.88 12.60 2.63 36.11 090 S

48400 ............. A Injection, intraoperative ................................... 1.95 1.03 0.24 3.22 ZZZ N

48500 ............. A Surgery of pancreas cyst ................................ 12.04 8.53 1.66 22.23 090 S

48510 ............. A Drain pancreatic pseudocyst .......................... 11.22 7.54 1.44 20.20 090 S

48520 ............. A Fuse pancreas cyst and bowel ....................... 12.97 11.30 2.43 26.70 090 S

48540 ............. A Fuse pancreas cyst and bowel ....................... 15.77 12.66 2.65 31.08 090 S

48545 ............. A Pancreatorrhaphy ........................................... 14.65 7.66 1.79 24.10 090 S

48547 ............. A Duodenal exclusion ........................................ 21.18 11.08 2.58 34.84 090 S

48550 ............. N Donor pancreatectomy ................................... 0.00 0.00 0.00 0.00 XXX 0

48554 ............. N Transplantallograft pancreas .......................... #34.17 17.87 4.16 56.20 XXX 0

48556 ............. A Removal, allograft pancreas ........................... 13.89 7.26 1.69 22.84 090 S

48999 ............. C Pancreas surgery procedure .......................... 0.00 0.00 0.00 0.00 YYY S

49000 ............. A Exploration of abdomen .................................. 8.99 6.79 1.40 17.18 090 S

49002 ............. A Reopening of abdomen .................................. 9.40 6.05 1.21 16.66 090 S

49010 ............. A Exploration behind abdomen .......................... 11.19 6.95 1.31 19.45 090 S

49020 ............. A Drain abdominal abscess ............................... 9.06 4.82 0.91 14.79 090 S

49040 ............. A Drain abdominal abscess ............................... 8.74 6.54 1.27 16.55 090 S

49060 ............. A Drain abdominal abscess ............................... 10.55 5.54 1.01 17.10 090 S

49080 ............. A Puncture, peritoneal cavity ............................. 1.35 0.87 0.08 2.30 000 N

49081 ............. A Removal of abdominal fluid ............................ 1.26 0.75 0.07 2.08 000 N
63241

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

49085 ............. A Remove abdomen foreign body ..................... 7.91 3.46 0.67 12.04 090 S

49180 ............. A Biopsy, abdominal mass ................................. 1.49 1.82 0.20 3.51 000 N

49200 ............. A Removal of abdominal lesion ......................... 9.19 8.38 1.70 19.27 090 S

49201 ............. A Removal of abdominal lesion ......................... 13.60 12.10 2.50 28.20 090 S

49215 ............. A Excise sacral spine tumor ............................... 21.05 8.50 1.59 31.14 090 S

49220 ............. A Multiple surgery, abdomen ............................. 13.66 12.30 2.53 28.49 090 S

49250 ............. A Excision of umbilicus ...................................... 7.42 4.52 0.96 12.90 090 S

49255 ............. A Removal of omentum ..................................... 4.04 *5.16 1.15 10.35 090 S

49400 ............. A Air injection into abdomen .............................. 1.88 1.12 0.17 3.17 000 S

49420 ............. A Insert abdominal drain .................................... 2.22 1.58 0.20 4.00 000 S

49421 ............. A Insert abdominal drain .................................... 4.89 4.14 0.81 9.84 090 S

49422 ............. A Remove perm cannula/catheter ..................... 5.85 4.14 0.81 10.80 010 S

49425 ............. A Insert abdomen-venous drain ......................... 10.22 8.48 1.78 20.48 090 S

49426 ............. A Revise abdomen-venous shunt ...................... 8.57 5.39 1.07 15.03 090 S

49427 ............. A Injection, abdominal shunt .............................. 0.89 0.49 0.03 1.41 000 N

49428 ............. A Ligation of shunt ............................................. 1.98 1.04 0.24 3.26 010 S

49429 ............. A Removal of shunt ............................................ 6.35 3.32 0.77 10.44 010 S

49495 ............. A Repair inguinal hernia, init .............................. 5.79 4.98 0.95 11.72 090 S

49496 ............. A Repair inguinal hernia, init .............................. 8.37 5.04 1.08 14.49 090 S

49500 ............. A Repair inguinal hernia ..................................... 4.41 4.98 0.95 10.34 090 S

49501 ............. A Repair inguinal hernia, init .............................. 7.26 5.04 1.08 13.38 090 S

49505 ............. A Repair inguinal hernia ..................................... 6.17 4.51 0.94 11.62 090 S

49507 ............. A Repair, inguinal hernia .................................... 7.40 5.04 1.08 13.52 090 S

49520 ............. A Rerepair inguinal hernia ................................. 7.87 5.22 1.11 14.20 090 S

49521 ............. A Repair inguinal hernia, rec ............................. 9.43 5.04 1.08 15.55 090 S

49525 ............. A Repair inguinal hernia ..................................... 6.97 5.55 1.16 13.68 090 S

49540 ............. A Repair lumbar hernia ...................................... 7.91 5.20 1.12 14.23 090 S

49550 ............. A Repair femoral hernia ..................................... 6.97 4.61 0.97 12.55 090 S

49553 ............. A Repair femoral hernia, init .............................. 7.40 4.61 0.97 12.98 090 S

49555 ............. A Repair femoral hernia ..................................... 7.29 6.07 1.26 14.62 090 S

49557 ............. A Repair femoral hernia, recur ........................... 8.73 6.07 1.26 16.06 090 S

49560 ............. A Repair abdominal hernia ................................ 9.48 5.65 1.19 16.32 090 S

49561 ............. A Repair incisional hernia .................................. 11.38 5.65 1.19 18.22 090 S

49565 ............. A Rerepair abdominal hernia ............................. 9.48 6.41 1.35 17.24 090 S

49566 ............. A Repair incisional hernia .................................. 11.38 6.41 1.35 19.14 090 S

49568 ............. A Hernia repair w/mesh ..................................... 4.89 2.56 0.59 8.04 ZZZ S

49570 ............. A Repair epigastric hernia .................................. 4.46 4.38 0.91 9.75 090 S

49572 ............. A Repair, epigastric hernia ................................. 5.35 5.60 1.18 12.13 090 S

49580 ............. A Repair umbilical hernia ................................... 3.24 *4.15 0.94 8.33 090 S

49582 ............. A Repair umbilical hernia ................................... 5.13 4.61 0.94 10.68 090 S

49585 ............. A Repair umbilical hernia ................................... 4.95 4.41 0.91 10.27 090 S

49587 ............. A Repair umbilical hernia ................................... 5.93 4.41 0.91 11.25 090 S

49590 ............. A Repair abdominal hernia ................................ 6.55 5.63 1.22 13.40 090 S

49600 ............. A Repair umbilical lesion .................................... 9.48 5.26 0.77 15.51 090 S

49605 ............. A Repair umbilical lesion .................................... 21.92 8.57 1.77 32.26 090 S

49606 ............. A Repair umbilical lesion .................................... 17.93 8.31 0.96 27.20 090 S

49610 ............. A Repair umbilical lesion .................................... 9.83 5.48 1.27 16.58 090 S

49611 ............. A Repair umbilical lesion .................................... 8.25 9.00 0.58 17.83 090 S

49900 ............. A Repair of abdominal wall ................................ 4.54 3.66 0.75 8.95 090 S

49905 ............. A Omental flap ................................................... 6.55 3.42 0.80 10.77 ZZZ S

49999 ............. C Abdomen surgery procedure .......................... 0.00 0.00 0.00 0.00 YYY S

50010 ............. A Exploration of kidney ...................................... 10.07 9.55 1.13 20.75 090 S

50020 ............. A Drainage of kidney abscess ........................... 12.41 6.80 0.85 20.06 090 S

50040 ............. A Drainage of kidney .......................................... 13.80 7.18 0.62 21.60 090 N

50045 ............. A Exploration of kidney ...................................... 14.48 9.81 0.89 25.18 090 S

50060 ............. A Removal of kidney stone ................................ 18.00 12.25 1.21 31.46 090 S

50065 ............. A Incision of kidney ............................................ 19.62 13.93 1.35 34.90 090 S

50070 ............. A Incision of kidney ............................................ 19.15 12.87 1.35 33.37 090 S

50075 ............. A Removal of kidney stone ................................ 24.05 16.87 1.62 42.54 090 S

50080 ............. A Removal of kidney stone ................................ 13.98 12.20 1.15 27.33 090 S

50081 ............. A Removal of kidney stone ................................ 20.58 14.96 1.44 36.98 090 S

50100 ............. A Revise kidney blood vessels .......................... 15.11 10.34 1.35 26.80 090 S

50120 ............. A Exploration of kidney ...................................... 15.00 10.91 1.24 27.15 090 S

50125 ............. A Explore and drain kidney ................................ 15.61 10.95 1.06 27.62 090 S

50130 ............. A Removal of kidney stone ................................ 16.12 12.80 1.26 30.18 090 S

50135 ............. A Exploration of kidney ...................................... 18.14 17.05 1.63 36.82 090 S
63242

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

50200 ............. A Biopsy of kidney ............................................. 2.63 2.61 0.22 5.46 000 N

50205 ............. A Biopsy of kidney ............................................. 12.69 5.64 0.69 19.02 090 S

50220 ............. A Removal of kidney .......................................... 15.98 13.31 1.43 30.72 090 S

50225 ............. A Removal of kidney .......................................... 18.93 16.52 1.70 37.15 090 S

50230 ............. A Removal of kidney .......................................... 20.56 18.40 1.84 40.80 090 S

50234 ............. A Removal of kidney & ureter ............................ 21.11 16.65 1.65 39.41 090 S

50236 ............. A Removal of kidney & ureter ............................ 23.33 17.74 1.74 42.81 090 S

50240 ............. A Partial removal of kidney ................................ 20.24 16.00 1.70 37.94 090 S

50280 ............. A Removal of kidney lesion ............................... 14.63 10.86 1.16 26.65 090 S

50290 ............. A Removal of kidney lesion ............................... 13.69 8.87 1.19 23.75 090 S

50300 ............. X Removal of donor kidney ................................ 0.00 0.00 0.00 0.00 XXX 0

50320 ............. A Removal of donor kidney ................................ 21.22 16.49 2.40 40.11 090 S

50340 ............. A Removal of kidney .......................................... 10.73 12.49 2.24 25.46 090 S

50360 ............. A Transplantation of kidney ............................... 27.05 24.45 4.24 55.74 090 S

50365 ............. A Transplantation of kidney ............................... 32.54 30.71 3.89 67.14 090 S

50370 ............. A Remove transplanted kidney .......................... 11.11 11.08 1.92 24.11 090 S

50380 ............. A Reimplantation of kidney ................................ 16.49 10.12 1.71 28.32 090 S

50390 ............. A Drainage of kidney lesion ............................... 3.24 1.69 0.15 5.08 000 N

50392 ............. A Insert kidney drain .......................................... 5.59 2.36 0.20 8.15 000 N

50393 ............. A Insert ureteral tube ......................................... 6.88 3.01 0.26 10.15 000 N

50394 ............. A Injection for kidney x-ray ................................ 0.76 0.55 0.05 1.36 000 N

50395 ............. A Create passage to kidney ............................... 5.15 3.33 0.29 8.77 000 N

50396 ............. A Measure kidney pressure ............................... 2.09 0.50 0.05 2.64 000 N

50398 ............. A Change kidney tube ........................................ 1.46 0.53 0.05 2.04 000 S

50400 ............. A Revision of kidney/ureter ................................ 18.07 13.66 1.36 33.09 090 S

50405 ............. A Revision of kidney/ureter ................................ 22.45 17.29 1.74 41.48 090 S

50500 ............. A Repair of kidney wound .................................. 18.27 12.46 1.64 32.37 090 S

50520 ............. A Close kidney-skin fistula ................................. 15.93 10.34 1.50 27.77 090 S

50525 ............. A Repair renal-abdomen fistula ......................... 20.59 12.61 1.99 35.19 090 S

50526 ............. A Repair renal-abdomen fistula ......................... 22.15 7.39 2.32 31.86 090 S

50540 ............. A Revision of horseshoe kidney ........................ 19.15 13.41 1.54 34.10 090 S

50551 ............. A Kidney endoscopy .......................................... 5.60 2.19 0.21 8.00 000 S

50553 ............. A Kidney endoscopy .......................................... 5.99 1.66 0.17 7.82 000 S

50555 ............. A Kidney endoscopy & biopsy ........................... 6.53 4.70 0.45 11.68 000 S

50557 ............. A Kidney endoscopy & treatment ...................... 6.62 4.71 0.49 11.82 000 S

50559 ............. A Renal endoscopy; radiotracer ......................... 6.78 1.34 0.14 8.26 000 S

50561 ............. A Kidney endoscopy & treatment ...................... 7.59 5.12 0.49 13.20 000 S

50570 ............. A Kidney endoscopy .......................................... 9.54 1.45 0.14 11.13 000 S

50572 ............. A Kidney endoscopy .......................................... 10.35 7.25 0.75 18.35 000 S

50574 ............. A Kidney endoscopy & biopsy ........................... 11.02 7.08 0.64 18.74 000 S

50575 ............. A Kidney endoscopy .......................................... 13.98 9.93 0.97 24.88 000 S

50576 ............. A Kidney endoscopy & treatment ...................... 10.99 8.69 0.77 20.45 000 S

50578 ............. A Renal endoscopy; radiotracer ......................... 11.35 3.79 1.19 16.33 000 S

50580 ............. A Kidney endoscopy & treatment ...................... 11.86 3.58 0.35 15.79 000 S

50590 ............. A Fragmenting of kidney stone .......................... 9.62 10.11 0.97 20.70 090 S

50600 ............. A Exploration of ureter ....................................... 14.78 9.69 1.01 25.48 090 S

50605 ............. A Insert ureteral support .................................... 14.40 6.11 0.60 21.11 090 S

50610 ............. A Removal of ureter stone ................................. 14.86 11.77 1.17 27.80 090 S

50620 ............. A Removal of ureter stone ................................. 14.17 11.49 1.16 26.82 090 S

50630 ............. A Removal of ureter stone ................................. 13.95 12.71 1.25 27.91 090 S

50650 ............. A Removal of ureter ........................................... 16.37 12.07 1.21 29.65 090 S

50660 ............. A Removal of ureter ........................................... 18.44 12.49 1.53 32.46 090 S

50684 ............. A Injection for ureter x-ray ................................. 0.76 0.49 0.05 1.30 000 S

50686 ............. A Measure ureter pressure ................................ 1.51 0.37 0.04 1.92 000 S

50688 ............. A Change of ureter tube .................................... 1.14 0.39 0.04 1.57 010 S

50690 ............. A Injection for ureter x-ray ................................. 1.16 0.32 0.03 1.51 000 S

50700 ............. A Revision of ureter ........................................... 14.10 12.57 1.29 27.96 090 S

50715 ............. A Release of ureter ............................................ 17.60 11.24 1.49 30.33 090 S

50722 ............. A Release of ureter ............................................ 15.11 10.32 1.97 27.40 090 S

50725 ............. A Release/revise ureter ...................................... 17.12 12.05 1.75 30.92 090 S

50727 ............. A Revise ureter .................................................. 7.57 5.37 0.51 13.45 090 S

50728 ............. A Revise ureter .................................................. 11.13 7.90 0.77 19.80 090 S

50740 ............. A Fusion of ureter & kidney ............................... 17.12 13.03 1.88 32.03 090 S

50750 ............. A Fusion of ureter & kidney ............................... 18.14 14.04 1.26 33.44 090 S

50760 ............. A Fusion of ureters ............................................. 17.12 13.47 1.48 32.07 090 S

50770 ............. A Splicing of ureters ........................................... 18.14 15.23 1.53 34.90 090 S
63243

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

50780 ............. A Reimplant ureter in bladder ............................ 17.12 13.78 1.46 32.36 090 S

50782 ............. A Reimplant ureter in bladder ............................ 18.23 13.78 1.46 33.47 090 S

50783 ............. A Reimplant ureter in bladder ............................ 19.17 13.78 1.46 34.41 090 S

50785 ............. A Reimplant ureter in bladder ............................ 19.15 15.42 1.80 36.37 090 S

50800 ............. A Implant ureter in bowel ................................... 13.10 14.67 1.51 29.28 090 S

50810 ............. A Fusion of ureter & bowel ................................ 18.14 12.57 1.75 32.46 090 S

50815 ............. A Urine shunt to bowel ....................................... 18.14 19.76 2.75 40.65 090 S

50820 ............. A Construct bowel bladder ................................. 20.15 18.97 2.50 41.62 090 S

50825 ............. A Construct bowel bladder ................................. 26.19 30.54 3.33 60.06 090 S

50830 ............. A Revise urine flow ............................................ 29.29 20.93 2.27 52.49 090 S

50840 ............. A Replace ureter by bowel ................................. 18.14 13.32 1.35 32.81 090 S

50845 ............. A Appendico-vesicostomy .................................. 19.52 13.87 1.35 34.74 090 S

50860 ............. A Transplant ureter to skin ................................. 13.99 10.92 1.16 26.07 090 S

50900 ............. A Repair of ureter ............................................... 12.58 9.98 1.15 23.71 090 S

50920 ............. A Closure ureter/skin fistula ............................... 13.22 9.52 0.99 23.73 090 S

50930 ............. A Closure ureter/bowel fistula ............................ 17.61 12.50 1.22 31.33 090 S

50940 ............. A Release of ureter ............................................ 13.47 9.90 0.95 24.32 090 S

50951 ............. A Endoscopy of ureter ....................................... 5.84 1.67 0.17 7.68 000 S

50953 ............. A Endoscopy of ureter ....................................... 6.24 1.66 0.16 8.06 000 S

50955 ............. A Ureter endoscopy & biopsy ............................ 6.75 2.55 0.25 9.55 000 S

50957 ............. A Ureter endoscopy & treatment ....................... 6.79 2.50 0.25 9.54 000 S

50959 ............. A Ureter endoscopy & tracer ............................. 4.40 3.38 0.29 8.07 000 S

50961 ............. A Ureter endoscopy & treatment ....................... 6.05 2.62 0.26 8.93 000 S

50970 ............. A Ureter endoscopy ........................................... 7.14 5.17 0.52 12.83 000 S

50972 ............. A Ureter endoscopy & catheter .......................... 6.89 1.54 0.16 8.59 000 S

50974 ............. A Ureter endoscopy & biopsy ............................ 9.17 7.01 0.65 16.83 000 S

50976 ............. A Ureter endoscopy & treatment ....................... 9.04 6.41 0.62 16.07 000 S

50978 ............. A Ureter endoscopy & tracer ............................. 5.10 4.05 0.48 9.63 000 S

50980 ............. A Ureter endoscopy & treatment ....................... 6.85 3.13 0.30 10.28 000 S

51000 ............. A Drainage of bladder ........................................ 0.78 0.48 0.05 1.31 000 S

51005 ............. A Drainage of bladder ........................................ 1.02 0.46 0.04 1.52 000 S

51010 ............. A Drainage of bladder ........................................ 2.54 0.97 0.11 3.62 010 S

51020 ............. A Incise & treat bladder ..................................... 6.04 6.85 0.71 13.60 090 S

51030 ............. A Incise & treat bladder ..................................... 6.04 4.53 0.43 11.00 090 S

51040 ............. A Incise & drain bladder ..................................... 4.08 *5.23 0.75 10.06 090 S

51045 ............. A Incise bladder, drain ureter ............................. 6.04 4.96 0.50 11.50 090 S

51050 ............. A Removal of bladder stone .............................. 6.04 7.12 0.70 13.86 090 S

51060 ............. A Removal of ureter stone ................................. 8.05 *10.31 1.19 19.55 090 S

51065 ............. A Removal of ureter stone ................................. 8.05 7.08 0.71 15.84 090 S

51080 ............. A Drainage of bladder abscess .......................... 5.41 5.18 0.57 11.16 090 S

51500 ............. A Removal of bladder cyst ................................. 9.54 6.86 1.21 17.61 090 S

51520 ............. A Removal of bladder lesion .............................. 8.69 8.53 0.87 18.09 090 S

51525 ............. A Removal of bladder lesion .............................. 12.78 10.67 1.06 24.51 090 S

51530 ............. A Removal of bladder lesion .............................. 11.32 9.25 1.02 21.59 090 S

51535 ............. A Repair of ureter lesion .................................... 11.51 7.68 1.14 20.33 090 S

51550 ............. A Partial removal of bladder .............................. 14.34 10.71 1.17 26.22 090 S

51555 ............. A Partial removal of bladder .............................. 19.60 12.26 1.31 33.17 090 S

51565 ............. A Revise bladder & ureter(s) .............................. 20.01 15.84 1.67 37.52 090 S

51570 ............. A Removal of bladder ........................................ 22.16 15.66 1.62 39.44 090 S

51575 ............. A Removal of bladder & nodes .......................... 27.93 22.87 2.25 53.05 090 S

51580 ............. A Remove bladder; revise tract .......................... 28.20 19.95 2.04 50.19 090 S

51585 ............. A Removal of bladder & nodes .......................... 32.22 25.12 2.42 59.76 090 S

51590 ............. A Remove bladder; revise tract .......................... 30.21 24.52 2.56 57.29 090 S

51595 ............. A Remove bladder; revise tract .......................... 34.25 33.80 3.34 71.39 090 S

51596 ............. A Remove bladder, create pouch ...................... 36.27 34.89 3.45 74.61 090 S

51597 ............. A Removal of pelvic structures .......................... 35.27 30.63 4.31 70.21 090 S

51600 ............. A Injection for bladder x-ray ............................... 0.88 0.28 0.03 1.19 000 S

51605 ............. A Preparation for bladder xray ........................... 1.13 0.30 0.03 1.46 000 S

51610 ............. A Injection for bladder x-ray ............................... 1.59 0.27 0.02 1.88 000 S

51700 ............. A Irrigation of bladder ......................................... 0.88 0.22 0.02 1.12 000 S

51705 ............. A Change of bladder tube .................................. 0.99 0.38 0.04 1.41 010 S

51710 ............. A Change of bladder tube .................................. 1.46 0.57 0.06 2.09 010 S

51715 ............. A Endoscopic injection/implant .......................... 3.74 2.65 0.27 6.66 000 S

51720 ............. A Treatment of bladder lesion ............................ 1.96 0.45 0.05 2.46 000 S

51725 ............. A Simple cystometrogram .................................. 1.51 1.01 0.11 2.63 000 S

51725 26 A Simple cystometrogram .................................. 1.51 0.63 0.07 2.21 000 S
63244

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

51725 TC A Simple cystometrogram .................................. 0.00 0.38 0.04 0.42 000 S

51726 ............. A Complex cystometrogram ............................... 1.71 1.29 0.13 3.13 000 S

51726 26 A Complex cystometrogram ............................... 1.71 0.81 0.08 2.60 000 S

51726 TC A Complex cystometrogram ............................... 0.00 0.48 0.05 0.53 000 S

51736 ............. A Urine flow measurement ................................. 0.84 0.41 0.04 1.29 000 S

51736 26 A Urine flow measurement ................................. 0.84 0.26 0.03 1.13 000 S

51736 TC A Urine flow measurement ................................. 0.00 0.15 0.01 0.16 000 S

51741 ............. A Electro-uroflowmetry, first ............................... 1.57 0.56 0.06 2.19 000 S

51741 26 A Electro-uroflowmetry, first ............................... 1.57 0.35 0.04 1.96 000 S

51741 TC A Electro-uroflowmetry, first ............................... 0.00 0.21 0.02 0.23 000 S

51772 ............. A Urethra pressure profile .................................. 1.61 0.94 0.11 2.66 000 S

51772 26 A Urethra pressure profile .................................. 1.61 0.52 0.06 2.19 000 S

51772 TC A Urethra pressure profile .................................. 0.00 0.42 0.05 0.47 000 S

51784 ............. A Anal/urinary muscle study .............................. 1.53 1.04 0.11 2.68 000 S

51784 26 A Anal/urinary muscle study ............................... 1.53 0.65 0.07 2.25 000 S

51784 TC A Anal/urinary muscle study ............................... 0.00 0.39 0.04 0.43 000 S

51785 ............. A Anal/urinary muscle study .............................. 1.53 1.04 0.11 2.68 000 S

51785 26 A Anal/urinary muscle study ............................... 1.53 0.65 0.07 2.25 000 S

51785 TC A Anal/urinary muscle study ............................... 0.00 0.39 0.04 0.43 000 S

51792 ............. A Urinary reflex study ......................................... 1.10 1.93 0.20 3.23 000 S

51792 26 A Urinary reflex study ......................................... 1.10 0.59 0.06 1.75 000 S

51792 TC A Urinary reflex study ......................................... 0.00 1.34 0.14 1.48 000 S

51795 ............. A Urine voiding pressure study .......................... 1.53 1.44 0.16 3.13 000 S

51795 26 A Urine voiding pressure study .......................... 1.53 0.57 0.06 2.16 000 S

51795 TC A Urine voiding pressure study .......................... 0.00 0.87 0.10 0.97 000 S

51797 ............. A Intraabdominal pressure test .......................... 1.60 0.96 0.10 2.66 000 S

51797 26 A Intraabdominal pressure test .......................... 1.60 0.51 0.05 2.16 000 S

51797 TC A Intraabdominal pressure test .......................... 0.00 0.45 0.05 0.50 000 S

51800 ............. A Revision of bladder/urethra ............................ 16.31 12.02 1.47 29.80 090 S

51820 ............. A Revision of urinary tract .................................. 16.67 7.39 1.32 25.38 090 S

51840 ............. A Attach bladder/urethra .................................... 9.78 9.22 1.26 20.26 090 S

51841 ............. A Attach bladder/urethra .................................... 12.10 11.01 1.48 24.59 090 S

51845 ............. A Repair bladder neck ....................................... 9.06 10.71 1.09 20.86 090 S

51860 ............. A Repair of bladder wound ................................ 11.17 7.62 0.91 19.70 090 S

51865 ............. A Repair of bladder wound ................................ 13.99 10.96 1.27 26.22 090 S

51880 ............. A Repair of bladder opening .............................. 7.21 4.96 0.52 12.69 090 S

51900 ............. A Repair bladder/vagina lesion .......................... 11.67 11.65 1.41 24.73 090 S

51920 ............. A Close bladder-uterus fistula ............................ 10.57 7.51 0.73 18.81 090 S

51925 ............. A Hysterectomy/bladder repair ........................... 14.10 10.07 2.33 26.50 090 S

51940 ............. A Correction of bladder defect ........................... 25.00 18.95 2.22 46.17 090 S

51960 ............. A Revision of bladder & bowel ........................... 21.15 21.40 2.27 44.82 090 S

51980 ............. A Construct bladder opening ............................. 10.43 7.46 0.75 18.64 090 S

52000 ............. A Cystoscopy ..................................................... 2.01 1.33 0.14 3.48 000 S

52005 ............. A Cystoscopy & ureter catheter ......................... 2.37 2.20 0.22 4.79 000 S

52007 ............. A Cystoscopy and biopsy ................................... 3.02 2.82 0.28 6.12 000 S

52010 ............. A Cystoscopy & duct catheter ............................ 3.02 1.90 0.20 5.12 000 S

52204 ............. A Cystoscopy ..................................................... 2.37 2.38 0.24 4.99 000 S

52214 ............. A Cystoscopy and treatment .............................. 3.71 2.80 0.28 6.79 000 S

52224 ............. A Cystoscopy and treatment .............................. 3.14 2.90 0.29 6.33 000 S

52234 ............. A Cystoscopy and treatment .............................. 4.63 4.71 0.45 9.79 000 S

52235 ............. A Cystoscopy and treatment .............................. 5.45 *6.97 0.81 13.23 000 S

52240 ............. A Cystoscopy and treatment .............................. 9.72 10.65 1.04 21.41 000 S

52250 ............. A Cystoscopy & radiotracer ............................... 4.50 2.86 0.29 7.65 000 S

52260 ............. A Cystoscopy & treatment ................................. 3.92 2.11 0.22 6.25 000 S

52265 ............. A Cystoscopy & treatment ................................. 2.94 1.35 0.14 4.43 000 S

52270 ............. A Cystoscopy & revise urethra .......................... 3.84 3.47 0.35 7.66 000 S

52275 ............. A Cystoscopy & revise urethra .......................... 4.70 3.42 0.34 8.46 000 S

52276 ............. A Cystoscopy and treatment .............................. 3.93 4.58 0.45 8.96 000 S

52277 ............. A Cystoscopy and treatment .............................. 6.17 4.82 0.47 11.46 000 S

52281 ............. A Cystoscopy and treatment .............................. 2.80 2.31 0.23 5.34 000 S

52283 ............. A Cystoscopy and treatment .............................. 3.74 1.51 0.15 5.40 000 S

52285 ............. A Cystoscopy and treatment .............................. 3.61 2.94 0.30 6.85 000 S

52290 ............. A Cystoscopy and treatment .............................. 4.59 2.34 0.24 7.17 000 S

52300 ............. A Cystoscopy and treatment .............................. 5.35 3.47 0.36 9.18 000 S

52305 ............. A Cystoscopy and treatment .............................. 5.31 3.50 0.35 9.16 000 S

52310 ............. A Cystoscopy and treatment .............................. 2.81 2.99 0.30 6.10 000 S
63245

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

52315 ............. A Cystoscopy and treatment .............................. 5.21 4.07 0.40 9.68 000 S

52317 ............. A Remove bladder stone ................................... 6.72 6.19 0.59 13.50 000 S

52318 ............. A Remove bladder stone ................................... 9.19 7.88 0.77 17.84 000 S

52320 ............. A Cystoscopy and treatment .............................. 4.70 4.86 0.47 10.03 000 S

52325 ............. A Cystoscopy, stone removal ............................ 6.16 7.01 0.68 13.85 000 S

52327 ............. A Cystoscopy, inject material ............................. 5.19 3.69 0.36 9.24 000 S

52330 ............. A Cystoscopy and treatment .............................. 5.04 3.47 0.35 8.86 000 S

52332 ............. A Cystoscopy and treatment .............................. 2.83 3.21 0.32 6.36 000 S

52334 ............. A Create passage to kidney ............................... 4.83 3.33 0.34 8.50 000 S

52335 ............. A Endoscopy of urinary tract .............................. 5.86 4.69 0.45 11.00 000 S

52336 ............. A Cystoscopy, stone removal ............................ 6.88 *8.81 0.99 16.68 000 S

52337 ............. A Cystoscopy, stone removal ............................ 7.97 *10.21 1.08 19.26 000 S

52338 ............. A Cystoscopy and treatment .............................. 7.34 5.92 0.57 13.83 000 S

52339 ............. A Cystoscopy and treatment .............................. 8.82 5.92 0.57 15.31 000 S

52340 ............. A Cystoscopy and treatment .............................. 7.76 5.15 0.50 13.41 090 S

52450 ............. A Incision of prostate ......................................... 7.05 4.99 0.49 12.53 090 S

52500 ............. A Revision of bladder neck ................................ 7.82 7.44 0.72 15.98 090 S

52510 ............. A Dilation prostatic urethra ................................. 6.04 7.64 0.74 14.42 090 S

52601 ............. A Prostatectomy (TURP) .................................... 11.51 11.87 1.16 24.54 090 S

52606 ............. A Control postop bleeding .................................. 7.51 3.32 0.33 11.16 090 S

52612 ............. A Prostatectomy, first stage ............................... 7.05 *9.03 0.99 17.07 090 S

52614 ............. A Prostatectomy, second stage ......................... 6.04 7.09 0.68 13.81 090 S

52620 ............. A Remove residual prostate ............................... 6.04 5.33 0.51 11.88 090 S

52630 ............. A Remove prostate regrowth ............................. 6.55 *8.38 1.13 16.06 090 S

52640 ............. A Relieve bladder contracture ............................ 6.04 6.43 0.62 13.09 090 S

52647 ............. A Laser surgery of prostate ............................... 9.84 11.87 1.16 22.87 090 S

52648 ............. A Laser surgery of prostate ............................... 10.69 11.87 1.16 23.72 090 S

52700 ............. A Drainage of prostate abscess ......................... 6.31 3.30 0.34 9.95 090 S

53000 ............. A Incision of urethra ........................................... 2.01 1.76 0.17 3.94 010 S

53010 ............. A Incision of urethra ........................................... 3.02 3.52 0.37 6.91 090 S

53020 ............. A Incision of urethra ........................................... 1.77 0.82 0.09 2.68 000 S

53025 ............. A Incision of urethra ........................................... 1.13 0.80 0.08 2.01 000 S

53040 ............. A Drainage of urethra abscess .......................... 6.01 1.85 0.19 8.05 090 S

53060 ............. A Drainage of urethra abscess .......................... 2.58 0.51 0.07 3.16 010 S

53080 ............. A Drainage of urinary leakage ........................... 5.87 3.98 0.45 10.30 090 S

53085 ............. A Drainage of urinary leakage ........................... 9.67 6.75 0.70 17.12 090 S

53200 ............. A Biopsy of urethra ............................................ 2.59 1.10 0.12 3.81 000 S

53210 ............. A Removal of urethra ......................................... 11.71 6.64 0.67 19.02 090 S

53215 ............. A Removal of urethra ......................................... 14.59 10.00 0.96 25.55 090 S

53220 ............. A Treatment of urethra lesion ............................ 6.58 4.77 0.49 11.84 090 S

53230 ............. A Removal of urethra lesion .............................. 9.04 7.93 0.79 17.76 090 S

53235 ............. A Removal of urethra lesion .............................. 9.60 5.02 0.49 15.11 090 N

53240 ............. A Surgery for urethra pouch .............................. 6.03 4.33 0.45 10.81 090 S

53250 ............. A Removal of urethra gland ............................... 5.69 4.05 0.40 10.14 090 S

53260 ............. A Treatment of urethra lesion ............................ 2.93 1.12 0.16 4.21 010 S

53265 ............. A Treatment of urethra lesion ............................ 3.07 1.88 0.22 5.17 010 S

53270 ............. A Removal of urethra gland ............................... 2.93 0.84 0.18 3.95 010 S

53275 ............. A Repair of urethra defect .................................. 4.37 2.37 0.25 6.99 010 S

53400 ............. A Revise urethra, 1st stage ............................... 11.79 7.47 0.76 20.02 090 S

53405 ............. A Revise urethra, 2nd stage .............................. 13.70 10.38 1.21 25.29 090 S

53410 ............. A Reconstruction of urethra ............................... 15.59 8.56 0.84 24.99 090 S

53415 ............. A Reconstruction of urethra ............................... 18.50 11.87 1.15 31.52 090 S

53420 ............. A Reconstruct urethra, stage 1 .......................... 13.28 10.88 1.05 25.21 090 S

53425 ............. A Reconstruct urethra, stage 2 .......................... 15.18 9.25 0.88 25.31 090 S

53430 ............. A Reconstruction of urethra ............................... 15.54 7.16 0.76 23.46 090 S

53440 ............. A Correct bladder function ................................. 11.49 13.14 1.39 26.02 090 S

53442 ............. A Remove perineal prosthesis ........................... 7.67 5.84 0.67 14.18 090 S

53443 ............. A Reconstruction of urethra ............................... 18.98 10.03 1.07 30.08 090 S

53445 ............. A Correct urine flow control ............................... 13.15 *16.83 2.03 32.01 090 S

53447 ............. A Remove artificial sphincter .............................. 12.37 9.16 0.89 22.42 090 S

53449 ............. A Correct artificial sphincter ............................... 9.16 8.41 0.82 18.39 090 S

53450 ............. A Revision of urethra ......................................... 5.72 2.74 0.27 8.73 090 S

53460 ............. A Revision of urethra ......................................... 6.70 2.44 0.25 9.39 090 S

53502 ............. A Repair of urethra injury ................................... 7.21 4.97 0.56 12.74 090 S

53505 ............. A Repair of urethra injury ................................... 7.21 5.18 0.51 12.90 090 S

53510 ............. A Repair of urethra injury ................................... 9.57 6.98 0.66 17.21 090 S
63246

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

53515 ............. A Repair of urethra injury ................................... 12.71 9.03 0.88 22.62 090 S

53520 ............. A Repair of urethra defect .................................. 8.21 5.89 0.56 14.66 090 S

53600 ............. A Dilate urethra stricture .................................... 1.21 0.33 0.03 1.57 000 S

53601 ............. A Dilate urethra stricture .................................... 0.98 0.29 0.03 1.30 000 S

53605 ............. A Dilate urethra stricture .................................... 1.28 0.46 0.05 1.79 000 S

53620 ............. A Dilate urethra stricture .................................... 1.62 0.47 0.05 2.14 000 S

53621 ............. A Dilate urethra stricture .................................... 1.35 0.38 0.04 1.77 000 S

53640 ............. A Relieve bladder retention ................................ 1.59 0.57 0.06 2.22 000 S

53660 ............. A Dilation of urethra ........................................... 0.71 0.28 0.03 1.02 000 S

53661 ............. A Dilation of urethra ........................................... 0.72 0.25 0.03 1.00 000 S

53665 ............. A Dilation of urethra ........................................... 0.76 0.36 0.04 1.16 000 S

53670 ............. A Insert urinary catheter ..................................... 0.50 0.22 0.02 0.74 000 S

53675 ............. A Insert urinary catheter ..................................... 1.47 0.47 0.05 1.99 000 S

53899 ............. C Urology surgery procedure ............................. 0.00 0.00 0.00 0.00 YYY S

54000 ............. A Slitting of prepuce ........................................... 1.49 0.63 0.07 2.19 010 S

54001 ............. A Slitting of prepuce ........................................... 2.14 0.84 0.09 3.07 010 S

54015 ............. A Drain penis lesion ........................................... 5.16 0.83 0.09 6.08 010 S

54050 ............. A Destruction, penis lesion(s) ............................ 1.19 0.38 0.03 1.60 010 S

54055 ............. A Destruction, penis lesion(s) ............................ 1.19 0.61 0.06 1.86 010 S

54056 ............. A Cryosurgery, penis lesion(s) ........................... 1.19 0.53 0.04 1.76 010 S

54057 ............. A Laser surg, penis lesion(s) ............................. 1.19 *1.52 0.21 2.92 010 S

54060 ............. A Excision of penis lesion(s) .............................. 1.88 1.17 0.12 3.17 010 S

54065 ............. A Destruction, penis lesion(s) ............................ 2.37 2.47 0.25 5.09 010 S

54100 ............. A Biopsy of penis ............................................... 1.90 0.65 0.07 2.62 000 S

54105 ............. A Biopsy of penis ............................................... 3.45 1.01 0.11 4.57 010 S

54110 ............. A Treatment of penis lesion ............................... 9.66 6.03 0.61 16.30 090 S

54111 ............. A Treat penis lesion, graft .................................. 13.03 9.18 0.97 23.18 090 S

54112 ............. A Treat penis lesion, graft .................................. 15.14 10.84 1.14 27.12 090 S

54115 ............. A Treatment of penis lesion ............................... 5.68 4.18 0.44 10.30 090 S

54120 ............. A Partial removal of penis .................................. 9.24 6.47 0.62 16.33 090 S

54125 ............. A Removal of penis ............................................ 12.80 11.56 1.17 25.53 090 S

54130 ............. A Remove penis & nodes .................................. 18.92 14.66 1.32 34.90 090 S

54135 ............. A Remove penis & nodes .................................. 25.01 17.75 1.74 44.50 090 S

54150 ............. A Circumcision ................................................... 1.78 0.54 0.05 2.37 010 S

54152 ............. A Circumcision ................................................... 2.26 1.82 0.20 4.28 010 S

54160 ............. A Circumcision ................................................... 2.43 1.66 0.21 4.30 010 S

54161 ............. A Circumcision ................................................... 3.22 2.17 0.23 5.62 010 S

54200 ............. A Treatment of penis lesion ............................... 1.01 0.32 0.03 1.36 010 S

54205 ............. A Treatment of penis lesion ............................... 7.20 5.11 0.50 12.81 090 S

54220 ............. A Treatment of penis lesion ............................... 2.42 1.58 0.17 4.17 000 S

54230 ............. A Prepare penis study ........................................ 1.34 1.34 0.13 2.81 000 S

54231 ............. A Dynamic cavernosometry ............................... 2.04 1.44 0.14 3.62 000 S

54235 ............. A Penile injection ................................................ 1.19 0.43 0.04 1.66 000 S

54240 ............. A Penis study ..................................................... 1.31 0.99 0.12 2.42 000 S

54240 26 A Penis study ..................................................... 1.31 0.51 0.06 1.88 000 S

54240 TC A Penis study ..................................................... 0.00 0.48 0.06 0.54 000 S

54250 ............. A Penis study ..................................................... 2.22 0.80 0.08 3.10 000 S

54250 26 A Penis study ..................................................... 2.22 0.50 0.05 2.77 000 S

54250 TC A Penis study ..................................................... 0.00 0.30 0.03 0.33 000 S

54300 ............. A Revision of penis ............................................ 10.05 6.88 0.87 17.80 090 S

54304 ............. A Revision of penis ............................................ 12.13 8.66 0.90 21.69 090 S

54308 ............. A Reconstruction of urethra ............................... 11.58 5.84 0.74 18.16 090 S

54312 ............. A Reconstruction of urethra ............................... 13.16 9.37 0.91 23.44 090 S

54316 ............. A Reconstruction of urethra ............................... 15.97 11.34 1.12 28.43 090 S

54318 ............. A Reconstruction of urethra ............................... 10.47 7.53 1.11 19.11 090 S

54322 ............. A Reconstruction of urethra ............................... 12.34 7.61 0.74 20.69 090 S

54324 ............. A Reconstruction of urethra ............................... 15.46 10.98 1.08 27.52 090 S

54326 ............. A Reconstruction of urethra ............................... 14.81 10.51 1.03 26.35 090 S

54328 ............. A Revise penis, urethra ...................................... 14.80 10.72 1.24 26.76 090 S

54332 ............. A Revise penis, urethra ...................................... 16.17 12.52 1.13 29.82 090 S

54336 ............. A Revise penis, urethra ...................................... 18.95 18.79 1.40 39.14 090 S

54340 ............. A Secondary urethral surgery ............................ 8.55 6.07 0.59 15.21 090 S

54344 ............. A Secondary urethral surgery ............................ 15.22 16.61 1.10 32.93 090 S

54348 ............. A Secondary urethral surgery ............................ 16.37 11.62 1.14 29.13 090 S

54352 ............. A Reconstruct urethra, penis ............................. 23.84 16.18 1.49 41.51 090 S

54360 ............. A Penis plastic surgery ...................................... 11.39 7.02 0.73 19.14 090 S
63247

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

54380 ............. A Repair penis .................................................... 12.59 9.42 0.75 22.76 090 S

54385 ............. A Repair penis .................................................... 14.75 10.46 0.89 26.10 090 S

54390 ............. A Repair penis and bladder ............................... 20.97 13.57 1.58 36.12 090 S

54400 ............. A Insert semi-rigid prosthesis ............................. 8.58 *10.99 1.27 20.84 090 S

54401 ............. A Insert self-contd prosthesis ............................. 9.67 *12.38 1.73 23.78 090 S

54402 ............. A Remove penis prosthesis ............................... 8.67 6.00 0.58 15.25 090 S

54405 ............. A Insert multi-comp prosthesis ........................... 12.63 *16.17 2.10 30.90 090 S

54407 ............. A Remove multi-comp prosthesis ...................... 12.61 11.22 1.10 24.93 090 S

54409 ............. A Revise penis prosthesis .................................. 11.53 8.97 0.87 21.37 090 S

54420 ............. A Revision of penis ............................................ 10.75 7.74 0.87 19.36 090 S

54430 ............. A Revision of penis ............................................ 9.55 6.99 0.69 17.23 090 S

54435 ............. A Revision of penis ............................................ 5.63 4.15 0.39 10.17 090 S

54440 ............. C Repair of penis ............................................... 0.00 0.00 0.00 0.00 090 S

54450 ............. A Preputial stretching ......................................... 1.12 0.68 0.07 1.87 000 S

54500 ............. A Biopsy of testis ............................................... 1.31 0.44 0.05 1.80 000 S

54505 ............. A Biopsy of testis ............................................... 3.41 1.86 0.22 5.49 010 S

54510 ............. A Removal of testis lesion ................................. 5.24 3.03 0.38 8.65 090 S

54520 ............. A Removal of testis ............................................ 4.93 5.31 0.52 10.76 090 S

54530 ............. A Removal of testis ............................................ 8.04 7.32 0.77 16.13 090 S

54535 ............. A Extensive testis surgery .................................. 11.43 8.54 1.02 20.99 090 S

54550 ............. A Exploration for testis ....................................... 7.36 5.25 0.61 13.22 090 S

54560 ............. A Exploration for testis ....................................... 10.46 7.23 0.81 18.50 090 S

54600 ............. A Reduce testis torsion ...................................... 6.59 4.62 0.48 11.69 090 S

54620 ............. A Suspension of testis ....................................... 4.69 3.32 0.33 8.34 010 S

54640 ............. A Suspension of testis ....................................... 6.55 7.82 0.91 15.28 090 S

54650 ............. A Orchiopexy (Fowler-Stephens) ....................... 10.93 7.82 0.91 19.66 090 S

54660 ............. A Revision of testis ............................................ 4.80 3.40 0.34 8.54 090 S

54670 ............. A Repair testis injury .......................................... 6.06 4.30 0.43 10.79 090 S

54680 ............. A Relocation of testis(es) ................................... 11.53 8.19 0.80 20.52 090 S

54700 ............. A Drainage of scrotum ....................................... 3.38 0.90 0.11 4.39 010 S

54800 ............. A Biopsy of epididymis ....................................... 2.33 1.97 0.19 4.49 000 S

54820 ............. A Exploration of epididymis ................................ 4.72 2.62 0.29 7.63 090 S

54830 ............. A Remove epididymis lesion .............................. 5.07 3.51 0.39 8.97 090 S

54840 ............. A Remove epididymis lesion .............................. 5.01 4.84 0.48 10.33 090 S

54860 ............. A Removal of epididymis ................................... 6.01 5.17 0.50 11.68 090 S

54861 ............. A Removal of epididymis ................................... 8.54 7.30 0.72 16.56 090 S

54900 ............. A Fusion of spermatic ducts .............................. 12.61 8.95 0.87 22.43 090 S

54901 ............. A Fusion of spermatic ducts .............................. 17.30 12.29 1.20 30.79 090 S

55000 ............. A Drainage of hydrocele .................................... 1.43 0.40 0.04 1.87 000 S

55040 ............. A Removal of hydrocele ..................................... 5.15 4.88 0.55 10.58 090 S

55041 ............. A Removal of hydroceles ................................... 7.38 7.47 0.81 15.66 090 S

55060 ............. A Repair of hydrocele ........................................ 5.21 4.13 0.50 9.84 090 S

55100 ............. A Drainage of scrotum abscess ......................... 2.03 0.63 0.07 2.73 010 S

55110 ............. A Explore scrotum .............................................. 5.28 3.48 0.37 9.13 090 S

55120 ............. A Removal of scrotum lesion ............................. 4.78 1.79 0.21 6.78 090 S

55150 ............. A Removal of scrotum ........................................ 6.62 5.45 0.57 12.64 090 S

55175 ............. A Revision of scrotum ........................................ 4.93 4.49 0.48 9.90 090 S

55180 ............. A Revision of scrotum ........................................ 10.07 6.83 0.82 17.72 090 S

55200 ............. A Incision of sperm duct .................................... 4.14 1.97 0.20 6.31 090 S

55250 ............. A Removal of sperm duct(s) .............................. 3.21 2.63 0.28 6.12 090 S

55300 ............. A Preparation, sperm duct x-ray ........................ 3.51 2.71 0.27 6.49 000 S

55400 ............. A Repair of sperm duct ...................................... 8.25 6.56 0.62 15.43 090 S

55450 ............. A Ligation of sperm duct .................................... 3.91 2.61 0.32 6.84 010 S

55500 ............. A Removal of hydrocele ..................................... 5.28 4.32 0.50 10.10 090 S

55520 ............. A Removal of sperm cord lesion ........................ 5.72 3.12 0.51 9.35 090 S

55530 ............. A Revise spermatic cord veins .......................... 5.45 5.20 0.60 11.25 090 S

55535 ............. A Revise spermatic cord veins .......................... 6.25 4.40 0.45 11.10 090 S

55540 ............. A Revise hernia & sperm veins .......................... 7.25 4.54 0.91 12.70 090 S

55600 ............. A Incise sperm duct pouch ................................ 6.07 4.31 0.55 10.93 090 S

55605 ............. A Incise sperm duct pouch ................................ 7.60 5.60 0.59 13.79 090 S

55650 ............. A Remove sperm duct pouch ............................ 11.26 7.22 0.76 19.24 090 S

55680 ............. A Remove sperm pouch lesion .......................... 4.82 4.43 0.38 9.63 090 S

55700 ............. A Biopsy of prostate ........................................... 1.57 1.50 0.15 3.22 000 S

55705 ............. A Biopsy of prostate ........................................... 4.41 3.37 0.34 8.12 010 S

55720 ............. A Drainage of prostate abscess ......................... 7.54 3.51 0.37 11.42 090 S

55725 ............. A Drainage of prostate abscess ......................... 7.70 5.62 0.54 13.86 090 S
63248

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

55801 ............. A Removal of prostate ....................................... 16.25 12.76 1.44 30.45 090 S

55810 ............. A Extensive prostate surgery ............................. 21.21 17.88 1.77 40.86 090 S

55812 ............. A Extensive prostate surgery ............................. 25.65 17.68 1.94 45.27 090 S

55815 ............. A Extensive prostate surgery ............................. 28.47 25.20 2.42 56.09 090 S

55821 ............. A Removal of prostate ....................................... 13.00 13.59 1.35 27.94 090 S

55831 ............. A Removal of prostate ....................................... 14.30 14.56 1.44 30.30 090 S

55840 ............. A Extensive prostate surgery ............................. 21.21 16.60 1.61 39.42 090 S

55842 ............. A Extensive prostate surgery ............................. 22.70 19.16 1.88 43.74 090 S

55845 ............. A Extensive prostate surgery ............................. 26.73 25.10 2.44 54.27 090 S

55859 ............. A Percut/needle insert, pros ............................... 8.29 5.89 0.58 14.76 090 S

55860 ............. A Surgical exposure, prostate ............................ 13.33 7.13 0.70 21.16 090 S

55862 ............. A Extensive prostate surgery ............................. 17.09 11.69 1.20 29.98 090 S

55865 ............. A Extensive prostate surgery ............................. 21.65 24.52 2.39 48.56 090 S

55870 ............. A Electroejaculation ............................................ 2.58 1.83 0.18 4.59 000 N

55899 ............. C Genital surgery procedure .............................. 0.00 0.00 0.00 0.00 YYY S

55970 ............. N Sex transformation, M to F ............................. 0.00 0.00 0.00 0.00 XXX 0

55980 ............. N Sex transformation, F to M ............................. 0.00 0.00 0.00 0.00 XXX 0

56300 ............. A Pelvis laparoscopy, dx .................................... 3.58 *4.58 1.03 9.19 010 S

56301 ............. A Laparoscopy; tubal cautery ............................ 3.68 *4.71 1.28 9.67 010 S

56302 ............. A Laparoscopy; tubal block ................................ 4.11 *5.26 1.32 10.69 010 S

56303 ............. A Laparoscopy; excise lesions ........................... 5.69 5.53 1.16 12.38 010 S

56304 ............. A Laparoscopy; lysis .......................................... 4.37 *5.60 1.20 11.17 010 S

56305 ............. A Pelvic laparoscopy; biopsy ............................. 3.80 *4.87 0.95 9.62 010 S

56306 ............. A Laparoscopy; aspiration .................................. 3.80 *4.87 1.18 9.85 010 S

56307 ............. A Laparoscopy; remove adnexa ........................ 5.60 *7.16 1.60 14.36 010 S

56308 ............. A Laparoscopy; hysterectomy ............................ 13.87 9.39 2.07 25.33 010 S

56309 ............. A Laparoscopy; remove myoma ........................ 5.60 4.76 1.03 11.39 010 S

56311 ............. A Laparoscopic lymph node biop ....................... 8.93 6.38 1.47 16.78 010 S

56312 ............. A Laparoscopic lymphadenectomy .................... 12.06 8.56 0.84 21.46 010 S

56313 ............. A Laparoscopic lymphadenectomy .................... 14.00 10.01 2.31 26.32 010 S

56315 ............. A Laparoscopic appendectomy .......................... 6.06 4.89 1.01 11.96 090 S

56316 ............. A Laparoscopic hernia repair ............................. 6.17 4.51 0.94 11.62 090 S

56317 ............. A Laparoscopic hernia repair ............................. 7.87 5.22 1.11 14.20 090 S

56320 ............. A Laparoscopy, spermatic veins ........................ 6.25 4.40 0.45 11.10 090 S

56322 ............. A Laparoscopy, vagus nerves ............................ 9.70 5.07 1.18 15.95 090 S

56323 ............. A Laparoscopy, vagus nerves ............................ 11.65 6.09 1.41 19.15 090 S

56324 ............. A Laparoscopy, cholecystoenter ........................ 11.90 9.16 1.93 22.99 090 S

56340 ............. A Laparoscopic cholecystectomy ....................... 10.68 7.99 1.74 20.41 090 S

56341 ............. A Laparoscopic cholecystectomy ....................... 11.53 8.43 1.84 21.80 090 S

56342 ............. A Laparoscopic cholecystectomy ....................... 13.86 9.37 2.00 25.23 090 S

56343 ............. A Laparoscopic salpingostomy .......................... 6.96 5.28 1.11 13.35 090 S

56344 ............. A Laparoscopic fimbrioplasty ............................. 7.16 5.11 1.19 13.46 090 S

56350 ............. A Hysteroscopy; diagnostic ................................ 2.39 1.99 0.44 4.82 000 S

56351 ............. A Hysteroscopy; biopsy ...................................... 2.85 1.99 0.44 5.28 000 S

56352 ............. A Hysteroscopy; lysis ......................................... 3.14 3.77 0.85 7.76 000 S

56353 ............. A Hysteroscopy; resect septum ......................... 3.51 3.77 0.85 8.13 000 S

56354 ............. A Hysteroscopy; remove myoma ....................... 3.85 *4.93 1.30 10.08 000 S

56355 ............. A Hysteroscopy; remove impact ........................ 3.09 1.99 0.44 5.52 000 S

56356 ............. A Hysteroscopy; ablation ................................... 3.43 *4.39 1.49 9.31 000 S

56360 ............. A Peritoneoscopy ............................................... 4.04 3.80 0.43 8.27 000 S

56361 ............. A Peritoneoscopy w/biopsy ................................ 4.32 4.93 0.49 9.74 000 S

56362 ............. A Peritoneoscopy w/cholangio ........................... 4.89 2.77 0.19 7.85 000 S

56363 ............. A Peritoneoscopy w/biopsy ................................ 5.18 3.93 0.45 9.56 000 S

56399 ............. C Laparoscopy procedure .................................. 0.00 0.00 0.00 0.00 YYY S

56405 ............. A I & D of vulva/perineum .................................. 1.39 0.76 0.15 2.30 010 S

56420 ............. A Drainage of gland abscess ............................. 1.34 0.80 0.13 2.27 010 S

56440 ............. A Surgery for vulva lesion .................................. 2.79 2.63 0.52 5.94 010 S

56441 ............. A Lysis of labial lesion(s) ................................... 1.92 1.65 0.30 3.87 010 S

56501 ............. A Destruction, vulva lesion(s) ............................ 1.48 0.54 0.11 2.13 010 S

56515 ............. A Destruction, vulva lesion(s) ............................ 1.85 *2.36 0.66 4.87 010 S

56605 ............. A Biopsy of vulva/perineum ............................... 0.86 0.68 0.15 1.69 000 S

56606 ............. A Biopsy of vulva/perineum ............................... 0.43 0.35 0.08 0.86 000 S

56620 ............. A Partial removal of vulva .................................. 6.67 6.47 1.40 14.54 090 S

56625 ............. A Complete removal of vulva ............................. 7.41 *9.52 2.13 19.06 090 S

56630 ............. A Extensive vulva surgery .................................. 10.47 *13.46 3.28 27.21 090 S

56631 ............. A Extensive vulva surgery .................................. 14.57 *18.70 4.51 37.78 090 S
63249

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

56632 ............. A Extensive vulva surgery .................................. 18.66 *21.32 4.51 44.49 090 S

56633 ............. A Extensive vulva surgery .................................. 12.15 *15.97 3.28 31.40 090 S

56634 ............. A Extensive vulva surgery .................................. 16.25 *21.21 4.51 41.97 090 S

56637 ............. A Extensive vulva surgery .................................. 20.34 21.42 4.51 46.27 090 S

56640 ............. A Extensive vulva surgery .................................. 20.09 19.95 4.36 44.40 090 S

56700 ............. A Partial removal of hymen ................................ 2.42 1.82 0.35 4.59 010 S

56720 ............. A Incision of hymen ............................................ 0.68 0.48 0.11 1.27 000 S

56740 ............. A Remove vagina gland lesion .......................... 3.60 2.87 0.55 7.02 010 S

56800 ............. A Repair of vagina ............................................. 3.73 2.92 0.57 7.22 010 S

56805 ............. A Repair clitoris .................................................. 15.49 11.75 1.37 28.61 090 S

56810 ............. A Repair of perineum ......................................... 3.97 2.62 0.51 7.10 010 S

57000 ............. A Exploration of vagina ...................................... 2.92 2.03 0.35 5.30 010 S

57010 ............. A Drainage of pelvic abscess ............................ 5.41 2.65 0.51 8.57 090 S

57020 ............. A Drainage of pelvic fluid ................................... 1.50 0.65 0.14 2.29 000 S

57061 ............. A Destruction vagina lesion(s) ........................... 1.20 0.82 0.17 2.19 010 S

57065 ............. A Destruction vagina lesion(s) ........................... 2.56 *3.28 0.74 6.58 010 S

57100 ............. A Biopsy of vagina ............................................. 0.97 0.62 0.13 1.72 000 S

57105 ............. A Biopsy of vagina ............................................. 1.64 1.57 0.33 3.54 010 S

57108 ............. A Partial removal of vagina ................................ 5.69 5.28 1.10 12.07 090 S

57110 ............. A Removal of vagina .......................................... 13.48 7.88 1.76 23.12 090 S

57120 ............. A Closure of vagina ............................................ 6.73 6.99 1.51 15.23 090 S

57130 ............. A Remove vagina lesion .................................... 2.40 2.62 0.55 5.57 010 S

57135 ............. A Remove vagina lesion .................................... 2.64 1.93 0.38 4.95 010 S

57150 ............. A Treat vagina infection ..................................... 0.94 0.19 0.04 1.17 000 S

57160 ............. A Insertion of pessary ........................................ 0.89 0.25 0.05 1.19 000 S

57170 ............. A Fitting of diaphragm/cap ................................. 0.91 0.32 0.06 1.29 000 S

57180 ............. A Treat vaginal bleeding .................................... 1.53 0.55 0.11 2.19 010 S

57200 ............. A Repair of vagina ............................................. 3.68 2.71 0.60 6.99 090 S

57210 ............. A Repair vagina/perineum .................................. 4.73 3.27 0.65 8.65 090 S

57220 ............. A Revision of urethra ......................................... 3.87 4.44 0.80 9.11 090 S

57230 ............. A Repair of urethral lesion ................................. 5.07 3.84 0.64 9.55 090 S

57240 ............. A Repair bladder & vagina ................................. 5.39 *6.90 1.60 13.89 090 S

57250 ............. A Repair rectum & vagina .................................. 4.96 *6.36 1.69 13.01 090 S

57260 ............. A Repair of vagina ............................................. 7.59 8.65 1.88 18.12 090 S

57265 ............. A Extensive repair of vagina .............................. 7.36 *9.42 2.11 18.89 090 S

57268 ............. A Repair of bowel bulge ..................................... 6.14 7.02 1.50 14.66 090 S

57270 ............. A Repair of bowel pouch .................................... 7.36 6.83 1.44 15.63 090 S

57280 ............. A Suspension of vagina ..................................... 8.35 8.53 1.85 18.73 090 S

57282 ............. A Repair of vaginal prolapse .............................. 8.06 8.72 1.89 18.67 090 S

57284 ............. A Repair paravaginal defect ............................... 12.10 8.59 0.84 21.53 090 S

57288 ............. A Repair bladder defect ..................................... 12.34 10.72 1.36 24.42 090 S

57289 ............. A Repair bladder & vagina ................................. 6.40 *8.19 1.13 15.72 090 S

57291 ............. A Construction of vagina .................................... 7.46 5.35 1.19 14.00 090 S

57292 ............. A Construct vagina with graft ............................. 12.34 6.55 1.38 20.27 090 S

57300 ............. A Repair rectum-vagina fistula ........................... 6.81 7.91 1.66 16.38 090 S

57305 ............. A Repair rectum-vagina fistula ........................... 8.69 7.55 1.56 17.80 090 S

57307 ............. A Fistula repair & colostomy .............................. 10.05 6.11 1.28 17.44 090 S

57310 ............. A Repair urethrovaginal lesion ........................... 6.10 4.32 0.48 10.90 090 S

57311 ............. A Repair urethrovaginal lesion ........................... 7.23 5.58 0.41 13.22 090 S

57320 ............. A Repair bladder-vagina lesion .......................... 7.33 *9.38 1.35 18.06 090 S

57330 ............. A Repair bladder-vagina lesion .......................... 11.67 8.29 0.81 20.77 090 S

57335 ............. A Repair vagina .................................................. 9.11 6.91 0.81 16.83 090 S

57400 ............. A Dilation of vagina ............................................ 0.83 0.33 0.06 1.22 000 S

57410 ............. A Pelvic examination .......................................... 0.59 0.36 0.05 1.00 000 S

57415 ............. A Removal vaginal foreign body ........................ 0.91 0.36 0.05 1.32 010 S

57452 ............. A Examination of vagina .................................... 0.99 0.65 0.14 1.78 000 S

57454 ............. A Vagina examination & biopsy ......................... 1.27 1.21 0.26 2.74 000 S

57460 ............. A Cervix excision ................................................ 2.83 2.02 0.46 5.31 000 S

57500 ............. A Biopsy of cervix .............................................. 0.97 0.57 0.12 1.66 000 S

57505 ............. A Endocervical curettage ................................... 1.09 0.63 0.13 1.85 010 S

57510 ............. A Cauterization of cervix .................................... 1.85 0.52 0.09 2.46 010 S

57511 ............. A Cryocautery of cervix ...................................... 1.85 0.85 0.17 2.87 010 S

57513 ............. A Laser surgery of cervix ................................... 1.85 *2.36 0.67 4.88 010 S

57520 ............. A Conization of cervix ........................................ 3.96 3.45 0.73 8.14 090 S

57522 ............. A Conization of cervix ........................................ 3.26 3.45 0.73 7.44 090 S

57530 ............. A Removal of cervix ........................................... 4.42 3.61 0.78 8.81 090 S
63250

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

57540 ............. A Removal of residual cervix ............................. 6.01 6.74 1.51 14.26 090 S

57545 ............. A Remove cervix, repair pelvis .......................... 6.63 4.58 1.03 12.24 090 S

57550 ............. A Removal of residual cervix ............................. 4.91 *6.28 1.54 12.73 090 S

57555 ............. A Remove cervix, repair vagina ......................... 8.14 10.10 2.17 20.41 090 S

57556 ............. A Remove cervix, repair bowel .......................... 7.56 9.44 1.92 18.92 090 S

57700 ............. A Revision of cervix ........................................... 3.30 2.39 0.34 6.03 090 S

57720 ............. A Revision of cervix ........................................... 3.87 2.76 0.50 7.13 090 S

57800 ............. A Dilation of cervical canal ................................. 0.77 0.48 0.10 1.35 000 S

57820 ............. A D&C of residual cervix .................................... 1.62 *2.08 0.46 4.16 010 S

58100 ............. A Biopsy of uterus lining .................................... 0.71 0.66 0.14 1.51 000 S

58120 ............. A Dilation and curettage (D&C) .......................... 2.45 2.70 0.56 5.71 010 S

58140 ............. A Removal of uterus lesion ................................ 7.61 8.33 1.71 17.65 090 S

58145 ............. A Removal of uterus lesion ................................ 7.36 8.24 1.54 17.14 090 S

58150 ............. A Total hysterectomy ......................................... 13.00 9.57 2.08 24.65 090 S

58152 ............. A Total hysterectomy ......................................... 14.10 11.99 2.59 28.68 090 S

58180 ............. A Partial hysterectomy ....................................... 9.06 9.76 2.11 20.93 090 S

58200 ............. A Extensive hysterectomy .................................. 20.34 12.98 2.80 36.12 090 S

58210 ............. A Extensive hysterectomy .................................. 23.97 17.77 3.87 45.61 090 S

58240 ............. A Removal of pelvis contents ............................ 28.79 28.73 6.15 63.67 090 S

58260 ............. A Vaginal hysterectomy ..................................... 11.39 9.39 2.07 22.85 090 S

58262 ............. A Vaginal hysterectomy ..................................... 13.06 9.39 2.07 24.52 090 S

58263 ............. A Vaginal hysterectomy ..................................... 14.27 10.32 2.22 26.81 090 S

58267 ............. A Hysterectomy & vagina repair ........................ 13.94 11.53 2.46 27.93 090 S

58270 ............. A Hysterectomy & vagina repair ........................ 12.60 10.32 2.22 25.14 090 S

58275 ............. A Hysterectomy, revise vagina .......................... 13.99 11.02 2.32 27.33 090 S

58280 ............. A Hysterectomy, revise vagina .......................... 14.35 10.50 2.30 27.15 090 S

58285 ............. A Extensive hysterectomy .................................. 17.45 11.60 2.70 31.75 090 S

58300 ............. N Insert intrauterine device ................................ #1.01 0.77 0.13 1.91 XXX 0

58301 ............. A Remove intrauterine device ............................ 0.73 0.45 0.08 1.26 000 S

58321 ............. A Artificial insemination ...................................... 0.92 0.71 0.15 1.78 000 S

58322 ............. A Artificial insemination ...................................... 1.10 0.71 0.15 1.96 000 S

58323 ............. A Sperm washing ............................................... 0.23 0.16 0.04 0.43 000 S

58340 ............. A Inject for uterus/tube x-ray .............................. 0.88 0.57 0.08 1.53 000 S

58345 ............. A Reopen fallopian tube ..................................... 4.61 3.49 0.41 8.51 010 S

58350 ............. A Reopen fallopian tube ..................................... 0.96 0.69 0.16 1.81 010 S

58400 ............. A Suspension of uterus ...................................... 5.66 5.64 1.16 12.46 090 S

58410 ............. A Suspension of uterus ...................................... 6.78 5.53 0.84 13.15 090 S

58520 ............. A Repair of ruptured uterus ............................... 6.35 4.24 0.99 11.58 090 S

58540 ............. A Revision of uterus ........................................... 8.58 6.13 1.42 16.13 090 S

58600 ............. A Division of fallopian tube ................................ 3.74 *4.79 1.38 9.91 090 S

58605 ............. A Division of fallopian tube ................................ 3.29 *4.21 1.01 8.51 090 S

58611 ............. A Ligate oviduct(s) ............................................. 0.63 0.47 0.10 1.20 ZZZ S

58615 ............. A Occlude fallopian tube(s) ................................ 3.85 2.91 0.35 7.11 010 S

58700 ............. A Removal of fallopian tube ............................... 5.92 6.33 1.31 13.56 090 S

58720 ............. A Removal of ovary/tube(s) ............................... 6.20 7.50 1.63 15.33 090 S

58740 ............. A Revise fallopian tube(s) .................................. 5.28 *6.76 1.88 13.92 090 S

58750 ............. A Repair oviduct ................................................. 8.82 6.31 1.46 16.59 090 S

58752 ............. A Revise ovarian tube(s) .................................... 7.94 6.74 0.93 15.61 090 S

58760 ............. A Remove tubal obstruction ............................... 7.16 5.11 1.19 13.46 090 S

58770 ............. A Create new tubal opening .............................. 6.96 5.28 1.11 13.35 090 S

58800 ............. A Drainage of ovarian cyst(s) ............................ 3.77 2.68 0.53 6.98 090 S

58805 ............. A Drainage of ovarian cyst(s) ............................ 5.44 6.38 1.36 13.18 090 S

58820 ............. A Drainage of ovarian abscess .......................... 3.96 2.76 0.49 7.21 090 S

58822 ............. A Drainage of ovarian abscess .......................... 6.18 3.55 0.81 10.54 090 S

58825 ............. A Transposition, ovary(s) ................................... 5.63 4.03 0.93 10.59 090 S

58900 ............. A Biopsy of ovary(s) ........................................... 5.49 5.19 1.07 11.75 090 S

58920 ............. A Partial removal of ovary(s) .............................. 6.28 6.78 1.41 14.47 090 S

58925 ............. A Removal of ovarian cyst(s) ............................. 6.40 6.56 1.38 14.34 090 S

58940 ............. A Removal of ovary(s) ....................................... 6.54 6.49 1.33 14.36 090 S

58943 ............. A Removal of ovary(s) ....................................... 17.49 12.11 2.63 32.23 090 S

58950 ............. A Resect ovarian malignancy ............................ 14.10 11.24 2.38 27.72 090 S

58951 ............. A Resect ovarian malignancy ............................ 20.34 18.34 3.93 42.61 090 S

58952 ............. A Resect ovarian malignancy ............................ 21.35 18.11 3.92 43.38 090 S

58960 ............. A Exploration of abdomen .................................. 10.14 *12.98 2.95 26.07 090 S

58970 ............. A Retrieval of oocyte .......................................... 3.53 2.52 0.58 6.63 000 N

58972 ............. D Fertilization of oocyte ...................................... 0.00 0.00 0.00 0.00 000 N
63251

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

58974 ............. C Transfer of embryo ......................................... 0.00 0.00 0.00 0.00 000 N

58976 ............. A Transfer of embryo ......................................... 3.83 2.73 0.63 7.19 000 N

58999 ............. C Genital surgery procedure .............................. 0.00 0.00 0.00 0.00 YYY S

59000 ............. A Amniocentesis ................................................. 1.30 0.97 0.18 2.45 000 S

59012 ............. A Fetal cord puncture, prenatal ......................... 3.45 2.62 0.31 6.38 000 S

59015 ............. A Chorion biopsy ................................................ 2.20 1.20 0.10 3.50 000 S

59020 ............. A Fetal contract stress test ................................ 0.66 *1.35 0.29 2.30 000 S

59020 26 A Fetal contract stress test ................................ 0.66 *0.85 0.19 1.70 000 S

59020 TC A Fetal contract stress test ................................ 0.00 0.50 0.10 0.60 000 S

59025 ............. A Fetal non-stress test ....................................... 0.53 0.61 0.12 1.26 000 S

59025 26 A Fetal non-stress test ....................................... 0.53 0.39 0.08 1.00 000 S

59025 TC A Fetal non-stress test ....................................... 0.00 0.22 0.04 0.26 000 S

59030 ............. A Fetal scalp blood sample ................................ 1.99 1.58 0.21 3.78 000 S

59050 ............. A Fetal monitor w/report ..................................... 0.89 0.81 0.15 1.85 XXX S

59051 ............. A Fetal monitor/interpret only ............................. 0.74 0.81 0.15 1.70 XXX N

59100 ............. A Remove uterus lesion ..................................... 5.96 4.14 0.96 11.06 090 S

59120 ............. A Treat ectopic pregnancy ................................. 7.11 7.86 1.50 16.47 090 S

59121 ............. A Treat ectopic pregnancy ................................. 6.99 5.38 1.07 13.44 090 S

59130 ............. A Treat ectopic pregnancy ................................. 7.88 5.96 0.70 14.54 090 S

59135 ............. A Treat ectopic pregnancy ................................. 13.00 9.85 1.15 24.00 090 S

59136 ............. A Treat ectopic pregnancy ................................. 8.69 6.22 1.44 16.35 090 S

59140 ............. A Treat ectopic pregnancy ................................. 5.09 4.66 0.29 10.04 090 S

59150 ............. A Treat ectopic pregnancy ................................. 6.34 4.53 1.05 11.92 090 S

59151 ............. A Treat ectopic pregnancy ................................. 7.24 8.61 0.64 16.49 090 S

59160 ............. A D&C after delivery .......................................... 2.66 2.93 0.52 6.11 010 S

59200 ............. A Insert cervical dilator ....................................... 0.79 0.54 0.11 1.44 000 S

59300 ............. A Episiotomy or vaginal repair ........................... 2.41 0.99 0.10 3.50 000 S

59320 ............. A Revision of cervix ........................................... 2.48 1.78 0.41 4.67 000 S

59325 ............. A Revision of cervix ........................................... 4.07 2.89 0.29 7.25 000 S

59350 ............. A Repair of uterus .............................................. 4.95 3.54 0.82 9.31 000 S

59400 ............. A Obstetrical care ............................................... 20.99 14.99 3.47 39.45 MMM S

59409 ............. A Obstetrical care ............................................... 13.28 9.48 2.20 24.96 MMM S

59410 ............. A Obstetrical care ............................................... 14.44 10.31 2.39 27.14 MMM S

59412 ............. A Antepartum manipulation ................................ 1.71 1.22 0.29 3.22 MMM S

59414 ............. A Deliver placenta .............................................. 1.61 1.15 0.27 3.03 MMM S

59425 ............. A Antepartum care only ..................................... 4.04 2.88 0.66 7.58 MMM S

59426 ............. A Antepartum care only ..................................... 6.91 4.94 1.14 12.99 MMM S

59430 ............. A Care after delivery .......................................... 2.01 0.38 0.07 2.46 MMM S

59510 ............. A Cesarean delivery ........................................... 23.67 16.90 3.92 44.49 MMM S

59514 ............. A Cesarean delivery only ................................... 15.39 10.99 2.55 28.93 MMM S

59515 ............. A Cesarean delivery ........................................... 16.55 11.82 2.73 31.10 MMM S

59525 ............. A Remove uterus after cesarean ....................... 8.54 3.81 0.88 13.23 MMM S

59610 ............. A Vbac delivery .................................................. 22.55 14.99 3.47 41.01 MMM S

59612 ............. A Vbac delivery only .......................................... 14.84 9.48 2.20 26.52 MMM S

59614 ............. A Vbac care after delivery .................................. 15.96 10.31 2.39 28.66 MMM S

59618 ............. A Attempted vbac delivery ................................. 25.23 16.90 3.92 46.05 MMM S

59620 ............. A Attempted vbac delivery only ......................... 16.95 10.99 2.55 30.49 MMM S

59622 ............. A Attempted vbac after care .............................. 18.11 11.82 2.73 32.66 MMM S

59812 ............. A Treatment of miscarriage ................................ 3.10 3.61 0.77 7.48 090 S

59820 ............. A Care of miscarriage ........................................ 3.73 3.75 0.77 8.25 090 S

59821 ............. A Treatment of miscarriage ................................ 4.26 2.72 0.62 7.60 090 S

59830 ............. A Treat uterus infection ...................................... 5.96 4.53 0.52 11.01 090 S

59840 ............. A Abortion ........................................................... 2.91 3.22 0.69 6.82 010 S

59841 ............. A Abortion ........................................................... 3.24 3.75 0.76 7.75 010 S

59850 ............. A Abortion ........................................................... 5.46 4.00 0.85 10.31 090 S

59851 ............. A Abortion ........................................................... 5.62 4.28 0.88 10.78 090 S

59852 ............. A Abortion ........................................................... 7.70 5.51 1.27 14.48 090 S

59855 ............. A Abortion ........................................................... 5.80 4.14 0.96 10.90 090 S

59856 ............. A Abortion ........................................................... 7.16 5.11 1.19 13.46 090 S

59857 ............. A Abortion ........................................................... 8.71 6.22 1.44 16.37 090 S

59870 ............. A Evacuate mole of uterus ................................. 4.08 2.91 0.67 7.66 090 S

59899 ............. C Maternity care procedure ................................ 0.00 0.00 0.00 0.00 YYY S

60000 ............. A Drain thyroid/tongue cyst ................................ 1.71 0.60 0.09 2.40 010 N

60001 ............. A Aspirate/inject thyriod cyst .............................. 0.97 1.05 0.12 2.14 000 N

60100 ............. A Biopsy of thyroid ............................................. 0.97 1.05 0.12 2.14 000 N

60200 ............. A Remove thyroid lesion .................................... 8.83 6.02 1.04 15.89 090 S
63252

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

60210 ............. A Partial excision thyroid .................................... 10.51 8.68 1.65 20.84 090 S

60212 ............. A Parital thyroid excision .................................... 15.48 9.04 1.74 26.26 090 S

60220 ............. A Partial removal of thyroid ................................ 9.86 8.54 1.61 20.01 090 S

60225 ............. A Partial removal of thyroid ................................ 11.65 10.49 1.92 24.06 090 S

60240 ............. A Removal of thyroid .......................................... 15.66 10.58 1.96 28.20 090 S

60252 ............. A Removal of thyroid .......................................... 15.40 13.65 2.55 31.60 090 S

60254 ............. A Extensive thyroid surgery ............................... 16.68 19.21 3.08 38.97 090 S

60260 ............. A Repeat thyroid surgery ................................... 14.49 3.14 0.34 17.97 090 S

60270 ............. A Removal of thyroid .......................................... 16.44 13.97 2.54 32.95 090 S

60271 ............. A Removal of thyroid .......................................... 14.16 12.14 2.25 28.55 090 S

60280 ............. A Remove thyroid duct lesion ............................ 5.55 *7.10 1.11 13.76 090 S

60281 ............. A Remove thyroid duct lesion ............................ 8.00 5.04 0.95 13.99 090 S

60500 ............. A Explore parathyroid glands ............................. 15.40 11.36 2.31 29.07 090 S

60502 ............. A Re-explore parathyroids ................................. 19.25 11.39 2.33 32.97 090 S

60505 ............. A Explore parathyroid glands ............................. 19.93 13.14 2.56 35.63 090 S

60512 ............. A Autotransplant, parathyroid ............................. 4.45 2.32 0.54 7.31 ZZZ S

60520 ............. A Removal of thymus gland ............................... 15.82 13.54 2.46 31.82 090 S

60521 ............. A Removal thymus gland ................................... 17.80 13.54 2.46 33.80 090 S

60522 ............. A Removal of thymus gland ............................... 21.76 13.54 2.46 37.76 090 S

60540 ............. A Explore adrenal gland ..................................... 15.72 12.05 2.08 29.85 090 S

60545 ............. A Explore adrenal gland ..................................... 18.51 14.27 2.34 35.12 090 S

60600 ............. A Remove carotid body lesion ........................... 16.13 11.46 1.88 29.47 090 S

60605 ............. A Remove carotid body lesion ........................... 18.20 10.71 2.21 31.12 090 S

60699 ............. C Endocrine surgery procedure ......................... 0.00 0.00 0.00 0.00 YYY S

61000 ............. A Remove cranial cavity fluid ............................. 1.58 1.07 0.17 2.82 000 S

61001 ............. A Remove cranial cavity fluid ............................. 1.49 0.88 0.17 2.54 000 S

61020 ............. A Remove brain cavity fluid ............................... 1.51 1.26 0.20 2.97 000 S

61026 ............. A Injection into brain canal ................................. 1.69 2.03 0.22 3.94 000 N

61050 ............. A Remove brain canal fluid ................................ 1.51 1.23 0.15 2.89 000 N

61055 ............. A Injection into brain canal ................................. 2.10 1.88 0.19 4.17 000 N

61070 ............. A Brain canal shunt procedure .......................... 0.89 0.49 0.03 1.41 000 N

61105 ............. A Drill skull for examination ............................... 8.19 6.89 1.24 16.32 090 S

61106 ............. A Drill skull for exam/surgery ............................. 7.35 6.15 1.15 14.65 ZZZ S

61107 ............. A Drill skull for implantation ............................... 4.35 *5.57 1.26 11.18 000 S

61108 ............. A Drill skull for drainage ..................................... 10.80 12.05 2.22 25.07 090 S

61120 ............. A Pierce skull for examination ........................... 9.31 5.95 1.08 16.34 090 S

61130 ............. A Pierce skull, exam/surgery .............................. 6.37 4.95 0.96 12.28 ZZZ S

61140 ............. A Pierce skull for biopsy .................................... 14.84 14.13 2.56 31.53 090 S

61150 ............. A Pierce skull for drainage ................................. 16.37 14.65 2.63 33.65 090 S

61151 ............. A Pierce skull for drainage ................................. 11.40 2.13 0.37 13.90 090 S

61154 ............. A Pierce skull, remove clot ................................ 13.67 *17.50 3.27 34.44 090 S

61156 ............. A Pierce skull for drainage ................................. 15.23 16.19 3.05 34.47 090 S

61210 ............. A Pierce skull; implant device ............................ 4.72 *6.04 1.53 12.29 000 S

61215 ............. A Insert brain-fluid device .................................. 10.05 9.00 1.63 20.68 090 S

61250 ............. A Pierce skull & explore ..................................... 11.03 8.03 1.44 20.50 090 S

61253 ............. A Pierce skull & explore ..................................... 13.00 9.62 1.69 24.31 090 S

61304 ............. A Open skull for exploration ............................... 20.63 26.03 4.78 51.44 090 S

61305 ............. A Open skull for exploration ............................... 24.77 29.11 5.05 58.93 090 S

61312 ............. A Open skull for drainage .................................. 20.54 24.13 4.46 49.13 090 S

61313 ............. A Open skull for drainage .................................. 20.54 24.04 4.38 48.96 090 S

61314 ............. A Open skull for drainage .................................. 22.78 25.62 4.68 53.08 090 S

61315 ............. A Open skull for drainage .................................. 25.91 24.41 4.47 54.79 090 S

61320 ............. A Open skull for drainage .................................. 23.90 18.70 3.41 46.01 090 S

61321 ............. A Open skull for drainage .................................. 26.66 19.83 3.54 50.03 090 S

61330 ............. A Decompress eye socket ................................. 15.65 12.97 1.22 29.84 090 S

61332 ............. A Explore/biopsy eye socket .............................. 26.08 20.72 2.76 49.56 090 S

61333 ............. A Explore orbit; remove lesion ........................... 26.75 20.46 3.26 50.47 090 S

61334 ............. A Explore orbit; remove object ........................... 17.07 14.65 1.82 33.54 090 S

61340 ............. A Relieve cranial pressure ................................. 11.56 *14.80 2.54 28.90 090 S

61343 ............. A Incise skull, pressure relief ............................. 27.87 30.05 5.28 63.20 090 S

61345 ............. A Relieve cranial pressure ................................. 25.36 19.18 3.45 47.99 090 S

61440 ............. A Incise skull for surgery .................................... 24.79 20.75 3.00 48.54 090 S

61450 ............. A Incise skull for surgery .................................... 24.29 20.43 3.43 48.15 090 S

61458 ............. A Incise skull for brain wound ............................ 25.97 27.28 4.87 58.12 090 S

61460 ............. A Incise skull for surgery .................................... 26.75 25.05 3.98 55.78 090 S

61470 ............. A Incise skull for surgery .................................... 20.79 13.86 2.53 37.18 090 S
63253

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

61480 ............. A Incise skull for surgery .................................... 16.77 15.07 1.78 33.62 090 S

61490 ............. A Incise skull for surgery .................................... 15.63 11.72 2.16 29.51 090 S

61500 ............. A Removal of skull lesion ................................... 16.93 20.07 3.58 40.58 090 S

61501 ............. A Remove infected skull bone ........................... 13.59 *17.40 3.33 34.32 090 S

61510 ............. A Removal of brain lesion .................................. 23.39 27.04 4.90 55.33 090 S

61512 ............. A Remove brain lining lesion ............................. 24.26 29.02 5.28 58.56 090 S

61514 ............. A Removal of brain abscess .............................. 23.49 25.52 4.74 53.75 090 S

61516 ............. A Removal of brain lesion .................................. 22.84 26.48 4.57 53.89 090 S

61518 ............. A Removal of brain lesion .................................. 32.27 30.02 5.46 67.75 090 S

61519 ............. A Remove brain lining lesion ............................. 33.84 31.22 5.77 70.83 090 S

61520 ............. A Removal of brain lesion .................................. 38.35 33.85 5.89 78.09 090 S

61521 ............. A Removal of brain lesion .................................. 39.48 32.97 5.85 78.30 090 S

61522 ............. A Removal of brain abscess .............................. 27.55 19.96 3.79 51.30 090 S

61524 ............. A Removal of brain lesion .................................. 26.02 27.45 5.15 58.62 090 S

61526 ............. A Removal of brain lesion .................................. 29.71 34.01 4.79 68.51 090 S

61530 ............. A Removal of brain lesion .................................. 42.35 34.01 4.79 81.15 090 S

61531 ............. A Implant brain electrodes ................................. 20.50 14.98 1.75 37.23 090 S

61533 ............. A Implant brain electrodes ................................. 23.41 17.02 3.33 43.76 090 S

61534 ............. A Removal of brain lesion .................................. 19.13 6.38 2.01 27.52 090 S

61535 ............. A Remove brain electrodes ................................ 10.23 7.66 1.25 19.14 090 S

61536 ............. A Removal of brain lesion .................................. 29.43 21.96 3.99 55.38 090 S

61538 ............. A Removal of brain tissue .................................. 28.05 29.08 4.97 62.10 090 S

61539 ............. A Removal of brain tissue .................................. 30.05 22.96 4.07 57.08 090 S

61541 ............. A Incision of brain tissue .................................... 26.95 19.80 3.78 50.53 090 S

61542 ............. A Removal of brain tissue .................................. 27.39 19.91 3.90 51.20 090 S

61543 ............. A Removal of brain tissue .................................. 20.62 17.24 2.49 40.35 090 S

61544 ............. A Remove & treat brain lesion ........................... 23.71 28.19 2.11 54.01 090 S

61545 ............. A Excision of brain tumor ................................... 34.50 25.66 4.80 64.96 090 S

61546 ............. A Removal of pituitary gland .............................. 29.33 27.01 4.78 61.12 090 S

61548 ............. A Removal of pituitary gland .............................. 20.15 24.78 4.03 48.96 090 S

61550 ............. A Release of skull seams .................................. 14.24 11.81 1.11 27.16 090 S

61552 ............. A Release of skull seams .................................. 19.02 13.83 2.70 35.55 090 S

61556 ............. A Incise skull/sutures ......................................... 21.35 15.53 3.04 39.92 090 S

61557 ............. A Incise skull/sutures ......................................... 21.47 15.62 3.05 40.14 090 S

61558 ............. A Excision of skull/sutures ................................. 24.41 17.74 3.47 45.62 090 S

61559 ............. A Excision of skull/sutures ................................. 31.65 23.01 4.50 59.16 090 S

61563 ............. A Excision of skull tumor .................................... 25.87 18.81 3.68 48.36 090 S

61564 ............. A Excision of skull tumor .................................... 32.64 23.73 4.64 61.01 090 S

61570 ............. A Remove brain foreign body ............................ 22.89 16.49 3.06 42.44 090 S

61571 ............. A Incise skull for brain wound ............................ 24.55 18.32 3.21 46.08 090 S

61575 ............. A Skull base/brainstem surgery ......................... 32.33 32.99 5.05 70.37 090 S

61576 ............. A Skull base/brainstem surgery ......................... 33.82 28.23 3.91 65.96 090 S

61580 ............. A Craniofacial approach, skull ........................... 28.90 21.01 4.10 54.01 090 S

61581 ............. A Craniofacial approach, skull ........................... 32.80 23.84 4.66 61.30 090 S

61582 ............. A Craniofacial approach, skull ........................... 29.77 21.65 4.22 55.64 090 S

61583 ............. A Craniofacial approach, skull ........................... 33.97 24.70 4.83 63.50 090 S

61584 ............. A Orbitocranial approach/skull ........................... 32.89 23.91 4.68 61.48 090 S

61585 ............. A Orbitocranial approach/skull ........................... 36.80 26.75 5.23 68.78 090 S

61590 ............. A Infratemporal approach/skull .......................... 40.02 29.10 5.68 74.80 090 S

61591 ............. A Infratemporal approach/skull .......................... 41.97 30.52 5.96 78.45 090 S

61592 ............. A Orbitocranial approach/skull ........................... 38.07 27.68 5.41 71.16 090 S

61595 ............. A Transtemporal approach/skull ........................ 28.12 20.44 4.00 52.56 090 S

61596 ............. A Transcochlear approach/skull ......................... 34.17 24.84 4.86 63.87 090 S

61597 ............. A Transcondylar approach/skull ......................... 36.12 26.26 5.13 67.51 090 S

61598 ............. A Transpetrosal approach/skull .......................... 31.83 23.13 4.52 59.48 090 S

61600 ............. A Resect/excise cranial lesion ........................... 24.41 17.74 3.46 45.61 090 S

61601 ............. A Resect/excise cranial lesion ........................... 26.16 19.03 3.72 48.91 090 S

61605 ............. A Resect/excise cranial lesion ........................... 27.62 20.09 3.93 51.64 090 S

61606 ............. A Resect/excise cranial lesion ........................... 37.00 26.90 5.25 69.15 090 S

61607 ............. A Resect/excise cranial lesion ........................... 34.56 25.13 4.91 64.60 090 S

61608 ............. A Resect/excise cranial lesion ........................... 40.21 29.24 5.71 75.16 090 S

61609 ............. A Transect, artery, sinus .................................... 9.89 7.19 1.40 18.48 ZZZ S

61610 ............. A Transect, artery, sinus .................................... 29.67 21.57 4.21 55.45 ZZZ S

61611 ............. A Transect, artery, sinus .................................... 7.42 5.39 1.06 13.87 ZZZ S

61612 ............. A Transect, artery, sinus .................................... 27.88 20.27 3.96 52.11 ZZZ S

61613 ............. A Remove aneurysm, sinus ............................... 39.43 28.67 5.61 73.71 090 S
63254

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

61615 ............. A Resect/excise lesion, skull .............................. 30.36 22.07 4.31 56.74 090 S

61616 ............. A Resect/excise lesion, skull .............................. 41.29 30.03 5.86 77.18 090 S

61618 ............. A Repair dura ..................................................... 15.62 11.35 2.22 29.19 090 S

61619 ............. A Repair dura ..................................................... 19.52 14.19 2.77 36.48 090 S

61624 ............. A Occlusion/embolization cath ........................... 20.15 15.28 1.79 37.22 000 N

61626 ............. A Occlusion/embolization cath ........................... 16.62 12.60 1.47 30.69 000 N

61680 ............. A Intracranial vessel surgery .............................. 36.45 31.06 5.79 73.30 090 S

61682 ............. A Intracranial vessel surgery .............................. 42.21 35.31 6.36 83.88 090 S

61684 ............. A Intracranial vessel surgery .............................. 39.25 29.76 3.47 72.48 090 S

61686 ............. A Intracranial vessel surgery .............................. 47.45 35.98 4.20 87.63 090 S

61690 ............. A Intracranial vessel surgery .............................. 33.82 27.46 4.09 65.37 090 S

61692 ............. A Intracranial vessel surgery .............................. 37.96 28.79 3.36 70.11 090 S

61700 ............. A Inner skull vessel surgery ............................... 34.83 31.69 5.67 72.19 090 S

61702 ............. A Inner skull vessel surgery ............................... 39.20 36.31 6.61 82.12 090 S

61703 ............. A Clamp neck artery .......................................... 16.27 12.21 2.24 30.72 090 S

61705 ............. A Revise circulation to head .............................. 34.49 30.41 5.25 70.15 090 S

61708 ............. A Revise circulation to head .............................. 33.59 25.20 2.32 61.11 090 S

61710 ............. A Revise circulation to head .............................. 28.14 16.63 1.75 46.52 090 S

61711 ............. A Fusion of skull arteries ................................... 34.62 33.04 6.20 73.86 090 S

61712 ............. A Skull or spine microsurgery ............................ 3.49 *4.47 0.93 8.89 ZZZ S

61720 ............. A Incise skull/brain surgery ................................ 15.85 *20.29 4.05 40.19 090 S

61735 ............. A Incise skull/brain surgery ................................ 17.08 12.96 1.51 31.55 090 S

61750 ............. A Incise skull; brain biopsy ................................ 10.03 *13.54 4.31 27.88 090 S

61751 ............. A Brain biopsy with cat scan .............................. 15.18 *19.43 4.44 39.05 090 S

61760 ............. A Implant brain electrodes ................................. 24.83 14.98 1.75 41.56 090 S

61770 ............. A Incise skull for treatment ................................ 15.14 *19.38 3.43 37.95 090 S

61790 ............. A Treat trigeminal nerve ..................................... 10.31 *13.19 3.03 26.53 090 S

61791 ............. A Treat trigeminal tract ....................................... 7.29 *9.77 3.16 20.22 090 S

61793 ............. A Focus radiation beam ..................................... 16.70 21.35 1.96 40.01 090 S

61795 ............. A Brain surgery using computer ......................... 4.04 *5.24 1.55 10.83 000 S

61850 ............. A Implant neuroelectrodes ................................. 15.98 11.63 2.26 29.87 090 S

61855 ............. A Implant neuroelectrodes ................................. 12.94 10.39 1.47 24.80 090 S

61860 ............. A Implant neuroelectrodes ................................. 11.20 8.14 1.59 20.93 090 S

61865 ............. A Implant neuroelectrodes ................................. 21.70 15.78 3.09 40.57 090 S

61870 ............. A Implant neuroelectrodes ................................. 5.77 4.19 0.82 10.78 090 S

61875 ............. A Implant neuroelectrodes ................................. 9.20 6.69 1.31 17.20 090 S

61880 ............. A Revise/remove neuroelectrode ....................... 5.72 4.79 0.66 11.17 090 S

61885 ............. A Implant neuroreceiver ..................................... 2.35 1.96 0.29 4.60 090 S

61888 ............. A Revise/remove neuroreceiver ......................... 3.10 2.25 0.44 5.79 010 S

62000 ............. A Repair of skull fracture ................................... 11.26 5.73 0.95 17.94 090 S

62005 ............. A Repair of skull fracture ................................... 14.84 11.08 1.97 27.89 090 S

62010 ............. A Treatment of head injury ................................ 18.43 19.20 3.39 41.02 090 S

62100 ............. A Repair brain fluid leakage ............................... 20.78 21.62 3.72 46.12 090 S

62115 ............. A Reduction of skull defect ................................ 20.50 15.51 1.82 37.83 090 S

62116 ............. A Reduction of skull defect ................................ 22.45 16.98 1.99 41.42 090 S

62117 ............. A Reduction of skull defect ................................ 25.38 19.20 2.25 46.83 090 S

62120 ............. A Repair skull cavity lesion ................................ 22.34 16.90 1.98 41.22 090 S

62121 ............. A Incise skull repair ............................................ 20.25 17.51 3.41 41.17 090 S

62140 ............. A Repair of skull defect ...................................... 12.63 13.43 2.39 28.45 090 S

62141 ............. A Repair of skull defect ...................................... 13.90 17.73 3.28 34.91 090 S

62142 ............. A Remove skull plate/flap .................................. 9.91 *12.69 2.64 25.24 090 S

62143 ............. A Replace skull plate/flap ................................... 12.11 9.17 1.65 22.93 090 S

62145 ............. A Repair of skull & brain .................................... 17.68 13.16 2.29 33.13 090 S

62146 ............. A Repair of skull with graft ................................. 15.11 10.99 2.15 28.25 090 S

62147 ............. A Repair of skull with graft ................................. 18.14 13.17 2.57 33.88 090 S

62180 ............. A Establish brain cavity shunt ............................ 12.72 14.21 2.70 29.63 090 S

62190 ............. A Establish brain cavity shunt ............................ 10.13 *12.97 3.21 26.31 090 S

62192 ............. A Establish brain cavity shunt ............................ 11.31 *14.48 2.74 28.53 090 S

62194 ............. A Replace/irrigate catheter ................................. 2.81 1.88 0.29 4.98 010 N

62200 ............. A Establish brain cavity shunt ............................ 13.24 *16.95 3.09 33.28 090 S

62201 ............. A Establish brain cavity shunt ............................ 12.10 8.78 1.72 22.60 090 S

62220 ............. A Establish brain cavity shunt ............................ 12.06 *15.43 3.12 30.61 090 S

62223 ............. A Establish brain cavity shunt ............................ 12.81 *16.40 3.02 32.23 090 S

62225 ............. A Replace/irrigate catheter ................................. 4.71 4.80 0.58 10.09 090 S

62230 ............. A Replace/revise brain shunt ............................. 9.71 9.83 1.82 21.36 090 S

62256 ............. A Remove brain cavity shunt ............................. 5.90 6.38 1.17 13.45 090 S
63255

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

62258 ............. A Replace brain cavity shunt ............................. 13.60 14.78 2.55 30.93 090 S

62268 ............. A Drain spinal cord cyst ..................................... 3.87 2.98 0.36 7.21 000 N

62269 ............. A Needle biopsy spinal cord .............................. 4.07 1.75 0.28 6.10 000 N

62270 ............. A Spinal fluid tap, diagnostic .............................. 1.13 0.71 0.06 1.90 000 N

62272 ............. A Drain spinal fluid ............................................. 1.35 1.01 0.12 2.48 000 N

62273 ............. A Treat lumbar spine lesion ............................... 2.15 1.12 0.26 3.53 000 N

62274 ............. A Inject spinal anesthetic ................................... 1.78 0.74 0.17 2.69 000 N

62275 ............. A Inject spinal anesthetic ................................... 1.79 0.59 0.19 2.57 000 N

62276 ............. A Inject spinal anesthetic ................................... 2.04 1.23 0.23 3.50 000 N

62277 ............. A Inject spinal anesthetic ................................... 2.15 0.84 0.23 3.22 000 N

62278 ............. A Inject spinal anesthetic ................................... 1.51 0.98 0.26 2.75 000 N

62279 ............. A Inject spinal anesthetic ................................... 1.58 0.82 0.24 2.64 000 N

62280 ............. A Treat spinal cord lesion .................................. 2.58 0.71 0.14 3.43 010 N

62281 ............. A Treat spinal cord lesion .................................. 2.61 0.87 0.28 3.76 010 N

62282 ............. A Treat spinal canal lesion ................................. 2.28 1.70 0.40 4.38 010 N

62284 ............. A Injection for myelogram .................................. 1.54 *1.98 0.34 3.86 000 S

62287 ............. A Percutaneous diskectomy ............................... 4.13 *6.96 2.65 13.74 090 S

62288 ............. A Injection into spinal canal ............................... 1.74 1.12 0.24 3.10 000 N

62289 ............. A Injection into spinal canal ............................... 1.64 1.07 0.29 3.00 000 N

62290 ............. A Inject for spine disk x-ray ............................... 3.58 1.86 0.24 5.68 000 N

62291 ............. A Inject for spine disk x-ray ............................... 2.91 1.78 0.39 5.08 000 N

62292 ............. A Injection into disk lesion ................................. 7.00 *8.96 2.13 18.09 090 S

62294 ............. A Injection into spinal artery ............................... 8.05 5.84 0.68 14.57 090 S

62298 ............. A Injection into spinal canal ............................... 2.20 1.04 0.13 3.37 000 N

62350 ............. A Implant spinal catheter ................................... 6.25 3.49 1.02 10.76 090 S

62351 ............. A Implant spinal catheter ................................... 9.25 5.16 1.50 15.91 090 S

62355 ............. A Remove spinal canal catheter ........................ 4.80 3.49 0.68 8.97 090 S

62360 ............. A Insert spine infusion device ............................ 2.00 1.12 0.33 3.45 090 S

62361 ............. A Implant spine infusion pump ........................... 4.80 2.68 0.78 8.26 090 S

62362 ............. A Implant spine infusion pump ........................... 6.29 3.51 1.02 10.82 090 S

62365 ............. A Remove spine infusion device ........................ 4.77 3.47 0.68 8.92 090 S

62367 ............. C Analyze spine infusion pump .......................... 0.00 0.00 0.00 0.00 XXX N

62367 26 A Analyze spine infusion pump .......................... 0.48 0.35 0.07 0.90 XXX N

