[Federal Register Volume 66, Number 111 (Friday, June 8, 2001)]
[Notices]
[Pages 31028-31084]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-14336]



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Part III





Department of Health and Human Services





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Health Care Financing Administration



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Medicare Program; Five-Year Review of Work Relative Value Units Under 
the Physician Fee Schedule; Notice

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / 
Notices

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[HCFA-1170-PN]
RIN 0938-AK56


Medicare Program; Five-Year Review of Work Relative Value Units 
Under the Physician Fee Schedule

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Proposed notice.

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SUMMARY: This proposed notice discusses changes to work relative value 
units (RVUs) affecting payment for physicians' services. Section 
1848(c)(2)(B)(i) of the Social Security Act requires that we review 
RVUs no less often than every 5 years. This is the second review of 
work RVUs since we implemented the physician fee schedule on January 1, 
1992. These work RVUs are proposed to be effective for services 
furnished beginning January 1, 2002.

DATES: To be assured of consideration, we must receive comments at the 
appropriate address, as provided below, no later than 5 p.m. on August 
7, 2001.

ADDRESSES: Mail written comments (1 original and 3 copies) to the 
following address only: Health Care Financing Administration, 
Department of Health and Human Services, Attention: HCFA-1170-PN, P.O. 
Box 8013, Baltimore, MD 21244-8013.
    Please allow sufficient time for mailed comments to be timely 
received in the event of delivery delays. If you prefer, you may 
deliver your written comments by courier (1 original and 3 copies) to 
one of the following addresses:

Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201,
        or
Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-8013

    Comments mailed to the above addresses may be delayed and received 
too late to be considered.
    Because of staff and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. In commenting, please refer 
to file code HCFA-1170-PN. Comments received timely will be available 
for public inspection as they are received, generally beginning 
approximately 3 weeks after publication of a document at the 
headquarters of the Health Care Financing Administration, 7500 Security 
Boulevard, Baltimore, Maryland, on Monday through Friday of each week 
from 8:30 a.m. to 5 p.m. Please call (410) 786-7197 to make an 
appointment to view the public comments.

FOR FURTHER INFORMATION CONTACT:
Jim Menas, (410) 786-4507.
Rick Ensor, (410) 786-5617.
Diane Milstead, (410) 786-3355.
Marc Hartstein (Regulatory Impact Analysis), (410) 786-4539.

Supplementary Information
    Copies: To order copies of the Federal Register containing this 
document, send your request to: New Orders, Superintendent of 
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date 
of the issue requested and enclose a check or money order payable to 
the Superintendent of Documents, or enclose your Visa or Master Card 
number and expiration date. Credit card orders can also be placed by 
calling the order desk at (202) 512-1800 or by faxing to (202) 512-
2250. The cost for each copy is $9. As an alternative, you can view and 
photocopy the Federal Register document at most libraries designated as 
Federal Depository Libraries and at many other public and academic 
libraries throughout the country that receive the Federal Register.
    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. The Website address is: http://www.access.gpo.gov/nara/index.html.
    To assist readers in referencing sections contained in the 
preamble, we are providing the following table of contents:

Table of Contents

I. Background

A. Legislative History
B. Published Changes to the Physician Fee Schedule
C. Current Proposed Notice
D. The 5-Year Review Process

II. Discussion of Comments and Decisions

A. Review of Comments
B. Discussion of Comments by Clinical Area
    1. Vascular Surgery
    2. General Surgery/Colon and Rectal Surgery
    3. Thoracic Surgery
    4. Orthopedic Surgery
    5. Ophthalmology
    6. Urology
    7. Obstetrics/Gynecology
    a. Specialty Comments
    b. Other Concerns
    8. Gastroenterology
    9. Pulmonary Medicine/Critical Care
    10. Cardiology
    11. Pediatrics
    12. Pediatric Surgery
    13. Radiology
    14. Plastic Surgery
C. Other Comments
    1. Anesthesia Services
    2. Spine Injection Procedures
    3. Biofeedback
    4. Surgical Management of Burn Wounds
    5. Transplantation
    6. Arthroscopy Services
    7. Wheelchair Management
    8. Psychological Testing
    9. Podiatric Services
D. Other Issues
    1. Critical Care Services in a Global Period
    2. Codes Referred to CPT
    3. Budget Neutrality
    4. Calculation of Practice Expense and Malpractice Relative 
Value Units
    5. Nature and Format of Comments on Work Relative Value Units

III. Collection of Information Requirements

IV. Response to Comments

V. Regulatory Impact Analysis

    Because of the many organizations and terms to which we refer by 
acronym in this proposed notice, we are listing these acronyms and 
their corresponding terms in alphabetical order below:

AANA  Arthroscopy Association of North America
AAO  American Academy of Opthalmology
AAP  American Academy of Pediatrics
ABA  American Burn Association
ACG  American College of Gastroenterology
ACOG  American College of Obstetrics and Gynecology
ACR  American College of Radiology
ACS  American College of Surgeons
AGA  American Gastrointestinal Association
AMA  American Medical Association
APMA  American Podiatric Medical Association
APSA  American Pediatric Surgical Association
APTA  American Physical Therapy Association
ASA  American Society of Anesthesiologists
ASCRS  American Society of Colon and Rectal Surgeons
ASGE  American Society for Gastrointestinal Endoscopy
ASPS  American Society of Plastic Surgery
ASTS  American Society for Transplant Surgeons
AUA  American Urological Association
BBA  Balanced Budget Act
CPT  Current procedural terminology
CY  Calendar year
ERCP  Endoscopic retrograde cholangio-pancreatography
FDA  Food and Drug Administration
FR  Federal Register
GAF  Geographic adjustment factor
GCPI  Geographic practice cost index
GPO  Government Printing Office

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HCFA  Health Care Financing Administration
HCPAC  Health Care Professionals Advisory Committee
HCPCS  HCFA Common Procedure Coding System
HHS  Health and Human Services
IWPUT  Intra-service work per unit of time
MEI  Medicare economic index
MQSA  Mammography Quality Standards Act of 1992
MSA  Metropolitan statistical area
PE  Practice expense
PEAC  Practice Expense Advisory Committee
RFA  Regulatory Flexibility Act
RIA  Regulatory impact analysis
RUC  [AMA's Specialty Society] Relative [Value] Update Committee
RVU  Relative value unit
STS  Society of Thoracic Surgeons
SVS  Society for Vascular Surgery

I. Background

A. Legislative History

    Since January 1, 1992, Medicare has paid for physician services 
under section 1848 of the Social Security Act (the Act), ``Payment for 
Physicians'' Services.'' This section contains three major elements, 
(1) a fee schedule for the payment of physicians' services; (2) a 
sustainable growth rate for the rates of increase in Medicare 
expenditures for physicians' services; and (3) limits on the amounts 
that nonparticipating physicians can charge beneficiaries. The Act 
requires that payments under the fee schedule be based on national 
uniform relative value units (RVUs) based on the resources used in 
furnishing a service. Section 1848(c) of the Act requires that national 
RVUs be established for physician work, practice expense, and 
malpractice expense.
    Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments 
in RVUs may not cause total physician fee schedule payments to differ 
by more than $20 million from what they would have been had the 
adjustments not been made. If this tolerance is exceeded, we must make 
adjustments to the conversion factors (CFs) to preserve budget 
neutrality.

B. Published Changes to the Physician Fee Schedule

    In the July 2000 proposed rule (65 FR 44177), we listed all of the 
final rules published through November 1999, relating to updates to the 
RVUs and revisions to the payment policies under the physician fee 
schedule. In the November 2000 final rule (65 FR 65376), we finalized 
the calendar year (CY) 2000 interim physician work RVUs and issued new 
interim work RVUs for new and revised codes for CY 2001. The final rule 
also discussed the activities underway with respect to the second 5-
year refinement of work RVUs.

C. Current Proposed Notice

    This proposed notice discusses changes to work RVUs affecting 
payment for physicians' services. Section 1848(c)(2)(B)(i) of the Act 
requires that we review RVUs no less often than every 5 years. We 
implemented the physician fee schedule effective for services furnished 
beginning January 1, 1992: the first 5-year review of work was 
initiated in December 1994 and was effective for services furnished 
beginning January 1, 1997. The revisions proposed in this notice are 
subject to a 60-day public comment period. We will review public 
comments, make adjustments as appropriate, and include revised values 
in our physician fee schedule final rule, to be published by November 
1, 2001, effective for services furnished beginning January 1, 2002.

D. The 5-Year Review Process

    We initiated the second 5-year review by soliciting public comments 
on potentially misvalued work RVUs for all services in the 2000 
physician fee schedule in our November 2, 1999 final rule (64 FR 
59427). To allow sufficient time for recommendations, we provided a 
120-day comment period. We included a discussion of the activities 
underway with respect to the second 5-year refinement of work RVUs in 
the July 17, 2000 proposed rule (65 FR 44201).
    We received comments from approximately 30 specialty groups, 
organizations, and individuals involving over 900 CPT and HCPCS codes. 
We also received comments on the proposed process for the 5-year 
review. As we indicated in the November 2, 1999 final rule and in the 
July 17, 2000 proposed rule, we shared these comments with the AMA 
Specialty Society Relative Value Update Committee (RUC). The RUC was 
formed in November 1991 and grew out of a series of discussions between 
the AMA and major national medical specialty societies. The work of the 
RUC is supported by the RUC Advisory Committee, which is made up of 
representatives of 100 specialty societies in the AMA's House of 
Delegates.
    The RUC currently makes recommendations to us on RVUs for new and 
revised CPT codes (hereafter referred to as codes). This process was 
used during the first 5-year review, and we believe that it was 
beneficial. We indicated that we believe the perspective of the RUC is 
helpful because of its experience in recommending RVUs for the codes 
that have been added to, or revised by, the CPT panel since we 
implemented the physician fee schedule in 1992. By virtue of its 
multispecialty membership and consultation with specialty societies, 
the RUC involves the medical community in formulating its 
recommendations. For codes used only by non-physician practitioners, 
the Health Care Professionals Advisory Committee (HCPAC), a companion 
to the RUC, has made recommendations to us.
    As we stated in the first 5-year review, we retain the 
responsibility for analyzing the comments and recommendations, 
developing the proposed rule, evaluating comments on the proposed rule, 
and deciding whether to revise RVUs.
    After we sent the RUC the comments we received on potentially 
misvalued services, the RUC identified specialty societies interested 
in making presentations concerning those misvalued services. In making 
presentations to the RUC, specialty societies compiled data using a 
standard survey instrument whereby respondents compared the surveyed 
service with similar ``reference'' services that have established, 
agreed upon work values. Respondents were asked to estimate the work 
for the survey code, the time to perform pre-, intra-, and postservice 
activities, and the technical skill, risk, and judgement involved with 
performing the service. Postservice activities were broken down into 
hospital and office visits and were assigned an appropriate evaluation 
and management code by the respondent. Each specialty society selected 
the physician sample that was surveyed. A minimum of 30 responses was 
required by the RUC for the survey to be considered valid.
    For this 5-year review, the RUC permitted a specialty society to 
use a ``minisurvey'' for some codes if the number of codes a specialty 
was reviewing was extremely high. These minisurveys required less 
information from the respondent but were similar in design.
    Some specialty societies used a ``building-block'' approach to 
validate the survey results for surgical services. In constructing the 
building blocks, a service is divided into ``pre-'', ``intra-'', and 
``post-'' service components. The preservice component consists of all 
services furnished before the physician makes the skin incision (for 
example, preoperative evaluation and scrubbing)

[[Page 31030]]

the intraservice component consists of the ``skin-to-skin'' time, and 
the postservice component includes immediate postsurgery services and 
subsequent hospital and office visits. Each component (or building 
block) is then assigned work RVUs. Preservice and intraservice work 
RVUs are based on time and intensity, and postservice work is based on 
the specified evaluation and management service for each postoperative 
visit. These three values are then summed to compute ``building-block'' 
work RVUs.
    The results of the surveys were reviewed and organized by the 
specialty society and then presented to the RUC. Based on the survey 
results and a discussion, the RUC developed a recommendation. The RUC 
used six workgroups to evaluate the codes. Each workgroup evaluated a 
series of related codes and submitted its report to the full RUC. The 
RUC then evaluated those reports and sent recommendations to us. Both 
the workgroups and the RUC evaluated the relative work (time and 
intensity) for each service compared to other services on the fee 
schedule.
    We received recommendations on work RVUs from the RUC for all of 
the codes we forwarded, with the exception of the anesthesia codes and 
conscious sedation codes.

II. Discussion of Comments and Decisions

A. Review of Comments

    During the comment period for our November 2, 1999 final rule, we 
received approximately 35 public comments on approximately 900 codes. 
After review by our medical staff, we forwarded all of the comments we 
received concerning misvalued services to the RUC. The RUC submitted 
work RVU recommendations for all of the codes we forwarded with the 
exception of the anesthesia codes and conscious sedation codes. The RUC 
used six workgroups to evaluate the codes. Each workgroup evaluated a 
series of related codes and submitted its report to the full RUC. The 
RUC then evaluated those reports and sent its recommendations to us. 
Both the workgroups and the RUC evaluated the relative work (time and 
intensity) for each service compared to other services on the fee 
schedule.
    As discussed below, we further analyzed all of the RUC 
recommendations; we evaluated both the recommended work RVUs and the 
rationale for the recommendations. If we had concerns about the 
application of a particular methodology, we verified that the 
recommended work RVUs were appropriate by using alternative 
methodologies.
    Table 1, Five-Year Review of Work Relative Value Units, lists the 
codes reviewed during the 5-year review. This table includes the 
following information:
    <bullet> CPT/HCPCS Code. This is the CPT or alphanumeric HCPCS code 
for a service.
    <bullet> Modifier. A modifier-26 is shown if the work RVUs 
represent the professional component of the service.
    <bullet> Description. This is an abbreviated version of the 
narrative description of the code.
    <bullet> 2000 Work RVUs. The work RVUs that appeared in the 
November 2, 1999 final rule are shown for each reviewed code.
    <bullet> Requested Work RVUs. This column identifies the work RVUs 
requested by the commenting specialty or individual commenter. If we 
received more than one comment on a code, the code is listed more than 
once with the recommended RVUs. If the commenters did not recommend 
specific RVUs, we indicate this by ``N/A''. A ``WD'' (withdrawal) 
indicates the commenter withdrew the request for review of a code and 
chose not to pursue review of the code under the 5-year review.
    <bullet> RUC Recommendation. This column identifies the work RVUs 
recommended by the RUC. ``CPT'' indicates that that the RUC referred 
this code to the AMA CPT Editorial Panel for review and clarification 
and recommended maintaining the current work RVUs. An ``(e)'' indicates 
the commenting specialty withdrew the proposal; therefore, the RUC 
recommends maintaining the current work RVUs.
    <bullet> HCPAC Recommendation. This column identifies the work RVUs 
recommended by the HCPAC. An ``(a)'' in this column indicates there was 
no HCPAC recommendation.
    <bullet> HCFA Decision. This column indicates whether we agreed 
with the RUC recommendation (``agree''); we are proposing work RVUs 
higher than the RUC recommendation (``increase''); or we are proposing 
work RVUs that are less than the RUC recommendation (``decrease''). 
Codes for which we did not accept the RUC recommendation are discussed 
in greater detail following Table 1. An ``(a)'' in this column 
indicates that in the absence of a RUC recommendation we are proposing 
to maintain the present work RVUs. A ``(b)'' in this column indicates 
that these services were reviewed as part of the July 2000 
Multispecialty Refinement Panels for new and/or revised services. 
(Meetings of Multispecialty Refinement Panels are conducted as needed 
to allow specialty representatives the opportunity to discuss the 
comments they submitted on our decisions on new or revised services 
published in the final rule. The goal of multispecialty refinement 
panels is to consider the interests of those who commented on the work 
RVUs against the redistributive effects that would occur in other 
specialties. Following each discussion of a specific service, panel 
members were instructed to individually rate the service under 
discussion. We then used a statistical analysis of these ratings to 
create final work RVUs for the services under discussion.) A ``(d)'' 
indicates there was no HCPAC recommendation. We propose maintaining 
current work RVUs.
    <bullet> Proposed work RVUs: This column contains the 2002 proposed 
work RVUs.
    The following is a categorization of our proposals as related to 
the RUC recommended work RVUs from the 5-year review of work RVUs. The 
RUC supplied us with recommendations on 857 services. We accepted RUC's 
recommended work RVUs for 792 of the services reviewed and disagreed 
with RUC's recommended work RVUs for 65 of the services reviewed. This 
is an acceptance percentage of 92 percent. Of the 65 services for which 
we did not accept the RUC's recommended work RVUs we increased the work 
RVUs for 37 services, decreased the work RVUs for 22 services, and 
rejected the RUC recommendation of an increase for 6 services that had 
already been reviewed at the Multispecialty Refinement Panel for CY 
2000.
    Additionally, the HCPAC reviewed a total of 12 services as part of 
the 5-year review. For 5 of the services reviewed, the HCPAC did not 
offer a recommendation. Of the remaining 7 services reviewed by the 
HCPAC, we have accepted the HCPAC recommendations.

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    --------------------
\1\ All CPT codes and descriptors copyright 2000 American Medical 
Association

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                             Table 1.--Five-Year Review of Work Relative Value Units
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   CPT/HCPCS                              2000  work   Requested                             HCFA      Proposed
   code \1\       Mod       Descriptor        RVU      work RVU    RUC  REC   HCPAC  REC   decision    work RVU
----------------------------------------------------------------------------------------------------------------
11055.........  .......  Trim skin              0.27        0.43  ..........         (a)         (a)        0.27
                          lesion.
11056.........  .......  Trim skin              0.39        0.61  ..........         (a)         (a)        0.39
                          lesion, 2 to 4.
11057.........  .......  Trim skin              0.50        0.79  ..........         (a)         (a)        0.50
                          lesions, over
                          4.
11100.........  .......  Biopsy of skin         0.81          WD         (e)  ..........         (a)        0.81
                          lesion.
11402.........  .......  Removal of skin        1.61        2.20        1.61  ..........       agree        1.61
                          lesion.
11642.........  .......  Removal of skin        2.93        3.05        2.93  ..........       agree        2.93
                          lesion.
11642.........  .......  Removal of skin        2.93        3.87        2.93  ..........       agree        2.93
                          lesion.
11719.........  .......  Trim nail(s)...        0.11        0.17  ..........         (a)         (a)        0.11
11730.........  .......  Removal of nail        1.13          WD         (e)  ..........         (a)        1.13
                          plate.
12001.........  .......  Repair                 1.70         N/A         CPT  ..........         CPT        1.70
                          superficial
                          wound(s).
12002.........  .......  Repair                 1.86         N/A         CPT  ..........         CPT        1.86
                          superficial
                          wound(s).
12011.........  .......  Repair                 1.76        2.37        1.76  ..........       agree        1.76
                          superficial
                          wound(s).
13101.........  .......  Repair of wound        3.92        5.43        3.92  ..........       agree        3.92
                          or lesion.
13131.........  .......  Repair of wound        3.79        4.79        3.79  ..........       agree        3.79
                          or lesion.
13132.........  .......  Repair of wound        5.95        6.95        5.95  ..........       agree        5.95
                          or lesion.
15000.........  .......  Skin graft.....        4.00        5.95         CPT  ..........         CPT        4.00
15001.........  .......  Skin graft add-        1.00        2.50         CPT  ..........         CPT        1.00
                          on.
15100.........  .......  Skin split             9.05        9.05         CPT  ..........         CPT        9.05
                          graft.
15101.........  .......  Skin split             1.72        1.72         CPT  ..........         CPT        1.72
                          graft add-on.
15120.........  .......  Skin split             9.83        9.83         CPT  ..........         CPT        9.83
                          graft.
15121.........  .......  Skin split             2.67        2.67         CPT  ..........         CPT        2.67
                          graft add-on.
15350.........  .......  Skin homograft.        4.00        4.00         CPT  ..........         CPT        4.00
15351.........  .......  Skin homograft         1.00        1.00         CPT  ..........         CPT        1.00
                          add-on.
15400.........  .......  Skin                   4.00        4.00         CPT  ..........         CPT        4.00
                          heterograft.
15401.........  .......  Skin                   1.00        1.00         CPT  ..........         CPT        1.00
                          heterograft
                          add-on.
17000.........  .......  Destroy benign/        0.60          WD         (e)  ..........         (a)        0.60
                          premal lesion.
17003.........  .......  Destroy                0.15          WD         (e)  ..........         (a)        0.15
                          lesions, 2-14.
17004.........  .......  Destroy                2.79          WD         (e)  ..........         (a)        2.79
                          lesions, 15 or
                          more.
19000.........  .......  Drainage of            0.84        1.27        0.84  ..........       agree        0.84
                          breast lesion.
19100.........  .......  Biopsy of              1.27        3.88        1.27  ..........       agree        1.27
                          breast.
19125.........  .......  Excision,              6.06        9.00        6.06  ..........       agree        6.06
                          breast lesion.
19160.........  .......  Removal of             5.99        8.38        5.99  ..........       agree        5.99
                          breast tissue.
19162.........  .......  Remove breast         13.53       15.68       13.53  ..........       agree       13.53
                          tissue, nodes.
19240.........  .......  Removal of            16.00       18.87       16.00  ..........       agree       16.00
                          breast.
20205.........  .......  Deep muscle            2.35        3.42         CPT  ..........         CPT        2.35
                          biopsy.
20245.........  .......  Bone biopsy,           3.95        7.97        8.50  ..........    decrease        7.78
                          excisional.
20600.........  .......  Drain/inject,          0.66          WD         (e)  ..........         (a)        0.66
                          joint/bursa.
20605.........  .......  Drain/inject,          0.68          WD         (e)  ..........         (a)        0.68
                          joint/bursa.
21740.........  .......  Reconstruction        16.50       21.00         CPT  ..........         CPT       16.50
                          of sternum.
21800.........  .......  Treatment of           0.96        1.77        0.96  ..........       agree        0.96
                          rib fracture.
23076.........  .......  Removal of             7.63       13.40         CPT  ..........         CPT        7.63
                          shoulder
                          lesion.
23472.........  .......  Reconstruct           16.92       21.27       21.10  ..........       agree       21.10
                          shoulder joint.
23485.........  .......  Revision of           13.43       18.73       13.43  ..........       agree       13.43
                          collar bone.
23585.........  .......  Treat scapula          8.96       11.46        8.96  ..........       agree        8.96
                          fracture.
23615.........  .......  Treat humerus          9.35       15.85        9.35  ..........       agree        9.35
                          fracture.
23630.........  .......  Treat humerus          7.35       12.45        7.35  ..........       agree        7.35
                          fracture.
23680.........  .......  Treat                 10.06       13.10       10.06  ..........       agree       10.06
                          dislocation/
                          fracture.
24076.........  .......  Remove arm/            6.30       10.20         CPT  ..........         CPT        6.30
                          elbow lesion.
24435.........  .......  Repair humerus        13.17       20.36       13.17  ..........       agree       13.17
                          with graft.
24545.........  .......  Treat humerus         10.46       12.26       10.46  ..........       agree       10.46
                          fracture.
25076.........  .......  Removal of             4.92       12.96         CPT  ..........         CPT        4.92
                          forearm lesion.
26562.........  .......  Repair of web          9.68       12.56       15.00  ..........       agree       15.00
                          finger.
27048.........  .......  Remove hip/            6.25       13.01         CPT  ..........         CPT        6.25
                          pelvis lesion.
27075.........  .......  Extensive hip         17.23       28.52       35.00  ..........       agree       35.00
                          surgery.
27077.........  .......  Extensive hip         23.13       30.00       40.00  ..........       agree       40.00
                          surgery.
27216.........  .......  Treat pelvic          15.19       25.00       15.19  ..........       agree       15.19
                          ring fracture.
27217.........  .......  Treat pelvic          14.11       17.11       14.11  ..........       agree       14.11
                          ring fracture.
27218.........  .......  Treat pelvic          20.15       22.15       20.15  ..........       agree       20.15
                          ring fracture.
27226.........  .......  Treat hip wall        14.91       19.91       14.91  ..........       agree       14.91
                          fracture.
27236.........  .......  Treat thigh           15.60       17.60       15.60  ..........       agree       15.60
                          fracture.
27280.........  .......  Fusion of             13.39       21.00       13.39  ..........       agree       13.39
                          sacroiliac
                          joint.
27282.........  .......  Fusion of pubic       11.34       21.66       11.34  ..........       agree       11.34
                          bones.
27284.........  .......  Fusion of hip         16.76       20.12       23.45  ..........       agree       23.45
                          joint.
27328.........  .......  Removal of             5.57        8.70         CPT  ..........         CPT        5.57
                          thigh lesion.

[[Page 31032]]

 
27472.........  .......  Repair/graft of       17.72       23.62       17.72  ..........       agree       17.72
                          thigh.
27513.........  .......  Treatment of          17.92       20.92       17.92  ..........       agree       17.92
                          thigh fracture.
27536.........  .......  Treat knee            15.65       19.00       15.65  ..........       agree       15.65
                          fracture.
27590.........  .......  Amputate leg at       12.03       15.52       12.03  ..........       agree       12.03
                          thigh.
27619.........  .......  Remove lower           8.40       10.02         CPT  ..........         CPT        8.40
                          leg lesion.
27724.........  .......  Repair/graft of       14.99       19.34       18.20  ..........       agree       18.20
                          tibia.
27822.........  .......  Treatment of           9.20       10.68       11.00  ..........       agree       11.00
                          ankle fracture.
27823.........  .......  Treatment of          11.80       13.27       13.00  ..........       agree       13.00
                          ankle fracture.
27828.........  .......  Treat lower leg       16.23       19.00       16.23  ..........       agree       16.23
                          fracture.
28299.........  .......  Correction of          8.88       11.90        9.18  ..........       agree        9.18
                          bunion.
28322.........  .......  Repair of              8.34       13.26        8.34  ..........       agree        8.34
                          metatarsals.
28420.........  .......  Treat/graft           16.64       23.52       16.64  ..........       agree       16.64
                          heel fracture.
28445.........  .......  Treat ankle            9.33       15.97       15.62  ..........       agree       15.62
                          fracture.
28705.........  .......  Fusion of foot        15.21       20.46       18.80  ..........       agree       18.80
                          bones.
29450.........  .......  Application of         1.02        3.00        2.08  ..........       agree        2.08
                          leg cast.
29450.........  .......  Application of         1.02         N/A        2.08  ..........       agree        2.08
                          leg cast.
29881.........  .......  Knee                   7.76          WD         (e)  ..........         (a)        7.76
                          arthroscopy/
                          surgery.
29883.........  .......  Knee                   9.46       12.00       11.05  ..........       agree       11.05
                          arthroscopy/
                          surgery.
29889.........  .......  Knee                  15.13       16.68       16.00  ..........       agree       16.00
                          arthroscopy/
                          surgery.
29889.........  .......  Knee                  15.13       18.47       16.00  ..........       agree       16.00
                          arthroscopy/
                          surgery.
31600.........  .......  Incision of            3.62        6.42        7.18  ..........       agree        7.18
                          windpipe.
31622.........  .......  Dx bronchoscope/       2.78        4.17        2.78  ..........       agree        2.78
                          wash.
31622.........  .......  Dx bronchoscope/       2.78         N/A        2.78  ..........       agree        2.78
                          wash.
31625.........  .......  Bronchoscopy           3.37         N/A        3.37  ..........       agree        3.37
                          with biopsy.
31645.........  .......  Bronchoscopy,          3.16         N/A        3.16  ..........       agree        3.16
                          clear airways.
32000.........  .......  Drainage of            1.54        2.88        1.54  ..........       agree        1.54
                          chest.
32000.........  .......  Drainage of            1.54         N/A        1.54  ..........       agree        1.54
                          chest.
32005.........  .......  Treat lung             2.19         N/A        2.19  ..........       agree        2.19
                          lining
                          chemically.
32020.........  .......  Insertion of           3.98         N/A        3.98  ..........       agree        3.98
                          chest tube.
32035.........  .......  Exploration of         8.67         N/A        8.67  ..........       agree        8.67
                          chest.
32095.........  .......  Biopsy through         8.36         N/A        8.36  ..........       agree        8.36
                          chest wall.
32100.........  .......  Exploration/          11.84         N/A       15.24  ..........       agree       15.24
                          biopsy of
                          chest.
32110.........  .......  Explore/repair        13.62         N/A       23.00  ..........       agree       23.00
                          chest.
32220.........  .......  Release of lung       19.27         N/A       24.00  ..........       agree       24.00
32225.........  .......  Partial release       13.96         N/A       13.96  ..........       agree       13.96
                          of lung.
32320.........  .......  Free/remove           20.54         N/A       24.00  ..........       agree       24.00
                          chest lining.
32440.........  .......  Removal of lung       21.02       35.08       25.00  ..........       agree       25.00
32440.........  .......  Removal of lung       21.02         N/A       25.00  ..........       agree       25.00
32480.........  .......  Partial removal       18.32       27.17       23.75  ..........       agree       23.75
                          of lung.
32480.........  .......  Partial removal       18.32         N/A       23.75  ..........       agree       23.75
                          of lung.
32482.........  .......  Bilobectomy....       19.71         N/A       25.00  ..........       agree       25.00
32491.........  .......  Lung volume           21.25         N/A       21.25  ..........       agree       21.25
                          reduction.
32500.........  .......  Partial removal       14.30         N/A       22.00  ..........       agree       22.00
                          of lung.
32520.........  .......  Remove lung &         21.68         N/A       21.68  ..........       agree       21.68
                          revise chest.
32602.........  .......  Thoracoscopy,          5.96         N/A        5.96  ..........       agree        5.96
                          diagnostic.
32651.........  .......  Thoracoscopy,         12.91         N/A       12.91  ..........       agree       12.91
                          surgical.
32652.........  .......  Thoracoscopy,         18.66         N/A       18.66  ..........       agree       18.66
                          surgical.
32655.........  .......  Thoracoscopy,         13.10         N/A       13.10  ..........       agree       13.10
                          surgical.
32657.........  .......  Thoracoscopy,         13.65         N/A       13.65  ..........       agree       13.65
                          surgical.
33207.........  .......  Insertion of           8.04          WD         (e)  ..........         (a)        8.04
                          heart
                          pacemaker.
33234.........  .......  Removal of             7.82         N/A        7.82  ..........       agree        7.82
                          pacemaker
                          system.
33235.........  .......  Removal of             9.40         N/A        9.40  ..........       agree        9.40
                          pacemaker
                          electrode.
33400.........  .......  Repair of             25.34         N/A       28.50  ..........       agree       28.50
                          aortic valve.
33405.........  .......  Replacement of        30.61         N/A       35.00  ..........       agree       35.00
                          aortic valve.
33406.........  .......  Replacement of        32.30         N/A       37.50  ..........       agree       37.50
                          aortic valve.
33410.........  .......  Replacement of        32.46         N/A       32.46  ..........       agree       32.46
                          aortic valve.
33411.........  .......  Replacement of        32.47         N/A       36.25  ..........       agree       36.25
                          aortic valve.
33412.........  .......  Replacement of        34.79         N/A       42.00  ..........       agree       42.00
                          aortic valve.
33413.........  .......  Replacement of        35.24         N/A       43.50  ..........       agree       43.50
                          aortic valve.
33415.........  .......  Revision,             27.15         N/A       27.15  ..........       agree       27.15
                          subvalvular
                          tissue.
33425.........  .......  Repair of             27.00         N/A       27.00  ..........       agree       27.00
                          mitral valve.
33426.........  .......  Repair of             31.03         N/A       33.00  ..........       agree       33.00
                          mitral valve.
33427.........  .......  Repair of             33.72         N/A       40.00  ..........       agree       40.00
                          mitral valve.
33430.........  .......  Replacement of        31.43         N/A       33.50  ..........       agree       33.50
                          mitral valve.
33468.........  .......  Revision of           30.12         N/A       30.12  ..........       agree       30.12
                          tricuspid
                          valve.
33475.........  .......  Replacement,          28.41         N/A       33.00  ..........       agree       33.00
                          pulmonary
                          valve.

[[Page 31033]]

 
33506.........  .......  Repair artery,        26.71         N/A       35.50  ..........       agree       35.50
                          translocation.
33510.........  .......  CABG, vein,           25.12         N/A       29.00  ..........       agree       29.00
                          single.
33511.........  .......  CABG, vein, two       27.40         N/A       30.00  ..........       agree       30.00
33512.........  .......  CABG, vein,           29.67         N/A       31.80  ..........       agree       31.80
                          three.
33513.........  .......  CABG, vein,           31.95         N/A       32.00  ..........       agree       32.00
                          four.
33514.........  .......  CABG, vein,           35.00         N/A       32.75  ..........       agree       32.75
                          five.
33516.........  .......  Cabg, vein, six       37.40         N/A       35.00  ..........       agree       35.00
                          or more.
33517.........  .......  CABG, artery-          2.57         N/A        2.57  ..........       agree        2.57
                          vein, single.
33518.........  .......  CABG, artery-          4.85         N/A        4.85  ..........       agree        4.85
                          vein, two.
33519.........  .......  CABG, artery-          7.12         N/A        7.12  ..........       agree        7.12
                          vein, three.
33521.........  .......  CABG, artery-          9.40         N/A        9.40  ..........       agree        9.40
                          vein, four.
33522.........  .......  CABG, artery-         11.67         N/A       11.67  ..........       agree       11.67
                          vein, five.
33523.........  .......  Cabg, art-vein,       13.95         N/A       13.95  ..........       agree       13.95
                          six or more.
33530.........  .......  Coronary               5.86         N/A        5.86  ..........       agree        5.86
                          artery, bypass/
                          reop.
33533.........  .......  CABG, arterial,       25.83         N/A       30.00  ..........       agree       30.00
                          single.
33534.........  .......  CABG, arterial,       28.82         N/A       32.20  ..........       agree       32.20
                          two.
33535.........  .......  CABG, arterial,       31.81         N/A       34.50  ..........       agree       34.50
                          three.
33536.........  .......  Cabg, arterial,       34.79         N/A       37.50  ..........       agree       37.50
                          four or more.
33611.........  .......  Repair double         32.30         N/A       34.00  ..........       agree       34.00
                          ventricle.
33612.........  .......  Repair double         33.26         N/A       35.00  ..........       agree       35.00
                          ventricle.
33615.........  .......  Repair, simple        32.06         N/A       34.00  ..........       agree       34.00
                          fontan.
33617.........  .......  Repair,               34.03         N/A       37.00  ..........       agree       37.00
                          modified
                          fontan.
33619.........  .......  Repair single         37.57         N/A       45.00  ..........       agree       45.00
                          ventricle.
33641.........  .......  Repair heart          21.39         N/A       21.39  ..........       agree       21.39
                          septum defect.
33660.........  .......  Repair of heart       25.54         N/A       30.00  ..........       agree       30.00
                          defects.
33670.........  .......  Repair of heart       32.73         N/A       35.00  ..........       agree       35.00
                          chambers.
33681.........  .......  Repair heart          27.67         N/A       30.61  ..........       agree       30.61
                          septum defect.
33694.........  .......  Repair of heart       31.73         N/A       34.00  ..........       agree       34.00
                          defects.
33697.........  .......  Repair of heart       33.71         N/A       36.00  ..........       agree       36.00
                          defects.
33730.........  .......  Repair heart-         31.67         N/A       34.25  ..........       agree       34.25
                          vein defect(s).
33750.........  .......  Major vessel          21.41         N/A       21.41  ..........       agree       21.41
                          shunt.
33767.........  .......  Major vessel          24.50         N/A       24.50  ..........       agree       24.50
                          shunt.
33770.........  .......  Repair great          33.29         N/A       37.00  ..........       agree       37.00
                          vessels defect.
33778.........  .......  Repair great          35.82         N/A       40.00  ..........       agree       40.00
                          vessels defect.
33780.........  .......  Repair great          36.94         N/A       41.75  ..........       agree       41.75
                          vessels defect.
33786.........  .......  Repair arterial       34.84         N/A       39.00  ..........       agree       39.00
                          trunk.
33820.........  .......  Revise major          16.29         N/A       16.29  ..........       agree       16.29
                          vessel.
33840.........  .......  Remove aorta          20.63         N/A       20.63  ..........       agree       20.63
                          constriction.
33860.........  .......  Ascending             33.96         N/A       38.00  ..........       agree       38.00
                          aortic graft.
33861.........  .......  Ascending             34.52         N/A       42.00  ..........       agree       42.00
                          aortic graft.
33863.........  .......  Ascending             36.47         N/A       45.00  ..........       agree       45.00
                          aortic graft.
33870.........  .......  Transverse            40.31         N/A       44.00  ..........       agree       44.00
                          aortic arch
                          graft.
33875.........  .......  Thoracic aortic       33.06         N/A         CPT  ..........         CPT       33.06
                          graft.
33877.........  .......  Thoracoabdomina       42.60         N/A         CPT  ..........         CPT       42.60
                          l graft.
33917.........  .......  Repair                24.50         N/A       24.50  ..........       agree       24.50
                          pulmonary
                          artery.
33919.........  .......  Repair                32.67         N/A       40.00  ..........       agree       40.00
                          pulmonary
                          atresia.
33945.........  .......  Transplantation       42.10         N/A       42.10  ..........       agree       42.10
                          of heart.
34001.........  .......  Removal of            12.91          WD         (e)  ..........         (a)       12.91
                          artery clot.
34101.........  .......  Removal of             9.97         N/A       10.00  ..........       agree       10.00
                          artery clot.
34111.........  .......  Removal of arm         8.07         N/A       10.00  ..........       agree       10.00
                          artery clot.
34151.........  .......  Removal of            16.86       27.51       25.00  ..........       agree       25.00
                          artery clot.
34151.........  .......  Removal of            16.86       28.00       25.00  ..........       agree       25.00
                          artery clot.
34201.........  .......  Removal of             9.13       10.40       10.03  ..........       agree       10.03
                          artery clot.
34201.........  .......  Removal of             9.13       10.58       10.03  ..........       agree       10.03
                          artery clot.
34203.........  .......  Removal of leg        12.21       14.99       16.50  ..........       agree       16.50
                          artery clot.
34203.........  .......  Removal of leg        12.21       16.50       16.50  ..........       agree       16.50
                          artery clot.
34401.........  .......  Removal of vein       12.86       26.63       25.00  ..........       agree       25.00
                          clot.
34401.........  .......  Removal of vein       12.86       28.00       25.00  ..........       agree       25.00
                          clot.
34421.........  .......  Removal of vein        9.93       15.75       12.00  ..........       agree       12.00
                          clot.
34421.........  .......  Removal of vein        9.93       15.94       12.00  ..........       agree       12.00
                          clot.
34451.........  .......  Removal of vein       14.44       29.05       27.00  ..........       agree       27.00
                          clot.
34451.........  .......  Removal of vein       14.44       30.00       27.00  ..........       agree       27.00
                          clot.
34490.........  .......  Removal of vein        7.60         N/A        9.86  ..........       agree        9.86
                          clot.
34501.........  .......  Repair valve,         10.93         N/A       16.00  ..........       agree       16.00
                          femoral vein.
34510.........  .......  Transposition         13.25         N/A       18.95  ..........       agree       18.95
                          of vein valve.
34520.........  .......  Cross-over vein       13.74         N/A       17.95  ..........       agree       17.95
                          graft.

