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 Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Part 405, 410, 411, 413, 414, 424, and 426
[CMS-1502-FC and CMS-1325-F]
RINs 0938-AN84 and 0938-AN58
 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
 ACTION: Final rule with comment.
 SUMMARY: This rule addresses Medicare Part B payment policy, including the physician fee schedule that are applicable for calendar year (CY) 2006; and finalizes certain provisions of the interim final rule to implement the Competitive Acquisition Program (CAP) for Part B Drugs. It also revises Medicare Part B payment and related policies regarding: Physician work; practice expense (PE) and malpractice relative value units (RVUs); Medicare telehealth services; multiple diagnostic imaging procedures; covered outpatient drugs and biologicals; supplemental payments to Federally Qualified Health Centers (FQHCs); renal dialysis services; coverage for glaucoma screening services; National Coverage Decision (NCD) timeframes; and physician referrals for nuclear medicine services and supplies to health care entities with which they have financial relationships. In addition, the rule finalizes the interim RVUs for CY 2005 and issues interim RVUs for new and revised procedure codes for CY 2006. This rule also updates the codes subject to the physician self-referral prohibition and discusses payment policies relating to teaching anesthesia services, therapy caps, private contracts and opt-out, and chiropractic and oncology demonstrations. As required by the statute, it also announces that the physician fee schedule update for CY 2006 is −4.4 percent, the initial estimate for the sustainable growth rate for CY 2006 is 1.7 percent and the conversion factor for CY 2006 is $36.1770.
 DATES: *Effective Date:*
                             These regulations are effective on January 1, 2006. *Comment Date:*
                             To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on January 3, 2006.
 ADDRESSES: In commenting, please refer to file code CMS-1502-FC. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of four ways (no duplicates, please): 1. 
                            *Electronically.*
                             You may submit electronic comments on specific issues in this regulation to 
                            *http://www.cms.hhs.gov/​regulations/​ecomments.*
                             (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.) 2. 
                            *By regular mail.*
                             You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1502-FC, P.O. Box 8017, Baltimore, MD 21244-8017. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. 
                            *By express or overnight mail.*
                             You may send written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1502-FC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. 4. 
                            *By hand or courier.*
                             If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786-7197 in advance to schedule your arrival with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-1850. (Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.) Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period. *Submission of comments on paperwork requirements.*
                             You may submit comments on this document's paperwork requirements by mailing your comments to the addresses provided at the end of the “Collection of Information Requirements” section in this document. For information on viewing public comments, see the beginning of the 
                            **SUPPLEMENTARY INFORMATION**
                             section.
 FOR FURTHER INFORMATION CONTACT: Pam West (410) 786-2302 (for issues related to practice expense). Rick Ensor (410) 786-5617 (for issues related to the nonphysician workpool and supplemental survey data). Stephanie Monroe (410) 786-6864 (for issues related to the geographic practice cost index and malpractice RVUs). Craig Dobyski (410) 786-4584 (for issues related to list of telehealth services). Ken Marsalek (410) 786-4502 (for issues related to multiple procedure reduction for diagnostic imaging services and payment for teaching anesthesiologists). Henry Richter (410) 786-4562 (for issues related to payments for end stage renal disease facilities). Angela Mason (410) 786-7452 or Catherine Jansto (410) 786-7762 (for issues related to payment for covered outpatient drugs and biologicals). Fred Grabau (410) 786-0206 (for issues related to private contracts and opt out provision). David Worgo (410) 786-5919 (for issues related to Federally Qualified Health Centers). Dorothy Shannon (410) 786-3396 (for issues related to the outpatient therapy cap). Vadim Lubarsky (410) 786-0840 (for issues related to National Coverage Decision timeframes). Bill Larson (410) 786-7176 (for issues related to coverage of screening for glaucoma). Lia Prela (410) 786-0548 (for issues related to the competitive acquisition program (CAP) for part B drugs). Diane Milstead (410) 786-3355 or Gaysha Brooks (410) 786-9649 (for all other issues).


SUPPLEMENTARY INFORMATION: *Submitting Comments:*
                         We welcome comments from the public on the following issues: interim RVUs for selected procedure codes identified in Addendum C; and the physician self referral designated health services listed in tables 32 and 33. You can assist us by referencing the file code CMS-1502-FC and the specific “issue identifier” that precedes the section on which you choose to comment. *Inspection of Public Comments:*
                         All comments received before the close of 
                        ( print page 70117)
                        the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. CMS posts all comments received before the close of the comment period on its public web site as soon as possible after they are received. Hard copy 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 Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951. This 
                        **Federal Register**
                         document is also available from the 
                        **Federal Register**
                         online database through GPO Access a service of the U.S. Government Printing Office. The web site address is: 
                        *http://www.access.gpo.gov/​nara/​index.html*. Information on the physician fee schedule can be found on the CMS homepage. You can access this data by using the following directions: 1. Go to the CMS homepage (
                        *http://www.cms.hhs.gov*). 2. Place your cursor over the word “Professionals” in the blue areas near the top of the page. Select “physicians” from the drop-down menu. 3. Under “Billing/Payment” select “Physician Fee Schedule”. To assist readers in referencing sections contained in this preamble, we are providing the following table of contents. Some of the issues discussed in this preamble affect the payment policies, but do not require changes to the regulations in the 
                        *Code of Federal Regulations*. Information on the regulation's impact appears throughout the preamble and is not exclusively in section VI. Table of Contents I. Background A. Introduction B. Development of the Relative Value System C. Components of the Fee Schedule Payment Amounts D. Most Recent Changes the Fee Schedule II. Provisions of the Final Rule A. Resource-Based Practice Expense Relative Value Units (PE RVUs) 1. Current Methodology 2. PE Proposals for CY 2006 3. PE Recommendations on CPEP Inputs for CY 2006 4. Payment for Splint and Cast Supplies 5. Miscellaneous PE Issues B. Geographic Practice Cost Indices (GPCIs) C. Malpractice RVUs 1. Five Percent Specialty Threshold 2. Specialty Crosswalk Issues 3. Cardiac Catheterization and Angioplasty Exception 4. Dominant Specialty for Low-Volume Codes 5. Collection of Premium Data D. Medicare Telehealth Services 1. Requests for Adding Services to the List of Medicare Telehealth Services 2. Definition of an Originating Site 3. Other Issues E. Contractor Pricing of Unlisted Therapy Modalities and Procedures F. Payment for Teaching Anesthesiologists G. End Stage Renal Disease (ESRD) Related Provisions 1. Revised Pricing Methodology for Separately Billable Drugs and Biologicals Furnished by ESRD Facilities. 2. Adjustment to Account for Changes in the Pricing of Separately Billable Drugs and Biologicals, and the Estimated Increase in Expenditures for Drugs and Biologicals 3. Revisions to Geographic Designations and Wage Indexes Applied to the ESRD Composite Payment Rate 4. Miscellaneous Comments on ESRD Issues 5. Revisions to the Composite Payment Rate Exceptions Process H. Payment for Covered Outpatient Drugs and Biologicals 1. ASP issues 2. Payment for Drugs Furnished During CY 2006 in Connection With the Furnishing of Renal Dialysis Services if Separately Billed by Renal Dialysis Facilities 3. Clotting Factor Furnishing Fee 4. Payment for Inhalation Drugs and Dispensing Fee 5. Supplying Fee 6. Competitive Acquisition of Outpatient Drugs And Biologicals Under Part B I. Private Contracts and Opt-out Provision J. Multiple Procedure Payment Reduction for Diagnostic Imaging K. Therapy Cap L. Chiropractic Demonstration Discussion M. Supplemental Payments to FQHCs Subcontracting with Medicare Advantage Plans N. National Coverage Decisions Timeframes O. Coverage of Screening for Glaucoma P. Additional Issues 1. Corrections to Conditions for Medicare Payment (§ 424.22) 2. Chemotherapy Demonstration Project III. Refinement of RVUs for CY 2006 and Response to Public Comments on Interim RVUs for 2005 A. Summary of Issues Discussed Related to the Adjustment of RVUs B. Process for Establishing Work RVUs for the 2005 PFS C. Work RVU Refinements of Interim RVUs 1. Methodology (Includes Table titled “Work Relative Value Unit Refinements of the 2004 Interim and Related Relative Value Units”) 2. Interim 2005 Codes D. Establishment of Interim Work RVUs for New and Revised Physician's Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System Codes (HCPCS) for 2006 (Includes Table titled “American Medical Association Specialty Relative Value Update Committee and Health Care Professionals Advisory Committee Recommendations and CMS's Decisions for New and Revised 2006 CPT Codes”) E. Discussion of Codes for Which There Were No RUC Recommendations or for Which the RUC Recommendations Were Not Accepted F. Establishment of Interim PE RVUs for New and Revised Physician's Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System (HCPCS) Codes for 2006 IV. Five-Year Refinement of RVUs -Status update V. Physician Self-Referral Prohibition: Nuclear Medicine and Annual Update to the List of CPT/HCPCS Codes A. General B. Nuclear Medicine 1. Response to Comments 2. Revisions to the List of Codes Identifying Nuclear Medicine Services C. Annual Update to the Code List 1. Response to Comments 2. Revisions Effective for 2006 VI. Physician Fee Schedule Update for CY 2006 A. Physician Fee Schedule Update B. The Percentage Change in the Medicare Economic Index (MEI) C. The Update Adjustment Factor VII. Allowed Expenditures for Physicians' Services and the Sustainable Growth Rate A. Medicare Sustainable Growth Rate B. Physicians' Services C. Preliminary Estimate of the SGR for 2006 D. Revised Sustainable Growth Rate for 2005 E. Final Sustainable Growth Rate for 2004 F. Calculation of 2006, 2005, and 2004 Sustainable Growth Rates VIII. Anesthesia and Physician Fee Schedule Conversion Factors for CY 2006 A. Physician Fee Schedule Conversion Factor B. Anesthesia Fee Schedule Conversion Factor IX. Telehealth Originating Site Facility Fee Payment Amount Update X. Provisions of the Final Rule XI. Waiver of Proposed Rulemaking XII. Collection of Information Requirements XIII. Response to Comments XIV. Regulatory Impact Analysis Addendum A—Explanation and Use of Addendum B. Addendum B—Relative Value Units and Related Information Addendum C—Codes with Interim RVUs Addendum D—2006 Geographic Practice Cost Indices by Medicare Carrier and Locality Addendum E-2006 GAFs Addendum F—CAP: Revised Single Drug Category List Addendum G—CAP: Revised New Drugs for CAP Bidding for 2006 Addendum H—List of CPT/HCPCS Codes Used to Describe Certain Designated Health Services Under Section 1877 of the Social Security Act 
 
 In addition, because of the many organizations and terms to which we refer by acronym in this proposed final rule with comment, we are listing these acronyms and their corresponding terms in alphabetical order below: AADA American Academy of Dermatology Association AAH American Association for Homecare ABN Advanced Beneficiary Notice ACC American College of Cardiology ACG American College of Gastroenterology ACR American College of Radiology AFROC Association of Freestanding Radiation Oncology Centers AGA American Gastroenterological Association AMA American Medical Association AMP Average manufacturer price AOAO American Osteopathic Academy of Orthopedics ASA American Society of Anesthesiologists ASGE American Society of Gastrointestinal Endoscopy ASP Average sales price ASTRO American Society for Therapeutic Radiation Oncology AUA American Urological Association AWP Average wholesale price BBA Balanced Budget Act of 1997 BBRA Balanced Budget Refinement Act of 1999 BIPA Benefits Improvement and Protection Act of 2000 BLS Bureau of Labor Statistics BMI Body mass index BNF Budget neutrality factor BSA Body surface area CAP Competitive Acquisition Program CBSA Core-Based Statistical Area CF Conversion factor CFR Code of Federal Regulations CMA California Medical Association CMS Centers for Medicare & Medicaid Services CNS Clinical nurse specialist COBC Coordination of Benefits Contractor CPEP Clinical Practice Expert Panel CPI Consumer Price Index CPO Care Plan Oversight CPT (Physicians') Current Procedural Terminology (4th Edition, 2002, copyrighted by the American Medical Association) CRNA Certified Registered Nurse Anesthetist CT Computed tomography CTA Computed tomographic angiography CY Calendar year DAW Dispense as written DHS Designated health services DME Durable medical equipment DMERC Durable Medical Equipment Regional Carrier DSMT Diabetes outpatient self-management training services EAC Estimated acquisition cost ECP External counterpulsation E/M Evaluation and management EPO Erythopoeitin ESRD End stage renal disease FAX Facsimile FDA Food and Drug Administration FI Fiscal intermediary FQHC Federally qualified health center FR  
                        **Federal Register** GAF Geographic adjustment factor GAO Government Accountability Office GPCI Geographic practice cost index GPOs Group Purchasing Organizations HCPAC Health Care Professional Advisory Committee HCPCS Healthcare Common Procedure Coding System HHA Home health agency HHS (Department of) Health and Human Services HIC Health Insurance Number HIPAA Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 HOCM High Osmolar Contrast Media HPSA Health professional shortage area HRSA Health Resources and Services Administration (HHS) IDTFs Independent diagnostic testing facilities IPF Inpatient psychiatric facility IPPS Inpatient prospective payment system IRF Inpatient rehabilitation facility ISO Insurance Services Office IVIG Intravenous immune globulin JCAAI Joint Council of Allergy, Asthma, and Immunology JUA Joint underwriting association LCD Local coverage determination LTCH Long-term care hospital LOCM Low Osmolar Contrast Media MA Medicare Advantage MCAC Medicare Coverage Advisory Committee MCG Medical College of Georgia MedPAC Medicare Payment Advisory Commission MEI Medicare Economic Index MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003 MNT Medical nutrition therapy MRA Magnetic resonance angiography MRI Magnetic resonance imaging MSA Metropolitan statistical area MSN Medicare summary notice NCD National coverage determination NCQDIS National Coalition of Quality Diagnostic Imaging Services NDC National drug code NECMA New England County Metropolitan Area NECTA New England City and Town Area NP Nurse practitioner NPP Nonphysician practitioners NPWP Nonphysician work pool OBRA Omnibus Budget Reconciliation Act OIG Office of Inspector General OMB Office of Management and Budget OPPS Outpatient prospective payment system OT Occupational therapy PA Physician assistant PC Professional component PE Practice Expense PEAC Practice Expense Advisory Committee PERC Practice Expense Review Committee PET Positron emission tomography PFS Physician Fee Schedule PLI Professional liability insurance PPAC Practicing Physicians Advisory Council PIN Provider identification number PPI Producer price index PPO Preferred provider organization PPS Prospective payment system PRA Paperwork Reduction Act PT Physical therapy RFA Regulatory Flexibility Act RIA Regulatory impact analysis RN Registered nurse RUC (AMA's Specialty Society) Relative (Value) Update Committee RVU Relative value unit SGR Sustainable growth rate SMS (AMA's) Socioeconomic Monitoring System SNF Skilled nursing facility SNM Society for Nuclear Medicine TA Technology assessment TC Technical component TEB Thoracic electrical bioimpedance tPA Tissue-type plasminogen activator UAF Update adjustment factor UPIN Unique provider identification number WAC Wholesale acquisition cost WAMP Widely available market price I. Background A. Introduction Since January 1, 1992, Medicare has paid for physicians' services under section 1848 of the Social Security Act (the Act), “Payment for Physicians‘ Services.” The Act requires that payments under the physician fee schedule (PFS) 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 (PE), and malpractice expense. Prior to the establishment of the 
                        ( print page 70119)
                        resource-based relative value system, Medicare payment for physicians' services was based on reasonable charges. 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 adjustments to RVUs cause expenditures to change by more than $20 million, we must make adjustments to ensure that they do not increase or decrease by more than $20 million. B. Development of the Relative Value System 1. Work RVUs The concepts and methodology underlying the PFS were enacted as part of the Omnibus Budget Reconciliation Act (OBRA) of 1989, Public Law 101-239, and OBRA 1990, (Public Law 101-508). The final rule published November 25, 1991 (56 FR 59502) set forth the fee schedule for payment for physicians' services beginning January 1, 1992. Initially, only the physician work RVUs were resource-based, and the PE and malpractice RVUs were based on average allowable charges. The physician work RVUs established for the implementation of the fee schedule in January 1992 were developed with extensive input from the physician community. A research team at the Harvard School of Public Health developed the original physician work RVUs for most codes in a cooperative agreement with the Department of Health and Human Services (HHS). In constructing the code-specific vignettes for the original physician work RVUs, Harvard worked with panels of experts, both inside and outside the government, and obtained input from numerous physician specialty groups. Section 1848(b)(2)(A) of the Act specifies that the RVUs for radiology services are based on a relative value scale we adopted under section 1834(b)(1)(A) of the Act, (the American College of Radiology (ACR) relative value scale), which we integrated into the overall PFS. Section 1848(b)(2)(B) of the Act specifies that the RVUs for anesthesia services are based on RVUs from a uniform relative value guide. We established a separate conversion factor (CF) for anesthesia services, and we continue to utilize time units as a basis for determining payment for these services. As a result, there is a separate payment methodology for anesthesia services. We establish physician work RVUs for new and revised codes based on recommendations received from the American Medical Association's (AMA) Specialty Society Relative Value Update Committee (RUC). 2. Practice Expense Relative Value Units (PE RVUs) Section 121 of the Social Security Act Amendments of 1994 (Pub. L. 103-432), enacted on October 31, 1994, amended section 1848(c)(2)(C)(ii) of the Act and required us to develop resource-based PE RVUs for each physician's service beginning in 1998. We were to consider the staff, equipment, and supplies used in the provision of various medical and surgical services. The legislation specifically required that, in implementing the new system of PE RVUs, we apply the same budget-neutrality provisions that are applicable to other adjustments under the physician fee schedule. Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105-33), amended section 1848(c)(2)(C)(ii) of the Act to delay implementation of the resource-based PE RVU system until January 1, 1999. In addition, section 4505(b) of the BBA provided for a 4-year transition period from charge-based PE RVUs to resource-based RVUs. We established the resource-based PE RVUs for each physician's service in a final rule, published November 2, 1998 (63 FR 58814), effective for services furnished in 1999. Based on the requirement to transition to a resource-based system for PE over a 4-year period, resource-based PE RVUs did not become fully effective until 2002. This resource-based system was based on two significant sources of actual PE data: The Clinical Practice Expert Panel (CPEP) data and the AMA's Socioeconomic Monitoring System (SMS) data. The CPEP data were collected from panels of physicians, practice administrators, and nonphysicians (for example, registered nurses) nominated by physician specialty societies and other groups. The CPEP panels identified the direct inputs required for each physician's service in both the office setting and out-of-office setting. The AMA's SMS data provided aggregate specialty-specific information on hours worked and PEs. Separate PE RVUs are established for procedures that can be performed in both a nonfacility setting, such as a physician's office, and a facility setting, such as a hospital outpatient department. The difference between the facility and nonfacility RVUs reflects the fact that a facility receives separate payment from Medicare for its costs of providing the service, apart from payment under the PFS. The nonfacility RVUs reflect all of the direct and indirect PEs of providing a particular service outside a facility setting. Section 212 of the Medicare, Medicaid and State Child Health Insurance Program Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113) directed the Secretary to establish a process under which we accept and use, to the maximum extent practicable and consistent with sound data practices, data collected or developed by entities and organizations to supplement the data we normally collect in determining the PE component. On May 3, 2000, we published the interim final rule (65 FR 25664) that set forth the criteria for the submission of these supplemental PE survey data. The criteria were modified in response to comments received, and published in the 
                        **Federal Register**
                         (65 FR 65376) as part of the November 1, 2000 final rule. The PFS final rules published in 2001 and 2003, respectively, (66 FR 55246 and 68 FR 63196) extended the period during which we would accept these supplemental data. As discussed in the January 7, 2004 physician fee schedule final rule (69 FR 1092), section 303(a)(1)(B) of MMA amended section 1848(c)(2) of the Act by adding new subparagraph (H), “Adjustments in Practice Expense Relative Value Units for Certain Drug Administration Services beginning in 2004”. Subparagraph (H)(i) requires the Secretary to determine the practice expense RVUs for 2004 using practice expense surveys submitted to the Secretary as of January 1, 2003 by a physician specialty organization in accordance with section 212 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 if the survey: (1) Covers practice expenses for oncology drug administration services; and (2) meets criteria established by the Secretary for acceptance of such surveys. Consistent with section 1848(c)(2)(H)(i) of the Act, in January 7, 2005 final rule, we announced we would use the ASCO survey to determine the practice expense RVUs for physician fee schedule services furnished on or after January 1, 2004 because it: (1) Was submitted prior to January 1, 2003; (2) includes expenses for drug administration services; and (3) meets criteria we have established for use of surveys.
                        ( print page 70120) 3. Resource-Based Malpractice RVUs Section 4505(f) of the BBA amended section 1848(c) of the Act to require us to implement resource-based malpractice RVUs for services furnished on or after 2000. The resource-based malpractice RVUs were implemented in the PFS final rule published November 2, 1999 (64 FR 59380). The malpractice RVUs are based on malpractice insurance premium data collected from commercial and physician-owned insurers from all the States, the District of Columbia, and Puerto Rico. 4. Refinements to the RVUs Section 1848(c)(2)(B)(i) of the Act requires that we review all RVUs no less often than every five years. The first 5-year review of the physician work RVUs went into effect in 1997, published on November 22, 1996 (61 FR 59489). The second 5-year review went into effect in 2002, published on November 1, 2001 (66 FR 55246). The next 5-year review is scheduled to go into effect in 2007. In 1999, the AMA's RUC established the Practice Expense Advisory Committee (PEAC) for the purpose of refining the direct PE inputs. Through March of 2004, the PEAC provided recommendations to CMS for over 7,600 codes (all but a few hundred of the codes currently listed in the AMA's Current Procedural Terminology (CPT) codes). In the November 15, 2004, PFS final rule (69 FR 66236), hereinafter referred to as the CY 2005 final rule, we implemented the first 5-year review of the malpractice RVUs (69 FR 66263). 5. Adjustments to RVUS Are Budget Neutral Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs for a year may not cause total PFS payments to differ by more than $20 million from what they would have been if the adjustments were not made. In accordance with section 1848(c)(2)(B)(ii)(II) of the Act, if adjustments to RVUs cause expenditures to change by more than $20 million, we make adjustments to ensure that expenditures do not increase or decrease by more than $20 million. C. Components of the Fee Schedule Payment Amounts Under the formula set forth in section 1848(b)(1) of the Act, the payment amount for each service paid under the physician fee schedule is the product of three factors: (1) A nationally uniform relative value unit (RVU) for the service; (2) a geographic adjustment factor (GAF) for each physician fee schedule area; and (3) a nationally uniform conversion factor (CF) for the service. The CF converts the relative values into payment amounts. For each physician fee schedule service, there are 3 relative values: (1) An RVU for physician work; (2) an RVU for practice expense; and (3) an RVU for malpractice expense. For each of these components of the fee schedule, there is a geographic practice cost index (GPCI) for each fee schedule area. To calculate the payment for every physician service, the components of the fee schedule (physician work, PE, and malpractice RVUs) are adjusted by a geographic practice cost index (GPCI). The GPCIs reflect the relative costs of physician work, PEs, and malpractice insurance in an area compared to the national average costs for each component. Payments are converted to dollar amounts through the application of a CF, which is calculated by the Office of the Actuary and is updated annually for inflation. The general formula for calculating the Medicare fee schedule amount for a given service and fee schedule area can be expressed as: Payment = [(RVU work × GPCI work) + (RVU PE × GPCI PE) + (RVU malpractice × GPCI malpractice)] × CF. The CF for calendar year (CY) 2005 appears in section VI, Physician Fee Schedule Update for CY 2006. The RVUs for CY 2006 are in Addendum B. The GPCIs for CY 2006 can be found in Addendum D. Section 1848(e) of the Act requires us to develop GAFs for all physician fee schedule areas. The total GAF for a fee schedule area is equal to a weighted average of the individual GPCIs for each of the three components of the service. However, in accordance with the statute, the GAF for the physician's work reflects one-quarter of the relative cost of physician's work compared to the national average. D. Most Recent Changes to the Fee Schedule In the CY 2005 final rule (69 FR 66236), we refined the resource-based PE RVUs and made other changes and clarifications to Medicare Part B payment policy. These included: Supplemental survey data for PE;
                    Updated GPCIs for physician work and PE;
                    Updated malpractice RVUs;
                    Revised requirements for supervision of therapy assistants;
                    Revised payment rules for low osmolar contrast media (LOCM);
                    Payment policies for physicians and practitioners managing dialysis patients;
                    Clarification of care plan oversight (CPO) requirements;
                    Requirements for supervision of diagnostic psychological testing services;
                    Clarifications to the policies affecting therapy services provided incident to a physician's service;
                    Requirements for assignment of Medicare claims;
                    Additions to the list of telehealth services;
                    Changes to payments for drug administration services; and
                    Several coding issues. The CY 2005 final rule (69 FR 66236) also addressed the following provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173): Coverage of an initial preventive physical examination.
                    Coverage of cardiovascular screening blood tests.
                    Coverage of diabetes screening tests.
                    Incentive payment improvements for physicians in physician shortage areas.
                    Changes to payment for covered outpatient drugs and biologicals and drug administration services.
                    Changes to payment for renal dialysis services.
                    Coverage of routine costs associated with certain clinical trials of category A devices as defined by the Food and Drug Administration.
                    Coverage of hospice consultation service.
                    Indexing the Part B deductible to inflation.
                    Extension of coverage of intravenous immune globulin (IVIG) for the treatment in the home of primary immune deficiency diseases.
                    Revisions to reassignment provisions.
                    Payment for diagnostic mammograms.
                    Coverage of religious nonmedical health care institution items and services to the beneficiary's home. In addition, the CY 2005 PFS final rule finalized the calendar year (CY) 2004 interim RVUs for new and revised codes in effect during CY 2004 and issued interim RVUs for new and revised procedure codes for CY 2005; updated the codes subject to the physician self-referral prohibition; discussed payment for set up of portable x-ray equipment; discussed the third 5-year refinement of work RVUs; and solicited comments on potentially misvalued work RVUs. In accordance with section 1848(d)(1)(E) of the Act, we also announced that the PFS update for CY 2005 would be 1.5 percent; the initial 
                        ( print page 70121)
                        estimate for the sustainable growth rate for CY 2005 was 4.3; and the CF for CY 2005 would be $37.8975. II. Provisions of the Final Rule In response to the August 8, 2005 proposed rule (70 FR 45764), we received approximately 15,000 comments. We received comments from individual physicians, health care workers, professional associations and societies, and beneficiaries. The majority of the comments addressed the proposals related to PE and the negative update to the PFS, GPCIs, and Teaching Anesthesiology. The proposed rule discussed policies that affected the RVUs on which payment for certain services would be based and other changes to Medicare Part B payment policy. We also discussed changes related to payment for covered outpatient drugs and biologicals; supplemental payments to federally qualified health centers (FQHCs); payment for renal dialysis services; the national coverage decision (NCD) process; coverage of screening for glaucoma; private contracts; and physician referrals for nuclear medicine services and supplies to health care entities with which they have financial relationships. RVU changes implemented through this final rule with comment are subject to the $20 million limitation on annual adjustments contained in section 1848(c)(2)(B)(ii)(II) of the Act. After reviewing the comments and determining the policies we would implement, we have estimated the costs and savings of these policies and discuss in detail the effects of these changes in the Regulatory Impact Analysis in section XIV. For the convenience of the reader, the headings for the policy issues correspond to the headings used in the August 8, 2005 proposed rule. More detailed background information for each issue can be found in the August 8, 2005 proposed rule. A. Resource Based Practice Expense (PE) RVUs Based on section 1848(c)(1)(B) of the Act, PEs are the portion of the resources used in furnishing the service that reflects the general categories of physician and practitioner expenses (such as office rent and wages of personnel, but excluding malpractice expenses). Section 121 of the Social Security Amendments of 1994 (Pub. L. 103-432), enacted on October 31, 1994, required us to develop a methodology for a resource-based system for determining PE RVUs for each physician's service. Up until that point, physicians' PEs were based on historical allowed charges. This legislation stated that the revised PE methodology must consider the staff, equipment, and supplies used in the provision of various medical and surgical services in various settings beginning in 1998. The Secretary has interpreted this to mean that Medicare payments for each service would be based on the relative PE resources typically involved with performing the service. The initial implementation of resource-based PE RVUs was delayed until January 1, 1999, by section 4505(a) of the BBA. In addition, section 4505(b) of the BBA required the new payment methodology be phased-in over 4 years, effective for services furnished in CY 1999, and fully effective in CY 2002. The first step toward implementation called for by the statute was to adjust the PE values for certain services for CY 1998. Section 4505(d) of BBA required that, in developing the resource-based PE RVUs, the Secretary must: Use, to the maximum extent possible, generally accepted cost accounting principles that recognize all staff, equipment, supplies, and expenses, not solely those that can be linked to specific procedures.
                    Develop a refinement method to be used during the transition.
                    Consider, in the course of notice and comment rulemaking, impact projections that compare new proposed payment amounts to data on actual physician PEs. Beginning in CY 1999, Medicare began the 4 year transition to resource-based PE RVUs. In CY 2002, the resource-based PE RVUs were fully transitioned. 1. Current Methodology The following sections discuss the current PE methodology. a. Data Sources There are two primary data sources used to calculate PEs. The AMA's SMS survey data are used to develop the PEs per hour for each specialty. The second source of data used to calculate PEs was originally developed by the CPEP. The CPEP data include the supplies, equipment, and staff times specific to each procedure. The AMA developed the SMS survey in 1981 and discontinued it in 1999. Beginning in 2002, we incorporated the 1999 SMS survey data into our calculation of the PE RVUs, using a 5-year average of SMS survey data. (See Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for CY 2002 final rule, published November 1, 2001 (66 FR 55246).) The SMS PE survey data are adjusted to a common year, 1995. The SMS data provide the following six categories of PE costs: Clinical payroll expenses, which are payroll expenses (including fringe benefits) for clinical nonphysician personnel.
                    Administrative payroll expenses, which are payroll expenses (including fringe benefits) for nonphysician personnel involved in administrative, secretarial or clerical activities.
                    Office expenses, which include expenses for rent, mortgage interest, depreciation on medical buildings, utilities and telephones.
                    Medical material and supply expenses, which include expenses for drugs, x-ray films, and disposable medical products.
                    Medical equipment expenses, which include depreciation expenses, leases, and rent of medical equipment used in the diagnosis or treatment of patients.
                    All other expenses, including expenses for legal services, accounting, office management, professional association memberships, and any professional expenses not mentioned above. In accordance with section 212 of the BBRA, we established a process to supplement the SMS data for a specialty with data collected by entities and organizations other than the AMA (that is, the specialty itself). (See the Criteria for Submitting Supplemental Practice Expense Survey Data interim final rule with comment period, published on May 3, 2000 (65 FR 25664).) Originally, the deadline to submit supplementary survey data was through August 1, 2001. This deadline was extended in the November 1, 2001 final rule through August 1, 2003. (See the Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for CY 2002 final rule, published on November 1, 2001 (66 FR 55246).) Then, to ensure maximum opportunity for specialties to submit supplementary survey data, we extended the deadline to submit surveys until March 1, 2005. (See the Revisions to Payment Policies Under the Physician Fee Schedule for CY 2002 final rule, published on November 7, 2003 (68 FR 63196).) The CPEPs consisted of panels of physicians, practice administrators, and nonphysicians (registered nurses, for example) who were nominated by physician specialty societies and other groups. There were 15 CPEPs consisting 
                        ( print page 70122)
                        of 180 members from more than 61 specialties and subspecialties. Approximately 50 percent of the panelists were physicians. The CPEPs identified specific inputs involved in each physician service provided in an office or facility setting. The inputs identified were the quantity and type of nonphysician labor, medical supplies, and medical equipment. In 1999, the AMA's Multi-specialty Relative Value Update Committee (RUC) established the PEAC. Since 1999, and until March 2004, the PEAC, a multi-specialty committee, reviewed the original CPEP inputs and provided us with recommendations for refining these direct PE inputs for existing CPT codes. Through its last meeting in March 2004, the PEAC provided recommendations which we have reviewed and accepted for over 7,600 codes. As a result of this scrutiny by the PEAC, the current CPEP/RUC inputs differ markedly from those originally recommended by the CPEPs. The PEAC has now been replaced by the Practice Expense Review Committee (PERC), which acts to assist the RUC in recommending PE inputs. b. Allocation of Practice Expenses to Services In order to establish PE RVUs for specific services, it is necessary to establish the direct and indirect PE associated with each service. Our current approach is to allocate aggregate specialty practice costs to specific procedures and, thus, it is often referred to as a “top-down” approach. The specialty PEs are derived from the AMA's SMS survey and supplementary survey data. The PEs for a given specialty are allocated to the services performed by that specialty on the basis of the CPEP/RUC data and work RVUs assigned to each CPT code. The specific process is detailed as follows: Step 1—Calculation of the SMS Cost Pool for Each Specialty The six SMS cost categories can be described as either direct or indirect expenses. The three direct expense categories include clinical labor, medical supplies and medical equipment. Indirect expenses include administrative labor, office expense, and all other expenses. We combine these indirect expenses into a single category. The SMS cost pool for each specialty is calculated as follows: The specialty PE per hour (PE/HR) for each of the three direct and one indirect cost categories from the SMS is calculated by dividing the aggregate PE per specialty by the specialty's total hours spent in patient care activities (also determined by the SMS survey). The PE/HR is divided by 60 to obtain the PE per minute (PE/MIN).
                    Each specialty's PE pools (for each of the three direct and one indirect cost categories) are created by multiplying the PE/MIN for the specialty by the total time the specialty spent treating Medicare patients for all procedures (determined using Medicare utilization data). Physician time on a procedure-specific level is available through RUC surveys of new or revised codes and through surveys conducted as part of the 5-year review process. For codes that the RUC has not yet reviewed, the original data from the Harvard resource-based RVU system survey is used. Physician time includes time spent on the case before, during, and after the procedure. The physician procedure time is multiplied by the frequency that each procedure is performed on Medicare patients by the specialty.
                    The total specialty-specific SMS PE for each cost category is the sum, for each direct and indirect cost category, of all of the procedure-specific total PEs. Table 1 illustrates an example of the calculation of the total SMS cost pools for the three direct and one indirect cost categories discussed in step 1. For this specialty, PE/HR for clinical payroll expenses is $9.30 per hour. The hourly rate is divided by 60 minutes to obtain the clinical payroll per minute for the specialty. The total clinical payroll for providing hypothetical procedure 00001 for this specialty of $3,633,465 is the result of taking the clinical payroll per minute of $0.16; multiplying this by the physician time for procedure 00001 (56 minutes); and multiplying the result by the number of times this procedure was provided to Medicare patients by this specialty (418,602). The total amount spent on clinical payroll in this specialty is $667,457,018. This amount is calculated by summing the clinical payroll expenses of procedure 00001 and all of the other services provided by this specialty.  Step 2—Calculation of CPEP Cost Pool CPEP data provide expenditure amounts for the direct expense categories (clinical labor, supplies, and equipment cost) at the procedure level. Multiplying the CPEP procedure-level PEs for each of these three categories by the number of times the specialty provided the procedure, produces a total category cost, per procedure, for that specialty. The sum of the total expenses from each procedure results in the total CPEP category cost for the specialty. 
                        ( print page 70123) For example, in Table 2, using CPEP data, the clinical labor cost of procedure 00001 is $65.23. Under the methodology described above in this step, this is multiplied by the number of services for the specialty (418,602), to yield the total CPEP data clinical labor cost of the procedure: $27,305,408. In this example, the clinical labor cost for all other services performed by this specialty is $831,618,600. Therefore, the entire clinical labor CPEP expense pool for the specialty is $858,924,008. Step 2 is repeated to calculate the CPEP supply and equipment costs.  Step 3—Calculation and Application of Scaling Factors This step ensures that the total of the CPEP costs across all procedures performed by the specialty equates with the total direct costs for the specialty as reflected by the SMS data. To accomplish this, the CPEP data are scaled to SMS data by means of a scaling factor so that the total CPEP costs for each specialty equals the total SMS cost for the specialty. (The scaling factor is calculated by dividing the specialty's SMS pool by the specialty's CPEP pool.) The unscaled CPEP cost per procedure value, at the direct cost level, is then multiplied by the respective specialty scalar to yield the scaled CPEP procedure value. The sum of the scaled CPEP direct cost pool expenditures equals the total scaled direct expense for the specific procedure at the specialty level. In the Step 3 example shown in Table 3, the SMS total clinical labor costs for the specialty is $667,457,018. This amount divided by the CPEP total clinical labor amount of $858,924,008 yields a scaling factor of 0.78. The CPEP clinical labor cost for hypothetical procedure 00001 is $65.23. Multiplying the 0.78 scaling factor for clinical labor costs by $65.23 yields the scaled clinical labor cost amount of $50.69. Individual scaling factors must also be calculated for supply and equipment expenses. The sum of the scaled direct cost values, $50.69, $43.90, and $139.45, respectively, equals the total scaled direct expense of $234.04. Table 3.—Calculation and Application of Scaling Factors
Standard methodology
Clinical/Labor
Supplies
Equipment
Total Scaled direct expense 
                                 (Sum of A, B, and C)(A)
(B)
(C)
(D)(a) Total—SMS Pool
$667,457,018
$344,493,945
$531,094,831(b) Total—CPEP Pool
858,924,008
411,894,617
5,929,275,023(c) Scaling Factor
0.78
52.49
1,556.86Unscaled Value(e) CPT 00001—Scaled Value
50.69
43.90
139.45
$234.04(c) = (a)/(b)(e) = (c)*(d)
 Step 4—Calculation of Indirect Expenses Indirect PEs cannot be directly attributed to a specific service because they are incurred by the practice as a whole. Indirect costs include rent, utilities, office equipment and supplies, and accounting and legal fees. There is not a single, universally accepted approach for allocating indirect practice costs to individual procedure codes. Rather allocation involves judgment in identifying the base or bases that are the best measures of a practice's indirect costs. To allocate the indirect PEs to a specific service, we use the following methodology: The total scaled direct expenses and the converted work RVU (the work RVU for the service is multiplied by $34.5030, the 1995 CF) are added together, and then multiplied by the number of services provided by the specialty to Medicare patients.
                    The total indirect PEs per specialty are calculated by summing the indirect expenses for all other procedures provided by that specialty. For example, in Table 4, the physician work RVU for procedure 00001 is 2.36. Multiplying the work RVU by the 1995 CF of $34.5030 equals $81.43. The physician work value is added to the scaled total direct expense from Step 3 
                        ( print page 70124)
                        ($234.04). The total of $314.47 is a proxy for the indirect PE for the specialty attributed to this procedure. The total indirect expenses are then multiplied by the number of times procedure 00001 is provided by the specialty (418,602), to calculate total indirect expenses for this procedure of $132,055,728. The process is repeated across all procedures performed by the specialty, and the indirect expenses for each service are summed to arrive at the total specialty indirect PE pool of $6,745,545,434. Table 4.—Calculation of Indirect Expense
Standard Methodology
Physician Work*
Total direct 
                                 expense
Total(A)
(B)
(C)(a) CPT 00001
$81.43
$234.04
$315.47(b) Allowed Services


418,602(c) Subtotal


132,055,728(d) All Other Services


6,613,489,706(e) Total Indirect Expense


6,745,545,434* Calculated by multiplying work RVU of 2.36 by 1995 CF of $34.5030.
 Step 5—Calculation and Application of Indirect Scaling Factors Similar to the direct costs, the indirect costs are scaled to ensure that the total across all procedures performed by the specialty equates with the total indirect costs for the specialty as reflected by the SMS data. To accomplish this, the indirect costs calculated in Step 4 (Table 4) are scaled to SMS data. The calculation of the indirect scaling factors is as follows: The specialty's total SMS indirect expense pool is divided by the specialty's total indirect expense pool calculated in Step 4 (Table 4), to yield the indirect expense scaling factor.
                    The unscaled indirect expense amount, at the procedure level, is multiplied by the specialty's scaling factor to calculate the procedure's scaled indirect expenses.
                    The sum of the scaled indirect expense amount and the procedure's direct expenses yields the total PEs for the specialty for this procedure. In table 5, to calculate the indirect scaling factor for hypothetical procedure 00001, divide the total SMS indirect pool, $3,337,285,089 (calculated in Step 1-Table 1)), by the total indirect expense for the specialty across all procedures of $6,745,545,434. This results in a scaling factor of 0.49. Next, the unscaled indirect cost of $315.47 is multiplied by the 0.49 scaling factor, resulting in scaled indirect cost of $156.07. To calculate the total PEs for the specialty for procedure 00001, the scaled direct and indirect expenses are added, totaling $390.12. Table 5.—Calculation of Indirect Scaling Factors and Total Practice Expenses
Standard methodology
Indirect costs
Direct cost
Specialty specific practice expenses 
                                 (Sum of A, B)(A)
(B)
(C)(a) Total—SMS Indirect Expense
$3,337,285,089(b) Total Indirect Expense for all Procedures (from Step 4)
6,745,545,434(c) Scaling Factor
0.49(d) CPT 00001—Unscaled Value
315.47(e) CPT 00001—Scaled Value
156.07
$234.04
$390.12
 Step 6—Weighted Average of RVUs for Procedures Performed by More Than One Specialty For codes that are performed by more than one specialty, a weighted-average PE is calculated based on Medicare frequency data of all specialties performing the procedure as shown in Table 6. Table 6.—Weight Averaging for All Specialties
Standard methodology
Practice expense value
Percent of total allowed services(A)
(B)(a) Specialty Total Practice Expense
$390.12
83(b) Weighted Avg.—All Other Specialties
929.87
17(c) Weighted Avg.—All Specialties
481.70
100
 
 
 Step 7—Budget Neutrality and Final RVU Calculation The total scaled direct and indirect inputs are then adjusted by a budget neutrality factor (BNF) to calculate RVUs. Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may not cause total PFS payments to differ by more than $20 million from what they would have been if the adjustments were not made. Budget neutrality for the upcoming year is determined relative to the sum of PE RVUs for the current year. Although the PE RVUs for any particular code may vary from year-to-year, the sum of PE RVUs across all codes is set equal to the current year. The BNF is equal to the sum of the current year's PE RVUs, divided by the sum of the direct and indirect inputs across all codes for the upcoming year. The BNF is applied to (multiplied by) the scaled direct and indirect expenses for each code to set the PE RVU for the upcoming year. In Table 7, the sum of the scaled direct and indirect expenses for hypothetical code 00001 ($481.70) is multiplied by the BNF (0.02 in this example) to yield a PE RVU of 10.60. Table 7.—Calculate PE RVU
Total scaled direct and indirect inputs
Budget neutrality factor
Final PE RVU(A)
(B)
(C)(a) Code 00001
$481.70
0.02
10.60
 c. Other Methodological Issues: Nonphysician Work Pool (NPWP) As an interim measure, until we could further analyze the effect of the top-down methodology on the Medicare payment for services with no physician work (including the technical components (TCs) of radiation oncology, radiology and other diagnostic tests), we created a separate PE pool for these services. However, any specialty society could request that its services be removed from the nonphysician work pool (NPWP). We have removed some services from the NPWP if we find that the requesting specialty provides the service the majority of the time. NPWP Step 1—Calculation of the SMS Cost Pool for Each Code This step parallels the calculations described above for the standard “top-down” PE allocation methodology. For codes in the NPWP, the direct and indirect SMS costs are set equal to the weighted average of the PE/HR for the specialties that provide the services in the pool. Clinical staff time is substituted for physician time in the calculation. The clinical staff time for the code is from CPEP data. Otherwise, the calculation is similar to the method described previously for codes with physician time. The following example in Table 8 illustrates this calculation for hypothetical code 00002. In this example, the average clinical payroll PE/HR for all specialties in the NPWP is $12.30 and the clinical staff time for code 00002 is 116 minutes.  NPWP Step 2—Calculation of Charge-Based PE RVU Cost Pool The NPWP calculation uses the 1998 (charge-based) PE RVU value for the code, multiplied by the 1995 CF (25.74 × $34.503 = $888.11). The percentage of clinical labor, supplies and equipment are the percentage that each PE category represents for all physicians relative to the total PE for all physicians (calculated from the SMS data) as shown in Table 9. 
 
  NPWP Step 3—Calculation and Application of Scaling Factors After the total cost pools for each code in the NPWP are calculated, the steps to ensure the total charge-based PEs for the procedure do not exceed the total SMS PEs for the procedure (scaling) are the same as those described previously for codes with physician work. In Table 10, the SMS total clinical labor costs are $2,499,159. This amount divided by the charge-based total clinical labor amount of $16,613,742 yields a scaling factor of 0.15. The charge-based clinical labor cost for hypothetical procedure 00002 is $158.08 (from NPWP Step 2—Table 9). Multiplying the 0.15 scaling factor for clinical labor costs by $158.08 yields the scaled clinical labor cost amount of $23.78. Individual scaling factors must be calculated for both supply and equipment expenses. The sum of the scaled direct cost values, $23.78, $32.57 and $2.72, respectively, equals the total scaled direct expense of $59.07. Table 10.—Calculation and Application of Direct Cost Scaling Factors
NPWP methodology
Clinical
Supplies
Equipment
Total scaled 
                                 direct expense  
                                 (Sum of A, B, and C)(A)
(B)
(C)
(D)(a) Total—NPWP Specialty Pool
$2,499,159
$1,503,559
$650,188(b) Total NPWP Charge-based Pool
16,613,742
4,386,775
9,986,912(c) Scaling Factor
0.15
0.34
0.06(d) CPT 00002—Unscaled Value
158.08
95.03
41.74(e) CPT 00002—Scaled Value
23.78
32.57
2.72
$59.07
 NPWP Step 4—Calculation of Indirect Expenses Because codes in the NPWP do not have work RVUs, indirect expenses are set equal to direct expenses (for codes with physician work, indirect expenses equal the sum of the scaled direct expenses and the converted work RVU). This amount is then multiplied by the number of times the procedure is performed. In Table 11, the scaled total direct expense from NPWP Step 3 (Table 10) ($59.07) is also the proxy for the total indirect expense attributed to the procedure. The total indirect expense is multiplied by the number of services (105,095), to calculate total indirect cost for this procedure of $6,207,961. Table 11.—Calculation of Indirect Expenses
NPWP methodology
Physician work *
Total direct 
                                 expense
Total(A)
(B)
(C)(a) CPT 00002