62367 TC C Analyze spine infusion pump .......................... 0.00 0.00 0.00 0.00 XXX N

62368 ............. C Analyze spine infusion pump .......................... 0.00 0.00 0.00 0.00 XXX N

62368 26 A Analyze spine infusion pump .......................... 0.75 0.55 0.11 1.41 XXX N

62368 TC C Analyze spine infusion pump .......................... 0.00 0.00 0.00 0.00 XXX N

63001 ............. A Removal of spinal lamina ............................... 14.50 *18.55 3.42 36.47 090 S

63003 ............. A Removal of spinal lamina ............................... 14.63 17.93 3.23 35.79 090 S

63005 ............. A Removal of spinal lamina ............................... 13.53 *17.32 3.10 33.95 090 S

63011 ............. A Removal of spinal lamina ............................... 11.11 9.99 1.87 22.97 090 S

63012 ............. A Removal of spinal lamina ............................... 14.21 18.07 3.15 35.43 090 S

63015 ............. A Removal of spinal lamina ............................... 16.59 *21.23 4.18 42.00 090 S

63016 ............. A Removal of spinal lamina ............................... 17.43 *22.30 4.11 43.84 090 S

63017 ............. A Removal of spinal lamina ............................... 15.85 *20.29 4.00 40.14 090 S

63020 ............. A Neck spine disk surgery ................................. 12.53 *16.04 3.38 31.95 090 S

63030 ............. A Low back disk surgery .................................... 12.11 *15.50 2.81 30.42 090 S

63035 ............. A Added spinal disk surgery .............................. 3.15 *4.04 0.76 7.95 ZZZ S

63040 ............. A Neck spine disk surgery ................................. 17.56 *22.48 4.30 44.34 090 S

63042 ............. A Low back disk surgery .................................... 17.27 *22.10 4.38 43.75 090 S

63045 ............. A Removal of spinal lamina ............................... 15.31 *19.59 4.38 39.28 090 S

63046 ............. A Removal of spinal lamina ............................... 14.61 *18.70 4.58 37.89 090 S

63047 ............. A Removal of spinal lamina ............................... 12.76 *16.33 4.48 33.57 090 S

63048 ............. A Removal of spinal lamina ............................... 3.26 *4.17 1.03 8.46 ZZZ S

63055 ............. A Decompress spinal cord ................................. 20.67 23.73 4.18 48.58 090 S

63056 ............. A Decompress spinal cord ................................. 19.11 21.84 3.76 44.71 090 S

63057 ............. A Decompress spinal cord ................................. 3.00 *3.84 0.85 7.69 ZZZ S

63064 ............. A Decompress spinal cord ................................. 23.23 23.83 4.09 51.15 090 S

63066 ............. A Decompress spinal cord ................................. 3.26 2.48 0.45 6.19 ZZZ S

63075 ............. A Neck spine disk surgery ................................. 19.77 17.57 3.21 40.55 090 S

63076 ............. A Neck spine disk surgery ................................. 4.05 *5.19 0.97 10.21 ZZZ S

63077 ............. A Spine disk surgery, thorax .............................. 20.25 18.42 3.17 41.84 090 S

63078 ............. A Spine disk surgery, thorax .............................. 3.28 2.61 0.45 6.34 ZZZ S

63081 ............. A Removal of vertebral body ............................. 22.08 26.26 4.50 52.84 090 S

63082 ............. A Removal of vertebral body ............................. 4.37 *5.60 1.22 11.19 ZZZ S

63085 ............. A Removal of vertebral body ............................. 25.07 27.39 4.69 57.15 090 S
63256

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

63086 ............. A Removal of vertebral body ............................. 3.19 *4.08 1.07 8.34 ZZZ S

63087 ............. A Removal of vertebral body ............................. 27.56 28.25 4.85 60.66 090 S

63088 ............. A Removal of vertebral body ............................. 4.33 *5.55 1.18 11.06 ZZZ S

63090 ............. A Removal of vertebral body ............................. 26.20 29.22 4.92 60.34 090 S

63091 ............. A Removal of vertebral body ............................. 3.03 2.73 0.46 6.22 ZZZ S

63170 ............. A Incise spinal cord tract(s) ............................... 18.18 18.88 3.28 40.34 090 S

63172 ............. A Drainage of spinal cyst ................................... 16.19 *20.72 4.26 41.17 090 S

63173 ............. A Drainage of spinal cyst ................................... 20.40 15.47 1.81 37.68 090 S

63180 ............. A Revise spinal cord ligaments .......................... 16.75 11.61 2.05 30.41 090 S

63182 ............. A Revise spinal cord ligaments .......................... 18.91 16.44 2.21 37.56 090 S

63185 ............. A Incise spinal column/nerves ........................... 13.85 15.55 2.93 32.33 090 S

63190 ............. A Incise spinal column/nerves ........................... 16.26 *20.81 3.91 40.98 090 S

63191 ............. A Incise spinal column/nerves ........................... 16.42 13.04 2.21 31.67 090 S

63194 ............. A Incise spinal column & cord ........................... 17.53 13.02 2.33 32.88 090 S

63195 ............. A Incise spinal column & cord ........................... 17.16 13.86 2.11 33.13 090 S

63196 ............. A Incise spinal column & cord ........................... 20.57 15.59 1.83 37.99 090 S

63197 ............. A Incise spinal column & cord ........................... 19.38 14.36 2.62 36.36 090 S

63198 ............. A Incise spinal column & cord ........................... 22.45 16.32 3.19 41.96 090 S

63199 ............. A Incise spinal column & cord ........................... 23.89 21.40 2.61 47.90 090 S

63200 ............. A Release of spinal cord .................................... 17.66 12.49 1.83 31.98 090 S

63250 ............. A Revise spinal cord vessels ............................. 38.67 27.99 5.22 71.88 090 S

63251 ............. A Revise spinal cord vessels ............................. 38.86 22.74 4.32 65.92 090 S

63252 ............. A Revise spinal cord vessels ............................. 38.85 28.25 5.52 72.62 090 S

63265 ............. A Excise intraspinal lesion ................................. 20.04 22.01 3.90 45.95 090 S

63266 ............. A Excise intraspinal lesion ................................. 20.65 24.76 4.43 49.84 090 S

63267 ............. A Excise intraspinal lesion ................................. 16.70 *21.38 4.20 42.28 090 S

63268 ............. A Excise intraspinal lesion ................................. 17.27 12.56 2.46 32.29 090 S

63270 ............. A Excise intraspinal lesion ................................. 24.84 18.14 3.42 46.40 090 S

63271 ............. A Excise intraspinal lesion ................................. 24.96 26.60 4.79 56.35 090 S

63272 ............. A Excise intraspinal lesion ................................. 23.69 23.15 4.26 51.10 090 S

63273 ............. A Excise intraspinal lesion ................................. 22.66 17.56 3.12 43.34 090 S

63275 ............. A Biopsy/excise spinal tumor ............................. 22.05 27.82 5.09 54.96 090 S

63276 ............. A Biopsy/excise spinal tumor ............................. 21.76 25.31 4.62 51.69 090 S

63277 ............. A Biopsy/excise spinal tumor ............................. 19.51 23.75 4.25 47.51 090 S

63278 ............. A Biopsy/excise spinal tumor ............................. 19.24 23.34 4.32 46.90 090 S

63280 ............. A Biopsy/excise spinal tumor ............................. 26.72 28.08 4.99 59.79 090 S

63281 ............. A Biopsy/excise spinal tumor ............................. 26.42 27.67 4.96 59.05 090 S

63282 ............. A Biopsy/excise spinal tumor ............................. 24.96 24.11 4.44 53.51 090 S

63283 ............. A Biopsy/excise spinal tumor ............................. 23.57 18.77 3.44 45.78 090 S

63285 ............. A Biopsy/excise spinal tumor ............................. 34.24 24.49 4.49 63.22 090 S

63286 ............. A Biopsy/excise spinal tumor ............................. 33.94 28.76 4.92 67.62 090 S

63287 ............. A Biopsy/excise spinal tumor ............................. 34.43 25.72 4.53 64.68 090 S

63290 ............. A Biopsy/excise spinal tumor ............................. 35.04 27.16 4.65 66.85 090 S

63300 ............. A Removal of vertebral body ............................. 22.78 17.27 2.02 42.07 090 S

63301 ............. A Removal of vertebral body ............................. 25.08 18.45 3.58 47.11 090 S

63302 ............. A Removal of vertebral body ............................. 25.60 21.36 3.02 49.98 090 S

63303 ............. A Removal of vertebral body ............................. 28.47 18.50 3.39 50.36 090 S

63304 ............. A Removal of vertebral body ............................. 28.10 21.31 2.49 51.90 090 S

63305 ............. A Removal of vertebral body ............................. 29.42 22.49 3.75 55.66 090 S

63306 ............. A Removal of vertebral body ............................. 30.01 22.76 2.65 55.42 090 S

63307 ............. A Removal of vertebral body ............................. 29.42 24.42 2.98 56.82 090 S

63308 ............. A Removal of vertebral body ............................. 5.25 4.05 0.73 10.03 ZZZ S

63600 ............. A Remove spinal cord lesion ............................. 13.08 10.70 2.63 26.41 090 N

63610 ............. A Stimulation of spinal cord ............................... 8.73 6.73 2.06 17.52 000 N

63615 ............. A Remove lesion of spinal cord ......................... 15.40 11.55 2.03 28.98 090 S

63650 ............. A Implant neuroelectrodes ................................. 5.99 *7.67 2.13 15.79 090 S

63655 ............. A Implant neuroelectrodes ................................. 8.95 *11.93 3.64 24.52 090 S

63660 ............. A Revise/remove neuroelectrode ....................... 5.54 *7.09 1.56 14.19 090 S

63685 ............. A Implant neuroreceiver ..................................... 6.29 7.40 1.46 15.15 090 S

63688 ............. A Revise/remove neuroreceiver ......................... 4.77 *6.10 1.26 12.13 090 S

63690 ............. A Analysis of neuroreceiver ............................... 0.45 *0.58 0.12 1.15 XXX N

63691 ............. A Analysis of neuroreceiver ............................... 0.65 0.41 0.11 1.17 XXX N

63700 ............. A Repair of spinal herniation .............................. 15.62 11.35 2.22 29.19 090 S

63702 ............. A Repair of spinal herniation .............................. 17.57 12.78 2.49 32.84 090 S

63704 ............. A Repair of spinal herniation .............................. 19.52 14.19 2.77 36.48 090 S

63706 ............. A Repair of spinal herniation .............................. 22.45 16.33 3.18 41.96 090 S
63257

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

63707 ............. A Repair spinal fluid leakage ............................. 10.14 *12.98 2.56 25.68 090 S

63709 ............. A Repair spinal fluid leakage ............................. 13.26 *16.97 3.30 33.53 090 S

63710 ............. A Graft repair of spine defect ............................. 13.01 9.75 1.58 24.34 090 S

63740 ............. A Install spinal shunt .......................................... 10.43 *13.35 2.99 26.77 090 S

63741 ............. A Install spinal shunt .......................................... 7.13 *9.13 2.39 18.65 090 S

63744 ............. A Revision of spinal shunt ................................. 6.83 8.15 1.68 16.66 090 S

63746 ............. A Removal of spinal shunt ................................. 5.60 5.52 1.08 12.20 090 S

63750 ............. D Insert spinal canal catheter ............................ 0.00 0.00 0.00 0.00 090 S

63780 ............. D Insert spinal canal catheter ............................ 0.00 0.00 0.00 0.00 090 N

64400 ............. A Injection for nerve block ................................. 1.11 0.48 0.05 1.64 000 N

64402 ............. A Injection for nerve block ................................. 1.25 0.62 0.09 1.96 000 S

64405 ............. A Injection for nerve block ................................. 1.32 0.64 0.07 2.03 000 N

64408 ............. A Injection for nerve block ................................. 1.41 1.04 0.11 2.56 000 N

64410 ............. A Injection for nerve block ................................. 1.43 0.71 0.15 2.29 000 N

64412 ............. A Injection for nerve block ................................. 1.18 0.62 0.08 1.88 000 N

64413 ............. A Injection for nerve block ................................. 1.40 0.74 0.08 2.22 000 N

64415 ............. A Injection for nerve block ................................. 1.48 0.26 0.07 1.81 000 N

64417 ............. A Injection for nerve block ................................. 1.44 0.63 0.15 2.22 000 N

64418 ............. A Injection for nerve block ................................. 1.32 0.85 0.10 2.27 000 N

64420 ............. A Injection for nerve block ................................. 1.18 0.64 0.07 1.89 000 N

64421 ............. A Injection for nerve block ................................. 1.68 0.83 0.17 2.68 000 N

64425 ............. A Injection for nerve block ................................. 1.75 0.57 0.10 2.42 000 N

64430 ............. A Injection for nerve block ................................. 1.46 0.70 0.12 2.28 000 S

64435 ............. A Injection for nerve block ................................. 1.45 0.47 0.09 2.01 000 S

64440 ............. A Injection for nerve block ................................. 1.34 0.79 0.09 2.22 000 N

64441 ............. A Injection for nerve block ................................. 1.79 1.01 0.12 2.92 000 N

64442 ............. A Injection for nerve block ................................. 1.41 1.19 0.16 2.76 000 N

64443 ............. A Injection for nerve block ................................. 1.35 0.63 0.12 2.10 ZZZ N

64445 ............. A Injection for nerve block ................................. 1.48 0.49 0.06 2.03 000 N

64450 ............. A Injection for nerve block ................................. 1.27 0.53 0.05 1.85 000 S

64505 ............. A Injection for nerve block ................................. 1.36 0.62 0.06 2.04 000 N

64508 ............. A Injection for nerve block ................................. 1.12 1.04 0.08 2.24 000 N

64510 ............. A Injection for nerve block ................................. 1.22 0.71 0.18 2.11 000 N

64520 ............. A Injection for nerve block ................................. 1.35 0.72 0.17 2.24 000 N

64530 ............. A Injection for nerve block ................................. 1.58 1.17 0.28 3.03 000 N

64550 ............. A Apply neurostimulator ..................................... 0.18 0.44 0.04 0.66 000 N

64553 ............. A Implant neuroelectrodes ................................. 2.26 1.02 0.10 3.38 010 N

64555 ............. A Implant neuroelectrodes ................................. 2.22 0.42 0.10 2.74 010 N

64560 ............. A Implant neuroelectrodes ................................. 2.31 1.45 0.24 4.00 010 S

64565 ............. A Implant neuroelectrodes ................................. 1.71 0.76 0.08 2.55 010 N

64573 ............. A Implant neuroelectrodes ................................. 4.35 3.16 0.61 8.12 090 S

64575 ............. A Implant neuroelectrodes ................................. 4.27 3.07 0.40 7.74 090 S

64577 ............. A Implant neuroelectrodes ................................. 4.54 2.76 0.45 7.75 090 S

64580 ............. A Implant neuroelectrodes ................................. 4.04 2.91 0.20 7.15 090 S

64585 ............. A Revise/remove neuroelectrode ....................... 2.01 0.97 0.09 3.07 010 S

64590 ............. A Implant neuroreceiver ..................................... 2.35 1.84 0.35 4.54 010 S

64595 ............. A Revise/remove neuroreceiver ......................... 1.68 1.12 0.21 3.01 010 S

64600 ............. A Injection treatment of nerve ............................ 3.40 1.69 0.17 5.26 010 N

64605 ............. A Injection treatment of nerve ............................ 5.56 1.56 0.33 7.45 010 N

64610 ............. A Injection treatment of nerve ............................ 7.11 7.26 1.35 15.72 010 N

64612 ............. A Destroy nerve, face muscle ............................ 1.91 1.45 0.17 3.53 010 S

64613 ............. A Destroy nerve, spine muscle .......................... 1.91 1.45 0.17 3.53 010 S

64620 ............. A Injection treatment of nerve ............................ 2.79 1.00 0.19 3.98 010 N

64622 ............. A Injection treatment of nerve ............................ 2.95 1.82 0.35 5.12 010 N

64623 ............. A Injection treatment of nerve ............................ 0.99 0.85 0.17 2.01 ZZZ N

64630 ............. A Injection treatment of nerve ............................ 2.95 1.74 0.38 5.07 010 N

64640 ............. A Injection treatment of nerve ............................ 2.49 0.92 0.09 3.50 010 N

64680 ............. A Injection treatment of nerve ............................ 2.57 1.55 0.41 4.53 010 N

64702 ............. A Revise finger/toe nerve ................................... 4.02 4.22 0.70 8.94 090 S

64704 ............. A Revise hand/foot nerve ................................... 4.44 5.38 0.74 10.56 090 S

64708 ............. A Revise arm/leg nerve ...................................... 5.71 *7.31 1.26 14.28 090 S

64712 ............. A Revision of sciatic nerve ................................. 7.18 *9.19 1.68 18.05 090 S

64713 ............. A Revision of arm nerve(s) ................................ 10.34 9.40 1.72 21.46 090 S

64714 ............. A Revise low back nerve(s) ............................... 9.87 6.13 1.41 17.41 090 S

64716 ............. A Revision of cranial nerve ................................ 5.80 4.83 0.67 11.30 090 S

64718 ............. A Revise ulnar nerve at elbow ........................... 5.48 6.72 1.13 13.33 090 S
63258

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

64719 ............. A Revise ulnar nerve at wrist ............................. 4.72 4.95 0.85 10.52 090 S

64721 ............. A Carpal tunnel surgery ..................................... 3.99 4.90 0.83 9.72 090 S

64722 ............. A Relieve pressure on nerve(s) ......................... 4.46 *5.71 1.11 11.28 090 S

64726 ............. A Release foot/toe nerve ................................... 3.97 0.72 0.07 4.76 090 S

64727 ............. A Internal nerve revision .................................... 3.10 3.24 0.55 6.89 ZZZ S

64732 ............. A Incision of brow nerve .................................... 4.15 4.31 0.72 9.18 090 S

64734 ............. A Incision of cheek nerve ................................... 4.62 4.61 0.67 9.90 090 S

64736 ............. A Incision of chin nerve ...................................... 4.40 4.46 0.42 9.28 090 S

64738 ............. A Incision of jaw nerve ....................................... 5.42 5.07 0.61 11.10 090 S

64740 ............. A Incision of tongue nerve ................................. 5.28 5.18 0.62 11.08 090 S

64742 ............. A Incision of facial nerve .................................... 5.91 5.00 0.44 11.35 090 S

64744 ............. A Incise nerve, back of head ............................. 4.87 6.10 1.10 12.07 090 S

64746 ............. A Incise diaphragm nerve .................................. 5.62 3.77 0.77 10.16 090 S

64752 ............. A Incision of vagus nerve ................................... 6.64 3.93 0.85 11.42 090 S

64755 ............. A Incision of stomach nerves ............................. 13.10 10.47 2.27 25.84 090 S

64760 ............. A Incision of vagus nerve ................................... 6.54 6.65 1.50 14.69 090 S

64761 ............. A Incision of pelvis nerve ................................... 6.10 4.66 0.50 11.26 090 S

64763 ............. A Incise hip/thigh nerve ...................................... 6.72 4.80 0.92 12.44 090 S

64766 ............. A Incise hip/thigh nerve ...................................... 8.31 6.67 1.20 16.18 090 S

64771 ............. A Sever cranial nerve ......................................... 6.99 6.42 0.73 14.14 090 S

64772 ............. A Incision of spinal nerve ................................... 6.79 6.77 1.30 14.86 090 S

64774 ............. A Remove skin nerve lesion .............................. 4.86 2.74 0.45 8.05 090 S

64776 ............. A Remove digit nerve lesion .............................. 4.86 2.78 0.41 8.05 090 S

64778 ............. A Added digit nerve surgery .............................. 3.11 2.73 0.43 6.27 ZZZ S

64782 ............. A Remove limb nerve lesion .............................. 5.81 4.70 0.46 10.97 090 S

64783 ............. A Added limb nerve surgery .............................. 3.72 3.26 0.47 7.45 ZZZ S

64784 ............. A Remove nerve lesion ...................................... 9.46 5.64 0.96 16.06 090 S

64786 ............. A Remove sciatic nerve lesion ........................... 15.10 12.66 2.14 29.90 090 S

64787 ............. A Implant nerve end ........................................... 4.30 3.47 0.60 8.37 ZZZ S

64788 ............. A Remove skin nerve lesion .............................. 4.30 3.63 0.50 8.43 090 S

64790 ............. A Removal of nerve lesion ................................. 10.95 7.11 1.22 19.28 090 S

64792 ............. A Removal of nerve lesion ................................. 14.40 8.99 1.66 25.05 090 S

64795 ............. A Biopsy of nerve ............................................... 3.01 2.38 0.39 5.78 000 S

64802 ............. A Remove sympathetic nerves .......................... 8.22 5.40 1.10 14.72 090 S

64804 ............. A Remove sympathetic nerves .......................... 13.65 12.77 2.44 28.86 090 S

64809 ............. A Remove sympathetic nerves .......................... 12.79 10.55 2.04 25.38 090 S

64818 ............. A Remove sympathetic nerves .......................... 9.42 8.57 1.72 19.71 090 S

64820 ............. A Remove sympathetic nerves .......................... 10.00 7.27 1.42 18.69 090 S

64830 ............. A Microrepair of nerve ........................................ 3.10 2.01 0.38 5.49 ZZZ S

64831 ............. A Repair of digit nerve ....................................... 8.84 3.38 0.56 12.78 090 S

64832 ............. A Repair additional nerve ................................... 5.66 1.40 0.24 7.30 ZZZ S

64834 ............. A Repair of hand or foot nerve .......................... 9.77 3.50 0.56 13.83 090 S

64835 ............. A Repair of hand or foot nerve .......................... 10.47 5.96 1.03 17.46 090 S

64836 ............. A Repair of hand or foot nerve .......................... 10.47 6.70 1.22 18.39 090 S

64837 ............. A Repair additional nerve ................................... 6.26 4.45 0.85 11.56 ZZZ S

64840 ............. A Repair of leg nerve ......................................... 12.43 10.35 0.53 23.31 090 S

64856 ............. A Repair/transpose nerve .................................. 12.81 8.21 1.46 22.48 090 S

64857 ............. A Repair arm/leg nerve ...................................... 13.43 9.53 1.54 24.50 090 S

64858 ............. A Repair sciatic nerve ........................................ 15.43 10.98 2.11 28.52 090 S

64859 ............. A Additional nerve surgery ................................. 4.26 3.50 0.58 8.34 ZZZ S

64861 ............. A Repair of arm nerves ...................................... 17.94 13.42 1.38 32.74 090 S

64862 ............. A Repair of low back nerves .............................. 18.14 21.56 1.61 41.31 090 S

64864 ............. A Repair of facial nerve ..................................... 11.87 7.86 1.16 20.89 090 S

64865 ............. A Repair of facial nerve ..................................... 14.70 12.34 1.50 28.54 090 S

64866 ............. A Fusion of facial/other nerve ............................ 14.94 11.19 1.84 27.97 090 S

64868 ............. A Fusion of facial/other nerve ............................ 13.36 11.19 1.47 26.02 090 S

64870 ............. A Fusion of facial/other nerve ............................ 15.19 13.91 1.70 30.80 090 S

64872 ............. A Subsequent repair of nerve ............................ 1.99 1.44 0.29 3.72 ZZZ S

64874 ............. A Repair & revise nerve ..................................... 2.98 2.17 0.43 5.58 ZZZ S

64876 ............. A Repair nerve; shorten bone ............................ 3.38 2.46 0.48 6.32 ZZZ N

64885 ............. A Nerve graft, head or neck ............................... 16.73 12.69 1.48 30.90 090 S

64886 ............. A Nerve graft, head or neck ............................... 19.95 15.13 1.77 36.85 090 S

64890 ............. A Nerve graft, hand or foot ................................ 14.35 12.26 2.12 28.73 090 S

64891 ............. A Nerve graft, hand or foot ................................ 15.21 10.42 1.73 27.36 090 S

64892 ............. A Nerve graft, arm or leg ................................... 13.85 11.04 1.69 26.58 090 S

64893 ............. A Nerve graft, arm or leg ................................... 14.61 13.93 2.27 30.81 090 S
63259

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

64895 ............. A Nerve graft, hand or foot ................................ 18.39 13.16 2.55 34.10 090 S

64896 ............. A Nerve graft, hand or foot ................................ 19.38 17.53 1.90 38.81 090 S

64897 ............. A Nerve graft, arm or leg ................................... 17.38 12.63 2.47 32.48 090 S

64898 ............. A Nerve graft, arm or leg ................................... 18.39 14.40 2.35 35.14 090 S

64901 ............. A Additional nerve graft ...................................... 10.22 10.16 0.87 21.25 ZZZ S

64902 ............. A Additional nerve graft ...................................... 11.83 11.92 0.99 24.74 ZZZ S

64905 ............. A Nerve pedicle transfer .................................... 13.22 9.40 0.70 23.32 090 S

64907 ............. A Nerve pedicle transfer .................................... 17.90 13.02 2.55 33.47 090 S

64999 ............. C Nervous system surgery ................................. 0.00 0.00 0.00 0.00 YYY N

65091 ............. A Revise eye ...................................................... 6.10 *7.81 0.45 14.36 090 S

65093 ............. A Revise eye with implant .................................. 6.47 *8.28 0.52 15.27 090 S

65101 ............. A Removal of eye ............................................... 6.52 *8.35 0.47 15.34 090 S

65103 ............. A Remove eye/insert implant ............................. 7.06 *9.04 0.50 16.60 090 S

65105 ............. A Remove eye/attach implant ............................ 7.82 *10.01 0.55 18.38 090 S

65110 ............. A Removal of eye ............................................... 13.18 15.99 1.14 30.31 090 S

65112 ............. A Remove eye, revise socket ............................ 15.44 12.16 1.09 28.69 090 S

65114 ............. A Remove eye, revise socket ............................ 16.59 13.07 1.65 31.31 090 S

65125 ............. A Revise ocular implant ..................................... 2.97 2.47 0.13 5.57 090 S

65130 ............. A Insert ocular implant ....................................... 6.75 *8.64 0.50 15.89 090 S

65135 ............. A Insert ocular implant ....................................... 6.93 5.42 0.35 12.70 090 S

65140 ............. A Attach ocular implant ...................................... 7.46 6.22 0.33 14.01 090 S

65150 ............. A Revise ocular implant ..................................... 5.97 *7.64 0.56 14.17 090 S

65155 ............. A Reinsert ocular implant ................................... 8.21 *10.50 0.90 19.61 090 S

65175 ............. A Removal of ocular implant .............................. 5.93 7.49 0.40 13.82 090 S

65205 ............. A Remove foreign body from eye ...................... 0.78 0.37 0.02 1.17 000 S

65210 ............. A Remove foreign body from eye ...................... 0.84 0.46 0.03 1.33 000 S

65220 ............. A Remove foreign body from eye ...................... 0.71 0.52 0.04 1.27 000 N

65222 ............. A Remove foreign body from eye ...................... 0.93 0.57 0.03 1.53 000 S

65235 ............. A Remove foreign body from eye ...................... 7.12 5.61 0.30 13.03 090 S

65260 ............. A Remove foreign body from eye ...................... 10.35 8.63 0.45 19.43 090 S

65265 ............. A Remove foreign body from eye ...................... 12.04 10.04 0.51 22.59 090 S

65270 ............. A Repair of eye wound ...................................... 1.85 1.17 0.07 3.09 010 S

65272 ............. A Repair of eye wound ...................................... 3.57 1.64 0.10 5.31 090 S

65273 ............. A Repair of eye wound ...................................... 3.89 3.22 0.21 7.32 090 S

65275 ............. A Repair of eye wound ...................................... 5.04 0.66 0.04 5.74 090 S

65280 ............. A Repair of eye wound ...................................... 7.10 *9.09 0.49 16.68 090 S

65285 ............. A Repair of eye wound ...................................... 12.06 12.26 0.64 24.96 090 S

65286 ............. A Repair of eye wound ...................................... 5.16 4.79 0.25 10.20 090 S

65290 ............. A Repair of eye socket wound ........................... 5.06 6.20 0.37 11.63 090 S

65400 ............. A Removal of eye lesion .................................... 5.61 6.46 0.35 12.42 090 S

65410 ............. A Biopsy of cornea ............................................. 1.47 1.59 0.11 3.17 000 S

65420 ............. A Removal of eye lesion .................................... 3.97 4.28 0.23 8.48 090 S

65426 ............. A Removal of eye lesion .................................... 5.05 *6.47 0.38 11.90 090 S

65430 ............. A Corneal smear ................................................ 0.87 0.54 0.03 1.44 000 S

65435 ............. A Curette/treat cornea ........................................ 0.92 0.77 0.04 1.73 000 S

65436 ............. A Curette/treat cornea ........................................ 3.99 1.53 0.08 5.60 090 S

65450 ............. A Treatment of corneal lesion ............................ 3.07 3.28 0.17 6.52 090 S

65600 ............. A Revision of cornea .......................................... 3.15 2.62 0.14 5.91 090 S

65710 ............. A Corneal transplant .......................................... 9.52 *12.44 1.13 23.09 090 S

65730 ............. A Corneal transplant .......................................... 11.83 *15.14 1.29 28.26 090 S

65750 ............. A Corneal transplant .......................................... 12.58 *16.10 1.33 30.01 090 S

65755 ............. A Corneal transplant .......................................... 12.58 *16.10 1.39 30.07 090 S

65760 ............. N Revision of cornea .......................................... 0.00 0.00 0.00 0.00 XXX 0

65765 ............. N Revision of cornea .......................................... 0.00 0.00 0.00 0.00 XXX 0

65767 ............. N Corneal tissue transplant ................................ 0.00 0.00 0.00 0.00 XXX 0

65770 ............. A Revise cornea with implant ............................ 16.56 13.81 0.71 31.08 090 S

65771 ............. N Radial keratotomy ........................................... 0.00 0.00 0.00 0.00 XXX 0

65772 ............. A Correction of astigmatism ............................... 4.04 *5.16 0.31 9.51 090 S

65775 ............. A Correction of astigmatism ............................... 5.44 *6.96 0.50 12.90 090 S

65800 ............. A Drainage of eye .............................................. 1.91 1.72 0.10 3.73 000 S

65805 ............. A Drainage of eye .............................................. 1.91 1.81 0.10 3.82 000 S

65810 ............. A Drainage of eye .............................................. 4.57 5.45 0.30 10.32 090 S

65815 ............. A Drainage of eye .............................................. 4.75 4.49 0.24 9.48 090 S

65820 ............. A Relieve inner eye pressure ............................. 7.60 9.54 0.51 17.65 090 S

65850 ............. A Incision of eye ................................................. 10.18 *13.03 0.69 23.90 090 S

65855 ............. A Laser surgery of eye ....................................... 4.65 *6.01 0.52 11.18 090 S
63260

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

65860 ............. A Incise inner eye adhesions ............................. 3.37 *4.31 0.37 8.05 090 S

65865 ............. A Incise inner eye adhesions ............................. 5.42 *6.93 0.41 12.76 090 S

65870 ............. A Incise inner eye adhesions ............................. 5.92 5.86 0.31 12.09 090 S

65875 ............. A Incise inner eye adhesions ............................. 6.14 6.28 0.34 12.76 090 S

65880 ............. A Incise inner eye adhesions ............................. 6.69 6.85 0.37 13.91 090 S

65900 ............. A Remove eye lesion ......................................... 10.43 7.91 0.92 19.26 090 S

65920 ............. A Remove implant from eye ............................... 7.90 8.36 0.44 16.70 090 S

65930 ............. A Remove blood clot from eye .......................... 7.03 7.68 0.41 15.12 090 S

66020 ............. A Injection treatment of eye ............................... 1.54 *1.98 0.14 3.66 010 S

66030 ............. A Injection treatment of eye ............................... 1.20 0.54 0.03 1.77 010 S

66130 ............. A Remove eye lesion ......................................... 7.54 5.28 0.28 13.10 090 S

66150 ............. A Glaucoma surgery .......................................... 7.60 *9.72 0.59 17.91 090 S

66155 ............. A Glaucoma surgery .......................................... 7.48 *9.57 0.50 17.55 090 S

66160 ............. A Glaucoma surgery .......................................... 9.47 10.77 0.55 20.79 090 S

66165 ............. A Glaucoma surgery .......................................... 7.31 *9.36 0.57 17.24 090 S

66170 ............. A Glaucoma surgery .......................................... 11.31 12.15 0.63 24.09 090 S

66172 ............. A Incision of eye ................................................. 13.67 12.15 0.63 26.45 090 S

66180 ............. A Implant eye shunt ........................................... 12.63 *16.17 1.03 29.83 090 S

66185 ............. A Revise eye shunt ............................................ 7.69 *9.85 0.58 18.12 090 S

66220 ............. A Repair eye lesion ............................................ 7.32 5.95 0.34 13.61 090 S

66225 ............. A Repair/graft eye lesion .................................... 10.55 *13.51 0.86 24.92 090 S

66250 ............. A Follow-up surgery of eye ................................ 5.63 *7.20 0.38 13.21 090 S

66500 ............. A Incision of iris .................................................. 3.58 *4.58 0.27 8.43 090 S

66505 ............. A Incision of iris .................................................. 3.93 3.27 0.17 7.37 090 S

66600 ............. A Remove iris and lesion ................................... 8.23 9.36 0.51 18.10 090 S

66605 ............. A Removal of iris ................................................ 12.34 11.87 0.67 24.88 090 S

66625 ............. A Removal of iris ................................................ 4.95 *6.33 0.48 11.76 090 S

66630 ............. A Removal of iris ................................................ 5.81 *7.43 0.45 13.69 090 S

66635 ............. A Removal of iris ................................................ 5.90 *7.56 0.49 13.95 090 S

66680 ............. A Repair iris and ciliary body ............................. 5.14 6.42 0.35 11.91 090 S

66682 ............. A Repair iris and ciliary body ............................. 5.86 7.33 0.38 13.57 090 S

66700 ............. A Destruction, ciliary body ................................. 4.55 *5.83 0.35 10.73 090 S

66710 ............. A Destruction, ciliary body ................................. 4.55 *5.83 0.41 10.79 090 S

66720 ............. A Destruction, ciliary body ................................. 4.55 *5.83 0.38 10.76 090 S

66740 ............. A Destruction, ciliary body ................................. 4.55 *5.83 0.39 10.77 090 S

66761 ............. A Revision of iris ................................................ 3.77 *5.10 0.47 9.34 090 S

66762 ............. A Revision of iris ................................................ 4.33 *5.92 0.55 10.80 090 S

66770 ............. A Removal of inner eye lesion ........................... 4.88 *6.24 0.45 11.57 090 S

66820 ............. A Incision, secondary cataract ........................... 3.76 *4.81 0.29 8.86 090 S

66821 ............. A After cataract laser surgery ............................ 2.78 *3.81 0.37 6.96 090 S

66825 ............. A Reposition intraocular lens ............................. 7.73 7.33 0.38 15.44 090 S

66830 ............. A Removal of lens lesion ................................... 7.80 7.67 0.40 15.87 090 S

66840 ............. A Removal of lens material ................................ 7.51 *9.61 0.54 17.66 090 S

66850 ............. A Removal of lens material ................................ 8.66 *11.09 0.70 20.45 090 S

66852 ............. A Removal of lens material ................................ 9.52 *12.19 0.90 22.61 090 S

66920 ............. A Extraction of lens ............................................ 8.46 *10.82 0.60 19.88 090 S

66930 ............. A Extraction of lens ............................................ 9.73 10.49 0.57 20.79 090 S

66940 ............. A Extraction of lens ............................................ 8.48 *10.85 0.62 19.95 090 S

66983 ............. A Remove cataract, insert lens .......................... 8.54 *10.94 0.95 20.43 090 S

66984 ............. A Remove cataract, insert lens .......................... 9.89 *12.66 0.94 23.49 090 S

66985 ............. A Insert lens prosthesis ...................................... 7.89 *10.10 0.63 18.62 090 S

66986 ............. A Exchange lens prosthesis ............................... 11.78 12.20 0.63 24.61 090 S

66999 ............. C Eye surgery procedure ................................... 0.00 0.00 0.00 0.00 YYY S

67005 ............. A Partial removal of eye fluid ............................. 6.63 *10.28 1.13 18.04 090 S

67010 ............. A Partial removal of eye fluid ............................. 6.67 *9.98 1.04 17.69 090 S

67015 ............. A Release of eye fluid ........................................ 6.69 6.45 0.35 13.49 090 S

67025 ............. A Replace eye fluid ............................................ 6.44 6.75 0.36 13.55 090 S

67028 ............. A Injection eye drug ........................................... 2.52 *3.22 0.18 5.92 000 S

67030 ............. A Incise inner eye strands ................................. 4.44 *5.75 0.50 10.69 090 S

67031 ............. A Laser surgery, eye strands ............................. 3.42 *6.15 0.75 10.32 090 S

67036 ............. A Removal of inner eye fluid .............................. 11.33 *15.67 1.49 28.49 090 S

67038 ............. A Strip retinal membrane ................................... 20.20 *25.85 1.80 47.85 090 S

67039 ............. A Laser treatment of retina ................................ 13.60 *18.22 1.68 33.50 090 S

67040 ............. A Laser treatment of retina ................................ 16.26 *20.81 1.75 38.82 090 S

67101 ............. A Repair, detached retina .................................. 7.02 *8.99 0.66 16.67 090 S

67105 ............. A Repair, detached retina .................................. 7.06 *9.14 0.80 17.00 090 S
63261

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

67107 ............. A Repair, detached retina .................................. 13.99 *17.91 1.10 33.00 090 S

67108 ............. A Repair, detached retina .................................. 19.90 *25.47 1.76 47.13 090 S

67109 ............. D Repair, detached retina .................................. 0.00 0.00 0.00 0.00 090 S

67110 ............. A Repair, detached retina .................................. 8.14 *10.60 0.97 19.71 090 S

67112 ............. A Re-repair, detached retina .............................. 16.15 16.51 0.86 33.52 090 S

67115 ............. A Release, encircling material ........................... 4.64 *5.93 0.44 11.01 090 S

67120 ............. A Remove eye implant material ......................... 5.63 7.15 0.38 13.16 090 S

67121 ............. A Remove eye implant material ......................... 10.17 9.42 0.49 20.08 090 S

67141 ............. A Treatment of retina ......................................... 4.90 *6.27 0.48 11.65 090 S

67145 ............. A Treatment of retina ......................................... 5.07 *6.50 0.49 12.06 090 S

67208 ............. A Treatment of retinal lesion .............................. 6.40 *8.19 0.52 15.11 090 S

67210 ............. A Treatment of retinal lesion .............................. 9.48 9.02 0.47 18.97 090 S

67218 ............. A Treatment of retinal lesion .............................. 12.73 13.31 0.70 26.74 090 S

67227 ............. A Treatment of retinal lesion .............................. 6.28 *8.04 0.51 14.83 090 S

67228 ............. A Treatment of retinal lesion .............................. 12.39 9.39 0.48 22.26 090 S

67250 ............. A Reinforce eye wall .......................................... 8.36 6.99 0.40 15.75 090 S

67255 ............. A Reinforce/graft eye wall .................................. 8.39 *10.73 0.87 19.99 090 S

67299 ............. C Eye surgery procedure ................................... 0.00 0.00 0.00 0.00 YYY S

67311 ............. A Revise eye muscle ......................................... 6.30 *8.06 0.47 14.83 090 S

67312 ............. A Revise two eye muscles ................................. 7.55 *9.66 0.53 17.74 090 S

67314 ............. A Revise eye muscle ......................................... 7.12 *9.12 0.58 16.82 090 S

67316 ............. A Revise two eye muscles ................................. 8.02 *10.27 0.67 18.96 090 S

67318 ............. A Revise eye muscle(s) ..................................... 7.45 6.21 0.33 13.99 090 S

67320 ............. A Revise eye muscle(s) ..................................... 8.26 *10.57 0.69 19.52 090 S

67331 ............. A Eye surgery follow-up ..................................... 7.72 *9.89 0.54 18.15 090 S

67332 ............. A Rerevise eye muscles .................................... 8.59 *11.00 0.58 20.17 090 S

67334 ............. A Revise eye muscle w/suture ........................... 7.56 6.30 0.33 14.19 090 S

67335 ............. A Eye suture during surgery .............................. 2.49 *3.89 0.43 6.81 ZZZ S

67340 ............. A Revise eye muscle ......................................... 9.45 7.88 0.41 17.74 090 S

67343 ............. A Release eye tissue ......................................... 7.00 5.83 0.31 13.14 090 S

67345 ............. A Destroy nerve of eye muscle .......................... 2.91 2.22 0.26 5.39 010 S

67350 ............. A Biopsy eye muscle .......................................... 2.87 2.39 0.13 5.39 000 S

67399 ............. C Eye muscle surgery procedure ....................... 0.00 0.00 0.00 0.00 YYY S

67400 ............. A Explore/biopsy eye socket .............................. 9.20 10.91 0.62 20.73 090 S

67405 ............. A Explore/drain eye socket ................................ 7.42 *9.49 0.67 17.58 090 S

67412 ............. A Explore/treat eye socket ................................. 9.14 *11.70 0.67 21.51 090 S

67413 ............. A Explore/treat eye socket ................................. 9.75 8.09 0.57 18.41 090 S

67414 ............. A Explore/decompress eye socket ..................... 10.07 8.39 0.44 18.90 090 S

67415 ............. A Aspiration orbital contents .............................. 1.76 2.02 0.12 3.90 000 S

67420 ............. A Explore/treat eye socket ................................. 13.36 16.78 1.11 31.25 090 S

67430 ............. A Explore/treat eye socket ................................. 12.79 10.65 0.54 23.98 090 S

67440 ............. A Explore/drain eye socket ................................ 12.43 *15.91 0.97 29.31 090 S

67445 ............. A Explore/decompress eye socket ..................... 13.36 11.13 0.57 25.06 090 S

67450 ............. A Explore/biopsy eye socket .............................. 12.80 15.29 0.87 28.96 090 S

67500 ............. A Inject/treat eye socket ..................................... 0.79 0.73 0.06 1.58 000 S

67505 ............. A Inject/treat eye socket ..................................... 0.82 1.04 0.06 1.92 000 S

67515 ............. A Inject/treat eye socket ..................................... 0.61 0.56 0.03 1.20 000 S

67550 ............. A Insert eye socket implant ................................ 9.69 9.62 0.70 20.01 090 S

67560 ............. A Revise eye socket implant .............................. 10.10 8.30 0.48 18.88 090 S

67570 ............. A Decompress optic nerve ................................. 12.52 7.56 0.39 20.47 090 S

67599 ............. C Orbit surgery procedure .................................. 0.00 0.00 0.00 0.00 YYY S

67700 ............. A Drainage of eyelid abscess ............................ 1.30 0.49 0.03 1.82 010 S

67710 ............. A Incision of eyelid ............................................. 0.97 1.01 0.06 2.04 010 S

67715 ............. A Incision of eyelid fold ...................................... 1.17 *1.49 0.09 2.75 010 S

67800 ............. A Remove eyelid lesion ..................................... 1.35 0.94 0.05 2.34 010 S

67801 ............. A Remove eyelid lesions .................................... 1.85 1.39 0.08 3.32 010 S

67805 ............. A Remove eyelid lesions .................................... 2.17 1.38 0.08 3.63 010 S

67808 ............. A Remove eyelid lesion(s) ................................. 3.55 2.13 0.13 5.81 090 S

67810 ............. A Biopsy of eyelid .............................................. 1.48 0.81 0.05 2.34 000 S

67820 ............. A Revise eyelashes ............................................ 0.89 0.38 0.02 1.29 000 S

67825 ............. A Revise eyelashes ............................................ 1.33 0.90 0.05 2.28 010 S

67830 ............. A Revise eyelashes ............................................ 1.65 *2.12 0.17 3.94 010 S

67835 ............. A Revise eyelashes ............................................ 5.41 *6.92 0.45 12.78 090 S

67840 ............. A Remove eyelid lesion ..................................... 1.99 1.22 0.07 3.28 010 S

67850 ............. A Treat eyelid lesion .......................................... 1.64 0.82 0.05 2.51 010 S

67875 ............. A Closure of eyelid by suture ............................. 1.35 *1.72 0.13 3.20 000 S
63262

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

67880 ............. A Revision of eyelid ........................................... 3.55 3.94 0.23 7.72 090 S

67882 ............. A Revision of eyelid ........................................... 4.77 *6.10 0.37 11.24 090 S

67900 ............. A Repair brow defect ......................................... 4.54 3.78 0.20 8.52 090 S

67901 ............. A Repair eyelid defect ........................................ 6.82 *8.73 0.64 16.19 090 S

67902 ............. A Repair eyelid defect ........................................ 6.88 *8.81 0.72 16.41 090 S

67903 ............. A Repair eyelid defect ........................................ 6.22 *7.96 0.73 14.91 090 S

67904 ............. A Repair eyelid defect ........................................ 5.96 *7.64 0.71 14.31 090 S

67906 ............. A Repair eyelid defect ........................................ 6.64 5.46 0.36 12.46 090 S

67908 ............. A Repair eyelid defect ........................................ 4.95 *6.34 0.54 11.83 090 S

67909 ............. A Revise eyelid defect ....................................... 5.22 *6.69 0.48 12.39 090 S

67911 ............. A Revise eyelid defect ....................................... 5.09 *6.58 0.79 12.46 090 S

67914 ............. A Repair eyelid defect ........................................ 3.60 *4.61 0.39 8.60 090 S

67915 ............. A Repair eyelid defect ........................................ 3.10 1.25 0.07 4.42 090 S

67916 ............. A Repair eyelid defect ........................................ 5.13 6.50 0.38 12.01 090 S

67917 ............. A Repair eyelid defect ........................................ 5.84 *7.48 0.47 13.79 090 S

67921 ............. A Repair eyelid defect ........................................ 3.32 3.82 0.20 7.34 090 S

67922 ............. A Repair eyelid defect ........................................ 2.98 1.19 0.07 4.24 090 S

67923 ............. A Repair eyelid defect ........................................ 5.70 6.88 0.38 12.96 090 S

67924 ............. A Repair eyelid defect ........................................ 5.64 *7.22 0.43 13.29 090 S

67930 ............. A Repair eyelid wound ....................................... 3.56 1.27 0.08 4.91 010 S

67935 ............. A Repair eyelid wound ....................................... 6.07 3.79 0.24 10.10 090 S

67938 ............. A Remove eyelid foreign body ........................... 1.28 0.52 0.03 1.83 010 S

67950 ............. A Revision of eyelid ........................................... 5.64 *7.22 0.45 13.31 090 S

67961 ............. A Revision of eyelid ........................................... 5.51 *7.05 0.50 13.06 090 S

67966 ............. A Revision of eyelid ........................................... 6.39 *8.18 0.66 15.23 090 S

67971 ............. A Reconstruction of eyelid ................................. 9.56 10.68 0.64 20.88 090 S

67973 ............. A Reconstruction of eyelid ................................. 12.59 13.54 0.91 27.04 090 S

67974 ............. A Reconstruction of eyelid ................................. 12.56 14.07 0.87 27.50 090 S

67975 ............. A Reconstruction of eyelid ................................. 8.90 4.15 0.24 13.29 090 S

67999 ............. C Revision of eyelid ........................................... 0.00 0.00 0.00 0.00 YYY S

68020 ............. A Incise/drain eyelid lining ................................. 1.32 0.51 0.03 1.86 010 S

68040 ............. A Treatment of eyelid lesions ............................ 0.85 0.45 0.02 1.32 000 S

68100 ............. A Biopsy of eyelid lining ..................................... 1.35 0.99 0.06 2.40 000 S

68110 ............. A Remove eyelid lining lesion ............................ 1.72 1.24 0.07 3.03 010 S

68115 ............. A Remove eyelid lining lesion ............................ 2.31 1.93 0.11 4.35 010 S

68130 ............. A Remove eyelid lining lesion ............................ 4.75 4.09 0.22 9.06 090 S

68135 ............. A Remove eyelid lining lesion ............................ 1.79 0.74 0.04 2.57 010 S

68200 ............. A Treat eyelid by injection .................................. 0.49 0.52 0.03 1.04 000 S

68320 ............. A Revise/graft eyelid lining ................................. 4.97 *6.37 0.42 11.76 090 S

68325 ............. A Revise/graft eyelid lining ................................. 6.96 *8.91 0.62 16.49 090 S

68326 ............. A Revise/graft eyelid lining ................................. 6.75 8.62 0.49 15.86 090 S

68328 ............. A Revise/graft eyelid lining ................................. 7.78 *9.96 0.82 18.56 090 S

68330 ............. A Revise eyelid lining ......................................... 4.53 *5.80 0.35 10.68 090 S

68335 ............. A Revise/graft eyelid lining ................................. 6.79 *8.69 0.68 16.16 090 S

68340 ............. A Separate eyelid adhesions ............................. 3.92 3.14 0.17 7.23 090 S

68360 ............. A Revise eyelid lining ......................................... 4.12 *5.28 0.33 9.73 090 S

68362 ............. A Revise eyelid lining ......................................... 6.94 8.01 0.42 15.37 090 S

68399 ............. C Eyelid lining surgery ....................................... 0.00 0.00 0.00 0.00 YYY S

68400 ............. A Incise/drain tear gland .................................... 1.64 1.00 0.06 2.70 010 S

68420 ............. A Incise/drain tear sac ....................................... 2.25 1.02 0.06 3.33 010 S

68440 ............. A Incise tear duct opening ................................. 0.89 0.76 0.04 1.69 010 S

68500 ............. A Removal of tear gland .................................... 10.47 7.61 0.75 18.83 090 S

68505 ............. A Partial removal tear gland .............................. 10.39 8.69 0.49 19.57 090 S

68510 ............. A Biopsy of tear gland ........................................ 4.61 3.69 0.28 8.58 000 S

68520 ............. A Removal of tear sac ....................................... 7.11 *9.10 0.51 16.72 090 S

68525 ............. A Biopsy of tear sac ........................................... 4.43 3.68 0.23 8.34 000 S

68530 ............. A Clearance of tear duct .................................... 3.61 2.85 0.17 6.63 010 S

68540 ............. A Remove tear gland lesion ............................... 10.10 8.31 0.50 18.91 090 S

68550 ............. A Remove tear gland lesion ............................... 12.66 11.34 0.74 24.74 090 S

68700 ............. A Repair tear ducts ............................................ 6.20 2.69 0.15 9.04 090 S

68705 ............. A Revise tear duct opening ................................ 2.01 1.02 0.05 3.08 010 S

68720 ............. A Create tear sac drain ...................................... 7.68 *9.84 0.74 18.26 090 S

68745 ............. A Create tear duct drain ..................................... 8.23 6.56 0.45 15.24 090 S

68750 ............. A Create tear duct drain ..................................... 8.21 *10.50 0.83 19.54 090 S

68760 ............. A Close tear duct opening ................................. 1.68 0.92 0.04 2.64 010 S

68761 ............. A Close tear duct opening ................................. 1.31 0.92 0.04 2.27 010 S
63263

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

68770 ............. A Close tear system fistula ................................ 6.62 4.24 0.23 11.09 090 S

68800 ............. A Dilate tear duct opening(s) ............................. 1.11 0.42 0.02 1.55 010 S

68820 ............. A Explore tear duct system ................................ 1.47 0.55 0.03 2.05 010 S

68825 ............. A Explore tear duct system ................................ 1.53 1.49 0.09 3.11 010 S

68830 ............. A Reopen tear duct channel .............................. 2.12 1.93 0.10 4.15 010 S

68840 ............. A Explore/irrigate tear ducts ............................... 1.22 0.49 0.03 1.74 010 S

68850 ............. A Injection for tear sac x-ray .............................. 0.80 0.51 0.04 1.35 000 S

68899 ............. C Tear duct system surgery ............................... 0.00 0.00 0.00 0.00 YYY S

69000 ............. A Drain external ear lesion ................................ 1.40 0.35 0.03 1.78 010 S

69005 ............. A Drain external ear lesion ................................ 2.06 1.16 0.13 3.35 010 S

69020 ............. A Drain outer ear canal lesion ........................... 1.43 0.45 0.04 1.92 010 S

69090 ............. N Pierce earlobes ............................................... 0.00 0.00 0.00 0.00 XXX 0

69100 ............. A Biopsy of external ear ..................................... 0.76 0.66 0.07 1.49 000 S

69105 ............. A Biopsy of external ear canal ........................... 0.85 0.80 0.09 1.74 000 S

69110 ............. A Partial removal external ear ........................... 3.34 2.63 0.37 6.34 090 S

69120 ............. A Removal of external ear ................................. 3.95 0.78 0.07 4.80 090 S

69140 ............. A Remove ear canal lesion(s) ............................ 7.68 8.00 0.88 16.56 090 S

69145 ............. A Remove ear canal lesion(s) ............................ 2.54 2.51 0.28 5.33 090 S

69150 ............. A Extensive ear canal surgery ........................... 13.01 10.46 1.25 24.72 090 S

69155 ............. A Extensive ear/neck surgery ............................ 17.03 15.92 1.61 34.56 090 S

69200 ............. A Clear outer ear canal ...................................... 0.77 0.42 0.04 1.23 000 N

69205 ............. A Clear outer ear canal ...................................... 1.15 1.07 0.11 2.33 010 S

69210 ............. A Remove impacted ear wax ............................. 0.61 0.23 0.02 0.86 000 N

69220 ............. A Clean out mastoid cavity ................................ 0.83 0.50 0.05 1.38 000 S

69222 ............. A Clean out mastoid cavity ................................ 1.35 0.74 0.08 2.17 010 S

69300 ............. R Revise external ear ......................................... 6.36 5.30 0.28 11.94 YYY S

69310 ............. A Rebuild outer ear canal .................................. 10.59 9.84 1.08 21.51 090 S

69320 ............. A Rebuild outer ear canal .................................. 16.60 14.65 1.66 32.91 090 S

69399 ............. C Outer ear surgery procedure .......................... 0.00 0.00 0.00 0.00 YYY S

69400 ............. A Inflate middle ear canal .................................. 0.83 0.45 0.05 1.33 000 S

69401 ............. A Inflate middle ear canal .................................. 0.63 0.25 0.03 0.91 000 S

69405 ............. A Catheterize middle ear canal .......................... 2.58 0.48 0.04 3.10 010 S

69410 ............. A Inset middle ear baffle .................................... 0.33 0.60 0.07 1.00 000 S

69420 ............. A Incision of eardrum ......................................... 1.28 0.69 0.08 2.05 010 S

69421 ............. A Incision of eardrum ......................................... 1.68 1.14 0.13 2.95 010 S

69424 ............. A Remove ventilating tube ................................. 0.85 0.60 0.06 1.51 000 S

69433 ............. A Create eardrum opening ................................. 1.47 1.33 0.15 2.95 010 S

69436 ............. A Create eardrum opening ................................. 1.91 2.13 0.23 4.27 010 S

69440 ............. A Exploration of middle ear ................................ 7.31 8.69 0.93 16.93 090 S

69450 ............. A Eardrum revision ............................................. 5.44 *6.96 1.15 13.55 090 S

69501 ............. A Mastoidectomy ................................................ 8.81 10.90 1.17 20.88 090 S

69502 ............. A Mastoidectomy ................................................ 11.96 13.36 1.45 26.77 090 S

69505 ............. A Remove mastoid structures ............................ 12.57 *16.09 1.79 30.45 090 S

69511 ............. A Extensive mastoid surgery ............................. 13.10 *16.77 1.84 31.71 090 S

69530 ............. A Extensive mastoid surgery ............................. 18.04 16.71 1.72 36.47 090 S

69535 ............. A Remove part of temporal bone ....................... 34.50 25.27 2.85 62.62 090 S

69540 ............. A Remove ear lesion .......................................... 1.15 1.27 0.14 2.56 010 S

69550 ............. A Remove ear lesion .......................................... 10.70 *13.70 2.00 26.40 090 S

69552 ............. A Remove ear lesion .......................................... 18.84 16.73 1.86 37.43 090 S

69554 ............. A Remove ear lesion .......................................... 25.78 22.87 2.63 51.28 090 S

69601 ............. A Mastoid surgery revision ................................. 12.79 14.02 1.55 28.36 090 S

69602 ............. A Mastoid surgery revision ................................. 13.16 16.27 1.75 31.18 090 S

69603 ............. A Mastoid surgery revision ................................. 13.60 17.34 1.88 32.82 090 S

69604 ............. A Mastoid surgery revision ................................. 13.60 *17.41 2.70 33.71 090 S

69605 ............. A Mastoid surgery revision ................................. 18.04 14.95 1.86 34.85 090 S

69610 ............. A Repair of eardrum ........................................... 4.38 0.93 0.10 5.41 010 S

69620 ............. A Repair of eardrum ........................................... 5.74 *7.34 1.16 14.24 090 S

69631 ............. A Repair eardrum structures .............................. 9.55 *12.22 1.61 23.38 090 S

69632 ............. A Rebuild eardrum structures ............................ 12.41 *15.88 1.73 30.02 090 S

69633 ............. A Rebuild eardrum structures ............................ 11.76 *15.05 1.78 28.59 090 S

69635 ............. A Repair eardrum structures .............................. 13.02 *16.65 1.91 31.58 090 S

69636 ............. A Rebuild eardrum structures ............................ 14.88 *19.05 2.11 36.04 090 S

69637 ............. A Rebuild eardrum structures ............................ 14.77 *18.90 2.22 35.89 090 S

69641 ............. A Revise middle ear & mastoid .......................... 12.29 *15.73 1.87 29.89 090 S

69642 ............. A Revise middle ear & mastoid .......................... 16.37 20.62 2.21 39.20 090 S

69643 ............. A Revise middle ear & mastoid .......................... 14.81 *18.95 2.51 36.27 090 S
63264

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

69644 ............. A Revise middle ear & mastoid .......................... 16.46 *21.07 2.70 40.23 090 S

69645 ............. A Revise middle ear & mastoid .......................... 15.80 *20.23 2.51 38.54 090 S

69646 ............. A Revise middle ear & mastoid .......................... 17.35 21.97 2.40 41.72 090 S

69650 ............. A Release middle ear bone ............................... 9.40 *12.03 1.33 22.76 090 S

69660 ............. A Revise middle ear bone .................................. 11.64 *14.90 1.82 28.36 090 S

69661 ............. A Revise middle ear bone .................................. 15.32 18.44 1.93 35.69 090 S

69662 ............. A Revise middle ear bone .................................. 15.04 18.02 1.94 35.00 090 S

69666 ............. A Repair middle ear structures .......................... 9.38 *12.00 1.77 23.15 090 S

69667 ............. A Repair middle ear structures .......................... 9.39 *12.02 1.66 23.07 090 S

69670 ............. A Remove mastoid air cells ............................... 11.05 10.18 1.08 22.31 090 S

69676 ............. A Remove middle ear nerve .............................. 9.23 8.53 0.86 18.62 090 S

69700 ............. A Close mastoid fistula ...................................... 7.97 7.86 0.84 16.67 090 S

69710 ............. N Implant/replace hearing aid ............................ 0.00 0.00 0.00 0.00 XXX 0

69711 ............. A Remove/repair hearing aid ............................. 10.13 8.44 0.44 19.01 090 S

69720 ............. A Release facial nerve ....................................... 13.80 *17.66 2.27 33.73 090 S

69725 ............. A Release facial nerve ....................................... 18.98 14.65 1.51 35.14 090 S

69740 ............. A Repair facial nerve .......................................... 15.39 11.83 1.69 28.91 090 S

69745 ............. A Repair facial nerve .......................................... 16.10 15.95 1.53 33.58 090 S

69799 ............. C Middle ear surgery procedure ......................... 0.00 0.00 0.00 0.00 YYY S

69801 ............. A Incise inner ear ............................................... 8.19 *10.48 1.84 20.51 090 S

69802 ............. A Incise inner ear ............................................... 12.44 11.24 1.22 24.90 090 S

69805 ............. A Explore inner ear ............................................ 10.27 *13.14 2.00 25.41 090 S

69806 ............. A Explore inner ear ............................................ 11.82 *15.13 2.54 29.49 090 S

69820 ............. A Establish inner ear window ............................. 10.14 8.85 1.00 19.99 090 S

69840 ............. A Revise inner ear window ................................ 10.06 8.49 0.51 19.06 090 S

69905 ............. A Remove inner ear ........................................... 10.70 *13.70 2.07 26.47 090 S

69910 ............. A Remove inner ear & mastoid .......................... 13.10 *16.77 2.34 32.21 090 S

69915 ............. A Incise inner ear nerve ..................................... 19.89 17.71 2.02 39.62 090 S

69930 ............. A Implant cochlear device .................................. 14.00 *18.56 3.34 35.90 090 S

69949 ............. C Inner ear surgery procedure ........................... 0.00 0.00 0.00 0.00 YYY S

69950 ............. A Incise inner ear nerve ..................................... 21.15 17.99 2.31 41.45 090 S

69955 ............. A Release facial nerve ....................................... 22.12 20.28 2.25 44.65 090 S

69960 ............. A Release inner ear canal ................................. 19.75 17.85 1.93 39.53 090 S

69970 ............. A Remove inner ear lesion ................................ 22.30 19.69 2.26 44.25 090 S

69979 ............. C Temporal bone surgery .................................. 0.00 0.00 0.00 0.00 YYY S

70010 ............. A Contrast x-ray of brain .................................... 1.19 4.65 0.34 6.18 XXX N

70010 26 A Contrast x-ray of brain .................................... 1.19 0.52 0.08 1.79 XXX N

70010 TC A Contrast x-ray of brain .................................... 0.00 4.13 0.26 4.39 XXX N

70015 ............. A Contrast x-ray of brain .................................... 1.19 1.81 0.17 3.17 XXX N

70015 26 A Contrast x-ray of brain .................................... 1.19 0.52 0.08 1.79 XXX N

70015 TC A Contrast x-ray of brain .................................... 0.00 1.29 0.09 1.38 XXX N

70030 ............. A X-ray eye for foreign body .............................. 0.17 0.48 0.04 0.69 XXX N

70030 26 A X-ray eye for foreign body .............................. 0.17 0.08 0.01 0.26 XXX N

70030 TC A X-ray eye for foreign body .............................. 0.00 0.40 0.03 0.43 XXX N

70100 ............. A X-ray exam of jaw ........................................... 0.18 0.59 0.04 0.81 XXX N

70100 26 A X-ray exam of jaw ........................................... 0.18 0.09 0.01 0.28 XXX N

70100 TC A X-ray exam of jaw ........................................... 0.00 0.50 0.03 0.53 XXX N

70110 ............. A X-ray exam of jaw ........................................... 0.25 0.71 0.06 1.02 XXX N

70110 26 A X-ray exam of jaw ........................................... 0.25 0.12 0.02 0.39 XXX N

70110 TC A X-ray exam of jaw ........................................... 0.00 0.59 0.04 0.63 XXX N

70120 ............. A X-ray exam of mastoids .................................. 0.18 0.68 0.05 0.91 XXX N

70120 26 A X-ray exam of mastoids .................................. 0.18 0.09 0.01 0.28 XXX N

70120 TC A X-ray exam of mastoids .................................. 0.00 0.59 0.04 0.63 XXX N

70130 ............. A X-ray exam of mastoids .................................. 0.34 0.91 0.07 1.32 XXX N

70130 26 A X-ray exam of mastoids .................................. 0.34 0.16 0.02 0.52 XXX N

70130 TC A X-ray exam of mastoids .................................. 0.00 0.75 0.05 0.80 XXX N

70134 ............. A X-ray exam of middle ear ............................... 0.34 0.86 0.07 1.27 XXX N

70134 26 A X-ray exam of middle ear ............................... 0.34 0.16 0.02 0.52 XXX N

70134 TC A X-ray exam of middle ear ............................... 0.00 0.70 0.05 0.75 XXX N

70140 ............. A X-ray exam of facial bones ............................. 0.19 0.68 0.05 0.92 XXX N

70140 26 A X-ray exam of facial bones ............................. 0.19 0.09 0.01 0.29 XXX N

70140 TC A X-ray exam of facial bones ............................. 0.00 0.59 0.04 0.63 XXX N

70150 ............. A X-ray exam of facial bones ............................. 0.26 0.87 0.07 1.20 XXX N

70150 26 A X-ray exam of facial bones ............................. 0.26 0.12 0.02 0.40 XXX N

70150 TC A X-ray exam of facial bones ............................. 0.00 0.75 0.05 0.80 XXX N

70160 ............. A X-ray exam of nasal bones ............................ 0.17 0.58 0.04 0.79 XXX N
63265

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

70160 26 A X-ray exam of nasal bones ............................ 0.17 0.08 0.01 0.26 XXX N

70160 TC A X-ray exam of nasal bones ............................. 0.00 0.50 0.03 0.53 XXX N

70170 ............. A X-ray exam of tear duct .................................. 0.30 1.04 0.08 1.42 XXX N

70170 26 A X-ray exam of tear duct .................................. 0.30 0.14 0.02 0.46 XXX N

70170 TC A X-ray exam of tear duct .................................. 0.00 0.90 0.06 0.96 XXX N

70190 ............. A X-ray exam of eye sockets ............................. 0.21 0.69 0.05 0.95 XXX N

70190 26 A X-ray exam of eye sockets ............................. 0.21 0.10 0.01 0.32 XXX N

70190 TC A X-ray exam of eye sockets ............................. 0.00 0.59 0.04 0.63 XXX N

70200 ............. A X-ray exam of eye sockets ............................. 0.28 0.88 0.07 1.23 XXX N

70200 26 A X-ray exam of eye sockets ............................. 0.28 0.13 0.02 0.43 XXX N

70200 TC A X-ray exam of eye sockets ............................. 0.00 0.75 0.05 0.80 XXX N

70210 ............. A X-ray exam of sinuses .................................... 0.17 0.67 0.05 0.89 XXX N

70210 26 A X-ray exam of sinuses .................................... 0.17 0.08 0.01 0.26 XXX N

70210 TC A X-ray exam of sinuses .................................... 0.00 0.59 0.04 0.63 XXX N

70220 ............. A X-ray exam of sinuses .................................... 0.25 0.87 0.07 1.19 XXX N

70220 26 A X-ray exam of sinuses .................................... 0.25 0.12 0.02 0.39 XXX N

70220 TC A X-ray exam of sinuses .................................... 0.00 0.75 0.05 0.80 XXX N

70240 ............. A X-ray exam pituitary saddle ............................ 0.19 0.49 0.04 0.72 XXX N

70240 26 A X-ray exam pituitary saddle ............................ 0.19 0.09 0.01 0.29 XXX N

70240 TC A X-ray exam pituitary saddle ............................ 0.00 0.40 0.03 0.43 XXX N

70250 ............. A X-ray exam of skull ......................................... 0.24 0.70 0.06 1.00 XXX N

70250 26 A X-ray exam of skull ......................................... 0.24 0.11 0.02 0.37 XXX N

70250 TC A X-ray exam of skull ......................................... 0.00 0.59 0.04 0.63 XXX N

70260 ............. A X-ray exam of skull ......................................... 0.34 1.01 0.08 1.43 XXX N

70260 26 A X-ray exam of skull ......................................... 0.34 0.16 0.02 0.52 XXX N

70260 TC A X-ray exam of skull ......................................... 0.00 0.85 0.06 0.91 XXX N

70300 ............. A X-ray exam of teeth ........................................ 0.10 0.30 0.03 0.43 XXX N

70300 26 A X-ray exam of teeth ........................................ 0.10 0.05 0.01 0.16 XXX N

70300 TC A X-ray exam of teeth ........................................ 0.00 0.25 0.02 0.27 XXX N

70310 ............. A X-ray exam of teeth ........................................ 0.16 0.47 0.04 0.67 XXX N

70310 26 A X-ray exam of teeth ........................................ 0.16 0.07 0.01 0.24 XXX N

70310 TC A X-ray exam of teeth ........................................ 0.00 0.40 0.03 0.43 XXX N

70320 ............. A Full mouth x-ray of teeth ................................ 0.22 0.85 0.07 1.14 XXX N

70320 26 A Full mouth x-ray of teeth ................................ 0.22 0.10 0.02 0.34 XXX N

70320 TC A Full mouth x-ray of teeth ................................. 0.00 0.75 0.05 0.80 XXX N

70328 ............. A X-ray exam of jaw joint ................................... 0.18 0.56 0.04 0.78 XXX N

70328 26 A X-ray exam of jaw joint ................................... 0.18 0.09 0.01 0.28 XXX N

70328 TC A X-ray exam of jaw joint ................................... 0.00 0.47 0.03 0.50 XXX N

70330 ............. A X-ray exam of jaw joints ................................. 0.24 0.91 0.07 1.22 XXX N

70330 26 A X-ray exam of jaw joints ................................. 0.24 0.11 0.02 0.37 XXX N

70330 TC A X-ray exam of jaw joints ................................. 0.00 0.80 0.05 0.85 XXX N

70332 ............. A X-ray exam of jaw joint ................................... 0.54 2.25 0.17 2.96 XXX N

70332 26 A X-ray exam of jaw joint ................................... 0.54 0.25 0.04 0.83 XXX N

70332 TC A X-ray exam of jaw joint ................................... 0.00 2.00 0.13 2.13 XXX N

70336 ............. A Magnetic image jaw joint ................................ 0.95 11.11 0.73 12.79 XXX N

70336 26 A Magnetic image jaw joint ................................ 0.95 0.43 0.06 1.44 XXX N

70336 TC A Magnetic image jaw joint ................................ 0.00 10.68 0.67 11.35 XXX N

70350 ............. A X-ray head for orthodontia .............................. 0.17 0.44 0.03 0.64 XXX N

70350 26 A X-ray head for orthodontia .............................. 0.17 0.08 0.01 0.26 XXX N

70350 TC A X-ray head for orthodontia .............................. 0.00 0.36 0.02 0.38 XXX N

70355 ............. A Panoramic x-ray of jaws ................................. 0.20 0.63 0.05 0.88 XXX N

70355 26 A Panoramic x-ray of jaws ................................. 0.20 0.09 0.01 0.30 XXX N

70355 TC A Panoramic x-ray of jaws ................................. 0.00 0.54 0.04 0.58 XXX N

70360 ............. A X-ray exam of neck ........................................ 0.17 0.48 0.04 0.69 XXX N

70360 26 A X-ray exam of neck ........................................ 0.17 0.08 0.01 0.26 XXX N

70360 TC A X-ray exam of neck ......................................... 0.00 0.40 0.03 0.43 XXX N

70370 ............. A Throat x-ray & fluoroscopy ............................. 0.32 1.39 0.10 1.81 XXX N

70370 26 A Throat x-ray & fluoroscopy ............................. 0.32 0.15 0.02 0.49 XXX N

70370 TC A Throat x-ray & fluoroscopy ............................. 0.00 1.24 0.08 1.32 XXX N

70371 ............. A Speech evaluation, complex ........................... 0.84 2.38 0.19 3.41 XXX N

70371 26 A Speech evaluation, complex ........................... 0.84 0.38 0.06 1.28 XXX N

70371 TC A Speech evaluation, complex ........................... 0.00 2.00 0.13 2.13 XXX N

70373 ............. A Contrast x-ray of larynx .................................. 0.44 1.90 0.14 2.48 XXX N

70373 26 A Contrast x-ray of larynx .................................. 0.44 0.20 0.03 0.67 XXX N

70373 TC A Contrast x-ray of larynx .................................. 0.00 1.70 0.11 1.81 XXX N

70380 ............. A X-ray exam of salivary gland .......................... 0.17 0.72 0.05 0.94 XXX N
63266

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

70380 26 A X-ray exam of salivary gland .......................... 0.17 0.08 0.01 0.26 XXX N

70380 TC A X-ray exam of salivary gland .......................... 0.00 0.64 0.04 0.68 XXX N

70390 ............. A X-ray exam of salivary duct ............................ 0.38 1.87 0.14 2.39 XXX N

70390 26 A X-ray exam of salivary duct ............................ 0.38 0.17 0.03 0.58 XXX N

70390 TC A X-ray exam of salivary duct ............................ 0.00 1.70 0.11 1.81 XXX N

70450 ............. A CAT scan of head or brain ............................. 0.85 4.88 0.35 6.08 XXX N

70450 26 A CAT scan of head or brain ............................. 0.85 0.38 0.06 1.29 XXX N

70450 TC A CAT scan of head or brain ............................. 0.00 4.50 0.29 4.79 XXX N

70460 ............. A Contrast CAT scan of head ............................ 1.13 5.89 0.43 7.45 XXX N

70460 26 A Contrast CAT scan of head ............................ 1.13 0.50 0.08 1.71 XXX N

70460 TC A Contrast CAT scan of head ............................ 0.00 5.39 0.35 5.74 XXX N

70470 ............. A Contrast CAT scans of head .......................... 1.27 7.30 0.52 9.09 XXX N

70470 26 A Contrast CAT scans of head .......................... 1.27 0.56 0.09 1.92 XXX N

70470 TC A Contrast CAT scans of head .......................... 0.00 6.74 0.43 7.17 XXX N

70480 ............. A CAT scan of skull ........................................... 1.28 5.07 0.38 6.73 XXX N

70480 26 A CAT scan of skull ........................................... 1.28 0.57 0.09 1.94 XXX N

70480 TC A CAT scan of skull ........................................... 0.00 4.50 0.29 4.79 XXX N

70481 ............. A Contrast CAT scan of skull ............................. 1.38 6.00 0.44 7.82 XXX N

70481 26 A Contrast CAT scan of skull ............................. 1.38 0.61 0.09 2.08 XXX N

70481 TC A Contrast CAT scan of skull ............................. 0.00 5.39 0.35 5.74 XXX N

70482 ............. A Contrast CAT scans of skull ........................... 1.45 7.38 0.53 9.36 XXX N

70482 26 A Contrast CAT scans of skull ........................... 1.45 0.64 0.10 2.19 XXX N

70482 TC A Contrast CAT scans of skull ........................... 0.00 6.74 0.43 7.17 XXX N

70486 ............. A CAT scan of face, jaw .................................... 1.14 5.00 0.37 6.51 XXX N

70486 26 A CAT scan of face, jaw .................................... 1.14 0.50 0.08 1.72 XXX N

70486 TC A CAT scan of face, jaw .................................... 0.00 4.50 0.29 4.79 XXX N

70487 ............. A Contrast CAT scan, face/jaw .......................... 1.30 5.96 0.44 7.70 XXX N

70487 26 A Contrast CAT scan, face/jaw .......................... 1.30 0.57 0.09 1.96 XXX N

70487 TC A Contrast CAT scan, face/jaw .......................... 0.00 5.39 0.35 5.74 XXX N

70488 ............. A Contrast CAT scans face/jaw ......................... 1.42 7.37 0.53 9.32 XXX N

70488 26 A Contrast CAT scans face/jaw ......................... 1.42 0.63 0.10 2.15 XXX N

70488 TC A Contrast CAT scans face/jaw ......................... 0.00 6.74 0.43 7.17 XXX N

70490 ............. A CAT scan of neck tissue ................................ 1.28 5.07 0.38 6.73 XXX N

70490 26 A CAT scan of neck tissue ................................ 1.28 0.57 0.09 1.94 XXX N

70490 TC A CAT scan of neck tissue ................................. 0.00 4.50 0.29 4.79 XXX N

70491 ............. A Contrast CAT of neck tissue .......................... 1.38 6.00 0.44 7.82 XXX N

70491 26 A Contrast CAT of neck tissue .......................... 1.38 0.61 0.09 2.08 XXX N

70491 TC A Contrast CAT of neck tissue ........................... 0.00 5.39 0.35 5.74 XXX N

70492 ............. A Contrast CAT of neck tissue .......................... 1.45 7.38 0.53 9.36 XXX N

70492 26 A Contrast CAT of neck tissue .......................... 1.45 0.64 0.10 2.19 XXX N

70492 TC A Contrast CAT of neck tissue ........................... 0.00 6.74 0.43 7.17 XXX N

70540 ............. A Magnetic image, face, neck ............................ 1.48 11.34 0.77 13.59 XXX N

70540 26 A Magnetic image, face, neck ............................ 1.48 0.66 0.10 2.24 XXX N

70540 TC A Magnetic image, face, neck ............................ 0.00 10.68 0.67 11.35 XXX N

70541 ............. R Magnetic image, head (MRA) ......................... 1.81 11.34 0.77 13.92 XXX N

70541 26 R Magnetic image, head (MRA) ......................... 1.81 0.66 0.10 2.57 XXX N

70541 TC R Magnetic image, head (MRA) ......................... 0.00 10.68 0.67 11.35 XXX N

70551 ............. A Magnetic image, brain (MRI) .......................... 1.48 11.34 0.77 13.59 XXX N

70551 26 A Magnetic image, brain (MRI) .......................... 1.48 0.66 0.10 2.24 XXX N

70551 TC A Magnetic image, brain (MRI) .......................... 0.00 10.68 0.67 11.35 XXX N

70552 ............. A Magnetic image, brain (MRI) .......................... 1.78 13.61 0.93 16.32 XXX N

70552 26 A Magnetic image, brain (MRI) .......................... 1.78 0.80 0.12 2.70 XXX N

70552 TC A Magnetic image, brain (MRI) .......................... 0.00 12.81 0.81 13.62 XXX N

70553 ............. A Magnetic image, brain .................................... 2.36 24.79 1.65 28.80 XXX N

70553 26 A Magnetic image, brain .................................... 2.36 1.07 0.16 3.59 XXX N

70553 TC A Magnetic image, brain .................................... 0.00 23.72 1.49 25.21 XXX N

71010 ............. A Chest x-ray ..................................................... 0.18 0.53 0.04 0.75 XXX N

71010 26 A Chest x-ray ..................................................... 0.18 0.08 0.01 0.27 XXX N

71010 TC A Chest x-ray ..................................................... 0.00 0.45 0.03 0.48 XXX N

71015 ............. A X-ray exam of chest ....................................... 0.21 0.60 0.04 0.85 XXX N

71015 26 A X-ray exam of chest ....................................... 0.21 0.10 0.01 0.32 XXX N

71015 TC A X-ray exam of chest ........................................ 0.00 0.50 0.03 0.53 XXX N

71020 ............. A Chest x-ray ..................................................... 0.22 0.69 0.05 0.96 XXX N

71020 26 A Chest x-ray ..................................................... 0.22 0.10 0.01 0.33 XXX N

71020 TC A Chest x-ray ..................................................... 0.00 0.59 0.04 0.63 XXX N

71021 ............. A Chest x-ray ..................................................... 0.27 0.82 0.07 1.16 XXX N
63267

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

71021 26 A Chest x-ray ..................................................... 0.27 0.12 0.02 0.41 XXX N

71021 TC A Chest x-ray ..................................................... 0.00 0.70 0.05 0.75 XXX N

71022 ............. A Chest x-ray ..................................................... 0.31 0.84 0.07 1.22 XXX N

71022 26 A Chest x-ray ..................................................... 0.31 0.14 0.02 0.47 XXX N

71022 TC A Chest x-ray ..................................................... 0.00 0.70 0.05 0.75 XXX N

71023 ............. A Chest x-ray and fluoroscopy ........................... 0.38 0.92 0.08 1.38 XXX N

71023 26 A Chest x-ray and fluoroscopy ........................... 0.38 0.17 0.03 0.58 XXX N

71023 TC A Chest x-ray and fluoroscopy ........................... 0.00 0.75 0.05 0.80 XXX N

71030 ............. A Chest x-ray ..................................................... 0.31 0.89 0.07 1.27 XXX N

71030 26 A Chest x-ray ..................................................... 0.31 0.14 0.02 0.47 XXX N

71030 TC A Chest x-ray ..................................................... 0.00 0.75 0.05 0.80 XXX N

71034 ............. A Chest x-ray & fluoroscopy .............................. 0.46 1.58 0.12 2.16 XXX N

71034 26 A Chest x-ray & fluoroscopy .............................. 0.46 0.21 0.03 0.70 XXX N

71034 TC A Chest x-ray & fluoroscopy .............................. 0.00 1.37 0.09 1.46 XXX N

71035 ............. A Chest x-ray ..................................................... 0.18 0.58 0.04 0.80 XXX N

71035 26 A Chest x-ray ..................................................... 0.18 0.08 0.01 0.27 XXX N

71035 TC A Chest x-ray ..................................................... 0.00 0.50 0.03 0.53 XXX N

71036 ............. A X-ray guidance for biopsy ............................... 0.54 1.75 0.14 2.43 XXX N

71036 26 A X-ray guidance for biopsy ............................... 0.54 0.25 0.04 0.83 XXX N

71036 TC A X-ray guidance for biopsy ............................... 0.00 1.50 0.10 1.60 XXX N

71038 ............. A X-ray guidance for biopsy ............................... 0.54 1.85 0.15 2.54 XXX N

71038 26 A X-ray guidance for biopsy ............................... 0.54 0.25 0.04 0.83 XXX N

71038 TC A X-ray guidance for biopsy ............................... 0.00 1.60 0.11 1.71 XXX N

71040 ............. A Contrast x-ray of bronchi ................................ 0.58 1.66 0.13 2.37 XXX N

71040 26 A Contrast x-ray of bronchi ................................ 0.58 0.27 0.04 0.89 XXX N

71040 TC A Contrast x-ray of bronchi ................................ 0.00 1.39 0.09 1.48 XXX N

71060 ............. A Contrast x-ray of bronchi ................................ 0.74 2.44 0.19 3.37 XXX N

71060 26 A Contrast x-ray of bronchi ................................ 0.74 0.34 0.05 1.13 XXX N

71060 TC A Contrast x-ray of bronchi ................................ 0.00 2.10 0.14 2.24 XXX N

71090 ............. A X-ray & pacemaker insertion .......................... 0.54 1.85 0.15 2.54 XXX N

71090 26 A X-ray & pacemaker insertion .......................... 0.54 0.25 0.04 0.83 XXX N

71090 TC A X-ray & pacemaker insertion .......................... 0.00 1.60 0.11 1.71 XXX N

71100 ............. A X-ray exam of ribs .......................................... 0.22 0.64 0.06 0.92 XXX N

71100 26 A X-ray exam of ribs .......................................... 0.22 0.10 0.02 0.34 XXX N

71100 TC A X-ray exam of ribs .......................................... 0.00 0.54 0.04 0.58 XXX N

71101 ............. A X-ray exam of ribs, chest ............................... 0.27 0.77 0.06 1.10 XXX N

71101 26 A X-ray exam of ribs, chest ............................... 0.27 0.13 0.02 0.42 XXX N

71101 TC A X-ray exam of ribs, chest ................................ 0.00 0.64 0.04 0.68 XXX N

71110 ............. A X-ray exam of ribs .......................................... 0.27 0.88 0.07 1.22 XXX N

71110 26 A X-ray exam of ribs .......................................... 0.27 0.13 0.02 0.42 XXX N

71110 TC A X-ray exam of ribs .......................................... 0.00 0.75 0.05 0.80 XXX N

71111 ............. A X-ray exam of ribs, chest ............................... 0.32 1.00 0.08 1.40 XXX N

71111 26 A X-ray exam of ribs, chest ............................... 0.32 0.15 0.02 0.49 XXX N

71111 TC A X-ray exam of ribs, chest ................................ 0.00 0.85 0.06 0.91 XXX N

71120 ............. A X-ray exam of breastbone .............................. 0.20 0.71 0.05 0.96 XXX N

71120 26 A X-ray exam of breastbone .............................. 0.20 0.09 0.01 0.30 XXX N

71120 TC A X-ray exam of breastbone .............................. 0.00 0.62 0.04 0.66 XXX N

71130 ............. A X-ray exam of breastbone .............................. 0.22 0.77 0.05 1.04 XXX N

71130 26 A X-ray exam of breastbone .............................. 0.22 0.10 0.01 0.33 XXX N

71130 TC A X-ray exam of breastbone .............................. 0.00 0.67 0.04 0.71 XXX N

71250 ............. A Cat scan of chest ............................................ 1.16 6.14 0.44 7.74 XXX N

71250 26 A Cat scan of chest ............................................ 1.16 0.51 0.08 1.75 XXX N

71250 TC A Cat scan of chest ............................................ 0.00 5.63 0.36 5.99 XXX N

71260 ............. A Contrast CAT scan of chest ........................... 1.24 7.29 0.51 9.04 XXX N

71260 26 A Contrast CAT scan of chest ........................... 1.24 0.55 0.08 1.87 XXX N

71260 TC A Contrast CAT scan of chest ........................... 0.00 6.74 0.43 7.17 XXX N

71270 ............. A Contrast CAT scans of chest .......................... 1.38 9.04 0.61 11.03 XXX N

71270 26 A Contrast CAT scans of chest .......................... 1.38 0.61 0.09 2.08 XXX N

71270 TC A Contrast CAT scans of chest .......................... 0.00 8.43 0.52 8.95 XXX N

71550 ............. A Magnetic image, chest .................................... 1.60 11.40 0.78 13.78 XXX N

71550 26 A Magnetic image, chest .................................... 1.60 0.72 0.11 2.43 XXX N

71550 TC A Magnetic image, chest .................................... 0.00 10.68 0.67 11.35 XXX N

71555 ............. N Magnetic imaging/chest (MRA) ....................... #1.81 11.40 0.78 13.99 XXX 0

71555 26 N Magnetic imaging/chest (MRA) ....................... #1.81 0.72 0.11 2.64 XXX 0

71555 TC N Magnetic imaging/chest (MRA) ....................... #0.00 10.68 0.67 11.35 XXX 0

72010 ............. A X-ray exam of spine ....................................... 0.45 1.18 0.09 1.72 XXX N
63268

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

72010 26 A X-ray exam of spine ....................................... 0.45 0.20 0.03 0.68 XXX N

72010 TC A X-ray exam of spine ........................................ 0.00 0.98 0.06 1.04 XXX N

72020 ............. A X-ray exam of spine ....................................... 0.15 0.47 0.04 0.66 XXX N

72020 26 A X-ray exam of spine ....................................... 0.15 0.07 0.01 0.23 XXX N

72020 TC A X-ray exam of spine ........................................ 0.00 0.40 0.03 0.43 XXX N

72040 ............. A X-ray exam of neck spine ............................... 0.22 0.67 0.05 0.94 XXX N

72040 26 A X-ray exam of neck spine ............................... 0.22 0.10 0.01 0.33 XXX N

72040 TC A X-ray exam of neck spine ............................... 0.00 0.57 0.04 0.61 XXX N

72050 ............. A X-ray exam of neck spine ............................... 0.31 0.99 0.08 1.38 XXX N

72050 26 A X-ray exam of neck spine ............................... 0.31 0.14 0.02 0.47 XXX N

72050 TC A X-ray exam of neck spine ............................... 0.00 0.85 0.06 0.91 XXX N

72052 ............. A X-ray exam of neck spine ............................... 0.36 1.25 0.09 1.70 XXX N

72052 26 A X-ray exam of neck spine ............................... 0.36 0.17 0.02 0.55 XXX N

72052 TC A X-ray exam of neck spine ............................... 0.00 1.08 0.07 1.15 XXX N

72069 ............. A X-ray exam of trunk spine .............................. 0.22 0.57 0.04 0.83 XXX N

72069 26 A X-ray exam of trunk spine .............................. 0.22 0.10 0.01 0.33 XXX N

72069 TC A X-ray exam of trunk spine .............................. 0.00 0.47 0.03 0.50 XXX N

72070 ............. A X-ray exam of thorax spine ............................ 0.22 0.72 0.05 0.99 XXX N

72070 26 A X-ray exam of thorax spine ............................ 0.22 0.10 0.01 0.33 XXX N

72070 TC A X-ray exam of thorax spine ............................ 0.00 0.62 0.04 0.66 XXX N

72072 ............. A X-ray exam of thoracic spine .......................... 0.22 0.80 0.06 1.08 XXX N

72072 26 A X-ray exam of thoracic spine .......................... 0.22 0.10 0.01 0.33 XXX N

72072 TC A X-ray exam of thoracic spine .......................... 0.00 0.70 0.05 0.75 XXX N

72074 ............. A X-ray exam of thoracic spine .......................... 0.22 0.97 0.07 1.26 XXX N

72074 26 A X-ray exam of thoracic spine .......................... 0.22 0.10 0.01 0.33 XXX N

72074 TC A X-ray exam of thoracic spine .......................... 0.00 0.87 0.06 0.93 XXX N

72080 ............. A X-ray exam of trunk spine .............................. 0.22 0.74 0.05 1.01 XXX N

72080 26 A X-ray exam of trunk spine .............................. 0.22 0.10 0.01 0.33 XXX N

72080 TC A X-ray exam of trunk spine .............................. 0.00 0.64 0.04 0.68 XXX N

72090 ............. A X-ray exam of trunk spine .............................. 0.28 0.77 0.06 1.11 XXX N

72090 26 A X-ray exam of trunk spine .............................. 0.28 0.13 0.02 0.43 XXX N

72090 TC A X-ray exam of trunk spine .............................. 0.00 0.64 0.04 0.68 XXX N

72100 ............. A X-ray exam of lower spine .............................. 0.22 0.74 0.05 1.01 XXX N

72100 26 A X-ray exam of lower spine .............................. 0.22 0.10 0.01 0.33 XXX N

72100 TC A X-ray exam of lower spine .............................. 0.00 0.64 0.04 0.68 XXX N

72110 ............. A X-ray exam of lower spine .............................. 0.31 1.01 0.08 1.40 XXX N

72110 26 A X-ray exam of lower spine .............................. 0.31 0.14 0.02 0.47 XXX N

72110 TC A X-ray exam of lower spine .............................. 0.00 0.87 0.06 0.93 XXX N

72114 ............. A X-ray exam of lower spine .............................. 0.36 1.30 0.09 1.75 XXX N

72114 26 A X-ray exam of lower spine .............................. 0.36 0.17 0.02 0.55 XXX N

72114 TC A X-ray exam of lower spine .............................. 0.00 1.13 0.07 1.20 XXX N

72120 ............. A X-ray exam of lower spine .............................. 0.22 0.95 0.07 1.24 XXX N

72120 26 A X-ray exam of lower spine .............................. 0.22 0.10 0.01 0.33 XXX N

72120 TC A X-ray exam of lower spine .............................. 0.00 0.85 0.06 0.91 XXX N

72125 ............. A CAT scan of neck spine ................................. 1.16 6.14 0.44 7.74 XXX N

72125 26 A CAT scan of neck spine ................................. 1.16 0.51 0.08 1.75 XXX N

72125 TC A CAT scan of neck spine ................................. 0.00 5.63 0.36 5.99 XXX N

72126 ............. A Contrast CAT scan of neck ............................ 1.22 7.27 0.51 9.00 XXX N

72126 26 A Contrast CAT scan of neck ............................ 1.22 0.53 0.08 1.83 XXX N

72126 TC A Contrast CAT scan of neck ............................ 0.00 6.74 0.43 7.17 XXX N

72127 ............. A Contrast CAT scans of neck .......................... 1.27 8.99 0.61 10.87 XXX N

72127 26 A Contrast CAT scans of neck .......................... 1.27 0.56 0.09 1.92 XXX N

72127 TC A Contrast CAT scans of neck ........................... 0.00 8.43 0.52 8.95 XXX N

72128 ............. A CAT scan of thorax spine ............................... 1.16 6.14 0.44 7.74 XXX N

72128 26 A CAT scan of thorax spine ............................... 1.16 0.51 0.08 1.75 XXX N

72128 TC A CAT scan of thorax spine ............................... 0.00 5.63 0.36 5.99 XXX N

72129 ............. A Contrast CAT scan of thorax .......................... 1.22 7.27 0.51 9.00 XXX N

72129 26 A Contrast CAT scan of thorax .......................... 1.22 0.53 0.08 1.83 XXX N

72129 TC A Contrast CAT scan of thorax .......................... 0.00 6.74 0.43 7.17 XXX N

72130 ............. A Contrast CAT scans of thorax ........................ 1.27 8.99 0.61 10.87 XXX N

72130 26 A Contrast CAT scans of thorax ........................ 1.27 0.56 0.09 1.92 XXX N

72130 TC A Contrast CAT scans of thorax ........................ 0.00 8.43 0.52 8.95 XXX N

72131 ............. A CAT scan of lower spine ................................ 1.16 6.14 0.44 7.74 XXX N

72131 26 A CAT scan of lower spine ................................ 1.16 0.51 0.08 1.75 XXX N

72131 TC A CAT scan of lower spine ................................ 0.00 5.63 0.36 5.99 XXX N

72132 ............. A Contrast CAT of lower spine .......................... 1.22 7.27 0.51 9.00 XXX N
63269

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

72132 26 A Contrast CAT of lower spine .......................... 1.22 0.53 0.08 1.83 XXX N

72132 TC A Contrast CAT of lower spine .......................... 0.00 6.74 0.43 7.17 XXX N

72133 ............. A Contrast CAT scans,low spine ....................... 1.27 8.99 0.61 10.87 XXX N

72133 26 A Contrast CAT scans,low spine ....................... 1.27 0.56 0.09 1.92 XXX N

72133 TC A Contrast CAT scans,low spine ....................... 0.00 8.43 0.52 8.95 XXX N

72141 ............. A Magnetic image, neck spine ........................... 1.60 11.40 0.78 13.78 XXX N

72141 26 A Magnetic image, neck spine ........................... 1.60 0.72 0.11 2.43 XXX N

72141 TC A Magnetic image, neck spine ........................... 0.00 10.68 0.67 11.35 XXX N

72142 ............. A Magnetic image, neck spine ........................... 1.92 13.67 0.94 16.53 XXX N

72142 26 A Magnetic image, neck spine ........................... 1.92 0.86 0.13 2.91 XXX N

72142 TC A Magnetic image, neck spine ........................... 0.00 12.81 0.81 13.62 XXX N

72146 ............. A Magnetic image, chest spine .......................... 1.60 12.58 0.85 15.03 XXX N

72146 26 A Magnetic image, chest spine .......................... 1.60 0.72 0.11 2.43 XXX N

72146 TC A Magnetic image, chest spine .......................... 0.00 11.86 0.74 12.60 XXX N

72147 ............. A Magnetic image, chest spine .......................... 1.92 13.67 0.94 16.53 XXX N

72147 26 A Magnetic image, chest spine .......................... 1.92 0.86 0.13 2.91 XXX N

72147 TC A Magnetic image, chest spine .......................... 0.00 12.81 0.81 13.62 XXX N

72148 ............. A Magnetic image, lumbar spine ....................... 1.48 12.52 0.84 14.84 XXX N

72148 26 A Magnetic image, lumbar spine ........................ 1.48 0.66 0.10 2.24 XXX N

72148 TC A Magnetic image, lumbar spine ........................ 0.00 11.86 0.74 12.60 XXX N

72149 ............. A Magnetic image, lumbar spine ....................... 1.78 13.61 0.93 16.32 XXX N

72149 26 A Magnetic image, lumbar spine ........................ 1.78 0.80 0.12 2.70 XXX N

72149 TC A Magnetic image, lumbar spine ........................ 0.00 12.81 0.81 13.62 XXX N

72156 ............. A Magnetic image, neck spine ........................... 2.57 24.87 1.66 29.10 XXX N

72156 26 A Magnetic image, neck spine ........................... 2.57 1.15 0.17 3.89 XXX N

72156 TC A Magnetic image, neck spine ........................... 0.00 23.72 1.49 25.21 XXX N

72157 ............. A Magnetic image, chest spine .......................... 2.57 24.87 1.66 29.10 XXX N

72157 26 A Magnetic image, chest spine .......................... 2.57 1.15 0.17 3.89 XXX N

72157 TC A Magnetic image, chest spine .......................... 0.00 23.72 1.49 25.21 XXX N

72158 ............. A Magnetic image, lumbar spine ....................... 2.36 24.79 1.65 28.80 XXX N

72158 26 A Magnetic image, lumbar spine ........................ 2.36 1.07 0.16 3.59 XXX N

72158 TC A Magnetic image, lumbar spine ........................ 0.00 23.72 1.49 25.21 XXX N

72159 ............. N Magnetic imaging/spine (MRA) ....................... #1.80 12.52 0.84 15.16 XXX 0

72159 26 N Magnetic imaging/spine (MRA) ....................... #1.80 0.66 0.10 2.56 XXX 0

72159 TC N Magnetic imaging/spine (MRA) ....................... #0.00 11.86 0.74 12.60 XXX 0

72170 ............. A X-ray exam of pelvis ....................................... 0.17 0.57 0.04 0.78 XXX N

72170 26 A X-ray exam of pelvis ....................................... 0.17 0.07 0.01 0.25 XXX N

72170 TC A X-ray exam of pelvis ....................................... 0.00 0.50 0.03 0.53 XXX N

72190 ............. A X-ray exam of pelvis ....................................... 0.21 0.74 0.05 1.00 XXX N

72190 26 A X-ray exam of pelvis ....................................... 0.21 0.10 0.01 0.32 XXX N

72190 TC A X-ray exam of pelvis ....................................... 0.00 0.64 0.04 0.68 XXX N

72192 ............. A CAT scan of pelvis ......................................... 1.09 6.11 0.43 7.63 XXX N

72192 26 A CAT scan of pelvis ......................................... 1.09 0.48 0.07 1.64 XXX N

72192 TC A CAT scan of pelvis ......................................... 0.00 5.63 0.36 5.99 XXX N

72193 ............. A Contrast CAT scan of pelvis ........................... 1.16 7.03 0.49 8.68 XXX N

72193 26 A Contrast CAT scan of pelvis ........................... 1.16 0.51 0.08 1.75 XXX N

72193 TC A Contrast CAT scan of pelvis ........................... 0.00 6.52 0.41 6.93 XXX N

72194 ............. A Contrast CAT scans of pelvis ......................... 1.22 8.62 0.58 10.42 XXX N

72194 26 A Contrast CAT scans of pelvis ......................... 1.22 0.53 0.08 1.83 XXX N

72194 TC A Contrast CAT scans of pelvis ......................... 0.00 8.09 0.50 8.59 XXX N

72196 ............. A Magnetic image, pelvis ................................... 1.60 11.40 0.78 13.78 XXX N

72196 26 A Magnetic image, pelvis ................................... 1.60 0.72 0.11 2.43 XXX N

72196 TC A Magnetic image, pelvis ................................... 0.00 10.68 0.67 11.35 XXX N

72198 ............. N Magnetic imaging/pelvis(MRA) ....................... #1.80 11.40 0.78 13.98 XXX 0

72198 26 N Magnetic imaging/pelvis(MRA) ....................... #1.80 0.72 0.11 2.63 XXX 0

72198 TC N Magnetic imaging/pelvis(MRA) ....................... #0.00 10.68 0.67 11.35 XXX 0

72200 ............. A X-ray exam sacroiliac joints ............................ 0.17 0.58 0.04 0.79 XXX N

72200 26 A X-ray exam sacroiliac joints ............................ 0.17 0.08 0.01 0.26 XXX N

72200 TC A X-ray exam sacroiliac joints ............................ 0.00 0.50 0.03 0.53 XXX N

72202 ............. A X-ray exam sacroiliac joints ............................ 0.19 0.68 0.05 0.92 XXX N

72202 26 A X-ray exam sacroiliac joints ............................ 0.19 0.09 0.01 0.29 XXX N

72202 TC A X-ray exam sacroiliac joints ............................ 0.00 0.59 0.04 0.63 XXX N

72220 ............. A X-ray exam of tailbone ................................... 0.17 0.62 0.05 0.84 XXX N

72220 26 A X-ray exam of tailbone ................................... 0.17 0.08 0.01 0.26 XXX N

72220 TC A X-ray exam of tailbone .................................... 0.00 0.54 0.04 0.58 XXX N

72240 ............. A Contrast x-ray of neck spine .......................... 0.91 4.93 0.35 6.19 XXX N
63270

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

72240 26 A Contrast x-ray of neck spine .......................... 0.91 0.41 0.06 1.38 XXX N

72240 TC A Contrast x-ray of neck spine ........................... 0.00 4.52 0.29 4.81 XXX N

72255 ............. A Contrast x-ray thorax spine ............................ 0.91 4.54 0.32 5.77 XXX N

72255 26 A Contrast x-ray thorax spine ............................ 0.91 0.41 0.06 1.38 XXX N