[[Page 31034]]

 
34530.........  .......  Leg vein fusion       17.61         N/A       16.64  ..........       agree       16.64
35011.........  .......  Repair defect         11.65       14.10       18.00  ..........       agree       18.00
                          of artery.
35011.........  .......  Repair defect         11.65       18.00       18.00  ..........       agree       18.00
                          of artery.
35013.........  .......  Repair artery         17.40       15.38       22.00  ..........       agree       22.00
                          rupture, arm.
35013.........  .......  Repair artery         17.40       20.00       22.00  ..........       agree       22.00
                          rupture, arm.
35045.........  .......  Repair defect         11.26       11.05       17.57  ..........       agree       17.57
                          of arm artery.
35045.........  .......  Repair defect         11.26       16.50       17.57  ..........       agree       17.57
                          of arm artery.
35081.........  .......  Repair defect         28.01       33.13       28.01  ..........       agree       28.01
                          of artery.
35082.........  .......  Repair artery         36.35       37.00       38.50  ..........       agree       38.50
                          rupture, aorta.
35082.........  .......  Repair artery         36.35       41.80       38.50  ..........       agree       38.50
                          rupture, aorta.
35092.........  .......  Repair artery         38.39       50.00       45.00  ..........       agree       45.00
                          rupture, aorta.
35092.........  .......  Repair artery         38.39       58.61       45.00  ..........       agree       45.00
                          rupture, aorta.
35103.........  .......  Repair artery         33.57       41.00       40.50  ..........       agree       40.50
                          rupture, groin.
35103.........  .......  Repair artery         33.57       44.12       40.50  ..........       agree       40.50
                          rupture, groin.
35111.........  .......  Repair defect         16.43       23.24       25.00  ..........       agree       25.00
                          of artery.
35111.........  .......  Repair defect         16.43       28.00       25.00  ..........       agree       25.00
                          of artery.
35112.........  .......  Repair artery         18.69       29.20       30.00  ..........       agree       30.00
                          rupture,spleen.
35112.........  .......  Repair artery         18.69       30.00       30.00  ..........       agree       30.00
                          rupture,spleen.
35121.........  .......  Repair defect         25.99       30.29       30.00  ..........       agree       30.00
                          of artery.
35121.........  .......  Repair defect         25.99       32.00       30.00  ..........       agree       30.00
                          of artery.
35122.........  .......  Repair artery         33.45       36.83       35.00  ..........       agree       35.00
                          rupture, belly.
35122.........  .......  Repair artery         33.45       37.00       35.00  ..........       agree       35.00
                          rupture, belly.
35131.........  .......  Repair defect         18.55       23.15       25.00  ..........       agree       25.00
                          of artery.
35131.........  .......  Repair defect         18.55       28.00       25.00  ..........       agree       25.00
                          of artery.
35132.........  .......  Repair artery         21.95       30.00       30.00  ..........       agree       30.00
                          rupture, groin.
35132.........  .......  Repair artery         21.95       30.54       30.00  ..........       agree       30.00
                          rupture, groin.
35141.........  .......  Repair defect         14.46       19.38       20.00  ..........       agree       20.00
                          of artery.
35141.........  .......  Repair defect         14.46       20.00       20.00  ..........       agree       20.00
                          of artery.
35142.........  .......  Repair artery         15.86       23.36       23.30  ..........       agree       23.30
                          rupture, thigh.
35142.........  .......  Repair artery         15.86       25.00       23.30  ..........       agree       23.30
                          rupture, thigh.
35151.........  .......  Repair defect         17.00       20.26       22.64  ..........       agree       22.64
                          of artery.
35151.........  .......  Repair defect         17.00       22.00       22.64  ..........       agree       22.64
                          of artery.
35152.........  .......  Repair artery         16.70       24.98       25.62  ..........       agree       25.62
                          rupture, knee.
35152.........  .......  Repair artery         16.70       27.50       25.62  ..........       agree       25.62
                          rupture, knee.
35182.........  .......  Repair blood          17.74         N/A       30.00  ..........       agree       30.00
                          vessel lesion.
35184.........  .......  Repair blood          12.25         N/A       18.00  ..........       agree       18.00
                          vessel lesion.
35189.........  .......  Repair blood          18.43         N/A       28.00  ..........       agree       28.00
                          vessel lesion.
35190.........  .......  Repair blood          12.75         N/A       12.75  ..........       agree       12.75
                          vessel lesion.
35201.........  .......  Repair blood           9.99       12.74       16.14  ..........       agree       16.14
                          vessel lesion.
35201.........  .......  Repair blood           9.99       18.35       16.14  ..........       agree       16.14
                          vessel lesion.
35206.........  .......  Repair blood           9.25         N/A       13.25  ..........       agree       13.25
                          vessel lesion.
35221.........  .......  Repair blood          16.42       26.00       24.39  ..........       agree       24.39
                          vessel lesion.
35221.........  .......  Repair blood          16.42       28.95       24.39  ..........       agree       24.39
                          vessel lesion.
35226.........  .......  Repair blood           9.06       14.00       14.50  ..........       agree       14.50
                          vessel lesion.
35226.........  .......  Repair blood           9.06       15.82       14.50  ..........       agree       14.50
                          vessel lesion.
35231.........  .......  Repair blood          12.00       15.64       20.00  ..........       agree       20.00
                          vessel lesion.
35231.........  .......  Repair blood          12.00       18.90       20.00  ..........       agree       20.00
                          vessel lesion.
35236.........  .......  Repair blood          10.54       12.85       17.11  ..........       agree       17.11
                          vessel lesion.
35236.........  .......  Repair blood          10.54       18.00       17.11  ..........       agree       17.11
                          vessel lesion.
35246.........  .......  Repair blood          19.84       26.00       26.45  ..........       agree       26.45
                          vessel lesion.
35246.........  .......  Repair blood          19.84         N/A       26.45  ..........       agree       26.45
                          vessel lesion.
35251.........  .......  Repair blood          17.49       31.00       30.20  ..........       agree       30.20
                          vessel lesion.
35251.........  .......  Repair blood          17.49       34.04       30.20  ..........       agree       30.20
                          vessel lesion.
35256.........  .......  Repair blood          11.38         N/A       18.36  ..........       agree       18.36
                          vessel lesion.
35261.........  .......  Repair blood          11.63       15.51       17.80  ..........       agree       17.80
                          vessel lesion.
35261.........  .......  Repair blood          11.63       18.90       17.80  ..........       agree       17.80
                          vessel lesion.
35266.........  .......  Repair blood          10.30       15.79       14.91  ..........       agree       14.91
                          vessel lesion.
35266.........  .......  Repair blood          10.30       17.00       14.91  ..........       agree       14.91
                          vessel lesion.
35276.........  .......  Repair blood          18.75       22.00       24.25  ..........       agree       24.25
                          vessel lesion.
35276.........  .......  Repair blood          18.75         N/A       24.25  ..........       agree       24.25
                          vessel lesion.
35281.........  .......  Repair blood          16.48       29.00       28.00  ..........       agree       28.00
                          vessel lesion.
35281.........  .......  Repair blood          16.48       32.01       28.00  ..........       agree       28.00
                          vessel lesion.
35286.........  .......  Repair blood          11.87         N/A       16.16  ..........       agree       16.16
                          vessel lesion.
35311.........  .......  Rechanneling of       23.85       30.00       27.00  ..........       agree       27.00
                          artery.
35311.........  .......  Rechanneling of       23.85         N/A       27.00  ..........       agree       27.00
                          artery.
35321.........  .......  Rechanneling of       11.97       16.47       16.00  ..........       agree       16.00
                          artery.

[[Page 31035]]

 
35321.........  .......  Rechanneling of       11.97       18.35       16.00  ..........       agree       16.00
                          artery.
35331.........  .......  Rechanneling of       23.52       24.81       26.20  ..........       agree       26.20
                          artery.
35331.........  .......  Rechanneling of       23.52       28.01       26.20  ..........       agree       26.20
                          artery.
35351.........  .......  Rechanneling of       20.11       24.09       23.00  ..........       agree       23.00
                          artery.
35351.........  .......  Rechanneling of       20.11       25.50       23.00  ..........       agree       23.00
                          artery.
35355.........  .......  Rechanneling of       16.09       20.01       18.50  ..........       agree       18.50
                          artery.
35355.........  .......  Rechanneling of       16.09       20.75       18.50  ..........       agree       18.50
                          artery.
35361.........  .......  Rechanneling of       23.59       29.08       28.20  ..........       agree       28.20
                          artery.
35361.........  .......  Rechanneling of       23.59       30.00       28.20  ..........       agree       28.20
                          artery.
35363.........  .......  Rechanneling of       24.66       32.00       30.20  ..........       agree       30.20
                          artery.
35363.........  .......  Rechanneling of       24.66       35.67       30.20  ..........       agree       30.20
                          artery.
35371.........  .......  Rechanneling of       11.64       12.97       14.72  ..........       agree       14.72
                          artery.
35371.........  .......  Rechanneling of       11.64       17.75       14.72  ..........       agree       14.72
                          artery.
35372.........  .......  Rechanneling of       13.56       18.04       18.00  ..........       agree       18.00
                          artery.
35372.........  .......  Rechanneling of       13.56       19.53       18.00  ..........       agree       18.00
                          artery.
35381.........  .......  Rechanneling of       15.81         N/A         CPT  ..........         CPT       15.81
                          artery.
35511.........  .......  Artery bypass         16.83       19.75       21.20  ..........       agree       21.20
                          graft.
35511.........  .......  Artery bypass         16.83       21.50       21.20  ..........       agree       21.20
                          graft.
35518.........  .......  Artery bypass         15.42       18.59       21.20  ..........       agree       21.20
                          graft.
35518.........  .......  Artery bypass         15.42       23.00       21.20  ..........       agree       21.20
                          graft.
35521.........  .......  Artery bypass         16.17       20.46       22.20  ..........       agree       22.20
                          graft.
35521.........  .......  Artery bypass         16.17       25.25       22.20  ..........       agree       22.20
                          graft.
35526.........  .......  Artery bypass         20.00       30.00       29.95  ..........       agree       29.95
                          graft.
35526.........  .......  Artery bypass         20.00         N/A       29.95  ..........       agree       29.95
                          graft.
35531.........  .......  Artery bypass         25.61       33.62       36.20  ..........       agree       36.20
                          graft.
35531.........  .......  Artery bypass         25.61       38.00       36.20  ..........       agree       36.20
                          graft.
35533.........  .......  Artery bypass         20.52       28.00       28.00  ..........       agree       28.00
                          graft.
35533.........  .......  Artery bypass         20.52       29.99       28.00  ..........       agree       28.00
                          graft.
35536.........  .......  Artery bypass         23.11       25.33       31.70  ..........       agree       31.70
                          graft.
35536.........  .......  Artery bypass         23.11       33.00       31.70  ..........       agree       31.70
                          graft.
35541.........  .......  Artery bypass         25.80         N/A         CPT  ..........         CPT       25.80
                          graft.
35546.........  .......  Artery bypass         25.54         N/A         CPT  ..........         CPT       25.54
                          graft.
35551.........  .......  Artery bypass         26.67         N/A         CPT  ..........         CPT       26.67
                          graft.
35556.........  .......  Artery bypass         21.76       24.50       21.76  ..........       agree       21.76
                          graft.
35556.........  .......  Artery bypass         21.76       24.50       21.76  ..........       agree       21.76
                          graft.
35558.........  .......  Artery bypass         14.04       22.00       21.20  ..........       agree       21.20
                          graft.
35558.........  .......  Artery bypass         14.04       22.08       21.20  ..........       agree       21.20
                          graft.
35560.........  .......  Artery bypass         23.56       28.19       32.00  ..........       agree       32.00
                          graft.
35560.........  .......  Artery bypass         23.56       35.50       32.00  ..........       agree       32.00
                          graft.
35563.........  .......  Artery bypass         15.14       24.00       24.20  ..........       agree       24.20
                          graft.
35563.........  .......  Artery bypass         15.14       25.00       24.20  ..........       agree       24.20
                          graft.
35565.........  .......  Artery bypass         15.14       23.65       23.20  ..........       agree       23.20
                          graft.
35565.........  .......  Artery bypass         15.14       24.00       23.20  ..........       agree       23.20
                          graft.
35571.........  .......  Artery bypass         18.58       23.65       24.06  ..........       agree       24.06
                          graft.
35571.........  .......  Artery bypass         18.58       26.92       24.06  ..........       agree       24.06
                          graft.
35582.........  .......  Vein bypass           27.13         N/A         CPT  ..........         CPT       27.13
                          graft.
35587.........  .......  Vein bypass           19.05       24.47       24.75  ..........       agree       24.75
                          graft.
35587.........  .......  Vein bypass           19.05       27.00       24.75  ..........       agree       24.75
                          graft.
35621.........  .......  Artery bypass         14.54       16.53       20.00  ..........       agree       20.00
                          graft.
35621.........  .......  Artery bypass         14.54       21.50       20.00  ..........       agree       20.00
                          graft.
35623.........  .......  Bypass graft,         16.62       17.62       24.00  ..........       agree       24.00
                          not vein.
35623.........  .......  Bypass graft,         16.62       25.75       24.00  ..........       agree       24.00
                          not vein.
35626.........  .......  Artery bypass         23.63       27.58       27.75  ..........       agree       27.75
                          graft.
35626.........  .......  Artery bypass         23.63       30.00       27.75  ..........       agree       27.75
                          graft.
35631.........  .......  Artery bypass         24.60       32.51       34.00  ..........       agree       34.00
                          graft.
35631.........  .......  Artery bypass         24.60       36.00       34.00  ..........       agree       34.00
                          graft.
35636.........  .......  Artery bypass         22.46       27.32       29.50  ..........       agree       29.50
                          graft.
35636.........  .......  Artery bypass         22.46       36.00       29.50  ..........       agree       29.50
                          graft.
35641.........  .......  Artery bypass         24.57         N/A         CPT  ..........         CPT       24.57
                          graft.
35646.........  .......  Artery bypass         25.81         N/A         CPT  ..........         CPT       25.81
                          graft.
35650.........  .......  Artery bypass         14.36       15.74       19.00  ..........       agree       19.00
                          graft.
35650.........  .......  Artery bypass         14.36       19.80       19.00  ..........       agree       19.00
                          graft.
35654.........  .......  Artery bypass         18.61       23.54       25.00  ..........       agree       25.00
                          graft.
35654.........  .......  Artery bypass         18.61       26.00       25.00  ..........       agree       25.00
                          graft.
35661.........  .......  Artery bypass         13.18       17.89       19.00  ..........       agree       19.00
                          graft.
35661.........  .......  Artery bypass         13.18       19.53       19.00  ..........       agree       19.00
                          graft.

[[Page 31036]]

 
35663.........  .......  Artery bypass         14.17       20.90       22.00  ..........       agree       22.00
                          graft.
35663.........  .......  Artery bypass         14.17       23.00       22.00  ..........       agree       22.00
                          graft.
35665.........  .......  Artery bypass         15.40       19.84       21.00  ..........       agree       21.00
                          graft.
35665.........  .......  Artery bypass         15.40       22.00       21.00  ..........       agree       21.00
                          graft.
35666.........  .......  Artery bypass         19.19       20.00       22.19  ..........       agree       22.19
                          graft.
35666.........  .......  Artery bypass         19.19       22.00       22.19  ..........       agree       22.19
                          graft.
35671.........  .......  Artery bypass         14.80       17.80       19.33  ..........       agree       19.33
                          graft.
35671.........  .......  Artery bypass         14.80       24.00       19.33  ..........       agree       19.33
                          graft.
35701.........  .......  Exploration,           5.55        9.38        8.50  ..........       agree        8.50
                          carotid artery.
35701.........  .......  Exploration,           5.55       15.00        8.50  ..........       agree        8.50
                          carotid artery.
35721.........  .......  Exploration,           5.28         N/A        7.18  ..........       agree        7.18
                          femoral artery.
35741.........  .......  Exploration            5.37         N/A        8.00  ..........       agree        8.00
                          popliteal
                          artery.
35840.........  .......  Explore                9.77         N/A         CPT  ..........         CPT        9.77
                          abdominal
                          vessels.
35860.........  .......  Explore limb           5.55         N/A         CPT  ..........         CPT        5.55
                          vessels.
35905.........  .......  Excision,             18.19       32.00       31.25  ..........       agree       31.25
                          graft, thorax.
35905.........  .......  Excision,             18.19         N/A       31.25  ..........       agree       31.25
                          graft, thorax.
35907.........  .......  Excision,             19.24       37.33       35.00  ..........       agree       35.00
                          graft, abdomen.
35907.........  .......  Excision,             19.24       40.00       35.00  ..........       agree       35.00
                          graft, abdomen.
36400.........  .......  Drawing blood..        0.18         N/A        0.38  ..........    decrease        0.18
36405.........  .......  Drawing blood..        0.18         N/A        0.32  ..........    decrease        0.18
36406.........  .......  Drawing blood..        0.18         N/A         CPT  ..........         CPT        0.18
36489.........  .......  Insertion of           1.22        2.75        2.50  ..........       agree        2.50
                          catheter, vein.
36489.........  .......  Insertion of           1.22        3.41        2.50  ..........       agree        2.50
                          catheter, vein.
36520.........  .......  Plasma and/or          1.74         N/A         CPT  ..........         CPT        1.74
                          cell exchange.
36533.........  .......  Insertion of           5.32        5.28         CPT  ..........         CPT        5.32
                          access device.
36534.........  .......  Revision of            2.80        5.15         CPT  ..........         CPT        2.80
                          access device.
36535.........  .......  Removal of             2.27        3.89         CPT  ..........         CPT        2.27
                          access device.
36600.........  .......  Withdrawal of          0.32          WD         (e)  ..........         (a)        0.32
                          arterial blood.
36620.........  .......  Insertion              1.15        2.25         CPT  ..........         CPT        1.15
                          catheter,
                          artery.
36625.........  .......  Insertion              2.11        2.65        2.11  ..........       agree        2.11
                          catheter,
                          artery.
36822.........  .......  Insertion of           5.42       19.00        5.42  ..........       agree        5.42
                          cannula(s).
37565.........  .......  Ligation of            4.44        9.01       10.88  ..........       agree       10.88
                          neck vein.
37565.........  .......  Ligation of            4.44       14.50       10.88  ..........       agree       10.88
                          neck vein.
37600.........  .......  Ligation of            4.57        9.19       11.25  ..........       agree       11.25
                          neck artery.
37600.........  .......  Ligation of            4.57       14.00       11.25  ..........       agree       11.25
                          neck artery.
37605.........  .......  Ligation of            6.19       11.85       13.11  ..........       agree       13.11
                          neck artery.
37605.........  .......  Ligation of            6.19       17.50       13.11  ..........       agree       13.11
                          neck artery.
37609.........  .......  Temporal artery        2.30        3.38        3.00  ..........       agree        3.00
                          procedure.
37609.........  .......  Temporal artery        2.30         N/A        3.00  ..........       agree        3.00
                          procedure.
37615.........  .......  Ligation of            5.73       12.31         CPT  ..........         CPT        5.73
                          neck artery.
37615.........  .......  Ligation of            5.73       18.00         CPT  ..........         CPT        5.73
                          neck artery.
37617.........  .......  Ligation of           15.95         N/A       22.06  ..........       agree       22.06
                          abdomen artery.
37618.........  .......  Ligation of            4.84         N/A         CPT  ..........         CPT        4.84
                          extremity
                          artery.
37650.........  .......  Revision of            5.13         N/A        7.80  ..........       agree        7.80
                          major vein.
37660.........  .......  Revision of           10.61         N/A       21.00  ..........       agree       21.00
                          major vein.
37700.........  .......  Revise leg vein        3.73         N/A         CPT  ..........         CPT        3.73
37720.........  .......  Removal of leg         5.66       10.71         CPT  ..........         CPT        5.66
                          vein.
37730.........  .......  Removal of leg         7.33         N/A         CPT  ..........         CPT        7.33
                          veins.
37735.........  .......  Removal of leg        10.53         N/A         CPT  ..........         CPT       10.53
                          veins/lesion.
37760.........  .......  Revision of leg       10.47         N/A         CPT  ..........         CPT       10.47
                          veins.
37785.........  .......  Revision               3.84         N/A         CPT  ..........         CPT        3.84
                          secondary
                          varicosity.
38100.........  .......  Removal of            13.01       14.70       14.50  ..........       agree       14.50
                          spleen, total.
38100.........  .......  Removal of            13.01       16.21       14.50  ..........       agree       14.50
                          spleen, total.
38101.........  .......  Removal of            13.74       14.79       15.31  ..........       agree       15.31
                          spleen,
                          partial.
38115.........  .......  Repair of             14.19       15.55       15.82  ..........       agree       15.82
                          ruptured
                          spleen.
38300.........  .......  Drainage, lymph        1.53        1.01        1.99  ..........       agree        1.99
                          node lesion.
38305.........  .......  Drainage, lymph        4.61        6.59        6.00  ..........       agree        6.00
                          node lesion.
38308.........  .......  Incision of            4.95        7.35        6.45  ..........       agree        6.45
                          lymph channels.
38500.........  .......  Biopsy/removal,        2.88        3.29        3.75  ..........       agree        3.75
                          lymph nodes.
38500.........  .......  Biopsy/removal,        2.88        4.58        3.75  ..........       agree        3.75
                          lymph nodes.
38510.........  .......  Biopsy/removal,        4.14        6.28        6.43  ..........       agree        6.43
                          lymph nodes.
38520.........  .......  Biopsy/removal,        5.12        6.93        6.67  ..........       agree        6.67
                          lymph nodes.
38525.........  .......  Biopsy/removal,        4.66        5.30        6.07  ..........       agree        6.07
                          lymph nodes.
38530.........  .......  Biopsy/removal,        6.13        9.58        7.98  ..........       agree        7.98
                          lymph nodes.
38571.........  .......  Laparoscopy,          12.38       19.84       12.38  ..........       agree       12.38
                          lymphadenectom
                          y.
38572.........  .......  Laparoscopy,          14.32       23.17       16.59  ..........       agree       16.59
                          lymphadenectom
                          y.

[[Page 31037]]

 
38740.........  .......  Remove armpit          6.77       10.68        8.42  ..........    increase       10.02
                          lymph nodes.
38745.........  .......  Remove armpit          8.84       12.78       11.00  ..........    increase       13.00
                          lymph nodes.
38746.........  .......  Remove thoracic        4.39         N/A        4.89  ..........       agree        4.89
                          lymph nodes.
38760.........  .......  Remove groin           8.74       11.35       10.88  ..........    increase       12.94
                          lymph nodes.
38765.........  .......  Remove groin          16.06       18.77       19.98  ..........       agree       19.98
                          lymph nodes.
38780.........  .......  Remove abdomen        16.59         N/A       16.59  ..........       agree       16.59
                          lymph nodes.
39010.........  .......  Exploration of        11.79         N/A       11.79  ..........       agree       11.79
                          chest.
39220.........  .......  Removal chest         17.42         N/A       17.42  ..........       agree       17.42
                          lesion.
39400.........  .......  Visualization          5.61         N/A        5.61  ..........       agree        5.61
                          of chest.
39503.........  .......  Repair of             34.85      122.75       95.00  ..........    decrease       34.85
                          diaphragm
                          hernia.
42205.........  .......  Reconstruct            9.59       12.00       13.29  ..........       agree       13.29
                          cleft palate.
43107.........  .......  Removal of            28.79         N/A       40.00  ..........       agree       40.00
                          esophagus.
43112.........  .......  Removal of            31.22         N/A       43.50  ..........       agree       43.50
                          esophagus.
43117.........  .......  Partial removal       30.02         N/A       40.00  ..........       agree       40.00
                          of esophagus.
43122.........  .......  Parital removal       29.11         N/A       40.00  ..........       agree       40.00
                          of esophagus.
43215.........  .......  Esophagus              2.60        4.91         CPT  ..........         CPT        2.60
                          endoscopy.
43217.........  .......  Esophagus              2.90        3.63        2.90  ..........       agree        2.90
                          endoscopy.
43219.........  .......  Esophagus              2.80        3.50        3.18  ..........    decrease        2.80
                          endoscopy.
43228.........  .......  Esoph                  3.77        4.72        3.77  ..........       agree        3.77
                          endoscopy,
                          ablation.
43239.........  .......  Upper GI               2.69        2.96        2.87  ..........    decrease        2.69
                          endoscopy,
                          biopsy.
43239.........  .......  Upper GI               2.69        3.79        2.87  ..........    decrease        2.69
                          endoscopy,
                          biopsy.
43244.........  .......  Upper GI               4.59        5.05        5.05  ..........    decrease        4.59
                          endoscopy/
                          ligation.
43246.........  .......  Place                  4.33        4.76        4.33  ..........       agree        4.33
                          gastrostomy
                          tube.
43246.........  .......  Place                  4.33        5.04        4.33  ..........       agree        4.33
                          gastrostomy
                          tube.
43247.........  .......  Operative upper        3.39        4.51        3.59  ..........    decrease        3.39
                          GI endoscopy.
43249.........  .......  Esoph                  2.90        5.01        3.35  ..........    decrease        2.90
                          endoscopy,
                          dilation.
43251.........  .......  Operative upper        3.70        4.44        3.70  ..........       agree        3.70
                          GI endoscopy.
43255.........  .......  Operative upper        4.40        5.40        4.82  ..........    decrease        4.40
                          GI endoscopy.
43258.........  .......  Operative upper        4.55        5.01        4.55  ..........       agree        4.55
                          GI endoscopy.
43259.........  .......  Endoscopic             4.89         N/A        8.59  ..........    decrease        4.89
                          ultrasound
                          exam.
43263.........  .......  Endo                   6.19        7.12        7.29  ..........    decrease        6.19
                          cholangiopancr
                          eatograph.
43265.........  .......  Endo                   8.90         N/A       10.02  ..........    decrease        8.90
                          cholangiopancr
                          eatograph.
43269.........  .......  Endo                   6.04        7.50        8.21  ..........    decrease        6.04
                          cholangiopancr
                          eatograph.
43305.........  .......  Repair                17.15          WD         (e)  ..........         (a)       17.15
                          esophagus and
                          fistula.
43310.........  .......  Repair of             25.39       50.50         CPT  ..........         CPT       25.39
                          esophagus.
43312.........  .......  Repair                28.42       56.75         CPT  ..........         CPT       28.42
                          esophagus and
                          fistula.
43320.........  .......  Fuse esophagus        16.07       26.45       19.93  ..........       agree       19.93
                          & stomach.
43324.........  .......  Revise                16.58       17.75       20.57  ..........       agree       20.57
                          esophagus &
                          stomach.
43325.........  .......  Revise                16.17       21.65       20.06  ..........       agree       20.06
                          esophagus &
                          stomach.
43326.........  .......  Revise                15.91       20.53       19.74  ..........       agree       19.74
                          esophagus &
                          stomach.
43330.........  .......  Repair of             15.94       15.44       19.77  ..........       agree       19.77
                          esophagus.
43331.........  .......  Repair of             16.23       17.60       20.13  ..........       agree       20.13
                          esophagus.
43340.........  .......  Fuse esophagus        15.81       26.72       19.61  ..........       agree       19.61
                          & intestine.
43341.........  .......  Fuse esophagus        16.81       29.07       20.85  ..........       agree       20.85
                          & intestine.
43350.........  .......  Surgical              12.72       32.97       15.78  ..........       agree       15.78
                          opening,
                          esophagus.
43351.........  .......  Surgical              14.79       31.92       18.35  ..........       agree       18.35
                          opening,
                          esophagus.
43352.........  .......  Surgical              12.30       25.47       15.26  ..........       agree       15.26
                          opening,
                          esophagus.
43360.........  .......  Gastrointestina       28.78       61.17       35.70  ..........       agree       35.70
                          l repair.
43361.........  .......  Gastrointestina       32.65       65.83       40.50  ..........       agree       40.50
                          l repair.
43400.........  .......  Ligate                17.09       29.96       21.20  ..........       agree       21.20
                          esophagus
                          veins.
43401.........  .......  Esophagus             17.81       34.94       22.09  ..........       agree       22.09
                          surgery for
                          veins.
43405.........  .......  Ligate/staple         16.13       36.67       20.01  ..........       agree       20.01
                          esophagus.
43410.........  .......  Repair                10.86       13.65       13.47  ..........       agree       13.47
                          esophagus
                          wound.
43415.........  .......  Repair                17.06       30.45       25.00  ..........       agree       25.00
                          esophagus
                          wound.
43420.........  .......  Repair                11.57       14.10       14.35  ..........       agree       14.35
                          esophagus
                          opening.
43425.........  .......  Repair                16.95       26.93       21.03  ..........       agree       21.03
                          esophagus
                          opening.
43500.........  .......  Surgical               8.44       11.81       11.05  ..........       agree       11.05
                          opening of
                          stomach.
43501.........  .......  Surgical repair       15.31       20.44       20.04  ..........       agree       20.04
                          of stomach.
43502.........  .......  Surgical repair       17.67       21.20       23.13  ..........       agree       23.13
                          of stomach.
43510.........  .......  Surgical               9.99       18.81       13.08  ..........       agree       13.08
                          opening of
                          stomach.
43520.........  .......  Incision of            7.63        8.88        9.99  ..........       agree        9.99
                          pyloric muscle.
43605.........  .......  Biopsy of              9.15       10.41       11.98  ..........       agree       11.98
                          stomach.
43610.........  .......  Excision of           11.15       17.37       14.60  ..........       agree       14.60
                          stomach lesion.
43611.........  .......  Excision of           13.63       23.82       17.84  ..........       agree       17.84
                          stomach lesion.
43620.........  .......  Removal of            22.54       33.61       30.04  ..........       agree       30.04
                          stomach.
43621.........  .......  Removal of            23.06       35.55       30.73  ..........       agree       30.73
                          stomach.

[[Page 31038]]

 
43622.........  .......  Removal of            24.41       35.56       32.53  ..........       agree       32.53
                          stomach.
43631.........  .......  Removal of            19.66       23.28       22.59  ..........       agree       22.59
                          stomach,
                          partial.
43632.........  .......  Removal of            19.66       25.92       22.59  ..........       agree       22.59
                          stomach,
                          partial.
43633.........  .......  Removal of            20.10       27.68       23.10  ..........       agree       23.10
                          stomach,
                          partial.
43634.........  .......  Removal of            21.86       34.19       25.12  ..........       agree       25.12
                          stomach,
                          partial.
43638.........  .......  Removal of            21.76       29.96       29.00  ..........       agree       29.00
                          stomach,
                          partial.
43638.........  .......  Removal of            21.76       39.80       29.00  ..........       agree       29.00
                          stomach,
                          partial.
43639.........  .......  Removal of            22.25       39.80       29.65  ..........       agree       29.65
                          stomach,
                          partial.
43640.........  .......  Vagotomy &            14.81       17.32       17.02  ..........       agree       17.02
                          pylorus repair.
43641.........  .......  Vagotomy &            15.03       21.34       17.27  ..........       agree       17.27
                          pylorus repair.
43651.........  .......  Laparoscopy,          10.15       15.17       10.15  ..........       agree       10.15
                          vagus nerve.
43652.........  .......  Laparoscopy,          12.15       19.21       12.15  ..........       agree       12.15
                          vagus nerve.
43800.........  .......  Reconstruction        10.46       11.86       13.69  ..........       agree       13.69
                          of pylorus.
43810.........  .......  Fusion of             11.19       13.81       14.65  ..........       agree       14.65
                          stomach and
                          bowel.
43820.........  .......  Fusion of             11.74       15.78       15.37  ..........       agree       15.37
                          stomach and
                          bowel.
43825.........  .......  Fusion of             14.68       18.16       19.22  ..........       agree       19.22
                          stomach and
                          bowel.
43830.........  .......  Place                  7.28        7.28        9.53  ..........       agree        9.53
                          gastrostomy
                          tube.
43832.........  .......  Place                 11.92       11.92       15.60  ..........       agree       15.60
                          gastrostomy
                          tube.
43840.........  .......  Repair of             11.89       11.89       15.56  ..........       agree       15.56
                          stomach lesion.
43842.........  .......  Gastroplasty          14.71       17.14       18.47  ..........       agree       18.47
                          for obesity.
43843.........  .......  Gastroplasty          14.85       20.62       18.65  ..........       agree       18.65
                          for obesity.
43846.........  .......  Gastric bypass        19.15       23.43       24.05  ..........       agree       24.05
                          for obesity.
43847.........  .......  Gastric bypass        21.44       29.95       26.92  ..........       agree       26.92
                          for obesity.
43848.........  .......  Revision              23.41       27.07       29.39  ..........       agree       29.39
                          gastroplasty.
43850.........  .......  Revise stomach-       19.69       23.27       24.72  ..........       agree       24.72
                          bowel fusion.
43855.........  .......  Revise stomach-       20.83       24.15       26.16  ..........       agree       26.16
                          bowel fusion.
43860.........  .......  Revise stomach-       19.91       26.08       25.00  ..........       agree       25.00
                          bowel fusion.
43865.........  .......  Revise stomach-       21.12       27.30       26.52  ..........       agree       26.52
                          bowel fusion.
43870.........  .......  Repair stomach         7.40        9.65        9.69  ..........       agree        9.69
                          opening.
43880.........  .......  Repair stomach-       19.63       23.60       24.65  ..........       agree       24.65
                          bowel fistula.
44005.........  .......  Freeing of            13.84       15.43       16.23  ..........       agree       16.23
                          bowel adhesion.
44010.........  .......  Incision of           10.68       15.90       12.52  ..........       agree       12.52
                          small bowel.
44020.........  .......  Exploration of        11.93       15.04       13.99  ..........       agree       13.99
                          small bowel.
44021.........  .......  Decompress            12.01       15.18       14.08  ..........       agree       14.08
                          small bowel.
44025.........  .......  Incision of           12.18       14.08       14.28  ..........       agree       14.28
                          large bowel.
44050.........  .......  Reduce bowel          11.40       13.75       14.03  ..........       agree       14.03
                          obstruction.
44050.........  .......  Reduce bowel          11.40       14.58       14.03  ..........       agree       14.03
                          obstruction.
44055.........  .......  Correct               13.14       22.00       22.00  ..........       agree       22.00
                          malrotation of
                          bowel.
44110.........  .......  Excision of           10.07       14.39       11.81  ..........       agree       11.81
                          bowel
                          lesion(s).
44111.........  .......  Excision of           12.19       16.32       14.29  ..........       agree       14.29
                          bowel
                          lesion(s).
44120.........  .......  Removal of            14.50       15.82       17.00  ..........       agree       17.00
                          small
                          intestine.
44125.........  .......  Removal of            14.96       17.54       17.54  ..........       agree       17.54
                          small
                          intestine.
44130.........  .......  Bowel to bowel        12.36       17.87       14.49  ..........       agree       14.49
                          fusion.
44130.........  .......  Bowel to bowel        12.36         N/A       14.49  ..........       agree       14.49
                          fusion.
44140.........  .......  Partial removal       18.35       20.94       18.35  ..........    increase       21.00
                          of colon.
44140.........  .......  Partial removal       18.35       24.58       18.35  ..........    increase       21.00
                          of colon.
44143.........  .......  Partial removal       20.17       30.36       20.17  ..........    increase       22.99
                          of colon.
44144.........  .......  Partial removal       18.89       29.46       18.89  ..........    increase       21.53
                          of colon.
44144.........  .......  Partial removal       18.89         N/A       18.89  ..........    increase       21.53
                          of colon.
44145.........  .......  Partial removal       23.18       27.91       23.18  ..........    increase       26.42
                          of colon.
44146.........  .......  Partial removal       24.16       30.97       24.16  ..........    increase       27.54
                          of colon.
44147.........  .......  Partial removal       18.17         N/A       18.17  ..........    increase       20.71
                          of colon.
44150.........  .......  Removal of            21.01       27.41       21.01  ..........    increase       23.95
                          colon.
44151.........  .......  Removal of            20.04       32.89       20.04  ..........    increase       26.88
                          colon/
                          ileostomy.
44151.........  .......  Removal of            20.04         N/A       20.04  ..........    increase       26.88
                          colon/
                          ileostomy.
44152.........  .......  Removal of            24.41       33.61       24.41  ..........    increase       27.83
                          colon/
                          ileostomy.
44153.........  .......  Removal of            26.83       33.11       26.83  ..........    increase       30.59
                          colon/
                          ileostomy.
44155.........  .......  Removal of            24.44       33.61       24.44  ..........    increase       27.86
                          colon/
                          ileostomy.
44156.........  .......  Removal of            23.01       36.27       23.01  ..........    increase       30.79
                          colon/
                          ileostomy.
44156.........  .......  Removal of            23.01         N/A       23.01  ..........    increase       30.79
                          colon/
                          ileostomy.
44160.........  .......  Removal of            15.88       17.45       18.62  ..........       agree       18.62
                          colon.
44200.........  .......  Laparoscopy,          14.44       16.11       14.44  ..........       agree       14.44
                          enterolysis.
44300.........  .......  Open bowel to          8.88       13.09       12.11  ..........       agree       12.11
                          skin.
44310.........  .......  Ileostomy/            11.70       18.14       15.95  ..........       agree       15.95
                          jejunostomy.
44312.........  .......  Revision of            5.88        6.79        8.02  ..........       agree        8.02
                          ileostomy.
44314.........  .......  Revision of           11.04       14.45       15.05  ..........       agree       15.05
                          ileostomy.