$59.07
$59.07(b) Allowed Services—NPWP


105,095(c) Total NPWP Indirect Expense


$6,207,961
 NPWP Step 5—Calculation and Application of Indirect Scaling Factors Similar to the direct costs, the indirect costs are scaled to ensure that the total of the charge-based PE costs across all procedures equates with the total indirect costs as reflected by the SMS data for the code. To accomplish this, the charge-based indirect PEs are scaled to the SMS indirect PEs. In Table 12, to calculate the indirect scaling factor for hypothetical procedure 00002, the total SMS indirect PE, $9,407,404 (from NPWP Step 1—Table 8), is divided by the total charge-based indirect expense of $6,207,961 (from NPWP Step 4—Table 11). This results in a scaling factor of 1.51. Next, the 
                        ( print page 70127)
                        unscaled indirect charge-based cost for procedure 00002 of $59.07 (from NPWP Step 4—Table 11) is multiplied by the 1.51 scaling factor, resulting in scaled indirect costs for this procedure of $89.19. Table 12.—Calculation and Application of Indirect Cost Scaling Factors
Standard methodology
Indirect costs
Direct cost
Specialty specific PE RVU 
                                 (Sum of A and B)(A)
(B)
(C)(a) Total—NPWP “SMS” Pool
$9,407,404(b) Total NPWP Indirect Expense
6,207,961(c) Scaling Factor
1.51(d) CPT 00002—Unscaled Value
59.07(e) CPT 00002—Scaled Value
89.19
$59.07
$148.26
 NPWP Step 6—Budget Neutrality and Final RVU Calculation Similar to the calculation for codes with physician work, the BNF is applied to (multiplied by) the scaled direct and indirect expenses for each code to set the PE RVU for the upcoming year. In Table 13, the sum of the scaled direct and indirect expenses for hypothetical code 00002 ($148.26) is multiplied by the BNF (0.022 in this example) to yield a PE RVU of 3.26. Table 13.—Budget Neutrality and Final RVU Calculation
Total scaled direct and indirect inputs
Budget neutrality factor
Final PE RVUCode 00002
$148.26
0.022
2.96
 d. Facility/Nonfacility Costs Procedures that can be performed in a physician's office as well as in a hospital have two PE RVUs; facility and nonfacility. The nonfacility setting includes physicians' offices, patients' homes, freestanding imaging centers, and independent pathology labs. Facility settings include hospitals, ambulatory surgery centers, and skilled nursing facilities (SNFs). The methodology for calculating the PE RVU is the same for both facility and nonfacility RVUs, but each is calculated independently to yield two separate PE RVUs. Because the PEs for services provided in a facility setting are generally included in the payment to the facility (rather than the payment to the physician under the fee schedule), the PE RVUs are generally lower for services provided in the facility setting. 2. PE Proposals for CY 2006 The following discussions outline the specific PE related proposals for CY 2006. a. Supplemental PE Surveys The following discussions outline the criteria for supplemental survey submission as well as information we have received for approval. (1) Survey Criteria and Submission Dates In accordance with section 212 of the BBRA, we established criteria to evaluate survey data collected by organizations to supplement the SMS survey data normally used in the calculation of the PE component of the PFS. In the final rule published November 7, 2003 (68 FR 63196), we provided that, beginning in 2004, supplemental survey data had to be submitted by March 1 to be considered for use in computing PE RVUs for the following year. This allows us to publish our decisions regarding survey data in the proposed rule and provides the opportunity for public comment on these results before implementation. To continue to ensure the maximum opportunity for specialties to submit supplemental PE data, we extended until 2005 the period that we would accept survey data that meet the criteria set forth in the November 2000 PFS final rule. The deadline for submission of supplemental data to be considered in CY 2006 was March 1, 2005. (2) Submission of Supplemental Survey Data The following discussion outlines the survey data submitted for CY 2004 and CY 2005. (a) Surveys Submitted in 2004 As discussed in the August 8, 2005 PFS proposed rule (70 FR 45774), we had received surveys by March 1, 2004 from the American College of Cardiology (ACC), the ACR, and the American Society for Therapeutic Radiation Oncology (ASTRO). The data submitted by the ACC and the ACR met our criteria. However, as requested by the ACC and the ACR, we deferred using their data until issues related to the NPWP could be addressed. In the August 8, 2005 proposed rule, we proposed to use the ACC and ACR survey data in the calculation of PE RVUs for CY 2006, but only as specified in the proposals relating to a revised methodology for establishing direct PE RVUs. The survey data from ASTRO did not meet the precision criteria established for supplemental surveys, therefore, we indicated we would not use it in the calculation of PE RVUs for CY 2005. However, we proposed to use these data to blend with data submitted by the Association of Freestanding Radiation Oncology Centers (AFROC) for CY 2006, as described below. (b) Surveys Submitted in 2005 In 2005 we received surveys from the AFROC, the American Urological Association (AUA), the American Academy of Dermatology Association (AADA), the Joint Council of Allergy, Asthma, and Immunology (JCAAI), the National Coalition of Quality Diagnostic Imaging Services (NCQDIS) and a joint survey from the American Gastroenterological Association (AGA), the American Society of Gastrointestinal Endoscopy (ASGE), and the American College of Gastroenterology (ACG). 
                        ( print page 70128) As explained in the August 8, 2005 proposed rule, we contract with the Lewin Group to evaluate whether the supplemental survey data that are submitted meet our criteria and to make recommendations to us regarding their suitability for use in calculating PE RVUs. (The Lewin Group report on the 2005 submissions is available on the CMS Web site at 
                        *http://www.cms.hhs.gov/​physicians/​pfs/​.*) The report indicated that, except for the survey from NCQDIS, all met our criteria and we are proposing to accept these surveys. The survey data submitted by the NCQDIS on independent diagnostic testing facilities (IDTFs) did not meet the precision criterion of a 90 percent confidence interval with a range of plus or minus 15 percent of the mean (that is, 1.645 times the standard error of the mean, divided by the mean, is equal to or less than 15 percent of the mean). For the NCQDIS survey, the precision level was calculated at 16.3 percent of the mean PE/HR (weighted by the number of physicians in the practice). However, the Lewin Group has recommended that we accept the data from NCQDIS. The Lewin Group points out that PE data for IDTFs do not currently exist, and suggests that the need for data for the specialty should be weighed against the precision requirement. We proposed not to accept the NCQDIS data to calculate the PE RVUs for services provided by IDTFs. As just noted, the NCQDIS data did not meet our precision requirements. We established the minimum precision standards because we believe it is necessary to ensure that the data used are valid and reliable, and the consistent application of the precision criteria is the best way to accomplish that objective. Section 303(a)(1) of the MMA added section 1848(c)(2)(I) of the Act to require us to use survey data that include expenses for the administration of drugs and biologicals submitted by a specialty group for which at least 40 percent of the Part B payments are attributable to the administration of drugs in 2002 to adjust PE RVUs for drug administration services. The provision applies to surveys received by March 1, 2005 for determining the CY 2006 PE RVUs. Section 303(a)(1) of the MMA also amended section 1848(c)(2)(B)(iv)(II) of the Act to provide an exemption from budget neutrality for any additional expenditures resulting from the use of this survey data to adjust PE RVUs for drug administration services. In the Changes to Medicare Payment for Drugs and Physician Fee Schedule Payments for CY 2004 interim final rule published January 7, 2004 (69 FR 1084), we stated that the specialty of urology meets the above criteria, along with gynecology and rheumatology (69 FR 1094). Because we proposed to accept the new survey data from the AUA, we are required to exempt from the budget neutrality adjustment any impacts of accepting these data for purposes of calculating PE RVUs for drug administration services. In addition, Lewin recommended blending the radiation oncology data from this year's AFROC survey data with last year's ASTRO survey data to calculate the PE/HR. According to the Lewin Group, the goal of the AFROC survey was to represent the population of freestanding radiation oncology centers only. In order to develop an overall average for the radiation oncology PE pool, the Lewin Group recommended we use the AFROC survey for freestanding radiation oncology centers, and the hospital-based subset of last year's ASTRO survey. Consistent with that recommendation, we proposed to use the new PE/HR calculated in this manner for radiation oncology. As discussed in the August 8, 2005 PFS proposed rule and also in the preamble of this final rule with comment, we proposed to revise our methodology to calculate direct PE RVUs from the current top-down cost allocation methodology to a bottom-up methodology. Although we would continue to use the SMS data and the incorporated supplemental survey data for indirect PEs, we did not extend the deadline for submitting supplemental survey data but rather requested comments on the most appropriate way to proceed to ensure the indirect PEs per hour are accurate and consistent across specialties. b. Revisions to the PE Methodology As discussed in the August 8, 2005 proposed rule, since 1997, when we first proposed a resource-based PE methodology, we have had several major goals for this payment system and have encouraged the maximum input from the medical community regarding our PE data and methodology. We also have had the following three specific goals for the resource-based PE methodology itself, which have also been supported in numerous comments we have received from the medical community: To ensure that the PE payments reflect, to the greatest extent possible, the actual relative resources required for each of the services on the PFS. This could only be accomplished by using the best available data to calculate the PE RVUs.
                    To develop a payment system for PE that is understandable and at least somewhat intuitive, so that specialties could generally predict the impacts of changes in the PE data.
                    To stabilize the PE payments so that there are not large fluctuations in the payment for given procedures from year-to-year. As we explained in the August 8, 2005 proposed rule, we believe that we have consistently made a good faith effort to ensure fairness in our PE payment system by using the best data available at any one time. The change from the originally proposed “bottom-up” to the “top-down” methodology came about because of a concern that the resource input data developed in 1995 by the CPEP were less reliable than the aggregate specialty cost data derived from the SMS process. The adoption of the top-down approach necessitated the creation of the NPWP. The NPWP is a separate pool created to allocate PEs for codes that have only a technical (rather than professional) component, or codes that are not performed by physicians. However, the situation has now changed. As we explained in the August 8, 2005 proposed rule, refinement of the original CPEP data is complete and the refined PE inputs now, in general, accurately capture the relative direct costs of performing PFS services. Also, the major specialties comprising the NPWP (radiology, radiation oncology, and cardiology) submitted supplemental survey data that we proposed to accept, which would eliminate the need to treat these technical services outside the PE methodology applied to other services. Due to the ongoing refinement by the RUC of the direct PE inputs, we had expected that the PE RVUs would necessarily fluctuate from year-to-year. However, it became apparent that certain aspects of our methodology exacerbated the yearly fluctuations. The services priced by the NPWP methodology have proven to be especially vulnerable to any change in the pool's composition. With the CPEP/RUC refinement of existing services virtually complete, we indicated this was an opportunity for us to propose a way to provide stability to the PE RVUs. Therefore, consistent with our goals of using the most appropriate data, simplifying our methodology, and increasing the stability of the payment system, we proposed the following changes to our PE methodology and also requested suggestions that would assist us in further refinement of the indirect PE methodology. 
                        ( print page 70129) (1) Use a Bottom-up Methodology To Calculate Direct PE Costs Instead of using the top-down approach to calculate the direct PE RVUs, where the aggregate CPEP/RUC costs for each specialty are scaled to match the aggregate SMS costs, we proposed to adopt a bottom-up method of determining the relative direct costs for each service. Under this method, the direct costs would be determined by summing the costs of the resources—the clinical staff, equipment and supplies—typically required to provide the service. The costs of the resources, in turn, would be calculated from the refined CPEP/RUC inputs in our PE database. (2) Eliminate the Nonphysician Work Pool (NPWP) Since we proposed to incorporate new survey data for the major specialties that comprise the NPWP, we proposed to eliminate the pool and calculate the PE RVUs for the services currently in the pool by the same methodology used for all other services. This would allow the use of the refined CPEP/RUC data to price the direct costs of individual services, rather than utilizing the pre-1998 charge-based PE RVUs. (3) Utilize the Current Indirect PE RVUs, Except for Those Services Affected by the Accepted Supplemental Survey Data As described previously, the SMS and supplemental survey data are the source for the specialty-specific aggregate indirect costs used in our PE calculations. We then allocate to particular codes on the basis of the direct costs allocated to a code and the work RVUs. Although we now believe the CPEP/RUC data are preferable to the SMS data for determining direct costs, we have no information that would indicate that the current indirect PE methodology is inaccurate. We also are not aware of any alternative approaches or data sources that we could use to calculate more appropriately the indirect PE, other than the new supplemental survey data, which we proposed to incorporate into our PE calculations. Therefore, we proposed to use the current indirect PEs in our calculation incorporating the new survey data into the codes performed by the specialities submitting the surveys. We specifically requested suggestions that would assist us in further refinement of the indirect PE methodology. For example, we noted in the proposed rule that we are considering whether we should continue to accept supplementary survey data or whether it would be preferable and feasible to have an SMS-type survey of only indirect costs for all specialties; or whether a more formula-based methodology independent of the SMS data should be adopted, perhaps using the specialty-specific indirect-to-total cost percentage as a basis of the calculation. (4) Transition the Resulting Revised PE RVUs Over a 4-Year Period We are concerned that, when combined with an expected negative update factor for CY 2006, the shifts in some of the PE RVUs resulting from our proposals could cause some measure of financial stress on medical practices. Therefore, we proposed to transition the proposed PE changes over a 4-year period. This would also give ample opportunity for us, as well as the medical specialties and the RUC, to identify any anomalies in the PE data, to make any further appropriate revisions, and to collect additional data, as needed prior to the full implementation of the proposed PE changes. During this transition period, the PE RVUs would be calculated on the basis of a blend of RVUs calculated using our proposed methodology described above (weighted by 25 percent during CY 2006, 50 percent during CY 2007, 75 percent during CY 2008, and 100 percent thereafter), and the current CY 2005 PE RVUs for each existing code. Now that the direct PE inputs have been refined, we believe that the CPEP/RUC direct input data are generally superior to the specialty-specific SMS PE/HR data for the purposes of determining the typical direct PE resources required to perform each service on the PFS. First, we have received recommendations on the procedure-specific inputs from the multi-specialty PEAC that were based on presentations from the relevant specialties after being closely scrutinized by the PEAC using standards and packages agreed to by all involved specialties. Second, the refined CPEP/RUC data are more current than the SMS data for the majority of specialties. Third, for direct costs, it appears more accurate to assume that the costs of the clinical staff, supplies and equipment are the same for a given service, regardless of the specialty that is performing it. This assumption does not hold true under the top-down direct cost methodology, where the specialty-specific scaling factors create widely differing costs for the same service. We also would argue that the proposed methodology is less confusing and more intuitive than the current approach. For instance, the NPWP would be eliminated and all services would be priced using one methodology, eliminating the complicated calculations needed to price NPWP services. Also, any revisions made to the direct inputs would now have predictable results. Changes in the direct practice inputs for a service would proportionately change the PE RVUs for that service without significantly affecting the PE RVUs for unrelated services. In addition, the proposed methodology would create a system that would be significantly more stable from year-to-year than the current approach. We recognized that there are still some outstanding issues that need further consideration, as well as input from the medical community. For example, although we believe that the elimination of the NPWP would be, on the whole, a positive step, some practitioner services, such as audiology and medical nutrition therapy (MNT), would be significantly impacted by the proposed change. In addition, there are still services, such as the end stage renal disease (ESRD) visit codes, for which we have no direct input information. Also, as mentioned above, we do not have current SMS or supplementary survey data to calculate the indirect costs for most specialties. Further, we do not yet have accurate utilization for the new drug administration codes that were created in response to the MMA provision on drug administration. Therefore, we did not propose to change the RVUs for these services at this time, but to include them under our proposed methodology in next year's rule when we have appropriate data. The proposed transition period would give us the opportunity to work with the affected specialties to collect the needed survey or other data or to determine whether further revisions to our PE methodology are needed. We requested comments on these proposed changes, particularly those concerning additional modifications to the indirect PE methodology that might help us further our intended goals. *Comment:*
                         There were 3 main concerns raised in comments we received on our overall proposed PE methodology which included: (1) Many of the proposed decreases appeared anomalous and were not explained; (2) there was insufficient information given to allow specialties to review and analyze the proposal and its impact; and (3) the use of the new PE data from the seven accepted supplementary surveys caused an inequitable redistribution of PE RVUs. As a result of these concerns, many commenters also requested a 
                        ( print page 70130)
                        delay in the implementation of our proposed methodology. The following are examples of the comments detailing the above concerns. The AMA and the RUC agreed with the goals that we have set for an accurate, intuitive and stable methodology to use for the calculation of PE RVUs. The RUC added that it looks forward to helping us meet these goals. However, the AMA urged us to provide more information, such as examples of how the new values were calculated, the PE/HR and source of the data for each specialty and the budget neutrality adjuster applied at the end of the process, so that the medical community would have the opportunity to review the values and impact of the proposal. Medicare Payment Advisory Commission (MedPAC) stated its agreement with the concerns regarding the current PE methodology that motivated us to propose a change, but did request that we assess the impact of proposed changes by groups of services—evaluation and management services, major procedures, other procedures, laboratory tests and imaging services, as well as by physician specialty group. A specialty society representing obstetrics and gynecology commended the goal of the new methodology, but suggested we offer two or more examples of how PE is calculated, starting with the inputs that are used and moving through the process of developing the final PE RVUs for those codes. An optometric association expressed regret that the proposed rule does not provide service-specific examples of how PE RVUs would be calculated using the current and proposed methodologies because this made it difficult to provide detailed comments on the proposal. Therefore, the commenter concluded that we should issue a final with a comment period. Two emergency medicine societies also requested the same service-specific examples. An ophthalmology society was troubled by our failure to make the indirect cost data used in determining the rates of change in PE values available to all specialties for review and by the lack of analysis explaining the significant impacts caused by the acceptance of the supplemental survey data. A specialty society representing cardiology urged us to provide more data and a more detailed explanation of the methodology, along with examples of how RVUs for specific codes were determined, so that stakeholders can gain a thorough understanding of our proposal. A dermatology association commented that it is pleased that we want to transition to a bottom-up approach. The association believes that this will result in a more easily understood and stable payment system, but it would be helpful to have more information in the final rule on the calculation of PE values under the new methodology. For example, the association asks for clarification of why the PE RVUs for several dermatology procedures decreased. A specialty society representing physical medicine expressed concern regarding a number of the results with respect to several physical medicine and rehabilitation codes and requested that we provide a more detailed description of the new methodology and address anomalies in the final rule. The commenter suggested that we establish a percentage decrease threshold that would trigger an opportunity for expedited review to determine whether the direct cost inputs are accurate. Four organizations representing radiation oncology submitted comments stating their concern that several radiation therapy codes, including those for intensity modulated radiation therapy, continuing medical physics consultation and brachytherapy, have inappropriate proposed reductions. Two of the commenters recommended that we examine the impact of the methodology on a code-specific basis and, if necessary, implement an adjustment factor that limits the reduction to no more than 15 percent of the 2005 global RVUs at the end of the 4-year transition period. Comments from societies representing nuclear cardiology and echocardiography also supported a cap on the maximum reduction applied to any procedure that resulted from the decision to adopt the new methodology. A geriatrics society expressed concern that geriatrics will experience a 1 percent reduction under the new methodology and stated that the transition period is critical, as it will lessen the impact of the proposed reduction. The society suggested that, during the transition period, we should work with stakeholders to explain the new methodology, to identify non-intuitive decreases in payment and to identify better ways to pay for indirect expenses. An association representing nursing facility medical directors expressed concern that the new methodology will reduce the PE RVUs for nearly all codes for nursing facility services. If we proceed with the changes, the association suggested that we provide a more detailed explanation of the new methodology in the final rule, with examples of the PE RVU calculations for specific services under the old and new methods. A consulting company expressed concern that we failed to make needed data available, such as the time file, utilization file and scaling factors and pools file. The commenter also requested that, in the future, we consider making available the same files we use to produce the PE RVUs, the assumptions used, such as crosswalks or projected utilization for new services and the data needed to evaluate the methodology used to go from the survey data to a PE/HR. The American Cancer Society expressed concern regarding the specific reductions in payment for screening mammography, pap smears, pelvic/breast exams and flexible sigmoidoscopies which could potentially reduce access to cancer screenings. An oncology nursing society strongly urged us to include drug administration services in the phase-in of the new methodology and exempt them from budget neutrality requirements. A cancer and blood disorders center expressed the same concern and stated that this omission would skirt the MMA mandate to exempt from budget neutrality limits any 2006 fee schedule changes to drug administration codes. An association representing medical colleges noted that, together with the negative update, the decrease in revenue across faculty practice groups will exceed −6 percent. The association recommended that this warrants further review by the medical community and CMS should make public examples of how the new values were calculated, the actual new PE values for each code, the PE per hour and source of the data for each specialty and the budget neutrality adjuster applied as a final step. A medical technology company requested that we explain how we intend to scale PE when CPT codes, such as endogenous radiofrequency ablation procedures, include a vascular as well as a radiology imaging procedure. The commenter recommended we should calculate the costs according to the primary group furnishing the procedure. In addition, the commenter contended that a deflation factor should not be applied to new procedures that have been valued by the RUC and CMS in late 2004 for establishment of 2005 payment. Following are examples of the comments explicitly requesting delay. 
                        ( print page 70131) A comment from specialty societies representing general surgeons, anesthesiology, ophthalmology, hematology, emergency medicine, neurosurgery, cataract surgery, thoracic surgery, orthopaedic surgery, otolaryngology and hand surgery, supported by a letter from a member of the Congress, stated agreement with our goals for a PE methodology. However, the commenters requested that the implementation of the new methodology and data be delayed for 1 year, citing several concerns: First, commenters claimed that CMS did not provide sufficient data and information or time to allow adequate review of the validity of the new methodology, the supplementary survey data or the proposed impact. As a result, the comment argued that physicians have not had a reasonable opportunity to participate in the rule making process, in compliance with the Administrative Procedure Act. In addition, the comment cited the Practicing Physician Advisory Committee recommendation that we delay implementation of the new data and methodology for 1 year. An oncology society commented that a final decision on the proposed revision to the PE methodology should be deferred 1 year until information is available on how the proposal will affect drug administration services. A large provider of oncology services was also troubled by the decision to exclude drug administration services from revisions to the PE methodology. A psychological association stated that its primary concern is “the proposed rule's lack of clarity regarding the impacts that the change in methodology will have on each health care specialty.” Because of the lack of this data, the Association requested a 1 year delay for our proposal. A specialty society representing surgeons stated that the proposed methodology apparently created many aberrant PE RVUs and gave examples: Closely related procedures with proposed RVUs that are inconsistent with their actual costs; services that contribute significantly to the increases in volume and intensity noted by MedPAC all receive significant increases; within specialties that should benefit from the higher PE/HR in their surveys, there are increases and decreases that cannot be explained; E/M services will be increased in the office setting, but decreased in the hospital setting. The college recommends that we withdraw the current proposal and republish it in a future PFS rule that includes a detailed description of the methodology. Two specialty societies representing thoracic and chest physicians expressed concern with the significant shifts in the PE that would necessitate a 4-year transition and suggested that there should be no change in PE until all specialties can complete supplemental PE surveys. A specialty society representing spine surgeons requested that we suspend the proposed PE changes until 2007, not because the methodology is flawed, but in order to allow all physicians an equal opportunity to submit data relevant to their specialties. A specialty society representing anesthesiologists contended that lack of information on data and methodology behind the PE changes requires a delay in implementation. The Society requested that we provide information that clearly breaks out the impact of the proposed changes by specialty on the indirect and direct PE payments. A medical group practice association fully supported the 4-year transition of the new PE values achieved under the new bottom-up calculation. However, because it believed that insufficient information has been made available, the association recommended that we delay implementation until the provider community has time to evaluate the methodology used to recalculate the PE RVUs. The following commenters requested a delay in calculating the PE RVUs for their own specific services under the new methodology. Several comments from a specialty society representing heart rhythm services, two manufacturers and a manufacturers association, as well as a provider of remote cardiac monitoring services expressed concern about the proposed cuts for remote cardiac monitoring services and requested that we not implement these proposed reductions, pending further study. Two societies representing audiology and speech language pathology, supported by a comment from two senators, expressed concern about the large reductions in payment for audiology services and urged us to impose a 1 year moratorium on the proposed reductions for these services so that an equitable methodology for their services can be developed. One commenter suggested that if we do not implement a moratorium on payment decreases for audiology services, we should consider an alternative, such as assigning proxy work RVUs for indirect PE using the otolaryngology PE/HR. The following commenters opposed any delay in implementing our proposed methodology. A gastroenterology association commented that, since all medical specialties had equal opportunity to conduct supplemental PE studies, there should not be a delay in the implementation of our proposed changes. A specialty society representing radiation oncology agreed that more information on the new methodology should be provided, but is opposed to any delay in the implementation of the proposed methodology as the transition provides sufficient opportunity for CMS to provide this information and resolve identified problems. A sonography society commented that we should not delay the implementation of the revised TC component services with a 4-year transition. An alternative to the zero-work pool has been many years in the making and we should fully implement the new values this year. An association representing urology disagrees with a 4-year phase in of the revised PE RVUs and strongly urged us to consider other options that will allow specialties with supplemental survey data to realize the full advantages of applying that data in 2006. The commenter claimed that a transition will allow specialties that did not conduct surveys to unfairly take a portion of the 4-year increases from specialties that did. A specialty society representing allergists expressed concern that the RVUs based on the new accepted data will be phased in over 4 years. The commenter contended that we have not provided any rationale for why we are breaking with past policy or why we have decided to phase-in the specialty survey data. The commenter is concerned in particular about the continued applicability of the old and incorrect scaling factors which result in the discounting of the specialty's costs. A pharmaceuticals company requested that we consider an immediate 100 percent transition to the 2009 proposed PE values for procedures like photodynamic therapy where access has been constrained due to the use of scaling factors. A society representing family physicians commented that the original legislation mandating resource-based PE was enacted in 1994 and that we delayed the initial implementation by a year before entering a 4-year transition under our current methodology. The commenter therefore encouraged us to shorten or eliminate the transition and finally complete the process of implementing resource-based PE. However a society representing internists supported our proposal to transition PE RVU changes resulting 
                        ( print page 70132)
                        from methodological changes in this proposed rule over a 4-year period. *Response:*
                         We very much appreciate all the thoughtful and helpful comments we received on our proposal to revise our PE methodology. In addition, we are pleased that so many commenters stated their agreement with the goals that we outlined for our PE methodology in order to implement a payment system for physician and practitioner practice costs that is accurate, understandable, and stable. We also still believe, despite all the concerns pointed out by commenters, that the implementation of a methodology that bases the PE calculations on the latest available data, that uses the PEAC-refined CPEP data to create a bottom-up approach for direct costs and that values all services using the same method will help us achieve those goals. However, based on the comments we received, it appears that our PE proposal was not as clear and intuitive as we had intended. We continue to believe that the proposal for direct costs was straightforward; this proposal would do away with costs pools and scaling factors and merely add up the costs of the PEAC-refined input data assigned to each code to arrive at the direct PE RVUs (pre-PE budget neutrality). We had not anticipated that our indirect PE calculation would create difficulties since we intended that, except for those services for which the acceptance of the new supplementary survey data produced direct increases, to utilize the current indirect PE RVUs to develop the pre-PE budget neutrality indirect PE RVUs for 2006. However, due to an error in our indirect PE program, the indirect costs were not calculated as intended. As a result, almost all of the PE RVUs published in the August 8, 2005 proposed rule were incorrect. Therefore, we are concerned that interested parties were not provided notice of the actual effect of the proposed changes in the PE RVU methodology and were not given the sufficient opportunity to submit meaningful comments on the proposal. As a result, we are withdrawing our entire PE methodology proposal and instead, with only three exceptions, we will use the current 2005 PE RVUs to value all services for CY 2006. First, as we usually do each year, we will value the work and PE on an interim basis for all codes that are new in 2006. Second, as required by section 1848(c)(2)(I) of the Act, we will apply the PE/HR data from the urology supplementary survey to the calculation of the PE RVUs for all the drug administration codes performed by urology. Third, we will apply the savings from the implementation of the multiple procedure payment reduction for certain imaging services across all the PE RVUs that are discussed later in the preamble of this rule. We understand that the withdrawal of this proposal will be welcomed by some and will be a disappointment to others, especially those specialties that undertook PE surveys that are not being used for 2006. We want to work with the medical community beginning now through the next proposed rule to exchange thoughts on all of the issues raised, to answer any questions and to provide additional data and corrected information. We hope to hold meetings on these topics early next year so that we can obtain maximum input from all interested parties to ensure that our next proposal does meet the goals we have set for our PE methodology. Acceptance of Supplementary Surveys for 2006 *Comment:*
                         Many commenters indicated their strong support for our proposal to accept the PE data from 7 supplementary surveys. Several specialty societies representing radiation therapy expressed approval for the proposal to blend the survey data submitted by ASTRO and AFROC to calculate a revised PE/HR for radiation oncology services. A specialty society representing interventional radiology stated support for the proposed use of the ACR's supplemental PE data for purposes of PE RVU determination. The ACC is pleased that we proposed to incorporate their supplemental PE survey data submitted for cardiology and other specialties that submitted data consistent with the acceptance criteria. The ACC commented that, given the rigorous and detailed analysis conducted by our contractor, these data are very likely superior to the SMS data that were used to calculate PE RVUs and that our acceptance of the supplemental PE data has been an important component of efforts to refine the resource-based PE RVUs. An echocardiography society and a commenter representing cardiovascular angiography also stated its support for use of the cardiology data. Two societies representing gastroenterology commented that they are pleased with our acceptance of the supplemental PE survey data for gastroenterology. The AUA strongly urged us to finalize our proposal to accept the AUA's supplemental survey data, as they believe language in the section 303(a)(1)(I) of the MMA requires us to accept supplemental data submitted by urology. In addition, the AUA stated that we are required by the MMA to update the 2006 PE RVUs for urology drug administration, applying the exemption from budget neutrality. A commenter representing prosthetic urology also agreed that we should use the urology supplemental data to allocate the indirect PE costs to each urology procedure. However, other commenters had concerns with the proposal. An otolaryngology specialty society questioned the validity of the dramatic increases in the PE/HR for the specialties that have submitted surveys because this could create a two-tiered system between those specialties that have submitted surveys and those which have not. Therefore, the society recommended that use of this new PE data be delayed until such time as a multispecialty PE survey can be conducted. A comment from an occupational therapy association recognized the need to use SMS aggregate data in the indirect calculations, but questioned the impact on specialties who did not participate in the survey and suggested that the transition period be used to examine the atypical impact of this change. Two thoracic surgery groups commented that the PE fluctuations and disparities caused by the acceptance of these surveys are counter-intuitive and advantage those for whom we have accepted data at the expense of those from whom we have not. The specialty society representing surgeons stated that the dramatic increase in the proposed PE/HR figures could cause significant distortions in the relativity of PE payments across specialties and urged that we delay implementation of the new data until a multi-specialty PE survey, similar to the AMA's SMS survey can be conducted. However, the society also recommended that we use the urology PE/HR data because it would be required by the MMA. A provider group representing remote cardiac services recommended that we should refrain from incorporating any additional survey data until all supplemental data is submitted. Conversely, a society representing echocardiographers stated that it is crucial for us to use the submitted survey meeting our criteria in order to retain the type of trust necessary for physician specialty groups to conduct this type of survey in the future. The commenters from the gastroenterology groups stated that use of these data should not be transitioned, but should be treated consistently with the manner in which all other supplemental data have been treated. Further, the commenter contended that, even if we agree to a delay in the implementation 
                        ( print page 70133)
                        of our proposed methodology, the accepted supplemental PE/HR data should be implemented immediately for both direct and indirect expenses. *Response:*
                         We understand the considerable effort, time and money expended by the specialty societies that submitted surveys that met our criteria and are aware that there will be considerable disappointment that the new data will not be used for 2006. We also understand the concern of those specialties that have not undertaken a supplementary survey that now fear that they could be relatively disadvantaged if the accepted surveys are used. We would point out that for the last five years there has been an equal opportunity for all specialties to submit supplementary data and it could be presumed that those specialties that did not avail themselves of the opportunity believed the effort was not worth the probable result. In addition, all specialties had the opportunity to comment on our proposed criteria for acceptance of survey data and the medical community at large did not comment that the criteria needed to be more stringent. However, we will not be using the accepted supplementary data in our indirect PE calculations for 2006, with the exception of the urology PE/HR data that we are applying to the drug administration codes performed by urology as required by section 1848(c)(2)(I) of the Act. We are not using the other accepted supplementary PE data because, as explained above, we are not adopting the proposed changes to our PE methodology, we did not propose to use the survey data for calculating the direct PE RVUs and the use of the survey data would have caused significant changes in the PE RVUs for which there would have been no opportunity for comment. *Comment:*
                         We also received several comments with specific concerns regarding our handling of the submitted PE survey data. A specialty society representing radiation oncology asserted that the approach to blending survey data has inadvertently lowered the values for certain radiation oncology services by under-weighting the PE expenses for freestanding facilities from the AFROC survey and by overestimating the hours in the denominator of the PE/HR calculation. In addition, three commenters questioned an apparent discrepancy with the PE/HR for radiology, radiation oncology and cardiology recommended by the Lewin Group and the PE/HR in the proposed rule and the subsequent correction notice. The commenters requested a clarification on how we applied the deflators in order to ensure that all specialties submitting surveys were evaluated in the same way. A comment from specialty societies representing most major surgical groups, as well as emergency medicine and anesthesia, contended that over the years we have treated supplemental survey data with different standards and have blended some while not blending others. A medical technology company requested that we explain how the data were evaluated, especially because we did not accept some recommendations presented by the Lewin Group. *Response:*
                         Because we are not utilizing the new supplementary data for indirect PE calculations for 2006, we plan to discuss all of these issues with the relevant specialties in order to determine if adjustments are needed to our calculations of the PE/HR data. However, we do not believe that we have treated supplemental data with different standards, but would request specific information from the commenters. Currently, we are not using any blended data for any supplementary survey that we have accepted and used. Although we rely heavily on the analysis and evaluation of the survey data done by the Lewin Group, we are responsible for the final decision on whether or not to accept the data from a given survey. The Lewin Group did recommend that we accept the data from the NCQDIS survey, which did not meet our precision criteria, because we currently have no survey data for them. However, we believe that it is more equitable to apply the same standards to all who submit surveys and we proposed not to accept the survey data at this time. *Comment:*
                         The NCQDIS expressed concern that we did not accept their PE survey data for diagnostic imaging services in IDTFs because the precision criteria was not met. NCQDIS pointed out that the Lewin Group recommended that we accept the data in spite of the precision level because PE data for IDTFs do not currently exist. The commenter stated that, after further analysis of the data, NCQDIS determined that inclusion of one inaccurate record skewed the findings outside the acceptable precision range. Therefore, NCQDIS recommended that we accept the revised analysis from the Lewin Group that includes updated PE information for the record in question and that we allow the updated data to be used in development of PE RVUs for 2006. The NCQDIS recommendation was supported by a comment from a society representing diagnostic medical sonography that contended that no alternative data is available for these entities and the current PE data used understates their PE. *Response:*
                         There have been further discussions between NCQDIS and our contractor. We will be discussing this with the specialty in order to resolve the issue for a future proposal. *Comment:*
                         A nuclear medicine society stated that it cannot respond to our use of the radiology and cardiology surveys because it has not seen the data as it relates to nuclear medicine. The commenter requested that we make the nuclear medicine supplementary survey information and impact available. A specialty society representing radiation oncology expressed the belief that the new survey data do not reflect the costs of brachytherapy because providers of this service were not adequately represented in the sample. *Response:*
                         We would be willing to discuss the societies' concerns to determine an appropriate resolution. *Comment:*
                         A long term care association urged us to use the data from the ACR supplementary survey as the PE/HR proxy for the portable x-ray set-up code (Q0092) to prevent inconsistencies in the application of the new payment methodology. *Response:*
                         We do not believe it would be appropriate to use the same indirect costs associated with a free-standing radiology center, which incurs costs for such requirements as lead shielding and structural reinforcements for heavy equipment, as the costs for setting up a portable x-ray machine. Therefore, we will not apply the data from the radiology supplementary survey to the calculations of the PE RVUs for Q0092. *Comment:*
                         Because we had proposed to accept the supplementary survey data for radiology, radiation oncology and cardiology, the specialties that make up the bulk of the NPWP, we also proposed eliminating the pool and pricing all of the services in the NPWP under the new proposed PE methodology. We received comments from several organizations including those representing diagnostic sonography, urology, medical physicists, allergy geriatrics and a blood disorder center supporting this proposal. However, the specialty society representing audiology urged that, before we dismantle the protection provided by the NPWP, a reasonable formula should be developed to fairly and adequately reimburse audiologists for their services. The societies representing audiology, speech language pathology and medical nutrition all commented that we should assign work RVUs to their services, rather than treating their professional work as PE. *Response:*
                         We are pleased that most commenters approved of our proposal to 
                        ( print page 70134)
                        eliminate the NPWP. However, because we will not be using the accepted new supplementary survey data in the calculation of PE RVUs for 2006, we believe it would be more equitable to defer the elimination of the pool as well. Therefore, we will not be implementing this proposal for 2006. This will also give us the additional time to work with audiology and other specialties to ensure that our future proposal will be equitable to all. Because we are maintaining the NPWP for 2006, we are deferring our decision regarding work RVUs for audiology, speech language pathology and medical nutrition pending further discussions with the specialties. Bottom-up for Direct PE *Comment:*
                         We received many comments on our proposal to value the direct PE for all services by the bottom-up method, using the PEAC refined staff, supply and equipment costs associated with each procedure as the basis for calculating the direct PE RVUs. Almost all of these comments favored our proposal to modify our PE methodology. This support was expressed whether the commenter also requested a delay in the implementation of our proposed methodology or recommended immediate implementation with no transitioning of the new PE RVUs. Commenters who were pleased with the resulting PE RVUs and those concerned with specific reductions also showed support. Below are some specific examples of the supporting comments. Two comments from specialty societies representing family physicians and internists agreed that the bottom-up approach will produce a more accurate, intuitive and stable PE methodology. One of the commenters contended that the proposed methodology would be more accurate because the bottom-up methodology assumes that the costs of the clinical labor, supplies and equipment are the same for a given service, regardless of the specialty performing it. A urological association supported switching to a bottom-up methodology for calculating PE RVUs and believed it meets our stated goals of using the most appropriate data, simplifying the PE methodology and increasing the stability of the PE payments. A major oncology center applauded our decision to implement a bottom-up approach because of the inequities that result when PE RVUs are set using a top-down approach which allows the frequent “leakage” of a specialty's costs to other specialties. This rationale was also stated by a society representing anesthesiologists and by a patient advocate foundation. An oncology nursing society commented it has long advocated a bottom-up modification to help ensure that PE payments reflect the actual relative resources required for each service provided by oncology nurses. An organization representing allergy supported our proposal to change to a bottom-up methodology for determining PE values because this is a more rational approach. This view was shared in a comment from a physical medicine and rehabilitation society, which added that a bottom-up approach would result in a more direct relationship between PE RVUs and direct costs. A spine society commented that it welcomed the change to a “bottom-up methodology because any movement in the direction of stability and uniformity will have positive effects across providers.” A specialty society representing neurology supported the proposed change to a bottom-up methodology for calculating direct costs. The society asserted that the top-down method is flawed as it unfairly raises the expenses for high-end procedures. The commenter also stated that the excellent work of the PEAC, and now the PERC, has produced reliable data for all the codes, making CPEP complete for all the codes and must be given primacy in any method we would chose to implement. Two radiation therapy societies stated their strong support of the proposed bottom-up methodology and the proposed implementation for January 1, 2006. One society commented that eliminating the scaling factors, at least for direct costs, is a step in the right direction toward a simpler and more transparent PE methodology. A respiratory care association stated support for our proposed bottom-up approach because this methodology would minimize aberrations that might inadvertently appear in the calculations, providing a more accurate representation of direct PE incurred by pulmonary physicians. A psychological association commented that the refinements approved by the PEAC may allow CMS to utilize a more simplified PE methodology which will make PE more understandable. An organization representing radiology contended that using the bottom-up methodology seems to be a simpler and easier way to make the transition with minimal impact. A medical sonography society stated that our efforts to help ensure a more accurate payment for healthcare services and create more year-to-year stability are to be commended. An occupational therapy association and a physical therapy association both agreed that the bottom-up method would be a preferable methodology. First, because it would rely on actual inputs from the specialties providing each service and second because it would create a more stable and predictable system and would reflect the actual relative resources required for each service. A specialty society representing hematology agreed that the top-down method for calculating the direct PE is extremely complex and not at all intuitive and stated that the bottom-up method will simplify the system and reduce the complexity of the calculations. Other organizations that supported the adoption of the bottom-up approach to valuing direct costs included specialty societies representing podiatry, prosthetic urology, geriatrics, infectious diseases, chest physicians, a pharmaceutical company, and medical group practices. *Response:*
                         We are very pleased that so many in the medical community approve of the concept of using a bottom-up methodology to value the direct PE RVUs. We believe, along with these commenters, that the use of the bottom-up approach in the future would allow us to calculate more accurately the relative direct costs for each service in the PFS. The bottom-up approach would be simple to understand—we merely sum the costs of the PEAC-refined clinical staff, supply and equipment inputs that are assigned to each service. The bottom-up approach would be intuitive—any change in direct inputs would lead to a commensurate change in the direct PE RVUs. The bottom-up methodology should also be more stable—with no cost pools or scaling factors to complicate the computation, direct PE RVUs for a service would only change if there was a revision to the inputs assigned. It was the hard work put forth by the AMA, the PEAC, the RUC and specialty societies in refining the CPEP inputs that made it possible to propose using a bottom-up methodology. However, for reasons discussed in this section, we are not implementing the bottom-up methodology for direct costs for 2006. However, we will be working with the RUC and the medical community to ensure that the inputs assigned to each service are correct and that the overall methodology works as intended so that we can propose this improvement in the future. 
                        ( print page 70135) *Comment:*
                         Several commenters expressed concern regarding the future refinement of the direct PE inputs that would ensure that a bottom-up methodology continues to lead to appropriate PE RVUs. A radiation oncology specialty society recommended that the bottom-up methodology be reviewed to ensure that the full input amounts are recognized accurately. A specialty society representing podiatry commented that the codes refined in the early stages of the PEAC may have inputs not consistent with codes refined later and that they should be looked at again by PEAC or PERC. The specialty society representing allergy suggested that there needs to be a continuing mechanism, such as the PEAC and PERC, for addressing changes in PE. A physical medicine society asserted that it is essential that we establish a system for updating or revising direct cost inputs based on new data or changes in technology. A thoracic medicine society supported the bottom-up methodology for creating direct PE inputs with continued refinement by the PEAC or the PERC. A pharmaceutical company supported the bottom-up method of determining the relative direct costs of each service, but requested that we establish a system to accept and review external data during the notice and comment period to update the direct cost inputs as needed. A specialty society representing prosthetic urology recommended that we adopt the bottom-up method and establish a method to review external data to ensure that the inputs are updated appropriately. *Response:*
                         We agree with the commenters that there needs to be a continuing review process for the direct PE inputs to reflect changes in practice or new technology. In addition, it will be necessary to ensure that the clinical staff time standards and supply and equipment packages that have been developed through the refinement process are applied appropriately to all services. We are hopeful that the RUC will continue to play a role in this further review and will be discussing this with RUC staff. In addition, we will continue to encourage input from the medical community in general regarding the accuracy of the direct inputs and their pricing. *Comment:*
                         There were a few specific concerns raised by commenters regarding the bottom-up methodology. A specialty society representing radiation oncology stated that the bottom-up methodology may be unintentionally compressing higher-cost technology. A health care provider supported the bottom-up approach conceptually, but expressed concerns that aggregate budget neutrality would be more difficult to control using a bottom-up approach than using the top-down. A medical group practice association, as well as a large multi-specialty clinic, had concerns that the RUC recommendations we have accepted for new technical procedures have, because of budget neutrality, eroded the value attributed to cognitive services. MedPAC had concerns about dealing with overvalued services and with the assumptions we use to allocate the cost of equipment to a specific service. For example, MedPAC questioned whether our assumption of 50 percent utilization for all equipment is valid. *Response:*
                         We are not sure how the bottom-up methodology would compress higher cost technology, but would be willing to discuss this with the commenter as we develop our next proposal. For budget neutrality, we are not certain that it is harder to control under a bottom-up approach; it would depend on which data source—the aggregate SMS-type data or the PEAC-refined input data—produces the most accurate estimate of direct costs. We understand, in a budget neutral system, the concern about the effect that adding inputs for expensive technology has on cognitive services, but under a bottom-up methodology there would not be the issue of scaling factors exaggerating this effect. We would like very much to discuss the issue raised by MedPAC as we endeavor to improve our PE methodology. Future Indirect PE Refinement *Comment:*
                         Although we did not propose any major change to the indirect PE methodology, other than incorporating the new PE survey data, we did indicate our interest in receiving suggestions on ways to continue to refine the indirect PE calculations. Most commenters focused on the need for us to acquire up-to-date survey information for all specialties so that the PE data for all specialties is as current as possible. Specialty societies representing infectious disease physicians, orthopaedists, remote cardiac services, chest physicians and physical medicine commented that we should extend the deadline to allow specialty societies to conduct supplemental PE surveys. A commenter representing otolaryngologists stated this would not be a preferred option since the high cost involved with conducting surveys would disadvantage smaller specialties. Other specialty societies representing cataract surgeons, anesthesiologists, emergency medicine and otolaryngology recommended that an unbiased SMS-type survey that cuts across all specialties would be most appropriate for use in the future, instead of having data from different time periods. In arguing for this multi-specialty approach, an emergency medicine association commented that, as MedPAC reports have indicated, only specialty societies who are likely to gain ground have incentive to produce new surveys. The specialty society representing otolaryngology cited the discussion in the Lewin Group report, “Recommendations Regarding Supplemental Practice Expense Data Submitted for 2006,” that suggests that the increase in the surveyed PE/HR could indicate a “secular trend in rising physician PEs,” and the need for a multi-specialty PE survey. The commenter also suggested that a universal survey could be paid for by using funds reallocated from the oncology demonstration. A specialty society representing spine surgeons commented that all physicians should have the opportunity to submit data relevant to their specialties because it would be unfair to reduce PE reimbursement for providers such as neurosurgeons and orthopedic surgeons without allowing those providers that opportunity to submit accurate data. The society suggested that, as we have established a model for survey data, we could allow societies to survey their membership and submit the results, either directly to CMS or through the RUC. An association representing medical group practices recommended that a comprehensive study be initiated to accurately balance the relativity of overhead costs of practice for each service on a nationwide basis and that this include the costs of information technology (IT) implementation. An emergency medicine commenter recommended including survey questions on uncompensated care. *Response:*
                         We agree with all the commenters that, for the PE RVUs to reflect accurately the relative indirect costs for all services, it would be most preferable to have current data for all specialties. However, section 212 of the BBRA required that we establish a process to use data developed by entities and organizations to supplement the data we normally collect in determining the PE component. We established this process and set criteria and a timeline for submission of this data. Although we twice extended the period during which we would accept these supplemental data, we are not proposing to extend this period beyond this year. We believe 
                        ( print page 70136)
                        that there has been sufficient time for individual specialties that had sufficient member support to do a survey, and that had reason to believe that the results of a survey would be helpful, to submit supplementary PE data to us. Therefore, we agree with the commenters who suggest that a multi-specialty survey done for a uniform time period would be most helpful. We are now planning to work with the AMA and the medical community to develop a strategy for funding and fielding a multi-specialty indirect PE survey that will help ensure that our PE methodology treats all specialties equitably. *Comment:*
                         Several commenters offered the following suggestions for revisions to the indirect methodology. Comments from two associations representing speech language pathologists and audiologists argued that the current method of assigning indirect costs to their services results in a gross underestimation of these costs for both audiology and speech-language pathology services. One association suggested an alternative method of basing indirect costs on the ratio of the refined direct costs to the total costs for all physicians or for otolaryngologists. A specialty society representing allergy expressed concern that the indirect costs of an allergy practice are not properly accounted for in the current methodology because most either are not assigned work RVUs or have very low work RVUs, but may have high actual indirect costs. The society recommended that we should either establish a mechanism for adjusting the indirect PE when the existing formula yields an inequitable result, or revise the direct costs to include administrative staff time. A comment from a manufacturer stated that we should not use the “All Physician” indirect cost data for IDTFs and recommended using the radiology PE/HR figure for IDTF radiological services and the cardiology PE/HR for IDTF cardiology services, with the exception of the cardiac remote monitoring services which should be paid at current levels, pending the collection of additional data. A comment from a clinical oncology society recommended that any revision in the methodology for direct costs should be accompanied by a revision in the methodology for allocating indirect costs. The society stated that both the Lewin Group and the Government Accountability Office have found that the current methodology for indirect costs is biased against services that lack a physician work component. A family physician association questioned why we use physician work, rather than physician time, in our formula for allocating indirect expenses. The commenter stated that there is no evidence that PE would vary with physician intensity and recommended that we use physician time rather than work in the allocation of indirect expenses. A group representing cardiac services providers recommended that if and when the new methodology is applied to remote cardiac monitoring, indirect costs for these services should be based on a survey of their group and not on the “All Physician” average PE/HR, which fails to reflect the actual practice costs incurred. The group also recommended that we allocated indirect costs solely on the basis of direct costs, without regard to physician work. *Response:*
                         We thank all the above commenters for their suggestions on improvements to our indirect PE methodology. We will certainly consider all of the above recommendations, as we work with the medical community to develop our next proposal for indirect PE. *Comment:*
                         The American College of Surgeons recommends that we convene a multi-stakeholder process to address indirect PE methodological issues so that we can make further changes before final implementation of our new methodology. *Response:*
                         As we have mentioned previously, we agree wholeheartedly with the above recommendation. We plan to initiate an open process with the medical community to exchange ideas, answer questions and provide information regarding changes to all aspects of our PE methodology before publication of the next PFS proposed rule. We recognize that in any payment system based on costs, indirect costs are always the most difficult to allocate fairly and accurately. Therefore, we will welcome all suggestions, including those recommended, to improve our indirect PE methodology. Other Issues *Comment:*
                         A group representing community cancer centers requested that we review the PE RVUs for drug administration services as soon as the needed data are available to ensure that they accurately reflect all the costs associated with these services. The National Patient Advocate Foundation agreed because of concern that use of the current indirect PE RVUs will not be sufficient to reimburse oncologists for drug administration costs. *Response:*
                         We should have the utilization data needed for the 2006 proposed rule and plan to include the drug administration services in whatever PE methodology is proposed. *Comment:*
                         Several commenters recommended that we maintain budget neutrality for PE RVU changes by adjusting the CF proportionately, rather than decreasing only PE RVUs. *Response:*
                         Though there could be operational difficulties with adjusting the CF to account for PE budget neutrality, we would like to solicit comments on how best to reflect the budget neutrality for PE. 3. PE Recommendations on CPEP Inputs for CY 2006 Since 1999, the PEAC, an advisory committee of the AMA's RUC, provided us with recommendations for refining the direct PE inputs (clinical staff, supplies, and equipment) for existing CPT codes. The PEAC held its last meeting in March 2004 and the AMA established a new committee, the PERC, to assist the RUC in recommending PE inputs. With the PERC's assistance, the RUC completed refinement of approximately 200 remaining codes at its meetings held in September 2004 and February 2005. A list of these codes appeared in Addendum C of proposed rule. We reviewed the RUC-submitted PE recommendations and proposed to adopt nearly all of them. We worked with the AMA staff to correct any typographical errors and to make certain that the recommendations are in line with previously accepted standards. As stated in the proposed rule, we revised the PE database to reflect these RUC recommendations which can be found on our web site. (See the “Supplementary Information” section of this rule for directions on accessing our web site.) We disagreed with the RUC's recommendation for clinical labor time for CPT code 36522, 
                        *Extracorporeal Photopheresis.*
                         In the CY 2005 final rule (69 FR 66236), we assigned, on an interim basis, 223 minutes of total clinical labor for the service period based on the typical treatment time of approximately 4 hours. The RUC, however, recommended 122 minutes total clinical labor time for the service period, which allowed for 90 minutes of nurse “intra service” time for the performance of the procedure (the society originally proposed 180 minutes). We believe that 135 minutes is a more appropriate estimation of the clinical staff time actually needed for the intra time, as it more closely approximates the time assigned to the other procedures in this family of codes, including CPT codes 36514, 36515, and 36516. Therefore, we proposed a total 
                        ( print page 70137)
                        clinical labor time of 167 minutes for the service period. We did not receive specific comments for this revision and are finalizing this change to the clinical labor time. While we have made the change in the PE database, the PE RVUs for 2006 will not reflect the adjustment due to the decision concerning the PE methodology to maintain all PE RVUs at the 2005 level as discussed previously. The RUC also recommended that no inputs be assigned to several codes because the services were not performed in the office setting. However, our utilization data shows that 4 of these codes (CPT codes 15852, 76975, 78350, and 86585) are currently priced in the office and are performed with sufficient frequency in the office to warrant this. Therefore, we proposed not to accept the RUC recommendations for these services at this time, but requested comments from the relevant specialties as to whether the recommendations should be accepted. *Comment:*
                         We received comments from one specialty society disagreeing with the RUC's recommendation for CPT 78350, single photon bone densitometry, as they believe this procedure is being performed in the office. They expressed their intentions to work with CMS as they develop appropriate PE inputs for this procedure in the nonfacility setting. The specialty society also expressed their agreement with the RUC's recommendation to eliminate the nonfacility PE RVUs for 76975 because virtually all of these exams are performed in the facility setting. In addition, a national organization representing medical directors of respiratory care, supported the retention of nonfacility PE RVUs for CPT 86585, TB tine test, because they believe it to be a legitimate office-based procedure. We did not receive comments on the appropriateness of nonfacility RVUs for CPT 15852. *Response:*
                         We will maintain the nonfacility setting PE RVUs for 78350 and look forward to working with the specialty society in their initiative to develop inputs for this procedure. We will remove the PE inputs for the nonfacility setting for CPT codes 76976 and 15852, although for the 2006 PFS these codes will reflect the 2005 PE RVU amounts. CPT 86585 has been deleted from CPT 2006 and will not appear on Addendum B. 4. Payment for Splint and Cast Supplies In the Physician Fee Schedule (CY 2000); Payment Policies and Relative Value Unit Adjustment final rule, published November 2, 1999 (64 FR 59379) and the Physician Fee Schedule (CY 2002); Payment Policies and Relative Value Units Five-Year Review and Adjustments final rule, published November 1, 2000 (66 FR 55245), we removed cast and splint supplies from the PE database for the CPT codes for fracture management and cast/strapping application procedures. Because casting supplies could be separately billed using Healthcare Common Procedure Coding System (HCPCS) codes that were established for payment of these supplies under section 1861(s)(5) of the Act, we did not want to make duplicate payment under the PFS for these items. However, in limiting payment of these supplies to the HCPCS codes Q4001 through Q4051, we unintentionally prohibited remuneration for these supplies when they are not used for reduction of a fracture or dislocation, but rather, are provided (and covered) as incident to a physician's service under section 1861(s)(2)(A) of the Act. Because these casting supplies are covered in sections 1861(s)(5) or 1861(s)(2)(A) of the Act, we proposed to eliminate the separate HCPCS codes for these casting supplies and to again include these supplies in the PE database. This would allow for payment for these supplies whether based on section 1861(s)(5) or 1861(s)(2)(A) of the Act, while ensuring that no duplicate payments are made. In addition, by bundling the cost of the cast and splint supplies into the PE component of the applicable procedure codes under the PFS, physicians would no longer need to bill Q-codes in addition to the procedure codes to be paid for these materials. Because these supplies were removed from the PE database prior to the refinement of these services by the PEAC, we proposed to add back the original CPEP supply data for casts and splints to each applicable CPT code and we requested that the relevant medical societies review the “Direct Practice Expense Inputs” on our web site and provide us with feedback regarding the appropriateness of the type and amount of casting and splinting supplies. We also requested specific information about the amount of casting supplies needed for the 10-day and 90-day global procedures, because these supplies may not be required at each follow-up visit; therefore, the number of follow-up visits may not reflect the typical number of cast changes required for each service. We reincorporated the following cast and splint supplies as direct inputs: fiberglass roll, 3 inch and 4 inch; cast padding, 4 inch; webril (now designated as cast padding, 3 inch); cast shoe; stockingnet/stockinette, 4 inch and 6 inch; dome paste bandage; cast sole; elastoplast roll; fiberglass splint; ace wrap, 6 inch; and kerlix (now designated as bandage, kerlix, sterile, 4.5 inch) and malleable arch bars. The cast and splint supplies were added, where applicable, to the following CPT codes: 23500 through 23680, 24500 through 24685, 25500 through 25695, 26600 through 26785, 27500 through 27566, 27750 through 27848, 28400 through 28675, and 29000 through 29750. Because we proposed to pay for splint and cast through the PE component of the PFS, we would no longer make separate payment for these items using the HCPCS Q-codes. *Comment:*
                         We received a comment on behalf of the American Osteopathic Academy of Orthopedics (AOAO) that provided specific information for the type and number of casts needed for the 10 or 90-day global period for each code in the relevant fracture management series. The AOAO also noted the type and amount of casting supplies, including stockinette, cast padding, fiberglass and post-op cast shoe, as appropriate. We also received a comment from the RUC expressing their appreciation for the proposal to make coding and billing for fracture management and casting/strapping supplies easier by reducing the number of codes for physicians to submit. In addition, the RUC expressed interest in reviewing the data submitted in response to our proposal so that the resulting casts and strapping PE inputs can “enjoy the same level of scrutiny and cross-specialty refinement that all of the other PE inputs have”. Other specialty societies supported our proposal to include casting material in the fracture care codes and the elimination of the Q codes. However, some of these societies expressed concerns about bundling all of the necessary casting/strapping supplies for the global period into the fracture management codes. These commenters related that only the initial cast/strapping supplies should be bundled into the relevant fracture care code series and that physicians should be able to continue to submit separate claims for the CPT codes for the application of casts and strapping procedures during the global period. Many commenters, primarily from orthopedic practices, expressed concern about the proposal, but misunderstood that this proposal was separate from the anticipated negative update for 2006 based on the SGR methodology. *Response:*
                         We thank AOAO for submitting the information we requested in the proposed rule. The society submitted a clear, 
                        ( print page 70138)
                        comprehensive and beautifully prepared spreadsheet detailing each CPT code in the various fracture management series. We commend them on their efforts to submit such a thorough and meticulous document in response to our proposed rule request. For the 2006 fee schedule, based on the decision concerning PE methodology to maintain all PE RVUs at the 2005 level previously discussed, we have removed the CPEP inputs for casts and splints from the PE database and CMS will retain use of the Q-code fee schedule as done in the past. In addition, we will use the interim time period before the notice of proposed rulemaking for the 2007 fee schedule to work with the affected specialties and the RUC to clarify issues related to Medicare payment policy and establish more appropriate amounts of casting/strapping materials for the relevant series of fracture management codes and the casts and strapping application codes. Due to the temporary status and intended limited use of the Q-code fee schedule, it is our intention to resolve these important payment issues in the near future. A detailed discussion of the SGR and the update for 2006 is found later in this final rule with comment. 5. Miscellaneous PE Issues In this section, we discuss our specific proposals related to PE inputs. a. Supply Items for CPT Code 95015 We proposed to change the supply inputs for CPT code 95015, 
                        *intracutaneous (intradermal) tests, sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, specify number of tests,*
                         based on comments received from the JCAAI. JCAAI reported that “venom” is the most typical test substance used when performing this service and that “antigen”, currently listed in the PE database, is never used. They also suggested that the appropriate venom quantity should be 0.3 ml (instead of the 0.1 ml listed for CY 2005) because of the necessity to use all 5 venoms (honey bee, yellow jacket, yellow hornet, white face hornet and wasp) to perform this sensitivity testing; that is, 1 ml of each venom type for a total of 5 ml of venom. The diluted venoms are sequentially administered until sensitivity is shown, beginning with the lowest concentration of venom and subsequently administering increasing concentrations of each venom. We accepted the specialty's argument and proposed to change the test substance in CPT code 95015 to venom, at $10.70 (from single antigen, at $5.18) and the quantity to 0.3 ml (from 0.1 ml). *Comment:*
                         JCAAI expressed their appreciation for our proposal to change the supply item input for CPT 95015 from 0.1 ml antigen to .3 ml of venom. *Response:*
                         The appropriate changes have been made to our PE database. However, as discussed above, because we are making only limited, necessary changes to PE RVUs for the 2006 PFS, the PE RVUs for this code will continue to reflect the 2005 PE RVU amounts. b. Flow Cytometry Services In the CY 2005 final rule (69 FR 66236), we solicited comments on the interim RVUs and PE inputs for new and revised codes, including flow cytometry services. Based on comments received and additional discussions with representatives from the society representing independent laboratories, we proposed to revise the PE inputs for the flow cytometry CPT codes 88184 and 88185. Based on information from the specialty society, we proposed to change the direct inputs used for PE as follows: Clinical Labor: Change the staff type in the service (intra) period in both CPT codes 88184 and 88185 to cytotechnologist, at $0.45 per minute (currently lab technician, at $0.33 per minute).
                    Supplies: Change the antibody cost for both CPT codes 88184 and 88185 to $8.50 (from $3.544).
                    Equipment: Add a computer, printer, slide strainer, biohazard hood, and FACS wash assistant to CPT code 88184. Add a computer and printer to the equipment for CPT code 88185. *Comment:*
                         We received comments from several organizations including those representing professional services in clinical laboratories, manufacturers, clinical laboratories, and clinical pathologists. These commenters all supported our proposal to revise the PE inputs outlined above for the flow cytometry CPT codes 88184 and 88185. *Response:*
                         We appreciate the support extended to us by these national organizations in regards to the revision of direct inputs for the CPT codes for flow cytometry. The PE changes have been made, as indicated above, to the database. However, because we are making only limited, necessary changes to PE RVUs for the 2006 PFS, the PE RVUs for these codes will continue to reflect the 2005 PE RVU amounts. c. Low Osmolar Contrast Media (LOCM) and High Osmolar Contrast Media (HOCM) HOCM and LOCM are used to enhance images produced by various types of diagnostic radiological procedures. In the CY 2005 final rule (69 FR 66356), we eliminated the criteria for the payment of LOCM that had been included at § 414.38. Effective April 1, 2005, providers can receive separate payment for LOCM when used with procedures requiring contrast media through the use of separate Q-codes. Payment for HOCM is currently included as part of the PE component under the PFS. We proposed, effective January 1, 2006, to no longer include payment for HOCM under the PFS and to establish Q-codes for the separate payment of HOCM. As noted in the proposed rule we reviewed the PE database and proposed to remove the following two supply items which we have identified as HOCM from the PE database: Conray inj. iothalamate 43 percent(supply item #SH026, deleted from 64 procedures).
                    Diatrizoate sodium 50 percent (supply item #SH0238, deleted from 74 procedures). We also identified 5 CPT codes (specifically CPT codes 42550, 70370, 93508, 93510 and 93526) that included omnipaque as a supply item, and proposed to remove this supply item from these 5 CPT codes since omnipaque is actually a type of LOCM. *Comment:*
                         We received several comments from organizations representing radiology physicians and manufacturers on our proposal to delete HOCM from the PE database. The commenters supported our proposal for separate payment for both HOCM and LOCM to ensure beneficiaries access to all the various types of medical imagining contrast media. The commenter representing the manufacturers requested that we notify carriers that separate payment for LOCM and HOCM is available. *Response:*
                         We thank the organizations for their comments in support of our proposal which would permit separate payment for HOCM in 2006. We have removed HOCM from the direct inputs in the PE database and also deleted LOCM from the 5 procedures as noted above. However, because we are not implementing the bottom-up methodology which utilizes the direct inputs to determine the PE RVUs, these imaging codes will again be valued in the NPWP where the PE RVUs are established using an appropriate crosswalked charge-based RVU containing HOCM as an inherent supply cost. We will delay separate payment for HOCM until such time the direct inputs are used to determine PE RVUs. For 2006, the PE RVUs will be retained at the 2005 level. We remind the commenters that the average sales price 
                        ( print page 70139)
                        (ASP) quarterly values are published on our Web site at the following address: 
                        *http://www.cms.hhs.gov/​providers/​drugs/​asp.asp.* d. Imaging Rooms We include standardized “rooms” for certain services in our PE equipment database, rather than listing each item separately. We received pricing information from the ACR for the following rooms that are included in the database. We accepted most of the proposed items that met the $500 threshold for equipment and proposed to include the items in each specific room, as follows: *Basic Radiology Room:*
                         $127,750 (x-ray machine @ $125,550 and camera @ $2,200). The recommended viewbox was not included because most codes assigned this room have also been assigned an alternator (automated film viewer) or a 4-panel viewbox. *Radiographic-Flouroscopic Room:*
                         $367,664 (Radiographic machine @ $365,464 and camera @ $2,200). The recommended viewbox was not included because most codes assigned this room have also been assigned an alternator (automated film viewer) or a 4-panel viewbox. *Mammography Room:*
                         $168,214 (mammography unit @ $124,900; reporting system @ $16,690; mammography phantom @ $674; densitometer @ $3,660; sensitometer @ $2,750; desktop PC for monitoring @ $1,840; and processor @ $17,700. Separately listed equipment items (densitometer, mammography reporting system, sensitometer, mammography phantom, desktop computer, and the film processor) that duplicated items included in the mammography room were removed from the codes assigned the room, eliminating the reporting system, sensitometer and phantom from the PE database. *Computed tomography (CT) Room:*
                         $1,284,000 (16-slice CT scanner with power injector and monitoring system) *Magnetic Resonance Imaging (MRI) Room:*
                         $1,605,000 (1.5T MR scanner with power injector and monitoring system) *Comment:*
                         We received comments from one specialty society requesting that we add 4 cassettes to the composition and cost of the mammography room although each cassette does not meet the $500 equipment threshold. Another commenter representing a large radiology group practice agreed that our cost allowance for the mammography room was appropriate for the standard analog mammography room. However, this commenter asked us to develop a separately identified cost for a digital mammography room, costing approximately 3 to 4 times as much as the analog room, citing this digital system provides better diagnostic services. *Response:*
                         We appreciate the comments regarding the cost and composition of the mammography room. We are sympathetic to the commenter's request for the creation of a separate digital mammography room. However, the direct PE inputs for labor, supplies and equipment that are included in physicians' services reflect the costs involved in the typical procedure or service provided in the nonfacility setting. We believe that the mammography room we proposed represents the equipment used to provide the typical mammography service and was based on information provided by the specialty society. We disagree with the specialty society in regards to adding the cost of the 4 cassettes to the room's price. The threshold for the inclusion of equipment for PE purposes remains at $500. For this reason, we will finalize the value of the mammography room as proposed, at $168,214. In addition we will finalize the proposed values for all of the above imaging rooms in this final rule with comment. However, because we are adopting only limited, necessary changes to PE RVUs for CY 2006, and will continue to utilize the NPWP to value these services, the RVUs will remain the same as those for 2005. e. Equipment Pricing for Select Services and Procedures From the CY 2005 Final Rule (69 FR 66236) In the August 8, 2005 proposed rule, we presented information on pricing of equipment for select services and procedures based on specialty information and stated we would be accepting the prices. The specific equipment was as follows: Equipment pricing for certain radiology services received from the ACR were presented in table 15 of the proposed rule.
                    Equipment pricing on the Ultrasound color Doppler transducers and vaginal probe received from the American College of Obstetrics and Gynecology was presented.
                    For CPT 36522, extracorporeal photopheresis, we discussed equipment pricing information specific to this procedure.
                    Pricing of EMG botox machine used in CPT code 92265 as presented by the American Academy of Ophthalmology. No comments were received on these items, therefore, the prices discussed in the proposed rule will be used in the PE database. However, we will continue to use the 2005 PE RVUs for each of these codes for CY 2006. f. Supply Item for In Situ Hybridization Codes (CPT 88365, 88367, and 88368) As discussed in the August 8, 2005 proposed rule, we received comments in response to the CY 2005 final rule from the College of American Pathologists regarding the number of DNA probes assigned to the in situ hybridization codes, CPT codes 88365, 88367, and 88368. Currently, CPT codes 88365 and 88368 have 1.5 probes assigned, while CPT code 88367 has only 0.75 of a probe assigned. The College of American Pathologists requested that we assign 1.5 probes to CPT code 88367, and provided justification for this request. We accepted the College of American Pathologists' rationale and proposed to change the probe quantity for CPT code 88367 to 1.5. *Comment:*
                         A society representing clinical pathologists supports the proposed change to the probe quantity for CPT 88367. *Response:*
                         We have entered the number of probes, at 1.5, to our PE database. This change will not be expressed in the 2006 PE RVUs because as discussed above, we will retain the 2005 PE RVUs. g. Supply Item for Percutaneous Vertebroplasty Procedures (CPT Codes 22520 and 22525) The Society for Interventional Radiology (SIR) provided us with documentation for the price of the vertebroplasty kit used in CPT codes 22520 and 22525. We proposed to accept a new price of $696 for this supply, currently listed as $660.50, a placeholder price from the CY 2005 final rule. *Comment:*
                         Commenters supported the proposed $696 cost estimate for the vertebroplasty kit. *Response:*
                         We are finalizing our proposal to value the vertebroplasty kit price at $696 in the supply database, although, as discussed previously, this will not be reflected in the 2006 PE RVUs because we will retain the 2005 PE RVUs. h. Clinical Labor for G-codes Related to Home Health and Hospice Physician Supervision, Certification and Recertification As discussed in the August 8, 2005 PFS proposed rule, 4 G-codes related to home health and hospice physician supervision, certification and 
                        ( print page 70140)
                        recertification, G0179, 180, 181, and 182, are incorrectly valued for clinical labor. These codes are cross-walked from CPT codes 99375 and 99378, which underwent PEAC refinement in January 2003 for the 2004 fee schedule. However, we did not apply the new refinements to these specific G-codes. This was an oversight on our part and we proposed to revise the PE database to reflect the new values in the 2006 physician fee schedule. *Comment:*
                         Commenters, including those representing the specialty societies for home care physicians and internists, expressed concern about the decrease in PE RVUs for the G-codes for hospice and home health supervision and care plan oversight services. One commenter requested that we elaborate on the sequence of events that lead to this decrease. *Response:*
                         We appreciate the concern expressed by the commenters and are providing additional information outlining the reason for this change. For the 2001 PFS, these G-codes were created in order to provide payment for these specific services. Changes made to the CPT codes (CPT codes 99375 and 99378) for 2001 did not enable us to recognize the CPT codes for Medicare payment purposes. Therefore, the PE inputs that had been applied to these CPT codes were cross-walked and used to establish the PE RVUS for the G codes that we established for these services. Subsequent to this, the CPT codes underwent refinement by the PEAC at its January 2003 meeting where a majority of the other E/M services were refined. CMS accepted these PE recommendations from the PEAC that included only a total of 36 minutes for clinical labor. The PEAC recommendations did not include supplies and equipment because they did not believe these were utilized in the typical services represented by these codes. These PE inputs were intended to be crosswalked to the G-codes for 2004, however, due to an oversight, this did not occur. We apologize to the specialties that this refinement was not done in a timely manner. Thus, we are finalizing the direct inputs for these G-codes in this rule and have changed the PE database accordingly. However in 2006, the PE RVUs for these 4 G-codes will remain at the 2005 level, as explained above. i. Programmers for Implantable Neurostimulators and Intrathecal Drug Infusion Pumps Subsequent to the CY 2005 final rule, we received comments from a manufacturer of programmers for implantable neurostimulators and intrathecal drug infusion pumps. The commenter indicated that the equipment costs for these programmers are not a direct expense for the physicians performing the programming of these devices and that the manufacturer furnishes these devices without cost because the programming device is considered a “necessary, ancillary item to the neurostimulator and drug pump and can only be used to program these devices.” Therefore, we proposed to remove the 2 programmers from the PE database: EQ208 for medication pump from 2 codes (CPT 62367 and 62368) and EQ209 for the neurostimulator from 8 codes (CPT 95970-97979). We also requested comments from the specialty societies performing these services as to whether this reflects typical practice. *Comment:*
                         Several commenters disagreed with this proposal indicating that not all programmers are provided without cost. Specifically, for the one manufacturer, the practice of providing physicians with these programmers free of charge is just a recent occurrence. In addition, one commenter informed us that there are other PE items that are not accounted for, including a printer, for 62367 and 62368. The RUC commented that several specialty societies conducted an email-based survey finding that the majority of the respondents reported paying for these programmers. The RUC asked us to reconsider our decision to delete the programmers from the PE direct inputs because it was based solely on the recommendation of one manufacturer. *Response:*
                         We are sympathetic to the commenters' concerns about the programmers used by pain medicine physicians. We have carefully reviewed our decision to delete the programmers from the PE database in light of the comments we received. Therefore, based on the uncertainty as to which brand product is typical, the survey results presented to us by the RUC, and the life, 7 years, of each programmer, we have determined that we will retain these programmers in the database. In addition, we have added “with printer” to the description of EQ208 to match that of EQ209 in order to assuage the commenter's concern that the price listed in the database, $1975, correctly reflects the cost of both the programmer and the printer. Because the PE RVUs for 2005 contained the price for these programmers, the PE RVUs for 2006 will continue to reflect their costs. j. Pricing of New Supply and Equipment Items As part of the CY 2005 final rule process, we reviewed and updated the prices for equipment items in our PE database and assigned a unique identifier to each equipment item with the first 2 elements corresponding to one of 7 categories. It was brought to our attention that we assigned the same category identifier (ELXXX) for both “lanes/rooms” as well as “laboratory equipment”. To correct this, we proposed assigning laboratory equipment items the new category identifier “EPXXX”, but the specific numbers associated with each item would remain the same. In addition, supply items were reviewed and updated in the rulemaking process for the 2004 PFS. During subsequent meetings of both the PEAC (now referred to as the PERC) and the RUC, supply and equipment items were added that were not included in the pricing updates. In the proposed rule we included 2 tables (Table 16: Proposed Practice Expense Supply Items and Table 17: Proposed Practice Expense Equipment Items) that listed the additional supply and equipment items for 2006 and the proposed associated prices that we would use in the PE calculation. The listing of new supplies and equipment in the proposed rule does not guarantee that the price listed for each item has been accepted. Rather, the new supply and equipment tables are to make specialties aware of the descriptors and assigned supply or equipment codes that can be used in future proposals to the RUC and HCPAC. As discussed below, the addition of an item to the tables for new supplies or equipment does not preclude the inclusion of the same item on the tables that require more detailed information and documentation from the specialty organization. k. Supply and Equipment Items Needing Specialty Input We also identified certain supply and equipment items for which we were unable to verify the pricing information, reflected in Table 18: Supply Items Needing Specialty Input for Pricing and Table 19: Equipment Items Needing Specialty Input for Pricing of the proposed rule. We stated that the items listed in these tables represent the outstanding items from last year and new items added from the RUC recommendations. Therefore, we requested that commenters, particularly specialty organizations, provide pricing information on items in these tables along with documentation to support the recommended price. Tables 14 and 15 reflect the comments and documentation we received for each item. Specialty societies are asked to review these supplies and equipment, as 
                        ( print page 70141)
                        appropriate, to assure that the item status is accurate and forward any necessary documentation. We would also like to reinforce the types of documents that meet the acceptable category. The following list includes examples of acceptable documentation: Photocopy or actual vendor catalog listing, indicating price, accessories or components (if applicable), available quantity, company name, brand name, and catalog date. Scanned versions, if readable, can also be emailed.
                    Photocopy of web page with specific supply or equipment including the necessary information listed in above bullet.
                    Photocopy of invoice indicating the price paid for specific supply or equipment, as well as the specific contents of kit, pack or tray for supplies and component or accessory parts for the equipment item.
                    Letter, FAX or e-mail from manufacturer, vendor or distributor noting the ASP of the supply or equipment. The description of the item must list all contents, accessories or component parts that are included in the price. The following information is not considered acceptable documentation, including: Web site addresses.
                    Vendor, manufacturer, or distributor phone number and address.
                    Approximated values. 
 
  
 
  
 
  
 
  
 
  
 
  
 