72255 TC A Contrast x-ray thorax spine ............................ 0.00 4.13 0.26 4.39 XXX N

72265 ............. A Contrast x-ray lower spine .............................. 0.83 4.26 0.31 5.40 XXX N

72265 26 A Contrast x-ray lower spine .............................. 0.83 0.38 0.06 1.27 XXX N

72265 TC A Contrast x-ray lower spine .............................. 0.00 3.88 0.25 4.13 XXX N

72270 ............. A Contrast x-ray of spine ................................... 1.33 6.40 0.46 8.19 XXX N

72270 26 A Contrast x-ray of spine ................................... 1.33 0.59 0.09 2.01 XXX N

72270 TC A Contrast x-ray of spine ................................... 0.00 5.81 0.37 6.18 XXX N

72285 ............. A X-ray of neck spine disk ................................. 0.83 8.37 0.56 9.76 XXX N

72285 26 A X-ray of neck spine disk ................................. 0.83 0.38 0.06 1.27 XXX N

72285 TC A X-ray of neck spine disk ................................. 0.00 7.99 0.50 8.49 XXX N

72295 ............. A X-ray of lower spine disk ................................ 0.83 7.87 0.52 9.22 XXX N

72295 26 A X-ray of lower spine disk ................................ 0.83 0.38 0.06 1.27 XXX N

72295 TC A X-ray of lower spine disk ................................ 0.00 7.49 0.46 7.95 XXX N

73000 ............. A X-ray exam of collarbone ............................... 0.16 0.57 0.04 0.77 XXX N

73000 26 A X-ray exam of collarbone ............................... 0.16 0.07 0.01 0.24 XXX N

73000 TC A X-ray exam of collarbone ............................... 0.00 0.50 0.03 0.53 XXX N

73010 ............. A X-ray exam of shoulder blade ........................ 0.17 0.58 0.04 0.79 XXX N

73010 26 A X-ray exam of shoulder blade ........................ 0.17 0.08 0.01 0.26 XXX N

73010 TC A X-ray exam of shoulder blade ........................ 0.00 0.50 0.03 0.53 XXX N

73020 ............. A X-ray exam of shoulder .................................. 0.15 0.52 0.04 0.71 XXX N

73020 26 A X-ray exam of shoulder .................................. 0.15 0.07 0.01 0.23 XXX N

73020 ............. A Contrast CAT scans of leg ............................. 1.22 7.61 0.53 9.36 XXX N

73020 26 A Contrast CAT scans of leg ............................. 1.22 0.53 0.08 1.83 XXX N

73020 TC A X-ray exam of shoulder .................................. 0.00 0.45 0.03 0.48 XXX N

73030 ............. A X-ray exam of shoulder .................................. 0.18 0.62 0.05 0.85 XXX N

73030 26 A X-ray exam of shoulder .................................. 0.18 0.08 0.01 0.27 XXX N

73030 TC A X-ray exam of shoulder .................................. 0.00 0.54 0.04 0.58 XXX N

73040 ............. A Contrast x-ray of shoulder .............................. 0.54 2.25 0.17 2.96 XXX N

73040 26 A Contrast x-ray of shoulder .............................. 0.54 0.25 0.04 0.83 XXX N

73040 TC A Contrast x-ray of shoulder .............................. 0.00 2.00 0.13 2.13 XXX N

73050 ............. A X-ray exam of shoulders ................................ 0.20 0.73 0.05 0.98 XXX N

73050 26 A X-ray exam of shoulders ................................ 0.20 0.09 0.01 0.30 XXX N

73050 TC A X-ray exam of shoulders ................................. 0.00 0.64 0.04 0.68 XXX N

73060 ............. A X-ray exam of humerus .................................. 0.17 0.62 0.05 0.84 XXX N

73060 26 A X-ray exam of humerus .................................. 0.17 0.08 0.01 0.26 XXX N

73060 TC A X-ray exam of humerus .................................. 0.00 0.54 0.04 0.58 XXX N

73070 ............. A X-ray exam of elbow ....................................... 0.15 0.57 0.04 0.76 XXX N

73070 26 A X-ray exam of elbow ....................................... 0.15 0.07 0.01 0.23 XXX N

73070 TC A X-ray exam of elbow ....................................... 0.00 0.50 0.03 0.53 XXX N

73080 ............. A X-ray exam of elbow ....................................... 0.17 0.62 0.05 0.84 XXX N

73080 26 A X-ray exam of elbow ....................................... 0.17 0.08 0.01 0.26 XXX N

73080 TC A X-ray exam of elbow ....................................... 0.00 0.54 0.04 0.58 XXX N

73085 ............. A Contrast x-ray of elbow .................................. 0.54 2.25 0.17 2.96 XXX N

73085 26 A Contrast x-ray of elbow .................................. 0.54 0.25 0.04 0.83 XXX N

73085 TC A Contrast x-ray of elbow ................................... 0.00 2.00 0.13 2.13 XXX N

73090 ............. A X-ray exam of forearm .................................... 0.16 0.57 0.04 0.77 XXX N

73090 26 A X-ray exam of forearm .................................... 0.16 0.07 0.01 0.24 XXX N

73090 TC A X-ray exam of forearm .................................... 0.00 0.50 0.03 0.53 XXX N

73092 ............. A X-ray exam of arm, infant ............................... 0.16 0.54 0.04 0.74 XXX N

73092 26 A X-ray exam of arm, infant ............................... 0.16 0.07 0.01 0.24 XXX N

73092 TC A X-ray exam of arm, infant ............................... 0.00 0.47 0.03 0.50 XXX N

73100 ............. A X-ray exam of wrist ......................................... 0.16 0.54 0.04 0.74 XXX N

73100 26 A X-ray exam of wrist ......................................... 0.16 0.07 0.01 0.24 XXX N

73100 TC A X-ray exam of wrist ......................................... 0.00 0.47 0.03 0.50 XXX N

73110 ............. A X-ray exam of wrist ......................................... 0.17 0.59 0.04 0.80 XXX N

73110 26 A X-ray exam of wrist ......................................... 0.17 0.08 0.01 0.26 XXX N

73110 TC A X-ray exam of wrist ......................................... 0.00 0.51 0.03 0.54 XXX N

73115 ............. A Contrast x-ray of wrist .................................... 0.54 1.75 0.14 2.43 XXX N

73115 26 A Contrast x-ray of wrist .................................... 0.54 0.25 0.04 0.83 XXX N

73115 TC A Contrast x-ray of wrist ..................................... 0.00 1.50 0.10 1.60 XXX N

73120 ............. A X-ray exam of hand ........................................ 0.16 0.54 0.04 0.74 XXX N

73120 26 A X-ray exam of hand ........................................ 0.16 0.07 0.01 0.24 XXX N
63271

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

73120 TC A X-ray exam of hand ........................................ 0.00 0.47 0.03 0.50 XXX N

73130 ............. A X-ray exam of hand ........................................ 0.17 0.59 0.04 0.80 XXX N

73130 26 A X-ray exam of hand ........................................ 0.17 0.08 0.01 0.26 XXX N

73130 TC A X-ray exam of hand ........................................ 0.00 0.51 0.03 0.54 XXX N

73140 ............. A X-ray exam of finger(s) ................................... 0.13 0.46 0.04 0.63 XXX N

73140 26 A X-ray exam of finger(s) ................................... 0.13 0.06 0.01 0.20 XXX N

73140 TC A X-ray exam of finger(s) ................................... 0.00 0.40 0.03 0.43 XXX N

73200 ............. A CAT scan of arm ............................................ 1.09 5.21 0.37 6.67 XXX N

73200 26 A CAT scan of arm ............................................ 1.09 0.48 0.07 1.64 XXX N

73200 TC A CAT scan of arm ............................................. 0.00 4.73 0.30 5.03 XXX N

73201 ............. A Contrast CAT scan of arm .............................. 1.16 6.14 0.44 7.74 XXX N

73201 26 A Contrast CAT scan of arm .............................. 1.16 0.51 0.08 1.75 XXX N

73201 TC A Contrast CAT scan of arm .............................. 0.00 5.63 0.36 5.99 XXX N

73202 ............. A Contrast CAT scans of arm ............................ 1.22 7.61 0.53 9.36 XXX N

73202 26 A Contrast CAT scans of arm ............................ 1.22 0.53 0.08 1.83 XXX N

73202 TC A Contrast CAT scans of arm ............................ 0.00 7.08 0.45 7.53 XXX N

73220 ............. A Magnetic image, arm, hand ............................ 1.48 11.34 0.77 13.59 XXX N

73220 26 A Magnetic image, arm, hand ............................ 1.48 0.66 0.10 2.24 XXX N

73220 TC A Magnetic image, arm, hand ............................ 0.00 10.68 0.67 11.35 XXX N

73221 ............. A Magnetic image, joint of arm .......................... 0.95 11.11 0.73 12.79 XXX N

73221 26 A Magnetic image, joint of arm .......................... 0.95 0.43 0.06 1.44 XXX N

73221 TC A Magnetic image, joint of arm .......................... 0.00 10.68 0.67 11.35 XXX N

73225 ............. N Magnetic imaging/upper (MRA) ...................... #1.73 11.34 0.77 13.84 XXX 0

73225 26 N Magnetic imaging/upper (MRA) ...................... #1.73 0.66 0.10 2.49 XXX 0

73225 TC N Magnetic imaging/upper (MRA) ...................... #0.00 10.68 0.67 11.35 XXX 0

73500 ............. A X-ray exam of hip ........................................... 0.17 0.53 0.04 0.74 XXX N

73500 26 A X-ray exam of hip ........................................... 0.17 0.08 0.01 0.26 XXX N

73500 TC A X-ray exam of hip ........................................... 0.00 0.45 0.03 0.48 XXX N

73510 ............. A X-ray exam of hip ........................................... 0.21 0.64 0.05 0.90 XXX N

73510 26 A X-ray exam of hip ........................................... 0.21 0.10 0.01 0.32 XXX N

73510 TC A X-ray exam of hip ........................................... 0.00 0.54 0.04 0.58 XXX N

73520 ............. A X-ray exam of hips ......................................... 0.26 0.76 0.06 1.08 XXX N

73520 26 A X-ray exam of hips ......................................... 0.26 0.12 0.02 0.40 XXX N

73520 TC A X-ray exam of hips ......................................... 0.00 0.64 0.04 0.68 XXX N

73525 ............. A Contrast x-ray of hip ....................................... 0.54 2.25 0.17 2.96 XXX N

73525 26 A Contrast x-ray of hip ....................................... 0.54 0.25 0.04 0.83 XXX N

73525 TC A Contrast x-ray of hip ....................................... 0.00 2.00 0.13 2.13 XXX N

73530 ............. A X-ray exam of hip ........................................... 0.29 0.63 0.05 0.97 XXX N

73530 26 A X-ray exam of hip ........................................... 0.29 0.13 0.02 0.44 XXX N

73530 TC A X-ray exam of hip ........................................... 0.00 0.50 0.03 0.53 XXX N

73540 ............. A X-ray exam of pelvis & hips ............................ 0.20 0.64 0.05 0.89 XXX N

73540 26 A X-ray exam of pelvis & hips ............................ 0.20 0.10 0.01 0.31 XXX N

73540 TC A X-ray exam of pelvis & hips ............................ 0.00 0.54 0.04 0.58 XXX N

73550 ............. A X-ray exam of thigh ........................................ 0.17 0.62 0.05 0.84 XXX N

73550 26 A X-ray exam of thigh ........................................ 0.17 0.08 0.01 0.26 XXX N

73550 TC A X-ray exam of thigh ........................................ 0.00 0.54 0.04 0.58 XXX N

73560 ............. A X-ray exam of knee ........................................ 0.17 0.57 0.04 0.78 XXX N

73560 26 A X-ray exam of knee ........................................ 0.17 0.07 0.01 0.25 XXX N

73560 TC A X-ray exam of knee ........................................ 0.00 0.50 0.03 0.53 XXX N

73562 ............. A X-ray exam of knee ........................................ 0.18 0.63 0.05 0.86 XXX N

73562 26 A X-ray exam of knee ........................................ 0.18 0.09 0.01 0.28 XXX N

73562 TC A X-ray exam of knee ........................................ 0.00 0.54 0.04 0.58 XXX N

73564 ............. A X-ray exam of knee ........................................ 0.22 0.69 0.06 0.97 XXX N

73564 26 A X-ray exam of knee ........................................ 0.22 0.10 0.02 0.34 XXX N

73564 TC A X-ray exam of knee ........................................ 0.00 0.59 0.04 0.63 XXX N

73565 ............. A X-ray exam of knee ........................................ 0.17 0.54 0.04 0.75 XXX N

73565 26 A X-ray exam of knee ........................................ 0.17 0.07 0.01 0.25 XXX N

73565 TC A X-ray exam of knee ........................................ 0.00 0.47 0.03 0.50 XXX N

73580 ............. A Contrast x-ray of knee joint ............................ 0.54 2.75 0.21 3.50 XXX N

73580 26 A Contrast x-ray of knee joint ............................ 0.54 0.25 0.04 0.83 XXX N

73580 TC A Contrast x-ray of knee joint ............................ 0.00 2.50 0.17 2.67 XXX N

73590 ............. A X-ray exam of lower leg ................................. 0.17 0.57 0.04 0.78 XXX N

73590 26 A X-ray exam of lower leg .................................. 0.17 0.07 0.01 0.25 XXX N

73590 TC A X-ray exam of lower leg .................................. 0.00 0.50 0.03 0.53 XXX N

73592 ............. A X-ray exam of leg, infant ................................ 0.16 0.54 0.04 0.74 XXX N

73592 26 A X-ray exam of leg, infant ................................ 0.16 0.07 0.01 0.24 XXX N
63272

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

73592 TC A X-ray exam of leg, infant ................................ 0.00 0.47 0.03 0.50 XXX N

73600 ............. A X-ray exam of ankle ....................................... 0.16 0.54 0.04 0.74 XXX N

73600 26 A X-ray exam of ankle ....................................... 0.16 0.07 0.01 0.24 XXX N

73600 TC A X-ray exam of ankle ........................................ 0.00 0.47 0.03 0.50 XXX N

73610 ............. A X-ray exam of ankle ....................................... 0.17 0.59 0.04 0.80 XXX N

73610 26 A X-ray exam of ankle ....................................... 0.17 0.08 0.01 0.26 XXX N

73610 TC A X-ray exam of ankle ........................................ 0.00 0.51 0.03 0.54 XXX N

73615 ............. A Contrast x-ray of ankle ................................... 0.54 2.25 0.17 2.96 XXX N

73615 26 A Contrast x-ray of ankle ................................... 0.54 0.25 0.04 0.83 XXX N

73615 TC A Contrast x-ray of ankle ................................... 0.00 2.00 0.13 2.13 XXX N

73620 ............. A X-ray exam of foot .......................................... 0.16 0.54 0.04 0.74 XXX N

73620 26 A X-ray exam of foot .......................................... 0.16 0.07 0.01 0.24 XXX N

73620 TC A X-ray exam of foot .......................................... 0.00 0.47 0.03 0.50 XXX N

73630 ............. A X-ray exam of foot .......................................... 0.17 0.59 0.04 0.80 XXX N

73630 26 A X-ray exam of foot .......................................... 0.17 0.08 0.01 0.26 XXX N

73630 TC A X-ray exam of foot .......................................... 0.00 0.51 0.03 0.54 XXX N

73650 ............. A X-ray exam of heel ......................................... 0.16 0.52 0.04 0.72 XXX N

73650 26 A X-ray exam of heel ......................................... 0.16 0.07 0.01 0.24 XXX N

73650 TC A X-ray exam of heel ......................................... 0.00 0.45 0.03 0.48 XXX N

73660 ............. A X-ray exam of toe(s) ....................................... 0.13 0.46 0.04 0.63 XXX N

73660 26 A X-ray exam of toe(s) ....................................... 0.13 0.06 0.01 0.20 XXX N

73660 TC A X-ray exam of toe(s) ....................................... 0.00 0.40 0.03 0.43 XXX N

73700 ............. A CAT scan of leg .............................................. 1.09 5.21 0.37 6.67 XXX N

73700 26 A CAT scan of leg .............................................. 1.09 0.48 0.07 1.64 XXX N

73700 TC A CAT scan of leg .............................................. 0.00 4.73 0.30 5.03 XXX N

73701 ............. A Contrast CAT scan of leg ............................... 1.16 6.14 0.44 7.74 XXX N

73701 26 A Contrast CAT scan of leg ............................... 1.16 0.51 0.08 1.75 XXX N

73701 TC A Contrast CAT scan of leg ............................... 0.00 5.63 0.36 5.99 XXX N

73702 ............. A Contrast CAT scans of leg ............................. 1.22 7.61 0.53 9.36 XXX N

73702 26 A Contrast CAT scans of leg ............................. 1.22 0.53 0.08 1.83 XXX N

73702 TC A Contrast CAT scans of leg ............................. 0.00 7.08 0.45 7.53 XXX N

73720 ............. A Magnetic image, leg, foot ............................... 1.48 11.34 0.77 13.59 XXX N

73720 26 A Magnetic image, leg, foot ............................... 1.48 0.66 0.10 2.24 XXX N

73720 TC A Magnetic image, leg, foot ............................... 0.00 10.68 0.67 11.35 XXX N

73721 ............. A Magnetic image, joint of leg ........................... 0.95 11.11 0.73 12.79 XXX N

73721 26 A Magnetic image, joint of leg ........................... 0.95 0.43 0.06 1.44 XXX N

73721 TC A Magnetic image, joint of leg ............................ 0.00 10.68 0.67 11.35 XXX N

73725 ............. N Magnetic imaging/lower (MRA) ....................... #1.82 11.34 0.77 13.93 XXX 0

73725 26 N Magnetic imaging/lower (MRA) ....................... #1.82 0.66 0.10 2.58 XXX 0

73725 TC N Magnetic imaging/lower (MRA) ....................... #0.00 10.68 0.67 11.35 XXX 0

74000 ............. A X-ray exam of abdomen ................................. 0.18 0.58 0.04 0.80 XXX N

74000 26 A X-ray exam of abdomen ................................. 0.18 0.08 0.01 0.27 XXX N

74000 TC A X-ray exam of abdomen ................................. 0.00 0.50 0.03 0.53 XXX N

74010 ............. A X-ray exam of abdomen ................................. 0.23 0.65 0.06 0.94 XXX N

74010 26 A X-ray exam of abdomen ................................. 0.23 0.11 0.02 0.36 XXX N

74010 TC A X-ray exam of abdomen ................................. 0.00 0.54 0.04 0.58 XXX N

74020 ............. A X-ray exam of abdomen ................................. 0.27 0.72 0.06 1.05 XXX N

74020 26 A X-ray exam of abdomen ................................. 0.27 0.13 0.02 0.42 XXX N

74020 TC A X-ray exam of abdomen ................................. 0.00 0.59 0.04 0.63 XXX N

74022 ............. A X-ray exam series, abdomen .......................... 0.32 0.85 0.07 1.24 XXX N

74022 26 A X-ray exam series, abdomen .......................... 0.32 0.15 0.02 0.49 XXX N

74022 TC A X-ray exam series, abdomen .......................... 0.00 0.70 0.05 0.75 XXX N

74150 ............. A CAT scan of abdomen .................................... 1.19 5.91 0.43 7.53 XXX N

74150 26 A CAT scan of abdomen .................................... 1.19 0.52 0.08 1.79 XXX N

74150 TC A CAT scan of abdomen .................................... 0.00 5.39 0.35 5.74 XXX N

74160 ............. A Contrast CAT scan of abdomen ..................... 1.27 7.08 0.50 8.85 XXX N

74160 26 A Contrast CAT scan of abdomen ..................... 1.27 0.56 0.09 1.92 XXX N

74160 TC A Contrast CAT scan of abdomen ..................... 0.00 6.52 0.41 6.93 XXX N

74170 ............. A Contrast CAT scans, abdomen ...................... 1.40 8.71 0.60 10.71 XXX N

74170 26 A Contrast CAT scans, abdomen ...................... 1.40 0.62 0.10 2.12 XXX N

74170 TC A Contrast CAT scans, abdomen ...................... 0.00 8.09 0.50 8.59 XXX N

74181 ............. A Magnetic image, abdomen (MRI) ................... 1.60 11.40 0.78 13.78 XXX N

74181 26 A Magnetic image, abdomen (MRI) ................... 1.60 0.72 0.11 2.43 XXX N

74181 TC A Magnetic image, abdomen (MRI) ................... 0.00 10.68 0.67 11.35 XXX N

74185 ............. N Magnetic image/abdomen (MRA) ................... #1.80 11.40 0.78 13.98 XXX 0

74185 26 N Magnetic image/abdomen (MRA) ................... #1.80 0.72 0.11 2.63 XXX 0
63273

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

74185 TC N Magnetic image/abdomen (MRA) ................... #0.00 10.68 0.67 11.35 XXX 0

74190 ............. A X-ray exam of peritoneum .............................. 0.48 1.37 0.10 1.95 XXX N

74190 26 A X-ray exam of peritoneum .............................. 0.48 0.13 0.02 0.63 XXX N

74190 TC A X-ray exam of peritoneum .............................. 0.00 1.24 0.08 1.32 XXX N

74210 ............. A Contrast xray exam of throat .......................... 0.36 1.29 0.09 1.74 XXX N

74210 26 A Contrast xray exam of throat .......................... 0.36 0.16 0.02 0.54 XXX N

74210 TC A Contrast xray exam of throat .......................... 0.00 1.13 0.07 1.20 XXX N

74220 ............. A Contrast xray exam, esophagus ..................... 0.46 1.34 0.10 1.90 XXX N

74220 26 A Contrast xray exam, esophagus ..................... 0.46 0.21 0.03 0.70 XXX N

74220 TC A Contrast xray exam, esophagus ..................... 0.00 1.13 0.07 1.20 XXX N

74230 ............. A Cinema xray throat/esophagus ....................... 0.53 1.49 0.12 2.14 XXX N

74230 26 A Cinema xray throat/esophagus ....................... 0.53 0.25 0.04 0.82 XXX N

74230 TC A Cinema xray throat/esophagus ....................... 0.00 1.24 0.08 1.32 XXX N

74235 ............. A Remove esophagus obstruction ..................... 1.19 3.02 0.25 4.46 XXX N

74235 26 A Remove esophagus obstruction ..................... 1.19 0.52 0.08 1.79 XXX N

74235 TC A Remove esophagus obstruction ..................... 0.00 2.50 0.17 2.67 XXX N

74240 ............. A X-ray exam upper GI tract .............................. 0.69 1.71 0.14 2.54 XXX N

74240 26 A X-ray exam upper GI tract .............................. 0.69 0.32 0.05 1.06 XXX N

74240 TC A X-ray exam upper GI tract .............................. 0.00 1.39 0.09 1.48 XXX N

74241 ............. A X-ray exam upper GI tract .............................. 0.69 1.74 0.14 2.57 XXX N

74241 26 A X-ray exam upper GI tract .............................. 0.69 0.32 0.05 1.06 XXX N

74241 TC A X-ray exam upper GI tract .............................. 0.00 1.42 0.09 1.51 XXX N

74245 ............. A X-ray exam upper GI tract .............................. 0.91 2.68 0.21 3.80 XXX N

74245 26 A X-ray exam upper GI tract .............................. 0.91 0.41 0.06 1.38 XXX N

74245 TC A X-ray exam upper GI tract .............................. 0.00 2.27 0.15 2.42 XXX N

74246 ............. A Contrast xray upper GI tract ........................... 0.69 1.89 0.15 2.73 XXX N

74246 26 A Contrast xray upper GI tract ........................... 0.69 0.32 0.05 1.06 XXX N

74246 TC A Contrast xray upper GI tract ........................... 0.00 1.57 0.10 1.67 XXX N

74247 ............. A Contrast xray upper GI tract ........................... 0.69 1.92 0.16 2.77 XXX N

74247 26 A Contrast xray upper GI tract ........................... 0.69 0.32 0.05 1.06 XXX N

74247 TC A Contrast xray upper GI tract ........................... 0.00 1.60 0.11 1.71 XXX N

74249 ............. A Contrast xray upper GI tract ........................... 0.91 2.86 0.22 3.99 XXX N

74249 26 A Contrast xray upper GI tract ........................... 0.91 0.41 0.06 1.38 XXX N

74249 TC A Contrast xray upper GI tract ........................... 0.00 2.45 0.16 2.61 XXX N

74250 ............. A X-ray exam of small bowel ............................. 0.47 1.45 0.11 2.03 XXX N

74250 26 A X-ray exam of small bowel ............................. 0.47 0.21 0.03 0.71 XXX N

74250 TC A X-ray exam of small bowel ............................. 0.00 1.24 0.08 1.32 XXX N

74251 ............. A X-ray exam of small bowel ............................. 0.69 1.45 0.11 2.25 XXX N

74251 26 A X-ray exam of small bowel ............................. 0.69 0.21 0.03 0.93 XXX N

74251 TC A X-ray exam of small bowel ............................. 0.00 1.24 0.08 1.32 XXX N

74260 ............. A X-ray exam of small bowel ............................. 0.50 1.65 0.12 2.27 XXX N

74260 26 A X-ray exam of small bowel ............................. 0.50 0.23 0.03 0.76 XXX N

74260 TC A X-ray exam of small bowel ............................. 0.00 1.42 0.09 1.51 XXX N

74270 ............. A Contrast x-ray exam of colon ......................... 0.69 1.94 0.16 2.79 XXX N

74270 26 A Contrast x-ray exam of colon ......................... 0.69 0.32 0.05 1.06 XXX N

74270 TC A Contrast x-ray exam of colon ......................... 0.00 1.62 0.11 1.73 XXX N

74280 ............. A Contrast x-ray exam of colon ......................... 0.99 2.58 0.21 3.78 XXX N

74280 26 A Contrast x-ray exam of colon ......................... 0.99 0.45 0.07 1.51 XXX N

74280 TC A Contrast x-ray exam of colon ......................... 0.00 2.13 0.14 2.27 XXX N

74283 ............. A Contrast x-ray exam of colon ......................... 2.02 3.34 0.30 5.66 XXX N

74283 26 A Contrast x-ray exam of colon ......................... 2.02 0.90 0.14 3.06 XXX N

74283 TC A Contrast x-ray exam of colon ......................... 0.00 2.44 0.16 2.60 XXX N

74290 ............. A Contrast x-ray, gallbladder ............................. 0.32 0.85 0.07 1.24 XXX N

74290 26 A Contrast x-ray, gallbladder ............................. 0.32 0.15 0.02 0.49 XXX N

74290 TC A Contrast x-ray, gallbladder .............................. 0.00 0.70 0.05 0.75 XXX N

74291 ............. A Contrast x-rays, gallbladder ............................ 0.20 0.49 0.04 0.73 XXX N

74291 26 A Contrast x-rays, gallbladder ............................ 0.20 0.09 0.01 0.30 XXX N

74291 TC A Contrast x-rays, gallbladder ............................ 0.00 0.40 0.03 0.43 XXX N

74300 ............. C X-ray bile ducts, pancreas .............................. 0.00 0.00 0.00 0.00 XXX N

74300 26 A X-ray bile ducts, pancreas .............................. 0.36 0.17 0.02 0.55 XXX N

74300 TC C X-ray bile ducts, pancreas .............................. 0.00 0.00 0.00 0.00 XXX N

74301 ............. C Additional x-rays at surgery ............................ 0.00 0.00 0.00 0.00 XXX N

74301 26 A Additional x-rays at surgery ............................ 0.21 0.10 0.01 0.32 XXX N

74301 TC C Additional x-rays at surgery ............................ 0.00 0.00 0.00 0.00 XXX N

74305 ............. A X-ray bile ducts, pancreas .............................. 0.42 0.94 0.08 1.44 XXX N

74305 26 A X-ray bile ducts, pancreas .............................. 0.42 0.19 0.03 0.64 XXX N
63274

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

74305 TC A X-ray bile ducts, pancreas .............................. 0.00 0.75 0.05 0.80 XXX N

74320 ............. A Contrast x-ray of bile ducts ............................ 0.54 3.25 0.23 4.02 XXX N

74320 26 A Contrast x-ray of bile ducts ............................. 0.54 0.25 0.04 0.83 XXX N

74320 TC A Contrast x-ray of bile ducts ............................. 0.00 3.00 0.19 3.19 XXX N

74327 ............. A X-ray for bile stone removal ........................... 0.70 2.00 0.16 2.86 XXX N

74327 26 A X-ray for bile stone removal ........................... 0.70 0.32 0.05 1.07 XXX N

74327 TC A X-ray for bile stone removal ........................... 0.00 1.68 0.11 1.79 XXX N

74328 ............. A Xray for bile duct endoscopy .......................... 0.70 3.32 0.24 4.26 XXX N

74328 26 A Xray for bile duct endoscopy .......................... 0.70 0.32 0.05 1.07 XXX N

74328 TC A Xray for bile duct endoscopy .......................... 0.00 3.00 0.19 3.19 XXX N

74329 ............. A X-ray for pancreas endoscopy ....................... 0.70 3.32 0.24 4.26 XXX N

74329 26 A X-ray for pancreas endoscopy ....................... 0.70 0.32 0.05 1.07 XXX N

74329 TC A X-ray for pancreas endoscopy ........................ 0.00 3.00 0.19 3.19 XXX N

74330 ............. A Xray, bile/pancreas endoscopy ...................... 0.70 3.32 0.24 4.26 XXX N

74330 26 A Xray, bile/pancreas endoscopy ...................... 0.70 0.32 0.05 1.07 XXX N

74330 TC A Xray, bile/pancreas endoscopy ...................... 0.00 3.00 0.19 3.19 XXX N

74340 ............. A X-ray guide for GI tube ................................... 0.54 2.75 0.21 3.50 XXX N

74340 26 A X-ray guide for GI tube ................................... 0.54 0.25 0.04 0.83 XXX N

74340 TC A X-ray guide for GI tube ................................... 0.00 2.50 0.17 2.67 XXX N

74350 ............. A X-ray guide, stomach tube ............................. 0.76 3.35 0.24 4.35 XXX N

74350 26 A X-ray guide, stomach tube ............................. 0.76 0.35 0.05 1.16 XXX N

74350 TC A X-ray guide, stomach tube .............................. 0.00 3.00 0.19 3.19 XXX N

74355 ............. A X-ray guide, intestinal tube ............................. 0.76 2.85 0.22 3.83 XXX N

74355 26 A X-ray guide, intestinal tube ............................. 0.76 0.35 0.05 1.16 XXX N

74355 TC A X-ray guide, intestinal tube ............................. 0.00 2.50 0.17 2.67 XXX N

74360 ............. A X-ray guide, GI dilation ................................... 0.54 3.25 0.23 4.02 XXX N

74360 26 A X-ray guide, GI dilation ................................... 0.54 0.25 0.04 0.83 XXX N

74360 TC A X-ray guide, GI dilation ................................... 0.00 3.00 0.19 3.19 XXX N

74363 ............. A X-ray, bile duct dilation ................................... 0.88 6.21 0.43 7.52 XXX N

74363 26 A X-ray, bile duct dilation ................................... 0.88 0.40 0.06 1.34 XXX N

74363 TC A X-ray, bile duct dilation ................................... 0.00 5.81 0.37 6.18 XXX N

74400 ............. A Contrast x-ray urinary tract ............................. 0.49 1.82 0.14 2.45 XXX N

74400 26 A Contrast x-ray urinary tract ............................. 0.49 0.22 0.03 0.74 XXX N

74400 TC A Contrast x-ray urinary tract ............................. 0.00 1.60 0.11 1.71 XXX N

74405 ............. A Contrast x-ray urinary tract ............................. 0.49 2.11 0.16 2.76 XXX N

74405 26 A Contrast x-ray urinary tract ............................. 0.49 0.22 0.03 0.74 XXX N

74405 TC A Contrast x-ray urinary tract ............................. 0.00 1.89 0.13 2.02 XXX N

74410 ............. A Contrast x-ray urinary tract ............................. 0.49 2.08 0.15 2.72 XXX N

74410 26 A Contrast x-ray urinary tract ............................. 0.49 0.22 0.03 0.74 XXX N

74410 TC A Contrast x-ray urinary tract ............................. 0.00 1.86 0.12 1.98 XXX N

74415 ............. A Contrast x-ray urinary tract ............................. 0.49 2.24 0.16 2.89 XXX N

74415 26 A Contrast x-ray urinary tract ............................. 0.49 0.22 0.03 0.74 XXX N

74415 TC A Contrast x-ray urinary tract ............................. 0.00 2.02 0.13 2.15 XXX N

74420 ............. A Contrast x-ray urinary tract ............................. 0.36 2.66 0.19 3.21 XXX N

74420 26 A Contrast x-ray urinary tract ............................. 0.36 0.16 0.02 0.54 XXX N

74420 TC A Contrast x-ray urinary tract ............................. 0.00 2.50 0.17 2.67 XXX N

74425 ............. A Contrast x-ray urinary tract ............................. 0.36 1.40 0.10 1.86 XXX N

74425 26 A Contrast x-ray urinary tract ............................. 0.36 0.16 0.02 0.54 XXX N

74425 TC A Contrast x-ray urinary tract ............................. 0.00 1.24 0.08 1.32 XXX N

74430 ............. A Contrast x-ray of bladder ................................ 0.32 1.15 0.09 1.56 XXX N

74430 26 A Contrast x-ray of bladder ................................ 0.32 0.15 0.02 0.49 XXX N

74430 TC A Contrast x-ray of bladder ................................ 0.00 1.00 0.07 1.07 XXX N

74440 ............. A Xray exam male genital tract .......................... 0.38 1.25 0.10 1.73 XXX N

74440 26 A Xray exam male genital tract .......................... 0.38 0.17 0.03 0.58 XXX N

74440 TC A Xray exam male genital tract .......................... 0.00 1.08 0.07 1.15 XXX N

74445 ............. A X-ray exam of penis ....................................... 1.14 1.58 0.15 2.87 XXX N

74445 26 A X-ray exam of penis ....................................... 1.14 0.50 0.08 1.72 XXX N

74445 TC A X-ray exam of penis ........................................ 0.00 1.08 0.07 1.15 XXX N

74450 ............. A X-ray exam urethra/bladder ............................ 0.33 1.54 0.11 1.98 XXX N

74450 26 A X-ray exam urethra/bladder ............................ 0.33 0.15 0.02 0.50 XXX N

74450 TC A X-ray exam urethra/bladder ............................ 0.00 1.39 0.09 1.48 XXX N

74455 ............. A X-ray exam urethra/bladder ............................ 0.33 1.65 0.12 2.10 XXX N

74455 26 A X-ray exam urethra/bladder ............................ 0.33 0.15 0.02 0.50 XXX N

74455 TC A X-ray exam urethra/bladder ............................ 0.00 1.50 0.10 1.60 XXX N

74470 ............. A X-ray exam of kidney lesion ........................... 0.54 1.44 0.12 2.10 XXX N

74470 26 A X-ray exam of kidney lesion ........................... 0.54 0.25 0.04 0.83 XXX N
63275

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

74470 TC A X-ray exam of kidney lesion ........................... 0.00 1.19 0.08 1.27 XXX N

74475 ............. A Xray control catheter insert ............................ 0.54 4.13 0.29 4.96 XXX N

74475 26 A Xray control catheter insert ............................ 0.54 0.25 0.04 0.83 XXX N

74475 TC A Xray control catheter insert ............................. 0.00 3.88 0.25 4.13 XXX N

74480 ............. A Xray control catheter insert ............................ 0.54 4.13 0.29 4.96 XXX N

74480 26 A Xray control catheter insert ............................ 0.54 0.25 0.04 0.83 XXX N

74480 TC A Xray control catheter insert ............................. 0.00 3.88 0.25 4.13 XXX N

74485 ............. A X-ray guide, GU dilation ................................. 0.54 3.25 0.23 4.02 XXX N

74485 26 A X-ray guide, GU dilation ................................. 0.54 0.25 0.04 0.83 XXX N

74485 TC A X-ray guide, GU dilation ................................. 0.00 3.00 0.19 3.19 XXX N

74710 ............. A X-ray measurement of pelvis .......................... 0.34 1.16 0.09 1.59 XXX N

74710 26 A X-ray measurement of pelvis .......................... 0.34 0.16 0.02 0.52 XXX N

74710 TC A X-ray measurement of pelvis .......................... 0.00 1.00 0.07 1.07 XXX N

74740 ............. A X-ray female genital tract ............................... 0.38 1.41 0.11 1.90 XXX N

74740 26 A X-ray female genital tract ............................... 0.38 0.17 0.03 0.58 XXX N

74740 TC A X-ray female genital tract ............................... 0.00 1.24 0.08 1.32 XXX N

74742 ............. A X-ray fallopian tube ......................................... 0.61 3.25 0.23 4.09 XXX N

74742 26 A X-ray fallopian tube ......................................... 0.61 0.25 0.04 0.90 XXX N

74742 TC A X-ray fallopian tube ......................................... 0.00 3.00 0.19 3.19 XXX N

74775 ............. A X-ray exam of perineum ................................. 0.62 1.68 0.13 2.43 XXX N

74775 26 A X-ray exam of perineum ................................. 0.62 0.29 0.04 0.95 XXX N

74775 TC A X-ray exam of perineum ................................. 0.00 1.39 0.09 1.48 XXX N

75552 ............. A Magnetic image, myocardium ......................... 1.60 11.40 0.78 13.78 XXX N

75552 26 A Magnetic image, myocardium ......................... 1.60 0.72 0.11 2.43 XXX N

75552 TC A Magnetic image, myocardium ......................... 0.00 10.68 0.67 11.35 XXX N

75553 ............. A Magnetic image, myocardium ......................... 2.00 11.40 0.78 14.18 XXX N

75553 26 A Magnetic image, myocardium ......................... 2.00 0.72 0.11 2.83 XXX N

75553 TC A Magnetic image, myocardium ......................... 0.00 10.68 0.67 11.35 XXX N

75554 ............. A Cardiac MRI/function ...................................... 1.83 11.40 0.78 14.01 XXX N

75554 26 A Cardiac MRI/function ...................................... 1.83 0.72 0.11 2.66 XXX N

75554 TC A Cardiac MRI/function ...................................... 0.00 10.68 0.67 11.35 XXX N

75555 ............. A Cardiac MRI/limited study ............................... 1.74 11.40 0.78 13.92 XXX N

75555 26 A Cardiac MRI/limited study ............................... 1.74 0.72 0.11 2.57 XXX N

75555 TC A Cardiac MRI/limited study ............................... 0.00 10.68 0.67 11.35 XXX N

75556 ............. N Cardiac MRI/flow mapping .............................. 0.00 0.00 0.00 0.00 XXX 0

75600 ............. A Contrast x-ray exam of aorta .......................... 0.49 12.23 0.78 13.50 XXX N

75600 26 A Contrast x-ray exam of aorta .......................... 0.49 0.22 0.03 0.74 XXX N

75600 TC A Contrast x-ray exam of aorta .......................... 0.00 12.01 0.75 12.76 XXX N

75605 ............. A Contrast x-ray exam of aorta .......................... 1.14 12.51 0.83 14.48 XXX N

75605 26 A Contrast x-ray exam of aorta .......................... 1.14 0.50 0.08 1.72 XXX N

75605 TC A Contrast x-ray exam of aorta .......................... 0.00 12.01 0.75 12.76 XXX N

75625 ............. A Contrast x-ray exam of aorta .......................... 1.14 12.51 0.83 14.48 XXX N

75625 26 A Contrast x-ray exam of aorta .......................... 1.14 0.50 0.08 1.72 XXX N

75625 TC A Contrast x-ray exam of aorta .......................... 0.00 12.01 0.75 12.76 XXX N

75630 ............. A X-ray aorta, leg arteries .................................. 1.31 13.09 0.88 15.28 XXX N

75630 26 A X-ray aorta, leg arteries .................................. 1.31 0.58 0.09 1.98 XXX N

75630 TC A X-ray aorta, leg arteries .................................. 0.00 12.51 0.79 13.30 XXX N

75650 ............. A Artery x-rays, head & neck ............................. 1.49 12.67 0.85 15.01 XXX N

75650 26 A Artery x-rays, head & neck ............................. 1.49 0.66 0.10 2.25 XXX N

75650 TC A Artery x-rays, head & neck ............................. 0.00 12.01 0.75 12.76 XXX N

75658 ............. A X-ray exam of arm arteries ............................. 1.31 12.59 0.84 14.74 XXX N

75658 26 A X-ray exam of arm arteries ............................. 1.31 0.58 0.09 1.98 XXX N

75658 TC A X-ray exam of arm arteries ............................. 0.00 12.01 0.75 12.76 XXX N

75660 ............. A Artery x-rays, head & neck ............................. 1.31 12.59 0.84 14.74 XXX N

75660 26 A Artery x-rays, head & neck ............................. 1.31 0.58 0.09 1.98 XXX N

75660 TC A Artery x-rays, head & neck ............................. 0.00 12.01 0.75 12.76 XXX N

75662 ............. A Artery x-rays, head & neck ............................. 1.66 12.75 0.86 15.27 XXX N

75662 26 A Artery x-rays, head & neck ............................. 1.66 0.74 0.11 2.51 XXX N

75662 TC A Artery x-rays, head & neck ............................. 0.00 12.01 0.75 12.76 XXX N

75665 ............. A Artery x-rays, head & neck ............................. 1.31 12.59 0.84 14.74 XXX N

75665 26 A Artery x-rays, head & neck ............................. 1.31 0.58 0.09 1.98 XXX N

75665 TC A Artery x-rays, head & neck ............................. 0.00 12.01 0.75 12.76 XXX N

75671 ............. A Artery x-rays, head & neck ............................. 1.66 12.75 0.86 15.27 XXX N

75671 26 A Artery x-rays, head & neck ............................. 1.66 0.74 0.11 2.51 XXX N

75671 TC A Artery x-rays, head & neck ............................. 0.00 12.01 0.75 12.76 XXX N

75676 ............. A Artery x-rays, neck .......................................... 1.31 12.59 0.84 14.74 XXX N
63276

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

75676 26 A Artery x-rays, neck .......................................... 1.31 0.58 0.09 1.98 XXX N

75676 TC A Artery x-rays, neck .......................................... 0.00 12.01 0.75 12.76 XXX N

75680 ............. A Artery x-rays, neck .......................................... 1.66 12.75 0.86 15.27 XXX N

75680 26 A Artery x-rays, neck .......................................... 1.66 0.74 0.11 2.51 XXX N

75680 TC A Artery x-rays, neck .......................................... 0.00 12.01 0.75 12.76 XXX N

75685 ............. A Artery x-rays, spine ......................................... 1.31 12.59 0.84 14.74 XXX N

75685 26 A Artery x-rays, spine ......................................... 1.31 0.58 0.09 1.98 XXX N

75685 TC A Artery x-rays, spine ......................................... 0.00 12.01 0.75 12.76 XXX N

75705 ............. A Artery x-rays, spine ......................................... 2.18 12.99 0.90 16.07 XXX N

75705 26 A Artery x-rays, spine ......................................... 2.18 0.98 0.15 3.31 XXX N

75705 TC A Artery x-rays, spine ......................................... 0.00 12.01 0.75 12.76 XXX N

75710 ............. A Artery x-rays, arm/leg ..................................... 1.14 12.51 0.83 14.48 XXX N

75710 26 A Artery x-rays, arm/leg ..................................... 1.14 0.50 0.08 1.72 XXX N

75710 TC A Artery x-rays, arm/leg ..................................... 0.00 12.01 0.75 12.76 XXX N

75716 ............. A Artery x-rays, arms/legs .................................. 1.31 12.59 0.84 14.74 XXX N

75716 26 A Artery x-rays, arms/legs .................................. 1.31 0.58 0.09 1.98 XXX N

75716 TC A Artery x-rays, arms/legs .................................. 0.00 12.01 0.75 12.76 XXX N

75722 ............. A Artery x-rays, kidney ....................................... 1.14 12.51 0.83 14.48 XXX N

75722 26 A Artery x-rays, kidney ....................................... 1.14 0.50 0.08 1.72 XXX N

75722 TC A Artery x-rays, kidney ....................................... 0.00 12.01 0.75 12.76 XXX N

75724 ............. A Artery x-rays, kidneys ..................................... 1.49 12.67 0.85 15.01 XXX N

75724 26 A Artery x-rays, kidneys ..................................... 1.49 0.66 0.10 2.25 XXX N

75724 TC A Artery x-rays, kidneys ..................................... 0.00 12.01 0.75 12.76 XXX N

75726 ............. A Artery x-rays, abdomen .................................. 1.14 12.51 0.83 14.48 XXX N

75726 26 A Artery x-rays, abdomen .................................. 1.14 0.50 0.08 1.72 XXX N

75726 TC A Artery x-rays, abdomen .................................. 0.00 12.01 0.75 12.76 XXX N

75731 ............. A Artery x-rays, adrenal gland ........................... 1.14 12.51 0.83 14.48 XXX N

75731 26 A Artery x-rays, adrenal gland ........................... 1.14 0.50 0.08 1.72 XXX N

75731 TC A Artery x-rays, adrenal gland ........................... 0.00 12.01 0.75 12.76 XXX N

75733 ............. A Artery x-rays, adrenal glands .......................... 1.31 12.59 0.84 14.74 XXX N

75733 26 A Artery x-rays, adrenal glands .......................... 1.31 0.58 0.09 1.98 XXX N

75733 TC A Artery x-rays, adrenal glands .......................... 0.00 12.01 0.75 12.76 XXX N

75736 ............. A Artery x-rays, pelvis ........................................ 1.14 12.51 0.83 14.48 XXX N

75736 26 A Artery x-rays, pelvis ........................................ 1.14 0.50 0.08 1.72 XXX N

75736 TC A Artery x-rays, pelvis ........................................ 0.00 12.01 0.75 12.76 XXX N

75741 ............. A Artery x-rays, lung .......................................... 1.31 12.59 0.84 14.74 XXX N

75741 26 A Artery x-rays, lung .......................................... 1.31 0.58 0.09 1.98 XXX N

75741 TC A Artery x-rays, lung .......................................... 0.00 12.01 0.75 12.76 XXX N

75743 ............. A Artery x-rays, lungs ......................................... 1.66 12.75 0.86 15.27 XXX N

75743 26 A Artery x-rays, lungs ......................................... 1.66 0.74 0.11 2.51 XXX N

75743 TC A Artery x-rays, lungs ......................................... 0.00 12.01 0.75 12.76 XXX N

75746 ............. A Artery x-rays, lung .......................................... 1.14 12.51 0.83 14.48 XXX N

75746 26 A Artery x-rays, lung .......................................... 1.14 0.50 0.08 1.72 XXX N

75746 TC A Artery x-rays, lung .......................................... 0.00 12.01 0.75 12.76 XXX N

75756 ............. A Artery x-rays, chest ......................................... 1.14 12.51 0.83 14.48 XXX N

75756 26 A Artery x-rays, chest ......................................... 1.14 0.50 0.08 1.72 XXX N

75756 TC A Artery x-rays, chest ......................................... 0.00 12.01 0.75 12.76 XXX N

75774 ............. A Artery x-ray, each vessel ................................ 0.36 12.17 0.77 13.30 XXX N

75774 26 A Artery x-ray, each vessel ................................ 0.36 0.16 0.02 0.54 XXX N

75774 TC A Artery x-ray, each vessel ................................ 0.00 12.01 0.75 12.76 XXX N

75790 ............. A Visualize A-V shunt ........................................ 1.84 2.12 0.21 4.17 XXX N

75790 26 A Visualize A-V shunt ........................................ 1.84 0.83 0.12 2.79 XXX N

75790 TC A Visualize A-V shunt ........................................ 0.00 1.29 0.09 1.38 XXX N

75801 ............. A Lymph vessel x-ray, arm/leg .......................... 0.81 5.53 0.38 6.72 XXX N

75801 26 A Lymph vessel x-ray, arm/leg ........................... 0.81 0.37 0.05 1.23 XXX N

75801 TC A Lymph vessel x-ray, arm/leg ........................... 0.00 5.16 0.33 5.49 XXX N

75803 ............. A Lymph vessel x-ray, arms/legs ....................... 1.17 5.67 0.41 7.25 XXX N

75803 26 A Lymph vessel x-ray, arms/legs ....................... 1.17 0.51 0.08 1.76 XXX N

75803 TC A Lymph vessel x-ray, arms/legs ....................... 0.00 5.16 0.33 5.49 XXX N

75805 ............. A Lymph vessel x-ray, trunk ............................... 0.81 6.18 0.42 7.41 XXX N

75805 26 A Lymph vessel x-ray, trunk ............................... 0.81 0.37 0.05 1.23 XXX N

75805 TC A Lymph vessel x-ray, trunk ............................... 0.00 5.81 0.37 6.18 XXX N

75807 ............. A Lymph vessel x-ray, trunk ............................... 1.17 6.32 0.45 7.94 XXX N

75807 26 A Lymph vessel x-ray, trunk ............................... 1.17 0.51 0.08 1.76 XXX N

75807 TC A Lymph vessel x-ray, trunk ............................... 0.00 5.81 0.37 6.18 XXX N

75809 ............. A Nonvascular shunt, x-ray ................................ 0.47 0.94 0.08 1.49 XXX N
63277

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

75809 26 A Nonvascular shunt, x-ray ................................ 0.47 0.19 0.03 0.69 XXX N

75809 TC A Nonvascular shunt, x-ray ................................ 0.00 0.75 0.05 0.80 XXX N

75810 ............. A Vein x-ray, spleen/liver ................................... 1.14 12.51 0.83 14.48 XXX N

75810 26 A Vein x-ray, spleen/liver ................................... 1.14 0.50 0.08 1.72 XXX N

75810 TC A Vein x-ray, spleen/liver ................................... 0.00 12.01 0.75 12.76 XXX N

75820 ............. A Vein x-ray, arm/leg ......................................... 0.70 1.22 0.11 2.03 XXX N

75820 26 A Vein x-ray, arm/leg ......................................... 0.70 0.32 0.05 1.07 XXX N

75820 TC A Vein x-ray, arm/leg ......................................... 0.00 0.90 0.06 0.96 XXX N

75822 ............. A Vein x-ray, arms/legs ...................................... 1.06 1.88 0.16 3.10 XXX N

75822 26 A Vein x-ray, arms/legs ...................................... 1.06 0.47 0.07 1.60 XXX N

75822 TC A Vein x-ray, arms/legs ...................................... 0.00 1.41 0.09 1.50 XXX N

75825 ............. A Vein x-ray, trunk ............................................. 1.14 12.51 0.83 14.48 XXX N

75825 26 A Vein x-ray, trunk ............................................. 1.14 0.50 0.08 1.72 XXX N

75825 TC A Vein x-ray, trunk ............................................. 0.00 12.01 0.75 12.76 XXX N

75827 ............. A Vein x-ray, chest ............................................. 1.14 12.51 0.83 14.48 XXX N

75827 26 A Vein x-ray, chest ............................................. 1.14 0.50 0.08 1.72 XXX N

75827 TC A Vein x-ray, chest ............................................. 0.00 12.01 0.75 12.76 XXX N

75831 ............. A Vein x-ray, kidney ........................................... 1.14 12.51 0.83 14.48 XXX N

75831 26 A Vein x-ray, kidney ........................................... 1.14 0.50 0.08 1.72 XXX N

75831 TC A Vein x-ray, kidney ........................................... 0.00 12.01 0.75 12.76 XXX N

75833 ............. A Vein x-ray, kidneys ......................................... 1.49 12.67 0.85 15.01 XXX N

75833 26 A Vein x-ray, kidneys ......................................... 1.49 0.66 0.10 2.25 XXX N

75833 TC A Vein x-ray, kidneys ......................................... 0.00 12.01 0.75 12.76 XXX N

75840 ............. A Vein x-ray, adrenal gland ............................... 1.14 12.51 0.83 14.48 XXX N

75840 26 A Vein x-ray, adrenal gland ............................... 1.14 0.50 0.08 1.72 XXX N

75840 TC A Vein x-ray, adrenal gland ............................... 0.00 12.01 0.75 12.76 XXX N

75842 ............. A Vein x-ray, adrenal glands .............................. 1.49 12.67 0.85 15.01 XXX N

75842 26 A Vein x-ray, adrenal glands .............................. 1.49 0.66 0.10 2.25 XXX N

75842 TC A Vein x-ray, adrenal glands .............................. 0.00 12.01 0.75 12.76 XXX N

75860 ............. A Vein x-ray, neck .............................................. 1.14 12.51 0.83 14.48 XXX N

75860 26 A Vein x-ray, neck .............................................. 1.14 0.50 0.08 1.72 XXX N

75860 TC A Vein x-ray, neck .............................................. 0.00 12.01 0.75 12.76 XXX N

75870 ............. A Vein x-ray, skull .............................................. 1.14 12.51 0.83 14.48 XXX N

75870 26 A Vein x-ray, skull .............................................. 1.14 0.50 0.08 1.72 XXX N

75870 TC A Vein x-ray, skull .............................................. 0.00 12.01 0.75 12.76 XXX N

75872 ............. A Vein x-ray, skull .............................................. 1.14 12.51 0.83 14.48 XXX N

75872 26 A Vein x-ray, skull .............................................. 1.14 0.50 0.08 1.72 XXX N

75872 TC A Vein x-ray, skull .............................................. 0.00 12.01 0.75 12.76 XXX N

75880 ............. A Vein x-ray, eye socket .................................... 0.70 1.22 0.11 2.03 XXX N

75880 26 A Vein x-ray, eye socket .................................... 0.70 0.32 0.05 1.07 XXX N

75880 TC A Vein x-ray, eye socket .................................... 0.00 0.90 0.06 0.96 XXX N

75885 ............. A Vein x-ray, liver ............................................... 1.44 12.65 0.85 14.94 XXX N

75885 26 A Vein x-ray, liver ............................................... 1.44 0.64 0.10 2.18 XXX N

75885 TC A Vein x-ray, liver ............................................... 0.00 12.01 0.75 12.76 XXX N

75887 ............. A Vein x-ray, liver ............................................... 1.44 12.65 0.85 14.94 XXX N

75887 26 A Vein x-ray, liver ............................................... 1.44 0.64 0.10 2.18 XXX N

75887 TC A Vein x-ray, liver ............................................... 0.00 12.01 0.75 12.76 XXX N

75889 ............. A Vein x-ray, liver ............................................... 1.14 12.51 0.83 14.48 XXX N

75889 26 A Vein x-ray, liver ............................................... 1.14 0.50 0.08 1.72 XXX N

75889 TC A Vein x-ray, liver ............................................... 0.00 12.01 0.75 12.76 XXX N

75891 ............. A Vein x-ray, liver ............................................... 1.14 12.51 0.83 14.48 XXX N

75891 26 A Vein x-ray, liver ............................................... 1.14 0.50 0.08 1.72 XXX N

75891 TC A Vein x-ray, liver ............................................... 0.00 12.01 0.75 12.76 XXX N

75893 ............. A Venous sampling by catheter ......................... 0.54 12.26 0.79 13.59 XXX N

75893 26 A Venous sampling by catheter ......................... 0.54 0.25 0.04 0.83 XXX N

75893 TC A Venous sampling by catheter ......................... 0.00 12.01 0.75 12.76 XXX N

75894 ............. A X-rays, transcatheter therapy ......................... 1.31 23.58 1.53 26.42 XXX N

75894 26 A X-rays, transcatheter therapy ......................... 1.31 0.58 0.09 1.98 XXX N

75894 TC A X-rays, transcatheter therapy ......................... 0.00 23.00 1.44 24.44 XXX N

75896 ............. A X-rays, transcatheter therapy ......................... 1.31 20.58 1.34 23.23 XXX N

75896 26 A X-rays, transcatheter therapy ......................... 1.31 0.58 0.09 1.98 XXX N

75896 TC A X-rays, transcatheter therapy ......................... 0.00 20.00 1.25 21.25 XXX N

75898 ............. A Follow-up angiogram ...................................... 1.65 1.74 0.18 3.57 XXX N

75898 26 A Follow-up angiogram ...................................... 1.65 0.74 0.11 2.50 XXX N

75898 TC A Follow-up angiogram ...................................... 0.00 1.00 0.07 1.07 XXX N

75900 ............. A Arterial catheter exchange .............................. 0.49 20.22 1.29 22.00 XXX N
63278

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

75900 26 A Arterial catheter exchange .............................. 0.49 0.23 0.03 0.75 XXX N

75900 TC A Arterial catheter exchange .............................. 0.00 19.99 1.26 21.25 XXX N

75940 ............. A X-ray placement, vein filter ............................. 0.54 12.26 0.79 13.59 XXX N

75940 26 A X-ray placement, vein filter ............................. 0.54 0.25 0.04 0.83 XXX N

75940 TC A X-ray placement, vein filter ............................. 0.00 12.01 0.75 12.76 XXX N

75960 ............. A Transcatheter intro, stent ................................ 0.82 14.57 0.94 16.33 XXX N

75960 26 A Transcatheter intro, stent ................................ 0.82 0.37 0.06 1.25 XXX N

75960 TC A Transcatheter intro, stent ................................ 0.00 14.20 0.88 15.08 XXX N

75961 ............. A Retrieval, broken catheter .............................. 4.25 11.91 0.90 17.06 XXX N

75961 26 A Retrieval, broken catheter .............................. 4.25 1.90 0.28 6.43 XXX N

75961 TC A Retrieval, broken catheter ............................... 0.00 10.01 0.62 10.63 XXX N

75962 ............. A Repair arterial blockage .................................. 0.54 15.25 0.98 16.77 XXX N

75962 26 A Repair arterial blockage .................................. 0.54 0.25 0.04 0.83 XXX N

75962 TC A Repair arterial blockage .................................. 0.00 15.00 0.94 15.94 XXX N

75964 ............. A Repair artery blockage, each ......................... 0.36 8.16 0.52 9.04 XXX N

75964 26 A Repair artery blockage, each .......................... 0.36 0.16 0.02 0.54 XXX N

75964 TC A Repair artery blockage, each .......................... 0.00 8.00 0.50 8.50 XXX N

75966 ............. A Repair arterial blockage .................................. 1.31 15.58 1.03 17.92 XXX N

75966 26 A Repair arterial blockage .................................. 1.31 0.58 0.09 1.98 XXX N

75966 TC A Repair arterial blockage .................................. 0.00 15.00 0.94 15.94 XXX N

75968 ............. A Repair artery blockage, each ......................... 0.36 8.16 0.52 9.04 XXX N

75968 26 A Repair artery blockage, each .......................... 0.36 0.16 0.02 0.54 XXX N

75968 TC A Repair artery blockage, each .......................... 0.00 8.00 0.50 8.50 XXX N

75970 ............. A Vascular biopsy .............................................. 0.83 11.38 0.75 12.96 XXX N

75970 26 A Vascular biopsy .............................................. 0.83 0.38 0.06 1.27 XXX N

75970 TC A Vascular biopsy .............................................. 0.00 11.00 0.69 11.69 XXX N

75978 ............. A Repair venous blockage ................................. 0.54 15.48 0.98 17.00 XXX N

75978 26 A Repair venous blockage ................................. 0.54 0.48 0.04 1.06 XXX N

75978 TC A Repair venous blockage ................................. 0.00 15.00 0.94 15.94 XXX N

75980 ............. A Contrast x-ray exam bile duct ......................... 1.44 5.80 0.43 7.67 XXX N

75980 26 A Contrast x-ray exam bile duct ......................... 1.44 0.64 0.10 2.18 XXX N

75980 TC A Contrast x-ray exam bile duct ......................... 0.00 5.16 0.33 5.49 XXX N

75982 ............. A Contrast x-ray exam bile duct ......................... 1.44 6.45 0.47 8.36 XXX N

75982 26 A Contrast x-ray exam bile duct ......................... 1.44 0.64 0.10 2.18 XXX N

75982 TC A Contrast x-ray exam bile duct ......................... 0.00 5.81 0.37 6.18 XXX N

75984 ............. A X-ray control catheter change ........................ 0.72 2.19 0.17 3.08 XXX N

75984 26 A X-ray control catheter change ........................ 0.72 0.33 0.05 1.10 XXX N

75984 TC A X-ray control catheter change ........................ 0.00 1.86 0.12 1.98 XXX N

75989 ............. A Abscess drainage under x-ray ........................ 1.19 3.52 0.27 4.98 XXX N

75989 26 A Abscess drainage under x-ray ........................ 1.19 0.52 0.08 1.79 XXX N

75989 TC A Abscess drainage under x-ray ........................ 0.00 3.00 0.19 3.19 XXX N

75992 ............. A Atherectomy, x-ray exam ................................ 0.54 15.25 0.98 16.77 XXX N

75992 26 A Atherectomy, x-ray exam ................................ 0.54 0.25 0.04 0.83 XXX N

75992 TC A Atherectomy, x-ray exam ................................ 0.00 15.00 0.94 15.94 XXX N

75993 ............. A Atherectomy, x-ray exam ................................ 0.36 8.16 0.52 9.04 XXX N

75993 26 A Atherectomy, x-ray exam ................................ 0.36 0.16 0.02 0.54 XXX N

75993 TC A Atherectomy, x-ray exam ................................ 0.00 8.00 0.50 8.50 XXX N

75994 ............. A Atherectomy, x-ray exam ................................ 1.31 15.58 1.03 17.92 XXX N

75994 26 A Atherectomy, x-ray exam ................................ 1.31 0.58 0.09 1.98 XXX N

75994 TC A Atherectomy, x-ray exam ................................ 0.00 15.00 0.94 15.94 XXX N

75995 ............. A Atherectomy, x-ray exam ................................ 1.31 15.58 1.03 17.92 XXX N

75995 26 A Atherectomy, x-ray exam ................................ 1.31 0.58 0.09 1.98 XXX N

75995 TC A Atherectomy, x-ray exam ................................ 0.00 15.00 0.94 15.94 XXX N

75996 ............. A Atherectomy, x-ray exam ................................ 0.36 8.16 0.52 9.04 XXX N

75996 26 A Atherectomy, x-ray exam ................................ 0.36 0.16 0.02 0.54 XXX N

75996 TC A Atherectomy, x-ray exam ................................ 0.00 8.00 0.50 8.50 XXX N

76000 ............. A Fluoroscope examination ................................ 0.17 1.31 0.09 1.57 XXX N

76000 26 A Fluoroscope examination ................................ 0.17 0.07 0.01 0.25 XXX N

76000 TC A Fluoroscope examination ................................ 0.00 1.24 0.08 1.32 XXX N

76001 ............. A Fluoroscope exam, extensive ......................... 0.67 2.81 0.22 3.70 XXX N

76001 26 A Fluoroscope exam, extensive ......................... 0.67 0.31 0.05 1.03 XXX N

76001 TC A Fluoroscope exam, extensive ......................... 0.00 2.50 0.17 2.67 XXX N

76003 ............. A Needle localization by x-ray ........................... 0.54 1.49 0.12 2.15 XXX N

76003 26 A Needle localization by x-ray ........................... 0.54 0.25 0.04 0.83 XXX N

76003 TC A Needle localization by x-ray ............................ 0.00 1.24 0.08 1.32 XXX N

76010 ............. A X-ray, nose to rectum ..................................... 0.18 0.58 0.04 0.80 XXX N
63279

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

76010 26 A X-ray, nose to rectum ..................................... 0.18 0.08 0.01 0.27 XXX N

76010 TC A X-ray, nose to rectum ..................................... 0.00 0.50 0.03 0.53 XXX N

76020 ............. A X-rays for bone age ........................................ 0.19 0.59 0.04 0.82 XXX N

76020 26 A X-rays for bone age ........................................ 0.19 0.09 0.01 0.29 XXX N

76020 TC A X-rays for bone age ........................................ 0.00 0.50 0.03 0.53 XXX N

76040 ............. A X-rays, bone evaluation .................................. 0.27 0.88 0.07 1.22 XXX N

76040 26 A X-rays, bone evaluation .................................. 0.27 0.13 0.02 0.42 XXX N

76040 TC A X-rays, bone evaluation .................................. 0.00 0.75 0.05 0.80 XXX N

76061 ............. A X-rays, bone survey ........................................ 0.45 1.15 0.09 1.69 XXX N

76061 26 A X-rays, bone survey ........................................ 0.45 0.20 0.03 0.68 XXX N

76061 TC A X-rays, bone survey ........................................ 0.00 0.95 0.06 1.01 XXX N

76062 ............. A X-rays, bone survey ........................................ 0.54 1.62 0.13 2.29 XXX N

76062 26 A X-rays, bone survey ........................................ 0.54 0.25 0.04 0.83 XXX N

76062 TC A X-rays, bone survey ........................................ 0.00 1.37 0.09 1.46 XXX N

76065 ............. A X-rays, bone evaluation .................................. 0.28 0.83 0.07 1.18 XXX N

76065 26 A X-rays, bone evaluation .................................. 0.28 0.13 0.02 0.43 XXX N

76065 TC A X-rays, bone evaluation .................................. 0.00 0.70 0.05 0.75 XXX N

76066 ............. A Joint(s) survey, single film .............................. 0.31 1.20 0.09 1.60 XXX N

76066 26 A Joint(s) survey, single film .............................. 0.31 0.14 0.02 0.47 XXX N

76066 TC A Joint(s) survey, single film .............................. 0.00 1.06 0.07 1.13 XXX N

76070 ............. A CT scan, bone density study .......................... 0.25 2.93 0.20 3.38 XXX N

76070 26 A CT scan, bone density study .......................... 0.25 0.12 0.02 0.39 XXX N

76070 TC A CT scan, bone density study .......................... 0.00 2.81 0.18 2.99 XXX N

76075 ............. A Dual energy x-ray study ................................. 0.30 3.07 0.21 3.58 XXX N

76075 26 A Dual energy x-ray study ................................. 0.30 0.12 0.02 0.44 XXX N

76075 TC A Dual energy x-ray study .................................. 0.00 2.95 0.19 3.14 XXX N

76080 ............. A X-ray exam of fistula ....................................... 0.54 1.25 0.11 1.90 XXX N

76080 26 A X-ray exam of fistula ....................................... 0.54 0.25 0.04 0.83 XXX N

76080 TC A X-ray exam of fistula ....................................... 0.00 1.00 0.07 1.07 XXX N

76086 ............. A X-ray of mammary duct .................................. 0.36 2.67 0.19 3.22 XXX N

76086 26 A X-ray of mammary duct .................................. 0.36 0.17 0.02 0.55 XXX N

76086 TC A X-ray of mammary duct .................................. 0.00 2.50 0.17 2.67 XXX N

76088 ............. A X-ray of mammary ducts ................................ 0.45 3.69 0.25 4.39 XXX N

76088 26 A X-ray of mammary ducts ................................ 0.45 0.20 0.03 0.68 XXX N

76088 TC A X-ray of mammary ducts ................................ 0.00 3.49 0.22 3.71 XXX N

76090 ............. A Mammogram, one breast ............................... 0.25 1.12 0.09 1.46 XXX N

76090 26 A Mammogram, one breast ............................... 0.25 0.12 0.02 0.39 XXX N

76090 TC A Mammogram, one breast ............................... 0.00 1.00 0.07 1.07 XXX N

76091 ............. A Mammogram, both breasts ............................. 0.41 1.42 0.11 1.94 XXX N

76091 26 A Mammogram, both breasts ............................. 0.41 0.18 0.03 0.62 XXX N

76091 TC A Mammogram, both breasts ............................. 0.00 1.24 0.08 1.32 XXX N

76092 ............. X Mammogram, screening ................................. 0.00 0.00 0.00 0.00 XXX 0

76093 ............. A Magnetic image, breast .................................. 1.63 17.52 1.16 20.31 XXX N

76093 26 A Magnetic image, breast .................................. 1.63 0.72 0.11 2.46 XXX N

76093 TC A Magnetic image, breast .................................. 0.00 16.80 1.05 17.85 XXX N

76094 ............. A Magnetic image, both breasts ........................ 1.63 23.51 1.53 26.67 XXX N

76094 26 A Magnetic image, both breasts ........................ 1.63 0.72 0.11 2.46 XXX N

76094 TC A Magnetic image, both breasts ........................ 0.00 22.79 1.42 24.21 XXX N

76095 ............. A Stereotactic breast biopsy .............................. 1.59 7.54 0.54 9.67 XXX N

76095 26 A Stereotactic breast biopsy .............................. 1.59 0.71 0.11 2.41 XXX N

76095 TC A Stereotactic breast biopsy .............................. 0.00 6.83 0.43 7.26 XXX N

76096 ............. A X-ray of needle wire, breast ........................... 0.56 1.50 0.12 2.18 XXX N

76096 26 A X-ray of needle wire, breast ........................... 0.56 0.26 0.04 0.86 XXX N

76096 TC A X-ray of needle wire, breast ........................... 0.00 1.24 0.08 1.32 XXX N

76098 ............. A X-ray exam, breast specimen ......................... 0.16 0.47 0.04 0.67 XXX N

76098 26 A X-ray exam, breast specimen ......................... 0.16 0.07 0.01 0.24 XXX N

76098 TC A X-ray exam, breast specimen ......................... 0.00 0.40 0.03 0.43 XXX N

76100 ............. A X-ray exam of body section ............................ 0.58 1.46 0.12 2.16 XXX N

76100 26 A X-ray exam of body section ............................ 0.58 0.27 0.04 0.89 XXX N

76100 TC A X-ray exam of body section ............................ 0.00 1.19 0.08 1.27 XXX N

76101 ............. A Complex body section x-ray ........................... 0.58 1.62 0.13 2.33 XXX N

76101 26 A Complex body section x-ray ........................... 0.58 0.27 0.04 0.89 XXX N

76101 TC A Complex body section x-ray ........................... 0.00 1.35 0.09 1.44 XXX N

76102 ............. A Complex body section x-rays ......................... 0.58 1.92 0.15 2.65 XXX N

76102 26 A Complex body section x-rays ......................... 0.58 0.27 0.04 0.89 XXX N

76102 TC A Complex body section x-rays ......................... 0.00 1.65 0.11 1.76 XXX N
63280

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

76120 ............. A Cinematic x-rays ............................................. 0.38 1.17 0.10 1.65 XXX N

76120 26 A Cinematic x-rays ............................................. 0.38 0.17 0.03 0.58 XXX N

76120 TC A Cinematic x-rays ............................................. 0.00 1.00 0.07 1.07 XXX N

76125 ............. A Cinematic x-rays ............................................. 0.27 0.87 0.07 1.21 XXX N

76125 26 A Cinematic x-rays ............................................. 0.27 0.12 0.02 0.41 XXX N

76125 TC A Cinematic x-rays ............................................. 0.00 0.75 0.05 0.80 XXX N

76140 ............. G X-ray consultation ........................................... 0.00 0.00 0.00 0.00 XXX 0

76150 ............. A X-ray exam, dry process ................................ 0.00 0.40 0.03 0.43 XXX N

76350 ............. C Special x-ray contrast study ........................... 0.00 0.00 0.00 0.00 XXX N

76355 ............. A CAT scan for localization ................................ 1.21 8.40 0.57 10.18 XXX N

76355 26 A CAT scan for localization ................................ 1.21 0.53 0.08 1.82 XXX N

76355 TC A CAT scan for localization ................................ 0.00 7.87 0.49 8.36 XXX N

76360 ............. A CAT scan for needle biopsy ........................... 1.16 8.37 0.57 10.10 XXX N

76360 26 A CAT scan for needle biopsy ........................... 1.16 0.50 0.08 1.74 XXX N

76360 TC A CAT scan for needle biopsy ........................... 0.00 7.87 0.49 8.36 XXX N

76365 ............. A CAT scan for cyst aspiration .......................... 1.16 8.37 0.57 10.10 XXX N

76365 26 A CAT scan for cyst aspiration .......................... 1.16 0.50 0.08 1.74 XXX N

76365 TC A CAT scan for cyst aspiration .......................... 0.00 7.87 0.49 8.36 XXX N

76370 ............. A CAT scan for therapy guide ........................... 0.85 3.19 0.24 4.28 XXX N

76370 26 A CAT scan for therapy guide ........................... 0.85 0.38 0.06 1.29 XXX N

76370 TC A CAT scan for therapy guide ............................ 0.00 2.81 0.18 2.99 XXX N

76375 ............. A CAT scans, other planes ................................ 0.16 3.44 0.22 3.82 XXX N

76375 26 A CAT scans, other planes ................................ 0.16 0.07 0.01 0.24 XXX N

76375 TC A CAT scans, other planes ................................ 0.00 3.37 0.21 3.58 XXX N

76380 ............. A CAT scan follow-up study ............................... 0.98 3.78 0.28 5.04 XXX N

76380 26 A CAT scan follow-up study ............................... 0.98 0.44 0.07 1.49 XXX N

76380 TC A CAT scan follow-up study ............................... 0.00 3.34 0.21 3.55 XXX N

76400 ............. A Magnetic image, bone marrow ....................... 1.60 11.40 0.78 13.78 XXX N

76400 26 A Magnetic image, bone marrow ....................... 1.60 0.72 0.11 2.43 XXX N

76400 TC A Magnetic image, bone marrow ....................... 0.00 10.68 0.67 11.35 XXX N

76499 ............. C Radiographic procedure ................................. 0.00 0.00 0.00 0.00 XXX N

76499 26 C Radiographic procedure ................................. 0.00 0.00 0.00 0.00 XXX N

76499 TC C Radiographic procedure ................................. 0.00 0.00 0.00 0.00 XXX N

76506 ............. A Echo exam of head ........................................ 0.63 1.64 0.13 2.40 XXX N

76506 26 A Echo exam of head ........................................ 0.63 0.29 0.04 0.96 XXX N

76506 TC A Echo exam of head ........................................ 0.00 1.35 0.09 1.44 XXX N

76511 ............. A Echo exam of eye ........................................... 0.94 1.44 0.12 2.50 XXX N

76511 26 A Echo exam of eye ........................................... 0.94 0.25 0.04 1.23 XXX N

76511 TC A Echo exam of eye ........................................... 0.00 1.19 0.08 1.27 XXX N

76512 ............. A Echo exam of eye ........................................... 0.66 1.75 0.15 2.56 XXX N

76512 26 A Echo exam of eye ........................................... 0.66 0.30 0.05 1.01 XXX N

76512 TC A Echo exam of eye ........................................... 0.00 1.45 0.10 1.55 XXX N

76513 ............. A Echo exam of eye, water bath ....................... 0.66 1.75 0.15 2.56 XXX N

76513 26 A Echo exam of eye, water bath ....................... 0.66 0.30 0.05 1.01 XXX N

76513 TC A Echo exam of eye, water bath ........................ 0.00 1.45 0.10 1.55 XXX N

76516 ............. A Echo exam of eye ........................................... 0.54 1.44 0.12 2.10 XXX N

76516 26 A Echo exam of eye ........................................... 0.54 0.25 0.04 0.83 XXX N

76516 TC A Echo exam of eye ........................................... 0.00 1.19 0.08 1.27 XXX N

76519 ............. A Echo exam of eye ........................................... 0.54 1.44 0.12 2.10 XXX N

76519 26 A Echo exam of eye ........................................... 0.54 0.25 0.04 0.83 XXX N

76519 TC A Echo exam of eye ........................................... 0.00 1.19 0.08 1.27 XXX N

76529 ............. A Echo exam of eye ........................................... 0.57 1.56 0.13 2.26 XXX N

76529 26 A Echo exam of eye ........................................... 0.57 0.26 0.04 0.87 XXX N

76529 TC A Echo exam of eye ........................................... 0.00 1.30 0.09 1.39 XXX N

76536 ............. A Echo exam of head and neck ........................ 0.56 1.61 0.13 2.30 XXX N

76536 26 A Echo exam of head and neck ........................ 0.56 0.26 0.04 0.86 XXX N

76536 TC A Echo exam of head and neck ......................... 0.00 1.35 0.09 1.44 XXX N

76604 ............. A Echo exam of chest ........................................ 0.55 1.50 0.12 2.17 XXX N

76604 26 A Echo exam of chest ........................................ 0.55 0.26 0.04 0.85 XXX N

76604 TC A Echo exam of chest ........................................ 0.00 1.24 0.08 1.32 XXX N

76645 ............. A Echo exam of breast ...................................... 0.54 1.25 0.11 1.90 XXX N

76645 26 A Echo exam of breast ...................................... 0.54 0.25 0.04 0.83 XXX N

76645 TC A Echo exam of breast ...................................... 0.00 1.00 0.07 1.07 XXX N

76700 ............. A Echo exam of abdomen ................................. 0.81 2.25 0.17 3.23 XXX N

76700 26 A Echo exam of abdomen ................................. 0.81 0.37 0.05 1.23 XXX N

76700 TC A Echo exam of abdomen ................................. 0.00 1.88 0.12 2.00 XXX N
63281

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

76705 ............. A Echo exam of abdomen ................................. 0.59 1.62 0.13 2.34 XXX N

76705 26 A Echo exam of abdomen ................................. 0.59 0.27 0.04 0.90 XXX N

76705 TC A Echo exam of abdomen ................................. 0.00 1.35 0.09 1.44 XXX N

76770 ............. A Echo exam abdomen back wall ..................... 0.74 2.22 0.17 3.13 XXX N

76770 26 A Echo exam abdomen back wall ..................... 0.74 0.34 0.05 1.13 XXX N

76770 TC A Echo exam abdomen back wall ...................... 0.00 1.88 0.12 2.00 XXX N

76775 ............. A Echo exam abdomen back wall ..................... 0.58 1.62 0.13 2.33 XXX N

76775 26 A Echo exam abdomen back wall ..................... 0.58 0.27 0.04 0.89 XXX N

76775 TC A Echo exam abdomen back wall ...................... 0.00 1.35 0.09 1.44 XXX N

76778 ............. A Echo exam kidney transplant ......................... 0.74 2.22 0.17 3.13 XXX N

76778 26 A Echo exam kidney transplant ......................... 0.74 0.34 0.05 1.13 XXX N

76778 TC A Echo exam kidney transplant ......................... 0.00 1.88 0.12 2.00 XXX N

76800 ............. A Echo exam spinal canal ................................. 1.13 1.85 0.17 3.15 XXX N

76800 26 A Echo exam spinal canal ................................. 1.13 0.50 0.08 1.71 XXX N

76800 TC A Echo exam spinal canal ................................. 0.00 1.35 0.09 1.44 XXX N

76805 ............. A Echo exam of pregnant uterus ....................... 0.99 2.45 0.20 3.64 XXX N

76805 26 A Echo exam of pregnant uterus ....................... 0.99 0.45 0.07 1.51 XXX N

76805 TC A Echo exam of pregnant uterus ....................... 0.00 2.00 0.13 2.13 XXX N

76810 ............. A Echo exam of pregnant uterus ....................... 1.97 4.88 0.38 7.23 XXX N

76810 26 A Echo exam of pregnant uterus ....................... 1.97 0.88 0.13 2.98 XXX N

76810 TC A Echo exam of pregnant uterus ....................... 0.00 4.00 0.25 4.25 XXX N

76815 ............. A Echo exam of pregnant uterus ....................... 0.65 1.65 0.13 2.43 XXX N

76815 26 A Echo exam of pregnant uterus ....................... 0.65 0.30 0.04 0.99 XXX N

76815 TC A Echo exam of pregnant uterus ....................... 0.00 1.35 0.09 1.44 XXX N

76816 ............. A Echo exam followup or repeat ........................ 0.57 1.32 0.11 2.00 XXX N

76816 26 A Echo exam followup or repeat ........................ 0.57 0.26 0.04 0.87 XXX N

76816 TC A Echo exam followup or repeat ........................ 0.00 1.06 0.07 1.13 XXX N

76818 ............. A Fetal biophysical profile .................................. 0.77 1.89 0.15 2.81 XXX N

76818 26 A Fetal biophysical profile .................................. 0.77 0.35 0.05 1.17 XXX N

76818 TC A Fetal biophysical profile .................................. 0.00 1.54 0.10 1.64 XXX N

76825 ............. A Echo exam of fetal heart ................................ 0.98 2.23 0.17 3.38 XXX N

76825 26 A Echo exam of fetal heart ................................ 0.98 0.35 0.05 1.38 XXX N

76825 TC A Echo exam of fetal heart ................................ 0.00 1.88 0.12 2.00 XXX N

76826 ............. A Echo exam of fetal heart ................................ 0.83 1.35 0.10 2.28 XXX N

76826 26 A Echo exam of fetal heart ................................ 0.83 0.68 0.05 1.56 XXX N

76826 TC A Echo exam of fetal heart ................................ 0.00 0.67 0.05 0.72 XXX N

76827 ............. A Echo exam of fetal heart ................................ 0.58 2.33 0.18 3.09 XXX N

76827 26 A Echo exam of fetal heart ................................ 0.58 0.69 0.05 1.32 XXX N

76827 TC A Echo exam of fetal heart ................................ 0.00 1.64 0.13 1.77 XXX N

76828 ............. A Echo exam of fetal heart ................................ 0.56 1.34 0.11 2.01 XXX N

76828 26 A Echo exam of fetal heart ................................ 0.56 0.28 0.02 0.86 XXX N

76828 TC A Echo exam of fetal heart ................................ 0.00 1.06 0.09 1.15 XXX N

76830 ............. A Echo exam, transvaginal ................................ 0.69 1.77 0.15 2.61 XXX N

76830 26 A Echo exam, transvaginal ................................ 0.69 0.32 0.05 1.06 XXX N

76830 TC A Echo exam, transvaginal ................................ 0.00 1.45 0.10 1.55 XXX N

76856 ............. A Echo exam of pelvis ....................................... 0.69 1.77 0.15 2.61 XXX N

76856 26 A Echo exam of pelvis ....................................... 0.69 0.32 0.05 1.06 XXX N

76856 TC A Echo exam of pelvis ....................................... 0.00 1.45 0.10 1.55 XXX N

76857 ............. A Echo exam of pelvis ....................................... 0.38 1.17 0.10 1.65 XXX N

76857 26 A Echo exam of pelvis ....................................... 0.38 0.17 0.03 0.58 XXX N

76857 TC A Echo exam of pelvis ....................................... 0.00 1.00 0.07 1.07 XXX N

76870 ............. A Echo exam of scrotum .................................... 0.64 1.74 0.14 2.52 XXX N

76870 26 A Echo exam of scrotum .................................... 0.64 0.29 0.04 0.97 XXX N

76870 TC A Echo exam of scrotum .................................... 0.00 1.45 0.10 1.55 XXX N

76872 ............. A Echo exam, transrectal ................................... 0.69 1.77 0.15 2.61 XXX N

76872 26 A Echo exam, transrectal ................................... 0.69 0.32 0.05 1.06 XXX N

76872 TC A Echo exam, transrectal ................................... 0.00 1.45 0.10 1.55 XXX N

76880 ............. A Echo exam of extremity .................................. 0.59 1.62 0.13 2.34 XXX N

76880 26 A Echo exam of extremity .................................. 0.59 0.27 0.04 0.90 XXX N

76880 TC A Echo exam of extremity .................................. 0.00 1.35 0.09 1.44 XXX N

76930 ............. A Echo guide for heart sac tap .......................... 0.67 1.76 0.15 2.58 XXX N

76930 26 A Echo guide for heart sac tap .......................... 0.67 0.31 0.05 1.03 XXX N

76930 TC A Echo guide for heart sac tap .......................... 0.00 1.45 0.10 1.55 XXX N

76932 ............. A Echo guide for heart biopsy ........................... 0.67 1.76 0.15 2.58 XXX N

76932 26 A Echo guide for heart biopsy ........................... 0.67 0.31 0.05 1.03 XXX N

76932 TC A Echo guide for heart biopsy ........................... 0.00 1.45 0.10 1.55 XXX N
63282

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

76934 ............. A Echo guide for chest tap ................................ 0.67 1.76 0.15 2.58 XXX N

76934 26 A Echo guide for chest tap ................................ 0.67 0.31 0.05 1.03 XXX N

76934 TC A Echo guide for chest tap ................................ 0.00 1.45 0.10 1.55 XXX N

76936 ............. A Echo guide for artery repair ............................ 1.99 7.24 0.48 9.71 XXX N

76936 26 A Echo guide for artery repair ............................ 1.99 1.24 0.10 3.33 XXX N

76936 TC A Echo guide for artery repair ............................ 0.00 6.00 0.38 6.38 XXX N

76938 ............. A Echo exam for drainage ................................. 0.67 1.76 0.15 2.58 XXX N

76938 26 A Echo exam for drainage ................................. 0.67 0.31 0.05 1.03 XXX N

76938 TC A Echo exam for drainage ................................. 0.00 1.45 0.10 1.55 XXX N

76941 ............. A Echo guide for transfusion .............................. 1.34 2.07 0.19 3.60 XXX N

76941 26 A Echo guide for transfusion .............................. 1.34 0.61 0.10 2.05 XXX N

76941 TC A Echo guide for transfusion .............................. 0.00 1.46 0.09 1.55 XXX N

76942 ............. A Echo guide for biopsy ..................................... 0.67 1.76 0.15 2.58 XXX N

76942 26 A Echo guide for biopsy ..................................... 0.67 0.31 0.05 1.03 XXX N

76942 TC A Echo guide for biopsy ..................................... 0.00 1.45 0.10 1.55 XXX N

76945 ............. A Echo guide, villus sampling ............................ 0.67 2.07 0.19 2.93 XXX N

76945 26 A Echo guide, villus sampling ............................ 0.67 0.61 0.10 1.38 XXX N

76945 TC A Echo guide, villus sampling ............................ 0.00 1.46 0.09 1.55 XXX N

76946 ............. A Echo guide for amniocentesis ........................ 0.38 1.62 0.13 2.13 XXX N

76946 26 A Echo guide for amniocentesis ........................ 0.38 0.17 0.03 0.58 XXX N

76946 TC A Echo guide for amniocentesis ........................ 0.00 1.45 0.10 1.55 XXX N

76948 ............. A Echo guide, ova aspiration ............................. 0.38 1.62 0.13 2.13 XXX N

76948 26 A Echo guide, ova aspiration ............................. 0.38 0.17 0.03 0.58 XXX N

76948 TC A Echo guide, ova aspiration ............................. 0.00 1.45 0.10 1.55 XXX N

76950 ............. A Echo guidance radiotherapy ........................... 0.58 1.51 0.12 2.21 XXX N

76950 26 A Echo guidance radiotherapy ........................... 0.58 0.27 0.04 0.89 XXX N

76950 TC A Echo guidance radiotherapy ........................... 0.00 1.24 0.08 1.32 XXX N

76960 ............. A Echo guidance radiotherapy ........................... 0.58 1.51 0.12 2.21 XXX N

76960 26 A Echo guidance radiotherapy ........................... 0.58 0.27 0.04 0.89 XXX N

76960 TC A Echo guidance radiotherapy ........................... 0.00 1.24 0.08 1.32 XXX N

76965 ............. A Echo guidance radiotherapy ........................... 1.34 7.38 0.52 9.24 XXX N

76965 26 A Echo guidance radiotherapy ........................... 1.34 2.07 0.19 3.60 XXX N

76965 TC A Echo guidance radiotherapy ........................... 0.00 5.31 0.33 5.64 XXX N

76970 ............. A Ultrasound exam follow-up ............................. 0.40 1.18 0.10 1.68 XXX N

76970 26 A Ultrasound exam follow-up ............................. 0.40 0.18 0.03 0.61 XXX N

76970 TC A Ultrasound exam follow-up ............................. 0.00 1.00 0.07 1.07 XXX N

76975 ............. A GI endoscopic ultrasound ............................... 0.81 1.79 0.15 2.75 XXX N

76975 26 A GI endoscopic ultrasound ............................... 0.81 0.34 0.05 1.20 XXX N

76975 TC A GI endoscopic ultrasound ............................... 0.00 1.45 0.10 1.55 XXX N

76986 ............. A Echo exam at surgery .................................... 1.20 3.03 0.25 4.48 XXX N

76986 26 A Echo exam at surgery .................................... 1.20 0.53 0.08 1.81 XXX N

76986 TC A Echo exam at surgery .................................... 0.00 2.50 0.17 2.67 XXX N

76999 ............. C Echo examination procedure .......................... 0.00 0.00 0.00 0.00 XXX N

76999 26 C Echo examination procedure .......................... 0.00 0.00 0.00 0.00 XXX N

76999 TC C Echo examination procedure .......................... 0.00 0.00 0.00 0.00 XXX N

77261 ............. A Radiation therapy planning ............................. 1.39 0.62 0.09 2.10 XXX N

77262 ............. A Radiation therapy planning ............................. 2.11 0.94 0.14 3.19 XXX N

77263 ............. A Radiation therapy planning ............................. 3.14 1.40 0.20 4.74 XXX N

77280 ............. A Set radiation therapy field ............................... 0.70 3.63 0.26 4.59 XXX N

77280 26 A Set radiation therapy field ............................... 0.70 0.32 0.05 1.07 XXX N

77280 TC A Set radiation therapy field ............................... 0.00 3.31 0.21 3.52 XXX N

77285 ............. A Set radiation therapy field ............................... 1.05 5.77 0.41 7.23 XXX N

77285 26 A Set radiation therapy field ............................... 1.05 0.46 0.07 1.58 XXX N

77285 TC A Set radiation therapy field ............................... 0.00 5.31 0.34 5.65 XXX N

77290 ............. A Set radiation therapy field ............................... 1.56 6.90 0.50 8.96 XXX N

77290 26 A Set radiation therapy field ............................... 1.56 0.70 0.11 2.37 XXX N

77290 TC A Set radiation therapy field ............................... 0.00 6.20 0.39 6.59 XXX N

77295 ............. A Set radiation therapy field ............................... 4.57 28.68 1.93 35.18 XXX N

77295 26 A Set radiation therapy field ............................... 4.57 2.06 0.23 6.86 XXX N

77295 TC A Set radiation therapy field ............................... 0.00 26.62 1.70 28.32 XXX N

77299 ............. C Radiation therapy planning ............................. 0.00 0.00 0.00 0.00 XXX N

77299 26 C Radiation therapy planning ............................. 0.00 0.00 0.00 0.00 XXX N

77299 TC C Radiation therapy planning ............................. 0.00 0.00 0.00 0.00 XXX N

77300 ............. A Radiation therapy dose plan ........................... 0.62 1.56 0.12 2.30 XXX N

77300 26 A Radiation therapy dose plan ........................... 0.62 0.28 0.04 0.94 XXX N

77300 TC A Radiation therapy dose plan ........................... 0.00 1.28 0.08 1.36 XXX N
63283

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

77305 ............. A Radiation therapy dose plan ........................... 0.70 2.09 0.17 2.96 XXX N

77305 26 A Radiation therapy dose plan ........................... 0.70 0.32 0.05 1.07 XXX N

77305 TC A Radiation therapy dose plan ........................... 0.00 1.77 0.12 1.89 XXX N

77310 ............. A Radiation therapy dose plan ........................... 1.05 2.68 0.22 3.95 XXX N

77310 26 A Radiation therapy dose plan ........................... 1.05 0.46 0.07 1.58 XXX N

77310 TC A Radiation therapy dose plan ........................... 0.00 2.22 0.15 2.37 XXX N

77315 ............. A Radiation therapy dose plan ........................... 1.56 3.23 0.28 5.07 XXX N

77315 26 A Radiation therapy dose plan ........................... 1.56 0.70 0.11 2.37 XXX N

77315 TC A Radiation therapy dose plan ........................... 0.00 2.53 0.17 2.70 XXX N

77321 ............. A Radiation therapy port plan ............................ 0.95 4.28 0.30 5.53 XXX N

77321 26 A Radiation therapy port plan ............................ 0.95 0.43 0.06 1.44 XXX N

77321 TC A Radiation therapy port plan ............................ 0.00 3.85 0.24 4.09 XXX N

77326 ............. A Radiation therapy dose plan ........................... 0.93 2.67 0.21 3.81 XXX N

77326 26 A Radiation therapy dose plan ........................... 0.93 0.42 0.06 1.41 XXX N

77326 TC A Radiation therapy dose plan ........................... 0.00 2.25 0.15 2.40 XXX N

77327 ............. A Radiation therapy dose plan ........................... 1.39 3.93 0.30 5.62 XXX N

77327 26 A Radiation therapy dose plan ........................... 1.39 0.62 0.09 2.10 XXX N

77327 TC A Radiation therapy dose plan ........................... 0.00 3.31 0.21 3.52 XXX N

77328 ............. A Radiation therapy dose plan ........................... 2.09 5.66 0.44 8.19 XXX N

77328 26 A Radiation therapy dose plan ........................... 2.09 0.93 0.14 3.16 XXX N

77328 TC A Radiation therapy dose plan ........................... 0.00 4.73 0.30 5.03 XXX N

77331 ............. A Special radiation dosimetry ............................ 0.87 0.87 0.09 1.83 XXX N

77331 26 A Special radiation dosimetry ............................ 0.87 0.39 0.06 1.32 XXX N

77331 TC A Special radiation dosimetry ............................. 0.00 0.48 0.03 0.51 XXX N

77332 ............. A Radiation treatment aid(s) .............................. 0.54 1.53 0.12 2.19 XXX N

77332 26 A Radiation treatment aid(s) .............................. 0.54 0.25 0.04 0.83 XXX N

77332 TC A Radiation treatment aid(s) .............................. 0.00 1.28 0.08 1.36 XXX N

77333 ............. A Radiation treatment aid(s) .............................. 0.84 2.19 0.18 3.21 XXX N

77333 26 A Radiation treatment aid(s) .............................. 0.84 0.38 0.06 1.28 XXX N

77333 TC A Radiation treatment aid(s) .............................. 0.00 1.81 0.12 1.93 XXX N

77334 ............. A Radiation treatment aid(s) .............................. 1.24 3.64 0.27 5.15 XXX N

77334 26 A Radiation treatment aid(s) .............................. 1.24 0.54 0.08 1.86 XXX N

77334 TC A Radiation treatment aid(s) .............................. 0.00 3.10 0.19 3.29 XXX N

77336 ............. A Radiation physics consult ............................... 0.00 2.84 0.18 3.02 XXX N

77370 ............. A Radiation physics consult ............................... 0.00 3.33 0.21 3.54 XXX N

77399 ............. C External radiation dosimetry ........................... 0.00 0.00 0.00 0.00 XXX N

77399 26 C External radiation dosimetry ........................... 0.00 0.00 0.00 0.00 XXX N

77399 TC C External radiation dosimetry ........................... 0.00 0.00 0.00 0.00 XXX N

77401 ............. A Radiation treatment delivery ........................... 0.00 1.69 0.11 1.80 XXX N

77402 ............. A Radiation treatment delivery ........................... 0.00 1.69 0.11 1.80 XXX N

77403 ............. A Radiation treatment delivery ........................... 0.00 1.69 0.11 1.80 XXX N

77404 ............. A Radiation treatment delivery ........................... 0.00 1.69 0.11 1.80 XXX N

77406 ............. A Radiation treatment delivery ........................... 0.00 1.69 0.11 1.80 XXX N

77407 ............. A Radiation treatment delivery ........................... 0.00 1.99 0.13 2.12 XXX N

77408 ............. A Radiation treatment delivery ........................... 0.00 1.99 0.13 2.12 XXX N

77409 ............. A Radiation treatment delivery ........................... 0.00 1.99 0.13 2.12 XXX N

77411 ............. A Radiation treatment delivery ........................... 0.00 1.99 0.13 2.12 XXX N

77412 ............. A Radiation treatment delivery ........................... 0.00 2.22 0.15 2.37 XXX N

77413 ............. A Radiation treatment delivery ........................... 0.00 2.22 0.15 2.37 XXX N

77414 ............. A Radiation treatment delivery ........................... 0.00 2.22 0.15 2.37 XXX N

77416 ............. A Radiation treatment delivery ........................... 0.00 2.22 0.15 2.37 XXX N

77417 ............. A Radiology port film(s) ...................................... 0.00 0.56 0.04 0.60 XXX N

77419 ............. A Weekly radiation therapy ................................ 3.60 1.61 0.23 5.44 XXX N

77420 ............. A Weekly radiation therapy ................................ 1.61 0.72 0.11 2.44 XXX N

77425 ............. A Weekly radiation therapy ................................ 2.44 1.10 0.17 3.71 XXX N

77430 ............. A Weekly radiation therapy ................................ 3.60 1.61 0.23 5.44 XXX N

77431 ............. A Radiation therapy management ..................... 1.81 0.81 0.12 2.74 XXX N

77432 ............. A Stereotactic radiation trmt ............................... 7.93 4.94 0.40 13.27 XXX N

77470 ............. A Special radiation treatment ............................. 2.09 11.55 0.80 14.44 XXX N

77470 26 A Special radiation treatment ............................. 2.09 0.93 0.14 3.16 XXX N

77470 TC A Special radiation treatment ............................. 0.00 10.62 0.66 11.28 XXX N

77499 ............. C Radiation therapy management ..................... 0.00 0.00 0.00 0.00 XXX N

77499 26 C Radiation therapy management ..................... 0.00 0.00 0.00 0.00 XXX N

77499 TC C Radiation therapy management ..................... 0.00 0.00 0.00 0.00 XXX N

77600 ............. A Hyperthermia treatment .................................. 1.56 3.60 0.29 5.45 ZZZ N

77600 26 A Hyperthermia treatment .................................. 1.56 0.70 0.11 2.37 ZZZ N
63284

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

77600 TC A Hyperthermia treatment .................................. 0.00 2.90 0.18 3.08 ZZZ N

77605 ............. A Hyperthermia treatment .................................. 2.09 4.80 0.39 7.28 ZZZ N

77605 26 A Hyperthermia treatment .................................. 2.09 0.93 0.14 3.16 ZZZ N

77605 TC A Hyperthermia treatment .................................. 0.00 3.87 0.25 4.12 ZZZ N

77610 ............. A Hyperthermia treatment .................................. 1.56 3.60 0.29 5.45 ZZZ N

77610 26 A Hyperthermia treatment .................................. 1.56 0.70 0.11 2.37 ZZZ N

77610 TC A Hyperthermia treatment .................................. 0.00 2.90 0.18 3.08 ZZZ N

77615 ............. A Hyperthermia treatment .................................. 2.09 4.80 0.39 7.28 ZZZ N

77615 26 A Hyperthermia treatment .................................. 2.09 0.93 0.14 3.16 ZZZ N

77615 TC A Hyperthermia treatment .................................. 0.00 3.87 0.25 4.12 ZZZ N

77620 ............. A Hyperthermia treatment .................................. 1.56 3.60 0.29 5.45 ZZZ N

77620 26 A Hyperthermia treatment .................................. 1.56 0.70 0.11 2.37 ZZZ N

77620 TC A Hyperthermia treatment .................................. 0.00 2.90 0.18 3.08 ZZZ N

77750 ............. A Infuse radioactive materials ............................ 4.59 3.32 0.38 8.29 090 N

77750 26 A Infuse radioactive materials ............................ 4.59 2.05 0.30 6.94 090 N

77750 TC A Infuse radioactive materials ............................ 0.00 1.27 0.08 1.35 090 N

77761 ............. A Radioelement application ............................... 3.56 3.98 0.39 7.93 090 N

77761 26 A Radioelement application ............................... 3.56 1.59 0.23 5.38 090 N

77761 TC A Radioelement application ............................... 0.00 2.39 0.16 2.55 090 N

77762 ............. A Radioelement application ............................... 5.35 5.83 0.57 11.75 090 N

77762 26 A Radioelement application ............................... 5.35 2.39 0.35 8.09 090 N

77762 TC A Radioelement application ............................... 0.00 3.44 0.22 3.66 090 N

77763 ............. A Radioelement application ............................... 8.01 7.86 0.77 16.64 090 N

77763 26 A Radioelement application ............................... 8.01 3.58 0.50 12.09 090 N

77763 TC A Radioelement application ............................... 0.00 4.28 0.27 4.55 090 N

77776 ............. A Radioelement application ............................... 4.66 4.16 0.45 9.27 XXX N

77776 26 A Radioelement application ............................... 4.66 2.09 0.31 7.06 XXX N

77776 TC A Radioelement application ............................... 0.00 2.07 0.14 2.21 XXX N

77777 ............. A Radioelement application ............................... 6.99 7.17 0.71 14.87 090 N