[[Page 31039]]

 
44316.........  .......  Devise bowel          15.47       26.57       21.09  ..........       agree       21.09
                          pouch.
44320.........  .......  Colostomy......       12.94       18.84       17.64  ..........       agree       17.64
44340.........  .......  Revision of            5.66        6.79        7.72  ..........       agree        7.72
                          colostomy.
44345.........  .......  Revision of           11.32       14.45       15.43  ..........       agree       15.43
                          colostomy.
44346.........  .......  Revision of           12.46       17.19       16.99  ..........       agree       16.99
                          colostomy.
44388.........  .......  Colon endoscopy        2.82        3.10        3.70  ..........    decrease        2.82
44389.........  .......  Colonoscopy            3.13        3.44        4.26  ..........    decrease        3.13
                          with biopsy.
44390.........  .......  Colonoscopy for        3.83        4.21        4.81  ..........    decrease        3.83
                          foreign body.
44391.........  .......  Colonoscopy for        4.32        4.75        5.18  ..........    decrease        4.32
                          bleeding.
44392.........  .......  Colonoscopy and        3.82        4.20        4.81  ..........    decrease        3.82
                          polypectomy.
44393.........  .......  Colonoscopy,           4.84        5.32        5.00  ..........    decrease        4.84
                          lesion removal.
44394.........  .......  Colonoscopy w/         4.43        4.87        4.43  ..........       agree        4.43
                          snare.
44394.........  .......  Colonoscopy w/         4.43         N/A        4.43  ..........       agree        4.43
                          snare.
44602.........  .......  Suture, small         10.61       15.26       11.91  ..........    increase       16.03
                          intestine.
44603.........  .......  Suture, small         14.00       19.50       15.72  ..........    increase       18.66
                          intestine.
44604.........  .......  Suture, large         14.28       16.59       16.03  ..........       agree       16.03
                          intestine.
44605.........  .......  Repair of bowel       15.37       25.03       17.25  ..........    increase       19.53
                          lesion.
44615.........  .......  Intestinal            14.19       18.97       15.93  ..........       agree       15.93
                          stricturoplast
                          y.
44620.........  .......  Repair bowel          10.87       14.99       12.20  ..........       agree       12.20
                          opening.
44625.........  .......  Repair bowel          13.41       16.79       15.05  ..........       agree       15.05
                          opening.
44626.........  .......  Repair bowel          22.59       24.43       25.36  ..........       agree       25.36
                          opening.
44640.........  .......  Repair bowel-         14.83       22.29       16.65  ..........    increase       21.65
                          skin fistula.
44650.........  .......  Repair bowel          15.25       22.29       17.12  ..........    increase       22.27
                          fistula.
44660.........  .......  Repair bowel-         14.63       24.70       16.42  ..........    increase       21.36
                          bladder
                          fistula.
44661.........  .......  Repair bowel-         16.99       25.63       19.07  ..........    increase       24.81
                          bladder
                          fistula.
44680.........  .......  Surgical              13.72       21.32       15.40  ..........       agree       15.40
                          revision,
                          intestine.
44700.........  .......  Suspend bowel w/      14.35       19.35       16.11  ..........       agree       16.11
                          prosthesis.
44800.........  .......  Excision of           11.23       10.85       11.23  ..........       agree       11.23
                          bowel pouch.
44820.........  .......  Excision of           10.31       11.23       12.09  ..........       agree       12.09
                          mesentery
                          lesion.
44850.........  .......  Repair of              9.57       12.00       10.74  ..........       agree       10.74
                          mesentery.
44900.........  .......  Drain app              8.82       11.79       10.14  ..........       agree       10.14
                          abscess, open.
44950.........  .......  Appendectomy...        8.70        8.37       10.00  ..........       agree       10.00
44960.........  .......  Appendectomy...       10.74       13.67       12.34  ..........       agree       12.34
44970.........  .......  Laparoscopy,           8.70       10.26        8.70  ..........       agree        8.70
                          appendectomy.
45000.........  .......  Drainage of            4.52       10.29        3.88  ..........    increase        4.52
                          pelvic abscess.
45020.........  .......  Drainage of            4.72        7.71        4.05  ..........    increase        4.72
                          rectal abscess.
45100.........  .......  Biopsy of              3.68        4.34        3.16  ..........    increase        3.68
                          rectum.
45108.........  .......  Removal of             4.76        5.25        4.09  ..........    increase        4.76
                          anorectal
                          lesion.
45110.........  .......  Removal of            23.80       29.53       28.00  ..........       agree       28.00
                          rectum.
45111.........  .......  Partial removal       16.48         N/A       16.48  ..........       agree       16.48
                          of rectum.
45112.........  .......  Removal of            25.96       32.46       30.54  ..........       agree       30.54
                          rectum.
45113.........  .......  Partial               25.99       33.11       30.58  ..........       agree       30.58
                          proctectomy.
45114.........  .......  Partial removal       23.22       29.46       27.32  ..........       agree       27.32
                          of rectum.
45116.........  .......  Partial removal       20.89       21.98       24.58  ..........       agree       24.58
                          of rectum.
45119.........  .......  Remove rectum w/      26.21       31.60       30.84  ..........       agree       30.84
                          reservoir.
45120.........  .......  Removal of            24.60       31.09       24.60  ..........       agree       24.60
                          rectum.
45121.........  .......  Removal of            27.04       32.14       27.04  ..........       agree       27.04
                          rectum and
                          colon.
45123.........  .......  Partial               14.20       22.51       16.71  ..........       agree       16.71
                          proctectomy.
45126.........  .......  Pelvic                38.39       47.99       45.16  ..........       agree       45.16
                          exenteration.
45130.........  .......  Excision of           13.97       14.26       16.44  ..........       agree       16.44
                          rectal
                          prolapse.
45135.........  .......  Excision of           16.39       30.14       19.28  ..........       agree       19.28
                          rectal
                          prolapse.
45160.........  .......  Excision of           13.02       19.86       15.32  ..........       agree       15.32
                          rectal lesion.
45170.........  .......  Excision of            9.77       12.81       11.49  ..........       agree       11.49
                          rectal lesion.
45190.........  .......  Destruction,           8.28        9.09        9.74  ..........       agree        9.74
                          rectal tumor.
45305.........  .......  Proctosigmoidos        1.01        1.22        1.01  ..........       agree        1.01
                          copy & biopsy.
45309.........  .......  Proctosigmoidos        2.01        2.45        2.01  ..........       agree        2.01
                          copy.
45330.........  .......  Diagnostic             0.96        1.39        0.96  ..........       agree        0.96
                          sigmoidoscopy.
45337.........  .......  Sigmoidoscopy &        2.36         N/A        2.36  ..........       agree        2.36
                          decompress.
45339.........  .......  Sigmoidoscopy..        3.14         N/A        3.14  ..........       agree        3.14
45378.........  .......  Diagnostic             3.70        4.66        3.70  ..........       agree        3.70
                          colonoscopy.
45380.........  .......  Colonoscopy and        4.01        5.01        4.44  ..........    decrease        4.01
                          biopsy.
45383.........  .......  Lesion removal         5.87        7.34        5.87  ..........       agree        5.87
                          colonoscopy.
45384.........  .......  Colonoscopy....        4.70        5.88        4.70  ..........       agree        4.70
45385.........  .......  Lesion removal         5.31        6.64        5.31  ..........       agree        5.31
                          colonoscopy.
45505.........  .......  Repair of              6.02        7.57        7.58  ..........       agree        7.58
                          rectum.
45540.........  .......  Correct rectal        12.92       17.79       16.27  ..........       agree       16.27
                          prolapse.

[[Page 31040]]

 
45541.........  .......  Correct rectal        10.64       13.23       13.40  ..........       agree       13.40
                          prolapse.
45550.........  .......  Repair rectum/        18.26       27.91       23.00  ..........       agree       23.00
                          remove sigmoid.
45560.........  .......  Repair of              8.40        7.70       10.58  ..........       agree       10.58
                          rectocele.
45562.........  .......  Exploration/          12.21       12.09       15.38  ..........       agree       15.38
                          repair of
                          rectum.
45563.........  .......  Exploration/          18.63       21.50       23.47  ..........       agree       23.47
                          repair of
                          rectum.
45800.........  .......  Repair rect/          14.11       14.36       17.77  ..........       agree       17.77
                          bladder
                          fistula.
45805.........  .......  Repair fistula        16.50       20.94       20.78  ..........       agree       20.78
                          w/colostomy.
45820.........  .......  Repair                14.67       13.81       18.48  ..........       agree       18.48
                          rectourethral
                          fistula.
45825.........  .......  Repair fistula        16.87       20.38       21.25  ..........       agree       21.25
                          w/colostomy.
45900.........  .......  Reduction of           1.83        3.27        2.61  ..........       agree        2.61
                          rectal
                          prolapse.
45905.........  .......  Dilation of            1.61        3.15        2.30  ..........       agree        2.30
                          anal sphincter.
45910.........  .......  Dilation of            1.96        3.23        2.80  ..........       agree        2.80
                          rectal
                          narrowing.
45910.........  .......  Dilation of            1.96         N/A        2.80  ..........       agree        2.80
                          rectal
                          narrowing.
45915.........  .......  Remove rectal          2.20        3.58        3.14  ..........       agree        3.14
                          obstruction.
46040.........  .......  Incision of            4.96        5.53        4.26  ..........    increase        4.96
                          rectal abscess.
46045.........  .......  Incision of            4.32        5.38        3.71  ..........    increase        4.32
                          rectal abscess.
46060.........  .......  Incision of            5.69        8.55        4.89  ..........    increase        5.69
                          rectal abscess.
46083.........  .......  Incise external        1.40        1.52        1.40  ..........       agree        1.40
                          hemorrhoid.
46083.........  .......  Incise external        1.40        2.34        1.40  ..........       agree        1.40
                          hemorrhoid.
46221.........  .......  Ligation of            1.43        1.94        2.04  ..........       agree        2.04
                          hemorrhoid(s).
46230.........  .......  Removal of anal        2.57        1.94        2.57  ..........       agree        2.57
                          tabs.
46250.........  .......  Hemorrhoidectom        4.53        4.13        3.89  ..........       agree        3.89
                          y.
46255.........  .......  Hemorrhoidectom        5.36        4.98        4.60  ..........       agree        4.60
                          y.
46257.........  .......  Remove                 6.28        5.43        5.40  ..........       agree        5.40
                          hemorrhoids &
                          fissure.
46258.........  .......  Remove                 6.67        5.86        5.73  ..........       agree        5.73
                          hemorrhoids &
                          fistula.
46258.........  .......  Remove                 6.67         N/A        5.73  ..........       agree        5.73
                          hemorrhoids &
                          fistula.
46260.........  .......  Hemorrhoidectom        7.42        6.18        6.37  ..........       agree        6.37
                          y.
46261.........  .......  Remove                 8.24        7.11        7.08  ..........       agree        7.08
                          hemorrhoids &
                          fissure.
46262.........  .......  Remove                 8.73        7.11        7.50  ..........       agree        7.50
                          hemorrhoids &
                          fistula.
46270.........  .......  Removal of anal        3.72        4.28        3.20  ..........    increase        3.72
                          fistula.
46275.........  .......  Removal of anal        4.56        5.18        3.92  ..........    increase        4.56
                          fistula.
46280.........  .......  Removal of anal        5.98        5.95        5.14  ..........    increase        5.98
                          fistula.
46288.........  .......  Repair anal            7.13        8.08        6.13  ..........    increase        7.13
                          fistula.
46320.........  .......  Removal of             1.61        1.52        1.61  ..........       agree        1.61
                          hemorrhoid
                          clot.
46320.........  .......  Removal of             1.61        2.63        1.61  ..........       agree        1.61
                          hemorrhoid
                          clot.
46700.........  .......  Repair of anal         7.25       10.22        9.13  ..........       agree        9.13
                          stricture.
46705.........  .......  Repair of anal         7.17        6.90        6.90  ..........       agree        6.90
                          stricture.
46715.........  .......  Repair of              7.46        7.20        7.20  ..........       agree        7.20
                          anovaginal
                          fistula.
46716.........  .......  Repair of             12.15       15.15       15.07  ..........       agree       15.07
                          anovaginal
                          fistula.
46730.........  .......  Construction of       21.57       25.50       26.75  ..........       agree       26.75
                          absent anus.
46735.........  .......  Construction of       25.94       36.00       32.17  ..........       agree       32.17
                          absent anus.
46740.........  .......  Construction of       23.11       35.00       30.00  ..........       agree       30.00
                          absent anus.
46742.........  .......  Repair of             29.67       38.00       35.80  ..........       agree       35.80
                          imperforated
                          anus.
46744.........  .......  Repair of             33.21       52.00       52.63  ..........       agree       52.63
                          cloacal
                          anomaly.
46746.........  .......  Repair of             36.74       53.50       58.22  ..........       agree       58.22
                          cloacal
                          anomaly.
46748.........  .......  Repair of             40.52       55.00       64.21  ..........       agree       64.21
                          cloacal
                          anomaly.
46750.........  .......  Repair of anal         8.14       10.99       10.25  ..........       agree       10.25
                          sphincter.
46753.........  .......  Reconstruction         6.58        5.45        8.29  ..........       agree        8.29
                          of anus.
46754.........  .......  Removal of             1.54        2.93        2.20  ..........       agree        2.20
                          suture from
                          anus.
46760.........  .......  Repair of anal        11.46       21.77       14.43  ..........       agree       14.43
                          sphincter.
46761.........  .......  Repair of anal        10.99       12.15       13.84  ..........       agree       13.84
                          sphincter.
46762.........  .......  Implant               10.09       15.01       12.71  ..........       agree       12.71
                          artificial
                          sphincter.
46900.........  .......  Destruction,           1.91        1.32        1.91  ..........       agree        1.91
                          anal lesion(s).
46910.........  .......  Destruction,           1.86        1.72        1.86  ..........       agree        1.86
                          anal lesion(s).
46916.........  .......  Cryosurgery,           1.86        1.72        1.86  ..........       agree        1.86
                          anal lesion(s).
46917.........  .......  Laser surgery,         1.86        3.32        1.86  ..........       agree        1.86
                          anal lesions.
46922.........  .......  Excision of            1.86        3.12        1.86  ..........       agree        1.86
                          anal lesion(s).
46924.........  .......  Destruction,           2.76        3.93        2.76  ..........       agree        2.76
                          anal lesion(s).
46924.........  .......  Destruction,           2.76        4.24        2.76  ..........       agree        2.76
                          anal lesion(s).
46934.........  .......  Destruction of         4.08        4.63        3.51  ..........       agree        3.51
                          hemorrhoids.
46935.........  .......  Destruction of         2.43        4.17        2.43  ..........       agree        2.43
                          hemorrhoids.
46936.........  .......  Destruction of         4.30        5.12        3.69  ..........       agree        3.69
                          hemorrhoids.
46940.........  .......  Treatment of           2.32        1.71        2.32  ..........       agree        2.32
                          anal fissure.
46942.........  .......  Treatment of           2.04        1.71        2.04  ..........       agree        2.04
                          anal fissure.
46945.........  .......  Ligation of            2.14        2.37        1.84  ..........       agree        1.84
                          hemorrhoids.
46946.........  .......  Ligation of            3.00        2.57        2.58  ..........       agree        2.58
                          hemorrhoids.

[[Page 31041]]

 
47010.........  .......  Open drainage,        10.28       16.25       16.01  ..........       agree       16.01
                          liver lesion.
47015.........  .......  Inject/aspirate        9.70       19.15       15.11  ..........       agree       15.11
                          liver cyst.
47100.........  .......  Wedge biopsy of        7.49        9.24       11.67  ..........       agree       11.67
                          liver.
47120.........  .......  Partial removal       22.79       39.57       35.50  ..........       agree       35.50
                          of liver.
47122.........  .......  Extensive             35.39       53.02       55.13  ..........       agree       55.13
                          removal of
                          liver.
47125.........  .......  Partial removal       31.58       44.50       49.19  ..........       agree       49.19
                          of liver.
47130.........  .......  Partial removal       34.25       46.45       53.35  ..........       agree       53.35
                          of liver.
47134.........  .......  Partial               39.15       49.00         CPT  ..........         CPT       39.15
                          removal, donor
                          liver.
47300.........  .......  Surgery for            9.68       12.45       15.08  ..........       agree       15.08
                          liver lesion.
47350.........  .......  Repair liver          12.56       19.16       19.56  ..........       agree       19.56
                          wound.
47360.........  .......  Repair liver          17.28       28.64       26.92  ..........       agree       26.92
                          wound.
47361.........  .......  Repair liver          30.25       40.14       47.12  ..........       agree       47.12
                          wound.
47362.........  .......  Repair liver          11.88       24.94       18.51  ..........       agree       18.51
                          wound.
47400.........  .......  Incision of           20.86       35.12       32.49  ..........       agree       32.49
                          liver duct.
47420.........  .......  Incision of           16.72       27.63       19.88  ..........       agree       19.88
                          bile duct.
47425.........  .......  Incision of           16.68       32.49       19.83  ..........       agree       19.83
                          bile duct.
47460.........  .......  Incise bile           15.17       25.74       18.04  ..........       agree       18.04
                          duct sphincter.
47480.........  .......  Incision of            9.10       15.26       10.82  ..........       agree       10.82
                          gallbladder.
47562.........  .......  Laparoscopic          11.09        9.59       11.09  ..........       agree       11.09
                          cholecystectom
                          y.
47563.........  .......  Laparoscopic          11.94       12.40       11.94  ..........       agree       11.94
                          cholecystectom
                          y.
47564.........  .......  Laparo                14.23       17.67       14.23  ..........       agree       14.23
                          cholecystectom
                          y/explr.
47570.........  .......  Laparo                12.58       18.62       12.58  ..........       agree       12.58
                          cholecystoente
                          rostomy.
47600.........  .......  Removal of            11.42       11.67       13.58  ..........       agree       13.58
                          gallbladder.
47605.........  .......  Removal of            12.36       13.26       14.69  ..........       agree       14.69
                          gallbladder.
47610.........  .......  Removal of            15.83       17.97       18.82  ..........       agree       18.82
                          gallbladder.
47612.........  .......  Removal of            15.80       22.68       18.78  ..........       agree       18.78
                          gallbladder.
47620.........  .......  Removal of            17.36       24.70       20.64  ..........       agree       20.64
                          gallbladder.
47701.........  .......  Bile duct             27.81       36.50       27.81  ..........       agree       27.81
                          revision.
47711.........  .......  Excision of           19.37       31.38       23.03  ..........       agree       23.03
                          bile duct
                          tumor.
47712.........  .......  Excision of           25.44       38.58       30.24  ..........       agree       30.24
                          bile duct
                          tumor.
47715.........  .......  Excision of           15.81       32.81       18.80  ..........       agree       18.80
                          bile duct cyst.
47716.........  .......  Fusion of bile        13.83       19.34       16.44  ..........       agree       16.44
                          duct cyst.
47720.........  .......  Fuse                  13.38       18.16       15.91  ..........       agree       15.91
                          gallbladder &
                          bowel.
47721.........  .......  Fuse upper gi         16.08       21.91       19.12  ..........       agree       19.12
                          structures.
47740.........  .......  Fuse                  15.54       20.63       18.48  ..........       agree       18.48
                          gallbladder &
                          bowel.
47741.........  .......  Fuse                  17.95       24.39       21.34  ..........       agree       21.34
                          gallbladder &
                          bowel.
47760.........  .......  Fuse bile ducts       21.74       21.91       25.85  ..........       agree       25.85
                          and bowel.
47765.........  .......  Fuse liver            20.93       30.62       24.88  ..........       agree       24.88
                          ducts & bowel.
47780.........  .......  Fuse bile ducts       22.29       26.86       26.50  ..........       agree       26.50
                          and bowel.
47785.........  .......  Fuse bile ducts       26.23       36.32       31.18  ..........       agree       31.18
                          and bowel.
47800.........  .......  Reconstruction        19.60       26.89       23.30  ..........       agree       23.30
                          of bile ducts.
47801.........  .......  Placement, bile       12.76       23.47       15.17  ..........       agree       15.17
                          duct support.
47802.........  .......  Fuse liver duct       18.13       34.11       21.55  ..........       agree       21.55
                          & intestine.
47900.........  .......  Suture bile           16.74       20.50       19.90  ..........       agree       19.90
                          duct injury.
48000.........  .......  Drainage of           14.91       40.79       28.07  ..........       agree       28.07
                          abdomen.
48001.........  .......  Placement of          18.83       55.20       35.45  ..........       agree       35.45
                          drain,
                          pancreas.
48005.........  .......  Resect/debride        22.40       57.70       42.17  ..........       agree       42.17
                          pancreas.
48020.........  .......  Removal of            14.22       23.50       15.70  ..........       agree       15.70
                          pancreatic
                          stone.
48100.........  .......  Biopsy of             11.08       14.57       12.23  ..........       agree       12.23
                          pancreas.
48120.........  .......  Removal of            14.36       26.05       15.85  ..........       agree       15.85
                          pancreas
                          lesion.
48140.........  .......  Partial removal       20.78       28.60       22.94  ..........       agree       22.94
                          of pancreas.
48145.........  .......  Partial removal       21.76       34.32       24.02  ..........       agree       24.02
                          of pancreas.
48146.........  .......  Pancreatectomy.       23.91       45.57       26.40  ..........       agree       26.40
48148.........  .......  Removal of            15.71       25.00       17.34  ..........       agree       17.34
                          pancreatic
                          duct.
48150.........  .......  Partial removal       43.48       54.73       48.00  ..........       agree       48.00
                          of pancreas.
48150.........  .......  Partial removal       43.48       54.75       48.00  ..........       agree       48.00
                          of pancreas.
48152.........  .......  Pancreatectomy.       39.63       39.63       43.75  ..........       agree       43.75
48153.........  .......  Pancreatectomy.       43.38       54.73       47.89  ..........       agree       47.89
48154.........  .......  Pancreatectomy.       39.95       51.80       44.10  ..........       agree       44.10
48155.........  .......  Removal of            22.32       44.70       24.64  ..........       agree       24.64
                          pancreas.
48180.........  .......  Fuse pancreas         22.39       32.52       24.72  ..........       agree       24.72
                          and bowel.
48500.........  .......  Surgery of            13.84       18.99       15.28  ..........       agree       15.28
                          pancreas cyst.
48510.........  .......  Drain                 12.96       16.08       14.31  ..........       agree       14.31
                          pancreatic
                          pseudocyst.
48520.........  .......  Fuse pancreas         14.12       19.68       15.59  ..........       agree       15.59
                          cyst and bowel.
48540.........  .......  Fuse pancreas         17.86       21.28       19.72  ..........       agree       19.72
                          cyst and bowel.
48545.........  .......  Pancreatorrhaph       16.47       33.39       18.18  ..........       agree       18.18
                          y.

[[Page 31042]]

 
48547.........  .......  Duodenal              23.40       41.76       25.83  ..........       agree       25.83
                          exclusion.
49000.........  .......  Exploration of        11.68       13.42       11.68  ..........       agree       11.68
                          abdomen.
49002.........  .......  Reopening of          10.49       12.67       10.49  ..........       agree       10.49
                          abdomen.
49010.........  .......  Exploration           12.28       15.06       12.28  ..........       agree       12.28
                          behind abdomen.
49020.........  .......  Drain abdominal       16.79       28.33       20.73  ..........    increase       22.84
                          abscess.
49040.........  .......  Drain, open,           9.94       23.60       12.27  ..........    increase       13.52
                          abdom abscess.
49060.........  .......  Drain, open,          11.66       19.52       14.40  ..........    increase       15.86
                          retrop abscess.
49085.........  .......  Remove abdomen         8.93       14.23       11.03  ..........    increase       12.14
                          foreign body.
49200.........  .......  Removal of            10.25       12.19       10.25  ..........       agree       10.25
                          abdominal
                          lesion.
49201.........  .......  Removal of            14.84       16.27       14.84  ..........       agree       14.84
                          abdominal
                          lesion.
49215.........  .......  Excise sacral         22.36       24.96       33.50  ..........       agree       33.50
                          spine tumor.
49215.........  .......  Excise sacral         22.36       30.00       33.50  ..........       agree       33.50
                          spine tumor.
49220.........  .......  Multiple              14.88       17.39       14.88  ..........       agree       14.88
                          surgery,
                          abdomen.
49255.........  .......  Removal of            11.14       13.42       11.14  ..........       agree       11.14
                          omentum.
49320.........  .......  Diag laparo            5.10        5.95        5.10  ..........       agree        5.10
                          separate proc.
49321.........  .......  Laparoscopy;           5.40         N/A        5.40  ..........       agree        5.40
                          biopsy.
49322.........  .......  Laparoscopy;           5.70         N/A        5.70  ..........       agree        5.70
                          aspiration.
49421.........  .......  Insert                 5.54        6.99        5.54  ..........       agree        5.54
                          abdominal
                          drain.
49422.........  .......  Remove perm            6.25        6.35        6.25  ..........       agree        6.25
                          cannula/
                          catheter.
49425.........  .......  Insert abdomen-       11.37       13.82       11.37  ..........       agree       11.37
                          venous drain.
49426.........  .......  Revise abdomen-        9.63       11.10        9.63  ..........       agree        9.63
                          venous shunt.
49428.........  .......  Ligation of            2.38        5.38        6.06  ..........       agree        6.06
                          shunt.
49429.........  .......  Removal of             7.40        9.57        7.40  ..........       agree        7.40
                          shunt.
49495.........  .......  Repair inguinal        5.89        6.96         CPT  ..........         CPT        5.89
                          hernia, init.
49495.........  .......  Repair inguinal        5.89       12.50         CPT  ..........         CPT        5.89
                          hernia, init.
49496.........  .......  Repair inguinal        8.79       10.56         CPT  ..........         CPT        8.79
                          hernia, init.
49496.........  .......  Repair inguinal        8.79       14.00         CPT  ..........         CPT        8.79
                          hernia, init.
49500.........  .......  Repair inguinal        4.68        7.61        5.48  ..........       agree        5.48
                          hernia.
49501.........  .......  Repair inguinal        7.58        9.26        8.88  ..........       agree        8.88
                          hernia, init.
49505.........  .......  Repair inguinal        6.49        8.31        7.60  ..........       agree        7.60
                          hernia.
49505.........  .......  Repair inguinal        6.49       11.50        7.60  ..........       agree        7.60
                          hernia.
49507.........  .......  Repair inguinal        8.17       11.38        9.57  ..........       agree        9.57
                          hernia.
49520.........  .......  Rerepair               8.22       11.02        9.63  ..........       agree        9.63
                          inguinal
                          hernia.
49521.........  .......  Repair inguinal       10.22       13.97       11.97  ..........       agree       11.97
                          hernia, rec.
49525.........  .......  Repair inguinal        7.32        8.36        8.57  ..........       agree        8.57
                          hernia.
49540.........  .......  Repair lumbar          8.87        8.52       10.39  ..........       agree       10.39
                          hernia.
49550.........  .......  Repair femoral         7.37        8.36        8.63  ..........       agree        8.63
                          hernia.
49553.........  .......  Repair femoral         8.06       10.31        9.44  ..........       agree        9.44
                          hernia, init.
49555.........  .......  Repair femoral         7.71        8.50        9.03  ..........       agree        9.03
                          hernia.
49557.........  .......  Repair femoral         9.52       11.82       11.15  ..........       agree       11.15
                          hernia, recur.
49560.........  .......  Repair                 9.88       11.69       11.57  ..........       agree       11.57
                          abdominal
                          hernia.
49561.........  .......  Repair                12.17       15.67       14.25  ..........       agree       14.25
                          incisional
                          hernia.
49565.........  .......  Rerepair               9.88       14.03       11.57  ..........       agree       11.57
                          abdominal
                          hernia.
49566.........  .......  Repair                12.30       16.43       14.40  ..........       agree       14.40
                          incisional
                          hernia.
49570.........  .......  Repair                 4.86        7.00        5.69  ..........       agree        5.69
                          epigastric
                          hernia.
49572.........  .......  Repair                 5.75        9.77        6.73  ..........       agree        6.73
                          epigastric
                          hernia.
49580.........  .......  Repair                 3.51        5.71        4.11  ..........       agree        4.11
                          umbilical
                          hernia.
49582.........  .......  Repair                 5.68        9.99        6.65  ..........       agree        6.65
                          umbilical
                          hernia.
49585.........  .......  Repair                 5.32        5.71        6.23  ..........       agree        6.23
                          umbilical
                          hernia.
49587.........  .......  Repair                 6.46        9.34        7.56  ..........       agree        7.56
                          umbilical
                          hernia.
49590.........  .......  Repair                 7.29        9.54        8.54  ..........       agree        8.54
                          abdominal
                          hernia.
49605.........  .......  Repair                22.66       97.62       76.00  ..........    decrease       22.66
                          umbilical
                          lesion.
49606.........  .......  Repair                18.60       21.31       18.60  ..........       agree       18.60
                          umbilical
                          lesion.
49650.........  .......  Laparo hernia          6.27        7.66        6.27  ..........       agree        6.27
                          repair initial.
49651.........  .......  Laparo hernia          8.24        7.88        8.24  ..........       agree        8.24
                          repair recur.
49900.........  .......  Repair of             12.28       16.92       12.28  ..........       agree       12.28
                          abdominal wall.
49905.........  .......  Omental flap...        6.55       17.79         CPT  ..........         CPT        6.55
50200.........  .......  Biopsy of              2.63         N/A         CPT  ..........         CPT        2.63
                          kidney.
50230.........  .......  Removal of            22.07         N/A         CPT  ..........         CPT       22.07
                          kidney.
51595.........  .......  Remove bladder/       37.14         N/A       37.14  ..........       agree       37.14
                          revise tract.
51596.........  .......  Remove bladder/       39.52         N/A       39.52  ..........       agree       39.52
                          create pouch.
52300.........  .......  Cystoscopy and         5.31          WD         (e)  ..........         (a)        5.31
                          treatment.
52327.........  .......  Cystoscopy,            5.19          WD         (e)  ..........         (a)        5.19
                          inject
                          material.
52340.........  .......  Cystoscopy and         9.68          WD         (e)  ..........         (a)        9.68
                          treatment.
56515.........  .......  Destruction,           1.88        3.09        2.76  ..........       agree        2.76
                          vulva
                          lesion(s).
56740.........  .......  Remove vagina          3.76        5.74        4.57  ..........       agree        4.57
                          gland lesion.

[[Page 31043]]

 
57100.........  .......  Biopsy of              0.97        1.90        1.20  ..........       agree        1.20
                          vagina.
57130.........  .......  Remove vagina          2.43        5.67        2.43  ..........       agree        2.43
                          lesion.
57292.........  .......  Construct             13.09         N/A       13.09  ..........       agree       13.09
                          vagina with
                          graft.
57307.........  .......  Fistula repair        15.93       20.24       15.93  ..........       agree       15.93
                          & colostomy.
57410.........  .......  Pelvic                 1.75        4.08        1.75  ..........       agree        1.75
                          examination.
57505.........  .......  Endocervical           1.14        0.97        1.14  ..........       agree        1.14
                          curettage.
57555.........  .......  Remove cervix/         8.95          WD         (e)  ..........         (a)        8.95
                          repair vagina.
58150.........  .......  Total                 15.24       17.75       15.24  ..........       agree       15.24
                          hysterectomy.
58152.........  .......  Total                 15.09       20.60       20.60  ..........       agree       20.60
                          hysterectomy.
58260.........  .......  Vaginal               12.20       12.98       12.98  ..........       agree       12.98
                          hysterectomy.
58262.........  .......  Vaginal               13.99       17.88       14.77  ..........       agree       14.77
                          hysterectomy.
58263.........  .......  Vaginal               15.28       21.26       16.06  ..........       agree       16.06
                          hysterectomy.
58267.........  .......  Hysterectomy &        15.00       17.55       17.04  ..........       agree       17.04
                          vagina repair.
58270.........  .......  Hysterectomy &        13.48       15.58       14.26  ..........       agree       14.26
                          vagina repair.
58275.........  .......  Hysterectomy/         14.98         N/A       15.76  ..........       agree       15.76
                          revise vagina.
58280.........  .......  Hysterectomy/         15.41         N/A       17.01  ..........       agree       17.01
                          revise vagina.
58285.........  .......  Extensive             18.57         N/A       22.26  ..........       agree       22.26
                          hysterectomy.
58323.........  .......  Sperm washing..        0.23        0.55        0.23  ..........       agree        0.23
58400.........  .......  Suspension of          6.36       11.68        6.36  ..........       agree        6.36
                          uterus.
58600.........  .......  Division of            3.84        4.60        5.60  ..........       agree        5.60
                          fallopian tube.
58605.........  .......  Division of            3.34        4.60        5.00  ..........       agree        5.00
                          fallopian tube.
58611.........  .......  Ligate                 0.63         N/A        1.45  ..........       agree        1.45
                          oviduct(s) add-
                          on.
58700.........  .......  Removal of             6.49       11.68       12.05  ..........       agree       12.05
                          fallopian tube.
58740.........  .......  Revise                 5.83       11.29       14.00  ..........       agree       14.00
                          fallopian
                          tube(s).
58805.........  .......  Drainage of            5.88       11.68        5.88  ..........       agree        5.88
                          ovarian
                          cyst(s).
58820.........  .......  Drain ovary            4.22        6.03        4.22  ..........       agree        4.22
                          abscess, open.
58825.........  .......  Transposition,         6.13       11.68       10.98  ..........       agree       10.98
                          ovary(s).
58920.........  .......  Partial removal        6.78       11.68       11.36  ..........       agree       11.36
                          of ovary(s).
58950.........  .......  Resect ovarian        15.27       16.93       16.93  ..........       agree       16.93
                          malignancy.
58951.........  .......  Resect ovarian        21.81       28.99       22.38  ..........       agree       22.38
                          malignancy.
59150.........  .......  Treat ectopic          6.89       11.67       11.67  ..........       agree       11.67
                          pregnancy.
59151.........  .......  Treat ectopic          7.86       11.49       11.49  ..........       agree       11.49
                          pregnancy.
59812.........  .......  Treatment of           3.25        4.01        4.01  ..........       agree        4.01
                          miscarriage.
59870.........  .......  Evacuate mole          4.28        5.00        6.01  ..........       agree        6.01
                          of uterus.
60100.........  .......  Biopsy of              0.97        1.88        1.56  ..........       agree        1.56
                          thyroid.
60220.........  .......  Partial removal       10.53       11.82       11.90  ..........       agree       11.90
                          of thyroid.
60220.........  .......  Partial removal       10.53       14.24       11.90  ..........       agree       11.90
                          of thyroid.
60252.........  .......  Removal of            18.20       22.32       20.57  ..........       agree       20.57
                          thyroid.
60254.........  .......  Extensive             23.88       27.43       26.99  ..........       agree       26.99
                          thyroid
                          surgery.
60260.........  .......  Repeat thyroid        15.46       18.83       17.47  ..........       agree       17.47
                          surgery.
60270.........  .......  Removal of            17.94       23.05       20.27  ..........       agree       20.27
                          thyroid.
60271.........  .......  Removal of            14.89       18.68       16.83  ..........       agree       16.83
                          thyroid.
60280.........  .......  Remove thyroid         6.08          WD         (e)  ..........         (a)        6.08
                          duct lesion.
60540.........  .......  Explore adrenal       17.03       20.53       17.03  ..........       agree       17.03
                          gland.
60545.........  .......  Explore adrenal       19.88       25.66       19.88  ..........       agree       19.88
                          gland.
62263.........  .......  Lysis epidural         6.14        7.20        7.20  ..........         (b)        6.14
                          adhesions.
62310.........  .......  Inject spine c/        1.91        1.95        2.20  ..........         (b)        1.91
                          t.
62311.........  .......  Inject spine l/        1.54        1.57        1.78  ..........         (b)        1.54
                          s (cd).
62318.........  .......  Inject spine w/        2.04        2.26        2.35  ..........         (b)        2.04
                          cath, c/t.
62319.........  .......  Inject spine w/        1.87        1.88        2.15  ..........         (b)        1.87
                          cath l/s (cd).
65855.........  .......  Laser surgery          4.30         N/A        3.85  ..........       agree        3.85
                          of eye.
66170.........  .......  Glaucoma              12.16          WD         (e)  ..........         (a)       12.16
                          surgery.
66172.........  .......  Incision of eye       15.04          WD         (e)  ..........         (a)       15.04
66180.........  .......  Implant eye           14.55         N/A       14.55  ..........       agree       14.55
                          shunt.
66986.........  .......  Exchange lens         12.28         N/A       12.28  ..........       agree       12.28
                          prosthesis.
67028.........  .......  Injection eye          2.52         N/A        2.52  ..........       agree        2.52
                          drug.
67108.........  .......  Repair detached       20.82          WD         (e)  ..........         (a)       20.82
                          retina.
67218.........  .......  Treatment of          13.52         N/A       18.53  ..........       agree       18.53
                          retinal lesion.
67904.........  .......  Repair eyelid          6.26         N/A        6.26  ..........       agree        6.26
                          defect.
69000.........  .......  Drain external         1.45          WD         (e)  ..........         (a)        1.45
                          ear lesion.
69005.........  .......  Drain external         2.11          WD         (e)  ..........         (a)        2.11
                          ear lesion.
69020.........  .......  Drain outer ear        1.48          WD         (e)  ..........         (a)        1.48
                          canal lesion.
69100.........  .......  Biopsy of              0.81          WD         (e)  ..........         (a)        0.81
                          external ear.
69105.........  .......  Biopsy of              0.85          WD         (e)  ..........         (a)        0.85
                          external ear
                          canal.
69110.........  .......  Remove external        3.44          WD         (e)  ..........         (a)        3.44
                          ear, partial.
69120.........  .......  Removal of             4.05          WD         (e)  ..........         (a)        4.05
                          external ear.