 l. Additional PE Issues Raised by Commenters *Comment:*
                         We received a comment from an equipment distributor and multiple comments from physicians asking us to add more clinical labor, supplies and equipment to CPT codes 78481 and 78483 for cardiac blood pool imaging using the first pass technique. The commenters emphasized that the labor costs are understated, and that additional supplies and equipment are necessary to perform these services. In particular, the commenters requested we add a nuclear medicine gamma camera to the equipment inputs or cross-walk the equipment listed for CPT 78465. The distributor presented supply and equipment tables for both codes, using direct PE inputs currently listed in the PE database, most of these are found in the PE for CPT 78465. *Response:*
                         The direct inputs for these “First Pass” services were presented by the specialty society to the PEAC at its January 2004 meeting. The RUC forwarded the PEAC's recommendations to CMS for consideration during the rulemaking process for the 2004 fee schedule at which time these recommendations were accepted. We do not believe that we are in a position to make the type of changes to the PE inputs for these 2 codes that the commenters have requested. We recommend that the commenters and the specialty society whose members perform these procedures, work together so that necessary changes can be considered through the usual RUC process. *Comment:*
                         We received comments from a specialty society and a manufacturer asking us to replace a supply item, a Tesio type dual catheter, with the Lifesite system in CPT 36566—a procedure described as the insertion of tunneled catheter with subcutaneous port(s). The specialty society explained that when the RUC valued this service in 2003, the incorrect catheter was included with their PE recommendations. The manufacturer asks for our assistance in correcting a “clerical error” in our database. The commenters explain that CPT codes 36565 and CPT 36566 are nearly identical in procedure, although CPT 36566 requires the insertion of “subcutaneous port(s)” and that the Tesio-type catheter, priced at $355, is currently listed for both of these procedures. The Lifesite system, containing a subcutaneous port, is priced at $1750. Both commenters noted that 2 Lifesite systems are necessary to perform this procedure instead of one for a total supply cost of $3500. *Response:*
                         We appreciate the commenters concerns about the specific supplies they believe are needed to perform this service. The work and PE values for CPT 36566 were forwarded by the RUC and accepted in our final rule, for the 2004 fee schedule. We believe that the RUC is the appropriate avenue to address correction of inputs to the PE database, particularly due to the expensive nature of this replacement, and are not revising the PE database to reflect this price change. *Comment:*
                         A specialty society commented that it believes the nonfacility PE RVUs were mistakenly deleted from CPT codes 59812, 59840, and 59841. The specialty also requested that nonfacility PE RVUs be added for CPT 58558. *Response:*
                         We have reviewed the specialty's request regarding nonfacility PE RVUs for the 4 codes noted above. The “NA” indicator for PE RVUs in the nonfacility setting is listed incorrectly for CPT codes 59840 and 59841 in Addendum B of our proposed rule. Both of these CPT codes should have PE RVUs listed in the nonfacility setting. The specialty society is mistaken, however, regarding the appropriateness of nonfacility PE RVUs for CPT 59812 and 58558. These codes have both undergone refinement by the PEAC at least once and the recommendations forwarded by the RUC clearly indicated that these procedures were not valued in the nonfacilty setting. We have changed our database, as appropriate, to reflect the changes for CPT 59840 and 59812. *Comment:*
                         We received comments from a specialty organization citing that the total RVUs for CPT 19298 are too low in comparison to those for CPT 19296—both new CPT codes for CY 2005. The specialty believes this difference is likely due to the supply PE inputs necessary to perform each procedure. The specialty states that the catheter supply expenses should be similar between the 2 services, yet the nonfacility PE RVUs for CPT 19298 (39.56) are significantly lower than those listed for CPT 19296 (117.96). The specialty stated that while the average number of catheters used for CPT 19298 is 25, ranging from 15-30, this cost should be comparable to the catheter required for CPT 19296. Finally, the specialty requests that we crosswalk the total RVUs for the nonfacility setting from CPT 19296 to CPT 19298 for 2006 while they gather detailed information to present to us. *Response:*
                         We have researched the specialty's concern about the supply cost differences between the 2 new CPT codes for 2005. Whereas the specialty contends that the catheter expenses are similar, or only somewhat greater for CPT 19296, we found that the differences between these 2 supply costs is significant. The mammosite tray, containing the catheter used for CPT 19296, is priced at $2,550 while the button-end implant catheters used for CPT 19298 are priced at $18.50 each. The PE database indicates that the RUC-recommended typical procedure would require 30 such catheters, opposed to 25 noted by the specialty, for a total cost of $555. Consequently, we will not change the PE RVUs for either procedure, although we remain puzzled as to the commenters' specific concerns. We look forward to the specialty's clarification regarding this issue and would urge them to address their concerns through the usual RUC process. We would also like to remind commenters that interim RVUs are published, for new and revised CPT codes, in our final rule each year and are subject to a 60-day comment period at that time. We encourage commenters to observe and utilize the respective comment periods during our annual rulemaking process in order that we may respond timely to issues and concerns. *Comment:*
                         We received many comments regarding the use of “NA” in Addendum B when used for the “Nonfacility PE RVUs” column, the “Facility PE RVUs” column, and the occasional code with NA noted in both PE RVU columns. These commenters asked us to provide a clear definition of how the service is paid when the NA is affixed to either PE RVU column in Addendum B which our rule for 2005 fee schedule had PE RVUs listed for the nonfacility. One commenter stated that private payors believe that payment is not made when the NA indicator is listed in Addendum B. *Response:*
                         We appreciate the commenters remarks regarding the uncertainty involved with interpreting Addendum B, particular regarding the use of the “NA” indicator for the PE RVUs nonfacility and facility columns. Due to the confusion expressed by the commenters surrounding the NA designations, we have added explanations to Addendum A in order to assist the readers of Addendum B. We are also including these definitions here because of this issue's importance. The following 2 explanations also appear in Addendum A of this rule: An “NA” in the “Non-facility PE RVUs” column of Addendum B means that CMS has not developed a PE RVU in the nonfacility setting for the service because it is typically performed in the hospital (that is, for example, an open heart surgery is generally performed in( print page 70149)
                        the hospital setting and not a physician's office).
                    Services that have an “NA” in the “Facility PE RVUs” column of Addendum B are typically not paid using the PFS when provided in a facility setting. These services (which include “incident to” services and the technical portion of a diagnostic tests) are generally paid under either the outpatient hospital prospective payment system or bundled into the hospital inpatient prospective payment system payment. *Comment:*
                         Other commenters, including specialty organizations, device manufacturers and physicians, noted that CMS had either mistakenly removed PE RVUs in the nonfacility setting or that we had made a decision to stop paying for services where, in Addendum B, an “NA” appeared in the proposed rule in the PE RVUs nonfacility column. Another commenter believes that a series of codes for E/M services were incorrectly marked as “NA” in the facility setting. These commenters requested that the PE RVUs be restored to these codes. *Response:*
                         We apologize to those commenters who found that where, due to the use of a new PE methodology, some of the codes listed in Addendum B of the proposed rule were mistakenly marked with an “NA” in either the nonfacility or facility PE RVU column when the service is actually valued in this setting and PE RVUs were listed previously. These mistakes were corrected for Addendum B in this final rule with comment. Most of the commenters requesting the restoration of “missing” PE RVUs in the nonfacility setting, though, were mistaken because, in fact, we have not developed nonfacility PE RVUs for these services and Addendum B continues to properly reflect the “NA” for the nonfacility PE RVU column. *Comment:*
                         Several commenters asked us to create PE RVUs for their services by cross-walking the direct inputs from other services. *Response:*
                         All of the requests we received to establish PE RVUs in the nonfacility setting were for services that the PEAC/RUC had either refined or developed without recommendations for PE nonfacility inputs. We would like to remind the specialty organizations that the RUC has a long standing process for the establishment and refinement of PE inputs and encourage all organizations to follow this process. *Comment:*
                         A manufacturer requested that we add 15 minutes of clinical labor and a tilt table to the PE database for CPT codes 36475 and 36476—both new codes for CPT 2005. *Response:*
                         We agree that the tilt table, for Trendelenberg, is needed for these procedures and are adding this equipment, for the respective service period minutes for each code. However, the commenter's request for additional clinical labor is not timely because the RVUs for these new codes were published as interim in the CY 2005 PFS final rule with comment at that time. As stated in the response above, we remind commenters to observe and utilize the comment period for new and revised codes at the time they are issued in our final rule or utilize the established RUC process, as appropriate. *Comment:*
                         We received a comment from an organization representing radiation oncology informing us that equipment for CPT codes 77333 and 77470 was missing. *Response:*
                         For CPT 77470, we disagree with the commenter that this service should be assigned equipment. At the January 2004 PEAC meeting, this code was valued specifically to compensate for the clinical labor costs involved with certain high-intensity radiation procedures, such as combined chemotherapy and radiation treatment. CPT 77470 was valued to be billed once throughout the course of treatment, that is typically comprised of 25 fractions. On the other hand, we agree with the commenter that the lack of equipment for CPT codes 77333 and CPT 77332 appears to be an oversight. We believe that the PEAC, at their September 2002 meeting, when considering equipment inputs for CPT code 77334, intended to cross-walk this equipment to the other 2 codes in the family, CPT code 77332 and 77333. Therefore, we are adding this equipment to 77332 and 77333, on an interim basis, and have changed the PE database to reflect this addition for the correlating service period time for each service. However, as explained above, because these codes will be valued in the NPWP and the 2005 PE RVUs will be retained in 2006, this addition will be transparent until such time as the direct inputs are used to establish the PE RVUs for the NPWP services. *Comment:*
                         We received comments from several organizations, a specialty society, device manufacturers, IDTFs and physicians regarding concerns about the remote cardiac event monitoring services, including CPT codes 93012, 93226, 93232, 93271, 93733 and 93736, based on the significant reduction in PE RVUs for these services published in our proposed rule using the bottom-up methodology and the elimination of the NPWP. Two of these services, CPT codes 93012 and 90271, were reviewed by the RUC in April 2005 and forwarded as part of the PERC/RUC recommendations in the proposed rule. The commenters noted that these services are typically provided by IDTFs that are equipped for continuous monitoring capabilities 24 hours a day, 7 days a week and require highly trained staff to perform the monitoring of transmissions. The commenters all agreed that the uniqueness of these services makes a poor fit with the usual accounting for direct practice expenses in the physician office. A specialty society requested CMS to work with the involved provider community, that is, the specialty IDTFs, to ensure that the direct and indirect costs of providing these services are adequately reflected in the nonfacility PE RVUs. *Response:*
                         We are pleased that the commenters are in agreement that these cardiac event monitoring services may not fit the usual PE model. We are also happy that the specialty society has requested our assistance to work with the specialized provider community in order to ensure more appropriate PE inputs for these services. We look forward to working with the provider organizations before the issuance of our next proposed rule. *Comment:*
                         A manufacturer requested that we increase the work and PE values for G0166, external counterpulsation (ECP), because of the significant decrease in PE RVUs for the nonfacility setting in the proposed rule. Specifically, the commenter asked that the labor time be increased to include pre and post service time in addition to the 60 minutes allotted for actual ECP treatment time. *Response:*
                         We agree with the commenter that the 60 minutes is inadequate to account for the other activities that the RN performs in relationship to each ECP service. We have assigned some of the standardized times for the activities previously identified by the PEAC as appropriate to this service, as follows: 3 minutes for meet and greet; 2 minutes to prepare the room; 2 minutes to position the patient; 3 minutes for vitals; and 3 minutes for cleaning the room. This extra 13 minutes has been added to the service period in the PE database yielding a total of 73 minutes for the ECP service—although, as discussed previously, this increase will not take effect in 2006 because, with limited exceptions, we will retain the 2005 PE RVU values for existing codes. *Comment:*
                         Many commenters, including physicians and a device manufacturer, requested that we increase labor, supplies, and equipment PE values for CPT code 93701, thoracic 
                        ( print page 70150)
                        electrical bioimpedance (TEB). Their concerns arose from the proposed reduction in PE RVUs in the proposed rule for this service. Some of the commenters told us that the average cost of the equipment from one manufacturer is $38,000, the electrodes are 10.95 ($8.95 with discount) and that the labor time for the TEB procedure ranges from 15-20 minutes. The commenters requested that we adjust the PE values accordingly. *Response:*
                         We are sympathetic to the commenters concerns regarding the decrease in PE RVUs reflected in the proposed rule that reflected both the elimination of the NPWP and the bottom-up methodology. For the labor time request, the PE database does contain 20 minutes, although this time was incorrectly cross-walked to the equipment time. We apologize to the commenters regarding this error, and have changed the equipment time to 20 minutes, from 10, in the database. We disagree with the commenters about the inaccuracy of the equipment cost. During the rulemaking process for the CY 2005 fee schedule, at which time we revalued all equipment in the PE database, we identified 2 different brands of equipment used for the TEB service. When the 2 prices are averaged (using $38,000 as noted above by the commenters), the cost of the TEB equipment is $28,625 which is the price listed in the database. We also repriced our supply database during rulemaking for the 2004 fee schedule. The TEB electrodes or sensors are listed at $9.95 in the database and that amount is based solely on a phone quote from the commenting manufacturer. TEB sensors from the other equipment manufacturer range from $4.43 to $6.00 for each patient application. Based on current valuation of the supplies and equipment in the PE database, we are not changing the price of equipment or supplies for the TEB service. m. Additional PE Issues Raised by Commenters *Comment:*
                         We received 2 comments from specialty organizations requesting CMS to re-evaluate the lack of physician work value for the 3 G-codes (G0237, G0238, and G0239) CMS created to describe services to improve respiratory function to reflect the physician's work in overseeing these incident to services. The commenters contend that the addition of CPT 99755, assistive technology assessment, in 2004 created a rank-order anomaly for the respiratory function G-codes. The commenters requested that CMS ask the RUC to evaluate the work for these G-codes. *Response:*
                         We disagree with the commenter's contention that a rank order anomaly exists between the respiratory function G-codes and CPT 97755. We were clear when we created these codes during rulemaking for the 2002 fee schedule that the G-codes would make billing of CPT codes 97000-97799 inappropriate for professionals involved in treating respiratory conditions, unless these services are delivered by physical therapists (PTs) and occupational therapists (OTs) and meet other requirements for physical and occupational therapy services. We also disagree that these services are always provided incident to a physician's service because in the CORF setting, where respiratory therapy services are statutorily delineated as a CORF service, the physician's direct supervision is not a requirement and the incident to provisions do not apply. The G-codes enable us to distinguish CORF respiratory therapy and incident to services from the services provided by PTs and OTs under the therapy benefit. Consequently, these G-codes cannot be used to bill for services provided under the physical and occupational benefit category at section 1861(P) of the Act and, as such, cannot create a rank order anomaly with the 97000 series of CPT codes. Although we have not assigned any work values for this final rule with comment, we are still considering the merits of this request and are happy to meet with the commenters prior to the issuance of our next proposed rule to discuss this issue in greater detail. We remind the specialty societies that they can make requests to the RUC to review the G-codes with respect to work values. However, we believe the appropriate review entity would be the HCPAC. *Comment:*
                         Several commenters expressed their concern regarding the high-priced supply items in our practice expense database. In their comments, the RUC requested that we consider a different approach for payment of high-priced disposable medical supplies, particularly with respect to new technology supply items—where prices commonly decrease within 6-12 months after being distributed into a wider market—as these services move into the physician's office. As an alternative, the RUC strongly encourages CMS to review and re-price medical supplies, priced at or above $200, on an annual basis. Another commenter noted that our listed price of $677 for the endovenous laser kit used for CPT 36478 is apparently in error because it is readily available at $250-$350 and listed four suppliers who distribute this supply in the noted price range. *Response:*
                         We appreciate comments and remarks. The RUC's comments regarding high cost medical supplies and the need to review these prices on a more frequent basis than every 5 years. Because we are committed to ensuring that the prices for supplies and equipment in the PE database are accurate, we also want to account in some way for the volatile nature of prices for new technology. We will consider options for revaluing these high cost “new tech” supply items and include a discussion of this issue in the next proposed rule *Comment:*
                         We received a comment from an organization representing services of audiologists noting that the salary for audiologists and the equipment for their services are too low or out of date. *Response:*
                         During the rulemaking process for the 2005 fee schedule, we revalued all equipment in the PE database, and requested specialty input at that time. To the extent that there have been changes since last year, we recommend that the organization utilize the establish RUC process. We would also encourage the commenter to supply us with updated salary information so that we may better address their other concern. Revisions to CPT Code Series 21076 Through 21087 We also want to note that, at the request of the RUC, we have been working directly with representatives of maxillofacial prosthetics to refine the PE inputs for the CPT code series 21076 through 21087. They have submitted spreadsheets to us for labor, supplies and equipment, and much of this information has been entered in the PE database although, as discussed above, the 2005 PE RVUs will be retained for 2006. We will continue to work with the specialty to refine these inputs, verifying prices and quantities, prior to the issuance of our next proposed rule. B. Geographic Practice Cost Indices (GPCIs) Section 1848(e)(1)(A) of the Act requires us to develop separate GPCIs to measure resource cost differences among localities compared to the national average for each of the three fee schedule components. While requiring that the PE and malpractice GPCIs reflect the full relative cost differences, section 1848(e)(1)(A)(iii) of the Act requires that the physician work GPCIs reflect only one-quarter of the relative cost differences compared to the national average. 
                        ( print page 70151) As discussed in the August 8, 2005 proposed rule (70 FR 45783), section 1848(e)(1)(E) of the Act, as amended by section 412 of the MMA, established a floor of 1.0 for the work GPCI for any locality where the GPCI would otherwise fall below 1.0. This 1.0 work GPCI floor was used for purposes of payment for services furnished on or after January 1, 2004 and before January 1, 2007. This 1.0 floor will remain in effect in 2006. Section 602 of the MMA added section 1848(e)(1)(G) of the Act, which sets a floor of 1.67 for the work, PE, and malpractice GPCIs for services furnished in Alaska between January 1, 2004 and December 31, 2005 for any locality where the GPCI would otherwise fall below 1.67. Effective January 1, 2006, this provision will end. In the proposed rule, we indicated the 2006 GPCIs for Alaska will be 1.017 for physician work, 1.103 for PE, and 1.029 for malpractice. Payment Localities In the August 8, 2005 proposed rule (70 FR 45783), we stated that we look for the support of a State medical society as the impetus for changes to existing payment localities. Because the GPCIs for each locality are calculated using the average of the county-specific data from all of the counties in the locality, removing high-cost counties from a locality will result in lower GPCIs for the remaining counties. Because of this redistributive impact, we have refrained, in the past, from making changes to payment localities unless the State medical association provides evidence that any proposed change has Statewide support. After the publication of the CY 2005 final rule, the California Medical Association (CMA) submitted a proposal for a demonstration project that was the same as its proposal submitted in response to the August 5, 2004 PFS proposed rule. The CMS proposed removing ten counties from the existing “Rest of California” payment locality and creating ten new payment localities. Additionally, reductions to the payments to the Rest of California locality, would be balanced by payment contributions from the other payment localities in the State. There were several aspects of the proposal that made implementation problematic for us under our demonstration authority. For example, physicians whose payments would decrease under the demonstration could challenge the validity of a new locality configuration established without providing them the opportunity to comment through the regulatory process (as is our normal process for making locality changes). In particular, physicians who are not members of county medical societies or the CMA, or did not agree to participate in the proposed demonstration may have challenged its implementation. Also, the Medicare PFS currently uses identical GPCIs to pay for services provided in an area by both physicians and nonphysician providers (such as podiatrists, optometrists, physical therapists, and nurse practitioner). Changing the locality configuration for medical doctors and doctors of osteopathic medicine, but not for other professionals, would have some peculiar results that were not addressed in the CMA proposal. For example, in areas where the GPCIs would be reduced under the demonstration, some practitioners not participating under the demonstration (such as physical therapists) could be paid more than physicians in the same locality. Conversely, where the GPCIs would be increased under the demonstration, there would likely be complaints from the nonphysician practitioners not included in the demonstration. Nonetheless, we do recognize the potential impact of wide variations in the practice costs within a single payment locality. In the CY 2005 final rule, we noted that we received many comments from physicians and individuals in Santa Cruz County expressing the opinion that Santa Cruz County should be removed from the Rest of California payment locality and placed in its own payment locality. The county-specific GAF of Santa Cruz County is 10 percent higher than the Rest of California locality GAF. Santa Cruz County is adjacent to Santa Clara County and San Mateo County. Santa Clara and San Mateo Counties have two of the highest GAFs in the nation. The published 2006 GAF for the Rest of California payment locality is 24 percent less than the GAFs of Santa Clara and San Mateo. Sonoma County is also part of the Rest of California payment locality. The county-specific GAF of Sonoma County is 8 percent higher than the Rest of California locality GAF. Sonoma County is bordered by Marin County and Napa County. Using published 2006 values, the payment locality that includes Marin and Napa counties has the fourth highest GAF in the nation, and is 13 percent higher than the GAF of the Rest of California payment locality. We recognize that changing demographics over time may lead to significant payment disparities in particular circumstances. We rely upon State medical societies to identify and propose consensus approaches to resolving these disparities, because there are redistributive impacts in the “budget neutral” process within a State when new localities are created (or existing ones reconfigured). Yet we also recognize our responsibility for establishing fee schedule areas. In the proposed rule, to assure the maximum opportunity for public discussion and comment to identify a consensus approach, we listed alternative locality configurations that we had examined, including: The CMA demonstration approach comparing county-specific GAFs to the payment locality GAF, and designating any county with a county-specific GAF at least 5 percent higher than its locality GAF as a new locality;
                    An approach that sorts counties by descending GAFs and compares the highest county to the second highest county. If the difference between these two counties is 5 percent or less, they are included in the same locality. The third highest county GAF is then compared to the highest county GAF and so on, until the next county GAF is not within 5 percent of the highest county GAF. At that point, the county GAF that is more than 5 percent lower than the highest county GAF becomes the comparison for the next lowest county GAF, to create a second locality. This process is repeated down throughout all of the counties;
                    An approach that compares the county with the highest GAF to the Statewide average, removing counties that are 5 percent or more than the Statewide average; and
                    An approach that bases GPCI payment localities on Metropolitan Statistical Areas as defined by the Office of Management and Budget. However, because these reconfigurations would result in significant redistributions across most California counties, we simply proposed the approach that would have the least impact on other counties. We proposed that Santa Cruz and Sonoma Counties (the two counties with the most significant disparity between the assigned Rest of California GAF and the county-specific GAF) be removed from the Rest of California payment locality and that each would be its own payment locality. We invited and received comments regarding this proposal and possible alternative approaches to address this issue. We were particularly interested in whether the CMA supported this approach. Those comments and our responses are discussed below. The issue of payment locality designation in light of changing economic and population trends will be 
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                        of importance to us for the foreseeable future. We also indicated in the proposed rule that we are interested in other solutions to the problem, and with any ideas or suggestions that will help resolve the problems associated with the designation and revision of payment localities. We would use those ideas and suggestions in developing any future proposal that would be subject to comment through the rulemaking process. *Comment:*
                         Numerous comments from the beneficiaries and health care providers in Santa Cruz and Sonoma Counties, and from several members of the Congress, including a U.S. Senator from California, supported our proposed change. These comments focused on the high costs of practicing in Santa Cruz and Sonoma Counties and were appreciative of the proposal. Most supporters referred to studies that have shown the high costs of working in Santa Cruz and Sonoma Counties have resulted in physicians restricting their practices or withdrawing from practice altogether. According to the commenters, this has made it more difficult for Medicare beneficiaries to find doctors in those counties. These commenters feel that our proposed change will encourage physicians to continue to treat Medicare patients in their Santa Cruz and Sonoma County practices. *Response:*
                         These two counties currently have the most significant disparities between their present GAFs and their county-specific GAFs. They are also bordered by counties with significantly higher GAFs. As we stated earlier in this section and in the proposed rule, we have received many comments in the past expressing concern that these disparities have led some practitioners to relocate their practices out of these counties, creating potential access problems. The proposal was an attempt to balance the interests of physicians and nonphysician practitioners and their patients in Santa Cruz and Sonoma Counties with the interests of providers and patients in the other counties in the Rest of California. We noted in the proposed rule that the 2006 Rest of California GAF would be 1.011, compared to the 2005 GAF of 1.012. Absent this proposal, the 2006 Rest of California GAF would be 1.017 (2006 is the second year of the transition to the new GPCIs and GAFs incorporating updated data). *Comment:*
                         We also received comments opposing the proposal from numerous providers and medical associations in the current Rest of California payment locality. In addition, several members of the Congress wrote letters opposing the proposed change. The CMA pointed to the fact, which is the result of the budget neutrality requirement for administrative actions to modify GPCIs, that the Rest of California locality would be negatively impacted. The CMA also notes that the proposal does not address the other localities it identified in its demonstration proposal. These views were echoed by the other commenters objecting to the proposal. *Response:*
                         It is indicative of the difficult nature of this issue that many of the same commenters who expressed disappointment that our proposal did not address all of the other counties that CMA identified in its demonstration proposal were also concerned that the proposal would simultaneously result in a reduction of the GPCIs for the Rest of California payment locality. Under our current statutory authority, it is well known that changes to the payment localities must be implemented in a budget neutral manner. Therefore, it is not possible to fully meet both objectives without legislation to provide additional funding for physician payments in California. While we appreciate the situation of practitioners in Santa Cruz and Sonoma Counties as described above, we also acknowledge the concerns of those in the Rest of California payment locality about the negative payment impact of removing the GPCI data for Santa Cruz and Sonoma Counties, and the lack of support from the CMA for an administrative solution to these payment concerns. As we mentioned earlier in this section, our proposal was designed to balance these two interests. As we have stated repeatedly in the past, we believe payment locality reconfigurations should be supported broadly across the State. It was our belief that the proposal we presented, which actually would have had the smallest possible negative impact on the Rest of California's GAF, might meet that criterion. However, based on the comments we received opposing the proposal, particularly those from the CMA, it is apparent that this proposed change is not acceptable to the majority of commenters at this time. *Comment:*
                         The CMA indicated that it supports a nationwide legislative solution that would provide additional funding for physicians in counties adversely affected by locality reconfigurations. The CMA states “this is the only GPCI solution that we are supporting at this time.” The Medicare Payment Advisory Commission (MedPAC) comments that the locality boundaries have not had a complete review since 1997 and that economic and population trends are likely to have changed since that time. MedPAC is studying these issues, and encourages CMS to do so as well, with the goal of revisiting the boundaries of all payment localities nationwide. We also received a comment from a member of the Congress urging us to conduct a national examination of the definitions of payment localities. The commenter recommended that we propose a method to reconfigure payment localities to be effective January 1, 2008. The commenter also recommended that we develop a process for periodically reviewing payment localities. *Response:*
                         As we stated earlier in this section and in the proposed rule, we are interested in all ideas that will help resolve the problems associated with the designation and revision of payment localities. Clearly, as illustrated by the situation discussed earlier in this section, one of the most significant issues to be addressed is the redistributive nature of changes to the payment localities in a budget neutral context. There are currently 89 separate payment localities. Of these, 34 are Statewide localities. Our last comprehensive evaluation of the definition and composition of the payment localities was discussed in the July 2, 1996 proposed rule (61 FR 34615) and the November 22, 1996 final rule (61 FR 59494). The localities existing at that time, which were developed by the local Medicare contractors, served as building blocks for the current localities (at the time, there were 210 separate localities, 22 of them were Statewide localities). We stated at the time that our major goals were to simplify payment areas and payment differences among adjacent geographic areas while maintaining accuracy in tracking input price differences among areas. There is an inherent trade-off between these two goals. Thus, at one extreme is a set of Statewide localities with no intra-state geographic adjustments; very simple, but less descriptive of input price differences. At the other extreme is a separate locality for each county; maximum input price adjustment for geographic variation, but operationally very cumbersome, expensive to develop and maintain, and potentially very confusing for providers. We do not disagree with the view that a comprehensive evaluation of the current payment localities is due, and we look forward to working cooperatively with MedPAC in that regard. We are examining all viable 
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                        options that will meet the general objectives discussed above. We would note, however, that our goals for this analysis are very similar to those we expressed in 1996. *Comment:*
                         A private insurer is opposed to our proposal because it increases the number of payment localities which increases commercial payer administrative costs. The insurer suggests we reduce the number of California payment localities from 10 to 3. *Response:*
                         While we appreciate and, as a matter of general policy, agree that it would be preferable to minimize the number of separate payment localities wherever possible, we do not believe that reducing the number of payment localities would resolve the issues discussed above. *Comment:*
                         We received comments from a medical clinic in Wisconsin and a research and management organization in Colorado. These commenters stated that CMS is using improper data to create the GPCIs. The commenters suggest we change the wage proxy categories to include physicians and remove physician work from the GPCI calculation. They further state that “Medicare payments are a primary stimulus in attracting greater numbers of physicians to high payment localities”. The commenters also suggest we look for alternative data sources for rent data. *Response:*
                         The CY 2005 final rule contained responses to commenters raising the same issues related to the data used to calculate the GPCIs as those noted above (69 FR 66260). Because the data used to calculate the GPCIs was not part of the proposed rule, we refer the commenter to that document rather than repeat that discussion here. We also note that we continue to evaluate other potential sources of data to use to calculate the GPCIs. We are disappointed that there was limited support for the proposal to create new, separate payment localities for Santa Cruz and Sonoma Counties. As we noted above, the proposal was designed to balance concerns of practitioners in higher-cost Santa Cruz and Sonoma Counties with the concerns of those in the Rest of California payment locality about the negative payment impact resulting from removal of the GPCI data for Santa Cruz and Sonoma counties from the Rest of California GPCI calculation. Because of the nearly complete lack of support for this proposal outside the two positively impacted counties, we have decided to withdraw this proposal at this time. As noted above, we intend to work with MedPAC and other interested parties toward a more comprehensive evaluation of potential refinements of the payment localities. Under section 1848(e)(1)(E) of the Act, the floor of 1.67 for the work, PE, and malpractice GPCIs for services furnished in Alaska ends as of January 1, 2006. Therefore, as of that date, the GPCIs for Alaska will be 1.017 for physician work, 1.103 for PE, and 1.029 for malpractice costs. C. Malpractice Relative Value Units (RVUs) We discussed several proposed technical changes and other issues related to the calculation of the malpractice RVUs in the proposed rule. These are summarized below, along with discussions of the comments we received and our responses. 1. Five Percent Specialty Threshold We are concerned that the malpractice RVUs could be inappropriately inflated or deflated due to irregular data based upon incorrectly reported specialty classifications and have examined the impact of establishing a minimum percentage threshold for any procedure performed by any specialty before the risk factor of that specialty is included in the malpractice RVU calculation of a particular code. We proposed excluding data for any specialty that performs less than 5 percent of a particular service or procedure from the malpractice RVU calculation for that service or procedure and discussed the code-specific impact of implementing this proposed threshold. Our assumption was that the infrequent instances of these specialties in our data represent aberrant occurrences and removing the associated risk factor from the malpractice RVU calculation would improve the accuracy and stability of the RVUs. This was based on our belief that removing data attributable to specialties that occur in our data less than 5 percent of the time would most appropriately balance the objective to identify irregular data (claims with a specialty identified that is highly unlikely to have performed a particular procedure) while including specialties that perform a procedure a small percentage (but at least 5 percent)of the time. We excluded evaluation and management (E&M) services from the analysis. Medicare claims data show that E&M services are performed by virtually all physician specialties. Therefore, in the case of E&M codes, it is likely that even the low relative percentages of performance by some specialties would accurately represent the provision of the service by those specialties. For all services other than E&M services, we stated our belief that removing data attributable to specialties that occur in our data less than 5 percent of the time would most appropriately balance the objective to identify irregular data (claims with a specialty identified that is highly unlikely to have performed a particular procedure) while including specialties that perform a procedure a small percentage of the time. The higher the threshold, the more likely it would result in the removal of data for specialties actually performing the procedure, while a lower threshold would be more likely to fail to remove some irregular data, particularly for low-volume codes (fewer than 100 occurrences, where each claim represents 1 or more percentage points). The overall impact of removing the risk factor for specialties that occur less than 5 percent of the time in our data for a procedure is minimal. There is no impact on the malpractice RVUs for over 5,280 codes, and there is an impact of less than 1 percent on the malpractice RVUs for over 1,300 additional codes. Only 16 codes decrease by at least 0.1 RVUs, with the biggest decrease being a negative 0.28 impact on the malpractice RVU for CPT code 17108, 
                        *Destruction of skin lesions,*
                         from a current RVU of 0.82 to a proposed RVU of 0.54. Conversely, there are 219 codes for which RVUs increase by at least 0.1, the largest increase being a positive 0.81 RVU increase for CPT code 61583, 
                        *Craniofacial approach, skull,*
                         from a current RVU of 8.32 to a proposed RVU of 9.13. Among codes whose malpractice RVUs would increase under our proposal, 646 have increases of less than 1 percent. The impact analysis section of this proposed rule examines the effects of this proposed change by specialty. *Comment:*
                         Numerous commenters supported the 5 percent specialty threshold. Several commenters suggested that we apply the threshold to the E&M codes. *Response:*
                         We appreciate the commenters' support of this change to our methodology. Regarding the exclusion of E&M codes from our analysis, we note our rationale as stated above in this section. The comments we received did not address our concern that all specialties use these codes. Therefore, we still believe it is appropriate not to apply the 5 percent specialty threshold to the E&M codes. *Comment:*
                         We received a comment recommending the threshold be lowered to 1 percent. The commenter is concerned that a 5 percent threshold inappropriately removes some 
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                        specialties actually performing interventional radiology services. The example of CPT code 35476 (percutaneous venous angioplasty) was provided. The commenter noted that CMS's proposed 5 percent threshold removed the risk factors for general surgeons and vascular surgeons, resulting in a decrease in the malpractice RVUs for this code. The commenter states this was contrary to our objective to remove irregular data because both of these specialties actually perform this procedure, and that a 1 percent threshold would better retain those specialties actually providing the service while still removing irregular data. *Response:*
                         In the case of CPT code 35476, the risk factors for the two specialties that were removed resulted in a decrease in the RVUs for this code; however, we review these data on a regular basis and if, in the future, the data support it, we will change the RVUs accordingly. We note that the majority of commenters supported a 5 percent threshold as reasonable. We do not believe a 1 percent threshold, as suggested by the commenter, is reasonable as this threshold would not be an effective screen for claims with a specialty identified that is highly unlikely to have performed a particular procedure. However, we will continue to assess whether a different threshold may ensure irregular data are removed without also removing data for specialties that actually perform the service. 2. Specialty Crosswalk Issues Malpractice insurers generally use five-digit codes developed by the Insurance Services Office (ISO), an advisory body serving property and casualty insurers, to classify physician specialties into different risk classes for premium rating purposes. ISO codes classify physicians not only by specialty, but in many cases also by whether or not the specialty performs surgical procedures. A given specialty could thus have two ISO codes, one for use in rating a member of that specialty who performs surgical procedures and another for rating a member who does not perform surgery. Medicare uses its own system of specialty classification for payment and data purposes. Therefore, to calculate the malpractice RVUs, it was necessary to map Medicare specialties to ISO codes and insurer risk classes, and in some instances to crosswalk unassigned specialties to the most approximate existing ISO codes and risk classes. We stated in the CY 2005 final rule that we would continue to work with the AMA RUC's Professional Liability Insurance (PLI) Workgroup to address any potential inconsistencies that may still exist in our methodology. Based upon this commitment, the RUC PLI Workgroup forwarded various recommendations for our consideration. The RUC developed its recommendations based upon comments submitted to them by physician specialty organizations. As discussed in the August 8, 2005 proposed rule, the Workgroup believes the risk factors assigned to certain professions overestimate the insurance premiums for these professions and, based on its recommendations, we proposed revising the risk factor for the following specialties to a risk factor of 1.00: clinical psychology; licensed clinical social work; psychology; occupational therapy; opticians and optometrists; chiropractic and physical therapy. We invited comment from representatives of the affected specialties and others regarding the appropriateness of this proposal, as well as other specialty crosswalks and suggestions for reliable sources of actual malpractice premium data for nonphysician groups. The RUC PLI Workgroup also believed that a number of professions that were assigned to the average for all physicians risk factor should be removed from the calculation of malpractice RVUs altogether and recommended excluding data from the following professions: Certified clinical nurse specialist; clinical laboratory; multispecialty clinic or group practice; nurse practitioner; physician assistant; and physiological laboratory (independent). We agreed with this recommendation and proposed to establish malpractice RVUs based upon the mix of specialties exclusive of the above specialties and professions. The PLI Workgroup also made recommendations for changing the crosswalks for risk factors for the following specialties which we did not accept: Certified registered nurse anesthetists; colorectal surgeons; gynecologists; and oncologists. We did not propose changes to the current crosswalks for these specialties and professions because we believe the current crosswalks we are using for these specialties appropriately reflect the types of services they provide. *Comment:*
                         One commenter objected to our proposed change in the crosswalk to the lowest current risk factor of 1.00 for opticians and optometrists. The commenter stated that the recommendation from the RUC was not based on examination of the premium data or any other objective evidence. However, another commenter supported the proposal to crosswalk optometrists and opticians to the lowest current risk factor of 1.00, arguing this more appropriately reflects the actual level of risk assumed during the performance of procedures. A commenter objected to the proposed crosswalk change to 1.00 for clinical psychologists, licensed clinical social workers, and psychologists because the commenter believes that the malpractice insurance costs for these nonphysician practitioners are well below those paid by psychiatrists. *Response:*
                         The proposed changes to the risk adjustment factor crosswalks were based on our agreement with the RUC PLI Workgroup's assertion that these nonphysician professionals incur costs most similar to the lowest cost physician specialty. Because we do not have actual premium data for these professional groups, it is necessary to select an appropriate crosswalk category. We proposed to change the crosswalks for these specialties because, absent actual premium data, we agree with the RUC that these groups very likely do not incur malpractice costs on par with the average physician specialty. In its comments, the RUC points out that each of the professions for which we proposed to change the malpractice crosswalk is represented on the RUC's Health Care Professional Advisory Committee (HCPAC). The HCPAC agreed that these professions should review their premium data and report back to the HCPAC at its September 29, 2005 meeting. Subsequently, on October 6, 2005 (after the close of the public comment period), the RUC submitted the results of these reviews. The RUC submitted to us after the close of the public comment period malpractice insurance premium data from many of these nonphysician professional groups. Because these data were received after the close of the comment period, and we believe it is important to allow the affected specialties the opportunity to comment on changes to the crosswalks, we are not incorporating these data in this final rule with comment. However, we would note that the data suggest that the annual premiums paid by these groups are below the average amounts paid by allergists and immunologists, the lowest premium cost physician specialties. We plan to continue to examine this issue in conjunction with the RUC's PLI Workgroup before the 2007 proposed rule. Based on the fact that commenters did not provide any alternative data to suggest the crosswalks we proposed 
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                        were inappropriate, we will adopt our proposals for 2006 without change. *Comment:*
                         One commenter supported our proposal to change the crosswalk for services of occupational therapists to 1.00, but suggests that the crosswalk should not be to allergy and immunology. Instead, the commenter recommended a crosswalk to physical medicine and rehabilitation. *Response:*
                         We appreciate the commenter's support of our proposal. With regard to the commenter's recommendation to crosswalk to the specialty of physical medicine and rehabilitation, we would note that the risk factor for this specialty is 1.26 rather than 1.00. As noted above, because the comments we received did not contain any alternative data to suggest the crosswalks we proposed were inappropriate, we are adopting our proposals for 2006. *Comment:*
                         Several commenters urged us to reconsider our proposal to not accept the RUC PLI's recommendations to crosswalk: the specialty of gynecologist/oncologist to surgical oncology; certified registered nurse anesthetists (CRNAs) to anesthesiology; and, colorectal surgery to general surgery. Commenters also suggested separate surgical and nonsurgical risk factors for urology, and that hand surgery be crosswalked to orthopedic surgery (without spine). *Response:*
                         With respect to the commenters' recommendation to crosswalk gynecologist/oncologist to surgical oncology, the commenters did not substantially justify the argument that the professional liability premiums of the specialty are similar to those of surgical oncologists; however, we will analyze the data for this suggestion for possible future consideration. Commenters noted that CRNAs are currently crosswalked to general surgery, which means that CRNAs have a higher risk factor than anesthesiologists. These commenters recommended that CRNAs be crosswalked to anesthesiology and we accept this recommendation. For the request to crosswalk colorectal surgery to general surgery, the specialty of colorectal surgery was not crosswalked. Instead, we used actual premium liability insurance data collected for this specialty. Consequently, we disagree that this specialty should be crosswalked to another specialty. As stated previously and in the proposed rule, we only crosswalked specialties for which no premium data were collected. With regard to the comments regarding separate surgical and nonsurgical risk factors for urology, we would be interested in further information regarding the appropriateness of this change. For the request to crosswalk hand surgery to orthopedic surgery, we note that, similar to colorectal surgery above, we used actual premium liability insurance data collected for this specialty. Consequently, we disagree that this specialty should be crosswalked to another specialty. *Comment:*
                         The RUC supported our proposal to remove the risk adjustment data for the following professions and providers: certified clinical nurse specialist; clinical laboratory; multispecialty clinic or group practice; nurse practitioners, physician assistants; and physiological laboratory (independent). *Response:*
                         We appreciate these supportive comments for this proposed change. 3. Cardiac Catheterization and Angioplasty Exception In the November 2, 1999 final PFS rule (64 FR 59384), we applied surgical risk factors to the following cardiology catheterization and angioplasty codes: 92980 to 92998 and 93501 to 93536. This exception was established because these procedures are quite invasive and more akin to surgical than nonsurgical procedures. In the CY 2005 (69 FR 66275), we discussed changes to the list of codes that would fall under the exception. In response to a request from the RUC's PLI Workgroup, we proposed to add the following CPT codes to the existing list of codes under the exception: 92975; 92980 to 92998; and 93617 to 93641. *Comment:*
                         Several commenters supported the changes made for the cardiac catheterization and angioplasty exception. *Response:*
                         We appreciate the supportive comments for this proposed change. 4. Dominant Specialty for Low-Volume Codes The final recommendation from the PLI Workgroup was to use the dominant specialty approach for services or procedures with fewer than 100 occurrences, and to apply this approach to the list of 1,844 services supplied by the workgroup. The PLI Workgroup worked in conjunction with various specialty organizations to identify the dominant specialty that performs each service. We did not propose to adopt this methodology and noted that low volume procedures or services are not necessarily performed by only one specialty. As noted previously, we would distinguish between excluding data presumed to be erroneous from data reflecting utilization by specialties that perform a service but are not the dominant specialty. However, we acknowledge that there may be instances where irregular data exist that would not be identified and removed by our proposed 5 percent threshold discussed previously. We will continue to work with the RUC PLI Workgroup examine this issue in the future. *Comment:*
                         Numerous commenters opposed our policy to use actual specialty data rather than dominant specialties and suggested that we adopt the RUC recommendations. *Response:*
                         As we stated in the PFS proposed rule (70 FR 45786), we believe that basing payment on all specialties that perform a particular service ensures that the actual professional liability insurance costs of all specialties are included in the calculation of the malpractice RVUs. Therefore, we do not believe it would be appropriate, even for these low-volume services, to include only the dominant specialty if other specialties regularly provide the service. 5. Collection of Premium Data Although this issue was not part of the proposed rule, many commenters suggested that we use alternative sources for our premium data. *Comment:*
                         Some commenters suggested we used data supplied by the Physicians Insurers Association of America (PIAA) or directly from physician providers. *Response:*
                         We are currently investigating the usefulness of the PIAA data and once our evaluation of the data is complete we will make a decision. We are not considering using physician provider self-reported premium costs. Final Decision We are implementing the proposed 5 percent threshold and specialty crosswalk changes discussed in the proposed rule. After considering all of the other comments received, we are not making other changes to the calculation of the malpractice RVUs. D. Medicare Telehealth Services 1. Requests for Adding Services to the List of Medicare Telehealth Services As discussed in the August 8, 2005 PFS proposed rule (70 FR 45786), section 1834(m) of the Act defines telehealth services as professional consultations, office and other outpatient visits, and office psychiatry services identified as of July 1, 2000 by CPT codes 99241 through 99275, 99201 
                        ( print page 70156)
                        through 99215, 90804 through 90809, and 90862. In addition, the statute requires us to establish a process for adding services to or deleting services from the list of telehealth services on an annual basis. In the December 31, 2002 
                        **Federal Register**
                         (67 FR 79988), we established a process for adding or deleting services to the list of Medicare telehealth services. This process provides the public an ongoing opportunity to submit requests for adding services. We assign any request to make additions to the list of Medicare telehealth services to one of the following categories: Category #1: Services that are similar to office and other outpatient visits, consultations, and office psychiatry services. In reviewing these requests, we look for similarities between the proposed and existing telehealth services for the roles of, and interactions among, the beneficiary, the physician (or other practitioner) at the distant site and, if necessary, the telepresenter. We also look for similarities in the telecommunications system used to deliver the proposed service (for example, the use of interactive audio and video equipment.)
                    Category #2: Services that are not similar to the current list of telehealth services. Our review of these requests includes an assessment of whether the use of a telecommunications system to deliver the service produces similar diagnostic findings or therapeutic interventions as compared with the face-to-face “hands on” delivery of the same service. Requestors should submit evidence showing that the use of a telecommunications system does not affect the diagnosis or treatment plan as compared to a face-to-face delivery of the requested service. Since establishing the process, we have added the psychiatric diagnostic interview examination and ESRD services with 2 to 3 visits per month and 4 or more visits per month to the list of Medicare telehealth services (although we require at least one in-person visit a month by a physician, clinical nurse specialist, nurse practitioner, or physician assistant to examine the vascular access site). Requests for adding services to the list of Medicare telehealth services must be submitted and received no later than December 31st of each year to be considered for the next proposed rule. For example, requests submitted before the end of CY 2004 are considered for the CY 2006 proposed rule. For more information on submitting a request for an addition to the list of Medicare telehealth services, visit our web site at 
                        *www.cms.hhs.gov/​physicians/​telehealth.* We received the following public requests for additional approved services in CY 2004: (1) Individual medical nutritional therapy (MNT) as described by HCPCS codes G0270, 97802 and 97803; (2) group MNT (HCPCS codes G0271 and 97804); (3) individual diabetes outpatient self-management training (DSMT) services (HCPCS code G0108); (4) Group DSMT (HCPCS code G0109); and (5) modification of the definition of an interactive telecommunications system for purposes of furnishing a telehealth service. After reviewing the public requests, we proposed to add individual MNT as represented by HCPCS codes G0270, 97802 and 97803 to the list of Medicare telehealth services. We also proposed to add individual MNT to the list of Medicare telehealth services at § 410.78 and § 414.65. Moreover, because a certified registered dietitian or other nutrition professional are the only practitioners permitted by law to furnish MNT, we proposed to revise § 410.78 to add a registered dietitian and nutrition professional as defined in § 410.134 to the list of practitioners who may furnish and receive payment for a telehealth service. We did not propose to add any additional services to the list of Medicare telehealth services or to make any changes to the definition of an interactive telecommunications system for CY 2006. For further information on our proposals, see the 
                        **Federal Register**
                         dated August 8, 2005 (70 FR 45786). Individual MNT *Comment:*
                         Many commenters supported our proposal to approve individual MNT for telehealth and to add a registered dietitian and nutrition professional to the list of practitioners authorized to furnish and receive payment for Medicare telehealth services. Commenters stated that adding MNT to the list of Medicare telehealth services would improve access and services for patients in remote areas where traditional MNT services may not be readily available. For example, a State dietetic association mentioned that in many cases, patients need to drive for more than an hour to receive MNT services and that the ability to furnish individual MNT as a telehealth service will provide great benefit to rural Medicare beneficiaries. Furthermore, a renal association stated that limited access to nutritional therapists is problematic for patients with stage 3 and 4 kidney disease who are located in rural or isolated areas. The commenter explained that nutritional counseling is an important tool for helping beneficiaries improve their nutritional status and in controlling levels of key electrolytes such as potassium and phosphorous. Several MNT practices also urged us to adopt our proposal to approve individual MNT for telehealth. Another commenter supported the addition of individual MNT, however stated that more conclusive data regarding efficacy is needed before further expansion. *Response:*
                         We agree with the commenters that approving individual MNT for telehealth would help provide greater access to registered dietitians and other nutritional professionals for beneficiaries in rural and or isolated areas. *Comment:*
                         A few commenters believe that MNT should not be approved as a Medicare telehealth service. For instance, a certified diabetes educator (CDE) stated that it would be very difficult to accurately assess cognitive and literacy levels, emotional state and motivation without seeing the patient. The commenter also believes that face-to-face interaction for assessment, establishment of goals, and reviewing written materials is essential. The commenter expressed support for using telehealth to furnish MNT in very limited circumstances, for example if there was no access to an educator within 50 miles or if the patient was homebound. One commenter contends that it would be difficult to assess a patient's understanding of the dietary prescription, nutrient content of each food group, portion control and information provided by food labels, especially for beneficiaries who cannot read and or have a vision impairment that prevents them from reading fine print. Moreover, another commenter believes that individual MNT includes skill-based training beyond an individual assessment, not unlike teaching insulin administration or blood glucose monitoring. The commenter stated that the skills taught in MNT cannot be verbally assessed through distance education. *Response:*
                         As discussed in the proposed rule, we believe that individual MNT is similar in nature to an office or other outpatient visit (which is defined in the law as a Medicare telehealth service). We believe that the components of an E/M office visit involve a similar level of patient counseling for following a treatment plan as compared to individual MNT. We also believe that a registered dietitian at the distant site, along with an appropriate medical professional 
                        ( print page 70157)
                        with the beneficiary at the originating site, could adequately assess and adjust to the beneficiary's ability to understand and follow his or her nutritional plan. We do not agree with the commenter that the same level of physical, skill-based training that is required in an individual DSMT session, (for example, teaching a Medicare beneficiary the skills necessary for the self-injection of insulin), is a requirement for individual MNT. *Comment:*
                         One commenter requested that we clarify whether we would pay a physician practice for individual MNT furnished as a telehealth service when a registered dietitian or other nutrition professional reassigns his or her right to bill for payment to the physician practice as an employer. *Response:*
                         As discussed in the CMS claims processing manual (Pub. 100-04, chapter 1, section 30.2.6), if the employer/employee reassignment exception is met, and the person furnishing the service and the entity wishing to bill are both enrolled in Medicare and each have their own billing number, then we could make payment to the physician practice for the MNT service. Group Medical Nutritional Therapy (MNT) and Diabetes Self-Management Training Services (DSMT) *Comment:*
                         Some commenters agreed with our proposal not to add DSMT to the list of Medicare telehealth services. For instance, one commenter wrote that DSMT can not be done as a telehealth service because in-person interaction with the client is crucial for assessing the skill development necessary for managing diabetes. Additionally, two certified diabetic educators (CDE) stated that DSMT can not be adequately furnished as a telehealth service and agreed with our proposal not to add DSMT to the list of Medicare telehealth services. Furthermore, another commenter stated that face-to-face interaction for assessment, establishment of goals, and reviewing written materials is essential for DSMT. *Response:*
                         As discussed in the proposed rule, we believe that DSMT is not similar to the current list of Medicare telehealth services and requires conclusive evidence showing that the use of a telecommunications system is an adequate substitute for the in-person delivery of DSMT. *Comment:*
                         A few commenters believe group MNT and group DSMT are similar in nature to the current list of Medicare telehealth services and therefore should be approved for telehealth under category 1 criteria. The commenters contend that the same presentation material, text books, manuals, DVD's and on site support staff are used whether group DSMT or group MNT is furnished in-person or through an interactive audio and video telecommunications system. The commenters stated that the practitioner would conduct the same training session for a telehealth service as they would in-person, and they believe that the interactive differences between group MNT and group DSMT and the current Medicare telehealth services should not be used as a basis for denying these services. The commenters believe that the criteria for approving group MNT and group DSMT should be based on whether the use of a telecommunications system is equivalent to the in-person delivery of the requested service. Moreover, commenters argue that no group services would ever be approved if we base approval upon whether the interactive dynamic of the requested service is similar to existing telehealth services and requested us to add group MNT and group DSMT as a precedent by which other future group service requests could be measured. *Response:*
                         Category 1 requests are reviewed to ensure that the roles of, and interaction among, the beneficiary and physician (or other practitioner) of the requested service are similar to the current telehealth services, for example office and other outpatient visits and consultation services. In other words, the roles of, and interaction among, the beneficiary and physician (or practitioner) is the criterion used to determine whether the requested service is similar to the current telehealth services. Since the interactive dynamic of group MNT and group DSMT is not similar to the current list of telehealth services, the request to add these services was assigned to category 2. For category 2 services, we assess whether the use of an interactive audio and video telecommunications system to deliver the requested service is equivalent to the in-person delivery of the service. To that end, we review any comparative analyses submitted by the requestor illustrating that the use of a telecommunications system is an adequate substitute for the in-person delivery of the requested service. If the requestor were to submit studies indicating that beneficiaries receiving group MNT and group DSMT comprehend and apply the training material as well by telehealth as in person, we would reconsider approving group MNT and group DSMT for telehealth. *Comment:*
                         The same group of commenters also believe that individual DSMT is similar to the existing list of telehealth services and should be approved as a category 1 request. The commenters contend that a telepresenter would be able to facilitate the “hands on” aspects of training a patient how to inject insulin. For example, a telepresenter with a patient at the originating site (who is not a certified CDE) could assist with filling syringes, mixing doses, and showing the injection site location through illustration or pointing to areas on the body. Commenters also argue that the use of a large video monitor to show gradient markings on a syringe could be beneficial for patients with poor vision. *Response:*
                         As discussed in the proposed rule, we considered individual DSMT as a category 2 request because the components included in training a Medicare beneficiary to administer insulin injections are typically not part of the services currently on the list of telehealth services. We did not propose to add individual DSMT because the requestors did not submit any comparative analyses illustrating that the use of an interactive audio and video telecommunications system is an adequate substitute for individual DSMT furnished in-person. *Comment:*
                         Several commenters submitted summaries of studies and or articles regarding group psychiatry, individual psychotherapy, and medication management furnished as telehealth services. Additionally, an individual practitioner mentioned a study that compared diabetes education furnished through telemedicine with diabetes education furnished in-person. *Response:*
                         For category 2 services, we require evidence showing that the requested telehealth service is equivalent to the in-person delivery of the same service. The articles regarding mental health services and pharmacologic management do not address whether the use of a telecommunications system is an adequate substitute for the in-person delivery of MNT or DSMT. Additionally, individual psychotherapy and pharmacologic management are already on the list of Medicare telehealth services. The comparison study regarding diabetes education focused on certain aspects of individual DSMT (but, as noted below, not on training patients to inject insulin), and therefore is irrelevant to the request to add group DSMT. The study conclusions mentioned that the “diabetes nurse educator was even successful in 
                        ( print page 70158)
                        teaching insulin administration via telemedicine to a patient who had very high blood glucose levels”. However, training patients on the self-administration of injectable drugs (which typically occurs during an individual training session) was not the focus of this study and no conclusive evidence was provided showing that insulin administration can routinely be taught as a telehealth service. *Comment:*
                         Some commenters suggested that we approve the majority of DSMT for telehealth and require selected aspects of the training such as the instruction of insulin injections to be furnished in person by a CDE. For instance, one CDE stated that the use of telehealth would not be appropriate for teaching selected skills (such as the administration of self-injectable drugs, glucometer testing, or insulin pump therapy), and should not replace the initial assessment or all follow-up visits. Some CDE's and DSMT programs stated that a combination of in-person and telehealth training works well for their patients. However, commenters stated that the majority of the curriculum for an American Diabetes Association (ADA) recognized DSMT program can be successfully provided as a telehealth service. For instance, a CDE stated that curriculum components such as nutritional management, foot care, ketone testing, sick day management, use of a supplemental insulin scale, and treatment of hypoglycemia or hyperglycemia could be furnished as a telehealth service. *Response:*
                         DSMT is furnished either as an individual or group service as described by HCPCS codes G0108 and G0109 respectively. As many commenters mentioned, teaching a patient how to inject insulin is typically furnished as part of an individual DSMT session rather than in a group setting. Additionally, as discussed at § 410.141(c)(1), Medicare payment for initial DSMT may not exceed 10 hours of beneficiary training in which 9 hours of the training are usually furnished as a group service. Since teaching a patient how to inject insulin is typically an integral component of an individual training session, and comprises only 1 hour of a maximum of 10 hours of initial training, we do not believe that it would be appropriate to carve out selected skill-based training from an individual DSMT service. We agree that skill-based training such as teaching patients how to inject insulin would be difficult to accomplish without the physical in-person presence of the teaching practitioner and believe this is not a common aspect of the current list of telehealth services. Given that teaching patients the skills required for insulin injection and blood glucose monitoring are typically furnished during an individual DSMT session we assigned the request to add individual DSMT to category 2. Moreover, as discussed previously, since the interactive dynamic of group DSMT is not similar to the current list of telehealth services, it does not meet the criteria for category 1. Therefore, we require evidence showing that the use of an interactive audio and video telecommunications system in furnishing DSMT is an adequate substitute for DSMT furnished in-person. *Comment:*
                         Some commenters believed that we compared group MNT to group psychiatric therapy or mental health counseling. The commenters suggest this is not a fair comparison because patients participating in a group MNT session typically do not discuss specific personal health information with the nutrition professional because the group “therapy” is a discussion of nutrition and is centered on a specific medical disease topic (for example, diabetes). Commenters contend that in the case of group MNT, the dietitian presents educational material to many beneficiaries at once and that the level of intense personal interaction found in group mental health services is not necessary in group MNT. *Response:*
                         As discussed previously, we compared the roles of, and interaction among, the beneficiary and physician (or other practitioner) in furnishing MNT and DSMT to the existing telehealth services. We did not compare group MNT to group psychiatric therapy or to group mental health counseling. *Comment:*
                         A few commenters stated that furnishing MNT for a diabetic patient is intended to be an adjunct to DSMT. For example, one group of commenters stated that without receiving DSMT, patients would not have an overall understanding of diabetes, how the disease develops and changes, and would not be taught additional methods for controlling glucose beyond those presented in MNT. *Response:*
                         Approving individual MNT for telehealth is one step along the way to helping more beneficiaries gain access to a collaborative skill-based DSMT program. As discussed earlier, we believe there should be conclusive evidence showing that DSMT can be as effective when furnished as a telehealth service as in a face-to-face encounter before we approve this service for telehealth. Additionally, we conduct and sponsor a number of innovative demonstration projects to test and measure the effect of potential program changes. Our demonstrations study the likely impact of new methods of service delivery, coverage of new types of service, and new payment approaches on beneficiaries, providers, health plans, states, and the Medicare Trust Funds. We would encourage the commenters to take advantage of other programs that the agency has set up to increase medical quality and reduce cost. For more information on demonstration projects visit our web site at 
                        *www.cms.hhs.gov/​researchers/​demos.* *Comment:*
                         A few commenters requested that we pay for DSMT education provided to patients over the phone. One commenter submitted several studies and articles regarding telephone-based interventions for diabetes care, (for example, telephone counseling). *Response:*
                         Patient education provided over the phone is beyond the scope of this provision. Telephone calls do not meet the definition of an interactive telecommunications system and are not on the list of Medicare telehealth services. Additionally, as discussed in the Medicare benefits policy manual, publication 100-2, chapter 15, section 30, no separate payment is made for phone calls under the Medicare program. *Comment:*
                         One commenter requested us to recognize CDE's as a Medicare practitioner and allow them to bill the Medicare program directly. *Response:*
                         The statute does not permit a CDE to bill and receive direct payment for Medicare services. The statute defines a certified DSMT provider as a physician, other individual, or entity who, in addition to providing DSMT services, provides other items or services for which direct payment may be made. We do not have the statutory authority to establish a separate CDE benefit category. Definition of an Interactive Telecommunications System We received many comments regarding the use of an interactive audio and one-way video telecommunications system for delivering a Medicare telehealth consultation. Several commenters expressed qualified support for the use of an interactive audio and one-way video telecommunication for purposes of furnishing a telehealth consultation. For instance, some commenters believe that allowing one-way video would be appropriate in situations when it enables the consulting physician to add value to the 
                        ( print page 70159)
                        diagnosis and decision making capabilities of the patient care team at the originating site which includes, at a minimum, a treating physician; and where observation of the consulting physician by the patient is either unnecessary or not possible (for example, when the patient is unconscious). Some commenters also suggested that we allow one-way video specifically for assessing suitability for stroke thrombolytic tissue-type plasminogen activator (tPA) therapy and compared the remote evaluation of a stroke patient for purposes of determining tPA treatment to a confirmatory consultation. For instance, the treating physician at the originating site would make a determination regarding the use of tPA and request a consultation to confirm his or her decision to use tPA therapy. Another commenter, who currently provides stroke consultation as a Medicare telehealth service, believes this service is an outpatient or inpatient consultation (where the neurologist at the distant site determines the treatment plan rather than offering a second or third opinion). The commenter also explained that they use an interactive audio and video telecommunications system that allows two-way real time video interaction between the consulting physician at the distant site and the originating site medical team. One organization stated that payment should be made for physicians' services that are safe, effective, medically appropriate, and provided under accepted standards of medical practice. The commenter believes that the critical factor in determining whether to pay for a service should be medical necessity rather than the technology used to furnish the service. The commenter also compared the use of one-way video and two-way audio to a physician furnishing a visit to a blind patient. The commenter contends that we would not deny payment for a face-to-face consultation on the basis that the patient could not see the physician, and therefore we should not deny a telehealth consultation on the same basis. Another commenter requested that we allow the use of one-way video equipment for delivering infectious disease telehealth consultations for ICU patients. The commenter explained that the hospital ICU is currently equipped with a one-way video, two-way audio telecommunications system and contends that moving interactive audio and video teleconferencing equipment to the ICU patient is very cumbersome and is only possible if appropriate technical staff are available. We received a few comments regarding the added clinical value of two-way video versus one-way video and whether one-way video is appropriate for a broad range of specialty consultations. One commenter made the point that two-way video would allow the patient to see the physician or practitioner at the distant site when a greater degree of interaction is necessary. One organization believes that two-way video may add value to a telehealth consultation by allowing the patient and presenting practitioner (if necessary) to see the body language and other non-verbal communication of the physician or practitioner at the distant site. However, the commenter stated that payment should not be denied for using a one-way video telecommunications system. Another commenter supported using one-way video in limited emergent circumstances, but also stated that additional research should be conducted to determine whether the use of one-way video is appropriate for a broad range of specialty consultations. Some commenters did not support the use of one-way video for furnishing a telehealth consultation. For instance, one commenter stated that face-to-face (interactive video) is a better method for obtaining patient compliance and results in a higher level of patient confidence with the health care team. *Response:*
                         We appreciate the comments on the use of an interactive audio and one-way video telecommunications system for purposes of furnishing a telehealth consultation. We intend to consider the suggestions raised by the commenters as we continue to evaluate conditions of payment for Medicare telehealth services. We continue to believe that the interaction between the consulting physician and the clinical staff at the originating site is important and it is not clear to us that one-way video is as effective in that regard as two-way video. With regard to the commenter who stated that the critical factor in determining whether to pay for a telehealth service should be based on medical necessity, we believe that the method used to furnish the service, for example the use of an appropriate telecommunications system, is just as critical as whether the service itself is medically necessary. 2. Definition of an Originating Site As discussed in the August 8, 2005 proposed rule, section 418 of the MMA required the Health Resources Services Administration (HRSA) within HHS, in consultation with CMS, to conduct an evaluation of demonstration projects under which SNFs, as defined in section 1819(a) of the Act, are treated as originating sites for Medicare telehealth services. The MMA also required HRSA to submit a report to the Congress that would include recommendations on “mechanisms to ensure that permitting a SNF to serve as an originating site for the use of telehealth services or any other service delivered via a telecommunications system does not serve as a substitute for in-person visits furnished by a physician, or for in-person visits furnished by a PA, NP or CNS, as is otherwise required by the Secretary.” We indicated that this report was currently under development and that if the Secretary concludes in the report that it is advisable to include a SNF as a Medicare telehealth originating site under section 1834(m) of the Act, we would consider the recommendations of the report to determine whether to add SNFs to the list of approved originating sites. We also solicited comments on this topic. *Comment:*
                         We received many comments supporting the use of telehealth in a SNF. The commenters noted that adding a SNF to the definition of an originating site would provide increased access to specialty physicians and practitioners, most notably mental health services, and decrease unnecessary travel for both the beneficiary and nursing facility staff. For example, one mental health practitioner stated that research studies indicate a critical shortage of psychiatrists in non-MSA areas and a lack of appropriate mental health care in rural SNF's as compared to their urban counterparts. As such, the commenter believes that many rural SNFs do not provide professional psychiatric or mental health care and that telehealth is one method that could be used to meet the mental health needs of the rural SNF population. Furthermore, the commenter stated that the lack of appropriate mental health care results in higher rates of psychiatric hospitalizations and the inability to effectively manage medications. Another commenter believes that allowing telehealth services to be furnished in a SNF would increase access to follow-up care and would result in cost savings. For example, the commenter contends that addressing acute medical conditions earlier before they develop into a crisis could save money by reducing transportation costs and decrease the number of hospital admissions. The commenter also mentioned that traveling and waiting in an unfamiliar waiting room is often 
                        ( print page 70160)
                        confusing and uncomfortable for the patient. The use of telehealth for SNF residents could result in less travel hardships for both the patient and SNF staff. *Response:*
                         We appreciate the comments regarding the addition of SNFs to the definition of an originating site. At this time the telehealth report to the Congress, as required by section 418 of the MMA, is under development within HHS. As discussed previously, we have the authority to approve telehealth furnished in a SNF if the Secretary concludes in the report that it is advisable to include a SNF as a Medicare telehealth originating site under section 1834(m) of the Act. *Comment:*
                         A few commenters requested us to add other facilities in addition to a SNF to the definition of an originating site. For example, one organization requested that we expand the definition of an originating site to include domiciliary care facilities and other congregate-living arrangements if SNFs are approved as an originating site. Another commenter requested that we expand the definition of an originating site to allow all community hospitals regardless of their location (for purposes of furnishing a telehealth consultation for stroke patients). The commenter noted that a timely evaluation of a stroke patient is crucial for effective stroke treatment and argued that beyond three hours after onset, resuscitation of injured brain cells becomes increasingly unlikely. The commenter contends that timely access to a critical care neurologist remains a concern for the majority of community hospitals. Moreover, a national society of nephrology requested that we add a dialysis facility to the list of originating sites. *Response:*
                         The statute defines an originating site facility as a physician's or practitioner's office, hospital, critical access hospital, rural health clinic, or FQHC. Additionally, the statute only permits telehealth services to be furnished at an originating site located in a rural health professional shortage area as defined in section 332(a)(1)(A) of the Public Health Service Act or within a county that is not included in a metropolitan statistical area. We do not have the legislative authority (except for SNFs as indicated previously) to expand the definition of an originating site facility or to allow telehealth services to be furnished in a hospital regardless of geographic location. 3. Other Issues *Comment:*
                         One association urged us to pay for asynchronous “store and forward” dermatology consultations. The commenter explained that a store and forward consultation involves the transmission of dermatological photographs and other medical information to the consulting practitioner without interaction between the patient and practitioner at the distant site; the patient is not present for the consultation. The commenter contends that store and forward consultation is more convenient for the patient, originating site and consulting physician. *Response:*
                         Medicare telehealth services include office and other outpatient visits (99201 through 99215), professional consultations (99241 through 99275), individual psychotherapy (90804 through 90809), pharmacologic management (90862), psychiatric diagnostic interview examination (90801), and ESRD-related services included in the MCP (except for one visit per month to examine the access site). As a condition of payment under Medicare, these services require an in-person patient encounter. We believe that the patient's presence, and the use of an interactive audio and video telecommunications system permitting the distant site practitioner to interact with the patient, provides a reasonable substitute for an in-person encounter. The statute provides for the use of asynchronous, store and forward technologies for delivering telehealth services only for Federal telemedicine demonstration programs conducted in Alaska or Hawaii. We do not have the authority to expand the use of store and forward technology in delivering telehealth services. *Comment:*
                         Two commenters urged us to consider adding speech-language pathologist and audiologists as practitioners allowed to furnish and receive payment for telehealth services and noted that we have not submitted the telehealth report to the Congress on additional sites, geographic areas and practitioners that may be appropriate for Medicare telehealth payment. The commenters also mentioned that the American Speech-Hearing Association (ASHA) previously submitted a request for consideration in the CY 2005 physician rule to add various speech and audiology services to the list of Medicare telehealth services. The commenters believe that we have not responded specifically to ASHA's request to approve speech and audiology services for telehealth. *Response:*
                         The report to the Congress (as required by section 223(d) of the Medicare, Medicaid and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-554)) on additional sites and settings, practitioners, and geographic areas that may be appropriate for Medicare telehealth payment is under development. We are considering the suggestions raised by the commenter as we formulate our recommendations to the Congress. Moreover, since speech language pathologists and audiologists are not permitted under current law to provide and receive payment for Medicare telehealth services at the distant site, we can not fully consider ASHA's request to add speech and audiology services to the list of Medicare telehealth services. *Comment:*
                         One commenter requested that we replace the term face-to-face with “in-person”. The commenter believes that the term “in-person” is a better description of an encounter where the patient and practitioner are in the physical presence of each other. *Response:*
                         The commenter's suggestion to use the term “in-person” to describe an encounter where the physician or practitioner and the beneficiary are physically in the same room has been noted. We will consider the commenter's suggestion as we discuss Medicare telehealth payment policy. Result of Evaluation of Comments We will add individual MNT as represented by HCPCS codes G0270, 97802 and 97803 to the list of Medicare telehealth services. We also will add individual MNT to the list of Medicare telehealth services at § 410.78 and § 414.65. Moreover, since a certified registered dietitian or other nutrition professional are the only practitioners permitted by statute to furnish MNT, we will revise § 410.78 to add a registered dietitian and nutrition professional as defined in § 410.134 to the list of practitioners that may furnish and receive payment for a telehealth service. E. Contractor Pricing of Unlisted Therapy Modalities and Procedures We recognize that there may be services or procedures performed that have no specific CPT codes assigned. In these situations, it is appropriate to use one of the CPT codes designated for reporting unlisted procedures. These unlisted codes do not typically have RVUs assigned to them. For services coded using these unlisted codes, the provider includes a description of the specific procedure(s) that was furnished. The contractor uses this information to determine an appropriate valuation. As explained in the August 8, 2005 PFS proposed rule (70 FR 45788), currently, there are two unlisted CPT 
                        ( print page 70161)
                        codes with assigned RVUs, CPT 97039, 
                        *Unlisted modality (specify and time if constant attendance),*
                         and 97139 
                        *Unlisted therapeutic procedure.* To make the pricing methodology consistent with our policy for other unlisted services, and to more appropriately match payments with the actual resources expended to deliver the services provided, we proposed to have our contractors value CPT codes 97039 and 97139. We received several comments on this proposal and provide the following summary of the comments and our response below. *Comment:*
                         Two commenters were opposed to the proposal. These commenters stated they were concerned that contractor pricing would create inconsistencies in the payment for these services or would lower payment resulting in the services no longer being provided, potentially increasing the administrative burden and resulting in delayed payments. One of these commenters suggested that we work with interested specialties to better understand the services billed under these codes. Another commenter expressed concern that obtaining new CPT codes requires a good deal of research and investigation to ensure accurate payment. Other commenters supported this proposed change, indicating that because these codes are used for widely different services they should be evaluated separately and there is no basis for assigning the code a set fee schedule rate. *Response:*
                         While it is true that having these codes priced by the contractors may result in some increase in administrative burden and impact the timeliness of payments, it will not necessarily result in lower payments. Our goal is to ensure appropriate payment for the actual services provided and we believe that our contractors will work with the provider community to make certain that this occurs. To the extent that providers believe that new codes are needed they might want to work with the specialty organizations to achieve this objective. *Final Decision:*
                         We are finalizing our proposal and our contractors will value CPT codes 97039 and 97139. We are assigning a status indicator of “C” to these two CPT codes. F. Payment for Teaching Anesthesiologists In the August 8, 2005 PFS proposed rule (70 FR 45789), we summarized the current policy for the payment for services provided by teaching anesthesiologists, including the revisions to the policy published November 7, 2003 (68 FR 63196 through 63395), where we revised § 414.46 of our regulations to allow teaching anesthesiologists to bill in a similar manner to teaching certified registered nurse anesthetists (CRNAs) for the teaching anesthesiologist's involvement in two concurrent cases involving residents. This policy took effect for services furnished on or after January 1, 2004 and was intended as an alternative to the “medical direction” payment policy applicable to concurrent cases involving teaching anesthesiologists and residents. As noted in the August 8, 2005 proposed rule, despite the higher level of payment available under this policy, the American Society of Anesthesiologists (ASA) has informed us that it is not aware of any teaching anesthesia programs that have arranged their practices to meet the conditions necessary to bill under the revised policy. The ASA suggests that the teaching physician regulations for teaching anesthesiologists should be similar to those for teaching surgeons for overlapping complex surgery procedures. The ASA thinks that anesthesia is similar to complex surgery in terms of critical periods, overlap, and availability of teaching physicians. However, as we noted in the August 8, 2005 proposed rule, the critical portions of the teaching anesthesia service and the critical portions of the teaching surgeon service are not the same. The ASA believes that inadequate payment levels have contributed to the loss of teaching anesthesiologists and an inability to recruit new faculty. In the August 8, 2005 proposed rule, we requested comments on a teaching physician policy for anesthesiologists that could build on the policy announced in the November 7, 2003 PFS final rule, but could provide the appropriate revisions that would allow it to be more flexible for teaching anesthesia programs. We also indicated we would be interested in receiving data and studies relevant to this issue as well as any offsetting savings that could be made to account for any potential costs that could be incurred if there was a policy change. Discussion of Comments Received As discussed previously in this section, we did not present a formal proposal, but asked for comments from interested stakeholders on these issues. While we have not fully analyzed all the relevant information and data, we have been provided anecdotal evidence that some anesthesiologists may be leaving academic practice for better compensated positions in private practice. While we recognize that Medicare payment policies are an important consideration in these decisions, they are not the only factor. In contrast, as pointed out by a commenter, there has been an increase in the number of nurse anesthesia programs from 83 programs in 2000 to 105 programs projected for 2006. The number of nurse anesthesia graduates has surged from 1075 nurse anesthetists in 2000 to 2035 projected for 2006. Despite these increases, nurse anesthesia programs had reported similar financial problems, such as levels of teachers' salaries, in recruiting faculty to teaching nurse anesthetists. In terms of anesthesia manpower, we did not receive any information from surgical groups indicating difficulty in getting anesthesiologists or CRNAs to provide anesthesia services. Additionally, we did not receive any comments identifying areas of offsetting savings that might be used to fund any change in the teaching anesthesia payment policy. We will continue to review the information and relevant data presented by the commenters and consult with the stakeholders before we move forward with any proposal. G. End Stage Renal Disease (ESRD) Related Provisions On August 8, 2005, we published the Revisions to Payment Policies Under the Physician Fee Schedule for CY 2006 proposed rule in the 
                        **Federal Register**
                         (70 FR 45789), revising payments to ESRD facilities under the provisions of the MMA. The proposed rule implements section 1881(b) of the Act, as amended by section 623 of the MMA, which directs the Secretary to make a number of revisions to the composite rate payment system, as well as payment for separately billable drugs furnished by ESRD facilities. Under section 1881(b)(12) of the Act, the add-on adjustment must reflect both the effect of the new payment methodology and estimate growth in ESRD drug expenditures. We proposed an add-on adjustment of 8.1 percent to the composite payment rate to account for the difference between previous payments for separately billed drugs and biologicals and the revised pricing that will take effect January 1, 2006. We updated that add-on adjustment to reflect estimated growth in ESRD drug expenditures of 0.7 percent. We combined the add-on adjustment of 8.1 percent that reflects the payment methodology we will be using for ESRD drugs with the 0.7 percent increase for expenditures in 2006 to produce one 
                        ( print page 70162)
                        proposed drug add-on adjustment for CY 2006 of 8.9 percent. Following publication of the proposed rule, it came to our attention that 3 codes had been omitted in our analysis of drug payments and utilization for the top ten ESRD drugs that affected our calculation of the proposed add-on adjustment. On September 1, 2005, we issued a correction notice on the CMS Web site, to correct our omission of the 3 J Codes in the estimation of the market shares for the top ten ESRD drugs used in our calculation of the proposed drug add-on adjustment for 2006. The “Correction to the Proposed ESRD Drug Add-on Adjustment: Revised Table 22” is available at 
                        *http://www.cms.hhs.gov/​providers/​esrd/​090105_​ESRD_​Correction.pdf.*
                         The corrected table shows the revised weights compared to the weights included in the proposed rule and resulted in a revised proposed total drug add-on adjustment to the composite payment rate of 11.3 percent for 2006. We also proposed to revise the drug pricing for ESRD drugs to ASP+6 percent for the top ten drugs furnished by independent facilities and EPO furnished by hospital-based facilities. In addition, section 1881(b)(12) of the Act as amended by section 623 of the MMA provided authority to the Secretary to revise the geographic index applied to the composite payment rate and phase in any changes to the index over a multi-year period. Accordingly, we proposed to revise the geographic classifications and wage indexes currently in effect for adjusting composite rate payments and to implement these changes over a 2-year transition period. We also proposed to revise the regulations applicable to the composite rate exceptions process to reflect section 623 of the MMA provisions that restricts exceptions to pediatric facilities. No changes to the current case-mix adjustments were proposed. We received a total of 37 comments from the ESRD community that represented major organizations, pharmaceutical companies, beneficiaries, and concerned individuals. The comments and responses are summarized in the following sections. 1. Revised Pricing Methodology for Separately Billable Drugs and Biologicals Furnished by ESRD Facilities In the August 8, 2005 proposed rule, we proposed that payment for drugs furnished in connection with renal dialysis services and separately billed by independent renal dialysis facilities would be based on payment amounts determined under section 1847A of the Act which are 106 percent of the ASP. We proposed to update the payment allowances quarterly, based on the ASP reported to us by drug manufacturers. We also proposed to pay for EPO in hospital-based facilities at the ASP+6 percent. We stated that we are interested in moving to the ASP+6 percent methodology for all separately billed drugs and solicited comments on a drug add-on estimation methodology that would allow us pay hospital-based facilities ASP+6 percent for all separately billable drugs. In this final rule with comment, we are implementing payment of ASP+6 percent for all ESRD drugs furnished by both independent and hospital-based ESRD facilities. A discussion of the final drug payment methodology and related comments and responses can be found in section II.H.2. 2. Adjustment to Account for Changes in the Pricing of Separately Billable Drugs and Biologicals, and the Estimated Increase in Expenditures for Drugs and Biologicals Section 1881(b)(12) of the Act, as added by section 623(d) of the MMA, contains two provisions that describe how the drug add-on adjustment will be implemented in the ESRD payment system. First, the add-on adjustment must reflect the difference between the payment methodology for separately billed drugs under the drug price in effect in CY 2004 and current drug pricing and, second, the aggregate payments for CY 2005 must equal aggregate payments absent this MMA provision. Prior to 2005, separately billable ESRD drugs and biologicals other than EPO furnished in independent facilities were paid under the average wholesale price (AWP) methodology. In 2005, section 1881(b)(13)(A)(ii) of the Act required that we pay the acquisition cost for separately billable ESRD drugs (including EPO) as determined by the Office of the Inspector General (OIG). If the OIG did not determine an acquisition cost for a separately billable drug or biological, then the Secretary was given discretion to determine the payment rate. In the CY 2005 final rule (69 FR 66322-66323), we described the methodology that we used for developing the drug add-on adjustment to the composite rate to account for the difference between estimated drug payments under the AWP payment system and the acquisition costs as determined by the OIG. This adjustment was developed so that aggregate spending for composite rates plus separately billed drugs would remain budget neutral for CY 2005. Section 1881(b)(12) of the Act, as added by section 623 (d) of the MMA, also contains two provisions related to adjustments to payments for drugs and biologicals for CY 2006. Section 1881(b)(12)(C)(ii) of the Act requires that we recalculate the 2005 add-on adjustment to reflect the difference between estimated payments using the AWP payment methodology and the payment methodology for 2006 which we proposed to be ASP+6 percent. In addition, section 1881(b)(12)(F) of the Act requires that, beginning in 2006, we establish an annual update adjustment to reflect estimated growth in expenditures for separately billable drugs and biologicals furnished by ESRD facilities. This update would be applied only to the drug add-on portion of the composite payment rate. In order to meet both requirements, we proposed to develop the CY 2006 drug add-on adjustment in two steps. First, we proposed to recalculate the CY 2005 add-on adjustment to reflect the difference in drug payments using 95 percent AWP pricing and payments using ASP+6 pricing. The result of this calculation would replace the current 8.7 percent adjustment and would be budget neutral to CY 2005 payments. Next, we proposed to develop a proposed annual update methodology that we would first use in CY 2006 to reflect the estimated growth in drug expenditures each year. As stated previously, this update would be applied only to the drug add-on portion of the composite payment rate. For specific details regarding the proposed adjustments, see the August 8, 2005 
                        **Federal Register**
                         (70 FR 45793 through 45800). As noted previously, we issued a correction to the proposed ESRD drug add-on adjustment contained in the proposed rule. In this notice we acknowledged that our estimation of the market shares for the top ten ESRD drugs that we used in the calculation of the proposed drug add-on for 2006 was incorrect. After further analysis of the 2003 expenditure data used to assign weights to the top ten ESRD drugs, we determined that our data did not account for 3 new “J” codes that were implemented in 2003. As a result, the weights for Iron Sucrose, Sodium Ferric Gluconate and Paricalcitol were understated. In addition, we noted that the weight for EPO incorrectly included expenditures for hospital-based facilities. Since the purpose of the weighting was to allocate the drug spread to all other drugs paid using the 
                        ( print page 70163)
                        proposed ASP+6 percent pricing, hospital-based data should not have been included because we paid for other hospital-based drugs based on cost. Table 16 shows the revised weights compared to the weights included in the proposed rule. Table 16.—Revised to Reflect Correction
Drugs
Published proposed weights
Revised proposed weightsEpogen
78.83
69.33Calcitriol
0.13
0.84Doxercalciferol
1.74
1.48Iron dextran
0.38
0.23Iron sucrose
0.71
7.03Levocarnitine
0.89
0.77Paricalcitol
17.37
14.61Sodium ferric glut
0.53
4.96Alteplase, Recombinant
0.18
0.56Vancomycin
0.24
0.19
 We note that as a result of these data corrections, the top ten drugs account for 98 percent of total ESRD drug expenditures, rather than 92 percent as stated in the proposed rule. Using these revised weights, the proposed recalculated 2005 drug add-on adjustment was corrected to 10.4 percent, and the proposed 2006 update was corrected to 0.8 percent. The corrected total drug add-on adjustment proposed for 2006 was 11.3 percent. The proposed rule also discussed a method to estimate the drug spread applicable to hospital-based facilities for non-EPO drugs if we decided to implement ASP+6 percent pricing for all hospital-based drugs. This methodology would use the weighted average drug spread percent for independent facilities to estimate the drug spread for non-EPO drugs furnished by hospital-based ESRD facilities. The following sections discuss the comments we received on these issues and provide a detailed description of the final drug add-on adjustment to the ESRD composite payment rate that will be implemented January 1, 2006. *Comment:*
                         We received a number of comments advocating that drug payments to hospital based facilities should be the same as to independent facilities. However, most of these comments raised no concerns regarding our proposed methodology for computing the drug spread applicable to hospital-based facilities. Two comments specifically supported our proposal to use the drug pricing drug spread from independent facilities to estimate the spread for hospital-based facilities. Two comments stated we should follow MedPAC's suggestion that we collect data to estimate hospital-based facilities' cost and Medicare payment per unit for ESRD drugs, but did not raise concerns with our proposed alternative method for estimating the drug spread applicable to hospital-based facilities if we implemented ASP+6 percent pricing. MedPAC recommended that we use the same methodology to pay for all drugs (regardless of setting) and suggested that we could use dosing data from independent facilities to estimate ASP+6 payments for hospital-based facilities to compute the drug spread related to hospital-based facility drug payments. *Response:*
                         Given both the MedPAC recommendation that ASP should be the basis of payment for all separately billable ESRD drugs and the overall support for providing consistent drug payments for both hospital-based and independent facilities, we have decided, in light of section 1881(b)(13)(A)(iii) of the Act, to implement ASP+6 percent pricing for hospital-based facilities beginning January 1, 2006. See section II.H.2 for a more detailed discussion of this issue. We are adopting the methodology outlined in the proposed rule to determine the drug spread applicable to hospital-based facilities and to calculate a drug add-on adjustment. We are also adopting the proposed methodology which would permit us to implement a change in payment to ASP+6 percent for all non-EPO drugs provided by hospital-based ESRD facilities. While we agree that the ideal approach would be to collect data from hospital-based facilities, this data collection would significantly delay implementation of a consistent ESRD drug payment policy. Absent the collection of data, we believe that using the estimation methodology described in the proposed rule brings us closer to the actual price of hospital drugs (ASP+6 percent) than does the policy of continuing to rely on reasonable costs. In response to MedPAC's suggestion, we did an analysis of drug dosing units from the billing data of independent facilities and were unable to determine accurate monthly average units from those bills, because facilities do not bill individual line items by date of service. As a result, the average monthly dose we computed for some drugs was significantly below the FDA expected monthly dose. In other words, the average monthly dose for the top ten ESRD drugs from independent facility data that we could use as a proxy for pricing the hospital-based bills was problematic. We believe the statute contemplates a single payment approach for separately billable ESRD drugs. Therefore, using our estimation proposal is a start towards MedPAC's principle that the same prices should be paid for the same services across all settings which we believe is consistent with the statute. Furthermore, moving to ASP+6 percent pricing for hospital-based facilities evens out the effect of the drug add-on adjustment between independent and hospital-based facilities. Therefore, we have computed the drug spread for non-EPO hospital based drugs using the weighted average drug spread percentage from independent facilities. We applied that percentage to the total hospital-based drug payments in order to estimate the amount of the drug spread as a result of revising the drug pricing methodology to ASP+6 percent for hospital-based facilities. We believe this method provides a reasonable estimation of the drug spread because, as explained previously, all drugs in both settings are based on ASP+6 pricing. Moreover, we believe that the benefits of implementing a consistent drug payment methodology outweighs any potential drawbacks that may result from estimating the drug spread without more precise data. We intend to pursue options for obtaining additional data to more accurately 
                        ( print page 70164)
                        compute and update the drug add-on adjustment. Once more complete hospital-based ESRD drug data become available, we will re-examine the computation of the drug add-on adjustment and make any necessary revisions to our estimations. *Comment:*
                         We received comments from two associations representing ESRD facilities that expressed concern about our interpretation of the statutory provision related to the drug add-on adjustment. These comments presented legal arguments challenging our decision to apply a single drug add-on adjustment that is applicable to both hospital-based and independent ESRD facilities. Both comments indicated that as long as separate drug payment methodologies are in place for hospital-based facilities and independent facilities, the statutory text, structure, and legislative history requires that we establish distinct drug add-on adjustments. Another commenter recommended that the add-on adjustment should be directly linked to hospital-based and independent facilities based on the actual loss of revenue due to changes in reimbursement for separately billed drugs. *Response:*
                         We continue to believe that our interpretation of this statutory provision represents the best reading of the statute as we explained, for reasons, discussed, in the CY 2005 final rule (see 69 FR 66319 through 66320). Accordingly, rather than adopting separate add-on adjustments for independent and hospital-based ESRD facilities, we are addressing the payment inequities expressed in the comments and pointed out in the MedPAC report that result from differential drug payment methodologies for hospital-based and independent facilities. As discussed previously, we are implementing a consistent drug payment methodology for all ESRD provider settings. In this way, we believe we have resolved the concerns expressed by these commenters in a manner consistent with the statute. a. Recalculation of the CY 2005 Drug Add-on Adjustment For CY 2006, we proposed to use the same method that we used to develop the drug add-on adjustment for CY 2005 to recalculate the 2005 adjustment to reflect the proposed revision to the ESRD drug payment methodology from acquisition costs to ASP+6 percent. That is, we proposed to calculate the spread based on the difference in aggregate payments between estimated payment based on AWP pricing and estimated payment based on ASP+6 pricing. Although we proposed to use pricing data from the second quarter of CY 2005, we indicated that all of the data used to develop the proposed add-on adjustment would be updated for the final rule with comment, as more current data would be available. (1) Historical Drug Expenditure Data To develop the drug add-on adjustment for this final rule with comment, we used historical total aggregate payments for separately billed ESRD drugs for calendar years 2001, 2002, 2003, and 2004. For EPO, these payments were broken down according to type of ESRD facility (hospital-based versus independent). We also used the number of dialysis treatments performed by these two types of facilities over the same period. (2) ASP+6 Percent Prices In the proposed rule we used the ASP+6 percent prices for the second quarter of CY 2005. However, we indicated that we would use all four quarters of CY 2005 prices to develop the CY 2005 ASP payments. *Comment:*
                         One commenter raised concerns regarding using four quarters of the ASP to determine an annual average. This commenter indicated that the most recent available quarter, specifically, the fourth quarter ASP prices of any CY represents the ASP for the entire year. This commenter recommended that, instead of using all four quarter of CY 2005, we use only the fourth quarter of CY 2005 ASP to calculate the difference in the aggregate payments based on 95 percent AWP pricing and the estimated payment based on ASP+6 percent. *Response:*
                         We do not agree with this recommendation and have used the average of ASP prices in all four quarters of 2005 to calculate the add-on adjustment. The fourth quarter of the ASP represents only the most current ASP prices, and does not represent an aggregate annual average. Therefore, our calculation for ASP+6 percent includes not only the most current quarter (that is, the fourth quarter ASP) but also the previous three quarters of ASP pricing data for 2005). We believe this calculation provides the most accurate estimation of 2005 actual ASP+6 percent payments. We used four quarters of 2005 ASP+6 percent prices for the drugs listed in Table 17. We averaged these to develop prices representing the average 2005 ASP payments. Table 17
Drug
Average sales price plus 6% 2005Epogen
$9.30Calcitriol
0.75Doxercalciferol
2.19Iron dextran
11.21Iron sucrose
0.36Levocarnitine
12.30Paricalcitol
3.92Sodium ferric glut
4.74Alteplase, Recombinant
30.61Vancomycin
2.95
 (3) Estimated Medicare Payments Using 95 Percent of AWP In the proposed rule, we used the first quarter 2005 AWP prices and updated them to the second quarter by applying, for drugs other than EPO, an estimated AWP quarterly growth of approximately 0.74 percent. In order to estimate AWP payments for this final rule with comment, we used 4 quarters of 2005 AWP prices and averaged them to obtain prices representative of 2005 payment amounts. This methodology was not applied to the price for Epogen since payment was maintained at $10.00 per thousand units prior to MMA (see Table 18). Table 18
Drugs
2005 average estimated medicare payments using 95% of AWPEpogen
$10.00Calcitriol
1.36Doxercalciferol
3.98Iron dextran
17.91Iron sucrose
0.65Levocarnitine
36.48Paricalcitol
5.32Sodium ferric glut
8.17Alteplase, Recombinant
31.89Vancomycin
3.79
 (4) Dialysis Treatments In the proposed rule, using the most complete data available at the time, we estimated total dialysis treatments for 2005 at 34.5 million. *Comment:*
                         We received comments suggesting that our estimate of dialysis treatments was overstated. *Response:*
                         Using more recent data that has become available since we issued the proposed rule, we increased our projection of total number of dialysis treatments based on actuarially projected growth in the number of ESRD beneficiaries. Since Medicare covers a maximum of three treatments per week, utilization growth is limited, and, therefore, any increase in the number of 
                        ( print page 70165)
                        treatments should be due to beneficiary enrollment. The actual 2004 data we used in this final rule with comment, showed higher treatment counts than we had projected for 2004 in the proposed rule. Therefore, for CY 2005, we estimate there will be a total of 34.7 million treatments performed. (5) Drug Payments In the proposed rule, we updated drug payments for both EPO and non-EPO drugs using the estimated trend factor for EPO of 9.0 percent. We proposed using the EPO 9.0 percent trend factor for all drugs (not just for EPO) because EPO constitutes the largest proportion of drugs furnished by ESRD facilities and because we determined that the extremely varied growth in spending for non-EPO drugs between 2000 and 2003 prohibited a reliable trend analysis. As we indicated we would do in the proposed rule, we used later 2004 drug payment data for the final rule with comment and trended those data forward to 2005. *Comment:*
                         We received a number of comments concerning our use of the EPO trend factor to update drug payments to 2005. These comments expressed concern that this resulted in understating the growth in ESRD drug payments. We also received comments that we should correlate the growth of EPO and other separately billable ESRD drugs. *Response:*
                         Since we now have 2004 data, we have modified the trend factor to more accurately reflect the growth in drug payments. In addition, we have calculated trend factors for non-EPO drugs independently of those for EPO. We updated the total aggregate EPO drug payments for both hospital-based and independent facilities by using historical trend factors using data from 2001 through 2004. For CY 2005, the CY 2004 payment level was increased by a trend factor of 11.0 percent. Similarly, we updated the aggregate spending for separately billable drugs, other than EPO, for both hospital-based and independent facilities by using a historical trend factor of 15 percent. In addition, we deducted 50 cents for each administration of EPO from the total EPO spending for both hospital-based and independent facilities to account for payment for syringes that were included in the EPO payments prior to the implementation of the MMA drug payment provisions. In the proposed rule, we estimated the cost of syringes at $1.6 million for hospital-based facilities and $26.8 million for independent facilities. *Comment:*
                         We received comments that the proposed $26.8 million dollars estimated for syringe payments to independent facilities was too high, because the estimated number of administrations of EPO exceeded the number of treatments. *Response:*
                         We have re-estimated the syringe payments to take into account problems we encountered related to the administrations field on the dialysis bills. Thus for the final rule with comment, we are calculating syringe payments as 50 cents multiplied by 90 percent of estimated treatments for 2005. The 90 percent represents the percent of dialysis patients that receive EPO. Since we only pay for one administration per treatment we applied this 90 percent to total treatments in order to estimate the number of EPO administrations. Using this methodology, for CY 2005, we estimate payments for these syringes will amount to $1.8 million for hospital-based facilities and $13.8 million for independent facilities. For CY 2005, we estimate that total spending for separately billable drugs will reach $462 million for drugs provided in hospital-based facilities ($217 million for EPO and $245 million for other drugs), and $3.102 billion for drugs provided in independent facilities ($2.082 billion for EPO and $1.019 billion for other drugs). *Comment:*
                         One comment indicated that we were eliminating separate payments for syringes. *Response:*
                         We believe the commenter misunderstood our payment policy. We currently pay separately for syringes used to administer ESRD drugs, and will continue to do so. We began paying separately for the syringes associated with administration of EPO when EPO payment was revised from payment at $10 per 1,000 units in 2005. While the previous $10 payment included payment for syringes, the new payment methodology does not. We have not modified our approach to paying for syringes in general, but now also pay separately for syringes associated with the administration of EPO. (6) Add-On Calculation and Budget Neutrality In the August 8, 2005 proposed rule (70 FR 45789), we acknowledged a mistake in our calculation of the proposed drug add-on adjustment. The proposed 2005 recalculated add-on adjustment was 10.4 percent. In addition, we indicated in the proposed rule that we intended to include more recent 2004 billing data in the calculation of the final drug add-on adjustment. *Comment:*
                         We received a number of comments commending us for responding to industry concerns by making the corrections to the proposed add-on calculation and urging us to use the most accurate, up-to-date data and trends available to compute the 2005 budget-neutral add-on adjustment. *Response:*
                         We have taken these comments into consideration and have updated all of the data and assumptions used to calculate the add-on adjustment as described below. For each of the top ten drugs, we calculated the percent by which ASP+6 percent is projected to be less than payment amounts under the 95 percent of AWP pricing system for 2005. We then calculated a weighted average of the percentages by which ASP+6 percent would be below 95 percent of AWP payment amounts, for the top 10 ESRD drugs for independent facilities. We weighted these percentages by using the 2005 estimated Medicare payment amounts for the top ten drugs. This procedure resulted in a weighted average payment difference of 16 percent. Table 19
Drugs
2005 estimated medicare payment weights as a 
                                 percentage of total drug  
                                 expenditures
Percent by which ASP+6% prices are below 95% of AWP pricesEpogen
67.96
7.03Calcitriol
0.45
44.74Doxercalciferol
3.62
44.94Iron dextran
0.11
37.40Iron sucrose
7.79
44.50( print page 70166)Levocarnitine
1.11
66.27Paricalcitol
13.38
26.44Sodium ferric glut
4.64
41.96Alteplase, Recombinant
0.75
4.00Vancomycin
0.20
22.20