77777 26 A Radioelement application ............................... 6.99 3.13 0.45 10.57 090 N

77777 TC A Radioelement application ............................... 0.00 4.04 0.26 4.30 090 N

77778 ............. A Radioelement application ............................... 10.46 9.58 0.98 21.02 090 N

77778 26 A Radioelement application ............................... 10.46 4.69 0.67 15.82 090 N

77778 TC A Radioelement application ............................... 0.00 4.89 0.31 5.20 090 N

77781 ............. A High intensity brachytherapy .......................... 1.55 20.04 1.32 22.91 090 N

77781 26 A High intensity brachytherapy .......................... 1.55 0.69 0.11 2.35 090 N

77781 TC A High intensity brachytherapy .......................... 0.00 19.35 1.21 20.56 090 N

77782 ............. A High intensity brachytherapy .......................... 2.33 20.40 1.37 24.10 090 N

77782 26 A High intensity brachytherapy .......................... 2.33 1.05 0.16 3.54 090 N

77782 TC A High intensity brachytherapy .......................... 0.00 19.35 1.21 20.56 090 N

77783 ............. A High intensity brachytherapy .......................... 3.49 20.90 1.44 25.83 090 N

77783 26 A High intensity brachytherapy .......................... 3.49 1.55 0.23 5.27 090 N

77783 TC A High intensity brachytherapy .......................... 0.00 19.35 1.21 20.56 090 N

77784 ............. A High intensity brachytherapy .......................... 5.24 21.69 1.56 28.49 090 N

77784 26 A High intensity brachytherapy .......................... 5.24 2.34 0.35 7.93 090 N

77784 TC A High intensity brachytherapy .......................... 0.00 19.35 1.21 20.56 090 N

77789 ............. A Radioelement application ............................... 1.05 0.89 0.10 2.04 090 N

77789 26 A Radioelement application ............................... 1.05 0.46 0.07 1.58 090 N

77789 TC A Radioelement application ............................... 0.00 0.43 0.03 0.46 090 N

77790 ............. A Radioelement handling ................................... 1.05 0.94 0.10 2.09 XXX N

77790 26 A Radioelement handling ................................... 1.05 0.46 0.07 1.58 XXX N

77790 TC A Radioelement handling ................................... 0.00 0.48 0.03 0.51 XXX N

77799 ............. C Radium/radioisotope therapy .......................... 0.00 0.00 0.00 0.00 XXX N

77799 26 C Radium/radioisotope therapy .......................... 0.00 0.00 0.00 0.00 XXX N

77799 TC C Radium/radioisotope therapy .......................... 0.00 0.00 0.00 0.00 XXX N

78000 ............. A Thyroid, single uptake .................................... 0.19 1.01 0.07 1.27 XXX N

78000 26 A Thyroid, single uptake .................................... 0.19 0.09 0.01 0.29 XXX N

78000 TC A Thyroid, single uptake .................................... 0.00 0.92 0.06 0.98 XXX N

78001 ............. A Thyroid, multiple uptakes ................................ 0.26 1.36 0.10 1.72 XXX N

78001 26 A Thyroid, multiple uptakes ................................ 0.26 0.12 0.02 0.40 XXX N

78001 TC A Thyroid, multiple uptakes ................................ 0.00 1.24 0.08 1.32 XXX N

78003 ............. A Thyroid suppress/stimul .................................. 0.33 1.07 0.08 1.48 XXX N

78003 26 A Thyroid suppress/stimul .................................. 0.33 0.15 0.02 0.50 XXX N

78003 TC A Thyroid suppress/stimul .................................. 0.00 0.92 0.06 0.98 XXX N

78006 ............. A Thyroid, imaging with uptake .......................... 0.49 2.49 0.18 3.16 XXX N

78006 26 A Thyroid, imaging with uptake .......................... 0.49 0.22 0.03 0.74 XXX N
63285

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

78006 TC A Thyroid, imaging with uptake .......................... 0.00 2.27 0.15 2.42 XXX N

78007 ............. A Thyroid, image, mult uptakes ......................... 0.50 2.68 0.19 3.37 XXX N

78007 26 A Thyroid, image, mult uptakes ......................... 0.50 0.23 0.03 0.76 XXX N

78007 TC A Thyroid, image, mult uptakes ......................... 0.00 2.45 0.16 2.61 XXX N

78010 ............. A Thyroid imaging .............................................. 0.39 1.90 0.14 2.43 XXX N

78010 26 A Thyroid imaging .............................................. 0.39 0.17 0.03 0.59 XXX N

78010 TC A Thyroid imaging .............................................. 0.00 1.73 0.11 1.84 XXX N

78011 ............. A Thyroid imaging with flow ............................... 0.45 2.50 0.18 3.13 XXX N

78011 26 A Thyroid imaging with flow ............................... 0.45 0.21 0.03 0.69 XXX N

78011 TC A Thyroid imaging with flow ............................... 0.00 2.29 0.15 2.44 XXX N

78015 ............. A Thyroid met imaging ....................................... 0.67 2.76 0.21 3.64 XXX N

78015 26 A Thyroid met imaging ....................................... 0.67 0.31 0.05 1.03 XXX N

78015 TC A Thyroid met imaging ....................................... 0.00 2.45 0.16 2.61 XXX N

78016 ............. A Thyroid met imaging/studies ........................... 0.82 3.70 0.27 4.79 XXX N

78016 26 A Thyroid met imaging/studies ........................... 0.82 0.38 0.06 1.26 XXX N

78016 TC A Thyroid met imaging/studies ........................... 0.00 3.32 0.21 3.53 XXX N

78017 ............. A Thyroid met imaging, mult .............................. 0.87 3.94 0.28 5.09 XXX N

78017 26 A Thyroid met imaging, mult .............................. 0.87 0.39 0.06 1.32 XXX N

78017 TC A Thyroid met imaging, mult .............................. 0.00 3.55 0.22 3.77 XXX N

78018 ............. A Thyroid, met imaging, body ............................ 0.95 5.60 0.39 6.94 XXX N

78018 26 A Thyroid, met imaging, body ............................ 0.95 0.43 0.06 1.44 XXX N

78018 TC A Thyroid, met imaging, body ............................ 0.00 5.17 0.33 5.50 XXX N

78070 ............. A Parathyroid nuclear imaging ........................... 0.51 1.96 0.15 2.62 XXX N

78070 26 A Parathyroid nuclear imaging ........................... 0.51 0.23 0.04 0.78 XXX N

78070 TC A Parathyroid nuclear imaging ........................... 0.00 1.73 0.11 1.84 XXX N

78075 ............. A Adrenal nuclear imaging ................................. 0.74 5.51 0.38 6.63 XXX N

78075 26 A Adrenal nuclear imaging ................................. 0.74 0.34 0.05 1.13 XXX N

78075 TC A Adrenal nuclear imaging ................................. 0.00 5.17 0.33 5.50 XXX N

78099 ............. C Endocrine nuclear procedure ......................... 0.00 0.00 0.00 0.00 XXX N

78099 26 C Endocrine nuclear procedure ......................... 0.00 0.00 0.00 0.00 XXX N

78099 TC C Endocrine nuclear procedure .......................... 0.00 0.00 0.00 0.00 XXX N

78102 ............. A Bone marrow imaging, ltd ............................... 0.55 2.19 0.17 2.91 XXX N

78102 26 A Bone marrow imaging, ltd ............................... 0.55 0.25 0.04 0.84 XXX N

78102 TC A Bone marrow imaging, ltd ............................... 0.00 1.94 0.13 2.07 XXX N

78103 ............. A Bone marrow imaging, mult ............................ 0.75 3.36 0.24 4.35 XXX N

78103 26 A Bone marrow imaging, mult ............................ 0.75 0.34 0.05 1.14 XXX N

78103 TC A Bone marrow imaging, mult ............................ 0.00 3.02 0.19 3.21 XXX N

78104 ............. A Bone marrow imaging, body ........................... 0.80 4.25 0.30 5.35 XXX N

78104 26 A Bone marrow imaging, body ........................... 0.80 0.37 0.05 1.22 XXX N

78104 TC A Bone marrow imaging, body ........................... 0.00 3.88 0.25 4.13 XXX N

78110 ............. A Plasma volume, single .................................... 0.19 0.99 0.07 1.25 XXX N

78110 26 A Plasma volume, single .................................... 0.19 0.09 0.01 0.29 XXX N

78110 TC A Plasma volume, single .................................... 0.00 0.90 0.06 0.96 XXX N

78111 ............. A Plasma volume, multiple ................................. 0.22 2.55 0.18 2.95 XXX N

78111 26 A Plasma volume, multiple ................................. 0.22 0.10 0.02 0.34 XXX N

78111 TC A Plasma volume, multiple ................................. 0.00 2.45 0.16 2.61 XXX N

78120 ............. A Red cell mass, single ..................................... 0.23 1.76 0.13 2.12 XXX N

78120 26 A Red cell mass, single ..................................... 0.23 0.11 0.02 0.36 XXX N

78120 TC A Red cell mass, single ...................................... 0.00 1.65 0.11 1.76 XXX N

78121 ............. A Red cell mass, multiple ................................... 0.32 2.92 0.19 3.43 XXX N

78121 26 A Red cell mass, multiple ................................... 0.32 0.15 0.02 0.49 XXX N

78121 TC A Red cell mass, multiple ................................... 0.00 2.77 0.17 2.94 XXX N

78122 ............. A Blood volume .................................................. 0.45 4.59 0.31 5.35 XXX N

78122 26 A Blood volume .................................................. 0.45 0.20 0.03 0.68 XXX N

78122 TC A Blood volume .................................................. 0.00 4.39 0.28 4.67 XXX N

78130 ............. A Red cell survival study .................................... 0.61 3.00 0.21 3.82 XXX N

78130 26 A Red cell survival study .................................... 0.61 0.28 0.04 0.93 XXX N

78130 TC A Red cell survival study .................................... 0.00 2.72 0.17 2.89 XXX N

78135 ............. A Red cell survival kinetics ................................ 0.64 4.93 0.34 5.91 XXX N

78135 26 A Red cell survival kinetics ................................ 0.64 0.29 0.04 0.97 XXX N

78135 TC A Red cell survival kinetics ................................ 0.00 4.64 0.30 4.94 XXX N

78140 ............. A Red cell sequestration .................................... 0.61 4.03 0.28 4.92 XXX N

78140 26 A Red cell sequestration .................................... 0.61 0.28 0.04 0.93 XXX N

78140 TC A Red cell sequestration .................................... 0.00 3.75 0.24 3.99 XXX N

78160 ............. A Plasma iron turnover ...................................... 0.33 3.64 0.24 4.21 XXX N

78160 26 A Plasma iron turnover ...................................... 0.33 0.15 0.02 0.50 XXX N
63286

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

78160 TC A Plasma iron turnover ...................................... 0.00 3.49 0.22 3.71 XXX N

78162 ............. A Iron absorption exam ...................................... 0.45 3.25 0.22 3.92 XXX N

78162 26 A Iron absorption exam ...................................... 0.45 0.20 0.03 0.68 XXX N

78162 TC A Iron absorption exam ...................................... 0.00 3.05 0.19 3.24 XXX N

78170 ............. A Red cell iron utilization ................................... 0.41 5.24 0.35 6.00 XXX N

78170 26 A Red cell iron utilization .................................... 0.41 0.18 0.03 0.62 XXX N

78170 TC A Red cell iron utilization .................................... 0.00 5.06 0.32 5.38 XXX N

78172 ............. C Total body iron estimation .............................. 0.00 0.00 0.00 0.00 XXX N

78172 26 A Total body iron estimation .............................. 0.53 0.25 0.04 0.82 XXX N

78172 TC C Total body iron estimation .............................. 0.00 0.00 0.00 0.00 XXX N

78185 ............. A Spleen imaging ............................................... 0.40 2.43 0.18 3.01 XXX N

78185 26 A Spleen imaging ............................................... 0.40 0.18 0.03 0.61 XXX N

78185 TC A Spleen imaging ............................................... 0.00 2.25 0.15 2.40 XXX N

78190 ............. A Platelet survival, kinetics ................................ 1.09 5.93 0.42 7.44 XXX N

78190 26 A Platelet survival, kinetics ................................ 1.09 0.48 0.07 1.64 XXX N

78190 TC A Platelet survival, kinetics ................................. 0.00 5.45 0.35 5.80 XXX N

78191 ............. A Platelet survival ............................................... 0.61 7.27 0.48 8.36 XXX N

78191 26 A Platelet survival ............................................... 0.61 0.28 0.04 0.93 XXX N

78191 TC A Platelet survival ............................................... 0.00 6.99 0.44 7.43 XXX N

78195 ............. A Lymph system imaging ................................... 0.70 4.20 0.30 5.20 XXX N

78195 26 A Lymph system imaging ................................... 0.70 0.32 0.05 1.07 XXX N

78195 TC A Lymph system imaging ................................... 0.00 3.88 0.25 4.13 XXX N

78199 ............. C Blood/lymph nuclear exam ............................. 0.00 0.00 0.00 0.00 XXX N

78199 26 C Blood/lymph nuclear exam ............................. 0.00 0.00 0.00 0.00 XXX N

78199 TC C Blood/lymph nuclear exam ............................. 0.00 0.00 0.00 0.00 XXX N

78201 ............. A Liver imaging .................................................. 0.44 2.44 0.18 3.06 XXX N

78201 26 A Liver imaging .................................................. 0.44 0.19 0.03 0.66 XXX N

78201 TC A Liver imaging .................................................. 0.00 2.25 0.15 2.40 XXX N

78202 ............. A Liver imaging with flow ................................... 0.51 2.98 0.21 3.70 XXX N

78202 26 A Liver imaging with flow ................................... 0.51 0.23 0.04 0.78 XXX N

78202 TC A Liver imaging with flow ................................... 0.00 2.75 0.17 2.92 XXX N

78205 ............. A Liver imaging (3D) .......................................... 0.71 5.96 0.41 7.08 XXX N

78205 26 A Liver imaging (3D) .......................................... 0.71 0.33 0.05 1.09 XXX N

78205 TC A Liver imaging (3D) .......................................... 0.00 5.63 0.36 5.99 XXX N

78215 ............. A Liver and spleen imaging ............................... 0.49 3.02 0.20 3.71 XXX N

78215 26 A Liver and spleen imaging ............................... 0.49 0.22 0.03 0.74 XXX N

78215 TC A Liver and spleen imaging ............................... 0.00 2.80 0.17 2.97 XXX N

78216 ............. A Liver & spleen image, flow ............................. 0.57 3.58 0.25 4.40 XXX N

78216 26 A Liver & spleen image, flow ............................. 0.57 0.26 0.04 0.87 XXX N

78216 TC A Liver & spleen image, flow ............................. 0.00 3.32 0.21 3.53 XXX N

78220 ............. A Liver function study ......................................... 0.49 3.77 0.25 4.51 XXX N

78220 26 A Liver function study ......................................... 0.49 0.22 0.03 0.74 XXX N

78220 TC A Liver function study ......................................... 0.00 3.55 0.22 3.77 XXX N

78223 ............. A Hepatobiliary imaging ..................................... 0.84 3.87 0.28 4.99 XXX N

78223 26 A Hepatobiliary imaging ..................................... 0.84 0.38 0.06 1.28 XXX N

78223 TC A Hepatobiliary imaging ..................................... 0.00 3.49 0.22 3.71 XXX N

78230 ............. A Salivary gland imaging ................................... 0.45 2.28 0.17 2.90 XXX N

78230 26 A Salivary gland imaging ................................... 0.45 0.21 0.03 0.69 XXX N

78230 TC A Salivary gland imaging .................................... 0.00 2.07 0.14 2.21 XXX N

78231 ............. A Serial salivary imaging .................................... 0.52 3.26 0.23 4.01 XXX N

78231 26 A Serial salivary imaging .................................... 0.52 0.24 0.04 0.80 XXX N

78231 TC A Serial salivary imaging .................................... 0.00 3.02 0.19 3.21 XXX N

78232 ............. A Salivary gland function exam ......................... 0.47 3.59 0.24 4.30 XXX N

78232 26 A Salivary gland function exam .......................... 0.47 0.22 0.03 0.72 XXX N

78232 TC A Salivary gland function exam .......................... 0.00 3.37 0.21 3.58 XXX N

78258 ............. A Esophageal motility study ............................... 0.74 3.09 0.22 4.05 XXX N

78258 26 A Esophageal motility study ............................... 0.74 0.34 0.05 1.13 XXX N

78258 TC A Esophageal motility study ............................... 0.00 2.75 0.17 2.92 XXX N

78261 ............. A Gastric mucosa imaging ................................. 0.69 4.23 0.30 5.22 XXX N

78261 26 A Gastric mucosa imaging ................................. 0.69 0.32 0.05 1.06 XXX N

78261 TC A Gastric mucosa imaging ................................. 0.00 3.91 0.25 4.16 XXX N

78262 ............. A Gastroesophageal reflux exam ....................... 0.68 4.36 0.31 5.35 XXX N

78262 26 A Gastroesophageal reflux exam ....................... 0.68 0.31 0.05 1.04 XXX N

78262 TC A Gastroesophageal reflux exam ....................... 0.00 4.05 0.26 4.31 XXX N

78264 ............. A Gastric emptying study ................................... 0.78 4.29 0.30 5.37 XXX N

78264 26 A Gastric emptying study ................................... 0.78 0.36 0.05 1.19 XXX N
63287

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

78264 TC A Gastric emptying study ................................... 0.00 3.93 0.25 4.18 XXX N

78270 ............. A Vit B–12 absorption exam .............................. 0.20 1.57 0.11 1.88 XXX N

78270 26 A Vit B–12 absorption exam .............................. 0.20 0.10 0.01 0.31 XXX N

78270 TC A Vit B–12 absorption exam .............................. 0.00 1.47 0.10 1.57 XXX N

78271 ............. A Vit B–12 absorp exam, IF ............................... 0.20 1.67 0.11 1.98 XXX N

78271 26 A Vit B–12 absorp exam, IF ............................... 0.20 0.10 0.01 0.31 XXX N

78271 TC A Vit B–12 absorp exam, IF ............................... 0.00 1.57 0.10 1.67 XXX N

78272 ............. A Vit B–12 absorp, combined ............................ 0.27 2.34 0.17 2.78 XXX N

78272 26 A Vit B–12 absorp, combined ............................ 0.27 0.13 0.02 0.42 XXX N

78272 TC A Vit B–12 absorp, combined ............................ 0.00 2.21 0.15 2.36 XXX N

78278 ............. A Acute GI blood loss imaging .......................... 0.99 5.09 0.37 6.45 XXX N

78278 26 A Acute GI blood loss imaging .......................... 0.99 0.45 0.07 1.51 XXX N

78278 TC A Acute GI blood loss imaging .......................... 0.00 4.64 0.30 4.94 XXX N

78282 ............. C GI protein loss exam ...................................... 0.00 0.00 0.00 0.00 XXX N

78282 26 A GI protein loss exam ...................................... 0.38 0.17 0.03 0.58 XXX N

78282 TC C GI protein loss exam ...................................... 0.00 0.00 0.00 0.00 XXX N

78290 ............. A Meckel’s divert exam ...................................... 0.68 3.21 0.23 4.12 XXX N

78290 26 A Meckel’s divert exam ...................................... 0.68 0.31 0.05 1.04 XXX N

78290 TC A Meckel’s divert exam ...................................... 0.00 2.90 0.18 3.08 XXX N

78291 ............. A Leveen/shunt patency exam ........................... 0.88 3.31 0.24 4.43 XXX N

78291 26 A Leveen/shunt patency exam ........................... 0.88 0.39 0.06 1.33 XXX N

78291 TC A Leveen/shunt patency exam ........................... 0.00 2.92 0.18 3.10 XXX N

78299 ............. C GI nuclear procedure ...................................... 0.00 0.00 0.00 0.00 XXX N

78299 26 C GI nuclear procedure ...................................... 0.00 0.00 0.00 0.00 XXX N

78299 TC C GI nuclear procedure ...................................... 0.00 0.00 0.00 0.00 XXX N

78300 ............. A Bone imaging, limited area ............................. 0.62 2.66 0.20 3.48 XXX N

78300 26 A Bone imaging, limited area ............................. 0.62 0.29 0.04 0.95 XXX N

78300 TC A Bone imaging, limited area ............................. 0.00 2.37 0.16 2.53 XXX N

78305 ............. A Bone imaging, multiple areas ......................... 0.83 3.87 0.28 4.98 XXX N

78305 26 A Bone imaging, multiple areas ......................... 0.83 0.38 0.06 1.27 XXX N

78305 TC A Bone imaging, multiple areas ......................... 0.00 3.49 0.22 3.71 XXX N

78306 ............. A Bone imaging, whole body ............................. 0.86 4.46 0.32 5.64 XXX N

78306 26 A Bone imaging, whole body ............................. 0.86 0.39 0.06 1.31 XXX N

78306 TC A Bone imaging, whole body ............................. 0.00 4.07 0.26 4.33 XXX N

78315 ............. A Bone imaging, 3 phase ................................... 1.02 5.00 0.36 6.38 XXX N

78315 26 A Bone imaging, 3 phase ................................... 1.02 0.45 0.07 1.54 XXX N

78315 TC A Bone imaging, 3 phase ................................... 0.00 4.55 0.29 4.84 XXX N

78320 ............. A Bone imaging (3D) .......................................... 1.04 6.09 0.43 7.56 XXX N

78320 26 A Bone imaging (3D) .......................................... 1.04 0.46 0.07 1.57 XXX N

78320 TC A Bone imaging (3D) .......................................... 0.00 5.63 0.36 5.99 XXX N

78350 ............. A Bone mineral, single photon ........................... 0.22 0.82 0.07 1.11 XXX N

78350 26 A Bone mineral, single photon ........................... 0.22 0.10 0.02 0.34 XXX N

78350 TC A Bone mineral, single photon ........................... 0.00 0.72 0.05 0.77 XXX N

78351 ............. N Bone mineral, dual photon ............................. #0.30 0.19 0.02 0.51 XXX 0

78399 ............. C Musculoskeletal nuclear exam ....................... 0.00 0.00 0.00 0.00 XXX N

78399 26 C Musculoskeletal nuclear exam ........................ 0.00 0.00 0.00 0.00 XXX N

78399 TC C Musculoskeletal nuclear exam ........................ 0.00 0.00 0.00 0.00 XXX N

78414 ............. C Non-imaging heart function ............................ 0.00 0.00 0.00 0.00 XXX N

78414 26 A Non-imaging heart function ............................ 0.45 0.20 0.03 0.68 XXX N

78414 TC C Non-imaging heart function ............................ 0.00 0.00 0.00 0.00 XXX N

78428 ............. A Cardiac shunt imaging .................................... 0.78 2.51 0.19 3.48 XXX N

78428 26 A Cardiac shunt imaging .................................... 0.78 0.36 0.05 1.19 XXX N

78428 TC A Cardiac shunt imaging .................................... 0.00 2.15 0.14 2.29 XXX N

78445 ............. A Vascular flow imaging ..................................... 0.49 2.01 0.15 2.65 XXX N

78445 26 A Vascular flow imaging ..................................... 0.49 0.24 0.04 0.77 XXX N

78445 TC A Vascular flow imaging ..................................... 0.00 1.77 0.11 1.88 XXX N

78455 ............. A Venous thrombosis study ............................... 0.73 4.13 0.29 5.15 XXX N

78455 26 A Venous thrombosis study ............................... 0.73 0.33 0.05 1.11 XXX N

78455 TC A Venous thrombosis study ............................... 0.00 3.80 0.24 4.04 XXX N

78457 ............. A Venous thrombosis imaging ........................... 0.77 2.88 0.22 3.87 XXX N

78457 26 A Venous thrombosis imaging ........................... 0.77 0.35 0.05 1.17 XXX N

78457 TC A Venous thrombosis imaging ........................... 0.00 2.53 0.17 2.70 XXX N

78458 ............. A Ven thrombosis images, bilat ......................... 0.90 4.23 0.30 5.43 XXX N

78458 26 A Ven thrombosis images, bilat ......................... 0.90 0.40 0.06 1.36 XXX N

78458 TC A Ven thrombosis images, bilat ......................... 0.00 3.83 0.24 4.07 XXX N

78459 ............. G Heart muscle imaging (PET) .......................... 0.00 0.00 0.00 0.00 XXX 0
63288

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

78459 26 G Heart muscle imaging (PET) .......................... #1.88 1.34 0.10 3.32 XXX 0

78459 TC G Heart muscle imaging (PET) .......................... 0.00 0.00 0.00 0.00 XXX 0

78460 ............. A Heart muscle blood single .............................. 0.86 2.64 0.21 3.71 XXX N

78460 26 A Heart muscle blood single .............................. 0.86 0.39 0.06 1.31 XXX N

78460 TC A Heart muscle blood single .............................. 0.00 2.25 0.15 2.40 XXX N

78461 ............. A Heart muscle blood multiple ........................... 1.23 5.04 0.37 6.64 XXX N

78461 26 A Heart muscle blood multiple ........................... 1.23 0.54 0.08 1.85 XXX N

78461 TC A Heart muscle blood multiple ........................... 0.00 4.50 0.29 4.79 XXX N

78464 ............. A Heart image (3D) single ................................. 1.09 7.22 0.50 8.81 XXX N

78464 26 A Heart image (3D) single .................................. 1.09 0.48 0.07 1.64 XXX N

78464 TC A Heart image (3D) single .................................. 0.00 6.74 0.43 7.17 XXX N

78465 ............. A Heart image (3D) multiple ............................... 1.46 11.89 0.80 14.15 XXX N

78465 26 A Heart image (3D) multiple ............................... 1.46 0.65 0.10 2.21 XXX N

78465 TC A Heart image (3D) multiple ............................... 0.00 11.24 0.70 11.94 XXX N

78466 ............. A Heart infarct image ......................................... 0.69 2.82 0.22 3.73 XXX N

78466 26 A Heart infarct image ......................................... 0.69 0.32 0.05 1.06 XXX N

78466 TC A Heart infarct image ......................................... 0.00 2.50 0.17 2.67 XXX N

78468 ............. A Heart infarct image, EF .................................. 0.80 3.85 0.27 4.92 XXX N

78468 26 A Heart infarct image, EF .................................. 0.80 0.36 0.05 1.21 XXX N

78468 TC A Heart infarct image, EF ................................... 0.00 3.49 0.22 3.71 XXX N

78469 ............. A Heart infarct image (3D) ................................. 0.92 5.39 0.38 6.69 XXX N

78469 26 A Heart infarct image (3D) ................................. 0.92 0.41 0.06 1.39 XXX N

78469 TC A Heart infarct image (3D) ................................. 0.00 4.98 0.32 5.30 XXX N

78472 ............. A Gated heart, resting ........................................ 0.98 5.69 0.41 7.08 XXX N

78472 26 A Gated heart, resting ........................................ 0.98 0.44 0.07 1.49 XXX N

78472 TC A Gated heart, resting ........................................ 0.00 5.25 0.34 5.59 XXX N

78473 ............. A Gated heart, multiple ...................................... 1.47 8.52 0.59 10.58 XXX N

78473 26 A Gated heart, multiple ...................................... 1.47 0.65 0.10 2.22 XXX N

78473 TC A Gated heart, multiple ...................................... 0.00 7.87 0.49 8.36 XXX N

78478 ............. A Heart wall motion (add-on) ............................. 0.62 1.76 0.14 2.52 XXX N

78478 26 A Heart wall motion (add-on) ............................. 0.62 0.28 0.04 0.94 XXX N

78478 TC A Heart wall motion (add-on) ............................. 0.00 1.48 0.10 1.58 XXX N

78480 ............. A Heart function, (add-on) .................................. 0.62 1.76 0.14 2.52 XXX N

78480 26 A Heart function, (add-on) .................................. 0.62 0.28 0.04 0.94 XXX N

78480 TC A Heart function, (add-on) .................................. 0.00 1.48 0.10 1.58 XXX N

78481 ............. A Heart first pass single ..................................... 0.98 5.42 0.39 6.79 XXX N

78481 26 A Heart first pass single ..................................... 0.98 0.44 0.07 1.49 XXX N

78481 TC A Heart first pass single ..................................... 0.00 4.98 0.32 5.30 XXX N

78483 ............. A Heart first pass multiple .................................. 1.47 8.15 0.57 10.19 XXX N

78483 26 A Heart first pass multiple .................................. 1.47 0.65 0.10 2.22 XXX N

78483 TC A Heart first pass multiple .................................. 0.00 7.50 0.47 7.97 XXX N

78499 ............. C Cardiovascular nuclear exam ......................... 0.00 0.00 0.00 0.00 XXX N

78499 26 C Cardiovascular nuclear exam ......................... 0.00 0.00 0.00 0.00 XXX N

78499 TC C Cardiovascular nuclear exam ......................... 0.00 0.00 0.00 0.00 XXX N

78580 ............. A Lung perfusion imaging .................................. 0.74 3.61 0.26 4.61 XXX N

78580 26 A Lung perfusion imaging .................................. 0.74 0.34 0.05 1.13 XXX N

78580 TC A Lung perfusion imaging .................................. 0.00 3.27 0.21 3.48 XXX N

78584 ............. A Lung V/Q image single breath ........................ 0.99 3.50 0.26 4.75 XXX N

78584 26 A Lung V/Q image single breath ........................ 0.99 0.45 0.07 1.51 XXX N

78584 TC A Lung V/Q image single breath ........................ 0.00 3.05 0.19 3.24 XXX N

78585 ............. A Lung V/Q imaging ........................................... 1.09 5.85 0.41 7.35 XXX N

78585 26 A Lung V/Q imaging ........................................... 1.09 0.48 0.07 1.64 XXX N

78585 TC A Lung V/Q imaging ........................................... 0.00 5.37 0.34 5.71 XXX N

78586 ............. A Aerosol lung image, single ............................. 0.40 2.65 0.19 3.24 XXX N

78586 26 A Aerosol lung image, single ............................. 0.40 0.18 0.03 0.61 XXX N

78586 TC A Aerosol lung image, single ............................. 0.00 2.47 0.16 2.63 XXX N

78587 ............. A Aerosol lung image, multiple .......................... 0.49 2.89 0.20 3.58 XXX N

78587 26 A Aerosol lung image, multiple .......................... 0.49 0.22 0.03 0.74 XXX N

78587 TC A Aerosol lung image, multiple .......................... 0.00 2.67 0.17 2.84 XXX N

78591 ............. A Vent image, 1 breath, 1 proj ........................... 0.40 2.90 0.20 3.50 XXX N

78591 26 A Vent image, 1 breath, 1 proj ........................... 0.40 0.18 0.03 0.61 XXX N

78591 TC A Vent image, 1 breath, 1 proj ........................... 0.00 2.72 0.17 2.89 XXX N

78593 ............. A Vent image, 1 proj, gas .................................. 0.49 3.51 0.24 4.24 XXX N

78593 26 A Vent image, 1 proj, gas .................................. 0.49 0.22 0.03 0.74 XXX N

78593 TC A Vent image, 1 proj, gas .................................. 0.00 3.29 0.21 3.50 XXX N

78594 ............. A Vent image, mult proj, gas ............................. 0.53 5.00 0.34 5.87 XXX N
63289

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

78594 26 A Vent image, mult proj, gas ............................. 0.53 0.25 0.04 0.82 XXX N

78594 TC A Vent image, mult proj, gas .............................. 0.00 4.75 0.30 5.05 XXX N

78596 ............. A Lung differential function ................................ 1.27 7.30 0.52 9.09 XXX N

78596 26 A Lung differential function ................................ 1.27 0.56 0.09 1.92 XXX N

78596 TC A Lung differential function ................................ 0.00 6.74 0.43 7.17 XXX N

78599 ............. C Respiratory nuclear exam ............................... 0.00 0.00 0.00 0.00 XXX N

78599 26 C Respiratory nuclear exam ............................... 0.00 0.00 0.00 0.00 XXX N

78599 TC C Respiratory nuclear exam ............................... 0.00 0.00 0.00 0.00 XXX N

78600 ............. A Brain imaging, ltd static .................................. 0.44 2.95 0.20 3.59 XXX N

78600 26 A Brain imaging, ltd static .................................. 0.44 0.20 0.03 0.67 XXX N

78600 TC A Brain imaging, ltd static .................................. 0.00 2.75 0.17 2.92 XXX N

78601 ............. A Brain ltd imaging & flow .................................. 0.51 3.48 0.24 4.23 XXX N

78601 26 A Brain ltd imaging & flow .................................. 0.51 0.24 0.04 0.79 XXX N

78601 TC A Brain ltd imaging & flow .................................. 0.00 3.24 0.20 3.44 XXX N

78605 ............. A Brain imaging, complete ................................. 0.53 3.49 0.24 4.26 XXX N

78605 26 A Brain imaging, complete ................................. 0.53 0.25 0.04 0.82 XXX N

78605 TC A Brain imaging, complete ................................. 0.00 3.24 0.20 3.44 XXX N

78606 ............. A Brain imaging comp & flow ............................. 0.64 3.98 0.27 4.89 XXX N

78606 26 A Brain imaging comp & flow ............................. 0.64 0.29 0.04 0.97 XXX N

78606 TC A Brain imaging comp & flow ............................. 0.00 3.69 0.23 3.92 XXX N

78607 ............. A Brain imaging (3D) .......................................... 1.23 6.79 0.47 8.49 XXX N

78607 26 A Brain imaging (3D) .......................................... 1.23 0.54 0.08 1.85 XXX N

78607 TC A Brain imaging (3D) .......................................... 0.00 6.25 0.39 6.64 XXX N

78608 ............. N Brain imaging (PET) ....................................... 0.00 0.00 0.00 0.00 XXX 0

78609 ............. N Brain imaging (PET) ....................................... 0.00 0.00 0.00 0.00 XXX 0

78610 ............. A Brain flow imaging only .................................. 0.30 1.64 0.12 2.06 XXX N

78610 26 A Brain flow imaging only .................................. 0.30 0.14 0.02 0.46 XXX N

78610 TC A Brain flow imaging only ................................... 0.00 1.50 0.10 1.60 XXX N

78615 ............. A Cerebral blood flow imaging ........................... 0.42 3.86 0.26 4.54 XXX N

78615 26 A Cerebral blood flow imaging ........................... 0.42 0.19 0.03 0.64 XXX N

78615 TC A Cerebral blood flow imaging ........................... 0.00 3.67 0.23 3.90 XXX N

78630 ............. A Cerebrospinal fluid scan ................................. 0.68 5.11 0.36 6.15 XXX N

78630 26 A Cerebrospinal fluid scan ................................. 0.68 0.31 0.05 1.04 XXX N

78630 TC A Cerebrospinal fluid scan ................................. 0.00 4.80 0.31 5.11 XXX N

78635 ............. A CSF ventriculography ..................................... 0.61 2.70 0.20 3.51 XXX N

78635 26 A CSF ventriculography ..................................... 0.61 0.28 0.04 0.93 XXX N

78635 TC A CSF ventriculography ..................................... 0.00 2.42 0.16 2.58 XXX N

78645 ............. A CSF shunt evaluation ..................................... 0.57 3.53 0.25 4.35 XXX N

78645 26 A CSF shunt evaluation ..................................... 0.57 0.26 0.04 0.87 XXX N

78645 TC A CSF shunt evaluation ..................................... 0.00 3.27 0.21 3.48 XXX N

78647 ............. A Cerebrospinal fluid scan ................................. 0.90 6.04 0.42 7.36 XXX N

78647 26 A Cerebrospinal fluid scan ................................. 0.90 0.41 0.06 1.37 XXX N

78647 TC A Cerebrospinal fluid scan ................................. 0.00 5.63 0.36 5.99 XXX N

78650 ............. A CSF leakage imaging ..................................... 0.61 4.70 0.32 5.63 XXX N

78650 26 A CSF leakage imaging ..................................... 0.61 0.28 0.04 0.93 XXX N

78650 TC A CSF leakage imaging ..................................... 0.00 4.42 0.28 4.70 XXX N

78655 ............. D Nuclear exam of eye lesion ............................ 0.00 0.00 0.00 0.00 XXX N

78655 26 D Nuclear exam of eye lesion ............................ 0.00 0.00 0.00 0.00 XXX N

78655 TC D Nuclear exam of eye lesion ............................ 0.00 0.00 0.00 0.00 XXX N

78660 ............. A Nuclear exam of tear flow ............................... 0.53 2.27 0.17 2.97 XXX N

78660 26 A Nuclear exam of tear flow ............................... 0.53 0.25 0.04 0.82 XXX N

78660 TC A Nuclear exam of tear flow ............................... 0.00 2.02 0.13 2.15 XXX N

78699 ............. C Nervous system nuclear exam ....................... 0.00 0.00 0.00 0.00 XXX N

78699 26 C Nervous system nuclear exam ....................... 0.00 0.00 0.00 0.00 XXX N

78699 TC C Nervous system nuclear exam ....................... 0.00 0.00 0.00 0.00 XXX N

78700 ............. A Kidney imaging, static ..................................... 0.45 3.10 0.21 3.76 XXX N

78700 26 A Kidney imaging, static ..................................... 0.45 0.20 0.03 0.68 XXX N

78700 TC A Kidney imaging, static ..................................... 0.00 2.90 0.18 3.08 XXX N

78701 ............. A Kidney imaging with flow ................................ 0.49 3.61 0.24 4.34 XXX N

78701 26 A Kidney imaging with flow ................................ 0.49 0.22 0.03 0.74 XXX N

78701 TC A Kidney imaging with flow ................................ 0.00 3.39 0.21 3.60 XXX N

78704 ............. A Imaging renogram ........................................... 0.74 4.11 0.29 5.14 XXX N

78704 26 A Imaging renogram ........................................... 0.74 0.34 0.05 1.13 XXX N

78704 TC A Imaging renogram ........................................... 0.00 3.77 0.24 4.01 XXX N

78707 ............. A Kidney flow & function image ......................... 0.94 4.68 0.33 5.95 XXX N

78707 26 A Kidney flow & function image ......................... 0.94 0.42 0.06 1.42 XXX N
63290

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

78707 TC A Kidney flow & function image ......................... 0.00 4.26 0.27 4.53 XXX N

78710 ............. A Kidney imaging (3D) ....................................... 0.66 5.93 0.41 7.00 XXX N

78710 26 A Kidney imaging (3D) ....................................... 0.66 0.30 0.05 1.01 XXX N

78710 TC A Kidney imaging (3D) ....................................... 0.00 5.63 0.36 5.99 XXX N

78715 ............. A Renal vascular flow exam ............................... 0.30 1.64 0.12 2.06 XXX N

78715 26 A Renal vascular flow exam ............................... 0.30 0.14 0.02 0.46 XXX N

78715 TC A Renal vascular flow exam ............................... 0.00 1.50 0.10 1.60 XXX N

78725 ............. A Kidney function study ..................................... 0.38 1.87 0.14 2.39 XXX N

78725 26 A Kidney function study ..................................... 0.38 0.17 0.03 0.58 XXX N

78725 TC A Kidney function study ..................................... 0.00 1.70 0.11 1.81 XXX N

78726 ............. A Kidney function w/intervent ............................. 0.87 3.21 0.24 4.32 XXX N

78726 26 A Kidney function w/intervent ............................. 0.87 0.39 0.06 1.32 XXX N

78726 TC A Kidney function w/intervent ............................. 0.00 2.82 0.18 3.00 XXX N

78727 ............. A Kidney transplant evaluation .......................... 0.99 4.25 0.31 5.55 XXX N

78727 26 A Kidney transplant evaluation .......................... 0.99 0.45 0.07 1.51 XXX N

78727 TC A Kidney transplant evaluation .......................... 0.00 3.80 0.24 4.04 XXX N

78730 ............. A Urinary bladder retention ................................ 0.36 1.55 0.11 2.02 XXX N

78730 26 A Urinary bladder retention ................................ 0.36 0.16 0.02 0.54 XXX N

78730 TC A Urinary bladder retention ................................ 0.00 1.39 0.09 1.48 XXX N

78740 ............. A Ureteral reflux study ....................................... 0.57 2.28 0.17 3.02 XXX N

78740 26 A Ureteral reflux study ....................................... 0.57 0.26 0.04 0.87 XXX N

78740 TC A Ureteral reflux study ........................................ 0.00 2.02 0.13 2.15 XXX N

78760 ............. A Testicular imaging ........................................... 0.66 2.85 0.21 3.72 XXX N

78760 26 A Testicular imaging ........................................... 0.66 0.30 0.04 1.00 XXX N

78760 TC A Testicular imaging ........................................... 0.00 2.55 0.17 2.72 XXX N

78761 ............. A Testicular imaging & flow ............................... 0.71 3.38 0.24 4.33 XXX N

78761 26 A Testicular imaging & flow ............................... 0.71 0.33 0.05 1.09 XXX N

78761 TC A Testicular imaging & flow ................................ 0.00 3.05 0.19 3.24 XXX N

78799 ............. C Genitourinary nuclear exam ........................... 0.00 0.00 0.00 0.00 XXX N

78799 26 C Genitourinary nuclear exam ........................... 0.00 0.00 0.00 0.00 XXX N

78799 TC C Genitourinary nuclear exam ............................ 0.00 0.00 0.00 0.00 XXX N

78800 ............. A Tumor imaging, limited area ........................... 0.66 3.54 0.24 4.44 XXX N

78800 26 A Tumor imaging, limited area ........................... 0.66 0.30 0.04 1.00 XXX N

78800 TC A Tumor imaging, limited area ........................... 0.00 3.24 0.20 3.44 XXX N

78801 ............. A Tumor imaging, mult areas ............................. 0.79 4.39 0.31 5.49 XXX N

78801 26 A Tumor imaging, mult areas ............................. 0.79 0.36 0.05 1.20 XXX N

78801 TC A Tumor imaging, mult areas ............................. 0.00 4.03 0.26 4.29 XXX N

78802 ............. A Tumor imaging, whole body ........................... 0.86 5.66 0.40 6.92 XXX N

78802 26 A Tumor imaging, whole body ........................... 0.86 0.39 0.06 1.31 XXX N

78802 TC A Tumor imaging, whole body ........................... 0.00 5.27 0.34 5.61 XXX N

78803 ............. A Tumor imaging (3D) ........................................ 1.09 6.73 0.46 8.28 XXX N

78803 26 A Tumor imaging (3D) ........................................ 1.09 0.48 0.07 1.64 XXX N

78803 TC A Tumor imaging (3D) ........................................ 0.00 6.25 0.39 6.64 XXX N

78805 ............. A Abscess imaging, ltd area .............................. 0.73 3.57 0.25 4.55 XXX N

78805 26 A Abscess imaging, ltd area .............................. 0.73 0.33 0.05 1.11 XXX N

78805 TC A Abscess imaging, ltd area .............................. 0.00 3.24 0.20 3.44 XXX N

78806 ............. A Abscess imaging, whole body ........................ 0.86 6.51 0.45 7.82 XXX N

78806 26 A Abscess imaging, whole body ........................ 0.86 0.38 0.06 1.30 XXX N

78806 TC A Abscess imaging, whole body ........................ 0.00 6.13 0.39 6.52 XXX N

78807 ............. A Nuclear localization/abscess .......................... 1.09 6.73 0.46 8.28 XXX N

78807 26 A Nuclear localization/abscess .......................... 1.09 0.48 0.07 1.64 XXX N

78807 TC A Nuclear localization/abscess .......................... 0.00 6.25 0.39 6.64 XXX N

78810 ............. N Tumor imaging (PET) ..................................... 0.00 0.00 0.00 0.00 XXX 0

78810 26 N Tumor imaging (PET) ..................................... #1.93 1.37 0.10 3.40 XXX 0

78810 TC N Tumor imaging (PET) ..................................... 0.00 0.00 0.00 0.00 XXX 0

78890 ............. B Nuclear medicine data proc ............................ #0.05 1.26 0.08 1.39 XXX 0

78890 26 B Nuclear medicine data proc ............................ #0.05 0.02 0.00 0.07 XXX 0

78890 TC B Nuclear medicine data proc ............................ #0.00 1.24 0.08 1.32 XXX 0

78891 ............. B Nuclear med data proc ................................... #0.10 2.55 0.18 2.83 XXX 0

78891 26 B Nuclear med data proc ................................... #0.10 0.05 0.01 0.16 XXX 0

78891 TC B Nuclear med data proc ................................... #0.00 2.50 0.17 2.67 XXX 0

78990 ............. G Provide diag radionuclide(s) ........................... 0.00 0.00 0.00 0.00 XXX 0

78999 ............. C Nuclear diagnostic exam ................................ 0.00 0.00 0.00 0.00 XXX N

78999 26 C Nuclear diagnostic exam ................................ 0.00 0.00 0.00 0.00 XXX N

78999 TC C Nuclear diagnostic exam ................................ 0.00 0.00 0.00 0.00 XXX N

79000 ............. A Intial hyperthyroid therapy .............................. 1.80 3.31 0.29 5.40 XXX N
63291

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

79000 26 A Intial hyperthyroid therapy .............................. 1.80 0.81 0.12 2.73 XXX N

79000 TC A Intial hyperthyroid therapy .............................. 0.00 2.50 0.17 2.67 XXX N

79001 ............. A Repeat hyperthyroid therapy .......................... 1.05 1.70 0.15 2.90 XXX N

79001 26 A Repeat hyperthyroid therapy .......................... 1.05 0.46 0.07 1.58 XXX N

79001 TC A Repeat hyperthyroid therapy .......................... 0.00 1.24 0.08 1.32 XXX N

79020 ............. A Thyroid ablation .............................................. 1.81 3.31 0.29 5.41 XXX N

79020 26 A Thyroid ablation .............................................. 1.81 0.81 0.12 2.74 XXX N

79020 TC A Thyroid ablation .............................................. 0.00 2.50 0.17 2.67 XXX N

79030 ............. A Thyroid ablation, carcinoma ........................... 2.10 3.44 0.31 5.85 XXX N

79030 26 A Thyroid ablation, carcinoma ........................... 2.10 0.94 0.14 3.18 XXX N

79030 TC A Thyroid ablation, carcinoma ............................ 0.00 2.50 0.17 2.67 XXX N

79035 ............. A Thyroid metastatic therapy ............................. 2.52 3.63 0.34 6.49 XXX N

79035 26 A Thyroid metastatic therapy ............................. 2.52 1.13 0.17 3.82 XXX N

79035 TC A Thyroid metastatic therapy ............................. 0.00 2.50 0.17 2.67 XXX N

79100 ............. A Hematopoetic nuclear therapy ........................ 1.32 3.08 0.26 4.66 XXX N

79100 26 A Hematopoetic nuclear therapy ........................ 1.32 0.58 0.09 1.99 XXX N

79100 TC A Hematopoetic nuclear therapy ........................ 0.00 2.50 0.17 2.67 XXX N

79200 ............. A Intracavitary nuc treatment ............................. 1.99 3.39 0.31 5.69 XXX N

79200 26 A Intracavitary nuc treatment ............................. 1.99 0.89 0.14 3.02 XXX N

79200 TC A Intracavitary nuc treatment ............................. 0.00 2.50 0.17 2.67 XXX N

79300 ............. C Interstitial nuclear therapy .............................. 0.00 0.00 0.00 0.00 XXX N

79300 26 A Interstitial nuclear therapy .............................. 1.60 0.71 0.11 2.42 XXX N

79300 TC C Interstitial nuclear therapy ............................... 0.00 0.00 0.00 0.00 XXX N

79400 ............. A Nonhemato nuclear therapy ........................... 1.96 3.37 0.30 5.63 XXX N

79400 26 A Nonhemato nuclear therapy ........................... 1.96 0.87 0.13 2.96 XXX N

79400 TC A Nonhemato nuclear therapy ........................... 0.00 2.50 0.17 2.67 XXX N

79420 ............. C Intravascular nuc therapy ............................... 0.00 0.00 0.00 0.00 XXX N

79420 26 A Intravascular nuc therapy ............................... 1.51 0.67 0.10 2.28 XXX N

79420 TC C Intravascular nuc therapy ............................... 0.00 0.00 0.00 0.00 XXX N

79440 ............. A Nuclear joint therapy ....................................... 1.99 3.39 0.31 5.69 XXX N

79440 26 A Nuclear joint therapy ....................................... 1.99 0.89 0.14 3.02 XXX N

79440 TC A Nuclear joint therapy ....................................... 0.00 2.50 0.17 2.67 XXX N

79900 ............. C Provide ther radiopharm(s) ............................. 0.00 0.00 0.00 0.00 XXX N

79999 ............. C Nuclear medicine therapy ............................... 0.00 0.00 0.00 0.00 XXX N

79999 26 C Nuclear medicine therapy ............................... 0.00 0.00 0.00 0.00 XXX N

79999 TC C Nuclear medicine therapy ............................... 0.00 0.00 0.00 0.00 XXX N

80002 ............. X 1–2 clinical chem tests ................................... 0.00 0.00 0.00 0.00 XXX 0

80003 ............. X 3 clinical chemistry tests ................................. 0.00 0.00 0.00 0.00 XXX 0

80004 ............. X 4 clinical chemistry tests ................................. 0.00 0.00 0.00 0.00 XXX 0

80005 ............. X 5 clinical chemistry tests ................................. 0.00 0.00 0.00 0.00 XXX 0

80006 ............. X 6 clinical chemistry tests ................................. 0.00 0.00 0.00 0.00 XXX 0

80007 ............. X 7 clinical chemistry tests ................................. 0.00 0.00 0.00 0.00 XXX 0

80008 ............. X 8 clinical chemistry tests ................................. 0.00 0.00 0.00 0.00 XXX 0

80009 ............. X 9 clinical chemistry tests ................................. 0.00 0.00 0.00 0.00 XXX 0

80010 ............. X 10 clinical chemistry tests ............................... 0.00 0.00 0.00 0.00 XXX 0

80011 ............. X 11 clinical chemistry tests ............................... 0.00 0.00 0.00 0.00 XXX 0

80012 ............. X 12 clinical chemistry tests ............................... 0.00 0.00 0.00 0.00 XXX 0

80016 ............. X 13–16 blood/urine tests .................................. 0.00 0.00 0.00 0.00 XXX 0

80018 ............. X 17–18 blood/urine tests .................................. 0.00 0.00 0.00 0.00 XXX 0

80019 ............. X 19 blood/urine tests ........................................ 0.00 0.00 0.00 0.00 XXX 0

80050 ............. X General health panel ...................................... 0.00 0.00 0.00 0.00 XXX 0

80055 ............. X Obstetric panel ................................................ 0.00 0.00 0.00 0.00 XXX 0

80058 ............. X Hepatic function panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80059 ............. X Hepatitis panel ................................................ 0.00 0.00 0.00 0.00 XXX 0

80061 ............. X Lipid panel ...................................................... 0.00 0.00 0.00 0.00 XXX 0

80072 ............. X Arthritis panel .................................................. 0.00 0.00 0.00 0.00 XXX 0

80090 ............. X Torch antibody panel ...................................... 0.00 0.00 0.00 0.00 XXX 0

80091 ............. X Thyroid panel .................................................. 0.00 0.00 0.00 0.00 XXX 0

80092 ............. X Thyroid panel w/TSH ...................................... 0.00 0.00 0.00 0.00 XXX 0

80100 ............. X Drug screen .................................................... 0.00 0.00 0.00 0.00 XXX 0

80101 ............. X Drug screen .................................................... 0.00 0.00 0.00 0.00 XXX 0

80102 ............. X Drug confirmation ........................................... 0.00 0.00 0.00 0.00 XXX 0

80103 ............. X Drug analysis, tissue prep .............................. 0.00 0.00 0.00 0.00 XXX 0

80150 ............. X Assay of amikacin ........................................... 0.00 0.00 0.00 0.00 XXX 0

80152 ............. X Assay of amitriptyline ...................................... 0.00 0.00 0.00 0.00 XXX 0

80154 ............. X Assay of benzodiazepines .............................. 0.00 0.00 0.00 0.00 XXX 0
63292

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

80156 ............. X Assay carbamazepine .................................... 0.00 0.00 0.00 0.00 XXX 0

80158 ............. X Assay of cyclosporine ..................................... 0.00 0.00 0.00 0.00 XXX 0

80160 ............. X Assay of desipramine ..................................... 0.00 0.00 0.00 0.00 XXX 0

80162 ............. X Assay for digoxin ............................................ 0.00 0.00 0.00 0.00 XXX 0

80164 ............. X Assay, dipropylacetic acid .............................. 0.00 0.00 0.00 0.00 XXX 0

80166 ............. X Assay of doxepin ............................................ 0.00 0.00 0.00 0.00 XXX 0

80168 ............. X Assay of ethosuximide .................................... 0.00 0.00 0.00 0.00 XXX 0

80170 ............. X Gentamicin ...................................................... 0.00 0.00 0.00 0.00 XXX 0

80172 ............. X Assay for gold ................................................. 0.00 0.00 0.00 0.00 XXX 0

80174 ............. X Assay of imipramine ....................................... 0.00 0.00 0.00 0.00 XXX 0

80176 ............. X Assay for lidocaine ......................................... 0.00 0.00 0.00 0.00 XXX 0

80178 ............. X Assay for lithium ............................................. 0.00 0.00 0.00 0.00 XXX 0

80182 ............. X Assay for nortriptyline ..................................... 0.00 0.00 0.00 0.00 XXX 0

80184 ............. X Assay for phenobarbital .................................. 0.00 0.00 0.00 0.00 XXX 0

80185 ............. X Assay for phenytoin ........................................ 0.00 0.00 0.00 0.00 XXX 0

80186 ............. X Assay for phenytoin, free ................................ 0.00 0.00 0.00 0.00 XXX 0

80188 ............. X Assay for primidone ........................................ 0.00 0.00 0.00 0.00 XXX 0

80190 ............. X Assay for procainamide .................................. 0.00 0.00 0.00 0.00 XXX 0

80192 ............. X Assay for procainamide .................................. 0.00 0.00 0.00 0.00 XXX 0

80194 ............. X Assay for quinidine ......................................... 0.00 0.00 0.00 0.00 XXX 0

80196 ............. X Assay for salicylate ......................................... 0.00 0.00 0.00 0.00 XXX 0

80198 ............. X Assay for theophylline .................................... 0.00 0.00 0.00 0.00 XXX 0

80200 ............. X Assay for tobramycin ...................................... 0.00 0.00 0.00 0.00 XXX 0

80202 ............. X Assay for vancomycin ..................................... 0.00 0.00 0.00 0.00 XXX 0

80299 ............. X Quantitative assay, drug ................................. 0.00 0.00 0.00 0.00 XXX 0

80400 ............. X Acth stimulation panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80402 ............. X Acth stimulation panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80406 ............. X Acth stimulation panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80408 ............. X Aldosterone suppression eval ........................ 0.00 0.00 0.00 0.00 XXX 0

80410 ............. X Calcitonin stimul panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80412 ............. X CRH stimulation panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80414 ............. X Testosterone response ................................... 0.00 0.00 0.00 0.00 XXX 0

80415 ............. X Estradiol response panel ................................ 0.00 0.00 0.00 0.00 XXX 0

80416 ............. X Renin stimulation panel .................................. 0.00 0.00 0.00 0.00 XXX 0

80417 ............. X Renin stimulation panel .................................. 0.00 0.00 0.00 0.00 XXX 0

80418 ............. X Pituitary evaluation panel ............................... 0.00 0.00 0.00 0.00 XXX 0

80420 ............. X Dexamethasone panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80422 ............. X Glucagon tolerance panel ............................... 0.00 0.00 0.00 0.00 XXX 0

80424 ............. X Glucagon tolerance panel ............................... 0.00 0.00 0.00 0.00 XXX 0

80426 ............. X Gonadotropin hormone panel ......................... 0.00 0.00 0.00 0.00 XXX 0

80428 ............. X Growth hormone panel ................................... 0.00 0.00 0.00 0.00 XXX 0

80430 ............. X Growth hormone panel ................................... 0.00 0.00 0.00 0.00 XXX 0

80432 ............. X Insulin suppression panel ............................... 0.00 0.00 0.00 0.00 XXX 0

80434 ............. X Insulin tolerance panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80435 ............. X Insulin tolerance panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80436 ............. X Metyrapone panel ........................................... 0.00 0.00 0.00 0.00 XXX 0

80438 ............. X TRH stimulation panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80439 ............. X TRH stimulation panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80440 ............. X TRH stimulation panel .................................... 0.00 0.00 0.00 0.00 XXX 0

80500 ............. A Lab pathology consultation ............................. 0.37 0.20 0.01 0.58 XXX N

80502 ............. A Lab pathology consultation ............................. 1.33 0.33 0.02 1.68 XXX N

81000 ............. X Urinalysis, nonauto, w/scope .......................... 0.00 0.00 0.00 0.00 XXX 0

81001 ............. X Urinalysis, auto, w/scope ................................ 0.00 0.00 0.00 0.00 XXX 0

81002 ............. X Urinalysis nonauto w/o scope ......................... 0.00 0.00 0.00 0.00 XXX 0

81003 ............. X Urinalysis, auto, w/o scope ............................. 0.00 0.00 0.00 0.00 XXX 0

81005 ............. X Urinalysis ........................................................ 0.00 0.00 0.00 0.00 XXX 0

81007 ............. X Urine screen for bacteria ................................ 0.00 0.00 0.00 0.00 XXX 0

81015 ............. X Microscopic exam of urine .............................. 0.00 0.00 0.00 0.00 XXX 0

81020 ............. X Urinalysis, glass test ....................................... 0.00 0.00 0.00 0.00 XXX 0

81025 ............. X Urine pregnancy test ...................................... 0.00 0.00 0.00 0.00 XXX 0

81050 ............. X Urinalysis, volume measure ............................ 0.00 0.00 0.00 0.00 XXX 0

81099 ............. X Urinalysis test procedure ................................ 0.00 0.00 0.00 0.00 XXX 0

82000 ............. X Assay blood acetaldehyde .............................. 0.00 0.00 0.00 0.00 XXX 0

82003 ............. X Assay acetaminophen .................................... 0.00 0.00 0.00 0.00 XXX 0

82009 ............. X Test for acetone/ketones ................................ 0.00 0.00 0.00 0.00 XXX 0

82010 ............. X Acetone assay ................................................ 0.00 0.00 0.00 0.00 XXX 0
63293

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

82013 ............. X Acetylcholinesterase assay ............................ 0.00 0.00 0.00 0.00 XXX 0

82024 ............. X ACTH .............................................................. 0.00 0.00 0.00 0.00 XXX 0

82030 ............. X ADP & AMP .................................................... 0.00 0.00 0.00 0.00 XXX 0

82040 ............. X Assay serum albumin ..................................... 0.00 0.00 0.00 0.00 XXX 0

82042 ............. X Assay urine albumin ....................................... 0.00 0.00 0.00 0.00 XXX 0

82043 ............. X Microalbumin, quantitative .............................. 0.00 0.00 0.00 0.00 XXX 0

82044 ............. X Microalbumin, semiquant ................................ 0.00 0.00 0.00 0.00 XXX 0

82055 ............. X Assay ethanol ................................................. 0.00 0.00 0.00 0.00 XXX 0

82075 ............. X Assay breath ethanol ...................................... 0.00 0.00 0.00 0.00 XXX 0

82085 ............. X Assay of aldolase ........................................... 0.00 0.00 0.00 0.00 XXX 0

82088 ............. X Aldosterone ..................................................... 0.00 0.00 0.00 0.00 XXX 0

82101 ............. X Assay of urine alkaloids .................................. 0.00 0.00 0.00 0.00 XXX 0

82103 ............. X Alpha-1-antitrypsin, total ................................. 0.00 0.00 0.00 0.00 XXX 0

82104 ............. X Alpha-1-antitrypsin, pheno .............................. 0.00 0.00 0.00 0.00 XXX 0

82105 ............. X Alpha-fetoprotein, serum ................................ 0.00 0.00 0.00 0.00 XXX 0

82106 ............. X Alpha-fetoprotein, amniotic ............................. 0.00 0.00 0.00 0.00 XXX 0

82108 ............. X Assay, aluminum ............................................ 0.00 0.00 0.00 0.00 XXX 0

82128 ............. X Test for amino acids ....................................... 0.00 0.00 0.00 0.00 XXX 0

82130 ............. X Amino acids analysis ...................................... 0.00 0.00 0.00 0.00 XXX 0

82131 ............. X Amino acids .................................................... 0.00 0.00 0.00 0.00 XXX 0

82135 ............. X Assay, aminolevulinic acid .............................. 0.00 0.00 0.00 0.00 XXX 0

82140 ............. X Assay of ammonia .......................................... 0.00 0.00 0.00 0.00 XXX 0

82143 ............. X Amniotic fluid scan .......................................... 0.00 0.00 0.00 0.00 XXX 0

82145 ............. X Assay of amphetamines ................................. 0.00 0.00 0.00 0.00 XXX 0

82150 ............. X Assay of amylase ........................................... 0.00 0.00 0.00 0.00 XXX 0

82154 ............. X Androstanediol glucuronide ............................ 0.00 0.00 0.00 0.00 XXX 0

82157 ............. X Assay of androstenedione .............................. 0.00 0.00 0.00 0.00 XXX 0

82160 ............. X Androsterone assay ........................................ 0.00 0.00 0.00 0.00 XXX 0

82163 ............. X Assay of angiotensin II ................................... 0.00 0.00 0.00 0.00 XXX 0

82164 ............. X Angiotensin I enzyme test .............................. 0.00 0.00 0.00 0.00 XXX 0

82172 ............. X Apolipoprotein ................................................. 0.00 0.00 0.00 0.00 XXX 0

82175 ............. X Assay of arsenic ............................................. 0.00 0.00 0.00 0.00 XXX 0

82180 ............. X Assay of ascorbic acid .................................... 0.00 0.00 0.00 0.00 XXX 0

82190 ............. X Atomic absorption ........................................... 0.00 0.00 0.00 0.00 XXX 0

82205 ............. X Assay of barbiturates ...................................... 0.00 0.00 0.00 0.00 XXX 0

82232 ............. X Beta-2 protein ................................................. 0.00 0.00 0.00 0.00 XXX 0

82239 ............. X Bile acids, total ............................................... 0.00 0.00 0.00 0.00 XXX 0

82240 ............. X Bile acids, cholylglycine .................................. 0.00 0.00 0.00 0.00 XXX 0

82250 ............. X Assay bilirubin ................................................. 0.00 0.00 0.00 0.00 XXX 0

82251 ............. X Assay bilirubin ................................................. 0.00 0.00 0.00 0.00 XXX 0

82252 ............. X Fecal bilirubin test ........................................... 0.00 0.00 0.00 0.00 XXX 0

82270 ............. X Test feces for blood ........................................ 0.00 0.00 0.00 0.00 XXX 0

82273 ............. X Test for blood, other source ........................... 0.00 0.00 0.00 0.00 XXX 0

82286 ............. X Assay of bradykinin ........................................ 0.00 0.00 0.00 0.00 XXX 0

82300 ............. X Assay cadmium .............................................. 0.00 0.00 0.00 0.00 XXX 0

82306 ............. X Assay of vitamin D .......................................... 0.00 0.00 0.00 0.00 XXX 0

82307 ............. X Assay of vitamin D .......................................... 0.00 0.00 0.00 0.00 XXX 0

82308 ............. X Assay of calcitonin .......................................... 0.00 0.00 0.00 0.00 XXX 0

82310 ............. X Assay calcium ................................................. 0.00 0.00 0.00 0.00 XXX 0

82330 ............. X Assay calcium ................................................. 0.00 0.00 0.00 0.00 XXX 0

82331 ............. X Calcium infusion test ...................................... 0.00 0.00 0.00 0.00 XXX 0

82340 ............. X Assay calcium in urine .................................... 0.00 0.00 0.00 0.00 XXX 0

82355 ............. X Calculus (stone) analysis ................................ 0.00 0.00 0.00 0.00 XXX 0

82360 ............. X Calculus (stone) assay ................................... 0.00 0.00 0.00 0.00 XXX 0

82365 ............. X Calculus (stone) assay ................................... 0.00 0.00 0.00 0.00 XXX 0

82370 ............. X X-ray assay, calculus (stone) ......................... 0.00 0.00 0.00 0.00 XXX 0

82374 ............. X Assay blood carbon dioxide ........................... 0.00 0.00 0.00 0.00 XXX 0

82375 ............. X Assay blood carbon monoxide ....................... 0.00 0.00 0.00 0.00 XXX 0

82376 ............. X Test for carbon monoxide ............................... 0.00 0.00 0.00 0.00 XXX 0

82378 ............. X Carcinoembryonic antigen .............................. 0.00 0.00 0.00 0.00 XXX 0

82380 ............. X Assay carotene ............................................... 0.00 0.00 0.00 0.00 XXX 0

82382 ............. X Assay urine catecholamines ........................... 0.00 0.00 0.00 0.00 XXX 0

82383 ............. X Assay blood catecholamines .......................... 0.00 0.00 0.00 0.00 XXX 0

82384 ............. X Assay three catecholamines ........................... 0.00 0.00 0.00 0.00 XXX 0

82387 ............. X Cathepsin-D .................................................... 0.00 0.00 0.00 0.00 XXX 0

82390 ............. X Assay ceruloplasmin ....................................... 0.00 0.00 0.00 0.00 XXX 0
63294

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

82397 ............. X Chemiluminescent assay ................................ 0.00 0.00 0.00 0.00 XXX 0

82415 ............. X Assay chloramphenicol ................................... 0.00 0.00 0.00 0.00 XXX 0

82435 ............. X Assay blood chloride ...................................... 0.00 0.00 0.00 0.00 XXX 0

82436 ............. X Assay urine chloride ....................................... 0.00 0.00 0.00 0.00 XXX 0

82438 ............. X Assay other fluid chlorides ............................. 0.00 0.00 0.00 0.00 XXX 0

82441 ............. X Test for chlorohydrocarbons ........................... 0.00 0.00 0.00 0.00 XXX 0

82465 ............. X Assay serum cholesterol ................................ 0.00 0.00 0.00 0.00 XXX 0

82480 ............. X Assay serum cholinesterase ........................... 0.00 0.00 0.00 0.00 XXX 0

82482 ............. X Assay rbc cholinesterase ................................ 0.00 0.00 0.00 0.00 XXX 0

82485 ............. X Assay chondroitin sulfate ................................ 0.00 0.00 0.00 0.00 XXX 0

82486 ............. X Gas/liquid chromatography ............................. 0.00 0.00 0.00 0.00 XXX 0

82487 ............. X Paper chromatography ................................... 0.00 0.00 0.00 0.00 XXX 0

82488 ............. X Paper chromatography ................................... 0.00 0.00 0.00 0.00 XXX 0

82489 ............. X Thin layer chromatography ............................. 0.00 0.00 0.00 0.00 XXX 0

82491 ............. X Chromotography, quantitative ......................... 0.00 0.00 0.00 0.00 XXX 0

82495 ............. X Assay chromium ............................................. 0.00 0.00 0.00 0.00 XXX 0

82507 ............. X Assay citrate ................................................... 0.00 0.00 0.00 0.00 XXX 0

82520 ............. X Assay for cocaine ........................................... 0.00 0.00 0.00 0.00 XXX 0

82525 ............. X Assay copper .................................................. 0.00 0.00 0.00 0.00 XXX 0

82528 ............. X Assay corticosterone ...................................... 0.00 0.00 0.00 0.00 XXX 0

82530 ............. X Cortisol, free ................................................... 0.00 0.00 0.00 0.00 XXX 0

82533 ............. X Total cortisol ................................................... 0.00 0.00 0.00 0.00 XXX 0

82540 ............. X Assay creatine ................................................ 0.00 0.00 0.00 0.00 XXX 0

82550 ............. X Assay CK (CPK) ............................................. 0.00 0.00 0.00 0.00 XXX 0

82552 ............. X Assay CPK in blood ........................................ 0.00 0.00 0.00 0.00 XXX 0

82553 ............. X Creatine, MB fraction ...................................... 0.00 0.00 0.00 0.00 XXX 0

82554 ............. X Creatine, isoforms ........................................... 0.00 0.00 0.00 0.00 XXX 0

82565 ............. X Assay creatinine ............................................. 0.00 0.00 0.00 0.00 XXX 0

82570 ............. X Assay urine creatinine .................................... 0.00 0.00 0.00 0.00 XXX 0

82575 ............. X Creatinine clearance test ................................ 0.00 0.00 0.00 0.00 XXX 0

82585 ............. X Assay cryofibrinogen ...................................... 0.00 0.00 0.00 0.00 XXX 0

82595 ............. X Assay cryoglobulin .......................................... 0.00 0.00 0.00 0.00 XXX 0

82600 ............. X Assay cyanide ................................................. 0.00 0.00 0.00 0.00 XXX 0

82607 ............. X Vitamin B–12 .................................................. 0.00 0.00 0.00 0.00 XXX 0

82608 ............. X B–12 binding capacity .................................... 0.00 0.00 0.00 0.00 XXX 0

82615 ............. X Test for urine cystines .................................... 0.00 0.00 0.00 0.00 XXX 0

82626 ............. X Dehydroepiandrosterone ................................ 0.00 0.00 0.00 0.00 XXX 0

82627 ............. X Dehydroepiandrosterone ................................ 0.00 0.00 0.00 0.00 XXX 0

82633 ............. X Desoxycorticosterone ..................................... 0.00 0.00 0.00 0.00 XXX 0

82634 ............. X Deoxycortisol .................................................. 0.00 0.00 0.00 0.00 XXX 0

82638 ............. X Assay dibucaine number ................................ 0.00 0.00 0.00 0.00 XXX 0

82646 ............. X Assay of dihydrocodeinone ............................ 0.00 0.00 0.00 0.00 XXX 0

82649 ............. X Assay of dihydromorphinone .......................... 0.00 0.00 0.00 0.00 XXX 0

82651 ............. X Dihydrotestosterone assay ............................. 0.00 0.00 0.00 0.00 XXX 0

82652 ............. X Assay, dihydroxyvitamin D .............................. 0.00 0.00 0.00 0.00 XXX 0

82654 ............. X Assay of dimethadione ................................... 0.00 0.00 0.00 0.00 XXX 0

82664 ............. X Electrophoretic test ......................................... 0.00 0.00 0.00 0.00 XXX 0

82666 ............. X Epiandrosterone assay ................................... 0.00 0.00 0.00 0.00 XXX 0

82668 ............. X Erythropoietin .................................................. 0.00 0.00 0.00 0.00 XXX 0

82670 ............. X Estradiol .......................................................... 0.00 0.00 0.00 0.00 XXX 0

82671 ............. X Estrogen assay ............................................... 0.00 0.00 0.00 0.00 XXX 0

82672 ............. X Estrogen assay ............................................... 0.00 0.00 0.00 0.00 XXX 0

82677 ............. X Estriol .............................................................. 0.00 0.00 0.00 0.00 XXX 0

82679 ............. X Estrone ............................................................ 0.00 0.00 0.00 0.00 XXX 0

82690 ............. X Ethchlorvynol .................................................. 0.00 0.00 0.00 0.00 XXX 0

82693 ............. X Ethylene glycol ................................................ 0.00 0.00 0.00 0.00 XXX 0

82696 ............. X Etiocholanolone .............................................. 0.00 0.00 0.00 0.00 XXX 0

82705 ............. X Fats/lipids, feces, qualitative ........................... 0.00 0.00 0.00 0.00 XXX 0

82710 ............. X Fats/lipids, feces, quantitative ........................ 0.00 0.00 0.00 0.00 XXX 0

82715 ............. X Fecal fat assay ............................................... 0.00 0.00 0.00 0.00 XXX 0

82725 ............. X Assay blood fatty acids ................................... 0.00 0.00 0.00 0.00 XXX 0

82728 ............. X Assay ferritin ................................................... 0.00 0.00 0.00 0.00 XXX 0

82735 ............. X Assay fluoride ................................................. 0.00 0.00 0.00 0.00 XXX 0

82742 ............. X Assay of flurazepam ....................................... 0.00 0.00 0.00 0.00 XXX 0

82746 ............. X Blood folic acid serum .................................... 0.00 0.00 0.00 0.00 XXX 0

82747 ............. X Folic acid, RBC ............................................... 0.00 0.00 0.00 0.00 XXX 0
63295

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

82757 ............. X Assay semen fructose .................................... 0.00 0.00 0.00 0.00 XXX 0

82759 ............. X RBC galactokinase assay ............................... 0.00 0.00 0.00 0.00 XXX 0

82760 ............. X Assay galactose .............................................. 0.00 0.00 0.00 0.00 XXX 0

82775 ............. X Assay galactose transferase .......................... 0.00 0.00 0.00 0.00 XXX 0

82776 ............. X Galactose transferase test .............................. 0.00 0.00 0.00 0.00 XXX 0

82784 ............. X Assay gammaglobulin IgM ............................. 0.00 0.00 0.00 0.00 XXX 0

82785 ............. X Assay, gammaglobulin IgE ............................. 0.00 0.00 0.00 0.00 XXX 0

82787 ............. X IgG1, 2, 3 and 4 ............................................. 0.00 0.00 0.00 0.00 XXX 0

82800 ............. X Blood pH ......................................................... 0.00 0.00 0.00 0.00 XXX 0

82803 ............. X Blood gases: pH, pO2 & pCO2 ...................... 0.00 0.00 0.00 0.00 XXX 0

82805 ............. X Blood gases W/O2 saturation ......................... 0.00 0.00 0.00 0.00 XXX 0

82810 ............. X Blood gases, O2 sat only ............................... 0.00 0.00 0.00 0.00 XXX 0

82820 ............. X Hemoglobin-oxygen affinity ............................ 0.00 0.00 0.00 0.00 XXX 0

82926 ............. X Assay gastric acid ........................................... 0.00 0.00 0.00 0.00 XXX 0

82928 ............. X Assay gastric acid ........................................... 0.00 0.00 0.00 0.00 XXX 0

82938 ............. X Gastrin test ..................................................... 0.00 0.00 0.00 0.00 XXX 0

82941 ............. X Assay of gastrin .............................................. 0.00 0.00 0.00 0.00 XXX 0

82943 ............. X Assay of glucagon .......................................... 0.00 0.00 0.00 0.00 XXX 0

82946 ............. X Glucagon tolerance test .................................. 0.00 0.00 0.00 0.00 XXX 0

82947 ............. X Assay quantitative, glucose ............................ 0.00 0.00 0.00 0.00 XXX 0

82948 ............. X Reagent strip/blood glucose ........................... 0.00 0.00 0.00 0.00 XXX 0

82950 ............. X Glucose test .................................................... 0.00 0.00 0.00 0.00 XXX 0

82951 ............. X Glucose tolerance test (GTT) ......................... 0.00 0.00 0.00 0.00 XXX 0

82952 ............. X GTT-added samples ....................................... 0.00 0.00 0.00 0.00 XXX 0

82953 ............. X Glucose-tolbutamide test ................................ 0.00 0.00 0.00 0.00 XXX 0

82955 ............. X Assay G6PD enzyme ..................................... 0.00 0.00 0.00 0.00 XXX 0

82960 ............. X Test for G6PD enzyme ................................... 0.00 0.00 0.00 0.00 XXX 0

82962 ............. X Glucose blood test .......................................... 0.00 0.00 0.00 0.00 XXX 0

82963 ............. X Glucosidase assay .......................................... 0.00 0.00 0.00 0.00 XXX 0

82965 ............. X Assay GDH enzyme ....................................... 0.00 0.00 0.00 0.00 XXX 0

82975 ............. X Assay glutamine ............................................. 0.00 0.00 0.00 0.00 XXX 0

82977 ............. X Assay of GGT ................................................. 0.00 0.00 0.00 0.00 XXX 0

82978 ............. X Glutathione assay ........................................... 0.00 0.00 0.00 0.00 XXX 0

82979 ............. X Assay RBC glutathione enzyme ..................... 0.00 0.00 0.00 0.00 XXX 0

82980 ............. X Assay of glutethimide ..................................... 0.00 0.00 0.00 0.00 XXX 0

82985 ............. X Glycated protein .............................................. 0.00 0.00 0.00 0.00 XXX 0

83001 ............. X Gonadotropin (FSH) ....................................... 0.00 0.00 0.00 0.00 XXX 0

83002 ............. X Gonadotropin (LH) .......................................... 0.00 0.00 0.00 0.00 XXX 0

83003 ............. X Assay growth hormone (HGH) ....................... 0.00 0.00 0.00 0.00 XXX 0

83008 ............. X Assay guanosine ............................................ 0.00 0.00 0.00 0.00 XXX 0

83010 ............. X Quant assay haptoglobin ................................ 0.00 0.00 0.00 0.00 XXX 0

83012 ............. X Assay haptoglobins ......................................... 0.00 0.00 0.00 0.00 XXX 0

83015 ............. X Heavy metal screen ........................................ 0.00 0.00 0.00 0.00 XXX 0

83018 ............. X Quantitative screen, metals ............................ 0.00 0.00 0.00 0.00 XXX 0

83020 ............. X Assay hemoglobin .......................................... 0.00 0.00 0.00 0.00 XXX 0

83020 26 A Assay hemoglobin .......................................... 0.37 0.20 0.01 0.58 XXX N

83026 ............. X Hemoglobin, copper sulfate ............................ 0.00 0.00 0.00 0.00 XXX 0

83030 ............. X Fetal hemoglobin assay .................................. 0.00 0.00 0.00 0.00 XXX 0

83033 ............. X Fetal fecal hemoglobin assay ......................... 0.00 0.00 0.00 0.00 XXX 0

83036 ............. X Glycated hemoglobin test ............................... 0.00 0.00 0.00 0.00 XXX 0

83045 ............. X Blood methemoglobin test .............................. 0.00 0.00 0.00 0.00 XXX 0

83050 ............. X Blood methemoglobin assay .......................... 0.00 0.00 0.00 0.00 XXX 0

83051 ............. X Assay plasma hemoglobin .............................. 0.00 0.00 0.00 0.00 XXX 0

83055 ............. X Blood sulfhemoglobin test .............................. 0.00 0.00 0.00 0.00 XXX 0

83060 ............. X Blood sulfhemoglobin assay ........................... 0.00 0.00 0.00 0.00 XXX 0

83065 ............. X Hemoglobin heat assay .................................. 0.00 0.00 0.00 0.00 XXX 0

83068 ............. X Hemoglobin stability screen ............................ 0.00 0.00 0.00 0.00 XXX 0

83069 ............. X Assay urine hemoglobin ................................. 0.00 0.00 0.00 0.00 XXX 0

83070 ............. X Qualt assay hemosiderin ................................ 0.00 0.00 0.00 0.00 XXX 0

83071 ............. X Quant assay of hemosiderin ........................... 0.00 0.00 0.00 0.00 XXX 0

83088 ............. X Assay histamine .............................................. 0.00 0.00 0.00 0.00 XXX 0

83150 ............. X Assay for HVA ................................................ 0.00 0.00 0.00 0.00 XXX 0

83491 ............. X Assay of corticosteroids .................................. 0.00 0.00 0.00 0.00 XXX 0

83497 ............. X Assay 5–HIAA ................................................. 0.00 0.00 0.00 0.00 XXX 0

83498 ............. X Assay of progesterone .................................... 0.00 0.00 0.00 0.00 XXX 0

83499 ............. X Assay of progesterone .................................... 0.00 0.00 0.00 0.00 XXX 0
63296

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

83500 ............. X Assay free hydroxyproline .............................. 0.00 0.00 0.00 0.00 XXX 0

83505 ............. X Assay total hydroxyproline .............................. 0.00 0.00 0.00 0.00 XXX 0

83516 ............. X Immunoassay, non antibody ........................... 0.00 0.00 0.00 0.00 XXX 0

83518 ............. X Immunoassay, dipstick ................................... 0.00 0.00 0.00 0.00 XXX 0

83519 ............. X Immunoassay nonantibody ............................. 0.00 0.00 0.00 0.00 XXX 0

83520 ............. X Immunoassay, RIA ......................................... 0.00 0.00 0.00 0.00 XXX 0

83525 ............. X Assay of insulin ............................................... 0.00 0.00 0.00 0.00 XXX 0

83527 ............. X Assay of insulin ............................................... 0.00 0.00 0.00 0.00 XXX 0

83528 ............. X Assay intrinsic factor ....................................... 0.00 0.00 0.00 0.00 XXX 0

83540 ............. X Assay iron ....................................................... 0.00 0.00 0.00 0.00 XXX 0

83550 ............. X Iron binding test .............................................. 0.00 0.00 0.00 0.00 XXX 0

83570 ............. X Assay IDH enzyme ......................................... 0.00 0.00 0.00 0.00 XXX 0

83582 ............. X Assay ketogenic steroids ................................ 0.00 0.00 0.00 0.00 XXX 0

83586 ............. X Assay 17-(17–KS)ketosteroids ....................... 0.00 0.00 0.00 0.00 XXX 0

83593 ............. X Fractionation ketosteroids ............................... 0.00 0.00 0.00 0.00 XXX 0

83605 ............. X Lactic acid assay ............................................ 0.00 0.00 0.00 0.00 XXX 0

83615 ............. X Lactate (LD) (LDH) enzyme ............................ 0.00 0.00 0.00 0.00 XXX 0

83625 ............. X Assay LDH enzymes ...................................... 0.00 0.00 0.00 0.00 XXX 0

83632 ............. X Placental lactogen .......................................... 0.00 0.00 0.00 0.00 XXX 0

83633 ............. X Test urine for lactose ...................................... 0.00 0.00 0.00 0.00 XXX 0

83634 ............. X Assay urine for lactose ................................... 0.00 0.00 0.00 0.00 XXX 0

83655 ............. X Assay for lead ................................................. 0.00 0.00 0.00 0.00 XXX 0

83661 ............. X Assay L/S ratio ............................................... 0.00 0.00 0.00 0.00 XXX 0

83662 ............. X L/S ratio, foam stability ................................... 0.00 0.00 0.00 0.00 XXX 0

83670 ............. X Assay LAP enzyme ........................................ 0.00 0.00 0.00 0.00 XXX 0

83690 ............. X Assay lipase .................................................... 0.00 0.00 0.00 0.00 XXX 0

83715 ............. X Assay blood lipoproteins ................................. 0.00 0.00 0.00 0.00 XXX 0

83717 ............. X Assay blood lipoproteins ................................. 0.00 0.00 0.00 0.00 XXX 0

83718 ............. X Blood lipoprotein assay .................................. 0.00 0.00 0.00 0.00 XXX 0

83719 ............. X Blood lipoprotein assay .................................. 0.00 0.00 0.00 0.00 XXX 0

83721 ............. X Blood lipoprotein assay .................................. 0.00 0.00 0.00 0.00 XXX 0

83727 ............. X LRH hormone assay ....................................... 0.00 0.00 0.00 0.00 XXX 0

83735 ............. X Assay magnesium .......................................... 0.00 0.00 0.00 0.00 XXX 0

83775 ............. X Assay of md enzyme ...................................... 0.00 0.00 0.00 0.00 XXX 0

83785 ............. X Assay of manganese ...................................... 0.00 0.00 0.00 0.00 XXX 0

83805 ............. X Assay of meprobamate ................................... 0.00 0.00 0.00 0.00 XXX 0

83825 ............. X Assay mercury ................................................ 0.00 0.00 0.00 0.00 XXX 0

83835 ............. X Assay metanephrines ..................................... 0.00 0.00 0.00 0.00 XXX 0

83840 ............. X Assay methadone ........................................... 0.00 0.00 0.00 0.00 XXX 0

83857 ............. X Assay methemalbumin ................................... 0.00 0.00 0.00 0.00 XXX 0

83858 ............. X Assay methsuximide ....................................... 0.00 0.00 0.00 0.00 XXX 0

83864 ............. X Mucopolysaccharides ..................................... 0.00 0.00 0.00 0.00 XXX 0

83866 ............. X Mucopolysaccharides screen ......................... 0.00 0.00 0.00 0.00 XXX 0

83872 ............. X Assay synovial fluid mucin .............................. 0.00 0.00 0.00 0.00 XXX 0

83873 ............. X Assay, CSF protein ......................................... 0.00 0.00 0.00 0.00 XXX 0

83874 ............. X Myoglobin ........................................................ 0.00 0.00 0.00 0.00 XXX 0

83883 ............. X Nephelometry, not specified ........................... 0.00 0.00 0.00 0.00 XXX 0

83885 ............. X Assay for nickel .............................................. 0.00 0.00 0.00 0.00 XXX 0

83887 ............. X Assay nicotine ................................................. 0.00 0.00 0.00 0.00 XXX 0

83890 ............. X Molecular diagnostics ..................................... 0.00 0.00 0.00 0.00 XXX 0

83892 ............. X Molecular diagnostics ..................................... 0.00 0.00 0.00 0.00 XXX 0

83894 ............. X Molecular diagnostics ..................................... 0.00 0.00 0.00 0.00 XXX 0

83896 ............. X Molecular diagnostics ..................................... 0.00 0.00 0.00 0.00 XXX 0

83898 ............. X Molecular diagnostics ..................................... 0.00 0.00 0.00 0.00 XXX 0

83912 ............. X Genetic examination ....................................... 0.00 0.00 0.00 0.00 XXX 0

83912 26 A Genetic examination ....................................... 0.37 0.20 0.01 0.58 XXX N

83915 ............. X Assay nucleotidase ......................................... 0.00 0.00 0.00 0.00 XXX 0

83916 ............. X Oligoclonal bands ........................................... 0.00 0.00 0.00 0.00 XXX 0

83918 ............. X Assay organic acids ........................................ 0.00 0.00 0.00 0.00 XXX 0

83925 ............. X Opiates ............................................................ 0.00 0.00 0.00 0.00 XXX 0

83930 ............. X Assay blood osmolality ................................... 0.00 0.00 0.00 0.00 XXX 0

83935 ............. X Assay urine osmolality .................................... 0.00 0.00 0.00 0.00 XXX 0

83937 ............. X Assay for osteocalcin ...................................... 0.00 0.00 0.00 0.00 XXX 0

83945 ............. X Assay oxalate ................................................. 0.00 0.00 0.00 0.00 XXX 0

83970 ............. X Assay of parathormone .................................. 0.00 0.00 0.00 0.00 XXX 0

83986 ............. X Assay body fluid acidity .................................. 0.00 0.00 0.00 0.00 XXX 0
63297

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

83992 ............. X Assay for phencyclidine .................................. 0.00 0.00 0.00 0.00 XXX 0

84022 ............. X Assay of phenothiazine .................................. 0.00 0.00 0.00 0.00 XXX 0

84030 ............. X Assay blood PKU ............................................ 0.00 0.00 0.00 0.00 XXX 0

84035 ............. X Assay phenylketones ...................................... 0.00 0.00 0.00 0.00 XXX 0

84060 ............. X Assay acid phosphatase ................................. 0.00 0.00 0.00 0.00 XXX 0

84061 ............. X Phosphatase, forensic exam .......................... 0.00 0.00 0.00 0.00 XXX 0

84066 ............. X Assay prostate phosphatase .......................... 0.00 0.00 0.00 0.00 XXX 0

84075 ............. X Assay alkaline phosphatase ........................... 0.00 0.00 0.00 0.00 XXX 0

84078 ............. X Assay alkaline phosphatase ........................... 0.00 0.00 0.00 0.00 XXX 0

84080 ............. X Assay alkaline phosphatases ......................... 0.00 0.00 0.00 0.00 XXX 0

84081 ............. X Amniotic fluid enzyme test .............................. 0.00 0.00 0.00 0.00 XXX 0

84085 ............. X Assay RBC PG6D enzyme ............................. 0.00 0.00 0.00 0.00 XXX 0

84087 ............. X Assay phosphohexose enzymes .................... 0.00 0.00 0.00 0.00 XXX 0

84100 ............. X Assay phosphorus .......................................... 0.00 0.00 0.00 0.00 XXX 0

84105 ............. X Assay urine phosphorus ................................. 0.00 0.00 0.00 0.00 XXX 0

84106 ............. X Test for porphobilinogen ................................. 0.00 0.00 0.00 0.00 XXX 0

84110 ............. X Assay porphobilinogen ................................... 0.00 0.00 0.00 0.00 XXX 0

84119 ............. X Test urine for porphyrins ................................ 0.00 0.00 0.00 0.00 XXX 0

84120 ............. X Assay urine porphyrins ................................... 0.00 0.00 0.00 0.00 XXX 0

84126 ............. X Assay feces porphyrins .................................. 0.00 0.00 0.00 0.00 XXX 0

84127 ............. X Porphyrins, feces ............................................ 0.00 0.00 0.00 0.00 XXX 0

84132 ............. X Assay serum potassium ................................. 0.00 0.00 0.00 0.00 XXX 0

84133 ............. X Assay urine potassium ................................... 0.00 0.00 0.00 0.00 XXX 0

84134 ............. X Prealbumin ...................................................... 0.00 0.00 0.00 0.00 XXX 0

84135 ............. X Assay pregnanediol ........................................ 0.00 0.00 0.00 0.00 XXX 0

84138 ............. X Assay pregnanetriol ........................................ 0.00 0.00 0.00 0.00 XXX 0

84140 ............. X Assay for pregnenolone .................................. 0.00 0.00 0.00 0.00 XXX 0

84143 ............. X Assay/17-hydroxypregnenolone ..................... 0.00 0.00 0.00 0.00 XXX 0

84144 ............. X Assay progesterone ........................................ 0.00 0.00 0.00 0.00 XXX 0

84146 ............. X Assay for prolactin .......................................... 0.00 0.00 0.00 0.00 XXX 0

84150 ............. X Assay of prostaglandin ................................... 0.00 0.00 0.00 0.00 XXX 0

84153 ............. X Prostate specific antigen ................................ 0.00 0.00 0.00 0.00 XXX 0

84155 ............. X Assay protein .................................................. 0.00 0.00 0.00 0.00 XXX 0

84160 ............. X Assay serum protein ....................................... 0.00 0.00 0.00 0.00 XXX 0

84165 ............. X Assay serum proteins ..................................... 0.00 0.00 0.00 0.00 XXX 0

84165 26 A Assay serum proteins ..................................... 0.37 0.20 0.01 0.58 XXX N

84181 ............. X Western blot test ............................................. 0.00 0.00 0.00 0.00 XXX 0

84181 26 A Western blot test ............................................. 0.37 0.20 0.01 0.58 XXX N

84182 ............. X Protein, western blot test ................................ 0.00 0.00 0.00 0.00 XXX 0

84182 26 A Protein, western blot test ................................ 0.37 0.20 0.01 0.58 XXX N

84202 ............. X Assay RBC protoporphyrin ............................. 0.00 0.00 0.00 0.00 XXX 0

84203 ............. X Test RBC protoporphyrin ................................ 0.00 0.00 0.00 0.00 XXX 0

84206 ............. X Assay of proinsulin ......................................... 0.00 0.00 0.00 0.00 XXX 0

84207 ............. X Assay vitamin B–6 .......................................... 0.00 0.00 0.00 0.00 XXX 0

84210 ............. X Assay pyruvate ............................................... 0.00 0.00 0.00 0.00 XXX 0

84220 ............. X Assay pyruvate kinase .................................... 0.00 0.00 0.00 0.00 XXX 0

84228 ............. X Assay quinine ................................................. 0.00 0.00 0.00 0.00 XXX 0

84233 ............. X Assay estrogen ............................................... 0.00 0.00 0.00 0.00 XXX 0

84234 ............. X Assay progesterone ........................................ 0.00 0.00 0.00 0.00 XXX 0

84235 ............. X Assay endocrine hormone .............................. 0.00 0.00 0.00 0.00 XXX 0

84238 ............. X Assay non-endocrine receptor ........................ 0.00 0.00 0.00 0.00 XXX 0

84244 ............. X Assay of renin ................................................. 0.00 0.00 0.00 0.00 XXX 0

84252 ............. X Assay vitamin B–2 .......................................... 0.00 0.00 0.00 0.00 XXX 0

84255 ............. X Assay selenium ............................................... 0.00 0.00 0.00 0.00 XXX 0

84260 ............. X Assay serotonin .............................................. 0.00 0.00 0.00 0.00 XXX 0

84270 ............. X Sex hormone globulin (SHBG) ....................... 0.00 0.00 0.00 0.00 XXX 0

84275 ............. X Assay sialic acid ............................................. 0.00 0.00 0.00 0.00 XXX 0

84285 ............. X Assay silica ..................................................... 0.00 0.00 0.00 0.00 XXX 0

84295 ............. X Assay serum sodium ...................................... 0.00 0.00 0.00 0.00 XXX 0

84300 ............. X Assay urine sodium ........................................ 0.00 0.00 0.00 0.00 XXX 0

84305 ............. X Somatomedin .................................................. 0.00 0.00 0.00 0.00 XXX 0

84307 ............. X Somatostatin ................................................... 0.00 0.00 0.00 0.00 XXX 0

84311 ............. X Spectrophotometry .......................................... 0.00 0.00 0.00 0.00 XXX 0

84315 ............. X Body fluid specific gravity ............................... 0.00 0.00 0.00 0.00 XXX 0

84375 ............. X Chromatogram assay, sugars ......................... 0.00 0.00 0.00 0.00 XXX 0

84392 ............. X Assay urine sulfate ......................................... 0.00 0.00 0.00 0.00 XXX 0
63298

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

84402 ............. X Testosterone ................................................... 0.00 0.00 0.00 0.00 XXX 0

84403 ............. X Assay total testosterone ................................. 0.00 0.00 0.00 0.00 XXX 0

84425 ............. X Assay vitamin B–1 .......................................... 0.00 0.00 0.00 0.00 XXX 0

84430 ............. X Assay thiocyanate ........................................... 0.00 0.00 0.00 0.00 XXX 0

84432 ............. X Thyroglobulin .................................................. 0.00 0.00 0.00 0.00 XXX 0

84436 ............. X Assay, total thyroxine ..................................... 0.00 0.00 0.00 0.00 XXX 0

84437 ............. X Assay neonatal thyroxine ............................... 0.00 0.00 0.00 0.00 XXX 0

84439 ............. X Assay, free thyroxine ...................................... 0.00 0.00 0.00 0.00 XXX 0

84442 ............. X Thyroid activity (TBG) assay .......................... 0.00 0.00 0.00 0.00 XXX 0

84443 ............. X Assay thyroid stim hormone ........................... 0.00 0.00 0.00 0.00 XXX 0

84445 ............. X Thyroid immunoglobulins TSI ......................... 0.00 0.00 0.00 0.00 XXX 0

84446 ............. X Assay vitamin E .............................................. 0.00 0.00 0.00 0.00 XXX 0

84449 ............. X Assay for transcortin ....................................... 0.00 0.00 0.00 0.00 XXX 0

84450 ............. X Transferase (AST) (SGOT) ............................. 0.00 0.00 0.00 0.00 XXX 0

84460 ............. X Alanine amino (ALT) (SGPT) .......................... 0.00 0.00 0.00 0.00 XXX 0

84466 ............. X Transferrin ....................................................... 0.00 0.00 0.00 0.00 XXX 0

84478 ............. X Assay triglycerides .......................................... 0.00 0.00 0.00 0.00 XXX 0

84479 ............. X Assay triiodothyronine (T–3) ........................... 0.00 0.00 0.00 0.00 XXX 0

84480 ............. X Total assay, TT–3 ........................................... 0.00 0.00 0.00 0.00 XXX 0

84481 ............. X Free assay (FT–3) .......................................... 0.00 0.00 0.00 0.00 XXX 0

84482 ............. X T3 reverse ....................................................... 0.00 0.00 0.00 0.00 XXX 0

84485 ............. X Assay duodenal fluid trypsin ........................... 0.00 0.00 0.00 0.00 XXX 0

84488 ............. X Test feces for trypsin ...................................... 0.00 0.00 0.00 0.00 XXX 0

84490 ............. X Assay feces for trypsin ................................... 0.00 0.00 0.00 0.00 XXX 0

84510 ............. X Assay tyrosine ................................................ 0.00 0.00 0.00 0.00 XXX 0

84520 ............. X Assay urea nitrogen ........................................ 0.00 0.00 0.00 0.00 XXX 0

84525 ............. X Urea nitrogen semi-quant ............................... 0.00 0.00 0.00 0.00 XXX 0

84540 ............. X Assay urine urea-N ......................................... 0.00 0.00 0.00 0.00 XXX 0

84545 ............. X Urea-N clearance test ..................................... 0.00 0.00 0.00 0.00 XXX 0

84550 ............. X Assay blood uric acid ..................................... 0.00 0.00 0.00 0.00 XXX 0

84560 ............. X Assay urine uric acid ...................................... 0.00 0.00 0.00 0.00 XXX 0

84577 ............. X Assay feces urobilinogen ................................ 0.00 0.00 0.00 0.00 XXX 0

84578 ............. X Test urine urobilinogen ................................... 0.00 0.00 0.00 0.00 XXX 0

84580 ............. X Assay urine urobilinogen ................................ 0.00 0.00 0.00 0.00 XXX 0

84583 ............. X Assay urine urobilinogen ................................ 0.00 0.00 0.00 0.00 XXX 0

84585 ............. X Assay urine VMA ............................................ 0.00 0.00 0.00 0.00 XXX 0

84586 ............. X VIP assay ........................................................ 0.00 0.00 0.00 0.00 XXX 0

84588 ............. X Assay vasopressin .......................................... 0.00 0.00 0.00 0.00 XXX 0

84590 ............. X Assay vitamin-A .............................................. 0.00 0.00 0.00 0.00 XXX 0

84597 ............. X Assay vitamin-K .............................................. 0.00 0.00 0.00 0.00 XXX 0

84600 ............. X Assay for volatiles ........................................... 0.00 0.00 0.00 0.00 XXX 0

84620 ............. X Xylose tolerance test ...................................... 0.00 0.00 0.00 0.00 XXX 0

84630 ............. X Assay zinc ....................................................... 0.00 0.00 0.00 0.00 XXX 0

84681 ............. X Assay C-peptide ............................................. 0.00 0.00 0.00 0.00 XXX 0

84702 ............. X Chorionic gonadotropin test ............................ 0.00 0.00 0.00 0.00 XXX 0

84703 ............. X Chorionic gonadotropin assay ........................ 0.00 0.00 0.00 0.00 XXX 0

84830 ............. X Ovulation tests ................................................ 0.00 0.00 0.00 0.00 XXX 0

84999 ............. X Clinical chemistry test ..................................... 0.00 0.00 0.00 0.00 XXX 0

85002 ............. X Bleeding time test ........................................... 0.00 0.00 0.00 0.00 XXX 0

85007 ............. X Differential WBC count ................................... 0.00 0.00 0.00 0.00 XXX 0

85008 ............. X Nondifferential WBC count ............................. 0.00 0.00 0.00 0.00 XXX 0

85009 ............. X Differential WBC count ................................... 0.00 0.00 0.00 0.00 XXX 0

85013 ............. X Hematocrit ....................................................... 0.00 0.00 0.00 0.00 XXX 0

85014 ............. X Hematocrit ....................................................... 0.00 0.00 0.00 0.00 XXX 0

85018 ............. X Hemoglobin ..................................................... 0.00 0.00 0.00 0.00 XXX 0

85021 ............. X Automated hemogram .................................... 0.00 0.00 0.00 0.00 XXX 0

85022 ............. X Automated hemogram .................................... 0.00 0.00 0.00 0.00 XXX 0

85023 ............. X Automated hemogram .................................... 0.00 0.00 0.00 0.00 XXX 0

85024 ............. X Automated hemogram .................................... 0.00 0.00 0.00 0.00 XXX 0

85025 ............. X Automated hemogram .................................... 0.00 0.00 0.00 0.00 XXX 0

85027 ............. X Automated hemogram .................................... 0.00 0.00 0.00 0.00 XXX 0

85029 ............. X Automated hemogram .................................... 0.00 0.00 0.00 0.00 XXX 0

85030 ............. X Automated hemogram .................................... 0.00 0.00 0.00 0.00 XXX 0

85031 ............. X Manual hemogram, complete cbc .................. 0.00 0.00 0.00 0.00 XXX 0