[[Page 31044]]

 
69140.........  .......  Remove ear             7.97          WD         (e)  ..........         (a)        7.97
                          canal
                          lesion(s).
69145.........  .......  Remove ear             2.62          WD         (e)  ..........         (a)        2.62
                          canal
                          lesion(s).
69150.........  .......  Extensive ear         13.43          WD         (e)  ..........         (a)       13.43
                          canal surgery.
69155.........  .......  Extensive ear/        20.80          WD         (e)  ..........         (a)       20.80
                          neck surgery.
69200.........  .......  Clear outer ear        0.77          WD         (e)  ..........         (a)        0.77
                          canal.
69205.........  .......  Clear outer ear        1.20          WD         (e)  ..........         (a)        1.20
                          canal.
69210.........  .......  Remove impacted        0.61          WD         (e)  ..........         (a)        0.61
                          ear wax.
69220.........  .......  Clean out              0.83          WD         (e)  ..........         (a)        0.83
                          mastoid cavity.
69222.........  .......  Clean out              1.40          WD         (e)  ..........         (a)        1.40
                          mastoid cavity.
69300.........  .......  Revise external        6.36          WD         (e)  ..........         (a)        6.36
                          ear.
69310.........  .......  Rebuild outer         10.79          WD         (e)  ..........         (a)       10.79
                          ear canal.
69320.........  .......  Rebuild outer         16.96          WD         (e)  ..........         (a)       16.96
                          ear canal.
69400.........  .......  Inflate middle         0.83          WD         (e)  ..........         (a)        0.83
                          ear canal.
69401.........  .......  Inflate middle         0.63          WD         (e)  ..........         (a)        0.63
                          ear canal.
69405.........  .......  Catheterize            2.63          WD         (e)  ..........         (a)        2.63
                          middle ear
                          canal.
69410.........  .......  Inset middle           0.33          WD         (e)  ..........         (a)        0.33
                          ear (baffle).
69420.........  .......  Incision of            1.33          WD         (e)  ..........         (a)        1.33
                          eardrum.
69421.........  .......  Incision of            1.73          WD         (e)  ..........         (a)        1.73
                          eardrum.
69424.........  .......  Remove                 0.85          WD         (e)  ..........         (a)        0.85
                          ventilating
                          tube.
69433.........  .......  Create eardrum         1.52          WD         (e)  ..........         (a)        1.52
                          opening.
69436.........  .......  Create eardrum         1.96          WD         (e)  ..........         (a)        1.96
                          opening.
69440.........  .......  Exploration of         7.57          WD         (e)  ..........         (a)        7.57
                          middle ear.
69450.........  .......  Eardrum                5.57          WD         (e)  ..........         (a)        5.57
                          revision.
69501.........  .......  Mastoidectomy..        9.07          WD         (e)  ..........         (a)        9.07
69502.........  .......  Mastoidectomy..       12.38          WD         (e)  ..........         (a)       12.38
69505.........  .......  Remove mastoid        12.99          WD         (e)  ..........         (a)       12.99
                          structures.
69511.........  .......  Extensive             13.52          WD         (e)  ..........         (a)       13.52
                          mastoid
                          surgery.
69530.........  .......  Extensive             19.19          WD         (e)  ..........         (a)       19.19
                          mastoid
                          surgery.
69535.........  .......  Remove part of        36.14          WD         (e)  ..........         (a)       36.14
                          temporal bone.
69540.........  .......  Remove ear             1.20          WD         (e)  ..........         (a)        1.20
                          lesion.
69550.........  .......  Remove ear            10.99          WD         (e)  ..........         (a)       10.99
                          lesion.
69552.........  .......  Remove ear            19.46          WD         (e)  ..........         (a)       19.46
                          lesion.
69554.........  .......  Remove ear            33.16          WD         (e)  ..........         (a)       33.16
                          lesion.
69601.........  .......  Mastoid surgery       13.24          WD         (e)  ..........         (a)       13.24
                          revision.
69602.........  .......  Mastoid surgery       13.58          WD         (e)  ..........         (a)       13.58
                          revision.
69603.........  .......  Mastoid surgery       14.02          WD         (e)  ..........         (a)       14.02
                          revision.
69604.........  .......  Mastoid surgery       14.02          WD         (e)  ..........         (a)       14.02
                          revision.
69605.........  .......  Remove mastoid        18.49          WD         (e)  ..........         (a)       18.49
                          structures.
69610.........  .......  Repair of              4.43          WD         (e)  ..........         (a)        4.43
                          eardrum.
69620.........  .......  Repair of              5.89          WD         (e)  ..........         (a)        5.89
                          eardrum.
69631.........  .......  Rebuild eardrum        9.86          WD         (e)  ..........         (a)        9.86
                          structures.
69632.........  .......  Rebuild eardrum       12.75          WD         (e)  ..........         (a)       12.75
                          structures.
69633.........  .......  Rebuild eardrum       12.10          WD         (e)  ..........         (a)       12.10
                          structures.
69635.........  .......  Repair eardrum        13.33          WD         (e)  ..........         (a)       13.33
                          structures.
69636.........  .......  Rebuild eardrum       15.22          WD         (e)  ..........         (a)       15.22
                          structures.
69637.........  .......  Rebuild eardrum       15.11          WD         (e)  ..........         (a)       15.11
                          structures.
69641.........  .......  Revise middle         12.71          WD         (e)  ..........         (a)       12.71
                          ear & mastoid.
69642.........  .......  Revise middle         16.84          WD         (e)  ..........         (a)       16.84
                          ear & mastoid.
69643.........  .......  Revise middle         15.32          WD         (e)  ..........         (a)       15.32
                          ear & mastoid.
69644.........  .......  Revise middle         16.97          WD         (e)  ..........         (a)       16.97
                          ear & mastoid.
69645.........  .......  Revise middle         16.38          WD         (e)  ..........         (a)       16.38
                          ear & mastoid.
69646.........  .......  Revise middle         17.99          WD         (e)  ..........         (a)       17.99
                          ear & mastoid.
69650.........  .......  Release middle         9.66          WD         (e)  ..........         (a)        9.66
                          ear bone.
69660.........  .......  Revise middle         11.90          WD         (e)  ..........         (a)       11.90
                          ear bone.
69661.........  .......  Revise middle         15.74          WD         (e)  ..........         (a)       15.74
                          ear bone.
69662.........  .......  Revise middle         15.44          WD         (e)  ..........         (a)       15.44
                          ear bone.
69666.........  .......  Repair middle          9.75          WD         (e)  ..........         (a)        9.75
                          ear structures.
69667.........  .......  Repair middle          9.76          WD         (e)  ..........         (a)        9.76
                          ear structures.
69670.........  .......  Remove mastoid        11.51          WD         (e)  ..........         (a)       11.51
                          air cells.
69676.........  .......  Remove middle          9.52          WD         (e)  ..........         (a)        9.52
                          ear nerve.
69700.........  .......  Close mastoid          8.23          WD         (e)  ..........         (a)        8.23
                          fistula.
69711.........  .......  Remove/repair         10.44          WD         (e)  ..........         (a)       10.44
                          hearing aid.
69720.........  .......  Release facial        14.38          WD         (e)  ..........         (a)       14.38
                          nerve.
69725.........  .......  Release facial        25.38          WD         (e)  ..........         (a)       25.38
                          nerve.
69740.........  .......  Repair facial         15.96          WD         (e)  ..........         (a)       15.96
                          nerve.
69745.........  .......  Repair facial         16.69          WD         (e)  ..........         (a)       16.69
                          nerve.

[[Page 31045]]

 
69801.........  .......  Incise inner           8.56          WD         (e)  ..........         (a)        8.56
                          ear.
69802.........  .......  Incise inner          13.10          WD         (e)  ..........         (a)       13.10
                          ear.
69805.........  .......  Explore inner         13.82          WD         (e)  ..........         (a)       13.82
                          ear.
69806.........  .......  Explore inner         12.35          WD         (e)  ..........         (a)       12.35
                          ear.
69820.........  .......  Establish inner       10.34          WD         (e)  ..........         (a)       10.34
                          ear window.
69840.........  .......  Revise inner          10.26          WD         (e)  ..........         (a)       10.26
                          ear window.
69905.........  .......  Remove inner          11.10          WD         (e)  ..........         (a)       11.10
                          ear.
69910.........  .......  Remove inner          13.63          WD         (e)  ..........         (a)       13.63
                          ear & mastoid.
69915.........  .......  Incise inner          21.23          WD         (e)  ..........         (a)       21.23
                          ear nerve.
69930.........  .......  Implant               16.81          WD         (e)  ..........         (a)       16.81
                          cochlear
                          device.
69950.........  .......  Incise inner          25.64          WD         (e)  ..........         (a)       25.64
                          ear nerve.
69955.........  .......  Release facial        27.04          WD         (e)  ..........         (a)       27.04
                          nerve.
69960.........  .......  Release inner         27.04          WD         (e)  ..........         (a)       27.04
                          ear canal.
69970.........  .......  Remove inner          30.04          WD         (e)  ..........         (a)       30.04
                          ear lesion.
69990.........  .......  Microsurgery           3.47         N/A        3.47  ..........       agree        3.47
                          add-on.
72275.........  .......  Epidurography..        0.76        0.83        0.83  ..........         (b)        0.76
76005.........  .......  Fluoroguide for        0.60        0.60       10.60  ..........       agree        0.60
                          spine inject.
76065.........  .......  X-rays, bone           0.28        0.60        0.70  ..........       agree        0.70
                          evaluation.
76090.........  .......  Mammogram, one         0.58        0.64        0.70  ..........       agree        0.70
                          breast.
76091.........  .......  Mammogram, both        0.69        0.76        0.87  ..........       agree        0.87
                          breasts.
76095.........  .......  Stereotactic           1.59        3.58        1.59  ..........       agree        1.59
                          breast biopsy.
88170.........  .......  Fine needle            1.27        3.28        1.27  ..........       agree        1.27
                          aspiration.
88171.........  .......  Fine needle            1.27        2.63        1.27  ..........       agree        1.27
                          aspiration.
90901.........  .......  Biofeedback            0.41         N/A  ..........        0.41       agree        0.41
                          train, any
                          meth.
90911.........  .......  Biofeedback            0.89         N/A        0.89  ..........       agree        0.89
                          peri/uro/
                          rectal.
90935.........  .......  Hemodialysis,          1.22         N/A         CPT  ..........         CPT        1.22
                          one evaluation.
90937.........  .......  Hemodialysis,          2.11         N/A         CPT  ..........         CPT        2.11
                          repeated eval.
90945.........  .......  Dialysis, one          1.28         N/A         CPT  ..........         CPT        1.28
                          evaluation.
90947.........  .......  Dialysis,              2.16         N/A         CPT  ..........         CPT        2.16
                          repeated eval.
90989.........  .......  Dialysis               0.00         N/A         CPT  ..........         CPT        0.00
                          training,
                          complete.
90993.........  .......  Dialysis               0.00         N/A         CPT  ..........         CPT        0.00
                          training,
                          incompl.
90997.........  .......  Hemoperfusion..        1.84         N/A         CPT  ..........         CPT        1.84
92018.........  .......  New eye exam &         1.51         N/A        2.50  ..........       agree        2.50
                          treatment.
93350.........  .......  Echo                   0.78         N/A        1.48  ..........       agree        1.48
                          transthoracic.
94640.........  .......  Airway                 0.00         N/A        0.00  ..........       agree        0.00
                          inhalation
                          treatment.
94664.........  .......  Aerosol or             0.00         N/A         CPT  ..........         CPT        0.00
                          vapor
                          inhalations.
94665.........  .......  Aerosol or             0.00         N/A         CPT  ..........         CPT        0.00
                          vapor
                          inhalations.
96100.........  .......  Psychological          0.00        2.00  ..........         (a)       agree        0.00
                          testing.
96105.........  .......  Assessment of          0.00        2.00  ..........         (a)       agree        0.00
                          aphasia.
96110.........  .......  Developmental          0.00        2.00  ..........         (a)       agree        0.00
                          test, lim.
96115.........  .......  Neurobehavior          0.00        2.20  ..........         (a)       agree        0.00
                          status exam.
96117.........  .......  Neuropsych test        0.00        2.20  ..........         (a)       agree        0.00
                          battery.
97542.........  .......  Wheelchair             0.25        0.45  ..........        0.45       agree        0.45
                          mngmnt
                          training.
99233.........  .......  Subsequent             1.51         N/A        1.51  ..........       agree        1.51
                          hospital care.
99273.........  .......  Confirmatory           1.19         N/A        1.19  ..........       agree        1.19
                          consultation.
99274.........  .......  Confirmatory           1.73         N/A        1.73  ..........       agree        1.73
                          consultation.
99291.........  .......  Critical care,         3.60        4.00        4.00  ..........       agree        4.00
                          first hour.
99291.........  .......  Critical care,         3.60        5.50        4.00  ..........       agree        4.00
                          first hour.
99291.........  .......  Critical care,         3.60         N/A        4.00  ..........       agree        4.00
                          first hour.
99292.........  .......  Critical care,         1.80        2.00        2.00  ..........       agree        2.00
                          addl 30 min.
99292.........  .......  Critical care,         1.80        2.77        2.00  ..........       agree        2.00
                          addl 30 min.
99292.........  .......  Critical care,         1.80         N/A        2.00  ..........       agree        2.00
                          addl 30 min.
99295.........  .......  Neonatal              16.00         N/A       16.00  ..........       agree       16.00
                          critical care.
99296.........  .......  Neonatal               8.00         N/A        8.00  ..........       agree        8.00
                          critical care.
99297.........  .......  Neonatal               4.00         N/A        4.00  ..........       agree        4.00
                          critical care.
99298.........  .......  Neonatal               2.75         N/A        2.75  ..........       agree        2.75
                          critical care.
99436.........  .......  Attendance,            1.50         N/A        1.50  ..........       agree        1.50
                          birth.
99440.........  .......  Newborn                2.93         N/A        2.93  ..........       agree        2.93
                          resuscitation.
G0127.........  .......  Trim nail(s)...        0.11         N/A  ..........         (a)         (a)        0.11
----------------------------------------------------------------------------------------------------------------

      
  

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / 
Notices

[[Page 31046]]


      
      
      

B. Discussion of Comments by Clinical Area

1. Vascular Surgery
    Comment: The Society for Vascular Surgery (SVS) and the North 
American Chapter of the International Society for Cardiovascular 
Surgery requested increases in work RVUs for 95 codes. Both groups 
commented that vascular surgery procedures were undervalued in the 
original Harvard Study and that only a small number of these RVUs have 
been adjusted since that time.
    The SVS's recommendations were based on surveys, a full RUC survey 
of 39 higher volume codes and minisurveys for 56 less frequently 
performed codes. (The full and minisurveys included estimates for each 
code of pre-, intra-, and postservice times and visits as well as 
estimates of physician work. The effect of these recommendations would 
be to correct current rank-order anomalies, while avoiding creation of 
new rank-order anomalies.) The SVS used a building-block approach to 
validate the survey results for each of their codes.

RUC Recommendation

    Of the 95 codes, the RUC recommended increases for 91 codes, a 
decrease for 1 code and no changes for 3 codes. In 60 percent of cases, 
the RUC recommendations to increase the work RVUs were based on 
physician surveys. The recommendations were based on either the 25th 
percentile or the median of survey responses. In almost all other 
cases, the RUC recommendation for a specific code work RVU was based on 
the work value of another comparable code. The building-block approach 
was used only to corroborate findings from the surveys or validate a 
comparison to another procedure. The following are the RUC 
recommendations for the codes submitted. (Please note that throughout 
this document the value in parentheses represents the RUC-recommended 
work RVUs unless they are shown in columns.)

------------------------------------------------------------------------
            CPT codes                            Work RVUs
------------------------------------------------------------------------
                  Family 1  Aneurysm Repairs in Abdomen
------------------------------------------------------------------------
35111............................  25.00
35131............................  25.00
35112............................  30.00
35132............................  30.00
35121............................  30.00
35122............................  35.00
35082............................  38.50
35103............................  40.50
35092............................  45.00
------------------------------------------------------------------------
                 Family 2  Bypass Grafts in the Abdomen
------------------------------------------------------------------------
35665............................  21.00
35663............................  22.00
35565............................  23.20
35563............................  24.20
35636............................  29.50
35536............................  31.70
35560............................  32.00
35631............................  34.00
35531............................  36.20
------------------------------------------------------------------------
            Family 3  Embolectomy/Thrombectomy in the Abdomen
------------------------------------------------------------------------
34401............................  25.00
34151............................  25.00
34451............................  27.00
------------------------------------------------------------------------
                 Family 4  Endarterectomy in the Abdomen
------------------------------------------------------------------------
35351............................  23.00
35331............................  26.20
35361............................  28.20
35363............................  30.20
------------------------------------------------------------------------
              Family 5  Repair Blood Vessels in the Abdomen
------------------------------------------------------------------------
37660............................  21.00
37617............................  22.06
35221............................  24.39
35281............................  28.00
35251............................  30.20
------------------------------------------------------------------------
       Family 6  Explorations, Revisions, Other in Chest & Abdomen
------------------------------------------------------------------------
35189............................  28.00
35182............................  30.00
35905............................  31.25
35907............................  35.00
------------------------------------------------------------------------

[[Page 31047]]

 
                 Family 7  Extra-anatomic Bypass Grafts
------------------------------------------------------------------------
35661............................  19.00
35650............................  19.00
35621............................  20.00
35558............................  21.20
35511............................  21.20
35518............................  21.20
35623............................  24.00
35521............................  22.20
35654............................  25.00
35533............................  28.00
------------------------------------------------------------------------
             Family 8  Arterial Bypass Grafts in Extremities
------------------------------------------------------------------------
35666............................  22.19
35671............................  19.23
35571............................  24.06
35587............................  24.75
------------------------------------------------------------------------
        Family 9  Embolectomy/Thrombectomy by Extremity Incision
------------------------------------------------------------------------
34490............................  9.86
34111............................  10.00
34201............................  10.03
34101............................  10.00
34421............................  12.00
34203............................  16.50
------------------------------------------------------------------------
              Family 10  Aneurysm Repairs in the Extremity
------------------------------------------------------------------------
35045............................  17.57
35011............................  18.00
35141............................  20.00
35013............................  22.00
35151............................  22.64
35142............................  23.30
35152............................  25.62
------------------------------------------------------------------------
             Family 11  Endarterectomy of Extremity Arteries
------------------------------------------------------------------------
35371............................  14.72
35321............................  16.00
35372............................  18.00
35355............................  18.50
------------------------------------------------------------------------
       Family 12  Arteriovenous Fistula Repairs in the Extremities
------------------------------------------------------------------------
35190............................  No change in work RVUs
35184............................  18.00
------------------------------------------------------------------------
             Family 13  Peripheral Artery and Vein Ligations
------------------------------------------------------------------------
35721............................  7.18
37650............................  7.80
35741............................  8.00
37618............................  No change in work RVUs
37565............................  10.88
37600............................  11.25
35701............................  8.50
37605............................  13.11
37615............................  No change in work RVUs
------------------------------------------------------------------------
            Family 14  Vessel/Repairs in Extremities and Neck
------------------------------------------------------------------------
35201............................  16.14
35206............................  13.25
35226............................  14.50
35266............................  14.91
35261............................  17.80
35286............................  16.16
35236............................  17.11
35231............................  20.00
35256............................  18.36
------------------------------------------------------------------------

[[Page 31048]]

 
          Family 15  Reconstruction for Chronic Venous Disease
------------------------------------------------------------------------
34501............................  16.00
34520............................  17.95
34510............................  18.95
34530............................  16.64 (decrease)
------------------------------------------------------------------------
    Family 16  Repairs, Bypass Grafts, Endarterectomies in the Chest
------------------------------------------------------------------------
35276............................  24.25
35246............................  26.45
35626............................  27.75
35526............................  29.95
35311............................  27.00
------------------------------------------------------------------------
            Family 17  Ligation or Biopsy of Temporal Artery
------------------------------------------------------------------------
37609............................  3.00
------------------------------------------------------------------------
                           Family 18  Untitled
------------------------------------------------------------------------
35081............................  28.01
35556............................  21.76
------------------------------------------------------------------------

    The RUC recommended the following codes be submitted to the CPT 
Editorial Panel for further consideration: 35381, 35541, 35546, 35551, 
35582, 35641, 35646, 35840, 35860, 37615, 37618, 37700, 37730, 37735, 
37760, 37785.
    HCFA Proposal: 
    We have reviewed and propose to accept all of the RUC 
recommendations for the vascular surgery codes. We believe that 
relativity is maintained, and the RVUs more appropriately reflect the 
work involved.
2. General Surgery/Colon and Rectal Surgery
    Comment: The American Society of General Surgeons (ASGS) submitted 
55 codes it believed to be undervalued. The ASGS recommended work RVUs 
for each service. After submitting the codes, the specialty society 
ultimately chose not to pursue review of RVUs for the following codes 
under the 5-year review: 20605, 34001, and 29881.
    The following codes 49505, 32440, 46320, 46924, 31622, 44140 (no 
change), 38500, 32480, 37609, 43239, 43638, 60220, 44050, 48150, and 
38100 were also submitted for review by other specialty groups and are 
discussed in other sections. (Note that codes 56305, 56341, 56300, 
56340, and 56306 are laparoscopic surgery codes also submitted for 
review by the specialty group; however, these services were deleted or 
renumbered by CPT for 2000.)
    RUC Recommendation: 
    The RUC recommended that the work RVUs for the following codes be 
increased (the RUC-recommended work RVUs are in parentheses):
    Code 36489, Placement of central venous catheter (subclavian, 
jugular, or other vein (eg, for central venous pressure, 
hyperalimentation, hemodialysis, or chemotherapy)); percutaneous, age 2 
years or under (2.50) to correct a rank-order anomaly; 60100, Biopsy 
thyroid, percutaneous core needle (1.56), to appropriately reflect the 
work involved and fit in the range of biopsy codes; and 31600, 
Tracheostomy, planned (separate procedure) (7.18), based on the 
building-block approach and the comparison to similar procedures.
    For the following codes, the RUC stated that there was no 
compelling evidence provided to support increasing the work RVUs. 
Therefore, it recommended maintaining the current work RVUs for the 
following codes: 19100, 88170, 57410, 76095, 88171, 32000, 21800, 
46083, 19000, 19125, 45330, 19160, 13101, 11402, 12011, 11642, 27590, 
45378, 36625, 45309, 45305, 35081, 19240, 58150, 43246, 19162, and 
35556. The RUC also recommended maintaining the current work RVUs for 
codes 49321 and 49322 because these services had recently been reviewed 
by the RUC.
    The RUC recommended that the following codes be referred to the CPT 
Editorial Panel for review or clarification: 37720 and 43215.
    HCFA Proposal:
    We have reviewed and propose to accept all of the RUC 
recommendations for these surgery codes.
    Comment: 
    The American College of Surgeons (ACS) submitted general surgery 
codes for review that account for approximately 50 percent of general 
surgery's Medicare-allowed charges for services categorized as surgery 
under our ``type of service'' classification. The procedures are 
predominantly performed by general surgeons, and they involve the 
gastrointestinal tract, abdominal organs, thyroid, lymph system, and 
endocrine system. Requests for review of some of these codes were also 
submitted by other specialty groups.
    In its comments, the ACS emphasized that its analysis determined 
that the work of codes in general surgery has been systematically 
undervalued.
    The ACS used a building-block approach with panel-assigned 
intraoperative work intensities for procedures. Preoperative work RVUs 
were determined based on an assigned intensity multiplied by the number 
of preservice minutes. The assigned preservice work intensity was below 
that of an evaluation and management service. A panel of ASC members 
assigned intraservice work intensity to each code using a scale. The 
intensity of an evaluation and management service was the low end of 
the scale, and liver resection services were on the high end of the 
scale. The ends of the scale were chosen to represent ``average'' work 
intensity throughout a procedure. The ACS maintains that the work 
intensity of any surgical procedure is greater than the work intensity 
of an evaluation and management service. Postservice work RVUs were 
calculated using current work RVUs for hospital visits and discounted 
work RVUs for office visits. Pre, intra-, and postwork RVUs were summed 
to equal the new work RVUs that the ACS developed for each code.

[[Page 31049]]

    The ACS assigned over 300 codes to 31 families of similar services 
(for example, all codes related to hernia repair were in one family). 
It conducted a traditional RUC survey for 32 codes (either high volume 
services or the service most representative of the family of codes). A 
minisurvey, which did not include a respondent-recommended work value, 
was conducted for the remaining codes, with participation from other 
specialty groups. The ACS indicated that the survey respondents tended 
to overvalue codes at the low end of the scale and undervalue codes at 
the high end of the scale. As a result, ACS recommended using the 25th 
percentile of survey results at the low end and the 75th percentile for 
work RVUs at the high end of the scale for fully-surveyed codes. 
However, they stated that acceptance of these survey results without 
adjustments to other codes in the family that were not fully surveyed 
would distort the relativity within and across families. They 
recommended a regression methodology to extrapolate the fully-surveyed 
code results to the other codes.
    RUC Recommendation: 
    The RUC workgroup reviewed the data collected for the 32 fully-
surveyed ACS codes. It also reviewed the families of services proposed 
by ACS and modified the families that were too dissimilar to permit 
appropriate comparison within the family. After the anchor code was 
reviewed, each family was reviewed to determine whether the change to 
the anchor code should be applied to the entire family of codes. In 
some instances the RUC agreed that the recommended change in the anchor 
code should be extrapolated to the entire family to ensure that rank-
order and relativity distortions were not created by a change to the 
anchor code. In other instances the RUC determined that the 
recommendation for the anchor code did not apply to the family of 
codes. In these instances, either new RVUs were recommended or the 
present work RVUs were maintained. The following are the code-specific 
RUC recommendations:

------------------------------------------------------------------------
            CPT codes                            Work RVUs
------------------------------------------------------------------------
                    Family 1A & B  Thyroid/Endocrine
------------------------------------------------------------------------
60220............................  11.90
60252............................  20.57
60254............................  26.99
60260............................  17.47
60270............................  20.27
60271............................  16.83
60540............................  No change
60545............................  No change
------------------------------------------------------------------------
                        Family 2  Lymphadenectomy
------------------------------------------------------------------------
38740............................  8.42
38745............................  11.00
38760............................  10.88
38765............................  19.98
------------------------------------------------------------------------
     Family 3  Lymph Nodes and Lymphatic Channels--Incision/Excision
------------------------------------------------------------------------
38300............................  1.99
38305............................  6.00
38308............................  6.45
38500............................  3.75
38510............................  6.43
38520............................  6.67
38525............................  6.07
38530............................  7.98
------------------------------------------------------------------------
                 Family 4  Intestines--Excision/Incision
------------------------------------------------------------------------
44005............................  16.23
44010............................  12.52
44020............................  13.99
44021............................  14.08
44025............................  14.28
44050............................  14.03
44110............................  11.81
44111............................  14.29
44120............................  17.00
44125............................  17.54
44130............................  14.49
44160............................  18.62
44800............................  11.23
44820............................  12.09
------------------------------------------------------------------------
              Family 5  Intestines--External Fistulization
------------------------------------------------------------------------
44300............................  12.11
44310............................  15.95
44312............................  8.02
44314............................  15.05
44316............................  21.09

[[Page 31050]]

 
44320............................  17.64
44340............................  17.72
44345............................  15.43
44346............................  16.99
------------------------------------------------------------------------
                     Family 6  Intestines--Colectomy
------------------------------------------------------------------------
Codes 44140, 44143, 44144, 44145, 44146, 44150, 44151, 44152, 44153,
 44155, and 44156. The RUC made no changes to any of these codes based
 on the lack of compelling evidence.
------------------------------------------------------------------------
                       Family 7 intestines--Repair
------------------------------------------------------------------------
44602............................  11.91
44603............................  15.72
44604............................  16.03
44605............................  17.25
44615............................  15.93
44620............................  12.20
44625............................  15.05
44626............................  25.36
44640............................  16.65
44650............................  17.12
44660............................  16.42
44661............................  19.07
44680............................  15.40
44700............................  16.11
44850............................  10.74
------------------------------------------------------------------------
               Family 8  Anus/Rectum--Hemorrhoids/Fistula
------------------------------------------------------------------------
45000............................  3.88
45020............................  4.05
45100............................  3.16
45108............................  4.09
46040............................  4.26
46045............................  3.71
46060............................  4.89
46250............................  3.89
46255............................  4.60
46257............................  5.40
46258............................  5.73
46260............................  6.37
46261............................  7.08
46262............................  7.50
46270............................  3.20
46275............................  3.92
46280............................  5.14
46288............................  6.13
46934............................  3.51
46936............................  3.69
46945............................  1.84
46946............................  2.58
 
 Note: All of the work RVUs for Family 8 reflect a recommended decrease
 from the CY 2000 work RVUs.
------------------------------------------------------------------------
     Family 9 A B &C  Anus/Rectum, Anus (destruction)--10-day global
------------------------------------------------------------------------
45900............................  2.61
45905............................  2.30
45910............................  2.80
45915............................  3.14
46221............................  2.04
46754............................  2.20
 
 Note: Based on the lack of compelling evidence, the RUC recommended
 that no changes be made to the following Family 9 codes: 46083, 46230,
 46320, 46935, 46940, 46942, 46900, 46910, 46916, 46917, 46922, and
 46924.
------------------------------------------------------------------------
                      Family 10  Anus/Rectum Repair
------------------------------------------------------------------------
45505............................  7.58
45540............................  16.27
45541............................  13.40
45550............................  23.00
45560............................  10.58
45562............................  15.38
45563............................  23.47

[[Page 31051]]

 
45800............................  17.77
45805............................  20.78
45820............................  18.48
45825............................  21.25
46700............................  9.13
46750............................  10.25
46753............................  8.29
46760............................  14.43
46761............................  13.84
46762............................  12.71
------------------------------------------------------------------------
                            Family 11  Hernia
------------------------------------------------------------------------
49500............................  5.48
49501............................  8.88
49505............................  7.60
49507............................  9.57
49520............................  9.63
49521............................  11.97
49525............................  8.57
49540............................  10.39
49550............................  8.63
49553............................  9.44
49555............................  9.03
49557............................  11.15
49560............................  11.57
49561............................  14.25
49565............................  11.57
49566............................  14.40
49570............................  5.69
49572............................  6.73
49580............................  4.11
49582............................  6.65
49585............................  6.23
49587............................  7.56
49590............................  8.54
------------------------------------------------------------------------
     Family 12 A & B  Stomach--Gastrectomy and Gastrectomy/Vagotomy
------------------------------------------------------------------------
43620............................  30.04
43621............................  30.73
43622............................  32.53
43638............................  29.00
43639............................  29.65
43631............................  22.59
43632............................  22.59
43633............................  23.10
43634............................  25.12
43640............................  17.02
43641............................  17.27
------------------------------------------------------------------------
    Family 13 A & B  Stomach--
     Incision/Excision/Repair
------------------------------------------------------------------------
43500............................  11.05
43501............................  20.04
43502............................  23.13
43510............................  13.08
43520............................  9.99
43605............................  11.98
43610............................  14.60
43611............................  17.84
43800............................  13.69
43810............................  14.65
43820............................  15.37
43825............................  19.22
43830............................  9.53
43832............................  15.60
43840............................  15.56
43870............................  9.69
43842............................  18.47
43843............................  18.65
43846............................  24.05
43847............................  26.92
43848............................  29.39

[[Page 31052]]

 
43850............................  24.72
43855............................  26.16
43860............................  25.00
43865............................  26.52
43880............................  24.65
------------------------------------------------------------------------
                Family 14 A  Abdomen, Peritoneum, Omentum
------------------------------------------------------------------------
The RUC recommended no changes for codes 49000, 49002, 49010, 49200,
 49201, 49220, 49255, 49900, 49421, 49422, 49425, 49426, and 49429.
------------------------------------------------------------------------
                Family 14 B  Abdomen, Peritoneum, Omentum
------------------------------------------------------------------------
49020............................  20.73
49040............................  12.27
49060............................  14.40
49085............................  11.03
------------------------------------------------------------------------
                Family 14 C  Abdomen, Peritoneum, Omentum
------------------------------------------------------------------------
49428............................  6.06
------------------------------------------------------------------------
                           Family 15  Appendix
------------------------------------------------------------------------
44900............................  10.14
44950............................  10.00
44960............................  12.34
========================================================================
                 Family 16  Rectum--Proctectomy/Excision
------------------------------------------------------------------------
45110............................  28.00
45112............................  30.54
45113............................  30.58
45114............................  27.32
45116............................  24.58
45119............................  30.84
45123............................  16.71
45126............................  45.16
45130............................  16.44
45135............................  19.28
45160............................  15.32
45170............................  11.49
45190............................  9.74
------------------------------------------------------------------------
                        Family 17  Biliary Tract
------------------------------------------------------------------------
47420............................  19.88
47425............................  19.83
47460............................  18.04
47480............................  10.82
47600............................  13.58
47605............................  14.69
47610............................  18.82
47612............................  18.78
47620............................  20.64
47711............................  23.03
47712............................  30.24
47715............................  18.80
47716............................  16.44
47720............................  15.91
47721............................  19.12
47740............................  18.48
47741............................  21.34
47760............................  25.85
47765............................  24.88
47780............................  26.50
47785............................  31.18
47800............................  23.30
47801............................  15.17
47802............................  21.55
47900............................  19.90
------------------------------------------------------------------------
               Family 18  Esophagus--Repair/Reconstruction
------------------------------------------------------------------------
43320............................  19.93

[[Page 31053]]

 
43324............................  20.57
43325............................  20.06
43326............................  19.74
43330............................  19.77
43331............................  20.13
43340............................  19.61
43341............................  20.85
43350............................  15.78
43351............................  18.35
43352............................  15.26
43360............................  35.70
43361............................  40.50
43400............................  21.20
43401............................  22.09
43405............................  20.01
43410............................  13.47
43415............................  25.00
43420............................  14.35
43425............................  21.03
------------------------------------------------------------------------
                            Family 19  Liver
------------------------------------------------------------------------
47010............................  16.01
47015............................  15.11
47100............................  11.67
47120............................  35.50
47122............................  55.13
47125............................  49.19
47130............................  53.35
47300............................  15.08
47350............................  19.56
47360............................  26.92
47361............................  47.12
47362............................  18.51
47400............................  32.49
------------------------------------------------------------------------
   Family 20 A & B  Spleen--Incision/Excision/Repair and Pancreatitis
                               Management
------------------------------------------------------------------------
38100............................  14.50
38101............................  15.31
38115............................  15.82
48000............................  28.07
48001............................  35.45
48005............................  42.17
------------------------------------------------------------------------
                        Family 21  Pancreatectomy
------------------------------------------------------------------------
48020............................  15.70
48100............................  12.23
48120............................  15.85
48140............................  22.94
48145............................  24.02
48146............................  26.40
48148............................  17.34
48150............................  48.00
48152............................  43.75
48153............................  47.89
48154............................  44.10
48155............................  24.64
48180............................  24.72
48500............................  15.28
48510............................  14.31
48520............................  15.59
48540............................  19.72
48545............................  18.18
48547............................  25.83
------------------------------------------------------------------------
                         Family 22  Laparoscopy
------------------------------------------------------------------------
The RUC recommended no changes to the following codes based on lack of
 compelling evidence: 43651, 43652, 44200, 44970, 47562, 47563, 47564,
 47570, 49320, 49650, and 49651.
------------------------------------------------------------------------


[[Page 31054]]

    The RUC also recommended that the following codes be referred to 
the CPT Editorial Panel for review and clarification: 36533, 36534, 
36535, 49495, and 49496.
    HCFA Proposal:
    The ACS conducted full surveys of 32 codes, and we agreed with the 
RUC analysis for most of the 32 codes. For the other codes the ACS did 
minisurveys that included pre-, intra-, and postservice times as well 
as the number and type of postservice visits. These minisurveys did not 
include an estimate of the relative work for the procedure. For this 
reason, the RUC used an extrapolation methodology to arrive at its work 
RVU recommendations for all codes that did not have a full RUC survey. 
To make appropriate extrapolations, the RUC divided all of the general 
surgery codes into families of related procedures. At least one code in 
each family was fully surveyed. After the RUC recommended work RVUs for 
each surveyed code, it applied the percent change for that code to all 
of the other codes in the family. When more than one code was fully 
surveyed within a family of services, the RUC extrapolated the 
percentage from the fully surveyed code that would produce the least 
increase in work RVUs.
    The validity of this extrapolation methodology relies on at least 
two things--first, that the relative work values of all codes in the 
family were correct before the extrapolation (or else the extrapolation 
perpetuates and magnifies any pre-existing anomalies), and second, that 
the relative misvaluation of each code in a family is similar.
    We did an analysis of all the families of codes in the general 
surgery group to determine whether the relative valuations in the 2001 
physician fee schedule contained any anomalies. If any anomalies 
existed, we reviewed the RUC recommendations to determine whether the 
anomalies were addressed by the RUC recommendations. If the anomalies 
were not corrected, we took steps to correct them.
    We also analyzed all of the recommended values for general surgery 
to ensure that the percentage changes for each family were appropriate. 
To determine if the extrapolation for each family was correct, we 
compared each extrapolated code to codes in other families, and to 
codes in other specialties. We compared extrapolated codes to codes 
whose current or RUC recommended work RVUs (from the 5-year-review) 
were similar to the extrapolated code. We then compared the preservice, 
intraservice, and postservice physician times as well as the number of 
postoperative visits. In addition, we generally determined whether the 
survey vignette was typical for the procedure. The following is an 
example of our review of the general surgery codes. Code 35132 (Direct 
repair of aneurysm, false aneurysm, or excision (partial or total) and 
graft insertion, with or without patch graft; for ruptured aneurysm, 
iliac artery (common, internal, external) (30.00 work RVUs) with a 
preservice time of 67 minutes, intraservice time of 180 minutes, seven 
hospital visits, and three office visits is similar to codes 47712 
(Excision of bile duct tumor, with or without primary repair of bile 
duct; intrahepatic) (30.24 work RVUs) with a preservice time of 75 
minutes, intraservice time of 210 minutes, one intensive care unit 
visit, nine hospital visits, and three office visits and 43638 
(Gastrectomy, partial, proximal, thoracic or abdominal approach and 
esophagogastrostomy with vagotomy) (29.00 work RVUs ) with a preservice 
time of 75 minutes, intraservice time of 210 minutes, 10 hospital 
visits, and 4 office visits. A review of these codes demonstrates the 
similarity in preservice and intraservice time and the proposed RVUs 
maintain relativity across surgical specialties.
    Upon completion of this analysis, we propose to accept the RUC 
recommendations for the following families of services:

Family 1A and 1B  Thyroid and Endocrine.
Family 3  Lymph Nodes and Lymphatic Channels--Incision/Excision.
Family 4  Intestines--Excision/Incision.
Family 5  Intestines--External Fistulization.
Family 9  Anus/Rectum--10-day global period.
Family 10  Anus/Rectum--Repair.
Family 11  Hernia.
Family 12  Stomach--Gastrectomy/Vagotomy.
Family 13  Stomach--Incision/Excision/Repair.
Family 14A and C  Abdomen, Peritoneum, Omentum.
Family 15  Appendectomy.
Family 16  Rectum-Proctectomy/Excision.
Family 17  Biliary Tract.
Family 18  Esophagus--Repair/Reconstruction.
Family 19  Liver.
Family 20  Pancreas/Spleen--Incision/Excision/Repair. 
Family 21  Pancreatectomy.
Family 22  Laparoscopy.

    For the above families, adopting the RUC-recommended RVUs maintains 
relativity of the codes based upon a comparison of the codes to 
procedures in other families and within the family.
    For other families of services, the extrapolation methodology 
inappropriately values codes or does not address current rank-order 
anomalies. Application of the percentage increases derived from the 
RUC's extrapolation methodology would only exacerbate any current rank-
order anomalies within families. Below, we have outlined, for each 
family of services, our proposed work RVUs to rectify these problems.