 Since we estimate that these 10 drugs represent nearly 98 percent of total 2005 drug payments to both hospital-based and independent facilities, we applied the weighted average to 100 percent or all of aggregate drug spending projections for hospital-based and independent facilities, producing a projected difference of $585 million (the sum of $76 million for hospital-based and $509 for independent facilities). Since we do not currently have reliable data on dosing units from hospital-based bills, we believe it is reasonable, as discussed above, to proxy the drug spread for hospital-based facilities using the spread for independent facilities. The weighted average is applied to 100 percent of drug spending projections for hospital-based and independent facilities. Distributing the total 2005 figure of $585 million over a total projected 34.7 million treatments results in a revised 2005 add-on to the per treatment composite rate of 13.1 percent. This compares to the proposed adjustment of 10.4 percent. By making this adjustment to the composite rate, we estimate that the aggregate payments to ESRD facilities would be budget neutral for drug payments for 2005, as required by the MMA. We note that, beginning January 1, 2006, this 13.1 percent adjustment replaces the 8.7 percent adjustment currently in effect for CY 2005. b. Calculation of the Proposed CY 2006 Inflation Update to the Drug Add-On Adjustment The proposed rule described the approach we proposed to use to update the drug add-on adjustment to account for the estimated growth in drug expenditures between 2005 and 2006. Based on the most recent, complete data that was available at the time, we proposed a 2006 inflation adjustment of 0.8 percent to the drug add-on to the composite payment to reflect the estimated growth in drug expenditures between 2005 and 2006. While we received no comments specific to the add-on inflation adjustment, we did receive comment about our growth projections used to calculate the adjustment. Those comments were addressed in the previous section. (1) Drug Payments and Dialysis Treatments Similar to the above mentioned process, we updated the total aggregate EPO drug spending for hospital-based and independent facilities using historical trend factors. For 2006, the EPO payment level was increased from 2005 by a trend factor of 11.0 percent. We also updated aggregate spending for separately billable drugs, other than EPO, for both hospital-based and independent facilities by a trend factor of 15 percent. This procedure resulted in projected drug expenditures of $523 million for drugs provided in hospital based facilities ($240 million for EPO and $283 million for other drugs) and $3.481 billion for drugs provided in independent facilities ($2.306 billion for EPO and $1.175 billion for other drugs). These numbers include an estimated reduction for the 50 cent payment for syringes of $1.9 million for hospital-based facilities and $14.1 million for independent facilities. We also updated the projected number of dialysis treatments using actuarial enrollment projections. This resulted in total of 35.6 million treatments for 2006. (2) Adjustment to Composite Rate Add-On The proposed computation of the 2006 inflation adjustment to the composite rate was 0.8 percent. We have updated our projected inflation adjustment for the drug add-on and have included data for non-EPO hospital-based drugs into the computation. Since EPO is updated at an average trend of 11 percent and other separately billable drugs are updated by a trend factor of 15 percent, for both hospital-based and independent facilities, for 2006 we computed a combined weighted average growth in total drug expenditures of 12.3 percent, based on the relative proportions of EPO and non-EPO drugs. We then applied the 12.3 percent projected growth in aggregate drug expenditures between 2005 and 2006 to the 2005 drug add-on figure of $585 million. This resulted in a projected incremental increase in the drug spread for 2006 of $72 million ($9 million for drugs furnished by hospital-based facilities and $63 million for drugs furnished by independent facilities). We distributed the $72 million over 35.6 million projected treatments, resulting in a 1.4 percent increase to the 2005 composite payment rate. *Comment:*
                         We received a number of comments regarding an annual update factor. Several comments recommended that we should provide an annual update to the composite rate. The specific recommendation suggested an annual market basket update in the composite rate equivalent to the MedPAC recommendation of an increase to the composite payment rate of 2.5 percent in 2006. The comments further acknowledged that the creation of an annual market basket update requires Congressional action. *Response:*
                         Because Congressional action is required, there is no specific provision in the current statute or regulations for an annual update for the composite payment rate based on the ESRD market basket rate of increase. However, the statute does, in effect, provide for an annual update to the drug add-on to the composite payment rate. As discussed previously, the statute requires that we annually update the amount of the drug spread included in the composite payment rate, based on the projected growth in drug expenditure between 2005 and 2006. We are providing an inflation adjustment to the composite payment rate of 1.4 percent. Even though this inflation adjustment is part of the overall add-on adjustment, the overall effect for 2006 is equal to an update of 1.4 percent. 
                        ( print page 70167) In addition, we note that as part of our work on the development of a fully bundled prospective payment system (PPS) for ESRD facilities, we will be developing an update framework that would include an ESRD market basket factor. We expect to include a discussion of this update framework as part of a Report to Congress on a fully bundled PPS for outpatient ESRD facilities. This report is still under development. *Comment:*
                         One comment stated that the add-on adjustment to the composite rate should be reflected as an absolute dollar amount rather than a percentage, stating that there is no logical reason why the drug add-on component should be adjusted by a wage index. *Response:*
                         Section 1881(b)(12)(A) of the Act which was added by the MMA, required the establishment of a “case-mix adjusted prospective payment system for dialysis services” that included: (1) The composite rate; (2) case-mix adjustment for a limited number of patient characteristics; and (3) a drug add-on adjustment to the composite rate to account for the difference in drug payments compared to the previous drug pricing methodology. Section 1881(b)(12)(D) requires that payments under this system be adjusted by a geographic index. Therefore, we are required to apply the wage index to all components of the case-mix adjusted composite rate system. c. Drug Add-On Adjustment for 2006 With the CY 2005 add-on to the per treatment composite rate being 13.1 percent and the additional increment for expenditures in CY 2006 being 1.4 percent, the combined drug add-on adjustment for 2006 is 14.7 percent (1.131 × 1.014). 3. Revisions to Geographic Designations and Wage Indexes Applied to the ESRD Composite Payment Rate Section 1881(b)(12)(D) of the Act, as added by section 623(d) of the MMA, gave the Secretary the discretionary authority to revise the current wage index incorporated in the ESRD composite payment rates. That provision also requires that any revised wage index be phased in over a multiyear period. We proposed to adopt OMB's revised geographic definitions (announced in OMB Bulletin No. 03-04, issued June 6, 2003) to determine urban and rural locales for purposes of calculating ESRD composite payment rates, beginning January 1, 2006. In conjunction with using OMB's geographic designations, we proposed to recalculate the ESRD wage index based on acute care hospital wage and employment data for FY 2002, as reported to us in connection with development of the wage index used in the inpatient hospital prospective payment system (IPPS). We also proposed to update the labor portion of the ESRD composite rate to which the wage index is applied. Below we discuss comments we received on these proposals and our final determinations regarding CY 2006 revisions to the wage index adjustment as it is applied to the ESRD composite payment rate. a. Use of Revised OMB Geographic Area Designations To Determine Urban and Rural Locales for ESRD Composite Payment Rates In the August 8, 2005 proposed rule, we proposed to use OMB's revised core-based statistical area (CBSA)-based definitions for Metropolitan Statistical Areas, New England County Metropolitan Areas, and Micropolitan Statistical Areas, announced in OMB Bulletin 03-04 (June 6, 2003) as the basis for revising the urban/rural locales and corresponding wage index values reflected in the composite payment rates. The definitions we proposed are the same urban and rural definitions used for the Medicare IPPS, but without regard to geographic reclassifications authorized under section 1886(d)(8) and (d)(10) of the Act. In conjunction with adopting OMB's geographic classifications, we proposed replacing the current weighted wage index based on a 60/40 blend of Bureau of Labor Statistics (BLS) and hospital wage index values with one developed exclusively from acute care hospital wage and employment data obtained from the Medicare hospital cost reports. We proposed to update the wage index annually. For a full discussion of our proposals, see the August 8, 2005 proposed rule (70 FR 45793 through 45800). The following section contains a summary of the comments that we received on the proposed wage index revisions. *Comment:*
                         Several commenters, generally those representing independent ESRD facilities located in rural areas, opposed implementation of the CBSA based wage index. The commenters expressed concern that the proposed wage index would jeopardize beneficiary access to care, and left little protection for rural facilities. Some commenters pointed out the amount of the reduction in composite payments that specific providers would incur based on the proposed urban/rural definitions and revised wage index values. *Response:*
                         The current urban/rural definitions reflected in the composite payment rates have been in effect for over 20 years, and needed to be updated. By revising those definitions to conform with the latest available OMB geographic designations as explained in the August 8, 2005 proposed rule, we believe that we are complying with the express intent of the Congress permitting revision of those designations, as set forth in section 1881(b)(12)(D) of the Act. While our authority to revise the current ESRD wage index is discretionary, we believe this revision is essential if the composite rates are to reflect accurately the costs of providing ESRD services. None of the commenters proposed an alternative to our proposed geographic classification system. Because we must have a national classification system built on clear objective standards, we are adopting the CBSA based urban/rural definitions, as described in our proposed rule. As to commenters' concerns about any reductions in the base composite payment rates, we have taken these concerns into consideration and have adopted a transition policy concerning the wage index. We address commenter's comments and provide a more detailed discussion of our transition policy in section II.3.c. of this final rule with comment. *Comment:*
                         While several commenters supported the implementation of the new CBSA based wage index, they expressed concern over the potential impact on independent ESRD facilities, particularly those located in rural areas. The most frequent recommendations to reduce the impact of any payment reductions were to extend the proposed transition period from 2 to 5 years, and provide annual updates of the wage index in each of those years. *Response:*
                         We agree that the new CBSA based wage index should be revised periodically to account for not only changes in labor market conditions, but also any future revisions in the definitions of the Metropolitan Statistical Areas and other geographic designations which may be announced by OMB. We will revise the ESRD wage index annually using the most recent Medicare cost report data as is used in the Medicare hospital IPPS. We also agree that the proposed transition period of 2 years may not be sufficiently long to provide ESRD facilities with enough time to adapt to the new wage index and have extended the transition period to 4 years. For a more complete discussion of our policies to help ESRD facilities adapt to the OMB geographic designations and wage index revisions 
                        ( print page 70168)
                        we have adopted for ESRD purposes (see section C of this preamble). *Comment:*
                         Several commenters endorsed our adoption of the proposed wage index based on the revised OMB definitions. However, the commenters were critical of what they perceived to be a lack of transparency in the data and methodology used to develop the new wage index, especially the budget neutrality adjustment. The commenters requested that we provide the data and methodology used to calculate the new wage index values and BNF. *Response:*
                         For purposes of adjusting the labor-related portion of the CY 2006 ESRD composite rate, we are using the most recent hospital wage data applicable to FY 2006 payments as discussed previously in this section. We start with the wage index used by the Skilled Nursing Home Prospective Payment System (SNF PPS) and multiply this index by a numeric factor, which is the budget neutrality adjustment. We use the SNF PPS wage index because we believe it reflects the most recent data, and is consistent with all other non-acute care facility payment systems. As explained earlier in this section, we begin with the same wage index values as those used by the SNF and multiply those values by the BNF (See Tables 21 and 22). The methodology for creating this wage index BNF is explained in further detail below. The wage index measures relative differences in the average hourly wage for the hospitals in each labor market area compared to the national average hourly wage. As stated previously, for ESRD payment purposes the wage index values are based on wage data as reported by hospitals on their Medicare cost reports. The wage data used to construct the wage index are updated annually, based on the most current data available. Accordingly, 2002 wage data were used to construct the wage index values used in this final rule with comment and 2003 wage data will be used to construct the wage index that we intend to use for the ESRD composite rate for CY 2007. For each geographic area, wage data for all providers in that area are combined. The sum of all wages for all providers in that geographic area is divided by the total hours for all providers in that geographic area. The result is the average hourly rate for that geographic area. This data can be found at the following link: 
                        *http://www.cms.hhs.gov/​providers/​hipps/​ippswage.asp.* The data will be found under the section labeled, “FY 2006 Wage Index Public Use Files”, and contains average hourly rate data and wage index. The index is computed by dividing the average hourly rate for each geographic area within the CBSA by the national average hourly wage. As we noted earlier, for the ESRD wage index we are using hospital wage data without regard to any approved geographic reclassification authorized under sections 1886(d)(8) and (d)(10) of the Act or other provision that only applies to hospitals paid under the IPPS. For purposes of the ESRD wage index methodology, the data we use is pre-reclassified, pre-floor hospital data and unadjusted by occupational mix. The final step is to multiply each wage index value by the wage index budget neutrality factor (BNF) (see section 4 for details about this adjustment). *Comment:*
                         One commenter strongly objected to our proposed implementation of the CBSA based wage index. The commenter maintained that we have failed to examine the entire dialysis patient delivery system taken as a whole. Specifically, we have not recognized that rural facilities generally have lower utilization, and consequently higher costs per treatment, especially for overhead and supplies, compared to urban facilities. The commenter offered three options for consideration-the establishment of one composite rate for all dialysis facilities, the creation of a special composite rate adjustment factor that compensates rural facilities for their higher overhead costs due to lower utilization, or the creation of an explicit exception for higher rural facility overhead costs. *Response:*
                         We recognize that large chain dialysis providers operate with the benefit of economies of scale, and may be better able to adapt to the impact of policy changes to the composite payment rates. However, we have no evidence to indicate that rural facilities have higher overhead and supply costs per treatment. Payments to rural facilities are lower compared to urban facilities because rural facility composite rate costs, including labor costs, are generally lower. We do not believe our use of a CBSA-based wage index would change our conclusion, however, as noted below, we will continue to monitor provider cost data. Moreover, section 623(b) of the MMA and section 422(a)(2) of BIPA prohibit the granting of new exceptions for the composite rate, except for pediatric ESRD facilities. b. Revised Labor-Related Portion The current composite rate wage index is applied to two different labor-related shares, 40.65 percent for independent facilities and 36.78 percent for hospital-based facilities. Given the age of the cost data used to develop these shares, we proposed revising the labor-related portion of the composite rate based on the ESRD composite rate market basket contained in our May 2003 Report to Congress on developing a bundled outpatient ESRD payment system. We proposed the use of a single labor-related share of 53.711 percent that would apply to both hospital-based and independent facilities. This proportion was based on the sum of the labor-related categories of costs that comprise the ESRD market basket. (70 FR 45796 through 45798). We received the following comments on this proposal. *Comment:*
                         One commenter criticized our use of the ESRD composite rate market basket developed from CY 1997 data to revise the labor related-portion of composite rate costs subject to wage index adjustment. The commenter maintained that the use of more recent cost report data to develop a revised labor-related share would be more reflective of current economic realities. Another commenter recommended that we use the hospital market basket, which was developed from fiscal year 2002 data, instead. The commenter reasoned that the hospital market basket would be a more appropriate measure, not only because it reflects more recent data, but also because ESRD facilities compete with hospitals for labor and use the same vendors for supplies. *Response:*
                         Calendar year 1997 was the most recent year for which relatively complete data were available when the ESRD composite rate market basket was developed in 2003. Until the ESRD market basket is rebased to incorporate later data, we believe it is proper to use the 1997-based ESRD composite rate market basket to determine the labor-related share because it reflects the cost structures of ESRD facilities serving Medicare beneficiaries. We will continue to evaluate the available data on ESRD facilities and expect to periodically rebase the ESRD market basket when appropriate. We disagree with the commenter's recommendation to use the 2002-based hospital market basket to determine the labor-related share for ESRD facilities. We believe the 1997-based ESRD market basket best reflects the types of medical services and cost structures used by ESRD facilities. This is consistent with other payment systems that use individually tailored market baskets to determine their labor-related share. *Comment:*
                         One commenter attempted to replicate the basic composite payment rate (that is, the payment rate 
                        ( print page 70169)
                        prior to application of the drug add on and patient specific case-mix adjustments) for the Orlando, Florida MSA. The commenter inquired whether the proposed revised wage index for each urban/rural area is applied to 40 percent or 100 percent of the wage adjustment reflected in the current composite payment rates. *Response:*
                         The published wage index applicable to each urban/rural area is neither applied to 40 percent nor 100 percent of the composite payment rate's current wage adjustment. We currently multiply the current wage index by one of two different labor-related portions of the composite payment rates, depending on the type of ESRD facility. The portion is 40.65 percent for independent facilities and 36.78 percent for hospital-based facilities. However, the composite rate wage index itself is a blend of two separate wage index values. Of the current measure, 40 percent, is based on the hospital wage index calculated from fiscal year 1986 data, and 60 percent is based on the hospital wage index calculated from 1980 BLS data. However, in our August 8, 2005 proposed rule, we proposed making the labor-related portion the same for both hospital-based and independent ESRD facilities. That proportion (53.711 percent) was developed from the labor-related components of the ESRD composite rate market basket. Moreover, the proposed wage index is not a blended measure. It was developed exclusively from hospital wage and employment data for fiscal year 2002 obtained from the Medicare hospital cost reports. We proposed to apply the proposed wage index values to 100 percent of the 53.711 percent labor-related share. The revised labor-related shares applicable to hospital-based and independent ESRD facilities were contained in Table 26 of our proposed rule. Using data contained in Table 26 in our proposed rule, we calculated that the basic composite payment rate for hospital-based ESRD facilities in the Orlando MSA would have been $71.12 × 0.9677 + $61.29 or $130.11. For independent facilities the rate would have been $68.94 × 0.9677 + $59.41 or $126.12. c. Adoption of Floor/Ceiling Wage Index Values and Transition Policies for Implementation of Revised Wage Index The wage index values in the current composite payment rates reflect a floor of 0.90 and a cap of 1.30. In the August 8, 2005 rule, we proposed eliminating the cap because of the effect it has had on restricting payments in high wage areas. While we stated that we would like to remove the floor as well, we were concerned that its immediate elimination could adversely affect beneficiary access to dialysis. To mitigate any potential adverse impact, we proposed a gradual reduction in the floor to 0.85 for 2006 and 0.80 in 2007, with a reevaluation of continued need for the floor in 2008. We also proposed a 2-year transition for implementation of the new composite payment rates, but only for those facilities whose CBSA based payment decreased. Under the proposed transition, facilities would be paid the higher of the new wage adjusted composite rate, or a 50-50 blend of the current wage adjusted rate and the new wage adjusted rate (70 FR 45798 through 45799). We received the following comments regarding the proposed ceiling and floor wage index values and the 2-year transition period. *Comment:*
                         Several commenters representing facilities whose payment rates would increase as a result of the revised urban/rural definitions and wage index values, endorsed the immediate introduction of the new basic composite payment rates. Other commenters either supported the proposed 2-year transition period, or recommended longer transitions of varying duration to mitigate further the impact of reduced composite payments. *Response:*
                         Most commenters endorsed our proposal to provide for a transition period to mitigate the impact of the revised CBSA based composite payment rates, but believed that a 2-year transition was too short. The recommended transition periods, generally ranged from 3 to 5 years, with several commenters supporting a transition period of 5 years. We agree that a longer transition period is appropriate to allow ESRD facilities sufficient time to adjust to the new CBSA based wage index, and have selected 4 years as a reasonable compromise among the recommended alternatives. While a 4-year transition is longer than the transition in other payment systems, we believe it is justified in the case of ESRD facilities because the wage data currently used for the wage index is over 20 years old. Thus, facilities need more than the usual transition. However, we will apply the 4-year transition period to all ESRD facilities, those whose base composite payment rates compared to those currently in effect increase as well as decrease. This represents a change from our proposed policy of applying a transition period only to those facilities whose composite payment rates decreased. We believe that a transition period of 4 years applied to all ESRD facilities achieves a reasonable balance between cushioning the impact for providers whose CBSA based composite payment rates decrease, and implementing the CBSA based wage index as quickly as possible. *Comment:*
                         We received several comments on our proposal to reduce gradually the wage index floor from its current level of 0.90, to 0.85 in 2006 and 0.80 in 2007. The comments included keeping the floor at 0.90, maintaining the floor at 0.90 but simultaneously increasing the ceiling from its current level of 1.30 to 1.40, and phasing out the floor as proposed, but also extending the phase out to the wage index ceiling as well. *Response:*
                         We recognize that only immediate elimination of the 0.90 floor could substantially reduce composite payments in locales where prevailing labor costs are lower. Although ESRD facilities in areas with wage levels below 0.90 have benefited from the application of the floor, we are concerned that its sudden elimination could adversely affect ESRD beneficiary access to care. In the August 8, 2005 rule, we proposed lifting the wage index cap of 1.30 entirely in 2006 because it has restricted payments in areas with high labor costs. Under our proposal ESRD facilities whose base composite payment rate increased would receive the full payment amount per treatment without regard to the cap. We have carefully reconsidered our proposal in light of concerns over the potential impact of the use of new CBSA-based geographic designations and wage index values on ESRD facilities that will experience a decrease in their composite payments. We believe that it would be more consistent and equitable for all ESRD facilities if we phased out the wage index floor and eliminated the ceiling. Accordingly, we are implementing a 4-year transition period that will apply to all ESRD facilities, those experiencing either an increase or decrease in their base composite payment rate for 2006. Although the present wage index ceiling of 1.30 will be eliminated in 2006, facilities whose payments have been restricted by the ceiling would not receive 100 percent of their otherwise applicable base composite payment per treatment without the ceiling until 2009. This occurs as a result of blending the proportion of old MSA and new CBSA based wage adjusted composite rates over the 4-year transition period as shown in Table 20. By applying blended shares during the 4-year transition period to all ESRD facilities, we believe we can achieve a balance between our goals of preserving access to care in low 
                        ( print page 70170)
                        wage areas and the ultimate elimination of constraints on the wage index. The wage index floors, caps, and blended shares of the base composite payment rates applicable to all ESRD facilities for CYs 2006 through 2009 are detailed in Table 20. Table 20.—Wage Index Transition Blend
CY payment
Floor
Ceiling
Old MSA
New CBSA2006
0.85 *
None
75
252007
0.80 *
None
50
502008
Reassess
None
25
752009
Reassess
None
0
100* Each wage index floor is multiplied by a budget neutrality adjustment factor. For CY 2006 the budget neutrality adjustment is 1.045287 resulting in an actual wage index floor of .8885.
 We plan to reassess the continuing application of the wage index floor in connection with the 2008 update to the composite payment rates. An example of how the base composite payment rates would be blended during the 4 year transition period to reflect the old MSA and new CBSA based geographic designating follows. Assume an ESRD facility whose base composite payment rate (that is, without regard to any case-mix adjustments) is $135.00 per treatment in 2005. Based on the new CBSA wage index designations, its base composite payment rate is $145.00 for 2006. This facility's blended rate during each year of the 4 year transition period would be as follows: CY 2006—.75 × $135.00 + .25 × $145.00 = $137.50 CY 2007—.50 × $135.00 + .50 × $145.00 = $140.00 CY 2008—.25 × $135.00 + .75 × $145.00 = $142.00 CY 2009—0 × $135.00 + 1.0 × $145.00 = $145.00 Of course, this hypothetical assumes that the calculated rate of $145.00 for 2006 will not change in 2007 and the following years. In actuality, it would because of annual revisions to the wage index. However, the example serves to illustrate how the new CBSA-based composite payment rates will be phased-in during the 4 year transition period, regardless of whether an ESRD facility's base composite payment increases or decreases in 2006 compared to 2005. *Comment:*
                         One commenter endorsed our proposed elimination of the wage index cap, but was concerned that isolated rural ESRD facilities, whose wage levels are generally lower than those prevailing in urban locales, could be adversely affected, even with the proposed floor wage index values. The commenter recommended that these facilities continue to be permitted to receive the isolated essential facility exception to their otherwise applicable composite payment rate under § 413.186. *Response:*
                         ESRD facilities which have been granted exceptions to their composite payment rates, including those granted under the authority of § 413.186, have the option of either retaining their exceptions, or becoming subject to the case-mix adjusted composite payments, at any time. Beyond this option, we have no discretion to grant new exceptions under § 413.186. Section 422(a)(2) of BIPA, as amended by section 623(b) of the MMA, eliminated the granting of new exceptions to the composite payment rates except for ESRD facilities qualifying as pediatric facilities. We believe that the wage index floors of 0.85 for 2006 and 0.80 for 2007, the extension of the transition period from 2 to 4 years, and affording facilities the option of retaining previously granted exceptions, should help cushion any potential adverse impact to ESRD facilities located in isolated rural areas. *Comment:*
                         Several commenters expressed particular concern over the relatively large reduction in payment rates for dialysis facilities in certain rural areas and in certain States. While most of these locales were unspecified, some commenters used Ohio out as an example, noting that implementation of the revised wage index would reduce payment rates in Ohio by more than $14.00 per treatment. The commenters requested that we provide a State specific impact analysis, delay implementation of the proposed revised composite payment rates for a 6-month period, and engage in dialysis community discussions to determine whether changes to the proposed wage index floor values and modification of the proposed 2-year transition period, would be necessary. *Response:*
                         We strive to engage in discussions with the dialysis community concerning ESRD payment policies, such as our open door forums where the dialysis community can provide input to CMS on ESRD issues. Moreover, as noted previously, based in part on the comments received we are implementing revisions to our proposed policies regarding continuation of the wage index floor and ceiling, and the duration of the transition period. These changes should lessen the impact of our adoption of CBSA-based geographic designations and revised wage index values for ESRD services. We believe that no 6-month delay in implementing the revised composite payment rates is necessary. To respond to the commenter's suggestion that we provide a State-specific impact analysis, we have provided this information in Table 52. We are extending the proposed 2-year transition to a 4-year transition to allow affected facilities to adjust to the revised wage indices. *Comment:*
                         We received several comments which endorsed a phase in of the new CBSA based wage index based on a 50/50 split, similar to the wage index adopted in connection with the FY 2006 SNF PPS. *Response:*
                         The FY 2006 SNF PPS, published in the 
                        **Federal Register**
                         on August 4, 2005 (70 FR 45026), adopted a wage index consisting of a blend of 50 percent of the FY 2006 MSA-based wage index, and 50 percent of the FY 2006 CBSA-based wage index, both of which were developed from FY 2002 hospital wage data (70 FR 45041). This blended wage index is effective for a 1 year period. As the current ESRD wage index is obsolete, we see no reason to use it as a part of a blended measure which would then reflect an outdated wage index as part of a transition mechanism. 4. ESRD Wage Index Budget Neutrality Section 623(d) of MMA added section 1881(b)(12)(E)(i) to the Act which requires that any revisions to the ESRD composite rate payment system as a result of the MMA provision (including the geographic adjustment) be made in a budget neutral manner. This means that aggregate payments to ESRD facilities in CY 2006 should be the same aggregate payments that would have 
                        ( print page 70171)
                        been made if we had not made any changes to the geographic adjusters. We proposed to apply a budget neutrality adjustment factor directly to the revised ESRD wage index values, rather than applying the adjustment to the base composite payment rates. We believe this is the simplest approach since it allows us to maintain a base composite rate for hospital-based facilities and one for independent facilities during the transition from the current wage adjustments to the revised wage adjustments. The proposed budget neutrality adjustment was 1.023024. For CY 2006, we will apply the budget neutrality adjustment factor directly to the revised ESRD wage index values. Since we will be transitioning to the new wage index over a 4-year period, the computation of the adjustment factor varies slightly from our proposal. However, the basic method and concept is still the same as we proposed. In order to compute the proposed wage index BNF, we used treatment counts from CY 2004 billing data and facility-specific CY 2005 composite payment rates. For purposes of adjusting the labor-related portion of the CY 2006 ESRD composite rate, we are using the most recent hospital wage data applicable to FY 2006 payments as discussed previously in this section. Using treatment counts from the 2004 claims and facility-specific CY 2005 composite payment rates, we computed the estimated dollar amount each ESRD provider would have received had there been no changes to the ESRD wage index. This becomes the target amount of expenditures for all ESRD facilities. Then we computed the estimated dollar amount that would have been paid to the same ESRD facilities using the revised ESRD wage index (including the 4-year transition). In the first year of the transition, ESRD facilities receive 25 percent of the CBSA wage adjusted composite rate and 75 percent of the current composite rate. This becomes the first year new amount of expenditures for all ESRD facilities. After comparing these two dollar amounts (target amount divided by first year new amount), we calculate an adjustment factor that, when multiplied by the ESRD wage index, will result in the target amount of expenditures for all ESRD facilities. Since the ESRD wage index is only applied to the labor-related portion of the composite rate payment, we computed the adjustment based on that proportion (53.711 percent). We apply the estimated budget neutrality adjustment factor to the revised wage index values for CY 2006 to ensure that estimated aggregate payments to ESRD facilities would remain budget neutral. The final wage index BNF adjustment factor is 1.045287. Applying this budget neutrality to the wage index floor of 0.8500, results in a wage index floor for 2006 of 0.8885. As stated earlier, the data used to compute the BNF are the wage index values in Table 21 and 22, the 2004 100 percent Outpatient Standard Analytic File (SAF) Claims, and geographic location information for each facility which  may be found through Dialysis Facility Compare. *Comment:*
                         Several commenters requested that we provide the data and methodology used to compute the wage index BNF. *Response:*
                         The purpose of the wage index BNF is to achieve budget neutrality as required by section 623(d) of the MMA, which added section 1881(b)(12)(E)(i) to the Act. That provision of the Act requires that any revisions to the ESRD composite rate payment system (including the geographic adjustment) must be made in a budget neutral manner. This means that aggregate payments to ESRD facilities in CY 2006 should be the same as aggregate payments that would have been made if we had not made any changes to the geographic adjusters. The methodology for computing the wage index BNF is described earlier in this section. The data used to compute the BNF are the wage index values in Tables 21 and 22, the 2004 100 percent Outpatient Standard Analytic File (SAF) Claims, and geographic location information for each provider which may be found through Dialysis Facility Compare. Dialysis Facility Compare can be found by going to the following link: 
                        *http://www.medicare/​Download/​DOWNLOADDB.asp.* d. Wage Index Table The following two tables show the ESRD wage indexes for urban areas (Table 21) and rural areas (Table 22). 
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
 4. Miscellaneous Comments on ESRD Issues We propose to make no changes to the existing case-mix adjustment system. We proposed to maintain the existing system as established in the CY 2005 final rule (69 FR 66238) and implemented on April 1, 2005. *Comment:*
                         One commenter recommended that we stop the implementation of the basic case-mix adjustment. The commenter was critical of the case-mix adjustment because this commenter could not calculate the impact on their payment of one of the case-mix variables, specifically, weight. This commenter did not want to report weight as a case-mix variable because of the fluctuations in this variable, that is, weight changes. *Response:*
                         Section 623(d)(1) of the MMA added section 1881(b)(12)(A) of the Act requiring that the outpatient dialysis services included in the composite rate be case-mix adjusted. Case-mix variables are characteristics of the patients served that enable payment systems to reflect the resources needed by patients. The statute required adjustments to the composite payment rate for a limited number of patient characteristics. We implemented the case-mix adjustments required by the statute in April 2005, using research on case-mix variables to support our selection of a limited number of case-mix adjusters. A report on that research, entitled, “Methodology for Developing a Basic Case-mix Adjustment for the Medicare ESRD Prospective Payment System” is available on 
                        *www.sph.umich.edu/​kecc*. The selected case-mix adjusters are age, low body mass index (BMI), and body surface area (BSA). BSA and low BMI were selected because they are a better predictor of cost of care than using weight alone. Height and weight are the case-mix variables that we use to calculate BMI and BSA adjusters. For this reason, and because we think that facilities should be easily able to report a case-mix variable that should be part of each patient's ongoing care plan, we will continue to require reporting of the patient's weight for purposes of calculating the case-mix adjusters. *Comment:*
                         There were several comments recommending that we explore the option of adding variables to the existing basic case-mix adjustments. Commenters recommended including variables that measured improved survival rates, creating a new code for ESRD patients with diabetes, and adding measures that reflect improvements in the quality of life for ESRD patients. Comments indicated that the current case-mix adjustments do not adequately compensate providers for resources used or the intensity of care that is required to provide services to the frail elderly, and patients with ambulatory limitations or selected comorbid conditions. In addition, commenters recommended that we should consider a variable that adjusts for time in treatment; specifically recommending that we consider the potential predictive power of a variable that exported the interval following the initial 6 months of ESRD treatments because the intensity of care and resources could increase. *Response:*
                         We indicated in the proposed rule that we anticipated maintaining the basic case-mix adjustment as established in the CY 2005 final rule (69 FR 66238) and implemented on April 1, 2005. Although we understand the comments that we explore additional case-mix variables, we do not currently have the data that would be necessary to analyze the current case-mix adjustment variables and refine the basic system. Therefore, we believe that it is premature at this time to add additional variables to the basic case-mix adjustment system. Several of the variables recommended, including intensity of care, survival rates and quality of life improvement, are excellent recommendations as variables for exploration. As we stated in the CY 2005 final rule, the basic case-mix system is adjusts for a limited number of patient characteristics, consistent with the provisions of section 1881(b)(12)(A) of the Act as added by section 623 of the MMA. The MMA legislation anticipated that work would continue toward the development of a more fully bundled case-mix payment system for ESRD. We are continuing to work towards a more fully bundled case-mix system through ongoing research and development of a demonstration project required by the MMA. We have a contract with the University of Michigan to continue the research that was initiated in 2001 to explore a number of variables that could be predictive of resource use in a fully bundled case-mix adjusted system. This research will include exploring the predictive potential of variables available from existing data sources, including assessing the potential impact of comorbid conditions to predict payments. Several of the suggestions, specifically, survival rates, assessing improvements in the quality of life for ESRD patients, developing frailty/ambulatory limitation measures, require the construction of classification measures of functioning for disability and health. These are beyond the scope of our existing research efforts; however, over time, HHS may include efforts to develop classifications of functioning for disability and health measures, as well as add quality measurements as part of our payment systems. In addition, we will be assessing the data submitted under the existing basic case-mix system. As the analysis of this data progresses, we will consider potential refinements to the basic case-mix system. We are also working on a demonstration project that will assess the use of a fully case-mix adjusted payment system. Both the demonstration and the ongoing research will examine the impact of comorbid conditions on case-mix and payment. Regarding the comment that we should create a reimbursement code for ESRD patients with diabetes, we note that we did analyze comorbid conditions as part of the research for the basic case-mix system. At that time diabetes was not found to be a significant predictor. In addition, our staff found that the reporting of comorbid conditions, including diabetes, was frequently limited. Therefore, as part of our training effort, we have encouraged facilities to report all comorbid conditions, and plan to use the reported data in our ongoing research related to refining the basic case-mix system. Thus, we will continue to assess the impact of diabetes as a case-mix variable and a predictor of resource use, but we will not be requesting, at this time, the creation of a new code for diabetic ESRD patients for payment. *Comment:*
                         One commenter expressed concern regarding the reporting of height and weight for individuals who are double amputees. The comments indicated because of the case-mix adjustments for these individuals, the average reimbursement was reduced by an average of $20 per treatment even though these patients generally require the same or additional treatment because they could be in a wheel chair or possibly transported by stretcher. *Response:*
                         We concur that there may be issues surrounding the reporting of the height and weight variables associated with double amputees. We have explored a number of reporting options for these patients in an attempt to resolve both clinical and operational issues related to the reporting of these values. We agree that requiring that the height for double amputees be measured “as they present” may not accurately measure the necessary dialysis dose, we also believe that the reported weight for 
                        ( print page 70214)
                        these patients would require adjusting if we instructed facilities to report height “pre-amputation.” Based on the available literature related to height and weight measurements for double amputees, we believe there is sufficient data from which to appropriately adjust weight if height is reported pre-amputation. We relied on the methodology in the K-DOQI “Guidelines for Peritoneal Dialysis Adequacy.” Appendix E, Guideline 9 contains instructions related to adjustments to weight for amputees. Based on those guidelines, we are adopting the following formula for adjusting weight using the adjustment factor for below the knee (BKA) double amputees which is the most common type of double amputation: Pre-Amputation Weight = Actual Weight × 1.15 Therefore, for dialysis treatments provided on or after January 1, 2006, we will revise our claims processing instructions related to the reporting of height and weight for double amputee dialysis patients. Height would be reported “pre-amputation” and weight would be adjusted by 1.15 to reflect the “pre-amputation” weight. *Comment:*
                         We received a number of comments from ESRD patients expressing concern regarding the impact that any reductions in payment could have on their care. One ESRD patient expressed concern that if there were payment cuts, the facilities could be adversely impacted resulting in facilities closing. *Response:*
                         The intent of the changes in payments to ESRD facilities was to appropriately pay facilities based on the characteristics of the patients they treat, as well as the wage levels for the areas in which they are located. We note that all of the changes in payments as a result of the MMA legislation were done in a budget neutral manner. That is, aggregate payments to ESRD facilities remain constant. While the result of the changes we have made to the wage adjustment will result in redistributing payments to individual facilities, these changes more accurately pay facilities based on local wage levels. We understand the concerns expressed by these patients and have provided for a transition from the old, outdated wage adjustment to the revised adjustment to help mitigate any adverse impact to individual facilities. In addition, we have provided a 1.4 percent increase to the payment facilities receive for 2006 based on the projected increase in drug expenditure between 2005 and 2006. 5. Revisions to the Composite Payment Rate Exceptions Process In response to the changes made by section 422 of BIPA and section 623 of MMA, in the August 8, 2005 proposed rule (70 FR 45840 through 45842), we proposed changes to the existing regulations at § 413.180 through § 413.192 (42 CFR Part 413, Subpart H) regarding criteria and application procedures for requesting an exception to the ESRD composite rate payment. We also proposed to revise § 413.170(b) to specify that subpart H provides procedures and criteria under which only a pediatric ESRD facility as specified in the statute may receive an exception. a. Pediatric ESRD Facility Exception Existing exception rates are protected under section 422(a)(2)(C) of BIPA. The “protection” clause for existing exception rates provides that exception rates in effect on December 1, 2000 (or approved based on an application by July 1, 2001) remain in effect as long as the facility's exception rate is higher than the updated composite rate. Pediatric ESRD facility exception rates granted under the provisions of section 623 of the MMA (hereinafter referred to as “pediatric facility exception rates”) are not subject to the “protection” clause for existing exception rates. However, we proposed to change our regulations to continue pediatric facility exception rates in the same way as existing nonpediatric exception rates. Specifically, we proposed that both nonpediatric and pediatric facility exception rates would remain in effect until the facility notifies its fiscal intermediary that it wishes to give up its rate because its case-mix adjusted composite rate is higher. As section 422(a)(2)(B) of BIPA allows existing nonpediatric exception rates to continue in effect as long as the exception rate exceeds the facility's updated composite payment rate, we expected that each facility would compare its existing exception rates to its basic case-mix adjusted composite rates to determine which is the higher rate. We believe the determination as to whether an ESRD facility's exception rate per treatment will exceed its average case-mix adjusted composite rate per treatment is best left to the affected entity. In the past, an ESRD facility could request an exception to its prospective composite payment rate within 180 days of the effective date of its new composite rate (s) or the date on which we opened a specific exception window. We proposed to revise § 413.180(d) to remove the requirement that an application for an exception must be filed within the 180-day window because we believe that the small volume of applications will make it feasible for us to accept applications on a rolling basis. Therefore, we proposed to revise § 413.180(d) to state that a pediatric ESRD facility may request an exception to its composite payment rate at any time after it has been in operation for at least 12 consecutive months. For a full discussion of our proposal, see the August 8, 2005 proposed rule (70 FR 45840 through 45842). We received the following comments on these issues: *Comment:*
                         Several commenters asked for clarification that CMS will continue to recognize the exceptions status of non pediatric ESRD facilities. The commenters stated that the proposed rule presents conflicting statements about the continuing validity of these exceptions. *Response:*
                         We agree, and we are revising proposed § 413.180(i) to include the statement that “ESRD facilities electing to retain their nonpediatric or pediatric exception rates (including self-dialysis training) do not need to notify their intermediaries.” An ESRD facility may notify its fiscal intermediary at any time if it wishes to give up its nonpediatric or pediatric exception rate. Thirty days after written notice is received by the intermediary, the facility will become subject to the new basic case-mix adjusted composite payment rate methodology. A facility's decision to give up its exception rate can not be subsequently rescinded or reversed. *Comment:*
                         One commenter is concerned that the composite rate as modified by the MMA will be maintained for patients under age 18 in many facilities that do not qualify for a pediatric exception because the pediatric population is below 50 percent of all patients dialyzed. Patients under age 18 require additional resources. The commenter recommends that a facility should qualify for a pediatric exception if 25 percent of its patients are under 21 years of age. *Response:*
                         Section 623 of the MMA amended BIPA to allow a pediatric ESRD facility that did not have an approved exception rate as of October 1, 2002, to file for an exception to its updated prospective payment rate. To apply for the exception rate, the MMA requires that the pediatric facility has to demonstrate that at least 50 percent of its patients are individuals under 18 years of age. We believe the statute is very specific regarding the criteria a pediatric ESRD facility must satisfy in order to apply for 
                        ( print page 70215)
                        an exception rate. We have incorporated these statutory provisions in our proposed regulatory changes to § 413.170, § 413.182, and § 413.184. However, we note, that regardless of whether the pediatric exception is available to a facility, pediatric ESRD patients (defined as those under the age of 18) receive a specific case-mix adjustment factor when the composite payment rate is determined. None of the other case-mix adjustors that apply to nonpediatric patients (that is, the five age groups, low BMI, and BSA) is applicable to pediatric ESRD patients. *Comment:*
                         We received two comments supporting the proposed change to allow pediatric ESRD facilities to file an exception at anytime after it is in operation for at least 12 consecutive months. *Response:*
                         Previously, a pediatric ESRD facility that has been denied its exception would have to wait until a subsequent exception request. We have revised § 413.180(d) to provide that a pediatric ESRD facility that has been denied an exception may immediately file another exception request. However, a subsequent exception request must address the deficiencies cited in our determination letter. b. Pediatric Facility Exception Request Process Section 422 of BIPA prohibited CMS from providing exceptions to ESRD facilities on or after December 31, 2000. Section 623 of the MMA amended BIPA by restoring the exception process, but only for pediatric facilities that that did not have an approved exception rate as of October 1, 2002. To file for an exception, the pediatric facility would have to demonstrate that at least 50 percent of its patients are individuals under 18 years of age. Since the MMA restored the exception process only for pediatric facilities, we proposed to remove existing exception criteria that are not applicable to the newly defined pediatric facilities, including exceptions for isolated essential facilities, extraordinary circumstances, and frequency of dialysis as specified in regulations at § 413.182(b), (c), and (e). However, we proposed to retain the exception criterion for self-dialysis training costs under § 413.182(d) because some pediatric facilities may qualify for an exception on that basis. For a full discussion of our proposal, see the August 8, 2005 proposed rule (70 FR 45841). The comments received on these issues and our response to those comments are as follows: *Comment:*
                         Several commenters asked that we retain the exceptions process for all five previous exception criteria in order to preserve access to care for dialysis patients and to foster evolution in the patterns of dialysis care. Commenters pointed out that the recent experience with Hurricane Katrina underscores the need for an exception process to provide for continuity of dialysis care during extraordinary circumstances. Commenters included a recommendation that self-dialysis and more frequent dialysis should be preserved as exception options, noting that patients with congestive heart failure may require four dialysis treatments per week, and this is a growing segment of the ESRD population. Finally, the commenters stated that the exception for isolated essential facilities should be retained because of the potential impact on access to care resulting from the proposed changes in the composite payment rate wage index and reimbursement for ESRD drugs. *Response:*
                         We have determined that pediatric facilities would not qualify for an exception under most of the existing exception criteria because of the uniqueness of their patient population (at least 50 percent under age 18). In the past, ESRD facilities with high percentages of pediatric patients only qualified for exceptions under the “atypical patient mix” criterion specified at § 413.182(a) and § 413.184. We have, therefore, proposed to replace the “atypical patient mix” criteria with a more specific “pediatric patient mix” criteria and to retain this exception at proposed §§ 413.182 and 413.184. We proposed to eliminate the exception criteria that we believe do not apply to facilities with large numbers of pediatric patients (that is, exceptions on the basis of isolated essential facilities, extraordinary circumstances, and frequency of dialysis). Based on our experience in granting ESRD exceptions, we do not believe that a situation exists where any newly defined pediatric facility with the required volume of pediatric patients would qualify for an exception under the isolated essential facilities criterion. Further, we note that previous exception requests for “frequency of dialysis” were granted to ESRD facilities that dialyzed their patients less frequently than 3 times a week and not more frequently as suggested by the commenter. However, we proposed to retain the exception criterion for self-dialysis training costs under § 413.182(d) because we have found that some pediatric facilities may qualify for an exception on that basis. With respect to Hurricane Katrina, we have taken into consideration that, in this type of emergency (an extraordinary circumstance), alternatives exist to ensure that ESRD patients will have continuing access to services in other ESRD facilities. Any ESRD facility that has adequate treatment capacity, and is located close to a displaced patient's home, would be glad to offer its dialysis services. However, if there are no remaining ESRD facilities nearby to voluntarily accept displaced patients, dialysis service will be made available to these patients that have been temporarily relocated to a local shelter or to another town. Displaced patients relocated to another town that are healthy enough to drive or to be driven to a dialysis facility, will receive dialysis services there. Displaced patients in temporary shelters will receive dialysis from providers or suppliers that will send the necessary equipment, personnel, and supplies to the shelter. We are finalizing the changes to § 413.180 through § 413.192 as proposed. However, we have added language to § 413.180 regarding the intermediary notification discussed above. In addition, we are adding a technical clarification to proposed § 413.170 to cross-reference § 413.184 which specifies pediatric patient-mix requirements that pediatric ESRD facilities must meet to qualify for an exception. H. Payment for Covered Outpatient Drugs and Biologicals Medicare Part B covers a limited number of prescription drugs and biologicals. For the purposes of this rule, the term “drugs” will hereafter refer to both drugs and biologicals. Medicare Part B covered drugs not paid on a cost or prospective payment basis generally fall into three categories: Drugs furnished incident to a physician's service.
                    DME drugs.
                    Drugs specifically covered by statute (immunosuppressive drugs, for example). Beginning in CY 2005, the vast majority of Medicare Part B drugs not paid on a cost or prospective payment basis are paid under the ASP methodology. The ASP methodology is based on data submitted to us quarterly by manufacturers. In addition to the payment for the drug, Medicare currently pays a dispensing fee for inhalation drugs, a furnishing fee for blood clotting factors, and a supplying fee for certain Part B drugs. In this section of the preamble we discuss the August 8, 2005 (70 FR 45843) proposed changes and issues related to the determination of the payment amounts for covered Part B drugs and the separate payments 
                        ( print page 70216)
                        allowable for dispensing inhalation drugs, furnishing blood clotting factor, and supplying certain other Part B drugs. We also discussed proposed changes in how manufacturers calculate the ASP and in the ASP data reported to us. 1. ASP Issues Section 303(c) of the MMA amended Title XVIII of the Act by adding new section 1847A. This new section establishes the use of the ASP methodology for payment for most drugs and biologicals not paid on a cost or prospective payment basis furnished on or after January 1, 2005. The ASP reporting requirements are set forth in section 1927(b) of the Act. Manufacturers must submit ASP data to us quarterly. The manufacturers' submissions are due to us not later than 30 days after the last day of each calendar quarter. The methodology for developing Medicare drug payment allowances based on the manufacturers' submitted ASP data is specified in the regulations in part 414, subpart K. Based on the data we receive, we update the Part B drug payment amounts quarterly. In this section of the preamble, we discuss: Our proposed changes related to the methodology manufacturers use to calculate the ASP and apply the estimate of lagged price concessions in the ASP calculation; the reporting of ASP data; the weighting methodology we follow to establish the Medicare payment amounts using the ASP data; the comments received and our responses; and our final policy with respect to these issues. a. Estimation Methodology for Lagged Price Concessions Section 1847A(c)(5)(A) of the Act states that the ASP is to be calculated by the manufacturer on a quarterly basis. As a part of that calculation, manufacturers are to take into account price concessions such as— Volume discounts.
                    Prompt pay discounts.
                    Cash discounts.
                    Free goods that are contingent on any purchase requirement.
                    Chargebacks.
                    Rebates (other than rebates under the Medicaid drug rebate program). If the data on these price concessions are lagged, then the manufacturer is required to estimate costs attributable to these price concessions. Specifically, the manufacturer sums the price concessions for the most recent 12-month period available associated with all sales subject to the ASP reporting requirements. The manufacturer then calculates a percentage using this summed amount as the numerator and the corresponding total sales data as the denominator. This results in a 12-month rolling average price concession percentage that is applied to the total in dollars for the sales subject to the ASP reporting requirement for the quarter being submitted to determine the price concession estimate for the quarter. The methodology is specified in § 414.804(a)(3). We identified a refinement of the ASP calculation and lagged price concession estimation methodology related to chargebacks that we believe improves the accuracy of the estimate. As a result, we proposed to clarify the ASP calculation in the August 8, 2005 proposed rule (70 FR 5843). b. Price Concessions: Wholesaler Chargebacks Wholesaler chargebacks are a type of price concession, generally paid on a lagged basis, that apply to sales to customers (for example, physicians) via a wholesaler (or distributor). Wholesaler chargeback arrangements may vary in scope and complexity. Under the current estimation methodology for lagged price concessions, total lagged price concessions, including lagged wholesaler chargebacks, for the 12-month period are divided by total sales for that same period to determine a ratio that is applied to the total sales for the reporting period. The ratio of lagged price concessions to sales is calculated over all sales, both indirect sales (sales to wholesalers and distributors and other similar entities that sells to others in the distribution chain) and direct sales (sales directly from manufacturer to providers, such as hospitals or HMOs). To the extent that the relationship between total dollars for indirect sales and total dollars for all sales is different for the reporting quarter and the 12-month period used, the current ratio methodology for estimating lagged price concessions may overstate or understate wholesaler chargebacks expected for the reporting period. A more accurate estimation of lagged price concessions would minimize the effect of quarter to quarter variations in the relationship between indirect sales and all sales. As a result, we proposed to revise § 414.804 to require manufacturers to calculate the ASP for direct sales independently from the ASP for all other sales subject to the ASP reporting requirement (indirect sales). Then, the manufacturer would calculate a weighted average of the direct sales ASP and the indirect sales ASP to submit to us. We believed that the weighted average of direct sales ASP and indirect sales ASP would improve the overall accuracy of the ASP calculation, particularly for NDCs with significant fluctuations in the percentage of sales that are direct sales. We proposed conforming changes to § 414.804 for the methodology for calculating the lagged price concessions percentage. We also proposed to revise the regulation to clarify that the estimation ratio methodology relates to lagged price concessions and also define “direct sales” and “indirect sales” in § 414.802. In addition, we requested comments about the advisability and potential effects of requiring manufacturers to calculate the ASP for direct sales, including price concessions, independently from the ASP for indirect sales and then calculating a weighted average of these ASPs to submit to us, as well as the proposed definitions of direct sales and indirect sales. *Comment:*
                         We received many comments on our proposed refinement to the ASP calculation. Nearly all of these commenters opposed this proposal and many asked for clarification of the proposed terminology. All but one of the comments received from drug manufacturers stated that the proposed change to the ASP calculation would require significant modifications to manufacturers' accounting and reporting data systems while resulting in minimal change or benefit to the ASP-based payment. Many commenters stated that the proposed modification to the ASP calculation would not result in more accurate payments. Further, comments from groups representing drug and biological manufacturers stated that they do not believe the proposed methodology will have a material impact on the overall ASP or the accuracy of the calculation. Many of the commenters opposing the proposal stated that the expense and burden of implementing the proposed change to the ASP calculation would be unjustified because direct and indirect sales and price concessions for a given product are stable over time, particularly for generic products, and further breakdown of the calculation would not have a significant impact on the ASP calculation. Many commenters also noted that implementing the proposed weighted average approach would increase both the complexity of the ASP calculation and the potential for calculation error. We received comments from manufacturers of oncology, inhalation, contrast media, and other drugs and biologicals that included estimates of the potential impacts of the proposed 
                        ( print page 70217)
                        modification to the ASP calculation for a limited number of NDCs chosen as examples. These estimates ranged from a slight decrease (less than one half of a percent) to a 4.3 percent increase in the overall ASP for the NDC. One manufacturer estimated that sales would have to vary 20 percent from the 12-month lag period to change the ASP by more than 1 percent. Notwithstanding the potential change in the overall ASP, all but one manufacturer, which reports ASP for a single product, recommended that we not adopt the proposed change. However, some of these commenters suggested that the weighted average approach be voluntary or applicable only in cases where significant fluctuations exist in the proportion of sales that are direct and indirect and there is a compelling need to apply the proposed methodology. Other commenters from the manufacturing community were concerned about consistency across manufacturers and recommended that we not leave it up to each manufacturer to choose whether to use the proposed methodology or not. One commenter suggested that the proposed methodology be mandatory for a manufacturer that has at least one NDC with direct sales of 33 percent or more of gross sales for the prior year. The manufacturer would then be required to calculate the ASP for all of its NDCs using the proposed methodology. Several commenters expressed concern that the proposed definitions of direct and indirect sales were unclear and required further clarification to ensure consistent application across manufacturers. Several commenters noted that our use of the term supplier was confusing; that it was unclear whether GPO sales would be considered direct or indirect; and it was unclear how utilization rebates to PBMs should be categorized. Several commenters noted that certain purchasers (for example, specialty pharmacies) may purchase both directly and indirectly during a given reporting period. Similarly, we received a comment from a drug manufacturer requesting greater clarification on how to allocate price concessions across direct and indirect sales when a customer purchases under both of these channels. Several manufacturers noted that their current data systems were not capable of capturing data at the level of detail necessary to accurately segregate sales into the direct and indirect categories. Other commenters noted that, in general, manufacturers do not track price concessions associated with direct or indirect sales. As a result, several commenters recommended that, if the proposed methodology is adopted, we implement the change prospectively to allow for a phase-in period and to delay implementation until April 2006 or later to provide time for systems changes to be implemented and tested. We received a few comments from drug manufacturers expressing their belief that other market issues cause fluctuation in the ASP, and that it would be more beneficial to receive guidance on how to resolve these issues. A few commenters were concerned with the time frame for implementation of the proposed modification of the ASP calculation. These commenters recommended that we consider delaying implementation until after a trial period or at least until April 2006. We also received comments from providers who have experienced difficulty acquiring drugs at or below the payment amount. These commenters, as well as comments from physician organizations, support changes to the ASP calculation insofar as they will result in more appropriate reimbursements for Part B drugs. *Response:*
                         Our goal is to ensure continued beneficiary access to care through implementation of accurate and sufficient payment systems. To this end, we proposed to refine the ASP calculation because the weighted average of direct sales ASP and indirect sales ASP could potentially improve the overall accuracy of the ASP calculation. We greatly appreciate the efforts undertaken by commenters to examine the potential impacts of the proposed method on the overall ASP calculation. Based on the comments received, we find compelling the commenters' concerns about the challenges and increased burden associated with calculating the ASP independently for direct and indirect sales and then calculating the weighted average ASP. Although we continue to have interest in the potential impacts of quarter to quarter variations in estimates of price concessions, we will not adopt the proposed change at this time. In reaching our decision, we noted that all of the drug manufacturers that submitted comments reported that the impact of the proposed refinement of the ASP calculation would be minimal or not material. We note that these commenters are in a position to assess the impacts of the proposed methodology on their customers and to weigh the potential benefits and burdens inherent with the proposed change. In all but one case (a manufacturer which reports ASP for only one product), they did not support the proposal because they believe the burden would outweigh the benefit. Among the comments received that specified potential percentage changes in the overall ASP, a range of potential impacts was reported. One of the examples submitted suggested that the impact could extend to upwards of a 4 percent increase in the ASP for an NDC, while another example showed a slight decrease. We cannot determine whether the reported examples are representative of other or all NDCs subject to the ASP reporting requirements. We also noted the concerns expressed by manufacturers regarding the significant additional burdens associated with the proposed methodology, the potential for inconsistent application of the proposed methodology across manufacturers, and the potential effects of the proposed methodology on manufacturers' systems. In addition, we carefully considered the comments from the physician community in support of refinements to the ASP calculation that would increase payments. Although we are not implementing the proposed refinement to the ASP calculation at this time, we will continue to work with manufacturer to better understand the instances in which the proposed methodology may benefit the program and the potential for appropriate use of that methodology for certain or all NDCs, and whether such an approach would be sustainable. We did not receive any comments on our proposal to revise the regulations at § 414.804 to clarify that the estimation ratio methodology published on September 16, 2004 (69 FR 55763), relates to lagged price concessions; therefore, we will implement the revised regulatory language as proposed. c. Determining the Payment Amount Based on ASP Data As explained in the August 8, 2005 proposed rule (70 FR 45844) in response to inquiries we have received related to the formula we use to calculate the payment amount for each billing code we posted information on our web site (
                        *http://www.questions.cms.hhs.gov*) earlier this year. We included this information (which follows) in the proposed rule to ensure greater public access to this information. For each billing code, we calculate a weighted ASP using the ASP data submitted by manufacturers.
                    Manufacturers submit ASP data at the 11-digit NDC level.
                    Manufacturers submit the number of units of the 11-digit NDC sold and the ASP for those units.( print page 70218)
                    We convert the manufacturers' ASP for each NDC into the ASP per billing unit by dividing the manufacturer's ASP for that NDC by the number of billing units in that NDC. For example, a manufacturer sells a box of 4 vials of a drug. Each vial contains 20 milligrams (mg). The billing code is per 10 mg. The conversion formula is: manufacturer's ASP/[(4 vials × 20 mg)/10 mg = 8 billable units per NDC].
                    Then, the ASP per billing unit and the number of units (11-digit NDCs) sold for each NDC assigned to the Billing Code are used to calculate a weighted ASP for the billing code. We sum the ASP per billing unit times the number of 11-digit NDCs sold for each NDC assigned to the billing code, and then divide by the total number of NDCs sold. The ASP per billing unit for each NDC is weighted equally regardless of package size. *Comment:*
                         Several manufacturers and other commenters representing the manufacturing community recommended that the formula be revised so that the payment limit is calculated based on the weighted ASP of the number of billing units sold rather than the number of NDCs sold. These commenters noted that products are available in different package sizes and that a billing code may encompass multiple NDCs. As a result, these commenters contend that weighting the ASP payment amount by NDCs sold does not reflect the true weighted average price per billing unit. Several commenters, including manufacturers and their trade associations, noted that altering the formula to weight by the number of billing units sold may increase or decrease the overall ASP. Nonetheless, these commenters recommend adoption of their recommended alternative formula. One commenter suggested that the alternative formula be adopted along with an exception process that would be applicable to billing codes that represent therapies of differing weights or dosage. We also received comments from manufacturers that supported continued use of the current formula. *Response:*
                         In establishing the formula used to calculate the payment amounts based on the manufacturers' ASP data, we considered various approaches, including the alternative approach recommended by some commenters. For the initial implementation of the ASP methodology, we operationalized the calculation of ASP by weighting the formula by the number of NDCs sold. As we gain more experience with the ASP data and other sources of information become available about the purchasing patterns of providers and their acquisition costs, we may consider altering the methodology or establishing exceptions, if we find good reason to do so. If we decided such a change is warranted, we would implement the change at the next quarterly update. *Comment:*
                         Although not directly related to the formula used to calculate the ASP payment amounts, we received several comments from oncology physician practices and other commenters related to the adequacy of the ASP+6 percent payment methodology and other topics. We received several comments from oncology and other providers contending that the Medicare payment amount does not always cover their acquisition costs for certain drugs. A mid-sized oncology practice reported that it is unable to obtain nearly half of the drugs it administers at a price below the Medicare reimbursement rate. This commenter believes that larger practices may not face drug acquisition costs that exceed ASP+6 percent. One oncology practice reported that the ASP+6 percent payment would cover its drug costs if beneficiaries could always afford their cost sharing amounts. A large oncology practice stated that its average Medicare reimbursement, which is 2 percent more than its acquisition costs, was insufficient and would cause it to discontinue treatment for beneficiaries. On the topic of price concessions, several commenters, including a drug manufacturer, suggested that prompt pay and other discounts given to wholesalers and distributors should not be included in the calculation of the manufacturers' ASP so that the payment amounts would be increased. *Response:*
                         It is true for all payment systems based on averages that the payment amount may not equal a specific provider's cost for every service. Section 1847A of the Act specifies that the Medicare payment is at 106 percent of ASP for the majority of Part B drugs and biologicals not paid on a cost or prospective payment basis. The statute requires use of the ASP+6 percent payment methodology except in limited instances. Although several commenters (most of which represent oncology practices) reported that the ASP+6 percent methodology was insufficient to cover their drug acquisition costs for certain drugs, these commenters also acknowledged that the Medicare payment exceeds their drug acquisition costs for other drugs. This is consistent with the findings of recent studies by the General Accountability Office (GAO) (GAO-05-142R), Office of Inspector General (OIG) (“Adequacy of Medicare Part B Drug Reimbursement to Physician Practices for the Treatment of Cancer Patients”, (A-06-05-00024), and MedPAC (October 6, 2005, public meeting report on oncology site visits). These studies have found that physicians generally can obtain oncology drugs for prices below Medicare reimbursement. We did not propose a change to the price concessions manufacturers must include in the ASP calculation. Section 1847A(c)(3) of the Act specifically identifies prompt pay discounts as a type of price concession that must be included in the manufacturer's calculation of the ASP. *Comment:*
                         We received comments from a few drug manufacturers requesting clarification and more detailed guidance on the treatment of administrative fees, service fees, and data fees in the ASP calculation. *Response:*
                         These issues are beyond the scope of this rule. We will continue to work with manufacturers to more fully understand these issues. We expect to publish a final rule on the ASP reporting requirements and will consider these comments in the course of preparing that rule. *Comment:*
                         We received comments from oncology practices, ESRD facilities and retail pharmacies, as well as IVIG manufacturers and stakeholders, indicating that manufacturer price increases are not reflected timely in the ASP+6 percent payment amounts due to the necessary lag time for calculating the rates and updating the payment systems. One commenter suggested that we implement a “true up” mechanism that immediately reconciles the historic reimbursement rate to reflect manufacturer price increases. Several IVIG stakeholders suggested that we issue payment rates on a retroactive basis. *Response:*
                         Section 1847A(c)(5)(B) specifies a prospective update in the payment amounts. We agree with the commenters' observations that there is a necessary time frame after the close of a calendar quarter for manufacturers to calculate and submit the ASP data to CMS, for CMS to prepare and issue the payment rates, and for the claims processing contractors to implement the updated payment files. As we stated in the CY 2005 final rule (69 FR 66300), we implement these new prices through program instructions or otherwise at the first opportunity after we receive the data, which is the calendar quarter after receipt. *Comment:*
                         Several commenters, including patient and industry representatives and physicians as well as manufacturers, requested that we take steps to improve the availability of IVIG. Many of these commenters noted their 
                        ( print page 70219)
                        ongoing collaboration with the Congress, HHS, CMS and others to better understand the market forces and dynamics influencing the current IVIG situation. These commenters reported that numerous patients and physician practices have been adversely impacted by the change in reimbursement to the ASP+6 percent methodology. These impacts include postponed infusions, increasing intervals between infusions, having to receive treatment in the hospital setting rather than in the physician office, possible unintended reactions as a result of switching brands of IVIG, and increased level of effort to obtain product and schedule services. Several commenters restated suggestions previously communicated to us, including concerns about our proposed changes for IVIG reimbursement in the outpatient setting. Comments from an industry group referenced its new study that it is conducting to help clarify the marketplace and provide insight into the costs for providing IVIG services. The study will examine IVIG acquisition costs and related services. Citing the adverse effects of patients migrating from physician offices to hospitals for treatment, several commenters requested that we consider an interim add-on payment for the complex activities related to furnishing IVIG until the industry study is completed. These commenters noted that the add-on payment would ensure that providers are paid sufficiently for IVIG under Part B so that their provision of IVIG remains viable and beneficiaries' access to IVIG is not reduced. *Response:*
                         We will continue to work with the IVIG community, manufacturers, the Congress, and other entities to seek better understanding of the supply and market issues influencing the current IVIG market. We look forward to learning of the industry's study findings as that work progresses. We have discussed the accuracy of the ASP data with the manufacturers and have been assured by these manufacturers that their ASPs have been developed in accordance with applicable guidance and that the resulting price reflects the current IVIG market in aggregate. At the same time, the IVIG manufacturers' association, the Plasma Protein Therapeutics Association, reports that the overall supply of IVIG is adequate and has improved in the past several months. However, based on the comments received and our ongoing work with manufacturers, patient groups, and other stakeholders, we continue to be concerned about reports of patients experiencing difficulties in accessing timely IVIG treatments and reports of providers experiencing difficulties in obtaining adequate amounts of IVIG products on a consistent basis to meet their patients' needs in the current marketplace. Most brands of IVIG have been put on allocation by manufacturers and some manufacturers have reported allocating products to a smaller number of distributors and reducing the size of inventories. In addition, there have been reports of diversion of products to the secondary market and secondary distributors raising prices markedly. The Secretary's Advisory Committee on Blood Safety and Availability has recommended immediate steps be taken to ensure access to IVIG so that patients' needs are being met. However, the complexity of the IVIG marketplace makes it unclear what particular systematic approaches would be most effective in addressing the many individual circumstances that have been shared with us while not exacerbating what appears to be a temporary disruption in the marketplace. IVIG is a complicated biological product that is purified from human plasma obtained from human plasma donors. Its purification is a complex process that occurs along a very long timeline, and only a small number of manufacturers provide commercially available products. Historically, numerous factors, including decreased manufacturing capacity, increased usage, more sophisticated processing steps, and low demand for byproducts from IVIG fractionation have affected the supply of IVIG. For CY 2006, there are 2 HCPCS codes that describe all IVIG products, based on their lyophilized versus liquid preparation. The recent patterns of utilization of IVIG also are unusual in comparison with most other drugs and biologicals. Different IVIG products are FDA-approved in a number of therapeutic areas for various specific conditions which include: anti-infective therapy (bone marrow transplant); immune globulin replacement therapy (primary immune deficiencies and chronic lymphocytic leukemia); anti-inflammatory therapy (Kawasaki disease); and immunomodulation therapy (idiopathic thrombocytopenic purpura). IVIG therapy, which has been available for about 25 years, was initially reserved for the treatment of these FDA-approved indications. More recently, IVIG has been increasingly used off-label so that off-label uses now significantly exceed on-label uses. Many of these off-label uses are for autoimmune, neurological, or systemic inflammatory conditions. Some off-label uses of IVIG are supported by a robust evidence base, while for other medical conditions the evidence has not demonstrated that IVIG infusions are of significant therapeutic benefit. There are also new emerging indications for IVIG treatment, including those based on recommendations from various professional associations and advisory groups. In addition, despite the growing uses of IVIG there are definite risks associated with IVIG treatment, including both early inflammatory reactions and more rare but serious renal and thromboembolic complications, as well as the inherent risk associated with receipt of any biological product even with the ongoing improvements in the safety of these types of products. Medicare currently has one national coverage determination in place since CY 2002 regarding IVIG infusions to treat autoimmune blistering diseases, and there are numerous local coverage policies that describe Medicare coverage for specific off-label indications. In the context of these national and local coverage policies, IVIG use in hospital outpatient departments has climbed steeply over the most recent years for which data are available, from about 40,000 infusion days in CY 2002, to 60,000 days in CY 2003, and again to over 70,000 days in CY 2004. The infusion of IVIG in physician offices increased from about 2.3 million grams in CY 2003 to 4.0 million grams in CY 2004. In the face of growing demand for IVIG in the absence of significant changes in the prevalence of medical conditions for which there is high quality evidence regarding the effectiveness of IVIG therapy, we are concerned that all patients with medical need for IVIG continue to have access to this expensive and valuable therapy. Over the upcoming year, we will be using our historical claims databases to study the epidemiology of IVIG treatment of Medicare beneficiaries in outpatient settings. We expect that the health system as a whole should encourage an accountable and scientifically-grounded use of IVIG, and we welcome discussions with industry, providers, and other interested entities regarding efforts to ensure that IVIG is responsibly utilized for evidence-based clinical indications so that optimal benefit is obtained. Commenters have indicated to us that the infusion of IVIG in physician offices is more complex and resource intensive, particularly during the actual infusion, than many other types of infusions currently reported using the same drug administration CPT codes. They have described the specific resources 
                        ( print page 70220)
                        required for initiating and monitoring infusions of IVIG for patients under various clinical circumstances. We encourage commenters to discuss their concerns with the CPT Editorial Panel to assess whether alternative coding or additional CPT guidance would be appropriate. In addition, they may wish to discuss their resource concerns with the AMA/Specialty Society RVS Update Committee that provides advice regarding the resources associated with physician services. Based on the potential access concerns, the growing demand for IVIG, and the unique features of IVIG detailed above, as we seek to gain improved understanding of the contemporary volatile IVIG marketplace, we will employ a two-pronged approach during CY 2006 to help ensure the availability of IVIG to physicians and hospital outpatient departments who care for Medicare beneficiaries and will be paid ASP+6 percent for the IVIG products. First, in addition to the ongoing monitoring and outreach activities within the HHS, the Office of the Inspector General (OIG) is studying the availability and pricing of IVIG as part of its monitoring of market prices pursuant to section 1847A(d)(2)(A) of the Act. We expect the OIG's work to provide a significant contribution to the analysis of the current situation with respect to the specific activities of manufacturers and distributors that may be contributing to possible access problems for IVIG as we move to the ASP methodology in both physician office and hospital outpatient settings. We hope to understand those particular market behaviors that may have led to such public alarm about the availability of IVIG and the adequacy of our payment rate of ASP+6 percent, concerns that have been particularly strong and persistent for IVIG in comparison with other drugs paid under the same ASP methodology. Second, we will provide additional payment in CY 2006. Presently the IVIG marketplace is a dynamic one, where a significant portion of IVIG products previously available in CY 2005 are being discontinued and other products are expected to enter the market over the next year. In light of this temporary market instability, we understand that manufacturers have continued allocation procedures aimed at stabilizing the supply of IVIG. Even so, we understand that providers may face purchasing whichever brand of IVIG is available, even if it is not a brand the patient is known to tolerate. Many patients treated with IVIG receive regular infusions on a predictable schedule. To meet this need, physicians' office staff must conduct significant preadministration services prior to IVIG infusions to monitor and manage their inventory, locate available IVIG products, reschedule infusions according to product availability and patients' needs, and implement physicians' determinations regarding whether the available formulations are appropriate for patients and whether specific dosing adjustments are required. Product-specific factors must be evaluated in light of patients' clinical indications for the IVIG infusions, their underlying medical conditions, and their past reactions to various IVIG products, and office staff must locate appropriate doses of IVIG products in light of these considerations. If the appropriate IVIG product formulations were more widely and reliably available, we do not believe that routine IVIG infusions would require these extensive preadministration-related services prior to each infusion. To continue to ensure appropriate patient access to IVIG in CY 2006 during this short-term period of market instability for IVIG, beginning for dates of service on or after January 1, 2006 through December 31, 2006, we will temporarily allow a separate payment to physicians to reflect the substantial additional resources that are associated with locating and acquiring adequate IVIG product and preparing for an office infusion of IVIG in the current environment. We expect that making separate payment for these additional necessary services will help insure that physicians are able to continue to provide IVIG infusions to their patients who depend upon them. We will also provide an additional payment to hospital outpatient departments for these special services, to ensure that patients continue to have access to IVIG infusions in the most medically appropriate settings, without undesirable shifts in sites of service for their care. Because the resources associated with the preadministration-related services for intravenous infusion of immunoglobulin are not accounted for in the physician office practice expense associated with the CY 2006 drug administration codes that will be billed for IVIG infusions, we are creating a temporary G-code to describe these additional preadministration services related to the intravenous infusion of immunoglobulin. We have established the following G-code for physician office billing for CY 2006: G0332; 
                        *Preadministration-related services for intravenous infusion of immunoglobulin, per infusion encounter (This service is to be billed in conjunction with administration of immunoglobulin).* Physicians may bill this service once per day in association with a patient encounter for administration of IVIG, in addition to billing for the appropriate drug administration service(s) and for appropriate units of the HCPCS code that describes the IVIG product infused. In addition, physicians may also bill for any significant and separately identifiable evaluation and management (E/M) service they perform at a level 2 through 5 in association with the infusion encounter, appending modifier -25 to the E/M service. We have established the payment level for this service in physician offices by cross-walking the RVUs for the new G-code to the practice expense RVUs of 1.90 for G0319, ESRD related services during the course of treatment, for patients 20 years of age and over; with 1 face-to-face physician visit per month. We do not believe there is increased preadministration physician work associated with preparation for intravenous infusion of immunoglobulin, so we have not allocated the physician work RVUs assigned to G0319 to G0332. Physician work associated with preparation for the intravenous infusion of immunoglobulin is already included in the physician work allocated to the drug administration services associated with the infusion and to the evaluation and management services (including the pre- and post-work already included in the relative values for evaluation and management services) provided to patients receiving intravenous immunoglobulin treatments. However, we think G0332 requires additional resources from the physician practice, particularly clinical labor, that are comparable to the practice expense for the ESRD management code. We expect that in many cases IVIG infusions will be provided once per month, with activities in preparation for the infusion, including consulting with patients and distributors, conducted over the course of a month as are the ESRD related services described by G0319. In addition, preparation for the IVIG infusion will generally not require a face-to-face visit with the patient prior to the infusion, so we have selected the ESRD related services G code that includes only one physician visit for the practice expense crosswalk. We believe that this temporary separate payment provided through G0332 in CY 2006 for the physician office and hospital outpatient resources associated with additional IVIG preadministration-related services due to the present significant fluctuations in 
                        ( print page 70221)
                        the IVIG marketplace will ensure that Medicare beneficiaries depending on IVIG experience no adverse health consequences from the market instability for IVIG products. In the meantime, we will continue to evaluate the market factors affecting the pricing and availability of IVIG products in the context of our ASP+6 percent payment methodology and our separate payment for G0332 in CY 2006. We expect that in CY 2006 with continued collection of updated ASP data for IVIG; improved understanding of the IVIG marketplace; more focused attention on the medical necessity of the utilization of IVIG; ongoing collaboration between CMS, the IVIG community, manufacturers, providers, and other interested entities; and this temporary separate payment for hospital and physician office resources required for the intensive preadministration services related to IVIG infusion, the IVIG marketplace should stabilize over the upcoming year. Substantial preadministration-related services for IVIG infusions should no longer be required of physician offices and hospital outpatient departments that provide IVIG infusions to patients who need them. Therefore, this additional payment for G0332 is effective for CY 2006 only. Thus, we will be closely monitoring this issue once again in the context of our rulemaking for CY 2007. *Comment:*
                         Several commenters representing providers of community cancer care and manufacturers noted that physicians do not receive separate payment for pharmaceutical management and related pharmacy and handling costs (such as drug inventory, disposal of toxic waste, and spillage and breakage), and that in the 2006 proposed rule for HOPD we proposed a 2 percent add-on payment to the ASP+6 percent payment for drugs. These commenters stated the costs for handling pharmaceuticals are similar across settings and that physicians should receive the same add-on. *Response:*
                         The costs for handling pharmaceuticals are paid through the PE RVUs for the drug administration code. d. Reporting WAC As explained in the August 8, 2005 proposed rule (70 FR 45844) we have provided information on our web site (
                        *http://www.questions.cms.hhs.gov*) concerning reporting WAC. We state that manufacturers must report the WAC for a single source drug or biological if it is less than the ASP for a quarter and in cases where the ASP during the first quarter of sales is unavailable. Upon further review, we have determined that the WAC must be reported each quarter if required for payment to be made under section 1847A of the Act, in addition to the ASP, if available. Section 1927(b)(3)(A)(iii) of the Act specifies the ASP data manufacturers must report. Section 1927(b)(3)(A)(iii)(II) of the Act specifies that the manufacturer must report the WAC, if it is required in order for payment to be made under section 1847A of the Act. Under section 1847A of the Act, the payment is based on WAC (as opposed to ASP) in the following cases: For a single source drug or biological, when the WAC-based calculated payment is less than the ASP-based calculated payment for all NDCs assigned to such drug or biological product. (*See*
                         section 1847A(b)(4) of the Act.)
                    During an initial period in which data on the prices for sales for the drug or biological is not sufficiently available from the manufacturer to compute an ASP. (*See*
                         section 1847A(c)(4) of the Act.) In these instances, we must make the determination of whether the payment amount is based on ASP or WAC. Therefore, WAC is required for payment in all of these instances. As explained in the August 8, 2005 proposed rule (70 FR 45844), we had previously published a template which manufacturers must use to report ASP data to us; however, the WAC was not included in that template. Therefore, because of the requirement to report the WAC and the confusion manufacturers have experienced in submitting the WAC data we proposed, in a separate information collection notice published August 19, 2005 (70 FR 48770), to revise the reporting template to include a place to report WAC. To clarify the instances when manufacturers are required to report the WAC, in the August 8, 2005 proposed rule (70 FR 45844), we stated that manufacturers are required to report quarterly both the ASP and the WAC for NDCs assigned to a single source drug or biological billing code. Manufacturers are also required to report the WAC for use in determining the payment during the initial period under section 1847A(c)(4) of the Act. That is, the WAC is reported for the reporting period prior to reporting the ASP based on a full quarter of sales. Because the WAC could change during a reporting period, we proposed that in reporting the WAC, manufacturers would be required to report the WAC in effect on the last day of the reporting period. *Comment:*
                         Some commenters noted that requiring manufacturers to report WAC for all single source drugs each quarter encompasses the requirement for manufacturers to report WAC for new drugs during the initial period. Separately specifying these instances in the preamble led some commenters to request clarification of how the proposed policy differs from the existing requirements posted on our web site. Several manufacturers requested that we clarify in the final rule with comment that the WAC in effect on the last day of the reporting period is the value to be submitted for that reporting period. *Response:*
                         We agree with the commenters who noted that new drugs are a subset of single source drugs. We separately specified the requirements for reporting WAC in these two instances so that manufacturers would be aware of the reporting requirement and because we have discussed these instances separately in past rulemaking. The proposed change is different from existing guidance previously posted on our web site in that we clarify that submission of the WAC in these instances is always necessary for payment to be made. The manufacturer does not decide if the WAC is to be submitted and the WAC is not submitted only if it is less than the ASP as previously posted on our web site. We interpret section 1927(b)(3)(A)(iii)(II) of the Act to apply to all NDCs of single source drugs. Final Decision Manufacturers must report WAC for all single source drugs (including new drugs) each reporting period. In submitting the WAC, manufacturers must report the WAC in effect on the last day of the reporting period. We will update our web site to include this decision. e. Revised Format for Submitting ASP Data The August 8, 2005 proposed rule (70 FR 45845) included a discussion of the format manufacturers are required to use to report the ASP data to us. However, as discussed above, the current template does not provide adequate instructions for manufacturers to report both the ASP and the WAC. Therefore, we published a separate information collection notice on August 19, 2005 (70 FR 48770) and proposed to revise the ASP reporting format to accommodate submission of both, the ASP and the WAC as well as collect the following additional information: Drug name.( print page 70222)
                    Package size (strength of product, volume per item, and number of items per NDC).
                    Expiration date for last lot manufactured.
                    Date the NDC was first marketed (for products first marketed on or after October 1, 2005).
                    Date of first sale for products first sold on or after October 1, 2005. *Comment:*
                         We received several comments in response to the proposed rule related to our separate information collection notice on the proposed changes to the ASP reporting format (CMS-10110; see 70 FR 48770). The commenters generally supported inclusion of the WAC and drug name within the reporting format. Some commenters expressed concerns related to the level of burden that would be necessary to report some of the proposed additional data elements, particularly the date the NDC was first marketed. Some commenters suggested refinements to the definitions of the proposed data elements and the frequency of their collection. In addition, commenters suggested that we consider using data elements collected by Medicaid in lieu of the proposed data elements pertaining to first marketing date, first date of sale, and expiration date. In addition, commenters stated that they were uncertain when the proposed changes to the reporting requirements would be effective. *Response:*
                         We appreciate receiving the comments on the proposed additional data elements and the proposed revisions to Addendum A used to report ASP data. To be considered timely, comments on the proposed modification to ASP reporting format must have been mailed within 60 days of that notice (by October 18, 2005). All timely comments were not available for consideration at the time of the preparation of this final rule with comment. Changes to the ASP information collection (CMS-10110; OMB control number 0938-0921), if adopted by CMS and approved by the OMB, would be effective as of the approval date of the information collection submission Manufacturers would begin reporting the additional data elements with the next reporting deadline. f. Limitations on ASP Section 1847A(d)(1) of the Act states that “the Inspector General of HHS shall conduct studies, which may include surveys to determine the widely available market prices (WAMP) of drugs and biologicals to which this section applies, as the Inspector General, in consultation with the Secretary determines to be appropriate.” Section 1847A(d)(2) of the Act states that “Based upon such studies and other data for drugs and biologicals, the Inspector General shall compare the ASP under this section for drugs and biologicals with— The widely available market price (WAMP) for these drugs and biologicals (if any); and
                    The average manufacturer price (AMP) (as determined under section 1927(k)(1) of the Act for such drugs and biologicals.” Section 1847A(d)(3)(A) of the Act states that “The Secretary may disregard the ASP for a drug or biological that exceeds the WAMP or the AMP for such drug or biological by the applicable threshold percentage (as defined in subparagraph (B)).” The applicable threshold is specified as 5 percent for CY 2005. For CY 2006 and subsequent years, section 1847A(d)(3)(B) of the Act establishes that the applicable threshold is “the percentage applied under this subparagraph subject to such adjustment as the Secretary may specify for the WAMP or the AMP, or both.” For CY 2006, we proposed to specify an applicable threshold percentage of 5 percent for both the WAMP and AMP. We did not receive the OIG's final report in time for consideration before developing the proposed rule. Thus, we believe that continuing the CY 2005 threshold percentage applicable to both the WAMP and AMP is most appropriate. *Comment:*
                         One commenter stated its support of credible drug rates that are based upon widely accepted health care industry standards, and that are established using methodologies that are clear and readily understood by persons with health care industry knowledge. In this context, the commenter expressed concern about how well the terms WAMP and AMP are understood across the health care industry. Several commenters supported our proposal to retain 5 percent as the applicable threshold for 2006, while strongly urging that we not implement the provisions relating to substitution of the ASP until notice and comment rulemaking is conducted. Many commenters referred to the language in the Conference Report accompanying the MMA that discusses rulemaking in connection with this issue and requested that we follow the intent of that language and provide the public the opportunity to evaluate the validity of the processes used and the data obtained by OIG. *Response:*
                         We appreciate the commenter's acknowledgement that we are required to specify the threshold percentage applicable in 2006. Section 1847A(d)(3)(B)(i) of the Act specified the applicable threshold percentage for 2005. Section 1847A(d)(1) of the Act requires that the OIG conduct studies to determine the WAMPs, and the OIG began its study activities shortly after the passage of the MMA. Upon completion, the OIG's findings and methodology will be available to the public. We are aware of the Conference Report language; however, given the statutory requirements in section 1847A(d), we do not believe rulemaking is appropriate at this time. Final Decision We will establish 5 percent as the applicable threshold for 2006. 2. Payment for Drugs Furnished During CY 2006 in Connection With the Furnishing of Renal Dialysis Services if Separately Billed by Renal Dialysis Facilities Section 1881(b)(13)(A)(iii) of the Act indicates that payment for a drug furnished during CY 2006 and subsequent years in connection with the furnishing of renal dialysis services, if separately billed by renal dialysis facilities, will be based on the acquisition cost of the drug as determined by the OIG report to the Secretary as required by section 623(c) of the MMA or, the amount determined under section 1847A of the Act for the drug, as the Secretary may specify. In the report entitled, “Medicare Reimbursement for Existing End Stage Renal Disease Drugs,” the OIG obtained the drug acquisition costs for the top 10 ESRD drugs for the 4 largest ESRD chains as well as a sampling of the remaining independent facilities. Based on the information obtained from this report, for CY 2005, payment for the top 10 ESRD drugs billed by freestanding facilities and payment for EPO billed by hospital-based facilities was based on acquisition costs as determined by the OIG. Due to the lag in the data obtained by the OIG, we updated the acquisition costs for the top 10 ESRD drugs to 2005 by the PPI. The separately billable ESRD drugs not contained in the OIG report were paid at the ASP+6 percent for freestanding facilities. The payment allowances for these remaining drugs were updated on a quarterly basis during 2005. Section 1881(b)(13)(A)(iii) of the Act gives the Secretary the authority to establish the payment amounts for separately billable ESRD drugs beginning in 2006 based on acquisition costs or the amount determined under section 1847A of the Act. As discussed in the proposed rule, we do not believe that it is appropriate to continue to use 
                        ( print page 70223)
                        2002 acquisition costs updated by the PPI for another year as the basis for payment. The acquisition costs are based on 2002 data which, despite updates by the PPI do not necessarily reflect current market conditions. Thus, the chances increase that Medicare payments will either overpay or underpay for drugs resulting in payments that are inconsistent with the goal of making accurate payments for drugs. We also considered whether actual acquisition cost data could be periodically updated. However, we do not believe that it would be feasible to base Medicare payments over the long term on continually acquiring data on actual acquisition costs from ESRD facilities. This approach would provide incentives for manufacturers and facilities to increase acquisition costs without constraint. It also would not necessarily provide data regarding current market rates. Therefore, we proposed that the payment methodology for all ESRD drugs when separately billed by freestanding ESRD facilities during CY 2006 be the amount determined under section 1847A of the Act. This payment amount is the ASP+6 percent rate. Based on an analysis of the 2002 acquisition costs for the top 10 separately billable ESRD drugs, when updated by the PPI for CY 2006, it is our contention that relying on 2002 acquisition cost data updated for a number of years as would be necessary to establish a payment amount for 2006 is not the most appropriate option for determining Medicare payment rates when other drug-specific pricing is available. Further, we contend that relying on the ASP+6 percent as the payment rate for all separately billable ESRD drugs when billed by freestanding ESRD facilities for CY 2006 is a more reliable indicator of the market transaction prices for these drugs. The ASP is reflective of manufacturer sales for specific drug products and is more indicative of market and sales trends for those specific products than the 2002 OIG acquisition cost data. We also note MedPAC's recommendation in its June 2005 report that the ASP be the basis of payment for all separately billable ESRD drugs provided by both freestanding and hospital-based facilities in CY 2006 (MedPAC, “Report to the Congress: Issues in a Modernized Medicare Program,” June 2005). In making this recommendation, MedPAC states that the ASP data are more current (updated quarterly) and more likely to reflect actual transaction prices when compared with acquisition cost data which are not regularly collected by the OIG or CMS. Furthermore, the report indicated that utilizing the same payment policy for both freestanding and hospital-based facilities would ensure uniformity across the various settings irrespective of the site of care. In addition, MedPAC recommends in its report that we obtain, “* * * data to estimate hospitals” costs and Medicare's payment per unit for these drugs. No published source identifies the unit payment for these drugs because Medicare pays hospitals their reasonable costs.” MedPAC further states: “We attempted to calculate the unit payment from 2003 claims data, but the accuracy of the data fields we needed to make this calculation was unclear, particularly the number of units furnished and Medicare's payment to the hospital.” MedPAC also recommends that CMS or the OIG collect acquisition cost data periodically in the future to gauge the appropriate percentage of ASP for the payment amount. We acknowledged MedPAC's recommendations regarding uniformity across the various settings irrespective of the site of care and believe it is more appropriate to pay for separately billed drugs furnished in hospital-based facilities under the ASP+6 percent methodology rather than on a reasonable cost basis. Therefore, for CY 2006, we proposed that payment for a drug furnished in connection with renal dialysis services and separately billed by freestanding renal dialysis facilities and EPO billed by hospital-based facilities be based on section 1847A of the Act. We proposed to update the payment allowances quarterly based on the ASP reported to us by drug manufacturers. We sought comment on our proposed decision to revise the payment methodology for separately billable ESRD drugs and about the potential method we have discussed in other sections of this final rule with comment which would permit us to pay hospital-based facilities under the ASP+6 percent methodology for 2006. We also sought comment on how this proposed decision could affect beneficiaries' or providers' access to these drugs. We received numerous comments regarding our proposal to pay for drugs furnished in connection with renal dialysis services and separately billed by free-standing renal dialysis facilities as well as EPO billed by hospital-based facilities at the ASP+6 percent payment methodology. We also received comments on our proposal to continue to pay hospital-based facilities reasonable cost for separately billable ESRD drugs. Those comments and responses are provided below. *Comment:*
                         Several commenters agreed with our proposal to use the ASP+6 percent methodology as the basis for payment for drugs furnished in connection with renal dialysis services and separately billed by free-standing renal dialysis facilities as well as EPO billed by hospital-based facilities and our decision to update the payment allowances on a quarterly basis. These commenters viewed the ASP+6 percent payment methodology as superior to the average acquisition payment methodology as the ASP+6 percent methodology enables payment to reflect the actual market transaction prices for ESRD drugs. Commenters stated that reliance on the ASP+6 percent methodology will lead to a more uniform payment policy across care settings. These commenters strongly recommended that we finalize our proposal to pay all ESRD drugs when separately billed by freestanding ESRD facilities, as well as EPO when furnished in hospital-based facilities at ASP+6 percent. It was noted that the ASP+6 percent methodology is easier for us to administer as we already collect and update ASP data on a quarterly basis. Other commenters were cautious in regards to the ASP system, indicating that although the shift from average acquisition cost to ASP+6 percent appeared rational, the ASP would be largely influenced by the lower large provider price. As a result, the ASP prices would not reflect the acquisition costs for all providers. Small dialysis facilities would be unable to purchase ESRD drugs at the proposed prices and would be at risk of being paid well below their acquisition costs, as they lack the same buying power or economics of scale that larger facilities possess. Some commenters focused on statements we made in the past in which we stated that we expected smaller providers to join buying groups in order to reduce acquisition costs. These commenters stated that although almost all small dialysis providers belong to such buying groups, such arrangements have not reduced the disparity between the large providers' acquisition prices and the small providers' acquisition prices. Commenters suggested that this “market dynamic” with extremely different buying power among providers does not exist in any other market where we have established drug payment policies. *Response:*
                         We agree with the commenters who suggested that we establish the 2006 payment rates for drug furnished in connection with renal dialysis services and separately billed 
                        ( print page 70224)
                        by freestanding renal dialysis facilities and EPO billed by hospital-based facilities using the ASP, rather than use the 2002 average acquisition costs updated by the PPI. We also agree for 2006 to apply the quarterly update of ASP data to payment for drugs furnished by freestanding renal dialysis facilities and EPO billed by hospital-based facilities. After consideration of the feasibility of continuing to use 2002 acquisition costs updated by the PPI for another year, we have determined that the ASP+6 percent methodology is the most accurate measure for paying for EPO furnished in hospital-based facilities and for separately billable ESRD drugs provided in freestanding dialysis facilities. Implemented in 2005 by the MMA of 2003, the ASP methodology is based on data submitted by manufacturers of Medicare Part B drugs. The ASP for all drug products included within the same billing and payment code is the volume-weighted average of the manufacturers' ASPs reported to us across all the NDCs assigned to the billing or payment code. Therefore, the ASP is a more accurate indicator of market trends for specific drugs. We do not agree with commenters who suggest that varying buying power only exists among providers of ESRD drugs. Other purchasers of Part B drugs have expressed concerns to us regarding a variation in buying power. We will continue to support groups representing Medicare Part B drug purchasers, especially small and rural purchasers, to help them identify the most favorable drug prices possible. *Comment:*
                         Many commenters requested that if we implemented the ASP-based methodology for separately billable ESRD drugs, we should utilize the most recently available ASP data and update that data quarterly. These commenters expressed concern about the significant lag time apparent in the current ASP methodology, indicating the lag time results in a decrease in payment that no dialysis facility has the ability to make up. Commenters encouraged us to provide retrospective payments to dialysis facilities, particularly small or independent dialysis providers to prevent such facilities from reducing services or from closing. One large drug manufacturer suggested that we consider an alternative drug payment option for small providers and we assure that these providers are not negatively affected by changes in the payment policy for drugs. Commenters suggested that we utilize a methodology that uses average acquisition price for small providers as the marker for ESRD drug reimbursement, citing section 1881(b)(13)(A)(ii) of the Act as the authority. Under this system, we would collect acquisition cost data from small providers, update the data for the current year and establish payment rates on these acquisition costs. Other commenters suggested that we consider establishing an exception process whereby rural or inner city ESRD facilities could request an alternate payment based on their actual drug acquisition costs as a result of unique economic circumstances. Some commenters suggested that we exclude EPO from the ASP payment methodology, stating that EPO has only one manufacturer and accounts for a large proportion of drug payment to independent dialysis facilities. Some commenters suggested that contracts of large providers are able to influence the ASP for EPO and for these providers; the acquisition price will be close to ASP. The inclusion of EPO in the ASP methodology will create disparity in patient care. *Response:*
                         In response to concerns regarding the significant lag time apparent in the ASP methodology, the ASP methodology is based on ASPs reported by manufacturers quarterly. Manufacturers must report to us no later than 30 days after the close of the quarter. We implement these new prices through program instructions or otherwise at the first opportunity after we receive the data, which is the calendar quarter after receipt. We do not agree with commenters who suggested that we permit small, rural, or inner city ESRD facilities to request an alternate payment based on their actual drug acquisition costs, or that we exclude EPO from the ASP payment methodology. We do not have that authority. Section 1881(b)(13)(A)(iii) of the Social Security Act states that the Secretary chooses the methodology to determine payment rates for all drugs separately billed by ESRD facilities. The language refers to the choice of acquisition costs as determined by the Inspector General of the ASP rates. Section 1881(b)(13)(A)(ii) does not provide authority for individual providers to choose whether to be paid on the basis of costs or the ASP method. *Comment:*
                         Several organizations stated that payment differences should be eliminated for separately billable drugs furnished in independent and hospital-based facilities and the ASP payment methodology should be used for all drugs provided in hospital-based facilities. One commenter agreed with our concerns regarding the lack of available data from hospital claims and recommended that the Secretary collect data on the acquisition cost and payment per unit for drugs furnished by hospital-based providers, or consider using the unit dosing information obtained from claims submitted by freestanding dialysis facilities and consult with clinical experts regarding the appropriateness of the dose data. *Response:*
                         We agree with commenters who suggested that we utilize the same payment methodology for separately billable drugs furnished in independent facilities and hospital-based facilities. For reasons discussed in the ESRD section of this final rule with comment, we believe it is appropriate to implement the ASP payment methodology for all drugs provided in hospital-based facilities. *Comment:*
                         Prompt pay discounts are included in the calculation of the ASP; however, commenters stated that small customers do not normally receive such discounts. Rather, these customers are charged an additional service fee to the price of the product. Thus, by including prompt pay discounts in the calculation of the ASP, the ASP is lowered, but the small providers are not privy to such discounts. Commenter also stated that sales to cutomers outside of independent dialysis facilities are included in the calculation of the ASP and thus, contribute to the difference between manufacturer-provided ASPs and provider acquisition costs. They stated that we have established a distinct methodology for drug payment for hospital-based dialysis facilities, and therefore, it is inappropriate to include such customers in the ASP payment system for independent dialysis facilities. *Response:*
                         In the calculation of the ASP, as specified in Section 1847A(c)(3), a manufacturer should include volume discounts, prompt pay discounts, cash discounts, free goods that are contingent on any purchase requirements, chargebacks, and rebates (other than rebates under the Medicaid rebate statute). We lack the statutory authority to permit manufacturers to exclude prompt pay discounts from the calculation of the ASP. Further, the statute does not permit the exclusion of or differentiation by classes of trade in the calculation of the ASP payment rates, except for the specific statutory exceptions described in the Medicaid best price calculation under sections 1927(c)(1)(C)(i) and 1927(c)(1)(C)(ii)(III) of the Act. *Comment:*
                         Several commenters stated that the ASP methodology does not take into consideration provider costs for storage, handling, and wastage. Small 
                        ( print page 70225)
                        providers will be disadvantaged as they have less efficient and more costly systems for storage and handling. *Response:*
                         The ASP+6 percent payment methodology was not intended to cover the handling and storage of drugs. 3. Clotting Factor Furnishing Fee Section 303(e)(1) of the MMA added section 1842(o)(5) of the Act which requires the Secretary, beginning in CY 2005, to pay a furnishing fee in an amount the Secretary determines to be appropriate to hemophilia treatment centers and homecare companies for the items and services associated with the furnishing of blood clotting factor. In the CY 2005 final rule (69 FR 66236), we established a furnishing fee of $0.14 per unit of clotting factor for CY 2005. Section 1842(o)(5) of the Act specifies that the furnishing fee for clotting factor for years after CY 2005 will be equal to the fee for the previous year increased by the percentage increase in the consumer price index (CPI) for medical care for the 12-month period ending with June of the previous year. The percent increase for the 12 months ending June 2005 is 4.2 percent. Consequently, the furnishing fee will be $0.146 per unit clotting factor for CY 2006. While the furnishing fee payment rate is calculated at 3 digits, the actual amount paid to providers and suppliers is rounded to 2 digits. The requests to publish the 2006 furnishing fee in the final rule with comment were the only comments we received on the clotting factor section in the proposed rule. 4. Payment for Inhalation Drugs and Dispensing Fee Medicare Part B pays for inhalation drugs administered via a nebulizer, a covered item of DME. Beginning in CY 2006, coverage for inhalation drugs administered through metered dose inhalers will generally be available through the Medicare Part D benefit. This represents an important expansion in the options available to beneficiaries for inhalation drug coverage under Medicare. We expect that both modes of inhalation drug delivery will play an important role in the Medicare program in the years to come. Prior to CY 2004, most Medicare Part B covered drugs, including inhalation drugs administered by a nebulizer (hereafter referred to as inhalation drugs), were paid at 95 percent of the AWP. Numerous studies by the OIG and GAO indicated that 95 percent of AWP substantially exceeded suppliers' acquisition costs for Medicare Part B drugs, particularly for the high volume inhalation drugs, albuterol and ipratropium bromide.[1]
                        