85041 ............. X Red blood cell (RBC) count ............................ 0.00 0.00 0.00 0.00 XXX 0

85044 ............. X Reticulocyte count .......................................... 0.00 0.00 0.00 0.00 XXX 0
63299

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

85045 ............. X Reticulocyte count .......................................... 0.00 0.00 0.00 0.00 XXX 0

85048 ............. X White blood cell (WBC) count ........................ 0.00 0.00 0.00 0.00 XXX 0

85060 ............. A Blood smear interpretation ............................. 0.45 0.22 0.02 0.69 XXX N

85095 ............. A Bone marrow aspiration .................................. 1.08 0.67 0.05 1.80 XXX N

85097 ............. A Bone marrow interpretation ............................ 0.94 0.48 0.04 1.46 XXX N

85102 ............. A Bone marrow biopsy ....................................... 1.37 0.80 0.05 2.22 XXX N

85130 ............. X Chromogenic substrate assay ........................ 0.00 0.00 0.00 0.00 XXX 0

85170 ............. X Blood clot retraction ........................................ 0.00 0.00 0.00 0.00 XXX 0

85175 ............. X Blood clot lysis time ........................................ 0.00 0.00 0.00 0.00 XXX 0

85210 ............. X Blood clot factor II test .................................... 0.00 0.00 0.00 0.00 XXX 0

85220 ............. X Blood clot factor V test ................................... 0.00 0.00 0.00 0.00 XXX 0

85230 ............. X Blood clot factor VII test ................................. 0.00 0.00 0.00 0.00 XXX 0

85240 ............. X Blood clot factor VIII test ................................ 0.00 0.00 0.00 0.00 XXX 0

85244 ............. X Blood clot factor VIII test ................................ 0.00 0.00 0.00 0.00 XXX 0

85245 ............. X Blood clot factor VIII test ................................ 0.00 0.00 0.00 0.00 XXX 0

85246 ............. X Blood clot factor VIII test ................................ 0.00 0.00 0.00 0.00 XXX 0

85247 ............. X Blood clot factor VIII test ................................ 0.00 0.00 0.00 0.00 XXX 0

85250 ............. X Blood clot factor IX test .................................. 0.00 0.00 0.00 0.00 XXX 0

85260 ............. X Blood clot factor X test ................................... 0.00 0.00 0.00 0.00 XXX 0

85270 ............. X Blood clot factor XI test .................................. 0.00 0.00 0.00 0.00 XXX 0

85280 ............. X Blood clot factor XII test ................................. 0.00 0.00 0.00 0.00 XXX 0

85290 ............. X Blood clot factor XIII test ................................ 0.00 0.00 0.00 0.00 XXX 0

85291 ............. X Blood clot factor XIII test ................................ 0.00 0.00 0.00 0.00 XXX 0

85292 ............. X Blood clot factor assay ................................... 0.00 0.00 0.00 0.00 XXX 0

85293 ............. X Blood clot factor assay ................................... 0.00 0.00 0.00 0.00 XXX 0

85300 ............. X Antithrombin III test ......................................... 0.00 0.00 0.00 0.00 XXX 0

85301 ............. X Antithrombin III test ......................................... 0.00 0.00 0.00 0.00 XXX 0

85302 ............. X Blood clot inhibitor antigen ............................. 0.00 0.00 0.00 0.00 XXX 0

85303 ............. X Blood clot inhibitor test ................................... 0.00 0.00 0.00 0.00 XXX 0

85305 ............. X Blood clot inhibitor assay ................................ 0.00 0.00 0.00 0.00 XXX 0

85306 ............. X Blood clot inhibitor test ................................... 0.00 0.00 0.00 0.00 XXX 0

85335 ............. X Factor inhibitor test ......................................... 0.00 0.00 0.00 0.00 XXX 0

85337 ............. X Thrombomodulin ............................................. 0.00 0.00 0.00 0.00 XXX 0

85345 ............. X Coagulation time ............................................. 0.00 0.00 0.00 0.00 XXX 0

85347 ............. X Coagulation time ............................................. 0.00 0.00 0.00 0.00 XXX 0

85348 ............. X Coagulation time ............................................. 0.00 0.00 0.00 0.00 XXX 0

85360 ............. X Euglobulin lysis ............................................... 0.00 0.00 0.00 0.00 XXX 0

85362 ............. X Fibrin degradation products ............................ 0.00 0.00 0.00 0.00 XXX 0

85366 ............. X Fibrinogen test ................................................ 0.00 0.00 0.00 0.00 XXX 0

85370 ............. X Fibrinogen test ................................................ 0.00 0.00 0.00 0.00 XXX 0

85378 ............. X Fibrin degradation ........................................... 0.00 0.00 0.00 0.00 XXX 0

85379 ............. X Fibrin degradation ........................................... 0.00 0.00 0.00 0.00 XXX 0

85384 ............. X Fibrinogen ....................................................... 0.00 0.00 0.00 0.00 XXX 0

85385 ............. X Fibrinogen ....................................................... 0.00 0.00 0.00 0.00 XXX 0

85390 ............. X Fibrinolysins screen ........................................ 0.00 0.00 0.00 0.00 XXX 0

85390 26 A Fibrinolysins screen ........................................ 0.37 0.20 0.01 0.58 XXX N

85400 ............. X Fibrinolytic plasmin ......................................... 0.00 0.00 0.00 0.00 XXX 0

85410 ............. X Fibrinolytic antiplasmin ................................... 0.00 0.00 0.00 0.00 XXX 0

85415 ............. X Fibrinolytic plasminogen ................................. 0.00 0.00 0.00 0.00 XXX 0

85420 ............. X Fibrinolytic plasminogen ................................. 0.00 0.00 0.00 0.00 XXX 0

85421 ............. X Fibrinolytic plasminogen ................................. 0.00 0.00 0.00 0.00 XXX 0

85441 ............. X Heinz bodies; direct ........................................ 0.00 0.00 0.00 0.00 XXX 0

85445 ............. X Heinz bodies; induced .................................... 0.00 0.00 0.00 0.00 XXX 0

85460 ............. X Hemoglobin, fetal ............................................ 0.00 0.00 0.00 0.00 XXX 0

85461 ............. X Hemoglobin, fetal ............................................ 0.00 0.00 0.00 0.00 XXX 0

85475 ............. X Hemolysin ....................................................... 0.00 0.00 0.00 0.00 XXX 0

85520 ............. X Heparin assay ................................................. 0.00 0.00 0.00 0.00 XXX 0

85525 ............. X Heparin ........................................................... 0.00 0.00 0.00 0.00 XXX 0

85530 ............. X Heparin-protamine tolerance .......................... 0.00 0.00 0.00 0.00 XXX 0

85535 ............. X Iron stain, blood cells ...................................... 0.00 0.00 0.00 0.00 XXX 0

85540 ............. X Wbc alkaline phosphatase .............................. 0.00 0.00 0.00 0.00 XXX 0

85547 ............. X RBC mechanical fragility ................................ 0.00 0.00 0.00 0.00 XXX 0

85549 ............. X Muramidase .................................................... 0.00 0.00 0.00 0.00 XXX 0

85555 ............. X RBC osmotic fragility ...................................... 0.00 0.00 0.00 0.00 XXX 0

85557 ............. X RBC osmotic fragility ...................................... 0.00 0.00 0.00 0.00 XXX 0

85576 ............. X Blood platelet aggregation .............................. 0.00 0.00 0.00 0.00 XXX 0
63300

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

85576 26 A Blood platelet aggregation .............................. 0.37 0.20 0.01 0.58 XXX N

85585 ............. X Blood platelet estimation ................................ 0.00 0.00 0.00 0.00 XXX 0

85590 ............. X Platelet manual count ..................................... 0.00 0.00 0.00 0.00 XXX 0

85595 ............. X Platelet count, automated ............................... 0.00 0.00 0.00 0.00 XXX 0

85597 ............. X Platelet neutralization ..................................... 0.00 0.00 0.00 0.00 XXX 0

85610 ............. X Prothrombin time ............................................ 0.00 0.00 0.00 0.00 XXX 0

85611 ............. X Prothrombin test ............................................. 0.00 0.00 0.00 0.00 XXX 0

85612 ............. X Viper venom prothrombin time ....................... 0.00 0.00 0.00 0.00 XXX 0

85613 ............. X Russell viper venom, diluted .......................... 0.00 0.00 0.00 0.00 XXX 0

85635 ............. X Reptilase test .................................................. 0.00 0.00 0.00 0.00 XXX 0

85651 ............. X RBC sed rate, nonauto ................................... 0.00 0.00 0.00 0.00 XXX 0

85652 ............. X RBC sed rate, auto ......................................... 0.00 0.00 0.00 0.00 XXX 0

85660 ............. X RBC sickle cell test ......................................... 0.00 0.00 0.00 0.00 XXX 0

85670 ............. X Thrombin time, plasma ................................... 0.00 0.00 0.00 0.00 XXX 0

85675 ............. X Thrombin time, titer ......................................... 0.00 0.00 0.00 0.00 XXX 0

85705 ............. X Thromboplastin inhibition ................................ 0.00 0.00 0.00 0.00 XXX 0

85730 ............. X Thromboplastin time, partial ........................... 0.00 0.00 0.00 0.00 XXX 0

85732 ............. X Thromboplastin time, partial ........................... 0.00 0.00 0.00 0.00 XXX 0

85810 ............. X Blood viscosity examination ........................... 0.00 0.00 0.00 0.00 XXX 0

85999 ............. X Hematology procedure ................................... 0.00 0.00 0.00 0.00 XXX 0

86000 ............. X Agglutinins; febrile .......................................... 0.00 0.00 0.00 0.00 XXX 0

86003 ............. X Allergen specific IgE ....................................... 0.00 0.00 0.00 0.00 XXX 0

86005 ............. X Allergen specific IgE ....................................... 0.00 0.00 0.00 0.00 XXX 0

86021 ............. X WBC antibody identification ............................ 0.00 0.00 0.00 0.00 XXX 0

86022 ............. X Platelet antibodies .......................................... 0.00 0.00 0.00 0.00 XXX 0

86023 ............. X Immunoglobulin assay .................................... 0.00 0.00 0.00 0.00 XXX 0

86038 ............. X Antinuclear antibodies .................................... 0.00 0.00 0.00 0.00 XXX 0

86039 ............. X Antinuclear antibodies (ANA) ......................... 0.00 0.00 0.00 0.00 XXX 0

86060 ............. X Antistreptolysin O titer .................................... 0.00 0.00 0.00 0.00 XXX 0

86063 ............. X Antistreptolysin O screen ................................ 0.00 0.00 0.00 0.00 XXX 0

86077 ............. A Physician blood bank service ......................... 0.37 0.30 0.02 0.69 XXX N

86078 ............. A Physician blood bank service ......................... 0.94 0.34 0.02 1.30 XXX N

86079 ............. A Physician blood bank service ......................... 0.37 0.33 0.02 0.72 XXX N

86140 ............. X C-reactive protein ........................................... 0.00 0.00 0.00 0.00 XXX 0

86147 ............. X Cardiolipin antibody ........................................ 0.00 0.00 0.00 0.00 XXX 0

86155 ............. X Chemotaxis assay .......................................... 0.00 0.00 0.00 0.00 XXX 0

86156 ............. X Cold agglutinin screen .................................... 0.00 0.00 0.00 0.00 XXX 0

86157 ............. X Cold agglutinin, titer ........................................ 0.00 0.00 0.00 0.00 XXX 0

86160 ............. X Complement, antigen ...................................... 0.00 0.00 0.00 0.00 XXX 0

86161 ............. X Complement/function activity .......................... 0.00 0.00 0.00 0.00 XXX 0

86162 ............. X Complement, total (CH50) .............................. 0.00 0.00 0.00 0.00 XXX 0

86171 ............. X Complement fixation, each ............................. 0.00 0.00 0.00 0.00 XXX 0

86185 ............. X Counterimmunoelectrophoresis ...................... 0.00 0.00 0.00 0.00 XXX 0

86215 ............. X Deoxyribonuclease, antibody .......................... 0.00 0.00 0.00 0.00 XXX 0

86225 ............. X DNA antibody .................................................. 0.00 0.00 0.00 0.00 XXX 0

86226 ............. X DNA antibody, single strand ........................... 0.00 0.00 0.00 0.00 XXX 0

86235 ............. X Nuclear antigen antibody ................................ 0.00 0.00 0.00 0.00 XXX 0

86243 ............. X Fc receptor ...................................................... 0.00 0.00 0.00 0.00 XXX 0

86255 ............. X Fluorescent antibody; screen ......................... 0.00 0.00 0.00 0.00 XXX 0

86255 26 A Fluorescent antibody; screen ......................... 0.37 0.20 0.01 0.58 XXX N

86256 ............. X Fluorescent antibody; titer .............................. 0.00 0.00 0.00 0.00 XXX 0

86256 26 A Fluorescent antibody; titer .............................. 0.37 0.20 0.01 0.58 XXX N

86277 ............. X Growth hormone antibody .............................. 0.00 0.00 0.00 0.00 XXX 0

86280 ............. X Hemagglutination inhibition ............................. 0.00 0.00 0.00 0.00 XXX 0

86287 ............. X Hepatitis B (HBsAg) ........................................ 0.00 0.00 0.00 0.00 XXX 0

86289 ............. X Hepatitis BC antibody test .............................. 0.00 0.00 0.00 0.00 XXX 0

86290 ............. X Hepatitis BC antibody test .............................. 0.00 0.00 0.00 0.00 XXX 0

86291 ............. X Hepatitis BS antibody test .............................. 0.00 0.00 0.00 0.00 XXX 0

86293 ............. X Hepatitis Be antibody test ............................... 0.00 0.00 0.00 0.00 XXX 0

86295 ............. X Hepatitis Be antibody test ............................... 0.00 0.00 0.00 0.00 XXX 0

86296 ............. X Hepatitis A antibody test ................................. 0.00 0.00 0.00 0.00 XXX 0

86299 ............. X Hepatitis A antibody test ................................. 0.00 0.00 0.00 0.00 XXX 0

86302 ............. X Hepatitis C antibody ....................................... 0.00 0.00 0.00 0.00 XXX 0

86303 ............. X Hepatitis C antibody ....................................... 0.00 0.00 0.00 0.00 XXX 0

86306 ............. X Hepatitis, delta agent ...................................... 0.00 0.00 0.00 0.00 XXX 0

86308 ............. X Heterophile antibodies .................................... 0.00 0.00 0.00 0.00 XXX 0
63301

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

86309 ............. X Heterophile antibodies .................................... 0.00 0.00 0.00 0.00 XXX 0

86310 ............. X Heterophile antibodies .................................... 0.00 0.00 0.00 0.00 XXX 0

86311 ............. X HIV antigen test .............................................. 0.00 0.00 0.00 0.00 XXX 0

86313 ............. X Immunoassay, infectious agent ...................... 0.00 0.00 0.00 0.00 XXX 0

86315 ............. X Immunoassay, infectious agent ...................... 0.00 0.00 0.00 0.00 XXX 0

86316 ............. X Immunoassay, tumor antigen ......................... 0.00 0.00 0.00 0.00 XXX 0

86317 ............. X Immunoassay, infectious agent ...................... 0.00 0.00 0.00 0.00 XXX 0

86318 ............. X Immunoassay, infectious agent ...................... 0.00 0.00 0.00 0.00 XXX 0

86320 ............. X Serum immunoelectrophoresis ....................... 0.00 0.00 0.00 0.00 XXX 0

86320 26 A Serum immunoelectrophoresis ....................... 0.37 0.20 0.01 0.58 XXX N

86325 ............. X Other immunoelectrophoresis ......................... 0.00 0.00 0.00 0.00 XXX 0

86325 26 A Other immunoelectrophoresis ......................... 0.37 0.20 0.01 0.58 XXX N

86327 ............. X Immunoelectrophoresis assay ........................ 0.00 0.00 0.00 0.00 XXX 0

86327 26 A Immunoelectrophoresis assay ........................ 0.37 0.20 0.01 0.58 XXX N

86329 ............. X Immunodiffusion .............................................. 0.00 0.00 0.00 0.00 XXX 0

86331 ............. X Immunodiffusion ouchterlony .......................... 0.00 0.00 0.00 0.00 XXX 0

86332 ............. X Immune complex assay .................................. 0.00 0.00 0.00 0.00 XXX 0

86334 ............. X Immunofixation procedure .............................. 0.00 0.00 0.00 0.00 XXX 0

86334 26 A Immunofixation procedure .............................. 0.37 0.20 0.01 0.58 XXX N

86337 ............. X Insulin antibodies ............................................ 0.00 0.00 0.00 0.00 XXX 0

86340 ............. X Intrinsic factor antibody ................................... 0.00 0.00 0.00 0.00 XXX 0

86341 ............. X Islet cell antibody ............................................ 0.00 0.00 0.00 0.00 XXX 0

86343 ............. X Leukocyte histamine release .......................... 0.00 0.00 0.00 0.00 XXX 0

86344 ............. X Leukocyte phagocytosis ................................. 0.00 0.00 0.00 0.00 XXX 0

86353 ............. X Lymphocyte transformation ............................ 0.00 0.00 0.00 0.00 XXX 0

86359 ............. X T cells, total count .......................................... 0.00 0.00 0.00 0.00 XXX 0

86360 ............. X T cell ratio ....................................................... 0.00 0.00 0.00 0.00 XXX 0

86376 ............. X Microsomal antibody ....................................... 0.00 0.00 0.00 0.00 XXX 0

86378 ............. X Migration inhibitory factor ............................... 0.00 0.00 0.00 0.00 XXX 0

86382 ............. X Neutralization test, viral .................................. 0.00 0.00 0.00 0.00 XXX 0

86384 ............. X Nitroblue tetrazolium dye ................................ 0.00 0.00 0.00 0.00 XXX 0

86403 ............. X Particle agglutination test ............................... 0.00 0.00 0.00 0.00 XXX 0

86406 ............. X Particle agglutination test ............................... 0.00 0.00 0.00 0.00 XXX 0

86430 ............. X Rheumatoid factor test ................................... 0.00 0.00 0.00 0.00 XXX 0

86431 ............. X Rheumatoid factor, quant ............................... 0.00 0.00 0.00 0.00 XXX 0

86485 ............. C Skin test, candida ........................................... 0.00 0.00 0.00 0.00 XXX N

86490 ............. A Coccidioidomycosis skin test .......................... 0.00 0.28 0.02 0.30 XXX N

86510 ............. A Histoplasmosis skin test ................................. 0.00 0.30 0.02 0.32 XXX N

86580 ............. A TB intradermal test ......................................... 0.00 0.24 0.02 0.26 XXX N

86585 ............. A TB tine test ..................................................... 0.00 0.19 0.01 0.20 XXX N

86586 ............. C Skin test, unlisted ........................................... 0.00 0.00 0.00 0.00 XXX N

86588 ............. X Streptocollus, direct screen ............................ 0.00 0.00 0.00 0.00 XXX 0

86590 ............. X Streptokinase, antibody .................................. 0.00 0.00 0.00 0.00 XXX 0

86592 ............. X Blood serology, qualitative .............................. 0.00 0.00 0.00 0.00 XXX 0

86593 ............. X Blood serology, quantitative ........................... 0.00 0.00 0.00 0.00 XXX 0

86602 ............. X Antinomyces antibody ..................................... 0.00 0.00 0.00 0.00 XXX 0

86603 ............. X Adenovirus, antibody ...................................... 0.00 0.00 0.00 0.00 XXX 0

86606 ............. X Aspergillus antibody ........................................ 0.00 0.00 0.00 0.00 XXX 0

86609 ............. X Bacterium, antibody ........................................ 0.00 0.00 0.00 0.00 XXX 0

86612 ............. X Blastomyces, antibody .................................... 0.00 0.00 0.00 0.00 XXX 0

86615 ............. X Bordetella antibody ......................................... 0.00 0.00 0.00 0.00 XXX 0

86617 ............. X Lyme disease antibody ................................... 0.00 0.00 0.00 0.00 XXX 0

86618 ............. X Lyme disease antibody ................................... 0.00 0.00 0.00 0.00 XXX 0

86619 ............. X Borrelia antibody ............................................. 0.00 0.00 0.00 0.00 XXX 0

86622 ............. X Brucella, antibody ........................................... 0.00 0.00 0.00 0.00 XXX 0

86625 ............. X Campylobacter, antibody ................................ 0.00 0.00 0.00 0.00 XXX 0

86628 ............. X Candida, antibody ........................................... 0.00 0.00 0.00 0.00 XXX 0

86631 ............. X Chlamydia, antibody ....................................... 0.00 0.00 0.00 0.00 XXX 0

86632 ............. X Chlamydia, IgM, antibody ............................... 0.00 0.00 0.00 0.00 XXX 0

86635 ............. X Coccidioides, antibody .................................... 0.00 0.00 0.00 0.00 XXX 0

86638 ............. X Q fever antibody ............................................. 0.00 0.00 0.00 0.00 XXX 0

86641 ............. X Cryptococcus antibody ................................... 0.00 0.00 0.00 0.00 XXX 0

86644 ............. X CMV antibody ................................................. 0.00 0.00 0.00 0.00 XXX 0

86645 ............. X CMV antibody, IgM ......................................... 0.00 0.00 0.00 0.00 XXX 0

86648 ............. X Diphtheria antibody ......................................... 0.00 0.00 0.00 0.00 XXX 0

86651 ............. X Encephalitis, antibody ..................................... 0.00 0.00 0.00 0.00 XXX 0
63302

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

86652 ............. X Encephalitis, antibody ..................................... 0.00 0.00 0.00 0.00 XXX 0

86653 ............. X Encephalitis, antibody ..................................... 0.00 0.00 0.00 0.00 XXX 0

86654 ............. X Encephalitis, antibody ..................................... 0.00 0.00 0.00 0.00 XXX 0

86658 ............. X Enterovirus, antibody ...................................... 0.00 0.00 0.00 0.00 XXX 0

86663 ............. X Epstein-barr, antibody ..................................... 0.00 0.00 0.00 0.00 XXX 0

86664 ............. X Epstein-barr, antibody ..................................... 0.00 0.00 0.00 0.00 XXX 0

86665 ............. X Epstein-barr, antibody ..................................... 0.00 0.00 0.00 0.00 XXX 0

86668 ............. X Francisella tularensis ...................................... 0.00 0.00 0.00 0.00 XXX 0

86671 ............. X Fungus, antibody ............................................ 0.00 0.00 0.00 0.00 XXX 0

86674 ............. X Giardia lamblia ................................................ 0.00 0.00 0.00 0.00 XXX 0

86677 ............. X Helicobacter pylori .......................................... 0.00 0.00 0.00 0.00 XXX 0

86682 ............. X Helminth, antibody .......................................... 0.00 0.00 0.00 0.00 XXX 0

86684 ............. X Hemophilus influenza ..................................... 0.00 0.00 0.00 0.00 XXX 0

86687 ............. X HTLV I ............................................................. 0.00 0.00 0.00 0.00 XXX 0

86688 ............. X HTLV-II ............................................................ 0.00 0.00 0.00 0.00 XXX 0

86689 ............. X HTLV/HIV confirmatory test ............................ 0.00 0.00 0.00 0.00 XXX 0

86692 ............. X Hepatitis, delta agent ...................................... 0.00 0.00 0.00 0.00 XXX 0

86694 ............. X Herpes simplex test ........................................ 0.00 0.00 0.00 0.00 XXX 0

86695 ............. X Herpes simplex test ........................................ 0.00 0.00 0.00 0.00 XXX 0

86698 ............. X Histoplasma .................................................... 0.00 0.00 0.00 0.00 XXX 0

86701 ............. X HIV–1 .............................................................. 0.00 0.00 0.00 0.00 XXX 0

86702 ............. X HIV–2 .............................................................. 0.00 0.00 0.00 0.00 XXX 0

86703 ............. X HIV–1/HIV–2, single assay ............................. 0.00 0.00 0.00 0.00 XXX 0

86710 ............. X Influenza virus ................................................. 0.00 0.00 0.00 0.00 XXX 0

86713 ............. X Legionella ........................................................ 0.00 0.00 0.00 0.00 XXX 0

86717 ............. X Leishmania ...................................................... 0.00 0.00 0.00 0.00 XXX 0

86720 ............. X Leptospira ....................................................... 0.00 0.00 0.00 0.00 XXX 0

86723 ............. X Listeria monocytogenes .................................. 0.00 0.00 0.00 0.00 XXX 0

86727 ............. X Lymph choriomeningitis .................................. 0.00 0.00 0.00 0.00 XXX 0

86729 ............. X Lympho venereum .......................................... 0.00 0.00 0.00 0.00 XXX 0

86732 ............. X Mucormycosis ................................................. 0.00 0.00 0.00 0.00 XXX 0

86735 ............. X Mumps ............................................................ 0.00 0.00 0.00 0.00 XXX 0

86738 ............. X Mycoplasma .................................................... 0.00 0.00 0.00 0.00 XXX 0

86741 ............. X Neisseria meningitidis ..................................... 0.00 0.00 0.00 0.00 XXX 0

86744 ............. X Nocardia .......................................................... 0.00 0.00 0.00 0.00 XXX 0

86747 ............. X Parvovirus ....................................................... 0.00 0.00 0.00 0.00 XXX 0

86750 ............. X Malaria ............................................................ 0.00 0.00 0.00 0.00 XXX 0

86753 ............. X Protozoa, not elsewhere ................................. 0.00 0.00 0.00 0.00 XXX 0

86756 ............. X Respiratory virus ............................................. 0.00 0.00 0.00 0.00 XXX 0

86759 ............. X Rotavirus ......................................................... 0.00 0.00 0.00 0.00 XXX 0

86762 ............. X Rubella ............................................................ 0.00 0.00 0.00 0.00 XXX 0

86765 ............. X Rubeola ........................................................... 0.00 0.00 0.00 0.00 XXX 0

86768 ............. X Salmonella ...................................................... 0.00 0.00 0.00 0.00 XXX 0

86771 ............. X Shigella ........................................................... 0.00 0.00 0.00 0.00 XXX 0

86774 ............. X Tetanus ........................................................... 0.00 0.00 0.00 0.00 XXX 0

86777 ............. X Toxoplasma .................................................... 0.00 0.00 0.00 0.00 XXX 0

86778 ............. X Toxoplasma, IgM ............................................ 0.00 0.00 0.00 0.00 XXX 0

86781 ............. X Treponema pallidum confirm .......................... 0.00 0.00 0.00 0.00 XXX 0

86784 ............. X Trichinella ........................................................ 0.00 0.00 0.00 0.00 XXX 0

86787 ............. X Varicella-zoster ............................................... 0.00 0.00 0.00 0.00 XXX 0

86790 ............. X Virus, not specified ......................................... 0.00 0.00 0.00 0.00 XXX 0

86793 ............. X Yersinia ........................................................... 0.00 0.00 0.00 0.00 XXX 0

86800 ............. X Thyroglobulin antibody .................................... 0.00 0.00 0.00 0.00 XXX 0

86805 ............. X Lymphocytotoxicity assay ............................... 0.00 0.00 0.00 0.00 XXX 0

86806 ............. X Lymphocytotoxicity assay ............................... 0.00 0.00 0.00 0.00 XXX 0

86807 ............. X Cytotoxic antibody screening .......................... 0.00 0.00 0.00 0.00 XXX 0

86808 ............. X Cytotoxic antibody screening .......................... 0.00 0.00 0.00 0.00 XXX 0

86812 ............. X HLA typing, A, B, or C .................................... 0.00 0.00 0.00 0.00 XXX 0

86813 ............. X HLA typing, A, B, or C .................................... 0.00 0.00 0.00 0.00 XXX 0

86816 ............. X HLA typing, DR/DQ ........................................ 0.00 0.00 0.00 0.00 XXX 0

86817 ............. X HLA typing, DR/DQ ........................................ 0.00 0.00 0.00 0.00 XXX 0

86821 ............. X Lymphocyte culture, mixed ............................. 0.00 0.00 0.00 0.00 XXX 0

86822 ............. X Lymphocyte culture, primed ........................... 0.00 0.00 0.00 0.00 XXX 0

86849 ............. X Immunology procedure ................................... 0.00 0.00 0.00 0.00 XXX 0

86850 ............. X RBC antibody screen ...................................... 0.00 0.00 0.00 0.00 XXX 0

86860 ............. X RBC antibody elution ...................................... 0.00 0.00 0.00 0.00 XXX 0
63303

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

86870 ............. X RBC antibody identification ............................ 0.00 0.00 0.00 0.00 XXX 0

86880 ............. X Coombs test .................................................... 0.00 0.00 0.00 0.00 XXX 0

86885 ............. X Coombs test .................................................... 0.00 0.00 0.00 0.00 XXX 0

86886 ............. X Coombs test .................................................... 0.00 0.00 0.00 0.00 XXX 0

86890 ............. X Autologous blood process .............................. 0.00 0.00 0.00 0.00 XXX 0

86891 ............. X Autologous blood, op salvage ........................ 0.00 0.00 0.00 0.00 XXX 0

86900 ............. X Blood typing, ABO .......................................... 0.00 0.00 0.00 0.00 XXX 0

86901 ............. X Blood typing, Rh (D) ....................................... 0.00 0.00 0.00 0.00 XXX 0

86903 ............. X Blood typing, antigen screen .......................... 0.00 0.00 0.00 0.00 XXX 0

86904 ............. X Blood typing, patient serum ............................ 0.00 0.00 0.00 0.00 XXX 0

86905 ............. X Blood typing, RBC antigens ........................... 0.00 0.00 0.00 0.00 XXX 0

86906 ............. X Blood typing, Rh phenotype ........................... 0.00 0.00 0.00 0.00 XXX 0

86910 ............. N Blood typing, paternity test ............................. 0.00 0.00 0.00 0.00 XXX 0

86911 ............. N Blood typing, antigen system ......................... 0.00 0.00 0.00 0.00 XXX 0

86915 ............. X Bone marrow .................................................. 0.00 0.00 0.00 0.00 XXX 0

86920 ............. X Compatibility test ............................................ 0.00 0.00 0.00 0.00 XXX 0

86921 ............. X Compatibility test ............................................ 0.00 0.00 0.00 0.00 XXX 0

86922 ............. X Compatibility test ............................................ 0.00 0.00 0.00 0.00 XXX 0

86927 ............. X Plasma, fresh frozen ....................................... 0.00 0.00 0.00 0.00 XXX 0

86930 ............. X Frozen blood prep .......................................... 0.00 0.00 0.00 0.00 XXX 0

86931 ............. X Frozen blood thaw .......................................... 0.00 0.00 0.00 0.00 XXX 0

86932 ............. X Frozen blood, freeze/thaw .............................. 0.00 0.00 0.00 0.00 XXX 0

86940 ............. X Hemolysins/agglutinins auto ........................... 0.00 0.00 0.00 0.00 XXX 0

86941 ............. X Hemolysins/agglutinins ................................... 0.00 0.00 0.00 0.00 XXX 0

86945 ............. X Blood product/irradiation ................................. 0.00 0.00 0.00 0.00 XXX 0

86950 ............. X Leukacyte transfusion ..................................... 0.00 0.00 0.00 0.00 XXX 0

86965 ............. X Pooling blood platelets ................................... 0.00 0.00 0.00 0.00 XXX 0

86970 ............. X RBC pretreatment ........................................... 0.00 0.00 0.00 0.00 XXX 0

86971 ............. X RBC pretreatment ........................................... 0.00 0.00 0.00 0.00 XXX 0

86972 ............. X RBC pretreatment ........................................... 0.00 0.00 0.00 0.00 XXX 0

86975 ............. X RBC pretreatment, serum ............................... 0.00 0.00 0.00 0.00 XXX 0

86976 ............. X RBC pretreatment, serum ............................... 0.00 0.00 0.00 0.00 XXX 0

86977 ............. X RBC pretreatment, serum ............................... 0.00 0.00 0.00 0.00 XXX 0

86978 ............. X RBC pretreatment, serum ............................... 0.00 0.00 0.00 0.00 XXX 0

86985 ............. X Split blood or products .................................... 0.00 0.00 0.00 0.00 XXX 0

86999 ............. X Transfusion procedure .................................... 0.00 0.00 0.00 0.00 XXX 0

87001 ............. X Small animal inoculation ................................. 0.00 0.00 0.00 0.00 XXX 0

87003 ............. X Small animal inoculation ................................. 0.00 0.00 0.00 0.00 XXX 0

87015 ............. X Specimen concentration ................................. 0.00 0.00 0.00 0.00 XXX 0

87040 ............. X Blood culture for bacteria ............................... 0.00 0.00 0.00 0.00 XXX 0

87045 ............. X Stool culture for bacteria ................................ 0.00 0.00 0.00 0.00 XXX 0

87060 ............. X Nose/throat culture, bacteria .......................... 0.00 0.00 0.00 0.00 XXX 0

87070 ............. X Culture specimen, bacteria ............................. 0.00 0.00 0.00 0.00 XXX 0

87072 ............. X Culture of specimen by kit .............................. 0.00 0.00 0.00 0.00 XXX 0

87075 ............. X Culture specimen, bacteria ............................. 0.00 0.00 0.00 0.00 XXX 0

87076 ............. X Bacteria identification ...................................... 0.00 0.00 0.00 0.00 XXX 0

87081 ............. X Bacteria culture screen ................................... 0.00 0.00 0.00 0.00 XXX 0

87082 ............. X Culture of specimen by kit .............................. 0.00 0.00 0.00 0.00 XXX 0

87083 ............. X Culture of specimen by kit .............................. 0.00 0.00 0.00 0.00 XXX 0

87084 ............. X Culture of specimen by kit .............................. 0.00 0.00 0.00 0.00 XXX 0

87085 ............. X Culture of specimen by kit .............................. 0.00 0.00 0.00 0.00 XXX 0

87086 ............. X Urine culture, colony count ............................. 0.00 0.00 0.00 0.00 XXX 0

87087 ............. X Urine bacteria culture ..................................... 0.00 0.00 0.00 0.00 XXX 0

87088 ............. X Urine bacteria culture ..................................... 0.00 0.00 0.00 0.00 XXX 0

87101 ............. X Skin fungus culture ......................................... 0.00 0.00 0.00 0.00 XXX 0

87102 ............. X Fungus isolation culture .................................. 0.00 0.00 0.00 0.00 XXX 0

87103 ............. X Blood fungus culture ....................................... 0.00 0.00 0.00 0.00 XXX 0

87106 ............. X Fungus identification ....................................... 0.00 0.00 0.00 0.00 XXX 0

87109 ............. X Mycoplasma culture ........................................ 0.00 0.00 0.00 0.00 XXX 0

87110 ............. X Culture, chlamydia .......................................... 0.00 0.00 0.00 0.00 XXX 0

87116 ............. X Mycobacteria culture ....................................... 0.00 0.00 0.00 0.00 XXX 0

87117 ............. X Mycobacteria culture ....................................... 0.00 0.00 0.00 0.00 XXX 0

87118 ............. X Mycobacteria identification ............................. 0.00 0.00 0.00 0.00 XXX 0

87140 ............. X Culture typing, fluorescent .............................. 0.00 0.00 0.00 0.00 XXX 0

87143 ............. X Culture typing, GLC method ........................... 0.00 0.00 0.00 0.00 XXX 0

87145 ............. X Culture typing, phage method ........................ 0.00 0.00 0.00 0.00 XXX 0
63304

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

87147 ............. X Culture typing, serologic ................................. 0.00 0.00 0.00 0.00 XXX 0

87151 ............. X Culture typing, serologic ................................. 0.00 0.00 0.00 0.00 XXX 0

87155 ............. X Culture typing, precipitin ................................. 0.00 0.00 0.00 0.00 XXX 0

87158 ............. X Culture typing, added method ........................ 0.00 0.00 0.00 0.00 XXX 0

87163 ............. X Special microbiology culture ........................... 0.00 0.00 0.00 0.00 XXX 0

87164 ............. X Dark field examination .................................... 0.00 0.00 0.00 0.00 XXX 0

87164 26 A Dark field examination .................................... 0.37 0.20 0.01 0.58 XXX N

87166 ............. X Dark field examination .................................... 0.00 0.00 0.00 0.00 XXX 0

87174 ............. X Endotoxin, bacterial ........................................ 0.00 0.00 0.00 0.00 XXX 0

87175 ............. X Assay, endotoxin, bacterial ............................. 0.00 0.00 0.00 0.00 XXX 0

87176 ............. X Endotoxin, bacterial ........................................ 0.00 0.00 0.00 0.00 XXX 0

87177 ............. X Ova and parasites smears ............................. 0.00 0.00 0.00 0.00 XXX 0

87178 ............. X Microbe identification ...................................... 0.00 0.00 0.00 0.00 XXX 0

87179 ............. X Microbe identification ...................................... 0.00 0.00 0.00 0.00 XXX 0

87181 ............. X Antibiotic sensitivity, each ............................... 0.00 0.00 0.00 0.00 XXX 0

87184 ............. X Antibiotic sensitivity, each ............................... 0.00 0.00 0.00 0.00 XXX 0

87186 ............. X Antibiotic sensitivity, MIC ................................ 0.00 0.00 0.00 0.00 XXX 0

87187 ............. X Antibiotic sensitivity, MBC ............................... 0.00 0.00 0.00 0.00 XXX 0

87188 ............. X Antibiotic sensitivity, each ............................... 0.00 0.00 0.00 0.00 XXX 0

87190 ............. X TB antibiotic sensitivity ................................... 0.00 0.00 0.00 0.00 XXX 0

87192 ............. X Antibiotic sensitivity, each ............................... 0.00 0.00 0.00 0.00 XXX 0

87197 ............. X Bactericidal level, serum ................................. 0.00 0.00 0.00 0.00 XXX 0

87205 ............. X Smear, stain & interpret .................................. 0.00 0.00 0.00 0.00 XXX 0

87206 ............. X Smear, stain & interpret .................................. 0.00 0.00 0.00 0.00 XXX 0

87207 ............. X Smear, stain & interpret .................................. 0.00 0.00 0.00 0.00 XXX 0

87207 26 A Smear, stain & interpret .................................. 0.37 0.20 0.01 0.58 XXX N

87208 ............. X Smear, stain & interpret .................................. 0.00 0.00 0.00 0.00 XXX 0

87210 ............. X Smear, stain & interpret .................................. 0.00 0.00 0.00 0.00 XXX 0

87211 ............. X Smear, stain & interpret .................................. 0.00 0.00 0.00 0.00 XXX 0

87220 ............. X Tissue exam for fungi ..................................... 0.00 0.00 0.00 0.00 XXX 0

87230 ............. X Assay, toxin or antitoxin ................................. 0.00 0.00 0.00 0.00 XXX 0

87250 ............. X Virus inoculation for test ................................. 0.00 0.00 0.00 0.00 XXX 0

87252 ............. X Virus inoculation for test ................................. 0.00 0.00 0.00 0.00 XXX 0

87253 ............. X Virus inoculation for test ................................. 0.00 0.00 0.00 0.00 XXX 0

87999 ............. X Microbiology procedure .................................. 0.00 0.00 0.00 0.00 XXX 0

88000 ............. N Autopsy (necropsy), gross .............................. 0.00 0.00 0.00 0.00 XXX 0

88005 ............. N Autopsy (necropsy), gross .............................. 0.00 0.00 0.00 0.00 XXX 0

88007 ............. N Autopsy (necropsy), gross .............................. 0.00 0.00 0.00 0.00 XXX 0

88012 ............. N Autopsy (necropsy), gross .............................. 0.00 0.00 0.00 0.00 XXX 0

88014 ............. N Autopsy (necropsy), gross .............................. 0.00 0.00 0.00 0.00 XXX 0

88016 ............. N Autopsy (necropsy), gross .............................. 0.00 0.00 0.00 0.00 XXX 0

88020 ............. N Autopsy (necropsy), complete ........................ 0.00 0.00 0.00 0.00 XXX 0

88025 ............. N Autopsy (necropsy), complete ........................ 0.00 0.00 0.00 0.00 XXX 0

88027 ............. N Autopsy (necropsy), complete ........................ 0.00 0.00 0.00 0.00 XXX 0

88028 ............. N Autopsy (necropsy), complete ........................ 0.00 0.00 0.00 0.00 XXX 0

88029 ............. N Autopsy (necropsy), complete ........................ 0.00 0.00 0.00 0.00 XXX 0

88036 ............. N Limited autopsy ............................................... 0.00 0.00 0.00 0.00 XXX 0

88037 ............. N Limited autopsy ............................................... 0.00 0.00 0.00 0.00 XXX 0

88040 ............. N Forensic autopsy (necropsy) .......................... 0.00 0.00 0.00 0.00 XXX 0

88045 ............. N Coroner’s autopsy (necropsy) ......................... 0.00 0.00 0.00 0.00 XXX 0

88099 ............. N Necropsy (autopsy) procedure ....................... 0.00 0.00 0.00 0.00 XXX 0

88104 ............. A Microscopic exam of cells ............................... 0.56 0.44 0.04 1.04 XXX N

88104 26 A Microscopic exam of cells ............................... 0.56 0.23 0.02 0.81 XXX N

88104 TC A Microscopic exam of cells ............................... 0.00 0.21 0.02 0.23 XXX N

88106 ............. A Microscopic exam of cells ............................... 0.56 0.37 0.03 0.96 XXX N

88106 26 A Microscopic exam of cells ............................... 0.56 0.20 0.01 0.77 XXX N

88106 TC A Microscopic exam of cells ............................... 0.00 0.17 0.02 0.19 XXX N

88107 ............. A Microscopic exam of cells ............................... 0.76 0.47 0.04 1.27 XXX N

88107 26 A Microscopic exam of cells ............................... 0.76 0.24 0.02 1.02 XXX N

88107 TC A Microscopic exam of cells ............................... 0.00 0.23 0.02 0.25 XXX N

88108 ............. A Cytopathology ................................................. 0.56 0.47 0.04 1.07 XXX N

88108 26 A Cytopathology ................................................. 0.56 0.24 0.02 0.82 XXX N

88108 TC A Cytopathology ................................................. 0.00 0.23 0.02 0.25 XXX N

88125 ............. A Forensic cytopathology ................................... 0.26 0.11 0.00 0.37 XXX N

88125 26 A Forensic cytopathology ................................... 0.26 0.07 0.00 0.33 XXX N

88125 TC A Forensic cytopathology ................................... 0.00 0.04 0.00 0.04 XXX N
63305

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

88130 ............. X Sex chromatin identification ............................ 0.00 0.00 0.00 0.00 XXX 0

88140 ............. X Sex chromatin identification ............................ 0.00 0.00 0.00 0.00 XXX 0

88150 ............. X Cytopathology, pap smear .............................. 0.00 0.00 0.00 0.00 XXX 0

88151 ............. X Cytopathology interpretation ........................... 0.00 0.00 0.00 0.00 XXX 0

88151 26 A Cytopathology interpretation ........................... 0.42 0.32 0.04 0.78 XXX N

88155 ............. X Cytopathology, pap smear .............................. 0.00 0.00 0.00 0.00 XXX 0

88156 ............. X TBS smear (bethesda system) ....................... 0.00 0.00 0.00 0.00 XXX 0

88157 ............. X TBS smear (bethesda system) ....................... 0.00 0.00 0.00 0.00 XXX 0

88157 26 A TBS smear (bethesda system) ....................... 0.42 0.32 0.04 0.78 XXX N

88160 ............. A Cytopathology ................................................. 0.50 0.33 0.03 0.86 XXX N

88160 26 A Cytopathology ................................................. 0.50 0.17 0.01 0.68 XXX N

88160 TC A Cytopathology ................................................. 0.00 0.16 0.02 0.18 XXX N

88161 ............. A Cytopathology ................................................. 0.50 0.39 0.03 0.92 XXX N

88161 26 A Cytopathology ................................................. 0.50 0.20 0.01 0.71 XXX N

88161 TC A Cytopathology ................................................. 0.00 0.19 0.02 0.21 XXX N

88162 ............. A Cytopathology, extensive ................................ 0.76 0.79 0.05 1.60 XXX N

88162 26 A Cytopathology, extensive ................................ 0.76 0.41 0.03 1.20 XXX N

88162 TC A Cytopathology, extensive ................................ 0.00 0.38 0.02 0.40 XXX N

88170 ............. A Fine needle aspiration .................................... 0.50 0.99 0.09 1.58 XXX N

88170 26 A Fine needle aspiration .................................... 0.50 0.52 0.05 1.07 XXX N

88170 TC A Fine needle aspiration .................................... 0.00 0.47 0.04 0.51 XXX N

88171 ............. A Fine needle aspiration .................................... 1.05 1.35 0.09 2.49 XXX N

88171 26 A Fine needle aspiration .................................... 1.05 0.71 0.05 1.81 XXX N

88171 TC A Fine needle aspiration .................................... 0.00 0.64 0.04 0.68 XXX N

88172 ............. A Evaluation of smear ........................................ 0.60 0.71 0.05 1.36 XXX N

88172 26 A Evaluation of smear ........................................ 0.60 0.36 0.03 0.99 XXX N

88172 TC A Evaluation of smear ........................................ 0.00 0.35 0.02 0.37 XXX N

88173 ............. A Interpretation of smear ................................... 1.08 0.87 0.05 2.00 XXX N

88173 26 A Interpretation of smear ................................... 1.08 0.45 0.03 1.56 XXX N

88173 TC A Interpretation of smear ................................... 0.00 0.42 0.02 0.44 XXX N

88180 ............. A Cell marker study ............................................ 0.36 0.33 0.03 0.72 XXX N

88180 26 A Cell marker study ............................................ 0.36 0.17 0.01 0.54 XXX N

88180 TC A Cell marker study ............................................ 0.00 0.16 0.02 0.18 XXX N

88182 ............. A Cell marker study ............................................ 0.77 0.89 0.07 1.73 XXX N

88182 26 A Cell marker study ............................................ 0.77 0.45 0.03 1.25 XXX N

88182 TC A Cell marker study ............................................ 0.00 0.44 0.04 0.48 XXX N

88199 ............. C Cytopathology procedure ................................ 0.00 0.00 0.00 0.00 XXX N

88199 26 C Cytopathology procedure ................................ 0.00 0.00 0.00 0.00 XXX N

88199 TC C Cytopathology procedure ................................ 0.00 0.00 0.00 0.00 XXX N

88230 ............. X Tissue culture, lymphocyte ............................. 0.00 0.00 0.00 0.00 XXX 0

88233 ............. X Tissue culture, skin/biopsy ............................. 0.00 0.00 0.00 0.00 XXX 0

88235 ............. X Tissue culture, placenta .................................. 0.00 0.00 0.00 0.00 XXX 0

88237 ............. X Tissue culture, bone marrow .......................... 0.00 0.00 0.00 0.00 XXX 0

88239 ............. X Tissue culture, other ....................................... 0.00 0.00 0.00 0.00 XXX 0

88245 ............. X Chromosome analysis .................................... 0.00 0.00 0.00 0.00 XXX 0

88248 ............. X Chromosome analysis .................................... 0.00 0.00 0.00 0.00 XXX 0

88250 ............. X Chromosome analysis .................................... 0.00 0.00 0.00 0.00 XXX 0

88260 ............. X Chromosome analysis: 5 cells ........................ 0.00 0.00 0.00 0.00 XXX 0

88261 ............. X Chromosome analysis: 5 cells ........................ 0.00 0.00 0.00 0.00 XXX 0

88262 ............. X Chromosome count: 15–20 cells .................... 0.00 0.00 0.00 0.00 XXX 0

88263 ............. X Chromosome analysis: 45 cells ...................... 0.00 0.00 0.00 0.00 XXX 0

88267 ............. X Chromosome analysis: placent ...................... 0.00 0.00 0.00 0.00 XXX 0

88269 ............. X Chromosome analysis: amniotic ..................... 0.00 0.00 0.00 0.00 XXX 0

88280 ............. X Chromosome karyotype study ........................ 0.00 0.00 0.00 0.00 XXX 0

88283 ............. X Chromosome banding study ........................... 0.00 0.00 0.00 0.00 XXX 0

88285 ............. X Chromosome count: additional ....................... 0.00 0.00 0.00 0.00 XXX 0

88289 ............. X Chromosome study: additional ....................... 0.00 0.00 0.00 0.00 XXX 0

88299 ............. C Cytogenetic study ........................................... 0.00 0.00 0.00 0.00 XXX N

88300 ............. A Surg path, gross ............................................. 0.08 *0.20 0.01 0.29 XXX N

88300 26 A Surg path, gross ............................................. 0.08 *0.10 0.01 0.19 XXX N

88300 TC A Surg path, gross ............................................. 0.00 0.10 0.00 0.10 XXX N

88302 ............. A Tissue exam by pathologist ............................ 0.13 *0.40 0.04 0.57 XXX N

88302 26 A Tissue exam by pathologist ............................ 0.13 *0.17 0.02 0.32 XXX N

88302 TC A Tissue exam by pathologist ............................ 0.00 0.23 0.02 0.25 XXX N

88304 ............. A Tissue exam by pathologist ............................ 0.22 *0.61 0.04 0.87 XXX N

88304 26 A Tissue exam by pathologist ............................ 0.22 *0.28 0.02 0.52 XXX N
63306

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

88304 TC A Tissue exam by pathologist ............................ 0.00 0.33 0.02 0.35 XXX N

88305 ............. A Tissue exam by pathologist ............................ 0.75 1.03 0.08 1.86 XXX N

88305 26 A Tissue exam by pathologist ............................ 0.75 0.53 0.04 1.32 XXX N

88305 TC A Tissue exam by pathologist ............................ 0.00 0.50 0.04 0.54 XXX N

88307 ............. A Tissue exam by pathologist ............................ 1.59 1.52 0.12 3.23 XXX N

88307 26 A Tissue exam by pathologist ............................ 1.59 0.78 0.06 2.43 XXX N

88307 TC A Tissue exam by pathologist ............................ 0.00 0.74 0.06 0.80 XXX N

88309 ............. A Tissue exam by pathologist ............................ 2.28 1.92 0.13 4.33 XXX N

88309 26 A Tissue exam by pathologist ............................ 2.28 0.99 0.07 3.34 XXX N

88309 TC A Tissue exam by pathologist ............................ 0.00 0.93 0.06 0.99 XXX N

88311 ............. A Decalcify tissue ............................................... 0.24 0.21 0.01 0.46 XXX N

88311 26 A Decalcify tissue ............................................... 0.24 0.11 0.01 0.36 XXX N

88311 TC A Decalcify tissue ............................................... 0.00 0.10 0.00 0.10 XXX N

88312 ............. A Special stains .................................................. 0.54 0.26 0.01 0.81 XXX N

88312 26 A Special stains .................................................. 0.54 0.14 0.01 0.69 XXX N

88312 TC A Special stains .................................................. 0.00 0.12 0.00 0.12 XXX N

88313 ............. A Special stains .................................................. 0.24 0.21 0.01 0.46 XXX N

88313 26 A Special stains .................................................. 0.24 0.11 0.01 0.36 XXX N

88313 TC A Special stains .................................................. 0.00 0.10 0.00 0.10 XXX N

88314 ............. A Histochemical stain ......................................... 0.45 0.62 0.04 1.11 XXX N

88314 26 A Histochemical stain ......................................... 0.45 0.35 0.02 0.82 XXX N

88314 TC A Histochemical stain ......................................... 0.00 0.27 0.02 0.29 XXX N

88318 ............. A Chemical histochemistry ................................. 0.42 0.24 0.01 0.67 XXX N

88318 26 A Chemical histochemistry ................................. 0.42 0.12 0.01 0.55 XXX N

88318 TC A Chemical histochemistry ................................. 0.00 0.12 0.00 0.12 XXX N

88319 ............. A Enzyme histochemistry ................................... 0.53 0.49 0.04 1.06 XXX N

88319 26 A Enzyme histochemistry ................................... 0.53 0.26 0.02 0.81 XXX N

88319 TC A Enzyme histochemistry ................................... 0.00 0.23 0.02 0.25 XXX N

88321 ............. A Microslide consultation ................................... 1.30 0.41 0.03 1.74 XXX N

88323 ............. A Microslide consultation ................................... 1.35 0.72 0.05 2.12 XXX N

88323 26 A Microslide consultation ................................... 1.35 0.39 0.03 1.77 XXX N

88323 TC A Microslide consultation .................................... 0.00 0.33 0.02 0.35 XXX N

88325 ............. A Comprehensive review of data ....................... 2.22 0.47 0.04 2.73 XXX N

88329 ............. A Pathology consult in surgery .......................... 0.67 0.37 0.03 1.07 XXX N

88331 ............. A Pathology consult in surgery .......................... 1.19 1.10 0.08 2.37 XXX N

88331 26 A Pathology consult in surgery .......................... 1.19 0.56 0.04 1.79 XXX N

88331 TC A Pathology consult in surgery .......................... 0.00 0.54 0.04 0.58 XXX N

88332 ............. A Pathology consult in surgery .......................... 0.59 0.56 0.04 1.19 XXX N

88332 26 A Pathology consult in surgery .......................... 0.59 0.29 0.02 0.90 XXX N

88332 TC A Pathology consult in surgery .......................... 0.00 0.27 0.02 0.29 XXX N

88342 ............. A Immunocytochemistry ..................................... 0.85 0.64 0.04 1.53 XXX N

88342 26 A Immunocytochemistry ..................................... 0.85 0.33 0.02 1.20 XXX N

88342 TC A Immunocytochemistry ..................................... 0.00 0.31 0.02 0.33 XXX N

88346 ............. A Immunofluorescent study ................................ 0.86 0.58 0.04 1.48 XXX N

88346 26 A Immunofluorescent study ................................ 0.86 0.31 0.02 1.19 XXX N

88346 TC A Immunofluorescent study ................................ 0.00 0.27 0.02 0.29 XXX N

88347 ............. A Immunofluorescent study ................................ 0.86 0.42 0.04 1.32 XXX N

88347 26 A Immunofluorescent study ................................ 0.86 0.15 0.02 1.03 XXX N

88347 TC A Immunofluorescent study ................................ 0.00 0.27 0.02 0.29 XXX N

88348 ............. A Electron microscopy ....................................... 1.51 2.28 0.16 3.95 XXX N

88348 26 A Electron microscopy ....................................... 1.51 1.19 0.08 2.78 XXX N

88348 TC A Electron microscopy ........................................ 0.00 1.09 0.08 1.17 XXX N

88349 ............. A Scanning electron microscopy ........................ 0.76 1.55 0.12 2.43 XXX N

88349 26 A Scanning electron microscopy ........................ 0.76 0.79 0.06 1.61 XXX N

88349 TC A Scanning electron microscopy ........................ 0.00 0.76 0.06 0.82 XXX N

88355 ............. A Analysis, skeletal muscle ................................ 1.85 1.74 0.13 3.72 XXX N

88355 26 A Analysis, skeletal muscle ................................ 1.85 0.92 0.07 2.84 XXX N

88355 TC A Analysis, skeletal muscle ................................ 0.00 0.82 0.06 0.88 XXX N

88356 ............. A Analysis, nerve ............................................... 3.02 2.66 0.18 5.86 XXX N

88356 26 A Analysis, nerve ............................................... 3.02 1.39 0.10 4.51 XXX N

88356 TC A Analysis, nerve ............................................... 0.00 1.27 0.08 1.35 XXX N

88358 ............. A Analysis, tumor ............................................... 2.82 2.32 0.16 5.30 XXX N

88358 26 A Analysis, tumor ............................................... 2.82 1.16 0.08 4.06 XXX N

88358 TC A Analysis, tumor ............................................... 0.00 1.16 0.08 1.24 XXX N

88362 ............. A Nerve teasing preparations ............................ 2.17 1.97 0.13 4.27 XXX N

88362 26 A Nerve teasing preparations ............................ 2.17 1.00 0.07 3.24 XXX N
63307

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

88362 TC A Nerve teasing preparations ............................ 0.00 0.97 0.06 1.03 XXX N

88365 ............. A Tissue hybridization ........................................ 0.93 0.75 0.05 1.73 XXX N

88365 26 A Tissue hybridization ........................................ 0.93 0.38 0.03 1.34 XXX N

88365 TC A Tissue hybridization ........................................ 0.00 0.37 0.02 0.39 XXX N

88371 ............. X Protein, western blot tissue ............................ 0.00 0.00 0.00 0.00 XXX 0

88371 26 A Protein, western blot tissue ............................ 0.37 0.20 0.01 0.58 XXX N

88372 ............. X Protein analysis w/probe ................................ 0.00 0.00 0.00 0.00 XXX 0

88372 26 A Protein analysis w/probe ................................ 0.37 0.20 0.01 0.58 XXX N

88399 ............. C Surgical pathology procedure ......................... 0.00 0.00 0.00 0.00 XXX N

88399 26 C Surgical pathology procedure ......................... 0.00 0.00 0.00 0.00 XXX N

88399 TC C Surgical pathology procedure ......................... 0.00 0.00 0.00 0.00 XXX N

89050 ............. X Body fluid cell count ....................................... 0.00 0.00 0.00 0.00 XXX 0

89051 ............. X Body fluid cell count ....................................... 0.00 0.00 0.00 0.00 XXX 0

89060 ............. X Exam, synovial fluid crystals .......................... 0.00 0.00 0.00 0.00 XXX 0

89060 26 A Exam, synovial fluid crystals ........................... 0.37 0.20 0.01 0.58 XXX N

89100 ............. A Sample intestinal contents .............................. 0.60 0.42 0.03 1.05 XXX N

89105 ............. A Sample intestinal contents .............................. 0.50 0.39 0.03 0.92 XXX N

89125 ............. X Specimen fat stain .......................................... 0.00 0.00 0.00 0.00 XXX 0

89130 ............. A Sample stomach contents .............................. 0.45 0.41 0.03 0.89 XXX N

89132 ............. A Sample stomach contents .............................. 0.19 0.19 0.02 0.40 XXX N

89135 ............. A Sample stomach contents .............................. 0.79 0.58 0.04 1.41 XXX N

89136 ............. A Sample stomach contents .............................. 0.21 0.22 0.02 0.45 XXX N

89140 ............. A Sample stomach contents .............................. 0.94 0.81 0.07 1.82 XXX N

89141 ............. A Sample stomach contents .............................. 0.85 0.73 0.06 1.64 XXX N

89160 ............. X Exam feces for meat fibers ............................ 0.00 0.00 0.00 0.00 XXX 0

89190 ............. X Nasal smear for eosinophils ........................... 0.00 0.00 0.00 0.00 XXX 0

89250 ............. X Fertilization of oocyte ...................................... 0.00 0.00 0.00 0.00 XXX 0

89300 ............. X Semen analysis .............................................. 0.00 0.00 0.00 0.00 XXX 0

89310 ............. X Semen analysis .............................................. 0.00 0.00 0.00 0.00 XXX 0

89320 ............. X Semen analysis .............................................. 0.00 0.00 0.00 0.00 XXX 0

89325 ............. X Sperm antibody test ........................................ 0.00 0.00 0.00 0.00 XXX 0

89329 ............. X Sperm evaluation test ..................................... 0.00 0.00 0.00 0.00 XXX 0

89330 ............. X Evaluation, cervical mucus ............................. 0.00 0.00 0.00 0.00 XXX 0

89350 ............. A Sputum specimen collection ........................... 0.00 0.39 0.03 0.42 XXX N

89355 ............. X Exam feces for starch ..................................... 0.00 0.00 0.00 0.00 XXX 0

89360 ............. A Collect sweat for test ...................................... 0.00 0.43 0.03 0.46 XXX N

89365 ............. X Water load test ............................................... 0.00 0.00 0.00 0.00 XXX 0

89399 ............. C Pathology lab procedure ................................. 0.00 0.00 0.00 0.00 XXX N

89399 26 C Pathology lab procedure ................................. 0.00 0.00 0.00 0.00 XXX N

89399 TC C Pathology lab procedure ................................. 0.00 0.00 0.00 0.00 XXX N

90700 ............. E DTaP immunization ........................................ 0.00 0.00 0.00 0.00 XXX 0

90701 ............. E DTP immunization .......................................... 0.00 0.00 0.00 0.00 XXX 0

90702 ............. E DT immunization ............................................. 0.00 0.00 0.00 0.00 XXX 0

90703 ............. E Tetanus immunization ..................................... 0.00 0.00 0.00 0.00 XXX 0

90704 ............. E Mumps immunization ...................................... 0.00 0.00 0.00 0.00 XXX 0

90705 ............. E Measles immunization .................................... 0.00 0.00 0.00 0.00 XXX 0

90706 ............. E Rubella immunization ..................................... 0.00 0.00 0.00 0.00 XXX 0

90707 ............. E MMR virus immunization ................................ 0.00 0.00 0.00 0.00 XXX 0

90708 ............. E Measles-rubella immunization ........................ 0.00 0.00 0.00 0.00 XXX 0

90709 ............. E Rubella & mumps immunization ..................... 0.00 0.00 0.00 0.00 XXX 0

90710 ............. E Combined vaccine .......................................... 0.00 0.00 0.00 0.00 XXX 0

90711 ............. E Combined vaccine .......................................... 0.00 0.00 0.00 0.00 XXX 0

90712 ............. E Oral poliovirus immunization .......................... 0.00 0.00 0.00 0.00 XXX 0

90713 ............. E Poliomyelitis immunization .............................. 0.00 0.00 0.00 0.00 XXX 0

90714 ............. E Typhoid immunization ..................................... 0.00 0.00 0.00 0.00 XXX 0

90716 ............. E Chicken pox vaccine ....................................... 0.00 0.00 0.00 0.00 XXX 0

90717 ............. E Yellow fever immunization .............................. 0.00 0.00 0.00 0.00 XXX 0

90718 ............. E Td immunization ............................................. 0.00 0.00 0.00 0.00 XXX 0

90719 ............. E Diphtheria immunization ................................. 0.00 0.00 0.00 0.00 XXX 0

90720 ............. E DTP/HIB vaccine ............................................ 0.00 0.00 0.00 0.00 XXX 0

90721 ............. E Dtap/hib vaccine ............................................. 0.00 0.00 0.00 0.00 XXX 0

90724 ............. X Influenza immunization ................................... 0.00 0.00 0.00 0.00 XXX 0

90725 ............. E Cholera immunization ..................................... 0.00 0.00 0.00 0.00 XXX 0

90726 ............. E Rabies immunization ...................................... 0.00 0.00 0.00 0.00 XXX 0

90727 ............. E Plague immunization ...................................... 0.00 0.00 0.00 0.00 XXX 0

90728 ............. E BCG immunization .......................................... 0.00 0.00 0.00 0.00 XXX 0
63308

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

90730 ............. E Hepatitis A vaccine ......................................... 0.00 0.00 0.00 0.00 XXX 0

90731 ............. D Hepatitis B immunization ................................ 0.00 0.00 0.00 0.00 XXX 0

90732 ............. X Pneumococcal immunization .......................... 0.00 0.00 0.00 0.00 XXX 0

90733 ............. E Meningococcal immunization .......................... 0.00 0.00 0.00 0.00 XXX 0

90735 ............. E Encephalitis virus vaccine .............................. 0.00 0.00 0.00 0.00 XXX 0

90737 ............. E Influenza B immunization ............................... 0.00 0.00 0.00 0.00 XXX 0

90741 ............. E Passive immunization, ISG ............................. 0.00 0.00 0.00 0.00 XXX 0

90742 ............. E Special passive immunization ......................... 0.00 0.00 0.00 0.00 XXX 0

90744 ............. X Hepatitis B vaccine, under 11 ........................ 0.00 0.00 0.00 0.00 XXX 0

90745 ............. X Hepatitis B vaccine, 11–19 ............................. 0.00 0.00 0.00 0.00 XXX 0

90746 ............. X Hepatitis B vaccine, over 20 ........................... 0.00 0.00 0.00 0.00 XXX 0

90747 ............. X Hepatitis B vaccine, ill pat .............................. 0.00 0.00 0.00 0.00 XXX 0

90749 ............. C Immunization procedure ................................. 0.00 0.00 0.00 0.00 XXX N

90780 ............. A IV infusion therapy, 1 hour ............................. 0.00 1.06 0.08 1.14 XXX N

90781 ............. A IV infusion, additional hour ............................. 0.00 0.53 0.04 0.57 XXX N

90782 ............. T Injection (SC)/(IM) ........................................... 0.00 0.10 0.01 0.11 XXX N

90783 ............. T Injection (IA) .................................................... 0.00 0.39 0.03 0.42 XXX N

90784 ............. T Injection (IV) .................................................... 0.00 0.45 0.04 0.49 XXX N

90788 ............. T Injection of antibiotic ....................................... 0.00 0.11 0.01 0.12 XXX N

90799 ............. C Therapeutic/diag injection ............................... 0.00 0.00 0.00 0.00 XXX N

90801 ............. A Psychiatric interview ....................................... 2.21 0.67 0.09 2.97 XXX N

90820 ............. A Diagnostic interview ........................................ 2.27 0.38 0.05 2.70 XXX N

90825 ............. B Evaluation of tests/records ............................. #0.97 0.31 0.04 1.32 XXX 0

90830 ............. D Psychological testing ...................................... 0.00 0.00 0.00 0.00 XXX N

90835 ............. A Special interview ............................................. 2.84 0.50 0.07 3.41 XXX N

90841 ............. G Psychotherapy ................................................ 0.00 0.00 0.00 0.00 XXX 0

90842 ............. A Psychotherapy, 75–80 min. ............................ 2.76 1.05 0.15 3.96 XXX N

90843 ............. A Psychotherapy, 20–30 min. ............................ 1.11 0.35 0.05 1.51 XXX N

90844 ............. A Psychotherapy, 45–50 min. ............................ 1.73 0.54 0.08 2.35 XXX N

90845 ............. A Medical psychoanalysis .................................. 1.79 0.41 0.05 2.25 XXX N

90846 ............. R Special family therapy .................................... 1.83 0.62 0.08 2.53 XXX N

90847 ............. R Special family therapy .................................... 2.21 0.58 0.08 2.87 XXX N

90849 ............. R Special family therapy .................................... 0.59 0.26 0.03 0.88 XXX N

90853 ............. A Special group therapy ..................................... 0.43 0.26 0.03 0.72 XXX N

90855 ............. A Individual psychotherapy ................................ 1.82 0.59 0.09 2.50 XXX N

90857 ............. A Special group therapy ..................................... 0.43 0.15 0.02 0.60 XXX N

90862 ............. A Medication management ................................ 0.95 0.37 0.05 1.37 XXX N

90870 ............. A Electroconvulsive therapy ............................... 1.88 0.55 0.08 2.51 000 N

90871 ............. A Electroconvulsive therapy ............................... 2.72 0.83 0.13 3.68 000 N

90880 ............. A Medical hypnotherapy ..................................... 2.19 0.64 0.07 2.90 XXX N

90882 ............. N Environmental manipulation ........................... 0.00 0.00 0.00 0.00 XXX 0

90887 ............. B Consultation with family .................................. #1.48 0.33 0.04 1.85 XXX 0

90889 ............. B Preparation of report ....................................... 0.00 0.00 0.00 0.00 XXX 0

90899 ............. C Psychiatric service/therapy ............................. 0.00 0.00 0.00 0.00 XXX N

90900 ............. A Biofeedback, electromyogram ........................ 0.89 0.90 0.08 1.87 000 N

90902 ............. A Biofeedback, nerve impulse ........................... 0.89 0.63 0.05 1.57 000 N

90904 ............. A Biofeedback, blood pressure .......................... 0.89 0.35 0.03 1.27 000 N

90906 ............. A Biofeedback, blood flow .................................. 0.89 1.60 0.11 2.60 000 N

90908 ............. A Biofeedback, brain waves ............................... 0.89 0.86 0.06 1.81 000 N

90910 ............. A Biofeedback, oculogram ................................. 0.89 0.67 0.10 1.66 000 N

90911 ............. A Anorectal biofeedback .................................... 2.15 1.13 0.27 3.55 000 N

90915 ............. A Biofeedback, unspecified ................................ 0.89 0.76 0.06 1.71 000 N

90918 ............. A ESRD related services, month ....................... 11.18 2.19 0.14 13.51 XXX P

90919 ............. A ESRD related services, month ....................... 8.54 2.19 0.14 10.87 XXX P

90920 ............. A ESRD related services, month ....................... 7.27 2.19 0.14 9.60 XXX P

90921 ............. A ESRD related services, month ....................... 4.47 2.19 0.14 6.80 XXX P

90922 ............. A ESRD related services, day ........................... 0.37 0.07 0.01 0.45 XXX P

90923 ............. A Esrd related services, day .............................. 0.28 0.07 0.01 0.36 XXX P

90924 ............. A Esrd related services, day .............................. 0.24 0.07 0.01 0.32 XXX P

90925 ............. A Esrd related services, day .............................. 0.15 0.07 0.01 0.23 XXX P

90935 ............. A Hemodialysis, one evaluation ......................... 1.22 1.49 0.10 2.81 000 N

90937 ............. A Hemodialysis, repeated eval. ......................... 2.11 *2.65 0.18 4.94 000 N

90945 ............. A Dialysis, one evaluation .................................. 1.28 1.27 0.08 2.63 000 N

90947 ............. A Dialysis, repeated eval. .................................. 2.16 2.09 0.14 4.39 000 N

90989 ............. X Dialysis training/complete ............................... 0.00 0.00 0.00 0.00 XXX 0

90993 ............. X Dialysis training/incomplete ............................ 0.00 0.00 0.00 0.00 XXX 0
63309

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

90997 ............. A Hemoperfusion ................................................ 1.84 *2.35 0.16 4.35 000 N

90999 ............. C Dialysis procedure .......................................... 0.00 0.00 0.00 0.00 XXX N

91000 ............. A Esophageal intubation .................................... 0.99 0.66 0.06 1.71 000 N

91000 26 A Esophageal intubation .................................... 0.99 0.59 0.05 1.63 000 N

91000 TC A Esophageal intubation .................................... 0.00 0.07 0.01 0.08 000 N

91010 ............. A Esophagus motility study ................................ 1.65 2.28 0.17 4.10 000 N

91010 26 A Esophagus motility study ................................ 1.65 1.50 0.11 3.26 000 N

91010 TC A Esophagus motility study ................................ 0.00 0.78 0.06 0.84 000 N

91011 ............. A Esophagus motility study ................................ 1.98 2.66 0.18 4.82 000 N

91011 26 A Esophagus motility study ................................ 1.98 1.68 0.11 3.77 000 N

91011 TC A Esophagus motility study ................................ 0.00 0.98 0.07 1.05 000 N

91012 ............. A Esophagus motility study ................................ 1.92 3.12 0.23 5.27 000 N

91012 26 A Esophagus motility study ................................ 1.92 2.02 0.15 4.09 000 N

91012 TC A Esophagus motility study ................................ 0.00 1.10 0.08 1.18 000 N

91020 ............. A Esophagogastric study ................................... 1.89 2.50 0.18 4.57 000 N

91020 26 A Esophagogastric study ................................... 1.89 1.77 0.12 3.78 000 N

91020 TC A Esophagogastric study ................................... 0.00 0.73 0.06 0.79 000 N

91030 ............. A Acid perfusion of esophagus .......................... 1.20 0.56 0.05 1.81 000 N

91030 26 A Acid perfusion of esophagus .......................... 1.20 0.35 0.03 1.58 000 N

91030 TC A Acid perfusion of esophagus .......................... 0.00 0.21 0.02 0.23 000 N

91032 ............. A Esophagus, acid reflux test ............................ 1.59 1.96 0.16 3.71 000 N

91032 26 A Esophagus, acid reflux test ............................ 1.59 1.25 0.10 2.94 000 N

91032 TC A Esophagus, acid reflux test ............................ 0.00 0.71 0.06 0.77 000 N

91033 ............. A Prolonged acid reflux test ............................... 1.71 2.97 0.25 4.93 000 N

91033 26 A Prolonged acid reflux test ............................... 1.71 1.69 0.14 3.54 000 N

91033 TC A Prolonged acid reflux test ............................... 0.00 1.28 0.11 1.39 000 N

91052 ............. A Gastric analysis test ....................................... 1.71 0.82 0.07 2.60 000 N

91052 26 A Gastric analysis test ....................................... 1.71 0.50 0.04 2.25 000 N

91052 TC A Gastric analysis test ........................................ 0.00 0.32 0.03 0.35 000 N

91055 ............. A Gastric intubation for smear ........................... 1.28 0.80 0.06 2.14 000 N

91055 26 A Gastric intubation for smear ........................... 1.28 0.51 0.04 1.83 000 N

91055 TC A Gastric intubation for smear ........................... 0.00 0.29 0.02 0.31 000 N

91060 ............. A Gastric saline load test ................................... 0.45 0.71 0.06 1.22 000 N

91060 26 A Gastric saline load test ................................... 0.45 0.50 0.04 0.99 000 N

91060 TC A Gastric saline load test ................................... 0.00 0.21 0.02 0.23 000 N

91065 ............. A Breath hydrogen test ...................................... 0.45 0.83 0.05 1.33 000 N

91065 26 A Breath hydrogen test ...................................... 0.45 0.49 0.03 0.97 000 N

91065 TC A Breath hydrogen test ...................................... 0.00 0.34 0.02 0.36 000 N

91100 ............. A Pass intestine bleeding tube .......................... 1.08 0.56 0.05 1.69 000 N

91105 ............. A Gastric intubation treatment ........................... 0.37 *0.46 0.04 0.87 000 N

91122 ............. A Anal pressure record ...................................... 1.77 1.73 0.22 3.72 000 S

91122 26 A Anal pressure record ...................................... 1.77 1.06 0.13 2.96 000 S

91122 TC A Anal pressure record ...................................... 0.00 0.67 0.09 0.76 000 S

91299 ............. C Gastroenterology procedure ........................... 0.00 0.00 0.00 0.00 XXX N

91299 26 C Gastroenterology procedure ........................... 0.00 0.00 0.00 0.00 XXX N

91299 TC C Gastroenterology procedure ........................... 0.00 0.00 0.00 0.00 XXX N

92002 ............. A Eye exam, new patient ................................... 1.01 0.49 0.02 1.52 XXX P

92004 ............. A Eye exam, new patient ................................... 1.61 0.57 0.02 2.20 XXX P

92012 ............. A Eye exam established pt ................................ 0.82 0.44 0.02 1.28 XXX N

92014 ............. A Eye exam & treatment .................................... 1.06 0.54 0.02 1.62 XXX N

92015 ............. N Refraction ........................................................ #0.38 0.32 0.02 0.72 XXX 0

92018 ............. A New eye exam & treatment ............................ 1.51 0.47 0.03 2.01 XXX N

92019 ............. A Eye exam & treatment .................................... 1.31 0.47 0.03 1.81 XXX N

92020 ............. A Special eye evaluation .................................... 0.37 0.29 0.01 0.67 XXX N

92060 ............. A Special eye evaluation .................................... 0.50 0.39 0.02 0.91 XXX N

92060 26 A Special eye evaluation .................................... 0.50 0.21 0.01 0.72 XXX N

92060 TC A Special eye evaluation .................................... 0.00 0.18 0.01 0.19 XXX N

92065 ............. A Orthoptic/pleoptic training ............................... 0.37 0.36 0.01 0.74 XXX N

92065 26 A Orthoptic/pleoptic training ............................... 0.37 0.20 0.01 0.58 XXX N

92065 TC A Orthoptic/pleoptic training ............................... 0.00 0.16 0.00 0.16 XXX N

92070 ............. A Fitting of contact lens ..................................... 0.70 1.20 0.06 1.96 XXX N

92081 ............. A Visual field examination(s) .............................. 0.36 0.32 0.01 0.69 XXX N

92081 26 A Visual field examination(s) .............................. 0.36 0.17 0.01 0.54 XXX N

92081 TC A Visual field examination(s) .............................. 0.00 0.15 0.00 0.15 XXX N

92082 ............. A Visual field examination(s) .............................. 0.44 0.49 0.02 0.95 XXX N

92082 26 A Visual field examination(s) .............................. 0.44 0.30 0.01 0.75 XXX N
63310

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

92082 TC A Visual field examination(s) .............................. 0.00 0.19 0.01 0.20 XXX N

92083 ............. A Visual field examination(s) .............................. 0.50 0.83 0.04 1.37 XXX N

92083 26 A Visual field examination(s) .............................. 0.50 0.55 0.03 1.08 XXX N

92083 TC A Visual field examination(s) .............................. 0.00 0.28 0.01 0.29 XXX N

92100 ............. A Serial tonometry exam(s) ............................... 0.92 0.25 0.01 1.18 XXX N

92120 ............. A Tonography & eye evaluation ......................... 0.81 0.31 0.02 1.14 XXX N

92130 ............. A Water provocation tonography ....................... 0.81 0.49 0.02 1.32 XXX N

92140 ............. A Glaucoma provocative tests ........................... 0.50 0.30 0.01 0.81 XXX N

92225 ............. A Special eye exam, initial ................................. 0.58 0.45 0.02 1.05 XXX N

92226 ............. A Special eye exam, subsequent ...................... 0.50 0.40 0.02 0.92 XXX N

92230 ............. A Eye exam with photos .................................... 0.60 0.69 0.04 1.33 XXX N

92235 ............. A Eye exam with photos .................................... 0.81 1.58 0.09 2.48 XXX N

92235 26 A Eye exam with photos .................................... 0.81 0.59 0.03 1.43 XXX N

92235 TC A Eye exam with photos .................................... 0.00 0.99 0.06 1.05 XXX N

92250 ............. A Eye exam with photos .................................... 0.44 0.42 0.02 0.88 XXX N

92250 26 A Eye exam with photos .................................... 0.44 0.25 0.01 0.70 XXX N

92250 TC A Eye exam with photos .................................... 0.00 0.17 0.01 0.18 XXX N

92260 ............. A Ophthalmoscopy/dynamometry ...................... 0.50 0.54 0.03 1.07 XXX N

92265 ............. A Eye muscle evaluation .................................... 0.81 0.29 0.02 1.12 XXX N

92265 26 A Eye muscle evaluation .................................... 0.81 0.07 0.00 0.88 XXX N

92265 TC A Eye muscle evaluation .................................... 0.00 0.22 0.02 0.24 XXX N

92270 ............. A Electro-oculography ........................................ 0.81 0.67 0.05 1.53 XXX N

92270 26 A Electro-oculography ........................................ 0.81 0.37 0.03 1.21 XXX N

92270 TC A Electro-oculography ........................................ 0.00 0.30 0.02 0.32 XXX N

92275 ............. A Electroretinography ......................................... 1.01 0.90 0.05 1.96 XXX N

92275 26 A Electroretinography ......................................... 1.01 0.51 0.03 1.55 XXX N

92275 TC A Electroretinography ......................................... 0.00 0.39 0.02 0.41 XXX N

92280 ............. D Special eye evaluation .................................... 0.00 0.00 0.00 0.00 XXX N

92280 26 D Special eye evaluation .................................... 0.00 0.00 0.00 0.00 XXX N

92280 TC D Special eye evaluation .................................... 0.00 0.00 0.00 0.00 XXX N

92283 ............. A Color vision examination ................................ 0.26 0.29 0.01 0.56 XXX N

92283 26 A Color vision examination ................................ 0.26 0.17 0.01 0.44 XXX N

92283 TC A Color vision examination ................................. 0.00 0.12 0.00 0.12 XXX N

92284 ............. A Dark adaptation eye exam ............................. 0.37 0.45 0.02 0.84 XXX N

92284 26 A Dark adaptation eye exam ............................. 0.37 0.28 0.01 0.66 XXX N

92284 TC A Dark adaptation eye exam .............................. 0.00 0.17 0.01 0.18 XXX N

92285 ............. A Eye photography ............................................. 0.20 0.29 0.01 0.50 XXX N

92285 26 A Eye photography ............................................. 0.20 0.18 0.01 0.39 XXX N

92285 TC A Eye photography ............................................. 0.00 0.11 0.00 0.11 XXX N

92286 ............. A Internal eye photography ................................ 0.66 1.22 0.07 1.95 XXX N

92286 26 A Internal eye photography ................................ 0.66 0.83 0.05 1.54 XXX N

92286 TC A Internal eye photography ................................ 0.00 0.39 0.02 0.41 XXX N

92287 ............. A Internal eye photography ................................ 0.81 1.52 0.08 2.41 XXX N

92310 ............. N Contact lens fitting .......................................... #1.17 1.32 0.00 2.49 XXX 0

92311 ............. A Contact lens fitting .......................................... 1.08 0.90 0.03 2.01 XXX N

92312 ............. A Contact lens fitting .......................................... 1.26 1.16 0.03 2.45 XXX N

92313 ............. A Contact lens fitting .......................................... 0.92 0.88 0.03 1.83 XXX N

92314 ............. N Prescription of contact lens ............................ #0.69 0.78 0.00 1.47 XXX 0

92315 ............. A Prescription of contact lens ............................ 0.45 0.66 0.03 1.14 XXX N

92316 ............. A Prescription of contact lens ............................ 0.68 0.95 0.04 1.67 XXX N

92317 ............. A Prescription of contact lens ............................ 0.45 0.39 0.02 0.86 XXX N

92325 ............. A Modification of contact lens ............................ 0.00 0.38 0.01 0.39 XXX N

92326 ............. A Replacement of contact lens .......................... 0.00 1.56 0.06 1.62 XXX N

92330 ............. A Fitting of artificial eye ...................................... 1.08 1.13 0.09 2.30 XXX N

92335 ............. A Fitting of artificial eye ...................................... 0.45 1.97 0.11 2.53 XXX N

92340 ............. N Fitting of spectacles ........................................ #0.37 0.42 0.00 0.79 XXX 0

92341 ............. N Fitting of spectacles ........................................ #0.47 0.53 0.00 1.00 XXX 0

92342 ............. N Fitting of spectacles ........................................ #0.53 0.60 0.00 1.13 XXX 0

92352 ............. B Special spectacles fitting ................................ #0.37 0.30 0.01 0.68 XXX 0

92353 ............. B Special spectacles fitting ................................ #0.50 0.40 0.01 0.91 XXX 0

92354 ............. B Special spectacles fitting ................................ #0.00 8.44 0.10 8.54 XXX 0

92355 ............. B Special spectacles fitting ................................ #0.00 4.13 0.01 4.14 XXX 0

92358 ............. B Eye prosthesis service .................................... #0.00 0.92 0.05 0.97 XXX 0

92370 ............. N Repair & adjust spectacles ............................. #0.32 0.36 0.00 0.68 XXX 0

92371 ............. B Repair & adjust spectacles ............................. #0.00 0.59 0.02 0.61 XXX 0

92390 ............. N Supply of spectacles ....................................... 0.00 0.00 0.00 0.00 XXX 0
63311

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

92391 ............. N Supply of contact lenses ................................ 0.00 0.00 0.00 0.00 XXX 0

92392 ............. G Supply of low vision aids ................................ #0.00 3.85 0.02 3.87 XXX 0

92393 ............. G Supply of artificial eye .................................... #0.00 11.96 0.67 12.63 XXX 0

92395 ............. G Supply of spectacles ....................................... #0.00 1.31 0.10 1.41 XXX 0

92396 ............. G Supply of contact lenses ................................ #0.00 2.19 0.08 2.27 XXX 0

92499 ............. C Eye service or procedure ............................... 0.00 0.00 0.00 0.00 XXX N

92499 26 C Eye service or procedure ............................... 0.00 0.00 0.00 0.00 XXX N

92499 TC C Eye service or procedure ............................... 0.00 0.00 0.00 0.00 XXX N

92502 ............. A Ear and throat examination ............................ 1.51 1.12 0.12 2.75 000 N

92504 ............. A Ear microscopy examination .......................... 0.18 0.26 0.02 0.46 XXX N

92506 ............. A Speech & hearing evaluation ......................... 0.86 0.52 0.05 1.43 XXX N

92507 ............. A Speech/hearing therapy .................................. 0.52 0.33 0.03 0.88 XXX N

92508 ............. A Speech/hearing therapy .................................. 0.26 0.18 0.02 0.46 XXX N

92510 ............. A Rehab for ear implant ..................................... 1.50 1.36 0.15 3.01 XXX N

92511 ............. A Nasopharyngoscopy ....................................... 0.84 0.85 0.09 1.78 000 S

92512 ............. A Nasal function studies .................................... 0.55 0.47 0.05 1.07 XXX N

92516 ............. A Facial nerve function test ............................... 0.43 0.39 0.04 0.86 XXX N

92520 ............. A Laryngeal function studies .............................. 0.76 0.53 0.05 1.34 XXX N

92525 ............. A Oral function evaluation .................................. 1.13 1.02 0.11 2.26 XXX N

92526 ............. A Oral function therapy ...................................... 0.52 0.47 0.05 1.04 XXX N

92531 ............. B Spontaneous nystagmus study ...................... 0.00 0.00 0.00 0.00 XXX 0

92532 ............. B Positional nystagmus study ............................ 0.00 0.00 0.00 0.00 XXX 0

92533 ............. B Caloric vestibular test ..................................... 0.00 0.00 0.00 0.00 XXX 0

92534 ............. B Optokinetic nystagmus ................................... 0.00 0.00 0.00 0.00 XXX 0

92541 ............. A Spontaneous nystagmus test ......................... 0.40 0.67 0.07 1.14 XXX N

92541 26 A Spontaneous nystagmus test ......................... 0.40 0.45 0.05 0.90 XXX N

92541 TC A Spontaneous nystagmus test ......................... 0.00 0.22 0.02 0.24 XXX N

92542 ............. A Positional nystagmus test ............................... 0.33 0.61 0.07 1.01 XXX N

92542 26 A Positional nystagmus test ............................... 0.33 0.36 0.04 0.73 XXX N

92542 TC A Positional nystagmus test ............................... 0.00 0.25 0.03 0.28 XXX N

92543 ............. A Caloric vestibular test ..................................... 0.38 0.82 0.09 1.29 XXX N

92543 26 A Caloric vestibular test ..................................... 0.38 0.42 0.05 0.85 XXX N

92543 TC A Caloric vestibular test ..................................... 0.00 0.40 0.04 0.44 XXX N

92544 ............. A Optokinetic nystagmus test ............................ 0.26 0.47 0.05 0.78 XXX N

92544 26 A Optokinetic nystagmus test ............................ 0.26 0.27 0.03 0.56 XXX N

92544 TC A Optokinetic nystagmus test ............................ 0.00 0.20 0.02 0.22 XXX N

92545 ............. A Oscillating tracking test ................................... 0.23 0.40 0.04 0.67 XXX N

92545 26 A Oscillating tracking test ................................... 0.23 0.20 0.02 0.45 XXX N

92545 TC A Oscillating tracking test ................................... 0.00 0.20 0.02 0.22 XXX N

92546 ............. A Sinusoidal rotational test ................................ 0.29 0.53 0.05 0.87 XXX N

92546 26 A Sinusoidal rotational test ................................ 0.29 0.30 0.03 0.62 XXX N

92546 TC A Sinusoidal rotational test ................................ 0.00 0.23 0.02 0.25 XXX N

92547 ............. A Supplemental electrical test ............................ 0.00 0.53 0.06 0.59 XXX N

92551 ............. N Pure tone hearing test, air .............................. 0.00 0.00 0.00 0.00 XXX 0

92552 ............. A Pure tone audiometry, air ............................... 0.00 0.42 0.04 0.46 XXX N

92553 ............. A Audiometry, air & bone ................................... 0.00 0.63 0.07 0.70 XXX N

92555 ............. A Speech threshold audiometry ......................... 0.00 0.36 0.04 0.40 XXX N

92556 ............. A Speech audiometry, complete ........................ 0.00 0.54 0.06 0.60 XXX N

92557 ............. A Comprehensive hearing test ........................... 0.00 1.13 0.13 1.26 XXX N

92559 ............. N Group audiometric testing .............................. 0.00 0.00 0.00 0.00 XXX 0

92560 ............. N Bekesy audiometry, screen ............................ 0.00 0.00 0.00 0.00 XXX 0

92561 ............. A Bekesy audiometry, diagnosis ........................ 0.00 0.68 0.07 0.75 XXX N

92562 ............. A Loudness balance test .................................... 0.00 0.39 0.04 0.43 XXX N

92563 ............. A Tone decay hearing test ................................. 0.00 0.36 0.04 0.40 XXX N

92564 ............. A Sisi hearing test .............................................. 0.00 0.45 0.05 0.50 XXX N

92565 ............. A Stenger test, pure tone ................................... 0.00 0.38 0.04 0.42 XXX N

92567 ............. A Tympanometry ................................................ 0.00 0.50 0.06 0.56 XXX N

92568 ............. A Acoustic reflex testing ..................................... 0.00 0.36 0.04 0.40 XXX N

92569 ............. A Acoustic reflex decay test ............................... 0.00 0.39 0.04 0.43 XXX N

92571 ............. A Filtered speech hearing test ........................... 0.00 0.37 0.04 0.41 XXX N

92572 ............. A Staggered spondaic word test ........................ 0.00 0.08 0.01 0.09 XXX N

92573 ............. A Lombard test ................................................... 0.00 0.33 0.04 0.37 XXX N

92574 ............. D Swinging story test ......................................... 0.00 0.00 0.00 0.00 XXX N

92575 ............. A Sensorineural acuity test ................................ 0.00 0.29 0.03 0.32 XXX N

92576 ............. A Synthetic sentence test .................................. 0.00 0.42 0.05 0.47 XXX N

92577 ............. A Stenger test, speech ....................................... 0.00 0.68 0.08 0.76 XXX N
63312

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

92578 ............. D Delayed auditory feedback ............................. 0.00 0.00 0.00 0.00 XXX N

92579 ............. A Visual audiometry (vra) ................................... 0.00 0.69 0.07 0.76 XXX N

92580 ............. D Electrodermal audiometry ............................... 0.00 0.00 0.00 0.00 XXX N

92582 ............. A Conditioning play audiometry ......................... 0.00 0.69 0.07 0.76 XXX N

92583 ............. A Select picture audiometry ............................... 0.00 0.85 0.09 0.94 XXX N

92584 ............. A Electrocochleography ..................................... 0.00 2.36 0.25 2.61 XXX N

92585 ............. A Auditory evoked potential ............................... 0.50 3.25 0.31 4.06 XXX N

92585 26 A Auditory evoked potential ............................... 0.50 1.49 0.14 2.13 XXX N

92585 TC A Auditory evoked potential ............................... 0.00 1.76 0.17 1.93 XXX N

92587 ............. A Evoked auditory test ....................................... 0.13 1.35 0.13 1.61 XXX N

92587 26 A Evoked auditory test ....................................... 0.13 0.11 0.01 0.25 XXX N

92587 TC A Evoked auditory test ....................................... 0.00 1.24 0.12 1.36 XXX N

92588 ............. A Evoked auditory test ....................................... 0.36 1.70 0.16 2.22 XXX N

92588 26 A Evoked auditory test ....................................... 0.36 0.30 0.02 0.68 XXX N

92588 TC A Evoked auditory test ....................................... 0.00 1.40 0.14 1.54 XXX N

92589 ............. A Auditory function test(s) .................................. 0.00 0.51 0.06 0.57 XXX N

92590 ............. N Hearing aid exam, one ear ............................. 0.00 0.00 0.00 0.00 XXX 0

92591 ............. N Hearing aid exam, both ears .......................... 0.00 0.00 0.00 0.00 XXX 0

92592 ............. N Hearing aid check, one ear ............................ 0.00 0.00 0.00 0.00 XXX 0

92593 ............. N Hearing aid check, both ears ......................... 0.00 0.00 0.00 0.00 XXX 0

92594 ............. N Electro hearing aid test, one .......................... 0.00 0.00 0.00 0.00 XXX 0

92595 ............. N Electro hearingaid test, both ........................... 0.00 0.00 0.00 0.00 XXX 0

92596 ............. A Ear protector evaluation ................................. 0.00 0.56 0.06 0.62 XXX N

92597 ............. A Oral speech device eval ................................. 1.11 1.01 0.11 2.23 XXX N

92598 ............. A Modify oral speech device .............................. 0.73 0.66 0.07 1.46 XXX N

92599 ............. C ENT procedure/service ................................... 0.00 0.00 0.00 0.00 XXX N

92599 26 C ENT procedure/service ................................... 0.00 0.00 0.00 0.00 XXX N

92599 TC C ENT procedure/service ................................... 0.00 0.00 0.00 0.00 XXX N

92950 ............. A Heart/lung resuscitation (CPR) ....................... 3.80 2.27 0.17 6.24 000 N

92953 ............. A Temporary external pacing ............................. 0.23 *0.66 0.15 1.04 000 N

92960 ............. A Heart electroconversion .................................. 2.25 1.88 0.16 4.29 000 N

92970 ............. A Cardioassist, internal ...................................... 3.52 3.47 0.41 7.40 000 N

92971 ............. A Cardioassist, external ..................................... 1.77 1.11 0.08 2.96 000 N

92975 ............. A Dissolve clot, heart vessel .............................. 7.25 5.71 0.42 13.38 000 N

92977 ............. A Dissolve clot, heart vessel .............................. 0.00 7.68 0.54 8.22 XXX N

92980 ............. A Insert intracoronary stent ................................ 14.84 16.41 1.22 32.47 000 N

92981 ............. A Insert intracoronary stent ................................ 4.17 *5.42 0.44 10.03 ZZZ N

92982 ............. A Coronary artery dilation .................................. 10.98 *14.05 1.22 26.25 000 N

92984 ............. A Coronary artery dilation .................................. 2.97 *3.80 0.44 7.21 ZZZ N

92986 ............. A Revision of aortic valve .................................. 20.34 12.04 0.90 33.28 090 N

92987 ............. A Revision of mitral valve ................................... 20.69 12.20 0.91 33.80 090 N

92990 ............. A Revision of pulmonary valve .......................... 16.22 9.59 0.71 26.52 090 N

92992 ............. C Revision of heart chamber ............................. 0.00 0.00 0.00 0.00 090 S

92993 ............. C Revision of heart chamber ............................. 0.00 0.00 0.00 0.00 090 S

92995 ............. A Coronary atherectomy .................................... 12.09 *15.47 1.22 28.78 000 N

92996 ............. A Coronary atherectomy .................................... 3.26 *4.17 0.44 7.87 ZZZ N

93000 ............. A Electrocardiogram, complete .......................... 0.17 0.59 0.04 0.80 XXX N

93005 ............. A Electrocardiogram, tracing .............................. 0.00 0.43 0.03 0.46 XXX N

93010 ............. A Electrocardiogram report ................................ 0.17 0.16 0.01 0.34 XXX N

93012 ............. A Transmission of ecg ....................................... 0.00 2.25 0.22 2.47 XXX N

93014 ............. A Report on transmitted ecg .............................. 0.52 0.40 0.05 0.97 XXX N

93015 ............. A Cardiovascular stress test .............................. 0.75 2.37 0.18 3.30 XXX N

93016 ............. A Cardiovascular stress test .............................. 0.45 0.39 0.03 0.87 XXX N

93017 ............. A Cardiovascular stress test .............................. 0.00 1.60 0.12 1.72 XXX N

93018 ............. A Cardiovascular stress test .............................. 0.30 0.38 0.03 0.71 XXX N

93024 ............. A Cardiac drug stress test ................................. 1.17 *2.56 0.23 3.96 XXX N

93024 26 A Cardiac drug stress test ................................. 1.17 *1.49 0.14 2.80 XXX N

93024 TC A Cardiac drug stress test .................................. 0.00 1.07 0.09 1.16 XXX N

93040 ............. A Rhythm ECG with report ................................ 0.16 0.26 0.02 0.44 XXX N

93041 ............. A Rhythm ECG, tracing ...................................... 0.00 0.14 0.01 0.15 XXX N

93042 ............. A Rhythm ECG, report ....................................... 0.16 0.12 0.01 0.29 XXX N

93201 ............. A Phonocardiogram & ECG lead ....................... 0.42 1.03 0.09 1.54 XXX N

93202 ............. A Phonocardiogram & ECG lead ....................... 0.00 0.75 0.07 0.82 XXX N

93204 ............. A Phonocardiogram & ECG lead ....................... 0.42 0.28 0.02 0.72 XXX N

93205 ............. A Special phonocardiogram ............................... 0.46 0.88 0.07 1.41 XXX N

93208 ............. A Special phonocardiogram ............................... 0.00 0.33 0.03 0.36 XXX N
63313

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

93209 ............. A Special phonocardiogram ............................... 0.46 0.55 0.04 1.05 XXX N

93210 ............. A Intracardiac phonocardiogram ........................ 0.92 1.73 0.13 2.78 XXX N

93210 26 A Intracardiac phonocardiogram ........................ 0.92 0.82 0.06 1.80 XXX N

93210 TC A Intracardiac phonocardiogram ........................ 0.00 0.91 0.07 0.98 XXX N

93220 ............. A Vectorcardiogram ............................................ 0.26 *0.91 0.07 1.24 XXX N

93221 ............. A Vectorcardiogram tracing ................................ 0.00 0.58 0.04 0.62 XXX N

93222 ............. A Vectorcardiogram report ................................. 0.26 *0.33 0.03 0.62 XXX N

93224 ............. A ECG monitor/report, 24 hrs ............................ 0.52 *3.93 0.31 4.76 XXX N

93225 ............. A ECG monitor/record, 24 hrs ........................... 0.00 1.18 0.09 1.27 XXX N

93226 ............. A ECG monitor/report, 24 hrs ............................ 0.00 2.08 0.16 2.24 XXX N

93227 ............. A ECG monitor/review, 24 hrs ........................... 0.52 *0.67 0.06 1.25 XXX N

93230 ............. A ECG monitor/report, 24 hrs ............................ 0.52 *4.19 0.34 5.05 XXX N

93231 ............. A ECG monitor/record, 24 hrs ........................... 0.00 1.45 0.11 1.56 XXX N

93232 ............. A ECG monitor/report, 24 hrs ............................ 0.00 2.07 0.15 2.22 XXX N

93233 ............. A ECG monitor/review, 24 hrs ........................... 0.52 *0.67 0.08 1.27 XXX N

93235 ............. A ECG monitor/report, 24 hrs ............................ 0.45 *3.07 0.23 3.75 XXX N

93236 ............. A ECG monitor/report, 24 hrs ............................ 0.00 2.50 0.17 2.67 XXX N

93237 ............. A ECG monitor/review, 24 hrs ........................... 0.45 *0.57 0.06 1.08 XXX N

93268 ............. A ECG record/review ......................................... 0.52 3.83 0.36 4.71 XXX N

93270 ............. A ECG recording ................................................ 0.00 1.18 0.09 1.27 XXX N

93271 ............. A ECG/monitoring and analysis ......................... 0.00 2.25 0.22 2.47 XXX N

93272 ............. A ECG/review, interpret only .............................. 0.52 0.40 0.05 0.97 XXX N

93278 ............. A ECG/signal-averaged ...................................... 0.35 *1.55 0.18 2.08 XXX N

93278 26 A ECG/signal-averaged ...................................... 0.35 *0.45 0.06 0.86 XXX N

93278 TC A ECG/signal-averaged ...................................... 0.00 1.10 0.12 1.22 XXX N

93307 ............. A Echo exam of heart ........................................ 0.78 *4.68 0.36 5.82 XXX N

93307 26 A Echo exam of heart ........................................ 0.78 *1.00 0.09 1.87 XXX N

93307 TC A Echo exam of heart ........................................ 0.00 3.68 0.27 3.95 XXX N

93308 ............. A Echo exam of heart ........................................ 0.53 2.53 0.19 3.25 XXX N

93308 26 A Echo exam of heart ........................................ 0.53 0.68 0.05 1.26 XXX N

93308 TC A Echo exam of heart ........................................ 0.00 1.85 0.14 1.99 XXX N

93312 ............. A Echo exam of heart ........................................ 1.57 4.95 0.45 6.97 XXX N

93312 26 A Echo exam of heart ........................................ 1.57 1.35 0.12 3.04 XXX N

93312 TC A Echo exam of heart ........................................ 0.00 3.60 0.33 3.93 XXX N

93313 ............. A Echo exam of heart ........................................ 0.95 0.67 0.06 1.68 XXX N

93314 ............. A Echo exam of heart ........................................ 0.95 4.27 0.39 5.61 XXX N