Family 2  Lymphadenectomy

    The RUC recommended an increase in work RVUs for the fully surveyed 
code 38745 (Axillary lymphadenectomy; complete) from 8.84 to 11.0 RVUs 
based on comparisons with codes 60210 (Partial thyroid lobectomy, 
unilateral, with or without isthmusectomy), and 32100 (Thoracotomy, 
major with exploration and biopsy). We disagree. Although codes 38745 
and 60210 are performed in the outpatient setting and 32100 is not, 
code 38745 requires more postoperative wound care. Additionally, the 
RUC compared 38745 to the pre-5-year review value of 32100. 
Subsequently the RUC reviewed code 32100 for the 5-year review and is 
recommending an RVU increase to 15.24 RVUs. Because the intraservice 
times for codes 38745 and 32100 are identical and 38745 requires more 
postoperative wound care, a clear rank order anomaly would exist if 
38745 was valued at 11.00 work RVUs and 32100 was valued at 15.24 work 
RVUs. Therefore, we are assigning the median survey RVUs of 13.00 to 
code 38745. We would also note that the survey RVU spread from the 25th 
percentile to the 75th percentile ranged from 12.15 to 14.29 RVUs, 
which is relatively small. An RVU of 13.00 places code 38745 in the 
correct rank order to the comparison codes. To maintain relativity 
within this family, we are extrapolating the 47 percent increase in 
work RVUs of code 38745 to codes 38740 (Axillary lymphadenectomy; 
superficial) and 38760 (Inguinofemoral lymphadenectomy, superficial, 
including Cloquets node (separate procedure)) for proposed work RVUs of 
10.02 and 12.94, respectively. However, code 38765 (Inguinofemoral 
lymphadenectomy, superficial, in continuity with pelvic 
lymphadenectomy, including external iliac, hypogastric, and obturator 
nodes (separate procedure)) represents a rank-order anomaly as it is 
currently valued too high relative to the other codes in the family. 
Therefore, we are accepting

[[Page 31055]]

the RUC recommendation for code 38765 of 19.98 work RVUs.

Family 6  Colectomy

    The RUC recommended no change in the work RVUs for this family of 
codes based on lack of compelling evidence for changing the RVUs of the 
fully surveyed code 44140 (Partial colectomy). Moreover, the 
intraservice time for code 44140 had not changed since the last 5-year 
review. Additionally, the RUC compared code 44140 to code 32480 
(Removal of lung, other than total pneumonectomy; single lobe 
(lobectomy)) and code 50230 (Nephrectomy, including partial 
ureterectomy, any approach including rib resection; radical, with 
regional lymphadenectomy and/or vena caval thrombectomy) that have 
similar work RVUs to 44140 and were believed to be longer, more intense 
procedures with more postoperative care. We disagree with this 
recommendation. If the RVUs for procedures in this family are not 
changed, the procedures will be significantly undervalued compared to 
other general surgery codes (Family 5 and Family 7) and vascular 
surgery codes. As an example, we note that the RUC-recommended work RVU 
for code 44153 Colectomy, total, abdominal, without proctectomy; with 
rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir 
(S or J), with or without loop, will significantly undervalue this code 
compared to code 45113, Proctectomy, partial, with rectal mucosectomy, 
ileoanal anastomosis, creation of ileal reservoir (S or J), with our 
without loop ileostomy, thus creating a rank-order anomaly.
    We compared code 44140 to code 32480 for which the RUC is 
recommending a work RVU increase to 23.75. These procedures have 
similar intraservice times, and the postoperative visits show that 
although the initial care required for code 32480 is more intense, the 
length of stay for code 44140 is frequently longer. We also compared 
code 44140 to codes 37617, Ligation, major artery (eg post-traumatic, 
rupture); abdomen, and 35221, Repair blood vessel, direct; intra-
abdominal. Code 37617, for which the RUC recommended work RVUs of 
22.06, is an emergency operation with a slightly shorter intraservice 
time and shorter hospital stay. Code 35221, which has RUC-recommended 
work RVUs of 24.39, is also an emergency operation with an intraservice 
time and length of stay identical to code 44140. Based on these 
comparisons, we believe that the survey's 25th percentile work RVUs of 
21.00 are appropriate and correctly rank code 44140 to the comparison 
procedures. This increase is 14 percent greater than the current work 
RVUs and, with the exception of the two codes discussed below, applying 
this 14 percent increase to the other codes in this family will place 
them in proper relationship to other comparable procedures.
    Family 6 contains two current rank-order anomalies: code 44151, 
Colectomy, total, abdominal, without proctectomy; with continent 
ileostomy, has lower work RVUs than code 44150, Colectomy, total, 
abdominal, without proctectomy; with ileostomy or ileoproctostomy, and 
44156, Colectomy, total, abdominal, with proctectomy; with continent 
ileostomy, has lower work RVUs than code 44155, Colectomy, total, 
abdominal, with proctectomy; with ileostomy. Code 44151 is identical to 
code 44150, and code 44156 is identical to code 44155, except that 
codes 44151 and 44156 involve the creation of a ``continent ileostomy'' 
instead of an ``ileostomy or ileoproctostomy.'' The work of creating a 
``continent ileostomy'' is greater than the work of creating an 
``ileostomy or ileoproctostomy.'' To correct this rank-order anomaly, 
we applied the 14 percent increase discussed above to codes 44150 and 
44155. Next, we determined the proper incremental increase in work for 
creation of a ``continent ileostomy'' by looking to codes 44310, 
Ileostomy or jejunostomy, non-tube (separate procedure), and 44316, 
Continent Ileostomy (Kock procedure) (separate procedure), because the 
work RVUs of 44316 are the same as the work RVUs of 44310 with the 
addition of creating a continent ileostomy. We subtracted the RUC-
recommended work RVUs of 15.95 for code 44310 from the RUC-recommended 
work RVUs of 21.09 for code 44316 and divided by 50 percent (50 percent 
approximates the intraservice portion of the extra work). This resulted 
in work RVUs of 2.57 that we increased by 14 percent to yield work RVUs 
of 2.93. We then added 2.93 work RVUs to the RVUs for codes 44150 and 
44155 to yield proposed work RVUs of 26.88 for code 44151 and 30.79 for 
code 44156.
    In summary, we propose the following work RVUs for the codes in 
this family:

------------------------------------------------------------------------
                            Code                              Work RVUs
------------------------------------------------------------------------
44140......................................................        21.00
44143......................................................        22.99
44144......................................................        21.53
44145......................................................        26.42
44146......................................................        27.54
44150......................................................        23.95
44151......................................................        26.88
44152......................................................        27.83
44153......................................................        30.59
44155......................................................        27.86
44156......................................................        30.79
------------------------------------------------------------------------

    With these assigned work RVUs, we believe that Family 6 is ranked 
appropriately in relation to other general and vascular surgery codes.

Family 7  Intestines--Repair

    The RUC recommended an increase of 14 percent for all work RVUs in 
this family based on a recommended increase in a fully surveyed code 
44604 (Suture of large intestine (colorrhaphy) for perforated ulcer, 
diverticulum, wound, injury or rupture (single or multiple 
perforations); without colostomy) from 14.28 work RVUs to 16.03 work 
RVUs.
    We agree with the increase in work RVUs for code 44604 but note 
that there are several rank-order anomalies currently in this family of 
codes that would be exacerbated by an across-the-board increase in work 
RVUs. Therefore, we propose to correct the rank-order anomalies as 
follows:
    We propose 16.03 work RVUs for 44602 (Suture of small intestine 
(enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or 
rupture; single perforation). The work RVUs for code 44602 are 
identical to the work RVUs for code 44604 because they describe the 
same procedure except code 44604 is for the large intestine.
    We propose work RVUs of 19.53 for code 44605 (Suture of large 
intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, 
injury or rupture (single or multiple perforations); with colostomy). 
The work RVUs for code 44605 are identical to the work RVUs for code 
44604 except that code 44605 includes creating a colostomy with the 
attendant increase in postoperative wound care. The intraservice work 
of creating a colostomy is captured by subtracting the work RVUs for 
code 44140 from code 44143, which leaves 1.99 RVUs. In addition, there 
is one extra postoperative visit required for code 44605 that we 
believe is equivalent to code 99233 that has 1.51. work RVUs. 
Therefore, we added 1.99 and 1.51 work RVUs to the work RVUs for code 
44604 to arrive at 19.53 work RVUs for code 44605.
    We propose 18.66 work RVUs for code 44603 (Suture of small 
intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, 
injury or rupture; multiple perforations). The additional work required 
for code 44603 as compared to code 44602 is similar to the additional 
work required for code 44605

[[Page 31056]]

as compared to code 44604 except, since there is no actual colostomy, 
the additional postoperative visit is comparable to code 99231 with 
0.64 work RVUs. Therefore, we added work RVUs of 1.99 and 0.64 to the 
work RVUs of code 44602 to arrive at 18.66 work RVUs for code 44603.
    The current work RVUs for codes 44640 (Closure of intestinal 
cutaneous fistula); 44650 (Closure of enteroenteric or enterocolic 
fistula); 44660 (Closure of enterovesical fistula; without intestinal 
or bladder resection); and 44661 (Closure of enterovesical fistula; 
with bowel and/or bladder resection) are rank-order anomalies as they 
are undervalued compared to code 44604. However, relativity among codes 
44640, 44650, 44660, and 44661 is appropriate. To correct the 
anomalies, we compared codes 44650 to 50525 (Closure of nephrovisceral 
fistula (eg renocolic) including visceral repair; abdominal approach), 
which involves similar intraoperative and postoperative work. The 
intraoperative work for code 50525 is greater than that of code 44650 
because code 50525 involves visceral repair but the postoperative work 
for code 44650 is greater than the postoperative work for code 50525 
because the fistula is enteroenteric or enterocolic as opposed to 
renovisceral (that is, renocolic). Therefore, we propose to assign 
22.27 work RVUs to code 44650 and, to keep the current relativity with 
the other codes, we propose 21.65 work RVUs for code 44640, 21.36 work 
RVUs for code 44660, and 24.81 work RVUs for code 44661. We propose to 
accept the RUC recommendations for the remaining codes (44615, 44620, 
44625, 44626, 44680, 44700, and 44850).

Family 8 Anus/Rectum--Hemorrhoids/Fistula

    The RUC extrapolated a 14 percent decrease in work RVUs to all 
codes in this family based upon a decrease in work RVUs for the fully 
surveyed code 46262, Hemorrhoidectomy, internal and external, complex 
or extensive; with fistulectomy, with or without fissurectomy. We agree 
with the RUC recommendation for the surveyed code, but disagree with 
the extrapolation to the anal fistula repair codes and the anal abscess 
treatment codes. The surveyed intraoperative time for code 46262 is not 
consistent with the surveyed intraoperative times for many of the other 
codes in the family. Moreover, the work RVUs for many of the codes 
subject to the minisurveys are significantly less than for code 46262 
and are not comparable. Therefore, we propose to maintain the current 
RVUs for codes 46270, 46275, 46280, 46288, 45000, 45020, 45100, 45108, 
46040, 46045, and 46060. We agree with the RUC recommendations and 
propose to decrease the work RVUs for other codes in this family of 
codes (46250, 46255, 46257, 46258, 46260, 46261, 46262, 46934, 46936, 
46945, and 46946).

Family 14B  Abdomen, Peritoneum, Omentum

    The RUC recommended an increase for the fully-surveyed code 49020, 
(Drainage of peritoneal abscess or localized peritonitis, exclusive of 
appendiceal abscess; open,) from 16.79 work RVUs to 20.73 work RVUs, 
the 25th percentile of surveyed work RVUs, based on a comparison to 
code 61312 (Craniectomy or craniotomy for evacuation of hematoma, 
supratentorial; extradural or subdural). We disagree and propose the 
surveyed median work RVUs of 22.84. We compared code 49020 to code 
35151 (Direct repair of aneurysm, false aneurysm, or excision (partial 
or total) and graft insertion, with or without patch graft; for 
aneurysm, false aneurysm and associated occlusive disease, popliteal 
artery), 48000 (Placement of drains, peripancreatic, for acute 
pancreatitis), and code 48140 (Pancreatectomy, distal subtotal, with 
our without splenectomy; without pancreaticojejunostomy). Code 48000 
involves sicker patients but the intraoperative time (120 minutes) and 
postoperative visits (10-day length of stay for code 48000 with two 
critical care visits versus an 11-day length of stay for code 49020 
with one critical care visit) are similar, and code 48000 has RUC-
recommended work RVUs of 28.07. Code 48140, with RUC-recommended work 
RVUs of 22.94, has a longer intraoperative time (150 minutes) with a 
shorter length of stay (9 days with one critical care visit) and 
involves less sick patients. Code 35151, with RUC-recommended work RVUs 
of 22.64, involves patients not nearly as ill as patients for whom code 
49020 is reported, has a surveyed intraoperative time of 150 minutes, 
and a 5-day length of stay with no critical care visits. Therefore, we 
propose the median surveyed work RVUs of 22.84 for code 49020. Since 
the current relativity within this family is correct, we propose to 
extrapolate this increase of 36 percent to the other codes in this 
family and value the work as follows: 49040 (13.52), 49060 (15.86), and 
49085 (12.14).
    Comment: The American Society of Colon and Rectal Surgeons 
collaborated with the ACS and submitted 12 codes for review that they 
believe to be undervalued. They also expressed support for the 
methodology proposed by ACS to value services. The specific codes 
referenced were: 44130, 44144, 44147, 44151, 44156, 44394, 45111, 
45113, 45337, 45339, 45910, and 46258.
    RUC Recommendation:
    The RUC recommended increasing the work RVUs for the following 
codes: 44130 (14.49), 45113 (30.58), and 45910 (2.80) to retain current 
rank-order and relativity within the grouping of services. However, for 
code 46258, the RUC recommended decreasing the work RVUs to 5.73 to 
retain the current rank-order and relativity within these services.
    For codes 44147, 44394, 45111, 45337, 45339, 44144, 44151, and 
44156, the RUC did not receive compelling evidence to suggest an 
increase was needed in the work RVUs; therefore, the RUC recommended 
that the current work RVUs for these codes be maintained.
    HCFA Proposal: We propose to accept all but one of the RUC 
recommendations for the surgical codes submitted by the American 
Society of Colon and Rectal Surgeons. For code 44147, Colectomy, 
partial; abdominal and transanal approach, we are proposing to increase 
the work RVUs by 14 percent to 20.71. This is similar to the increase 
applied to ACS family 6 and will prevent a rank-order anomaly.
    Comment: The American Academy of Otolaryngology-Head and Neck 
Surgery submitted codes, on behalf of the American Otological Society 
and the American Academy of Facial Plastic and Reconstructive Surgery, 
that they believe to be undervalued, along with suggested new work RVUs 
for each service. However, subsequent to the submission of their 
comments, the specialty society chose not to pursue revaluing of the 
following codes: (69450, 69436, 69440, 69631, 69205, 69801, 69633, 
69501, 69632, 69905, 69666, 69650, 69806, 69667, 69720, 69641, 69550, 
69636, 69637, 69643, 69140, 69505, 69635, 69502, 69645, 69511, 69601, 
69602, 69642, 69603, 69644, 69910, 69660, 69604, 69646, 69662, 69661, 
69930, 69145, 69676, 69310, 69620, 69805, 69670, 69700, 69802, 69320, 
69530, 69820, 68711, 69840, 69540, 69421, 69552, 69150, 69915, 69605, 
69300, 69000, 69005, 69020, 69711, 69100, 69105, 69110, 69120, 69140, 
69145, 691500, 69155, 69200, 69205, 69210, 69220, 69222, 69300, 69310, 
69320, 69400, 69401, 69405, 69410, 69420, 69421, 69424, 69433, 69436, 
69535, 69554, 69610, 69725, 69740, 69745, 69950, 69955, 69960, 69970).

[[Page 31057]]

    RUC Recommendation: For codes 69990, 11642, 13131, and 13132, the 
RUC recommends no change to the current RVUs for these services, as 
compelling evidence was not provided to demonstrate the need for an 
increase.
    HCFA Proposal: We have reviewed and propose to accept all of the 
RUC recommendations for the surgical codes submitted by the American 
Academy of Otolaryngology-Head and Neck Surgery.
3. Thoracic Surgery
    Comment: In their comments, the Society of Thoracic Surgeons (STS) 
indicated that there have been major changes in the practice of 
thoracic surgery since the initial development of the physician fee 
schedule. These major changes in surgical techniques, along with 
changes in the typical patient, have had an impact on physician work. 
Time and intensity of a number of procedures, including the reference 
procedures used by STS, have been affected.
    The STS grouped codes into three categories: general thoracic 
surgery, adult cardiac surgery, and congenital thoracic surgery. These 
three categories were grouped into 23 families of codes. Each family 
had an anchor code that received a full RUC survey. Each of the 
remaining codes in a family received a minisurvey. The minisurvey 
collected information on time and the number of postoperative visits. 
The minisurvey also asked respondents to estimate work RVUs for the 
procedure based on the reference service for the family of codes.
    The RUC had a number of concerns with the STS approach. They are as 
follows: (1) The RUC concluded that STS inappropriately had the same 
survey respondents review and estimate both misvalued services and 
reference services. (2) In many instances, the respondents valued the 
code under review relative to their perception of what the reference 
code value should be, not the current value of the reference code. (3) 
The STS also used too many minisurveys and too few full surveys. (4) 
Within a family of codes, the STS inappropriately mixed codes with 
different global periods.
    To overcome these methodological problems, the RUC first reviewed 
the reference service that was used for each family, and the resulting 
value was compared to the codes in each family. For the adult cardiac 
surgery codes, the RUC developed a building-block methodology to 
validate the survey results. For the congenital thoracic codes, 
previous RUC reviews of the codes were used to determine how the work 
has changed since the last 5-year review. In addition, for the 
pediatric thoracic codes, the specialty's society's presenter offered 
additional information demonstrating that the patient population has 
changed, (for example, more neonates) leading to a higher intensity of 
work.
    Additionally, The STS subsequently chose not to pursue review of 
code 33207 under the 5-year review.
    RUC Recommendations: The RUC reviewed 89 thoracic surgery codes. Of 
this total, the RUC recommended increases for 44 codes, no changes for 
43 codes, and decreases for 2 codes. The recommendations by family are 
as follows:
    Family 1: The RUC generally found that the STS had not furnished 
compelling evidence or that the STS inappropriately compared codes with 
a zero global period to codes with a 90-day global period. The RUC 
recommended no increase in work RVUs for codes 32000, 32005, 32020, 
32035, 32225, 32602, 32651, and 32652. The RUC recommended increases in 
work RVUs for code 32220 (24.00) and code 32320 (24.00), based on the 
median surveyed work RVUs which would place these codes in proper rank 
order.
    Family 2: The RUC recommended increases for code 32440 (25.00) 
based on the median survey value, and code 32480 (23.75) based on the 
value of 43415. The RUC also recommended increases in work RVUs for 
codes 32100 (15.24) and 32110 (23.00) based on a comparison to code 
58150. These values place all these codes in proper rank order.
    Family 3: The RUC recommended increases in codes 32482 (25.00) and 
32500 (22.00), based on the STS surveyed median work RVUs for each 
code, which would create the proper rank order within the family of 
codes.
    Family 4: The RUC recommended no increase for code 32655 because 
the STS had not furnished compelling evidence for an increase in work. 
The RUC recommended increases for codes 31600 (7.18) and 32500 (22.00) 
based on survey data, a sicker patient population, and, in the case of 
31600, comparison to 35474.
    Family 5: The RUC recommended increases for codes 38746 (4.89) 
based on the work RVU for 38747, but recommended no increases for codes 
39010, 39220 or 39400 due to lack of compelling evidence or 
inappropriate comparisons to codes with 90-day global periods.
    Family 6: The RUC agreed with the STS analysis of work for codes 
43107 (40.00) and 43112 (43.50) and stated that using the survey median 
for each code correctly rank ordered these codes in the family of 
esophagectomy codes.
    Family 7: The RUC recommended an increase for code 43117 (40.00) 
after comparing it to the reference service code 43361 which had 
similar data. The RUC also recommended an increase for code 43122 
(40.00) based on the survey median of 40.00 work RVUs which correctly 
rank ordered this code in the family of esophagectomy codes.
    Family 8: The RUC recommended no increase for codes 31625 or 31645 
because the STS did not furnish compelling evidence for an increase in 
work.
    Family 9: The RUC recommended increases for the following codes: 
33400 (28.50), 33405 (35.00), 33406 (37.50), 33411 (36.25), 33412 
(42.00), and 33413 (43.50), based on a building-block approach that 
used code 33405 as the anchor code for this family.
    Family 10: The RUC recommended increases for the following codes: 
33426 (33.00), 33427 (40.00), 33430 (33.50), and 33475 (33.00), based 
on a building-block approach that used code 33427 as the anchor code 
for this family. The RUC recommended no increases for codes 33425 or 
33468 because the building-block approach did not support the STS's 
requested increase.
    Family 11: The RUC recommended increases for the following codes: 
33510 (29.00), 33511 (30.00), 33512 (31.80), and 33513 (32.00), based 
on a building-block approach that used code 33512 as the anchor code 
for the family. The RUC recommended decreases for codes 33514 (32.75) 
and 33516 (35.00). These were the values recommended by the STS and 
validated through the building-block approach.
    Family 12: The RUC recommended no increases for the following add-
on codes: 33517, 33518, 33519, 33521, 33522, 33523, and 33530, because 
it believes that they were inappropriately surveyed as 90-day global 
procedure codes and the results were not reliable.
    Family 13: The RUC recommended increases in work RVUs for the 
following codes: 33533 (30.00), 33534 (32.20), 33535 (34.50), and 33536 
(37.50), based on a building-block approach that used code 33533 as the 
anchor code for the family of codes. The RUC recommended no increase 
for code 33530 because it is an add-on code and was inappropriately 
surveyed as a 90-day global surgical procedure.
    Family 14: The RUC recommended increases in work RVUs in the 
following codes: 33860 (38.00), 33861 (42.00), 33863 (45.00), and 33870 
(44.00) based on a building-block approach that used code 33860 as the 
anchor code for the family. The RUC recommended no increase for code 
33945 because the building-block approach did not

[[Page 31058]]

support the higher value requested by the STS.
    Family 15: The RUC recommended no increases in work RVUs for the 
following codes: 33750, 33820, and 33840, due to lack of compelling 
evidence to support an increase.
    Family 16: The RUC recommended an increase in code 33660 (30.00) 
based on intraservice work RVUs for 33401 and pre- and postservice work 
RVUs for 33641. The RUC recommended no increase in code 33641 as it did 
not find any compelling evidence to warrant a change in the work RVUs.
    Family 17: The RUC recommended no increase in work RVUs for code 
33415, because it did not believe that the typical patient for this 
procedure has changed, and the minisurvey did not provide compelling 
evidence to justify a change in the work RVUs. However, the RUC 
recommended an increase in work RVUs in code 33681 (30.61), because the 
intraservice intensity of 33681 is more complex than it was 5 years 
ago.
    Family 18: The RUC recommended increases in the following codes: 
33615 (34.00), 33670 (35.00), and 33730 (34.25) based on a comparison 
to code 33412.
    Family 19: The RUC recommended increases in work RVUs for the 
following codes: 33611 (34.00), 33612 (35.00), 33694 (34.00) and 33697 
(36.00). The RUC compared the intraservice time of code 33611 to the 
family anchor code of 33694 and recommended 34.00 work RVUs to maintain 
proper rank order in the family. The RUC compared code 33612 to code 
33611 and agreed code 33612 was equivalent to 33611 plus 1 additional 
work RVU. The RUC compared code 33694 to 33412 and concluded that all 
measures of physician work were greater for 33694. The RUC compared 
code 33697 to 33694 and recommended 36.00 work RVUs to maintain rank 
order. The RUC recommended no increase for 33767 because there was no 
compelling evidence for a change in the work RVUs.
    Family 20: The RUC recommended an increase in code 33617 (37.00), 
after comparing it to code 33412 and noting that 33617 has greater 
intraservice time and higher intensity ranking than code 33412.
    Family 21: The RUC recommended an increase in code 33619 (45.00) 
after comparing it to codes 48150 and 62530.
    Family 22: The RUC recommended an increase in code 33506 (35.50) to 
preserve proper rank order within this family. The RUC recommended an 
increase in code 33770 (37.00) after finding that the work of this code 
is more than that of the comparison code 33697. The RUC recommended an 
increase in code 33778 (40.00), after comparing it to 33870, and 33412 
which are less intense procedures. The RUC recommended an increase in 
code 33780 (41.75), based on a comparison to 33778. 33780 involves more 
work and warrants an additional 1.75 RVUs due to the additional 35 
minutes of intraservice time.
    Family 23: The RUC recommended an increase in code 33786 (39.00) 
after comparing it to 33412, which has less time and intensity. Given 
the limited specialty survey data, the RUC believed that the 
recommended increase in code 33919 to 40.00 work RVUs was warranted, 
but that the survey did not support a value higher than the median 
survey value.
    Based on information supplied to the RUC, the RUC did not recommend 
a change in RVUs for codes 32520, 33917, 31622, and 32657. For codes 
32095, 33410 and 32491, the RUC indicated that it had recently reviewed 
these codes, and thus it recommended no change. The RUC recommended 
that codes 33875, 33877, 43107, and 43112 be referred to the CPT 
Editorial Panel.
    HCFA Proposal:
    We validated the RUC recommendations by comparing the thoracic 
surgery codes to vascular surgery and general surgery codes and propose 
to use the RUC-recommended work RVUs for the thoracic codes based on 
our own analysis. The following is an example of our review of the 
thoracic surgery codes. We compared code 32440 (Removal of lung, total 
pneumonectomy) (25.00 work RVUs) with a preservice time of 90 minutes, 
intraservice time of 160 minutes, one intensive care unit visit, six 
hospital visits, and three office visits with the following surgical 
codes in other surgical specialties: code 34151 (Embolectomy or 
thrombectomy, with or without catheter; renal, celiac, mesentery, 
aortoiliac artery, by abdominal incision) (25.00 work RVUs) with a 
preservice time of 75 minutes, intraservice time of 150 minutes, seven 
hospital visits, and three office visits and code 44150 (Colectomy, 
total, abdominal, without proctectomy; with ileostomy or 
ileoproctostomy) (23.95 work RVUs) with a preservice time of 63 
minutes, intraservice time of 200 minutes, eight hospital visits, and 
three office visits. A review of these codes demonstrates the 
similarity in preservice time and intraservice time and the proposed 
RVUs maintains relativity across surgical specialties.
4. Orthopedic Surgery
    Comment: The American Academy of Orthopaedic Surgeons forwarded 42 
codes for review. It indicated that these codes were undervalued when 
compared to their respective reference codes.
    RUC Recommendation:
    The RUC recommended increasing the work RVUs for the following 
codes: 29883 (11.05) because this service consists of two procedures; 
29889 (16.00) based on increase in post and intraservice work; 29450 
(2.08) based on the increased intraservice time for manipulating the 
foot of the patient; code 28299 (9.18) which is of value equal to the 
reference code, with the understanding that the code be sent to CPT 
Editorial Panel to better define the code; code 28705 (18.80), which 
more accurately reflects the work of the two distinct services of this 
procedure (ankle fusion and triple arthrodesis); code 23472 (21.10) to 
correct a rank-order anomaly; code 26562 (15.00) to correct a rank-
order anomaly; code 20245 (8.50) to correct a rank-order anomaly; code 
27075 (35.00) noting that this is a major operation and there is 
increased intraservice time with respect to the reference code; code 
27077 (40.00) noting that this a major operation and there is increased 
intraservice time with respect to the reference code; 27284 (23.45) 
because this is the value for code 27227 that has identical pre-, 
intra-, and postservice times; code 27286 (23.45) to avoid creating a 
rank-order anomaly due to the recommended work RVUs increase of code 
27284; code 27822 (11.00) to correct an existing rank-order anomaly; 
code 27823 (13.00) to avoid creating a rank-order anomaly caused by 
increasing code 27822; code 28445 (15.62) to correct a rank-order 
anomaly and appropriately reflect the work involved; code 27724 (18.20) 
to reflect the work for obtaining a graft that was not included in the 
last 5-year review.
    The RUC believed that the commenter provided no compelling evidence 
to revise the work RVUs for codes 27280, 27282, 23585, 23615, 23630, 
23680, 24545, 27216, 27217, 27218, 27226, 27236, 27513, 27536, 27828, 
23485, 24435, 27472, 28322, and 28420. Therefore, the RUC recommended 
the current work RVUs be maintained for these codes.
    The RUC referred the following codes to the CPT Editorial Panel for 
clarification: 23076, 24076, 25076, 27048, 27328, 27619, and 20205, 
because these codes are being reported incorrectly.
    HCFA Proposal:

[[Page 31059]]

    We propose to accept all but one of the of the RUC recommendations 
for the orthopedic surgery codes. For code 20245, (Biopsy, bone, 
excisional; deep (eg, humerus, ischium, femur), the RUC recommended an 
increase from 3.95 work RVUs to 8.5 work RVUs and compared code 20245 
to codes 27635 (Excision or curettage of bone cyst or benign tumor, 
tibia or fibula), and 27607 (Incision (eg, osteomyelitis or bone 
abscess), leg or ankle) (work RVUs of 7.78 and 7.97, respectively), 
because it believed the work required for code 20245 was similar to the 
work required for these codes. The survey for code 20245 compared the 
code to code 27635. The intraservice times were similar (90 versus 85 
minutes) and the amount of postservice was similar (169 versus 163 
minutes). However, the survey median work RVUs were 13 and the 25th 
percentile RVUs were 8.5. The RUC recommended the 25th percentile RVUs 
because the RVUs were reasonably close to the RVUs for code 27635. We 
agree that the current work RVUs are a rank-order anomaly with code 
20240 (Biopsy, bone, excisional; superficial (eg, ilium, sternum, 
spinous process, ribs, trochanter or femur)); however, we disagree with 
the RUC recommendation. The intraservice work of a deep excisional bone 
biopsy is similar to the work of excising a bone cyst or benign tumor 
from the tibia and fibula (code 27635). This is reflected in the 
similarity in their pre-, intra-, and postservice times. Moreover, the 
vignette used for code 20245 was atypical in that it involved an 
ischial lesion, whereas the code is also to be reported for lesions of 
the humerus and femur. Lesions of the humerus and femur require less 
dissection and would be more comparable to lesions of the tibia and 
fibula. Moreover, code 27635 requires complete removal of a known 
lesion, whereas code 20245 is only an excisional biopsy. Additionally, 
we are concerned about the spread of work RVUs in the work survey (25th 
percentile was 8.5 RVUs and 50th percentile was 13.0 work RVUs) and 
lack of consistency with the time data from the survey. We do not 
believe there is compelling evidence that the work of code 20245 is 
greater than the work of code 27635 and are therefore proposing to 
assign 7.78 work RVUs to code 20245, which is identical to work RVUs 
for the reference service code 27635.
5. Ophthalmology
    Comment: The American Academy of Ophthalmology submitted comments 
requesting nine codes be reviewed, including one code for evaluation of 
the global period and not the work RVU. The specialty society 
subsequently chose not to pursue review of codes 66170, 66172, and 
67108.
    RUC Recommendation:
    The RUC agreed with the request from the specialty society to 
change the global period from 90 days to 10 days for code 65855 (Laser 
surgery of eye) and also reduced the work RVUs to 3.85 to account for 
this reduction in the global period. The RUC noted that code 67218 
includes two procedures, and the specialty society indicated that this 
was not reflected in the original valuation. To correct this error, a 
building-block approach was used to arrive at new RVUs more reflective 
of the work of both procedures. The RUC recommended work RVUs of 18.53 
for this service. For code 92018, the RUC acknowledged that the 
preservice work of this service was greater than the standard office 
procedure because of the need for anesthesia. While concerned about the 
reliability of the data provided, the RUC recommended that the work 
RVUs be increased to 2.50, as it suggested during the first 5-year 
review, with the understanding that the code would be sent to the CPT 
Editorial Panel for clarification.
    For codes 66180, 66986, 67028, and 67904, the RUC believed that the 
commenters provided no compelling evidence to justify an increase in 
the work RVUs; therefore, the RUC recommended maintaining the current 
value for this code.
    HCFA Proposal:
    We have reviewed and propose to accept all of the RUC 
recommendations for the ophthalmology codes.
6. Urology
    Comment: The American Urological Association presented four codes 
for review: 50230, 51595, 51596, and 38780. They believed that the work 
RVUs for these codes do not account for all the in-hospital and office-
based postoperative care.
    RUC Recommendation:
    The RUC questioned the arguments for an increase in RVUs, noting 
that there was no compelling evidence presented for recommending an 
increase for three of these codes (51595, 51596 and 38780). However, 
the RUC noted that the code descriptor for code 50230 includes the term 
``and/or vena caval thrombectomy'' which impacts the work RVU. The RUC 
agreed to refer this code back to the CPT Editorial Panel to separate 
these two distinct services so each may be reported and valued 
appropriately.
    HCFA Proposal:
    We have reviewed and propose to accept all of the RUC 
recommendations for the urology codes.
7. Obstetrics/Gynecology
a. Specialty Comments
    Comment: The American College of Obstetrics and Gynecology (ACOG) 
referenced 35 codes in their written comments submitted to us. The 
specialty society chose not to pursue the review of work RVUs for code 
57555, as well as the work RVUs for codes 59150 and 59151.
    RUC recommendation:
    The RUC recommended increases in the RVUs for the following codes: 
38572 (16.59) that would align the code relative to the work of other 
laparoscopic codes; 56515 (2.76), which was not the value requested by 
the specialty group but was the value assigned to code 46924, which has 
comparable work and intraservice time; 56740 (4.57) based on a modified 
building-block approach, which was similar to ACOG's approach; 57100 
(1.20) as presented by the specialty society; 58152 (20.60) in 
recognition that the current work RVUs are less than the RVUs for code 
58150 performed alone even though 58152 combines the work of codes 
58150 and 58840; 58260 (12.98) to reflect work of additional office 
visits included in the procedure; 58262 (14.77) to accurately reflect 
the work of its component procedures; 58263 (16.06), 58275 (15.76), 
58270 (14.26) and 58280 (17.01) to maintain relativity within family of 
hysterectomy codes; 58267 (17.04) because the procedure is currently 
undervalued since it encompasses three separate components; 58285 
(22.26), which was lower than requested by the specialty group, but 
which the RUC believed was more reflective of the work for the 
procedure; 58600 (5.60) based on similarity of this procedure to code 
58670; 58605 (5.00) to reflect the slightly lower pre-, intra-, and 
post-times for this code as compared to 58670; 58611 (1.45) to 
appropriately reflect the increase in preservice work; 58700 (12.05) 
reflecting the higher technical skill associated with this procedure 
(removing only fallopian tube versus ovary and fallopian tube); 58740 
(14.00) to reflect increase in intra-service time and postoperative 
work; 58825 (10.98) which aligns the work value with other codes with 
similar work; 58920 (11.36) to correct a rank-order anomaly; 58950 
(16.93) which combines both codes 58720 and 49255 and applies the 
multiple procedure rule; 58951 (22.38) based on the similarity of work 
to 58285 which has the same

[[Page 31060]]

recommended value; 59812 (4.01) based on the similarity of work to code 
59820; 59870 (6.01) based on increased physician work and postoperative 
time.
    The RUC indicated that the commenter provided no compelling 
evidence to support an increase in the work RVUs for codes 38571, 
57130, 57292, 57307, 57505, 58323, 58400, and 58805.
    For code 58820, the RUC indicated that this service had recently 
been reviewed by the RUC and, therefore, the current work RVUs should 
be maintained.
    HCFA Proposal:
    We have reviewed and propose to accept all of the RUC 
recommendations for the obstetrics/gynecology codes.
b. Other Concerns
    We have been alerted to concerns that certain female-specific 
procedures may be undervalued. Our staff has reviewed the work RVUs 
associated with a number of female-specific procedures, including major 
and minor surgical procedures as well as several laparoscopic 
procedures and has determined that, for the most part, the RVUs 
assigned seem reasonable and consistent with the time, intensity, and 
postoperative care involved with the procedures. However, there were 
several codes that seemed to be inappropriately valued as compared to 
other similar procedures. These procedures are: code 56515 (Destruction 
of vulvar lesions, extensive); code 57100 (Biopsy of vagina); code 
56605 (Biopsy of vulva); code 58100 (Biopsy of endometrium); and code 
56810 (Perineoplasty).
    We forwarded two of these codes (codes 56515 and 57100) to the RUC 
for review under the 5-year refinement process, and the RUC has 
recommended an increase in work RVUs for both of these codes.
    We have referred the remaining three codes that appear to be 
misvalued to the RUC for review, and we anticipate receiving a response 
from the RUC that we can consider in the November 1, 2001 final rule.
8. Gastroenterology
    Comment: The American Society for Gastrointestinal Endoscopy 
(ASGE), American College of Gastroenterology (ACG), and the American 
Gastrointestinal Association (AGA) provided comments describing 
gastrointestinal services that they believed to be misvalued. Their 
comments focused on the identification of specific services whose work 
RVUs they believe are too low in comparison to other gastroenterology 
services when comparing time and intensity of the procedures. They also 
expressed concern that the work RVUs for all gastroenterology 
procedures involving conscious sedation are substantially undervalued 
and need to be increased because of the added requirements associated 
with conscious sedation.
    RUC Recommendation:
    With regard to conscious sedation, the RUC was concerned about--(1) 
The need to break out different levels of physician work for conscious 
sedation, and (2) many gastroenterology codes have been previously 
valued with conscious sedation included and some codes were not valued 
with conscious sedation included. Therefore, the RUC agreed to create a 
joint RUC and CPT workgroup to review and define the issues related to 
conscious sedation. Based upon information presented by the specialty 
at the February 2001 RUC meeting, the RUC agreed that elements of 
conscious sedation have changed over the past 5 years; however, the RUC 
was not able to quantify the change in physician work. While the RUC 
did not recommend a specific increase, it did recommend and urge us to 
allow separate reporting and payment of conscious sedation codes 99141 
and 99142 when conscious sedation is not inherently included as a 
component of the physician work of the procedure.
    Based on technological advances, increased complexity in procedure, 
and changes in patient population the RUC recommended an increase in 
work RVUs for the following codes: 43219 (3.18); 43239 (2.87); 43244 
(5.05); 43247 (3.59): 43249 (3.35); 43255 (4.82); 43259 (8.59); 43263 
(7.29); 43265 (10.02); 43269 (8.21); 44388 (3.70); 44389 (4.26); 44390 
(4.81); 44391 (5.18); 44392 (4.81); 44393 (5.00); and 45380 (4.44).
    Based on the lack of compelling evidence to increase the work RVUs, 
the RUC recommended that the current work RVUs be maintained for the 
following codes: 43217, 43228, 43246, 43251, 43258, 44394, 45383, 
45384, and 45385.
    HCFA Proposal:
    The RUC reviewed a selected series of gastrointestinal endoscopy 
codes for the 5-year review. These codes included endoscopy of the 
esophagus, stomach, duodenum, small intestine, large intestine, stoma, 
and biliary tree. The RUC recommended increases in work RVUs for some 
of the codes and no change in work for other codes. Unfortunately, the 
RUC could not review all of the endoscopy codes in each family and, 
therefore, was in the position of having to make recommendations that 
would likely cause new rank-order anomalies or exacerbate existing 
rank-order anomalies within and among these families. Furthermore, 
creation of rank-order anomalies across specialties was also likely. 
For example, a bronchoscopic biopsy would be valued significantly less 
than a gastrointestinal endoscopic biopsy if the gastrointestinal 
endoscopic biopsy was increased in value.
    Although we are concerned that some of these endoscopy codes may be 
misvalued, we are proposing to keep all work RVUs for gastrointestinal 
endoscopy codes unchanged. However, we believe that a comprehensive 
review of the work RVUs for all gastrointestinal endoscopy codes is 
warranted. Therefore, we are asking the RUC to perform a comprehensive 
review of all gastrointestinal endoscopy codes to ensure that all codes 
are properly valued, and that no rank-order anomalies within and across 
specialties are created or exacerbated. We hope to receive 
recommendations from the RUC for these codes in time for the proposed 
physician fee schedule regulation in 2002.
    Below we discuss our reasons for proposing to reject the 
recommended work increases for each code. However, we note that many 
new gastrointestinal endoscopy CPT codes were created for use in 2002 
and reviewed by the RUC concurrent with the 5-year review. 
Recommendations for these new codes were made by comparing them to the 
current work RVUs of existing gastrointestinal endoscopy codes, some of 
which were reviewed as part of the 5-year review. Therefore, any 
increases in work RVUs for codes in the 5-year review will likely 
invalidate the work RVUs for many of the new codes reviewed by the RUC. 
Furthermore, proposals have been made for even more gastrointestinal 
endoscopy CPT codes for CYs 2002 and 2003. We want to ensure that these 
new codes are properly reviewed and appropriate work RVUs assigned. 
Until a comprehensive review of all gastrointestinal endoscopy codes is 
performed we do not believe this is possible.
    Code 43219, Esophagoscopy, rigid or flexible; with insertion of 
plastic tube or stent:
    The RUC recommended an increase in work RVUs from 2.8 to 3.18 based 
upon the increased complexity of the condition of patients receiving 
these stents. The current work increment between this code and 43200 
(1.21 RVUs) has been used extensively by the RUC to make 
recommendations for other endoscopic stent placement procedures. 
Therefore, in spite of this recommendation, it appears that the RUC and 
the specialists who perform