                         The MMA changed the Medicare payment methodology for many Part B covered drugs, including inhalation drugs. As an interim step, in CY 2004, Medicare paid a reduced percentage of AWP, 80 percent of AWP in the case of albuterol and ipratropium bromide. Beginning with CY 2005, Medicare paid for inhalation drugs at 106 percent of the average sales price (ASP+6 percent). In addition to making payment for the drug itself, Medicare also pays a dispensing fee to suppliers of inhalation drugs. Prior to CY 2005, Medicare paid a monthly $5 dispensing fee for each covered inhalation drug or combination of drugs used. In the August 5, 2004 proposed rule (69 FR 47488), we sought comment on an appropriate dispensing fee level to cover the shipping, handling, compounding, and other pharmacy activities required to get these medications to beneficiaries. We received many comments asserting that a substantial fee was needed to compensate suppliers for a wide range of costs associated with dispensing drugs to beneficiaries, with many citing a 2004 report prepared by a consultant for the American Association for Homecare (AAH) that recommended a $68 fee.[2]
                        
                         The 2004 AAH report provided information for 10 cost categories: clinical intake; establishing/revising the plan of care; delivery of services; compliance monitoring/refill calls; billing/collections; other direct costs; patient education; caregiver training; care coordination; and in-home visits. In addition, as discussed in the August 8, 2005, proposed rule, a 2004 study by the GAO showed substantial variation in supplier costs of dispensing inhalation drugs.[3]
                        
                         With the wide variation in the reported costs and services provided by inhalation drug suppliers suggested by the comments and the GAO study, we stated in the CY 2005 final rule (69 FR 66338) that we would establish an interim dispensing fee for inhalation drugs applicable for CY 2005 and reconsider the issue for CY 2006. The 2005 dispensing fee for a 30-day supply of inhalation drugs was based on the industry recommended $68 fee from the 2004 AAH study, excluding certain costs that Medicare generally does not reimburse regardless of the Medicare Part B benefit category (that is, sales and marketing, bad debt, and an explicit profit margin). The resulting fee established for a 30-day supply of inhalation drugs was $57 for CY 2005. Because the 2004 AAH study did not establish a fee for a 90-day supply, we applied the methodology used in the 2004 GAO report to convert the 30-day fee to a 90-day fee. Accordingly, the 2005 fee established for a 90-day supply was $80. In establishing the dispensing fee rates for 2005, we indicated in the CY 2005 final rule that although the AAH study contained costs related to services that may be of potential benefit to our beneficiaries, we were concerned that these services may be outside the scope of a dispensing fee. We indicated that we would consider this issue further in order to establish an appropriate dispensing fee for CY 2006. As discussed in the August 8, 2005 proposed rule (70 FR 45847), we indicated that we intend to establish a dispensing fee amount for 2006 that is appropriate to cover the costs of those services that fall within the scope of a dispensing fee. Furthermore, we indicated that we thought this fee amount likely would be lower than the current fee of $57 per 30-day period in 2005. In the proposed rule we solicited public comments and information on a number of issues including the following: What services appropriately fall within the scope of a dispensing fee; the cost of providing those services; and, whether any of the services being provided by inhalation drug suppliers may be covered through another part of the Medicare program, such as the PFS or the DME benefit.
                    An appropriate dispensing fee level for 2006 as well as data and information on the various services inhalation drug suppliers are currently providing to Medicare beneficiaries and the associated costs, and typical dispensing costs for an efficient, high-quality supplier.
                    The extent to which inhalation drug suppliers have utilized the newly available 90-day scripts in order to reduce unit shipping costs and any reasons as to why 90-day supplies may not have been utilized.
                    How revised guidelines regarding the timeframe for delivery of refills has affected the need for overnight delivery services as well as the extent to which suppliers have shifted their shipping to ground services.
                    Comments on the potential impact on beneficiaries and providers of possible changes to the inhalation drug dispensing fee in 2006, as well as the( print page 70226)
                        impact of the new drug benefit on inhalation drug access. *Comment:*
                         Many commenters suggested that dispensing inhalation drugs to Medicare beneficiaries involves a wide range of services that should be compensated through the dispensing fee. A number of commenters referenced a 2005 report by an industry consultant sponsored by the AAH.[4]
                        
                         The 2005 AAH report indicated that suppliers provide services in seven broad categories: Intake; compounding, dispensing, and pharmacy assessment; delivery, set-up, and patient education; follow-up and compliance monitoring; quality assurance, accreditation, licensing, and regulatory compliance; Medicare billing and compliance; and other direct and indirect costs and expenses. Within these seven categories, the 2005 AAH report indicated that there were “117 discrete services” provided to or on behalf of Medicare beneficiaries. The 2005 report surveyed 82 homecare pharmacies. The vast majority of survey respondents thought the 117 discrete services outlined by the consultant fell within the scope of a dispensing fee, and the vast majority of respondents indicated they were providing these services. Several commenters suggested that the survey demonstrated there was widespread agreement that the standard of care for inhalation drug suppliers involved a wide range of services. In addition, one commenter asserted that the 117 services identified in the 2005 AAH report encompassed all of the functions identified in the 2004 AAH report prepared by the same consultant, which formed the basis of the 2005 fee. *Response:*
                         We established the interim dispensing fee for 2005 based on cost data from the 2004 AAH report. That report provided cost data for 10 service categories: Clinical intake; establishing/revising the plan of care; delivery of services; compliance monitoring/refill calls; billing/collections; other direct costs; patient education; caregiver training; care-coordination; and in-home visits. In using this data to establish the 2005 fee in the CY 2005 final rule, we indicated that we were concerned that some of the services in the industry cost data may be outside the scope of a dispensing fee and we would revisit this issue further in order to establish an appropriate dispensing fee for CY 2006. As discussed in the August 8, 2005, proposed rule, we continue to have concerns with respect to what services should be included within the dispensing fee payment. Authority for a dispensing fee for inhalation drugs is based on section 1842(o)(2) of the Act, which provides that if payment is made to a licensed pharmacy for a drug or biological under Medicare Part B, the Secretary may pay a dispensing fee (less the applicable deductible and coinsurance) to the pharmacy. The statute did not define the term dispensing fee or set parameters as to what activities should be included within the scope of that definition. However, as discussed below, we do not believe the Congress intended us to adopt the broad reading of dispensing fee suggested by commenters. We are not persuaded by suggestions that Medicare should broadly define the definition of dispensing fees for inhalation drugs to include pharmacy care management services such as patient education, caregiver training, care coordination, and in-home visits. A number of commenters suggested the dispensing fee be based on the total costs of supplying inhalation drugs indicated by the 2004 AAH report data. That data indicated that suppliers expend on average 63.5 minutes per new patient and 50 minutes per established patient per month on patient education, caregiver training, care coordination, and in-home visits. Such services represent pharmacy care management services, which (if included in dispensing fee payments) would extend the definition of dispensing fee beyond what we believe should be reasonably  included within the scope this benefit. As an initial matter, we do not believe that there is any indication that the Congress intended these care management activities to be included in the definition of dispensing fees. Where the Congress wished for us to cover the costs of such training and management services under Medicare, it specifically directed us to do so (for example, by amending the statute to recognize diabetes outpatient self management training under Medicare Part B and medication therapy management programs under Medicare Part D (see sections 1861(qq) and 1860D-4(c) of the Social Security Act). Therefore, in accordance with our interpretation of the statute, we do not believe it is reasonable for us to define the term dispensing fee under Medicare Part B to include the costs of such services. In addition, we also believe that the inclusion of beneficiary education and training about use of nebulizers would raise duplicate payment issues. Payment for DME is based on fee schedule amounts which include, in part, amounts for training beneficiaries on the use of nebulizer equipment. Thus, the equipment supplier is responsible for educating the beneficiary on the use of the DME or ensuring that “another qualified party” has done so as specified in § 424.57(c)(12). In addition, under the physician fee schedule Medicare makes a separate payment for beneficiary training by a physician or physician's staff regarding use of a nebulizer (CPT code 94664, demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). We believe that physicians can play an important role in beneficiary training concerning the use of nebulizers, as they are ultimately responsible for directing beneficiary care, and determining what drug treatment regimen is most effective for an individual patient. Accordingly, because payment for education, training, and management concerning use of nebulizer equipment may be separately recognized under Medicare, we are concerned that the inclusion of such services within the definition of dispensing fee would increase the potential for double billing. We are also not persuaded by commenters' suggestions that the 2005 AAH report demonstrates that the standard of care for supplying inhalation drugs includes a broad range of services. The 2005 AAH report presented results from a survey of homecare companies, in which the companies were asked whether 117 activities or overhead items should be included in the dispensing fee and whether the companies currently provide or undertake each activity/item (although the frequency and extent to which each activity/item was provided was not asked). The 2005 report identified services provided but failed to provide any information on the proportion of beneficiaries actually receiving various services (for example, patient education, caregiver training, in-home visits). It also did not provide any information on the cost of various services (other than delivery), or the amount of time involved in providing these services to the typical beneficiary. Consequently, the 2005 AAH report fails to demonstrate that the 117 activities/overhead items outlined in the 2005 report translate into an average of 63.5 minutes per new patient and 50 minutes per established patient each month for the care management services of patient education, caregiver training, in-home visits, and care coordination in the 2004 AAH report. Since the 2005 report did 
                        ( print page 70227)
                        not include information on costs, the 2004 AAH report is the only information we have on average cost and time per activity. However, even the 2004 AAH report does not contain information on the proportion of beneficiaries that actually receive the care management services. Accordingly, given the data identified in the reports, we are not persuaded by the AAH reports that the standard of care for supplying inhalation drugs includes extensive care management services for patient education, caregiver training, in-home visits, and care coordination. Furthermore, a September 2005 OIG study entitled “Review of Services Provided by Inhalation Drug Suppliers” [5]
                        