93314 26 A Echo exam of heart ........................................ 0.95 0.67 0.06 1.68 XXX N

93314 TC A Echo exam of heart ........................................ 0.00 3.60 0.33 3.93 XXX N

93320 ............. A Doppler echo exam, heart .............................. 0.38 *2.11 0.18 2.67 XXX N

93320 26 A Doppler echo exam, heart .............................. 0.38 *0.48 0.05 0.91 XXX N

93320 TC A Doppler echo exam, heart .............................. 0.00 1.63 0.13 1.76 XXX N

93321 ............. A Doppler echo exam, heart .............................. 0.15 *1.25 0.11 1.51 XXX N

93321 26 A Doppler echo exam, heart .............................. 0.15 *0.19 0.02 0.36 XXX N

93321 TC A Doppler echo exam, heart .............................. 0.00 1.06 0.09 1.15 XXX N

93325 ............. A Doppler color flow ........................................... 0.07 2.80 0.25 3.12 XXX N

93325 26 A Doppler color flow ........................................... 0.07 0.04 0.01 0.12 XXX N

93325 TC A Doppler color flow ........................................... 0.00 2.76 0.24 3.00 XXX N

93350 ............. A Echo exam of heart ........................................ 0.78 *3.63 0.24 4.65 XXX N

93350 26 A Echo exam of heart ........................................ 0.78 *1.95 0.10 2.83 XXX N

93350 TC A Echo exam of heart ........................................ 0.00 1.68 0.14 1.82 XXX N

93501 ............. A Right heart catheterization .............................. 3.02 19.72 1.54 24.28 000 N

93501 26 A Right heart catheterization .............................. 3.02 3.61 0.34 6.97 000 N

93501 TC A Right heart catheterization .............................. 0.00 16.11 1.20 17.31 000 N

93503 ............. A Insert/place heart catheter .............................. 2.43 2.37 0.36 5.16 000 N

93505 ............. A Biopsy of heart lining ...................................... 4.56 4.92 0.46 9.94 000 N

93505 26 A Biopsy of heart lining ...................................... 4.56 3.03 0.28 7.87 000 N

93505 TC A Biopsy of heart lining ...................................... 0.00 1.89 0.18 2.07 000 N

93510 ............. A Left heart catheterization ................................ 4.33 38.28 2.86 45.47 000 N

93510 26 A Left heart catheterization ................................ 4.33 3.06 0.23 7.62 000 N

93510 TC A Left heart catheterization ................................ 0.00 35.22 2.63 37.85 000 N

93511 ............. A Left heart catheterization ................................ 5.03 36.91 2.76 44.70 000 N

93511 26 A Left heart catheterization ................................ 5.03 2.62 0.20 7.85 000 N

93511 TC A Left heart catheterization ................................ 0.00 34.29 2.56 36.85 000 N

93514 ............. A Left heart catheterization ................................ 7.05 38.84 2.94 48.83 000 S

93514 26 A Left heart catheterization ................................ 7.05 4.55 0.38 11.98 000 S

93514 TC A Left heart catheterization ................................ 0.00 34.29 2.56 36.85 000 S
63314

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

93524 ............. A Left heart catheterization ................................ 6.95 49.45 3.69 60.09 000 N

93524 26 A Left heart catheterization ................................ 6.95 4.65 0.34 11.94 000 N

93524 TC A Left heart catheterization ................................ 0.00 44.80 3.35 48.15 000 N

93526 ............. A Rt & Lt heart catheters ................................... 5.99 51.48 3.83 61.30 000 N

93526 26 A Rt & Lt heart catheters ................................... 5.99 5.45 0.39 11.83 000 N

93526 TC A Rt & Lt heart catheters ................................... 0.00 46.03 3.44 49.47 000 N

93527 ............. A Rt & Lt heart catheters ................................... 7.28 51.94 3.85 63.07 000 N

93527 26 A Rt & Lt heart catheters ................................... 7.28 7.14 0.50 14.92 000 N

93527 TC A Rt & Lt heart catheters ................................... 0.00 44.80 3.35 48.15 000 N

93528 ............. A Rt & Lt heart catheters ................................... 9.00 49.23 3.68 61.91 000 N

93528 26 A Rt & Lt heart catheters ................................... 9.00 4.43 0.33 13.76 000 N

93528 TC A Rt & Lt heart catheters ................................... 0.00 44.80 3.35 48.15 000 N

93529 ............. A Rt, Lt heart catheterization ............................. 4.80 47.73 3.57 56.10 000 N

93529 26 A Rt, Lt heart catheterization ............................. 4.80 2.93 0.22 7.95 000 N

93529 TC A Rt, Lt heart catheterization ............................. 0.00 44.80 3.35 48.15 000 N

93536 ............. A Insert circulation assi ...................................... 4.85 *6.20 0.71 11.76 000 N

93539 ............. A Injection, cardiac cath ..................................... 0.29 *0.88 0.20 1.37 000 N

93540 ............. A Injection, cardiac cath ..................................... 0.43 *0.88 0.20 1.51 000 N

93541 ............. A Injection for lung angiogram ........................... 0.29 *0.73 0.16 1.18 000 N

93542 ............. A Injection for heart x-rays ................................. 0.29 *0.72 0.16 1.17 000 N

93543 ............. A Injection for heart x-rays ................................. 0.29 *0.57 0.11 0.97 000 N

93544 ............. A Injection for aortography ................................. 0.29 *0.57 0.11 0.97 000 N

93545 ............. A Injection for coronary xrays ............................ 0.29 *1.03 0.24 1.56 000 N

93555 ............. A Imaging, cardiac cath ..................................... 0.81 6.25 0.42 7.48 XXX N

93555 26 A Imaging, cardiac cath ..................................... 0.81 0.27 0.04 1.12 XXX N

93555 TC A Imaging, cardiac cath ..................................... 0.00 5.98 0.38 6.36 XXX N

93556 ............. A Imaging, cardiac cath ..................................... 0.83 9.88 0.65 11.36 XXX N

93556 26 A Imaging, cardiac cath ..................................... 0.83 0.45 0.07 1.35 XXX N

93556 TC A Imaging, cardiac cath ..................................... 0.00 9.43 0.58 10.01 XXX N

93561 ............. A Cardiac output measurement ......................... 1.15 1.25 0.16 2.56 000 N

93561 26 A Cardiac output measurement ......................... 1.15 0.75 0.09 1.99 000 N

93561 TC A Cardiac output measurement ......................... 0.00 0.50 0.07 0.57 000 N

93562 ............. A Cardiac output measurement ......................... 0.37 *0.76 0.10 1.23 000 N

93562 26 A Cardiac output measurement ......................... 0.37 *0.46 0.06 0.89 000 N

93562 TC A Cardiac output measurement ......................... 0.00 0.30 0.04 0.34 000 N

93600 ............. A Bundle of His recording .................................. 2.12 *4.57 0.38 7.07 000 N

93600 26 A Bundle of His recording .................................. 2.12 *2.71 0.24 5.07 000 N

93600 TC A Bundle of His recording .................................. 0.00 1.86 0.14 2.00 000 N

93602 ............. A Intra-atrial recording ........................................ 2.12 2.83 0.22 5.17 000 N

93602 26 A Intra-atrial recording ........................................ 2.12 1.77 0.14 4.03 000 N

93602 TC A Intra-atrial recording ........................................ 0.00 1.06 0.08 1.14 000 N

93603 ............. A Right ventricular recording .............................. 2.12 3.79 0.28 6.19 000 N

93603 26 A Right ventricular recording .............................. 2.12 2.19 0.16 4.47 000 N

93603 TC A Right ventricular recording .............................. 0.00 1.60 0.12 1.72 000 N

93607 ............. A Right ventricular recording .............................. 3.26 3.63 0.28 7.17 000 N

93607 26 A Right ventricular recording .............................. 3.26 2.21 0.17 5.64 000 N

93607 TC A Right ventricular recording .............................. 0.00 1.42 0.11 1.53 000 N

93609 ............. A Mapping of tachycardia .................................. 10.07 6.43 0.47 16.97 000 N

93609 26 A Mapping of tachycardia .................................. 10.07 3.84 0.28 14.19 000 N

93609 TC A Mapping of tachycardia .................................. 0.00 2.59 0.19 2.78 000 N

93610 ............. A Intra-atrial pacing ............................................ 3.02 3.60 0.27 6.89 000 N

93610 26 A Intra-atrial pacing ............................................ 3.02 2.31 0.17 5.50 000 N

93610 TC A Intra-atrial pacing ............................................ 0.00 1.29 0.10 1.39 000 N

93612 ............. A Intraventricular pacing .................................... 3.02 3.88 0.29 7.19 000 N

93612 26 A Intraventricular pacing .................................... 3.02 2.34 0.17 5.53 000 N

93612 TC A Intraventricular pacing .................................... 0.00 1.54 0.12 1.66 000 N

93615 ............. A Esophageal recording ..................................... 0.99 0.65 0.04 1.68 000 N

93615 26 A Esophageal recording ..................................... 0.99 0.35 0.02 1.36 000 N

93615 TC A Esophageal recording ..................................... 0.00 0.30 0.02 0.32 000 N

93616 ............. A Esophageal recording ..................................... 1.49 1.66 0.10 3.25 000 N

93616 26 A Esophageal recording ..................................... 1.49 1.36 0.08 2.93 000 N

93616 TC A Esophageal recording ..................................... 0.00 0.30 0.02 0.32 000 N

93618 ............. A Heart rhythm pacing ....................................... 4.26 *9.24 0.72 14.22 000 N

93618 26 A Heart rhythm pacing ....................................... 4.26 *5.46 0.44 10.16 000 N

93618 TC A Heart rhythm pacing ....................................... 0.00 3.78 0.28 4.06 000 N

93619 ............. A Electrophysiology evaluation .......................... 7.32 *16.71 1.40 25.43 000 N
63315

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

93619 26 A Electrophysiology evaluation .......................... 7.32 *9.37 0.86 17.55 000 N

93619 TC A Electrophysiology evaluation .......................... 0.00 7.34 0.54 7.88 000 N

93620 ............. A Electrophysiology evaluation .......................... 11.59 22.07 1.55 35.21 000 N

93620 26 A Electrophysiology evaluation .......................... 11.59 13.53 0.95 26.07 000 N

93620 TC A Electrophysiology evaluation .......................... 0.00 8.54 0.60 9.14 000 N

93621 ............. C Electrophysiology evaluation .......................... 0.00 0.00 0.00 0.00 000 N

93621 26 A Electrophysiology evaluation .......................... 12.66 14.94 1.11 28.71 000 N

93621 TC C Electrophysiology evaluation .......................... 0.00 0.00 0.00 0.00 000 N

93622 ............. C Electrophysiology evaluation .......................... 0.00 0.00 0.00 0.00 000 N

93622 26 A Electrophysiology evaluation .......................... 12.74 14.74 1.07 28.55 000 N

93622 TC C Electrophysiology evaluation .......................... 0.00 0.00 0.00 0.00 000 N

93623 ............. C Stimulation, pacing heart ................................ 0.00 0.00 0.00 0.00 000 N

93623 26 A Stimulation, pacing heart ................................ 2.85 2.78 0.20 5.83 000 N

93623 TC C Stimulation, pacing heart ................................ 0.00 0.00 0.00 0.00 000 N

93624 ............. A Electrophysiologic study ................................. 4.81 4.88 0.35 10.04 000 N

93624 26 A Electrophysiologic study ................................. 4.81 2.99 0.21 8.01 000 N

93624 TC A Electrophysiologic study ................................. 0.00 1.89 0.14 2.03 000 N

93631 ............. A Heart pacing, mapping ................................... 7.60 11.62 1.37 20.59 000 N

93631 26 A Heart pacing, mapping ................................... 7.60 5.76 0.67 14.03 000 N

93631 TC A Heart pacing, mapping ................................... 0.00 5.86 0.70 6.56 000 N

93640 ............. A Evaluation heart device .................................. 3.52 *11.51 1.09 16.12 000 N

93640 26 A Evaluation heart device .................................. 3.52 *4.67 0.61 8.80 000 N

93640 TC A Evaluation heart device .................................. 0.00 6.84 0.48 7.32 000 N

93641 ............. A Electrophysiology evaluation .......................... 5.93 *13.85 1.09 20.87 000 N

93641 26 A Electrophysiology evaluation .......................... 5.93 *7.01 0.61 13.55 000 N

93641 TC A Electrophysiology evaluation .......................... 0.00 6.84 0.48 7.32 000 N

93642 ............. A Electrophysiology evaluation .......................... 4.89 *13.09 1.09 19.07 000 N

93642 26 A Electrophysiology evaluation .......................... 4.89 *6.25 0.61 11.75 000 N

93642 TC A Electrophysiology evaluation .......................... 0.00 6.84 0.48 7.32 000 N

93650 ............. A Ablate heart dysrhythm focus ......................... 10.51 *13.46 1.34 25.31 000 N

93651 ............. A Ablate heart dysrhythm focus ......................... 16.25 17.83 1.34 35.42 000 N

93652 ............. A Ablate heart dysrhythm focus ......................... 17.68 17.83 1.34 36.85 000 N

93660 ............. C Tilt table evaluation ......................................... 0.00 0.00 0.00 0.00 000 N

93660 26 A Tilt table evaluation ......................................... 1.89 1.44 0.17 3.50 000 N

93660 TC C Tilt table evaluation ......................................... 0.00 0.00 0.00 0.00 000 N

93720 ............. A Total body plethysmography .......................... 0.17 *0.89 0.10 1.16 XXX N

93721 ............. A Plethysmography tracing ................................ 0.00 0.67 0.07 0.74 XXX N

93722 ............. A Plethysmography report .................................. 0.17 *0.22 0.03 0.42 XXX N

93724 ............. A Analyze pacemaker system ............................ 4.89 6.66 0.50 12.05 000 N

93724 26 A Analyze pacemaker system ............................ 4.89 2.88 0.22 7.99 000 N

93724 TC A Analyze pacemaker system ............................ 0.00 3.78 0.28 4.06 000 N

93731 ............. A Analyze pacemaker system ............................ 0.45 0.79 0.07 1.31 XXX N

93731 26 A Analyze pacemaker system ............................ 0.45 0.32 0.03 0.80 XXX N

93731 TC A Analyze pacemaker system ............................ 0.00 0.47 0.04 0.51 XXX N

93732 ............. A Analyze pacemaker system ............................ 0.92 0.91 0.08 1.91 XXX N

93732 26 A Analyze pacemaker system ............................ 0.92 0.42 0.04 1.38 XXX N

93732 TC A Analyze pacemaker system ............................ 0.00 0.49 0.04 0.53 XXX N

93733 ............. A Telephone analysis, pacemaker ..................... 0.17 *0.91 0.08 1.16 XXX N

93733 26 A Telephone analysis, pacemaker ..................... 0.17 *0.22 0.02 0.41 XXX N

93733 TC A Telephone analysis, pacemaker ..................... 0.00 0.69 0.06 0.75 XXX N

93734 ............. A Analyze pacemaker system ............................ 0.38 0.64 0.06 1.08 XXX N

93734 26 A Analyze pacemaker system ............................ 0.38 0.31 0.03 0.72 XXX N

93734 TC A Analyze pacemaker system ............................ 0.00 0.33 0.03 0.36 XXX N

93735 ............. A Analyze pacemaker system ............................ 0.74 0.85 0.08 1.67 XXX N

93735 26 A Analyze pacemaker system ............................ 0.74 0.43 0.04 1.21 XXX N

93735 TC A Analyze pacemaker system ............................ 0.00 0.42 0.04 0.46 XXX N

93736 ............. A Telephone analysis, pacemaker ..................... 0.15 *0.79 0.09 1.03 XXX N

93736 26 A Telephone analysis, pacemaker ..................... 0.15 *0.19 0.03 0.37 XXX N

93736 TC A Telephone analysis, pacemaker ..................... 0.00 0.60 0.06 0.66 XXX N

93737 ............. A Analyze cardio/defibrillator .............................. 0.45 0.74 0.06 1.25 XXX N

93737 26 A Analyze cardio/defibrillator .............................. 0.45 0.27 0.02 0.74 XXX N

93737 TC A Analyze cardio/defibrillator .............................. 0.00 0.47 0.04 0.51 XXX N

93738 ............. A Analyze cardio/defibrillator .............................. 0.92 0.88 0.07 1.87 XXX N

93738 26 A Analyze cardio/defibrillator .............................. 0.92 0.39 0.03 1.34 XXX N

93738 TC A Analyze cardio/defibrillator .............................. 0.00 0.49 0.04 0.53 XXX N

93740 ............. A Temperature gradient studies ......................... 0.16 0.45 0.04 0.65 XXX N
63316

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

93740 26 A Temperature gradient studies ......................... 0.16 0.30 0.03 0.49 XXX N

93740 TC A Temperature gradient studies ......................... 0.00 0.15 0.01 0.16 XXX N

93760 ............. N Cephalic thermogram ..................................... 0.00 0.00 0.00 0.00 XXX 0

93762 ............. N Peripheral thermogram ................................... 0.00 0.00 0.00 0.00 XXX 0

93770 ............. A Measure venous pressure .............................. 0.16 0.20 0.02 0.38 XXX N

93770 26 A Measure venous pressure .............................. 0.16 0.17 0.02 0.35 XXX N

93770 TC A Measure venous pressure .............................. 0.00 0.03 0.00 0.03 XXX N

93784 ............. N Ambulatory BP monitoring .............................. 0.00 0.00 0.00 0.00 XXX 0

93786 ............. N Ambulatory BP recording ................................ 0.00 0.00 0.00 0.00 XXX 0

93788 ............. N Ambulatory BP analysis .................................. 0.00 0.00 0.00 0.00 XXX 0

93790 ............. N Review/report BP recording ............................ 0.00 0.00 0.00 0.00 XXX 0

93797 ............. A Cardiac rehab ................................................. 0.18 0.30 0.02 0.50 000 N

93798 ............. A Cardiac rehab/monitor .................................... 0.28 0.47 0.04 0.79 000 N

93799 ............. C Cardiovascular procedure ............................... 0.00 0.00 0.00 0.00 XXX N

93799 26 C Cardiovascular procedure ............................... 0.00 0.00 0.00 0.00 XXX N

93799 TC C Cardiovascular procedure ............................... 0.00 0.00 0.00 0.00 XXX N

93875 ............. A Extracranial study ........................................... 0.22 *1.36 0.18 1.76 XXX N

93875 26 A Extracranial study ........................................... 0.22 *0.31 0.06 0.59 XXX N

93875 TC A Extracranial study ........................................... 0.00 1.05 0.12 1.17 XXX N

93880 ............. A Extracranial study ........................................... 0.60 3.94 0.44 4.98 XXX N

93880 26 A Extracranial study ........................................... 0.60 0.39 0.04 1.03 XXX N

93880 TC A Extracranial study ........................................... 0.00 3.55 0.40 3.95 XXX N

93882 ............. A Extracranial study ........................................... 0.40 2.62 0.29 3.31 XXX N

93882 26 A Extracranial study ........................................... 0.40 0.26 0.03 0.69 XXX N

93882 TC A Extracranial study ........................................... 0.00 2.36 0.26 2.62 XXX N

93886 ............. A Intracranial study ............................................ 0.94 4.44 0.50 5.88 XXX N

93886 26 A Intracranial study ............................................ 0.94 0.42 0.05 1.41 XXX N

93886 TC A Intracranial study ............................................ 0.00 4.02 0.45 4.47 XXX N

93888 ............. A Intracranial study ............................................ 0.62 2.96 0.34 3.92 XXX N

93888 26 A Intracranial study ............................................ 0.62 0.28 0.03 0.93 XXX N

93888 TC A Intracranial study ............................................ 0.00 2.68 0.31 2.99 XXX N

93922 ............. A Extremity study ............................................... 0.25 *1.38 0.19 1.82 XXX N

93922 26 A Extremity study ............................................... 0.25 *0.28 0.05 0.58 XXX N

93922 TC A Extremity study ............................................... 0.00 1.10 0.14 1.24 XXX N

93923 ............. A Extremity study ............................................... 0.45 *2.59 0.35 3.39 XXX N

93923 26 A Extremity study ............................................... 0.45 *0.51 0.09 1.05 XXX N

93923 TC A Extremity study ............................................... 0.00 2.08 0.26 2.34 XXX N

93924 ............. A Extremity study ............................................... 0.50 *2.83 0.39 3.72 XXX N

93924 26 A Extremity study ............................................... 0.50 *0.57 0.10 1.17 XXX N

93924 TC A Extremity study ............................................... 0.00 2.26 0.29 2.55 XXX N

93925 ............. A Lower extremity study ..................................... 0.58 3.96 0.44 4.98 XXX N

93925 26 A Lower extremity study ..................................... 0.58 0.39 0.04 1.01 XXX N

93925 TC A Lower extremity study ..................................... 0.00 3.57 0.40 3.97 XXX N

93926 ............. A Lower extremity study ..................................... 0.39 2.64 0.30 3.33 XXX N

93926 26 A Lower extremity study ..................................... 0.39 0.26 0.03 0.68 XXX N

93926 TC A Lower extremity study ..................................... 0.00 2.38 0.27 2.65 XXX N

93930 ............. A Upper extremity study ..................................... 0.46 4.18 0.47 5.11 XXX N

93930 26 A Upper extremity study ..................................... 0.46 0.39 0.05 0.90 XXX N

93930 TC A Upper extremity study ..................................... 0.00 3.79 0.42 4.21 XXX N

93931 ............. A Upper extremity study ..................................... 0.31 2.78 0.31 3.40 XXX N

93931 26 A Upper extremity study ..................................... 0.31 0.26 0.03 0.60 XXX N

93931 TC A Upper extremity study ..................................... 0.00 2.52 0.28 2.80 XXX N

93965 ............. A Extremity study ............................................... 0.35 *1.49 0.19 2.03 XXX N

93965 26 A Extremity study ............................................... 0.35 *0.45 0.06 0.86 XXX N

93965 TC A Extremity study ............................................... 0.00 1.04 0.13 1.17 XXX N

93970 ............. A Extremity study ............................................... 0.68 4.33 0.51 5.52 XXX N

93970 26 A Extremity study ............................................... 0.68 0.40 0.05 1.13 XXX N

93970 TC A Extremity study ............................................... 0.00 3.93 0.46 4.39 XXX N

93971 ............. A Extremity study ............................................... 0.45 2.89 0.34 3.68 XXX N

93971 26 A Extremity study ............................................... 0.45 0.27 0.03 0.75 XXX N

93971 TC A Extremity study ............................................... 0.00 2.62 0.31 2.93 XXX N

93975 ............. A Vascular study ................................................ 1.80 4.90 0.55 7.25 XXX N

93975 26 A Vascular study ................................................ 1.80 0.42 0.05 2.27 XXX N

93975 TC A Vascular study ................................................ 0.00 4.48 0.50 4.98 XXX N

93976 ............. A Vascular study ................................................ 1.21 3.27 0.37 4.85 XXX N

93976 26 A Vascular study ................................................ 1.21 0.28 0.03 1.52 XXX N
63317

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

93976 TC A Vascular study ................................................ 0.00 2.99 0.34 3.33 XXX N

93978 ............. A Vascular study ................................................ 0.65 4.06 0.47 5.18 XXX N

93978 26 A Vascular study ................................................ 0.65 0.39 0.05 1.09 XXX N

93978 TC A Vascular study ................................................ 0.00 3.67 0.42 4.09 XXX N

93979 ............. A Vascular study ................................................ 0.44 2.70 0.31 3.45 XXX N

93979 26 A Vascular study ................................................ 0.44 0.26 0.03 0.73 XXX N

93979 TC A Vascular study ................................................ 0.00 2.44 0.28 2.72 XXX N

93980 ............. A Penile vascular study ...................................... 1.82 4.15 0.45 6.42 XXX N

93980 26 A Penile vascular study ...................................... 1.82 0.82 0.07 2.71 XXX N

93980 TC A Penile vascular study ...................................... 0.00 3.33 0.38 3.71 XXX N

93981 ............. A Penile vascular study ...................................... 0.64 3.47 0.39 4.50 XXX N

93981 26 A Penile vascular study ...................................... 0.64 0.40 0.03 1.07 XXX N

93981 TC A Penile vascular study ...................................... 0.00 3.07 0.36 3.43 XXX N

93990 ............. A Doppler flow testing ........................................ 0.25 2.57 0.29 3.11 XXX N

93990 26 A Doppler flow testing ........................................ 0.25 0.19 0.02 0.46 XXX N

93990 TC A Doppler flow testing ........................................ 0.00 2.38 0.27 2.65 XXX N

94010 ............. A Breathing capacity test ................................... 0.17 0.68 0.05 0.90 XXX N

94010 26 A Breathing capacity test ................................... 0.17 0.28 0.02 0.47 XXX N

94010 TC A Breathing capacity test ................................... 0.00 0.40 0.03 0.43 XXX N

94060 ............. A Evaluation of wheezing ................................... 0.31 1.27 0.09 1.67 XXX N

94060 26 A Evaluation of wheezing ................................... 0.31 0.38 0.03 0.72 XXX N

94060 TC A Evaluation of wheezing ................................... 0.00 0.89 0.06 0.95 XXX N

94070 ............. A Evaluation of wheezing ................................... 0.60 1.77 0.13 2.50 XXX N

94070 26 A Evaluation of wheezing ................................... 0.60 0.38 0.03 1.01 XXX N

94070 TC A Evaluation of wheezing ................................... 0.00 1.39 0.10 1.49 XXX N

94150 ............. A Vital capacity test ............................................ 0.11 0.20 0.02 0.33 XXX N

94150 26 A Vital capacity test ............................................ 0.11 0.12 0.01 0.24 XXX N

94150 TC A Vital capacity test ............................................ 0.00 0.08 0.01 0.09 XXX N

94160 ............. A Vital capacity screening .................................. 0.18 0.37 0.02 0.57 XXX N

94160 26 A Vital capacity screening .................................. 0.18 0.19 0.01 0.38 XXX N

94160 TC A Vital capacity screening .................................. 0.00 0.18 0.01 0.19 XXX N

94200 ............. A Lung function test (MBC/MVV) ....................... 0.11 *0.38 0.03 0.52 XXX N

94200 26 A Lung function test (MBC/MVV) ....................... 0.11 *0.14 0.01 0.26 XXX N

94200 TC A Lung function test (MBC/MVV) ....................... 0.00 0.24 0.02 0.26 XXX N

94240 ............. A Residual lung capacity .................................... 0.26 0.88 0.07 1.21 XXX N

94240 26 A Residual lung capacity .................................... 0.26 0.23 0.02 0.51 XXX N

94240 TC A Residual lung capacity .................................... 0.00 0.65 0.05 0.70 XXX N

94250 ............. A Expired gas collection ..................................... 0.11 *0.27 0.02 0.40 XXX N

94250 26 A Expired gas collection ..................................... 0.11 *0.14 0.01 0.26 XXX N

94250 TC A Expired gas collection ..................................... 0.00 0.13 0.01 0.14 XXX N

94260 ............. A Thoracic gas volume ...................................... 0.13 *0.69 0.06 0.88 XXX N

94260 26 A Thoracic gas volume ...................................... 0.13 *0.17 0.02 0.32 XXX N

94260 TC A Thoracic gas volume ...................................... 0.00 0.52 0.04 0.56 XXX N

94350 ............. A Lung nitrogen washout curve ......................... 0.26 0.73 0.05 1.04 XXX N

94350 26 A Lung nitrogen washout curve ......................... 0.26 0.21 0.01 0.48 XXX N

94350 TC A Lung nitrogen washout curve ......................... 0.00 0.52 0.04 0.56 XXX N

94360 ............. A Measure airflow resistance ............................. 0.26 1.11 0.07 1.44 XXX N

94360 26 A Measure airflow resistance ............................. 0.26 0.19 0.01 0.46 XXX N

94360 TC A Measure airflow resistance ............................. 0.00 0.92 0.06 0.98 XXX N

94370 ............. A Breath airway closing volume ......................... 0.26 0.40 0.03 0.69 XXX N

94370 26 A Breath airway closing volume ......................... 0.26 0.14 0.01 0.41 XXX N

94370 TC A Breath airway closing volume ......................... 0.00 0.26 0.02 0.28 XXX N

94375 ............. A Respiratory flow volume loop ......................... 0.31 0.67 0.04 1.02 XXX N

94375 26 A Respiratory flow volume loop ......................... 0.31 0.21 0.01 0.53 XXX N

94375 TC A Respiratory flow volume loop ......................... 0.00 0.46 0.03 0.49 XXX N

94400 ............. A CO2 breathing response curve ...................... 0.40 0.77 0.19 1.36 XXX N

94400 26 A CO2 breathing response curve ...................... 0.40 0.47 0.13 1.00 XXX N

94400 TC A CO2 breathing response curve ....................... 0.00 0.30 0.06 0.36 XXX N

94450 ............. A Hypoxia response curve ................................. 0.40 0.61 0.05 1.06 XXX N

94450 26 A Hypoxia response curve ................................. 0.40 0.24 0.02 0.66 XXX N

94450 TC A Hypoxia response curve ................................. 0.00 0.37 0.03 0.40 XXX N

94620 ............. A Pulmonary stress testing ................................ 0.88 2.05 0.15 3.08 XXX N

94620 26 A Pulmonary stress testing ................................ 0.88 0.70 0.05 1.63 XXX N

94620 TC A Pulmonary stress testing ................................ 0.00 1.35 0.10 1.45 XXX N

94640 ............. A Airway inhalation treatment ............................ 0.00 0.39 0.03 0.42 XXX N

94642 ............. C Aerosol inhalation treatment ........................... 0.00 0.00 0.00 0.00 XXX N
63318

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

94650 ............. A Pressure breathing (IPPB) .............................. 0.00 0.37 0.03 0.40 XXX N

94651 ............. A Pressure breathing (IPPB) .............................. 0.00 0.36 0.03 0.39 XXX N

94652 ............. A Pressure breathing (IPPB) .............................. 0.00 0.41 0.08 0.49 XXX N

94656 ............. A Initial ventilator mgmt ...................................... 1.22 1.13 0.12 2.47 XXX N

94657 ............. A Cont. ventilator ................................................ 0.83 0.62 0.05 1.50 XXX N

94660 ............. A Pos airway pressure, CPAP ........................... 0.76 0.71 0.06 1.53 XXX N

94662 ............. A Neg pressure ventilation, cnp ......................... 0.76 0.30 0.02 1.08 XXX N

94664 ............. A Aerosol or vapor inhalations ........................... 0.00 0.50 0.04 0.54 XXX N

94665 ............. A Aerosol or vapor inhalations ........................... 0.00 0.46 0.05 0.51 XXX N

94667 ............. A Chest wall manipulation .................................. 0.00 0.55 0.05 0.60 XXX N

94668 ............. A Chest wall manipulation .................................. 0.00 0.34 0.03 0.37 XXX N

94680 ............. A Exhaled air analysis: O2 ................................. 0.26 0.82 0.10 1.18 XXX N

94680 26 A Exhaled air analysis: O2 ................................. 0.26 0.33 0.03 0.62 XXX N

94680 TC A Exhaled air analysis: O2 ................................. 0.00 0.49 0.07 0.56 XXX N

94681 ............. A Exhaled air analysis: O2, CO2 ....................... 0.20 *1.58 0.17 1.95 XXX N

94681 26 A Exhaled air analysis: O2, CO2 ....................... 0.20 *0.26 0.04 0.50 XXX N

94681 TC A Exhaled air analysis: O2, CO2 ....................... 0.00 1.32 0.13 1.45 XXX N

94690 ............. A Exhaled air analysis ........................................ 0.07 0.56 0.04 0.67 XXX N

94690 26 A Exhaled air analysis ........................................ 0.07 0.05 0.00 0.12 XXX N

94690 TC A Exhaled air analysis ........................................ 0.00 0.51 0.04 0.55 XXX N

94720 ............. A Monoxide diffusing capacity ........................... 0.26 1.03 0.08 1.37 XXX N

94720 26 A Monoxide diffusing capacity ........................... 0.26 0.23 0.02 0.51 XXX N

94720 TC A Monoxide diffusing capacity ........................... 0.00 0.80 0.06 0.86 XXX N

94725 ............. A Membrane diffusion capacity .......................... 0.26 1.84 0.14 2.24 XXX N

94725 26 A Membrane diffusion capacity .......................... 0.26 0.18 0.01 0.45 XXX N

94725 TC A Membrane diffusion capacity .......................... 0.00 1.66 0.13 1.79 XXX N

94750 ............. A Pulmonary compliance study .......................... 0.23 0.83 0.06 1.12 XXX N

94750 26 A Pulmonary compliance study .......................... 0.23 0.28 0.02 0.53 XXX N

94750 TC A Pulmonary compliance study .......................... 0.00 0.55 0.04 0.59 XXX N

94760 ............. A Measure blood oxygen level ........................... 0.00 0.25 0.02 0.27 XXX N

94761 ............. A Measure blood oxygen level ........................... 0.00 0.64 0.06 0.70 XXX N

94762 ............. A Measure blood oxygen level ........................... 0.00 1.08 0.10 1.18 XXX N

94770 ............. A Exhaled carbon dioxide test ........................... 0.20 0.40 0.11 0.71 XXX N

94770 26 A Exhaled carbon dioxide test ........................... 0.20 0.11 0.03 0.34 XXX N

94770 TC A Exhaled carbon dioxide test ........................... 0.00 0.29 0.08 0.37 XXX N

94772 ............. C Breath recording, infant .................................. 0.00 0.00 0.00 0.00 XXX N

94772 26 C Breath recording, infant .................................. 0.00 0.00 0.00 0.00 XXX N

94772 TC C Breath recording, infant .................................. 0.00 0.00 0.00 0.00 XXX N

94799 ............. C Pulmonary service/procedure ......................... 0.00 0.00 0.00 0.00 XXX N

94799 26 C Pulmonary service/procedure ......................... 0.00 0.00 0.00 0.00 XXX N

94799 TC C Pulmonary service/procedure ......................... 0.00 0.00 0.00 0.00 XXX N

95004 ............. A Allergy skin tests ............................................. 0.00 0.09 0.01 0.10 XXX N

95010 ............. A Sensitivity skin tests ....................................... 0.15 0.11 0.01 0.27 XXX N

95015 ............. A Sensitivity skin tests ....................................... 0.15 0.11 0.01 0.27 XXX N

95024 ............. A Allergy skin tests ............................................. 0.00 0.14 0.01 0.15 XXX N

95027 ............. A Skin end point titration .................................... 0.00 0.14 0.01 0.15 XXX N

95028 ............. A Allergy skin tests ............................................. 0.00 0.22 0.01 0.23 XXX N

95044 ............. A Allergy patch tests .......................................... 0.00 0.19 0.01 0.20 XXX N

95052 ............. A Photo patch test .............................................. 0.00 0.24 0.01 0.25 XXX N

95056 ............. A Photosensitivity tests ...................................... 0.00 0.17 0.01 0.18 XXX N

95060 ............. A Eye allergy tests ............................................. 0.00 0.33 0.02 0.35 XXX N

95065 ............. A Nose allergy test ............................................. 0.00 0.19 0.01 0.20 XXX N

95070 ............. A Bronchial allergy tests .................................... 0.00 2.17 0.02 2.19 XXX N

95071 ............. A Bronchial allergy tests .................................... 0.00 2.78 0.02 2.80 XXX N

95075 ............. A Ingestion challenge test .................................. 0.95 1.97 0.02 2.94 XXX N

95078 ............. A Provocative testing ......................................... 0.00 0.24 0.02 0.26 XXX N

95115 ............. A Immunotherapy, one injection ........................ 0.00 0.37 0.02 0.39 000 N

95117 ............. A Immunotherapy injections ............................... 0.00 0.48 0.02 0.50 000 N

95120 ............. G Immunotherapy, one injection ........................ 0.00 0.00 0.00 0.00 XXX 0

95125 ............. G Immunotherapy, many antigens ..................... 0.00 0.00 0.00 0.00 XXX 0

95130 ............. G Immunotherapy, insect venom ........................ 0.00 0.00 0.00 0.00 XXX 0

95131 ............. G Immunotherapy, insect venoms ...................... 0.00 0.00 0.00 0.00 XXX 0

95132 ............. G Immunotherapy, insect venoms ...................... 0.00 0.00 0.00 0.00 XXX 0

95133 ............. G Immunotherapy, insect venoms ...................... 0.00 0.00 0.00 0.00 XXX 0

95134 ............. G Immunotherapy, insect venoms ...................... 0.00 0.00 0.00 0.00 XXX 0

95144 ............. A Antigen therapy services ................................ 0.06 0.13 0.01 0.20 000 N
63319

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

95145 ............. A Antigen therapy services ................................ 0.06 0.34 0.03 0.43 000 N

95146 ............. A Antigen therapy services ................................ 0.06 0.61 0.03 0.70 000 N

95147 ............. A Antigen therapy services ................................ 0.06 0.91 0.03 1.00 000 N

95148 ............. A Antigen therapy services ................................ 0.06 0.91 0.03 1.00 000 N

95149 ............. A Antigen therapy services ................................ 0.06 1.14 0.03 1.23 000 N

95165 ............. A Antigen therapy services ................................ 0.06 0.10 0.01 0.17 000 N

95170 ............. A Antigen therapy services ................................ 0.06 0.35 0.03 0.44 000 N

95180 ............. A Rapid desensitization ...................................... 2.01 0.14 0.01 2.16 000 N

95199 ............. C Allergy immunology services .......................... 0.00 0.00 0.00 0.00 000 N

95805 ............. A Multiple sleep latency test .............................. 1.88 5.51 0.45 7.84 XXX N

95805 26 A Multiple sleep latency test .............................. 1.88 0.56 0.07 2.51 XXX N

95805 TC A Multiple sleep latency test .............................. 0.00 4.95 0.38 5.33 XXX N

95807 ............. A Sleep study ..................................................... 1.66 8.75 0.67 11.08 XXX N

95807 26 A Sleep study ..................................................... 1.66 2.45 0.19 4.30 XXX N

95807 TC A Sleep study ..................................................... 0.00 6.30 0.48 6.78 XXX N

95808 ............. A Polysomnography, 1–3 ................................... 2.65 8.75 0.67 12.07 XXX N

95808 26 A Polysomnography, 1–3 ................................... 2.65 2.45 0.19 5.29 XXX N

95808 TC A Polysomnography, 1–3 ................................... 0.00 6.30 0.48 6.78 XXX N

95810 ............. A Polysomnography, 4 or more ......................... 3.53 8.75 0.67 12.95 XXX N

95810 26 A Polysomnography, 4 or more ......................... 3.53 2.45 0.19 6.17 XXX N

95810 TC A Polysomnography, 4 or more ......................... 0.00 6.30 0.48 6.78 XXX N

95812 ............. A Electroencephalogram (EEG) ......................... 1.08 1.85 0.15 3.08 XXX N

95812 26 A Electroencephalogram (EEG) ......................... 1.08 0.50 0.04 1.62 XXX N

95812 TC A Electroencephalogram (EEG) ......................... 0.00 1.35 0.11 1.46 XXX N

95813 ............. A Electroencephalogram (EEG) ......................... 1.73 1.85 0.15 3.73 XXX N

95813 26 A Electroencephalogram (EEG) ......................... 1.73 0.50 0.04 2.27 XXX N

95813 TC A Electroencephalogram (EEG) ......................... 0.00 1.35 0.11 1.46 XXX N

95816 ............. A Electroencephalogram (EEG) ......................... 1.08 1.54 0.13 2.75 XXX N

95816 26 A Electroencephalogram (EEG) ......................... 1.08 0.28 0.03 1.39 XXX N

95816 TC A Electroencephalogram (EEG) ......................... 0.00 1.26 0.10 1.36 XXX N

95819 ............. A Electroencephalogram (EEG) ......................... 1.08 1.80 0.14 3.02 XXX N

95819 26 A Electroencephalogram (EEG) ......................... 1.08 0.50 0.04 1.62 XXX N

95819 TC A Electroencephalogram (EEG) ......................... 0.00 1.30 0.10 1.40 XXX N

95822 ............. A Sleep electroencephalogram .......................... 1.08 2.28 0.18 3.54 XXX N

95822 26 A Sleep electroencephalogram .......................... 1.08 0.56 0.04 1.68 XXX N

95822 TC A Sleep electroencephalogram .......................... 0.00 1.72 0.14 1.86 XXX N

95824 ............. A Electroencephalography ................................. 0.74 0.98 0.07 1.79 XXX N

95824 26 A Electroencephalography ................................. 0.74 0.58 0.04 1.36 XXX N

95824 TC A Electroencephalography ................................. 0.00 0.40 0.03 0.43 XXX N

95827 ............. A Night electroencephalogram ........................... 1.08 3.06 0.24 4.38 XXX N

95827 26 A Night electroencephalogram ........................... 1.08 0.88 0.07 2.03 XXX N

95827 TC A Night electroencephalogram ........................... 0.00 2.18 0.17 2.35 XXX N

95829 ............. A Surgery electrocorticogram ............................. 6.21 0.59 0.05 6.85 XXX N

95829 26 A Surgery electrocorticogram ............................. 6.21 0.45 0.03 6.69 XXX N

95829 TC A Surgery electrocorticogram ............................. 0.00 0.14 0.02 0.16 XXX N

95830 ............. A Insert electrodes for EEG ............................... 1.70 0.78 0.07 2.55 XXX N

95831 ............. A Limb muscle testing, manual .......................... 0.28 0.29 0.03 0.60 XXX N

95832 ............. A Hand muscle testing, manual ......................... 0.29 0.25 0.02 0.56 XXX N

95833 ............. A Body muscle testing, manual ......................... 0.47 0.38 0.05 0.90 XXX N

95834 ............. A Body muscle testing, manual ......................... 0.60 0.61 0.06 1.27 XXX N

95851 ............. A Range of motion measurements .................... 0.28 0.24 0.02 0.54 XXX N

95852 ............. A Range of motion measurements .................... 0.19 0.15 0.02 0.36 XXX N

95857 ............. A Tensilon test ................................................... 0.53 0.50 0.04 1.07 XXX N

95858 ............. A Tensilon test & myogram ................................ 1.56 1.02 0.09 2.67 XXX N

95858 26 A Tensilon test & myogram ................................ 1.56 0.64 0.05 2.25 XXX N

95858 TC A Tensilon test & myogram ................................ 0.00 0.38 0.04 0.42 XXX N

95860 ............. A Muscle test, one limb ...................................... 0.96 1.09 0.09 2.14 XXX N

95860 26 A Muscle test, one limb ...................................... 0.96 0.73 0.06 1.75 XXX N

95860 TC A Muscle test, one limb ...................................... 0.00 0.36 0.03 0.39 XXX N

95861 ............. A Muscle test, two limbs .................................... 1.54 1.97 0.16 3.67 XXX N

95861 26 A Muscle test, two limbs .................................... 1.54 1.27 0.10 2.91 XXX N

95861 TC A Muscle test, two limbs .................................... 0.00 0.70 0.06 0.76 XXX N

95863 ............. A Muscle test, 3 limbs ........................................ 1.87 2.30 0.18 4.35 XXX N

95863 26 A Muscle test, 3 limbs ........................................ 1.87 1.41 0.11 3.39 XXX N

95863 TC A Muscle test, 3 limbs ........................................ 0.00 0.89 0.07 0.96 XXX N

95864 ............. A Muscle test, 4 limbs ........................................ 1.99 3.45 0.27 5.71 XXX N
63320

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

95864 26 A Muscle test, 4 limbs ........................................ 1.99 1.75 0.14 3.88 XXX N

95864 TC A Muscle test, 4 limbs ........................................ 0.00 1.70 0.13 1.83 XXX N

95867 ............. A Muscle test, head or neck .............................. 0.62 1.13 0.09 1.84 XXX N

95867 26 A Muscle test, head or neck .............................. 0.62 0.58 0.05 1.25 XXX N

95867 TC A Muscle test, head or neck .............................. 0.00 0.55 0.04 0.59 XXX N

95868 ............. A Muscle test, head or neck .............................. 1.50 1.92 0.15 3.57 XXX N

95868 26 A Muscle test, head or neck .............................. 1.50 1.26 0.10 2.86 XXX N

95868 TC A Muscle test, head or neck .............................. 0.00 0.66 0.05 0.71 XXX N

95869 ............. A Muscle test, limited ......................................... 0.37 0.53 0.05 0.95 XXX N

95869 26 A Muscle test, limited ......................................... 0.37 0.33 0.03 0.73 XXX N

95869 TC A Muscle test, limited ......................................... 0.00 0.20 0.02 0.22 XXX N

95872 ............. A Muscle test, one fiber ..................................... 1.50 1.25 0.11 2.86 XXX N

95872 26 A Muscle test, one fiber ..................................... 1.50 0.68 0.06 2.24 XXX N

95872 TC A Muscle test, one fiber ..................................... 0.00 0.57 0.05 0.62 XXX N

95875 ............. A Limb exercise test ........................................... 1.34 0.60 0.10 2.04 XXX N

95875 26 A Limb exercise test ........................................... 1.34 0.22 0.04 1.60 XXX N

95875 TC A Limb exercise test ........................................... 0.00 0.38 0.06 0.44 XXX N

95880 ............. D Cerebral aphasia testing ................................. 0.00 0.00 0.00 0.00 XXX N

95881 ............. D Cerebral developmental test ........................... 0.00 0.00 0.00 0.00 XXX N

95882 ............. D Cognitive function testing ............................... 0.00 0.00 0.00 0.00 XXX N

95883 ............. D Neuropsychological testing ............................. 0.00 0.00 0.00 0.00 XXX N

95900 ............. A Motor nerve conduction test ........................... 0.42 0.62 0.05 1.09 XXX N

95900 26 A Motor nerve conduction test ........................... 0.42 0.35 0.03 0.80 XXX N

95900 TC A Motor nerve conduction test ........................... 0.00 0.27 0.02 0.29 XXX N

95903 ............. A Motor nerve conduction test ........................... 0.60 0.59 0.05 1.24 XXX N

95903 26 A Motor nerve conduction test ........................... 0.60 0.35 0.03 0.98 XXX N

95903 TC A Motor nerve conduction test ........................... 0.00 0.24 0.02 0.26 XXX N

95904 ............. A Sense nerve conduction test .......................... 0.34 0.55 0.05 0.94 XXX N

95904 26 A Sense nerve conduction test .......................... 0.34 0.34 0.03 0.71 XXX N

95904 TC A Sense nerve conduction test .......................... 0.00 0.21 0.02 0.23 XXX N

95920 ............. A Intraoperative nerve testing ............................ 2.11 2.67 0.20 4.98 XXX N

95920 26 A Intraoperative nerve testing ............................ 2.11 1.43 0.12 3.66 XXX N

95920 TC A Intraoperative nerve testing ............................ 0.00 1.24 0.08 1.32 XXX N

95925 ............. A Somatosensory testing ................................... 0.54 1.51 0.12 2.17 XXX N

95925 26 A Somatosensory testing ................................... 0.54 0.64 0.05 1.23 XXX N

95925 TC A Somatosensory testing ................................... 0.00 0.87 0.07 0.94 XXX N

95926 ............. A Somatosensory testing ................................... 0.54 1.51 0.12 2.17 XXX N

95926 26 A Somatosensory testing ................................... 0.54 0.64 0.05 1.23 XXX N

95926 TC A Somatosensory testing ................................... 0.00 0.87 0.07 0.94 XXX N

95927 ............. A Somatosensory testing ................................... 0.54 1.51 0.12 2.17 XXX N

95927 26 A Somatosensory testing ................................... 0.54 0.64 0.05 1.23 XXX N

95927 TC A Somatosensory testing ................................... 0.00 0.87 0.07 0.94 XXX N

95930 ............. A Visual evoked potential test ............................ 0.35 0.83 0.05 1.23 XXX N

95930 26 A Visual evoked potential test ............................ 0.35 0.58 0.04 0.97 XXX N

95930 TC A Visual evoked potential test ............................ 0.00 0.25 0.01 0.26 XXX N

95933 ............. A Blink reflex test ............................................... 0.59 1.25 0.10 1.94 XXX N

95933 26 A Blink reflex test ............................................... 0.59 0.50 0.04 1.13 XXX N

95933 TC A Blink reflex test ............................................... 0.00 0.75 0.06 0.81 XXX N

95934 ............. A ‘H’ reflex test ................................................... 0.51 0.54 0.05 1.10 XXX N

95934 26 A ‘H’ reflex test ................................................... 0.51 0.34 0.03 0.88 XXX N

95934 TC A ‘H’ reflex test ................................................... 0.00 0.20 0.02 0.22 XXX N

95935 ............. D ‘H’ or ‘F’ reflex study ....................................... 0.00 0.00 0.00 0.00 XXX N

95935 26 D ‘H’ or ‘F’ reflex study ....................................... 0.00 0.00 0.00 0.00 XXX N

95935 TC D ‘H’ or ‘F’ reflex study ....................................... 0.00 0.00 0.00 0.00 XXX N

95936 ............. A ‘H’ reflex test ................................................... 0.55 0.54 0.05 1.14 XXX N

95936 26 A ‘H’ reflex test ................................................... 0.55 0.34 0.03 0.92 XXX N

95936 TC A ‘H’ reflex test ................................................... 0.00 0.20 0.02 0.22 XXX N

95937 ............. A Neuromuscular junction test ........................... 0.60 0.77 0.07 1.44 XXX N

95937 26 A Neuromuscular junction test ........................... 0.60 0.45 0.04 1.09 XXX N

95937 TC A Neuromuscular junction test ........................... 0.00 0.32 0.03 0.35 XXX N

95950 ............. A Ambulatory eeg monitoring ............................. 1.51 7.25 0.60 9.36 XXX N

95950 26 A Ambulatory eeg monitoring ............................. 1.51 1.21 0.10 2.82 XXX N

95950 TC A Ambulatory eeg monitoring ............................. 0.00 6.04 0.50 6.54 XXX N

95951 ............. A EEG monitoring/videorecord ........................... 3.80 8.83 0.64 13.27 XXX N

95951 26 A EEG monitoring/videorecord ........................... 3.80 1.50 0.11 5.41 XXX N

95951 TC A EEG monitoring/videorecord ........................... 0.00 7.33 0.53 7.86 XXX N
63321

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

95953 ............. A EEG monitoring/computer .............................. 3.08 7.25 0.60 10.93 XXX N

95953 26 A EEG monitoring/computer .............................. 3.08 1.21 0.10 4.39 XXX N

95953 TC A EEG monitoring/computer ............................... 0.00 6.04 0.50 6.54 XXX N

95954 ............. A EEG monitoring/giving drugs .......................... 2.45 2.32 0.28 5.05 XXX N

95954 26 A EEG monitoring/giving drugs .......................... 2.45 1.87 0.22 4.54 XXX N

95954 TC A EEG monitoring/giving drugs .......................... 0.00 0.45 0.06 0.51 XXX N

95955 ............. A EEG during surgery ........................................ 1.01 2.90 0.30 4.21 XXX N

95955 26 A EEG during surgery ........................................ 1.01 1.03 0.11 2.15 XXX N

95955 TC A EEG during surgery ........................................ 0.00 1.87 0.19 2.06 XXX N

95956 ............. A EEG monitoring/cable/radio ............................ 3.08 7.54 0.61 11.23 XXX N

95956 26 A EEG monitoring/cable/radio ............................ 3.08 1.50 0.11 4.69 XXX N

95956 TC A EEG monitoring/cable/radio ............................ 0.00 6.04 0.50 6.54 XXX N

95957 ............. A EEG digital analysis ........................................ 1.98 2.25 0.18 4.41 XXX N

95957 26 A EEG digital analysis ........................................ 1.98 0.63 0.05 2.66 XXX N

95957 TC A EEG digital analysis ........................................ 0.00 1.62 0.13 1.75 XXX N

95958 ............. A EEG monitoring/function test .......................... 4.25 4.89 0.52 9.66 XXX N

95958 26 A EEG monitoring/function test .......................... 4.25 3.23 0.38 7.86 XXX N

95958 TC A EEG monitoring/function test .......................... 0.00 1.66 0.14 1.80 XXX N

95961 ............. A Electrode stimulation, brain ............................ 2.97 2.67 0.20 5.84 XXX N

95961 26 A Electrode stimulation, brain ............................ 2.97 1.43 0.12 4.52 XXX N

95961 TC A Electrode stimulation, brain ............................ 0.00 1.24 0.08 1.32 XXX N

95962 ............. A Electrode stimulation, brain ............................ 3.21 2.67 0.20 6.08 XXX N

95962 26 A Electrode stimulation, brain ............................ 3.21 1.43 0.12 4.76 XXX N

95962 TC A Electrode stimulation, brain ............................ 0.00 1.24 0.08 1.32 XXX N

95999 ............. C Neurological procedure ................................... 0.00 0.00 0.00 0.00 XXX N

96100 ............. A Psychological testing ...................................... 0.00 1.68 0.20 1.88 XXX N

96105 ............. A Assessment of aphasia .................................. 0.00 1.68 0.20 1.88 XXX N

96110 ............. C Developmental test, lim .................................. 0.00 0.00 0.00 0.00 XXX N

96111 ............. A Developmental test, extend ............................ 0.00 1.68 0.20 1.88 XXX N

96115 ............. A Neurobehavior status exam ............................ 0.00 1.68 0.20 1.88 XXX N

96117 ............. A Neuropsych test battery .................................. 0.00 1.68 0.20 1.88 XXX N

96400 ............. A Chemotherapy, (SC)/(IM) ............................... 0.00 0.13 0.01 0.14 XXX N

96405 ............. A Intralesional chemo admin .............................. 0.52 0.38 0.03 0.93 000 S

96406 ............. A Intralesional chemo admin .............................. 0.80 0.56 0.04 1.40 000 S

96408 ............. A Chemotherapy, push technique ...................... 0.00 0.92 0.06 0.98 XXX N

96410 ............. A Chemotherapy, infusion method ..................... 0.00 1.47 0.09 1.56 XXX N

96412 ............. A Chemotherapy, infusion method ..................... 0.00 1.10 0.08 1.18 XXX N

96414 ............. A Chemotherapy, infusion method ..................... 0.00 1.27 0.09 1.36 XXX N

96420 ............. A Chemotherapy, push technique ...................... 0.00 1.19 0.09 1.28 XXX N

96422 ............. A Chemotherapy, infusion method ..................... 0.00 1.17 0.09 1.26 XXX N

96423 ............. A Chemotherapy, infusion method ..................... 0.00 0.46 0.03 0.49 XXX N

96425 ............. A Chemotherapy, infusion method ..................... 0.00 1.36 0.09 1.45 XXX N

96440 ............. A Chemotherapy, intracavitary ........................... 2.37 0.81 0.06 3.24 000 N

96445 ............. A Chemotherapy, intracavitary ........................... 2.20 0.98 0.09 3.27 000 N

96450 ............. A Chemotherapy, into CNS ................................ 1.89 0.87 0.06 2.82 000 N

96520 ............. A Pump refilling, maintenance ........................... 0.00 0.85 0.06 0.91 XXX N

96530 ............. A Pump refilling, maintenance ........................... 0.00 1.01 0.07 1.08 XXX N

96542 ............. A Chemotherapy injection .................................. 1.42 1.09 0.13 2.64 XXX N

96545 ............. B Provide chemotherapy agent .......................... 0.00 0.00 0.00 0.00 XXX 0

96549 ............. C Chemotherapy, unspecified ............................ 0.00 0.00 0.00 0.00 XXX N

96900 ............. A Ultraviolet light therapy ................................... 0.00 0.38 0.03 0.41 XXX N

96910 ............. A Photochemotherapy with UV-B ...................... 0.00 0.55 0.04 0.59 XXX N

96912 ............. A Photochemotherapy with UV-A ...................... 0.00 0.63 0.05 0.68 XXX N

96913 ............. A Photochemotherapy, UV-A or B ..................... 0.00 1.29 0.10 1.39 XXX N

96999 ............. C Dermatological procedure ............................... 0.00 0.00 0.00 0.00 XXX N

97010 ............. A Hot or cold packs therapy .............................. 0.11 0.21 0.02 0.34 XXX N

97012 ............. A Mechanical traction therapy ............................ 0.25 0.19 0.02 0.46 XXX N

97014 ............. A Electric stimulation therapy ............................. 0.18 0.20 0.02 0.40 XXX N

97016 ............. A Vasopneumatic device therapy ...................... 0.18 0.25 0.02 0.45 XXX N

97018 ............. A Paraffin bath therapy ...................................... 0.11 0.24 0.03 0.38 XXX N

97020 ............. A Microwave therapy .......................................... 0.11 0.20 0.02 0.33 XXX N

97022 ............. A Whirlpool therapy ............................................ 0.25 0.19 0.02 0.46 XXX N

97024 ............. A Diathermy treatment ....................................... 0.11 0.21 0.02 0.34 XXX N

97026 ............. A Infrared therapy .............................................. 0.11 0.19 0.02 0.32 XXX N

97028 ............. A Ultraviolet therapy ........................................... 0.20 0.19 0.01 0.40 XXX N

97032 ............. A Electrical stimulation ....................................... 0.25 0.14 0.01 0.40 XXX N
63322

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

97033 ............. A Electric current therapy ................................... 0.26 0.14 0.02 0.42 XXX N

97034 ............. A Contrast bath therapy ..................................... 0.21 0.10 0.01 0.32 XXX N

97035 ............. A Ultrasound therapy ......................................... 0.21 0.11 0.01 0.33 XXX N

97036 ............. A Hydrotherapy .................................................. 0.38 0.21 0.02 0.61 XXX N

97039 ............. A Physical therapy treatment ............................. 0.29 0.24 0.03 0.56 XXX N

97110 ............. A Therapeutic exercises ..................................... 0.45 0.13 0.02 0.60 XXX N

97112 ............. A Neuromuscular reeducation ............................ 0.45 0.13 0.01 0.59 XXX N

97113 ............. A Aquatic therapy/exercises ............................... 0.44 0.20 0.02 0.66 XXX N

97116 ............. A Gait training therapy ....................................... 0.40 0.11 0.01 0.52 XXX N

97122 ............. A Manual traction therapy .................................. 0.45 0.11 0.01 0.57 XXX N

97124 ............. A Massage therapy ............................................ 0.35 0.11 0.01 0.47 XXX N

97139 ............. A Physical medicine procedure .......................... 0.21 0.16 0.02 0.39 XXX N

97150 ............. A Group therapeutic procedures ........................ 0.27 0.20 0.02 0.49 XXX N

97250 ............. A Myofascial release .......................................... 0.45 0.35 0.04 0.84 000 N

97260 ............. A Regional manipulation .................................... 0.19 0.20 0.02 0.41 000 N

97261 ............. A Supplemental manipulations ........................... 0.12 0.11 0.01 0.24 000 N

97265 ............. A Joint mobilization ............................................ 0.45 0.35 0.04 0.84 XXX N

97500 ............. A Orthotics training ............................................. 0.31 0.27 0.04 0.62 XXX N

97501 ............. A Supplemental training ..................................... 0.17 0.15 0.02 0.34 XXX N

97520 ............. A Prosthetic training ........................................... 0.37 0.30 0.04 0.71 XXX N

97521 ............. A Supplemental training ..................................... 0.22 0.17 0.02 0.41 XXX N

97530 ............. A Therapeutic activities ...................................... 0.44 0.17 0.02 0.63 XXX N

97535 ............. A Self care mngment training ............................ 0.33 0.17 0.02 0.52 XXX N

97537 ............. A Community/work reintegration ........................ 0.33 0.17 0.02 0.52 XXX N

97540 ............. D Training for daily living .................................... 0.00 0.00 0.00 0.00 XXX N

97541 ............. D Supplemental training ..................................... 0.00 0.00 0.00 0.00 XXX N

97542 ............. A Wheelchair mngement training ....................... 0.25 0.17 0.02 0.44 XXX N

97545 ............. R Work hardening .............................................. 0.00 0.00 0.00 0.00 XXX N

97546 ............. R Work hardening .............................................. 0.00 0.00 0.00 0.00 XXX N

97700 ............. D Training checkout ........................................... 0.00 0.00 0.00 0.00 XXX N

97701 ............. D Supplemental checkout .................................. 0.00 0.00 0.00 0.00 XXX N

97703 ............. A Prosthetic checkout ........................................ 0.25 0.18 0.03 0.46 XXX N

97750 ............. A Physical performance test .............................. 0.45 0.24 0.03 0.72 XXX N

97770 ............. A Cognitive skills development .......................... 0.44 0.28 0.03 0.75 XXX N

97799 ............. C Physical medicine procedure .......................... 0.00 0.00 0.00 0.00 XXX N

98925 ............. A Osteopathic manipulation ............................... 0.45 0.25 0.02 0.72 000 N

98926 ............. A Osteopathic manipulation ............................... 0.65 0.40 0.03 1.08 000 N

98927 ............. A Osteopathic manipulation ............................... 0.87 0.38 0.03 1.28 000 N

98928 ............. A Osteopathic manipulation ............................... 1.03 0.42 0.04 1.49 000 N

98929 ............. A Osteopathic manipulation ............................... 1.19 0.39 0.03 1.61 000 N

99000 ............. B Specimen handling ......................................... 0.00 0.00 0.00 0.00 XXX 0

99001 ............. B Specimen handling ......................................... 0.00 0.00 0.00 0.00 XXX 0

99002 ............. B Device handling .............................................. 0.00 0.00 0.00 0.00 XXX 0

99024 ............. B Post-op follow-up visit ..................................... 0.00 0.00 0.00 0.00 XXX 0

99025 ............. B Initial surgical evaluation ................................ 0.00 0.00 0.00 0.00 XXX 0

99050 ............. B Medical services after hrs ............................... 0.00 0.00 0.00 0.00 XXX 0

99052 ............. B Medical services at night ................................ 0.00 0.00 0.00 0.00 XXX 0

99054 ............. B Medical services, unusual hrs ........................ 0.00 0.00 0.00 0.00 XXX 0

99056 ............. B Non-office medical services ............................ 0.00 0.00 0.00 0.00 XXX 0

99058 ............. B Office emergency care ................................... 0.00 0.00 0.00 0.00 XXX 0

99070 ............. B Special supplies .............................................. 0.00 0.00 0.00 0.00 XXX 0

99071 ............. B Patient education materials ............................ 0.00 0.00 0.00 0.00 XXX 0

99075 ............. N Medical testimony ........................................... 0.00 0.00 0.00 0.00 XXX 0

99078 ............. B Group health education .................................. 0.00 0.00 0.00 0.00 XXX 0

99080 ............. B Special reports or forms ................................. 0.00 0.00 0.00 0.00 XXX 0

99082 ............. C Unusual physician travel ................................. 0.00 0.00 0.00 0.00 XXX N

99090 ............. B Computer data analysis .................................. 0.00 0.00 0.00 0.00 XXX 0

99100 ............. B Special anesthesia service ............................. 0.00 0.00 0.00 0.00 XXX 0

99116 ............. B Anesthesia with hypothermia .......................... 0.00 0.00 0.00 0.00 XXX 0

99135 ............. B Special anesthesia procedure ........................ 0.00 0.00 0.00 0.00 XXX 0

99140 ............. B Emergency anesthesia ................................... 0.00 0.00 0.00 0.00 XXX 0

99175 ............. A Induction of vomiting ....................................... 0.00 1.33 0.10 1.43 XXX N

99178 ............. D Development evaluation tests ........................ 0.00 0.00 0.00 0.00 XXX N

99183 ............. A Hyperbaric oxygen therapy ............................. 2.34 1.67 0.11 4.12 XXX N

99185 ............. A Regional hypothermia ..................................... 0.00 0.61 0.04 0.65 XXX N

99186 ............. A Total body hypothermia .................................. 0.00 1.70 0.52 2.22 XXX N
63323

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

99190 ............. X Special pump services .................................... 0.00 0.00 0.00 0.00 XXX 0

99191 ............. X Special pump services .................................... 0.00 0.00 0.00 0.00 XXX 0

99192 ............. X Special pump services .................................... 0.00 0.00 0.00 0.00 XXX 0

99195 ............. A Phlebotomy ..................................................... 0.00 0.42 0.03 0.45 XXX N

99199 ............. C Special service or report ................................. 0.00 0.00 0.00 0.00 XXX N

99201 ............. A Office/outpatient visit, new .............................. 0.38 0.37 0.04 0.79 XXX P

99202 ............. A Office/outpatient visit, new .............................. 0.75 0.45 0.05 1.25 XXX P

99203 ............. A Office/outpatient visit, new .............................. 1.14 0.52 0.06 1.72 XXX P

99204 ............. A Office/outpatient visit, new .............................. 1.71 0.78 0.08 2.57 XXX P

99205 ............. A Office/outpatient visit, new .............................. 2.28 0.85 0.09 3.22 XXX P

99211 ............. A Office/outpatient visit, est ............................... 0.17 0.19 0.02 0.38 XXX P

99212 ............. A Office/outpatient visit, est ............................... 0.38 0.28 0.02 0.68 XXX P

99213 ............. A Office/outpatient visit, est ............................... 0.55 0.38 0.03 0.96 XXX P

99214 ............. A Office/outpatient visit, est ............................... 0.94 0.50 0.04 1.48 XXX P

99215 ............. A Office/outpatient visit, est ............................... 1.51 0.76 0.07 2.34 XXX P

99217 ............. A Observation care discharge ............................ 1.09 0.52 0.04 1.65 XXX N

99218 ............. A Observation care ............................................ 1.08 0.68 0.06 1.82 XXX N

99219 ............. A Observation care ............................................ 1.75 1.05 0.09 2.89 XXX N

99220 ............. A Observation care ............................................ 2.41 1.14 0.09 3.64 XXX N

99221 ............. A Initial hospital care .......................................... 1.06 0.67 0.06 1.79 XXX N

99222 ............. A Initial hospital care .......................................... 1.84 1.04 0.09 2.97 XXX N

99223 ............. A Initial hospital care .......................................... 2.57 1.13 0.08 3.78 XXX N

99231 ............. A Subsequent hospital care ............................... 0.51 0.38 0.03 0.92 XXX N

99232 ............. A Subsequent hospital care ............................... 0.88 0.45 0.04 1.37 XXX N

99233 ............. A Subsequent hospital care ............................... 1.25 0.60 0.05 1.90 XXX N

99238 ............. A Hospital discharge day ................................... 1.06 0.51 0.04 1.61 XXX N

99239 ............. A Hospital discharge day ................................... 1.75 0.51 0.04 2.30 XXX N

99241 ............. A Office consultation .......................................... 0.54 0.64 0.08 1.26 XXX N

99242 ............. A Office consultation .......................................... 1.11 0.77 0.09 1.97 XXX N

99243 ............. A Office consultation .......................................... 1.47 0.97 0.10 2.54 XXX N

99244 ............. A Office consultation .......................................... 2.23 1.23 0.11 3.57 XXX N

99245 ............. A Office consultation .......................................... 2.96 1.69 0.16 4.81 XXX N

99251 ............. A Initial inpatient consult .................................... 0.54 0.67 0.08 1.29 XXX N

99252 ............. A Initial inpatient consult .................................... 1.13 0.76 0.09 1.98 XXX N

99253 ............. A Initial inpatient consult .................................... 1.56 0.95 0.10 2.61 XXX N

99254 ............. A Initial inpatient consult .................................... 2.27 1.20 0.11 3.58 XXX N

99255 ............. A Initial inpatient consult .................................... 3.14 1.57 0.14 4.85 XXX N

99261 ............. A Follow-up inpatient consult ............................. 0.36 0.33 0.03 0.72 XXX N

99262 ............. A Follow-up inpatient consult ............................. 0.74 0.46 0.04 1.24 XXX N

99263 ............. A Follow-up inpatient consult ............................. 1.16 0.67 0.04 1.87 XXX N

99271 ............. A Confirmatory consultation ............................... 0.45 *0.58 0.07 1.10 XXX N

99272 ............. A Confirmatory consultation ............................... 0.84 0.71 0.09 1.64 XXX N

99273 ............. A Confirmatory consultation ............................... 1.19 1.02 0.11 2.32 XXX N

99274 ............. A Confirmatory consultation ............................... 1.73 1.22 0.11 3.06 XXX N

99275 ............. A Confirmatory consultation ............................... 2.31 1.74 0.17 4.22 XXX N

99281 ............. A Emergency dept visit ...................................... 0.28 0.28 0.01 0.57 XXX P

99282 ............. A Emergency dept visit ...................................... 0.47 0.38 0.03 0.88 XXX P

99283 ............. A Emergency dept visit ...................................... 1.07 0.49 0.04 1.60 XXX P

99284 ............. A Emergency dept visit ...................................... 1.68 0.70 0.06 2.44 XXX P

99285 ............. A Emergency dept visit ...................................... 2.63 1.13 0.08 3.84 XXX P

99288 ............. B Direct advanced life support ........................... 0.00 0.00 0.00 0.00 XXX 0

99291 ............. A Critical care, first hour .................................... 3.64 1.43 0.11 5.18 XXX N

99292 ............. A Critical care, addl 30 min ................................ 1.84 0.63 0.04 2.51 XXX N

99295 ............. A Neonatal critical care ...................................... 16.03 5.08 1.55 22.66 XXX N

99296 ............. A Neonatal critical care ...................................... 7.40 2.46 0.77 10.63 XXX N

99297 ............. A Neonatal critical care ...................................... 3.84 1.23 0.38 5.45 XXX N

99301 ............. A Nursing facility care ........................................ 1.07 0.45 0.03 1.55 XXX P

99302 ............. A Nursing facility care ........................................ 1.67 0.50 0.04 2.21 XXX P

99303 ............. A Nursing facility care ........................................ 2.29 0.95 0.07 3.31 XXX P

99311 ............. A Nursing facility care, subseq .......................... 0.54 0.34 0.03 0.91 XXX P

99312 ............. A Nursing facility care, subseq .......................... 0.89 0.41 0.03 1.33 XXX P

99313 ............. A Nursing facility care, subseq .......................... 1.19 0.46 0.04 1.69 XXX P

99321 ............. A Rest home visit, new patient .......................... 0.71 0.37 0.03 1.11 XXX P

99322 ............. A Rest home visit, new patient .......................... 1.01 0.51 0.05 1.57 XXX P

99323 ............. A Rest home visit, new patient .......................... 1.28 0.73 0.06 2.07 XXX P

99331 ............. A Rest home visit, estab pat .............................. 0.60 0.28 0.02 0.90 XXX P
63324

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

99332 ............. A Rest home visit, estab pat .............................. 0.80 0.36 0.03 1.19 XXX P

99333 ............. A Rest home visit, estab pat .............................. 1.00 0.44 0.02 1.46 XXX P

99341 ............. A Home visit, new patient .................................. 1.12 0.53 0.05 1.70 XXX P

99342 ............. A Home visit, new patient .................................. 1.58 0.60 0.05 2.23 XXX P

99343 ............. A Home visit, new patient .................................. 2.09 0.77 0.06 2.92 XXX P

99351 ............. A Home visit, estab patient ................................ 0.83 0.45 0.04 1.32 XXX P

99352 ............. A Home visit, estab patient ................................ 1.12 0.53 0.04 1.69 XXX P

99353 ............. A Home visit, estab patient ................................ 1.48 0.61 0.05 2.14 XXX P

99354 ............. A Prolonged service, office ................................ 1.51 0.76 0.07 2.34 XXX P

99355 ............. A Prolonged service, office ................................ 1.51 0.76 0.07 2.34 XXX P

99356 ............. A Prolonged service, inpatient ........................... 1.44 0.85 0.08 2.37 XXX N

99357 ............. A Prolonged service, inpatient ........................... 1.44 0.85 0.08 2.37 XXX N

99358 ............. B Prolonged serv, w/o contact ........................... 0.00 0.00 0.00 0.00 XXX 0

99359 ............. B Prolonged serv, w/o contact ........................... 0.00 0.00 0.00 0.00 XXX 0

99360 ............. X Physician standby services ............................ 0.00 0.00 0.00 0.00 XXX 0

99361 ............. B Physician/team conference ............................. 0.00 0.00 0.00 0.00 XXX 0

99362 ............. B Physician/team conference ............................. 0.00 0.00 0.00 0.00 XXX 0

99371 ............. B Physician phone consultation ......................... 0.00 0.00 0.00 0.00 XXX 0

99372 ............. B Physician phone consultation ......................... 0.00 0.00 0.00 0.00 XXX 0

99373 ............. B Physician phone consultation ......................... 0.00 0.00 0.00 0.00 XXX 0

99375 ............. A Care plan oversight/30–60 ............................. 1.73 0.51 0.04 2.28 XXX P

99376 ............. B Care plan oversight/over 60 ........................... 0.00 0.00 0.00 0.00 XXX 0

99381 ............. N Preventive visit, new, infant ............................ #1.19 1.23 0.08 2.50 XXX 0

99382 ............. N Preventive visit, new, age 1–4 ....................... #1.36 1.41 0.09 2.86 XXX 0

99383 ............. N Preventive visit, new, age 5–11 ..................... #1.36 1.41 0.09 2.86 XXX 0

99384 ............. N Preventive visit, new, 12–17 ........................... #1.53 1.59 0.10 3.22 XXX 0

99385 ............. N Preventive visit, new, 18–39 ........................... #1.53 1.40 0.09 3.02 XXX 0

99386 ............. N Preventive visit, new, 40–64 ........................... #1.88 1.72 0.10 3.70 XXX 0

99387 ............. N Preventive visit, new, 65 & over ..................... #2.06 1.88 0.11 4.05 XXX 0

99391 ............. N Preventive visit, est, infant .............................. #1.02 1.06 0.07 2.15 XXX 0

99392 ............. N Preventive visit, est, age 1–4 ......................... #1.19 1.23 0.08 2.50 XXX 0

99393 ............. N Preventive visit, est, age 5–11 ....................... #1.19 1.23 0.08 2.50 XXX 0

99394 ............. N Preventive visit, est, 12–17 ............................ #1.36 1.41 0.09 2.86 XXX 0

99395 ............. N Preventive visit, est, 18–39 ............................ #1.36 1.25 0.08 2.69 XXX 0

99396 ............. N Preventive visit, est, 40–64 ............................ #1.53 1.40 0.09 3.02 XXX 0

99397 ............. N Preventive visit, est, 65 & over ....................... #1.71 1.56 0.10 3.37 XXX 0

99401 ............. N Preventive counseling, indiv ........................... #0.48 0.45 0.03 0.96 XXX 0

99402 ............. N Preventive counseling, indiv ........................... #0.98 0.89 0.05 1.92 XXX 0

99403 ............. N Preventive counseling, indiv ........................... #1.46 1.34 0.08 2.88 XXX 0

99404 ............. N Preventive counseling, indiv ........................... #1.95 1.78 0.11 3.84 XXX 0

99411 ............. N Preventive counseling, group ......................... #0.15 0.14 0.01 0.30 XXX 0

99412 ............. N Preventive counseling, group ......................... #0.25 0.23 0.01 0.49 XXX 0

99420 ............. N Health risk assessment test ........................... 0.00 0.00 0.00 0.00 XXX 0

99429 ............. N Unlisted preventive service ............................. 0.00 0.00 0.00 0.00 XXX 0

99431 ............. A Initial care, normal newborn ........................... 1.17 1.21 0.08 2.46 XXX N

99432 ............. A Newborn care not in hospital .......................... 1.26 1.31 0.08 2.65 XXX N

99433 ............. A Normal newborn care, hospital ....................... 0.62 0.64 0.04 1.30 XXX N

99435 ............. A Hospital NB discharge day ............................. 1.50 1.55 0.10 3.15 XXX P

99440 ............. A Newborn resuscitation .................................... 2.93 3.04 0.19 6.16 XXX N

99450 ............. N Life/disability evaluation .................................. 0.00 0.00 0.00 0.00 XXX 0

99455 ............. R Disability examination ..................................... 0.00 0.00 0.00 0.00 XXX N

99456 ............. R Disability examination ..................................... 0.00 0.00 0.00 0.00 XXX N

99499 ............. C Unlisted E/M service ....................................... 0.00 0.00 0.00 0.00 XXX N

A0021 ............. G Outside state ambulance serv ........................ 0.00 0.00 0.00 0.00 XXX 0

A0030 ............. X Air ambulance service .................................... 0.00 0.00 0.00 0.00 XXX 0

A0040 ............. X Helicopter ambulance service ......................... 0.00 0.00 0.00 0.00 XXX 0

A0050 ............. X Water amb service emergency ....................... 0.00 0.00 0.00 0.00 XXX 0

A0080 ............. G Noninterest escort in non er ........................... 0.00 0.00 0.00 0.00 XXX 0

A0090 ............. G Interest escort in non er ................................. 0.00 0.00 0.00 0.00 XXX 0

A0100 ............. G Nonemergency transport taxi .......................... 0.00 0.00 0.00 0.00 XXX 0

A0110 ............. G Nonemergency transport bus ......................... 0.00 0.00 0.00 0.00 XXX 0

A0120 ............. G Noner transport mini-bus ................................ 0.00 0.00 0.00 0.00 XXX 0

A0130 ............. G Noner transport wheelch van .......................... 0.00 0.00 0.00 0.00 XXX 0

A0140 ............. G Nonemergency transport air ........................... 0.00 0.00 0.00 0.00 XXX 0

A0160 ............. G Noner transport case worker .......................... 0.00 0.00 0.00 0.00 XXX 0

A0170 ............. G Noner transport parking fees .......................... 0.00 0.00 0.00 0.00 XXX 0
63325

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

A0180 ............. G Noner transport lodgng recip .......................... 0.00 0.00 0.00 0.00 XXX 0

A0190 ............. G Noner transport meals recip ........................... 0.00 0.00 0.00 0.00 XXX 0

A0200 ............. G Noner transport lodgng escrt .......................... 0.00 0.00 0.00 0.00 XXX 0

A0210 ............. G Noner transport meals escort ......................... 0.00 0.00 0.00 0.00 XXX 0

A0225 ............. X Neonatal emergency transport ....................... 0.00 0.00 0.00 0.00 XXX 0

A0300 ............. X Ambulance basic non-emer all ....................... 0.00 0.00 0.00 0.00 XXX 0

A0302 ............. X Ambulance basic emergeny all ....................... 0.00 0.00 0.00 0.00 XXX 0

A0304 ............. X Amb adv non-er no serv all ............................ 0.00 0.00 0.00 0.00 XXX 0

A0306 ............. X Amb adv non-er spec serv all ......................... 0.00 0.00 0.00 0.00 XXX 0

A0308 ............. X Amb adv er no spec serv all ........................... 0.00 0.00 0.00 0.00 XXX 0

A0310 ............. X Amb adv er spec serv all ................................ 0.00 0.00 0.00 0.00 XXX 0

A0320 ............. X Amb basic non-er + supplies .......................... 0.00 0.00 0.00 0.00 XXX 0

A0322 ............. X Amb basic emerg + supplies .......................... 0.00 0.00 0.00 0.00 XXX 0

A0324 ............. X Adv non-er serv sep mileage .......................... 0.00 0.00 0.00 0.00 XXX 0

A0326 ............. X Adv non-er no serv sep mile .......................... 0.00 0.00 0.00 0.00 XXX 0

A0328 ............. X Adv er no serv sep mileage ............................ 0.00 0.00 0.00 0.00 XXX 0

A0330 ............. X Adv er spec serv sep mile .............................. 0.00 0.00 0.00 0.00 XXX 0

A0340 ............. X Amb basic non-er + mileage .......................... 0.00 0.00 0.00 0.00 XXX 0

A0342 ............. X Ambul basic emer + mileage .......................... 0.00 0.00 0.00 0.00 XXX 0

A0344 ............. X Amb adv non-er no serv + mile ...................... 0.00 0.00 0.00 0.00 XXX 0

A0346 ............. X Amb adv non-er serv + mile ........................... 0.00 0.00 0.00 0.00 XXX 0

A0348 ............. X Adv emer no spec serv + mile ....................... 0.00 0.00 0.00 0.00 XXX 0

A0350 ............. X Adv emer spec serv + mileage ....................... 0.00 0.00 0.00 0.00 XXX 0

A0360 ............. X Basic non-er sep mile & supp ........................ 0.00 0.00 0.00 0.00 XXX 0

A0362 ............. X Basic emer sep mile & supply ........................ 0.00 0.00 0.00 0.00 XXX 0

A0364 ............. X Adv non-er no serv sep mi&su ....................... 0.00 0.00 0.00 0.00 XXX 0

A0366 ............. X Adv non-er serv sep mil&supp ....................... 0.00 0.00 0.00 0.00 XXX 0

A0368 ............. X Adv er no serv sep mile&supp ....................... 0.00 0.00 0.00 0.00 XXX 0

A0370 ............. X Adv er spec serv sep mi&supp ....................... 0.00 0.00 0.00 0.00 XXX 0

A0380 ............. X Basic life support mileage ............................... 0.00 0.00 0.00 0.00 XXX 0

A0382 ............. X Basic support routine suppls .......................... 0.00 0.00 0.00 0.00 XXX 0

A0384 ............. X Bls defibrillation supplies ................................ 0.00 0.00 0.00 0.00 XXX 0

A0390 ............. X Advanced life support mileag ......................... 0.00 0.00 0.00 0.00 XXX 0

A0392 ............. X Als defibrillation supplies ................................ 0.00 0.00 0.00 0.00 XXX 0

A0394 ............. X Als IV drug therapy supplies .......................... 0.00 0.00 0.00 0.00 XXX 0

A0396 ............. X Als esophageal intub suppls ........................... 0.00 0.00 0.00 0.00 XXX 0

A0398 ............. X Als routine disposble suppls ........................... 0.00 0.00 0.00 0.00 XXX 0

A0420 ............. X Ambulance waiting 1/2 hr ............................... 0.00 0.00 0.00 0.00 XXX 0

A0422 ............. X Ambulance 02 life sustaining .......................... 0.00 0.00 0.00 0.00 XXX 0

A0424 ............. X Extra ambulance attendant ............................. 0.00 0.00 0.00 0.00 XXX 0

A0888 ............. N Noncovered ambulance mileage .................... 0.00 0.00 0.00 0.00 XXX 0

A0999 ............. X Unlisted ambulance service ............................ 0.00 0.00 0.00 0.00 XXX 0

A2000 ............. A Chiropractor manip of spine ........................... 0.45 0.29 0.01 0.75 XXX N

A4190 ............. P Transparent film each ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4200 ............. P Gauze pad medicated/non-med ..................... 0.00 0.00 0.00 0.00 XXX 0

A4202 ............. P Elastic gauze roll ............................................ 0.00 0.00 0.00 0.00 XXX 0

A4203 ............. P Non-elastic gauze roll ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4204 ............. P Absorptive dressing ........................................ 0.00 0.00 0.00 0.00 XXX 0

A4205 ............. P Nonabsorptive dressing .................................. 0.00 0.00 0.00 0.00 XXX 0

A4206 ............. P 1 CC sterile syringe & needle ......................... 0.00 0.00 0.00 0.00 XXX 0

A4207 ............. P 2 CC sterile syringe & needle ......................... 0.00 0.00 0.00 0.00 XXX 0

A4208 ............. P 3 CC sterile syringe & needle ......................... 0.00 0.00 0.00 0.00 XXX 0

A4209 ............. P 5+ CC sterile syringe & needle ...................... 0.00 0.00 0.00 0.00 XXX 0

A4210 ............. N Nonneedle injection device ............................. 0.00 0.00 0.00 0.00 XXX 0

A4211 ............. P Supp for self-adm injections ........................... 0.00 0.00 0.00 0.00 XXX 0

A4212 ............. P Non coring needle or stylet ............................. 0.00 0.00 0.00 0.00 XXX 0

A4213 ............. P 20+ CC syringe only ....................................... 0.00 0.00 0.00 0.00 XXX 0

A4214 ............. P 30 CC sterile water/saline ............................... 0.00 0.00 0.00 0.00 XXX 0

A4215 ............. P Sterile needle .................................................. 0.00 0.00 0.00 0.00 XXX 0

A4220 ............. P Infusion pump refill kit ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4230 ............. N Infus insulin pump non needle ....................... 0.00 0.00 0.00 0.00 XXX 0

A4231 ............. N Infusion insulin pump needle .......................... 0.00 0.00 0.00 0.00 XXX 0

A4232 ............. N Syringe w/needle insulin 3cc .......................... 0.00 0.00 0.00 0.00 XXX 0

A4244 ............. P Alcohol or peroxide per pint ........................... 0.00 0.00 0.00 0.00 XXX 0

A4245 ............. P Alcohol wipes per box .................................... 0.00 0.00 0.00 0.00 XXX 0

A4246 ............. P Betadine/phisohex solution ............................. 0.00 0.00 0.00 0.00 XXX 0
63326

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

A4247 ............. P Betadine/iodine swabs/wipes .......................... 0.00 0.00 0.00 0.00 XXX 0

A4250 ............. R Urine reagent strips/tablets ............................. 0.00 0.00 0.00 0.00 XXX N

A4253 ............. P Blood glucose/reagent strips .......................... 0.00 0.00 0.00 0.00 XXX 0

A4254 ............. X Battery for glucose monitor ............................. 0.00 0.00 0.00 0.00 XXX 0

A4256 ............. P Calibrator solution/chips ................................. 0.00 0.00 0.00 0.00 XXX 0

A4258 ............. P Lancet device each ......................................... 0.00 0.00 0.00 0.00 XXX 0

A4259 ............. P Lancets per box .............................................. 0.00 0.00 0.00 0.00 XXX 0

A4260 ............. N Levonorgestrel implant ................................... 0.00 0.00 0.00 0.00 XXX 0

A4262 ............. B Temporary tear duct plug ............................... 0.00 0.00 0.00 0.00 XXX 0

A4263 ............. A Permanent tear duct plug ............................... 0.00 0.95 0.00 0.95 XXX N

A4265 ............. P Paraffin ............................................................ 0.00 0.00 0.00 0.00 XXX 0

A4270 ............. B Disposable endoscope sheath ....................... 0.00 0.00 0.00 0.00 XXX 0

A4300 ............. A Cath impl vasc access portal .......................... 0.00 0.95 0.00 0.95 XXX N

A4301 ............. P Implantable access syst perc ......................... 0.00 0.00 0.00 0.00 XXX 0

A4305 ............. P Drug delivery system >=50 ML ....................... 0.00 0.00 0.00 0.00 XXX 0

A4306 ............. P Drug delivery system <=5 ML ......................... 0.00 0.00 0.00 0.00 XXX 0

A4310 ............. P Insert tray w/o bag/cath .................................. 0.00 0.00 0.00 0.00 XXX 0

A4311 ............. P Catheter w/o bag 2-way latex ......................... 0.00 0.00 0.00 0.00 XXX 0

A4312 ............. P Cath w/o bag 2-way silicone ........................... 0.00 0.00 0.00 0.00 XXX 0

A4313 ............. P Catheter w/bag 3-way ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4314 ............. P Cath w/drainage 2-way latex .......................... 0.00 0.00 0.00 0.00 XXX 0

A4315 ............. P Cath w/drainage 2-way silcne ......................... 0.00 0.00 0.00 0.00 XXX 0

A4316 ............. P Cath w/drainage 3-way ................................... 0.00 0.00 0.00 0.00 XXX 0

A4320 ............. P Irrigation tray ................................................... 0.00 0.00 0.00 0.00 XXX 0

A4322 ............. P Irrigation syringe ............................................. 0.00 0.00 0.00 0.00 XXX 0

A4323 ............. P Saline irrigation solution ................................. 0.00 0.00 0.00 0.00 XXX 0

A4326 ............. P Male external catheter .................................... 0.00 0.00 0.00 0.00 XXX 0

A4327 ............. P Fem urinary collect dev cup ........................... 0.00 0.00 0.00 0.00 XXX 0

A4328 ............. P Fem urinary collect pouch .............................. 0.00 0.00 0.00 0.00 XXX 0

A4329 ............. P External catheter start set ............................... 0.00 0.00 0.00 0.00 XXX 0

A4330 ............. P Stool collection pouch ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4335 ............. P Incontinence supply ........................................ 0.00 0.00 0.00 0.00 XXX 0

A4338 ............. P Indwelling catheter latex ................................. 0.00 0.00 0.00 0.00 XXX 0

A4340 ............. P Indwelling catheter special ............................. 0.00 0.00 0.00 0.00 XXX 0

A4344 ............. P Cath indw foley 2 way silicn ........................... 0.00 0.00 0.00 0.00 XXX 0

A4346 ............. P Cath indw foley 3 way .................................... 0.00 0.00 0.00 0.00 XXX 0

A4347 ............. P Male external catheter .................................... 0.00 0.00 0.00 0.00 XXX 0

A4351 ............. P Straight tip urine catheter ............................... 0.00 0.00 0.00 0.00 XXX 0

A4352 ............. P Coude tip urinary catheter .............................. 0.00 0.00 0.00 0.00 XXX 0

A4354 ............. P Cath insertion tray w/bag ................................ 0.00 0.00 0.00 0.00 XXX 0

A4355 ............. P Bladder irrigation tubing .................................. 0.00 0.00 0.00 0.00 XXX 0

A4356 ............. P Ext ureth clmp or compr dvc .......................... 0.00 0.00 0.00 0.00 XXX 0

A4357 ............. P Bedside drainage bag ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4358 ............. P Urinary leg bag ............................................... 0.00 0.00 0.00 0.00 XXX 0

A4359 ............. P Urinary suspensory w/o leg bag ..................... 0.00 0.00 0.00 0.00 XXX 0

A4361 ............. P Ostomy face plate ........................................... 0.00 0.00 0.00 0.00 XXX 0

A4362 ............. P Solid skin barrier ............................................. 0.00 0.00 0.00 0.00 XXX 0

A4363 ............. P Liquid skin barrier ........................................... 0.00 0.00 0.00 0.00 XXX 0

A4364 ............. P Ostomy/cath adhesive .................................... 0.00 0.00 0.00 0.00 XXX 0

A4367 ............. P Ostomy belt ..................................................... 0.00 0.00 0.00 0.00 XXX 0

A4397 ............. P Irrigation supply sleeve ................................... 0.00 0.00 0.00 0.00 XXX 0

A4398 ............. P Irrigation supply bags ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4399 ............. P Irrigation supply cone/cathe ............................ 0.00 0.00 0.00 0.00 XXX 0

A4400 ............. P Ostomy irrigation set ....................................... 0.00 0.00 0.00 0.00 XXX 0

A4402 ............. P Lubricant per ounce ........................................ 0.00 0.00 0.00 0.00 XXX 0

A4404 ............. P Ostomy ring each ........................................... 0.00 0.00 0.00 0.00 XXX 0

A4421 ............. P Ostomy supply misc ........................................ 0.00 0.00 0.00 0.00 XXX 0

A4454 ............. P Tape all types all sizes ................................... 0.00 0.00 0.00 0.00 XXX 0

A4455 ............. P Adhesive remover per ounce .......................... 0.00 0.00 0.00 0.00 XXX 0

A4460 ............. P Elastic compression bandage ......................... 0.00 0.00 0.00 0.00 XXX 0

A4465 ............. P Non-elastic extremity binder ........................... 0.00 0.00 0.00 0.00 XXX 0

A4470 ............. P Gravlee jet washer .......................................... 0.00 0.00 0.00 0.00 XXX 0

A4480 ............. P Vabra aspirator ............................................... 0.00 0.00 0.00 0.00 XXX 0

A4490 ............. N Above knee surgical stocking ......................... 0.00 0.00 0.00 0.00 XXX 0

A4495 ............. N Thigh length surg stocking ............................. 0.00 0.00 0.00 0.00 XXX 0

A4500 ............. N Below knee surgical stocking ......................... 0.00 0.00 0.00 0.00 XXX 0
63327

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

A4510 ............. N Full length surg stocking ................................. 0.00 0.00 0.00 0.00 XXX 0

A4550 ............. A Surgical trays .................................................. 0.00 0.95 0.00 0.95 XXX N

A4554 ............. N Disposable underpads .................................... 0.00 0.00 0.00 0.00 XXX 0

A4556 ............. P Electrodes ....................................................... 0.00 0.00 0.00 0.00 XXX 0

A4557 ............. P Lead wires ...................................................... 0.00 0.00 0.00 0.00 XXX 0

A4558 ............. P Conductive paste or gel .................................. 0.00 0.00 0.00 0.00 XXX 0

A4560 ............. X Pessary ........................................................... 0.00 0.00 0.00 0.00 XXX 0

A4565 ............. X Slings .............................................................. 0.00 0.00 0.00 0.00 XXX 0

A4570 ............. X Splint ............................................................... 0.00 0.00 0.00 0.00 XXX 0

A4572 ............. X Rib belt ............................................................ 0.00 0.00 0.00 0.00 XXX 0

A4575 ............. N Hyperbaric O2 chamber disps ........................ 0.00 0.00 0.00 0.00 XXX 0

A4580 ............. X Cast supplies (plaster) .................................... 0.00 0.00 0.00 0.00 XXX 0

A4581 ............. X Risser jacket supplies ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4590 ............. X Special casting material .................................. 0.00 0.00 0.00 0.00 XXX 0

A4595 ............. X TENS suppl 2 lead per month ........................ 0.00 0.00 0.00 0.00 XXX 0

A4610 ............. X Med supplies for use in DME ......................... 0.00 0.00 0.00 0.00 XXX 0

A4611 ............. X Heavy duty battery .......................................... 0.00 0.00 0.00 0.00 XXX 0

A4612 ............. X Battery cables ................................................. 0.00 0.00 0.00 0.00 XXX 0

A4613 ............. X Battery charger ............................................... 0.00 0.00 0.00 0.00 XXX 0

A4615 ............. X Cannula nasal ................................................. 0.00 0.00 0.00 0.00 XXX 0

A4616 ............. X Tubing (oxygen) per foot ................................ 0.00 0.00 0.00 0.00 XXX 0

A4617 ............. X Mouth piece .................................................... 0.00 0.00 0.00 0.00 XXX 0

A4618 ............. X Breathing circuits ............................................ 0.00 0.00 0.00 0.00 XXX 0

A4619 ............. X Face tent ......................................................... 0.00 0.00 0.00 0.00 XXX 0

A4620 ............. X Variable concentration mask .......................... 0.00 0.00 0.00 0.00 XXX 0

A4621 ............. X Tracheotomy mask or collar ........................... 0.00 0.00 0.00 0.00 XXX 0

A4622 ............. X Tracheostomy or larngectomy ........................ 0.00 0.00 0.00 0.00 XXX 0

A4623 ............. X Tracheostomy inner cannula .......................... 0.00 0.00 0.00 0.00 XXX 0

A4624 ............. X Tracheal suction tube ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4625 ............. X Trach care kit for new trach ............................ 0.00 0.00 0.00 0.00 XXX 0

A4626 ............. X Tracheostomy cleaning brush ......................... 0.00 0.00 0.00 0.00 XXX 0

A4627 ............. X Spacer bag/reservoir ...................................... 0.00 0.00 0.00 0.00 XXX 0

A4628 ............. X Oropharyngeal suction cath ............................ 0.00 0.00 0.00 0.00 XXX 0

A4629 ............. X Tracheostomy care kit .................................... 0.00 0.00 0.00 0.00 XXX 0

A4630 ............. X Repl bat t.e.n.s. own by pt ............................. 0.00 0.00 0.00 0.00 XXX 0

A4631 ............. X Wheelchair battery .......................................... 0.00 0.00 0.00 0.00 XXX 0

A4635 ............. X Underarm crutch pad ...................................... 0.00 0.00 0.00 0.00 XXX 0

A4636 ............. X Handgrip for cane etc ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4637 ............. X Repl tip cane/crutch/walker ............................. 0.00 0.00 0.00 0.00 XXX 0

A4640 ............. X Alternating pressure pad ................................ 0.00 0.00 0.00 0.00 XXX 0

A4641 ............. E Diagnostic imaging agent ............................... 0.00 0.00 0.00 0.00 XXX 0

A4642 ............. E Satumomab pendetide per dose .................... 0.00 0.00 0.00 0.00 XXX 0

A4643 ............. E High dose contrast MRI .................................. 0.00 0.00 0.00 0.00 XXX 0

A4644 ............. E Contrast 100–199 MGs iodine ........................ 0.00 0.00 0.00 0.00 XXX 0

A4645 ............. E Contrast 200–299 MGs iodine ........................ 0.00 0.00 0.00 0.00 XXX 0

A4646 ............. E Contrast 300–399 MGs iodine ........................ 0.00 0.00 0.00 0.00 XXX 0

A4647 ............. B Supp- paramagnetic contr mat ....................... 0.00 0.00 0.00 0.00 XXX 0

A4649 ............. B Surgical supplies ............................................. 0.00 0.00 0.00 0.00 XXX 0

A4650 ............. X Supp esrd centrifuge ...................................... 0.00 0.00 0.00 0.00 XXX 0

A4655 ............. X Esrd syringe/needle ........................................ 0.00 0.00 0.00 0.00 XXX 0

A4660 ............. X Esrd blood pressure device ............................ 0.00 0.00 0.00 0.00 XXX 0

A4663 ............. X Esrd blood pressure cuff ................................ 0.00 0.00 0.00 0.00 XXX 0

A4670 ............. N Auto blood pressure monitor .......................... 0.00 0.00 0.00 0.00 XXX 0

A4680 ............. X Activated carbon filters ................................... 0.00 0.00 0.00 0.00 XXX 0

A4690 ............. X Dialyzers ......................................................... 0.00 0.00 0.00 0.00 XXX 0

A4700 ............. X Standard dialysate solution ............................ 0.00 0.00 0.00 0.00 XXX 0

A4705 ............. X Bicarb dialysate solution ................................. 0.00 0.00 0.00 0.00 XXX 0

A4712 ............. X Sterile water .................................................... 0.00 0.00 0.00 0.00 XXX 0

A4714 ............. X Treated water for dialysis ............................... 0.00 0.00 0.00 0.00 XXX 0

A4730 ............. X Fistula cannulation set dial ............................. 0.00 0.00 0.00 0.00 XXX 0

A4735 ............. X Local/topical anesthetics ................................. 0.00 0.00 0.00 0.00 XXX 0

A4740 ............. X Esrd shunt accessory ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4750 ............. X Arterial or venous tubing ................................ 0.00 0.00 0.00 0.00 XXX 0

A4755 ............. X Arterial and venous tubing .............................. 0.00 0.00 0.00 0.00 XXX 0

A4760 ............. X Standard testing solution ................................ 0.00 0.00 0.00 0.00 XXX 0

A4765 ............. X Dialysate concentrate ..................................... 0.00 0.00 0.00 0.00 XXX 0
63328

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

A4770 ............. X Blood testing supplies ..................................... 0.00 0.00 0.00 0.00 XXX 0

A4771 ............. X Blood clotting time tube .................................. 0.00 0.00 0.00 0.00 XXX 0

A4772 ............. X Dextrostick/glucose strips ............................... 0.00 0.00 0.00 0.00 XXX 0

A4773 ............. X Hemostix ......................................................... 0.00 0.00 0.00 0.00 XXX 0

A4774 ............. X Ammonia test paper ....................................... 0.00 0.00 0.00 0.00 XXX 0

A4780 ............. X Esrd sterilizing agent ...................................... 0.00 0.00 0.00 0.00 XXX 0

A4790 ............. X Esrd cleansing agents .................................... 0.00 0.00 0.00 0.00 XXX 0

A4800 ............. X Heparin/antidote dialysis ................................. 0.00 0.00 0.00 0.00 XXX 0

A4820 ............. X Supplies hemodialysis kit ............................... 0.00 0.00 0.00 0.00 XXX 0

A4850 ............. X Rubber tipped hemostats ............................... 0.00 0.00 0.00 0.00 XXX 0

A4860 ............. X Disposable catheter caps ............................... 0.00 0.00 0.00 0.00 XXX 0

A4870 ............. X Plumbing/electrical work ................................. 0.00 0.00 0.00 0.00 XXX 0

A4880 ............. X Water storage tanks ....................................... 0.00 0.00 0.00 0.00 XXX 0

A4890 ............. N Contracts/repair/maintenance ......................... 0.00 0.00 0.00 0.00 XXX 0