[[Page 31061]]

this procedure agree that the correct increment for stent placement is 
1.21 work RVUs. If the work RVUs for code 43219 were accepted, many 
other recommendations from the RUC would need to be reevaluated. 
Furthermore, it is unclear from the vignette used to value this 
procedure whether or not predilation of the esophagus was included in 
the work of this code. Currently, code 43226 describes the work of 
predilation and may be billed in addition to code 43219. The 
incremental work for placing a tracheal stent with predilation (the 
difference in work between codes 31622 and 31631) is 1.59 work RVUs. 
This is significantly less than the current work increment for 
esophageal stent placement with predilation, 1.96 (1.21 + .75). 
Additionally, the vignette describes placement of an expandable wire 
mesh stent but the code is also used for plastic stents, placement of 
which may require less work. We propose maintaining the current RVU for 
this code in view of these concerns and the rank-order anomalies that 
would be created by accepting the RUC recommendation.
    Code 43239 (Upper gastrointestinal endoscopy including esophagus, 
stomach, and either the duodenum and/or jejunum as appropriate; with 
biopsy, single or multiple):
    The RUC recommended an increase in work RVUs from 2.69 to 2.87 
based on a larger number of biopsies obtained during a procedure. The 
RUC also stated that technological advances allowing for greater 
precision and detail in finding abnormalities have increased the need 
for this service. The RUC also stated that technological advances have 
allowed for more immediacy of results which increases the post service 
work in conveying the biopsy information and treatment guidance to the 
patient. We would note that the current work increments for all 
endoscopic gastrointestinal biopsy codes (described as the base 
procedure with ``biopsy, single or multiple'') are 0.3 RVUs. Accepting 
the RUC recommendation would increase this increment to 0.48 work RVUs 
while keeping all the other biopsy increments at 0.3 work RVUs, 
creating a clear rank-order anomaly. Furthermore, this code is used for 
``single'' biopsies, and, with the increase in work, these biopsies 
would be overvalued. We also do not understand how technological 
advances in locating lesions and getting more immediate results 
increases the work of the procedure itself. Therefore, we propose 
maintaining the current work RVU for this procedure.
    Code 43244 (Upper gastrointestinal endoscopy including esophagus, 
stomach, and either the duodenum and/or jejunum as appropriate; with 
band ligation of esophageal and/or gastric varices) and 43255 (Upper 
gastrointestinal endoscopy including esophagus, stomach, and either the 
duodenum and/or jejunum as appropriate; with control of bleeding, any 
method):
    The RUC recommended an increase in work RVUs for code 43255 from 
4.4 to 4.82 work RVUs based on new technology, such as lasers, to 
control bleeding. The RUC also states that this new technology 
increases the intensity of the procedure. However, the vignette used to 
survey code 43255 describes use of cautery to control bleeding. The 
work for this code must be appropriate for all methods of controlling 
bleeding and the vignette must represent the typical case. The current 
work increment for ``control of bleeding, any method'' for 
gastrointestinal endoscopic procedures is 2.01 work RVUs. Acceptance of 
the RUC recommendation for code 43255 would make this work increment 
2.43 RVUs, for upper gastrointestinal endoscopy only, creating a clear 
rank-order anomaly.
    The RUC recommended an increase in work RVUs for code 43244 from 
4.59 to 5.05 RVUs, based on the increased number of bands used to treat 
esophageal varices. However, the RUC agreed that the work RVUs for code 
43244 were similar to the work RVUs for code 43255. Therefore, 
accepting the RUC recommendation for code 43244 and not code 43255 
would create a clear rank-order anomaly. We believe that these two 
codes should have similar work RVUs. Therefore, we propose to maintain 
the current work RVUs for these procedures.
    Code 43247 (Upper gastrointestinal endoscopy including esophagus, 
stomach, and either the duodenum and/or jejunum as appropriate; with 
removal of foreign body):
    The RUC recommended an increase in work RVUs for this code from 
3.39 to 3.59 work RVUs based on increased complexity of the condition 
of patients undergoing this procedure with a concomitant increase in 
risk of morbidity. The RUC used a building-block approach to validate 
its acceptance of the median work RVUs from the survey. We do not fully 
understand the building-block analysis the RUC used but believe it was 
invalid. Moreover, the current work increment for ``removal of foreign 
body'' for gastrointestinal endoscopy procedures is 1.0 work RVUs. 
Acceptance of the RUC recommendation would create a clear rank-order 
anomaly. Therefore, we propose to maintain the current work RVUs for 
this procedure.
    Code 43249 (Upper gastrointestinal endoscopy including esophagus, 
stomach, and either the duodenum and/or jejunum as appropriate; with 
balloon dilation of esophagus (less than 30mm diameter)):
    The RUC recommended an increase from 2.9 to 3.35 work RVUs for this 
code based on increased complexity of the condition of patients 
undergoing this procedure. The current work increment for ``balloon 
dilation of esophagus (less than 30 mm diameter)'' is 0.51 RVUs for 
both the esophagus and upper gastrointestinal endoscopy families. Since 
this is the same procedure in both families, it is unclear why the work 
should be increased to 0.96 work RVUs for the upper gastrointestinal 
family only. Accepting the RUC recommendation would create a clear 
rank-order anomaly. Therefore, we are proposing to maintain the current 
work RVUs for this code.
    Code 43259 (Upper gastrointestinal endoscopy including esophagus, 
stomach, and either the duodenum and/or jejunum as appropriate; with 
endoscopic ultrasound examination):
    The RUC recommended an increase in work RVUs from 4.59 to 8.59 
based on the complexity of the equipment and the skill and judgement 
required. The RUC also noted that the survey results supported this 
procedure as more difficult than an endoscopic retrograde cholangio-
pancreatography (ERCP). The RUC then used the following building-block 
methodology: (1) The RUC added 1.5 work RVUs, which was approximately 
75 percent of the difference between the RUC recommendation from the 
last 5-year review (6.11 work RVUs) and the work RVUs that we assigned 
(4.0 work RVUs). (2) The RUC then added 2.2 work RVUs, which are the 
work RVUs of code 93312. Not only do we disagree with the RUC 
methodology for this recommendation, but we also note that the RUC has 
used the current work RVUs for code 43259 to value not only other 
gastrointestinal transendoscopic ultrasound procedures but also many 
transendoscopic ultrasound guided biopsy codes. We would also note that 
the RUC has recently re-evaluated code 43231, Esophagoscopy, rigid or 
flexible; with endoscopic ultrasound examination, and will be sending a 
new recommendation to us regarding the work valuation of this 
procedure. Accepting the RUC recommendation for this code would be 
inconsistent with the RUC's reevaluation of code 43231, would 
invalidate the work valuation of many other gastrointestinal endoscopy

[[Page 31062]]

codes, and would create numerous rank-order anomalies. Therefore, we 
propose to maintain this code at its current work RVUs.
    Codes 43263 (Endoscopic retrograde cholangio-pancreatography 
(ERCP); with pressure measurement of sphincter of Oddi (pancreatic duct 
or common bile duct)), 43265 (ERCP; with endoscopic retrograde 
destruction, lithotripsy of stone(s), any method), and 43269 (ERCP; 
with endoscopic retrograde removal of foreign body and/or change of 
tube or stent):
    The RUC recommended an increase in work RVUs from 6.19 to 7.29 for 
code 43263 based on the need to measure pressures in both the biliary 
and pancreatic sphincters as well as the need for prolonged 
postoperative monitoring. The RUC arrived at its recommendation by 
adding 1.1 work RVUs (the value of code 99214) to the current work 
RVUs. We disagree with valuing a post procedure observation period as 
equal to an evaluation and management service. Furthermore, increasing 
the value of this code while not adjusting the values of codes 43262, 
43267, and 43268 creates clear rank-order anomalies.
    The RUC recommended an increase in work RVUs from 8.9 to 10.02 for 
code 43265 based on a rank-order anomaly with code 43264. The RUC 
compared survey times to the Harvard study times for this code and used 
a building-block method to arrive at its recommendation. We do not 
fully understand the RUC methodology and disagree with the conclusion. 
The Harvard study time data show less time for code 43265 than for code 
43264, which would indicate that the current valuations of these codes 
are correct. Moreover, increasing the value of 43265 while not 
adjusting codes 43264, 43267, and 43268 would create clear rank-order 
anomalies.
    The RUC recommended an increase in work RVUs from 6.04 to 8.21 for 
code 43269 based on a rank-order anomaly between this code and code 
43268. The RUC used a building-block methodology adding 0.82 work RVUs 
to the work RVUs of code 43268 (7.39) to arrive at its recommendation. 
We disagree with the RUC methodology of using an evaluation and 
management service to arrive at its recommendation since this is an 
invasive procedure. Furthermore, we believe increasing the value of 
this code creates a rank-order anomaly with codes 43271 and 43272. 
Therefore, we are proposing maintaining the current work RVUs of all 
three of these codes.
    Codes 44388 (Colonoscopy through stoma; diagnostic with or without 
collection of specimen(s) by brushing or washing (separate procedure)), 
44389 (Colonoscopy through stoma; with biopsy, single or multiple), 
44390 (Colonoscopy through stoma; with removal of foreign body), 44391 
(Colonoscopy through stoma; with control of bleeding, any method) 44392 
(Colonoscopy through stoma; with removal of tumor(s), polyp(s), or 
other lesion(s) by hot biopsy forceps or bipolar cautery), and 44393 
(Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or 
other lesion(s) not amenable to removal by hot biopsy forceps, bipolar 
cautery or snare technique). 
    These codes are in the same family of codes, and the RUC 
recommended increases in work RVUs for all these codes based on a 
misvaluation of the base code in this family of codes, code 44388. The 
RUC valued it similarly to code 45378. We disagree. We think this 
creates a clear rank-order anomaly between the value of this family and 
the value of the colonoscopy family of codes beginning with code 45378. 
Colonoscopy through a stoma is clearly less work than colonoscopy of 
the complete colon and it has been valued as such since the inception 
of the physician fee schedule. We question the accuracy of the surveyed 
intraservice time for this service. Because of our nonacceptance of the 
increase in work RVUs for the base code in this family, we must also 
not accept the recommendations for all other increases in work RVUs for 
other codes in this family. Moreover, the recommendations create 
increments of work for ``biopsy, single or multiple,'' ``removal of 
foreign body,'' ``control of bleeding, any method,'' ``removal of 
tumors,'' and ``ablation of tumors,'' which are inconsistent with the 
same increments for the colonoscopy family of codes beginning with code 
45378. Accepting these RUC recommendations would create clear rank-
order anomalies that do not currently exist. Therefore, we are 
proposing to maintain the current work RVUs for these procedures.
    Code 45380 (Colonoscopy, flexible, proximal to splenic flexure; 
with biopsy, single or multiple).
    The RUC recommended an increase in work RVUs from 3.98 to 4.44 for 
this code based on the increased number of biopsies generally taken 
during this procedure and the increased difficulty in removing these 
polyps. The current work increment for ``biopsy, single or multiple'' 
for gastrointestinal endoscopic procedures is 0.3 work RVUs. Accepting 
the RUC recommendation would create a clear rank-order anomaly. 
Moreover, we note that this code is also used for single biopsies that 
would become significantly overvalued if we accepted the RUC 
recommendation. Therefore, we are proposing to maintain the current 
work RVUs for this code.
    In summary, we believe the only way to accurately value 
gastrointestinal endoscopy procedures is to evaluate the entire series 
of codes, including all families of codes (esophagus, upper 
gastrointestinal, ERCP, and colonoscopy etc.) at the same time. Only 
then can appropriate incremental work RVUs be determined without 
creating rank-order anomalies. We would also suggest that the RUC 
consider reorganization of all these codes to facilitate more accurate 
coding (for example, to determine whether every family of codes needs a 
code for ``removal of foreign body'' or whether the base code be 
revalued to include more procedures than it currently does).
    We suggest that while the RUC is reevaluating these codes that it 
delay making recommendations on any new codes for this series so that 
conflicting recommendations are not made and the chance of creating 
rank-order anomalies is minimized.
    With respect to the RUC recommendation concerning reporting and 
payment of conscious sedation codes 90141 and 90142, we will be 
reviewing data concerning this issue. Any proposals we would have 
concerning payment and reporting of conscious sedation codes would be 
the subject of future rulemaking.
9. Pulmonary Medicine/Critical Care
    Comment: Several specialty groups, including the societies for 
pulmonary medicine and critical care, indicated that codes 36620 and 
36489 were undervalued. Commenters indicated that the work RVUs for 
code 36489 should be greater than the work RVUs for the reference 
service code, 36010, because there is more work involved. Commenters 
also stated that code 36620 is undervalued as compared to the reference 
code 36140, because there are more variables affecting the work 
involved with this procedure.
    These specialty groups also requested that codes 99291 and 99292 be 
evaluated because the groups claimed they were undervalued.
    RUC Recommendation:
    For code 36489, the RUC noted that there is additional work and 
postoperative time involved in this procedure as compared to that of 
the reference service code 36010, and recommended work RVUs of 2.50 
which are higher than the reference service code 36010 (2.43), which 
corrects the rank-order anomaly. With respect to 36620, the RUC 
compared this

[[Page 31063]]

procedure to the reference service (code 36140) and agreed that this 
service appeared to be undervalued. However, the RUC was concerned that 
anesthesiologists who perform this procedure over 80 percent of the 
time did not comment or participate in the survey conducted by the 
specialty groups. The RUC concluded that code 36620 should be referred 
to the CPT Editorial Panel to clarify the appropriate use of this code.
    The RUC recommended maintaining the work RVUs for critical care 
services (codes 99291 and 99292) due to the lack of compelling evidence 
to recommend an increase in the work RVUs above the 2001 work RVUs of 
4.00 and 2.00, respectively.
    HCFA Proposal:
    We have reviewed and propose to accept all of the RUC 
recommendations for the pulmonary medicine and critical care codes.
10. Cardiology
    Comment: The American College of Cardiology (ACC) recommended 
review of three procedure codes under the 5-year refinement. They are 
code 93350, which was not reviewed during the first 5-year review but 
which the ACC believes is undervalued; and codes 33234 and 33235, which 
ACC argues are undervalued because it does not believe the codes 
reflect the level of difficulty associated with the procedures.
    RUC Recommendation:
    The RUC supported an increase in the work RVUs for code 93350 to 
account for the increased work and more complex conditions of the 
patient population as supported by survey information submitted. The 
RUC recommendation was to increase the work RVUs to 1.48. For codes 
33234 and 33235, they recommended that no change be made in the work 
RVUs because both procedures had been recently reviewed by the RUC.
    HCFA Proposal:
    We have reviewed and propose to accept all of the RUC 
recommendations for the cardiology codes.
11. Pediatrics
    Comment: The American Academy of Pediatrics (AAP) submitted 
approximately 40 codes involving several specialty areas and indicated 
that they believed these services are undervalued, particularly when 
they are provided to the pediatric population. A few of these codes 
were also submitted by other specialty groups and are discussed under 
those areas (codes 29450, 99291, and 99292). The AAP subsequently 
indicated to the RUC that they were not interested in pursuing the 
review of the work RVUs for the following codes for this 5-year review: 
11100, 11730, 17000, 17003, 17004, 20600, 36600, 52300, 52327, and 
52340.
    RUC Recommendation:
    For codes 36400 and 36405, the RUC agreed that an increase in the 
work RVUs appeared to be warranted and recommended work RVUs of 0.38 
and 0.32, respectively. However, for codes 94640, 99440, 99233, 99273, 
and 99274, the RUC indicated that compelling evidence was not provided 
to suggest a recommendation to increase the work RVUs and thus the 
current RVUs should be maintained for these services.
    The RUC recommended that the following codes be submitted to the 
CPT Editorial panel for further consideration: 12001, 12002, 36406, 
36520, 50200, 90935, 90937, 90945, 90947, 90989, 90993, 90997, 94664, 
and 94665.
    For codes 99295, 99296, 99297, 99298, and 99436, the RUC 
recommended no change in the work RVUs for these services because these 
services had recently been reviewed by the RUC.
    HCFA Proposal:
    We have reviewed and propose to accept all but two of the RUC 
recommendations for the pediatric codes.
    For code 36400 (Venipuncture, under age 3 years; femoral, jugular 
or sagittal sinus), the RUC recommended an increase in work RVUs from 
0.18 to 0.38. The RUC survey compared this code to code 36410 (Drawing 
blood, child over 3 or adult, necessitating physician's skill (separate 
procedure), for diagnostic or therapeutic purposes) (work RVUs of 
0.18). The survey times indicated that the pre-, intra-, and 
postservice times for code 36400 were less than the times for code 
36410. The median work RVUs from the survey were 0.71, and the 25th 
percentile work RVUs were 0.30. The specialty society recommended work 
RVUs of 0.71, citing the change in population of patients requiring 
this procedure (being younger and smaller). The RUC also compared code 
36400 to code 99212 (Office/outpatient visit, established patient) with 
work RVUs of 0.45 and believed the work RVUs of code 36400 were 
comparable to the work RVUs of code 99212). The RUC then recommended 
work RVUs between the 25th percentile of the survey and the work RVUs 
of code 99212. We do not believe it is appropriate to compare the work 
RVUs of a venipuncture to the work of an evaluation and management 
service. Furthermore, we are concerned about the spread in the survey 
work RVUs from 0.30 at the 25th percentile to 0.71 at the median. In 
view of the survey times being less than the reference code (with work 
RVUs of 0.18), the inconsistency of the survey times with the survey 
RVUs, and the inappropriate comparison to an evaluation and management 
service, we are proposing to continue the work RVUs of code 36400 as 
0.18 work RVUs.
    For code 36405 (Venipuncture, under age 3 years; scalp vein), the 
RUC recommended an increase in work RVUs from 0.18 to 0.32. The survey 
compared code 36405 to code 36410. The pre-, intra-, and postservice 
times for code 36405 were less than the times for the reference code. 
The survey RVUs were widely spread with the 25th percentile work RVUs 
being 0.2 and the median work RVUs being 0.4. The RUC also compared 
code 36405 to code 99212 (0.45) and recommended a value between the 
survey 25th percentile work RVUs and the work RVUs for code 99212. Our 
concerns about this recommendation are similar to the concerns about 
the recommendation for code 36400. In view of the survey times, the 
wide range of survey work RVUs, and the inappropriate comparison to an 
evaluation and management service, we are proposing to continue the 
work RVUs of code 36405 at 0.18.
12. Pediatric Surgery
    Comment: The American Pediatric Surgical Association (APSA) stated 
that the pediatric surgery procedure codes are misvalued and included 
recommended work RVUs. While they suggested reductions in the work RVUs 
of codes 46705 and 46715 to retain relativity in the family of 
services, they believed that the majority of the codes they provide are 
significantly undervalued. The association justifies the need to 
increase the work RVUs for these services based on one or more of the 
following rationales:
    <bullet> A change in practice and technology.
    <bullet> A change in the patient population for which the code is 
most frequently applied.
    <bullet> An undervaluation of the postservice work in the global 
period.
    <bullet> Rank-order anomalies.
    <bullet> Extended postoperative critical care. It is the provision 
of very intensive, prolonged services with long episodes of critical 
care and long hospital stays that account for the very high work RVUs 
recommended for some procedures. APSA subsequently indicated that they 
did not want to pursue review of two codes under the 5-year review: 
43305 and 60280.
    RUC Recommendation:
    The RUC recommended that the suggested decreases in the work RVUs

[[Page 31064]]

for codes 46705 and 46715 be implemented. The recommended work RVUs are 
6.90 for code 46705 and 7.20 for code 46715.
    Based on the information provided by the specialty society, the RUC 
recommended increasing work RVUs for the following codes to address the 
undervalued physician work in the intra- and postservice periods, the 
extended critical care services, and a change in patient population: 
39503 (95.00); 44055 (22.00); 46716 (15.07); 46730 (26.75); 46735 
(32.17); 46740 (30.00); 46742 (35.80); 46744 (52.63); 46746 (58.22); 
46748 (64.21); 49215 (33.50); and 49605 (76.00).
    The RUC did not receive compelling evidence to suggest that an 
increase is needed in the work RVUs for these codes: 36822, 45120, 
45121, 47701, and 49606.
    The RUC recommended that the following codes be referred to the CPT 
Editorial Panel for clarification and review: 21740, 43310, 43312, 
49495, and 49496. In some instances, new codes may need to be created 
to accurately value services performed on the pediatric and adult 
population.
    HCFA Proposal:
    We propose to accept all but two of the RUC recommendations for the 
pediatric surgery codes. The RUC recommended large increases in work 
RVUs for codes 39503 (Repair, neonatal hernia, with or without chest 
tube insertion and with or without creation of ventral hernia) and 
49605 (Repair of large omphalocele or gastrochsis; with or without 
prosthesis) for both of these procedures (an increase from 37.54 to 
95.0 work RVUs for code 39503 and from 24.94 to 76.0 work RVUs for code 
49605). These increases were based entirely on the increase of 
postoperative work required for these procedures, resulting in an 
increase of approximately 50 work units for each code. Both procedures 
are performed on neonates who require prolonged stays in the intensive 
care unit postoperatively. We understand that the postoperative care 
may be performed by the surgeon, the intensivist, or both physicians. 
In situations where the postoperative care is provided by both 
physicians, we could make duplicate payments for postoperative care if 
we continue to value these as 90-day global procedures. To permit the 
physician who is performing the postoperative care to be appropriately 
paid, but prevent duplicate payment for the same services, we are 
considering a reduction in the global period (for example, making the 
global period 10 or 0 days). If we shortened the global period for 
these services, appropriate work RVUs consistent with this change would 
need to be developed. If the surgeon provides postoperative care 
outside of the 10-day global period (that is, 10 days after the date of 
surgery)or outside of the 0-day global period (that is, the day after 
surgery) he or she would bill separately for those services. Moreover, 
if the intensivist provides the postoperative care, then the 
intensivist would bill for the service, and there would be no duplicate 
payment to the surgeon.
    Based on the above discussion, we are proposing to maintain the 
current RVUs for these two CPT codes (39503 and 49605) as an interim 
for 2002 and would ask the RUC to submit work RVU recommendations for 
these codes valued with reduced global periods (a 0-day or 10-day 
period). We would consider the RUC recommendations and make a proposal 
to initiate a change to the global period as well as associated RVUs in 
next year's proposed rule. We invite comments on the issue of reducing 
the global period for these services and welcome any alternative 
suggestions that we could consider that address our concerns of 
eliminating duplicate payment.
13. Radiology
    Comment: The American College of Radiology (ACR) identified three 
codes that they believe are undervalued. The code 76065, radiologic 
examination of an infant, is most commonly performed in the situation 
of alleged child abuse and requires a significant amount of physician 
work. Additionally, radiologists indicated that the work RVUs for two 
mammography procedure codes (codes 76090 and 76091) are not reflective 
of the amount of physician work necessary to perform all the 
requirements for the government regulated procedures and ACR standards. 
The level of quality control and quality assurance requirements 
instituted by the Food and Drug Administration (FDA) and Mammography 
Quality Standards Act of 1992 (MQSA) have increased the level of 
physician time outside of the direct patient care time. The current 
work RVUs assigned to these codes are not adequate to perform this 
procedure in accordance with Federal regulations or ACR standards. ACR 
contended the combination of increased mental effort and judgement, 
psychological stress, time, and intensity mandate that the work RVUs 
for these codes should be increased.
    RUC Recommendation:
    The RUC noted that the intensity for code 76065 is higher than the 
reference service code 76062 and that for intraservice work the 
physician typically reviews more films. The RUC recommended work RVUs 
of 0.70 for code 76065. For the mammography procedure codes, the RUC 
was in agreement that as a result of the revisions of the MQSA 
requirements, which require the physician to code radiologic results 
using BIRADs terminology and require that separate reports be sent to 
the patient and referring physician, the codes result in increased 
physician time, mental effort, and judgement. In addition, code 76091 
is a bilateral mammography requiring two studies to be performed. Based 
on survey information, the RUC determined the 25th percentile of the 
survey was the appropriate value and recommended work RVUs of 0.70 for 
code 76090 and 0.87 for code 76091.
    HCFA Proposal: 
    We have reviewed and propose to accept all of the RUC 
recommendations for the radiology codes discussed above.
    We would also note that section 104 of the Medicare, Medicaid, and 
SCHIP Benefits Improvement and Protection Act of 2000 (Public Law 106-
554) puts screening mammography under the physician fee schedule for 
services furnished beginning January 1, 2002. We will include our 
recommendation of the work RVUs for this service for CY 2002 as part of 
the physician fee schedule proposed rule for CY 2002.
    Because this will be a new code in the physician fee schedule, we 
have asked the RUC to recommend work RVUs for screening mammography.
14. Plastic Surgery
    Comment: The American Society of Plastic Surgery (ASPS) requested 
that codes 42205 and 49905 be reviewed under the 5-year review. ASPS 
indicated that there currently is a rank-order anomaly for code 42205 
that was created when other codes in the family of codes were reviewed 
and increased during the first 5-year review. They recommended an 
increase to the work RVUs (9.59 to 12.0) for this code that would 
reestablish rank-order in the cleft palate family of codes. With 
respect to code 49905, ASPS stated that this code is currently 
designated as an add-on code, which was not the intent of the specialty 
group when they submitted the proposal to the AMA CPT Editorial Panel 
in 1991 for creation of this code. They also disagree with our 
assumption that pre- and postoperative work was included in the RUC-
recommended work RVUs that we reduced. ASPA recommended that code 49905 
be changed from an add-on to a primary procedure code with a 90-day 
global period and be assigned work RVUs

[[Page 31065]]

comparable to those of code 15374 (17.79).
    RUC Recommendation: 
    The RUC reviewed code 42205 and recommended an increase in the work 
RVUs (for work RVUs of 13.29), which will correct the existing rank-
order anomaly in this family of codes. The RUC recommended that code 
49905 be referred to the CPT Editorial Panel for review.
    HCFA Proposal: 
    We have reviewed and proposed to accept the RUC recommendations for 
the plastic surgery codes.

C. Other Comments

1. Anesthesia Services
    The American Society of Anesthesiologists (ASA) contended that the 
work of anesthesia services is undervalued by almost 31 percent. (This 
initial request was subsequently adjusted based on additional 
discussions with the RUC.)
    As required by law, we base Medicare payments for anesthesia 
services on allowable base and time units. We have developed a uniform 
relative value guide in which the base unit per anesthesia code is 
largely based on the American Society of Anesthesiologists' 1988 
relative value guide. Anesthesiologists report the actual anesthesia 
time for each procedure on the claim, and the carrier converts the time 
to time units. The carriers then multiply the sum of the base units and 
time units by the anesthesia conversion factor.
    We used the results of the original Harvard Study on work to 
determine the adjustment to the anesthesia CF under the physician fee 
schedule in 1992. (Anesthesia services do not have work RVUs. 
Therefore, if work RVUs of other physician services are increased an 
adjustment has to be made to the anesthesia CF so that the work of 
anesthesia services remains on the same scale as other physician work.)
    In the first 5-year review of work, we accepted the RUC's 
recommendation that the work of anesthesia services was undervalued by 
22.76 percent, which resulted in a 16 percent increase in the 
anesthesia CF.
    The approach to this 5-year review used by the ASA involves a 
physician survey and a consensus panel review. The survey was sent to 
262 members of the ASA in a geographically representative sample. 
Eighty-five surveys were returned from respondents who were 
geographically representative of the specialty as a whole. The findings 
of the survey were presented to an expert consensus panel of 16 
practicing anesthesiologists from the ASA's Relative Value System (RVS) 
Committee. The work of the anesthesia service was uniformly divided 
into five components. These components are--preoperative evaluation, 
equipment and supply preparation, induction period, postinduction 
anesthesia period, and postoperative care and visits. The survey median 
times were assigned to each of the five components. The consensus panel 
assigned the work RVUs of an evaluation and management code, usually 
codes 99202 or 99201, to the preoperative evaluation. The consensus 
panel developed a code-specific survey time estimate and intensity 
value for equipment and supply preparation. For postoperative care and 
visits, the consensus panel assigned work RVUs equivalent to those of 
an evaluation and management code, usually code 99211 or 99231. The 
survey median time for the postinduction anesthesia period was divided 
in quintiles and each quintile was assigned intensity work RVUs ranging 
from 0.026 to 0.085. The consensus panel identified the typical 
anesthetic by procedure code and generally used the intensity of code 
31500, Intubation, endotracheal, emergency procedure, a similar CPT 
code, to value the work. This methodology was used for 19 high-volume 
surgical codes requiring anesthesia and representing a reasonable 
variety of surgical services.
    The following illustrates this approach for anesthesia code 00404 
and the underlying surgical code 19240 (Modified radical mastectomy):

------------------------------------------------------------------------
                                                       Work RVUs
------------------------------------------------------------------------
Preanesthesia Median Time....................  15 min.
<bullet> Preanesthesia reference code 99202..        0.88
Equipment and Supply Preparation Median Time.  10 min.      0.14
Induction Period Procedure Time..............  10 min.      0.93
Post Induction Anesthesia Period:
    Level 1 Time.............................  87 min.
    Level 2 Time.............................  10 min.
    Level 3 Time.............................  10 min.
    Level 4 Time.............................  0 min.
    Level 5 Time.............................  0 min.      3.09
Postanesthesia Time..........................  14 min.
<bullet> Postanesthesia Reference Code 99231.        0.64
    Total Work RVUs..........................        5.68
------------------------------------------------------------------------

    For each code, the total work RVUs were compared to a Medicare fee 
schedule imputed work value. The Medicare imputed work value is 
computed by multiplying the average allowed anesthesia charge per code 
by the anesthesia work share and dividing by the national CF. The 
average anesthesia allowed charge is determined by surgical code from 
HCFA's 5 percent Beneficiary File.
    Based on this analysis, the ASA requested a 24 percent increase in 
anesthesia work.
    RUC Recommendation:
    The RUC furnished no recommendation on anesthesia services; instead 
it assigned to a newly created workgroup the responsibility for 
reviewing anesthesia services in the context of the physician fee 
schedule. The ASA will be working with this workgroup on clinical 
issues, such as induction and postinduction intensity RVUs.
    HCFA Proposal:
    We propose to make no changes to the anesthesia CF at this time to 
reflect the 5-year review of physician work for anesthesia services. 
However, we may make changes in response to recommendations the RUC may 
provide.
2. Spine Injection Procedures
    Comment: The American Society of Anesthesiologists submitted a 
request for re-evaluation of seven spinal injection codes that they, 
along with several other medical associations, had expressed concern 
about when the codes were revalued for CY 2000. They continue to 
believe the work RVUs

[[Page 31066]]

assigned by the RUC in 1999 and forwarded to HCFA were appropriate.
    RUC recommendation:
    In 1999, when the RUC forwarded revised work RVUs, we agreed with 
the relativity of the four injection codes (62310, 62311, 62318, and 
62319), but applied a budget-neutrality factor that the specialties 
believe is inappropriate. In 1999, we also decreased the RUC-
recommended work RVUs for codes 72275, 62263, and 76005 based on our 
belief that the values were too high. The RUC has now reviewed the 
original surveys and subsequent recommendations and continues to 
believe that its 1999 recommendations for work RVUs for these codes are 
appropriate. They recommended the following work RVUs for these 
services: 62310 (2.20); 62311 (1.78); 62318 (2.35); 62319 (2.15); 62263 
(7.20); 72275 (0.83) and 76005 (0.60). (Note: for code 76005, the work 
RVUs were 0.60 for this service on the CY 2000 fee schedule)
    HCFA Proposal:
    We propose to reject the RUC recommendations for these codes for 
the following reasons:
    Codes 62310 (Single injection (not via indwelling catheter), not 
including neurolytic substances, with or without contrast (for either 
localization or epidurography), of diagnostic or therapeutic 
substance(s) (including anesthetic, antispasmodic, opioid, steroid, 
other solution), epidural or subarachnoid; cervical or thoracic)), 
62311 (Single injection (not via indwelling catheter), not including 
neurolytic substances, with or without contrast (for either 
localization or epidurography), of diagnostic or therapeutic 
substance(s) (including anesthetic, antispasmodoic, opioid, steroid, 
other solution), epidural or subarachnoid, lumbar, sacral(caudal)), 
62318 (Injection, including catheter placement, continuous infusion or 
intermittent bolus, not including neurolytic substances, with or 
without contrast(for either localization or epidurography), of 
diagnostic or therapeutic substance(s) (including anesthetic, 
antispasmodic, opioid, steroid, other solution), epidural or 
subarachnoid; cervical or thoracic), and 62319 (Injection, including 
catheter placement, continuous infusion or intermittent bolus, not 
including neurolytic substances, with or without contrast (for either 
localization or epidurography), of diagnostic or therapeutic 
substance(s) (including anesthetic, antispasmodoic, opioid, steroid, 
other solution), epidural or subarachnoid; lumbar, sacral (caudal)).
    These were new codes for CY 2000. The RUC submitted recommendations 
for these codes in CY 1999. We accepted the RUC recommendations and 
made a work-neutrality adjustment because these new codes replaced 
codes under which these services were billed before 2000. The RUC and 
several specialty societies disagreed with the data we used in making 
our work-neutrality adjustment. (Work-neutrality adjustments ensure 
that the recommendations for work RVUs for new and revised services are 
adjusted so that the sum of the new or revised work RVUs (weighted by 
projected frequency of use).) for a family of codes will be the same as 
the sum of the current work RVUs (weighted by frequency of use). We 
have reviewed the data used to make our work-neutrality adjustment and 
have determined that the adjustment made was accurate. The RUC work 
recommendations for the 5-year review are identical to the 
recommendations we received and evaluated in CY 1999. In view of this, 
we are proposing to maintain the current work RVUs for these services.
    Code 62263 (Percutaneous lysis of epidural adhesions using solution 
injection (eg, hypertonic saline, enzyme) or mechanical means (eg, 
spring-wound catheter) including radiologic localization (includes 
contrast when administered).
    This was a new code for CY 2000. We received RUC recommendations in 
CY 1999 for this code and disagreed with them. The RUC recommendation 
was 7.20 work RVUs, and we made the interim work RVUs 6.02 for CY 2000. 
In the summer of 2000, we convened a multispecialty review panel that 
reviewed this code in detail and recommended work RVUs of 6.14. We 
finalized the multispecialty review panel recommendation of 6.14 work 
RVUs for CY 2001. The current RUC recommendation is identical to the 
RUC recommendation from CY 1999. We find no compelling reason to change 
the RVUs for this procedure, especially since this procedure was 
reviewed by a multispecialty panel less than 1 year ago. We propose to 
continue the current work RVUs for this procedure.
    Code 72275 (Epidurography, radiological supervision and 
interpretation).
    This code was new for CY 2000. The RUC submitted a recommendation 
for 0.83 RVUs. We disagreed with this recommendation and made the 
interim work RVUs 0.54 for CY 2000. We submitted this code to a 
multispecialty review panel that recommended an increase to 0.76 work 
RVUs that we implemented for CY 2001. The RUC now submits a 
recommendation of 0.83 work RVUs for this procedure, identical to its 
prior recommendation. In the absence of compelling reasons to change 
the current work RVUs, and because this code was reviewed by an 
objective multispecialty panel less than 1 year ago, we are proposing 
to continue the current work RVUs.
    Additionally, codes 62310, 62311, 62318, 62319, 62263, and 72275 
were reviewed and finalized in the July 2000 Multispecialty Refinement 
Panels for new and/or revised services. Since the RUC recommendations 
have offered no evidence in addition to that which was presented at the 
July 2000 Multispecialty Refinement Panel Meeting, we propose to retain 
the existing work RVUs.
3. Biofeedback
    Comment: One organization, Medcare, requested review of the work 
and practice expense RVUs for biofeedback codes 90911 and 90901, as it 
believes that these codes currently are undervalued.
    RUC Recommendation:
    The RUC reviewed the original survey data for code 90911 and noted 
that while we had decreased the original RUC-recommended work RVUs, we 
received no further information to indicate that our rationale for 
reducing the work RVUs was inappropriate, and the specialty societies 
that perform the service did not present new information in response to 
the decrease. The RUC recommended that the current RVUs be maintained 
since it received no compelling evidence to recommend an increase in 
work RVUs.
    HCPAC Recommendation:
    The HCPAC recommended that the current work RVUs be maintained for 
code 90901 because we received no additional information from the 
specialists who perform this service to warrant an increase in work 
RVUs.
    HCFA Proposal:
    We reviewed and propose to accept the RUC and HCPAC recommendations 
for biofeedback services.
4. Surgical Management of Burn Wounds
    Comment: The American Burn Association (ABA) submitted codes 
commonly used for the surgical management of burn wounds (codes 15000 
through 15641). The ABA requested assignment of RVUs for these codes 
that more appropriately reflect the work involved. ABA also requested 
the creation of more specific codes that would obviate the need for 
``G'' codes. The ABA indicated that these codes should be exempt from 
CPT payment policies with respect to the 90-day global period, multiple 
procedures and

[[Page 31067]]

staged procedures due to the unique clinical case management of burns.
    RUC Recommendation:
    The RUC recommended that the following codes be reviewed by the CPT 
Editorial Panel: 15000, 15001, 15100, 15101, 15120, 15121, 15350, 
15351, 15400, and 15401.
    HCFA Proposal:
    We have reviewed and proposed to accept the RUC recommendation for 
these codes.
5. Transplantation
    Comment: The American Society for Transplant Surgeons requested 
reassessment of the work RVUs for code 47134 because the current work 
RVUs do not accurately reflect the work involved (it contended that 
over 50 percent of these procedures involve right lobectomies that are 
more labor intensive than left lobectomies, on which the current work 
RVUs are based). As an alternative, the American Society for Transplant 
Surgeons also suggested referral to the CPT Editorial Panel for 
consideration of creation of an additional code.
    RUC Recommendation:
    The RUC recommended that code 47134 be forwarded to the CPT 
Editorial Panel for further consideration.
    HCFA Proposal:
    We have reviewed and propose to accept the RUC recommendation for 
this code.
6. Arthroscopy Services
    Comment: The Arthroscopy Association of North America (AANA) 
requested that work for other arthroscopy services be reconsidered in 
light of the increase in work RVUs for code 29848 in the last 5-year 
review. The AANA also requested a specific increase in the work RVUs 
for code 29889. Subsequently, the specialty society chose not to pursue 
its request for consideration for code 29881.
    RUC Recommendations:
    For code 29883, the RUC noted that this service consisted of two 
procedures, medial and lateral meniscus repair. Because this service 
encompassed the work involved in code 29882 plus additional work for 
the lateral meniscus repair, and using the building-block approach, the 
RUC recommended work RVUs of 11.05 for this service. For code 29889, 
the RUC indicated that, due to the increase in post-and intraservice 
time, the work RVUs should be increased to 16.00.
    HCFA Proposal:
    We have reviewed and propose to accept the RUC recommendation for 
this code.
7. Wheelchair Management
    Comment: The American Physical Therapy Association requested review 
of code 97542.
    HCPAC Proposal: We had revised the recommended work RVUs for this 
code when it was previously reviewed by the HCPAC in 1995, based on a 
comparison of code 97542 to code 97032 rather than to code 97110. The 
HCPAC concluded that our comparison was incorrect because code 97032 is 
the application of a modality, while code 97542 requires additional 
skills because the patients requiring this service have cognitive, 
sensory, and physical disabilities. In addition, HCPAC indicated that 
we may not have understood that this procedure is reported very 
infrequently. The HCPAC supports its original recommendation of 0.45 
work RVUs for this service.
    HCFA Proposal:
    We have reviewed and propose to accept the HCPAC recommendation for 
this code.
8. Psychological Testing
    Comment: The American Psychological Association recommended that we 
review five psychological testing codes (96100, 96105, 96110, 96115, 
and 96117).
    HCPAC Recommendation:
    The HCPAC did not have any recommendations for these codes at this 
time. However, it indicated that the American Psychological Association 
may request HCPAC to review these services at a future date once 
additional information is collected.
    HCFA Proposal:
    We propose to make no changes at this time. We believe more precise 
definitions of these services may be necessary to value them properly 
and to ensure proper coding and billing of these services.
9. Podiatric Services
    Comment: The American Podiatric Medical Association submitted five 
codes (trim skin lesions/trim nails) for review (11719, 11055, 11056, 
11057, and G0127) indicating that they are undervalued and do not 
accurately reflect the level of physician work involved.
    HCPAC Recommendation:
    The HCPAC reviewed these codes and had no information to support an 
increase in work RVUs. However, the HCPAC requested that we review our 
current utilization data to ensure that the original utilization 
assumptions were correct. The HCPAC recommended that the current review 
of data should be based on actual 1999 utilization data since these 
codes were not fully implemented until April 1, 1998.
    HCFA Proposal:
    Taking into account the recommendation of the HCPAC, we propose to 
review utilization data associated with the aforementioned codes to 
ensure the original assumptions are still correct. We will publish our 
final decision in the November 2001 final rule.