                         found little evidence that inhalation drug suppliers provide care management services to many beneficiaries. The OIG report sought to ascertain the nature and extent of services provided by inhalation drug suppliers. The OIG examined services such as clinical intake, revising the plan of care, patient/caregiver education, responding to patient/caregiver inquiries about the drug, contacting the physician's office, contacting a patient for a refill, reviewing medication compliance, and other certain services. The OIG did not focus on certain core activities such as filling prescriptions, delivery, and billing that they indicated were necessary for suppliers to dispense drugs and receive reimbursement. They also indicated that they excluded equipment related services because Medicare pays suppliers separately for equipment. The OIG report concluded that beneficiaries receive few services from their inhalation drug supplier beyond calls to ask if they need a drug refill. The OIG report found that among beneficiaries with at least 2 months of claims in 2003, 16 percent received no services (that is, no educational services, refill calls, or other adjunct services the OIG examined) from their inhalation drug supplier during the entire year. The OIG found that refill calls accounted for the majority of services provided by inhalation drug suppliers. In addition, the OIG found that only 16 percent of beneficiaries received an educational service from their drug supplier, 8 percent made a non-billing inquiry to their drug supplier, 8 percent received an in-home visit, 5 percent had a care plan revision, and 3 percent received a respiratory assessment from their drug supplier at least once during 2003. Furthermore, the OIG report indicated that only 27 percent of beneficiaries had their medication compliance reviewed by drug supplier at least once in 2003, with 89 percent of these reviews occurring during refill calls. Accordingly, in light of the OIG findings regarding services actually provided, we remain unconvinced regarding the standard of care contentions set forth in comments concerning the 2004 and 2005 AAH reports. As mentioned previously, we do not believe it is appropriate to include care management services such as patient education, caregiver training, care coordination, and in-home visits in the inhalation drug dispensing fee. Furthermore, the OIG found that few care management services were actually provided to a typical beneficiary. While it is possible that some types of care management services may be of potential benefit to some beneficiaries, at this time there is not clear evidence that such services are widely provided to beneficiaries nor have there been studies evaluating the effect of such services on beneficiary outcomes. Given such concerns, we do not believe it is appropriate for us to define dispensing fee under Medicare Part B to include care management services. However, we believe it is very important that the Medicare program support better patient care outcomes, particularly for beneficiaries with chronic respiratory conditions. We plan to explore how the Medicare program can engage physicians and their partners on issues of quality and performance to foster high quality of care for Medicare beneficiaries using respiratory drugs. For example, we believe there may be an opportunity under our demonstration authority to implement a demonstration program to test whether care management and care coordination services by physicians and their partners can improve health outcomes and reduce Medicare costs for beneficiaries who use inhalation drugs. *Comment:*
                         Some commenters criticized the OIG report as being too narrow in scope. A few commenters suggested that the OIG study excluded many essential services such as drug deliveries and billing activity that account for the bulk of services and costs. Another commenter suggested that the study did not capture all the services inhalation drug suppliers provide, including many that are required by State and Federal regulations (for example, Food and Drug Administration and State Pharmacy Boards), and standards of care for pharmacy practice. The commenters also criticized the OIG report for excluding billing services and not taking into account the substantial amounts of time spent doing the following: Collecting and processing the relevant billing information from the beneficiary and beneficiary's physician, which the commenter indicated often requires multiple on-site visits to doctors offices; verifying eligibility and processing reimbursement from secondary insurers responsible for payment of coinsurance; and researching and on-site verification of beneficiary financial and living circumstances in order to validate a waiver of coinsurance for hardship. The commenters also criticized the OIG report for not taking into account non-payment of coinsurance by Medicaid, the costs of Medicare billing requirements, and costs of oversight by multiple carriers. Furthermore, several commenters suggested that the OIG study undercounted services because the OIG survey instrument requested documentation for each service provided and the report focused on documented services. Some commenters suggested that this approach left out those services for which suppliers did not have documentation, either because they had discarded the documentation after it was no longer useful or because they had not documented services since there was no requirement to do so. Some commenters indicated that the mandatory refill calls require two telephone contacts on average before contact is made with the beneficiary. One commenter indicated that it maintains documentation of failed call attempts only for several months, and is not required to maintain long-term documentation of repeated calls and visits to patient homes and physicians' offices to gather documentation and information. In addition, one commenter noted that the OIG report expanded the categories of services it analyzed in its report based on information submitted by respondents in the survey instrument's “other” category. The commenter believed that this meant participants in the OIG report may not have always been explicitly asked about certain types of services. This commenter also criticized the OIG report for not conducting field work to observe the activities of inhalation drug suppliers, and indicated its belief that the GAO and 2004 AAH report included a more thorough analysis. Another commenter stated that the OIG report does not address the issue that the costs of dispensing drugs are higher than the current $57 fee for high quality suppliers in compliance with applicable requirements. Furthermore, the commenter stated that 
                        ( print page 70228)
                        the service levels suggested in the OIG report are not representative of high quality suppliers. The commenter also stated that the behavior of noncompliant suppliers should not serve as a basis for reducing the fee because they contend the various services are required to comply with the regulations of Medicare, other government entities, and accrediting or quality assurance organizations. *Response:*
                         We do not find the criticisms of the OIG report persuasive. While a number of commenters criticized the methodology and findings of the OIG study, we believe that the results of the OIG study are credible. The OIG study examined the extent to which certain services such as patient/caregiver education, responding to patient/caregiver inquiries about drugs, revising the plan of care, contacting the physician's office, contacting a patient for a refill, reviewing medication compliance, and certain other services were actually being provided to beneficiaries by inhalation drug suppliers. The OIG failed to find evidence that many beneficiaries received such services from their inhalation drug suppliers, with the exception of drug refill calls. Although some commenters criticized the OIG report for not including core dispensing activities such as filling the prescription and billing, the OIG report indicated that it did not focus on those activities because it did not have cause to question that they are necessary to dispense drugs and be reimbursed. The OIG instead focused on those services where less was known about the extent to which the services were actually being provided to beneficiaries. The OIG report examined a set of services that accounted for 60 percent of costs included in the 2004 AAH data. In addition, some costs cited by one commenter as being improperly excluded from the OIG study, such as non-payment of coinsurance by Medicaid, costs associated with waivers of coinsurance for indigent beneficiaries, and assessment of the beneficiary's situation for coinsurance waiver, are not generally reimbursed under Medicare Part B as a matter of general policy. We are not persuaded by those commenters who suggested that the OIG study should be disregarded because the OIG undercounted the number of services suppliers actually provide due to the OIG's focus on documented services. Although the OIG focused its analysis on documented services, the OIG report indicated that if they had included undocumented services reported by suppliers in their analysis, the average number of services per beneficiary would still have been low (increasing from an average of 1.2 to 1.59 services per beneficiary per month). In addition, if various services are essential to dispensing these drugs to beneficiaries as some have suggested, we would have expected that suppliers would have documented the content and frequency of the services in patient records in order to track patient progress and maintain continuity of care. Furthermore, although some contend that the OIG study suggests that some suppliers are non-compliant in their provision of required services, as commenters pointed out, the OIG study did not generally collect information on the core services required to furnish inhalation drugs, with the exception of refill recalls. The OIG report found that not all beneficiaries who should have received a refill call actually got one. We plan to study the issue of refill call compliance further, and we believe it is important to reflect the costs of refills call in the dispensing fee. In terms of the comment that the OIG study added several service categories based on information submitted by commenters, the survey instrument included an “other” category under which suppliers could report any services that were not captured by the categories provided. We do not view the opportunity for suppliers to elaborate on the types of services provided to be a weakness but rather a strength of the study. Although the OIG study was criticized by some for not conducting field work, the OIG adopted a methodology that was designed to provide information on a representative sample of beneficiaries receiving inhalation drugs. While the OIG report does not provide information on supplier costs, that was not the objective of the OIG study. The OIG report provides information on the percent of beneficiaries that received various services from their drug suppliers, and as a result, and we believe it offers helpful information in our consideration of the inhalation drug dispensing fee. *Comment:*
                         We received a number of comments recommending either an increase or no reduction in the dispensing fee for 2006. Several commenters suggested the 2005 AAH report provided an appropriate fee for 2006. For that report, a consultant surveyed homecare pharmacies about what fee level they thought was appropriate for 2006. Survey respondents on average suggested a fee of $66.55 for a 30-day supply and a fee of $138.80 a 90-day supply. Suggested fees from other commenters ranged from $57 to $68, with a few commenters suggesting an inflation adjustment on top of those levels. One insurer commented that the current dispensing fee appears high. Some commenters provided cost information as part of their contention that the fee should not be reduced or should be increased. One large supplier indicated that its costs were about $75 per beneficiary for a 30-day period, with the 3 cost categories accounting for the largest share being delivery, setup, and patient education ($20); clinical intake ($15); and compounding, dispensing, and assessment ($14). Another supplier indicated its costs broke out as follows: delivery, set-up, and patient education (27.3 percent); compounding, dispensing, pharmacy assessment (19.0 percent); patient intake (17.8 percent); follow-up and compliance monitoring (11.6 percent); quality assurance, accreditation, licensing and regulatory compliance (9.1 percent), other direct and indirect costs (4.2 percent). The supplier indicated that its costs were largely for salaries, freight and other delivery charges, and business infrastructure. A number of commenters stated that the dispensing fee should not be based on retail pharmacy costs, stating that retail pharmacies do not provide the array of services that homecare pharmacies do. One retail pharmacy clarified its comments from the prior year cited in the proposed rule. By suggesting a fee of 5 to 6 times the current fee last year, the retail pharmacy said they meant 5 to 6 times the $10 proposed supplying fee (for immunosuppressive, oral anticancer, and oral anti-emetic drugs) for 2005 (that is, $50 to $60). In addition, a respiratory company stated that a comment received on the August 5, 2004 proposed rule from another retail pharmacy, which was cited in the August 8, 2005 proposed rule, may have been intended to mean $25 per prescription rather than $25 per 30-day period. Also, the commenter stated that the prior cost data was irrelevant because it preceded experience with the ASP system. Comments from retail pharmacies and a pharmacy association indicated support for the dispensing fee level urged by the 2005 AAH report. A number of commenters stated there would be adverse effects on beneficiary access to inhalation drugs if the fee were reduced. Some suppliers asserted that they would reduce the services offered to beneficiaries or cease supplying inhalation drugs to Medicare beneficiaries. A number of commenters pointed to the 2005 AAH survey, which indicated that 45 percent of providers 
                        ( print page 70229)
                        would not accept Medicare patients if the dispensing fee were reduced more than a nominal amount, while 50 percent indicated they would reduce services provided to beneficiaries, and 2.5 percent indicated they would close. One commenter maintained that some providers had already closed or are seeking acquisition by other companies under current reimbursement rates. Another commenter speculated that a reduction in the dispensing fee would cause a shift away from small home care pharmacies to retail pharmacies, and asserted that these pharmacies would have to gear up by increasing inventories or directing patients to their mail order pharmacies. Some commenters suggested that a fee reduction could lead to adverse health effect for beneficiaries, reduced quality, or use of more intensive Medicare services. Others raised concerns that a reduction could create adverse incentives for substituting MDIs for nebulizers, even for patients where nebulizers are the preferred delivery mechanism. Some commenters suggested that it is premature to reduce the dispensing fee. Some of these commenters asserted that CMS did not provide any new cost data in the proposed rule that would warrant a reduction. Several commenters stated costs had increased due to higher fuel prices, unforeseen natural disasters, and wage inflation. Several commenters pointed to the 2005 AAH study which indicated that the average cost of shipping increased from $12.13 in 2004 to $14.41 in 2005. One commenter indicated that its overnight shipping costs were between $27 to $40 per shipment. Another commenter cited a 12.5 percent increase in the fuel surcharge cap for one large shipping company, which they indicated would cause their delivery costs to increase an additional 4 percent on top of prior increases. One commenter indicated that its cost per shipment had increased by $0.40 due to increased fuel costs in 2005, and it expected additional future increases. In urging an increase in the fee to take into account inflation, another commenter mentioned that it had consolidated the number of pharmacies it operated to increase efficiency, but indicated that the number of costs that could be reduced was limited. Another commenter stated that we should not reduce the fee because the agency indicated in a October 8, 2004 letter to GAO that a fee of $55 to $64 was a reasonable range for a 2005 fee. Other commenters asserted that experience with the ASP system and the current dispensing fee is too limited to conclude there are overpayments. One commenter stated that the payment reduction in 2005 was greater than the Congressional Budget Office or the CMS Actuaries Office had projected prior to passage of the Medicare Modernization Act. This commenter suggested actual levels in 2005 claims data be compared to original estimates before taking any action. *Response:*
                         As noted previously, we established the 2005 dispensing fee using data from the 2004 AAH report. That report included costs for a wide range of services beyond basic dispensing, such as patient education, caregiver training, care coordination, and in-home visits. As discussed previously, we believe these activities represent care management services that should not fall within the scope of a dispensing fee. Furthermore, the September 2005 OIG report found little evidence that many beneficiaries receive these care management services. Consequently, we are establishing a dispensing fee for 2006 using the 2004 AAH cost data excluding separable costs for care management services. We believe this interpretation represents an appropriate reading of the statute. Based on the 2004 AAH data for homecare pharmacies, excluding costs for care coordination, in-home visits, patient education, and caregiver training (as well as sales, marketing, bad debt and profit which were also excluded last year because Medicare does not generally reimburse those costs with respect to Part B services), we are establishing a dispensing fee of $33 for a 30-day supply of inhalation drugs. Because greater levels of effort may be involved in dispensing inhalation drugs when a patient begins these drugs for the first time, we have decided to maintain the current $57 dispensing fee for the first 30-day period in which an individual uses inhalation drugs as a Medicare beneficiary. Thus, beginning in 2006, we will pay a dispensing fee of $57 for the first month an individual uses inhalation drugs as a Medicare beneficiary, and $33 for a 30-day supply of inhalation drugs for all other months. Although some commenters urged an inflation adjustment, we do not believe it is warranted for 2006 because we do not believe it is clear that total dispensing costs have increased since the 2004 industry cost data was collected. Although data from the 2004 industry report may not reflect wage inflation or increased delivery costs due to fuel price increases, it would also not include any efficiencies that providers may have achieved as they have adjusted to the new payment system in 2005. The 2005 AAH report did not provide updated cost data for the service categories included in the 2004 AAH report. Given that the 2004 AAH cost data would not reflect inflationary pressures, nor increased efficiencies in business operations, it is uncertain whether an upward or downward adjustment to the 2004 cost data should be made. As a result, we believe it is best to use the 2004 AAH data as is. We will consider the appropriateness of an inflation adjustment for the future. Regarding concerns raised by some commenters about beneficiary access, we believe, as discussed previously, that the fee level we are establishing is appropriate to cover suppliers' dispensing costs, and beneficiaries will maintain good access to inhalation drugs. The fee amount is based on the 2004 AAH cost data for clinical intake, establishing/revising the plan of care, delivery of services, refill calls/compliance monitoring, billing/collections, “other” direct costs, and indirect costs, excluding sales, marketing, bad debt, and profit which are not reimbursed by Medicare. Having based the 2006 dispensing fee on industry cost data for those activities that we believe fall within the scope of a dispensing fee, we believe the fees are appropriate to cover providers' costs and will not impair access. In addition, we will continue to monitor access to care. Regarding concerns raised by some commenters about CMS lowering the fee without the benefit of new cost data, we believe it is our fiduciary responsibility to establish an appropriate payment for 2006. As discussed previously, our decision is based on our determination that certain services should not fall within the scope of the dispensing fee and the OIG report which found that these services are furnished infrequently to beneficiaries. We believe our decision to lower the fee for 2006 is consistent with our October 8, 2004 letter to the GAO, in which we stated that a dispensing fee in the range of $55 to $64 would be appropriate for the interim 2005 fee. Regarding the comment that the savings from the ASP system are greater for inhalation drugs than the savings projected by CBO or the CMS actuaries prior to enactment of the MMA, we recognize the concerns regarding the shift from a payment system based on AWP; however, we do not believe such concerns are an appropriate consideration in determining the dispensing fee for 2006. Medicare does not generally establish payment rates based on budget projections. Rather, we use the most reliable cost data available to establish 
                        ( print page 70230)
                        a payment rate that is consistent with the statute and appropriate for Medicare covered services. *Comment:*
                         In response to our request for comments on providers' experience with the dispensing fee for a 90-day supply, we received a number of comments. One commenter pointed to the 2005 AAH survey, which found that most respondents (77 percent) do not provide a 90-day supply, and among those that do it represents 3 percent of their business. Reasons cited by survey respondents for non-use of a 90-day supply included—(1) 30-day supply promotes more contact with patients and compliance monitoring; (2) patient prescriptions often change; and (3) many suppliers believed the 90-day dispensing fee ($80 in 2005) was not adequate to cover costs. Less than 1 percent indicated they do not provide a 90-day supply because it is less profitable than a 30-day supply. A few other commenters raised concerns about the 90-day dispensing fee and provided similar reasons for non-use of the 90-day supply as the 2005 AAH survey. In addition, one commenter cited Medicare's refund requirements for unused drugs as being another reason for non-use of the 90-day supply. However, one commenter suggested that the 90-day supply is not used because it receives less reimbursement overall than using the 30-day supply. A physician specialty group supported the 90-day prescription because it reduces paperwork and redundant efforts by patients, physicians, and DME suppliers. *Response:*
                         We agree with the physician specialty group that dispensing a 90-day supply has merit; thus, we have continued the 90-day dispensing fee for 2006. As cited by respondents to the 2005 AAH study, a 30-day supply may be most appropriate for certain beneficiaries such as those with changing prescriptions. However, for those situations where it is medically appropriate, we believe it is important to have a 90-day option available. In the CY 2005 final rule, we calculated the 90-day dispensing fee by taking direct costs for the 30-day fee and tripling indirect costs (which was based on the methodology used in the October 2004 GAO report). However, as discussed, some commenters voiced concern about the adequacy of the 2005 90-day dispensing fee. Some commenters supported the reimbursement amounts suggested by respondents in the 2005 AAH survey. In that survey, respondents suggested an average fee for a 90-day supply ($138.80) that was roughly twice the amount they suggested for a 30-day supply ($66.55). For 2006 using a 2 to 1 ratio for the 90-day versus 30-day fee would yield a 90-day fee about 40 percent higher than our previous methodology. We believe it is important that adequate reimbursement be available for the 90-day option, as well as, the 30-day option. Therefore, using the 2 to 1 ratio recommended by commenters for the 90-day versus 30-day supply payment rates, we are establishing a fee of $66 for a 90-day supply of inhalation drugs for 2006. Although we established two levels of dispensing fees for a 30-day supply, an initial 30-day fee of $57 and a 30-day fee of $33 for all other months, we do not believe a higher initial fee is warranted for a 90-day supply given that we do not believe a 90-day supply is generally used when a beneficiary first begins inhalation drugs. A number of commenters noted that the 90-day supply is not well-suited for patients whose prescriptions are likely to change. We recognize that beneficiaries who begin using inhalation drugs for the first time are more likely than established patients to experience changes in drugs or dosages, or to discontinue use altogether. Accordingly, we do not believe it is appropriate to encourage use of a 90-day supply when a beneficiary first begins using inhalation drugs by establishing a higher initial 90-day fee. Consequently, given such concerns, we have not provided two levels of dispensing fees with the 90-day option. *Comment:*
                         Some commenters noted that refill calls are a service required by Medicare. *Response:*
                         We agree that Medicare requires that a supplier confirm that a beneficiary needs a refill before sending a new shipment, and we have included the costs of refill calls from the 2004 AAH report within the dispensing fee. *Comment:*
                         A few commenters suggested that many of the activities they carry out are required to maintain compliance with FDA, Medicare, and State regulations, and with standards imposed by accrediting bodies such as JCAHO. Some commenters noted that CMS has issued draft supplier quality standards, and that they are required to provide certain services as part of those standards. The commenters suggested that the dispensing fee should accommodate their costs in these areas. *Response:*
                         With the exception of certain guidelines concerning compounding, we do not believe that the requirements applicable to inhalation drug suppliers are in general substantially different from the requirements applicable to pharmacies dispensing other drugs. Furthermore, we view costs such as regulatory compliance and quality assurance as part of overhead, which we have included in the dispensing fee based on the 2004 AAH cost data for overhead and other direct costs. We also do not believe that the costs associated with regulatory requirements applicable to equipment suppliers should be compensated through the inhalation drug dispensing fee. The Medicare program makes separate payments to equipment suppliers for rental/purchase of nebulizers and maintenance, and regulatory requirements applicable to equipment suppliers would be covered through the basic payment rates for the equipment, not the Medicare payment rate for drugs or dispensing. Regarding the draft supplier quality standards that have been released for comment, we note that the agency has adopted a two-step process for developing those standards. An initial document with draft quality standards for suppliers of several types of durable medical equipment has been released for public comment. We expect to release a second document that will clarify which quality standards apply to inhalation drug suppliers. We expect that the standards applying to inhalation drug suppliers will be consistent with accepted quality standards for pharmacies. Furthermore, the standards will establish minimum requirements for being a supplier, which we consider to be part of the standard cost of doing business that is covered through our basic payment rates. As with conditions of participations (COP) for providers, we do not increase our payment rate as a result of a change in COP requirements. *Comment:*
                         One commenter stated that section 1842(b)(3) of the Act requires Medicare payments be reasonable. The commenter asserted that the agency has established in § 405.502(a) criteria for determining what is reasonable, and stated that Medicare has a history of recognizing and reimbursing services related to patient care. *Response:*
                         We recognize the commenter's concern regarding the reasonableness of Medicare payments. We have based the dispensing fee payment rates on industry cost data from the 2004 AAH report, which was submitted as part of comments by AAH on the CY 2005 proposed rule, and used in the CY 2005 final rule, to establish the 2005 dispensing fee. To establish the 2006 dispensing fee, we have used the 2004 AAH cost data excluding those services that fall outside the scope of a dispensing fee. 
                        ( print page 70231) *Comment:*
                         Some commenters cited Medicare's drug payment rates (ASP+6 percent) as a reason the dispensing fee should remain the same or be increased. One homecare pharmacy indicated that it could not obtain drugs at ASP+6 percent. A few commenters stated that their costs exceed reimbursement for drugs in cases where a physician writes brand medically necessary and the drug is in a billing code that contains both brand and generic drugs. An inhalation drug supplier indicated that for three inhalation drugs its acquisition costs exceeded Medicare reimbursement. Some commenters indicated Medicare drug payments (ASP+6 percent) were inadequate for a variety of reasons such as exclusion of wholesaler markup from ASP, the lag time between sales for a quarter and the inclusion of such information in the Medicare ASP+6 drug payment rates, volatility in ASP+6 reimbursement from quarter to quarter, and class of trade differences in pricing. One commenter suggested that Medicare had addressed concerns about the adequacy of ASP+6 percent reimbursement for oncology patients by implementing the Demonstration of Improved Quality of Care for Cancer Patients Undergoing Chemotherapy. They also suggested that the ASP+6 percent cap on reimbursement for the upcoming Part B drug competitive acquisition program (CAP) was a reason for its delay, because they asserted vendors did not want to commit to a program where ASP+6 percent was the reimbursement limit. The commenter stated that the issues it has encountered with ASP+6 percent are similar to the issues faced by oncologists and vendors under CAP program and therefore should be addressed through the inhalation drug dispensing fee. In addition, a few commenters suggested that Medicare payments for equipment were inadequate, necessitating a substantial dispensing fee. *Response:*
                         Although some commenters stated that the dispensing fee should account for drug acquisition costs in excess of the ASP+6 percent payment, we disagree. Section 1847A of the Act specifies that the Medicare payment for inhalation drugs is at 106 percent of the ASP. We believe the Congress established the ASP based payment for inhalation drugs and separate authority for dispensing of these drugs for good reason, namely to pay appropriately for each service and to eliminate cross subsidization of services. Similarly, we believe payment for nebulizer equipment is a distinct policy separate from the dispensing fee, and one should not cross subsidize the other. In establishing the dispensing fee of $33 for a 30-day supply of inhalation drugs (and higher first month payment), we are focusing on what we believe is the appropriate scope and payment for the dispensing fee. Although one commenter suggested that we had addressed perceived issues about ASP+6 percent payment adequacy by implementing the Demonstration of Improved Quality of Care for Cancer Patients Undergoing Chemotherapy, we disagree. The purpose of the demonstration program is to promote improvements in quality by measuring patient outcomes in several areas of concern often cited by patients undergoing chemotherapy, which can then be traced to treatments and outcomes. In addition, we believe that the commenter's statement that the change in the timeframe for implementation of the Medicare Part B drug CAP was a result of the ASP+6 percent cap on vendor reimbursement is not accurate and not related to the inhalation drug dispensing fee. *Comment:*
                         A few commenters expressed concern that the 30-day dispensing fee is the same regardless of the number of prescriptions dispensed. They noted that if a prescription is changed in the middle of the 30-day period they do not receive an additional fee. They suggested CMS consider a per script fee. *Response:*
                         The dispensing fee amount we have established is based on the 2004 AAH report data, which presented average costs for a month. Consequently, we believe our payment rate should be adequate to cover situations where multiple prescriptions are provided. We will consider the suggestion of a per script fee in future rulemaking, as necessary. *Comment:*
                         Several commenters indicated that our revised guidelines concerning the timeframe for shipping refills had not reduced their need to use of overnight shipping. An industry association indicated that several factors often force overnight shipping such as hospitals giving beneficiaries only a one or two dose supply and beneficiaries waiting until they are out of medication to reorder. The 2005 AAH survey indicated that the percent of shipments that were overnight increased slightly from 56.3 percent in 2004 to 56.9 percent in 2005. One commenter indicated that 60 percent of its shipments occur on an overnight basis because of several factors such as needing multiple calls to reach a beneficiary and new prescriptions reportedly needing to be shipped overnight. The commenter urged us to permit refill calls as needed to be ready to ship refill orders at least 7 days before the patient's medication runs out. The commenter believes that this would allow for ground shipping in most cases, including refill dates that fall on weekends and 3-day holidays. One commenter suggested that the 30-day dispensing fee reimbursement guideline had reduced the amount of drugs that they could ship in a month, necessitating more use of overnight shipping. In addition, one commenter asserted if beneficiaries come in for a refill before the end of the month, then the pharmacy would receive no fee. While most commenters indicated that the revised delivery timeframes had not had a substantial impact on their delivery practices, one commenter indicated that 70 percent of its shipment through the third quarter of 2005 were ground deliveries, and they hoped to transition an additional 20 percent of shipments to ground delivery in the fourth quarter of 2005 as a result of Medicare's extension of the patient notification and shipment window. *Response:*
                         In the CY 2005 final rule, we made several administrative changes aimed at reducing inhalation drug supplier costs, including providing more flexible refill timeframes. We currently allow refills to be sent up to approximately 5 days before the end of the current usage period. To further facilitate the use of ground delivery, we are in the process of working to expand this timeframe to allow refills to be sent up to 7 days before the end of the current usage period. Under this new delivery timeframe, we will allow a dispensing fee to be paid up to 7 days before the end of current usage period, with up to 12 months of dispensing fees payable per year per beneficiary. In addition, we note that for 2006, we are establishing a dispensing fee of $57 for the first month an individual uses inhalation drugs as a Medicare beneficiary because greater levels of effort may be involved in dispensing inhalation drugs when a patient begins these drugs for the first time, for example, following hospital discharge. *Comment:*
                         Many commenters responded to our request for comments on the impact of Medicare Part D coverage of metered dose inhalers on beneficiary access to care. A number of commenters asserted that they did not believe there would be a substantial shift to MDIs when they become covered under Medicare Part D. One commenter said that MDIs are not a substitute for nebulizers, as many patients require nebulizers due to inability to use MDIs properly, or physicians' experience has shown nebulizers are more effective than MDIs. 
                        ( print page 70232)
                        Another commenter said that although research has not been able to demonstrate the superiority of nebulizers to MDIs, nebulizers are the standard of care for COPD and chronic lung diseases in the moderate to severe stages. Other reasons commenters cited for their belief that there would not be a substantial shift to MDIs include: Physician inability to properly train patients on MDIs; patient familiarity with nebulizer use gained during hospital stays; research suggesting patient preference for nebulizers; potential use of nebulizers and MDIs by the same patient; and potential differences in cost-sharing across Medicare Part B and Part D. However, one physician specialty group said that it anticipates many Medicare beneficiaries will migrate to MDIs, and those that remain on nebulizers will be more frail and in need of more personalized service. *Response:*
                         We believe expansion of Medicare coverage of inhalation drugs to include MDIs under Medicare Part D will provide additional options for treatment and positively impact access to care. As we indicated in the proposed rule, we recognize that nebulizers are required by many beneficiaries because of their individual circumstances. We believe that physicians will choose the treatment option that best meets a beneficiary's needs, and both nebulizers and MDIs will play an important role in the Medicare program in the years to come. *Comment:*
                         A health professional association asserted that individuals that provide patient education on use of nebulizers, MDIs, and dry powder inhalers (DPIs) should be qualified by virtue of education, training, and competency testing. It also urged CMS to pay a separate education fee to physicians when prescribing an MDI or dry powder inhaler. The commenter also proposed various levels of fees for initial and follow-up services. Another commenter raised concerns about what it asserts is a trend toward drop shipping respiratory related devices. The commenter expressed concern that contact between a respiratory patient and provider may disappear, raising potential concerns about correct usage of the respiratory device. *Response:*
                         We agree that it is important that beneficiaries are properly trained in the use of nebulizers. The Medicare program provides that equipment suppliers either directly train the beneficiary in the use of the nebulizer or ensure that the beneficiary has been trained by other qualified individuals (§ 424.57(c)(12)). In addition, under the physician fee schedule, Medicare will pay physicians to train the beneficiary in the use of a nebulizer, MDI, or inhalation device (CPT code 94664, demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). *Comment:*
                         One commenter stated that CMS evaded its notice and comment rulemaking obligations under the Administrative Procedures Act (APA) to collect meaningful data in support of an appropriate dispensing fee. The commenter urged us to publish data in a subsequent rule, and seek comment, before publishing a final payment rate for 2006. *Response:*
                         In the August 8, 2005 proposed rule, we identified and reviewed available studies and data on the cost of providing inhalation drugs, sought comment as well as additional data and information concerning an appropriate payment amount and scope, and indicated that we thought it likely that the payment amount for 2006 would be lower than the current amount. Furthermore, in establishing the 2006 dispensing fee, we analyzed the available studies and data in response to comments received on the proposed rule and based on that analysis have continued to use the 2004 AAH data that was identified in the proposed rule and also used to establish the 2005 fee. Furthermore, as discussed previously, it is our opinion that the rates established in this rule are appropriate in light of the statute and our understanding of Congressional intent. We believe, therefore, this met our obligations under the APA. *Comment:*
                         One commenter took issue with our description in the proposed rule of inhalation drugs as supplies. *Response:*
                         Medicare coverage of inhalation drugs is derived from their use in covered nebulizers. For Medicare coverage purposes, they are considered covered supplies. *Comment:*
                         A few commenters expressed concern about precedents Medicare Part B will set for Medicare Part D. They asserted that 90-day scripts are not appropriate for nursing home patients. *Response:*
                         The Medicare Part B policy concerning a 90-day dispensing fee does not carry over to Medicare Part D. *Comment:*
                         Although the assignment of benefits form (AOB) has been eliminated, one commenter noted that the requirement to obtain a payment authorization signed by the beneficiary before submitting the claim diminishes the benefit of eliminating the AOB. The commenter urged CMS to eliminate the requirement for signed payment authorization for providers and those reimbursed based on assignment only. *Response:*
                         We thank the commenter for the comment. CMS is reviewing the beneficiary signature requirement for claims submission in light of the elimination of the AOB form in instances of mandatory assignment. However, CMS currently requires a beneficiary signature for claims submission. *Comment:*
                         One drug manufacturer suggested that compounding that attempts to mimic production of commercially available products threatens patient safety. The commenter urged CMS to structure the dispensing fee to reduce the likelihood of inappropriate compounding. The commenter also suggested code modifiers for pharmacy-compounded medications to help identify their occurrence. Another drug manufacturer suggested that reducing the dispensing fee could spur suppliers to provide compounded versions of commercially available products without physician or patient authorization. The commenter suggested that we review supplier documentation to ensure compounded solutions are only furnished where documentation supports medical necessity of a customized product. *Response:*
                         The inclusion of costs for pharmacy compounding in the dispensing fee is not in any way an endorsement of compounding that is inconsistent with FDA guidelines. Furthermore, Medicare expects that pharmacies comply with FDA guidelines irrespective of the dispensing fee payment amount established. We understand the concerns the commenters raised and will consider the issues further. *Comment:*
                         One commenter urged us to require code modifiers for claims associated with patient compounding of inhalation drugs. The commenter asserts that when a physician writes a prescription for a compounded drug, the inhalation drug supplier has an incentive to dispense the drugs separately in order to obtain two dispensing fees. The commenter asserts that implementing the modifiers would allow us to pay only one dispensing fee, instead of two, under these circumstances. *Response:*
                         Medicare pays only one dispensing fee per 30-day (or 90-day) period, regardless of the number of drugs dispensed. As a result, these modifiers would not affect Medicare expenditures. *Comment:*
                         We received some comments in response to our request for information about why there is substantial variation in costs across 
                        ( print page 70233)
                        suppliers. A few commenters suggested that many beneficiaries receive services from small providers who may have higher costs. *Response:*
                         We appreciate the comments. We note that the GAO report, which showed wide cost variation, found that larger suppliers did not necessarily have lower costs than small suppliers. We continue to believe that this is an issue that might benefit from further study. 5. Supplying Fee Section 303(e)(2) of the MMA added section 1842(o)(6) of the Act which requires the Secretary to pay a supplying fee (less applicable deductible and coinsurance) to pharmacies for certain Medicare Part B drugs and biologicals, as determined appropriate by the Secretary. The types of Medicare Part B drugs and biologicals eligible for a supplying fee are immunosuppressive drugs described in section 1861(s)(2)(J) of the Act, oral anticancer chemotherapeutic drugs described in section 1861(s)(2)(Q) of the Act, and oral anti-emetic drugs used as part of an anticancer chemotherapeutic regimen described in section 1861(s)(2)(T) of the Act. Beginning with CY 2005, Medicare established a supplying fee of $24 per prescription for these categories of drugs, with a higher fee of $50 for the initial oral immunosuppressive prescription supplied in the first month after a transplant. When multiple drugs are supplied to a beneficiary, a separate supplying fee is paid for each prescription, except when different strengths of the same drug are supplied on a single day. When we established the $24 supplying fee in the CY 2005 final rule (69 FR 66236), we indicated that we were establishing a rate higher than that of other payers due to the additional costs associated with Medicare Part B's lack of online claims adjudication. As part of the August 8, 2005 proposed rule (70 FR 45848), we proposed changes to the supplying fee for multiple prescriptions supplied during the same month. We proposed to continue paying $24 for the first prescription supplied during a month (or $50 for the first oral immunosuppressive prescription supplied in the first month after a transplant) and a supplying fee of $8 for each additional prescription the pharmacy supplied to the beneficiary during the same month. Each pharmacy supplying these drugs to a beneficiary during a month would be entitled to one $24 supplying fee per beneficiary during that month. In making this proposal, we indicated that when a pharmacy supplies multiple drugs to a beneficiary during the same month, many of which are likely to be supplied on the same day, we were concerned that we were overpaying for the costs associated with our lack of online claims adjudication. Furthermore, we indicated that we believe that the $24 supplying fee for the first prescription would adequately compensate a supplier for the billing costs associated with the lack of on-line claims adjudication, and that the cost of supplying additional prescriptions in the same month should be comparable to that of other payers. We also proposed to expand the circumstances under which we pay supplying fees for multiple prescriptions filled on the same day. Currently, we pay a supplying fee for each prescription supplied on the same day as long as the prescriptions are for different drugs. We proposed to pay a supplying fee for each prescription, even if the prescriptions are for different strengths of the same drug. We requested comments about the appropriateness of our proposed supplying fee for multiple prescriptions supplied during a single month along with data and information about the incremental costs of supplying additional prescriptions to a Medicare beneficiary during a single month. We also asked for comments about how pharmacy costs and reimbursement for supplying oral drugs under Medicare compares to that of other payers. We received numerous comments regarding our supplying fee proposals. Those comments and responses are provided below. *Comment:*
                         Numerous commenters were supportive of our proposal to expand the circumstances under which we pay a supplying fee to include paying separate fees when multiple strengths of the same drug are supplied on the same day. However, many commenters expressed concern about our proposal to pay a supplying fee of $24 to a pharmacy for the first prescription and $8 for all subsequent prescriptions supplied in a 30-day period. Commenters generally urged no reduction in the supplying fee when multiple prescriptions are provided in the same month, and a few urged a payment increase. In opposing the $8 subsequent fee, some commenters stated that the agency had included no new cost data in the proposed rule to support a reduction. At the same time, some commenters provided cost information as part of their comments. A few commenters indicated that the cost of supplying a drug for an insurer with online claims adjudication had increased from $8 (as cited in the proposed rule) to $9 to $10 based on new studies. An association representing chain drug stores provided information from a few large chains indicating that the average cost to supply a Medicare Part B prescription was between $19 and $21, noting that small chains or independent pharmacies may have higher costs. The association asserted that the current $24 fee was reasonable considering the fact that Medicare currently does not pay separate supplying fees for different strengths of the same drug supplied on the same day. The association urged us to consider an increase in the $24 fee to take into account inflation, and an increase in the $50 fee for the first prescription after a transplant to compensate for the intense patient monitoring that the association indicated was needed. A large chain pharmacy indicated its average cost of supplying a Medicare prescription was $19.02, which included $5.54 for bad debt. An association for specialty transplant pharmacies submitted data suggesting that Medicare's reimbursement (combined payment for the drug and supplying fee) to these pharmacies for 2 large volume immunosuppressive drugs is comparable or lower than that of Medicaid or private payers. This association pointed to a 2004 report prepared by a consultant, which indicated that specialty pharmacy costs for immunosuppressive drugs for Medicare patients averaged about $35. This association also indicated that transplant pharmacies have higher costs because they offer more extensive services, routinely stock specialty medicines and maintain regular and consistent contact with their Medicare clients. The association suggested that these services should be compensated through the supplying fee. In addition, this association also claimed that chain pharmacy data collected in a similar manner to the specialty pharmacy data yield costs of $21. The group asserted that the chain costs appear lower than the specialty pharmacy costs in part because chains supply items such as diabetic test-strips, which they indicate cost less to supply. In opposing a reduction in the supplying fee for subsequent prescriptions in a month, a number of commenters took issue with the rationale provided in the proposed rule for the reduction, saying that there are not economies of scale in processing Medicare claims when multiple prescriptions are provided in the same month. Many commenters outlined costs associated with billing Medicare. 
                        ( print page 70234)
                        Because of the lack of online claims adjudication, some stated that there was more bad debt associated with Medicare Part B claims. Other commenters indicated that it takes longer to process a Medicare claim because of the requirement of a signed order from the physician as well as the lack of online claims adjudication. Some commenters indicated that without online claims adjudication, pharmacies must call the DMERC to check the beneficiary's deductible as well as verify whether the beneficiary is still enrolled in traditional Medicare as opposed to Medicare Advantage. Other commenters indicated that the lack of online claims adjudication and automatic cross over claims means that they may have to refund a beneficiary's coinsurance if it is later determined that the beneficiary has supplemental insurance. Other billing activities and requirements that commenters cited as creating added costs include: contracting with a special entity to convert Medicare Part B claims from the NCPDP format to ANSI X837; working with physicians to determine whether oral anticancer or anti-emetic drugs are being prescribed for Medicare Part B covered indications; having to submit the unique physician identifying number (UPIN) on the claim; and Medicare's requirement that the date of service and date of prescription be the same. Although most commenters did not support the proposal for a reduced fee when multiple prescriptions are supplied in a month, one health insurer commented that the current supplying fee payment amounts appear high, and put upward pressure on commercial rates. *Response:*
                         As we indicated in the CY 2005 final rule (69 FR 66236), we recognize that the cost of supplying Medicare Part B drugs is somewhat higher than that of other payers because of the lack of on-line claims adjudication for Medicare Part B claims. We believe it is appropriate for Medicare's supplying fee to compensate for the Medicare billing costs associated with the lack of online claims adjudication. However, as we indicated last year, we do not believe the supplying fee for these drugs should be higher than other payers for reasons other than the lack of on-line claims adjudication. The comments included information on the costs of supplying Medicare Part B drugs for some chain pharmacies. One chain reported Medicare costs of $14.48 ($19.02 - $5.54 non-reimbursed bad debt). A retail pharmacy association commented that a few chains had indicated that their costs of supplying a Medicare Part B prescription were between $19-$21 per prescription (without indicating whether bad debt was included). Furthermore, as we indicated in the August 14, 2004 final rule (69 FR 66236), our analysis of data from a 2004 survey of specialty pharmacies yields a supplying fee in the range of $13-$27 depending on the proportion of personnel costs assumed to be associated with Medicare billing. This range was developed by using a figure of $5 or $10 for the payment rates of payers with on-line adjudication, and adding to that Medicare claims processing costs from the specialty pharmacy data ($8), and a portion of personnel costs from the specialty pharmacy data (total was $9) assumed to be related to Medicare billing. This results in supplying fee between $13 ($5 + $8) and $27 ($10 + $8 + $9), depending on the portion of personnel costs associated with Medicare billings. Based on this information from chains and specialty pharmacies, we agree that an $8 fee for subsequent prescriptions is too low. However, as discussed in more detail subsequently, our analysis of the cost information from the comments has led us to believe that a subsequent prescription supplying fee that is slightly lower than $24 would be appropriate. Based on our analysis, we believe that a $24 fee for the first prescription in a 30-day period, and a $16 fee per prescription for all subsequent prescriptions in the 30-day period would be consistent with the cost information included in the comments. Under this fee structure, reimbursement to a pharmacy for the supplying fee would average $24 for a patient with 1 prescription in a 30-day period, $20 per prescription for patients with 2 prescriptions, $18.67 per prescription for a patient with 3 prescriptions, and $18 per prescription for a patient with 4 prescriptions, for example. Our claims data currently indicate that beneficiaries receiving immunosuppressive, oral anticancer, or oral anti-emetic drugs under Medicare Part B average 2.2 prescriptions per month, with a majority receiving 4 or fewer. We believe average supplying fee payments ranging from $18 to $24 are consistent with the chain drug store costs indicated in the comments and falls within the mid-range of the potential supply fee amounts we calculated based on the specialty pharmacy data survey. Because we continue to believe that there are some economies of scale for Medicare billing costs when multiple prescriptions are supplied in the same month, particularly when they are billed on the same claim form, we believe it is appropriate to pay a higher fee for the first prescription in a 30-day period, and the somewhat lower fee for all subsequent prescriptions in the 30-day period. For example, several activities related to Medicare billing that commenters cited as being costly including calling the DMERC to verify the beneficiary's Medicare fee for service eligibility, locating the physician's UPIN to include on the Medicare Part B claim form, handling coinsurance refunds for crossover claims, and completing other information on the claim form would only have to be performed once, rather than twice, when multiple prescriptions are submitted on the same claim. Moreover, following through on our proposal to expand payment of the supplying fee to include paying separate fees when multiple strengths of the same drug are supplied on the same day, we believe it is important that the subsequent prescription supplying fee reflect lower incremental costs. Consequently, beginning in 2006, we are establishing a supplying fee of $24 for the first prescription in a 30-day period, and $16 for each subsequent prescription in the period. Each pharmacy will be eligible for one $24 fee per beneficiary per 30-day period. As mentioned previously, beginning in 2006 we are also expanding the circumstances under which we pay the supplying fee to include paying separate fees for different strengths of the same drug that are a supplied on the same day. We are not altering the current policy of paying a $50 supplying fee for the first immunosuppressive prescription after a transplant. If a supplier receives a $50 supplying fee for the initial prescription after a transplant, a supplying fee of $16 will be paid for all subsequent prescriptions, after the initial prescription, furnished by that supplier to the beneficiary during that 30-day period. We are making conforming changes to § 414.1001(b) to reflect this policy concerning subsequent prescriptions supplied during the same 30-day period as the initial immunosuppressive prescription after a transplant. *Comment:*
                         A number of commenters expressed concerns about beneficiary access if the supplying fee were reduced. Some suggested that pharmacies may stop providing these drugs to beneficiaries if the supplying fee is lowered. Others believe that a reduction in the fee could lead specialty pharmacies to stop providing support services to transplant patients, which they assert could adversely impact transplant success for some patients. 
                        ( print page 70235) *Response:*
                         We believe the supplying fee payment amounts we have established are appropriate based on the cost information available from the comments, and beneficiaries will continue to have good access to these drugs. Furthermore, we note that the reduction in Medicare payments resulting from the supplying fee changes are expected to represent at most 1 percent of Medicare total payments to pharmacies for these drugs. *Comment:*
                         Some commenters expressed concern about the reduction in reimbursement that would result from the subsequent prescription supplying fee in certain situations (for example, for drugs that have a 3-week prescription cycle or for patients with 3 prescriptions per month). *Response:*
                         Under the supplying fee rates established for 2006, Medicare reimbursement for the supplying fee would in the majority of cases average from $24 (patient with 1 Medicare Part B prescription) to $18 (patient with 4 Medicare Part B prescriptions). As mentioned previously, we believe this range of average reimbursement is consistent with the chain pharmacy cost information in the comments and falls near the mid-range of the potential supplying fee payment amounts we calculated based on the 2004 survey data for specialty pharmacies. Furthermore, we believe the supplying fee payment rates appropriately reflect the potential for economies of scale when multiple prescriptions are supplied in the same month. *Comment:*
                         A few commenters stated that a lower subsequent prescription fee may encourage pharmacies to send patients to affiliate locations in order to receive the $24 fee. *Response:*
                         We disagree. As mentioned previously, we believe that the supplying fee payment rates established are adequate to cover pharmacies' supplying costs based on the cost information included in the comments. We do not believe that these reimbursement changes would spur pharmacies to take actions that would cause inconvenience to the beneficiaries they serve. *Comment:*
                         Some commenters maintained Medicare's drug payment rates (the average sales price + 6 percent) were below their acquisition costs for certain drugs, and stated that the current $24 per prescription supplying fee should be unchanged or increased to compensate for this. *Response:*
                         Although some commenters stated that the supplying fee should account for drug acquisition costs in excess of the ASP+6 percent payment, we disagree. Section 1847A of the Act specifies that the Medicare payment for these drugs is at 106 percent of the ASP. We believe the Congress established the ASP based payment for these drugs and separate payment for the supplying of these drugs for good reason, namely to pay appropriately for each distinct service. In expanding the circumstances under which we pay a supplying fee and establishing the supplying fee payment amounts ($24 for the first prescription in a 30-day period and $16 for all subsequent prescriptions in a 30-day period, as well as the $50 fee for first immunosuppressive prescription after a transplant), we are focusing on the appropriate scope and payment for the supplying fee. *Comment:*
                         A few commenters suggested that for 2006 the current supplying fee payment amounts ($50 for initial prescription after a transplant, and $24 per prescription otherwise) be increased for inflation or to ensure adequate reimbursement for services provided by suppliers. *Response:*
                         We believe that the supplying fee payment amounts we have established for 2006 are consistent with the cost information from the comments this year. We will consider an inflation adjustment for the future. *Comment:*
                         Some commenters raised concern that if a beneficiary sought a refill before the end of the month, the pharmacy would not be eligible for a $24 fee for that refill. *Response:*
                         We understand the commenters' concern. We are taking several steps to address this potential issue. First, we have decided to use a 30-day period rather than a calendar month as the basis for determining whether a $24 or $16 supplying fee is payable. Thus, we will pay a $24 supplying fee for the first prescription supplied by a pharmacy in a 30-day period (or a $50 supplying fee for the first immunosuppressive prescription after a transplant), and a $16 supplying fee for each subsequent prescription supplied by that pharmacy to the beneficiary in the 30-day period. We believe using a 30-day period avoids arbitrary fluctuations in payment that might otherwise occur as a result of variation in the number of days per month. In addition, in our instructions to implement the 2006 supplying fee, we will allow a $24 supplying fee to be paid for a refill prescription up to 7 days before the end of the 30-day period for which the last $24 supplying fee was paid to that pharmacy, with up to twelve $24 supplying fees payable per beneficiary per year. *Comment:*
                         A number of commenters expressed concern that the assignment of benefits (AOB) forms, which the August 14, 2004 final rule indicated would be eliminated, has not yet been eliminated. *Response:*
                         The requirement that a pharmacy obtain an AOB form when supplying drugs to a beneficiary was eliminated for dates of services on or after January 1, 2005. Because of technical issues, the claims processing contractors did not immediately implement this change. We published a change request in August 2005 clarifying that the requirement for an AOB form was eliminated effective January 1, 2005 for pharmacies supplying Medicare Part B drugs to beneficiaries (as well as in other circumstances where assignment is mandatory). This change request will be implemented on November 14, 2005. The change request can be found at: 
                        *http://www.cms.hhs.gov/​manuals/​pm_​trans/​R643CP.pdf.* *Comment:*
                         Several commenters expressed concern that the DMERC Information Form (DIF), which the August 14, 2004 final rule indicated would be eliminated, had not been eliminated yet. A commenter also mentioned some suppliers having difficulty with the rejection of claims for immunosuppressives for “DIFs not on file,” when they are on file. In addition, one commenter urged us to not only eliminate the DIF, but also to eliminate the requirement that pharmacies collect and submit the DIF information with each claim. The commenter suggests that most of this information can be obtained by information submitted to Medicare by the transplant facility or transplant physician, and the requirement for pharmacies to submit the information is duplicative. *Response:*
                         The elimination of the DIF will be implemented with the quarterly systems release that occurs April 2006. A number of systems issues makes the elimination of the DIF more involved than anticipated. We regret the delay in the elimination of this requirement, and remain committed to implementing the change in April 2006. Regarding the other issues concerning the DIF raised in the comments, these billing issues are outside the scope of this final rule; however, we encourage commenters to continue to bring these concerns to our attention. *Comment:*
                         A specialty pharmacy group indicated that some pharmacies had encountered situations where Medicaid or other third party payers were not covering the beneficiary's coinsurance on the supplying fee. The commenter requested that the final rule include an explanation of these parties' 
                        ( print page 70236)
                        responsibilities concerning beneficiary coinsurance on the supplying fee. *Response:*
                         The supplying fee is covered under Medicare Part B. Like all other Medicare Part B benefit categories, standardized Medigap plans are responsible for paying all (plans A-J) or a specified proportion (plans K and L) of a beneficiary's Part B coinsurance once the Part B deductible has been met. With some exceptions, State Medicaid programs are responsible for beneficiary cost-sharing for the supplying fee for beneficiaries who are dually eligible for both Medicare and Medicaid. State Medicaid programs can limit coinsurance payments to the extent that any payment, when combined with Medicare payments, equals the amount of reimbursement payable under the State Medicaid program. A State Medicaid program may deem a pharmacy to be paid in full even if it has received either no coinsurance payment or a reduced payment from the State. Beneficiaries have no liability beyond the State's payment amount as set forth in section 1902(n)(2) of the Act. *Comment:*
                         One commenter suggested that physicians be allowed to bill for the supplying fee for immunosuppressive, oral anti-cancer, and oral anti-emetic drugs. The commenter suggested we could define a pharmacy, for the purposes of the supplying fee, to include physicians acting as pharmacists. As another approach, they suggested we could use our inherent reasonableness authority to extend the supplying fee to physicians. *Response:*
                         As we indicated in the CY 2005 final rule, given our understanding of Congressional intent, we do not believe it would be appropriate to pay a supplying fee to physicians. In addition, at this time, we do not have sufficient data to determine if our inherent reasonableness authority would apply in this instance. *Comment:*
                         A specialty pharmacy group requested that we include clarification in the final rule concerning whether temporary billing codes for the supplying fee G0369 and G0370 will be replaced with permanent codes. *Response:*
                         Effective January 2006, we intend to replace the G-codes for the supplying fee with Q-codes. 6. Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B In this section of the preamble, we discuss the Competitive Acquisition Program (CAP) for Part B drugs; summarize the requirements established in the July 6, 2005 interim final rule with comment titled “Competitive Acquisition of Outpatient Drugs and Biologicals Under Medicare Part B” (70 FR 39022); respond to comments on selected issues in that rule and finalize the associated policies; and discuss the next steps in the implementation of the CAP program. We are addressing the issue of inclusion of CAP drug units in the ASP calculation in separate rulemaking. General Overview of CAP Section 303(d) of the MMA amended the Act by adding a new section 1847B, which establishes a program for the acquisition of and payment for competitively biddable Part B covered drugs and biologicals furnished on or after January 1, 2006. Implementation of the CAP will provide physicians with a choice between— Obtaining these drugs from entities selected to participate in the CAP in a competitive bidding process; or
                    Acquiring and billing for Part B covered drugs under the ASP drug payment methodology. In our July 6, 2005 interim final rule with comment, we finalized provisions set forth in the Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B proposed rule published on March 4, 2005 in the 
                        **Federal Register**
                         (70 FR 10746), but also provided the public an additional opportunity to comment on the final provisions established for the CAP. We codified the requirements and provisions for the CAP in regulations at 42 CFR part 414, subpart K, with § 414.906 through § 414.920 containing requirements for payment under the CAP as follows: *Section 414.906 (Competitive acquisition program as the basis for payment).*
                         This section specifies how payment for CAP drugs is determined, including vendor responsibilities for billing, shipment and delivery; computation of the payment amount; substitution of CAP drugs and resupply of a participating CAP physician's drug inventory.
                    *Section 414.908 (Competitive acquisition program).*
                         This section specifies the process for a physician to select an approved CAP vendor and the responsibilities of a participating CAP physician, including the specific information that must be included on the prescription order as well as notification and the timeframe for submission of claims. This section also specifies the process for selecting approved CAP vendors, as well as factors that are considered in the selection process such as exclusion under section 1128 of the Act from participation in Medicare or other Federal health care programs.
                    *Section 414.910 (Bidding process).*
                         This section outlines the specific criteria for submission of a bidding price for a CAP drug, and specifies what costs should be included in the bid price.
                    *Section 414.912 (Conflicts of interest).*
                         This section discusses requirements and standards for conflict of interest that applicants that bid to participate and approved CAP vendors must meet.
                    *Section 414.914 (Terms of contract).*
                         This section outlines the contract provisions between CMS and the approved CAP vendor including contract length and termination, and specific requirements the approved CAP vendor must comply with.
                    *Section 414.916 (Dispute resolution for vendors and beneficiaries).*
                         This section discusses the process available to an approved CAP vendor and beneficiaries for resolution of denied drug claims, outlining the steps, timeframes and requirements that must be met.
                    *Section 414.917 (Dispute resolution and process for suspension or termination of approved CAP contract).*
                         This section discusses the process available to participating CAP physicians for resolution of quality or service issues concerning an approved CAP vendor, including steps and timeframes that are to be followed.
                    *Section 414.918 (Assignment) and § 414.920 (Judicial review).*
                         Application of assignment and administrative and judicial review for the CAP are discussed in these sections of the regulation, respectively. In the July 6, 2005, interim final rule with comment for the CAP published as CMS 1325-IFC, we also defined terms used for the CAP in § 414.902. We also established that for initial implementation, the competitive acquisition area, in which approved CAP vendors supply drugs, will be on a national level and include all 50 States, the District of Columbia, Puerto Rico, and the U.S. territories. In addition, we established a single drug category consisting of approximately 180 drugs commonly provided “incident to” a physician's service and included these in the addenda to the July 6, 2005 interim final rule with comment. These drugs represent about 40 percent of the approximately 440 drugs that may be billed “incident to” physician services and about 85 percent of physicians’ Part B drugs by billed charges, as reflected in our Part B billing data. Effective August 3, 2005, we suspended the vendor bidding process that began with publication of the July 
                        ( print page 70237)
                        6, 2005 interim final rule with comment to allow us more time to fully review public comments on the interim final rule with comment and also to further refine the bidding process. We provided notification of the suspension on the CMS Web site 
                        *http://www.cms.hhs.gov/​providers/​drugs/​compbid/​*
                         and through the pharmacy and physician Listservs. We also announced the suspension of the bid process in the Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B: Interpretation and Correction interim final rule with comment, published on September 6, 2005 in the 
                        **Federal Register**
                         (70 FR 52930). In that document, we stated we would publish a final rule for implementing the CAP after we analyzed the additional comments on the July 6, 2005 interim final rule with comment and determined the best manner for improving the efficiency of the CAP and increasing potential participation of both vendors and physicians in the program. We also indicated that we would announce the dates for the new vendor bidding period as well as a special physician election period with the publication of the final rule. As noted earlier in this section of the preamble and as discussed in more detail below, in this final rule with comment, we are addressing certain issues raised by commenters responding to the July 6, 2005 interim final rule with comment. We believe it is critical to address these specific concerns we have identified through review of the comments and finalize or clarify specific policy issues raised to allow us to effectively implement the CAP. Other issues raised by commenters that are not addressed in this final rule with comment will be addressed in future rulemaking, once we have fully reviewed all of the comments not addressed in this rulemaking. Specific information concerning implementation of the CAP, including vendor bidding and physician election are discussed later in this section. Analysis of and Response to Public Comments We received a total of 225 timely comments in response to the July 6, 2005 interim final rule with comment (70 FR 39022). Commenters included trade associations, medical societies and organizations, a health insurance company, pharmaceutical manufacturers and wholesalers, specialty pharmacies and pharmacy benefits management groups, as well as practitioners, private citizens and patient advocates, and a member of the Congress. All public comments were reviewed and grouped by related topics and focused on various aspects of the CAP interim final rule with comment. In this final rule with comment, we are responding to comments related to certain aspects of the CAP, and making modifications to the regulation text where necessary so that an improved implementation can be achieved. We will be responding to the remaining comments and issues raised in future rulemaking after we have had the opportunity to fully review those comments and issues. The specific areas being addressed are discussed below. a. Design of the Program In this section, we discuss the policy and process for changes to the original CAP Single Drug Category List (Addendum A) and changes in the original New Drugs for the CAP Bidding for 2006 (Addendum B). These changes are reflected in Addendum F and Addendum G of this final rule with comment. We also clarify issues related to drugs included in the CAP and updated certain requirements for bidding. We discuss the process for when and how an approved CAP vendor may request that we approve a change to its CAP drug list. Finally we discuss CAP drug weighting for the single drug category. (1) Changes to the List of Drugs Supplied Under the CAP The CAP is intended to provide beneficiaries with access to Medicare Part B drugs and maintain physician flexibility when prescribing medications. In the July 6, 2005 interim final rule with comment, we described how the single drug category list was developed and how newer agents and substitute products could be incorporated into the CAP. In this section of the preamble, we will respond to comments relating to drugs supplied under the CAP. We developed the single drug category list by developing criteria based on Part B drug utilization. This list was published in Addendum A of the July 6, 2005 interim final rule with comment and contains the majority of drugs that a prospective CAP vendor will bid on. Newer drugs without utilization data were listed in Addendum B—New Drugs for CAP Bidding in 2006 in the July 6, 2005 interim final rule with comment. Development of these lists began with the statutory definition of competitively biddable drugs and biologicals (section 1847B(a)(2) of the Act) and then the application of specific steps described in the July 6, 2005 interim final rule with comment (70 FR 39030) to narrow the list of possible drugs based on utilization and other factors, as described in the interim final rule with comment, that we believe made inclusion of the drug in the CAP drug category appropriate for the initial implementation stage of the CAP. Section 1847B(a)(1)(B) of the Act requires that the Secretary establish categories of drugs that will be included under the CAP, and requires the Secretary to phase-in the program with respect to these categories. The statute also defines “competitively biddable drugs and biologicals” for the purposes of the CAP by referring to section 1842(o)(1)(C) of the Act. Relying on our authority to phase in the CAP drug categories as appropriate, we narrowed our focus to drugs furnished “incident to” a physician's service. In response to comments, and in an effort to offer the CAP to as many physicians as possible, we chose not to phase-in the CAP on the basis of drugs typically used by any one particular specialty; however, we realized that certain types of drugs may be better suited for inclusion in early stages of the CAP than others. During our review of comments on the July 6, 2005 interim final rule with comment and subsequent review of the single drug category list published in Addendum A, we became aware of supply issues with one specific drug. These issues have prompted us to make changes to the Single Drug Category List in Addendum A of the interim final rule with comment (included with this rule as Addendum F). We have deleted a HCPCS code (J1710) for a drug that is being phased out of the market and revised the addenda that comprise the CAP drug category to account for upcoming changes to HCPCS codes. Also, before the CAP is implemented, several new permanent HCPCS codes will be approved and several others modified. A number of these newly approved codes would have been included in the CAP drug category identified in our July 6, 2005 interim final rule with comment, had permanent HCPCS codes been available at that time. Therefore, we are amending the list of drugs published in the New Drugs for CAP Bidding for 2006 in Addendum B of the interim final rule with comment to account for drugs in the new HCPCS codes, and to account for HCPCS codes that appeared in Addendum A of the July 6, 2005 interim final rule with comment that have since been split into separate HCPCS codes for which we are unable to calculate new weights. Updated lists of drugs that are included in the initial CAP drug category appear 
                        ( print page 70238)
                        in Addendum F and Addendum G of this rule. (a) Changes to the Single Drug Category List—Addendum A of the July 6, 2005 Interim Final Rule With Comment The July 6, 2005 interim final rule with comment discussed criteria for developing the Single Drug Category List (Addendum A of the interim final rule with comment). In the following section, we describe factors that led us to revise this list. After suspending the bidding process, we reviewed the drugs included in the Single Drug Category List that was published in Addendum A of the July 6, 2005 interim final rule with comment (70 FR 39101). During this process, we found that the brand name product under HCPCS code J1710 (hydrocortisone sodium phosphate injection) was withdrawn from the market and that generic products for this code are not reliably available. This drug's weight in the CAP's Single Drug Category List as published in Addendum A is 0.000060285401. Because of the availability issue associated with this drug we will remove J1710 from the Single Drug Category List and recalculate weights for the remaining drugs. The impact on other drugs' weights will be minimal because of J1710's very low weight. Yearly updates to the HCPCS codes also impacted the CAP drug lists in several ways. One code J7051 Sterile saline or water up to 5cc (CAP weight = 0.006953978284) was modified to A4218 Sterile saline or water, metered dose dispenser, 10 ml. “A codes” are primarily medical and surgical supplies, and we believe that the change reflects usage that is primarily through a means other than incident to a physician's service. Therefore, we will remove this code from the Single Drug Category list and recalculate weights for the remaining drugs. Revisions to the Single Drug list also reflect modifications to several HCPCS codes. These modifications will not affect the weighting calculation because they are either changes in names or consolidation of multiple codes into one. The previous codes' utilization data will be used in the updated calculation. Table 23 illustrates the affected HCPCS codes. Table 23
New HCPCS code
New description
Old HCPCS codeJ0881
Injection, darbepoetin alfa, 1 microgram (non-esrd use)
J0880 
                                 Q0137J0885
Injection, epoetin alfa, (for non-esrd use), 1000 units
Q0136J7318
Hyaluronan (Sodium Hyaluronate) or derivative, intra-articular injection, 1 mg
J7317 
                                 J7320
 The changes to the HCPCS codes also affected iron dextran. A discussion of iron dextran's removal from the single drug category list and the addition of the two new iron dextran HCPCS codes to the Revised New Drugs for CAP Bidding For 2006 appears in the following section. (b) Changes to New Drugs for CAP Bidding for 2006—Addendum B of July 6, 2005 Interim Final Rule With Comment (See Addendum G in This Final Rule With Comment) Addendum B, published in the July 6, 2005 interim final rule with comment (70 FR 39102), was developed in response to comments on the proposed rule that urged us to provide a means to include newer drugs. We are updating Addendum B with drugs that have been recently assigned new HCPCS codes, and drugs that were previously listed in Addendum A of the July 6, 2005 interim final rule with comment, but because of HCPCS code changes, cannot be re-weighted. These changes appear in Addendum G of this rule. Further details are provided below. *Comment:*
                         We received numerous comments asking that individual drugs that were recently approved and introduced to the United States market be included in the CAP. Improving the selection of products that could be supplied through the CAP was commonly given as a reason for the request. *Response:*
                         We agree that it is desirable for the CAP to include a wide variety of drugs and to maintain the flexibility to adapt to a rapidly changing marketplace. Therefore, we are adding additional procedures to the CAP that will allow approved CAP vendors to adjust and update their drug lists. These changes are described below. In the July 6, 2005 interim final rule with comment, we stated that we intended to provide the physician with choice and flexibility within groups of drugs that might be used by different specialties for the treatment of various conditions. The drugs available under the CAP are intended to accommodate a variety of physician practice patterns and a variety of specialties. As discussed in other sections of this rule, the CAP also seeks to provide access to new drug therapies. As a part of the annual HCPCS code update, several new permanent HCPCS codes were issued. Billing with these codes will begin on January 1, 2006. In order to keep the CAP list of drugs as comprehensive and complete as possible, we have updated the New Drugs for CAP Bidding that was originally published in Addendum B of the July 6, 2005 interim final rule with comment to account for the coding changes. This list of newly issued HCPCS codes provided us with an opportunity to add drugs to the CAP drug category; the additions include several recently approved drugs. Examination of the new HCPCS codes also revealed that several codes for drugs listed in Addendum A of the July 6, 2005 interim final rule with comment had undergone modification. For example, beginning in January 2006, the HCPCS code for iron dextran will be split into two codes, and the HCPCS code for darbepoetin alfa when used for non-end stage renal disease will be revised. We are unable to recalculate the weights for these split HCPCS codes because it is not possible to estimate the new codes' utilization. Therefore, we are including these drugs in a revised version of Addendum B—New Drugs for CAP Bidding 2006, which was published in the July 6, 2005 in the interim final rule with comment. The list of New Drugs for CAP Bidding 2006 is now Addendum G of this rule. We believe this change is appropriate because we had already decided to include these drugs in the CAP drug category, and adding them to Addendum G will avoid a recalculation of the other CAP drugs' weights based on an imprecise estimate of utilization. Addenda F and G published in this final rule with comment supersede Addenda A and B from the July 6, 2005 interim final rule with comment. Note that HCPCS code modifications as they 
                        ( print page 70239)
                        relate to the Single Drug Category list were discussed in section II.H.6.a.(1).(a) of this final rule with comment. In order to be included in Addendum G—Revised List of New Drugs for CAP Bidding for 2006, we determined that a drug must not appear in the Revised Single Drug Category List (Addendum F of this rule) and must meet at least one of the following three criteria: Criterion 1: The drug must have been listed in Addendum B of the July 6, 2005 interim final rule with comment, “New drugs for CAP Bidding for 2006”.
                    Criterion 2: The drug must have a new J or Q HCPCS code effective January 1, 2006, and meet the three following conditions: + Be administered incident to a physician's service. + Have had a previous C, S or “NOC” (Not Otherwise Classified or Miscellaneous) code. + Have one national published ASP payment price and not meet either of the following two conditions: ++ Be primarily billed through the DME process. ++ Be primarily used as a diagnostic agent. Criterion 3: The drug must be listed in Addendum A—Single Drug Category List published in the July 6, 2005 interim final rule with comment, but had its HCPCS code terminated effective January 1, 2006 and split into J or Q Codes that become effective January 1, 2006. Criterion 1 describes drugs listed in Addendum B of the July 6, 2005 interim final rule with comment. Tables 24 and 25 list drugs that meet criteria 2 and 3. Table 24 lists drugs that will have new HCPCS codes beginning January 1, 2006 and Table 25 is a list of drugs that were previously included in Addendum A but whose HCPCS codes were split. Combining these three lists will yield Addendum G—Revised New Drugs for CAP Bidding for 2006, which is published in this rule. Table 24.—CAP Drugs With New HCPCS Codes Effective January 1, 2006
HCPCS 
                                 (effective  
                                 1/1/2006)
Long descriptionJ0128
Abarelix injection.J0180
Agalsidase beta injection.J0878
Daptomycin injection.J1931
Laronidase injection.J2357
Omalizumab injection.J2469
Palonosetron HCl.J2794
Risperidone, long acting.J9035
Bevacizumab injection.J9041
Bortezomib injection.J9055
Cetuximab injection.J9305
Pemetrexed injection.J9264
Paclitaxel protein bound particles.J2503
Pegaptanib.J0278
Amikacin.J9225
Histrelin implant.
 Table 25.—HCPCS Codes From Addendum A That Have Been Split
HCPCS 
                                 (effective  
                                 1/1/2006)
2006 Long 
                                 description
Discontinued HCPCSJ1751
Iron Dextran 165
J1750J1752
Iron Dextran 267
J1750
 The drugs identified in Addendum G will be bid and paid for as described in the July 6, 2005 interim final rule with comment (70 FR 39072). In the July 6, 2005 interim final rule with comment, we stated that we will require that prospective vendors include bids for all of these drugs in their submissions and provide these drugs to physicians who elect to participate in the CAP. However, we will not incorporate the bids for these drugs into the composite bid methodology, because we lack sufficient utilization data to compute appropriate weights for these drugs. Instead, we will consider these bids separately from, but parallel to, evaluation of the composite bid for the other drugs for which we have adequate utilization data. Specifically, we will require bidders to submit a separate bid for each drug in the list. We will also impose a ceiling on acceptable bids. As in the case of the composite bids, that ceiling will be tied to the ASP payment methodology. Specifically, we will not accept any bid for a drug listed in Addendum G that is higher than 106 percent of the ASP for that drug (as determined at the time when the bidding begins). In order to be eligible for selection as an approved CAP vendor, a bidder must meet all of the criteria outlined in § 414.908 of the regulation text and must submit acceptable bids on each of the drugs listed in Addenda F and G of this final rule with comment. (c) Process for Adding NDCs Within a HCPCS Code in an Approved CAP Vendor's Drug List We acknowledge that given the 3-year CAP contract duration, some changes to the approved CAP vendors' CAP drug lists are anticipated during the life of the contract. In the July 6, 2005 interim final rule with comment (70 FR 39075), we described a mechanism where approved CAP vendors could request CMS approval to add new drugs to their CAP drug lists once the drug had a permanent HCPCS code. We also described a mechanism (70 FR 39044 and § 414.906(f)(2)(i)) where, if a particular NDC becomes unavailable or goes through a period of short supply an approved CAP vendor could substitute a different NDC within the HCPCS code for the NDC currently supplied by the approved CAP vendor for an extended period of time (2 weeks or longer) if the approved CAP vendor identifies the replacement product, CMS approval for the substitution is obtained, and all participating CAP physicians who have selected the approved CAP vendor are notified of the change. *Comment:*
                         Numerous commenters recommended that we develop a mechanism to allow approved CAP vendors to add drug products (identified by an NDC) to those already supplied within a HCPCS code during the CAP contract period. Potential vendors indicated in their comments that they would like the flexibility to add NDCs because, as experience with the CAP grows, they may encounter situations where the addition of certain drugs supplied under a HCPCS code may improve beneficiary access, reduce waste, and improve the vendor's cost efficiency. *Response:*
                         We agree that additional mechanisms to expand an approved CAP vendor's drug list at the NDC level are desirable. The current requirements state that an approved CAP vendor must offer at least one NDC within each HCPCS code in the CAP drug category. We encourage potential vendors to bid more than the minimum of one NDC per HCPCS code. However, we also understand that, as the 3-year contract period progresses, opportunities to modify the initial list of NDCs supplied under a HCPCS code will occur. Examples of these opportunities could include introduction of a new package size, the introduction of a new manufacturer's products (including new multisource products), and price changes in existing NDCs. We believe that in order for an approved CAP vendor to continue to meet participating CAP physicians' 
                        ( print page 70240)
                        needs, it is in the approved CAP vendor's best interest to provide and maintain a satisfactory range of products, and to improve the range of available products as experience with the program increases. We agree that a mechanism to increase the number of CAP drugs offered by an approved CAP vendor is expected to improve access to Part B drugs and to improve prescribing flexibility for physicians who obtain drugs through the CAP. We believe that the process to add NDCs to the existing list of NDCs supplied by an approved CAP vendor is appropriate, provided that the additions to the approved CAP vendor's list undergo an approval process. In the July 6, 2005 interim final rule with comment, in § 414.906(f)(2), we stated that the designated carrier's medical director will approve long-term substitutions to the list of drugs supplied by an approved CAP vendor “on behalf of CMS.” As described in the following sections of this rule and based on comments on the interim final rule with comment, we have expanded this request and approval process for incorporating changes into the list of drugs supplied by the CAP vendor to include new NDCs, and new HCPCS codes. In addition, beginning in 2007, approved CAP vendors will be able to request approval to add newly approved drugs to their CAP drug list before the drug is assigned a HCPCS code. In order to provide flexibility for managing this task and consistency for these processes, we are amending § 414.906 to allow CMS or its designee to approve long-term substitutions and additions to approved CAP vendors' CAP drug lists. We are also revising § 414.906(f)(4)(iii) to specify that substitutions that are due to a drug shortage, or other exigent circumstance, may become effective immediately provided that the approved CAP vendor's participating CAP physicians are notified of the substitution immediately following CMS approval. We are modeling the process of adding new NDCs within a HCPCS code on the substitution mechanism described in the July 6, 2005 interim final rule with comment (70 FR 39044) and specified in § 414.906(f). We note that because this is a mechanism for the addition of drugs to an approved CAP vendor's CAP drug list, the approved CAP vendor will be required to continue supplying all NDCs from its most recently updated CAP drug list. (The substitution process should be used if the approved CAP vendor is seeking approval to remove an NDC from its CAP drug list and replace it with another NDC.) In order to add a new NDC within a HCPCS code being offered in the approved CAP vendor's CAP drug list, the approved CAP vendor must make a written request to CMS or its designee. Requests for approval must include a rationale and discussion of impact on the CAP, including safety, waste, and potential for cost savings. The requests will be reviewed and, if approved, changes will become effective as of the beginning of the next quarter. Like the substitution procedure, the addition of new NDCs to an approved CAP vendor's CAP drug list will not affect the CAP payment amount for that particular HCPCS, as the payment amount will have been set during the initial bidding (or approval process for adding an additional HCPCS code) and, if applicable, updated as outlined in § 414.906. This application process is reflected in the amended § 414.906(f)(2)(ii). Participating CAP physicians who have selected the approved CAP vendor must be notified of additions to the approved CAP vendor's CAP drug list at least on a quarterly basis (at least 30 days or earlier before the approved changes are due to take effect). Both the approved CAP drug vendor and CMS (or its designee) will be responsible for maintaining this information and disseminating it. Approved CAP vendors must provide direct (for example, mail or e-mail) notification of updates to the participating CAP physicians enrolled with them on a quarterly basis. The entire list of drugs supplied by the approved CAP vendor should be disseminated at least once yearly; and approved CAP vendors must make a complete list that incorporates the most recent updates available to participating CAP physicians on an ongoing basis. We will post the updated drug lists on our web site. The approved CAP vendor may also post the complete, updated, and approved list on its web site. We have added these requirements to new § 414.914(f)(15). We will issue additional instructions for this process at a later date. (d) Process for Expediting the Addition of Newly Approved Drugs to the CAP (“NOC” Codes) The July 6, 2005 interim final rule with comment outlined a process that approved CAP vendors can use to add new drugs to the list of drugs supplied under the CAP once the new drug has been assigned a permanent HCPCS code, provided the drug would have been properly assigned to the single drug category and that CMS determines that the drug is appropriate for inclusion. This mechanism was intended to provide an opportunity for vendors to supply drugs that were introduced too late to be incorporated into the Addendum B—New Drugs for CAP bidding for 2006 published in the July 6, 2005 interim final rule with comment. *Comment:*
                         Several commenters have requested that we develop a process to further expedite the addition of newly approved or marketed drugs to an approved CAP vendor's drug list. Commenters stated that access to newly approved drugs should be immediate. These commenters further stated that participating CAP physicians should not have to go outside of the CAP to acquire new drugs. Several commenters suggested a mechanism that uses the miscellaneous (“NOC”) HCPCS codes for physicians and vendors to bill CAP drugs that do not have a permanent HCPCS code. Certain commenters also suggested that approved CAP vendors be required to offer the new drugs as soon as they are on the market. *Response:*
                         We agree with the commenters that the earlier addition of newly approved or newly marketed drugs to the CAP is desirable, to the extent these drugs are appropriate for inclusion in the CAP. The tight timeframe for CAP implementation and the requirement for additional system changes prevent us from implementing the process suggested by the commenters at this time. In 2007, approved CAP vendors will be able to request CMS approval to add new drugs without a permanent HCPCS code to their CAP drug lists. This process will be similar to the process established in the July 6, 2005 interim final rule with comment that allows approved CAP vendors to add new drugs that are assigned a permanent HCPCS code to their CAP drug lists. Approved CAP vendors will submit a request to add these drugs, and CMS or its designee will determine whether the particular drugs are appropriate for inclusion in the CAP using a process that parallels the development of the Single Drug Category List and the List of New Drugs for CAP bidding for 2006. Updates to the approved CAP vendors' CAP drug lists will be made on a quarterly basis; we anticipate that all approved CAP vendors' updates will be posted on the CMS Web site simultaneously. Payment for new CAP drugs approved for inclusion in the approved CAP vendor's CAP drug list before they are assigned a HCPCS code would be at the price published in the ASP's “not otherwise classified” (NOC) price file consistent with the next quarterly update. And we note that these drugs would be considered for inclusion in the CAP only if CMS is able to identify 
                        ( print page 70241)
                        a single ASP payment amount for the drug. At a future date, we will issue additional guidance to approved CAP vendors on the application procedures for requesting approval to add these changes to the approved CAP vendor's CAP drug list, and we will issue additional guidance to participating CAP physicians on how to order these particular drugs once they are added to the approved CAP vendor's CAP drug list. We do not believe that requiring approved CAP vendors to add all new drugs to their CAP lists is advisable. Instead, we believe that a request and approval process as described for other changes to an approved CAP vendor's drug list would be appropriate because it would allow for flexibility while ensuring that only those that are appropriate for inclusion in the CAP are added to an approved CAP vendor's CAP drug list. As discussed in the July 6, 2005 interim final rule with comment (70 FR 39027 through 39031) some drugs may not be good candidates for the CAP, for instance, some new drugs are not typically administered “incident to” a physician's services, some new drugs may have very low utilization, and some may have special storage, distribution, or handling requirements that would make these drugs inappropriate for inclusion in the CAP. The existing procedures for adding new NDCs within the HCPCS codes that are on an approved CAP vendor's CAP drug list, and the new procedures for adding new HCPCS codes to an approved CAP vendor's CAP drug list also rely on approved CAP vendors' voluntary requests and our approval of these requests. Simply put, we want to expand the number of CAP drugs that approved CAP vendors offer, but we do not believe that all new drugs should be added to the CAP, or that addition of certain drugs should be mandatory, especially at the beginning of this program. As we gain experience with the program we may consider other approaches to the addition of drugs that a vendor supplies under the CAP. Beginning in 2007, approved CAP vendors will be able to request approval to add new “NOC” drugs to their CAP drug lists. The procedures will parallel those for addition of new HCPCS codes and new NDCs within a HCPCS code, as specified in § 414.906(f)(2)(iv). In each case, the approved CAP vendor must make a written request to CMS (or its designee). Requests for approval must include a rationale and discussion of impact on the CAP, including safety, waste, and potential for cost savings. The requests will be reviewed and, if approved, changes will become effective on a quarterly basis. We remind physicians that an approved CAP vendor's CAP drug list is subject to change over the contract period. Upon electing to participate in the CAP and selecting an approved CAP vendor, participating CAP physicians are agreeing to accept, in most cases, the particular NDCs listed and shipped by the selected approved CAP vendor for the duration of the participating CAP physician's election period with the approved CAP vendor. By electing to participate with a particular approved CAP vendor, the participating CAP physician also is agreeing to accept the approved changes to the approved CAP vendor's CAP drug list and drugs supplied under the updated and approved lists. We believe that the changes in the approved CAP vendor's CAP drug list will improve (or at least maintain) a participating CAP physician's selection of available drugs and will likewise improve (or maintain) Medicare beneficiaries' access to drugs supplied under the CAP. We are revising § 414.908(a)(3)(vi) to state this requirement. We remind physicians that routine orders for CAP drugs should be placed at the HCPCS level, unless the participating CAP physician determines that a particular product that is on the approved CAP vendor's CAP drug list is medically necessary for a patient. In this case, a participating CAP physician may order that specific NDC from the approved CAP vendor under the “furnish as written” process. Documentation of medical necessity in the medical record is also required; this information may be subject to medical review. We are revising § 414.908(a)(3)(vii) to reflect this requirement. (e) Process for Adding Drugs With a New HCPCS Code to the CAP In the July 6, 2005 interim final rule with comment (70 FR 39075), we stated that we would allow approved CAP vendors to petition CMS to add drugs with a new HCPCS code to their CAP drug lists; however, we did not include regulation text to implement this section. In order to implement this process we are amending regulation text at § 414.906(f)(2)(iii). (f) Process for Adding Single Indication Orphan Drugs to the CAP Table 26 is a brief summary of methods that an approved vendor may use to amend the list of drugs it supplies under the CAP. Please note that all of these methods require approval from CMS or its designee. *Comment:*
                         We received several comments from manufacturers requesting inclusion of their single indication orphan drugs in the CAP. Most commenters stated that these low volume products were quite suitable for the CAP because availability through the CAP would minimize the associated administrative burden for physicians who choose to administer them. Inclusion of one product (thyrotropin alfa) was also requested by a number of physicians who treat patients with thyroid cancer and by patients who had been treated for thyroid cancer. One manufacturer specifically requested that its orphan drug (azacitidine) not be included in the CAP, citing concern about timely access to the drug. *Response:*
                         We appreciate the comments that we received regarding single indication orphan drugs. Improving access to Part B drugs is a desirable quality for this program. For example, we have endeavored to improve access by allowing the addition of new NDCs and new HCPCS codes to a drug vendor's list. During this initial stage of the CAP, as described in the July 6, 2005 interim final rule with comment (70 FR 39032), we also have sought to strike a balance that would allow for a sufficiently sized market volume for approved CAP vendors, while making the CAP a meaningful alternative for most physician specialties. In order to decrease the inventory burden for approved CAP vendors, we wanted to minimize the number of drugs included in the CAP drug category that are billed in very low volumes, so we applied dollar value thresholds to the CAP. As noted by commenters, the addition of the single indication orphan drugs to the CAP drug category may decrease administrative burden on the participating CAP physicians, and we agree that a decreased burden is desirable. We are persuaded by the number of commenters that asked us to include single indication orphan drugs in the CAP drug category that a mechanism for their addition to an approved CAP vendor's CAP drug list is desirable. However, for the reasons that prompted us not to include single indication orphan drugs in the initial drug category (as described in the July 6, 2005 interim final rule with comment), we continue to believe that we should not require approved CAP vendors to supply these drugs. Therefore, we are specifying that approved CAP vendors may request CMS approval to add single indication orphan drugs (as described in the July 6, 2005 interim final rule with comment) to their CAP drug lists. The 
                        ( print page 70242)
                        single indication drugs covered by this provision are the following: J0205, J0256. J9300, J1785, J2355, J3240, J7513, J9010, J9015, J9017, J9160, J9216 and their successor codes. Payment for single indication orphan drugs that vendors voluntarily add to the CAP will be based on ASP+6 percent. Table 26.—Methods for Changing an Approved CAP Vendor's CAP Drug List
Description
Regulation textSubstitution: Approved CAP vendor may request approval to replace one or more NDCs in a HCPCS code supplied by the approved CAP vendor with one or more other NDCs
§ 414.906(f)(2)(i).Add newly issued HCPCS Codes: Approved CAP vendor may request that CMS allow it to supply additional HCPCS codes under the CAP
§ 414.906(f)(2)(iii).Additional NDCs: Approved CAP vendor may request that CMS allow it to supply additional NDCs under a HCPCS code that the approved CAP vendor already supplies under the CAP
§ 414.906(f)(2)(ii).Newly approved drugs without HCPCS codes (“NOC” dugs”): Beginning in 2007, approved CAP vendor may request that CMS allow it to supply a newly approved drug under the CAP before a permanent HCPCS code is assigned to the drug
§ 414.906(f)(2)(iv).Single Indication Orphan Drugs: Approved CAP vendor may request that CMS allowed it to supply single indication orphan drugs under the CAP
§ 414.906(f)(2)(iii).
 (g) Other Issues Related to Drugs Supplied Under the CAP (i) Addition of Other Specific Drugs We received comments regarding the addition of low volume drugs, and dermal tissue biologicals to the CAP. Specific comments and responses for each type of drug follow. *Comment:*
                         One commenter asked whether we would allow approved CAP vendors to voluntarily supply drugs with low utilization volumes through the CAP. The commenter was specifically referring to drugs that were not included in the CAP category because of utilization criteria described in the interim final rule with comment (70 FR 39031-39032). *Response:*
                         Drugs included in the initial CAP drug category account for about 85 percent of Part B drugs billed by physicians. In other sections of this rule we have described methods that an approved CAP vendor may use to request the addition of new NDCs or new HCPCS codes to the CAP. Although we appreciate the request to add drugs with low utilization volumes to the CAP drug category, we believe it is appropriate to allow additions to an approved CAP vendor's CAP drug list through the case-by-case approval process we have described above and specified in § 414.906. Once we gain experience with the CAP, we anticipate being able to consider broadening the scope of drugs included in future CAP drug categories. *Comment:*
                         The manufacturers of two dermal tissue products expressed concern about language in the July 6, 2005 interim final rule with comment that stated “tissues are not considered drug products.” One manufacturer asked that its product be included in the CAP, while the other stated other reasons for excluding its product were appropriate and did not ask that its product be included in the CAP. *Response:*
                         We thank the commenters for providing us with the opportunity to clarify the discussion about dermal tissue found in the July 6, 2005 interim final rule with comment (70 FR 39031). During development of the criteria used to create Addendum A—Single Drug Category List of the July 6, 2005 interim final rule with comment, we attempted to allow for a sufficiently sized market for approved CAP vendors, while making the CAP a meaningful alternative for most physician specialties. The statement that the commenter references above was intended to explain why we did not include dermal tissue products in the initial CAP drug category and was not intended to reflect overall Medicare policy for dermal tissue products. We are not including tissues in the initial CAP drug category at this time because the products do not have sufficient documented utilization, and some products may require specialized handling. As we gain experience with the CAP, we anticipate reevaluating exclusion criteria applied to bidding for the initial phase of this program. (ii) Formularies and the CAP In the July 6, 2005 interim final rule with comment, we responded to comments on the subject of formularies. We respond to additional comments on the subject from the July 6, 2005 interim final rule with comment below. *Comment:*
                         We received several comments that encouraged us to refrain from creating formularies in the CAP and to avoid situations where a formulary-like process could be created. Commenters raised concerns about a formulary's likelihood to limit beneficiaries' access to a wide selection of drugs and the impact on a physician's choice in prescribing medications. *Response:*
                         In the July 6, 2005 interim final rule, we stated that we were not accepting the recommendation that vendors be permitted to establish formularies because the statute expressly requires that for multiple source drugs, a competition be conducted for the acquisition of at least one drug per billing code within that category (70 FR 39034). We agree that in an effort to provide physicians with maximum flexibility in prescribing, we should avoid the use of formularies in the CAP. Furthermore, we believe that making the CAP less restrictive will increase physician interest and, therefore, improve vendor participation. In the July 6, 2005 interim final rule with comment (70 FR 39033 through 39034 and 39068), we stated that “we do not expect there to be a creation of a drug formulary,” and we further discussed our belief that vendors would find it prudent to structure their bids in a way to supply more than one NDC per HCPCS code. We wish to emphasize that this is still our position on formularies in the CAP. It is our opinion that approved CAP vendors who offer more than one product per HCPCS code would be selected by a greater number of participating CAP physicians. (iii) Physicians Regulatory Issues Team Drugs The July 6, 2005 interim final rule with comment also discussed issues regarding drugs that have posed acquisition problems for some physicians under the ASP system. We received additional comments on this topic. *Comment:*
                         Commenters asked whether drugs included on the Physicians Regulatory Issues Team (PRIT) list (drugs reported to be difficult for physicians to obtain for less than ASP+6 percent) have been included in the CAP. Commenters also asked that 
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                        the PRIT list be made available to the public. *Response:*
                         The PRIT is a group of CMS subject matter experts who work to reduce the regulatory burden on Medicare physicians. Since the inception of the ASP payment system, individual physicians have reported difficulty in acquiring certain drugs for less than ASP+6 percent. At the request of the Physicians Practice Advisory Committee, the PRIT began compiling reports of these situations. More information about the PRIT may be found at the following web site: 
                        *http://www.cms.hhs.gov/​physicians/​prit/​.* Because the PRIT list is based on voluntary reporting, and information is received on an ad-hoc, nonrepresentative basis, the PRIT list may not fully describe overall drug pricing or availability patterns; therefore, we have chosen not to use the PRIT list as a specific criterion for the CAP. However, as stated in of the July 6, 2006 interim final rule with comment (70 FR 39033), we did review drugs that had been associated with access problems under the ASP payment system during the development of the CAP single drug category and we have subsequently examined the PRIT list during the writing of this rule. We have found that the CAP includes most drugs reported to the PRIT. PRIT list drugs not in the CAP are drugs that were not included for specific reasons described in the July 6, 2005 interim final rule with comment, such as -single indication orphan drugs, drugs without permanent HCPCS codes, oral medications, and drugs with low utilization. (iv) Discussion of Intrathecal Pain Management The July 6, 2005 interim final rule with comment's discussion of specific drugs contained a comment and response on ziconotide (Prialt®). *Comment:*
                         One commenter stated that, in our discussion of intrathecal pain management, we mischaracterized ziconotide as an opioid analgesic. The commenter points out our inconsistency in referring to ziconotide as an opioid, but following with a discussion that demonstrates understanding that ziconotide is not an opiate. The commenter asked if non-opiate pain medications administered intrathecally through an implanted pump or external infusion device would be suitable for inclusion in the CAP. The commenter also asked whether ziconotide could be added to Addendum B—New Drugs for CAP Bidding for 2006 of the drug bidding list if a permanent HCPCS code were assigned in the Fall of 2005. The commenter also noted that baclofen and clonidine, two other medications that can be administered intrathecally through a pump, are included in the CAP drug category. *Response:*
                         We appreciate the opportunity to clarify our discussion. Ziconotide is not an opiate analgesic and it is not a controlled substance. Neither the comment nor the corresponding response were intended to describe ziconotide as an opioid or to limit the discussion to intrathecally administered opioids. Our response to the comment in the interim final rule with comment was intended to address two points. First, we did not consider opioids and ziconotide for inclusion into the bid list for different reasons. Opioids are controlled substances and are subject to extra record keeping requirements as stated in the July 6, 2005 interim final rule with comment (70 FR 39028); ziconotide was not included in the CAP drug category because it had not yet been assigned a HCPCS code. Second, we agreed in principle that opioid medications administered intrathecally through implanted variable-rate infusion devices could be included under the CAP, when they are administered by physicians in their offices incident to their services. Although we specifically referred to opioid medications in this discussion, the statement applies to non-opioid medications as well. However in the interim final rule with comment, we described our methodology for determining whether a drug would be included in the initial CAP drug category. (70 FR 39028 and 39031 through 39032). Although ziconotide generally appears to meet the criteria for inclusion in the initial CAP drug category, we have become aware of an unresolved payment methodology issue with this drug resulting in the lack of a consistent ASP for ziconotide. It is important that drugs included in the CAP drug category have an ASP that we can determine, because a drug's ASP is used to calculate the overall price ceiling for the composite bid and the maximum payment amount for CAP drugs not included in the composite bidding process. For this reason, we are not including this drug in the CAP at this time. (v) Leuprolide and Related Drugs During the development of the Single Drug Category List published in Addendum A of the July 6, 2005 interim final rule with comment, we chose not to include injectable forms of leuprolide acetate (J9217 and J9218) in the initial CAP drug category. We provide a discussion of local coverage determinations (LCDs) and LCA policy as it relates to the CAP in the July 6, 2005 interim final rule with comment (70 FR 39039). We note that leuprolide acetate implant (J9219) remains in the CAP's Single Drug Category List. *Comment:*
                         We received several comments about leuprolide and other luteinizing hormone-releasing hormone (LHRH) analogues, which include goserelin, triptorelin, and histrelin. Commenters acknowledged the complexity of applying LCA policies to the CAP for both physicians and vendors. They also questioned whether all regions of the United States were subject to LCA policies for this leuprolide, and commenters expressed concern that the policies may extend to LHRH other than leuprolide and goserelin, such as histrelin and triptorelin. Two commenters suggested that the CAP not use LCA policies, and failing that the commenter suggested that drugs covered by LCA policies be “carved out” of the CAP. Another commenter stated that LCA policies varied so much that not including leuprolide in the CAP drug category was an incomplete solution to the LCA issue because the entire group of LHRH analogues was in the process of becoming affected by LCAs, and that continuing price changes could not guarantee that goserelin would remain the least costly alternative drug among the LHRH analogues. *Response:*
                         We appreciate the concerns raised by the commenters. However, we do not believe that we have the authority to specify that CAP prices supersede an LCA policy. As we stated in the July 6, 2005 interim final rule with comment, nothing in this rule is intended to disrupt the longstanding ability of contractors to apply an LCA policy under section 1862(a)(1)(A) of the Act. Section 1862(a)(1)(A) of the Act provides that notwithstanding any other provision in the Medicare statute (that is, including section 1847B of the Act), no payment may be made under Part A or Part B for any expenses incurred for items and services that are not medically necessary. As a result, if a carrier applies an LCA policy to a particular drug, a claim submitted to the carrier for that drug is subject to LCA. After considering the comments, we continue to believe that the decisions outlined in the July 6, 2005 interim final rule with comment pertaining to which drugs are included in the CAP drug category maintain a balance between physician access to LHRH analogues 
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                        and vendor risk associated with the application of LCAs for these drugs. (h) Drug Weighting In the July 6, 2005 interim final rule with comment (70 FR 39069), we finalized our proposal to employ a “composite bid” for selecting bidders. The composite bid will be constructed by weighting each HCPCS bid by the HCPCS code's share of volume (measured in HCPCS units) of drugs in our single drug category during the prior year. Within the single category, the drugs weights will sum to one. *Comment:*
                         Some commenters suggested that instead of using only utilization data to derive weights, we should use both utilization and allowed charges data so that products with high utilization, but low charges, are not over weighted. *Response:*
                         We appreciate the suggestion of an alternative weighting methodology, and we recognize that the weighting methodology could be developed in a number of ways. We are also aware that changing the weighting methodology from utilization volume to dollar volume could impact overall weighting. For the initial bidding cycle, we chose to use a relatively simple weighting methodology based on claims volume, but corrected for the appearance of multiple identical claim lines on a given day of service. We also believe that the creation of a single drug category further minimizes some effects associated with using utilization data as the only weighting parameter. We do not believe that a change in weighting methodology would result in significantly different weights than those derived under the current weighting methodology for the majority of drugs in the single drug category list. Therefore, we will implement CAP using the same weighting methodology described in the July 6, 2005 interim final rule with comment (70 FR 39069 through 39071) and will consider alternatives for future bidding cycles. Earlier in this section we have discussed the need to make changes to the Single Drug Category List published in Addendum A of the July 6 2005 interim final rule with comment. The resulting change in the composition of the Single Drug List required us to recalculate the drug weights. A complete discussion of the reasons for this revision is included in section II.H.6.a.(1)(a), Changes to the Single Drug Category List—Addendum A of the July 6, 2005 interim final rule with comment. b. Vendor/Bidding Issues In this section we discuss issues related to vendor bidding such as drug quality, vendor subcontracting, confidentiality of the bids, vendor call center requirements, the inclusion of prompt pay discounts in vendor net acquisition costs, and the mechanics of the bidding process. (1) Quality/Product Integrity In the July 6, 2005 interim final rule with comment (70 FR 390660 through 390662), we discussed product integrity and the requirement to comply with existing State and Federal laws regarding adulteration, misbranding, spoilage, contamination, expiration, and counterfeiting of products. We stated that although we do not propose to require applicants or potential CAP vendors to employ measures beyond those required for licensure and regulatory compliance, we believe these measures set a minimum standard, and we requested that applicants discuss any additional measures they have taken to ensure product integrity. We also provided examples of additional measures that pose minimal burden but enhance the ability to detect adulterated, misbranded, or counterfeit drugs. We further stated that the approved CAP vendor application process, the maintenance of appropriate licensure, and Medicare supplier status form the framework for product integrity. We also noted that potential CAP vendors are required to submit a compliance plan as part of the bidding process that contains policies and procedures for the prevention of fraud, waste, and abuse, and provides detailed information on steps to ensure product integrity as specified in § 414.914. *Comment:*
                         Many commenters supported the steps outlined in the July 6, 2005 interim final rule with comment to ensure quality and product integrity. There were some commenters, however, who expressed concern that the provisions in the interim final rule with comment will not be adequate to prevent fraud and abuse and ensure product integrity. One commenter believed that patient health and safety could be compromised by the imposition of a third party (the approved CAP vendor) for drug acquisition, preparation, and delivery. This commenter was also concerned about the possibility that certain drugs could be reconstituted in their vials by the approved CAP vendor. Another commenter suggested that the Verified-Accredited Wholesale Distributors TM
                         Program could play a key role in adherence to quality and performance standards among approved CAP vendors. This is a program developed by the Task Force on Counterfeit Drugs and Wholesale Distributors that was convened in 2003 by the National Association of Boards of Pharmacy to ensure that a wholesale distribution facility is licensed and operating under best practices for drug distribution. *Response:*
                         We appreciate and share the commenters' concerns about ensuring quality and product integrity. However, we do not agree that the approved CAP vendor's role in drug acquisition, preparation, and delivery will compromise patient health and safety. We addressed the issue of reconstituted vials in the July 6, 2005 interim final rule with comment (70 FR 39061) by stating that approved CAP vendors may split vial trays, but cannot ship opened vials. As we gain more experience with the CAP, we will explore the Verified-Accredited Wholesale Distributors TM
                         Program and other options to further protect product integrity. *Comments:*
                         Several commenters recommended that CMS establish standards and survey procedures for approved CAP vendors and their subcontractors to inspect the chain of custody of the drugs delivered to participating CAP physicians. These commenters also requested that CMS establish and disseminate information about the procedure that participating CAP physicians should follow to report a suspected delivery of counterfeit drugs, and suggested that a web-based quality reporting system be available on various aspects of the approved CAP vendor's performance. These commenters also wanted clarification that one substantiated instance of purchase or distribution of a counterfeit drug by an approved CAP vendor will result in the automatic termination of the vendor's Part B supplier contract and the CAP contract. *Response:*
                         We continue to believe that existing Federal and State requirements, along with the specific requirements for approved CAP vendors outlined in the bidding and selection process, provide an adequate framework for protecting product integrity. Participating CAP Physicians should notify the approved CAP vendor immediately if there are any questions regarding the integrity of a CAP drug, and report any violations to the appropriate Federal and State authorities, as well as to the designated carrier's dispute resolution staff. In addition, the designated carrier will act promptly to investigate CAP quality complaints under the process outlined for dispute resolution as described in § 414.916. 
                        ( print page 70245) As we gain experience with the CAP, we will assess whether additional steps are needed to ensure product quality. We are committed to ensuring that approved CAP vendors ship only high quality products and any reports of compromised quality will be addressed promptly. (2) Subcontracting In the July 6, 2005 interim final rule with comment (70 FR 39060, 39064, and 39065), we stated that a vendor could subcontract with another entity as long as that entity met all of our approved CAP vendor requirements, is in compliance with all applicable laws and regulations, has a demonstrable record of integrity regarding fraud and abuse and conflict of interest, and has adequate administrative arrangements in place to ensure effective operations. Information on specific requirements for subcontractors was provided in the July 6, 2005 interim final rule with comment and is a required part of the vendor's CAP application. In § 414.914(f)(9), we also stated that it is the approved CAP vendor's responsibility to determine that subcontractors remain compliant with these standards. It was further noted that we intend that subcontractors or other entities associated with furnishing CAP drugs under an approved CAP vendor's contract maintain the same standards as the approved CAP vendor for the role that they play in supplying CAP drugs. *Comment:*
                         Many commenters expressed support that we intend to hold any subcontractors to the same standards as the approved CAP vendors. However, some commenters requested clarification on certain aspects of subcontracts or requested more stringent requirements. Two commenters requested that approved CAP vendors include in their subcontractor agreements a covenant binding on the subcontractor to comply with all rules applicable to approved CAP vendors, including those rules regarding product integrity and drug pedigree, and that HHS be a third party beneficiary to these agreements with the right to enforce any of the provisions relating to CAP compliance. One commenter wanted assurance that a contract between a large distributor and a specialty pharmacy would not be considered a conflict of interest. Another commenter requested that we require full disclosure of a potential CAP vendor's corporate relationships and specifically prohibit potential CAP vendor subsidiaries from bidding against their parent company or other subsidiaries with the same parent company. *Response:*
                         We appreciate the commenters' interest in maintaining quality of the CAP by ensuring integrity in all aspects of the approved CAP vendor and subcontractor relationship. We believe that we have stated clearly our intention to hold all subcontractors to the same rigorous standards that we require of approved CAP vendors. We also believe that we have the necessary authority to review, enforce, and take any needed action to ensure that quality and integrity of the subcontractor relationship is maintained. Because an approved CAP vendor is ultimately responsible for any activity of its subcontractor and risks termination of its CAP contract if quality or integrity are compromised, we believe that the approved CAP vendor will take adequate steps to ensure compliance with all requirements. Therefore, we will not require a binding covenant between approved CAP vendors and subcontractors, although we would expect that an approved CAP vendor may want to include this type of provision in its subcontracts for its own protection. Contracts between a distributor and a specialty pharmacy are not automatically problematic. However, these arrangements would be subject to the same requirements as specified in the CAP statute and regulations that apply to all other subcontracting arrangements. Approved CAP vendors may wish to consult with legal counsel to determine whether there exists unique circumstances that could present a conflict of interest. We also appreciate the commenters' concern about corporate relationships and the possibility of a potential CAP vendor's subsidiaries bidding against their parent company or other subsidiaries with the same parent company. However, because of the complexity of many corporate relationships, we believe that rejecting bids based on a test such as the commenter suggests could exclude some legitimate and qualified entities from participating in the CAP. We will not prohibit any qualified bidder from submitting a bid to be an approved CAP vendor, but we expect applicants to submit any relevant information, including information about their corporate relationships. We will review all this information as part of the application and bidding process described in this final rule with comment and the July 6, 2005 interim final rule with comment. (3) Confidentiality of the Bids (Potential CAP Vendor Information) In both the March 4, 2005 proposed rule (70 FR 10746) and the July 6, 2005 interim final rule with comment (70 FR 39065), we affirmed that all cost information will be confidential and not made available for public display, and that bid prices will be kept confidential in accordance with section 1927(b)(3)(D) of the Act. We also stated that section 1847B(a)(1)(C) of the Act provides that, in implementing the CAP, the Secretary may waive provisions of the Federal Acquisition Regulation (FAR), “other than provisions relating to the confidentiality of information.” The confidentiality provisions of the FAR apply to the data submitted by bidders and potential CAP vendors under the CAP. However, we noted that what is confidential for FAR purposes may not necessarily be protected under the provisions of the Freedom of Information Act (FOIA), and that if a FOIA request is received for pricing information, the request will be processed in accordance with 5 U.S.C section 552(b) and 45 CFR part 5, subpart F to determine whether any of the FOIA's exemptions to mandatory disclosure may apply to protect the information. *Comment:*
                         One commenter expressed concern that drug pricing information may be subject to disclosure under FOIA and suggested that it is protected from disclosure under FOIA exemption (b)(4). This commenter also suggested that drug pricing information provided under the CAP be treated the same as the drug pricing information provided for Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Part D prescription drug benefit. Another commenter wanted assurance that all potential CAP vendor cost data will be protected as proprietary and will remain confidential and unidentifiable by manufacturer or wholesaler. *Response:*
                         We again affirm that, to the extent permitted by law, all cost information submitted during the bidding process and as part of the contract's price adjustment process will remain confidential and not made available, and that potential CAP vendor pricing information will be kept confidential. The FAR directly addresses the government's obligation to protect contractor information submitted in response to a solicitation for competitive bids. If a FOIA request is received seeking disclosure of a bidder's pricing data, that request would 
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                        be forwarded to the CMS FOIA officer for review in accordance with FOIA requirements. To the extent allowed by Federal law, we will assert applicable FOIA exemptions to protect confidential cost and pricing information. The FOIA exemptions are set forth in Department of Health & Human Services Freedom of Information regulations at 45 CFR part 5, subpart F. (4) Approved CAP Vendor Requirements/Call Center Hours of Operation In the July 6, 2005 interim final rule with comment (70 FR 39065), we stated that the approved CAP vendor would be required to— Maintain the operation of a grievance process so that participating CAP physician, beneficiary, and beneficiary caregiver complaints can be addressed;
                    Provide a prompt response to any inquiry as outlined in the vendor application form;
                    Maintain business hours on weekdays and weekends with staff available to provide customer assistance for the disabled, including the hearing impaired, and to Spanish speaking inquirers; and
                    Provide toll-free emergency assistance when the call center is closed. We also required that approved CAP vendors maintain a formal mechanism for responding to complaints from participating CAP physicians, beneficiaries, and their caregivers (if applicable) (70 FR 39065). Additionally, we stated that customer service is of primary importance and approved CAP vendors must demonstrate the ability to respond to inquiries on both weekdays and weekends (70 FR 39085). *Comment:*
                         We received no objections to any of the requirements. A commenter noted that although vendors are required to have procedures to resolve complaints and inquiries about CAP drug shipments, there were no clear standards for systems or procedures that approved CAP vendors must maintain. This commenter supported the establishment of a call center or other patient support center to answer patients' questions about billing, payment schedules, and other matters. *Response:*
                         We believe that customer service is of primary importance and that approved CAP vendors must demonstrate the ability to respond promptly and satisfactorily to inquiries from providers, beneficiaries, and caregivers. We believe that approved CAP vendors should have the flexibility to develop standards and systems that meet our requirements. However, we note that an approved CAP vendor will be required to respond to inquiries from a wide variety of sources, including beneficiaries and physician office staff, and that inquiries could come from a variety of time zones. Therefore, we are finalizing this policy and revising § 414.914 to reflect that an approved CAP vendor will be required to— Maintain the operation of a grievance process so that participating CAP physician, beneficiary, and beneficiary caregiver complaints can be addressed.
                    Respond within 2 business days to any inquiry, or sooner if the inquiry is related to drug quality.
                    Staff a toll-free line from 8:30 a.m. or earlier and until 5 p.m. or later for all time zones served in the continental United States by the approved CAP vendor on business days (Monday through Friday excluding Federal holidays) to provide customer assistance, and establish reasonable hours of operation for Hawaii, Alaska, Puerto Rico, and the other U.S. territories.
                    Staff a toll-free emergency line for weekend and evening access when the call center is closed, and determine which hours on Saturdays and Sundays the call center will be staffed and which hours a toll-free emergency line will be activated.
                    Include assistance for the disabled, the hearing impaired, and Spanish speaking inquirers in all customer service operations. We also recommend that all approved CAP vendors have arrangements in place to obtain translation services in other languages if serving a sizable population of beneficiaries or caregivers whose language is other than English or Spanish and who do not have access to translator assistance. When a beneficiary has a question about a coinsurance bill from an approved CAP vendor, the beneficiary is directed to contact the approved CAP vendor or his or her supplemental insurance provider (if applicable). If the beneficiary has no supplemental insurance, and believes he or she is not liable for the coinsurance bill, but is unable to resolve the situation on their own, the beneficiary may contact the designated carrier's customer service staff for assistance. The dispute resolution process is described in § 414.916(d) and in the July 6, 2005 interim final rule with comment (70 FR 39098). (5) Prompt Pay Discounts In the July 6, 2005 interim final rule with comment, we stated that prompt pay discounts should be disclosed by the approved CAP vendor and included in determining reasonable, net acquisition costs for purposes of section 1847B(c)(7) of the Act, and that we were interested in receiving comments about how these discounts are arranged and whether they are indeed different from other price concessions and discount arrangements. *Comment:*
                         Some commenters questioned the inclusion of prompt pay discounts in the determination of approved CAP vendors' reasonable net acquisition costs. They argued that so long as prompt pay discounts truly represent the time value of money and the fair market value of the distribution and financial services that are provided and are not passed on to providers, they should not be included in the approved CAP vendor's net acquisition costs. The commenters also raised issues with the treatment of prompt pay discounts under the ASP system. *Response:*
                         We disagree that prompt payment discounts should be excluded from the determination of an approved CAP vendor's reasonable, net acquisition costs. Section 1847B(c)(7) of the Act makes reference to an approved CAP vendor's “reasonable, 
                        *net*
                         acquisition costs”. The statute's use of the word “net” indicates these costs should reflect discounts the approved CAP vendor has received. Further, we believe it is appropriate that “net acquisition costs” be calculated in a manner consistent with the calculation of ASP. Prompt pay discounts are price concessions that must be included in a manufacturer's calculation of ASP. Please see section II.H.1 of this preamble, ASP Issues, for further discussion of prompt pay discounts under the ASP payment methodology. (6) Bidding Process In the July 6, 2005 interim final rule with comment, we stated that the composite bid ceiling will be determined on the basis of ASP prices in effect during the quarter in which the bids are generated, and that the single price for each drug (HCPCS code) will be initially determined on the basis of the median of the bids submitted during the second quarter of CY 2005 for that drug. We further stated that the price of each drug will then be updated to the mid-point of CY 2006 (five quarter increase) Producer Price Index (PPI) for prescription preparations. Given the 6 month delay in implementation and the corresponding change in the bidding period, we will be making certain adjustments to the bidding process to account for more recent data. In general, we will retain the process described in the July 6, 2005 
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                        interim final rule with comment (§ 414.904). However, we will require bidders to base their bid on the October ASP file which accounts for the most recent ASP data available and can be found at 
                        *http://www.cms.hhs.gov/​providers/​drugs/​asp.*
                         As a result of the use of the updated drug pricing data and the delay in the implementation, we will no longer need to update the bid price by 5 quarters of PPI. Instead, we will update prices by 4 quarters of PPI. This allows the data to be trended forward from the period in which bidding is conducted (the fourth quarter of CY 2005) to the period in which the single prices will actually be in effect (second half of CY 2006). Specifically, the price of each CAP drug will be updated to the mid-point of the 2006 payment period on the basis of projecting the overall change in PPI prices for prescription preparations. Bidding for potential CAP vendors will commence upon publication of this final rule with comment. Bidders will have at least 30 days to submit an application. Upon publication of the final rule, CAP bidding forms and additional information regarding bidding timelines, and other related material, can be found at 
                        *http://www.cms.hhs.gov/​providers/​drugs/​compbid/​bid_​form_​announ.asp.* c. Operational Issues In this section, we address drug product waste and returns, and when unused portions of single-use drugs may be billable to Medicare under the CAP. We address billing issues and timing of claims processing and payment. We address comments regarding coinsurance and collection of Advanced Beneficiary Notice forms (ABNs) and arrangements between approved CAP vendors and participating CAP physicians for services relating to the CAP. We also address several CAP drug-ordering issues. We describe the resupply option and emergency use within the CAP. We clarify when a Medicare beneficiary's height and weight are needed for ordering a CAP drug. We also clarify the “furnish as written” option. Finally, we address patient confidentiality. (1) Unused Drug Product (Waste and Returns) In the July 6, 2005 interim final rule with comment (70 FR 39062), we responded to commenters asking for specific guidance on how to manage drug waste and returns as follows: Although a variety of situations may create quantities of unused drugs at the place of administration, we believe the unused CAP drugs will come in the following 3 forms: An unopened vial (or vial package) as shipped by the approved CAP vendor.
                    An opened vial (that may or may not be reconstituted or partly used).
                    A drug that has been removed from a vial or package and is in a syringe, IV bag, or other device or container used for drug administration. Unused quantities of a drug may increase the risk of waste, fraud and abuse, and attempts to use the excess drug may violate applicable pharmacy law or may compromise product integrity. We expect that approved CAP vendors will furnish drugs in a manner that will minimize unused drugs. We also expect that participating CAP physicians and approved CAP vendors will both make an effort to label, ship, and store CAP drugs in a manner that will allow the legally permissible reuse of an unopened and intact container of a CAP drug. Returns of unused products through a distribution system may be acceptable, but many States prohibit reusing drugs that have been dispensed by a pharmacy (For further information, see FDA Office of Regulatory Affairs (ORA) Compliance Policy Guides Manual Sec. 460.300, Return of Unused Prescription Drugs to Pharmacy Stock, CPG 7132.09). We are aware of situations when an approved CAP vendor may label a vendor-supplied outer container for prescriptions to keep the actual manufacturer's packaging intact and unlabelled. We further expect approved CAP vendors to offer and ship units of a drug that match the beneficiary's dosing requirements and HCPCS billing amount as closely as practical. In this way, a degree of waste will be prevented. Specific details, including how waste, returns, and their cost burden are handled, will depend on State law and regulation as well as the individual situations. Approved CAP vendors should establish policies on these issues (making sure that they comply with applicable laws and regulations) and make the policies available for physicians to review during the election period and through the term of the approved CAP vendor's participation in the CAP. Approved CAP vendors will supply CAP drugs to participating CAP physicians' offices in unopened vials. However, in situations where a CAP drug is dosed by body weight or BSA, the amount of drug in vials may not match the Medicare patient's actual dose, and the approved CAP vendor will be forced to ship excess drug. In certain States, pharmacy law may prevent the use of excess CAP drug for another Medicare beneficiary if the order must be labeled as a prescription. The return process is guided by the following: Federal Law and guidelines (such as the FDA/ORA CPG 460.300), State law, Medicare requirements (such as the Claims Processing Manual), drug stability, and appropriate standards (such as United States Pharmacopoeia Chapter 797, Pharmaceutical Compounding—Sterile Preparations) will be used to determine how an extra drug product(s) may be used for subsequent dosing on the same beneficiary or for use on another beneficiary.
                    If excess drug product remaining in a vial shipped by an approved CAP vendor must be returned, the approved CAP vendor is expected to accept excess CAP drugs for disposal and is expected to pay for shipping. The participating CAP physician is responsible for appropriately packing the drug. Consolidating shipping into larger and less frequent packages by the participating CAP physician would be encouraged. We do not intend for this process to be used as a vehicle for routine disposal of empty or nearly empty vials, disposal of any drug product not shipped by an approved CAP vendor, or disposal of drugs mixed in IV bags, syringes, associated needles and tubing, or other devices used in the administration of the drug product to a beneficiary. The approved CAP vendor bills Medicare only for the amount of CAP drug administered to the Medicare beneficiary and the beneficiary's coinsurance amount will be calculated from the quantity of drug that is administered. Because the CAP statute authorizes us to pay the approved CAP vendor only upon administration of the CAP drug, any discarded drug (or drug that is considered waste) will not be eligible for payment. We also stated that the CAP dispute resolution process will be available to resolve any associated disputes. *Comment:*
                         Most commenters objected to our payment policy for the unused portion of drugs. Most commenters perceived that the payment policy for the unused portion of a drug under the CAP was more restrictive than the payment policy for the unused portion of a drug under the ASP payment system. Many, but not all, commenters on this issue supported the general concept of payment for the unused portion of drugs contingent upon good faith efforts on the part of the participating CAP physician and approved CAP vendor to minimize unused drugs. However, some commenters indicated that payment to 
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                        the approved CAP vendor for the unused portion of CAP drugs should not be contingent on good faith efforts by the participating CAP physician, but only good faith efforts by the approved CAP vendor in furnishing the drug. *Response:*
                         Under the ASP payment system, physicians may bill the program for the unused portion of a drug remaining in an opened single-use vial if the physician made good faith efforts to minimize the unused portion of the drug in how he or she scheduled patients and how he or she ordered, accepted, stored, and used the drug. This policy does not apply to the unused portion of drugs from multiple use vials. We expect that approved CAP vendors and participating CAP physicians will act and interact in a manner that will minimize unused drugs. Section 1847B(a)(3)(A)(iii) of the Act states that payment for CAP drugs is conditioned upon the administration of these drugs. We are clarifying that we consider the unused portion of a drug remaining in an opened single-use vial to be administered for the limited purpose of section 1847B(a)(3)(A)(iii)(II) of the Act, but only if the participating CAP physician has made good faith efforts to minimize the unused portion of the CAP drug in how he or she scheduled patients and how he or she ordered, accepted, stored, and used the drug, and only if the approved CAP vendor has made good faith efforts to minimize the unused portion of the drug in how it supplied the drug. This policy does not apply to the unused portion of drugs from multiple use vials. We disagree with commenters who indicated that payment for the unused portion of drugs should not be contingent on good faith efforts by the participating CAP physician, but only on good faith efforts by the approved CAP vendor in supplying the drug. The program should not pay for the unused portion of a drug resulting from circumstances that were avoidable through good faith efforts. However, in response to these comments, we are including a new obligation in participating CAP physicians' CAP election agreement that requires the participating CAP physician to make good faith efforts to minimize the unused portion of CAP drugs in how he or she schedules patients and how he or she orders, accepts, stores, and uses the drugs. The requirement stated in the July 6, 2005 interim final rule with comment (70FR 39048) still applies, that when a participating CAP physician does not administer a CAP drug during the time frame specified on the prescription order, or administers a smaller amount of the drug than was originally ordered, the participating CAP physician must contact the approved CAP vendor to discuss what to do. If it is permissible under State law, and if the CAP drug is unopened and both the participating CAP physician and the approved CAP vendor are in agreement, then the participating CAP physician may retain the drug for administration to another Medicare beneficiary. However, before the drug could be administered to another Medicare beneficiary, the participating CAP physician would need to provide the approved CAP vendor with a new prescription order for the drug, and the approved CAP vendor would need to provide the participating CAP physician with a new beneficiary-specific prescription order number. If the unused portion of the CAP drug is from a single-use vial, and all of the other conditions are met, the approved CAP vendor may bill for the unused portion of the CAP drug in the single-use vial. However, if the unused portion of the CAP drug is from a multi-use vial or an unopened vial, the participating CAP physician and approved CAP vendor must come to an arrangement on what to do with the unused CAP drug consistent with statute, the CAP regulations, and all applicable State and Federal laws and regulations. We note that unused CAP drugs are the property of the approved CAP vendor. *Comment:*
                         Some commenters asked for clarification of wastage, spillage or spoilage. *Response:*
                         Any drug or portion of a CAP drug that is not administered to a Medicare patient is considered wastage, spillage or spoilage. We note that if the other conditions described in the previous response are met, the unused portion of a CAP drug from a single-use vial is considered to have been administered for purposes of section 1847B(a)(3)(A)(iii)(II) of the Act, and, therefore, would not be considered wastage, spillage, or spoilage. *Comment:*
                         One commenter indicated that totally unopened or unused vials or packages ordered by the participating CAP physician should be purchased by the participating CAP physician for his or her own inventory. *Response:*
                         We expect participating CAP physicians will make good faith efforts to minimize unused CAP drugs. One of the goals of the CAP program is to allow physicians a choice between obtaining CAP drugs from approved CAP vendors selected in a competitive bidding process or acquiring and billing for Part B covered drugs under the ASP drug payment methodology. We do not believe that requiring participating CAP physicians to purchase totally unopened or unused vials or packages for their own inventory is consistent with this goal. *Comment:*
                         One commenter stated that many neurology practices that administer botox infusions split vials of the medication between two patients in cases where the patient does not need the full vial. The commenter indicated that the interim final rule with comment would prohibit this practice. *Response:*
                         We indicated in the interim final rule with comment that unused quantities of a drug may increase the risk of waste, fraud and abuse, and attempts to use the excess drug may violate pharmacy law and may compromise product integrity. However, we also indicated that specific details will depend on State law and regulation as well as the individual situations. Approved CAP vendors will establish policies on these issues (making sure that they comply with applicable laws and regulations) and make the policies available for physicians to review during the election period and through approved CAP vendor's participation in the CAP. Note also our policy regarding unused portions of a CAP drug from a single-use vial, which is described above. (2) Timing of Approved CAP Vendor Billing/Payment of Claims In the July 6, 2005 interim final rule with comment, we stated the participating CAP physician must file his or her drug administration claim within 14 days of administration (70 FR 39050 and 39095), and that the approved CAP vendor could not bill the beneficiary for drug product coinsurance until the claims matched and the approved CAP vendor received payment from the designated carrier (70 FR 39052 and 39097). *Comment:*
                         Potential vendors have proposed ways to shorten the time frame of the approved CAP vendor's payment window. One suggested that approved CAP vendors should be permitted to bill and be paid for drugs upon delivery to a participating CAP physician. Another suggested that the participating CAP physician be deemed to have “purchased” the drug if the participating CAP physician has not filed his or her claim within 14 days of delivery. These potential vendors are concerned about the viability of the CAP from a cash flow perspective. *Response:*
                         In most cases, assuming the participating CAP physician and the approved CAP vendor have promptly and properly submitted their claims, the approved CAP vendor should be paid by CMS within two to three weeks from the 
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                        date of drug administration. The anticipated sequence of events for the majority of CAP claims that are in compliance with local coverage determinations (LCDs) is described in the timeline in Diagram 1. This timeline (diagram 1) is offered as an illustration of how the approved CAP vendor's drug claim and the participating CAP physician's administration claim would travel through the Medicare claims processing system using the month of October as an example. The claims depicted here are assumed to have passed “front end edits” and been considered “clean claims.”  In the July 6, 2005 interim final rule with comment, we asked the approved CAP vendor to submit its drug claim to the designated carrier no earlier than the first day of the anticipated week of administration as indicated on the drug order (70 FR 39040). After performing initial “front end” edits to validate the claim, the designated carrier will forward the approved CAP vendor's claim to the CMS central claims processing system. If there is not an immediate match between the approved CAP vendor's drug product claim and the participating CAP physician's drug administration claim in the CMS central claims system on the day the approved CAP vendor's claim is received, then the approved CAP vendor's claim goes into a recycling phase and will be reviewed for a match regularly thereafter. Section 1842(c)(3)(A) of the Act requires that no payment on an electronic claim shall be issued in less than 13 days. We add one day for mailroom and check handling and refer to this 14-day period as the “payment floor.” The payment floor clock starts on the day the approved CAP vendor's claim is received by the designated carrier as long as the claim passes all edits and is classified as a “clean claim”. In the July 6, 2005 interim final rule with comment, we stated that participating CAP physicians are required to file their claims for drug administration services within 14 days of the date of administration (70 FR 39050). Statistics obtained from Medicare claims filing data indicate that 75 percent of physician claims are filed within 14 days of the date of service, and that 95.6 percent of all Part B claims are considered clean when first filed. Within 3 days of receipt of a participating CAP physician's clean claim that has not been suspended for medical review, the CMS central claims processing system will generate a match between the participating CAP physician's claim and the approved CAP vendor's claim and permit payment of the approved drug vendor's drug product claim, provided the 14-day payment floor has been satisfied. In the July 6, 2005 interim final rule with comment, we stated that drug administration claims will undergo electronic medical review for compliance with LCDs (70 FR 39038). Historically, approximately 5 percent of Part B drug claims are suspended for manual review, and approximately 7 percent of all claims (that is, not just those for Part B drugs) are denied. We expect that a small number of CAP drug claims will be reviewed for off-label use. As for the 20 percent coinsurance portion of the bill, about 80 percent of Medicare beneficiaries have a supplemental insurance policy that covers the beneficiary's cost sharing obligation. Approved CAP vendors will know which beneficiaries have a supplemental policy because that information is required to be included on the prescription order. Approved CAP vendors will also be able to verify the beneficiary's supplemental coverage by contacting the supplemental insurer. If the supplemental insurer has an arrangement with CMS as part of the automatic coordination of benefits process, the approved CAP vendor's claim will automatically cross over to the supplemental insurer after Medicare has paid its 80 percent share of the claim. In addition, under the mandatory Medigap crossover process, claims will be forwarded to the supplemental insurers for their use calculating their financial liability after Medicare if the approved CAP vendor properly coded the claim with the trading partner (for example, supplemental insurers) information. In both of these situations, after the supplemental insurer receives the claim it will issue applicable payment to the approved CAP vendor. When an approved CAP vendor has supplied a CAP drug for administration to a beneficiary without supplemental insurance, the approved CAP vendor may bill the beneficiary upon receipt of Medicare's payment from the designated carrier or upon administration of the drug, if the approved CAP vendor has received notice of administration from the participating CAP physician. The approved CAP vendor may enter into a voluntary arrangement with a participating CAP physician to receive notification that the drug has been administered. The approved CAP vendor may also enter into a voluntary arrangement with the participating CAP physician to arrange for the collection of the beneficiary's coinsurance after the drug is administered, or to deliver information and notices on coninsurance assistance. (3) Arrangements Between Approved CAP Vendors and Participating CAP Physicians for the Collection of Coinsurance and ABNs In the July 6, 2005 interim final rule with comment, we stated that nothing in the CAP statute or regulations prohibited an approved CAP vendor and a participating CAP physician from entering into an agreement governing their arrangements for the provision of CAP drugs or other items or services (70 FR 39050). We added that parties to these agreements must ensure that the arrangements do not violate the physician self-referral (“Stark”) prohibition (section 1877 of the Act), the Federal anti-kickback statute (section 1128B(b) of the Act), or any other Federal or State law or regulation governing billing or claims submission. *Comment:*
                         Some commenters requested that we state explicitly that approved CAP vendors and participating CAP physicians are allowed to enter into these arrangements. They suggested that drug industry relationships commonly include supplier/physician arrangements. These commenters believed that approved CAP vendor/participating CAP physician arrangements will promote more participation in the CAP, stimulate greater cooperation between the parties, and generate fiscal efficiencies. Physician and manufacturer commenters requested that we implement the CAP with safeguards that preserve the participating CAP physician's prescribing authority in the presence of these arrangements. They asked us to ensure that approved CAP vendors have no incentive and no regulatory pathway by which to restrict, limit, or change a participating CAP physician's access to specific drug and biological therapy. *Response:*
                         We are stating explicitly that nothing in the CAP statute or regulations prohibits approved CAP vendors and participating CAP physicians from entering into voluntary written arrangements that include— An arrangement between a participating CAP physician and an approved CAP vendor to notify the approved CAP vendor after the CAP drug has been administered to the beneficiary;
                    An arrangement between a participating CAP physician and an approved CAP vendor to communicate with the beneficiary about coinsurance for CAP drugs on behalf of the approved CAP vendor;
                    An arrangement between a participating CAP physician and an approved CAP vendor to issue an ABN on behalf of the approved CAP vendor;
                    An arrangement between a participating CAP physician and an approved CAP vendor to collect applicable coinsurance and deductible on behalf of the approved CAP vendor from the beneficiary with no supplemental insurance coverage after the drug has been administered; and
                    Any other appropriate and legal arrangement between a participating CAP physician and an approved CAP vendor. (We note that the provisions of § 414.914(h) also allow the participating CAP physician and the approved CAP vendor to enter into an arrangement for( print page 70252)
                        the participating CAP physician to deliver notices related to the vendor's coinsurance assistance program.) We will not dictate the breadth of use or the specific obligations contained in these arrangements, other than to note that they must comply with applicable law and to prohibit approved CAP vendors from coercing participating CAP physicians into entering any of these arrangements, as noted below. All written arrangements between approved CAP vendors and participating CAP physicians must comply with the requirements discussed below. These arrangements should be carefully scrutinized by the parties to ensure that these arrangements are not disguised payments for referrals for items or services payable by a Federal health care program. These arrangements are subject to the physician self-referral (“Stark”) prohibition, the Federal anti-kickback statute or any other Federal or State law or regulation governing billing or claims submission. Arrangements should be at fair market value for actual services provided and should not take into account the volume or value of referrals. Percentage compensation arrangements or per item arrangements for billing and collection services between participating CAP physicians and approved CAP vendors would be highly suspect under the fraud and abuse laws. Approved CAP vendors who enter into these arrangements with participating CAP physicians remain subject to liability for improper waivers of deductibles and coinsurance, including violations of the Federal anti-kickback statute and liability under section 1128A(a)(5) of the Act. Cost-sharing waivers are permitted under certain conditions for financially needy beneficiaries as specified in section 1128A(i)(6) of the Act. Parties should monitor these arrangements to ensure that waivers are made appropriately and create safeguards to ensure that these arrangements are not used by approved CAP vendors or participating CAP physicians as inappropriate marketing tools. A participating CAP physician's decision to enter into an arrangement with an approved CAP vendor must be completely voluntary. An approved CAP vendor may not refuse to do business with a participating CAP physician because the participating CAP physician has declined to enter into an arrangement with the approved CAP vendor. Approved CAP vendors must accept all participating CAP physicians who choose to enroll with that approved CAP vendor. *Comment:*
                         Some commenters proposed that approved CAP vendors should have authority to obtain beneficiary credit card authorization before shipping drugs for them. One commenter suggested that Medicare withhold the approved CAP vendor's 20 percent coinsurance from the participating CAP physician's drug administration claim payment. The participating CAP physician would then collect both the administration coinsurance together with the drug product coinsurance from the beneficiary and/or the beneficiary's supplemental insurer. The approved CAP vendor would be paid the full amount. *Response:*
                         The CAP statute requires that we develop a process for the sharing of information between the participating CAP physician and the approved CAP vendor related to the payment of deductible and coinsurance (section 1847B(a)(3)(C) of the Act). In the July 6, 2005 interim final rule with comment, we interpreted this to mean beneficiary contact information, Medicare information, and third party insurance information (70 FR 39041). In the interim final rule with comment, we stated that we will not ask the participating CAP physician to collect the beneficiary's credit card information and share it with the approved CAP vendor because this information is not necessary to complete the drug ordering process, nor is it part of any supplemental insurance coverage that the beneficiary may have. We maintain that position in this final rule with comment. We do not ask the participating CAP physician to collect and forward credit card information to a third party supplier in any other Medicare setting. The beneficiary will have supplemental insurance approximately 80 percent of the time, rendering beneficiary payment information unnecessary in most cases. We do not believe it is appropriate to require participating CAP physicians to secure drug coinsurance payment information from beneficiaries with no supplemental insurance, since provisions of section 1847B(a)(3)(A)(ii) of the Act make the collection of coinsurance the responsibility of the approved CAP vendor. However, as discussed previously, the participating CAP physician and the approved CAP vendor may enter into a voluntary arrangement, whereby the participating CAP physician, on the approved CAP vendor's behalf, would collect coinsurance from beneficiaries with no supplemental insurance coverage. (4) Resupply Option/Definition of Emergency As stated in the July 6, 2005 interim final rule with comment (70 FR 39037 and 39047), the four criteria that govern the resupply option are contained in section 1847B(a)(5) of the Act, which says that a participating CAP physician may acquire drugs under the CAP to resupply his or her private inventory if all of the following requirements are met: The drugs were required immediately.
                    The participating CAP physician could not have anticipated the need for the drugs.
                    The approved CAP vendor could not have delivered the drugs in a timely manner.
                    The participating CAP physician administered the drugs in an emergency situation. As we also stated in the July 6, 2005 interim final rule with comment, these criteria are set forth in the CAP statute, and, therefore, we do not have the authority to change them, or to allow that some of them be optional. In the July 6, 2005 interim final rule with comment, we defined “delivery in a timely manner” for the resupply provisions of the CAP as the ability to meet emergency delivery standards for timely delivery as defined in § 414.902. We also defined “emergency situation” for the purposes of the resupply provisions of the CAP in § 414.902 as an unforeseen occurrence or situation determined by the participating CAP physician, in his or her clinical judgment, to require prompt action or attention for purposes of permitting the participating CAP physician to use a drug from his or her own stock, if the other requirements of § 414.906(e) are met. In the July 6, 2005 interim final rule with comment, we stated that we anticipated that the local carrier would, at times, conduct a post-payment review of claims for emergency drug replacement in order to determine whether participating CAP physicians were complying with conditions for emergency drug replacement. The local carrier would use the emergency replacement modifier code to identify claims for emergency drug replacement for random post-payment review. *Comment:*
                         Numerous commenters expressed concern that the emergency resupply provisions were too restrictive and would have a negative impact on patient care. These commenters stated that, particularly for oncology treatment, health status changes are common, resulting in frequent changes in drug 
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                        dosage or medication(s). These commenters believe that the requirements regarding emergency resupply would result in delayed treatment for patients already ill, and increase the burden on the patient and their caregivers. The impact on people in rural areas who may live several hours from where they receive treatment was mentioned by many commenters, and it was suggested that the patient's driving distance be considered in the ability of a participating CAP physician to provide drugs out of office supply and be resupplied by the approved CAP vendor. One commenter also noted that acute and infectious disease patients could be at risk if there was any delay in treatment. Some commenters expressed concern that participating CAP physicians who use the emergency resupply option might be subjected to unwarranted audits. Others expressed concern that frequent use of the emergency resupply option would result in adverse consequences for the participating CAP physician. There were also questions about the approved CAP vendor's ability to withhold shipment if the approved CAP vendor did not agree that an emergency existed or if they believe the drug that was used in the emergency situation would not be covered. *Response:*
                         As stated in the July 6, 2005 interim final rule with comment, we believe that the definition of emergency used in this situation should be one that enables the participating CAP physician to use his or her clinical judgment to determine when his or her patient needs immediate treatment. We have defined emergency for purposes of this provision as a situation determined by the participating CAP physician's clinical judgment to be an unforeseen situation that requires prompt action or attention. If the approved CAP vendor's emergency delivery timeframe would result in delivery of the drug after the time necessary to meet the patient's clinical need, it would be considered that the CAP drug could not have been delivered in a timely manner. We are firm in our view that the determination of clinical need rests with the participating CAP physician and we leave it to the participating CAP physician to determine the scope of the clinical need. As previously stated, the participating CAP physician will assess whether all of the criteria are applicable and will document the patient's medical record accordingly. However, we do not believe that driving distance in itself should be a determining factor in the use of the emergency supply provision. Rather, the participating CAP physician should evaluate the entire clinical situation of the patient and make an appropriate determination based on all relevant information. Approved CAP vendors do not have the authority to override a participating CAP physician's determination of what constitutes an emergency situation for purposes of the resupply provision. Policies regarding the shipment of CAP drugs are the same for the emergency resupply provision as they are for routine ordering and shipping of CAP drugs and for the “furnish as written” procedures. In all of these cases, the approved CAP vendor is required to deliver CAP drug(s) upon receipt of a prescription order, ensuring that the participating CAP physician's judgment about the appropriate treatment is the final determining factor in the decision-making process. The same principle applies to the emergency replacement process. If a participating CAP physician orders a CAP drug to resupply inventory on the basis of an emergency administration, the approved CAP vendor must ship it, unless the conditions of § 414.914(h) are met. As stated in the July 6, 2005 interim final rule with comment, we anticipate that at times the local carrier would conduct a post payment review of emergency drug replacement in order to determine whether participating CAP physicians were complying with conditions for emergency drug replacement. We acknowledge that there may be some participating CAP physicians that may have legitimate reasons for more frequent use of the emergency resupply option. The post payment review process will also provide us with information on participating CAP physicians' use of the emergency resupply provision and help to distinguish between appropriate and inappropriate use of this provision. As we gain more experience with the CAP, we will assess whether the emergency resupply provision is working as intended, and whether further refinement is necessary. (5) Order Form Information on Patient's Height and Weight In the July 6, 2005 interim final rule with comment (70 FR 39095), we stated that the participating CAP physician would agree to provide specific information to the approved CAP vendor from whom he or she has elected to receive drugs information. The specific information required included the Medicare beneficiary's height and weight. We also stated that abbreviated information could be sent for repeat patient orders. We received comments regarding the patient's height and weight. *Comment:*
                         Some commenters stated that including the patient's height and weight on the CAP order form should not be required. *Response:*
                         It is possible for an approved CAP vendor to be a wholesaler distributor, a specialty pharmacy or a combination of both. State and Federal laws that govern specialty pharmacy operations may be different from those that govern wholesale distributor operations. For example, State laws, regulations, and recognized professional practice standards may require that specialty pharmacy services be provided by a qualified pharmacist. If the approved CAP vendor is a specialty pharmacy or distributor with an arrangement with a specialty pharmacy to supply drugs to a participating CAP physician, then information on patient height and weight may be required in order for a pharmacist to check a dispensed dose. If the approved CAP vendor operates solely as a drug wholesaler this information may not be necessary. To reflect the different requirements that may apply to different potential types of approved CAP vendors, we are amending § 414.908(a)(3)(v)(M) to specify that height and weight should be provided only if necessary. (6) Furnish as Written In the July 6, 2005 interim final rule with comment (70 FR 39043), we stated that we would allow the participating CAP physician to obtain a drug and bill Medicare under the ASP system using the “furnish as written” (FAW) option when medical necessity requires that a specific formulation of a drug be furnished to the patient, and that formulation is not provided by the approved CAP vendor. Documentation of the medical necessity must be maintained in the Medicare patient's medical record. The participating CAP physician would use a FAW modifier to identify that he or she was allowed to bill Medicare under the ASP system in this limited circumstance. *Comment:*
                         One commenter stated the examples given under the description of FAW were very narrow and would keep a participating CAP physician from using the FAW option proactively. *Response:*
                         If the approved CAP vendor does not carry a specific NDC that is medically necessary for a patient, the participating CAP physician may purchase the drug, bill for it and use the FAW modifier on the drug claim. In this situation, the local carrier will pay the participating CAP physician under the ASP payment system. We remind physicians that the FAW process 
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                        requires documentation of medical necessity. Although the July 6, 2005 interim final rule with comment contained several examples of when the FAW process may be used, we did not intend to imply that these were exhaustive. The examples were meant to be illustrative, and were not meant to exclude other situations where FAW could legitimately be used in order to furnish a patient with the most appropriate therapy. Rather, we wished to indicate two points—(1) Participating CAP physicians who use FAW must appropriately document clinical judgment in support of the use of FAW; and (2) FAW is not intended to provide participating CAP physicians with an “end run” around their decision to participate in the CAP. The CAP is in no way intended to bar access to a medically necessary therapy. However, where medical necessity is served by the drug formulation supplied by the approved CAP vendor, coverage is available only if the participating CAP physician obtains the drug from the approved CAP vendor. We again remind physicians that routine orders for CAP drugs should be placed at the HCPCS level. Specific products not on an approved CAP vendor's drug list that are medically necessary for the beneficiary may be obtained through the ASP system. Please note that the approved CAP vendor has the ability to request CMS approval to add new drugs to its CAP drug list. This process was discussed in the July 6, 2005 interim final rule with comment (70 FR 39075) and further described previously in this section. (7) Patient Data Confidentiality In the July 6, 2005 interim final rule with comment (70 FR 39065), we stated that approved CAP vendors would be required to comply with the HIPAA Administrative Simplification Rules, including the Privacy Rule. *Comment:*
                         One commenter requested that CMS explicitly prohibit approved CAP vendors from using, sharing, or selling patient information for any purpose other than that which is strictly related to fulfilling CAP orders. Another commenter wanted assurance that approved CAP vendor subcontractors would be subject to the same confidentiality requirements as the approved CAP vendor. *Response:*
                         We concur with the commenters that patient information must be protected from misuse, and believe that this requirement is adequately addressed by the requirement that approved CAP vendors comply with the HIPAA Privacy and Security rules. We also note that subcontractors are held to the same requirements and standards as the approved CAP vendor, including those pertaining to confidentiality. d. Beneficiary Issues In this section we discuss the policy permitting an approved CAP vendor to stop supplying drugs for a beneficiary who is not meeting their coinsurance obligations. We also discuss the ABN process as it pertains to the CAP. Finally, we respond to comments about the financial liability of a Medicare/Medicaid dual eligible beneficiary who receives a CAP drug. (1) Coinsurance In the July 6, 2005 interim final rule with comment, we specified requirements at § 414.914(g) to include a provision requiring approved CAP vendors to provide information on sources of cost-sharing assistance available to beneficiaries on request (70 FR 39096). We noted that routine waiver of deductibles and coinsurance could violate the Federal anti-kickback statute, as well as, the civil prohibition on offering inducements to beneficiaries at section 1128A(a)(5) of the Act (70 FR 39050). However, cost-sharing waivers are permitted under certain conditions for beneficiaries who are experiencing financial hardship. We also stated in the July 6, 2005 interim final rule with comment that we would not require an approved CAP vendor to continue to supply CAP drugs for beneficiaries who do not pay their deductible or coinsurance. Rather, we would allow the approved CAP vendor to refuse to make further shipments to the participating CAP physician for that beneficiary as long as the requirements of § 414.914(h) are met. In instances where a beneficiary failed to meet his or her obligation to pay coinsurance or deductible for a CAP drug, and the approved CAP vendor refused to continue providing the drug, we stated that we would permit the participating CAP physician to opt out of that drug category for the CAP. *Comment:*
                         Commenters from the community of potential CAP vendors expressed support for the approved CAP vendor's right to refuse to ship drugs for beneficiaries who do not meet their deductible and coinsurance obligations. They recommend removal of the requirement that the approved CAP vendor wait up to 60 days before discontinuing shipment of drugs on behalf of beneficiaries who do not meet their coinsurance obligations. The commenters offer that their exposure for additional uncollected coinsurance during the waiting period represents a risk so great that it renders participation in CAP untenable, and they should be permitted to collect coinsurance amounts on the day they ship the drugs. Physicians and some drug manufacturers commented that the 45 to 60 day waiting period is too short, suggesting the period after the vendor's referral to a specific, bona fide charitable organization should be extended to permit the beneficiary sufficient time to apply for the aid, and the charitable organization time to process the request. A longer period was requested for cognitively impaired beneficiaries. *Response:*
                         Approved CAP vendors who become concerned about additional drug coinsurance exposure during the waiting period may make reasonable contact with the beneficiary for assurance that he or she is making timely and meaningful efforts to secure additional sources of funding. The additional 15-day waiting period after the specific, bona fide charitable organization referral represents a safety valve, and is not suggested as the starting point for the beneficiary's effort to secure alternative funding. The regulatory time periods set up a framework for an enforceable remedy. However, in light of the comments, and to reflect our policy change that an approved CAP vendor may make an arrangement with a participating CAP physician to collect coinsurance on its behalf, we are making modifications to § 414.914(h) to reflect that the 45-day period will begin on the date that the bill for coinsurance is delivered to the beneficiary whether it is mailed by the approved CAP vendor or delivered by the participating CAP physician on the behalf of the approved CAP vendor. We are also clarifying that the delivery of the coinsurance bill need not be subsequent to Medicare payment if the approved CAP vendor has received notice of drug administration from the participating CAP physician and the beneficiary lacks supplemental insurance. Because we believe the regulatory provision with this technical modification appropriately balances the interests of all involved, we are not going to change the length of the waiting period in § 414.904(h). *Comment:*
                         Some physician commenters have indicated that they waive coinsurance for indigent beneficiaries in some cases and expect that vendors should do likewise as a matter of routine. *Response:*
                         Approved CAP vendors and participating CAP physicians must conduct their business in compliance 
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                        with the requirements of sections 1128A(a)(5) and 1128A(i)(6) of the Act. In the July 6, 2005 interim final rule with comment (70 FR 39053) we stated that we were modifying the program requirements at § 414.914(g) to include a provision requiring approved CAP vendors to provide information on sources of cost-sharing assistance available to beneficiaries on request. It is important to note that routine waiver of deductibles and coinsurance can violate the Federal anti-kickback statute, as well as the civil prohibition on offering inducements to beneficiaries at section 1128A(a)(5) of the Act. However, cost-sharing waivers are permitted under certain conditions for beneficiaries who are experiencing financial hardship. The assistance offered by the approved CAP vendor must take the form of one of the following: A referral to a bona fide and independent charitable organization, implementation of a reasonable payment plan, or a full or partial waiver of the cost-sharing amount based on the individual financial need of the patient, provided that the waiver meets all of the requirements in § 1003.101(1) (Definition of “Remuneration”). The availability of waivers may not be advertised or be made as part of a solicitation; however, approved CAP vendors may inform beneficiaries generally of the various categories of assistance noted in the preceding sentence. In no event may the approved CAP vendor include or make any statements or representations that promise or guarantee that beneficiaries will receive cost-sharing waivers. We will evaluate the procedures that applicant vendors propose to implement to make cost-sharing assistance referrals as part of the approved CAP vendor application review process. *Comment:*
                         Some physician commenters opposed the vendor's right to refuse further shipment because they believe it will fall to the physician to communicate to the beneficiary that his or her drugs are not being delivered, even though the decision to refuse shipment was the approved CAP vendor's. *Response:*
                         We understand the commenters' concern. However, when notifying the beneficiary of the approved CAP vendor's refusal to ship CAP drugs, the participating CAP physician need not justify the approved CAP vendor's decision. Instead, the participating CAP physician need only direct the beneficiary to the approved CAP vendor's grievance process. We believe it is the responsibility of the approved CAP vendor to notify the beneficiary about the conditions (specified in § 414.914(h)) under which the approved CAP vendor could permissibly cease delivery of CAP drugs for a beneficiary. *Comment:*
                         A few physician commenters expressed concern that an approved CAP vendor could use the refusal to ship for nonpayment of coinsurance as a way to influence the participating CAP physician's treatment plan, such as forcing the participating CAP physician to admit the beneficiary to a hospital. *Response:*
                         In order to preserve the flexibility of the participating CAP physician as required by the statute we have significantly limited the instances in which an approved CAP vendor can refuse to ship. However, we have a very specific process to provide the approved CAP vendor with some economic protection, and we will monitor the instances where an approved CAP vendor refuses to ship for nonpayment of coinsurance to ensure it is not being abused. The participating CAP physician may seek assistance from the CAP designated carrier in working out disputes where the participating CAP physician believes the approved CAP vendor is abusing the process under § 414.917. *Comment:*
                         One physician group commented that the regulation should be revised to require that the approved CAP vendor must provide information on cost sharing assistance to needy beneficiaries. The commenter stated that because the regulation at § 414.914(g)(3) and § 414.914(h)(3) state that the approved CAP vendor 
                        *may*
                         inform beneficiaries that they generally make available categories of assistance such as referral to a bona fide charitable organization, implementation of a payment plan, or a full or partial waiver of the cost sharing amount that they were not required to do so. *Response:*
                         In the July 6, 2005 interim final rule with comment (70 FR 39086), we stated that the approved CAP vendor would be required on request, to provide information to beneficiaries on sources of coinsurance assistance. The regulations at § 414.914(g) state that the “approved CAP vendor must provide assistance to beneficiaries experiencing financial difficulty in paying their cost sharing amounts * * *” However, § 414.914(g)(3) and § 414.914(h)(3) state that approved CAP vendors may inform beneficiaries that they generally make cost sharing assistance available. It was our intention as reflected in the language in the preamble and § 414.914(g) and § 414.914(h)(3) to require approved CAP vendors to have a cost sharing assistance program available if the beneficiary expressed a need for one. Section 14.914(g)(3) and § 414.914(h)(3) were intended to convey that approved CAP vendors may generally inform beneficiaries of the existence of this program rather than waiting for the beneficiary to request assistance. It was not our intention to convey that the approved CAP vendor had the option not to provide this assistance. In order to resolve any confusion we are revising § 414.914(g)(3) and § 414.914(h)(3) to reflect our original intent. The revision now reads, “Approved CAP vendors 
                        *must*
                         inform beneficiaries,” that they generally make available the categories of assistance described in paragraphs § 414.914(g)(1), (g)(2), and (g)(3) of this section.” *Comment:*
                         One manufacturer commented that the vendor should be required to document “reasonable collection efforts” before being allowed to cut off a beneficiary. *Response:*
                         Because approximately 80 percent of beneficiaries have a Medicare supplemental policy that includes coverage for Part B cost sharing, their coinsurance and deductible payments should be made automatically in most cases by their supplemental insurer under the coordination of benefits process. Some beneficiaries without supplemental insurance may have difficulty making their coinsurance and deductible payments at times, and may seek assistance from the approved CAP vendor or some other third party. As we stated previously in this final rule and in the July 6, 2005 interim final rule with comment and consistent with the requirements of section 1128A(a)(5) of the Act and § 414.914(g) of the regulations, at the time of billing, the approved CAP vendor must inform the beneficiary generally of the types of cost-sharing assistance that may be available. If the beneficiary is unable to pay the coinsurance or deductible, he or she may request assistance from the approved CAP vendor as described above. The approved CAP vendor has an obligation to provide the information requested, and to take one of the actions specified in § 414.914(g). However, if the beneficiary has not requested financial assistance and if after a period of 45 days from delivery date of the approved CAP vendor's bill to the beneficiary whether by the approved CAP vendor or by the participating CAP physician on the behalf of the approved CAP vendor, the beneficiary's coinsurance obligation remains unpaid, the approved CAP vendor may refuse to make further shipments of drugs to the participating CAP physician for that 
                        ( print page 70256)
                        beneficiary. (We note that these provisions assume that the approved CAP vendor bills the beneficiary after payment is received from Medicare and his or her supplemental insurance provider (if applicable).) If the beneficiary requests cost-sharing assistance and the approved CAP vendor refers the beneficiary to a bona fide independent charitable organization for assistance or offers a payment plan, the approved vendor must wait an additional 15 days from the date of delivery (which would be the postmark date when mailed and received date when hand delivered) of the approved CAP vendor's response to the beneficiary's request for cost-sharing assistance. If at the end of the 15-day time period, the approved CAP vendor has not received a cost-sharing payment (either from the charitable organization or from the beneficiary under the payment plan), the approved CAP vendor may refuse to ship additional drugs to the physician on behalf of that beneficiary. Further, if the approved CAP vendor implements a reasonable payment plan, it must continue to ship CAP drugs for the beneficiary, so long as the beneficiary remains in compliance with the payment plan. Finally, if the approved CAP vendor waives the cost-sharing in accordance with section 1128A(i)(6)(A) of the Act and § 1003.101 and § 414.914(g)(3) of the regulations, it may not refuse to ship CAP drugs for the beneficiary. At this time, we believe that sufficient safeguards are built into the system to protect the beneficiary. Beneficiaries who believe that the approved CAP vendor is not adhering to these standards may use the vendor's grievance process. If that does not resolve the issue to their satisfaction they may request assistance from the designated carrier under the dispute resolution process. We will monitor the implementation of this provision to see whether a requirement that the approved CAP vendor document collection efforts should be implemented at a later date. *Comment:*
                         A beneficiary advocacy group requested that the approved CAP vendor be required to assess the beneficiary's financial condition and waive coinsurance for beneficiaries who meet a prescribed poverty test. *Response:*
                         Any beneficiary who is unable to meet his or her cost-sharing obligations is free to request assistance from the approved CAP vendor. We assume that if the approved CAP vendor administers its own plan rather than referring the beneficiary to a charitable organization for assistance, it will develop eligibility guidelines for the plan. We do not require any provider to waive coinsurance on a routine basis. (2) Advance Beneficiary Notices (ABNs) In the July 6, 2005 interim final rule with comment, we stated that the approved CAP vendor could issue an ABN to the beneficiary if the approved CAP vendor and the participating CAP physician did not agree about whether the drug administration service claim would be paid as a medically necessary service (70 FR 39058). We also stated that the approved CAP vendor may ask the participating CAP physician to deliver an ABN. If the participating CAP physician agrees to do so, he or she will describe both the administration of the drug and the drug product on the ABN, together with the estimated cost for each that the beneficiary must pay if he or she receives the drug and Medicare does not pay. We also noted that if the participating CAP physician declined to issue the ABN, then the approved CAP vendor could issue the ABN to the beneficiary before the drug was administered. In the July 6, 2005 interim final rule with comment, we used the phrase “signed ABN” where we meant to say “enforceable ABN” (70 FR 39039 and 39051). We wish to clarify this point because there are circumstances under which an ABN issued via telephone can be enforced. The requirements for delivery of ABNs can be found in the Medicare Claims Processing Manual, Pub. 100-4, Chapter 30, Section 40.3.4. These requirements may be accessed electronically at 
                        *http://cms.hhs.gov/​manuals/​104_​claims/​clm104c30.pdf.* *Comment:*
                         Some physicians commented that an obligation to collect an ABN on behalf of the approved CAP vendor represented an unwelcomed administrative burden. Others expressed concern that approved CAP vendors would overuse the ABN process, issuing ABNs even when the approved CAP vendor had no reasonable belief that the physician's drug administration claim or the vendor's claim for the drug would be denied. A commenter stated that it would be a logical anomaly for the approved CAP vendor to ask a participating CAP physician to collect an ABN in cases where the physician believes the drug administration services and, consequently, the drug product will be covered. The commenter believes this puts the participating CAP physician in an untenable situation and will serve to confuse the beneficiary unnecessarily. Commenters from the community of potential vendors requested that we allow the approved CAP vendor to refuse to ship the CAP drug if the approved CAP vendor believes the applicable coverage policy prohibits payment and the participating CAP physician refuses to collect an ABN for the CAP drug on behalf of the vendor, suggesting that, in this case, the participating CAP physician should be allowed to use the furnish as written process. One commenter requested that we allow the approved CAP vendor to terminate CAP business with a participating CAP physician who refused to issue an ABN on behalf of the approved CAP vendor when the underlying claim was not paid. *Response:*
                         In response to the commenters' concerns, we reemphasize that the participating CAP physician's decision to issue an ABN on behalf of the approved CAP vendor is completely voluntary. An approved CAP vendor is always free to contact the beneficiary and issue an ABN on its own. Because the participating CAP physician's decision to issue an ABN is voluntary, the approved CAP vendor may not penalize the participating CAP physician who refuses to do so by refusing to ship the drug or attempting in some other way to force the participating CAP physician to obtain it. We note that, approved CAP vendors will have a disincentive to abuse the ABN process. Should an approved CAP vendor issue an ABN that is not consistent with CMS requirements, and the claim for the drug is denied and appealed to an Administrative Law Judge (ALJ), the ALJ could review the case and determine that the use of the ABN was inappropriate or invalid, thereby shifting liability to the approved CAP vendor. In addition, if an approved CAP vendor frequently seeks ABNs in cases where the participating CAP physician's local carrier routinely determines a particular drug to be covered, the approved CAP vendor may not be seen as a good business partner by the participating CAP physician and could lose his or her business at the next CAP election period. After careful consideration of the comments we have received, and balancing all the policy implications we have decided to maintain the policy with respect to ABNs set forth in the July 6, 2005 interim final rule with comment. (3) Dual Eligibles In the July 6, 2005 interim final rule with comment, we addressed the situation of beneficiaries who are dually eligible for the Medicare and Medicaid programs. We stated that Medicaid coinsurance payments would vary by State and that we had no authority to change the coinsurance amount based 
                        ( print page 70257)
                        on who was responsible for payment of the coinsurance (70 FR 39054). *Comment:*
                         Several commenters requested that we specifically state that dual eligible, Medicare/Medicaid beneficiaries may not be held responsible for more coinsurance than what the Medicaid State Agency pays. They have asked us to make clear that approved CAP vendors may not balance bill the beneficiary for that portion of the 20 percent Medicare coinsurance that is above the given State's Medicaid upper payment limit. *Response:*
                         State Medicaid programs can limit coinsurance payments to the extent that any payment for a covered Medicaid benefit, when combined with Medicare payments, equals the amount of reimbursement payable under the Medicaid program. A State Medicaid program may deem an approved CAP vendor to be paid in full even if it has received either no coinsurance payment or a reduced payment from the State. Dual eligible beneficiaries have no liability for a covered Medicaid benefit beyond the State's payment amount as set forth in section 1902(n)(2) of the Act. e. Physician Election Issues and Education In the July, 6, 2005 interim final rule with comment (70 FR 39079), we stated that section 1847B(a)(1)(A) of the Act specifies that each physician be given the opportunity annually to elect to participate in the CAP. Physicians who do not elect to participate in the CAP would continue to buy the drugs they provide to beneficiaries “incident to” their service and bill the Medicare program for them under section 1847A of the Act, the ASP system. Section 1847B(a)(5)(A) of the Act requires that we develop a process that physicians who wish to participate in the CAP may use to select an approved CAP vendor. This election is to occur on an annual basis. The statute requires that we coordinate this process with the Medicare Participating Physician Process described in section 1842(h) of the Act. Additionally, we stated that physicians who elect to participate in the CAP would be required to complete a CAP election agreement and would agree to the participating CAP physician requirements as established in the July 6, 2005 interim final rule with comment (70 FR 39079 through 39083). In the July 6, 2005 interim final rule with comment, we also stated that the participating CAP physician election process would operate from October 1 to November 15 of each calendar year. In the September 6, 2005 interim final rule with comment interpretation and correction notice (70 FR 52930), we announced a delay in CAP implementation to approximately July 1, 2006. We anticipate that the bidding for the initial round of CAP will commence upon the publication of this rule. Thus, for this first CAP year the participating CAP physician election process will occur for approximately 6 weeks in early to mid-spring. Exact dates and election procedures will be announced on our web site. Later in 2006, we will conduct the annual participating CAP physician election for CY 2007. The election period for 2007 will occur from October 1, 2006 to November 15, 2006, with subsequent annual participating CAP physician election periods running from October 1 to November 15 of each calendar year thereafter. In the July 6, 2005 interim final rule with comment, we stated that participating CAP physicians who wish to continue their participation in the CAP into subsequent years would do so by executing an abbreviated agreement, which would, if applicable, indicate a preference to change approved CAP vendors or, if applicable, CAP drug category. We also described specific instances in which participating CAP physicians will be permitted to select another approved CAP vendor or leave the CAP mid-year. These instances are when the selected approved CAP vendor ceases to participate in the CAP because its contract is terminated or suspended or if the participating CAP physician leaves the group practice that had selected the given approved CAP vendor or relocates to another competitive area (if multiple CAP competitive areas are implemented). Additionally, physicians newly enrolled in Medicare have 90 days from the date of enrollment to elect to participate in the CAP. The election process was summarized in the July 6, 2005 interim final rule with comment (70 FR 39083). We also stated that when a physician bills as a member of a group using the group's Provider Identification Number (PIN), he or she must follow the group's election to participate or not to participate in the CAP. Thus, members of a group practice would elect to participate in the CAP as a group when billing under the group PIN. We also stated that if a group practice physician maintains a separate solo practice, he or she could make a separate determination of whether to participate in the CAP for the solo practice if using his or her individual PIN for the solo practice. (1) Group vs. Individual Participation in CAP We received several comments on the CAP participation of physicians who are in a group practice. *Comment:*
                         Several commenters suggest that when a physician is part of a group practice that the choice to elect the CAP should be made by the individual physician or by the physician specialty. Commenters sought clarification on the ability of physicians to be able to make their own, independent decisions related to the CAP so as not to affect the continuity of the group practices. One commenter specifically sought clarification on whether a physician within a group practice could opt out of CAP while his partners within the group opted in. The commenter believed that the language allows one physician within a group to continue with the “buy and bill” method while the others within the group opt to elect the CAP as long as the physician bills all of his or her professional services rendered to group patients under his or her own individual PIN. *Response:*
                         In the July 6, 2005 interim final rule with comment (70 FR 39082), we stated that we were required to coordinate the selection of the approved CAP vendor with agreements entered into under section 1842(h) of the Act (agreements to become a Medicare participating physician). The Medicare participating physician enrollment process coordinates the Medicare payment for the health care services delivered to a Medicare beneficiary. When payments for services are made to a health care provider, they are made based on the PIN. In order for a physician to “buy and bill” separately from the group he or she must not have reassigned his or her benefits to the group. By reassigning his or her benefits to the group practice, the physician will be billing Medicare using the group's PIN. Thus, the group will make the choice about whether to participate in the CAP. *Comment:*
                         Another commenter sought clarification on whether a non-participating physician who joined the CAP will be able to accept assignment for CAP drug administration. *Response:*
                         When a Medicare physician is a non-participating physician, he or she may still accept assignment on a case-by-case basis for his or her services. However, he or she must agree to accept assignment for all Medicare Part B drug payment as specified in section 1842(o)(3)(A) of the Act. If the non-participating physician elects to participate in the CAP he or 
                        ( print page 70258)
                        she will no longer be billing Medicare for the Part B drugs that he or she obtains through CAP, but he or she will still be able to bill Medicare for the administration of those drugs. Thus, if a non-participating physician elects to participate in the CAP, he or she must agree to accept assignment for drug administration for all CAP drugs to allow for the Medicare beneficiary's and approved CAP vendor's appeal rights. (2) Practitioners in CAP-Clarification In the July, 6, 2005 interim final rule with comment, we stated that physicians would have a choice to participate in the CAP or continue to buy the drugs they provide to beneficiaries “incident to” their service and bill the Medicare program for them under the ASP system as specified in section 1847A of the Act. We would like to clarify that for the purposes of the CAP, a physician includes all practitioners that meet the definition of a “physician” in section 1861(r) of the Act. (3) Physician Choice of Approved CAP Vendor *Comment:*
                         One commenter believes that approved CAP vendors will be entirely dependent on physicians for various actions including—filing claims, appealing a denial, obtaining beneficiary information, and, where necessary, obtaining an ABN. The commenter asserts that approved CAP vendors should be allowed the right to decline to work with a participating CAP physician who has— Previously failed to pay for drugs on a timely basis.
                    Materially breached his or her contractual obligations to the approved CAP vendor or his or her CAP election agreement with CMS.
                    Acted in a manner that obstructs the purpose or intent of the CAP, or otherwise hinders its effectiveness.
                    Otherwise acted in bad faith. The commenter is concerned that as long as a participating CAP physician is not currently suspended, the participating CAP physician may select any approved CAP vendor he or she wishes, including an approved CAP vendor that might have generated a suspension request for that participating CAP physician. The commenter further asserts that because of the critical reliance of approved CAP vendors on participating CAP physician's compliance with CAP requirements that in the event of the participating CAP physician's noncompliance the approved CAP vendors should have the right not to work with a participating CAP physician if it has a reasonable basis for concern. The commenter also believes it is important for the approved CAP vendor to have some recourse when it will potentially be selling drug products to the physician, and, thus, potentially be owed significant amounts by a physician in certain situations. *Response:*
                         The commenter's reference to a vendor “selling” drugs to a physician appears to be expressing concern about an approved CAP vendor's relationship with a participating CAP physician outside the scope of the CAP. These relationships are beyond the scope of this rule. Currently, physicians purchase the drugs they administer to their Medicare beneficiary patients and are reimbursed for those drugs through the ASP payment system. The CAP is an alternative way for physicians to obtain drugs. In the CAP, the participating CAP physician does not purchase CAP drugs, but rather orders them. Because participating CAP physicians will not own the CAP drugs they order from the approved CAP vendor, the approved CAP vendor will not be “selling” the drug to the participating CAP physician. Instead, the approved CAP vendor will ship CAP drugs to the participating CAP physician and bill Medicare for them upon administration. In addition, as we have stated in this final rule with comment and the July 6, 2005 interim final rule with comment, an approved CAP vendor must accept any participating CAP physician who selects it. However, in developing the CAP, we recognized that the approved CAP vendor, as the owner of the CAP drugs, would have significant financial risk. We developed a dispute resolution process to assist the approved CAP vendor if there were occurrences of participating CAP physician noncompliance within the program. In the July 6, 2005 interim final rule with comment (70 FR 39054), we detailed the dispute resolution process for addressing participating CAP physician's non-compliance with CAP obligations. We believe the dispute resolution process is the appropriate forum for addressing these concerns. (4) Participating CAP Physician Mid Year Opt-Out In this section, we discuss the comments received concerning the ability of a participating CAP physician to opt-out of the CAP prior to the end of the year and our responses to those comments. *Comment:*
                         We received a number of comments requesting that participating CAP physicians have the ability to opt-out of CAP for any approved CAP vendor issues, including quality and delivery issues. *Response:*
                         We understand the commenters' concerns. We believe that we have provided for a sound method to ensure the quality of the CAP and to resolve these issues. As discussed in the July 6, 2005 interim final rule with comment (70 FR 39058), we established financial and quality standards to ensure that we choose reputable and experienced vendors to participate in the CAP. Participating CAP physicians will have the option of changing approved CAP vendors or opting out of the CAP program on an annual basis. We also provided the circumstances, as specified in § 414.908(a)(2), under which a participating CAP physician may choose a different approved CAP vendor mid-year or opt-out of the CAP. These circumstances are: (1) If the selected approved CAP vendor ceases to participate in the CAP; (2) if the participating CAP physician leaves the group practice that had selected the approved CAP vendor; (3) if the participating CAP physician relocates to another competitive acquisition area (once multiple CAP competitive areas are developed); or, (4) for other exigent circumstances defined by CMS. We identified a separate exigent circumstance relating to instances in which an approved CAP vendor declines to ship CAP drugs (when the conditions of § 414.914(h) are met) in § 414.908(a)(5). We note that in all these cases, while there is only one drug category for CAP, the participating CAP physician would be allowed to opt-out of the CAP altogether. In the July 6, 2005 interim final rule with comment, we also discussed how the participating CAP physician would use the approved CAP vendor's grievance process for drug quality and service issues and turn to the designated carrier for assistance in developing solutions (70 FR 39057). If a participating CAP physician is dissatisfied with the drug quality or drug delivery performance of an approved CAP vendor, we expect the participating CAP physician to attempt to resolve the issue with the approved CAP vendor informally, and then to use the approved CAP vendor's grievance procedure. The next step is to ask for the designated carrier's assistance in developing a solution with cooperation from both parties. The designated carrier will act promptly to investigate quality and service issues. If these are not resolved, the designated carrier may recommend to CMS the suspension or termination of the approved CAP vendor's contract. We will act on that 
                        ( print page 70259)
                        recommendation after gathering any necessary, or additional information from the participating CAP physician and approved CAP vendor. If the approved CAP vendor is suspended from the program, that vendor will be unable to participate in the CAP for the remainder of that year. The ultimate sanction for service and quality issues is termination of the approved CAP vendor's 3-year contract upon exhaustion of the reconsideration process as specified in § 414.917. If the approved CAP vendor contract is suspended or terminated, the participating CAP physician would be able to choose another approved CAP vendor or leave the CAP altogether. (5) Participating CAP Physician Opt-Out for Non-Payment of Coinsurance In the July 6, 2005 interim final rule with comment (70 FR 39053), we stated that in instances where a beneficiary has failed to meet his or her obligation to pay the coinsurance or the deductible for a drug, the conditions of § 414.914(h) were met, and the approved CAP vendor has refused to continue shipping CAP drugs to the participating CAP physician for the beneficiary, we will permit the participating CAP physician to opt-out of that drug category for the CAP. We noted that for the initial implementation of the CAP, there is only one CAP drug category. Thus, a participating CAP physician exercising this option will be opting out of the entire CAP program until the next opportunity to elect to participate. We are making a technical change to § 414.908(a)(5) to state that if the approved CAP vendor refuses to ship to the participating CAP physician because the conditions of § 414.914(h) have been met; the participating CAP physician can withdraw from the applicable CAP drug category for the remainder of the year immediately upon notice to CMS and to the approved CAP vendor. We note again, that for the initial implementation of the CAP, there is only one CAP drug category. Thus, a participating CAP physician exercising this option will, in effect, be opting out of the entire CAP program until the next opportunity to elect to participate. *Comment:*
                         We received numerous comments on the exigent circumstance that allows a participating CAP physician to opt-out of CAP if an approved CAP vendor were to stop providing a drug to a Medicare beneficiary due to non-payment of the coinsurance to the approved CAP vendor. Commenters requested that we allow the participating CAP physician to opt-out of CAP for only that one Medicare beneficiary allowing the participating CAP physician to continue in CAP for the other Medicare beneficiaries. *Response:*
                         We do not believe that allowing a participating CAP physician to opt-out of CAP on a beneficiary-by-beneficiary basis is consistent with the CAP statute. When a physician elects to obtain drugs through the CAP that physician will no longer be able to bill Medicare for drugs under the ASP methodology that is available from the approved CAP vendor unless permitted under the “furnish as written” option. The approved CAP vendor will bill Medicare for the CAP drugs administered by the participating CAP physician. Therefore, if an approved CAP vendor has refused to ship the CAP drug as specified in § 415.914(h), we will permit the participating CAP physician to opt-out of CAP for that category. However, we note that for the initial implementation of CAP there is only one drug category. (6) Physician Education In the July 6, 2005 interim final rule with comment, we stated that we would instruct the Medicare carriers to use various communication channels at the local and national levels to disseminate information about the CAP and assist approved CAP vendors and participating CAP physicians in understanding the Medicare program's operations, policy, and billing and administration procedures regarding the CAP in conjunction with use (70 FR 39084). The Medicare carriers will be instructed to use data analyses in tailoring their outreach and educational efforts for potential vendors and physicians regarding identified areas of confusion about the CAP. Additionally, we specified that the Medicare carriers would be instructed to use mass media, as well as educational and outreach products, services, forums, and partnerships in an effort to disseminate information about, and provide assistance regarding, the CAP to potential vendors and healthcare practitioner communities. We stated that the goal of our outreach and education would be to ensure that those who provide services to Medicare beneficiaries receive the information they need to understand the Medicare program so that they can administer it and bill it correctly. *Comment:*
                         There were comments requesting assistance and education for the CAP. One commenter was concerned with the availability of assistance and education to the participating CAP physician discussed in the July 6, 2005 interim final rule with comment. The commenter asserted that we have not elaborated on how physicians would be able to obtain education and assistance on CAP throughout the year. The commenter believed that physicians will have questions related to the CAP processes or other technical aspects not clear at the beginning of the program. The commenter also believed that we might make changes during the course of the year once the program is implemented and improvements are instituted. The commenter encouraged us to anticipate the need for on-going, real-time assistance to the participating CAP physician utilizing the CAP, particularly in the first year and implement a proactive education strategy. Another commenter requested that given the short time frame allowed for the CAP election, we ensure that physicians are properly educated and informed about CAP before they make an election. They suggested that we require approved CAP vendors to provide participating CAP physicians with a disclosure form and to certify that they have accurately disclosed all program features including administrative requirements, technical/software requirements, penalties, restrictions on delivery and transporting of drugs. *Response:*
                         The commenter is correct to note that there will be changes in the CAP during the course of the year. As we previously discussed, approved CAP vendors will have the opportunity to request approval to change their drug lists in several ways. Physicians should be aware of this before electing to participate in the CAP, but CMS and approved CAP vendors will inform participating CAP physicians of these and other changes on a timely basis, as described in a previous section of this preamble. In the July 6, 2005 interim final rule with comment, we stated that we would post on our Web site, the approved CAP vendors we have selected for the CAP, their categories of drugs (and specific NDCs), and the geographic areas within which they would operate (70 FR 39081). (See 
                        *http://www.cms.hhs.gov/​providers/​drugs/​compbid/​*). We stated that we would publicize the participating CAP physician election information on our Web site, listservs, Medicare fee-for-service contractors' Web sites, and newsletters. We stated our intention to coordinate with physician specialty organizations to inform their members that the participating CAP physician election information is available. We also stated that we would provide a CAP fact sheet so that the carriers can disseminate it to their physicians and that there would be an education campaign to inform 
                        ( print page 70260)
                        physicians about the CAP Web site and the election process. We described our plan to make available, the participating CAP physician election agreement forms with instruction on how to download, complete, and sign them and return them to the local carrier. The local carrier will note the physician's decision to participate in the CAP, the approved CAP vendor and the selected categories of drugs (when multiple categories of drugs become available). The local carrier will forward information from the participating CAP physician election agreement to the CAP designated carrier. The designated carrier will compile a master list of all participating CAP physicians' approved CAP vendor and drug category selections. In addition, the designated carrier will notify each approved CAP vendor of the participating CAP physicians who have elected to enroll with that approved CAP vendor. Throughout the year we will continue to provide participating CAP physician assistance through the participating CAP physician's local carrier and the designated carrier. Both the participating CAP physician's local carrier and the designated carrier will have toll free numbers for participating CAP physicians to use in requesting assistance. f. Brief Summary of Comments We Are Not Addressing In response to the July 6, 2005 interim final rule with comment, we received comments on a wide variety of issues related to the CAP. This final rule with comment addresses those issues that are most urgent to begin CAP implementation. Other issues raised in the comments will be fully considered and addressed at a later time. Among the comments we are not addressing at this time are comments related to rural operational issues, the impact of CAP delivery times on satellite clinics, restrictions on transporting drugs, the 14 day participating CAP physician billing requirement, impact on clinical research, and licensure requirements for CAP pharmacies and distributors. I. Private Contracts and Opt-Out Provision Section 4507 of the BBA of 1997 amended section 1802 of the Act to permit certain physicians and practitioners to opt-out of Medicare if certain conditions were met, and to provide through private contracts services that would otherwise be covered by Medicare. When a physician or practitioner fails to maintain the conditions necessary for opt-out and does not take good faith efforts to correct his or her failure to maintain opt-out, current regulations at § 405.435(b) specify the consequences to that physician or practitioner for the remainder of that physician's or practitioner's 2-year opt-out period. However, § 405.435(b) describes a situation where the Medicare carrier notifies the physician or practitioner that he or she is violating the regulations and the statute. As explained in the August 8, 2005 proposed rule, the current regulations do not address the consequences to physicians and practitioners in situations when a condition resulting in failure to maintain opt-out occurs during the 2-year opt-out period, but a Medicare carrier does not discover or give notice of a physician's or practitioner's failure to maintain opt-out during the 2-year opt-out period. We proposed to amend § 405.435 in order to clarify that the consequences specified in § 405.435(b) for the failure on the part of a physician or practitioner to maintain opt-out will apply regardless of whether or when a carrier notifies a physician or practitioner of the failure to maintain opt-out. We also proposed to add a new paragraph (d) to clarify that in situations where a violation of § 405.435(a) is not discovered by the carrier during the 2-year opt-out period when the violation actually occurred, then the requirements of § 405.435(b)(1) through (b)(8) would be applicable from the date that the first violation of § 405.435(a) occurred until the end of the opt-out period during which the violation occurred (unless the physician or practitioner takes good faith efforts to restore opt-out conditions, for example, by refunding the amounts in excess of the charge limits to beneficiaries with whom he or she did not sign a private contract). These good faith efforts must be made within 45 days of any notice by the carrier that the physician or practitioner has failed to maintain opt-out (where the carrier discovers the failure after the 2-year opt-out period has expired), or within 45 days after the physician or practitioner has discovered the failure to maintain opt-out, whichever is earlier. *Comment:*
                         One commenter stated that having physicians suffer regulatory consequences for failure to maintain opt-out status, even when they are not notified of their status, would be unfair and discouraging. They recommended that Medicare carriers be required to notify physicians of their opt-out status 60 days before any actions are taken against them. *Response:*
                         The revision to § 405.435 does not instruct Medicare carriers to take action against physicians without sufficient notice to the physician. In situations where a physician or practitioner fails to maintain opt-out and the carrier discovers that violation either during the physician's or practitioner's opt-out period or after it expires, carriers will notify the physician or practitioner of the violation and the physician or practitioner will have 45 days from the date of the carrier's notice to correct that violation. Similarly, in the situation where the physician or practitioner discovers that he or she has failed to maintain opt-out, the physician or practitioner will be on notice that unless he or she takes corrective action within 45 days the provisions of § 405.435(b)(1)-(b)(8) are applicable. We do not agree with the commenter's suggestion that the 45-day period for taking corrective action should begin in all cases until the carrier sends a notice, that is, including situations in which the physician or practitioner discovers the failure to maintain opt-out. If physicians and practitioners were permitted to intentionally violate their opt-out responsibilities, or ignore unintentional violations that they discovered subsequently, until the carrier notifies the physician or practitioner of the violation, harm to both beneficiaries and the program could result. For example, beneficiaries could enter into private contracts that do not meet the notice requirements of § 405.415 or the Medicare program could make mistaken payments due to the physician or practitioner billing Medicare in violation of § 405.425. In order to minimize these harms when a physician or practitioner discovers a failure to maintain opt-out, we believe the 45-day period should begin on the date the failure to maintain opt-out is discovered, not at some later date when a carrier discovers the failure and gives notice. *Comment:*
                         One commenter stated that the proposed rule would establish regulations that address situations where a physician or practitioner that has opted out of the Medicare program fails to maintain the requirements of their status. In particular, the proposed regulatory language would provide physicians or practitioners that have opted out of the Medicare program 45 days to correct the violation. The commenter believes these regulations are reasonable as proposed. However, the commenter urges the agency to establish standardized language for the violation notice and clear guidelines for carriers to execute timely notice of opt-out violation.
                        ( print page 70261) *Response:*
                         The CMS Internet-Only Manual (Publication 100-2, chapter 15, section 40.12) currently provides Medicare's carriers with standardized guidelines regarding the notice to physicians and practitioners, and the actions to take, in cases of failure to maintain opt out status. We are finalizing our proposed changes to § 405.435 (b) and adding new paragraph (d) as proposed. J. Multiple Procedure Payment Reduction for Diagnostic Imaging As explained in the August 8, 2005 proposed rule (70 FR 45849), diagnostic imaging procedures are priced in the following three ways: The professional component (PC) represents the physician work, that is, the interpretation.
                    The technical component (TC) represents PE, that is, clinical staff, supplies, and equipment.
                    The global service represents both PC and TC. Under the resource-based PE methodology, specific PE inputs of clinical labor, supplies, and equipment are used to calculate PE RVUs for each individual service. We do not believe these same inputs are needed to perform subsequent procedures. When multiple images are taken in a single session, most of the clinical labor activities and most supplies are not performed or furnished twice. In addition, equipment time and indirect costs are allocated based on clinical labor time; therefore, these inputs should be reduced accordingly. Excluding these PE inputs, which we believe are duplicative, supports a 50 percent reduction in the payment for the TC of subsequent procedures. A reduction of 50 percent is also currently used in the multiple procedure payment reduction for surgery, which has been a longstanding policy. Therefore, we proposed extending the multiple procedure payment reduction to the TC of specific procedures listed in Table 29 of the August 8, 2005 proposed rule (70 FR 45850). Table 29 identified 11 families of imaging procedures by imaging modality (ultrasound, CT and computed tomographic angiography (CTA), MRI and magnetic resonance angiography (MRA)), and contiguous body area (for example, CT and CTA of Chest/Thorax/Abdomen/Pelvis). We proposed applying the reduction only to procedures involving contiguous body areas within a family of codes, not across families, and to those multiple procedures that were provided in one session. We also proposed only to apply the multiple procedure payment reduction to the TC of certain procedures because, while we believe there may be some reduction in physician work associated with the performance of multiple diagnostic imaging procedures on contiguous body areas, we have no specific plans to extend the proposal to the PC. In addition, since the global service payment equals the combined PC and TC components, when the global service code is billed for these procedures, the TC would be reduced to the same as above, but the PC would be paid in full. We proposed making full payment for the TC of the highest priced procedure and payment at 50 percent of the TC for each additional procedure. *Comment:*
                         Several commenters supported our proposal, and described it as appropriate, reasonable, justified, rational, and consistent with the private sector. One commenter suggested extending the proposal to the professional component. Two other commenters stated that it should not be applied to the professional component. One commenter suggested applying the reduction to noncontiguous body areas imaged using the same modality. Another commenter indicated an understanding of the rationale for the proposal but did not want it extended to traditional radiographs. *Response:*
                         We appreciate the commenters' support. We currently have no plans to extend our proposal to incorporate the commenters' suggestions (that is, to include noncontiguous body areas, other radiologic examinations, or the professional component of imaging services). We are not certain whether and to what degree a multiple procedure payment reduction policy would be appropriate in these types of situations. *Comment:*
                         Several commenters opposed our proposal on the basis that diagnostic imaging is not comparable to surgery. For example, they noted that diagnostic imaging is not paid as part of a global package of services; its pre and post activities and resources are typically not as extensive as those required for surgery, and so should comprise a much smaller portion of the payment than for surgery; and it is highly capital intensive compared to surgery. One commenter stated that nuclear medicine procedures were inappropriately discounted and should not serve as precedent for discounting diagnostic imaging procedures. *Response:*
                         We agree that diagnostic imaging procedures are not comparable to surgical procedures and did not base the development of the multiple imaging procedure payment reduction policy on specific comparisons with the reductions applicable to multiple surgical procedures. Instead, with findings from the MedPAC recommendation about a multiple imaging procedure reduction, detailed information regarding current imaging reduction payment policies in the private insurance industry, and our analysis of PE data, we believe that the rationale for the proposed reduction is sound. The 50 percent reduction was specifically founded upon well-established and professionally accepted data we examined from the PEAC, as described below, and was not based simply on the fact that a 50 percent reduction is applied to multiple surgical procedures. In addition, the reduction for six nuclear medicine procedures has been in effect for 11 years. During that time, we have received no evidence to indicate that it is not appropriate. Nevertheless, we did not base our multiple imaging procedure reduction policy on comparisons with nuclear medicine procedures. *Comment:*
                         Numerous commenters agreed that some clinical labor activities, supplies, and equipment are not duplicated for subsequent procedures. Other commenters indicated exactly the opposite (that is, that these items, including some portion of scanning time, are duplicated). In addition, some commenters indicated that where equipment adjustments are required between studies, clinical labor time could actually increase when multiple imaging procedures are performed on the same patient during a single session. The majority of commenters agreed that there are some efficiencies when multiple procedures are performed but disagreed that all the activities we listed above are never duplicated. Therefore, they disagreed that the efficiencies achieved in subsequent procedures support a 50 percent reduction. Many commenters indicated that a 50 percent reduction is arbitrary and that we provided no supporting data. Several commenters suggested that the reduction should be somewhere between 5 and 25 percent. The ACR offered several suggestions on the relative level of reduction among families of procedures, for example, that the reduction for the procedures in family four should be less than for family two; and that the reduction for procedures in family seven should be less than for family two, but greater than for family four. However, they provided no specific percentages for the reductions in each family. A few commenters recommended varying the percentage reduction by modality because efficiencies are not 
                        ( print page 70262)
                        uniform across all families of procedures. Two commenters indicated that the proposal was inconsistent with the mandate to make resource-based PE payments. Specific comments included the following: For ultrasound procedures, all clinical labor activities except for greeting the patient, are duplicated.
                    For some CTs, repositioning the patient is necessary. Some CTs require multi-phasic contrast injections that are separately scanned.
                    For CTs, MRIs and MRAs, the number of prior exams for review before the studies are performed has increased significantly.
                    Some CTs, CTAs, MRIs, and MRAs require more images, slices or pulse sequences.
                    For brain MRIs and neck MRAs, it is necessary to remove the patient; change from a head coil to a neurovascular coil; retune the coil; enter multiple new scan parameters; reposition the patient; and run a new set of pulse sequences. The patient often requests a break between procedures. Several commenters recommended delaying implementation of the proposal for 1 year pending further study. Their reasons included: postponing until the PE inputs are fully implemented and clearly defined; deferring until the entire PFS methodology is reassessed; and delaying until MedPAC's other imaging study recommendations are implemented. Two commenters suggested that we phase-in the reduction. The ACR offered to work with CMS to reexamine the procedures subject to the reduction; reconfigure the families of procedures; and, determine appropriate reductions based on modality family. *Response:*
                         We indicated in the proposed rule that the following activities are not duplicated for subsequent procedures: Greeting the patient.
                    Positioning and escorting the patient.
                    Providing education and obtaining consent.
                    Retrieving prior exams.
                    Setting up the IV.
                    Preparing and cleaning the room. In addition, we consider supplies, with the exception of film, are not duplicated for subsequent procedures. Therefore, the 50 percent reduction for subsequent procedures is based on eliminating the time for the clinical labor activities noted above, plus supplies, with the exception of film. We do not assume any reduction in procedure (scanning) time or equipment for subsequent procedures. However, as noted in the proposed rule, equipment, time, and indirect costs are allocated based on clinical labor time; therefore, these inputs were reduced accordingly. The 50 percent reduction was determined based on the examination of multiple pairs of procedure codes from the families representing all modalities (that is, ultrasound, CT/CTA, and MRI/MRA studies) that were frequently performed on a single day based on historical claims data. Using PE input data provided by the RUC, we factored out the clinical staff minutes for the activities we indicated are not duplicated for subsequent procedures, and the supplies, other than film, which we consider are not duplicated for subsequent procedures. As noted previously, equipment time and indirect costs are allocated based on clinical labor time; therefore, these inputs were reduced accordingly. Removing the PE inputs for activities that are not duplicated, and adjusting the equipment time and indirect costs for the individual pairs of procedures studied, supports payment reductions ranging from 40 to 59 percent for the subsequent services. Because we found a relatively narrow range of percentage payment reductions across modalities and families, and taking into consideration that we did not eliminate any duplicative image acquisition time for subsequent procedures in our analysis, we decided that an across-the-board reduction for all 11 families of 50 percent (which is approximately the midpoint of the range established through our analysis) was both justified and conservative. We believe this payment reduction policy represents an appropriate reduction for the typical delivery of multiple imaging services in all 11 families. Because the reduction is based on eliminating the specific practice expense inputs that are not duplicated, we believe the proposal is consistent with the resource-based practice expense methodology. While various alternative reduction percentages were suggested, no evidence was presented to support specific alternative percentages. However, we recognize that many commenters raised significant objections and we appreciate their comments indicating their specific concerns regarding the appropriate reductions for each family and specific combinations of services within families. To allow for a transition of the changes in payments for these services attributable to this reduction policy, and provide a further opportunity for comment, we have decided to phase-in the policy over 2 years. We will implement a 25 percent payment reduction in CY 2006 and a 50 percent reduction for all 11 families in CY 2007 for all code families, unless we find upon further review during the upcoming year that modifications to this policy are appropriate. To enhance our review, we are soliciting, from providers of diagnostic imaging services, comprehensive data regarding the efficiencies associated with different combinations of imaging services in the 11 families. We welcome the opportunity to have other discussions with the physician community on these issues. *Comment:*
                         One commenter noted that a patient having both a pelvic and transvaginal ultrasound often needs a break between procedures and requires repositioning, along with the use of a different probe for the second study. The commenter also noted that breast and pelvic ultrasounds are often performed in different locations and by different physicians. *Response:*
                         The commenter has raised some serious questions concerning whether any payment reduction is appropriate for the procedures indicated. Therefore, we have decided to delete transvaginal ultrasound and ultrasound of the breast(s) (CPT codes 76830 and 76645, respectively) from the list of procedures in family one subject to the payment reduction, pending further study. We believe there may be common clinical scenarios where these services are provided in combination with other ultrasound studies where payment reduction may not be appropriate. These typical efficiencies associated with these services when provided in combination with other studies in family one require further study. *Comment:*
                         Many commenters asked how “single session” is defined and what mechanism will be used to distinguish single and multiple sessions. One commenter indicated that multiple procedures are frequently performed in separate rooms within the radiology department or in different areas within the hospital. In these cases, the patient must be transported from one room to another and the process restarted. One commenter noted the potential for abuse by self-referring physicians writing separate prescriptions for studies on different days. Another commenter indicated that the proposal will force providers to schedule further studies on additional days. *Response:*
                         We consider a single session to be one encounter where a patient could receive one or more radiological studies. If more than one of the imaging services in a single family 
                        ( print page 70263)
                        is provided to the patient during one encounter, then this would constitute a single session and the lower-priced procedure(s) would be reduced. On the other hand, if a patient has a separate encounter on the same day for a medically necessary reason and receives a second imaging service from the same family, we consider these multiple studies in the same family on the same day to be provided in separate sessions. In the latter case, we have established that the physician should use modifier -59 to indicate multiple sessions, and that the multiple procedure reduction does not apply. Medicare carriers will establish edits to ensure that separate sessions are not inappropriately scheduled for contiguous body area imaging in attempts to bypass the reduction. Use of the modifier where not medically necessary in order to bypass the payment reduction constitutes fraud. *Comment:*
                         One commenter suggested that the proposal required multiple body area imaging whenever a procedure in a particular family was performed, resulting in unnecessary imaging. Another commenter stated that grouping procedures to justify lower reimbursement provides no medical or monetary benefit and is detrimental to patient care. *Response:*
                         It appears the commenters have misinterpreted our proposal. The proposal in no way requires the performance of unnecessary multiple imaging procedures when only a single study is medically necessary. The families of procedures are based on claims data indicating that these procedures are often done in combination, most likely in a single session. We believe that the payment reduction for the lower-priced imaging procedures from one family performed on contiguous body areas provides the most appropriate payments for the services provided. *Comment:*
                         A few commenters recommended that we apply the budget neutrality adjustment only to PE RVUs and not to work RVUs. *Response:*
                         The commenters are correct that, because the payment reduction applies only to PE RVUs, the savings should likewise only apply to PE RVUs. We agree with this comment and have made the necessary adjustment. *Comment:*
                         One commenter indicated that we should request a statutory change to exempt the proposal from budget neutrality. *Response:*
                         We believe it is up to the Congress to decide whether it wants to make adjustments to the application of budget neutrality. We have no plans to request this change. Final Decision We have revised our proposal as follows: Phase in the payment reduction, with a 25 percent reduction in CY 2006 and a 50 percent reduction in CY 2007. Our review of the multiple imaging payment reduction policy will be ongoing.
                    Deleting CPT codes 76830 and 76645 from the list of procedures in family one subject to the reduction, pending further study.
                    Applying the budget neutrality adjustment only to PE RVUs, rather than to both work and PE RVUs. An example of the current and CY 2006 payments is summarized in Table 26, and the revised lists of procedures subject to the reduction, are set forth in Table 27: Table 26.—Example of Payments
Procedure 1 74183
Procedure 2 72196
Current total 
                                 payment
CY 2006 total payment
CY 2006 payment calculationPC
$117.00
$90.00
$207.00
$207.00
no reduction.TC
978.00
529.00
1,507.00
1,374.75
978 + (.75 × $529).Global
1,095.00
619.00
1,714.00
1,581.75
$207 + $978 + (0.75 × $529).
 