A4900 ............. X Capd supply kit ............................................... 0.00 0.00 0.00 0.00 XXX 0

A4901 ............. X Ccpd supply kit ............................................... 0.00 0.00 0.00 0.00 XXX 0

A4905 ............. X Ipd supply kit ................................................... 0.00 0.00 0.00 0.00 XXX 0

A4910 ............. X Esrd nonmedical supplies ............................... 0.00 0.00 0.00 0.00 XXX 0

A4912 ............. X Gomco drain bottle ......................................... 0.00 0.00 0.00 0.00 XXX 0

A4913 ............. X Esrd supply ..................................................... 0.00 0.00 0.00 0.00 XXX 0

A4914 ............. X Preparation kit ................................................. 0.00 0.00 0.00 0.00 XXX 0

A4918 ............. X Venous pressure clamp .................................. 0.00 0.00 0.00 0.00 XXX 0

A4919 ............. X Supp dialysis dialyzer holde ........................... 0.00 0.00 0.00 0.00 XXX 0

A4920 ............. X Harvard pressure clamp ................................. 0.00 0.00 0.00 0.00 XXX 0

A4921 ............. X Measuring cylinder .......................................... 0.00 0.00 0.00 0.00 XXX 0

A4927 ............. X Gloves ............................................................. 0.00 0.00 0.00 0.00 XXX 0

A5051 ............. P Pouch clsd w barr attached ............................ 0.00 0.00 0.00 0.00 XXX 0

A5052 ............. P Clsd ostomy pouch w/o barr ........................... 0.00 0.00 0.00 0.00 XXX 0

A5053 ............. P Clsd ostomy pouch faceplate ......................... 0.00 0.00 0.00 0.00 XXX 0

A5054 ............. P Clsd ostomy pouch w/flange .......................... 0.00 0.00 0.00 0.00 XXX 0

A5055 ............. P Stoma cap ....................................................... 0.00 0.00 0.00 0.00 XXX 0

A5061 ............. P Pouch drainable w barrier at .......................... 0.00 0.00 0.00 0.00 XXX 0

A5062 ............. P Drnble ostomy pouch w/o barr ....................... 0.00 0.00 0.00 0.00 XXX 0

A5063 ............. P Drain ostomy pouch w/flange ......................... 0.00 0.00 0.00 0.00 XXX 0

A5064 ............. P Drain ostomy pouch w/fceplte ........................ 0.00 0.00 0.00 0.00 XXX 0

A5065 ............. P Drain ostomy pouch on fcplte ......................... 0.00 0.00 0.00 0.00 XXX 0

A5071 ............. P Urinary pouch w/barrier .................................. 0.00 0.00 0.00 0.00 XXX 0

A5072 ............. P Urinary pouch w/o barrier ............................... 0.00 0.00 0.00 0.00 XXX 0

A5073 ............. P Urinary pouch on barr w/flng .......................... 0.00 0.00 0.00 0.00 XXX 0

A5074 ............. P Urinary pouch w/faceplate .............................. 0.00 0.00 0.00 0.00 XXX 0

A5075 ............. P Urinary pouch on faceplate ............................ 0.00 0.00 0.00 0.00 XXX 0

A5081 ............. P Continent stoma plug ...................................... 0.00 0.00 0.00 0.00 XXX 0

A5082 ............. P Continent stoma catheter ............................... 0.00 0.00 0.00 0.00 XXX 0

A5093 ............. P Ostomy accessory convex inse ...................... 0.00 0.00 0.00 0.00 XXX 0

A5102 ............. P Bedside btle rigid/expanable .......................... 0.00 0.00 0.00 0.00 XXX 0

A5105 ............. P Urinary suspensory ......................................... 0.00 0.00 0.00 0.00 XXX 0

A5112 ............. P Urinary leg bag ............................................... 0.00 0.00 0.00 0.00 XXX 0

A5113 ............. P Latex leg strap ................................................ 0.00 0.00 0.00 0.00 XXX 0

A5114 ............. P Foam/fabric leg strap ...................................... 0.00 0.00 0.00 0.00 XXX 0

A5119 ............. P Skin barrier wipes box pr 50 ........................... 0.00 0.00 0.00 0.00 XXX 0

A5121 ............. P Solid skin barrier 6x6 ...................................... 0.00 0.00 0.00 0.00 XXX 0

A5122 ............. P Solid skin barrier 8x8 ...................................... 0.00 0.00 0.00 0.00 XXX 0

A5123 ............. P Skin barrier with flange ................................... 0.00 0.00 0.00 0.00 XXX 0

A5126 ............. P Adhesive disc/foam pad ................................. 0.00 0.00 0.00 0.00 XXX 0

A5131 ............. P Appliance cleaner ........................................... 0.00 0.00 0.00 0.00 XXX 0

A5149 ............. P Incontinence/ostomy supply ........................... 0.00 0.00 0.00 0.00 XXX 0

A5500 ............. X Diab shoe for density insert ............................ 0.00 0.00 0.00 0.00 XXX 0

A5501 ............. X Diabetic custom molded shoe ........................ 0.00 0.00 0.00 0.00 XXX 0

A5502 ............. X Diabetic shoe density insert ........................... 0.00 0.00 0.00 0.00 XXX 0

A5503 ............. X Diabetic shoe w/roller/rockr ............................ 0.00 0.00 0.00 0.00 XXX 0

A5504 ............. X Diabetic shoe with wedge ............................... 0.00 0.00 0.00 0.00 XXX 0

A5505 ............. X Diab shoe w/metatarsal bar ............................ 0.00 0.00 0.00 0.00 XXX 0

A5506 ............. X Diabetic shoe w/off set heel ........................... 0.00 0.00 0.00 0.00 XXX 0

A5507 ............. X Modification diabetic shoe .............................. 0.00 0.00 0.00 0.00 XXX 0

A6020 ............. P Collagen dressing cover ea ............................ 0.00 0.00 0.00 0.00 XXX 0

A9150 ............. E Misc/exper non-prescript dru .......................... 0.00 0.00 0.00 0.00 XXX 0
63329

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

A9160 ............. N Podiatrist non-covered servi ........................... 0.00 0.00 0.00 0.00 XXX 0

A9170 ............. N Chiropractor non-covered ser ......................... 0.00 0.00 0.00 0.00 XXX 0

A9190 ............. N Misc/expe personal comfort i .......................... 0.00 0.00 0.00 0.00 XXX 0

A9270 ............. N Non-covered item or service ........................... 0.00 0.00 0.00 0.00 XXX 0

A9300 ............. N Exercise equipment ........................................ 0.00 0.00 0.00 0.00 XXX 0

A9500 ............. E Technetium TC 99m sestamibi ....................... 0.00 0.00 0.00 0.00 XXX 0

A9505 ............. E Thallous chloride TL 201/mci .......................... 0.00 0.00 0.00 0.00 XXX 0

D0110 ............. D Initial oral examination .................................... 0.00 0.00 0.00 0.00 YYY N

D0120 ............. N Periodic oral evaluation .................................. 0.00 0.00 0.00 0.00 XXX 0

D0130 ............. D Emergency oral examination .......................... 0.00 0.00 0.00 0.00 YYY N

D0140 ............. N Limit oral eval problm focus ............................ 0.00 0.00 0.00 0.00 XXX 0

D0150 ............. R Comprehensve oral evaluation ....................... 0.00 0.00 0.00 0.00 YYY N

D0160 ............. N Extensv oral eval prob focus .......................... 0.00 0.00 0.00 0.00 XXX 0

D0210 ............. G Intraor complete film series ............................ 0.00 0.00 0.00 0.00 XXX 0

D0220 ............. G Intraoral periapical first f ................................. 0.00 0.00 0.00 0.00 XXX 0

D0230 ............. G Intraoral periapical ea add .............................. 0.00 0.00 0.00 0.00 XXX 0

D0240 ............. R Intraoral occlusal film ...................................... 0.00 0.00 0.00 0.00 YYY N

D0250 ............. R Extraoral first film ............................................ 0.00 0.00 0.00 0.00 YYY N

D0260 ............. R Extraoral ea additional film ............................. 0.00 0.00 0.00 0.00 YYY N

D0270 ............. R Dental bitewing single film .............................. 0.00 0.00 0.00 0.00 YYY N

D0272 ............. R Dental bitewings two films .............................. 0.00 0.00 0.00 0.00 YYY N

D0274 ............. R Dental bitewings four films .............................. 0.00 0.00 0.00 0.00 YYY N

D0290 ............. G Dental film skull/facial bon .............................. 0.00 0.00 0.00 0.00 XXX 0

D0310 ............. G Dental saliography .......................................... 0.00 0.00 0.00 0.00 XXX 0

D0320 ............. G Dental tmj arthrogram incl i ............................ 0.00 0.00 0.00 0.00 XXX 0

D0321 ............. G Dental other tmj films ...................................... 0.00 0.00 0.00 0.00 XXX 0

D0322 ............. G Dental tomographic survey ............................. 0.00 0.00 0.00 0.00 XXX 0

D0330 ............. G Dental panoramic film ..................................... 0.00 0.00 0.00 0.00 XXX 0

D0340 ............. G Dental cephalometric film ............................... 0.00 0.00 0.00 0.00 XXX 0

D0415 ............. N Bacteriologic study .......................................... 0.00 0.00 0.00 0.00 XXX 0

D0425 ............. N Caries susceptibility test ................................. 0.00 0.00 0.00 0.00 XXX 0

D0460 ............. R Pulp vitality test ............................................... 0.00 0.00 0.00 0.00 YYY N

D0470 ............. N Diagnostic casts .............................................. 0.00 0.00 0.00 0.00 XXX 0

D0471 ............. R Diagnostic photographs .................................. 0.00 0.00 0.00 0.00 YYY N

D0501 ............. R Histopathologic examinations ......................... 0.00 0.00 0.00 0.00 YYY N

D0502 ............. R Other oral pathology procedu ......................... 0.00 0.00 0.00 0.00 YYY N

D0999 ............. R Unspecified diagnostic proce .......................... 0.00 0.00 0.00 0.00 YYY N

D1110 ............. N Dental prophylaxis adult ................................. 0.00 0.00 0.00 0.00 XXX 0

D1120 ............. N Dental prophylaxis child .................................. 0.00 0.00 0.00 0.00 XXX 0

D1201 ............. N Topical fluor w prophy child ............................ 0.00 0.00 0.00 0.00 XXX 0

D1203 ............. N Topical fluor w/o prophy chi ............................ 0.00 0.00 0.00 0.00 XXX 0

D1204 ............. N Topical fluor w/o prophy adu .......................... 0.00 0.00 0.00 0.00 XXX 0

D1205 ............. N Topical fluoride w/ prophy a ........................... 0.00 0.00 0.00 0.00 XXX 0

D1310 ............. N Nutri counsel-control caries ............................ 0.00 0.00 0.00 0.00 XXX 0

D1320 ............. N Tobacco counseling ........................................ 0.00 0.00 0.00 0.00 XXX 0

D1330 ............. N Oral hygiene instruction .................................. 0.00 0.00 0.00 0.00 XXX 0

D1351 ............. N Dental sealant per tooth ................................. 0.00 0.00 0.00 0.00 XXX 0

D1510 ............. R Space maintainer fxd unilat ............................ 0.00 0.00 0.00 0.00 YYY N

D1515 ............. R Fixed bilat space maintainer ........................... 0.00 0.00 0.00 0.00 YYY N

D1520 ............. R Remove unilat space maintain ....................... 0.00 0.00 0.00 0.00 YYY N

D1515 ............. R Fixed bilat space maintainer ........................... 0.00 0.00 0.00 0.00 YYY N

D1520 ............. R Remove unilat space maintain ....................... 0.00 0.00 0.00 0.00 YYY N

D1525 ............. R Remove bilat space maintain ......................... 0.00 0.00 0.00 0.00 YYY N

D1550 ............. R Recement space maintainer ........................... 0.00 0.00 0.00 0.00 YYY N

D2110 ............. N Amalgam one surface primary ........................ 0.00 0.00 0.00 0.00 XXX 0

D2120 ............. N Amalgam two surfaces primary ...................... 0.00 0.00 0.00 0.00 XXX 0

D2130 ............. N Amalgam three surfaces prima ....................... 0.00 0.00 0.00 0.00 XXX 0

D2131 ............. N Amalgam four/more surf prima ....................... 0.00 0.00 0.00 0.00 XXX 0

D2140 ............. N Amalgam one surface permanen ................... 0.00 0.00 0.00 0.00 XXX 0

D2150 ............. N Amalgam two surfaces permane .................... 0.00 0.00 0.00 0.00 XXX 0

D2160 ............. N Amalgam three surfaces perma ..................... 0.00 0.00 0.00 0.00 XXX 0

D2161 ............. N Amalgam 4 or > surfaces perm ...................... 0.00 0.00 0.00 0.00 XXX 0

D2210 ............. N Silcate cement per restorat ............................. 0.00 0.00 0.00 0.00 XXX 0

D2330 ............. N Resin one surface-anterior ............................. 0.00 0.00 0.00 0.00 XXX 0

D2331 ............. N Resin two surfaces-anterior ............................ 0.00 0.00 0.00 0.00 XXX 0

D2332 ............. N Resin three surfaces-anterio .......................... 0.00 0.00 0.00 0.00 XXX 0
63330

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

D2335 ............. N Resin 4/> surf or w incis an ............................ 0.00 0.00 0.00 0.00 XXX 0

D2336 ............. N Composite resin crown ................................... 0.00 0.00 0.00 0.00 XXX 0

D2380 ............. N Resin one surf poster primar .......................... 0.00 0.00 0.00 0.00 XXX 0

D2381 ............. N Resin two surf poster primar .......................... 0.00 0.00 0.00 0.00 XXX 0

D2382 ............. N Resin three/more surf post p .......................... 0.00 0.00 0.00 0.00 XXX 0

D2385 ............. N Resin one surf poster perman ........................ 0.00 0.00 0.00 0.00 XXX 0

D2386 ............. N Resin two surf poster perman ........................ 0.00 0.00 0.00 0.00 XXX 0

D2387 ............. N Resin three/more surf post p .......................... 0.00 0.00 0.00 0.00 XXX 0

D2410 ............. N Dental gold foil one surface ............................ 0.00 0.00 0.00 0.00 XXX 0

D2420 ............. N Dental gold foil two surface ............................ 0.00 0.00 0.00 0.00 XXX 0

D2430 ............. N Dental gold foil three surfa ............................. 0.00 0.00 0.00 0.00 XXX 0

D2510 ............. N Dental inlay metalic 1 surf .............................. 0.00 0.00 0.00 0.00 XXX 0

D2520 ............. N Dental inlay metallic 2 surf ............................. 0.00 0.00 0.00 0.00 XXX 0

D2530 ............. N Dental inlay metl 3/more sur ........................... 0.00 0.00 0.00 0.00 XXX 0

D2540 ............. D Dental onlay metallic ...................................... 0.00 0.00 0.00 0.00 YYY N

D2543 ............. N Dental onlay metallic 3 surf ............................ 0.00 0.00 0.00 0.00 XXX 0

D2544 ............. N Dental onlay metl 4/more sur ......................... 0.00 0.00 0.00 0.00 XXX 0

D2610 ............. N Inlay porcelain/ceramic 1 su ........................... 0.00 0.00 0.00 0.00 XXX 0

D2620 ............. N Inlay porcelain/ceramic 2 su ........................... 0.00 0.00 0.00 0.00 XXX 0

D2630 ............. N Dental onlay porc 3/more sur ......................... 0.00 0.00 0.00 0.00 XXX 0

D2640 ............. D Onlay w inlay porcelain/cera ........................... 0.00 0.00 0.00 0.00 YYY N

D2642 ............. N Dental onlay porcelin 2 surf ............................ 0.00 0.00 0.00 0.00 XXX 0

D2643 ............. N Dental onlay porcelin 3 surf ............................ 0.00 0.00 0.00 0.00 XXX 0

D2644 ............. N Dental onlay porc 4/more sur ......................... 0.00 0.00 0.00 0.00 XXX 0

D2650 ............. N Inlay composite/resin one su .......................... 0.00 0.00 0.00 0.00 XXX 0

D2651 ............. N Inlay composite/resin two su .......................... 0.00 0.00 0.00 0.00 XXX 0

D2652 ............. N Dental inlay resin 3/mre sur ............................ 0.00 0.00 0.00 0.00 XXX 0

D2660 ............. D Onlay w inlay composite/resi .......................... 0.00 0.00 0.00 0.00 YYY N

D2662 ............. N Dental onlay resin 2 surface ........................... 0.00 0.00 0.00 0.00 XXX 0

D2663 ............. N Dental onlay resin 3 surface ........................... 0.00 0.00 0.00 0.00 XXX 0

D2664 ............. N Dental onlay resin 4/mre sur .......................... 0.00 0.00 0.00 0.00 XXX 0

D2710 ............. N Crown resin laboratory .................................... 0.00 0.00 0.00 0.00 XXX 0

D2720 ............. N Crown resin w/ high noble me ........................ 0.00 0.00 0.00 0.00 XXX 0

D2721 ............. N Crown resin w/ base metal ............................. 0.00 0.00 0.00 0.00 XXX 0

D2722 ............. N Crown resin w/ noble metal ............................ 0.00 0.00 0.00 0.00 XXX 0

D2740 ............. N Crown porcelain/ceramic subs ........................ 0.00 0.00 0.00 0.00 XXX 0

D2750 ............. N Crown porcelain w/ h noble m ........................ 0.00 0.00 0.00 0.00 XXX 0

D2751 ............. N Crown porcelain fused base m ....................... 0.00 0.00 0.00 0.00 XXX 0

D2752 ............. N Crown porcelain w/ noble met ........................ 0.00 0.00 0.00 0.00 XXX 0

D2790 ............. N Crown full cast high noble m .......................... 0.00 0.00 0.00 0.00 XXX 0

D2791 ............. N Crown full cast base metal ............................. 0.00 0.00 0.00 0.00 XXX 0

D2792 ............. N Crown full cast noble metal ............................ 0.00 0.00 0.00 0.00 XXX 0

D2810 ............. N Crown 3/4 cast metallic .................................. 0.00 0.00 0.00 0.00 XXX 0

D2910 ............. N Dental recement inlay ..................................... 0.00 0.00 0.00 0.00 XXX 0

D2920 ............. N Dental recement crown ................................... 0.00 0.00 0.00 0.00 XXX 0

D2930 ............. N Prefab stnlss steel crwn pri ............................ 0.00 0.00 0.00 0.00 XXX 0

D2931 ............. N Prefab stnlss steel crown pe .......................... 0.00 0.00 0.00 0.00 XXX 0

D2932 ............. N Prefabricated resin crown ............................... 0.00 0.00 0.00 0.00 XXX 0

D2933 ............. N Prefab stainless steel crown ........................... 0.00 0.00 0.00 0.00 XXX 0

D2940 ............. N Dental sedative filling ...................................... 0.00 0.00 0.00 0.00 XXX 0

D2950 ............. N Core build-up incl any pins ............................. 0.00 0.00 0.00 0.00 XXX 0

D2951 ............. N Tooth pin retention .......................................... 0.00 0.00 0.00 0.00 XXX 0

D2952 ............. N Post and core cast + crown ............................ 0.00 0.00 0.00 0.00 XXX 0

D2954 ............. N Prefab post/core + crown ............................... 0.00 0.00 0.00 0.00 XXX 0

D2955 ............. N Post removal ................................................... 0.00 0.00 0.00 0.00 XXX 0

D2960 ............. N Laminate labial veneer ................................... 0.00 0.00 0.00 0.00 XXX 0

D2961 ............. N Lab labial veneer resin ................................... 0.00 0.00 0.00 0.00 XXX 0

D2962 ............. N Lab labial veneer porcelain ............................ 0.00 0.00 0.00 0.00 XXX 0

D2970 ............. R Temporary- fractured tooth ............................. 0.00 0.00 0.00 0.00 YYY N

D2980 ............. N Crown repair ................................................... 0.00 0.00 0.00 0.00 XXX 0

D2999 ............. R Dental unspec restorative pr .......................... 0.00 0.00 0.00 0.00 YYY N

D3110 ............. N Pulp cap direct ................................................ 0.00 0.00 0.00 0.00 XXX 0

D3120 ............. N Pulp cap indirect ............................................. 0.00 0.00 0.00 0.00 XXX 0

D3220 ............. N Therapeutic pulpotomy ................................... 0.00 0.00 0.00 0.00 XXX 0

D3230 ............. N Pulpal therapy anterior prim ........................... 0.00 0.00 0.00 0.00 XXX 0

D3240 ............. N Pulpal therapy posterior pri ............................. 0.00 0.00 0.00 0.00 XXX 0
63331

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

D3310 ............. N Anterior ........................................................... 0.00 0.00 0.00 0.00 XXX 0

D3320 ............. N Root canal therapy 2 canals ........................... 0.00 0.00 0.00 0.00 XXX 0

D3330 ............. N Root canal therapy 3 canals ........................... 0.00 0.00 0.00 0.00 XXX 0

D3346 ............. N Retreat root canal anterior .............................. 0.00 0.00 0.00 0.00 XXX 0

D3347 ............. N Retreat root canal bicuspid ............................. 0.00 0.00 0.00 0.00 XXX 0

D3348 ............. N Retreat root canal molar ................................. 0.00 0.00 0.00 0.00 XXX 0

D3351 ............. N Apexification/recalc initial ................................ 0.00 0.00 0.00 0.00 XXX 0

D3352 ............. N Apexification/recalc interim ............................. 0.00 0.00 0.00 0.00 XXX 0

D3353 ............. N Apexification/recalc final ................................. 0.00 0.00 0.00 0.00 XXX 0

D3410 ............. N Apicoect/perirad surg anter ............................ 0.00 0.00 0.00 0.00 XXX 0

D3421 ............. N Root surgery bicuspid ..................................... 0.00 0.00 0.00 0.00 XXX 0

D3425 ............. N Root surgery molar ......................................... 0.00 0.00 0.00 0.00 XXX 0

D3426 ............. N Root surgery ea add root ............................... 0.00 0.00 0.00 0.00 XXX 0

D3430 ............. N Retrograde filling ............................................. 0.00 0.00 0.00 0.00 XXX 0

D3450 ............. N Root amputation ............................................. 0.00 0.00 0.00 0.00 XXX 0

D3460 ............. R Endodontic endosseous implan ...................... 0.00 0.00 0.00 0.00 YYY N

D3470 ............. N Intentional replantation ................................... 0.00 0.00 0.00 0.00 XXX 0

D3910 ............. N Isolation- tooth w rubb dam ............................ 0.00 0.00 0.00 0.00 XXX 0

D3920 ............. N Tooth splitting ................................................. 0.00 0.00 0.00 0.00 XXX 0

D3950 ............. N Canal prep/fitting of dowel .............................. 0.00 0.00 0.00 0.00 XXX 0

D3960 ............. N Bleaching of discolored toot ........................... 0.00 0.00 0.00 0.00 XXX 0

D3999 ............. R Endodontic procedure ..................................... 0.00 0.00 0.00 0.00 YYY N

D4210 ............. G Gingivectomy/plasty per quad ........................ 0.00 0.00 0.00 0.00 XXX 0

D4211 ............. G Gingivectomy/plasty per toot .......................... 0.00 0.00 0.00 0.00 XXX 0

D4220 ............. N Gingival curettage per quadr .......................... 0.00 0.00 0.00 0.00 XXX 0

D4240 ............. N Gingival flap proc w/ planin ............................ 0.00 0.00 0.00 0.00 XXX 0

D4249 ............. N Crown lengthen hard tissue ............................ 0.00 0.00 0.00 0.00 XXX 0

D4250 ............. R Mucogingival surg per quadra ........................ 0.00 0.00 0.00 0.00 YYY N

D4260 ............. R Osseous surgery per quadrant ....................... 0.00 0.00 0.00 0.00 YYY S

D4261 ............. D Bone replace graft single si ............................ 0.00 0.00 0.00 0.00 YYY S

D4262 ............. D Bone replace graft mult site ........................... 0.00 0.00 0.00 0.00 YYY N

D4263 ............. R Bone replce graft first site ............................... 0.00 0.00 0.00 0.00 YYY N

D4264 ............. R Bone replce graft each add ............................ 0.00 0.00 0.00 0.00 YYY N

D4266 ............. N Guided tiss regen resorble ............................. 0.00 0.00 0.00 0.00 XXX 0

D4267 ............. N Guided tiss regen nonresorb .......................... 0.00 0.00 0.00 0.00 XXX 0

D4268 ............. D Guided tissue regeneration ............................ 0.00 0.00 0.00 0.00 YYY N

D4270 ............. R Pedicle soft tissue graft pr .............................. 0.00 0.00 0.00 0.00 YYY S

D4271 ............. R Free soft tissue graft proc ............................... 0.00 0.00 0.00 0.00 YYY S

D4273 ............. R Subepithelial tissue graft ................................ 0.00 0.00 0.00 0.00 YYY N

D4274 ............. N Distal/proximal wedge proc ............................. 0.00 0.00 0.00 0.00 XXX 0

D4320 ............. N Provision splnt intracoronal ............................. 0.00 0.00 0.00 0.00 XXX 0

D4321 ............. N Provisional splint extracoro ............................. 0.00 0.00 0.00 0.00 XXX 0

D4341 ............. N Periodontal scaling & root ............................... 0.00 0.00 0.00 0.00 XXX 0

D4345 ............. D Periodontal scaling w/inflam ........................... 0.00 0.00 0.00 0.00 YYY N

D4355 ............. R Full mouth debridement .................................. 0.00 0.00 0.00 0.00 YYY N

D4381 ............. R Localized chemo delivery ............................... 0.00 0.00 0.00 0.00 YYY N

D4910 ............. N Periodontal maint procedures ......................... 0.00 0.00 0.00 0.00 XXX 0

D4920 ............. N Unscheduled dressing change ....................... 0.00 0.00 0.00 0.00 XXX 0

D4999 ............. N Unspecified periodontal proc .......................... 0.00 0.00 0.00 0.00 XXX 0

D5110 ............. N Dentures complete maxillary .......................... 0.00 0.00 0.00 0.00 XXX 0

D5120 ............. N Dentures complete mandible .......................... 0.00 0.00 0.00 0.00 XXX 0

D5130 ............. N Dentures immediat maxillary .......................... 0.00 0.00 0.00 0.00 XXX 0

D5140 ............. N Dentures immediat mandible .......................... 0.00 0.00 0.00 0.00 XXX 0

D5211 ............. N Dentures maxill part resin ............................... 0.00 0.00 0.00 0.00 XXX 0

D5212 ............. N Dentures mand part resin ............................... 0.00 0.00 0.00 0.00 XXX 0

D5213 ............. N Dentures maxill part metal .............................. 0.00 0.00 0.00 0.00 XXX 0

D5214 ............. N Dentures mandibl part metal .......................... 0.00 0.00 0.00 0.00 XXX 0

D5281 ............. N Removable partial denture ............................. 0.00 0.00 0.00 0.00 XXX 0

D5410 ............. N Dentures adjust cmplt maxil ........................... 0.00 0.00 0.00 0.00 XXX 0

D5411 ............. N Dentures adjust cmplt mand ........................... 0.00 0.00 0.00 0.00 XXX 0

D5421 ............. N Dentures adjust part maxill ............................. 0.00 0.00 0.00 0.00 XXX 0

D5422 ............. N Dentures adjust part mandbl .......................... 0.00 0.00 0.00 0.00 XXX 0

D5510 ............. N Dentur repr broken compl bas ........................ 0.00 0.00 0.00 0.00 XXX 0

D5520 ............. N Replace denture teeth complt ........................ 0.00 0.00 0.00 0.00 XXX 0

D5610 ............. N Dentures repair resin base ............................. 0.00 0.00 0.00 0.00 XXX 0

D5620 ............. N Rep part denture cast frame .......................... 0.00 0.00 0.00 0.00 XXX 0
63332

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

D5630 ............. N Rep partial denture clasp ............................... 0.00 0.00 0.00 0.00 XXX 0

D5640 ............. N Replace part denture teeth ............................. 0.00 0.00 0.00 0.00 XXX 0

D5650 ............. N Add tooth to partial denture ............................ 0.00 0.00 0.00 0.00 XXX 0

D5660 ............. N Add clasp to partial denture ........................... 0.00 0.00 0.00 0.00 XXX 0

D5710 ............. N Dentures rebase cmplt maxil .......................... 0.00 0.00 0.00 0.00 XXX 0

D5711 ............. N Dentures rebase cmplt mand ......................... 0.00 0.00 0.00 0.00 XXX 0

D5720 ............. N Dentures rebase part maxill ............................ 0.00 0.00 0.00 0.00 XXX 0

D5721 ............. N Dentures rebase part mandbl ......................... 0.00 0.00 0.00 0.00 XXX 0

D5730 ............. N Denture reln cmplt maxil ch ............................ 0.00 0.00 0.00 0.00 XXX 0

D5731 ............. N Denture reln cmplt mand chr .......................... 0.00 0.00 0.00 0.00 XXX 0

D5740 ............. N Denture reln part maxil chr ............................. 0.00 0.00 0.00 0.00 XXX 0

D5741 ............. N Denture reln part mand chr ............................ 0.00 0.00 0.00 0.00 XXX 0

D5750 ............. N Denture reln cmplt max lab ............................ 0.00 0.00 0.00 0.00 XXX 0

D5751 ............. N Denture reln cmplt mand lab .......................... 0.00 0.00 0.00 0.00 XXX 0

D5760 ............. N Denture reln part maxil lab ............................. 0.00 0.00 0.00 0.00 XXX 0

D5761 ............. N Denture reln part mand lab ............................. 0.00 0.00 0.00 0.00 XXX 0

D5810 ............. N Denture interm cmplt maxill ............................ 0.00 0.00 0.00 0.00 XXX 0

D5811 ............. N Denture interm cmplt mandbl ......................... 0.00 0.00 0.00 0.00 XXX 0

D5820 ............. N Denture interm part maxill .............................. 0.00 0.00 0.00 0.00 XXX 0

D5821 ............. N Denture interm part mandbl ............................ 0.00 0.00 0.00 0.00 XXX 0

D5850 ............. N Denture tiss conditn maxill .............................. 0.00 0.00 0.00 0.00 XXX 0

D5851 ............. N Denture tiss condtin mandbl ........................... 0.00 0.00 0.00 0.00 XXX 0

D5860 ............. N Overdenture complete .................................... 0.00 0.00 0.00 0.00 XXX 0

D5861 ............. N Overdenture partial ......................................... 0.00 0.00 0.00 0.00 XXX 0

D5862 ............. N Precision attachment ...................................... 0.00 0.00 0.00 0.00 XXX 0

D5899 ............. N Removable prosthodontic proc ....................... 0.00 0.00 0.00 0.00 XXX 0

D5911 ............. R Facial moulage sectional ................................ 0.00 0.00 0.00 0.00 YYY N

D5912 ............. R Facial moulage complete ................................ 0.00 0.00 0.00 0.00 YYY N

D5913 ............. G Nasal prosthesis ............................................. 0.00 0.00 0.00 0.00 XXX 0

D5914 ............. G Auricular prosthesis ........................................ 0.00 0.00 0.00 0.00 XXX 0

D5915 ............. G Orbital prosthesis ............................................ 0.00 0.00 0.00 0.00 XXX 0

D5916 ............. G Ocular prosthesis ............................................ 0.00 0.00 0.00 0.00 XXX 0

D5919 ............. G Facial prosthesis ............................................. 0.00 0.00 0.00 0.00 XXX 0

D5922 ............. G Nasal septal prosthesis .................................. 0.00 0.00 0.00 0.00 XXX 0

D5923 ............. G Ocular prosthesis interim ................................ 0.00 0.00 0.00 0.00 XXX 0

D5924 ............. G Cranial prosthesis ........................................... 0.00 0.00 0.00 0.00 XXX 0

D5925 ............. G Facial augmentation implant ........................... 0.00 0.00 0.00 0.00 XXX 0

D5926 ............. G Replacement nasal prosthesis ....................... 0.00 0.00 0.00 0.00 XXX 0

D5927 ............. G Auricular replacement ..................................... 0.00 0.00 0.00 0.00 XXX 0

D5928 ............. G Orbital replacement ........................................ 0.00 0.00 0.00 0.00 XXX 0

D5929 ............. G Facial replacement ......................................... 0.00 0.00 0.00 0.00 XXX 0

D5931 ............. G Surgical obturator ........................................... 0.00 0.00 0.00 0.00 XXX 0

D5932 ............. G Postsurgical obturator ..................................... 0.00 0.00 0.00 0.00 XXX 0

D5933 ............. G Refitting of obturator ....................................... 0.00 0.00 0.00 0.00 XXX 0

D5934 ............. G Mandibular flange prosthesis .......................... 0.00 0.00 0.00 0.00 XXX 0

D5935 ............. G Mandibular denture prosth .............................. 0.00 0.00 0.00 0.00 XXX 0

D5936 ............. G Temp obturator prosthesis .............................. 0.00 0.00 0.00 0.00 XXX 0

D5937 ............. G Trismus appliance ........................................... 0.00 0.00 0.00 0.00 XXX 0

D5951 ............. R Feeding aid ..................................................... 0.00 0.00 0.00 0.00 YYY N

D5952 ............. G Pediatric speech aid ....................................... 0.00 0.00 0.00 0.00 XXX 0

D5953 ............. G Adult speech aid ............................................. 0.00 0.00 0.00 0.00 XXX 0

D5954 ............. G Superimposed prosthesis ............................... 0.00 0.00 0.00 0.00 XXX 0

D5955 ............. G Palatal lift prosthesis ....................................... 0.00 0.00 0.00 0.00 XXX 0

D5958 ............. G Intraoral con def inter plt ................................ 0.00 0.00 0.00 0.00 XXX 0

D5959 ............. G Intraoral con def mod palat ............................ 0.00 0.00 0.00 0.00 XXX 0

D5960 ............. G Modify speech aid prosthesis ......................... 0.00 0.00 0.00 0.00 XXX 0

D5982 ............. G Surgical stent .................................................. 0.00 0.00 0.00 0.00 XXX 0

D5983 ............. R Radiation applicator ........................................ 0.00 0.00 0.00 0.00 YYY N

D5984 ............. R Radiation shield .............................................. 0.00 0.00 0.00 0.00 YYY N

D5985 ............. R Radiation cone locator .................................... 0.00 0.00 0.00 0.00 YYY N

D5986 ............. N Fluoride applicator .......................................... 0.00 0.00 0.00 0.00 XXX 0

D5987 ............. R Commissure splint .......................................... 0.00 0.00 0.00 0.00 YYY N

D5988 ............. R Surgical splint ................................................. 0.00 0.00 0.00 0.00 YYY N

D5999 ............. G Maxillofacial prosthesis ................................... 0.00 0.00 0.00 0.00 XXX 0

D6010 ............. G Odontics endosteal implant ............................ 0.00 0.00 0.00 0.00 XXX 0

D6020 ............. G Odontics abutment placement ........................ 0.00 0.00 0.00 0.00 XXX 0
63333

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

D6030 ............. D Prosthodont endosseous impl ........................ 0.00 0.00 0.00 0.00 YYY N

D6040 ............. G Odontics eposteal implant .............................. 0.00 0.00 0.00 0.00 XXX 0

D6050 ............. G Odontics transosteal implnt ............................ 0.00 0.00 0.00 0.00 XXX 0

D6055 ............. G Implant connecting bar ................................... 0.00 0.00 0.00 0.00 XXX 0

D6080 ............. G Implant maintenance ...................................... 0.00 0.00 0.00 0.00 XXX 0

D6090 ............. G Repair implant ................................................. 0.00 0.00 0.00 0.00 XXX 0

D6095 ............. G Odontics repr abutment .................................. 0.00 0.00 0.00 0.00 XXX 0

D6100 ............. G Removal of implant ......................................... 0.00 0.00 0.00 0.00 XXX 0

D6199 ............. G Implant procedure ........................................... 0.00 0.00 0.00 0.00 XXX 0

D6210 ............. N Prosthodont high noble metal ......................... 0.00 0.00 0.00 0.00 XXX 0

D6211 ............. N Bridge base metal cast ................................... 0.00 0.00 0.00 0.00 XXX 0

D6212 ............. N Bridge noble metal cast .................................. 0.00 0.00 0.00 0.00 XXX 0

D6240 ............. N Bridge porcelain high noble ............................ 0.00 0.00 0.00 0.00 XXX 0

D6241 ............. N Bridge porcelain base metal ........................... 0.00 0.00 0.00 0.00 XXX 0

D6242 ............. N Bridge porcelain nobel metal .......................... 0.00 0.00 0.00 0.00 XXX 0

D6250 ............. N Bridge resin w/high noble ............................... 0.00 0.00 0.00 0.00 XXX 0

D6251 ............. N Bridge resin base metal .................................. 0.00 0.00 0.00 0.00 XXX 0

D6252 ............. N Bridge resin w/noble metal ............................. 0.00 0.00 0.00 0.00 XXX 0

D6520 ............. N Dental retainer two surfaces ........................... 0.00 0.00 0.00 0.00 XXX 0

D6530 ............. N Retainer metallic 3+ surface ........................... 0.00 0.00 0.00 0.00 XXX 0

D6540 ............. D Retainer metallic cusps ................................... 0.00 0.00 0.00 0.00 YYY N

D6543 ............. N Dental retainr onlay 3 surf .............................. 0.00 0.00 0.00 0.00 XXX 0

D6544 ............. N Dental retainr onlay 4/more ............................ 0.00 0.00 0.00 0.00 XXX 0

D6545 ............. N Dental retainr cast metl ................................... 0.00 0.00 0.00 0.00 XXX 0

D6720 ............. N Retain crown resin w hi nble .......................... 0.00 0.00 0.00 0.00 XXX 0

D6721 ............. N Crown resin w/base metal .............................. 0.00 0.00 0.00 0.00 XXX 0

D6722 ............. N Crown resin w/noble metal ............................. 0.00 0.00 0.00 0.00 XXX 0

D6750 ............. N Crown porcelain high noble ............................ 0.00 0.00 0.00 0.00 XXX 0

D6751 ............. N Crown porcelain base metal ........................... 0.00 0.00 0.00 0.00 XXX 0

D6752 ............. N Crown porcelain noble metal .......................... 0.00 0.00 0.00 0.00 XXX 0

D6780 ............. N Crown 3/4 high noble metal ........................... 0.00 0.00 0.00 0.00 XXX 0

D6790 ............. N Crown full high noble metal ............................ 0.00 0.00 0.00 0.00 XXX 0

D6791 ............. N Crown full base metal cast ............................. 0.00 0.00 0.00 0.00 XXX 0

D6792 ............. N Crown full noble metal cast ............................ 0.00 0.00 0.00 0.00 XXX 0

D6920 ............. R Dental connector bar ...................................... 0.00 0.00 0.00 0.00 YYY N

D6930 ............. N Dental recement bridge .................................. 0.00 0.00 0.00 0.00 XXX 0

D6940 ............. N Stress breaker ................................................ 0.00 0.00 0.00 0.00 XXX 0

D6950 ............. N Precision attachment ...................................... 0.00 0.00 0.00 0.00 XXX 0

D6970 ............. N Post & core plus retainer ................................ 0.00 0.00 0.00 0.00 XXX 0

D6971 ............. N Cast post bridge retainer ................................ 0.00 0.00 0.00 0.00 XXX 0

D6972 ............. N Prefab post & core plus reta .......................... 0.00 0.00 0.00 0.00 XXX 0

D6973 ............. N Core build up for retainer ............................... 0.00 0.00 0.00 0.00 XXX 0

D6975 ............. N Coping metal ................................................... 0.00 0.00 0.00 0.00 XXX 0

D6980 ............. N Bridge repair ................................................... 0.00 0.00 0.00 0.00 XXX 0

D6999 ............. N Fixed prosthodontic proc ................................ 0.00 0.00 0.00 0.00 XXX 0

D7110 ............. R Oral surgery single tooth ................................ 0.00 0.00 0.00 0.00 YYY S

D7120 ............. R Each add tooth extraction ............................... 0.00 0.00 0.00 0.00 YYY S

D7130 ............. R Tooth root removal ......................................... 0.00 0.00 0.00 0.00 YYY S

D7210 ............. R Rem imp tooth w mucoper flp ........................ 0.00 0.00 0.00 0.00 YYY S

D7220 ............. R Impact tooth remov soft tiss ........................... 0.00 0.00 0.00 0.00 YYY S

D7230 ............. R Impact tooth remov part bony ......................... 0.00 0.00 0.00 0.00 YYY S

D7240 ............. R Impact tooth remov comp bony ...................... 0.00 0.00 0.00 0.00 YYY S

D7241 ............. R Impact tooth rem bony w/comp ...................... 0.00 0.00 0.00 0.00 YYY S

D7250 ............. R Tooth root removal ......................................... 0.00 0.00 0.00 0.00 YYY S

D7260 ............. R Oral antral fistula closure ................................ 0.00 0.00 0.00 0.00 YYY S

D7270 ............. N Tooth reimplantation ....................................... 0.00 0.00 0.00 0.00 XXX 0

D7271 ............. D Tooth implantation .......................................... 0.00 0.00 0.00 0.00 YYY N

D7272 ............. N Tooth transplantation ...................................... 0.00 0.00 0.00 0.00 XXX 0

D7280 ............. N Exposure impact tooth orthod ........................ 0.00 0.00 0.00 0.00 XXX 0

D7281 ............. N Exposure tooth aid eruption ........................... 0.00 0.00 0.00 0.00 XXX 0

D7285 ............. G Biopsy of oral tissue hard ............................... 0.00 0.00 0.00 0.00 XXX 0

D7286 ............. G Biopsy of oral tissue soft ................................ 0.00 0.00 0.00 0.00 XXX 0

D7290 ............. N Repositioning of teeth ..................................... 0.00 0.00 0.00 0.00 XXX 0

D7291 ............. R Transseptal fiberotomy ................................... 0.00 0.00 0.00 0.00 YYY N

D7310 ............. G Alveoplasty w/ extraction ................................ 0.00 0.00 0.00 0.00 XXX 0

D7320 ............. G Alveoplasty w/o extraction .............................. 0.00 0.00 0.00 0.00 XXX 0
63334

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

D7340 ............. G Vestibuloplasty ridge extens ........................... 0.00 0.00 0.00 0.00 XXX 0

D7350 ............. G Vestibuloplasty exten graft ............................. 0.00 0.00 0.00 0.00 XXX 0

D7410 ............. G Rad exc lesion up to 1.25 cm ......................... 0.00 0.00 0.00 0.00 XXX 0

D7420 ............. G Lesion > 1.25 cm ............................................ 0.00 0.00 0.00 0.00 XXX 0

D7430 ............. G Exc benign tumor to 1.25 cm ......................... 0.00 0.00 0.00 0.00 XXX 0

D7431 ............. G Benign tumor exc > 1.25 cm .......................... 0.00 0.00 0.00 0.00 XXX 0

D7440 ............. G Malig tumor exc to 1.25 cm ............................ 0.00 0.00 0.00 0.00 XXX 0

D7441 ............. G Malig tumor > 1.25 cm .................................... 0.00 0.00 0.00 0.00 XXX 0

D7450 ............. G Rem odontogen cyst to 1.25cm ..................... 0.00 0.00 0.00 0.00 XXX 0

D7451 ............. G Rem odontogen cyst > 1.25 cm ..................... 0.00 0.00 0.00 0.00 XXX 0

D7460 ............. G Rem nonodonto cyst to 1.25cm ..................... 0.00 0.00 0.00 0.00 XXX 0

D7461 ............. G Rem nonodonto cyst > 1.25 cm ..................... 0.00 0.00 0.00 0.00 XXX 0

D7465 ............. G Lesion destruction ........................................... 0.00 0.00 0.00 0.00 XXX 0

D7470 ............. G Rem exostosis maxilla/mandib ....................... 0.00 0.00 0.00 0.00 XXX 0

D7480 ............. G Partial ostectomy ............................................ 0.00 0.00 0.00 0.00 XXX 0

D7490 ............. G Mandible resection .......................................... 0.00 0.00 0.00 0.00 XXX 0

D7510 ............. G I&d absc intraoral soft tiss .............................. 0.00 0.00 0.00 0.00 XXX 0

D7520 ............. G I&d abscess extraoral ..................................... 0.00 0.00 0.00 0.00 XXX 0

D7530 ............. G Removal fb skin/areolar tiss ........................... 0.00 0.00 0.00 0.00 XXX 0

D7540 ............. G Removal of fb reaction ................................... 0.00 0.00 0.00 0.00 XXX 0

D7550 ............. G Removal of sloughed off bone ....................... 0.00 0.00 0.00 0.00 XXX 0

D7560 ............. G Maxillary sinusotomy ...................................... 0.00 0.00 0.00 0.00 XXX 0

D7610 ............. G Maxilla open reduct simple ............................. 0.00 0.00 0.00 0.00 XXX 0

D7620 ............. G Clsd reduct simpl maxilla fx ............................ 0.00 0.00 0.00 0.00 XXX 0

D7630 ............. G Open red simpl mandible fx ........................... 0.00 0.00 0.00 0.00 XXX 0

D7640 ............. G Clsd red simpl mandible fx ............................. 0.00 0.00 0.00 0.00 XXX 0

D7650 ............. G Open red simp malar/zygom fx ...................... 0.00 0.00 0.00 0.00 XXX 0

D7660 ............. G Clsd red simp malar/zygom fx ........................ 0.00 0.00 0.00 0.00 XXX 0

D7670 ............. G Open red simple alveolus fx ........................... 0.00 0.00 0.00 0.00 XXX 0

D7680 ............. G Reduct simple facial bone fx .......................... 0.00 0.00 0.00 0.00 XXX 0

D7710 ............. G Maxilla open reduct compound ...................... 0.00 0.00 0.00 0.00 XXX 0

D7720 ............. G Clsd reduct compd maxilla fx ......................... 0.00 0.00 0.00 0.00 XXX 0

D7730 ............. G Open reduct compd mandble fx ..................... 0.00 0.00 0.00 0.00 XXX 0

D7740 ............. G Clsd reduct compd mandble fx ....................... 0.00 0.00 0.00 0.00 XXX 0

D7750 ............. G Open red comp malar/zygma fx ..................... 0.00 0.00 0.00 0.00 XXX 0

D7760 ............. G Clsd red comp malar/zygma fx ....................... 0.00 0.00 0.00 0.00 XXX 0

D7770 ............. G Open reduc compd alveolus fx ....................... 0.00 0.00 0.00 0.00 XXX 0

D7780 ............. G Reduct compnd facial bone fx ........................ 0.00 0.00 0.00 0.00 XXX 0

D7810 ............. G Tmj open reduct-dislocation ........................... 0.00 0.00 0.00 0.00 XXX 0

D7820 ............. G Closed tmp manipulation ................................ 0.00 0.00 0.00 0.00 XXX 0

D7830 ............. G Tmj manipulation under anest ........................ 0.00 0.00 0.00 0.00 XXX 0

D7840 ............. G Removal of tmj condyle .................................. 0.00 0.00 0.00 0.00 XXX 0

D7850 ............. G Tmj meniscectomy .......................................... 0.00 0.00 0.00 0.00 XXX 0

D7852 ............. G Tmj repair of joint disc .................................... 0.00 0.00 0.00 0.00 XXX 0

D7854 ............. G Tmj excisn of joint membrane ........................ 0.00 0.00 0.00 0.00 XXX 0

D7856 ............. G Tmj cutting of a muscle .................................. 0.00 0.00 0.00 0.00 XXX 0

D7858 ............. G Tmj reconstruction .......................................... 0.00 0.00 0.00 0.00 XXX 0

D7860 ............. G Tmj cutting into joint ....................................... 0.00 0.00 0.00 0.00 XXX 0

D7865 ............. G Tmj reshaping components ............................ 0.00 0.00 0.00 0.00 XXX 0

D7870 ............. G Tmj aspiration joint fluid .................................. 0.00 0.00 0.00 0.00 XXX 0

D7872 ............. G Tmj diagnostic arthroscopy ............................. 0.00 0.00 0.00 0.00 XXX 0

D7873 ............. G Tmj arthroscopy lysis adhesn ......................... 0.00 0.00 0.00 0.00 XXX 0

D7874 ............. G Tmj arthroscopy disc reposit ........................... 0.00 0.00 0.00 0.00 XXX 0

D7875 ............. G Tmj arthroscopy synovectomy ........................ 0.00 0.00 0.00 0.00 XXX 0

D7876 ............. G Tmj arthroscopy discectomy ........................... 0.00 0.00 0.00 0.00 XXX 0

D7877 ............. G Tmj arthroscopy debridement ......................... 0.00 0.00 0.00 0.00 XXX 0

D7880 ............. G Occlusal orthotic appliance ............................. 0.00 0.00 0.00 0.00 XXX 0

D7899 ............. G Tmj unspecified therapy ................................. 0.00 0.00 0.00 0.00 XXX 0

D7910 ............. G Dent sutur recent wnd to 5cm ........................ 0.00 0.00 0.00 0.00 XXX 0

D7911 ............. G Dental suture wound to 5 cm ......................... 0.00 0.00 0.00 0.00 XXX 0

D7912 ............. G Suture complicate wnd > 5 cm ....................... 0.00 0.00 0.00 0.00 XXX 0

D7920 ............. G Dental skin graft .............................................. 0.00 0.00 0.00 0.00 XXX 0

D7940 ............. R Reshaping bone orthognathic ......................... 0.00 0.00 0.00 0.00 YYY S

D7941 ............. G Bone cutting ramus closed ............................. 0.00 0.00 0.00 0.00 XXX 0

D7942 ............. G Bone cutting ramus open ............................... 0.00 0.00 0.00 0.00 XXX 0

D7943 ............. G Cutting ramus open w/graft ............................ 0.00 0.00 0.00 0.00 XXX 0
63335

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

D7944 ............. G Bone cutting segmented ................................. 0.00 0.00 0.00 0.00 XXX 0

D7945 ............. G Bone cutting body mandible ........................... 0.00 0.00 0.00 0.00 XXX 0

D7946 ............. G Reconstruction maxilla total ............................ 0.00 0.00 0.00 0.00 XXX 0

D7947 ............. G Reconstruct maxilla segment .......................... 0.00 0.00 0.00 0.00 XXX 0

D7948 ............. G Reconstruct midface no graft .......................... 0.00 0.00 0.00 0.00 XXX 0

D7949 ............. G Reconstruct midface w/graft ........................... 0.00 0.00 0.00 0.00 XXX 0

D7950 ............. G Mandible graft ................................................. 0.00 0.00 0.00 0.00 XXX 0

D7955 ............. G Repair maxillofacial defects ............................ 0.00 0.00 0.00 0.00 XXX 0

D7960 ............. G Frenulectomy/frenulotomy .............................. 0.00 0.00 0.00 0.00 XXX 0

D7970 ............. G Excision hyperplastic tissue ............................ 0.00 0.00 0.00 0.00 XXX 0

D7971 ............. G Excision pericoronal gingiva ........................... 0.00 0.00 0.00 0.00 XXX 0

D7980 ............. G Sialolithotomy .................................................. 0.00 0.00 0.00 0.00 XXX 0

D7981 ............. G Excision of salivary gland ............................... 0.00 0.00 0.00 0.00 XXX 0

D7982 ............. G Sialodochoplasty ............................................. 0.00 0.00 0.00 0.00 XXX 0

D7983 ............. G Closure of salivary fistula ............................... 0.00 0.00 0.00 0.00 XXX 0

D7990 ............. G Emergency tracheotomy ................................. 0.00 0.00 0.00 0.00 XXX 0

D7991 ............. G Dental coronoidectomy ................................... 0.00 0.00 0.00 0.00 XXX 0

D7993 ............. D Implant facial bones ........................................ 0.00 0.00 0.00 0.00 YYY N

D7994 ............. D Implant chin .................................................... 0.00 0.00 0.00 0.00 YYY N

D7995 ............. G Synthetic graft facial bones ............................ 0.00 0.00 0.00 0.00 XXX 0

D7996 ............. G Implant mandible for augment ........................ 0.00 0.00 0.00 0.00 XXX 0

D7999 ............. G Oral surgery procedure ................................... 0.00 0.00 0.00 0.00 XXX 0

D8010 ............. N Limited dental tx primary ................................ 0.00 0.00 0.00 0.00 XXX 0

D8020 ............. N Limited dental tx transition .............................. 0.00 0.00 0.00 0.00 XXX 0

D8030 ............. N Limited dental tx adolescent ........................... 0.00 0.00 0.00 0.00 XXX 0

D8040 ............. N Limited dental tx adult .................................... 0.00 0.00 0.00 0.00 XXX 0

D8050 ............. N Intercep dental tx primary ............................... 0.00 0.00 0.00 0.00 XXX 0

D8060 ............. N Intercep dental tx transitn ............................... 0.00 0.00 0.00 0.00 XXX 0

D8070 ............. N Compre dental tx transition ............................. 0.00 0.00 0.00 0.00 XXX 0

D8080 ............. N Compre dental tx adolescent .......................... 0.00 0.00 0.00 0.00 XXX 0

D8090 ............. N Compre dental tx adult ................................... 0.00 0.00 0.00 0.00 XXX 0

D8110 ............. D Orthodontic rem appliance tx .......................... 0.00 0.00 0.00 0.00 YYY N

D8120 ............. D Fixed appliance therapy guid .......................... 0.00 0.00 0.00 0.00 YYY N

D8210 ............. N Orthodontic rem appliance tx .......................... 0.00 0.00 0.00 0.00 XXX 0

D8220 ............. N Fixed appliance therapy habt ......................... 0.00 0.00 0.00 0.00 XXX 0

D8360 ............. D Orthodontic rem appliance tx .......................... 0.00 0.00 0.00 0.00 YYY N

D8370 ............. D Fixed appliance interceptive ........................... 0.00 0.00 0.00 0.00 YYY N

D8460 ............. D Trans dentit class 1 maloccl ........................... 0.00 0.00 0.00 0.00 YYY N

D8470 ............. D Class ii malocclusion trnstn ............................ 0.00 0.00 0.00 0.00 YYY N

D8480 ............. D Class iii malocclusion trnst ............................. 0.00 0.00 0.00 0.00 YYY N

D8560 ............. D Class i tx atyp/ext skel cas ............................. 0.00 0.00 0.00 0.00 YYY N

D8570 ............. D Class ii malocclusion perman ......................... 0.00 0.00 0.00 0.00 YYY N

D8580 ............. D Class iii malocclusion permn .......................... 0.00 0.00 0.00 0.00 YYY N

D8650 ............. D Tx atypical/extend skel case .......................... 0.00 0.00 0.00 0.00 YYY N

D8660 ............. N Preorthodontic tx visit ..................................... 0.00 0.00 0.00 0.00 XXX 0

D8670 ............. N Periodic orthodontc tx visit .............................. 0.00 0.00 0.00 0.00 XXX 0

D8680 ............. N Orthodontic retention ...................................... 0.00 0.00 0.00 0.00 XXX 0

D8690 ............. N Orthodontic treatment ..................................... 0.00 0.00 0.00 0.00 XXX 0

D8750 ............. D Post-treatment stabilization ............................ 0.00 0.00 0.00 0.00 YYY N

D8999 ............. N Orthodontic procedure .................................... 0.00 0.00 0.00 0.00 XXX 0

D9110 ............. R Tx dental pain minor proc ............................... 0.00 0.00 0.00 0.00 YYY N

D9210 ............. G Dent anesthesia w/o surgery .......................... 0.00 0.00 0.00 0.00 XXX 0

D9211 ............. G Regional block anesthesia .............................. 0.00 0.00 0.00 0.00 XXX 0

D9212 ............. G Trigeminal block anesthesia ........................... 0.00 0.00 0.00 0.00 XXX 0

D9215 ............. G Local anesthesia ............................................. 0.00 0.00 0.00 0.00 XXX 0

D9220 ............. G General anesthesia ......................................... 0.00 0.00 0.00 0.00 XXX 0

D9221 ............. G General anesthesia ea ad 15m ...................... 0.00 0.00 0.00 0.00 XXX 0

D9230 ............. R Analgesia ........................................................ 0.00 0.00 0.00 0.00 YYY N

D9240 ............. G Intravenous sedation ...................................... 0.00 0.00 0.00 0.00 XXX 0

D9310 ............. G Dental consultation ......................................... 0.00 0.00 0.00 0.00 XXX 0

D9410 ............. G Dental house call ............................................ 0.00 0.00 0.00 0.00 XXX 0

D9420 ............. G Hospital call .................................................... 0.00 0.00 0.00 0.00 XXX 0

D9430 ............. G Office visit during hours .................................. 0.00 0.00 0.00 0.00 XXX 0

D9440 ............. G Office visit after hours ..................................... 0.00 0.00 0.00 0.00 XXX 0

D9610 ............. G Dent therapeutic drug inject ........................... 0.00 0.00 0.00 0.00 XXX 0

D9630 ............. R Other drugs/medicaments ............................... 0.00 0.00 0.00 0.00 YYY N
63336

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

D9910 ............. N Dent appl desensitizing med .......................... 0.00 0.00 0.00 0.00 XXX 0

D9920 ............. N Behavior management .................................... 0.00 0.00 0.00 0.00 XXX 0

D9930 ............. R Treatment of complications ............................. 0.00 0.00 0.00 0.00 YYY N

D9940 ............. R Dental occlusal guard ..................................... 0.00 0.00 0.00 0.00 YYY N

D9941 ............. N Fabrication athletic guard ............................... 0.00 0.00 0.00 0.00 XXX 0

D9950 ............. R Occlusion analysis .......................................... 0.00 0.00 0.00 0.00 YYY N

D9951 ............. R Limited occlusal adjustment ........................... 0.00 0.00 0.00 0.00 YYY N

D9952 ............. R Complete occlusal adjustment ........................ 0.00 0.00 0.00 0.00 YYY N

D9970 ............. N Enamel microabrasion .................................... 0.00 0.00 0.00 0.00 XXX 0

D9999 ............. G Adjunctive procedure ...................................... 0.00 0.00 0.00 0.00 XXX 0

G0001 ............. X Drawing blood for specimen ........................... 0.00 0.00 0.00 0.00 XXX 0

G0002 ............. A Temporary urinary catheter ............................ 0.50 0.70 0.02 1.22 000 S

G0004 ............. A ECG transm phys review & int ....................... 0.52 7.31 0.65 8.48 XXX N

G0005 ............. A ECG 24 hour recording .................................. 0.00 1.18 0.09 1.27 XXX N

G0006 ............. A ECG transmission & analysis ......................... 0.00 5.73 0.51 6.24 XXX N

G0007 ............. A ECG phy review & interpret ............................ 0.52 0.40 0.05 0.97 XXX N

G0008 ............. X Admin influenza virus vac ............................... 0.00 0.00 0.00 0.00 XXX 0

G0009 ............. X Admin pneumococcal vaccine ........................ 0.00 0.00 0.00 0.00 XXX 0

G0010 ............. X Admin hepatitis b vaccine ............................... 0.00 0.00 0.00 0.00 XXX 0

G0015 ............. A Post symptom ECG tracing ............................ 0.00 5.73 0.51 6.24 XXX N

G0016 ............. A Post symptom ECG md review ...................... 0.52 0.40 0.05 0.97 XXX N

G0020 ............. D Prepare face/oral prosthesis ........................... 0.00 0.00 0.00 0.00 010 S

G0021 ............. D Prepare orbital prosthesis ............................... 0.00 0.00 0.00 0.00 090 S

G0025 ............. A Collagen skin test kit ...................................... 0.00 0.95 0.00 0.95 XXX N

G0026 ............. X Fecal leukocyte examination .......................... 0.00 0.00 0.00 0.00 XXX 0

G0027 ............. X Semen analysis .............................................. 0.00 0.00 0.00 0.00 XXX 0

G0030 ............. C PET imaging prev PET single ........................ 0.00 0.00 0.00 0.00 XXX N

G0030 26 A PET imaging prev PET single ........................ 1.09 0.48 0.07 1.64 XXX N

G0030 TC C PET imaging prev PET single ........................ 0.00 0.00 0.00 0.00 XXX N

G0031 ............. C PET imaging prev PET multple ...................... 0.00 0.00 0.00 0.00 XXX N

G0031 26 A PET imaging prev PET multple ...................... 1.46 0.65 0.10 2.21 XXX N

G0031 TC C PET imaging prev PET multple ...................... 0.00 0.00 0.00 0.00 XXX N

G0032 ............. C PET follow SPECT 78464 singl ...................... 0.00 0.00 0.00 0.00 XXX N

G0032 26 A PET follow SPECT 78464 singl ...................... 1.09 0.48 0.07 1.64 XXX N

G0032 TC C PET follow SPECT 78464 singl ...................... 0.00 0.00 0.00 0.00 XXX N

G0033 ............. C PET follow SPECT 78464 mult ...................... 0.00 0.00 0.00 0.00 XXX N

G0033 26 A PET follow SPECT 78464 mult ...................... 1.46 0.65 0.10 2.21 XXX N

G0033 TC C PET follow SPECT 78464 mult ...................... 0.00 0.00 0.00 0.00 XXX N

G0034 ............. C PET follow SPECT 76865 singl ...................... 0.00 0.00 0.00 0.00 XXX N

G0034 26 A PET follow SPECT 76865 singl ...................... 1.09 0.48 0.07 1.64 XXX N

G0034 TC C PET follow SPECT 76865 singl ...................... 0.00 0.00 0.00 0.00 XXX N

G0035 ............. C PET follow SPECT 78465 mult ...................... 0.00 0.00 0.00 0.00 XXX N

G0035 26 A PET follow SPECT 78465 mult ...................... 1.46 0.65 0.10 2.21 XXX N

G0035 TC C PET follow SPECT 78465 mult ...................... 0.00 0.00 0.00 0.00 XXX N

G0036 ............. C PET follow cornry angio sing .......................... 0.00 0.00 0.00 0.00 XXX N

G0036 26 A PET follow cornry angio sing .......................... 1.09 0.48 0.07 1.64 XXX N

G0036 TC C PET follow cornry angio sing .......................... 0.00 0.00 0.00 0.00 XXX N

G0037 ............. C PET follow cornry angio mult .......................... 0.00 0.00 0.00 0.00 XXX N

G0037 26 A PET follow cornry angio mult .......................... 1.46 0.65 0.10 2.21 XXX N

G0037 TC C PET follow cornry angio mult .......................... 0.00 0.00 0.00 0.00 XXX N

G0038 ............. C PET follow myocard perf sing ......................... 0.00 0.00 0.00 0.00 XXX N

G0038 26 A PET follow myocard perf sing ......................... 1.09 0.48 0.07 1.64 XXX N

G0038 TC C PET follow myocard perf sing ......................... 0.00 0.00 0.00 0.00 XXX N

G0039 ............. C PET follow myocard perf mult ........................ 0.00 0.00 0.00 0.00 XXX N

G0039 26 A PET follow myocard perf mult ........................ 1.46 0.65 0.10 2.21 XXX N

G0039 TC C PET follow myocard perf mult ........................ 0.00 0.00 0.00 0.00 XXX N

G0040 ............. C PET follow stress echo singl .......................... 0.00 0.00 0.00 0.00 XXX N

G0040 26 A PET follow stress echo singl .......................... 1.09 0.48 0.07 1.64 XXX N

G0040 TC C PET follow stress echo singl .......................... 0.00 0.00 0.00 0.00 XXX N

G0041 ............. C PET follow stress echo mult ........................... 0.00 0.00 0.00 0.00 XXX N

G0041 26 A PET follow stress echo mult ........................... 1.46 0.65 0.10 2.21 XXX N

G0041 TC C PET follow stress echo mult ........................... 0.00 0.00 0.00 0.00 XXX N

G0042 ............. C PET follow ventriculogm sing ......................... 0.00 0.00 0.00 0.00 XXX N

G0042 26 A PET follow ventriculogm sing ......................... 1.09 0.48 0.07 1.64 XXX N

G0042 TC C PET follow ventriculogm sing ......................... 0.00 0.00 0.00 0.00 XXX N

G0043 ............. C PET follow ventriculogm mult ......................... 0.00 0.00 0.00 0.00 XXX N
63337

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

G0043 26 A PET follow ventriculogm mult ......................... 1.46 0.65 0.10 2.21 XXX N

G0043 TC C PET follow ventriculogm mult ......................... 0.00 0.00 0.00 0.00 XXX N

G0044 ............. C PET following rest ECG singl ......................... 0.00 0.00 0.00 0.00 XXX N

G0044 26 A PET following rest ECG singl ......................... 1.09 0.48 0.07 1.64 XXX N

G0044 TC C PET following rest ECG singl ......................... 0.00 0.00 0.00 0.00 XXX N

G0045 ............. C PET following rest ECG mult .......................... 0.00 0.00 0.00 0.00 XXX N

G0045 26 A PET following rest ECG mult .......................... 1.46 0.65 0.10 2.21 XXX N

G0045 TC C PET following rest ECG mult .......................... 0.00 0.00 0.00 0.00 XXX N

G0046 ............. C PET follow stress ECG singl .......................... 0.00 0.00 0.00 0.00 XXX N

G0046 26 A PET follow stress ECG singl .......................... 1.09 0.48 0.07 1.64 XXX N

G0046 TC C PET follow stress ECG singl .......................... 0.00 0.00 0.00 0.00 XXX N

G0047 ............. C PET follow stress ECG mult ........................... 0.00 0.00 0.00 0.00 XXX N

G0047 26 A PET follow stress ECG mult ........................... 1.46 0.65 0.10 2.21 XXX N

G0047 TC C PET follow stress ECG mult ........................... 0.00 0.00 0.00 0.00 XXX N

G0050 ............. A Residual urine by ultrasound .......................... 0.00 0.81 0.05 0.86 XXX N

G0054 ............. X Blood cholesterol test ..................................... 0.00 0.00 0.00 0.00 XXX 0

G0055 ............. X Glucose post dose measure ........................... 0.00 0.00 0.00 0.00 XXX 0

G0056 ............. X Glucose tolerance 3 specimen ....................... 0.00 0.00 0.00 0.00 XXX 0

G0057 ............. X Glucose tolerance>3 specimen ...................... 0.00 0.00 0.00 0.00 XXX 0

G0058 ............. X Auto multichannel 20 tests ............................. 0.00 0.00 0.00 0.00 XXX 0

G0059 ............. X Auto multichannel 21 tests ............................. 0.00 0.00 0.00 0.00 XXX 0

G0060 ............. X Auto multichannel 22 tests ............................. 0.00 0.00 0.00 0.00 XXX 0

G0061 ............. N Lung volume reduction surg ........................... #17.62 15.81 3.01 36.44 XXX 0

H5300 ............. G Occupational therapy ...................................... #0.32 0.24 0.03 0.59 XXX 0

J0110 ............. D Administration injection ................................... 0.00 0.00 0.00 0.00 XXX 0

J0120 ............. E Tetracyclin injection ........................................ 0.00 0.00 0.00 0.00 XXX 0

J0150 ............. E Injection adenosine 6 MG ............................... 0.00 0.00 0.00 0.00 XXX 0

J0170 ............. E Adrenalin epinephrin inject ............................. 0.00 0.00 0.00 0.00 XXX 0

J0190 ............. E Inj biperiden lactate/5 mg ............................... 0.00 0.00 0.00 0.00 XXX 0

J0205 ............. E Alglucerase injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J0210 ............. E Methyldopate hcl injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J0256 ............. E Alpha 1-proteinase 500 MG ........................... 0.00 0.00 0.00 0.00 XXX 0

J0280 ............. E Aminophyllin 250 MG inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J0290 ............. E Ampicillin 500 MG inj ...................................... 0.00 0.00 0.00 0.00 XXX 0

J0295 ............. E Ampicillin sodium per 1.5 gm ......................... 0.00 0.00 0.00 0.00 XXX 0

J0300 ............. E Amobarbital 125 MG inj .................................. 0.00 0.00 0.00 0.00 XXX 0

J0330 ............. E Succinycholine chloride inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J0340 ............. E Nandrolon phenpropionate inj ........................ 0.00 0.00 0.00 0.00 XXX 0

J0350 ............. E Injection anistreplase 30 u .............................. 0.00 0.00 0.00 0.00 XXX 0

J0360 ............. E Hydralazine hcl injection ................................. 0.00 0.00 0.00 0.00 XXX 0

J0380 ............. E Inj metaraminol bitartrate ................................ 0.00 0.00 0.00 0.00 XXX 0

J0390 ............. E Chloroquine injection ...................................... 0.00 0.00 0.00 0.00 XXX 0

J0400 ............. E Inj trimethaphan camsylate ............................. 0.00 0.00 0.00 0.00 XXX 0

J0460 ............. E Atropine sulfate injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J0470 ............. E Dimecaprol injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J0475 ............. E Baclofen 10 MG injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J0500 ............. E Dicyclomine injection ...................................... 0.00 0.00 0.00 0.00 XXX 0

J0510 ............. E Benzquinamide injection ................................. 0.00 0.00 0.00 0.00 XXX 0

J0515 ............. E Inj benztropine mesylate ................................. 0.00 0.00 0.00 0.00 XXX 0

J0520 ............. E Bethanechol chloride inject ............................. 0.00 0.00 0.00 0.00 XXX 0

J0530 ............. E Penicillin g benzathine inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J0540 ............. E Penicillin g benzathine inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J0550 ............. E Penicillin g benzathine inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J0560 ............. E Penicillin g benzathine inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J0570 ............. E Penicillin g benzathine inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J0580 ............. E Penicillin g benzathine inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J0585 ............. E Botulinum toxin a per 100 u ........................... 0.00 0.00 0.00 0.00 XXX 0

J0590 ............. E Ethylnorepinephrine hcl inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J0600 ............. E Edetate calcium disodium inj .......................... 0.00 0.00 0.00 0.00 XXX 0

J0610 ............. E Calcium gluconate injection ............................ 0.00 0.00 0.00 0.00 XXX 0

J0620 ............. E Calcium glycer & lact/10 ML ........................... 0.00 0.00 0.00 0.00 XXX 0

J0630 ............. E Calcitonin salmon injection ............................. 0.00 0.00 0.00 0.00 XXX 0

J0635 ............. E Calcitriol injection ............................................ 0.00 0.00 0.00 0.00 XXX 0

J0640 ............. E Leucovorin calcium injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J0670 ............. E Inj mepivacaine HCL/10 ml ............................. 0.00 0.00 0.00 0.00 XXX 0

J0680 ............. D Deslanoside injection ...................................... 0.00 0.00 0.00 0.00 XXX 0
63338

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

J0690 ............. E Cefazolin sodium injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J0694 ............. E Cefoxitin sodium injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J0695 ............. E Cefonocid sodium injection ............................. 0.00 0.00 0.00 0.00 XXX 0

J0696 ............. E Ceftriaxone sodium injection .......................... 0.00 0.00 0.00 0.00 XXX 0

J0697 ............. E Sterile cefuroxime injection ............................. 0.00 0.00 0.00 0.00 XXX 0

J0698 ............. E Cefotaxime sodium injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J0702 ............. E Betamethasone acet&sod phosp .................... 0.00 0.00 0.00 0.00 XXX 0

J0704 ............. E Betamethasone sod phosp/4 MG ................... 0.00 0.00 0.00 0.00 XXX 0

J0710 ............. E Cephapirin sodium injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J0713 ............. E Inj ceftazidime per 500 mg ............................. 0.00 0.00 0.00 0.00 XXX 0

J0715 ............. E Ceftizoxime sodium / 500 MG ........................ 0.00 0.00 0.00 0.00 XXX 0

J0720 ............. E Chloramphenicol sodium injec ........................ 0.00 0.00 0.00 0.00 XXX 0

J0725 ............. E Chorionic gonadotropin/1000u ........................ 0.00 0.00 0.00 0.00 XXX 0

J0730 ............. E Chlorpheniramin maleate inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J0743 ............. E Cilastatin sodium injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J0745 ............. E Inj codeine phosphate /30 MG ....................... 0.00 0.00 0.00 0.00 XXX 0

J0760 ............. E Colchicine injection ......................................... 0.00 0.00 0.00 0.00 XXX 0

J0770 ............. E Colistimethate sodium inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J0780 ............. E Prochlorperazine injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J0800 ............. E Corticotropin injection ..................................... 0.00 0.00 0.00 0.00 XXX 0

J0810 ............. E Cortisone injection .......................................... 0.00 0.00 0.00 0.00 XXX 0

J0820 ............. D Cortigel 40 injection ........................................ 0.00 0.00 0.00 0.00 XXX 0

J0835 ............. E Inj cosyntropin per 0.25 MG ........................... 0.00 0.00 0.00 0.00 XXX 0

J0850 ............. E Cytomegalovirus imm IV /vial ......................... 0.00 0.00 0.00 0.00 XXX 0

J0895 ............. E Deferoxamine mesylate inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J0900 ............. E Testosterone enanthate inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J0945 ............. E Brompheniramine maleate inj ......................... 0.00 0.00 0.00 0.00 XXX 0

J0970 ............. E Estradiol valerate injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J1000 ............. E Depo-estradiol cypionate inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J1020 ............. E Methylprednisolone 20 MG inj ........................ 0.00 0.00 0.00 0.00 XXX 0

J1030 ............. E Methylprednisolone 40 MG inj ........................ 0.00 0.00 0.00 0.00 XXX 0

J1040 ............. E Methylprednisolone 80 MG inj ........................ 0.00 0.00 0.00 0.00 XXX 0

J1050 ............. E Medroxyprogesterone inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J1055 ............. E Medrxyprogester acetate inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J1060 ............. E Testosterone cypionate 1 ML ......................... 0.00 0.00 0.00 0.00 XXX 0

J1070 ............. E Testosterone cypionat 100 MG ...................... 0.00 0.00 0.00 0.00 XXX 0

J1080 ............. E Testosterone cypionat 200 MG ...................... 0.00 0.00 0.00 0.00 XXX 0

J1090 ............. E Testosterone cypionate 50 MG ...................... 0.00 0.00 0.00 0.00 XXX 0

J1095 ............. E Inj dexamethasone acetate ............................ 0.00 0.00 0.00 0.00 XXX 0

J1100 ............. E Dexamethosone sodium phos ........................ 0.00 0.00 0.00 0.00 XXX 0

J1110 ............. E Inj dihydroergotamine mesylt .......................... 0.00 0.00 0.00 0.00 XXX 0

J1120 ............. E Acetazolamid sodium injectio ......................... 0.00 0.00 0.00 0.00 XXX 0

J1160 ............. E Digoxin injection .............................................. 0.00 0.00 0.00 0.00 XXX 0

J1165 ............. E Phenytoin sodium injection ............................. 0.00 0.00 0.00 0.00 XXX 0

J1170 ............. E Hydromorphone injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J1180 ............. E Dyphylline injection ......................................... 0.00 0.00 0.00 0.00 XXX 0

J1200 ............. E Diphenhydramine hcl injectio .......................... 0.00 0.00 0.00 0.00 XXX 0

J1205 ............. E Chlorothiazide sodium inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1212 ............. E Dimethyl sulfoxide 50% 50 ML ....................... 0.00 0.00 0.00 0.00 XXX 0

J1230 ............. E Methadone injection ........................................ 0.00 0.00 0.00 0.00 XXX 0

J1240 ............. E Dimenhydrinate injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J1245 ............. E Dipyridamole injection ..................................... 0.00 0.00 0.00 0.00 XXX 0

J1250 ............. E Inj dobutamine HCL/250 mg ........................... 0.00 0.00 0.00 0.00 XXX 0

J1320 ............. E Amitriptyline injection ...................................... 0.00 0.00 0.00 0.00 XXX 0

J1330 ............. E Ergonovine maleate injection ......................... 0.00 0.00 0.00 0.00 XXX 0

J1340 ............. D Aqueous/saline placebo inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J1362 ............. E Erythromycin glucep / 250 MG ....................... 0.00 0.00 0.00 0.00 XXX 0

J1364 ............. E Erythro lactobionate /500 MG ......................... 0.00 0.00 0.00 0.00 XXX 0

J1380 ............. E Estradiol valerate 10 MG inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J1390 ............. E Estradiol valerate 20 MG inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J1410 ............. E Inj estrogen conjugate 25 MG ........................ 0.00 0.00 0.00 0.00 XXX 0

J1435 ............. E Injection estrone per 1 MG ............................. 0.00 0.00 0.00 0.00 XXX 0

J1436 ............. E Etidronate disodium inj ................................... 0.00 0.00 0.00 0.00 XXX 0

J1440 ............. E Filgrastim 300 mcg injeciton ........................... 0.00 0.00 0.00 0.00 XXX 0

J1441 ............. E Filgrastim 480 mcg injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J1455 ............. E Foscarnet sodium injection ............................. 0.00 0.00 0.00 0.00 XXX 0
63339

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

J1460 ............. E Gamma globulin 1 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1470 ............. E Gamma globulin 2 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1480 ............. E Gamma globulin 3 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1490 ............. E Gamma globulin 4 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1500 ............. E Gamma globulin 5 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1510 ............. E Gamma globulin 6 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1520 ............. E Gamma globulin 7 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1530 ............. E Gamma globulin 8 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1540 ............. E Gamma globulin 9 CC inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1550 ............. E Gamma globulin 10 CC inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J1560 ............. E Gamma globulin > 10 CC inj .......................... 0.00 0.00 0.00 0.00 XXX 0

J1561 ............. E Immune globulin injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J1562 ............. E Immune globulin 10% /5 grams ...................... 0.00 0.00 0.00 0.00 XXX 0

J1570 ............. E Ganciclovir sodium injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J1580 ............. E Garamycin gentamicin inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1600 ............. E Gold sodium thiomaleate inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J1610 ............. E Glucagon hydrochloride/1 MG ........................ 0.00 0.00 0.00 0.00 XXX 0

J1620 ............. E Gonadorelin hydroch/ 100 mcg ...................... 0.00 0.00 0.00 0.00 XXX 0

J1625 ............. E Granisetron hydrochlor/1 MG ......................... 0.00 0.00 0.00 0.00 XXX 0

J1630 ............. E Haloperidol injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J1631 ............. E Haloperidol decanoate inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J1642 ............. E Inj heparin sodium per 10 u ........................... 0.00 0.00 0.00 0.00 XXX 0

J1644 ............. E Inj heparin sodium per 1000u ......................... 0.00 0.00 0.00 0.00 XXX 0

J1650 ............. E Inj enoxaparin sodium 30 mg ......................... 0.00 0.00 0.00 0.00 XXX 0

J1660 ............. D Histamine injection .......................................... 0.00 0.00 0.00 0.00 XXX 0

J1670 ............. E Tetanus immune globulin inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J1690 ............. E Prednisolone tebutate inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J1700 ............. E Hydrocortisone acetate inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J1710 ............. E Hydrocortisone sodium ph inj ......................... 0.00 0.00 0.00 0.00 XXX 0

J1720 ............. E Hydrocortisone sodium succ i ......................... 0.00 0.00 0.00 0.00 XXX 0

J1730 ............. E Diazoxide injection .......................................... 0.00 0.00 0.00 0.00 XXX 0

J1739 ............. E Hydroxyprogesterone cap 125 ....................... 0.00 0.00 0.00 0.00 XXX 0

J1741 ............. E Hydroxyprogesterone cap 250 ....................... 0.00 0.00 0.00 0.00 XXX 0

J1760 ............. E Iron dextran 2 CC inj ...................................... 0.00 0.00 0.00 0.00 XXX 0

J1770 ............. E Iron dextran 5 CC inj ...................................... 0.00 0.00 0.00 0.00 XXX 0

J1780 ............. E Iron dextran 10 CC inj .................................... 0.00 0.00 0.00 0.00 XXX 0

J1785 ............. E Injection imiglucerase /unit ............................. 0.00 0.00 0.00 0.00 XXX 0

J1790 ............. E Droperidol injection ......................................... 0.00 0.00 0.00 0.00 XXX 0

J1800 ............. E Propranolol injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J1810 ............. E Droperidol/fentanyl inj ..................................... 0.00 0.00 0.00 0.00 XXX 0

J1820 ............. E Insulin injection ............................................... 0.00 0.00 0.00 0.00 XXX 0

J1830 ............. E Interferon beta-1b / .25 MG ............................ 0.00 0.00 0.00 0.00 XXX 0

J1840 ............. E Kanamycin sulfate 500 MG inj ........................ 0.00 0.00 0.00 0.00 XXX 0

J1850 ............. E Kanamycin sulfate 75 MG inj .......................... 0.00 0.00 0.00 0.00 XXX 0

J1885 ............. E Ketorolac tromethamine inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J1890 ............. E Cephalothin sodium injection .......................... 0.00 0.00 0.00 0.00 XXX 0

J1910 ............. E Kutapressin injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J1930 ............. E Propiomazine injection .................................... 0.00 0.00 0.00 0.00 XXX 0

J1940 ............. E Furosemide injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J1950 ............. E Leuprolide acetate /3.75 MG .......................... 0.00 0.00 0.00 0.00 XXX 0

J1955 ............. E Inj levocarnitine per 1 gm ............................... 0.00 0.00 0.00 0.00 XXX 0

J1960 ............. E Levorphanol tartrate inj ................................... 0.00 0.00 0.00 0.00 XXX 0

J1970 ............. E Methotrimeprazine injection ............................ 0.00 0.00 0.00 0.00 XXX 0

J1980 ............. E Hyoscyamine sulfate inj .................................. 0.00 0.00 0.00 0.00 XXX 0

J1990 ............. E Chlordiazepoxide injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J2000 ............. E Lidocaine injection .......................................... 0.00 0.00 0.00 0.00 XXX 0

J2010 ............. E Lincomycin injection ........................................ 0.00 0.00 0.00 0.00 XXX 0

J2050 ............. E Liver injection .................................................. 0.00 0.00 0.00 0.00 XXX 0

J2060 ............. E Lorazepam injection ........................................ 0.00 0.00 0.00 0.00 XXX 0

J2100 ............. D Luminal sodium injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J2150 ............. E Mannitol injection ............................................ 0.00 0.00 0.00 0.00 XXX 0

J2175 ............. E Meperidine hydrochl /100 MG ........................ 0.00 0.00 0.00 0.00 XXX 0

J2180 ............. E Meperidine/promethazine inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J2190 ............. D Mersalyl & theophylline inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J2210 ............. E Methylergonovin maleate inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J2240 ............. E Metocurine iodide injection ............................. 0.00 0.00 0.00 0.00 XXX 0
63340

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

J2250 ............. E Inj midazolam hydrochloride ........................... 0.00 0.00 0.00 0.00 XXX 0

J2260 ............. E Inj milrinone lactate / 5 ML ............................. 0.00 0.00 0.00 0.00 XXX 0

J2270 ............. E Morphine sulfate injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J2275 ............. E Morphine sulfate injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J2300 ............. E Inj nalbuphine hydrochloride ........................... 0.00 0.00 0.00 0.00 XXX 0

J2310 ............. E Inj naloxone hydrochloride .............................. 0.00 0.00 0.00 0.00 XXX 0

J2320 ............. E Nandrolone decanoate 50 MG ....................... 0.00 0.00 0.00 0.00 XXX 0

J2321 ............. E Nandrolone decanoate 100 MG ..................... 0.00 0.00 0.00 0.00 XXX 0

J2322 ............. E Nandrolone decanoate 200 MG ..................... 0.00 0.00 0.00 0.00 XXX 0

J2330 ............. E Thiothixene injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J2350 ............. E Niacinamide/niacin injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J2360 ............. E Orphenadrine injection .................................... 0.00 0.00 0.00 0.00 XXX 0

J2370 ............. E Phenylephrine hcl injection ............................. 0.00 0.00 0.00 0.00 XXX 0

J2400 ............. E Chloroprocaine hcl injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J2405 ............. E Ondansetron hcl injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J2410 ............. E Oxymorphone hcl injection ............................. 0.00 0.00 0.00 0.00 XXX 0

J2430 ............. E Pamidronate disodium /30 MG ....................... 0.00 0.00 0.00 0.00 XXX 0

J2440 ............. E Papaverin hcl injection .................................... 0.00 0.00 0.00 0.00 XXX 0

J2460 ............. E Oxytetracycline injection ................................. 0.00 0.00 0.00 0.00 XXX 0

J2480 ............. E Hydrochlorides of opium inj ............................ 0.00 0.00 0.00 0.00 XXX 0

J2495 ............. D Tridihexethyl chloride inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J2510 ............. E Penicillin g procaine inj ................................... 0.00 0.00 0.00 0.00 XXX 0

J2512 ............. E Inj pentagastrin per 2 ML ............................... 0.00 0.00 0.00 0.00 XXX 0

J2515 ............. E Pentobarbital sodium inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J2540 ............. E Penicillin g potassium inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J2545 ............. E Pentamidine isethionte/300mg ....................... 0.00 0.00 0.00 0.00 XXX 0

J2550 ............. E Promethazine hcl injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J2560 ............. E Phenobarbital sodium inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J2590 ............. E Oxytocin injection ............................................ 0.00 0.00 0.00 0.00 XXX 0

J2597 ............. E Inj desmopressin acetate ................................ 0.00 0.00 0.00 0.00 XXX 0

J2640 ............. E Prednisolone sodium ph inj ............................ 0.00 0.00 0.00 0.00 XXX 0

J2650 ............. E Prednisolone acetate inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J2670 ............. E Totazoline hcl injection ................................... 0.00 0.00 0.00 0.00 XXX 0

J2675 ............. E Inj progesterone per 50 MG ........................... 0.00 0.00 0.00 0.00 XXX 0

J2680 ............. E Fluphenazine decanoate 25 MG .................... 0.00 0.00 0.00 0.00 XXX 0

J2690 ............. E Procainamide hcl injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J2700 ............. E Oxacillin sodium injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J2710 ............. E Neostigmine methylslfte inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J2720 ............. E Inj protamine sulfate/10 MG ........................... 0.00 0.00 0.00 0.00 XXX 0

J2725 ............. E Inj protirelin per 250 mcg ................................ 0.00 0.00 0.00 0.00 XXX 0

J2730 ............. E Pralidoxime chloride inj ................................... 0.00 0.00 0.00 0.00 XXX 0

J2760 ............. E Phentolaine mesylate inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J2765 ............. E Metoclopramide hcl injection .......................... 0.00 0.00 0.00 0.00 XXX 0

J2790 ............. E Rho d immune globulin inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J2800 ............. E Methocarbamol injection ................................. 0.00 0.00 0.00 0.00 XXX 0

J2810 ............. E Inj theophylline per 40 MG ............................. 0.00 0.00 0.00 0.00 XXX 0

J2820 ............. E Sargramostim injection ................................... 0.00 0.00 0.00 0.00 XXX 0

J2860 ............. E Secobarbital sodium inj .................................. 0.00 0.00 0.00 0.00 XXX 0

J2910 ............. E Aurothioglucose injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J2912 ............. E Sodium chloride injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J2914 ............. D Sodium salicylate injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J2920 ............. E Methylprednisolone injection .......................... 0.00 0.00 0.00 0.00 XXX 0

J2930 ............. E Methylprednisolone injection .......................... 0.00 0.00 0.00 0.00 XXX 0

J2950 ............. E Promazine hcl injection ................................... 0.00 0.00 0.00 0.00 XXX 0

J2970 ............. E Methicillin sodium injection ............................. 0.00 0.00 0.00 0.00 XXX 0

J2995 ............. E Inj streptokinase /250000 IU ........................... 0.00 0.00 0.00 0.00 XXX 0

J2996 ............. E Alteplase recombinant inj ............................... 0.00 0.00 0.00 0.00 XXX 0

J3000 ............. E Streptomycin injection ..................................... 0.00 0.00 0.00 0.00 XXX 0

J3005 ............. E Strontium-89 chloride /10 ML ......................... 0.00 0.00 0.00 0.00 XXX 0

J3010 ............. E Fentanyl citrate injection ................................. 0.00 0.00 0.00 0.00 XXX 0

J3030 ............. E Sumatriptan succinate / 6 MG ........................ 0.00 0.00 0.00 0.00 XXX 0

J3070 ............. E Pentazocine hcl injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J3080 ............. E Chlorprothixene injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J3105 ............. E Terbutaline sulfate inj ..................................... 0.00 0.00 0.00 0.00 XXX 0

J3120 ............. E Testosterone enanthate inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J3130 ............. E Testosterone enanthate inj ............................. 0.00 0.00 0.00 0.00 XXX 0
63341

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

J3140 ............. E Testosterone suspension inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J3150 ............. E Testosterone propionate inj ............................ 0.00 0.00 0.00 0.00 XXX 0

J3230 ............. E Chlorpromazine hcl injection .......................... 0.00 0.00 0.00 0.00 XXX 0

J3240 ............. E Thyrotropin injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J3250 ............. E Trimethobenzamide hcl inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J3260 ............. E Tobramycin sulfate injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J3265 ............. E Injection torsemide 10 mg/ml .......................... 0.00 0.00 0.00 0.00 XXX 0

J3270 ............. E Imipramine hcl injection .................................. 0.00 0.00 0.00 0.00 XXX 0

J3280 ............. E Thiethylperazine maleate inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J3301 ............. E Triamcinolone acetonide inj ............................ 0.00 0.00 0.00 0.00 XXX 0

J3302 ............. E Triamcinolone diacetate inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J3303 ............. E Triamcinolone hexacetonl inj .......................... 0.00 0.00 0.00 0.00 XXX 0

J3305 ............. E Inj trimetrexate glucoronate ............................ 0.00 0.00 0.00 0.00 XXX 0

J3310 ............. E Perphenazine injection ................................... 0.00 0.00 0.00 0.00 XXX 0

J3320 ............. E Spectinomycin di-hcl inj .................................. 0.00 0.00 0.00 0.00 XXX 0

J3340 ............. D Cryptenamine acetate inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J3350 ............. E Urea injection .................................................. 0.00 0.00 0.00 0.00 XXX 0

J3360 ............. E Diazepam injection ......................................... 0.00 0.00 0.00 0.00 XXX 0

J3364 ............. E Urokinase 5000 IU injection ........................... 0.00 0.00 0.00 0.00 XXX 0

J3365 ............. E Urokinase 250,000 IU inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J3370 ............. E Vancomycin hcl injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J3380 ............. D Isoxsuprine hcl injection ................................. 0.00 0.00 0.00 0.00 XXX 0

J3390 ............. E Methoxamine injection .................................... 0.00 0.00 0.00 0.00 XXX 0

J3400 ............. E Triflupromazine hcl inj ..................................... 0.00 0.00 0.00 0.00 XXX 0

J3410 ............. E Hydroxyzine hcl injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J3420 ............. E Vitamin b12 injection ...................................... 0.00 0.00 0.00 0.00 XXX 0

J3430 ............. E Vitamin k phytonadione inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J3450 ............. E Mephentermine sulfate inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J3470 ............. E Hyaluronidase injection ................................... 0.00 0.00 0.00 0.00 XXX 0

J3475 ............. E Inj magnesium sulfate ..................................... 0.00 0.00 0.00 0.00 XXX 0

J3480 ............. E Inj potassium chloride ..................................... 0.00 0.00 0.00 0.00 XXX 0

J3490 ............. E Drugs unclassified injection ............................ 0.00 0.00 0.00 0.00 XXX 0

J3500 ............. D Vitamin therapy ............................................... 0.00 0.00 0.00 0.00 XXX 0

J3520 ............. N Edetate disodium per 150 mg ........................ 0.00 0.00 0.00 0.00 XXX 0

J3530 ............. E Nasal vaccine inhalation ................................. 0.00 0.00 0.00 0.00 XXX 0

J3535 ............. E Metered dose inhaler drug ............................. 0.00 0.00 0.00 0.00 XXX 0

J3540 ............. D Autogenous blood extract ............................... 0.00 0.00 0.00 0.00 XXX 0

J3550 ............. D Intra-arterial oxygen inj ................................... 0.00 0.00 0.00 0.00 XXX 0

J3560 ............. D Adrenal cortex extract ..................................... 0.00 0.00 0.00 0.00 XXX 0

J3570 ............. N Laetrile amygdalin vit B17 .............................. 0.00 0.00 0.00 0.00 XXX 0

J6015 ............. D Typhus immun/injection .................................. 0.00 0.00 0.00 0.00 XXX 0

J7030 ............. E Normal saline solution infus ............................ 0.00 0.00 0.00 0.00 XXX 0

J7040 ............. E Normal saline solution infus ............................ 0.00 0.00 0.00 0.00 XXX 0

J7042 ............. E 5% dextrose/normal saline ............................. 0.00 0.00 0.00 0.00 XXX 0

J7050 ............. E Normal saline solution infus ............................ 0.00 0.00 0.00 0.00 XXX 0

J7051 ............. E Sterile saline/water ......................................... 0.00 0.00 0.00 0.00 XXX 0

J7060 ............. E 5% dextrose/water .......................................... 0.00 0.00 0.00 0.00 XXX 0

J7070 ............. E D5w infusion ................................................... 0.00 0.00 0.00 0.00 XXX 0

J7080 ............. D 5% albumisol infusion ..................................... 0.00 0.00 0.00 0.00 XXX 0

J7090 ............. D 25% albumisol infusion ................................... 0.00 0.00 0.00 0.00 XXX 0

J7100 ............. E Dextran 40 infusion ......................................... 0.00 0.00 0.00 0.00 XXX 0

J7110 ............. E Dextran 75 infusion ......................................... 0.00 0.00 0.00 0.00 XXX 0

J7120 ............. E Ringers lactate infusion .................................. 0.00 0.00 0.00 0.00 XXX 0

J7130 ............. E Hypertonic saline solution ............................... 0.00 0.00 0.00 0.00 XXX 0

J7140 ............. N Prescription oral drug ..................................... 0.00 0.00 0.00 0.00 XXX 0

J7150 ............. N Prescription oral chemo drug .......................... 0.00 0.00 0.00 0.00 XXX 0

J7190 ............. X Factor viii ........................................................ 0.00 0.00 0.00 0.00 XXX 0

J7191 ............. X Factor VIII (porcine) ........................................ 0.00 0.00 0.00 0.00 XXX 0

J7192 ............. X Factor viii recombinant .................................... 0.00 0.00 0.00 0.00 XXX 0

J7194 ............. X Factor ix complex ........................................... 0.00 0.00 0.00 0.00 XXX 0

J7196 ............. X Othr hemophilia clot factors ............................ 0.00 0.00 0.00 0.00 XXX 0

J7197 ............. X Antithrombin iii injection .................................. 0.00 0.00 0.00 0.00 XXX 0

J7300 ............. N Intraut copper contraceptive ........................... 0.00 0.00 0.00 0.00 XXX 0

J7500 ............. X Azathiop po tab 50mg 100s ea ...................... 0.00 0.00 0.00 0.00 XXX 0

J7501 ............. X Azathioprine parenteral ................................... 0.00 0.00 0.00 0.00 XXX 0

J7502 ............. X Cyclosporine oral solution ............................... 0.00 0.00 0.00 0.00 XXX 0
63342

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

J7503 ............. X Cyclosporine parenteral .................................. 0.00 0.00 0.00 0.00 XXX 0

J7504 ............. X Lymphocyte immune globulin ......................... 0.00 0.00 0.00 0.00 XXX 0

J7505 ............. X Monoclonal antibodies .................................... 0.00 0.00 0.00 0.00 XXX 0

J7506 ............. X Prednisone ...................................................... 0.00 0.00 0.00 0.00 XXX 0

J7507 ............. E Tacrolimus oral per 1 MG ............................... 0.00 0.00 0.00 0.00 XXX 0

J7508 ............. E Tacrolimus oral per 5 MG ............................... 0.00 0.00 0.00 0.00 XXX 0

J7509 ............. X Methylprednisolone oral .................................. 0.00 0.00 0.00 0.00 XXX 0

J7510 ............. X Prednisolone oral per 5 mg ............................ 0.00 0.00 0.00 0.00 XXX 0

J7599 ............. X Immunosuppressive drug noc ......................... 0.00 0.00 0.00 0.00 XXX 0

J7610 ............. E Acetylcysteine 10% injection .......................... 0.00 0.00 0.00 0.00 XXX 0

J7615 ............. E Acetylcysteine 20% injection .......................... 0.00 0.00 0.00 0.00 XXX 0

J7620 ............. E Albuterol sulfate .083% inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J7625 ............. E Albuterol sulfate .5% inj .................................. 0.00 0.00 0.00 0.00 XXX 0

J7627 ............. E Bitolterolmesylate inhal sol ............................. 0.00 0.00 0.00 0.00 XXX 0

J7630 ............. E Cromolyn sodium injection .............................. 0.00 0.00 0.00 0.00 XXX 0

J7640 ............. E Epinephrine injection ...................................... 0.00 0.00 0.00 0.00 XXX 0

J7645 ............. E Ipratropium bromide .02%/ml .......................... 0.00 0.00 0.00 0.00 XXX 0

J7650 ............. E Isoetharine hcl .1% inj .................................... 0.00 0.00 0.00 0.00 XXX 0

J7651 ............. E Isoetharine hcl .125% inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J7652 ............. E Isoetharine hcl .167% inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J7653 ............. E Isoetharine hcl .2%/ inj ................................... 0.00 0.00 0.00 0.00 XXX 0

J7654 ............. E Isoetharine hcl .25% inj .................................. 0.00 0.00 0.00 0.00 XXX 0

J7655 ............. E Isoetharine hcl 1% inj ..................................... 0.00 0.00 0.00 0.00 XXX 0

J7660 ............. E Isoproterenol hcl .5% inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J7665 ............. E Isoproterenol hcl 1% inj .................................. 0.00 0.00 0.00 0.00 XXX 0

J7670 ............. E Metaproterenol sulfate .4% ............................. 0.00 0.00 0.00 0.00 XXX 0

J7672 ............. E Metaproterenol sulfate .6% ............................. 0.00 0.00 0.00 0.00 XXX 0

J7675 ............. E Metaproterenol sulfate 5% .............................. 0.00 0.00 0.00 0.00 XXX 0

J7699 ............. E Inhalation solution for DME ............................ 0.00 0.00 0.00 0.00 XXX 0

J7799 ............. E Non-inhalation drug for DME .......................... 0.00 0.00 0.00 0.00 XXX 0

J8499 ............. N Oral prescrip drug non chemo ........................ 0.00 0.00 0.00 0.00 XXX 0

J8530 ............. E Cyclophosphamide oral 25 MG ...................... 0.00 0.00 0.00 0.00 XXX 0

J8560 ............. E Etoposide oral 50 MG ..................................... 0.00 0.00 0.00 0.00 XXX 0

J8600 ............. E Melphalan oral 2 MG ...................................... 0.00 0.00 0.00 0.00 XXX 0

J8610 ............. E Methotrexate oral 2.5 MG ............................... 0.00 0.00 0.00 0.00 XXX 0

J8999 ............. E Oral prescription drug chemo ......................... 0.00 0.00 0.00 0.00 XXX 0

J9000 ............. E Doxorubic hcl 10 MG vl chemo ...................... 0.00 0.00 0.00 0.00 XXX 0

J9010 ............. E Doxorubicin hcl 50 MG inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J9015 ............. E Aldesleukin/single use vial .............................. 0.00 0.00 0.00 0.00 XXX 0

J9020 ............. E Asparaginase injection .................................... 0.00 0.00 0.00 0.00 XXX 0

J9031 ............. E Bcg live intravesical vac ................................. 0.00 0.00 0.00 0.00 XXX 0

J9040 ............. E Bleomycin sulfate injection ............................. 0.00 0.00 0.00 0.00 XXX 0

J9045 ............. E Carboplatin injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J9050 ............. E Carmus bischl nitro inj .................................... 0.00 0.00 0.00 0.00 XXX 0

J9060 ............. E Cisplatin 10 MG injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J9062 ............. E Cisplatin 50 MG injection ................................ 0.00 0.00 0.00 0.00 XXX 0

J9065 ............. E Inj cladribine per 1 MG ................................... 0.00 0.00 0.00 0.00 XXX 0

J9070 ............. E Cyclophosphamide 100 MG inj ....................... 0.00 0.00 0.00 0.00 XXX 0