D. Other Issues

1. Critical Care Services in a Global Period
    Validation of RUC recommendations for the work of many surgical 
procedures included the use of a ``building-block'' methodology as 
previously described. Before this 5-year review, the RUC compared the 
work of a postoperative intensive care unit visit by the surgeon to a 
level three subsequent hospital visit (code 99233) which is valued at 
1.51 work RVUs. Now, for the first time since the inception of the 
physician fee schedule, one of the ``building blocks'' the RUC used to 
validate postoperative work by the surgeon in the intensive care unit 
is code 99291 (Critical care, evaluation and management of the 
critically ill or critically injured patient, first 30-74 minutes), 
which is valued at 4.00 work RVUs. Specifically, the RUC validated the 
postoperative work of several thoracic, vascular, and general surgical 
procedures by comparing the surgeon's intensive care unit visits to 
code 99291.
    Current Medicare policy allows separate payment to the surgeon for 
postoperative critical care services during the surgical global period 
only when the patient has suffered trauma or burns. If the surgeon 
provides critical care services during the global period, for reasons 
unrelated to the surgery, that is separately payable as well.
    The RUC recommendations have raised several issues for which we are 
considering future action. In view of our desire to ensure that 
Medicare beneficiaries have appropriate access to critical care 
services, and to ensure that we make appropriate payments to physicians 
furnishing postoperative critical care services to Medicare 
beneficiaries, we are soliciting information and comments on the 
following questions and issues:
    1. If critical care (as described in CPT 2001) is provided 
postoperative, who typically provides this care? The surgeon, an 
intensivist, other physicians?
    2. Do surgeons typically meet the CPT requirements for billing 
critical care services (as described in CPT 2001)

[[Page 31068]]

when making intensive care unit visits on their postoperative patients?
    3. Are surgeons currently performing more, or less, critical care 
on their postoperative patients than they were at the time of the last 
5-year review?
    4. What is, or will be, the effect of ``closed'' intensive care 
units (a unit staffed by dedicated intensivists who manage the care for 
all patients in the intensive care unit) on who performs postoperative 
critical care services?
    5. What is the likelihood of making duplicate payment for critical 
care services if the surgical global period is valued with the 
inclusion of critical care in the postoperative work (for example, if 
we also pay an intensivist for postoperative critical care services)?
    6. If valuation of the surgical global period includes 
postoperative critical care, are there concerns about additional 
carrier scrutiny being applied to claims from intensivists for 
postoperative critical care services?
    7. Does valuation of the surgical global period with the inclusion 
of postoperative critical care create an incentive for the surgeon to 
either (a) not perform postoperative critical care services if there is 
an intensivist available or (b) to not consult an intensivist if one is 
available?
    Below are some of the options we are considering:
    <bullet> Removing work RVUs for critical care services from the 
surgical global period, valuing these services as subsequent hospital 
visits and allowing surgeons to bill separately for critical care (for 
an identified subset of surgical procedures where there is a high 
likelihood that the surgeon is typically providing critical care 
services).
    <bullet> Removing the work RVUs for critical care services from the 
surgical global period, valuing these services as subsequent hospital 
visits and not allowing surgeons to bill separately for critical care 
services.
    <bullet> Leaving the work RVUs for critical care services in the 
surgical global period, not allowing surgeons to bill separately for 
critical care services, requiring surgeons to follow documentation 
rules for critical care services and instructing carriers to make 
payment for medically necessary critical care services furnished by 
other physicians. (This option would facilitate tracking of critical 
care services, permit appropriate medical record review, and provide a 
basis to re-evaluate the work of the procedure.)
    Valuing the surgeon's postoperative intensive care unit visits as 
critical care services has raised a number of issues. We believe these 
issues will require a change in payment policy to ensure that 
postoperative critical care is appropriately paid. Therefore, we are 
proposing to make the work RVUs for those surgical codes where any 
postoperative intensive care unit visits were valued as critical care, 
interim, until we address the issues discussed above.
2. Codes Referred to CPT
    As discussed in sections B and C above, there were some codes that 
commenters had submitted for review that the RUC recommended be 
referred to the CPT Editorial Panel for clarification or consideration 
of definitional changes. These codes are listed in Table 2, which 
follows.

Table 2.--Codes Referred to CPT Editorial Panel From Five-Year Review of
                        Work Relative Value Units
------------------------------------------------------------------------
   CPT/HCPCS  code \1\            Mod                 Descriptor
------------------------------------------------------------------------
12001....................  .................  Repair superficial
                                               wound(s)
12002....................  .................  Repair superficial
                                               wound(s)
15000....................  .................  Skin graft
15001....................  .................  Skin graft add-on
15100....................  .................  Skin split graft
15101....................  .................  Skin split graft add-on
15120....................  .................  Skin split graft
15121....................  .................  Skin split graft add-on
15350....................  .................  Skin homograft
15351....................  .................  Skin homograft add-on
15400....................  .................  Skin heterograft
15401....................  .................  Skin heterograft add-on
20205....................  .................  Deep muscle biopsy
21740....................  .................  Reconstruction of sternum
23076....................  .................  Removal of shoulder lesion
24076....................  .................  Remove arm/elbow lesion
25076....................  .................  Removal of forearm lesion
27048....................  .................  Remove hip/pelvis lesion
27328....................  .................  Removal of thigh lesion
27619....................  .................  Remove lower leg lesion
33875....................  .................  Thoracic aortic graft
33877....................  .................  Thoracoabdominal graft
35381....................  .................  Rechanneling of artery
35541....................  .................  Artery bypass graft
35546....................  .................  Artery bypass graft
35551....................  .................  Artery bypass graft
35582....................  .................  Vein bypass graft
35641....................  .................  Artery bypass graft
35646....................  .................  Artery bypass graft
35840....................  .................  Explore abdominal vessels
35860....................  .................  Explore limb vessels
36406....................  .................  Drawing blood
36520....................  .................  Plasma and/or cell
                                               exchange
36533....................  .................  Insertion of access device
36534....................  .................  Revision of access device
36535....................  .................  Removal of access device
36620....................  .................  Insertion catheter, artery
37615....................  .................  Ligation of neck artery
37618....................  .................  Ligation of extremity
                                               artery
37700....................  .................  Revise leg vein
37720....................  .................  Removal of leg vein
37730....................  .................  Removal of leg veins
37735....................  .................  Removal of leg veins/
                                               lesion
37760....................  .................  Revision of leg veins
37785....................  .................  Revision secondary
                                               varicosity
43215....................  .................  Esophagus endoscopy
43310....................  .................  Repair of esophagus
43312....................  .................  Repair esophagus and
                                               fistula
47134....................  .................  Partial removal, donor
                                               liver
49495....................  .................  Repair inguinal hernia,
                                               init
49496....................  .................  Repair inguinal hernia,
                                               init
49905....................  .................  Omental flap
50200....................  .................  Biopsy of kidney
50230....................  .................  Removal of kidney
90935....................  .................  Hemodialysis, one
                                               evaluation
90937....................  .................  Hemodialysis, repeated
                                               eval
90945....................  .................  Dialysis, one evaluation
90947....................  .................  Dialysis, repeated eval
90989....................  .................  Dialysis training,
                                               complete
90993....................  .................  Dialysis training, incompl
90997....................  .................  Hemoperfusion
94664....................  .................  Aerosol or vapor
                                               inhalations
94665....................  .................  Aerosol or vapor
                                               inhalations
------------------------------------------------------------------------

3. Budget Neutrality
    Section 1848(c)(2)(B) of the Act requires that increases or 
decreases in relative value units may not cause the amount of 
expenditures for the year to differ by more than $20 million from what 
expenditures would have been in the absence of these changes. If this 
threshold is exceeded, we make adjustments to preserve budget 
neutrality. This year, budget-neutrality adjustments will be required 
for changes in work relative value units resulting from the 5-year 
refinement. Revisions in payment policies, including the establishment 
of interim and final relative value units for coding changes that will 
be announced later this year, may result in additional budget-
neutrality adjustments.
    We considered making the statutorily required budget-neutrality 
adjustments

[[Page 31069]]

to account for the 5-year review of physician work by reducing all work 
RVUs. We estimate that all work RVUs would have to be reduced by 0.7 
percent under this option. Alternatively, we considered making an 
adjustment to the physician fee schedule CF to meet the provisions of 
section 1848(c)(2)(B). This option would require an estimated 0.3 
percent reduction in the conversion factor. For the 5-year review, we 
are proposing to reduce the conversion factor by 0.3 percent to meet 
the provisions of section 1848(c)(2)(B).
    HCFA Proposal:
    We propose to make the budget-neutrality adjustment by reducing the 
CF.
4. Calculation of Practice Expense and Malpractice Expense RVUs
    As we noted in the November 2, 1999 final rule (64 FR 59427), 
practice expense and malpractice expense RVUs were not subject to 
comment and will not be recalculated (other than the change to practice 
expense RVUs that result from changes in work) as part of the 5-year 
review of work RVUs. Section 4505 of the BBA also provides for the 
gradual 4-year transition for resource-based practice expenses, with 
resource-based practice expenses becoming fully effective in CY 2002. 
We are currently in the process of developing our annual physician fee 
schedule proposed rule that will continue the 4-year refinement process 
for resource-based practice expense RVUs.
    Section 4505(f) of the Balanced Budget Act of 1997 (BBA) amended 
section 1848(c)(2)(C) of the Act and requires us to implement resource-
based malpractice RVUs for services furnished beginning in CY 2000. A 
methodology for establishing resource-based malpractice RVUs was 
included in the November 1999 final rule and implemented January 1, 
2000. In addition, based on concerns expressed by commenters, updated 
premium data used under this methodology were obtained and used to 
calculate malpractice RVUs for CY 2001.
    Since resource-based malpractice RVUs were recently implemented, 
and resource-based practice expenses are in the final phase of 
transition to a fully resource-based system, these components are not 
being included in this 5-year review. However, as stated above we 
expect to publish our annual physician fee schedule proposed rule that 
will propose continuing refinements to resource-based practice expense 
RVUs.
5. Nature and Format of Comments on Work RVUs
    We will accept comments on the proposed work RVUs for the codes 
identified in the Addendum of this notice. We will also accept comments 
on the anesthesia codes. Comments should discuss how the work 
associated with a given CPT or HCPCS code is analogous to the work in 
other services or discuss the rationale for disagreeing with the 
proposed work RVU. We are especially interested in information or 
arguments that were not presented in earlier comments.

III. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently it need not be reviewed by the 
Office of Management and Budget under the authority of the Paperwork 
Reduction Act of 1995 (44 U.S.C. 3501 et seq.)

IV. 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 comment received by the date and time specified in the DATES 
section of this preamble, and we will respond to the comments in the 
physician fee schedule final rule.

V. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impacts of this proposed notice as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review) 
and the Regulatory Flexibility Act (RFA) (September 9, 1980 Public Law 
96-354). Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects, distributive impacts, and equity).
    A regulatory impact analysis must be prepared for major rules with 
economically significant effects ($100 million or more annually). While 
the changes in the Medicare physician fee schedule due to the 5-year 
review are budget neutral, they do involve a redistribution of Medicare 
spending among procedures that will exceed $100 million. For this 
reason, we are considering this to be a major rule. We estimate that 
the aggregate amount of payments being redistributed among specialties 
as a result of the 5-year review will be over $200 million.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations and government agencies. Most 
hospitals and most other providers and suppliers are small entities, 
either by nonprofit status or by having revenues of $7.5 million or 
less annually for physicians and $5 million or less for other 
practitioners. For purposes of the RFA and based on small business 
administration data for 1997 we estimate that there are 162,000 
physician organizations that meet the definition of a small entity. 
There are about 700,000 physicians and other practitioners who receive 
Medicare payment under the physician fee schedule. Individuals and 
States are not included in the definition of a small entity.
    In addition, section 1102(b) of the Act requires us 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 603 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area and has fewer than 100 beds.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule that may result in expenditure in any one year by 
State, local, or tribal governments, in the aggregate, or by the 
private sector, of $110 million. We have determined that this rule has 
no consequential effect on State, local or tribal governments. We 
believe the private sector costs of this rule will fall below this 
threshold as well.
    For purposes of Executive Order 12866 and the RFA, we have prepared 
the following analysis, which, together with the rest of this preamble, 
meets all four assessment requirements. It explains the rationale for 
and purpose of the proposed notice, details the costs and benefits of 
the proposed notice, analyzes alternatives, and presents the measures 
we considered to minimize burden on small entities. Section 
1848(c)(2)(B) of the Act requires that increases or decreases in RVUs 
may not cause the amount of expenditures for the year to differ by more 
than $20 million from what expenditures would have been in the absence 
of these changes. If this threshold is exceeded,

[[Page 31070]]

we make adjustments to preserve budget neutrality. This year, budget-
neutrality adjustments will be required for changes in work relative 
value units resulting from the 5-year refinement. Revisions in payment 
policies, including the establishment of interim and final relative 
value units for coding changes that will be announced later this year, 
may result in additional budget-neutrality adjustments.
    We considered making the statutorily required budget-neutrality 
adjustments to account for the 5-year review of physician work by 
reducing all work RVUs. We estimate that all work RVUs would have to be 
reduced by 0.7 percent under this option. Alternatively, we considered 
making an adjustment to the physician fee schedule CF to meet the 
provisions of section 1848(c)(2)(B) of the Act. This option would 
require an estimated 0.3 percent reduction in the CF. For the 5-year 
review, we are proposing to reduce the CF by 0.3 percent to meet the 
provisions of section 1848(c)(2)(B) of the Act.

        Table 3.--Percent Change in Total Payments by Specialty Resulting From the 5 Year Review of Work
----------------------------------------------------------------------------------------------------------------
                                                                             Percent
                                                                            change in     Percent       Total
                                                                Allowed       total      change in     percent
                          Specialty                             charges      payments      total      change in
                                                               (billions)      from       payments     payments
                                                                           increase in  from change  from 5 year
                                                                               work        in PE        review
----------------------------------------------------------------------------------------------------------------
Anesthesiology..............................................          1.5            1            0            1
Cardiac Surgery.............................................          0.3            5            1            6
Cardiology..................................................          4.2            0           -1           -1
Chiropractor................................................          0.4            0            0            0
Clinics.....................................................          1.6            0            0            0
Dermatology.................................................          1.4            0            0            0
Emergency Medicine..........................................          1.0            0            0            0
Family Practice.............................................          3.3            0            0            0
Gastroenterology............................................          1.2            0            0            0
General Practice............................................          1.0            0            0            0
General Surgery.............................................          2.0            3            1            4
Hematology Oncology.........................................          0.6            0           -1           -1
Internal Medicine...........................................          7.1            0            0            0
Nephrology..................................................          1.0            0            0            0
Neurology...................................................          0.9            0            0            0
Neurosurgery................................................          0.4            0            0            0
Nonphysician Practitioner...................................          1.2            0            0            0
Obstetrics/Gynecology.......................................          0.4            0            0            0
Ophthalmology...............................................          3.9            0            0            0
Optometrist.................................................          0.5            0            0            0
Orthopedic Surgery..........................................          2.3            0            0            0
Other Physician.............................................          1.6            0            0            0
Otolaryngology..............................................          0.6            0            0            0
Pathology...................................................          0.6            0            0            0
Plastic Surgery.............................................          0.2            0            0            0
Podiatry....................................................          1.1            0            0            0
Psychiatry..................................................          1.1            0            0            0
Pulmonary...................................................          1.1            0            0            0
Radiation Oncology..........................................          0.7            0           -1           -1
Radiology...................................................          3.3            0           -1           -1
Rheumatology................................................          0.3            0            0            0
Suppliers...................................................          0.5            0            0           -1
Thoracic Surgery............................................          0.5            4            1            5
Urology.....................................................          1.3            0            0            0
Vascular Surgery............................................          0.3            2            0            2
----------------------------------------------------------------------------------------------------------------
Note: This table incorporates two separate budget neutrality adjustments. The increase in practice expense
  relative value units is incorporated through a rescaling of all practice expense RVUs. In addition, all
  physician fee schedule payments (not the work RVUs) are reduced to make the increase in physician work RVUs
  budget neutral.

    The table above shows the specialty level payment impact of changes 
in work and practice expense relative values resulting from the 5-year 
review. The table includes the effect of budget-neutrality adjustments 
applied to the physician fee schedule CF. Since the practice expense 
RVUs are based, in part, on physician work, the table also reflects 
changes in practice expense RVUs that will result from the 5-year 
review of physician work. The changes in practice expense RVUs 
resulting from the changes in physician work RVUs were made budget 
neutral by rescaling all practice expense RVUs. This table shows the 
impact on payments per service at the specialty level that would result 
only from the 5-year review of physician work RVUs.
    We are in the process of developing our annual physician fee 
schedule proposed rule that will make refinements in practice expense 
RVUs and other policies that will affect payment for physician fee 
schedule services in CY 2002. As part of the physician fee schedule 
proposed rule, we expect to use revised physician times submitted to us 
by the RUC in the methodology for determining practice expense RVUs. 
The RUC is recommending that we use new time data for codes in which 
they recommended a change in work RVUs. In addition, the RUC is 
recommending a revision of the time data for many other codes. For some 
specialties, we expect that use of the revised times will change the 
impacts shown here.
    In particular, it appears that the revised times submitted to us by 
the

[[Page 31071]]

RUC are less than the times included in our database for many heart and 
chest procedures. Our expectation is that use of the RUC recommended 
times will result in a reduction in the practice expense RVUs for these 
services that are predominantly performed by cardiac and thoracic 
surgeons. This means that our expectation is that the total payment 
increase shown here for these specialties will be less when the revised 
times are used to determine the practice expense RVUs. In addition, 
there may be other refinements to the practice expense RVUs or other 
changes in policies that may result in a specialty level payment impact 
for 2002 that we will announce in our proposed rule. We will show the 
combined payment impact by specialty, as a result of the revised times 
and other proposed policy changes, in our notice of proposed rulemaking 
that we expect to be published shortly.
    We will show the combined impact of all policy changes affecting 
physician fee schedule payments in 2002 in one final rule that we 
expect to be published no later than November 1, 2001.
    Federalism: Executive Order 13132 establishes certain requirements 
that an agency must meet when it promulgates a proposed rule (and 
subsequent final rule) that imposes substantial direct requirement 
costs on State and local governments, preempts State law, or otherwise 
has Federalism implications. We have determined that this rule will not 
impose substantial direct requirement costs on State and local 
governments, preempt State law, or otherwise have Federalism 
implications.
    In accordance with the provisions of Executive Order 12866, this 
regulation was reviewed by the Office of Management and Budget.

(42 U.S.C. 1395k(a)(2)(F) and 1395l(i)(1) and (2)); 42 CFR 416.120, 
416.125, and 416.130)

(Catalog of Federal Domestic Assistance Programs No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: April 17, 2001.
Michael McMullan,
Acting Deputy Administrator, Health Care Financing Administration.

    Dated: April 23, 2001.
Tommy G. Thompson,
Secretary.
    --------------------
\1\ All CPT codes and descriptors copyright 2000 American Medical 
Association

[[Page 31071]]



                   Addendum--Codes Subject to Comment
------------------------------------------------------------------------
                                                               Proposed
CPT/HCPCS  code \1\       Mod              Descriptor          work RVU
------------------------------------------------------------------------
G0127..............  ............  Trim nail(s).............        0.11
11055..............  ............  Trim skin lesion.........        0.27
11056..............  ............  Trim skin lesion, 2 to 4.        0.39
11057..............  ............  Trim skin lesions, over 4        0.50
11402..............  ............  Removal of skin lesion...        1.61
11642..............  ............  Removal of skin lesion...        2.93
11642..............  ............  Removal of skin lesion...        2.93
11719..............  ............  Trim nail(s).............        0.11
12001..............  ............  Repair superficial               1.70
                                    wound(s).
12002..............  ............  Repair superficial               1.86
                                    wound(s).
12011..............  ............  Repair superficial               1.76
                                    wound(s).
13101..............  ............  Repair of wound or lesion        3.92
13131..............  ............  Repair of wound or lesion        3.79
13132..............  ............  Repair of wound or lesion        5.95
15000..............  ............  Skin graft...............        4.00
15001..............  ............  Skin graft add-on........        1.00
15100..............  ............  Skin split graft.........        9.05
15101..............  ............  Skin split graft add-on..        1.72
15120..............  ............  Skin split graft.........        9.83
15121..............  ............  Skin split graft add-on..        2.67
15350..............  ............  Skin homograft...........        4.00
15351..............  ............  Skin homograft add-on....        1.00
15400..............  ............  Skin heterograft.........        4.00
15401..............  ............  Skin heterograft add-on..        1.00
19000..............  ............  Drainage of breast lesion        0.84
19100..............  ............  Biopsy of breast.........        1.27
19125..............  ............  Excision, breast lesion..        6.06
19160..............  ............  Removal of breast tissue.        5.99
19162..............  ............  Remove breast tissue,           13.53
                                    nodes.
19240..............  ............  Removal of breast........       16.00
20205..............  ............  Deep muscle biopsy.......        2.35
20245..............  ............  Bone biopsy, excisional..        7.78
21740..............  ............  Reconstruction of sternum       16.50
21800..............  ............  Treatment of rib fracture        0.96
23076..............  ............  Removal of shoulder              7.63
                                    lesion.
23472..............  ............  Reconstruct shoulder            21.10
                                    joint.
23485..............  ............  Revision of collar bone..       13.43
23585..............  ............  Treat scapula fracture...        8.96
23615..............  ............  Treat humerus fracture...        9.35
23630..............  ............  Treat humerus fracture...        7.35
23680..............  ............  Treat dislocation/              10.06
                                    fracture.
24076..............  ............  Remove arm/elbow lesion..        6.30
24435..............  ............  Repair humerus with graft       13.17

[[Page 31072]]

 
24545..............  ............  Treat humerus fracture...       10.46
25076..............  ............  Removal of forearm lesion        4.92
26562..............  ............  Repair of web finger.....       15.00
27048..............  ............  Remove hip/pelvis lesion.        6.25
27075..............  ............  Extensive hip surgery....       35.00
27077..............  ............  Extensive hip surgery....       40.00
27216..............  ............  Treat pelvic ring               15.19
                                    fracture.
27217..............  ............  Treat pelvic ring               14.11
                                    fracture.
27218..............  ............  Treat pelvic ring               20.15
                                    fracture.
27226..............  ............  Treat hip wall fracture..       14.91
27236..............  ............  Treat thigh fracture.....       15.60
27280..............  ............  Fusion of sacroiliac            13.39
                                    joint.
27282..............  ............  Fusion of pubic bones....       11.34
27284..............  ............  Fusion of hip joint......       23.45
27328..............  ............  Removal of thigh lesion..        5.57
27472..............  ............  Repair/graft of thigh....       17.72
27513..............  ............  Treatment of thigh              17.92
                                    fracture.
27536..............  ............  Treat knee fracture......       15.65
27590..............  ............  Amputate leg at thigh....       12.03
27619..............  ............  Remove lower leg lesion..        8.40
27724..............  ............  Repair/graft of tibia....       18.20
27822..............  ............  Treatment of ankle              11.00
                                    fracture.
27823..............  ............  Treatment of ankle              13.00
                                    fracture.
27828..............  ............  Treat lower leg fracture.       16.23
28299..............  ............  Correction of bunion.....        9.18
28322..............  ............  Repair of metatarsals....        8.34
28420..............  ............  Treat/graft heel fracture       16.64
28445..............  ............  Treat ankle fracture.....       15.62
28705..............  ............  Fusion of foot bones.....       18.80
29450..............  ............  Application of leg cast..        2.08
29450..............  ............  Application of leg cast..        2.08
29883..............  ............  Knee arthroscopy/surgery.       11.05
29889..............  ............  Knee arthroscopy/surgery.       16.00
29889..............  ............  Knee arthroscopy/surgery.       16.00
31600..............  ............  Incision of windpipe.....        7.18
31622..............  ............  Dx bronchoscope/wash.....        2.78
31622..............  ............  Dx bronchoscope/wash.....        2.78
31625..............  ............  Bronchoscopy with biopsy.        3.37
31645..............  ............  Bronchoscopy, clear              3.16
                                    airways.
32000..............  ............  Drainage of chest........        1.54
32000..............  ............  Drainage of chest........        1.54
32005..............  ............  Treat lung lining                2.19
                                    chemically.
32020..............  ............  Insertion of chest tube..        3.98
32035..............  ............  Exploration of chest.....        8.67
32095..............  ............  Biopsy through chest wall        8.36
32100..............  ............  Exploration/biopsy of           15.24
                                    chest.
32110..............  ............  Explore/repair chest.....       23.00
32220..............  ............  Release of lung..........       24.00
32225..............  ............  Partial release of lung..       13.96
32320..............  ............  Free/remove chest lining.       24.00
32440..............  ............  Removal of lung..........       25.00
32440..............  ............  Removal of lung..........       25.00
32480..............  ............  Partial removal of lung..       23.75
32480..............  ............  Partial removal of lung..       23.75
32482..............  ............  Bilobectomy..............       25.00
32491..............  ............  Lung volume reduction....       21.25
32500..............  ............  Partial removal of lung..       22.00
32520..............  ............  Remove lung & revise            21.68
                                    chest.
32602..............  ............  Thoracoscopy, diagnostic.        5.96
32651..............  ............  Thoracoscopy, surgical...       12.91
32652..............  ............  Thoracoscopy, surgical...       18.66
32655..............  ............  Thoracoscopy, surgical...       13.10
32657..............  ............  Thoracoscopy, surgical...       13.65
33234..............  ............  Removal of pacemaker             7.82
                                    system.
33235..............  ............  Removal of pacemaker             9.40
                                    electrode.
33400..............  ............  Repair of aortic valve...       28.50

[[Page 31073]]

 
33405..............  ............  Replacement of aortic           35.00
                                    valve.
33406..............  ............  Replacement of aortic           37.50
                                    valve.
33410..............  ............  Replacement of aortic           32.46
                                    valve.
33411..............  ............  Replacement of aortic           36.25
                                    valve.
33412..............  ............  Replacement of aortic           42.00
                                    valve.
33413..............  ............  Replacement of aortic           43.50
                                    valve.
33415..............  ............  Revision, subvalvular           27.15
                                    tissue.
33425..............  ............  Repair of mitral valve...       27.00
33426..............  ............  Repair of mitral valve...       33.00
33427..............  ............  Repair of mitral valve...       40.00
33430..............  ............  Replacement of mitral           33.50
                                    valve.
33468..............  ............  Revision of tricuspid           30.12
                                    valve.
33475..............  ............  Replacement, pulmonary          33.00
                                    valve.
33506..............  ............  Repair artery,                  35.50
                                    translocation.
33510..............  ............  CABG, vein, single.......       29.00
33511..............  ............  CABG, vein, two..........       30.00
33512..............  ............  CABG, vein, three........       31.80
33513..............  ............  CABG, vein, four.........       32.00
33514..............  ............  CABG, vein, five.........       32.75
33516..............  ............  Cabg, vein, six or more..       35.00
33517..............  ............  CABG, artery-vein, single        2.57
33518..............  ............  CABG, artery-vein, two...        4.85
33519..............  ............  CABG, artery-vein, three.        7.12
33521..............  ............  CABG, artery-vein, four..        9.40
33522..............  ............  CABG, artery-vein, five..       11.67
33523..............  ............  Cabg, art-vein, six or          13.95
                                    more.
33530..............  ............  Coronary artery, bypass/         5.86
                                    reop.
33533..............  ............  CABG, arterial, single...       30.00
33534..............  ............  CABG, arterial, two......       32.20
33535..............  ............  CABG, arterial, three....       34.50
33536..............  ............  Cabg, arterial, four or         37.50
                                    more.
33611..............  ............  Repair double ventricle..       34.00
33612..............  ............  Repair double ventricle..       35.00
33615..............  ............  Repair, simple fontan....       34.00
33617..............  ............  Repair, modified fontan..       37.00
33619..............  ............  Repair single ventricle..       45.00
33641..............  ............  Repair heart septum             21.39
                                    defect.
33660..............  ............  Repair of heart defects..       30.00
33670..............  ............  Repair of heart chambers.       35.00
33681..............  ............  Repair heart septum             30.61
                                    defect.
33694..............  ............  Repair of heart defects..       34.00
33697..............  ............  Repair of heart defects..       36.00
33730..............  ............  Repair heart-vein               34.25
                                    defect(s).
33750..............  ............  Major vessel shunt.......       21.41
33767..............  ............  Major vessel shunt.......       24.50
33770..............  ............  Repair great vessels            37.00
                                    defect.
33778..............  ............  Repair great vessels            40.00
                                    defect.
33780..............  ............  Repair great vessels            41.75
                                    defect.
33786..............  ............  Repair arterial trunk....       39.00
33820..............  ............  Revise major vessel......       16.29
33840..............  ............  Remove aorta constriction       20.63
33860..............  ............  Ascending aortic graft...       38.00
33861..............  ............  Ascending aortic graft...       42.00
33863..............  ............  Ascending aortic graft...       45.00
33870..............  ............  Transverse aortic arch          44.00
                                    graft.
33875..............  ............  Thoracic aortic graft....       33.06
33877..............  ............  Thoracoabdominal graft...       42.60
33917..............  ............  Repair pulmonary artery..       24.50
33919..............  ............  Repair pulmonary atresia.       40.00
33945..............  ............  Transplantation of heart.       42.10
34101..............  ............  Removal of artery clot...       10.00
34111..............  ............  Removal of arm artery           10.00
                                    clot.
34151..............  ............  Removal of artery clot...       25.00
34151..............  ............  Removal of artery clot...       25.00
34201..............  ............  Removal of artery clot...       10.03
34201..............  ............  Removal of artery clot...       10.03

[[Page 31074]]

 
34203..............  ............  Removal of leg artery           16.50
                                    clot.
34203..............  ............  Removal of leg artery           16.50
                                    clot.
34401..............  ............  Removal of vein clot.....       25.00
34401..............  ............  Removal of vein clot.....       25.00
34421..............  ............  Removal of vein clot.....       12.00
34421..............  ............  Removal of vein clot.....       12.00
34451..............  ............  Removal of vein clot.....       27.00
34451..............  ............  Removal of vein clot.....       27.00
34490..............  ............  Removal of vein clot.....        9.86
34501..............  ............  Repair valve, femoral           16.00
                                    vein.
34510..............  ............  Transposition of vein           18.95
                                    valve.
34520..............  ............  Cross-over vein graft....       17.95
34530..............  ............  Leg vein fusion..........       16.64
35011..............  ............  Repair defect of artery..       18.00
35011..............  ............  Repair defect of artery..       18.00
35013..............  ............  Repair artery rupture,          22.00
                                    arm.
35013..............  ............  Repair artery rupture,          22.00
                                    arm.
35045..............  ............  Repair defect of arm            17.57
                                    artery.
35045..............  ............  Repair defect of arm            17.57
                                    artery.
35081..............  ............  Repair defect of artery..       28.01
35082..............  ............  Repair artery rupture,          38.50
                                    aorta.
35082..............  ............  Repair artery rupture,          38.50
                                    aorta.
35092..............  ............  Repair artery rupture,          45.00
                                    aorta.
35092..............  ............  Repair artery rupture,          45.00
                                    aorta.
35103..............  ............  Repair artery rupture,          40.50
                                    groin.
35103..............  ............  Repair artery rupture,          40.50
                                    groin.
35111..............  ............  Repair defect of artery..       25.00
35111..............  ............  Repair defect of artery..       25.00
35112..............  ............  Repair artery rupture,          30.00
                                    spleen.
35112..............  ............  Repair artery rupture,          30.00
                                    spleen.
35121..............  ............  Repair defect of artery..       30.00
35121..............  ............  Repair defect of artery..       30.00
35122..............  ............  Repair artery rupture,          35.00
                                    belly.
35122..............  ............  Repair artery rupture,          35.00
                                    belly.
35131..............  ............  Repair defect of artery..       25.00
35131..............  ............  Repair defect of artery..       25.00
35132..............  ............  Repair artery rupture,          30.00
                                    groin.
35132..............  ............  Repair artery rupture,          30.00
                                    groin.
35141..............  ............  Repair defect of artery..       20.00
35141..............  ............  Repair defect of artery..       20.00
35142..............  ............  Repair artery rupture,          23.30
                                    thigh.
35142..............  ............  Repair artery rupture,          23.30
                                    thigh.
35151..............  ............  Repair defect of artery..       22.64
35151..............  ............  Repair defect of artery..       22.64
35152..............  ............  Repair artery rupture,          25.62
                                    knee.
35152..............  ............  Repair artery rupture,          25.62
                                    knee.
35182..............  ............  Repair blood vessel             30.00
                                    lesion.
35184..............  ............  Repair blood vessel             18.00
                                    lesion.
35189..............  ............  Repair blood vessel             28.00
                                    lesion.
35190..............  ............  Repair blood vessel             12.75
                                    lesion.
35201..............  ............  Repair blood vessel             16.14
                                    lesion.
35201..............  ............  Repair blood vessel             16.14
                                    lesion.
35206..............  ............  Repair blood vessel             13.25
                                    lesion.
35221..............  ............  Repair blood vessel             24.39
                                    lesion.
35221..............  ............  Repair blood vessel             24.39
                                    lesion.
35226..............  ............  Repair blood vessel             14.50
                                    lesion.
35226..............  ............  Repair blood vessel             14.50
                                    lesion.
35231..............  ............  Repair blood vessel             20.00
                                    lesion.
35231..............  ............  Repair blood vessel             20.00
                                    lesion.
35236..............  ............  Repair blood vessel             17.11
                                    lesion.
35236..............  ............  Repair blood vessel             17.11
                                    lesion.
35246..............  ............  Repair blood vessel             26.45
                                    lesion.
35246..............  ............  Repair blood vessel             26.45
                                    lesion.
35251..............  ............  Repair blood vessel             30.20
                                    lesion.
35251..............  ............  Repair blood vessel             30.20
                                    lesion.
35256..............  ............  Repair blood vessel             18.36
                                    lesion.