 
  
 
  
 
 K. Therapy Cap As discussed in the August 8, 2005 proposed rule, section 1833(g)(1) of the Act applies an annual, per beneficiary combined cap on outpatient physical therapy and speech-language pathology services, and a similar separate cap on outpatient occupational therapy services under Medicare Part B. While Section 624 of the MMA placed a moratorium on the application of these caps from December 8, 2003 through December 31, 2005, the caps will become effective again beginning January 1, 2006. (The caps were last implemented from September 1, 2003 through December 7, 2003.) Section 1833(g)(2) of the Act provides that, for 1999 through 2001, the caps were $1500, and for years after 2001, the caps are equal to the preceding year's cap increased by the percentage increase in the MEI (except that if an increase for a year is not a multiple of $10, it is rounded to the nearest multiple of $10). All of the comments we received questioned the use of therapy caps as a way to ensure beneficiaries get needed service while constraining the growth in spending. The large majority also pointed out the negative effects the therapy caps had on beneficiaries and providers when they were last implemented. However, most of the commenters recognized that we do not have the authority to change the caps. Commenters also wrote in support of an extended moratorium; separating physical therapy and speech-language pathology into two caps; a condition-based payment system; a pay-for-performance system; and a demonstration to assess one or more alternative limitation methods. We will implement therapy caps on January 1, 2006 according to the statute. We note that significant progress has been made toward the challenging goal of establishing a payment policy “based on the classification individuals” as required by the Congress in the BBA section 4541(d)(2) and again in the BBRA section 221(c)(2)(B). First, in order to evaluate Medicare payments for therapy services, we developed a method of identifying therapy services and their individual costs on Medicare claim lines. Then, we identified classification groups and conducted initial analyses of the type and amount of treatment utilized by each group. These 21 classification groups consisted of patients whose conditions were similar based on ICD-9 diagnosis codes, utilization patterns, published research and clinical opinion that indicated they may have similar health risk and require similar level of care and expenditures for service. For example, spinal cord injury, hip fracture, and musculoskeletal disorders form classifications that include many similar diagnoses. This demonstrated that if the expected need for service can be determined for subsets of each classification group, system edits that limit spending based on expected needs are feasible and would result in cost savings. To implement a payment method based on the conditions described by classification groups, additional information is needed on the claim about the patient's need for therapy services. Indicators or measurements that represent need, such as severity and acuity of a patient's condition, are not available on the current Medicare claim form and are not consistently gathered or reported by therapists. In order to be useful, these factors must be obtained from a sufficiently large database of patients to predict patients' needs with statistical validity and reliability. We currently have studies underway to extend the progress made in prior studies to explore the potential for using patient condition information to predict therapy needs and likely outcomes. We expect these studies to be completed in 2006. After issuance of this rule, we will issue instructions to contractors related to the implementation of therapy caps. We will consider comments received in response to the August 8, 2005 proposed rule as we develop those instructions. Since 2003, we have maintained, and we recently updated, a web site that describes therapy caps. We encourage providers and beneficiaries to review that information at 
                        *www.cms.hhs.gov/​medlearn/​therapy*
                         (Therapy Cap Status). Based on the formula established in 1883(g)(2) of the Act, the therapy caps will be implemented January 1, 2006. The dollar amount for the therapy caps for CY 2006 is $1,740. L. Chiropractic Demonstration Discussion Section 1861(r)(5) of the Act limits current Medicare coverage for chiropractic treatment by means of the manual manipulation of the spine for the purpose of correcting a subluxation, defined generally as a malfunction of the spine. Specifically, Medicare covers three CPT Codes provided by chiropractors: 98940 (manipulative treatment, 1-2 regions of the spine); 98941 (manipulative treatment, 3-4 regions of the spine); and 98942 (manipulative treatment, 5 regions of the spine). Treatment must be provided for an active subluxation only, and not for prevention or maintenance. Additionally, treatment of the subluxation must be related to a neuromusculoskeletal condition where there is a reasonable expectation of recovery or functional improvement. In the August 8, 2005 proposed rule, we included a discussion of the 2-year demonstration authorized by Section 651 of the MMA to evaluate the feasibility and advisability of covering additional chiropractic services under Medicare. These services extend beyond the current coverage for manipulation to care for neuromusculoskeletal conditions typical among eligible beneficiaries, and cover diagnostic and other services that a chiropractor is legally authorized to perform by the State or jurisdiction in which the treatment is provided. Physician approval will not be required for these services. The demonstration is being conducted in four sites, two rural and two urban. One site of each area type must be a health professional shortage area (HPSA). The demonstration must also be budget neutral. The statute requires the Secretary to ensure that aggregate payments made under the Medicare program do not exceed those that would be paid in the absence of this demonstration. Ensuring budget neutrality requires that the Secretary develop a strategy for recouping funds should the demonstration result in costs higher than would occur in the absence of the demonstration. In this case, we would make adjustments in the national chiropractor fee schedule to recover the costs of the demonstration in excess of the amount estimated to yield budget neutrality. We will assess budget neutrality by determining the change in costs based on a pre/post comparison of costs and the rate of change for specific diagnoses that are treated by chiropractors and physicians in the demonstration sites and control sites. We will not limit our analysis to reviewing only chiropractor claims, because the costs of the expanded chiropractor services may have an impact on other Medicare costs. Any needed reduction would be made in the CY 2010 and CY 2011 fee schedules as it will take approximately 2 years to complete the claims analysis. If we determine that the adjustment for budget neutrality is greater than 2 percent of spending for the chiropractor fee schedule codes (comprised of the 3 currently covered CPT codes 98940, 98941 and 98942), we will implement the adjustment over a 2-year period. However, if the adjustment is less than 2 percent of spending under the chiropractor fee schedule codes, we will implement the adjustment over a 1-year period. We will include the detailed 
                        ( print page 70267)
                        analysis of budget neutrality and any proposed offset in the CY 2009 
                        **Federal Register**
                         publication of the PFS. We also noted in the proposed rule that PT services performed by chiropractors under the demonstration will be included under the PT cap described in section II.K. of the preamble to this final rule with comment. These services are included under the cap because chiropractors are subject to the same rules as medical doctors for therapy services under the demonstration. The following is a summary of the comments received and our responses. *Comment:*
                         Several commenters expressed concern regarding specific aspects of the demonstration project, including PT services being provided by chiropractors and including the PT services provided by chiropractors under the demonstration under the therapy cap. *Response:*
                         A discussion of the chiropractic demonstration was included in the PFS proposed rule because of the potential for a budget neutrality adjustment that will be discussed in the CY 2009 
                        **Federal Register**
                         publication of the PFS. Issues concerning the demonstration project itself were outside the scope of the proposed rule. We are including PT services provided by chiropractors under the therapy cap because under the demonstration, we are subjecting chiropractors to the same rules as physicians for therapy services. *Comment:*
                         One commenter suggested that in the calculation of the budget neutrality of the demonstration project that the therapy rendered by the chiropractors or their therapists is a “trade off” of associated costs that would have required evaluation, order and recertification by a medical doctor. They also suggested that the management of neuromuscular conditions is more efficient when all contributing factors are identified and addressed simultaneously by the combined skills of each specialty. The patient would normally learn to function more rapidly through concurrent multidisciplinary management than with any limited single approach. In addition, the commenters noted that to accurately assess the demonstration a variety of variables, such as medical services that were not required or services directly replaced by another provider, need to be considered. *Response:*
                         Section 651(a)(1) specified that the chiropractic services provided under the demonstration should include diagnostic and other services that a chiropractor is legally authorized to perform by the State or jurisdiction in which the treatment is provided. There is no requirement for concurrent multidisciplinary management of neuromuscular conditions. We recognize that covering additional services by chiropractors could have an impact on currently covered Medicare services. For this reason, we plan to assess budget neutrality by examining the total Medicare costs for specific diagnoses, and not just the chiropractor costs. As we noted previously, we will provide a detailed analysis of budget neutrality and any proposed offset in the CY 2009 
                        **Federal Register**
                         publication of the PFS. *Comment:*
                         Commenters requested that we clarify plans for making reductions to maintain budget neutrality and identify claims we will analyze. The commenters also requested that we provide information on how this will impact the SGR, particularly if the chiropractic demonstration results in increased spending on physicians' services, since this could result in reductions in reimbursement for all physicians, not just chiropractors. Another commenter opposed the application of any adjustments to the national chiropractic fee schedule instead of an adjustment to the overall fee schedule. This commenter believes that the totality of funds under part B and not subset of services within it should finance the demonstration program and that this is reflected in section 651(f)(A)of the MMA. *Response:*
                         Section 651(f)(A) requires that “* * * the Secretary shall ensure that the aggregate payment made by the Secretary under the Medicare program do not exceed the amount which the Secretary would have paid under the Medicare program if the demonstrations projects under this section were not implemented.” The legislation does not specify a specific methodology for ensuring budget neutrality. Our methodology meets the legislative intent, and appropriately impacts the profession that is directly affected by the demonstration. Because the demonstration is located in only four sites in which the expansion of services is permitted, we anticipate that the impact on the SGR would be negligible. M. Supplemental Payments to Federally Qualified Health Centers (FQHCs) Subcontracting With Medicare Advantage (MA) Plans Section 237 of the MMA amended section 1833(a)(3) of Act to provide supplemental payments to FQHCs that contract with Medicare Advantage (MA) organizations to cover the difference, if any, between the payment received by the FQHC for treating enrollees in MA plans offered by the MA organization and the payment that the FQHC is entitled to receive under the cost-based all-inclusive payment rate as set forth in part 405, subpart X. The supplemental payment for covered Medicare FQHC services furnished to MA enrollees augments the direct payments made by MA plans to FQHCs for covered Medicare FQHC services. In order to implement this new payment provision, we must determine whether the Medicare cost-based payments to which the FQHC would be entitled exceed the amount of payments received by the center from the MA organization and, if so, pay the difference to the FQHC. The proposed supplemental payment for FQHC covered services rendered to MA enrollees is equal to the difference between 100 percent of the FQHC's all-inclusive cost-based per-visit rate and the average per-visit rate received by the FQHC from the MA plan in which the enrollee is enrolled, less any amount the FQHC may charge as described in section 1857(e)(3)(B) of the Act. A supplemental payment will be made every time a face-to-face encounter occurs between an MA enrollee and any one of the FQHC's core practitioners: physician, nurse practitioner, physician assistant, clinical nurse midwife, clinical psychologist, or clinical social worker. The supplemental payment is made directly to each FQHC through the Medicare Fiscal Intermediary (FI). In the August 8, 2005 proposed rule, we proposed conforming changes to our regulations to add § 405.2469 to provide a supplemental payment, based on a per-visit calculation, to FQHCs under contract (directly or indirectly) with MA organizations. We received comments on the portion of the proposed rule addressing the FQHC supplemental payment provision of section 237 of the MMA. A summary of those comments and our responses follows: *Comment:*
                         One commenter asked how the Medicare contractor will know the amount the health plan paid when FQHCs bill the Medicare contractor for the supplemental payment. *Response:*
                         The Medicare contractor will know the amount paid by the MA plan based on the required MA payment estimate furnished by the FQHC to the contractor. The payment amount difference between the interim FQHC all-inclusive cost based rate and the average interim MA rate will be reported on the FQHC claim form every time the FQHC submits a bill to the 
                        ( print page 70268)
                        contractor to collect an FQHC supplemental payment. The Medicare contractor will pay FQHCs the difference between the interim FQHC all-inclusive rate and the interim MA rate on a per-visit basis. *Comment:*
                         A commenter requested clarification regarding cost sharing rules for MA enrollees as referenced in § 405.2469(a)(ii), which stipulates that FQHCs may charge Medicare patients as described in section 1857(e)(3)(B) of the Act. *Response:*
                         Section 1857(e)(3)(B) of the Act provides that a FQHC must accept the MA payment and the Federal supplemental payment (that is, the payment decribed in section 1833(a)(3)(B)) as payment in full for services covered by the agreement, except that the FQHC may collect any amount of cost-sharing permitted under the MA contract, so long as the amounts of any deductible, coinsurance, or co-payment comply with the requirements under section 1854(e) of the Act. In general, an MA plan offered by an MA organization satisfies section 1854(e) of the Act beginning in 2006 if the monthly basic MA premium and the actuarial value of the cost sharing charged to enrollees for services covered under Parts A and B of original Medicare do not exceed the actuarial value of cost sharing charged to beneficiaries in original Medicare. MA plans must also disclose cost sharing amounts to their members. *Comment:*
                         Two commenters urged us to deduct from the supplemental payment calculation only the amount of cost-sharing actually collected by the FQHC. Furthermore, the commenters asked that we recognize any uncollected cost-sharing amounts as “bad debt” on the FQHC cost report. *Response:*
                         The supplemental payment calculation shall deduct the cost sharing amounts set forth in the formal contract between the FQHC and MA plan, not the actual amounts collected by the FQHC. Section 1833(a)(1)(B) states that the supplemental payment is to be calculated net of any amount the FQHC “may charge” as described in section 1857(e)(3)(B) of the Act. Thus the language of the statute plainly states that the supplemental payment is to be based on what the FQHC could charge as cost sharing, not cost sharing amounts that the FQHC actually collects. Rules regarding what may constitute “bad debt” for purposes of a FQHC's cost report are beyond the scope of this final rule with comment. Furthermore, the rules we are finalizing pertain to section 237 of the MMA which addresses a supplemental payment to FQHCs that contract, directly or indirectly, with an MA organization. Thus, arrangements pertaining to “bad debt” for uncollected cost sharing owed by an MA plan enrollee, if any, would be governed by the contract between the FQHC and the MA organization. *Comment:*
                         A commenter questioned whether the upper payment limit would apply in determining the supplemental payment. *Response:*
                         For FQHCs operating below the FQHC national payment limit, we will use their actual per-visit all-inclusive rate to determine the FQHC supplemental. For FQHCs operating at or above the national payment limit, we will use the applicable national FQHC urban or rural upper limit to calculate the FQHC supplemental payment. The amount of the supplemental payment will be the amount by which the original FQHC payment exceeds the MA plan payment. Section 237 of the MMA clearly requires the use of a cost-based rate or based on other tests of reasonableness as the Secretary may prescribe in regulations. The longstanding national FQHC payment limit is an integral part of the FQHC payment methodology as set forth in regulations. *Comment:*
                         A commenter questioned whether the provider types listed on page 45853 (Proposed Payment Methodology Section) of the August 8, 2005 proposed rule is broader than the original FQHC benefit. *Response:*
                         In the proposed rule, we explained that an FQHC supplemental payment is made only when a face-to-face encounter occurs between a core FQHC practitioner and an MA enrollee. This list of core FQHC practitioners is identical to the practitioner list for the original FQHC Medicare benefit. Furthermore, these FQHC practitioners must meet all applicable qualification requirements as set forth in section 405 and 491 of the CFR in order to qualify for the supplemental payment. *Comment:*
                         A commenter requested that we amend the regulatory definition of eligible centers for the FQHC supplemental payments to allow payments for health centers for the homeless. The preamble of the proposed rule states that eligible FQHCs include all centers receiving grants under Section 330 except those centers that receive funds pursuant to Section 330(h) of the Public Health Service Act (that is, Health Care for the Homeless grantees). The commenter specifically requested that we recognize these centers for supplemental payments, or at a minimum, be prepared to do so as soon as legislation is passed. *Response:*
                         We currently do not have the statutory authority to recognize as Medicare FQHCs any entity that does not meet statutory requirements for designation as an FQHC. Consequently, we cannot provide centers that are not FQHCs with Medicare FQHC supplemental payments for treating MA enrollees. If changes were made to the statute, we would implement regulations, as necessary, consistent with statutory requirements. *Comment:*
                         A commenter asked for clarification regarding the statement in the rule that FQHCs under contract (indirectly or directly) with MA organizations are eligible for supplemental payments. The commenter requested specific confirmation that the term “indirect” is intended to include arrangements under which the health center contracts with another organization, which in turn, contracts with the MA organization in order to provide Medicare services. *Response:*
                         We interpreted section 237 of the MMA to mean that any Medicare FQHC furnishing covered FQHC services to MA plan enrollees would be eligible for supplemental payments regardless of whether they have a direct contract with an MA organization or contract with another entity (for example, a medical group) that has a direct contract with the MA organization to treat its enrollees. *Comment:*
                         A commenter asked whether a health center with an MA contract can bill Medicare directly on a fee-for-service basis if the center provides services to plan enrollees that are not FQHC services. For example, can they directly bill for services the FQHC could otherwise bill as Part B services if it were not providing the service to an MA plan enrollee? A commenter requested clarification whether a health center will be allowed to bill original Medicare for extended hours of operation not included under the center's MA arrangement. Another commenter asked whether a health center that utilizes a specialist, who is not included in the MA plan's specialty panel, to provide an FQHC core service will be permitted to bill Medicare for these services. *Response:*
                         The FQHC should bill original Medicare only for covered services rendered to original Medicare beneficiaries that are “not” enrolled in an MA plan. In accordance with section 1851(i) of the Act, with limited exceptions, only the MA organization is entitled to receive Medicare payments for services furnished to its enrollees. Therefore, FQHCs under direct or indirect contract with an MA organization must look to the MA 
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                        organization for payment. The additional payment permitted by section 1833(a)(3)(B) of the Act applies only to FQHC services described in section 1832(a)(2)(D)(ii) of the Act. *Comment:*
                         A commenter questioned whether services not covered under original Medicare, but offered and paid for by the MA plan, such as dental, are included in determining the CMS wrap-around payment to the center. *Response:*
                         Only services meeting the definition of an FQHC service as defined under section 1832(a)(2)(D) of the Act are included in the determination of the FQHC supplemental payment. Thus, services other than those defined under section 1832(a)(2)(D), such as dental services, are not included in the determination of the supplemental payment. *Comment:*
                         A commenter requested that we modify our proposed FQHC supplemental payment methodology to include Medicare FQHC covered services that are not necessarily performed as a face-to-face encounter. *Response:*
                         All covered Medicare FQHCs services are eligible for supplemental payments regardless of whether these services trigger a billable FQHC visit. For purposes of consistency, we adopt the longstanding FQHC visit definition under original Medicare, which would provide a supplemental payment every time there is a face-to-face encounter between an MA enrollee and one or more of the following FQHC covered core practitioners: physicians, nurse practitioners, physician assistants, clinical nurse midwives, clinical psychologists, or clinical social workers. The costs of services incidental to the professional services of the above core FQHC practitioners would be bundled into the calculation of the supplemental payment. In light of the fact that all incidental services and costs are recognized, we believe that the use of the FQHC encounter definition for the supplemental payment provision is reasonable and appropriate. *Comment:*
                         A commenter requested clarification regarding the interim rate that should be utilized for these health centers in light of the fact that centers have yet to have their annual reconciliation from 2004 performed. *Response:*
                         The interim rate for MA payments will be based on estimates from the contracting FQHC until actual MA payments and visits are captured on the FQHC cost report. We will use these estimates until actual MA payments and visits are captured on the FQHC cost reports. At that point, payments will be adjusted accordingly. *Comment:*
                         A commenter asked for clarification regarding which fiscal year would apply to the rate calculation methodology for services rendered on or after January 1, 2006—the Federal fiscal year, the health center, or the MA plan. Furthermore, clarification was requested regarding the transition process for reconciling differences between centers' fiscal year and the MA contract year. *Response:*
                         The FQHC supplemental payment calculation shall be based on the FQHC's cost report year. For the initial year, if the MA plan's contract year and the FQHC's fiscal year do not coincide, the FQHC supplemental payment calculation shall be based on a weighted average of MA payments based on the number of MA visits expected in each respective MA contract year. In subsequent FQHC cost report years, actual MA payments and visits will be used to calculate final FQHC supplemental payments as well as the interim supplemental payments for the following year. Since actual payments and visits already reflect the differences between the FQHC fiscal year and the MA contract year, no transition process is necessary. *Comment:*
                         A commenter requested clarification whether payments will be aggregated across multiple MA plans or whether the payments will be plan specific. *Response:*
                         In cases where an FQHC has multiple arrangements in place with different MA plans, payments will be aggregated across multiple plans to determine final Medicare program liability. In other words, at cost settlement MA payments will be aggregated for all MA enrollees treated by the FQHC. *Comment:*
                         A commenter expressed concern that the required detailed MA payment estimates from FQHCs will result in a significant increase in administrative time. In light of this new requirement, they suggested that we develop standard forms and information requests to ease the burden as much as possible. *Response:*
                         Each eligible FQHC seeking the supplemental payment is required to submit (for the first two rate years) to the Medicare Fiscal Intermediary (FI) an estimate of the average MA payments (per-visit basis) for covered FQHC services provided to MA enrollees. Every eligible FQHC seeking the supplemental payment is required to submit a documented estimate of its average per-visit payment for MA enrollees in each MA plan offered by the MA organization and any other information as may be required to enable the FI to accurately establish an interim supplemental payment. Expected payments from the MA organization would be used only until actual MA revenue and visits collected on the FQHC's cost report can be used to establish the amount of the supplemental payment. Until we modify the FQHC cost report form to identify and capture MA payments and visits, each eligible FQHC requesting supplemental payments will be required to submit estimates to CMS. *Comment:*
                         A commenter urged us to calculate and provide supplemental payments on a per-visit basis to ensure adequate cash flow to contracting FQHCs. *Response:*
                         Under the proposed rule, we added § 405.2469 to specify that the FQHC supplemental payment methodology is on a per-visit basis. *Comment:*
                         A commenter requested timely annual system reviews of cost reports to ensure that the health centers are provided with a continuous cash flow of Medicare funding. *Response:*
                         The Medicare contractors responsible for processing FQHC claims and reviewing cost reports will use all available resources for timely cost report settlement. *Comment:*
                         A commenter requests that we provide guidance under this rule regarding the methods of enforcing the statutory requirement that MA plan payments to contracting FQHCs must be comparable to other contracting health care providers furnishing similar services. *Response:*
                         Generally, we will examine contracts and attendant fee schedules between MA organizations and FQHCs and between MA organizations and other providers to ensure that payment levels for similar services are comparable. *Comment:*
                         A commenter requested clarification regarding how our cross-over system will work for MA enrollees who are dually-eligible for the Medicare and Medicaid programs. They asked if claims for dually-eligible patients will be forwarded to the Medicaid agency by the MA plan or by CMS. *Response:*
                         Our crossover processes do not apply to MA claims but rather to claims that are processed under original Medicare, fee-for-service contractor operations. Therefore, claims for persons who have enrolled in an MA plan will not be crossed over by CMS. The MA plan would need to coordinate with Medicaid. *Comment:*
                         A commenter expressed concern about the appeals process for circumstances under which the MA plan denies a claim, which would result in our denial of the supplemental payment. They asked what procedures 
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                        the health center should follow when faced with this situation. *Response:*
                         If an FQHC signs a waiver of liability, the FQHC may utilize the MA appeals process at 42 CFR part 422, subpart M to contest an MA organization's payment denial. If the MA organization's claim denial is overturned upon appeal, CMS will make a supplemental payment to a FQHC. *Comment:*
                         A commenter requested that we work with MA plans on establishing an expedited credentialing process to ensure that all health center providers are credentialed on a timely basis, preferably prior to January 1, 2006. *Response:*
                         The requirements related to credentialing MA plan providers are found in subpart E the Part 422. Note that with limited exceptions, the credentialing process that MA organizations follow for providers is at the MA organization's discretion (see § 422.204). *Comment:*
                         A commenter requested clarification that supplemental payments are available for Medicare-covered services provided by FQHCs under non-traditional managed care approaches, such as Preferred Provider Organization (PPOs). *Response:*
                         FQHCs contracting with any MA organization are eligible for supplemental payments. MA organizations can offer various types of MA plans, including PPOs. We are revising § 405.2469 as proposed with one change, the first use of the term “Medicare Advantage plans” is revised to read “Medicare Advantage organizations.” N. National Coverage Decisions Timeframes We have established requirements concerning the administrative review of local coverage determinations (LCDs) and National Coverage Determinations (NCDs) at 42 CFR part 426, with subpart C specifically addressing the general provisions for the review of LCDs and NCDs. We are updating these requirements as they apply to NCDs to reflect changes in the statute. Under our existing regulations in part 426, Subpart C, the Departmental Appeals Board may stay the adjudicatory proceedings in certain circumstances to allow CMS to consider significant new evidence that is submitted in the context of a challenge to an NCD. Our previous regulations at § 426.340(e), permitted a brief stay of the adjudicatory proceedings (not more than 90 days), for CMS to complete its reconsideration of the NCD. Those timeframes, although short, were consistent with the previous process for making NCDs that did not require publication of a proposed decision memorandum and an opportunity for public comment on the proposed decision memorandum. As discussed in the August 8, 2005 proposed rule (70 FR 45853), based on the provisions of section 731 of the MMA of 2003, we proposed to amend § 426.340 to state that if the CMS informs the Board that a revision or reconsideration was or will be initiated, then the Board will stay the proceedings and set appropriate timeframes by which the revision or reconsideration will be completed, that reflects sufficient time for the publication of a proposed determination, a 30-day public comment period, and time for CMS to prepare a final determination that responds to public comments as specified in section 1862(l) of the Act. We also proposed to eliminate the reference to the 90-day reconsideration period in § 426.340(e)(3) for NCD appeals to reflect the new timeframes in the MMA. *Comment:*
                         We received 7 comments regarding the proposed NCD timeframes. All commenters supported the change. However, a few commenters raised concerns about the delays regarding a specific NCD that was initiated before the December 8, 2003 effective date for the statutory change. *Response:*
                         We will finalize the changes to § 426.340 as proposed with minor technical edits, and will continue to work diligently to assure that all NCDs submitted after the December 8, 2003 effective date for the statutory change are developed within the set timeframes. O. Coverage of Screening for Glaucoma On January 1, 2002, we implemented regulations at § 410.23(a)(2), Conditions for and limitations on coverage of screening for glaucoma, requiring that the term “eligible beneficiary” be defined to include individuals in the following high risk categories: Individuals with diabetes mellitus; individuals with a family history of glaucoma; or African-Americans age 50 and over. As discussed in the August 8, 2005 proposed rule (70 FR 45853) based on our review of the current medical literature, we believe that there are other beneficiaries who are at risk for glaucoma and should be included in the definition of eligible beneficiary for purposes of the glaucoma screening benefit. We believe the evidence is adequate to conclude that Hispanic persons age 65 and older are at high risk and could benefit from glaucoma screening. Therefore in § 410.23(a)(2), we proposed to revise the definition of an eligible beneficiary to include Hispanic Americans age 65 and over. In view of the possibility that it may be appropriate to include other individuals in the definition of those at “high risk” for glaucoma, we also requested comments on this issue, including documentation from the peer-reviewed medical literature in support of suggested changes. We received seven comments on the proposal to expand coverage of the glaucoma screening benefit to include Hispanic Americans within the category of those individuals at “high risk” for glaucoma. The following is a summary of the comments received and our responses. *Comment:*
                         One commenter stated that it might be appropriate to include other individuals (and not only Hispanic-Americans over age 65) in the definition of those at “high risk” for glaucoma. The commenter cited the Los Angeles Latino Eye Study and the research conducted by the Eye Diseases Prevalence Research Group as illustrating a sharp rise in the prevalence of glaucoma among Hispanic-Americans beginning at age 60 (Archives of Ophthalmology 2004; 122:532-538). The commenter indicated that according to the latter research, the risk of developing glaucoma among Hispanics between the ages 50-59 is 2.92 percent, and that this number increases significantly to 7.36 percent for Hispanics between the ages 60-69. In view of this increase in the prevalence of glaucoma in the Hispanic population between the ages 60-69, the commenter recommended that CMS reduce the proposed screening coverage age from 65 to 60 years of age, suggesting that this lowering of the age would allow for medical intervention at an earlier stage during this critical period for glaucoma development. *Response:*
                         We note that the commenter relied on the results of a major study (See the Archives Ophthalmology 2004; 122:532-538) in offering their suggestion for revising the proposal. That, in turn, relied on the results of another major study (See Archives of Ophthalmology 2001; 119:1819-1826) for data on incidence and prevalence of primary open angle glaucoma in Hispanic-Americans. The latter study (Quigley, et al.) contains a graph on page 1822 which, in addition to stating the same data that the commenter referenced, shows an acceleration in prevalence of open angle glaucoma in Hispanic-Americans as compared to White persons beginning at age 65. This study by Quigley et al. 
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                        yields data supporting a higher incidence of open angle glaucoma in Hispanics as compared to Whites beginning at age 65 (Quigley, HA et al). The prevalence of glaucoma in a population based study of Hispanic subjects: proyecto VER. (Annals of Ophthalmology 2001; 119:1819-1825). Though they are not statistically significant in that age group, the data strongly favors our conclusion. However, for ages under 65 years, the evidence is poor for any differences in these 2 groups for an incidence of open angle glaucoma. Therefore, we have chosen a coverage baseline for the glaucoma screening benefit of age 65 and older for Hispanic-Americans. *Comment:*
                         One commenter stated that they did not support the proposal to expand the definition of those individuals at “high risk” for glaucoma because they do not believe there is sufficient evidence in the medical literature to recommend for or against screening adults for glaucoma, including Hispanic-Americans age 65 and older. The commenter cited the United States Preventive Services Task Force (USPSTF) recommendation that concluded that there is insufficient evidence to recommend for or against screening adults for glaucoma. The commenter also noted that while the USPSFT clinical considerations section of its recommendation states that increased ocular pressure, family history, older age, and being of African-American descent place an individual at risk for glaucoma, it makes no mention of Hispanic-Americans. Therefore, the commenter concluded that CMS should not make any changes to the current definition. *Response:*
                         As stated previously, the articles in Archives of Ophthalmology, show that the prevalence of glaucoma in Hispanics begins to increase at age 65 markedly when compared to Whites. While the USPSTF concluded that there is insufficient evidence to recommend either for or against screening any adult for glaucoma, section 1861(s)(2)(K) of the Act mandates coverage of screening for glaucoma for individuals determined to be at high risk for glaucoma, individuals with a family history of glaucoma and individuals with diabetes. Based on our review of the two published studies, we believe that the evidence is adequate to conclude that Hispanics age 65 and older meet the definition of individuals at high risk for glaucoma and could benefit from glaucoma screening. Further, since glaucoma is prevalent in Hispanics, we would rather be inclusive rather than exclusive for the screening benefit. *Comment:*
                         Two commenters urge CMS to help educate providers and Hispanic beneficiaries to ensure that they are aware of the benefits associated with the new coverage when it is included in the final rule. *Response:*
                         We agree and will release appropriate manual and transmittal instructions and information from our educational components for the medical community, including a MedLearn Matters article and fact sheets. We also encourage the medical community to join this effort in educating physicians and beneficiaries by distributing their own communications, bulletins, or other publications. In addition, we have specifically included information on the expanded glaucoma screening benefit in the 2006 English and Spanish versions of the 
                        *Medicare and You Handbook*, and we plan to revise the booklet, Medicare's Preventive Services, and the bilingual brochure for Hispanic beneficiaries, to reflect the expanded benefit as well. *Comment:*
                         One commenter expressed concern that at the present time, if a glaucoma screening is performed and a disease or condition other than glaucoma is discovered the screening examination will no longer be considered to be a covered service, which may leave providers open to additional financial liability unless they ensure that the patient sign an ABN. The commenter recommends that Medicare should cover screening examinations without regard to the diagnosis that is determined as a result of the screening in a particular case. *Response:*
                         The availability of coverage under the screening benefit does not depend on whether or not a disease condition is discovered during the annual screening examination. Medicare covers the screening examination regardless of the findings at the time of the screening examination, but if the provider decides to perform and bill Medicare for the more comprehensive eye exam, the cost of the screening examination is considered bundled into the Medicare payment for the more expensive comprehensive eye examination. For example, if a disease, cataract, or a macular degeneration condition is discovered at the time of the glaucoma screening, the provider may decide to perform a medically necessary comprehensive eye examination and bill Medicare Part B for that more expensive covered service. In this example, it would be inappropriate for the provider to bill Medicare for the less expensive glaucoma screening service as well as the more comprehensive and expensive service because it would be duplicative for Medicare to pay for both services. In this situation, the only eye service that may be billed Medicare is the comprehensive eye examination and it would be presumed that the glaucoma screening service is bundled into the Medicare payment for the comprehensive eye service. *Comment:*
                         One commenter suggested that CMS work with the Secretary of HHS to add on beneficiary eligibility for all Medicare covered screening tests to the ASC X12N 270/271 eligibility transaction. *Response:*
                         This issue does not fall within the scope of the Medicare PFS regulations; and therefore, we are unable to address it in this final rule with comment. *Comment:*
                         Two commenters expressed concern about the statement in the Regulatory Impact Analysis (70 FR 45870) of the proposed rule that stated that the expansion of the benefit to include Hispanic persons age 65 and older “is not expected to have a significant cost impact on the Medicare program.” The commenters urge CMS to make available to the public it's calculation of the impact on spending that would result from the proposed increase in glaucoma screening coverage and to reflect these spending increases in the SGR, including increases due to the initial test and all related and follow-up care. *Response:*
                         Based on the projected utilization of the expanded glaucoma screening coverage to include Hispanic persons age 65 and older, we estimated in the proposed rule that the expanded benefit would result in an increase in Medicare payments to ophthalmologists or optometrists who will provide these screening tests and related follow-up tests and treatment. However, we noted that this change was not expected to have a significant cost impact on the Medicare program. Based on Medicare Part B carrier claims processing data, we estimate that the program paid for about 1,100 glaucoma screening services in CY 2004 at a cost of about $47,000 for the same time period. While it is not possible to predict how many Hispanic-Americans might take advantage of the new coverage that will be available to them, judging from the impact of the present glaucoma screening benefit on the Medicare costs in CY 2004, we do not believe the expansion will have a significant impact on program costs in CY 2005 and subsequent years. *Comment:*
                         One commenter suggested that CMS seek to improve its coverage web site in the future to reflect all changes being considered by the agency—both regulatory and NCD developments—that relate to Medicare 
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                        coverage of various preventive services. The commenter stated that providing references to all matters affecting Medicare coverage in one place would provide the pubic with a better understanding of the extent of the agency's efforts in this area. *Response:*
                         We note that the regulation and the NCD processes are two separate methods specified in the Medicare statute for developing and publishing national coverage policies. However, we plan to review the commenter's suggestion for providing references on the CMS Coverage web site to all matters—both regulatory and NCD developments—affecting Medicare coverage in the preventive services area. Final Decision We are revising the definition of an eligible beneficiary who is at “high risk” for glaucoma to include Hispanic-Americans age 65 and older as proposed. P. Additional Issues 1. Corrections to Conditions for Medicare Payment (§ 424.22) Two typographical errors in 42 CFR 424.22 were discovered. First, § 424.22(d) erroneously refers to the definition of “financial relationship” in “§ 411.351” instead of “§ 411.354”. In addition, footnote 1 of § 424.22(a)(1)(iv) contains an error in the spelling of the word “hospital.” Therefore, we are revising § 424.22 to correct these errors. 2. Chemotherapy Demonstration Project CMS seeks to encourage quality care in all facets of cancer treatment and care by encouraging best clinical practices and quality care. In the CY 2005 final rule, we announced the initiation of a 1 year demonstration project for CY 2005 for office-based oncology services. The authority for this demonstration is based on sections 402(a)(1)(B) and 402(b) of the Social Security Act Amendments of 1967 (Pub. L. 90-248). These provisions allow the Secretary to develop and engage in experiments and demonstration projects to provide incentives for economy while maintaining or improving quality in the provision of health services. This CY 2005 project focused on three areas of concern often cited by patients undergoing chemotherapy: controlling pain; minimizing nausea and vomiting; and reducing fatigue. Participating practitioners are reporting standardized assessments of patient symptoms at the time of chemotherapy encounters. We are collecting data based on these assessments over the course of chemotherapy treatment to trace changes in patient symptoms, quality of life, and medical responses associated with standardized physician assessment of these important areas. To facilitate the collection of information, we established new Billing Codes, that is, G-codes, to be reported by practitioners in the demonstration. The codes correspond to four patient assessment levels for each of the three patient symptom areas: Nausea and vomiting; pain; and fatigue. These levels, based on the Rotterdam scale, have already proven effective in measuring patient symptoms associated with cancer care, are easily understood by patients, and are in widespread use. Practices reporting data on all three factors to Medicare qualify for an additional payment of $130 per encounter. By billing the designated codes, the practitioner self-enrolls in the project. Although we did not include a discussion item or demonstration proposal in the August 8, 2005, proposed physician fee schedule rule, we did release a fact sheet on August 1, 2005, titled, “Demonstration of Improved Quality of Care for Cancer Patients Undergoing Chemotherapy” which was posted on our web site. The fact sheet provided background on the demonstration project, shared preliminary data on the results of the demonstration, and indicated that we would continue to consult with its stakeholders about the merits of the program and the utility of the data captured. We received comments on the proposed rule on the demonstration itself and the specific items in the fact sheet. Some commenters pointed out what they perceived as limitations of the demonstration itself, such as the application of the Part B coinsurance to the demonstration codes. Almost all commenters urged CMS to extend the demonstration project in its current form or revise it to capture better data on quality and outcomes. Several commenters favored extending the demonstration to services provided by other physician specialties, such as rheumatology, gastroenterology, urology, or infectious disease; or to those services currently not included in the framework of the demonstration, such as chemotherapy administration to hospital outpatients or chemotherapy services provided through oral anti-cancer drugs. One major specialty group opposed the continuation of the demonstration project stating that it is inconsistent with current efforts to build evidence-based medicine into the delivery of high quality care to Medicare patients. Following extensive discussions with various groups representing the interests of oncologists and advocates for patient care, we have decided to retain the demonstration project for one more year, but we will revise the G-codes for reporting in order to take a further step toward encouraging quality care and promoting best clinical practices that should lead to improved patient outcomes. We will eliminate the CY 2005 G-codes specific to the assessment of patient symptoms, while maintaining our focus on quality cancer care, including the management of debilitating symptoms, to assure the best possible quality of life for cancer patients. Reconfiguration of the Demonstration for CY 2006 The new 1 year oncology demonstration, applicable to services furnished in CY 2006, will build on the use of G codes to gather more specific information relevant to the quality of care for cancer patients, their treatments, and the spectrum of care they receive from their doctors, and whether or not the care follows clinical guidelines. The project will emphasize evidence-based practice guidelines that have been shown to lead to better patient outcomes as the source for standard of care, permitting us to monitor and encourage quality care to cancer patients. Reporting will no longer be specific to chemotherapy administration services, but instead will be associated with physician E/M visits for established patients with cancer, visits that are frequent and essential to assuring quality of care and life for patients. The demonstration is available to office-based hematologists/oncologists who provide an E/M service of level 2, 3, 4, or 5 to an established patient, when the service is delivered to a patient with a primary diagnosis of cancer belonging to one of the following major diagnostic categories: Breast cancer (invasive).
                    Colon cancer.
                    Rectal cancer.
                    Prostate cancer.
                    Lung cancer (either non-small cell or small cell).
                    Stomach cancer.
                    Esophageal cancer.
                    Pancreatic cancer.
                    Ovarian cancer.
                    Non-Hodgkins Lymphoma.
                    Chronic myelogenous leukemia.
                    Multiple myeloma.
                    Cancer of the head and neck. E/M services furnished by hematologists/oncologists for patients with other cancers as the principal 
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                        diagnosis will not qualify under the demonstration. We are establishing a 2006 payment amount of $23 for the 1 year oncology demonstration payment. To qualify for the $23 oncology demonstration payment, the physician must submit one G-code from each of the following three categories when an E/M service of level 2, 3, 4, or 5 is billed: (1) The primary focus of the E/M service; (2) the current disease state; and (3) whether current management adheres to clinical guidelines. We will inform the public on more details of this demonstration through a fact sheet and information on our Web site at 
                        *www.cms.hhs.gov/​*. III. Refinement of Relative Value Units for Calendar Year 2006 and Response to Public Comments on Interim Relative Value Units for 2005 [If you choose to comment on issues in this section, please include the caption “Interim Relative Value Units” at the beginning of your comments.] A. Summary of Issues Discussed Related to the Adjustment of Relative Value Units Section III.B. and III.C. of this final rule with comment describes the methodology used to review the comments received on the RVUs for physician work and the process used to establish RVUs for new and revised CPT codes. Changes to codes on the PFS reflected in Addendum B are effective for services furnished beginning January 1, 2006. B. Process for Establishing Work Relative Value Units for the 2005 Physician Fee Schedule Our CY 2005 final rule (69 FR 66236) contained the work RVUs for Medicare payment for existing procedure codes under the PFS and interim RVUs for new and revised codes beginning January 1, 2005. We considered the RVUs for the interim codes to be subject to public comment under the annual refinement process. In this section, we summarize the refinements to the interim work RVUs published in the CY 2005 final rule and our establishment of the work RVUs for new and revised codes for the 2006 PFS. C. Work Relative Value Unit Refinements of Interim Relative Value Units 1. Methodology (Includes Table Titled “Work Relative Value Unit Refinements of the 2004 Interim and Related Relative Value Units”) Although the RVUs in the CY 2005 PFS final rule were used to calculate 2005 payment amounts, we considered the RVUs for the new or revised codes to be interim. We accepted comments for a period of 60 days. We received substantive comments for 7 CPT codes with interim work RVUs. To evaluate these comments, we used a process similar to the process used since 1997. (See the October 31, 1997 final rule (62 FR 59084) for the discussion of refinement of CPT codes with interim work RVUs.) We convened a multispecialty panel of physicians to assist us in the review of the comments. The comments that we did not submit to panel review are discussed at the end of this section, as well as those that were reviewed by the panel, which are contained in Table 28, Codes Reviewed Under the Refinement Process. We invited representatives from the organizations from which we received substantive comments to attend a panel for discussion of the code on which they had commented. The panel was moderated by our medical staff, and consisted of the following voting members: One or two clinicians representing the commenting organization.
                    One primary care clinician nominated by the American Academy of Family Physicians.
                    Three carrier medical directors.
                    Two clinicians with practices in related specialties who were expected to have knowledge of the service under review. The panel discussed the work involved in the procedure under review in comparison to the work associated with other services under the PFS. We assembled a set of 75 reference services and asked the panel members to compare the clinical aspects of the work of the service a commenter believed was incorrectly valued to one or more of the reference services. In compiling the set, we attempted to include: (1) Services that are commonly performed whose work RVUs are not controversial; (2) services that span the entire spectrum from the easiest to the most difficult; and (3) at least three services performed by each of the major specialties so that each specialty would be represented. The intent of the panel process was to capture each participant's independent judgment based on the discussion and his or her clinical experience. Following the discussion, each participant rated the work for the procedure. Ratings were individual and confidential, and there was no attempt to achieve consensus among the panel members. We then analyzed the ratings based on a presumption that the interim RVUs were correct. To overcome this presumption, the inaccuracy of the interim RVUs had to be apparent to the broad range of physicians participating in each panel. Ratings of work were analyzed for consistency among the groups represented on each panel. In addition, we used statistical tests to determine whether there was enough agreement among the groups of the panel and whether the agreed-upon RVUs were significantly different from the interim RVUs published in Addendum C of the final rule. We did not modify the RVUs unless there was a clear indication for a change. If there was agreement across groups for change, but the groups did not agree on what the new RVUs should be, we eliminated the outlier group and looked for agreement among the remaining groups as the basis for new RVUs. We used the same methodology in analyzing the ratings that we first used in the refinement process for the 1993 PFS. The statistical tests were described in detail in the November 25, 1992 final rule (57 FR 55938). Our decision to convene multispecialty panels of physicians and to apply the statistical tests we described was based on our need to balance the interests of those who commented on the work RVUs against the redistributive effects that would occur in other specialties. Table 28 lists those interim codes reviewed under the refinement panel process described in this section. This table includes the following information: CPT Code. This is the CPT code for a service.
                    Description. This is an abbreviated version of the narrative description of the code.
                    2005 Work RVU. The work RVUs that appeared in the CY 2005 final rule are shown for each reviewed code.
                    Requested Work RVU. This column identifies the work RVUs requested by commenters.
                    2006 Work RVU. This column contains the final RVUs for physician work.( print page 70274) Table 28.—Codes Reviewed Under the Refinement Panel Process
CPT code*
Mod
Descriptor
2005 work RVU
Requested work RVU
2006 work RVU97605

Neg press wound tx, < 50 cm
Bundled
0.55
0.5597606

Neg press wound tx, > 50 cm
Bundled
0.60
0.60* All CPT codes and descriptions copyright 2005 AMA. All rights reserved and applicable FARS/DFARS clauses apply.
 2. Interim 2005 Codes CPT codes 97605 
                        *Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters and 97606 Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters.* The RUC HCPAC review board recommended 0.55 work RVUs for CPT code 97605 and 0.60 work RVUs for CPT code 97606, which we did not accept. We disagreed with their recommendation that these services contained physician work and did not assign work RVUs. Further, when the negative pressure wound therapy service does not encompass selective debridement, we consider the service to represent a dressing change and will not make separate payment. When the negative pressure wound therapy service includes the need for selective debridement, we consider the services represented by CPT codes 97605 and 97606 to be bundled into CPT codes 97597 or 97598. We assigned a status indicator of “B” to CPT code 97605 and 97606, meaning that we would not make separate payment for these services. *Comment:*
                         Commenters disagreed with our decision not to accept the RUC HCPAC recommended work RVU of 0.55 for CPT code 97605 and 0.60 work RVU for CPT code 97606 and with our decision not to make separate payment for these services. Based on these comments, we referred these codes to the multispecialty validation panel for review. *Response:*
                         As a result of the statistical analysis of the 2005 multispecialty validation panel ratings, we have assigned 0.55 work RVUs to CPT code 97605 and 0.60 work RVUs to CPT code 97606. CPT codes 32855 
                        *Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; unilateral;*
                         32856 
                        *Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; bilateral;*
                         33933
                        *Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, and trachea for implantation; Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation;*
                         44715
                        *Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein;*
                         47143
                        *Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without trisegment or lobe split;*
                         47144 
                        *Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with trisegment split of whole liver graft into two partial liver grafts (ie, left lateral segment (segments II and III) and right trisegment (segments I and IV through VIII));*
                         47145 
                        *Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe split of whole liver graft into two partial liver grafts (ie, left lobe (segments II, III, and IV) and right lobe (segments I and V through VIII));*
                         48551 
                        *Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and Y-graft arterial anastomoses from iliac artery to superior mesenteric artery and to splenic artery;*
                         50323 
                        *Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary; and*
                         50325
                        *Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary.*
                         These codes, all of which were approved in 2004 for inclusion in the 2005 CPT, were designated by us as carrier-priced. *Comment:*
                         Commenters believed these codes describe services which are not payable under the Medicare PFS because they are hospital organ acquisition costs reimbursed under Part A of Medicare. The commenters requested that we change the designation of the standard backbench services from carrier priced to “excluded by law”, to be consistent with deceased donor procurement codes thereby indicating that they are not included in the definition of physician services for PFS purposes. Commenters also requested that we clarify that these services are included in the definition of hospital organ acquisition costs. *Response:*
                         The backbench standard preparation codes describe procedures that are performed by physicians to prepare donor organs for implantation. The procedure is usually performed at the same hospital by the same surgical transplant team where the recipient transplant operation occurs, often in the same or adjacent operating room. It is usually completed shortly prior to or during the recipient transplant operation (especially for the heart and 
                        ( print page 70275)
                        lung) although more time is available to complete the transplant operations for the liver, kidney, and pancreas. This procedure is a necessary component for completion of the recipient transplant operation. With the exception of living donors, these services are rarely rendered at the hospital where the donor organs are procured. Hospital organ acquisition costs primarily consist of charges for services rendered by the hospital, Organ Procurement Organization (OPO), and the physicians related to retrieving the cadaveric donor organs at the “donor hospital” location. By virtue of its proximate timing and spatial association with the recipient transplant operation, this group of backbench standard preparation procedures are similar to other transplant surgery procedures that are performed by physicians and paid under the Medicare PFS. Therefore, we do not see how they would be considered as hospital organ acquisition costs (as suggested by the commenter). Since the codes for these backbench procedures do not represent deceased donor procurement codes, they would not appropriately be designated as “excluded by law” as requested by the commenter. It would be more appropriate to pay for these services under the PFS. In the specific case of living donors, both the “donor hospital” and the “recipient hospital” are obviously the same, although both operations are performed simultaneously by different surgical teams. In these cases, the backbench standard preparation procedures may be performed by physician members of either the donor team, the recipient team, or even a third surgical team. It is recognized that on occasion a donor organ will not be used for transplant at the facility where the backbench standard preparation procedure is performed (often because the intended recipient is found to be medically unsuitable after completion of the backbench work). In these situations, the donor organ may be sent to a different facility for another potential transplant recipient. Even in these situations, the physician performing the backbench procedure has no particular association with the initial donor procurement operation, the OPO, or the “donor hospital” site. Therefore, this physician's work is still a physician service that should be paid under the Medicare PFS. CPT codes 36475 
                        *Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated*
                         and 36476 
                        *Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; second and subsequent veins treated in a single extremity, each through separate access sites.*
                         We accepted the RUC recommendation of 6.72 work RVUs for 36475 and 3.38 work RVUs for 36476. *Comment:*
                         We received a comment expressing concerns that we assigned endovenous radiofrequency (RF) ablation procedures (CPT code 36475 and 36476) the same work RVUs as were assigned to endovenous laser procedures (CPT codes 36478 and 36479). The commenter strongly urged us to reevaluate the work RVUs for RF ablation procedures. The commenter also noted that the vignette developed for the RF procedure was used for the laser procedure with one modification—the word radiofrequency was changed to “laser” and as a result, the vignette for the laser procedure was inaccurate, misleading, and created the impression that the work for the laser procedure is as intense as the work for the RF procedure. The commenter believed the mistaken description likely blurred the distinctions between the two procedures in terms of work and procedure time. The commenter also believed the flawed survey is evidence that the work RVUs for RF procedures were not appropriate and should be reexamined. *Response:*
                         We believe the RUC appropriately valued these codes based upon the information that was provided to them during the RUC survey process and suggest the commenter contact the specialty society to have these codes reexamined by the RUC. In the CY 2005 final rule (69 FR 66370), we also responded to the RUC recommendations on the PE inputs for the new and revised CPT codes for 2005. Comments received on the PE inputs were addressed earlier in this preamble in the PE proposals for CY 2006 with the exception of comments received on CPT codes 36475 and 36476. As noted in the previous discussion concerning refinement of interim work RVUs, the commenter indicated the vignette was incorrect and therefore we believe the concerns about PE should also be handled through the RUC process by the specialty society. D. Establishment of Interim Work Relative Value Units for New and Revised Physician's Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System Codes (HCPCS) for 2006 (Includes Table titled “American Medical Association Specialty Relative Value Update Committee and Health Care Professionals Advisory Committee Recommendations and CMS's Decisions for New and Revised 2006 CPT Codes”) One aspect of establishing RVUs for 2006 was to assign interim work RVUs for all new and revised CPT codes. As described in our November 25, 1992 notice on the 1993 PFS (57 FR 55951) and in section III.B. of the November 22, 1996 final rule (61 FR 59505), we established a process, based on recommendations received from the AMA's RUC, for establishing interim work RVUs for new and revised codes. This year we received work RVU recommendations for 175 new and revised CPT codes from the RUC. Our staff and medical officers reviewed the RUC recommendations by comparing them to our reference set or to other comparable services for which work RVUs had previously been established. We also considered the relationships among the new and revised codes for which we received RUC recommendations and agreed with the majority of the relative relationships reflected in the RUC values. In some instances, although we agreed with the relationships, we nonetheless revised the work RVUs to achieve work neutrality within families of codes. That is, the work RVUs were adjusted so that the sum of the new or revised work RVUs (weighted by projected frequency of use) for a family will be the same as the sum of the current work RVUs (weighted by projected frequency of use) for the family of codes. We reviewed all the RUC recommendations and accepted approximately 94 percent of the RUC recommended values. For approximately 6 percent of the recommendations, we agreed with the relativity established by the RUC, but needed to adjust work RVUs to retain budget neutrality. We received 9 recommendations from the Health Care Professional Advisory Committee (HCPAC). We agreed with seven of these recommendations and disagreed with two of them. Table 29, titled “AMA RUC and HCPAC Recommendations and CMS Decisions for New and Revised 2006 CPT Codes,” lists the new or revised CPT codes, and their associated work RVUs, that will be interim in 2006. This 
                        ( print page 70276)
                        table includes the following information: A “#” identifies a new code for 2006.
                    CPT code. This is the CPT code for a service.
                    Modifier. A “26” in this column indicates that the work RVUs are for the professional component of the code.
                    Description. This is an abbreviated version of the narrative description of the code.
                    RUC recommendations. This column identifies the work RVUs recommended by the RUC.
                    HCPAC recommendations. This column identifies the work RVUs recommended by the HCPAC.
                    CMS decision. This column indicates whether we agreed or we disagreed with the RUC recommendation. Codes for which we did not accept the RUC recommendation are discussed in greater detail following this table. An “(a)” indicates that no RUC recommendation was provided.
                    2006 Work RVUs. This column establishes the interim 2006 work RVUs for physician work. 
 