J9080 ............. E Cyclophosphamide 200 MG inj ....................... 0.00 0.00 0.00 0.00 XXX 0

J9090 ............. E Cyclophosphamide 500 MG inj ....................... 0.00 0.00 0.00 0.00 XXX 0

J9091 ............. E Cyclophosphamide 1.0 grm inj ....................... 0.00 0.00 0.00 0.00 XXX 0

J9092 ............. E Cyclophosphamide 2.0 grm inj ....................... 0.00 0.00 0.00 0.00 XXX 0

J9093 ............. E Cyclophosphamide lyophilized ....................... 0.00 0.00 0.00 0.00 XXX 0

J9094 ............. E Cyclophosphamide lyophilized ....................... 0.00 0.00 0.00 0.00 XXX 0

J9095 ............. E Cyclophosphamide lyophilized ....................... 0.00 0.00 0.00 0.00 XXX 0

J9096 ............. E Cyclophosphamide lyophilized ....................... 0.00 0.00 0.00 0.00 XXX 0

J9097 ............. E Cyclophosphamide lyophilized ....................... 0.00 0.00 0.00 0.00 XXX 0

J9100 ............. E Cytarabine hcl 100 MG inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J9110 ............. E Cytarabine hcl 500 MG inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J9120 ............. E Dactinomycin actinomycin d ........................... 0.00 0.00 0.00 0.00 XXX 0

J9130 ............. E Dacarbazine 10 MG inj ................................... 0.00 0.00 0.00 0.00 XXX 0

J9140 ............. E Dacarbazine 200 MG inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J9150 ............. E Daunorubicin hcl injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J9165 ............. E Diethylstilbestrol injection ............................... 0.00 0.00 0.00 0.00 XXX 0

J9181 ............. E Etoposide 10 MG inj ....................................... 0.00 0.00 0.00 0.00 XXX 0

J9182 ............. E Etoposide 100 MG inj ..................................... 0.00 0.00 0.00 0.00 XXX 0
63343

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

J9185 ............. E Fludarabine phosphate inj .............................. 0.00 0.00 0.00 0.00 XXX 0

J9190 ............. E Fluorouracil injection ....................................... 0.00 0.00 0.00 0.00 XXX 0

J9200 ............. E Floxuridine injection ........................................ 0.00 0.00 0.00 0.00 XXX 0

J9202 ............. E Goserelin acetate implant ............................... 0.00 0.00 0.00 0.00 XXX 0

J9208 ............. E Ifosfomide injection ......................................... 0.00 0.00 0.00 0.00 XXX 0

J9209 ............. E Mesna injection ............................................... 0.00 0.00 0.00 0.00 XXX 0

J9211 ............. E Idarubicin hcl injection .................................... 0.00 0.00 0.00 0.00 XXX 0

J9213 ............. E Interferon alfa-2a inj ........................................ 0.00 0.00 0.00 0.00 XXX 0

J9214 ............. E Interferon alfa-2b inj ........................................ 0.00 0.00 0.00 0.00 XXX 0

J9215 ............. E Interferon alfa-n3 inj ........................................ 0.00 0.00 0.00 0.00 XXX 0

J9216 ............. E Interferon gamma 1-b inj ................................ 0.00 0.00 0.00 0.00 XXX 0

J9217 ............. E Leuprolide acetate suspnsion ......................... 0.00 0.00 0.00 0.00 XXX 0

J9218 ............. E Leuprolide acetate injection ............................ 0.00 0.00 0.00 0.00 XXX 0

J9230 ............. E Mechlorethamine hcl inj .................................. 0.00 0.00 0.00 0.00 XXX 0

J9245 ............. E Inj melphalan hydrochl 50 MG ........................ 0.00 0.00 0.00 0.00 XXX 0

J9250 ............. E Methotrexate sodium inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J9260 ............. E Methotrexate sodium inj ................................. 0.00 0.00 0.00 0.00 XXX 0

J9265 ............. E Paclitaxel injection .......................................... 0.00 0.00 0.00 0.00 XXX 0

J9266 ............. E Pegaspargase/singl dose vial ......................... 0.00 0.00 0.00 0.00 XXX 0

J9268 ............. E Pentostatin injection ........................................ 0.00 0.00 0.00 0.00 XXX 0

J9270 ............. E Plicamycin (mithramycin) inj ........................... 0.00 0.00 0.00 0.00 XXX 0

J9280 ............. E Mitomycin 5 MG inj ......................................... 0.00 0.00 0.00 0.00 XXX 0

J9290 ............. E Mitomycin 20 MG inj ....................................... 0.00 0.00 0.00 0.00 XXX 0

J9291 ............. E Mitomycin 40 MG inj ....................................... 0.00 0.00 0.00 0.00 XXX 0

J9293 ............. E Mitoxantrone hydrochl / 5 MG ........................ 0.00 0.00 0.00 0.00 XXX 0

J9295 ............. D Polyestradiol phosphate inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J9320 ............. E Streptozocin injection ...................................... 0.00 0.00 0.00 0.00 XXX 0

J9340 ............. E Thiotepa injection ............................................ 0.00 0.00 0.00 0.00 XXX 0

J9360 ............. E Vinblastine sulfate inj ...................................... 0.00 0.00 0.00 0.00 XXX 0

J9370 ............. E Vincristine sulfate 1 MG inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J9375 ............. E Vincristine sulfate 2 MG inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J9380 ............. E Vincristine sulfate 5 MG inj ............................. 0.00 0.00 0.00 0.00 XXX 0

J9390 ............. E Vinorelbine tartrate/10 mg .............................. 0.00 0.00 0.00 0.00 XXX 0

J9999 ............. E Chemotherapy drug ........................................ 0.00 0.00 0.00 0.00 XXX 0

M0005 ............. G Off visit 2/more modalities .............................. #0.76 0.31 0.03 1.10 XXX 0

M0006 ............. G One phys therapy modality ............................. #0.50 0.15 0.02 0.67 XXX 0

M0007 ............. G Combined phys ther mod & tx ........................ #1.01 0.35 0.04 1.40 XXX 0

M0008 ............. G Combined phys ther mod & tx ........................ #0.50 0.11 0.01 0.62 XXX 0

M0064 ............. A Visit for drug monitoring ................................. 0.37 0.19 0.03 0.59 XXX N

M0075 ............. N Cellular therapy ............................................... 0.00 0.00 0.00 0.00 XXX 0

M0076 ............. N Prolotherapy .................................................... 0.00 0.00 0.00 0.00 XXX 0

M0100 ............. N Intragastric hypothermia ................................. 0.00 0.00 0.00 0.00 XXX 0

M0101 ............. A Cutting or removal of corns ............................ 0.37 0.35 0.03 0.75 XXX S

M0300 ............. N IV chelation therapy ........................................ 0.00 0.00 0.00 0.00 XXX 0

M0301 ............. N Fabric wrapping of aneurysm ......................... 0.00 0.00 0.00 0.00 XXX 0

M0302 ............. N Assessment of cardiac output ........................ 0.00 0.00 0.00 0.00 XXX 0

P2028 ............. X Cephalin floculation test ................................. 0.00 0.00 0.00 0.00 XXX 0

P2029 ............. X Congo red blood test ...................................... 0.00 0.00 0.00 0.00 XXX 0

P2031 ............. N Hair analysis ................................................... 0.00 0.00 0.00 0.00 XXX 0

P2033 ............. X Blood thymol turbidity ..................................... 0.00 0.00 0.00 0.00 XXX 0

P2038 ............. X Blood mucoprotein .......................................... 0.00 0.00 0.00 0.00 XXX 0

P3000 ............. X Screen pap by tech w md supv ...................... 0.00 0.00 0.00 0.00 XXX 0

P3001 ............. X Screening pap smear by phys ........................ 0.00 0.00 0.00 0.00 XXX 0

P3001 26 A Screening pap smear by phys ........................ 0.42 0.32 0.04 0.78 XXX N

P7001 ............. G Culture bacterial urine .................................... 0.00 0.00 0.00 0.00 XXX 0

P9010 ............. E Whole blood for transfusion ............................ 0.00 0.00 0.00 0.00 XXX 0

P9011 ............. E Blood split unit ................................................ 0.00 0.00 0.00 0.00 XXX 0

P9012 ............. E Cryoprecipitate each unit ................................ 0.00 0.00 0.00 0.00 XXX 0

P9013 ............. E Unit/s blood fibrinogen .................................... 0.00 0.00 0.00 0.00 XXX 0

P9014 ............. E Gamma globulin 1 ML .................................... 0.00 0.00 0.00 0.00 XXX 0

P9015 ............. E Rh immune globulin 1 ML ............................... 0.00 0.00 0.00 0.00 XXX 0

P9016 ............. E Leukocyte poor blood, unit ............................. 0.00 0.00 0.00 0.00 XXX 0

P9017 ............. E One donor fresh frozn plasma ........................ 0.00 0.00 0.00 0.00 XXX 0

P9018 ............. E Plasma protein fract, unit ................................ 0.00 0.00 0.00 0.00 XXX 0

P9019 ............. E Platelet concentrate unit ................................. 0.00 0.00 0.00 0.00 XXX 0

P9020 ............. E Platelet rich plasma unit ................................. 0.00 0.00 0.00 0.00 XXX 0
63344

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

P9021 ............. E Red blood cells unit ........................................ 0.00 0.00 0.00 0.00 XXX 0

P9022 ............. E Washed red blood cells unit ........................... 0.00 0.00 0.00 0.00 XXX 0

P9603 ............. X One-way allow prorated miles ........................ 0.00 0.00 0.00 0.00 XXX 0

P9604 ............. X One-way allow prorated trip ............................ 0.00 0.00 0.00 0.00 XXX 0

P9605 ............. D Routine venipuncture ...................................... 0.00 0.00 0.00 0.00 XXX 0

P9610 ............. X Urine specimen collect singl ........................... 0.00 0.00 0.00 0.00 XXX 0

P9615 ............. X Urine specimen collect mult ............................ 0.00 0.00 0.00 0.00 XXX 0

Q0034 ............. X Admin of influenza vaccine ............................. 0.00 0.00 0.00 0.00 XXX 0

Q0035 ............. A Cardiokymography .......................................... 0.17 0.49 0.04 0.70 XXX N

Q0035 26 A Cardiokymography .......................................... 0.17 0.12 0.01 0.30 XXX N

Q0035 TC A Cardiokymography .......................................... 0.00 0.37 0.03 0.40 XXX N

Q0068 ............. A Extracorpeal plasmapheresis .......................... 1.67 1.27 0.16 3.10 000 N

Q0091 ............. A Obtaining screen pap smear .......................... 0.37 0.28 0.03 0.68 XXX N

Q0092 ............. A Set up port xray equipment ............................ 0.00 0.30 0.01 0.31 XXX N

Q0103 ............. A Physical therapy evaluation ............................ 1.01 0.35 0.11 1.47 XXX N

Q0104 ............. A Phys therapy re-evaluation ............................. 0.50 0.04 0.01 0.55 XXX N

Q0109 ............. A Occupational therapy eval .............................. 1.01 0.35 0.11 1.47 XXX N

Q0110 ............. A Occupational therap re-eval ........................... 0.50 0.04 0.01 0.55 XXX N

Q0111 ............. X Wet mounts/ w preparations ........................... 0.00 0.00 0.00 0.00 XXX 0

Q0112 ............. X Potassium hydroxide preps ............................ 0.00 0.00 0.00 0.00 XXX 0

Q0113 ............. X Pinworm examinations .................................... 0.00 0.00 0.00 0.00 XXX 0

Q0114 ............. X Fern test .......................................................... 0.00 0.00 0.00 0.00 XXX 0

Q0115 ............. X Post-coital mucous exam ............................... 0.00 0.00 0.00 0.00 XXX 0

Q0116 ............. X Hemoglbn sngle analyte exam ....................... 0.00 0.00 0.00 0.00 XXX 0

Q0132 ............. X Dispensing fee DME neb drug ....................... 0.00 0.00 0.00 0.00 XXX 0

Q0136 ............. X Non esrd epoetin alpha inj ............................. 0.00 0.00 0.00 0.00 XXX 0

Q0137 ............. D Dexamethasone acetate 8MG/ML .................. 0.00 0.00 0.00 0.00 XXX 0

Q0138 ............. D Dexamethasone acetat 16MG/ML .................. 0.00 0.00 0.00 0.00 XXX 0

Q0139 ............. D Inj desmopressin acetat 4mcg ........................ 0.00 0.00 0.00 0.00 XXX N

Q0140 ............. D Inj potassium chloride, 2meg .......................... 0.00 0.00 0.00 0.00 XXX 0

Q0141 ............. D Inj magnesum sulfate, 500 mg ....................... 0.00 0.00 0.00 0.00 XXX N

Q0142 ............. D Sup thallous chloride tl 201 ............................ 0.00 0.00 0.00 0.00 XXX N

Q0143 ............. D Sup technetium tc sestamibi .......................... 0.00 0.00 0.00 0.00 XXX 0

Q9920 ............. E Epoetin with hct <= 20 .................................... 0.00 0.00 0.00 0.00 XXX 0

Q9921 ............. E Epoetin with hct = 21 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9922 ............. E Epoetin with hct = 22 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9923 ............. E Epoetin with hct = 23 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9924 ............. E Epoetin with hct = 24 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9925 ............. E Epoetin with hct = 25 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9926 ............. E Epoetin with hct = 26 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9927 ............. E Epoetin with hct = 27 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9928 ............. E Epoetin with hct = 28 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9929 ............. E Epoetin with hct = 29 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9930 ............. E Epoetin with hct = 30 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9931 ............. E Epoetin with hct = 31 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9932 ............. E Epoetin with hct = 32 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9933 ............. E Epoetin with hct = 33 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9934 ............. E Epoetin with hct = 34 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9935 ............. E Epoetin with hct = 35 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9936 ............. E Epoetin with hct = 36 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9937 ............. E Epoetin with hct = 37 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9938 ............. E Epoetin with hct = 38 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9939 ............. E Epoetin with hct = 39 ...................................... 0.00 0.00 0.00 0.00 XXX 0

Q9940 ............. E Epoetin with hct >= 40 .................................... 0.00 0.00 0.00 0.00 XXX 0

R0070 ............. C Transport portable x-ray ................................. 0.00 0.00 0.00 0.00 XXX N

R0075 ............. C Transport port x-ray multipl ............................. 0.00 0.00 0.00 0.00 XXX N

R0076 ............. C Transport portable EKG .................................. 0.00 0.00 0.00 0.00 XXX N

V2020 ............. X Vision svcs frames purchases ........................ 0.00 0.00 0.00 0.00 XXX 0

V2025 ............. N Eyeglasses delux frames ................................ 0.00 0.00 0.00 0.00 XXX 0

V2100 ............. X Lens spher single plano 4.00 ......................... 0.00 0.00 0.00 0.00 XXX 0

V2101 ............. X Single visn sphere 4.12–7.00 ......................... 0.00 0.00 0.00 0.00 XXX 0

V2102 ............. X Singl visn sphere 7.12–20.00 ......................... 0.00 0.00 0.00 0.00 XXX 0

V2103 ............. X Spherocylindr 4.00d/12–2.00d ........................ 0.00 0.00 0.00 0.00 XXX 0

V2104 ............. X Spherocylindr 4.00d/2.12–4d .......................... 0.00 0.00 0.00 0.00 XXX 0

V2105 ............. X Spherocylinder 4.00d/4.25–6d ........................ 0.00 0.00 0.00 0.00 XXX 0

V2106 ............. X Spherocylinder 4.00d/>6.00d .......................... 0.00 0.00 0.00 0.00 XXX 0
63345

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

V2107 ............. X Spherocylinder 4.25d/12–2d ........................... 0.00 0.00 0.00 0.00 XXX 0

V2108 ............. X Spherocylinder 4.25d/2.12–4d ........................ 0.00 0.00 0.00 0.00 XXX 0

V2109 ............. X Spherocylinder 4.25d/4.25–6d ........................ 0.00 0.00 0.00 0.00 XXX 0

V2110 ............. X Spherocylinder 4.25d/over 6d ......................... 0.00 0.00 0.00 0.00 XXX 0

V2111 ............. X Spherocylindr 7.25d/.25–2.25 ......................... 0.00 0.00 0.00 0.00 XXX 0

V2112 ............. X Spherocylindr 7.25d/2.25–4d .......................... 0.00 0.00 0.00 0.00 XXX 0

V2113 ............. X Spherocylindr 7.25d/4.25–6d .......................... 0.00 0.00 0.00 0.00 XXX 0

V2114 ............. X Spherocylinder over 12.00d ............................ 0.00 0.00 0.00 0.00 XXX 0

V2115 ............. X Lens lenticular bifocal ..................................... 0.00 0.00 0.00 0.00 XXX 0

V2116 ............. X Nonaspheric lens bifocal ................................ 0.00 0.00 0.00 0.00 XXX 0

V2117 ............. X Aspheric lens bifocal ....................................... 0.00 0.00 0.00 0.00 XXX 0

V2118 ............. X Lens aniseikonic single ................................... 0.00 0.00 0.00 0.00 XXX 0

V2199 ............. X Lens single vision not oth c ............................ 0.00 0.00 0.00 0.00 XXX 0

V2200 ............. X Lens spher bifoc plano 4.00d ......................... 0.00 0.00 0.00 0.00 XXX 0

V2201 ............. X Lens sphere bifocal 4.12–7.0 ......................... 0.00 0.00 0.00 0.00 XXX 0

V2202 ............. X Lens sphere bifocal 7.12–20. ......................... 0.00 0.00 0.00 0.00 XXX 0

V2203 ............. X Lens sphcyl bifocal 4.00d/.1 ........................... 0.00 0.00 0.00 0.00 XXX 0

V2204 ............. X Lens sphcy bifocal 4.00d/2.1 .......................... 0.00 0.00 0.00 0.00 XXX 0

V2205 ............. X Lens sphcy bifocal 4.00d/4.2 .......................... 0.00 0.00 0.00 0.00 XXX 0

V2206 ............. X Lens sphcy bifocal 4.00d/ove ......................... 0.00 0.00 0.00 0.00 XXX 0

V2207 ............. X Lens sphcy bifocal 4.25–7d/. .......................... 0.00 0.00 0.00 0.00 XXX 0

V2208 ............. X Lens sphcy bifocal 4.25–7/2. .......................... 0.00 0.00 0.00 0.00 XXX 0

V2209 ............. X Lens sphcy bifocal 4.25–7/4. .......................... 0.00 0.00 0.00 0.00 XXX 0

V2210 ............. X Lens sphcy bifocal 4.25–7/ov ......................... 0.00 0.00 0.00 0.00 XXX 0

V2211 ............. X Lens sphcy bifo 7.25–12/.25- ......................... 0.00 0.00 0.00 0.00 XXX 0

V2212 ............. X Lens sphcyl bifo 7.25–12/2.2 .......................... 0.00 0.00 0.00 0.00 XXX 0

V2213 ............. X Lens sphcyl bifo 7.25–12/4.2 .......................... 0.00 0.00 0.00 0.00 XXX 0

V2214 ............. X Lens sphcyl bifocal over 12. ........................... 0.00 0.00 0.00 0.00 XXX 0

V2215 ............. X Lens lenticular bifocal ..................................... 0.00 0.00 0.00 0.00 XXX 0

V2216 ............. X Lens lenticular nonaspheric ............................ 0.00 0.00 0.00 0.00 XXX 0

V2217 ............. X Lens lenticular aspheric bif ............................. 0.00 0.00 0.00 0.00 XXX 0

V2218 ............. X Lens aniseikonic bifocal .................................. 0.00 0.00 0.00 0.00 XXX 0

V2219 ............. X Lens bifocal seg width over ............................ 0.00 0.00 0.00 0.00 XXX 0

V2220 ............. X Lens bifocal add over 3.25d ........................... 0.00 0.00 0.00 0.00 XXX 0

V2299 ............. X Lens bifocal speciality ..................................... 0.00 0.00 0.00 0.00 XXX 0

V2300 ............. X Lens sphere trifocal 4.00d .............................. 0.00 0.00 0.00 0.00 XXX 0

V2301 ............. X Lens sphere trifocal 4.12–7. ........................... 0.00 0.00 0.00 0.00 XXX 0

V2302 ............. X Lens sphere trifocal 7.12–20 .......................... 0.00 0.00 0.00 0.00 XXX 0

V2303 ............. X Lens sphcy trifocal 4.0/.12- ............................ 0.00 0.00 0.00 0.00 XXX 0

V2304 ............. X Lens sphcy trifocal 4.0/2.25 ............................ 0.00 0.00 0.00 0.00 XXX 0

V2305 ............. X Lens sphcy trifocal 4.0/4.25 ............................ 0.00 0.00 0.00 0.00 XXX 0

V2306 ............. X Lens sphcyl trifocal 4.00/>6 ............................ 0.00 0.00 0.00 0.00 XXX 0

V2307 ............. X Lens sphcy trifocal 4.25–7/. ............................ 0.00 0.00 0.00 0.00 XXX 0

V2308 ............. X Lens sphc trifocal 4.25–7/2. ........................... 0.00 0.00 0.00 0.00 XXX 0

V2309 ............. X Lens sphc trifocal 4.25–7/4. ........................... 0.00 0.00 0.00 0.00 XXX 0

V2310 ............. X Lens sphc trifocal 4.25–7/>6 ........................... 0.00 0.00 0.00 0.00 XXX 0

V2311 ............. X Lens sphc trifo 7.25–12/.25- ........................... 0.00 0.00 0.00 0.00 XXX 0

V2312 ............. X Lens sphc trifo 7.25–12/2.25 .......................... 0.00 0.00 0.00 0.00 XXX 0

V2313 ............. X Lens sphc trifo 7.25–12/4.25 .......................... 0.00 0.00 0.00 0.00 XXX 0

V2314 ............. X Lens sphcyl trifocal over 12 ............................ 0.00 0.00 0.00 0.00 XXX 0

V2315 ............. X Lens lenticular trifocal ..................................... 0.00 0.00 0.00 0.00 XXX 0

V2316 ............. X Lens lenticular nonaspheric ............................ 0.00 0.00 0.00 0.00 XXX 0

V2317 ............. X Lens lenticular aspheric tri .............................. 0.00 0.00 0.00 0.00 XXX 0

V2318 ............. X Lens aniseikonic trifocal ................................. 0.00 0.00 0.00 0.00 XXX 0

V2319 ............. X Lens trifocal seg width > 28 ............................ 0.00 0.00 0.00 0.00 XXX 0

V2320 ............. X Lens trifocal add over 3.25d ........................... 0.00 0.00 0.00 0.00 XXX 0

V2399 ............. X Lens trifocal speciality .................................... 0.00 0.00 0.00 0.00 XXX 0

V2410 ............. X Lens variab asphericity sing ........................... 0.00 0.00 0.00 0.00 XXX 0

V2430 ............. X Lens variable asphericity bi ............................ 0.00 0.00 0.00 0.00 XXX 0

V2499 ............. X Variable asphericity lens ................................. 0.00 0.00 0.00 0.00 XXX 0

V2500 ............. X Contact lens pmma spherical ......................... 0.00 0.00 0.00 0.00 XXX 0

V2501 ............. X Cntct lens pmma-toric/prism ........................... 0.00 0.00 0.00 0.00 XXX 0

V2502 ............. X Contact lens pmma bifocal ............................. 0.00 0.00 0.00 0.00 XXX 0

V2503 ............. X Cntct lens pmma color vision ......................... 0.00 0.00 0.00 0.00 XXX 0

V2510 ............. X Cntct gas permeable sphericl ......................... 0.00 0.00 0.00 0.00 XXX 0

V2511 ............. X Cntct toric prism ballast .................................. 0.00 0.00 0.00 0.00 XXX 0
63346

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 Copyright 1994 American Dental Association. All rights reserved (D0110–D9999).

3 # Indicates RVUs are not used for Medicare payment. 4 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

V2512 ............. X Cntct lens gas permbl bifocl ........................... 0.00 0.00 0.00 0.00 XXX 0

V2513 ............. X Contact lens extended wear ........................... 0.00 0.00 0.00 0.00 XXX 0

V2520 ............. P Contact lens hydrophilic ................................. 0.00 0.00 0.00 0.00 XXX 0

V2521 ............. X Cntct lens hydrophilic toric .............................. 0.00 0.00 0.00 0.00 XXX 0

V2522 ............. X Cntct lens hydrophil bifocl ............................... 0.00 0.00 0.00 0.00 XXX 0

V2523 ............. X Cntct lens hydrophil extend ............................ 0.00 0.00 0.00 0.00 XXX 0

V2530 ............. X Contact lens gas impermeable ....................... 0.00 0.00 0.00 0.00 XXX 0

V2531 ............. X Contact lens gas permeable ........................... 0.00 0.00 0.00 0.00 XXX 0

V2599 ............. X Contact lens/es other type .............................. 0.00 0.00 0.00 0.00 XXX 0

V2600 ............. X Hand held low vision aids ............................... 0.00 0.00 0.00 0.00 XXX 0

V2610 ............. X Single lens spectacle mount ........................... 0.00 0.00 0.00 0.00 XXX 0

V2615 ............. X Telescop/othr compound lens ........................ 0.00 0.00 0.00 0.00 XXX 0

V2623 ............. X Plastic eye prosth custom ............................... 0.00 0.00 0.00 0.00 XXX 0

V2624 ............. X Polishing artifical eye ...................................... 0.00 0.00 0.00 0.00 XXX 0

V2625 ............. X Enlargemnt of eye prosthesis ......................... 0.00 0.00 0.00 0.00 XXX 0

V2626 ............. X Reduction of eye prosthesis ........................... 0.00 0.00 0.00 0.00 XXX 0

V2627 ............. X Scleral cover shell .......................................... 0.00 0.00 0.00 0.00 XXX 0

V2628 ............. X Fabrication & fitting ......................................... 0.00 0.00 0.00 0.00 XXX 0

V2629 ............. X Prosthetic eye other type ................................ 0.00 0.00 0.00 0.00 XXX 0

V2630 ............. X Anter chamber intraocul lens .......................... 0.00 0.00 0.00 0.00 XXX 0

V2631 ............. X Iris support intraoclr lens ................................ 0.00 0.00 0.00 0.00 XXX 0

V2632 ............. X Post chmbr intraocular lens ............................ 0.00 0.00 0.00 0.00 XXX 0

V2700 ............. X Balance lens ................................................... 0.00 0.00 0.00 0.00 XXX 0

V2710 ............. X Glass/plastic slab off prism ............................. 0.00 0.00 0.00 0.00 XXX 0

V2715 ............. X Prism lens/es .................................................. 0.00 0.00 0.00 0.00 XXX 0

V2718 ............. X Fresnell prism press-on lens .......................... 0.00 0.00 0.00 0.00 XXX 0

V2730 ............. X Special base curve ......................................... 0.00 0.00 0.00 0.00 XXX 0

V2740 ............. X Rose tint plastic .............................................. 0.00 0.00 0.00 0.00 XXX 0

V2741 ............. X Non-rose tint plastic ........................................ 0.00 0.00 0.00 0.00 XXX 0

V2742 ............. X Rose tint glass ................................................ 0.00 0.00 0.00 0.00 XXX 0

V2743 ............. X Non-rose tint glass .......................................... 0.00 0.00 0.00 0.00 XXX 0

V2744 ............. X Tint photochromatic lens/es ............................ 0.00 0.00 0.00 0.00 XXX 0

V2750 ............. X Anti-reflective coating ..................................... 0.00 0.00 0.00 0.00 XXX 0

V2755 ............. X UV lens/es ...................................................... 0.00 0.00 0.00 0.00 XXX 0

V2760 ............. X Scratch resistant coating ................................ 0.00 0.00 0.00 0.00 XXX 0

V2770 ............. X Occluder lens/es ............................................. 0.00 0.00 0.00 0.00 XXX 0

V2780 ............. X Oversize lens/es ............................................. 0.00 0.00 0.00 0.00 XXX 0

V2781 ............. X Progressive lens per lens ............................... 0.00 0.00 0.00 0.00 XXX 0

V2785 ............. X Corneal tissue processing .............................. 0.00 0.00 0.00 0.00 XXX 0

V2799 ............. X Miscellaneous vision service .......................... 0.00 0.00 0.00 0.00 XXX 0

V5008 ............. N Hearing screening ........................................... 0.00 0.00 0.00 0.00 XXX 0

V5010 ............. N Assessment for hearing aid ............................ 0.00 0.00 0.00 0.00 XXX 0

V5011 ............. N Hearing aid fitting/checking ............................ 0.00 0.00 0.00 0.00 XXX 0

V5014 ............. N Hearing aid repair/modifying ........................... 0.00 0.00 0.00 0.00 XXX 0

V5020 ............. N Conformity evaluation ..................................... 0.00 0.00 0.00 0.00 XXX 0

V5030 ............. N Body-worn hearing aid air ............................... 0.00 0.00 0.00 0.00 XXX 0

V5040 ............. N Body-worn hearing aid bone .......................... 0.00 0.00 0.00 0.00 XXX 0

V5050 ............. N Body-worn hearing aid in ear ......................... 0.00 0.00 0.00 0.00 XXX 0

V5060 ............. N Behind ear hearing aid ................................... 0.00 0.00 0.00 0.00 XXX 0

V5070 ............. N Glasses air conduction ................................... 0.00 0.00 0.00 0.00 XXX 0

V5080 ............. N Glasses bone conduction ............................... 0.00 0.00 0.00 0.00 XXX 0

V5090 ............. N Hearing aid dispensing fee ............................. 0.00 0.00 0.00 0.00 XXX 0

V5100 ............. N Body-worn bilat hearing aid ............................ 0.00 0.00 0.00 0.00 XXX 0

V5110 ............. N Hearing aid dispensing fee ............................. 0.00 0.00 0.00 0.00 XXX 0

V5120 ............. N Body-worn binaur hearing aid ......................... 0.00 0.00 0.00 0.00 XXX 0

V5130 ............. N In ear binaural hearing aid ............................. 0.00 0.00 0.00 0.00 XXX 0

V5140 ............. N Behind ear binaur hearing aid ........................ 0.00 0.00 0.00 0.00 XXX 0

V5150 ............. N Glasses binaural hearing aid .......................... 0.00 0.00 0.00 0.00 XXX 0

V5160 ............. N Dispensing fee binaural .................................. 0.00 0.00 0.00 0.00 XXX 0

V5170 ............. N Within ear cros hearing aid ............................. 0.00 0.00 0.00 0.00 XXX 0

V5180 ............. N Behind ear cros hearing aid ........................... 0.00 0.00 0.00 0.00 XXX 0

V5190 ............. N Glasses cros hearing aid ................................ 0.00 0.00 0.00 0.00 XXX 0

V5200 ............. N Cros hearing aid dispens fee .......................... 0.00 0.00 0.00 0.00 XXX 0

V5210 ............. N In ear bicros hearing aid ................................. 0.00 0.00 0.00 0.00 XXX 0

V5220 ............. N Behind ear bicros hearing aid ......................... 0.00 0.00 0.00 0.00 XXX 0

V5230 ............. N Glasses bicros hearing aid ............................. 0.00 0.00 0.00 0.00 XXX 0
63347

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

CPT 1/

HCPCS2 MOD Status Description

Physician

work

RVUs 3

Practice

expense

RVUs 4

Malpractice

RVUs

Total Global

period Update

V5240 ............. N Dispensing fee bicros ..................................... 0.00 0.00 0.00 0.00 XXX 0

V5299 ............. R Hearing service ............................................... 0.00 0.00 0.00 0.00 XXX N

V5336 ............. N Repair communication device ......................... 0.00 0.00 0.00 0.00 XXX 0

V5362 ............. R Speech screening ........................................... 0.00 0.00 0.00 0.00 XXX N

V5363 ............. R Language screening ....................................... 0.00 0.00 0.00 0.00 XXX N

V5364 ............. R Dysphagia screening ...................................... 0.00 0.00 0.00 0.00 XXX N

Addendum C—Codes With Interim Relative

Value Units

Addendum C lists the codes for which

interim RVUs have been established. Because

these RVUs are interim, public comments on

these codes will be considered if they are

received by 5 p.m., February 6, 1996. Any

revisions to the interim RVUs will be

announced in a document to be published in

1996 that provides our analysis of and

responses to public comments. These

revisions will apply to services furnished

beginning January 1, 1997.

Addendum C contains the following

information:

1. CPT/HCPCS code. This is either a CPT

or alphanumeric HCPCS code for the service

in question. CPT codes are listed first,

followed by alphanumeric HCPCS codes.

2. Modifier. A modifier is shown if there

is TC (modifier TC) and a PC (modifier ¥26)

for the service. If there is a PC and a TC for

the service, Addendum C contains three

entries for the code: One for the global values

(both professional and technical); one for

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

The global service is not designated by a

modifier, and physicians must bill using the

code without a modifier if the physician

furnishes both the PCs and the TCs of the

service.

3. Status indicator. This indicator shows

whether the CPT/HCPCS code is in the fee

schedule and whether it is separately payable

if the service is covered. See Addendum B for

a description of the status indicators.

4. Description of the code. This is an

abbreviated version of the narrative

description of the code.

5. Physician work RVUs. These are the

interim RVUs for the physician work for this

service.

6. Practice expense RVUs. These are the

interim RVUs for the practice expense for the

service.

7. Malpractice expense RVUs. These are

the interim RVUs for the malpractice expense

for the service.

8. Total RVUs. This is the sum of the work,

practice expense, and malpractice expense

RVUs.

9. Global period. This indicator shows the

number of days in the global period for the

code (0, 10, or 90 days). See Addendum B for

explanations of the alpha codes.

10. Update. This column indicates whether

the update for surgical procedures, primary

care services, or other nonsurgical services

applies to the CPT/HCPCS code in column 1.

A ‘‘0’’ appears in this field for codes that are

deleted in 1996 or are not paid under the

physician fee schedule. A ‘‘P’’ in this column

indicates that the update and CF for primary

care services applies to this code. An ‘‘N’’ in

this column indicates that the update and CF

for other nonsurgical services applies to this

code. An ‘‘S’’ in this column indicates that

the separate update and CF for surgical

procedures applies.

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 # Indicates RVUs are not used for Medicare payment. 3 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM C.—CODES WITH INTERIM RVUS

CPT/

HCPCS1 MOD Status Description

Physician

work

RVUs 2

Practice

expense

RVUs 3

Malpractice

RVUs

Total Global

period Update

17110 ............. A Destruction of skin lesions .............................. 0.55 0.40 0.03 0.98 010 S

20100 ............. A Explore wound, neck ...................................... 9.50 4.97 1.16 15.63 010 S

20101 ............. A Explore wound, chest ..................................... 3.00 1.57 0.37 4.94 010 S

20102 ............. A Explore wound, abdomen ............................... 3.68 1.92 0.45 6.05 010 S

20103 ............. A Explore wound, extremity ............................... 4.95 2.59 0.60 8.14 010 S

20930 ............. B Spinal bone allograft ....................................... 0.00 0.00 0.00 0.00 XXX 0

20931 ............. A Spinal bone allograft ....................................... 1.81 1.73 0.28 3.82 ZZZ S

20936 ............. B Spinal bone autograft ..................................... 0.00 0.00 0.00 0.00 XXX 0

20937 ............. A Spinal bone autograft ..................................... 2.79 2.66 0.44 5.89 ZZZ S

20938 ............. A Spinal bone autograft ..................................... 3.02 2.88 0.47 6.37 ZZZ S

21076 ............. A Prepare face/oral prosthesis ........................... 12.54 16.77 1.35 30.66 010 S

21077 ............. A Prepare face/oral prosthesis ........................... 31.54 42.18 3.39 77.11 090 S

21141 ............. A Reconstruct midface, lefort ............................. 16.92 14.34 1.68 32.94 090 S

21142 ............. A Reconstruct midface, lefort ............................. 17.58 14.84 1.74 34.16 090 S

21143 ............. A Reconstruct midface, lefort ............................. 18.30 15.40 1.81 35.51 090 S

21145 ............. A Reconstruct midface, lefort ............................. 18.92 14.34 1.68 34.94 090 S

21146 ............. A Reconstruct midface, lefort ............................. 19.58 14.84 1.74 36.16 090 S

21147 ............. A Reconstruct midface, lefort ............................. 20.30 15.40 1.81 37.51 090 S

22100 ............. A Remove part of neck vertebra ........................ 9.05 7.64 1.09 17.78 090 S

22101 ............. A Remove part, thorax vertebra ......................... 9.00 8.01 1.38 18.39 090 S

22102 ............. A Remove part, lumbar vertebra ........................ 9.00 4.50 0.67 14.17 090 S

22103 ............. A Remove extra spine segment ......................... 2.34 2.23 0.37 4.94 ZZZ S

22110 ............. A Remove part of neck vertebra ........................ 11.59 9.72 1.64 22.95 090 S

22112 ............. A Remove part, thorax vertebra ......................... 11.59 9.90 1.63 23.12 090 S

22114 ............. A Remove part, lumbar vertebra ........................ 11.59 7.25 1.17 20.01 090 S
63348

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 # Indicates RVUs are not used for Medicare payment. 3 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT/

HCPCS1 MOD Status Description

Physician

work

RVUs 2

Practice

expense

RVUs 3

Malpractice

RVUs

Total Global

period Update

22116 ............. A Remove extra spine segment ......................... 2.32 2.21 0.36 4.89 ZZZ S

22210 ............. A Revision of neck spine ................................... 22.51 13.83 2.43 38.77 090 S

22212 ............. A Revision of thorax spine ................................. 18.14 17.29 2.83 38.26 090 S

22214 ............. A Revision of lumbar spine ................................ 18.14 15.11 2.68 35.93 090 S

22216 ............. A Revise, extra spine segment .......................... 6.04 5.07 0.89 12.00 ZZZ S

22220 ............. A Revision of neck spine ................................... 20.15 16.64 2.63 39.42 090 S

22222 ............. A Revision of thorax spine ................................. 20.15 13.61 1.58 35.34 090 S

22224 ............. A Revision of lumbar spine ................................ 20.15 14.68 2.66 37.49 090 S

22226 ............. A Revise, extra spine segment .......................... 6.04 5.07 0.89 12.00 ZZZ S

22305 ............. A Treat spine process fracture ........................... 1.86 *2.38 0.37 4.61 090 S

22310 ............. A Treat spine fracture ........................................ 1.86 *2.52 0.69 5.07 090 S

22315 ............. A Treat spine fracture ........................................ 8.36 5.51 0.86 14.73 090 S

22325 ............. A Repair of spine fracture .................................. 17.19 8.32 1.34 26.85 090 S

22326 ............. A Repair neck spine fracture ............................. 18.43 15.93 2.74 37.10 090 S

22327 ............. A Repair thorax spine fracture ........................... 17.56 15.95 2.35 35.86 090 S

22328 ............. A Repair each add spine fx ............................... 4.61 4.40 0.72 9.73 ZZZ S

22548 ............. A Neck spine fusion ........................................... 24.08 22.74 3.82 50.64 090 S

22554 ............. A Neck spine fusion ........................................... 17.24 19.81 3.52 40.57 090 S

22556 ............. A Thorax spine fusion ........................................ 22.27 21.68 3.58 47.53 090 S

22558 ............. A Lumbar spine fusion ....................................... 21.22 20.17 3.38 44.77 090 S

22585 ............. A Additional spinal fusion ................................... 5.53 5.40 0.93 11.86 ZZZ S

22590 ............. A Spine & skull spinal fusion ............................. 19.50 21.57 3.44 44.51 090 S

22595 ............. A Neck spinal fusion .......................................... 18.19 22.46 3.87 44.52 090 S

22600 ............. A Neck spine fusion ........................................... 14.74 19.36 3.32 37.42 090 S

22610 ............. A Thorax spine fusion ........................................ 14.62 17.87 2.75 35.24 090 S

22612 ............. A Lumbar spine fusion ....................................... 20.19 20.60 3.33 44.12 090 S

22614 ............. A Spine fusion, extra segment ........................... 6.44 5.65 0.92 13.01 ZZZ S

22630 ............. A Lumbar spine fusion ....................................... 20.03 18.44 3.15 41.62 090 S

22632 ............. A Spine fusion, extra segment ........................... 5.23 4.99 0.82 11.04 ZZZ S

22800 ............. A Fusion of spine ............................................... 16.92 *21.66 3.58 42.16 090 S

22802 ............. A Fusion of spine ............................................... 29.74 28.32 4.61 62.67 090 S

22804 ............. A Fusion of spine ............................................... 35.00 28.32 4.61 67.93 090 S

22808 ............. A Fusion of spine ............................................... 25.00 18.41 3.15 46.56 090 S

22810 ............. A Fusion of spine ............................................... 29.00 18.41 3.15 50.56 090 S

22812 ............. A Fusion of spine ............................................... 31.00 25.93 4.24 61.17 090 S

22830 ............. A Exploration of spinal fusion ............................ 10.22 *13.07 2.18 25.47 090 S

22840 ............. A Insert spine fixation device ............................. 6.27 5.98 0.98 13.23 ZZZ S

22841 ............. B Insert spine fixation device ............................. 0.00 0.00 0.00 0.00 XXX 0

22842 ............. A Insert spine fixation device ............................. 7.19 6.86 1.12 15.17 ZZZ S

22843 ............. A Insert spine fixation device ............................. 8.97 8.55 1.40 18.92 ZZZ S

22844 ............. A Insert spine fixation device ............................. 10.96 10.45 1.71 23.12 ZZZ S

22845 ............. A Insert spine fixation device ............................. 5.98 5.70 0.93 12.61 ZZZ S

22846 ............. A Insert spine fixation device ............................. 8.28 7.90 1.29 17.47 ZZZ S

22847 ............. A Insert spine fixation device ............................. 9.20 8.77 1.44 19.41 ZZZ S

22848 ............. A Insert pelvic fixation device ............................ 6.00 5.72 0.94 12.66 ZZZ S

22851 ............. A Apply spine prosth device .............................. 6.71 6.40 1.05 14.16 ZZZ S

32095 ............. A Biopsy through chest wall ............................... 7.13 8.25 1.45 16.83 090 S

32501 ............. A Repair bronchus (add-on) ............................... 4.69 4.31 0.70 9.70 ZZZ S

33253 ............. A Reconstruct atria ............................................. 30.00 21.81 4.26 56.07 090 S

33924 ............. A Remove pulmonary shunt ............................... 5.50 4.00 0.78 10.28 ZZZ S

38231 ............. A Stem cell collection ......................................... 1.50 1.37 0.08 2.95 000 N

38240 ............. A Bone marrow/stem transplant ......................... 2.24 2.08 0.14 4.46 XXX N

38241 ............. A Bone marrow/stem transplant ......................... 2.24 2.04 0.13 4.41 XXX N

47350 ............. A Repair liver wound .......................................... 11.29 7.46 1.49 20.24 090 S

47360 ............. A Repair liver wound .......................................... 15.34 10.93 2.18 28.45 090 S

47361 ............. A Repair liver wound .......................................... 28.00 14.64 3.41 46.05 090 S

47362 ............. A Repair liver wound .......................................... 10.00 5.23 1.22 16.45 090 S

49000 ............. A Exploration of abdomen .................................. 8.99 6.79 1.40 17.18 090 S

49002 ............. A Reopening of abdomen .................................. 9.40 6.05 1.21 16.66 090 S

49010 ............. A Exploration behind abdomen .......................... 11.19 6.95 1.31 19.45 090 S

55859 ............. A Percut/needle insert, pros ............................... 8.29 5.89 0.58 14.76 090 S

56343 ............. A Laparoscopic salpingostomy .......................... 6.96 5.28 1.11 13.35 090 S

56344 ............. A Laparoscopic fimbrioplasty ............................. 7.16 5.11 1.19 13.46 090 S

57284 ............. A Repair paravaginal defect ............................... 12.10 8.59 0.84 21.53 090 S

59610 ............. A Vbac delivery .................................................. 22.55 14.99 3.47 41.01 MMM S

59612 ............. A Vbac delivery only .......................................... 14.84 9.48 2.20 26.52 MMM S
63349

444444444444

1All CPT codes and descriptors copyright 1995 American Medical Association.

2 # Indicates RVUs are not used for Medicare payment. 3 * Indicates reduction of Practice Expense RVUs as a result of OBRA 1993.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT/

HCPCS1 MOD Status Description

Physician

work

RVUs 2

Practice

expense

RVUs 3

Malpractice

RVUs

Total Global

period Update

59614 ............. A Vbac care after delivery .................................. 15.96 10.31 2.39 28.66 MMM S

59618 ............. A Attempted vbac delivery ................................. 25.23 16.90 3.92 46.05 MMM S

59620 ............. A Attempted vbac delivery only ......................... 16.95 10.99 2.55 30.49 MMM S

59622 ............. A Attempted vbac after care .............................. 18.11 11.82 2.73 32.66 MMM S

62274 ............. A Inject spinal anesthetic ................................... 1.78 0.74 0.17 2.69 000 N

62288 ............. A Injection into spinal canal ............................... 1.74 1.12 0.24 3.10 000 N

62350 ............. A Implant spinal catheter ................................... 6.25 3.49 1.02 10.76 090 S

62351 ............. A Implant spinal catheter ................................... 9.25 5.16 1.50 15.91 090 S

62355 ............. A Remove spinal canal catheter ........................ 4.80 3.49 0.68 8.97 090 S

62360 ............. A Insert spine infusion device ............................ 2.00 1.12 0.33 3.45 090 S

62361 ............. A Implant spine infusion pump ........................... 4.80 2.68 0.78 8.26 090 S

62362 ............. A Implant spine infusion pump ........................... 6.29 3.51 1.02 10.82 090 S

62365 ............. A Remove spine infusion device ........................ 4.77 3.47 0.68 8.92 090 S

62367 26 A Analyze spine infusion pump .......................... 0.48 0.35 0.07 0.90 XXX N

62368 26 A Analyze spine infusion pump .......................... 0.75 0.55 0.11 1.41 XXX N

67107 ............. A Repair detached retina ................................... 13.99 *17.91 1.10 33.00 090 S

67108 ............. A Repair detached retina ................................... 19.90 *25.47 1.76 47.13 090 S

67112 ............. A Re-repair detached retina ............................... 16.15 16.51 0.86 33.52 090 S

76965 26 A Echo guidance radiotherapy ........................... 1.34 2.07 0.19 3.60 XXX N

78459 26 G Heart muscle imaging (PET) .......................... #1.88 1.34 0.10 3.32 XXX 0

78810 26 N Tumor imaging (PET) ..................................... #1.93 1.37 0.10 3.40 XXX 0

92506 ............. A Speech & hearing evaluation ......................... 0.86 0.52 0.05 1.43 XXX N

92507 ............. A Speech/hearing therapy .................................. 0.52 0.33 0.03 0.88 XXX N

92508 ............. A Speech/hearing therapy .................................. 0.26 0.18 0.02 0.46 XXX N

92510 ............. A Rehab for ear implant ..................................... 1.50 1.36 0.15 3.01 XXX N

92516 ............. A Facial nerve function test ............................... 0.43 0.39 0.04 0.86 XXX N

92525 ............. A Oral function evaluation .................................. 1.13 1.02 0.11 2.26 XXX N

92526 ............. A Oral function therapy ...................................... 0.52 0.47 0.05 1.04 XXX N

92546 26 A Sinusoidal rotational test ................................ 0.29 0.30 0.03 0.62 XXX N

92579 ............. A Visual audiometry (vra) ................................... 0.00 0.69 0.07 0.76 XXX N

92597 ............. A Oral speech device eval ................................. 1.11 1.01 0.11 2.23 XXX N

92598 ............. A Modify oral speech device .............................. 0.73 0.66 0.07 1.46 XXX N

92987 ............. A Revision of mitral valve ................................... 20.69 12.20 0.91 33.80 090 N

95872 26 A Muscle test, one fiber ..................................... 1.50 0.68 0.06 2.24 XXX N

95900 26 A Motor nerve conduction test ........................... 0.42 0.35 0.03 0.80 XXX N

95903 26 A Motor nerve conduction test ........................... 0.60 0.35 0.03 0.98 XXX N

95904 26 A Sense nerve conduction test .......................... 0.34 0.34 0.03 0.71 XXX N

95925 26 A Somatosensory testing ................................... 0.54 0.64 0.05 1.23 XXX N

95926 26 A Somatosensory testing ................................... 0.54 0.64 0.05 1.23 XXX N

95927 26 A Somatosensory testing ................................... 0.54 0.64 0.05 1.23 XXX N

95930 26 A Visual evoked potential test ............................ 0.35 0.58 0.04 0.97 XXX N

95934 26 A ‘H’ reflex test ................................................... 0.51 0.34 0.03 0.88 XXX N

95936 26 A ‘H’ reflex test ................................................... 0.55 0.34 0.03 0.92 XXX N

97010 ............. A Hot or cold packs therapy .............................. 0.11 0.21 0.02 0.34 XXX N

97012 ............. A Mechanical traction therapy ............................ 0.25 0.19 0.02 0.46 XXX N

97014 ............. A Electric stimulation therapy ............................. 0.18 0.20 0.02 0.40 XXX N

97016 ............. A Vasopneumatic device therapy ...................... 0.18 0.25 0.02 0.45 XXX N

97018 ............. A Paraffin bath therapy ...................................... 0.11 0.24 0.03 0.38 XXX N

97020 ............. A Microwave therapy .......................................... 0.11 0.20 0.02 0.33 XXX N

97022 ............. A Whirlpool therapy ............................................ 0.25 0.19 0.02 0.46 XXX N

97024 ............. A Diathermy treatment ....................................... 0.11 0.21 0.02 0.34 XXX N

97026 ............. A Infrared therapy .............................................. 0.11 0.19 0.02 0.32 XXX N

97028 ............. A Ultraviolet therapy ........................................... 0.20 0.19 0.01 0.40 XXX N

97032 ............. A Electrical stimulation ....................................... 0.25 0.14 0.01 0.40 XXX N

97033 ............. A Electric current therapy ................................... 0.26 0.14 0.02 0.42 XXX N

97034 ............. A Contrast bath therapy ..................................... 0.21 0.10 0.01 0.32 XXX N

97035 ............. A Ultrasound therapy ......................................... 0.21 0.11 0.01 0.33 XXX N

97036 ............. A Hydrotherapy .................................................. 0.38 0.21 0.02 0.61 XXX N

97039 ............. A Physical therapy treatment ............................. 0.29 0.24 0.03 0.56 XXX N

97110 ............. A Therapeutic exercises ..................................... 0.45 0.13 0.02 0.60 XXX N

97112 ............. A Neuromuscular reeducation ............................ 0.45 0.13 0.01 0.59 XXX N

97113 ............. A Aquatic therapy/exercises ............................... 0.44 0.20 0.02 0.66 XXX N

97116 ............. A Gait training therapy ....................................... 0.40 0.11 0.01 0.52 XXX N

97122 ............. A Manual traction therapy .................................. 0.45 0.11 0.01 0.57 XXX N

97124 ............. A Massage therapy ............................................ 0.35 0.11 0.01 0.47 XXX N

97139 ............. A Physical medicine procedure .......................... 0.21 0.16 0.02 0.39 XXX N
63350 Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT/

HCPCS1 MOD Status Description

Physician

work

RVUs 2

Practice

expense

RVUs 3

Malpractice

RVUs

Total Global

period Update

97150 ............. A Group therapeutic procedures ........................ 0.27 0.20 0.02 0.49 XXX N

97250 ............. A Myofascial release .......................................... 0.45 0.35 0.04 0.84 000 N

97260 ............. A Regional manipulation .................................... 0.19 0.20 0.02 0.41 000 N

97261 ............. A Supplemental manipulations ........................... 0.12 0.11 0.01 0.24 000 N

97265 ............. A Joint mobilization ............................................ 0.45 0.35 0.04 0.84 XXX N

97500 ............. A Orthotics training ............................................. 0.31 0.27 0.04 0.62 XXX N

97501 ............. A Supplemental training ..................................... 0.17 0.15 0.02 0.34 XXX N

97520 ............. A Prosthetic training ........................................... 0.37 0.30 0.04 0.71 XXX N

97521 ............. A Supplemental training ..................................... 0.22 0.17 0.02 0.41 XXX N

97530 ............. A Therapeutic activities ...................................... 0.44 0.17 0.02 0.63 XXX N

97535 ............. A Self care mngment training ............................ 0.33 0.17 0.02 0.52 XXX N

97537 ............. A Community/work reintegration ........................ 0.33 0.17 0.02 0.52 XXX N

97542 ............. A Wheelchair mngement training ....................... 0.25 0.17 0.02 0.44 XXX N

97703 ............. A Prosthetic checkout ........................................ 0.25 0.18 0.03 0.46 XXX N

97750 ............. A Physical performance test .............................. 0.45 0.24 0.03 0.72 XXX N

97770 ............. A Cognitive skills development .......................... 0.44 0.28 0.03 0.75 XXX N

99238 ............. A Hospital discharge day ................................... 1.06 0.51 0.04 1.61 XXX N

99239 ............. A Hospital discharge day ................................... 1.75 0.51 0.04 2.30 XXX N

99435 ............. A Hospital NB discharge day ............................. 1.50 1.55 0.10 3.15 XXX P

G0030 26 A PET imaging prev PET single ........................ 1.09 0.48 0.07 1.64 XXX N

G0031 26 A PET imaging prev PET multple ...................... 1.46 0.65 0.10 2.21 XXX N

G0032 26 A PET follow SPECT 78464 singl ...................... 1.09 0.48 0.07 1.64 XXX N

G0033 26 A PET follow SPECT 78464 mult ...................... 1.46 0.65 0.10 2.21 XXX N

G0034 26 A PET follow SPECT 76865 singl ...................... 1.09 0.48 0.07 1.64 XXX N

G0035 26 A PET follow SPECT 78465 mult ...................... 1.46 0.65 0.10 2.21 XXX N

G0036 26 A PET follow cornry angio sing .......................... 1.09 0.48 0.07 1.64 XXX N

G0037 26 A PET follow cornry angio mult .......................... 1.46 0.65 0.10 2.21 XXX N

G0038 26 A PET follow myocard perf sing ......................... 1.09 0.48 0.07 1.64 XXX N

G0039 26 A PET follow myocard perf mult ........................ 1.46 0.65 0.10 2.21 XXX N

G0040 26 A PET follow stress echo singl .......................... 1.09 0.48 0.07 1.64 XXX N

G0041 26 A PET follow stress echo mult ........................... 1.46 0.65 0.10 2.21 XXX N

G0042 26 A PET follow ventriculogm sing ......................... 1.09 0.48 0.07 1.64 XXX N

G0043 26 A PET follow ventriculogm mult ......................... 1.46 0.65 0.10 2.21 XXX N

G0044 26 A PET following rest ECG singl ......................... 1.09 0.48 0.07 1.64 XXX N

G0045 26 A PET following rest ECG mult .......................... 1.46 0.65 0.10 2.21 XXX N

G0046 26 A PET follow stress ECG singl .......................... 1.09 0.48 0.07 1.64 XXX N

G0047 26 A PET follow stress ECG mult ........................... 1.46 0.65 0.10 2.21 XXX N

444444444444

Note: Work GPCI is the 1/4 work GPCI required by Section 1848(e)(1)(A)(iii) of the Social Security Act,

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM D.—1996 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY

Carrier

number

Locality

number Locality name Work Practiceexpense

Malpractice

00510 05 Birmingham, AL ................................................................................................................. 0.994 0.912 0.927

00510 04 Mobile, AL ......................................................................................................................... 0.975 0.858 0.927

00510 02 North Central AL ............................................................................................................... 0.973 0.850 0.927

00510 01 Northwest AL ..................................................................................................................... 0.990 0.873 0.927

00510 06 Rest Of AL ......................................................................................................................... 0.964 0.818 0.927

00510 03 Southeast AL ..................................................................................................................... 0.970 0.858 0.927

01020 01 Alaska ................................................................................................................................ 1.064 1.155 1.617

01030 05 Flagstaff, AZ ...................................................................................................................... 0.971 0.936 1.321

01030 01 Phoenix, AZ ....................................................................................................................... 1.004 0.963 1.321

01030 07 Prescott, AZ ....................................................................................................................... 0.971 0.912 1.321

01030 99 Rest Of AZ ........................................................................................................................ 0.989 0.948 1.321

01030 02 Tucson, AZ ........................................................................................................................ 0.978 0.942 1.321

01030 08 Yuma, AZ .......................................................................................................................... 0.984 0.925 1.321

00520 13 Arkansas ............................................................................................................................ 0.954 0.853 0.427

02050 26 Anaheim/Santa Ana, CA ................................................................................................... 1.037 1.205 0.752

00542 14 Bakersfield, CA .................................................................................................................. 1.023 0.992 0.686

00542 11 Fresno/Madera, CA ........................................................................................................... 1.000 0.977 0.596

00542 13 Kings/Tulare, CA ............................................................................................................... 0.987 0.954 0.596

02050 18 Los Angeles (1st Of 8) ...................................................................................................... 1.056 1.207 0.752

02050 19 Los Angeles (2nd Of 8) ..................................................................................................... 1.056 1.207 0.752

02050 20 Los Angeles (3rd Of 8) ...................................................................................................... 1.056 1.207 0.752

02050 21 Los Angeles (4th Of 8) ...................................................................................................... 1.056 1.207 0.752

02050 22 Los Angeles (5th Of 8) ...................................................................................................... 1.056 1.207 0.752
63351

444444444444

Note: Work GPCI is the 1/4 work GPCI required by Section 1848(e)(1)(A)(iii) of the Social Security Act,

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM D.—1996 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—Continued

Carrier

number

Locality

number Locality name Work Practiceexpense

Malpractice

02050 23 Los Angeles (6th Of 8) ...................................................................................................... 1.056 1.207 0.752

02050 24 Los Angeles (7th Of 8) ...................................................................................................... 1.056 1.207 0.752

02050 25 Los Angeles (8th Of 8) ...................................................................................................... 1.056 1.207 0.752

00542 03 Marin/Napa/Solano, CA ..................................................................................................... 1.015 1.180 0.596

00542 10 Merced/Surr.Cntys, CA ..................................................................................................... 1.002 0.988 0.596

00542 12 Monterey/Santa Cruz, CA ................................................................................................. 1.008 1.143 0.596

00542 01 N. Coastal Cntys, CA ........................................................................................................ 1.003 1.090 0.596

00542 02 Ne Rural, CA ..................................................................................................................... 0.982 0.953 0.596

00542 07 Oakland/Berkeley, CA ....................................................................................................... 1.042 1.215 0.596

00542 27 Riverside, CA .................................................................................................................... 1.011 1.059 0.667

00542 04 Sacramento/Surr. Cntys, CA ............................................................................................. 1.020 1.069 0.596

00542 15 San Bernadino/E.Ctrl Cntys .............................................................................................. 1.015 1.056 0.749

02050 28 San Diego/Imperial, CA ..................................................................................................... 1.017 1.077 0.618

00542 05 San Francisco, CA ............................................................................................................ 1.068 1.330 0.596

00542 06 San Mateo, CA .................................................................................................................. 1.049 1.300 0.596

02050 16 Santa Barbara, CA ............................................................................................................ 1.016 1.119 0.686

00542 09 Santa Clara, CA ................................................................................................................ 1.064 1.289 0.596

00542 08 Stockton/Surr. Cntys., CA ................................................................................................. 1.001 1.041 0.596

02050 17 Ventura, CA ....................................................................................................................... 1.028 1.192 0.686

00824 01 Colorado ............................................................................................................................ 0.989 0.951 0.827

10230 04 Eastern CT ........................................................................................................................ 1.033 1.132 1.001

10230 01 Nw And N. Cntrl CT .......................................................................................................... 1.049 1.159 1.001

10230 03 S. Cntrl CT ........................................................................................................................ 1.056 1.226 1.001

10230 02 Sw CT ................................................................................................................................ 1.055 1.275 1.001

00570 01 Delaware ........................................................................................................................... 1.021 1.032 0.792

00580 01 DC+MD/VA Suburbs ......................................................................................................... 1.051 1.192 0.980

00590 03 Fort Lauderdale, FL ........................................................................................................... 0.998 1.036 1.867

00590 04 Miami, FL ........................................................................................................................... 1.016 1.087 2.456

00590 02 N/Nc FL Cities ................................................................................................................... 0.978 0.952 1.417

00590 01 Rest Of Florida .................................................................................................................. 0.971 0.914 1.417

01040 01 Atlanta, GA ........................................................................................................................ 1.007 1.030 0.902

01040 04 Rest Of GA ........................................................................................................................ 0.965 0.856 0.902

01040 02 Small GA Cities 02 ............................................................................................................ 0.981 0.917 0.902

01040 03 Small GA Cities 03 ............................................................................................................ 0.966 0.884 0.902

01120 01 Hawaii/Guam ..................................................................................................................... 0.999 1.220 0.921

05130 12 North Idaho ........................................................................................................................ 0.957 0.864 0.588

05130 11 South Idaho ....................................................................................................................... 0.963 0.887 0.588

00621 10 Champaign-Urbana, IL ...................................................................................................... 0.952 0.884 1.008

00621 16 Chicago, IL ........................................................................................................................ 1.028 1.080 1.382

00621 03 De Kalb, IL ........................................................................................................................ 0.953 0.873 0.780

00621 11 Decatur, IL ......................................................................................................................... 0.962 0.864 0.880

00621 12 East St. Louis, IL ............................................................................................................... 0.988 0.929 1.202

00621 06 Kankakee, IL ..................................................................................................................... 0.959 0.881 0.901

00621 08 Normal, IL .......................................................................................................................... 0.969 0.893 0.731

00621 01 Northwest, IL ..................................................................................................................... 0.951 0.842 0.731

00621 05 Peoria, IL ........................................................................................................................... 0.980 0.906 0.731

00621 07 Quincy, IL .......................................................................................................................... 0.946 0.824 0.731

00621 04 Rock Island, IL .................................................................................................................. 0.972 0.858 0.731

00621 02 Rockford, IL ....................................................................................................................... 0.978 0.941 0.813

00621 13 Southeast IL ...................................................................................................................... 0.946 0.814 0.731

00621 14 Southern IL ........................................................................................................................ 0.946 0.822 0.822

00621 09 Springfield, IL .................................................................................................................... 0.981 0.936 0.946

00621 15 Suburban Chicago, IL ....................................................................................................... 1.007 1.093 1.159

00630 01 Metropolitan IN .................................................................................................................. 0.989 0.937 0.363

00630 03 Rest Of IN ......................................................................................................................... 0.973 0.872 0.346

00630 02 Urban IN ............................................................................................................................ 0.974 0.896 0.346

00640 00 Iowa ................................................................................................................................... 0.960 0.877 0.679

00740 05 Kansas City, Kansas ......................................................................................................... 0.989 0.949 1.191

00650 01 Rest Of Kansas ................................................................................................................. 0.958 0.877 1.191

00740 04 Suburban Kansas City, Kans ............................................................................................ 0.989 0.949 1.191

00660 01 Lexington & Louisville, KY ................................................................................................ 0.989 0.904 0.819

00660 03 Rest Of Kentucky .............................................................................................................. 0.957 0.821 0.819

00660 02 Sm Cities (City Limits), KY ................................................................................................ 0.960 0.850 0.819

00528 07 Alexandria, LA ................................................................................................................... 0.958 0.864 0.911

00528 03 Baton Rouge, LA ............................................................................................................... 0.984 0.894 0.911

00528 06 Lafayette, LA ..................................................................................................................... 0.971 0.857 0.911

00528 04 Lake Charles, LA ............................................................................................................... 0.974 0.901 0.911

00528 05 Monroe, LA ........................................................................................................................ 0.958 0.867 0.911
63352

444444444444

Note: Work GPCI is the 1/4 work GPCI required by Section 1848(e)(1)(A)(iii) of the Social Security Act,

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM D.—1996 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—Continued

Carrier

number

Locality

number Locality name Work Practiceexpense

Malpractice

00528 01 New Orleans, LA ............................................................................................................... 0.999 0.946 0.997

00528 50 Rest Of LA ......................................................................................................................... 0.965 0.850 0.913

00528 02 Shreveport, LA .................................................................................................................. 0.971 0.889 0.911

21200 02 Central Maine .................................................................................................................... 0.961 0.929 0.759

21200 01 Northern Maine .................................................................................................................. 0.964 0.920 0.759

21200 03 Southern Maine ................................................................................................................. 0.980 1.034 0.759

00901 01 Baltimore/Surr. Cntys, MD ................................................................................................ 1.021 1.036 1.115

00901 03 South & E. Shore MD ....................................................................................................... 0.985 0.972 0.862

00901 02 Western MD ...................................................................................................................... 0.982 0.930 0.862

00700 02 MA Suburbs/Rural Cities ................................................................................................... 1.015 1.101 0.978

00700 01 Urban MA .......................................................................................................................... 1.030 1.167 0.978

00623 01 Detroit, MI .......................................................................................................................... 1.043 1.038 3.051

00623 02 Michigan, Not Detroit ......................................................................................................... 0.998 0.935 1.844

00720 00 Minnesota (Blue Shield) .................................................................................................... 0.990 0.965 0.594

10240 00 Minnesota (Travelers) ....................................................................................................... 0.990 0.965 0.594

10250 01 Rest Of Mississippi ............................................................................................................ 0.950 0.813 0.726

10250 02 Urban Mississippi .............................................................................................................. 0.964 0.868 0.726

00740 03 K.C. (Jackson Cnty), MO .................................................................................................. 0.989 0.949 1.207

00740 02 N K.C. (Clay/Platte), MO ................................................................................................... 0.989 0.949 1.204

11260 03 Rest Of MO ....................................................................................................................... 0.944 0.810 1.159

00740 06 Rural Nw Counties, MO .................................................................................................... 0.950 0.835 1.159

11260 02 Sm E. Cities, MO .............................................................................................................. 0.940 0.809 1.159

00740 01 St Joseph, MO .................................................................................................................. 0.952 0.850 1.159

11260 01 St. Louis/Lg E. Cities, MO ................................................................................................. 0.983 0.921 1.193

00751 01 Montana ............................................................................................................................. 0.952 0.864 0.756

00655 00 Nebraska ........................................................................................................................... 0.951 0.872 0.444

01290 03 Elko & Ely (Cities), NV ...................................................................................................... 0.984 0.986 0.887

01290 01 Las Vegas, Et Al. (Cities), NV ........................................................................................... 1.012 1.022 0.887

01290 02 Reno, Et Al. (Cities), NV ................................................................................................... 0.997 1.049 0.887

01290 99 Rest Of Nevada ................................................................................................................. 0.997 1.013 0.887

00780 40 New Hampshire ................................................................................................................. 0.988 1.034 0.916

00860 02 Middle NJ .......................................................................................................................... 1.032 1.137 0.762

00860 01 Northern NJ ....................................................................................................................... 1.059 1.215 0.762

00860 03 Southern NJ ...................................................................................................................... 1.024 1.082 0.762

01360 05 New Mexico ....................................................................................................................... 0.975 0.903 0.792

00801 01 Buffalo/Surr. Cntys, NY ..................................................................................................... 1.003 0.936 0.821

00803 01 Manhattan, NY .................................................................................................................. 1.095 1.359 1.546

00801 03 N. Central Cities, NY ......................................................................................................... 1.005 0.967 0.821

00803 02 Nyc Suburbs/Long I., NY .................................................................................................. 1.068 1.235 1.759

00803 03 Poughkpsie/N Nyc Suburbs, NY ....................................................................................... 1.011 1.081 1.218

14330 04 Queens, NY ....................................................................................................................... 1.058 1.240 1.686

00801 04 Rest Of New York ............................................................................................................. 0.989 0.937 0.821

00801 02 Rochester/Surr. Cntys, NY ................................................................................................ 1.012 0.992 0.821

05535 00 North Carolina ................................................................................................................... 0.971 0.918 0.435

00820 01 North Dakota ..................................................................................................................... 0.951 0.860 0.617

16360 00 Ohio ................................................................................................................................... 0.991 0.940 1.049

01370 00 Oklahoma .......................................................................................................................... 0.970 0.882 0.481

01380 02 Eugene, et al. (Cities), OR ................................................................................................ 0.959 0.938 0.637

01380 01 Portland, et al. (Cities), OR ............................................................................................... 0.997 1.000 0.637

01380 99 Rest Of Oregon ................................................................................................................. 0.962 0.907 0.637

01380 03 Salem, et al. (Cities), OR .................................................................................................. 0.965 0.929 0.637

01380 12 Sw Cities (City Limits), OR ............................................................................................... 0.967 0.954 0.637

00865 02 Lg PA Cities ...................................................................................................................... 1.006 1.002 0.936

00865 01 Philly/Pitt Med Shcls/Hosps, PA ....................................................................................... 1.027 1.040 1.213

00865 04 Rest Of PA ........................................................................................................................ 0.973 0.899 0.719

00865 03 Sm PA Cities ..................................................................................................................... 0.983 0.917 0.736

00973 20 Puerto Rico ........................................................................................................................ 0.883 0.739 0.268

00870 01 Rhode Island ..................................................................................................................... 1.019 1.074 1.569

00880 01 South Carolina ................................................................................................................... 0.976 0.899 0.361

00820 02 South Dakota ..................................................................................................................... 0.936 0.856 0.443

05440 35 Tennessee ......................................................................................................................... 0.976 0.899 0.524

00900 29 Abilene, TX ........................................................................................................................ 0.960 0.851 0.827

00900 26 Amarillo, TX ....................................................................................................................... 0.975 0.883 0.827

00900 31 Austin, TX .......................................................................................................................... 0.987 0.986 0.827

00900 20 Beaumont, TX ................................................................................................................... 0.993 0.893 1.428

00900 09 Brazoria, TX ...................................................................................................................... 0.993 0.966 1.428

00900 10 Brownsville, TX .................................................................................................................. 0.955 0.848 0.827

00900 24 Corpus Christi, TX ............................................................................................................. 0.983 0.898 0.827
Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations 63353

ADDENDUM D.—1996 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—Continued

Carrier

number

Locality

number Locality name Work Practiceexpense

Malpractice

00900 11 Dallas, TX .......................................................................................................................... 1.012 1.012 0.893

00900 12 Denton, TX ........................................................................................................................ 0.968 0.952 0.827

00900 14 El Paso, TX ....................................................................................................................... 0.973 0.893 0.893

00900 28 Fort Worth, TX ................................................................................................................... 0.989 0.972 0.893

00900 15 Galveston, TX .................................................................................................................... 0.989 0.966 1.428

00900 16 Grayson, TX ...................................................................................................................... 0.959 0.874 0.827

00900 18 Houston, TX ...................................................................................................................... 1.021 1.005 1.428

00900 33 Laredo, TX ......................................................................................................................... 0.957 0.851 0.827

00900 17 Longview, TX ..................................................................................................................... 0.973 0.863 0.827

00900 21 Lubbock, TX ...................................................................................................................... 0.955 0.894 0.827

00900 19 McAllen, TX ....................................................................................................................... 0.961 0.837 0.827

00900 23 Midland, TX ....................................................................................................................... 0.991 0.900 0.827

00900 02 Northeast Rural TX ........................................................................................................... 0.960 0.857 0.827

00900 13 Odessa, TX ....................................................................................................................... 0.991 0.900 0.827

00900 25 Orange, TX ........................................................................................................................ 0.993 0.893 0.827

00900 30 San Angelo, TX ................................................................................................................. 0.948 0.844 0.827

00900 07 San Antonio, TX ................................................................................................................ 0.978 0.926 0.827

00900 03 Southeast Rural TX ........................................................................................................... 0.963 0.872 0.889

00900 06 Temple, TX ........................................................................................................................ 0.968 0.884 0.827

00900 08 Texarkana, TX ................................................................................................................... 0.955 0.872 0.827

00900 27 Tyler, TX ............................................................................................................................ 0.971 0.894 0.827

00900 32 Victoria, TX ........................................................................................................................ 0.983 0.868 0.827

00900 22 Waco, TX ........................................................................................................................... 0.966 0.877 0.827

00900 04 Western TX ....................................................................................................................... 0.956 0.818 0.827

00900 34 Wichita Falls, TX ............................................................................................................... 0.950 0.857 0.827

00910 09 Utah ................................................................................................................................... 0.978 0.891 0.644

00780 50 Vermont ............................................................................................................................. 0.974 0.988 0.452

00973 50 Virgin Islands ..................................................................................................................... 0.966 0.978 1.023

10490 04 Rest Of VA ........................................................................................................................ 0.976 0.876 0.504

10490 01 Richmond & Charlottesville, VA ........................................................................................ 1.004 0.991 0.511

10490 03 Sm Town/Industrial VA ...................................................................................................... 0.974 0.897 0.517

10490 02 Tidewater & N VA Cntys ................................................................................................... 0.990 0.965 0.530

01390 03 E Cntrl & Ne WA ............................................................................................................... 0.985 0.943 0.748

01390 02 Seattle (King Cnty), WA .................................................................................................... 1.006 1.077 0.748

01390 01 W & Se WA (Excl Seattle) ................................................................................................ 0.982 0.968 0.748

16510 16 Charleston, WV ................................................................................................................. 0.980 0.881 1.004

16510 18 Eastern Valley, WV ........................................................................................................... 0.960 0.899 1.004

16510 19 Ohio River Valley, WV ...................................................................................................... 0.959 0.833 1.004

16510 20 Southern Valley, WV ......................................................................................................... 0.952 0.815 1.004

16510 17 Wheeling, WV .................................................................................................................... 0.957 0.840 1.004

00951 13 Central WI ......................................................................................................................... 0.959 0.849 1.160

00951 40 Green Bay (Northeast), WI ............................................................................................... 0.976 0.894 1.160

00951 54 Janesville (S Cntrl), WI ..................................................................................................... 0.966 0.895 1.160

00951 19 La Crosse (W Cntrl), WI .................................................................................................... 0.972 0.879 1.160

00951 15 Madison (Dane Cnty), WI .................................................................................................. 0.990 1.000 1.160

00951 46 Milwaukee Suburbs (Se), WI ............................................................................................ 0.990 0.959 1.160

00951 04 Milwaukee, WI ................................................................................................................... 1.001 0.978 1.160

00951 12 Northwest WI ..................................................................................................................... 0.961 0.850 1.160

00951 60 Oshkosh (E Cntrl), WI ....................................................................................................... 0.973 0.886 1.160

00951 14 Southwest WI .................................................................................................................... 0.959 0.850 1.160

00951 36 Wausau (N Cntrl), WI ........................................................................................................ 0.962 0.866 1.160

00825 21 Wyoming ............................................................................................................................ 0.968 0.881 0.811

444444444444

*Added to the list as of 1/1/96.

#All CPT codes and descriptors copyright 1995 American Medical Association.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL

CPT/

HCPCS# Description

10040 Acne surgery.

10060 Drainage of skin abscess.

10061 Drainage of skin abscess.

10080 Drainage of pilonidal cyst.

10081 Drainage of pilonidal cyst.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

10120 Remove foreign body.

10121 Remove foreign body.

10140 Drainage of hematoma/fluid.

10160 Puncture drainage of lesion.

11000 Surgical cleansing of skin.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

11001 Additional cleansing of skin.

11040 Surgical cleansing, abrasion.

11041 Surgical cleansing of skin.

* 11042 Cleansing of skin/tissue.

11050 Trim skin lesion.
63354

444444444444

*Added to the list as of 1/1/96.

#All CPT codes and descriptors copyright 1995 American Medical Association.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

11051 Trim 2 to 4 skin lesions.

11052 Trim over 4 skin lesions.

11100 Biopsy of skin lesion.

11101 Biopsy, each added lesion.

11200 Removal of skin tags.

11201 Removal of added skin tags.

11300 Shave skin lesion.

11301 Shave skin lesion.

11302 Shave skin lesion.

11303 Shave skin lesion.

11305 Shave skin lesion.

11306 Shave skin lesion.

11307 Shave skin lesion.

11308 Shave skin lesion.

11310 Shave skin lesion.

11311 Shave skin lesion.

11312 Shave skin lesion.

11313 Shave skin lesion.

11400 Removal of skin lesion.

11401 Removal of skin lesion.

11402 Removal of skin lesion.

11403 Removal of skin lesion.

* 11404 Removal of skin lesion.

11420 Removal of skin lesion.

11421 Removal of skin lesion.

11422 Removal of skin lesion.

11423 Removal of skin lesion.

* 11424 Removal of skin lesion.

11440 Removal of skin lesion.

11441 Removal of skin lesion.

11442 Removal of skin lesion.

11443 Removal of skin lesion.

* 11444 Removal of skin lesion.

* 11446 Removal of skin lesion.

11600 Removal of skin lesion.

11601 Removal of skin lesion.

11602 Removal of skin lesion.

11603 Removal of skin lesion.

* 11604 Removal of skin lesion.

11620 Removal of skin lesion.

11621 Removal of skin lesion.

11622 Removal of skin lesion.

11623 Removal of skin lesion.

* 11624 Removal of skin lesion.

11640 Removal of skin lesion.

11641 Removal of skin lesion.

11642 Removal of skin lesion.

11643 Removal of skin lesion.

* 11644 Removal of skin lesion.

11700 Scraping of 1-5 nails.

11701 Scraping of additional nails.

11710 Scraping of 1-5 nails.

11711 Scraping of additional nails.

11730 Removal of nail plate.

11731 Removal of second nail plate.

11732 Remove additional nail plate.

11740 Drain blood from under nail.

11750 Removal of nail bed.

11752 Remove nail bed/finger tip.

11760 Reconstruction of nail bed.

11762 Reconstruction of nail bed.

11765 Excision of nail fold, toe.

11900 Injection into skin lesions.

11901 Added skin lesion injections.

* 12021 Closure of split wound.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

12031 Layer closure of wound(s).

12032 Layer closure of wound(s).

12041 Layer closure of wound(s).

12042 Layer closure of wound(s).

12051 Layer closure of wound(s).

12052 Layer closure of wound(s).

* 13100 Repair of wound or lesion.

* 13101 Repair of wound or lesion.

* 13120 Repair of wound or lesion.

* 13121 Repair of wound or lesion.

* 13131 Repair of wound or lesion.

* 13132 Repair of wound or lesion.

* 13151 Repair of wound or lesion.

* 13152 Repair of wound or lesion.

* 14000 Skin tissue rearrangement.

* 14040 Skin tissue rearrangement.

* 14041 Skin tissue rearrangement.

* 14061 Skin tissue rearrangement.

15780 Abrasion treatment of skin.

15781 Abrasion treatment of skin.

15782 Abrasion treatment of skin.

15783 Abrasion treatment of skin.

15786 Abrasion treatment of lesion.

15787 Abrasion, added skin lesions.

15851 Removal of sutures.

15852 Dressing change, not for burn.

16000 Initial treatment of burn(s).

16010 Treatment of burn(s).

16020 Treatment of burn(s).

16025 Treatment of burn(s).

17000 Destroy benign/premal lesion.

17001 Destruction of add’l lesions.

17002 Destruction of add’l lesions.

17010 Destruction skin lesion(s).

17100 Destruction of skin lesion.

17101 Destruction of 2nd lesion.

17102 Destruction of add’l lesions.

17104 Destruction of skin lesions.

17105 Destruction of skin lesions.

17106 Destruction of skin lesions.

17107 Destruction of skin lesions.

17110 Destruction of skin lesions.

17200 Electrocautery of skin tags.

17201 Electrocautery added lesions.

17250 Chemical cautery, tissue.

17260 Destruction of skin lesions.

17261 Destruction of skin lesions.

17262 Destruction of skin lesions.

17263 Destruction of skin lesions.

17264 Destruction of skin lesions.

17266 Destruction of skin lesions.

17270 Destruction of skin lesions.

17271 Destruction of skin lesions.

17272 Destruction of skin lesions.

17273 Destruction of skin lesions.

17274 Destruction of skin lesions.

17276 Destruction of skin lesions.

17280 Destruction of skin lesions.

17281 Destruction of skin lesions.

17282 Destruction of skin lesions.

17283 Destruction of skin lesions.

17284 Destruction of skin lesions.

17286 Destruction of skin lesions.

17304 Chemosurgery of skin lesion.

17305 2nd stage chemosurgery.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

17306 3rd stage chemosurgery.

17307 Followup skin lesion therapy.

17310 Extensive skin chemosurgery.

17340 Cryotherapy of skin.

17360 Skin peel therapy.

19000 Drainage of breast lesion.

19001 Drain added breast lesion.

* 19100 Biopsy of breast.

20000 Incision of abscess.

20500 Injection of sinus tract.

20520 Removal of foreign body.

20550 Inj tendon/ligament/cyst.

20600 Drain/inject joint/bursa.

20605 Drain/inject joint/bursa.

20610 Drain/inject joint/bursa.

20615 Treatment of bone cyst.

* 20670 Removal of support implant.

20974 Electrical bone stimulation.

* 21025 Excision of bone, lower jaw.

* 21026 Excision of facial bone(s).

21029 Contour of face bone lesion.

21030 Removal of face bone lesion.

21031 Remove exostosis, mandible.

21032 Remove exostosis, maxilla.

* 21040 Removal of jaw bone lesion.

* 21041 Removal of jaw bone lesion.

21079 Prepare face/oral prosthesis.

21080 Prepare face/oral prosthesis.

21081 Prepare face/oral prosthesis.

21082 Prepare face/oral prosthesis.

21083 Prepare face/oral prosthesis.

21084 Prepare face/oral prosthesis.

21085 Prepare face/oral prosthesis.

21086 Prepare face/oral prosthesis.

21087 Prepare face/oral prosthesis.

21088 Prepare face/oral prosthesis.

21089 Prepare face/oral prosthesis.

21110 Interdental fixation.

* 21210 Face bone graft.

* 21215 Lower jaw bone graft.

* 21248 Reconstruction of jaw.

* 21249 Reconstruction of jaw.

* 21485 Reset dislocated jaw.

* 21550 Biopsy of neck/chest.

* 21920 Biopsy soft tissue of back.

23031 Drain shoulder bursa.

* 23330 Remove shoulder foreign body.

* 23620 Treat humerus fracture.

* 23931 Drainage of arm bursa.

* 24065 Biopsy arm/elbow soft tissue.

24200 Removal of arm foreign body.

* 24362 Reconstruct elbow joint.

24650 Treat radius fracture.

* 25065 Biopsy forearm soft tissues.

25500 Treat fracture of radius.

25530 Treat fracture of ulna.

25600 Treat fracture radius/ulna.

25622 Treat wrist bone fracture.

* 25624 Treat wrist bone fracture.

25630 Treat wrist bone fracture.

* 25635 Treat wrist bone fracture.

25650 Repair wrist bone fracture.

26010 Drainage of finger abscess.

* 26070 Explore/treat hand joint.

* 26432 Repair finger tendon.
63355

444444444444

*Added to the list as of 1/1/96.

#All CPT codes and descriptors copyright 1995 American Medical Association.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

26600 Treat metacarpal fracture.

* 26605 Treat metacarpal fracture.

26720 Treat finger fracture, each.

26725 Treat finger fracture, each.

26740 Treat finger fracture, each.

* 27086 Remove hip foreign body.

* 27323 Biopsy thigh soft tissues.

* 27520 Treat kneecap fracture.

* 27604 Drain lower leg bursa.

* 27613 Biopsy lower leg soft tissue.

* 27760 Treatment of ankle fracture.

* 27780 Treatment of fibula fracture.

* 27786 Treatment of ankle fracture.

* 27788 Treatment of ankle fracture.

28001 Drainage of bursa of foot.

* 28003 Treatment of foot infection.

28010 Incision of toe tendon.

28011 Incision of toe tendons.

28022 Exploration of a foot joint.

28024 Exploration of a toe joint.

28052 Biopsy of foot joint lining.

28108 Removal of toe lesions.

28124 Partial removal of toe.

28126 Partial removal of toe.

28153 Partial removal of toe.

28160 Partial removal of toe.

28190 Removal of foot foreign body.

28220 Release of foot tendon.

* 28222 Release of foot tendons.

28230 Incision of foot tendon(s).

28232 Incision of toe tendon.

28234 Incision of foot tendon.

28270 Release of foot contracture.

28272 Release of toe joint, each.

* 28313 Repair of demormity of toe.

* 28400 Treatment of heal fracture.

28430 Treatment of ankle fracture.

28450 Treat midfoot fracture, each.

28455 Treat midfoot fracture, each.

28470 Treat metatarsal fracture.

28475 Treat metatarsal fracture.

28490 Treat big toe fracture.

28495 Treat big toe fracture.

28510 Treatment of toe fracture.

28515 Treatment of toe fracture.

28530 Treat sesamoid bone fracture.

28540 Treat foot dislocation.

28570 Treat foot dislocation.

28600 Treat foot dislocation.

28630 Treat toe dislocation.

* 28635 Treat toe dislocation.

* 28665 Treat toe dislocation.

29015 Application of body cast.

29020 Application of body cast.

29025 Application of body cast.

29035 Application of body cast.

29049 Application of shoulder cast.

29065 Application of long arm cast.

29075 Application of forearm cast.

29085 Apply hand/wrist cast.

29105 Apply long arm splint.

29125 Apply forearm splint.

29126 Apply forearm splint.

29130 Application of finger splint.

29131 Application of finger splint.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

29200 Strapping of chest.

29220 Strapping of low back.

29260 Strapping of elbow or wrist.

29280 Strapping of hand or finger.

29345 Application of long leg cast.

29355 Application of long leg cast.

29358 Apply long leg cast brace.

29365 Application of long leg cast.

29405 Apply short leg cast.

29425 Apply short leg cast.

29435 Apply short leg cast.

29440 Addition of walker to cast.

29450 Application of leg cast.

29515 Application of lower leg splint.

29520 Strapping of hip.

29530 Strapping of knee.

29540 Strapping of ankle.

29550 Strapping of toes.

29580 Application of paste boot.

29590 Application of foot splint.

29700 Removal/revision of cast.

29705 Removal/revision of cast.

29710 Removal/revision of cast.

29715 Removal/revision of cast.

29720 Repair of body cast.

29730 Windowing of cast.

29740 Wedging of cast.

29750 Wedging of clubfoot cast.

29850 Knee arthroscopy/surgery.

30000 Drainage of nose lesion.

30020 Drainage of nose lesion.

30100 Intranasal biopsy.

30110 Removal of nose polyp(s).

* 30124 Removal of nose lesion.

30200 Injection treatment of nose.

30210 Nasal sinus therapy.

30220 Insert nasal septal button.

30300 Remove nasal foreign body.

* 30560 Release of nasal adhesions.

* 30580 Repair upper jaw fistula.

* 30801 Cauterization inner nose.

30901 Control of nosebleed.

31000 Irrigation maxillary sinus.

31002 Irrigation sphenoid sinus.

* 31233 Nasal/sinus endoscopy, dx.

* 31235 Nasal/sinus endoscopy, dx.

* 31237 Nasal/sinus endoscopy, surg.

* 31238 Nasal/sinus endoscopy, surg.

31505 Diagnostic laryngoscopy.

* 31525 Diagnostic laryngoscopy.

* 31570 Laryngoscopy with injection.

31575 Diagnostic laryngoscopy.

31579 Diagnostic laryngoscopy.

* 33011 Repeat drainage of heart sac.

36000 Place needle in vein.

36400 Drawing blood.

36405 Drawing blood.

36406 Drawing blood.

36410 Drawing blood.

36430 Blood transfusion service.

36450 Exchange transfusion service.

36470 Injection therapy of vein.

36471 Injection therapy of veins.

36510 Insertion of catheter, vein.

* 38300 Drainage lymph node lesion.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

* 38505 Needle biopsy, lymph node(s).

40490 Biopsy of lip.

40800 Drainage of mouth lesion.

* 40801 Drainage of mouth lesion.

40804 Removal foreign body, mouth.

40808 Biopsy of mouth lesion.

40810 Excision of mouth lesion.

40812 Excise/repair mouth lesion.

* 40814 Excise/repair mouth lesion.

* 40816 Excision of mouth lesion.

* 40819 Excise lip or cheek fold.

* 40820 Treatment of mouth lesion.

* 41000 Drainage of mouth lesion.

* 41008 Drainage of mouth lesion.

41100 Biopsy of tongue.

* 41105 Biopsy of tongue.

41108 Biopsy of floor of mouth.

* 41110 Excision of tongue lesion.

* 41112 Excision of tongue lesion.

* 41113 Excision of tongue lesion.

* 41800 Drainage of gum lesion.

* 41806 Removal of foreign body, jawbone.

41825 Excision of gum lesion.

41826 Excision of gum lesion.

* 41827 Excision of gum lesion.

* 42000 Drainage mouth roof lesion.

42100 Biopsy roof of mouth.

* 42104 Excision lesion, mouth roof.

* 42106 Excision lesion, mouth roof.

* 42107 Excision lesion, mouth roof.

* 42160 Treatment mouth roof lesion.

* 42300 Drainage of salivary gland.

* 42310 Drainage of salivary gland.

42330 Removal of salivary stone.

* 42335 Removal of salivary stone.

* 42340 Removal of salivary stone.

42400 Biopsy of salivary gland.

* 42405 Biopsy of salivary gland.

42650 Dilation of salivary duct.

42660 Dilation of salivary duct.

* 42700 Drainage of tonsil abscess.

42800 Biopsy of throat.

45300 Proctosigmoidoscopy.

45303 Proctosigmoidoscopy.

* 45305 Proctosigmoidoscopy; biopsy.

* 45308 Proctosigmoidoscopy.

* 45309 Proctosigmoidoscopy.

45330 Sigmoidoscopy, diagnostic.

45520 Treatment of rectal prolapse.

* 46050 Incision of anal abscess.

46083 Incise external hemorrhoid.

46221 Ligation of hemorrhoid(s).

46230 Removal of anal tabs.

46320 Removal of hemorrhoid clot.

46500 Injection into hemorrhoids.

46600 Diagnostic anoscopy.

46604 Anoscopy and dilation.

46606 Anoscopy and biopsy.

* 46611 Anoscopy.

46614 Anoscopy; control bleeding.

46615 Anoscopy.

46900 Destruction, anal lesion(s).

46910 Destruction, anal lesion(s).

46916 Cryosurgery, anal lesion(s).

46917 Laser surgery, anal lesion(s).
63356

444444444444

*Added to the list as of 1/1/96.

#All CPT codes and descriptors copyright 1995 American Medical Association.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

46934 Destruction of hemorrhoids.

46935 Destruction of hemorrhoids.

46936 Destruction of hemorrhoids.

46940 Treatment of anal fissure.

46942 Treatment of anal fissure.

46945 Ligation of hemorrhoids.

46946 Ligation of hemorrhoids.

51700 Irrigation of bladder.

51705 Change of bladder tube.

* 51710 Change of bladder tube.

51720 Treatment of bladder lesion.

* 52000 Cystoscopy.

* 52010 Cystoscopy & duct catheter.

52265 Cystoscopy & treatment.

* 52281 Cystoscopy & treatment.

* 52285 Cystoscopy & treatment.

53270 Removal of urethra gland.

* 53420 Reconstruct urethra, stage 1.

53600 Dilate urethra stricture.

53601 Dilate urethra stricture.

53620 Dilate urethra stricture.

53621 Dilate urethra stricture.

53660 Dilation of urethra.

53661 Dilation of urethra.

53670 Insert urinary catheter.

54050 Destruction, penis lesion(s).

54055 Destruction, penis lesion(s).

54056 Cryosurgery, penis lesion(s).

* 54065 Destruction, penis lesion(s).

54200 Treatment of penis lesion.

54230 Prepare penis study.

54235 Penile injection.

55000 Drainage of hydrocele.

55250 Removal of sperm duct(s).

* 55700 Biopsy of prostate.

* 56405 I & D of vulva/perineum.

56420 Drainage of gland abscess.

56501 Destruction, vulva lesion(s).

* 56605 Biopsy of vulva/perineum.

56606 Biopsy of vulva/perineum.

57061 Destruction vagina lesion(s).

57100 Biopsy of vagina.

57150 Treat vagina infection.

57160 Insertion of pessary.

57170 Fitting of diaphragm/cap.

* 57180 Treat vaginal bleeding.

57452 Examination of vagina.

57454 Vagina examination & biopsy.

57460 Leep procedure.

57500 Biopsy of cervix.

57505 Endocervical curettage.

57510 Cauterization of cervix.

57511 Cryocautery of cervix.

* 57800 Dilation of cervical canal.

58100 Biopsy of uterus lining.

58301 Remove intrauterine device.

59200 Insert cervical dilator.

59300 Episiotomy or vaginal repair.

59425 Antepartum care only.

59426 Antepartum care only.

59430 Care after delivery.

* 60000 Drain thyroid/tongue cyst.

60100 Biopsy of thyroid.

61001 Remove cranial cavity fluid.

* 61070 Brain canal shunt procedure.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

63690 Analysis of neuroreceiver.

63691 Analysis of neuroreceiver.

64400 Injection for nerve block.

64405 Injection for nerve block.

64408 Injection for nerve block.

64412 Injection for nerve block.

64413 Injection for nerve block.

64418 Injection for nerve block.

64435 Injection for nerve block.

64440 Injection for nerve block.

64441 Injection for nerve block.

64445 Injection for nerve block.

64450 Injection for nerve block.

64505 Injection for nerve block.

64508 Injection for nerve block.

64550 Apply neurostimulator.

64553 Implant neuroelectrodes.

64555 Implant neuroelectrodes.

64560 Implant neuroelectrodes.

64565 Implant neuroelectrodes.

64612 Destroy nerve, face muscle.

64613 Destroy nerve, spine muscle.

65205 Remove foreign body from eye.

65210 Remove foreign body from eye.

65220 Remove foreign body from eye.

65222 Remove foreign body from eye.

65286 Repair of eye wound.

65430 Corneal smear.

65435 Curette/treat cornea.

65436 Curette/treat cornea.

65600 Revision of cornea.

65772 Correction of astigmatism.

* 65805 Drainage of eye.

65855 Laser surgery of eye.

65860 Incise inner eye adhesions.

* 66030 Injection treatment of eye.

66761 Revision of iris.

* 66762 Revision of iris.

66770 Removal of inner eye lesion.

* 67031 Laser surgery, eye strands.

* 67101 Repair detached retina.

* 67105 Repair detached retina.

* 67141 Treatment of retina.

67145 Treatment of retina.

* 67208 Treatment of retinal lesion.

67210 Treatment of retinal lesion.

67228 Treatment of retinal lesion.

67345 Destroy nerve of eye muscle.

67505 Inject/treat eye socket.

67515 Inject/treat eye socket.

67700 Drainage of eyelid abscess.

67710 Incision of eyelid.

67800 Remove eyelid lesion.

67801 Remove eyelid lesions.

67805 Remove eyelid lesions.

67810 Biopsy of eyelid.

67820 Revise eyelashes.

67825 Revise eyelashes.

67840 Remove eyelid lesion.

67850 Treat eyelid lesion.

67915 Repair eyelid defect.

67922 Repair eyelid defect.

67930 Repair eyelid wound.

67938 Remove eyelid foreign body.

68020 Incise/drain eyelid lining.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

68040 Treatment of eyelid lesions.

68100 Biopsy of eyelid lining.

68110 Remove eyelid lining lesion.

68135 Remove eyelid lining lesion.

68200 Treat eyelid by injection.

68400 Incise/drain tear gland.

68420 Incise/drain tear sac.

68440 Incise tear duct opening.

68530 Clearance of tear duct.

68705 Revise tear duct opening.

68760 Close tear duct opening.

68761 Close tear duct opening.

68770 Close tear system fistula.

68800 Dilate tear duct opening(s).

68820 Explore tear duct system.

68830 Reopen tear duct channel.

68840 Explore/irrigate tear ducts.

69000 Drain external ear lesion.

69005 Drain external ear lesion.

69020 Drain outer ear canal lesion.

69100 Biopsy of external ear.

69105 Biopsy of external ear canal.

69200 Clear outer ear canal.

69210 Remove impacted ear wax.

69220 Clean out mastoid cavity.

69222 Clean out mastoid cavity.

69400 Inflate middle ear canal.

69401 Inflate middle ear canal.

69405 Catheterize middle ear canal.

69410 Inset middle ear baffle.

69420 Incision of eardrum.

* 69424 Remove ventilating tube.

69433 Create eardrum opening.

69540 Remove ear lesion.

69610 Repair of eardrum.

92002 Eye exam, new patient.

92004 Eye exam, new patient.

92012 Eye exam established pt.

92014 Eye exam & treatment.

92019 Eye exam & treatment.

92020 Special eye evaluation.

92070 Fitting of contact lens.

92100 Serial tonometry exam(s).

92120 Tonography & eye evaluation.

92130 Water provocation tonography.

92140 Glaucoma provocative tests.

92225 Special eye exam, initial.

92226 Special eye exam, subsequent.

92230 Eye exam with photos.

92260 Ophthalmoscopy/dynamometry.

92287 Internal eye photography.

92311 Contact lens fitting.

92312 Contact lens fitting.

92313 Contact lens fitting.

92315 Prescription of contact lens.

92316 Prescription of contact lens.

92317 Prescription of contact lens.

92330 Fitting of artificial eye.

92335 Fitting of artificial eye.

92352 Special spectacles fitting.

92353 Special spectacles fitting.

92354 Special spectacles fitting.

92371 Repair & adjust spectacles.

92504 Ear microscopy examination.

92506 Speech & hearing evaluation.
63357

444444444444

*Added to the list as of 1/1/96.

#All CPT codes and descriptors copyright 1995 American Medical Association.

Federal Register / Vol. 60, No. 236 / Friday, December 8, 1995 / Rules and Regulations

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

92507 Speech/hearing therapy.

92508 Speech/hearing therapy.

92511 Nasopharyngoscopy.

92512 Nasal function studies.

92516 Facial nerve function test.

92520 Laryngeal function studies.

92565 Stenger test, pure tone.

92571 Filtered speech hearing test.

92575 Sensorineural acuity test.

92576 Synthetic sentence test.

92577 Stenger test, speech.

92582 Conditioning play audiometry.

93205 Special phonocardiogram.

93221 Vectorcardiogram tracing.

93721 Plethysmography tracing.

93797 Cardiac rehab.

93798 Cardiac rehab/monitor.

95010 Sensitivity skin tests.

95015 Sensitivity skin tests.

95056 Photosensitivity tests.

95065 Nose allergy test.

95075 Ingestion challenge test.

95144 Antigen therapy services.

95145 Antigen therapy services.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

95146 Antigen therapy services.

95147 Antigen therapy services.

95148 Antigen therapy services.

95149 Antigen therapy services.

95165 Antigen therapy services.

95170 Antigen therapy services.

95180 Rapid desensitization.

95831 Limb muscle testing, manual.

95832 Hand muscle testing, manual.

95833 Body muscle testing, manual.

95834 Body muscle testing, manual.

95851 Range of motion measurements.

95852 Range of motion measurements.

95857 Tensilon test.

96405 Intralesional chemo admin.

96406 Intralesional chemo admin.

96445 Chemotherapy, intracavitary.

96450 Chemotherapy, into cns.

96542 Chemotherapy injection.

99201 Office/outpatient visit, new.

99202 Office/outpatient visit, new.

99203 Office/outpatient visit, new.

99204 Office/outpatient visit, new.

99205 Office/outpatient visit, new.

ADDENDUM E.—PROCEDURE CODES

SUBJECT TO THE SITE-OF-SERVICE

DIFFERENTIAL—Continued

CPT/

HCPCS# Description

99211 Office/outpatient visit, est.

99212 Office/outpatient visit, est.

99213 Office/outpatient visit, est.

99214 Office/outpatient visit, est.

99215 Office/outpatient visit, est.

99241 Office consultation.

99242 Office consultation.

99243 Office consultation.

99244 Office consultation.

99245 Office consultation.

99271 Confirmatory consultation.

99272 Confirmatory consultation.

99273 Confirmatory consultation.

99274 Confirmatory consultation.

99354 Prolonged service, office.

99355 Prolonged service, office.

A2000 Chiropractor manip of spine.

G0020 Prepare face/oral prosthesis.

G0021 Prepare face/oral prosthesis.

H5300 Occupational therapy.

M0101 Cutting/remove corns/calluses.