[[Page 31075]]

 
35261..............  ............  Repair blood vessel             17.80
                                    lesion.
35261..............  ............  Repair blood vessel             17.80
                                    lesion.
35266..............  ............  Repair blood vessel             14.91
                                    lesion.
35266..............  ............  Repair blood vessel             14.91
                                    lesion.
35276..............  ............  Repair blood vessel             24.25
                                    lesion.
35276..............  ............  Repair blood vessel             24.25
                                    lesion.
35281..............  ............  Repair blood vessel             28.00
                                    lesion.
35281..............  ............  Repair blood vessel             28.00
                                    lesion.
35286..............  ............  Repair blood vessel             16.16
                                    lesion.
35311..............  ............  Rechanneling of artery...       27.00
35311..............  ............  Rechanneling of artery...       27.00
35321..............  ............  Rechanneling of artery...       16.00
35321..............  ............  Rechanneling of artery...       16.00
35331..............  ............  Rechanneling of artery...       26.20
35331..............  ............  Rechanneling of artery...       26.20
35351..............  ............  Rechanneling of artery...       23.00
35351..............  ............  Rechanneling of artery...       23.00
35355..............  ............  Rechanneling of artery...       18.50
35355..............  ............  Rechanneling of artery...       18.50
35361..............  ............  Rechanneling of artery...       28.20
35361..............  ............  Rechanneling of artery...       28.20
35363..............  ............  Rechanneling of artery...       30.20
35363..............  ............  Rechanneling of artery...       30.20
35371..............  ............  Rechanneling of artery...       14.72
35371..............  ............  Rechanneling of artery...       14.72
35372..............  ............  Rechanneling of artery...       18.00
35372..............  ............  Rechanneling of artery...       18.00
35381..............  ............  Rechanneling of artery...       15.81
35511..............  ............  Artery bypass graft......       21.20
35511..............  ............  Artery bypass graft......       21.20
35518..............  ............  Artery bypass graft......       21.20
35518..............  ............  Artery bypass graft......       21.20
35521..............  ............  Artery bypass graft......       22.20
35521..............  ............  Artery bypass graft......       22.20
35526..............  ............  Artery bypass graft......       29.95
35526..............  ............  Artery bypass graft......       29.95
35531..............  ............  Artery bypass graft......       36.20
35531..............  ............  Artery bypass graft......       36.20
35533..............  ............  Artery bypass graft......       28.00
35533..............  ............  Artery bypass graft......       28.00
35536..............  ............  Artery bypass graft......       31.70
35536..............  ............  Artery bypass graft......       31.70
35541..............  ............  Artery bypass graft......       25.80
35546..............  ............  Artery bypass graft......       25.54
35551..............  ............  Artery bypass graft......       26.67
35556..............  ............  Artery bypass graft......       21.76
35556..............  ............  Artery bypass graft......       21.76
35558..............  ............  Artery bypass graft......       21.20
35558..............  ............  Artery bypass graft......       21.20
35560..............  ............  Artery bypass graft......       32.00
35560..............  ............  Artery bypass graft......       32.00
35563..............  ............  Artery bypass graft......       24.20
35563..............  ............  Artery bypass graft......       24.20
35565..............  ............  Artery bypass graft......       23.20
35565..............  ............  Artery bypass graft......       23.20
35571..............  ............  Artery bypass graft......       24.06
35571..............  ............  Artery bypass graft......       24.06
35582..............  ............  Vein bypass graft........       27.13
35587..............  ............  Vein bypass graft........       24.75
35587..............  ............  Vein bypass graft........       24.75
35621..............  ............  Artery bypass graft......       20.00
35621..............  ............  Artery bypass graft......       20.00
35623..............  ............  Bypass graft, not vein...       24.00
35623..............  ............  Bypass graft, not vein...       24.00
35626..............  ............  Artery bypass graft......       27.75
35626..............  ............  Artery bypass graft......       27.75

[[Page 31076]]

 
35631..............  ............  Artery bypass graft......       34.00
35631..............  ............  Artery bypass graft......       34.00
35636..............  ............  Artery bypass graft......       29.50
35636..............  ............  Artery bypass graft......       29.50
35641..............  ............  Artery bypass graft......       24.57
35646..............  ............  Artery bypass graft......       25.81
35650..............  ............  Artery bypass graft......       19.00
35650..............  ............  Artery bypass graft......       19.00
35654..............  ............  Artery bypass graft......       25.00
35654..............  ............  Artery bypass graft......       25.00
35661..............  ............  Artery bypass graft......       19.00
35661..............  ............  Artery bypass graft......       19.00
35663..............  ............  Artery bypass graft......       22.00
35663..............  ............  Artery bypass graft......       22.00
35665..............  ............  Artery bypass graft......       21.00
35665..............  ............  Artery bypass graft......       21.00
35666..............  ............  Artery bypass graft......       22.19
35666..............  ............  Artery bypass graft......       22.19
35671..............  ............  Artery bypass graft......       19.33
35671..............  ............  Artery bypass graft......       19.33
35701..............  ............  Exploration, carotid             8.50
                                    artery.
35701..............  ............  Exploration, carotid             8.50
                                    artery.
35721..............  ............  Exploration, femoral             7.18
                                    artery.
35741..............  ............  Exploration popliteal            8.00
                                    artery.
35840..............  ............  Explore abdominal vessels        9.77
35860..............  ............  Explore limb vessels.....        5.55
35905..............  ............  Excision, graft, thorax..       31.25
35905..............  ............  Excision, graft, thorax..       31.25
35907..............  ............  Excision, graft, abdomen.       35.00
35907..............  ............  Excision, graft, abdomen.       35.00
36400..............  ............  Drawing blood............        0.18
36405..............  ............  Drawing blood............        0.18
36406..............  ............  Drawing blood............        0.18
36489..............  ............  Insertion of catheter,           2.50
                                    vein.
36489..............  ............  Insertion of catheter,           2.50
                                    vein.
36520..............  ............  Plasma and/or cell               1.74
                                    exchange.
36533..............  ............  Insertion of access              5.32
                                    device.
36534..............  ............  Revision of access device        2.80
36535..............  ............  Removal of access device.        2.27
36620..............  ............  Insertion catheter,              1.15
                                    artery.
36625..............  ............  Insertion catheter,              2.11
                                    artery.
36822..............  ............  Insertion of cannula(s)..        5.42
37565..............  ............  Ligation of neck vein....       10.88
37565..............  ............  Ligation of neck vein....       10.88
37600..............  ............  Ligation of neck artery..       11.25
37600..............  ............  Ligation of neck artery..       11.25
37605..............  ............  Ligation of neck artery..       13.11
37605..............  ............  Ligation of neck artery..       13.11
37609..............  ............  Temporal artery procedure        3.00
37609..............  ............  Temporal artery procedure        3.00
37615..............  ............  Ligation of neck artery..        5.73
37615..............  ............  Ligation of neck artery..        5.73
37617..............  ............  Ligation of abdomen             22.06
                                    artery.
37618..............  ............  Ligation of extremity            4.84
                                    artery.
37650..............  ............  Revision of major vein...        7.80
37660..............  ............  Revision of major vein...       21.00
37700..............  ............  Revise leg vein..........        3.73
37720..............  ............  Removal of leg vein......        5.66
37730..............  ............  Removal of leg veins.....        7.33
37735..............  ............  Removal of leg veins/           10.53
                                    lesion.
37760..............  ............  Revision of leg veins....       10.47
37785..............  ............  Revision secondary               3.84
                                    varicosity.
38100..............  ............  Removal of spleen, total.       14.50
38100..............  ............  Removal of spleen, total.       14.50
38101..............  ............  Removal of spleen,              15.31
                                    partial.
38115..............  ............  Repair of ruptured spleen       15.82

[[Page 31077]]

 
38300..............  ............  Drainage, lymph node             1.99
                                    lesion.
38305..............  ............  Drainage, lymph node             6.00
                                    lesion.
38308..............  ............  Incision of lymph                6.45
                                    channels.
38500..............  ............  Biopsy/removal, lymph            3.75
                                    nodes.
38500..............  ............  Biopsy/removal, lymph            3.75
                                    nodes.
38510..............  ............  Biopsy/removal, lymph            6.43
                                    nodes.
38520..............  ............  Biopsy/removal, lymph            6.67
                                    nodes.
38525..............  ............  Biopsy/removal, lymph            6.07
                                    nodes.
38530..............  ............  Biopsy/removal, lymph            7.98
                                    nodes.
38571..............  ............  Laparoscopy,                    12.38
                                    lymphadenectomy.
38572..............  ............  Laparoscopy,                    16.59
                                    lymphadenectomy.
38740..............  ............  Remove armpit lymph nodes       10.02
38745..............  ............  Remove armpit lymph nodes       13.00
38746..............  ............  Remove thoracic lymph            4.89
                                    nodes.
38760..............  ............  Remove groin lymph nodes.       12.94
38765..............  ............  Remove groin lymph nodes.       19.98
38780..............  ............  Remove abdomen lymph            16.59
                                    nodes.
39010..............  ............  Exploration of chest.....       11.79
39220..............  ............  Removal chest lesion.....       17.42
39400..............  ............  Visualization of chest...        5.61
39503..............  ............  Repair of diaphragm             34.85
                                    hernia.
42205..............  ............  Reconstruct cleft palate.       13.29
43107..............  ............  Removal of esophagus.....       40.00
43112..............  ............  Removal of esophagus.....       43.50
43117..............  ............  Partial removal of              40.00
                                    esophagus.
43122..............  ............  Parital removal of              40.00
                                    esophagus.
43215..............  ............  Esophagus endoscopy......        2.60
43217..............  ............  Esophagus endoscopy......        2.90
43219..............  ............  Esophagus endoscopy......        2.80
43228..............  ............  Esoph endoscopy, ablation        3.77
43239..............  ............  Upper GI endoscopy,              2.69
                                    biopsy.
43239..............  ............  Upper GI endoscopy,              2.87
                                    biopsy.
43244..............  ............  Upper GI endoscopy/              4.59
                                    ligation.
43246..............  ............  Place gastrostomy tube...        4.33
43246..............  ............  Place gastrostomy tube...        4.33
43247..............  ............  Operative upper GI               3.39
                                    endoscopy.
43249..............  ............  Esoph endoscopy, dilation        2.90
43251..............  ............  Operative upper GI               3.70
                                    endoscopy.
43255..............  ............  Operative upper GI               4.40
                                    endoscopy.
43258..............  ............  Operative upper GI               4.55
                                    endoscopy.
43259..............  ............  Endoscopic ultrasound            4.89
                                    exam.
43263..............  ............  Endo                             6.19
                                    cholangiopancreatograph.
43265..............  ............  Endo                             8.90
                                    cholangiopancreatograph.
43269..............  ............  Endo                             6.04
                                    cholangiopancreatograph.
43310..............  ............  Repair of esophagus......       25.39
43312..............  ............  Repair esophagus and            28.42
                                    fistula.
43320..............  ............  Fuse esophagus & stomach.       19.93
43324..............  ............  Revise esophagus &              20.57
                                    stomach.
43325..............  ............  Revise esophagus &              20.06
                                    stomach.
43326..............  ............  Revise esophagus &              19.74
                                    stomach.
43330..............  ............  Repair of esophagus......       19.77
43331..............  ............  Repair of esophagus......       20.13
43340..............  ............  Fuse esophagus &                19.61
                                    intestine.
43341..............  ............  Fuse esophagus &                20.85
                                    intestine.
43350..............  ............  Surgical opening,               15.78
                                    esophagus.
43351..............  ............  Surgical opening,               18.35
                                    esophagus.
43352..............  ............  Surgical opening,               15.26
                                    esophagus.
43360..............  ............  Gastrointestinal repair..       35.70
43361..............  ............  Gastrointestinal repair..       40.50
43400..............  ............  Ligate esophagus veins...       21.20
43401..............  ............  Esophagus surgery for           22.09
                                    veins.
43405..............  ............  Ligate/staple esophagus..       20.01
43410..............  ............  Repair esophagus wound...       13.47
43415..............  ............  Repair esophagus wound...       25.00
43420..............  ............  Repair esophagus opening.       14.35
43425..............  ............  Repair esophagus opening.       21.03

[[Page 31078]]

 
43500..............  ............  Surgical opening of             11.05
                                    stomach.
43501..............  ............  Surgical repair of              20.04
                                    stomach.
43502..............  ............  Surgical repair of              23.13
                                    stomach.
43510..............  ............  Surgical opening of             13.08
                                    stomach.
43520..............  ............  Incision of pyloric              9.99
                                    muscle.
43605..............  ............  Biopsy of stomach........       11.98
43610..............  ............  Excision of stomach             14.60
                                    lesion.
43611..............  ............  Excision of stomach             17.84
                                    lesion.
43620..............  ............  Removal of stomach.......       30.04
43621..............  ............  Removal of stomach.......       30.73
43622..............  ............  Removal of stomach.......       32.53
43631..............  ............  Removal of stomach,             22.59
                                    partial.
43632..............  ............  Removal of stomach,             22.59
                                    partial.
43633..............  ............  Removal of stomach,             23.10
                                    partial.
43634..............  ............  Removal of stomach,             25.12
                                    partial.
43638..............  ............  Removal of stomach,             29.00
                                    partial.
43638..............  ............  Removal of stomach,             29.00
                                    partial.
43639..............  ............  Removal of stomach,             29.65
                                    partial.
43640..............  ............  Vagotomy & pylorus repair       17.02
43641..............  ............  Vagotomy & pylorus repair       17.27
43651..............  ............  Laparoscopy, vagus nerve.       10.15
43652..............  ............  Laparoscopy, vagus nerve.       12.15
43800..............  ............  Reconstruction of pylorus       13.69
43810..............  ............  Fusion of stomach and           14.65
                                    bowel.
43820..............  ............  Fusion of stomach and           15.37
                                    bowel.
43825..............  ............  Fusion of stomach and           19.22
                                    bowel.
43830..............  ............  Place gastrostomy tube...        9.53
43832..............  ............  Place gastrostomy tube...       15.60
43840..............  ............  Repair of stomach lesion.       15.56
43842..............  ............  Gastroplasty for obesity.       18.47
43843..............  ............  Gastroplasty for obesity.       18.65
43846..............  ............  Gastric bypass for              24.05
                                    obesity.
43847..............  ............  Gastric bypass for              26.92
                                    obesity.
43848..............  ............  Revision gastroplasty....       29.39
43850..............  ............  Revise stomach-bowel            24.72
                                    fusion.
43855..............  ............  Revise stomach-bowel            26.16
                                    fusion.
43860..............  ............  Revise stomach-bowel            25.00
                                    fusion.
43865..............  ............  Revise stomach-bowel            26.52
                                    fusion.
43870..............  ............  Repair stomach opening...        9.69
43880..............  ............  Repair stomach-bowel            24.65
                                    fistula.
44005..............  ............  Freeing of bowel adhesion       16.23
44010..............  ............  Incision of small bowel..       12.52
44020..............  ............  Exploration of small            13.99
                                    bowel.
44021..............  ............  Decompress small bowel...       14.08
44025..............  ............  Incision of large bowel..       14.28
44050..............  ............  Reduce bowel obstruction.       14.03
44050..............  ............  Reduce bowel obstruction.       14.03
44055..............  ............  Correct malrotation of          22.00
                                    bowel.
44110..............  ............  Excision of bowel               11.81
                                    lesion(s).
44111..............  ............  Excision of bowel               14.29
                                    lesion(s).
44120..............  ............  Removal of small                17.00
                                    intestine.
44125..............  ............  Removal of small                17.54
                                    intestine.
44130..............  ............  Bowel to bowel fusion....       14.49
44130..............  ............  Bowel to bowel fusion....       14.49
44140..............  ............  Partial removal of colon.       21.00
44140..............  ............  Partial removal of colon.       21.00
44143..............  ............  Partial removal of colon.       22.99
44144..............  ............  Partial removal of colon.       21.53
44144..............  ............  Partial removal of colon.       21.53
44145..............  ............  Partial removal of colon.       26.42
44146..............  ............  Partial removal of colon.       27.54
44147..............  ............  Partial removal of colon.       20.71
44150..............  ............  Removal of colon.........       23.95
44151..............  ............  Removal of colon/               26.88
                                    ileostomy.
44151..............  ............  Removal of colon/               26.88
                                    ileostomy.
44152..............  ............  Removal of colon/               27.83
                                    ileostomy.

[[Page 31079]]

 
44153..............  ............  Removal of colon/               30.59
                                    ileostomy.
44155..............  ............  Removal of colon/               27.86
                                    ileostomy.
44156..............  ............  Removal of colon/               30.79
                                    ileostomy.
44156..............  ............  Removal of colon/               30.79
                                    ileostomy.
44160..............  ............  Removal of colon.........       18.62
44200..............  ............  Laparoscopy, enterolysis.       14.44
44300..............  ............  Open bowel to skin.......       12.11
44310..............  ............  Ileostomy/jejunostomy....       15.95
44312..............  ............  Revision of ileostomy....        8.02
44314..............  ............  Revision of ileostomy....       15.05
44316..............  ............  Devise bowel pouch.......       21.09
44320..............  ............  Colostomy................       17.64
44340..............  ............  Revision of colostomy....        7.72
44345..............  ............  Revision of colostomy....       15.43
44346..............  ............  Revision of colostomy....       16.99
44388..............  ............  Colon endoscopy..........        2.82
44389..............  ............  Colonoscopy with biopsy..        3.13
44390..............  ............  Colonoscopy for foreign          3.83
                                    body.
44391..............  ............  Colonoscopy for bleeding.        4.32
44392..............  ............  Colonoscopy and                  3.82
                                    polypectomy.
44393..............  ............  Colonoscopy, lesion              4.84
                                    removal.
44394..............  ............  Colonoscopy w/snare......        4.43
44394..............  ............  Colonoscopy w/snare......        4.43
44602..............  ............  Suture, small intestine..       16.03
44603..............  ............  Suture, small intestine..       18.66
44604..............  ............  Suture, large intestine..       16.03
44605..............  ............  Repair of bowel lesion...       19.53
44615..............  ............  Intestinal                      15.93
                                    stricturoplasty.
44620..............  ............  Repair bowel opening.....       12.20
44625..............  ............  Repair bowel opening.....       15.05
44626..............  ............  Repair bowel opening.....       25.36
44640..............  ............  Repair bowel-skin fistula       21.65
44650..............  ............  Repair bowel fistula.....       22.57
44660..............  ............  Repair bowel-bladder            21.36
                                    fistula.
44661..............  ............  Repair bowel-bladder            24.81
                                    fistula.
44680..............  ............  Surgical revision,              15.40
                                    intestine.
44700..............  ............  Suspend bowel w/                16.11
                                    prosthesis.
44800..............  ............  Excision of bowel pouch..       11.23
44820..............  ............  Excision of mesentery           12.09
                                    lesion.
44850..............  ............  Repair of mesentery......       10.74
44900..............  ............  Drain app abscess, open..       10.14
44950..............  ............  Appendectomy.............       10.00
44960..............  ............  Appendectomy.............       12.34
44970..............  ............  Laparoscopy, appendectomy        8.70
45000..............  ............  Drainage of pelvic               4.52
                                    abscess.
45020..............  ............  Drainage of rectal               4.72
                                    abscess.
45100..............  ............  Biopsy of rectum.........        3.68
45108..............  ............  Removal of anorectal             4.76
                                    lesion.
45110..............  ............  Removal of rectum........       28.00
45111..............  ............  Partial removal of rectum       16.48
45112..............  ............  Removal of rectum........       30.54
45113..............  ............  Partial proctectomy......       30.58
45114..............  ............  Partial removal of rectum       27.32
45116..............  ............  Partial removal of rectum       24.58
45119..............  ............  Remove rectum w/reservoir       30.84
45120..............  ............  Removal of rectum........       24.60
45121..............  ............  Removal of rectum and           27.04
                                    colon.
45123..............  ............  Partial proctectomy......       16.71
45126..............  ............  Pelvic exenteration......       45.16
45130..............  ............  Excision of rectal              16.44
                                    prolapse.
45135..............  ............  Excision of rectal              19.28
                                    prolapse.
45160..............  ............  Excision of rectal lesion       15.32
45170..............  ............  Excision of rectal lesion       11.49
45190..............  ............  Destruction, rectal tumor        9.74
45305..............  ............  Proctosigmoidoscopy &            1.01
                                    biopsy.
45309..............  ............  Proctosigmoidoscopy......        2.01

[[Page 31080]]

 
45330..............  ............  Diagnostic sigmoidoscopy.        0.96
45337..............  ............  Sigmoidoscopy &                  2.36
                                    decompress.
45339..............  ............  Sigmoidoscopy............        3.14
45378..............  ............  Diagnostic colonoscopy...        3.70
45380..............  ............  Colonoscopy and biopsy...        4.01
45383..............  ............  Lesion removal                   5.87
                                    colonoscopy.
45384..............  ............  Colonoscopy..............        4.70
45385..............  ............  Lesion removal                   5.31
                                    colonoscopy.
45505..............  ............  Repair of rectum.........        7.58
45540..............  ............  Correct rectal prolapse..       16.27
45541..............  ............  Correct rectal prolapse..       13.40
45550..............  ............  Repair rectum/remove            23.00
                                    sigmoid.
45560..............  ............  Repair of rectocele......       10.58
45562..............  ............  Exploration/repair of           15.38
                                    rectum.
45563..............  ............  Exploration/repair of           23.47
                                    rectum.
45800..............  ............  Repair rect/bladder             17.77
                                    fistula.
45805..............  ............  Repair fistula w/               20.78
                                    colostomy.
45820..............  ............  Repair rectourethral            18.48
                                    fistula.
45825..............  ............  Repair fistula w/               21.25
                                    colostomy.
45900..............  ............  Reduction of rectal              2.61
                                    prolapse.
45905..............  ............  Dilation of anal                 2.30
                                    sphincter.
45910..............  ............  Dilation of rectal               2.80
                                    narrowing.
45910..............  ............  Dilation of rectal               2.80
                                    narrowing.
45915..............  ............  Remove rectal obstruction        3.14
46040..............  ............  Incision of rectal               4.96
                                    abscess.
46045..............  ............  Incision of rectal               4.32
                                    abscess.
46060..............  ............  Incision of rectal               5.69
                                    abscess.
46083..............  ............  Incise external                  1.40
                                    hemorrhoid.
46083..............  ............  Incise external                  1.40
                                    hemorrhoid.
46221..............  ............  Ligation of hemorrhoid(s)        2.04
46230..............  ............  Removal of anal tabs.....        2.57
46250..............  ............  Hemorrhoidectomy.........        3.89
46255..............  ............  Hemorrhoidectomy.........        4.60
46257..............  ............  Remove hemorrhoids &             5.40
                                    fissure.
46258..............  ............  Remove hemorrhoids &             5.73
                                    fistula.
46258..............  ............  Remove hemorrhoids &             5.73
                                    fistula.
46260..............  ............  Hemorrhoidectomy.........        6.37
46261..............  ............  Remove hemorrhoids &             7.08
                                    fissure.
46262..............  ............  Remove hemorrhoids &             7.50
                                    fistula.
46270..............  ............  Removal of anal fistula..        3.72
46275..............  ............  Removal of anal fistula..        4.56
46280..............  ............  Removal of anal fistula..        5.98
46288..............  ............  Repair anal fistula......        7.13
46320..............  ............  Removal of hemorrhoid            1.61
                                    clot.
46320..............  ............  Removal of hemorrhoid            1.61
                                    clot.
46700..............  ............  Repair of anal stricture.        9.13
46705..............  ............  Repair of anal stricture.        6.90
46715..............  ............  Repair of anovaginal             7.20
                                    fistula.
46716..............  ............  Repair of anovaginal            15.07
                                    fistula.
46730..............  ............  Construction of absent          26.75
                                    anus.
46735..............  ............  Construction of absent          32.17
                                    anus.
46740..............  ............  Construction of absent          30.00
                                    anus.
46742..............  ............  Repair of imperforated          35.80
                                    anus.
46744..............  ............  Repair of cloacal anomaly       52.63
46746..............  ............  Repair of cloacal anomaly       58.22
46748..............  ............  Repair of cloacal anomaly       64.21
46750..............  ............  Repair of anal sphincter.       10.25
46753..............  ............  Reconstruction of anus...        8.29
46754..............  ............  Removal of suture from           2.20
                                    anus.
46760..............  ............  Repair of anal sphincter.       14.43
46761..............  ............  Repair of anal sphincter.       13.84
46762..............  ............  Implant artificial              12.71
                                    sphincter.
46900..............  ............  Destruction, anal                1.91
                                    lesion(s).
46910..............  ............  Destruction, anal                1.86
                                    lesion(s).
46916..............  ............  Cryosurgery, anal                1.86
                                    lesion(s).
46917..............  ............  Laser surgery, anal              1.86
                                    lesions.

[[Page 31081]]

 
46922..............  ............  Excision of anal                 1.86
                                    lesion(s).
46924..............  ............  Destruction, anal                2.76
                                    lesion(s).
46924..............  ............  Destruction, anal                2.76
                                    lesion(s).
46934..............  ............  Destruction of                   3.51
                                    hemorrhoids.
46935..............  ............  Destruction of                   2.43
                                    hemorrhoids.
46936..............  ............  Destruction of                   3.69
                                    hemorrhoids.
46940..............  ............  Treatment of anal fissure        2.32
46942..............  ............  Treatment of anal fissure        2.04
46945..............  ............  Ligation of hemorrhoids..        1.84
46946..............  ............  Ligation of hemorrhoids..        2.58
47010..............  ............  Open drainage, liver            16.01
                                    lesion.
47015..............  ............  Inject/aspirate liver           15.11
                                    cyst.
47100..............  ............  Wedge biopsy of liver....       11.67
47120..............  ............  Partial removal of liver.       35.50
47122..............  ............  Extensive removal of            55.13
                                    liver.
47125..............  ............  Partial removal of liver.       49.19
47130..............  ............  Partial removal of liver.       53.35
47134..............  ............  Partial removal, donor          39.15
                                    liver.
47300..............  ............  Surgery for liver lesion.       15.08
47350..............  ............  Repair liver wound.......       19.56
47360..............  ............  Repair liver wound.......       26.92
47361..............  ............  Repair liver wound.......       47.12
47362..............  ............  Repair liver wound.......       18.51
47400..............  ............  Incision of liver duct...       32.49
47420..............  ............  Incision of bile duct....       19.88
47425..............  ............  Incision of bile duct....       19.83
47460..............  ............  Incise bile duct                18.04
                                    sphincter.
47480..............  ............  Incision of gallbladder..       10.82
47562..............  ............  Laparoscopic                    11.09
                                    cholecystectomy.
47563..............  ............  Laparoscopic                    11.94
                                    cholecystectomy.
47564..............  ............  Laparo cholecystectomy/         14.23
                                    explr.
47570..............  ............  Laparo                          12.58
                                    cholecystoenterostomy.
47600..............  ............  Removal of gallbladder...       13.58
47605..............  ............  Removal of gallbladder...       14.69
47610..............  ............  Removal of gallbladder...       18.82
47612..............  ............  Removal of gallbladder...       18.78
47620..............  ............  Removal of gallbladder...       20.64
47701..............  ............  Bile duct revision.......       27.81
47711..............  ............  Excision of bile duct           23.03
                                    tumor.
47712..............  ............  Excision of bile duct           30.24
                                    tumor.
47715..............  ............  Excision of bile duct           18.80
                                    cyst.
47716..............  ............  Fusion of bile duct cyst.       16.44
47720..............  ............  Fuse gallbladder & bowel.       15.91
47721..............  ............  Fuse upper gi structures.       19.12
47740..............  ............  Fuse gallbladder & bowel.       18.48
47741..............  ............  Fuse gallbladder & bowel.       21.34
47760..............  ............  Fuse bile ducts and bowel       25.85
47765..............  ............  Fuse liver ducts & bowel.       24.88
47780..............  ............  Fuse bile ducts and bowel       26.50
47785..............  ............  Fuse bile ducts and bowel       31.18
47800..............  ............  Reconstruction of bile          23.30
                                    ducts.
47801..............  ............  Placement, bile duct            15.17
                                    support.
47802..............  ............  Fuse liver duct &               21.55
                                    intestine.
47900..............  ............  Suture bile duct injury..       19.90
48000..............  ............  Drainage of abdomen......       28.07
48001..............  ............  Placement of drain,             35.45
                                    pancreas.
48005..............  ............  Resect/debride pancreas..       42.17
48020..............  ............  Removal of pancreatic           15.70
                                    stone.
48100..............  ............  Biopsy of pancreas.......       12.23
48120..............  ............  Removal of pancreas             15.85
                                    lesion.
48140..............  ............  Partial removal of              22.94
                                    pancreas.
48145..............  ............  Partial removal of              24.02
                                    pancreas.
48146..............  ............  Pancreatectomy...........       26.40
48148..............  ............  Removal of pancreatic           17.34
                                    duct.
48150..............  ............  Partial removal of              48.00
                                    pancreas.
48150..............  ............  Partial removal of              48.00
                                    pancreas.

[[Page 31082]]

 
48152..............  ............  Pancreatectomy...........       43.75
48153..............  ............  Pancreatectomy...........       47.89
48154..............  ............  Pancreatectomy...........       44.10
48155..............  ............  Removal of pancreas......       24.64
48180..............  ............  Fuse pancreas and bowel..       24.72
48500..............  ............  Surgery of pancreas cyst.       15.28
48510..............  ............  Drain pancreatic                14.31
                                    pseudocyst.
48520..............  ............  Fuse pancreas cyst and          15.59
                                    bowel.
48540..............  ............  Fuse pancreas cyst and          19.72
                                    bowel.
48545..............  ............  Pancreatorrhaphy.........       18.18
48547..............  ............  Duodenal exclusion.......       25.83
49000..............  ............  Exploration of abdomen...       11.68
49002..............  ............  Reopening of abdomen.....       10.49
49010..............  ............  Exploration behind              12.28
                                    abdomen.
49020..............  ............  Drain abdominal abscess..       22.84
49040..............  ............  Drain, open, abdom              13.52
                                    abscess.
49060..............  ............  Drain, open, retrop             15.86
                                    abscess.
49085..............  ............  Remove abdomen foreign          12.14
                                    body.
49200..............  ............  Removal of abdominal            10.25
                                    lesion.
49201..............  ............  Removal of abdominal            14.84
                                    lesion.
49215..............  ............  Excise sacral spine tumor       33.50
49215..............  ............  Excise sacral spine tumor       33.50
49220..............  ............  Multiple surgery, abdomen       14.88
49255..............  ............  Removal of omentum.......       11.14
49320..............  ............  Diag laparo separate proc        5.10
49321..............  ............  Laparoscopy; biopsy......        5.40
49322..............  ............  Laparoscopy; aspiration..        5.70
49421..............  ............  Insert abdominal drain...        5.54
49422..............  ............  Remove perm cannula/             6.25
                                    catheter.
49425..............  ............  Insert abdomen-venous           11.37
                                    drain.
49426..............  ............  Revise abdomen-venous            9.63
                                    shunt.
49428..............  ............  Ligation of shunt........        6.06
49429..............  ............  Removal of shunt.........        7.40
49495..............  ............  Repair inguinal hernia,          5.89
                                    init.
49495..............  ............  Repair inguinal hernia,          5.89
                                    init.
49496..............  ............  Repair inguinal hernia,          8.79
                                    init.
49496..............  ............  Repair inguinal hernia,          8.79
                                    init.
49500..............  ............  Repair inguinal hernia...        5.48
49501..............  ............  Repair inguinal hernia,          8.88
                                    init.
49505..............  ............  Repair inguinal hernia...        7.60
49505..............  ............  Repair inguinal hernia...        7.60
49507..............  ............  Repair inguinal hernia...        9.57
49520..............  ............  Rerepair inguinal hernia.        9.63
49521..............  ............  Repair inguinal hernia,         11.97
                                    rec.
49525..............  ............  Repair inguinal hernia...        8.57
49540..............  ............  Repair lumbar hernia.....       10.39
49550..............  ............  Repair femoral hernia....        8.63
49553..............  ............  Repair femoral hernia,           9.44
                                    init.
49555..............  ............  Repair femoral hernia....        9.03
49557..............  ............  Repair femoral hernia,          11.15
                                    recur.
49560..............  ............  Repair abdominal hernia..       11.57
49561..............  ............  Repair incisional hernia.       14.25
49565..............  ............  Rerepair abdominal hernia       11.57
49566..............  ............  Repair incisional hernia.       14.40
49570..............  ............  Repair epigastric hernia.        5.69
49572..............  ............  Repair epigastric hernia.        6.73
49580..............  ............  Repair umbilical hernia..        4.11
49582..............  ............  Repair umbilical hernia..        6.65
49585..............  ............  Repair umbilical hernia..        6.23
49587..............  ............  Repair umbilical hernia..        7.56
49590..............  ............  Repair abdominal hernia..        8.54
49605..............  ............  Repair umbilical lesion..       22.66
49606..............  ............  Repair umbilical lesion..       18.60
49650..............  ............  Laparo hernia repair             6.27
                                    initial.
49651..............  ............  Laparo hernia repair             8.24
                                    recur.
49900..............  ............  Repair of abdominal wall.       12.28

[[Page 31083]]

 
49905..............  ............  Omental flap.............        6.55
50200..............  ............  Biopsy of kidney.........        2.63
50230..............  ............  Removal of kidney........       22.07
51595..............  ............  Remove bladder/revise           37.14
                                    tract.
51596..............  ............  Remove bladder/create           39.52
                                    pouch.
56515..............  ............  Destruction, vulva               2.76
                                    lesion(s).
56740..............  ............  Remove vagina gland              4.57
                                    lesion.
57100..............  ............  Biopsy of vagina.........        1.20
57130..............  ............  Remove vagina lesion.....        2.43
57292..............  ............  Construct vagina with           13.09
                                    graft.
57307..............  ............  Fistula repair &                15.93
                                    colostomy.
57410..............  ............  Pelvic examination.......        1.75
57505..............  ............  Endocervical curettage...        1.14
58150..............  ............  Total hysterectomy.......       15.24
58152..............  ............  Total hysterectomy.......       20.60
58260..............  ............  Vaginal hysterectomy.....       12.98
58262..............  ............  Vaginal hysterectomy.....       14.77
58263..............  ............  Vaginal hysterectomy.....       16.06
58267..............  ............  Hysterectomy & vagina           17.04
                                    repair.
58270..............  ............  Hysterectomy & vagina           14.26
                                    repair.
58275..............  ............  Hysterectomy/revise             15.76
                                    vagina.
58280..............  ............  Hysterectomy/revise             17.01
                                    vagina.
58285..............  ............  Extensive hysterectomy...       22.26
58323..............  ............  Sperm washing............        0.23
58400..............  ............  Suspension of uterus.....        6.36
58600..............  ............  Division of fallopian            5.60
                                    tube.
58605..............  ............  Division of fallopian            5.00
                                    tube.
58611..............  ............  Ligate oviduct(s) add-on.        1.45
58700..............  ............  Removal of fallopian tube       12.05
58740..............  ............  Revise fallopian tube(s).       14.00
58805..............  ............  Drainage of ovarian              5.88
                                    cyst(s).
58820..............  ............  Drain ovary abscess, open        4.22
58825..............  ............  Transposition, ovary(s)..       10.98
58920..............  ............  Partial removal of              11.36
                                    ovary(s).
58950..............  ............  Resect ovarian malignancy       16.93
58951..............  ............  Resect ovarian malignancy       22.38
59150..............  ............  Treat ectopic pregnancy..       11.67
59151..............  ............  Treat ectopic pregnancy..       11.49
59812..............  ............  Treatment of miscarriage.        4.01
59870..............  ............  Evacuate mole of uterus..        6.01
60100..............  ............  Biopsy of thyroid........        1.56
60220..............  ............  Partial removal of              11.90
                                    thyroid.
60220..............  ............  Partial removal of              11.90
                                    thyroid.
60252..............  ............  Removal of thyroid.......       20.57
60254..............  ............  Extensive thyroid surgery       26.99
60260..............  ............  Repeat thyroid surgery...       17.47
60270..............  ............  Removal of thyroid.......       20.27
60271..............  ............  Removal of thyroid.......       16.83
60540..............  ............  Explore adrenal gland....       17.03
60545..............  ............  Explore adrenal gland....       19.88
62263..............  ............  Lysis epidural adhesions.        6.14
62310..............  ............  Inject spine c/t.........        1.91
62311..............  ............  Inject spine l/s (cd)....        1.54
62318..............  ............  Inject spine w/cath, c/t.        2.04
62319..............  ............  Inject spine w/cath l/s          1.87
                                    (cd).
65855..............  ............  Laser surgery of eye.....        3.85
66180..............  ............  Implant eye shunt........       14.55
66986..............  ............  Exchange lens prosthesis.       12.28
67028..............  ............  Injection eye drug.......        2.52
67218..............  ............  Treatment of retinal            18.53
                                    lesion.
67904..............  ............  Repair eyelid defect.....        6.26
69990..............  ............  Microsurgery add-on......        3.47
72275..............  ............  Epidurography............        0.76
76005..............  ............  Fluoroguide for spine            0.60
                                    inject.
76065..............  ............  X-rays, bone evaluation..        0.70
76090..............  ............  Mammogram, one breast....        0.70

[[Page 31084]]

 
76091..............  ............  Mammogram, both breasts..        0.87
76095..............  ............  Stereotactic breast              1.59
                                    biopsy.
88170..............  ............  Fine needle aspiration...        1.27
88171..............  ............  Fine needle aspiration...        1.27
90901..............  ............  Biofeedback train, any           0.41
                                    meth.
90911..............  ............  Biofeedback peri/uro/            0.89
                                    rectal.
90935..............  ............  Hemodialysis, one                1.22
                                    evaluation.
90937..............  ............  Hemodialysis, repeated           2.11
                                    eval.
90945..............  ............  Dialysis, one evaluation.        1.28
90947..............  ............  Dialysis, repeated eval..        2.16
90989..............  ............  Dialysis training,               0.00
                                    complete.
90993..............  ............  Dialysis training,               0.00
                                    incompl.
90997..............  ............  Hemoperfusion............        1.84
92018..............  ............  New eye exam & treatment.        2.50
93350..............  ............  Echo transthoracic.......        1.48
94640..............  ............  Airway inhalation                0.00
                                    treatment.
94664..............  ............  Aerosol or vapor                 0.00
                                    inhalations.
94665..............  ............  Aerosol or vapor                 0.00
                                    inhalations.
96100..............  ............  Psychological testing....        0.00
96105..............  ............  Assessment of aphasia....        0.00
96110..............  ............  Developmental test, lim..        0.00
96115..............  ............  Neurobehavior status exam        0.00
96117..............  ............  Neuropsych test battery..        0.00
97542..............  ............  Wheelchair mngmnt                0.45
                                    training.
99233..............  ............  Subsequent hospital care.        1.51
99273..............  ............  Confirmatory consultation        1.19
99274..............  ............  Confirmatory consultation        1.73
99291..............  ............  Critical care, first hour        4.00
99291..............  ............  Critical care, first hour        4.00
99291..............  ............  Critical care, first hour        4.00
99292..............  ............  Critical care, addl 30           2.00
                                    min.
99292..............  ............  Critical care, addl 30           2.00
                                    min.
99292..............  ............  Critical care, addl 30           2.00
                                    min.
99295..............  ............  Neonatal critical care...       16.00
99296..............  ............  Neonatal critical care...        8.00
99297..............  ............  Neonatal critical care...        4.00
99298..............  ............  Neonatal critical care...        2.75
99436..............  ............  Attendance, birth........        1.50
99440..............  ............  Newborn resuscitation....       2.93
------------------------------------------------------------------------
\1\All CPT codes and descriptors copyright 2000 American Medical
  Association

      
  

Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 / 
Notices

[[Page 31084]]


      
      
      
[FR Doc. 01-14336 Filed 6-7-01; 8:45 am]
BILLING CODE 4120-01-P