  
 
  
 
  
 
  Table 30, which is titled “AMA RUC ANESTHESIA RECOMMENDATIONS AND CMS DECISIONS FOR NEW AND REVISED 2006 CPT CODES”, lists the new or revised CPT codes for anesthesia and their base units that will be interim in 2006. This table includes the following information: CPT code. This is the CPT code for a service.
                    Description. This is an abbreviated version of the narrative description of the code.
                    RUC recommendations. This column identifies the base units recommended by the RUC.
                    CMS decision. This column indicates whether we agreed or we disagreed with the RUC recommendation. Codes for which we did not accept the RUC recommendation are discussed in greater detail following this table.
                    2006 Base Units. This column establishes the 2006 base units for these services.( print page 70281) Table 30.—AMA RUC Anesthesia Recommendations and CMS Decisions for New and Revised CPT Codes
*
                                 CPT CODE
Description
RUC recommendation
CMS decision
2006 base units#01965
ANESTH, INC/MISSED AB PROC
4.00
Agree
4.00#01966
ANESTH, INDUCED AB PROCEDURE
4.00
Agree
4.00*
                             All CPT codes copyright 2005 AMA.# New CPT code.
 E. Discussion of Codes for Which There Were No RUC Recommendations or for Which the RUC Recommendations Were Not Accepted The following is a summary of our rationale for not accepting particular RUC work RVUs, base unit recommendations, or for accepting RUC recommendations with an intention to continue to monitor and reexamine the code(s) in the near future. It is arranged by type of service in CPT order. This summary refers only to work RVUs or Base Units. New and Revised Codes for 2006 CPT codes 61630 
                        *Balloon angioplasty, intracranial (e.g., atherosclerotic stenosis), percutaneous;*
                         61635 
                        *Transcatheter placement of intravascular stent(s), intracranial (e.g., athersosclerotic stenosis), including balloon angioplasty if performed;*
                         61640 
                        *Balloon dilatation of intracranial vasospasm, percutaneous, initial vessel;*
                         61641 
                        *Balloon dilatation of intracranial vasospasm, percutaneous, initial vessel; each additional vessel in same vascular family;*
                         and 61642 
                        *Balloon dilatation of intracranial vasospasm, percutaneous, initial vessel; each additional vessel in different vascular family.*
                        —The RUC recommended 21.08 work RVUs for 61630, 23.08 work RVUs for 61635, 12.32 work RVUs for 61640, 4.33 work RVUs for 61641 and 8.66 work RVUs for 61642. We are assigning a status indicator of N for these services because they are noncovered under Medicare due to a National Coverage Decision. CPT codes 76376 
                        *3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality; not requiring image post-processing on an independent workstation*
                         and 76377 
                        *3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality; requiring image post processing on an independent workstation.*
                        —The CPT Editorial Panel created CPT codes 76376 and 76377 to describe the new technology of volumetric acquisition of advanced cross-sectional imaging. The RUC recommended 0.20 work RVUs for CPT code 76376 and 0.79 work RVUs for CPT code 76377. These services were previously reported using CPT code 76375 
                        *Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomography modality.*
                         —According to the specialty society of the services reported for 76375, 80 to 90 percent reflected two-dimensional multiplanar reformatting and only 10 to 20 percent reflected three-dimensional rendering described in codes 76376 and 76377. Although we are accepting the utilization crosswalks recommended by the specialty society and the work RVUs recommended by the RUC, we will continue to evaluate the work and utilization associated with these services over the next year and reexamine these codes in the future. CPT code 88334 
                        *Pathology consultation during surgery; cytologic examination (e.g., touch prep, squash prep), each additional site.*
                        —The RUC recommended a work RVU of 0.80 for this service based on a comparison of this procedure to CPT code 88332 
                        *Pathology consultation during surgery; each additional tissue block, with frozen section(s).*
                         The RUC reviewed the specialty society's survey data and noted that the surveyed code 88334, when compared to the reference code 88332 has higher intensity/complexity measures and an additional five minutes of intra-service time, 20 minutes and 15 minutes, respectively. Although 88334 has an additional five minutes of intra-service time, we believe that 88334 is very similar in work to 88332 and, therefore, should be valued the same. We have assigned 0.59 work RVUs to 88334. CPT codes 88384 
                        *Array-based evaluation of multiple molecular probes; 11 through 50 probes,*
                         88385 
                        *Array-based evaluation of multiple molecular probes; 51 through 250 probes*
                         and 88386 
                        *Array-based evaluation of multiple molecular probes; 251 through 500 probes.*
                        —The RUC recommended that the base code (88384) be carrier priced and recommended 1.50 work RVUs for 88385 and 1.88 work RVUs for 88386. We will allow the base code to be carrier priced and are accepting the RUC recommended values for 88385 and 88386. We will continue to evaluate the work and utilization associated with all of these services over the next year and reexamine these codes in the future. CPT code 90773 
                        *Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intra-arterial.*
                        —We did not receive a final RUC recommendation for this code. This code replaces CPT code 90783 
                        *Therapeutic, prophylactic or diagnostic injection (specify material injected); intra-arterial,*
                         which has been deleted and was assigned 0.17 work RVUs. On an interim basis, we have assigned 0.17 work RVUs to 90773 since it replaces 90783. CPT code 92630 
                        *Auditory rehabilitation, pre-lingual hearing loss*
                         and 92633 
                        *Auditory rehabilitation, post-lingual hearing loss.*
                        —CPT codes 92630 and 92633 represent speech language pathology and audiology services. These CPT codes describe rehabilitative or therapeutic services. When speech-language pathologists (SLPs) provide these services, they may bill for them by using CPT code 92507 
                        *Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual,*
                         as appropriate. According to the Medicare statute, section 1861(ll)(2) of the Act, audiologists are recognized for purposes of providing diagnostic testing services to Medicare beneficiaries. Therefore, we will not recognize CPT codes 92630 and 92633 under Medicare and have assigned a status indicator of I because these services represent therapeutic services rather than diagnostic tests. CPT code 95251 
                        *Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for up to 72 hours; physician interpretation and report.*
                        —The RUC recommended a work RVU of 0.85 for this service. We disagree with the RUC's recommendation because we believe the work for this service is similar to CPT code 93268 
                        *Patient demand single or multiple event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; includes 
                            ( print page 70282)
                            transmission, physician review and interpretation,*
                         which involves the review of data over a 30 day period. Therefore, we have assigned 0.52 work RVUs to 95251. CPT codes 95873 
                        *Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) and 95874 (Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure).*
                        —The RUC recommended a work RVU of 0.56 for CPT codes 95873 and 95874. The RUC examined reference code 95860 
                        *(Needle electromyography; one extremity with or without related paraspinal areas)*
                         and determined that the intensity for the new procedures and the reference procedure were the same so a proper value for both new codes should be based on the ratio of time with the reference code. We believe that the work involved with 95873 and 95874 is very similar to 95870 and therefore should be valued the same. We have assigned 0.37 work RVUs to CPT codes 95873 and 95874. CPT codes 96116 
                        *Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities); per hour of the psychologist's or physician's time, both face-to-face time with the patient and time preparing the report and 96118 Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test); per hour of the psychologist's or physician's time, both face-to-face time with the patient and time preparing the report.*
                        —The HCPAC recommended 2.05 work RVUs for CPT codes 96116 and 96118. We disagree with the HCPAC's recommendation and believe the physician work associated with these services is similar to 96101, as reflected by the technical skill, judgment and complexity of these services. Therefore, we have assigned 1.86 work RVUs to 96116 and 96118. CPT codes 98960 
                        *Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient;*
                         98961 
                        *Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients;*
                         and 98962 
                        *Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients.*
                        —We are assigning a status indicator of N for these services because they are noncovered under Medicare. CPT codes 99143 
                        *Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status, under 5 years of age; first 30 minutes intra-service time,*
                         99144 
                        *Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status, age 5 years or older; first 30 minutes intra-service time,*
                         99145 
                        *Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status, age 5 years or older; each additional 15 minutes intra-service time,*
                         99148 
                        *Moderate sedation services (other than those services described by codes 00100-01999) provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, under 5 years of age; first 30 minutes intra-service time,*
                         99149 
                        *Moderate sedation services (other than those services described by codes 00100-01999) provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, age 5 years or older; first 30 minutes intra-service time,*
                         99150 
                        *Moderate sedation services (other than those services described by codes 00100-01999) provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, each additional 15 minutes intra-service time.*
                        —The CPT Editorial Panel created six new codes to accurately report 2 separate families of moderate sedation. One family describes the provision of moderate sedation services by the physician who is performing the diagnostic or therapeutic service and supervising an independent trained observer while the other family describes moderate sedation services performed by a physician (other than an anesthesiologist) other than the physician performing a diagnostic or therapeutic service. These new codes replace CPT codes 99141 
                        *Sedation with or without analgesia (conscious sedation); intravenous, intra-muscular or inhalation*
                         and 99142 
                        *Sedation with or without analgesia (conscious sedation); oral, rectal and/or intranasal,*
                         which were bundled under the PFS. The RUC recommended 0.70 work RVUs for 99143, 0.66 work RVUs for 99144, 0.23 work RVUs for 99145, 1.75 work RVUs for 99148, 1.65 work RVUs for 99149 and 0.47 work RVUs for 99150. We are uncertain whether the RUC assigned values are appropriate and have carrier priced these codes in order to gather information for utilization and proper pricing. F. Establishment of Interim PE RVUs for New and Revised Physician's Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System (HCPCS) Codes for 2006. We have developed a process for establishing interim PE RVUs for new and revised codes that is similar to that used for work RVUs. Under this process, the RUC recommends the PE direct inputs (the staff time, supplies and equipment) associated with each new code. We then review the recommendations in a manner similar to our evaluation of the recommended work RVUs. The RUC recommendations on the PE inputs for the new and revised 2006 codes were submitted to us as interim recommendations. We have accepted, in the interim, the PE recommendations submitted by the RUC for the codes listed in the table titled “AMA RUC and HCPAC RVU Recommendations and CMS Decisions for New and Revised 2006 CPT Codes.” CPT code 28890 
                        *Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia.*
                        —We accepted the work RVUs for CPT 28890. However, we disagree with the RUC's recommendation to value this procedure only in the facility setting. We believe that this procedure is being performed in the nonfacility setting and are assigning the following PE inputs based on information that the RUC 
                        ( print page 70283)
                        provided for informational purposes: (a) Total clinical labor time of 133 minutes consisting of 16 minutes for pre-service, 36 minutes for the service period, and 81 minutes for the post-service period; (b) supplies consist of 4 multispecialty supply packages (1 each for the procedure and each of the 3 post visits), 1 fenestrated drape, 3 18-24 gauge needles, 1 10cc syringe, 5cc of lidocaine 1 percent, 5cc of marcaine 0.5 percent, and 2 alcohol swabs; and (c) equipment includes ESW machine used for the procedure for 36 minutes and a power table and an exam lamp each for 117 minutes (includes the 36 minute procedure and 81 minutes for the post visits). CPT 89049 
                        *Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and report.*
                        —While we accepted the work RVUs for this procedure, we disagreed with a PE recommendation regarding 30 minutes clinical labor—provided by a staff blend comprised of a combination laboratory technician and histotechnologist—that was requested to prepare the registry report. Because we do not pay for the clinical labor necessary to prepare registry reports in any other procedure codes, we have deleted the 30 minutes report preparation time from the total service period time in the practice labor expense database. The net result for the clinical labor service period is 274 minutes for CPT 89049. IV. Five-Year Refinement of RVUs—Status Update In the CY 2005 final rule (69 FR 66236), we solicited comments on the work RVUs that may be inappropriately valued. Since we recognized that this process generally elicits comments focusing on undervalued codes, we also indicated that we would identify codes (especially high-volume codes across specialties) that: Are valued as being performed in the inpatient setting, but that are now predominantly performed on an outpatient basis; and
                    Were not reviewed by the RUC, (that is, Harvard RVUs are still being used, or there is no information). We received comments on potentially misvalued services from approximately 35 specialty organizations and individuals involving over 500 codes. We shared these comments with the RUC and also identified approximately 160 additional codes for review. As explained in the CY 2005 final rule (69 FR 66236), we proposed to utilize a process similar to that established for the assignment of RVUs for new and revised CPT codes where the RUC makes recommendations on work RVUs for services. This process was used during the last 5-year review, and we believe that it was beneficial. The RUC's perspective is helpful because of its experience in recommending RVUs for new and revised CPT codes since we implemented the PFS. Furthermore, the RUC, by virtue of its multispecialty membership and consultation with approximately 65 specialty societies, involves the medical community in the refinement process. We will consider all comments on all work RVUs in the development of a proposed rule that we will publish 2006. In that rule, we will propose the revisions to work RVUs that we believe are needed. We will then review and analyze the comments received in response to our proposed revisions and publish our decisions in the final rule for CY 2007. V. Physician Self-Referral Prohibition: Nuclear Medicine and Annual Update to the List of CPT/HCPCS Codes A. General Section 1877 of the Act prohibits a physician from referring a Medicare beneficiary for certain designated health services (DHS) to a health care entity with which the physician (or a member of the physician's immediate family) has a financial relationship, unless an exception applies. Section 1877 of the Act also prohibits the DHS entity from submitting claims to Medicare or billing the beneficiary or any other entity for Medicare DHS that are furnished as a result of a prohibited referral. As specified in our regulations at § 411.351, the following services are DHS: Clinical laboratory services.
                    Physical therapy, occupational therapy, and speech-language pathology services.
                    Radiology and certain other imaging services.
                    Radiation therapy services and supplies.
                    Durable medical equipment and supplies.
                    Parenteral and enteral nutrients, equipment, and supplies.
                    Prosthetics, orthotics, and prosthetic devices and supplies.
                    Home health services.
                    Outpatient prescription drugs.
                    Inpatient and outpatient hospital services. B. Nuclear Medicine In the August 8, 2005 rule, we proposed to include diagnostic and therapeutic nuclear medicine procedures under the DHS categories for radiology and certain other imaging services and radiation therapy services and supplies, respectively. The DHS categories of radiology and certain other imaging services and radiation therapy services and supplies are defined by a list of CPT and HCPCS codes that is updated annually and posted on our web site. In the August 8, 2005 proposed rule (70 FR 45764), we stated that we would revise the list of CPT and HCPCS codes (List of CPT/HCPCS Codes) that identifies the items and services that are included in each of these DHS categories. Addendum G of the proposed rule set forth a list of codes for all diagnostic nuclear medicine procedures, all therapeutic nuclear medicine procedures, and the radiopharmaceuticals used in diagnostic and therapeutic nuclear medicine procedures. Additionally, we stated our intention to include diagnostic nuclear medicine services on the revised List of CPT/HCPCS Codes under “Radiology and Certain Other Imaging Services” and to include therapeutic nuclear medicine services on the revised List of CPT/HCPCS Codes under “Radiation Therapy Services and Supplies”. We stated that some radiopharmaceuticals may be included in both categories. We requested comments concerning whether the list was accurate and complete. In addition, we requested comments as to whether, or how, to minimize the impact on physicians who are currently parties to arrangements that involve nuclear medicine services and supplies (that is, by specifying a delayed effective date or by grandfathering certain arrangements). 1. Response to Comments We received many comments in response to our proposal to add diagnostic and therapeutic nuclear medicine services and supplies to the list of designated health services subject to the physician self-referral prohibition. Comments were submitted by or on behalf of numerous specialty societies, individual physicians, physician group practices, manufacturers, hospitals, the AMA and other trade associations, diagnostic imaging centers, and the Medicare Payment Advisory Commission (MedPAC). We received a few general comments, but the vast majority of comments centered on five specific issues. We address the comments in the following order: General Comments.
                    Authority to Include Nuclear Medicine Services and Supplies as Designated Health Services.
                    Overutilization or Abuse.
                    Beneficiary Access to Care.( print page 70284)
                    Quality of Care.
                    Grandfathering Existing Arrangements or Delaying the Effective Date. a. General Comments *Comment:*
                         One commenter questioned how our proposal would affect a physician's ability to refer patients to a positron emission tomography (PET) center that purchases radiopharmaceuticals (which are DHS under our proposal) from a company with which the referring physician has a financial relationship. *Response:*
                         The effect of this final rule with comment on a physician who has a financial relationship with a company that produces and supplies radiopharmaceuticals for PET scanning will depend on the nature of the physician's financial relationship with the supplying company and the supplying company's financial relationship with the PET center to which the physician wishes to refer. Depending on the facts, the arrangement described by the commenter could constitute an indirect compensation arrangement (as defined in § 411.354(c)(2). If an indirect compensation arrangement exists between the referring physician and the PET center, the physician may not refer to the PET center unless the arrangement complies with the indirect compensation arrangement exception at § 411.357(p). *Comment:*
                         One commenter expressed concern about our proposal and requested that we maintain the ability of radiation oncologists to order, perform and use as needed, diagnostic and therapeutic nuclear medicine services for radiation treatment planning and treatment delivery. *Response:*
                         We do not believe this final rule with comment will prohibit a radiation oncologist from ordering or performing diagnostic and therapeutic nuclear medicine services for purposes of radiation treatment planning and delivery. A “referral” does not include the request by a radiation oncologist for radiation therapy, including therapeutic nuclear medicine, if the request results from a consultation initiated by another physician and the services are furnished by or under the supervision of the radiation oncologist, or under the supervision of another radiation oncologist in the same group practice. In the March 26, 2004 final rule (69 FR 16065), we stated that the radiation oncologist exception in the definition of “referral” would also protect “necessary and integral ancillary services requested, and appropriately supervised, by the radiation oncologist.” We believe that diagnostic nuclear medicine procedures that are necessary and integral to the provision of radiation therapy fall within the scope of this protection. Accordingly, we are modifying the definition of “Referral” in § 411.351. *Comment:*
                         Two commenters suggested that the in-office ancillary services exception be modified or amended to prevent referring physicians from circumventing the physician self-referral law and its provisions. *Response:*
                         We understand the commenter's viewpoint, but the commenter's request goes beyond the scope of this rulemaking. We believe the in-office ancillary services exception strikes an appropriate balance between preventing program abuse without unduly interfering with the practice of medicine. However, we will continue to monitor the potential for abuse with respect to existing exceptions. *Comment:*
                         One commenter requested that we create a new exception for a physician's investment or ownership in a health care entity which provides nuclear medicine services and supplies, if the physician who refers patients to these entities directly supervises (on-site) the technicians or other personnel performing the nuclear medicine procedures on patients referred by that physician. *Response:*
                         Under section 1877(b)(4) of the Act, we may create a regulatory exception only if we determine that the exception would pose no risk of program or patient abuse. The commenter seems to believe that the potential for program and patient abuse would be eliminated by having an owner physician on-site when a technician performs a nuclear medicine procedure that the physician has ordered. We do not see how this requirement would eliminate the risk of overutilization or other program or patient abuse that arises when a physician self-refers to an entity with which he or she has a financial relationship. b. Authority To Include Nuclear Medicine Services and Supplies as a Designated Health Services (DHS) The physician self-referral statute, at section 1877(h)(6) of the Act, includes within the list of DHS, “radiology services, including magnetic resonance imaging, computerized axial tomography, and ultrasound services,” and “radiation therapy services and supplies.” We proposed to include diagnostic and therapeutic nuclear medicine as DHS because we believe they are within the statute's meaning of radiology services and radiation therapy services and supplies. We did not receive any comments disputing the assertion that therapeutic nuclear medicine services are radiation therapy services and supplies. However, regarding diagnostic nuclear medicine services, we received some comments that disagreed with our interpretation of the statute as well as some that agreed with our interpretation. *Comment:*
                         Three commenters noted that we proposed to include diagnostic nuclear medicine procedures within our definition of “radiology and certain other imaging services” in § 405.351. These commenters stated that “other imaging services” does not appear in the statute, and they asserted that the Congress rejected virtually identical (in their view) statutory phrasing. The commenters noted that when the Congress initially included radiology as a DHS in the Omnibus Budget Reconciliation Act of 1993, the language read “radiology and other diagnostic services” and that the Congress amended the statute in the Social Security Amendments of 1994 to delete the phrase “and other diagnostic services.” The commenters also asserted that if the Congress had meant to include nuclear medicine within the DHS category of radiology, it would have specifically mentioned diagnostic nuclear medicine, as it did magnetic resonance imaging (MRIs), computerized axial tomography (CT scans), and ultrasound services. *Response:*
                         We are including diagnostic nuclear imaging services in our definition of “radiology and certain other imaging services” because we believe they are radiology services within the meaning of section 1877(h)(6)(D) of the Act. We disagree with the commenter's assertion that we lack statutory authority to include certain imaging services in the DHS category described at section 1877(h)(6)(D) of the Act. We believe that the Congress meant to include all forms of radiology, that is, those that have traditionally been considered to be radiology, as well as certain other imaging services, such as ultrasound that may or may or not be considered to be radiology in the traditional sense. Further, we believe the Congress meant to include all forms of radiology, regardless of whether the particular form existed or was covered by Medicare on the date the statutory language was enacted or became effective. We believe that, by describing the DHS category as “[r]adiology services, including [MRI, CAT scans], and ultrasound services,” the Congress merely provided examples (rather than an exhaustive list) of some of the most 
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                        common forms of radiology other than x-rays. *Comment:*
                         Three commenters stated that nuclear medicine should not be considered a DHS because it is clinically and technically distinct from the services that the Congress enumerated when it defined the scope of radiology services. The commenters noted that the American Board of Nuclear Medicine defines nuclear medicine as “the medical specialty that employs radionuclides to evaluate metabolic, physiologic and pathologic conditions of the body for purposes of diagnosis, therapy and research.” According to the commenters, the introduction of radiolabeled, biologically active compounds into patients distinguishes nuclear medicine from radiology, which may involve the administration of biologically inert contrast agents, such as barium sulfate, iodine or gadolinium. One of these commenters stated that the mere use of radioactive material does not render a service radiology because radioactive materials are used in non-radiology services such as the performance of radioimmunoassay and irradiation of blood products. *Response:*
                         We are not persuaded that the common definitions of “radiology” cited in our proposed rule (70 FR 45854-55) are incorrect or do not include diagnostic nuclear imaging. As we stated in the proposed rule (70 FR 45855-56), radiology is “that branch of the health sciences dealing with radioactive substances and radiant energy and with the diagnosis and treatment of disease by means of both ionizing (that is, x-rays) and non-ionizing (that is, ultrasound) radiations.” (quoting Dorland's Illustrated Medical Dictionary). We noted in the proposed rule (70 FR 45855-56) that, “[i]n more recent years, radiology has come also to embrace diagnosis by a method of organ scanning with the use of radioactive isotopes and non-ionizing radiation, such as ultrasound and nuclear magnetic resonance.” (quoting Encyclopaedia Britannica outline). Diagnostic nuclear medicine services involve the use of radioactive substances and ionizing radiation for purposes of diagnosis. Like the other services the Congress identified in describing “radiology services,” the final product is an image used for purposes of diagnosis. We believe that the Congress intended to include as “radiology services” all forms of radiological imaging, regardless of whether exposure to radioactive materials or radiation is achieved through ingestion or eternal application and regardless of whether the form of radiation is ionizing or non-ionizing. We also note that certain professional medical organizations such as the AMA and the ACR consider diagnostic nuclear imaging to be a subspecialty of radiology. We agree that the use of radioactive substances to perform a particular service does not, by itself, render that service “radiology” within the meaning of section 1877(h)(6)(D). We are not including as “radiology and certain other imaging services” any diagnostic nuclear medicine services that are not imaging services. We note that radioimmunoassay is a clinical laboratory service for purposes of section 1877, and irradiation of blood products is not a DHS. *Comment:*
                         We received several comments addressing whether nuclear medicine is a subspecialty of radiology. MedPAC stated that it strongly supports the proposal to include nuclear medicine services in the definition of “radiology and certain other imaging services.” MedPAC further stated its belief that the proposal is justified because physician groups such as the ACR and the AMA consider nuclear medicine to be a subspecialty of radiology. (We note that although the AMA objected to our proposal on the grounds that overutilization has not been shown for nuclear medicine services, the AMA did not assert that diagnostic nuclear medicine is not a subspecialty of radiology.) Another commenter stated that it is reasonable to include nuclear medicine as a DHS, but took exception to our statement in the proposed rule that diagnostic nuclear medicine is a subset of radiology. This commenter stated that the Nuclear Regulatory Commission (NRC) recognizes multiple alternative pathways to becoming a medical authorized user of isotopes in addition to certification from the American Board of Radiology. The commenter also noted that many different subspecialties, in addition to radiology, are recognized stakeholders with voting rights at the NRC Advisory Committee on the Medical Use of Isotopes. Two other commenters stated that according to the American Board of Medical Specialties, nuclear medicine and radiology are separate medical specialties, and that each is one of only 26 distinct medical disciplines subject to Primary Board Certification. These commenters stated that, although it is true that some nuclear medicine training is incorporated into the diagnostic radiology training program, and that the American Board of Radiology does include questions on nuclear medicine in its certification examination, physicians become eligible to take the American Board of Nuclear Medicine examination only after successfully completing a nuclear medicine residency program. Finally, one commenter objected to the proposal to include nuclear medicine as a DHS insofar as the proposal relates to the subspecialty of nuclear cardiology. According to this commenter, nuclear cardiology is the science of performing cardiac stress testing with the interpretation of nuclear images for purposes of determining a patient's diagnosis and prognosis; therefore, nuclear cardiology is not simply the interpretation of images, which the commenter stated is the case in nuclear medicine. The commenter asserted that the great majority of physicians certified by the Certification Board of Nuclear Cardiology are cardiologists rather than radiologists. *Response:*
                         We recognize that there is some difference of opinion, including among competing certification organizations, as to whether nuclear medicine is a subspecialty of radiology or whether it: (1) Is a subspecialty of both radiology and some other area of medicine; or (2) has achieved some type of independent status. However, even if nuclear medicine has achieved some type of independent status, it, nevertheless, is a form of radiology (as that term is commonly defined) and that therapeutic nuclear medicine is a form of radiation therapy. Likewise, the fact that cardiologists have found nuclear imaging to be particularly useful for evaluating heart disease and have developed a subspecialty in nuclear cardiology does not alter the essential fact that nuclear imaging employs radioactive material and is a form of radiology. *Comment:*
                         One commenter stated that our January 4, 2001 final rule clearly and permanently established the principle that nuclear medicine services are not radiology services. The commenter believes that the January 2001 rule fairly interpreted the law and that it is inappropriate to change the regulation in the absence of specific direction from the Congress in the form of a statutory change. *Response:*
                         We disagree with the commenter's belief that our regulations remain fixed for all time absent a change in the statute. As stated in the August 8, 2005 proposed rule, we believe that a better reading of the statute is that the radiology and radiation therapy DHS categories, as set forth in section 1877(h)(6) of the Act, encompass diagnostic and therapeutic nuclear medicine services, respectively. Therefore, we believe it is appropriate to 
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                        amend our regulations to include diagnostic and therapeutic nuclear medicine services within the respective DHS categories of radiology services and radiation therapy services and supplies. c. Overutilization or Abuse In the August 8, 2005 proposed rule, we cited several studies that suggest that a physician's referral patterns and utilization of nuclear medicine services and supplies closely correlate to whether the physician has a financial interest in the entity providing the services and supplies. We received several comments representing divergent views as to whether nuclear medicine services and supplies are at risk for abuse and overutilization when physicians have financial interests in the entities that provide the services and supplies. *Comment:*
                         One commenter supported our proposal to include nuclear medicine as a DHS and believed that there has been significant overutilization and abuse of this imaging modality in his State. The commenter believes that the problems have become more acute with the proliferation of PET and PET/CT imaging centers set up as joint ventures between select groups of referring physicians and venture capitalists in the State and requested that we prohibit these types of ventures. *Response:*
                         We welcome the commenter's observations regarding the impact on the utilization of PET and PET/CT imaging when physicians enter into arrangements with non-physician investors to own these imaging centers. Inclusion of nuclear medicine services and supplies as DHS likely will have an impact on these ventures (and potentially the utilization of PET and PET/CT imaging). However, whether or not PET joint ventures are abusive is not a determinative factor in our decision to include diagnostic and therapeutic nuclear medicine as DHS. Rather, our decision is based on our belief that these services and supplies properly are categorized as “radiology and certain other imaging services” and “radiation therapy services and supplies” within the meaning of the statute. *Comment:*
                         One commenter provided a summary of the findings from its own clinical and financial database regarding the incidence of physician self-referral for nuclear medicine services. The commenter asserted that the data show that self-referring providers are much more likely to order these types of services than those who do not self-refer. *Response:*
                         We appreciate the commenter's willingness to share its data regarding the incidence of physician self-referral for one specific type of nuclear imaging service (nuclear cardiology). The commenter's findings are consistent with the information we already have, including the studies cited in the August 8, 2005 proposed rule, that nuclear medicine services and supplies pose the same risk of abuse that the Congress intended to eliminate for other types of radiology, imaging and radiation therapy services and supplies. *Comment:*
                         Two commenters supported the expansion of the physician self-referral provisions to include nuclear medicine services and supplies. One of the commenters stated his or her belief that the proliferation of imaging units in non-hospital environments has contributed significantly to the increase in diagnostic imaging costs. This commenter urged that, although the advancement of PET technology has proven to be a clinically effective diagnostic imaging tool, the physician self-referral law should have equal extension and universal application to all imaging providers. The other commenter stated that recent studies of the effects of physician self-referral have shown that, when physicians have an investment interest in imaging equipment and have the opportunity to self-refer, their utilization is significantly higher than among physicians who refer their patients to a provider in which the referring physician has no financial interest. This commenter added that nuclear medicine services and supplies should have been included in the original listing, because the potential for abuse is no different than for CT scans or MRI scans. Both this commenter and MedPAC contend that our policy change will help limit referrals for nuclear medicine services that are based on financial, rather than clinical, reasons. *Response:*
                         We believe that the position advocated by these commenters is consistent with the studies we cited in the August 8, 2005 proposed rule. As we stated in the proposed rule, although we believe that diagnostic and therapeutic nuclear medicine services are radiology and radiation therapy services and supplies within the meaning of the statute, we would resolve any doubt as to this matter in favor of including them as DHS. After careful review of the information available to us currently, we believe it is appropriate to include diagnostic and therapeutic nuclear medicine services and supplies as DHS. *Comment:*
                         One commenter asserted that the risk of anti-competitive behavior would increase by limiting the parties that may provide nuclear medicine services, which is contrary to our rationale of protecting against abuse and ensuring quality patient care. In contrast, MedPAC referred to the 1994 GAO report (GAO/HEHS-95-2) and supported the inclusion of nuclear medicine as DHS. MedPAC contended that physician self-referral to nuclear medicine facilities undermines fair competition among these facilities because physician investors have a financial incentive to refer patients to the facility they own. *Response:*
                         We agree with MedPAC regarding potential anti-competitive behavior. Moreover, we do not agree with the other commenter's assertion that the inclusion of nuclear medicine services and supplies as DHS would limit the types of entities that may provide nuclear medicine services. Rather, the inclusion of these services and supplies as DHS merely limits the type of investors in the entities providing nuclear medicine services and supplies (that is, except for investors in either rural providers (as defined at § 411.356(c)(1) or entities that furnish the services in compliance with the in-office ancillary services exception, our proposal would limit physician investors to those who will not refer patients to the entity). *Comment:*
                         Several commenters asserted (but did not provide data or other proof) that nuclear medicine services are not at risk for the kind of overutilization that the physician self-referral law is designed to prevent. Other commenters disagreed with the proposal to include nuclear medicine services and supplies (and, in particular, nuclear cardiology) as DHS. The commenters stated that it is not possible to know if the rise in utilization of nuclear medicine services is due to abuse and believed that we must show evidence that these services are currently being abused before including nuclear medicine services and supplies as DHS. *Response:*
                         In the August 8, 2005 proposed rule, we referenced several studies concerning overutilization and increases in imaging services being performed in physician offices. We received comments, both data-driven and anecdotal, to support our belief that nuclear medicine services are subject to overutilization when physician self-interest is present, as is the case in many (but not all) office-based (or non-hospital) imaging procedures. We must emphasize, however, that our decision to include nuclear medicine as a DHS is based upon our current knowledge of nuclear medicine. We believe it is appropriate to interpret the DHS 
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                        categories described in section 1877(h)(6)(D) and (E) of the Act to include diagnostic nuclear medicine services and supplies and therapeutic nuclear medicine services and supplies, respectively. Although we are conscious of a possible correlation between increased utilization and a showing of abuse, in the January 4, 2001 final rule with comment (66 FR 860), we stated that we did not believe the Congress intended us to review every possible service within a DHS category to determine its potential for overutilization. The Congress has already made the determination that the services in each of the eleven DHS categories are potentially subject to overutilization or other abuse. The risk of abuse and the potential for anti-competitive behavior inherent in physician self-referrals for nuclear medicine services simply provide additional support in favor of including nuclear medicine as DHS. *Comment:*
                         One commenter claimed that the increase in utilization of nuclear imaging services and supplies is due, at least in part, to the shift in site of service from the hospital setting to the physician office as well as a change in the standard of care in the treatment of patients due to improved technology and its applications. The commenter asserted that physician self-referral does not appear to be the primary driver of growth in imaging services, citing a study that shows that access to imaging technology, even in the absence of financial incentives, will result in increased utilization. The commenter contended that “eliminating the ability of specialty physicians to perform and interpret imaging tests in their offices is not protection against the growth in utilization.” *Response:*
                         We are aware of the apparent shift in the site of service. However, we do not believe that the change in site of service accounts for all, or even most, of the increase in Medicare payments for nuclear medicine services. In fact, in its March 2005 “Report to the Congress: Medicare Payment Policy”, MedPAC indicated that about 80 percent of the increase in the volume and intensity of imaging services, including nuclear medicine, between 1999 and 2002, was unrelated to any shift in service setting. We disagree with the commenter that inclusion of nuclear medicine services and supplies as DHS necessarily will prohibit physicians from performing and interpreting imaging tests in their offices. Certain arrangements and referrals may qualify for protection under existing provisions of the physician self-referral law and regulations (for example, the in-office ancillary services exception). In addition, even if we assume the commenter's sources are correct and utilization will increase with access to technology regardless of financial incentives for the referring physician, this does not affect the definition of radiology and radiation therapy, nor does it affect the proper inclusion of nuclear medicine services and supplies in these categories of DHS. We also note that, even if not the main “driver” of overutilization, self-interested referrals that cause any overutilization are problematic. d. Beneficiary Access We received numerous comments regarding the impact of our provision on beneficiary access to care. Our responses to these comments follow. *Comment:*
                         Several commenters expressed concern that our proposal would limit beneficiary access to nuclear medicine services. The AMA expressed concern about the potential impact of our proposal with regard to disruption of patient care, as well as access to these services. One of the commenters believes that our proposal will have a negative impact on the availability of PET scans, which constitute an important share of Medicare-covered nuclear imaging. In addition, another commenter raised concerns about where physicians would send patients for PET/CT scans. *Response:*
                         We recognize that the inclusion of nuclear medicine as a DHS may cause some changes in physician ownership of, or investment interests in PET centers; however, we do not agree with the commenters' assertions that our proposal would disrupt patient care and limit access to nuclear medicine services such as PET scans. We believe that most patients will continue to receive nuclear medicine services in the same location or vicinity where those services had been provided before. We see no reason why other providers or entities in the vicinity of existing PET centers would not be available or become available to furnish these services should a physician choose to divest any ownership or investment interest in an entity that furnishes nuclear medicine services. Alternatively, by restructuring their arrangements to comply with an existing exception, physicians may be able to continue referring patients to the same location for nuclear medicine services. In other words, whereas this rule may affect a physician's ability to refer to a PET center with which he or she has a financial relationship, there should be either alternative entities available to provide the services in the same setting or alternative business structures that would permit the physician to continue furnishing the services to his or her own patients. Other commenters, such as MedPAC, have also noted that there are a large number and variety of settings in which nuclear medicine services are available (such as hospitals, freestanding centers that are not owned by physicians, and physician offices). Therefore, we believe there would be no decrease in beneficiary access to care. Nevertheless, we have taken steps, as described in our discussion of the delayed effective date, to minimize any potential disruption of patient care or access to these services. *Comment:*
                         One commenter stated that there were not many PET scanners in the State of Oklahoma, and thus, patients would have to travel long distances for testing. *Response:*
                         We do not believe that this regulatory change will cause any significant disruption in patient care. The only referrals for PET scans that our proposal would prohibit are those made by physicians whose financial relationship with the entity furnishing the PET scans does not satisfy an exception such as the in-office ancillary services exception or the rural provider exception. If the financial relationship is an ownership interest in a non-rural provider, the physician may: (1) Divest the interest; (2) restructure the financial relationship so that it complies with an exception; or (3) maintain the interest and refer his or her patients to another entity for PET scans. If the physician chooses to divest or appropriately restructure his interest in the PET center, the physician's subsequent referrals to the PET center would not be prohibited under section 1877 of the Act, provided that the physician has no other financial relationship with the entity that fails to comply with an exception. We believe that the rural provider exception will ensure that beneficiaries in rural areas have continued access to nuclear medicine services. *Comment:*
                         One commenter expressed concern that if PET services are reclassified as DHS, physicians will be prevented from performing this service in mobile coaches due to the exclusion of mobile settings from the in-office ancillary exception. The commenter contended that beneficiary access will be limited where physicians cannot afford to operate PET services at fixed locations. The commenter requested that the final rule exclude PET services from DHS, or, in the alternative, create an exemption for physician ownership arrangements of PET units that contain 
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                        certain intrinsic checks against over-utilization. *Response:*
                         The commenter is correct that nuclear medicine services such as PET furnished in mobile coaches would not satisfy the “same building” element of the in-office ancillary services exception. However, if the entity furnishing the mobile services furnishes at least 75 percent of all the DHS it furnishes is to residents of a rural area (as defined in § 411.356(c)(c)(1)), it could meet the requirements of the rural provider exception. The commenter did not specify the nature of any intrinsic checks against overutilization and as we noted in Phase I (66 FR 861), medical necessity reviews and other efforts may not be sufficient to control overutilization. The statute permits us to create an exception only when there is no risk of fraud or program abuse. We have concluded that internal controls or medical necessity reviews are not necessarily effective controls on over-utilization, unfair competition, or other abuse. Therefore, we decline to adopt the requested exception. Additionally, we do not agree with the commenter's assertion that where physicians cannot afford to operate PET centers at fixed locations, the result will be to limit access to beneficiaries. As we have noted above, PET services are furnished in various settings other than physician-owned entities. Therefore, we do not believe our proposal will have a negative impact on beneficiary access. e. Quality of Care *Comment:*
                         Two physicians disagreed with the proposal to include nuclear medicine services because they believed that the inclusion of nuclear medicine would reduce quality of care to patients. One of the physicians expressed specific concern about the timeliness of diagnosis and initiation of therapy. The physician recommended that we disseminate evidence-based guidelines on the appropriate use of nuclear medicine procedures for diagnosis and treatment, and measurement of the quality of the service provided. Additionally, the commenter suggested that Medicare reimbursement should be site-neutral, ownership-neutral, and based on the clinical appropriateness, safety, and quality of the service provided. *Response:*
                         We do not believe that the inclusion of nuclear medicine as a DHS would reduce quality of care. We have no data, and the commenter furnished no data or anecdotal evidence, to support the physician's contention that nuclear medicine facilities owned by non-physicians furnish lower quality of care, as may be evidenced by delays in diagnosis and the initiation of treatment. Regarding the commenter's other recommendations, this regulation is not the appropriate vehicle for addressing the development of evidence-based guidelines, measurement of the quality of the service, and changes in Medicare reimbursement. *Comment:*
                         One commenter stated that the increased referrals and physician investment may not be attributable to financial incentives but rather may be attributable to improved services and diagnosis achieved by utilizing better equipment. The commenter expressed concern that the adoption of this provision could have a negative impact on the future provision of quality health care as physicians may hesitate to invest in new technology or services. The commenter contended that patient care has improved due to physician investment in entities providing nuclear medicine and PET services. Specifically, the commenter stated that the ability to invest in new technology has led to improved diagnostic and treatment ability, and lower costs and improved patient care. In addition, the commenter stated that physician investment has led to increased access to these services. According to the commenter, nuclear medicine and PET scan services require more expensive equipment than traditional radiology services and therefore physician investment in this equipment fills a necessary gap where large care providers have been unable to afford such equipment or choose not to acquire such equipment. *Response:*
                         We recognize that in some instances, new technology has led to improved diagnostic and treatment lower costs, and improved patient care; however, this final rule with comment does not prevent physicians from furnishing nuclear medicine services or utilizing better nuclear medicine equipment. Rather, and consistent with the purposes of the statute, the provisions of this final rule with comment restrict the circumstances under which physicians can financially benefit from DHS they order. Moreover, we believe that many non-physician owned entities will invest in new technology or new services and that quality of care will not be affected because most physicians will continue to refer patients for medically necessary services even where there is no potential for personal profit. Finally, we note that the commenters offered no evidence to support their claim that physician ownership of nuclear medicine facilities results in improved quality of care. *Comment:*
                         Some commenters opposed our proposal as it related to nuclear cardiology services, which the commenters asserted are integral to the diagnosis of heart disease and are performed primarily by cardiologists. One commenter stated that our proposal would prevent cardiologists from referring their patients for these services, thus causing primary care practitioners to refer these same patients directly to radiologists for nuclear testing, effectively bypassing a cardiologist's input on the appropriate approach to cardiac testing. The commenter asserted that nuclear medicine services performed in hospitals will be interpreted by radiologists who do not possess the specialized skills of cardiologists, and that our proposal would, therefore, negatively affect patient care. *Response:*
                         We are not persuaded by the commenters' concerns. First, our proposal would not prohibit a cardiologist from referring patients for nuclear medicine services; it would merely prohibit the physician from referring patients for these services to entities with which the physician has a financial relationship if that financial relationship does not comply with an existing exception. Second, we do not believe that patient care would be negatively affected if a cardiologist had to refer patients to a hospital for nuclear cardiology tests that would be interpreted by a radiologist. We are not convinced that cardiologists are the only individuals qualified to interpret these tests. Moreover, we believe that hospitals have every incentive to ensure that such tests are interpreted by qualified physicians (including cardiologists, if necessary). *Comment:*
                         Another commenter suggested that the inclusion of nuclear medicine as a DHS will limit the development of diagnostic testing facilities and thereby make the hospital setting the only permissible setting for nuclear cardiology. *Response:*
                         We do not agree that the effect of this rule will be to make the hospital setting the only permissible setting for nuclear cardiology. Physician-owned diagnostic testing facilities are not prohibited if the physician owners do not refer patients to the facilities or if the financial relationship complies with another exception, such as the rural provider or in-office ancillary services exceptions. Additionally, as MedPAC noted, there are numerous other types of non-hospital entities or non-physician owned entities that currently furnish these services. 
                        ( print page 70289) f. Grandfathering Existing Arrangements or Delaying the Effective Date In the August 8, 2005 proposed rule, we requested comments as to whether, or how, to minimize the impact on physicians who are currently parties to arrangements that involve nuclear medicine services and supplies (that is, by grandfathering certain arrangements, or by specifying a delayed effective date). Most commenters addressed this aspect of the proposed rule and either requested that current financial arrangements be grandfathered or recommended a delay in the effective date of our proposal. *Comment:*
                         Many commenters supported a delayed effective date for our proposal. Commenters suggested various lengths of delay in implementing our proposal. Several commenters favored delaying the effective date for three to six months. One of the commenters suggested that physicians should have at least five years to divest themselves of existing ownership or investment interests. This commenter believed that this would be the minimum period for physicians to recover a fair share of their capital investments and dispose of their assets without having to resort to “bargain basement” sales. The Society of Nuclear Medicine strongly encouraged a phased-in implementation over two to three years to decrease the chances that patient access would be compromised. The ACR recommended an effective date of January 1, 2006 with a 1-year “grace period” prior to enforcement. *Response:*
                         We have carefully considered the impact of our proposal on both beneficiaries and physicians. We have also considered our duty to implement the statute. Given our conclusion that nuclear medicine services and supplies are radiology and radiation therapy services and supplies, we do not believe we can delay the effective date beyond a reasonable period of time. After weighing these considerations, we have decided to delay the effective date of this regulatory change until January 1, 2007. We believe this delay provides adequate notice to the general public and a reasonable length of time for physicians to divest any existing ownership interests or to restructure their financial relationships with nuclear medicine entities so that they comply with a statutory or regulatory exception (if that is the course of action they choose to take), without unduly delaying our statutory duty to implement the statute. We are aware that many of the financial arrangements concerning nuclear medicine entities are complex and involve ownership, investment, and leasing arrangements. Accordingly, we are rejecting commenters' suggestions for a shorter or longer delay in implementation as being impractical or unreasonable. *Comment:*
                         Many commenters recommended that current financial arrangements be grandfathered and that the process be clearly implemented with as little administrative burden as possible. For example, some commenters urged us to grandfather existing PET joint ventures. The AMA stated its belief that CMS has the authority to implement a grandfather clause, and urged us to use it to avoid “fire sales” wherein physicians may not be able to recover the initial costs of their investment due to much greater supply than demand. Another commenter expressed a similar belief that the sales prices will reflect the forced nature of an immediate need to sell and be significantly below the prices that could be obtained in the absence of a grandfather provision. The commenter stated that “even if CMS allowed a three to five year period to divest, investors may still not receive the full value of their investment.” A physician stated that he and other physicians took risk by investing in nuclear medicine entities and believed that they should not have to divest their interest. Therefore, the physician advocated that we grandfather existing establishments and present ownership structures. Another commenter suggested that we grandfather financial relationships that were established prior to the effective date of the proposed rule. A few commenters objected to grandfathering for several reasons including—(1) There was no precedent for grandfathering; (2) the statute does not permit grandfathering; and (3) to do so would negate the intent of the proposal. *Response:*
                         After reconsidering the issue, we question whether we have the authority to grandfather existing arrangements. Grandfathering existing arrangements would essentially require the creation of a new exception for physician financial relationships with certain nuclear medicine facilities. We have authority to create exceptions only for arrangements that pose no risk of patient or program abuse. We believe that physician self-referrals for diagnostic and therapeutic nuclear medicine services and supplies pose a risk of abuse, and we do not believe this risk is mitigated or eliminated simply because financial relationship was acquired before a particular date. Therefore, we have decided not to grandfather existing financial relationships between physicians and nuclear medicine facilities. However, we believe our decision to specify a delayed effective date will provide physicians with sufficient time to divest their ownership interests or to restructure appropriately existing financial arrangements. 2. Revisions to the List of Codes Identifying Nuclear Medicine Services We have carefully reviewed the list of codes identifying nuclear medicine services and supplies (Nuclear Medicine Code List), as published in Addendum G of the August 8, 2005 PFS proposed rule. We have identified various additions and deletions. Table 31 reflects the addition of new CPT and HCPCS codes that become effective January 1, 2006 or that became effective since the publication of the proposed rule. Table 31 also reflects the addition of codes that will be recognized by Medicare for payment purposes effective January 1, 2006. Table 31 reflects the deletions necessary to conform the Nuclear Medicine Code List to the most recent publications of CPT and HCPCS codes. We have also deleted all C codes listed in the proposed rule because these are hospital outpatient services and are thus included in a different DHS category. Table 31 identifies the nuclear medicine codes that will be included (effective January 1, 2007) in the DHS categories of radiology and certain other imaging services and radiation therapy services and supplies. 
 
  
 
  
 
  
 
  
 
  
 
  
 
 C. Annual Update to the Code List In § 411.351, we specify that the entire scope of four DHS categories is defined in a list of CPT/HCPCS codes (the Code List), which is updated annually to account for changes in the most recent CPT and HCPCS publications. The DHS categories defined and updated in this manner are: Clinical laboratory services.
                    Physical therapy, occupational therapy, and speech-language pathology services.
                    Radiology and certain other imaging services.
                    Radiation therapy services and supplies. The updated Code List appears as Addendum H in this PFS final rule with comment and is available on our Web site at 
                        *http://cms.hhs.gov/​medlearn/​refphys.asp.*
                         We also include in the Code List those items and services that may qualify for either of the following two exceptions to the physician self-referral prohibition: EPO and other dialysis-related drugs furnished in or by an ESRD facility (§ 411.355(g)).
                    Preventive screening tests, immunizations or vaccines (§ 411.355(h)). The Code List was last updated in the CY 2005 PFS final rule (69 FR 66236). The updated all-inclusive Code List effective January 1, 2006 (except as otherwise noted for specific nuclear medicine codes) is presented in Addendum H of this final rule with comment. 1. Response to Comments We received the following comment: *Comment:*
                         One commenter suggested incorporating the Code List in the National Physician Fee Relative Value File as discussed in the CY 2005 PFS final rule (69 FR 66373). *Response:*
                         We have decided not to incorporate the Code List into the National Physician Fee Relative Value File as suggested by the commenter. That file is updated quarterly and would entail a quarterly update to the PFS. In discussions with the commenter (an association representing medical group practices), we learned that its primary goal was to have the Code List in a format that could be downloaded. The previous Code Lists were generally posted on our web site as PDF files that could not be downloaded. Therefore, we will be posting the updated Code List on our physician self-referral Web site in an Excel spreadsheet that may be downloaded. 2. Revisions Effective for 2006 Tables 32 and 33, in this section, identify the additions and deletions, respectively, to the comprehensive Code List published in Addendum L of the CY 2005 PFS final rule. Tables 32 and 33 also identify the additions and deletions to the lists of codes used to identify the items and services that may qualify for the exceptions in § 411.355(g) (regarding EPO and other dialysis-related outpatient prescription drugs furnished in or by an ESRD facility) and in § 411.355(h) (regarding preventive screening tests, immunizations and vaccines). We will consider comments for the codes listed in Tables 32 and 33, if we receive them by the date specified in the 
                        **DATES**
                         section of this final rule with comment. We will not consider any comment that advocates a substantive change to any of the DHS defined in § 411.351. 
 
  
 
  The additions specified in Table 32 generally reflect new CPT and HCPCS codes that become effective January 1, 2006 or that became effective since our last update. Table 32 also reflects the addition of codes that will be recognized by Medicare for payment purposes effective January 1, 2006. It does not reflect the addition of the nuclear medicine codes that were discussed in section V.B.2 of this preamble. For the convenience of physicians and DHS entities, nuclear medicine codes appear on Addendum H with an asterisk to indicate that they will become effective on January 1, 2007 for physician self-referral purposes. As a result of reviewing nuclear medicine codes as set forth in the CPT, we are adding CPT 78267 and 78268 for urea breath tests and analyses to the DHS category of clinical laboratory services. Although these codes appear under the nuclear medicine subheading in the CPT, they do not represent imaging services. Therefore, we do not consider CPT 78267 and 78268 radiology or other imaging services. We are adding these codes to the Code List under the clinical laboratory services category. This is consistent with our payment policy, since these codes are reimbursed under the clinical laboratory fee schedule. We note that there are other tests involving the use of radiopharmaceuticals (for example, CPT 83519) that are identified by the Code List as clinical laboratory services. Additionally, we are adding CPT code 92506 for the evaluation of speech, language, voice, communication, and/or auditory processing. We had deleted this code in the Phase II physician self-referral interim final rule published on March 26, 2004 (69 FR 16054) because it represented an audiology service. However, Medicare does not provide reimbursement for CPT code 92506 as an audiology service. Under Medicare, that code is only reimbursed as a speech-language pathology service and therefore must be added to the Code List. VI. Physician Fee Schedule Update for CY 2006 A. Physician Fee Schedule Update The PFS update is determined using a formula specified by statute. Under section 1848(d)(4) of the Act, the update 
                        ( print page 70299)
                        is equal to the product of 1 plus the percentage increase in the Medicare Economic Index (MEI) (divided by 100) and 1 plus the update adjustment factor (UAF). For CY 2006, the MEI is equal to 2.8 percent (1.028). The UAF is −7.0 percent (0.930). The product of the MEI (1.028) and the UAF (0.930), equals the CY 2006 update of −4.4 percent (0.95604). Our calculations of these figures are explained in this section. B. The Percentage Change in the Medicare Economic Index (MEI) The MEI measures the weighted-average annual price change for various inputs needed to produce physicians' services. The MEI is a fixed-weight input price index, with an adjustment for the change in economy-wide multifactor productivity. This index, which has 2000 base year weights, is comprised of two broad categories: physician's own time and physician's PE. The physician's own time component represents the net income portion of business receipts and primarily reflects the input of the physician's own time into the production of physicians' services in physicians' offices. This category consists of two subcomponents: (1) Wages and salaries; and (2) fringe benefits. The physician's PE category represents nonphysician inputs used in the production of services in physicians' offices. This category consists of wages and salaries and fringe benefits for nonphysician staff and other nonlabor inputs. The physician's PE component also includes the following categories of nonlabor inputs: Office expense; medical materials and supplies; professional liability insurance; medical equipment; and other expenses. The components are adjusted to reflect productivity growth in physicians' offices by the 10-year moving average of productivity in the private nonfarm business sector. Table 34 presents a listing of the MEI cost categories with associated weights and percent changes for price proxies for the 2006 update. For CY 2006, the increase in the MEI is 2.8 percent, which includes a 1.0 percent productivity offset based on the 10-year moving average of multifactor productivity. This is the result of a 3.2 percent increase in physician's own time and a 4.4 percent increase in physician's PE. Within the physician's PE, the largest increase occurred in professional liability insurance, which increased 13.7 percent. 
 
  
 
 C. The Update Adjustment Factor Section 1848(d) of the Act provides that the PFS update is equal to the product of the MEI and the UAF. The UAF is applied to make actual and target expenditures (referred to in the statute as “allowed expenditures”) equal. Allowed expenditures are equal to actual expenditures in a base period updated each year by the sustainable growth rate (SGR). The SGR sets the annual rate of growth in allowed expenditures and is determined by a formula specified in section 1848(f) of the Act. 1. Calculation Under Current Law Under section 1848(d)(4)(B) of the Act, the UAF for a year beginning with 2001 is equal to the sum of the following— Prior Year Adjustment Component. An amount determined by— + Computing the difference (which may be positive or negative) between the amount of the allowed expenditures for physicians' services for the prior year (the year prior to the year for which the update is being determined) and the amount of the actual expenditures for those services for that year; + Dividing that difference by the amount of the actual expenditures for those services for that year; and + Multiplying that quotient by 0.75. Cumulative Adjustment Component. An amount determined by— + Computing the difference (which may be positive or negative) between the amount of the allowed expenditures for physicians' services from April 1, 1996, through the end of the prior year and the amount of the actual expenditures for those services during that period; + Dividing that difference by actual expenditures for those services for the prior year as increased by the SGR for the year for which the UAF is to be determined; and + Multiplying that quotient by 0.33. Section 1848(d)(4)(E) of the Act requires the Secretary to recalculate allowed expenditures consistent with section 1848(f)(3) of the Act. Section 1848(f)(3) specifies that the SGR (and, in turn, allowed expenditures) for the upcoming CY (2006 in this case), the current CY (2005) and the preceding CY (2004) are to be determined on the basis of the best data available as of September 1 of the current year. Allowed expenditures are initially estimated and subsequently revised twice. The second revision occurs after the CY has ended (that is, we are making the final revision to 2004 allowed expenditures in this final rule with comment). Once the SGR and allowed expenditures for a year have been revised twice, they are final. Table 35 shows annual and cumulative allowed expenditures for physicians' services from April 1, 1996 through the end of the current CY, including the transition period to a CY system that occurred in 1999. Also shown is the SGR corresponding with each period. The calculation of the SGR is discussed in detail below. 
 
  
 
  
 
 Consistent with section 1848(d)(4)(E) of the Act, Table 35 includes our final revision of allowed expenditures for 2004, a recalculation of allowed expenditures for 2005, and our initial estimate of allowed expenditures for 2006. To determine the UAF for 2006, the statute requires that we use allowed and actual expenditures from April 1, 1996 through December 31, 2005 and the 2006 SGR. Consistent with section 1848(d)(4)(E) of the Act, we will be making further revisions to the 2005 and 2006 SGRs and 2005 and 2006 allowed expenditures. Because we have incomplete actual expenditure data for 2005, we are using an estimate for this period. Any difference between current estimates and final figures will be taken into account in determining the UAF for future years. We are using figures from Table 35 in the statutory formula illustrated below:  UAF = Update Adjustment Factor Target05
                         = Allowed Expenditures for 2005 or $80.4 billion Actual05
                         = Estimated Actual Expenditures for 2005 = $93.3 billion Target4/96-12/05
                         = Allowed Expenditures from 4/1/1996-12/31/2005 = $611.8 billion Actual4/96-12/05
                         = Estimated Actual Expenditures from 4/1/1996-12/31/2005 = $642.5 billion SGR06
                         = 1.7 percent (1.017)  Section 1848(d)(4)(D) of the Act indicates that the UAF determined under section 1848(d)(4)(B) of the Act for a year may not be less than −0.070 or greater than 0.03. Since −0.210 is less than −0.070, the UAF for 2005 will be −0.070. Section 1848(d)(4)(A)(ii) of the Act indicates that 1 should be added to the UAF determined under section 1848(d)(4)(B) of the Act. Thus, adding 1 to −0.070 makes the UAF equal to 0.930. VII. Allowed Expenditures for Physicians' Services and the Sustainable Growth Rate A. Medicare Sustainable Growth Rate The SGR is an annual growth rate that applies to physicians' services paid by Medicare. The use of the SGR is intended to control growth in aggregate Medicare expenditures for physicians' services. Payments for services are not withheld if the percentage increase in actual expenditures exceeds the SGR. Rather, the PFS update, as specified in section 1848(d)(4) of the Act, is adjusted based on a comparison of allowed expenditures (determined using the SGR) and actual expenditures. If actual expenditures exceed allowed expenditures, the update is reduced. If actual expenditures are less than allowed expenditures, the update is increased. Section 1848(f)(2) of the Act specifies that the SGR for a year (beginning with 2001) is equal to the product of the following four factors: (1) The estimated change in fees for physicians' services; (2) The estimated change in the average number of Medicare fee-for-service beneficiaries; (3) The estimated projected growth in real gross domestic product (GDP) per capita; and (4) The estimated change in expenditures due to changes in statute or regulations. In general, section 1848(f)(3) of the Act requires us to publish SGRs for 3 different time periods, no later than November 1 of each year, using the best data available as of September 1 of each year. Under section 1848(f)(3)(C)(i) of the Act, the SGR is estimated and subsequently revised twice (beginning with the FY and CY 2000 SGRs) based on later data. (There were also provisions in the Act to adjust the FY 1998 and FY 1999 SGRs. See the February 28, 2003 
                        **Federal Register**
                         (68 FR 9567) for a discussion of these SGRs). Under section 1848(f)(3)(C)(ii) of the Act, there are no further revisions to the SGR once it has been estimated and subsequently revised in each of the 2 years following the preliminary estimate. In this final rule with comment, we are making our preliminary estimate of the 2006 SGR, a revision to the 2005 SGR, and our final revision to the 2004 SGR. B. Physicians' Services Section 1848(f)(4)(A) of the Act defines the scope of physicians' services covered by the SGR. The statute indicates that “the term ‘physicians' services’ includes other items and services (such as clinical diagnostic laboratory tests and radiology services), specified by the Secretary, that are commonly performed or furnished by a physician or in a physician's office, but does not include services furnished to a Medicare+Choice plan enrollee.” We published a definition of physicians' services for use in the SGR in the 
                        **Federal Register**
                         (66 FR 55316) on November 1, 2001. We defined physicians' services to include many of the medical and other health services listed in section 1861(s) of the Act. For purposes of determining allowed expenditures, actual expenditures, and SGRs, we have specified that physicians' services include the following medical and other health services if bills for the items and services are processed and paid by Medicare carriers (and those paid through intermediaries where specified): Physicians' services.
                    Services and supplies furnished incident to physicians' services.
                    Outpatient physical therapy services and outpatient occupational therapy services.
                    Antigens prepared by, or under the direct supervision of, a physician.
                    Services of physician assistants, certified registered nurse anesthetists, certified nurse midwives, clinical psychologists, clinical social workers, nurse practitioners, and certified nurse specialists.
                    Screening tests for prostate cancer, colorectal cancer, and glaucoma.( print page 70305)
                    Screening mammography, screening pap smears, and screening pelvic exams.
                    Diabetes outpatient self-management training services.
                    Medical nutrition therapy services.
                    Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests (including outpatient diagnostic laboratory tests paid through intermediaries).
                    X-ray, radium, and radioactive isotope therapy.
                    Surgical dressings, splints, casts, and other devices used for the reduction of fractures and dislocations.
                    Bone mass measurements.
                    An initial preventive exam.
                    Cardiovascular screening blood tests.
                    Diabetes screening tests.
                    Telehealth services.
                    Physician work and resources to establish and document the need for a power mobility device (see70 FR 50940). Telehealth services and the power mobility device related services have been added because they meet the statutory criteria for services to be included in the SGR (that is, these services are commonly performed or furnished by a physician or in a physician's office). We appreciate the tremendous number of comments we received expressing concern about the negative update for 2006. Those comments are summarized below, along with our responses. *Comment:*
                         Commenters noted that physicians' costs are rising, while fees are being cut. The cumulative impact of the projected reductions from 2006 to 2012 will be about −27 percent, while the MEI increase over this same period is projected to be 19 percent. Commenters predict that, based on the MEI alone, payments should increase by 3.5 percent in 2006. Instead, payments are being reduced. Because commercial insurance carriers base their payment updates upon Medicare's PFS, the overall negative impact is compounded. Many comments predict that costs to provide care will soon exceed reimbursement. The result will be that patient quality of care will be compromised, with doctors taking drastic measures to cut costs of health care delivery to remain solvent. Eventually, physicians will be unable to absorb the losses, and they will refuse or limit Medicare patients, resulting in reduced access to care. Costs will shift to inpatient settings, which will be more costly for Medicare, less efficient in delivering care, and yield worse health outcomes for beneficiaries. Commenters recommend that the SGR be replaced with an appropriate inflation rate (for example, the projected change in prices or the MEI). Updates should be linked to changes in the actual costs of medical practice. *Response:*
                         We are fully cognizant of the potential implications of seven years of negative physician updates, remain concerned regarding those trends, and are closely monitoring physicians' participation in the Medicare program, as well as beneficiaries' access to care. At the same time, simply increasing spending by adding larger updates into the current volume-based payment system that is already experiencing increases of 12 to 13 percent or more per year would have an adverse effect from the standpoint both Medicare's finances and beneficiary premiums and cost-sharing, and therefore would not promote better quality care. However, it is clear, under our current system, that there is much potential for physicians to improve the value of our health care spending. Under the current system, there are substantial variations in resources and in spending growth for the same medical condition in different practices and in different parts of the country, without apparent differences in quality and outcomes, and without a clear basis in existing medical evidence. A study published in 2003 looked at regional variations in the number of services received by Medicare patients who were hospitalized for hip fractures, colorectal cancer, and acute myocardial infarction.[6]
                        
                         The researchers found that patients in higher spending areas received approximately 60 percent more care, but that quality of care in those regions was no better on most measures and was even worse for several preventive care measures. Further, there are many examples of steps that physicians can take to improve quality while helping to keep overall costs down (for example, management of diabetic patients may result in reduced hospital admissions). Because it is critical for CMS payment systems to support better outcomes for our beneficiaries while safeguarding Medicare's finances, we are working closely and collaboratively with medical professionals and the Congress to consider changes to increase the effectiveness of the payment methodology Medicare uses to compensate physicians for providing services to Medicare beneficiaries. We are engaging physicians on issues of quality and performance with the goal of supporting the most effective clinical and financial approaches to achieve better health outcomes for Medicare beneficiaries. We are committed to developing reporting and payment systems that enable us to support and reward quality, and to improve care without increasing overall Medicare costs. When clear, valid and widely accepted quality measures are in place, pay-for-performance is a tool that can enable our reimbursement methodology to better support efforts to improve quality and to avoid unnecessary costs. Currently, hospitals and physicians are paid under separate systems. Under these systems, physicians do not receive credit for avoiding unnecessary hospitalizations by providing better care to their patients. However, in our physician group practice demonstration project, physicians could receive performance-based payments derived from savings from preventing chronic disease complications, avoiding hospitalizations, and improving quality of care. The evidence is increasing that when healthcare providers are given incentives for achieving higher quality care, they respond by taking a range of steps from the simple to the high-tech to improve care and reduce costs (for example, by avoiding unnecessary hospital care). This is not surprising, as our health professionals are dedicated, and they want to do everything in their power to get the best care to their patients. So when we support high quality care, we enable professionals to do what they do best. We have seen this approach work first-hand with hospital payments where we have tied the annual hospital payment update to quality measure reporting. It has had a positive impact on the availability of quality information, with about 98 percent of the hospitals subject to this provision reporting quality data. Reporting clinically valid quality measures is an important step toward achieving major improvements in quality. If you cannot measure something, it is hard to take steps to improve it. We have been working hard in close collaboration with health professionals and other stakeholders to promote the development of better measures for reporting on the quality of care. *Comment:*
                         Most commenters support the overall development of measures related to the quality and efficiency of care furnished by physicians, but many 
                        ( print page 70306)
                        are concerned that the promotion of high quality health care is incompatible with the current SGR system. Any performance measures may involve additional services or administrative actions, and will exacerbate the problems with the current volume-based update formula. Some commenters note that many electronic health record systems with decision support tools specifically prompt physicians to perform additional diagnostic tests and screenings, which, in turn, could offset any projected savings. Overall, pay-for-performance will drive spending over the target, negatively impacting future updates, and thereby penalizing physicians for participating in pay-for-performance. Commenters also expressed the concern that health information technology systems, a key component of many pay for performance programs, will be unaffordable to physicians facing payment cuts. *Response:*
                         Medicare needs to encourage and reward efficiency and high quality care, and not simply pay for more services, regardless of the quality of those services or of the impact that those services have on patient health. Currently, the physician payment system does not always recognize clinically appropriate care. For example, Medicare will pay for a duplicate x-ray or blood test right before surgery if a hospital does not coordinate care adequately with the physician's office. The physician payment system should support, encourage, and provide an incentive for physicians to improve quality and reduce unnecessary Medicare costs by avoiding unnecessary services (like duplicate tests). Another way the current physician payment system fails to encourage clinically appropriate care is the way in which it tends to steer patient care decisions. Oncologists, for example, are paid less for transitioning a terminal patient to palliative care and focusing on quality of life issues, than for recommending and providing intensive procedures, even if the side effects of those procedures are significant and the benefits negligible. In addition, the current payment system does not reward physicians who actively prevent readmissions for patients with heart failure or diabetes. Linking a portion of Medicare payments to valid measures of quality and effective use of resources could give physicians more direct incentives to implement the innovative ideas and approaches that actually result in improvements in both the value and quality of care that people with Medicare receive. We have been working on the technical methods for supporting effective, simple, and least burdensome reporting and payment based on these measures. In the years ahead, it is expected that electronic record systems can be developed that would provide information that is needed to measure and report on quality while fully protecting patient confidentiality. However, while electronic health records would greatly facilitate the accurate and efficient use of information on quality measures and quality improvement, progress on supporting quality improvement should not be delayed until electronic health records are widely used. Indeed, taking steps now to promote quality reporting and improvement also could promote the adoption of and investment by physicians in electronic records, which would facilitate more efficient quality reporting and quality improvement activities. In the short term, there is considerable evidence that information on a broad range of quality measures can be obtained adequately via information transmitted on existing claims. Steps will be taken to ensure patient confidentiality when obtaining these quality measures. In addition, we believe that several Federal government actions are creating favorable market conditions for the adoption of health information technology. First, HHS, through the Office of the National Coordinator for Health Information Technology, is leading a public-private partnership to reduce the risk of Health Information Technology investment by: harmonizing health information standards; certifying health IT products to ensure consistency with standards; addressing variations in privacy and security policies that can pose challenges to interoperability; and, developing an architecture for nationwide sharing of electronic health information. Second, two recently proposed rules discussed an exception to the Stark statute and a safe harbor to the anti-kickback statute for e-prescribing technology and electronic health records, which would create opportunities for physicians to acquire health information technology free or at a reduced cost. In January 2006, we will start the process of collecting quality information on services provided by physicians in certain specialties and subspecialties through the voluntary reporting of G-Codes for quality indicators. The G-codes were established by Medicare to supplement claims data with clinical data pertinent to a variety of quality measures, without the burdens of chart abstraction. Those quality measures have been achieved through a process of study and consensus with input from physicians and others. *Comment:*
                         Commenters suggested that we should assume the leadership in pushing the Congress to enact legislation preventing a negative update for 2006, and to replace the SGR with a more sustainable system. They stated that it would be a show of good faith and leadership for CMS to take the administrative action to remove drugs from the SGR and levels of allowed expenditures retroactively to 1996, even prior to legislative action. The commenters opined that if CMS makes the administrative changes now, worth about $111 billion, then the legislative price tag will drop and will increase the likelihood of Congressional action to fix the SGR permanently. *Response:*
                         We are concerned about the projections of seven years of negative updates to physician payments and are closely monitoring the current volume-based payment system for physicians' services. The CMS Office of the Actuary (OACT) estimated under its Mid-Session Baseline that removing drugs from the SGR and allowed expenditures retroactively to 1996 would cost $111 billion. We note that our current estimate is that removing drugs prospectively would not provide relief to the negative updates projected for 2006 and the succeeding several years. OACT estimates removing drugs prospectively would cost an additional $36 billion over 10 years. These changes would also have significant impacts on beneficiary premiums. Consequently, while we have carefully reviewed our authority to make this administrative change, we also have been working with the Congress and health professional organizations on payment reforms that would improve the effectiveness of the payment methodology for physicians without increasing overall Medicare costs. *Comment:*
                         Many commenters indicated that they support removing the costs of Part B covered drugs from the calculation of the SGR, and provided or referenced legal opinions and Congressional support for this view. Some commented that they find no basis in the statute for ever including drugs in the definition of physicians' services, and CMS is therefore obligated to remove them retroactively from the SGR. Commenters contend that the rapid increase in the price of drugs is a major contributor to increased spending on physician-administered drugs. Therefore, it is not logical to include 
                        ( print page 70307)
                        drugs in calculating the target, because the growth in expenditures on these drugs is not controlled by physicians and reduced payments to physicians will not affect future spending on Part B drugs provided incident to physicians' services. Some commenters noted that including drugs in the SGR has not led to controls on drug spending and, as a result, removing them would not lead to increased spending on drugs. These commenters opined that spending on drugs is rising far more rapidly than spending on physicians' and other practitioners' services. According to these commenters, in 1996 drugs represented 3.7 percent of the physician spending portion of the SGR calculation, but in 2004, drugs represented 9.8 percent. Commenters stated that growth in Medicare spending on drugs is driven primarily by the introduction of expensive new drugs to the Medicare population and extensive marketing (including direct-to-consumer advertising), and that prices are set by drug companies that are not impacted by negative updates to the Medicare physician fee schedule. Some commenters indicated that the increase in drug spending is due to government policies that encourage the rapid development of drugs. *Response:*
                         The statute provides the Secretary with clear authority to specify the services that are included in the SGR. Section 1848(f)(4)(A) of the Act indicates that the term “physicians services” includes other items and services specified by the Secretary that are commonly performed or furnished by a physician or in a physician's office. We disagree with the comments suggesting that the Secretary does not have the authority to include drugs in the definition of physicians' services for purposes of determining allowed expenditures, actual expenditures, and the SGR. We define “physicians' services” to include many of the medical and other health services listed in section 1861(s) of the Act that meet the criterion of being commonly performed by a physician or furnished in a physicians' office. Because “incident to” drugs covered under 1861(s) of the Act are commonly furnished in physicians' offices, we include these items in the calculation of the SGR and allowed expenditures. We have indicated in the past that retrospective removal of drugs from the SGR is statutorily difficult. For example, the statute requires the estimated SGR be refined twice based on actual data. We do not see a legal basis to re-estimate the SGR and allowed expenditures for a year after it has been estimated and revised twice. Further, as noted previously, our current estimate is that removing drugs retroactively from the SGR would not result in a positive update for 2006 or the succeeding few years. *Comment:*
                         CMS has clearly excluded drugs from physicans' services for purposes of administering other Medicare payment provisions. For example, in the December 13, 2002 Inherent Reasonableness rule (67 FR 76684), CMS applied inherent reasonableness to certain Part B items and services other than physicians' services as defined and paid for under section 1848 of the Act, stating that drugs are paid under section 1842(o) of the Act and not section 1848 of the Act. In response to comments, CMS asserted that the inherent reasonableness provision should therefore be applied to drugs administered in physicians' offices. *Response:*
                         As we pointed out in the December 13, 2002 
                        **Federal Register**
                        , the statute specifies that inherent reasonableness applies to certain Part B items and services other than physicians' services as defined and paid for under section 1848 of the Act. Drugs are paid under section 1842(o) of the Act and not section 1848 of the Act. The application of inherent reasonableness to payments for drugs relates to the payment methodology for drugs, not to whether they are physicians' services. Accordingly, our decision to permit the application of inherent reasonableness to compute the payment amounts for Part B drugs is not inconsistent with our determination that it is appropriate to include drugs furnished incident to a physician's services in the definition of physicians' services for purposes of computing the SGR and actual and allowed expenditures under the physician fee schedule. *Comment:*
                         We received many comments criticizing the ability of the current SGR methodology to appropriately reflect many factors affecting physician spending. For example, malpractice insurance continues to escalate; there is a general increase in overhead and inflation; and there are additional expenses associated with regulatory compliance for which the SGR is not adjusted. The SGR does not account for trends in utilization attributable to important technological improvements, improved quality of care, and efficiency in the health care system overall. Also, commenters stated that payment updates under the SGR formula are tied to GDP, which bears little relationship to patients' health care needs or physicians' practice costs because medical needs of individual patients are not related to the overall economy. Patients' needs do not diminish in slower economies, and are therefore wholly unrelated to measures of GDP. In addition, Medicare patients have more chronic diseases and require more medications, tests, counseling, and education than the average health care consumer; therefore, the time required to see a Medicare patient is disproportionately high relative to the Medicare payment received. Commenters are concerned that services to Medicare beneficiaries are not adequately reflected in GDP because they are disproportionately more expensive than services provided to the rest of the population. Commenters believe that reliance on GDP makes the SGR an inherently unstable system, and unnecessarily detracts from an appropriate focus on an analysis of actual data regarding the increasing costs of providing physicians' services to Medicare beneficiaries. The formula fails to consider the growth in beneficiary population and utilization factors unrelated to economic trends. The GDP is a factor beyond physicians' control and it is inappropriate to use it as a means to control growth in Medicare spending. *Response:*
                         Under section 1848(d)(4) of the Act, the PFS update is equal to the product of the percentage increase in the MEI and the UAF. The UAF is determined by comparing allowed and actual expenditures from prior years and the current year, and adjusting the update to account for the difference. The SGR is used to calculate allowed expenditures, and the GDP is one of the components used to calculate the SGR. Change in enrollment in fee-for-service Medicare is one of the factors used in computing the SGR. (See section 1848(f)(2)(B) of the Act.) The percentage change in the MEI is one of the key components used to update the PFS CF. In accounting for the weighted average price change for various inputs involved with producing physicians' services, the MEI measures inflation in physician practice costs and general wage levels. Elements of the MEI include measures of physicians' PEs, including nonphysician employee compensation, office expenses, medical material and supplies, professional liability insurance, and medical equipment. As noted above in this section, professional liability insurance experienced the largest percentage increase of any component of the MEI for 2006.
                        ( print page 70308) The GDP is a general measure of economic growth. It is not intended to reflect factors specific to operating a medical practice because these are captured in the MEI. Currently, the statute requires that we use the GDP as a component of the SGD, which is then used to calculate the target level of expenditures. We disagree with the comment that use of GDP makes the SGR inherently unstable. The SGR is based on the 10 year average of GDP, so year-to-year changes are averaged over a significant period, modulating any fluctuations from one year to the next. *Comment:*
                         Some commenters stated that physicians are penalized with pay cuts when Medicare spending on physicians' services exceeds the SGR spending target, yet the SGR is not adjusted to take into account many factors beyond physicians' control, including government policies that, although good for patients, promote Medicare spending on physicians' services. Specifically, government-induced increases in spending on physicians' services should be accurately reflected in the SGR target. The impact of these government policies on spending for physicians' services is ignored or underestimated in calculating the target. New government policies often result not only in direct expenditures, but can also lead to ancillary new expenditures that are not appropriately reflected in the target. For example, new preventive benefits can lead to additional physician services, such as office visits. CMS has not provided details as to how its estimates of costs for new benefits are calculated under section 1848(f)(2)(D) of the Act, making it impossible to judge the accuracy of its target adjustments. Commenters also contend there have been a number of regulatory changes that encouraged growth in spending on physicians' services by shifting services from facilities to physicians' offices. Services previously provided by facilities (and not included in the calculation of actual and allowed expenditures in the base year) are now provided in physicians' offices, and are not reflected in the current level of allowed expenditures. For example, the growth in therapy services was influenced by the elimination of cost-based reimbursement to many facilities. This led many rehabilitation agencies to terminate their provider numbers and enroll as physical therapists in private practice. It also provided incentives for hospitals to discharge patients sooner, leading to increased therapy services paid under the physician fee schedule. Commenters urge CMS to adjust for other spending increases attributable to quality improvement programs that trigger physicians' services. Commenters provided examples of increased administrative demands and costs being imposed upon physicians through Federal program requirements including: transition of new and dually eligible beneficiaries into Medicare Part D drug plans; electronic prescribing; national demonstration on pay for performance; and Medicare policies on competitive acquisition for outpatient drugs and biologicals under Part B. *Response:*
                         As described previously, the calculation of the SGR is determined by statute. Policy changes due to statute or regulation are required to be accounted for in the SGR calculation. For example, past changes that were expected to result in increased spending for therapy were reflected in prior years' SGR calculations. (See the CY 2002 Final Rule (66 FR 55320).) Similarly, last year we made an adjustment to the SGR to account for increased Medicare spending for physicians' services as a result of the MMA provisions providing for Medicare coverage of an initial preventive physical examination, cardiovascular, and diabetes screening tests. (See the CY 2005 Final Rule (69 FR 66388).) Based on subsequent data, we will revise these estimates and adjust the SGR as discussed in section F. of this preamble. *Comment:*
                         We received many public comments that argued for adjusting the SGR for changes in expenditures resulting from national coverage determinations (NCDs). According to these comments, any changes in national Medicare coverage policy, such as a Program Memorandum or an NCD, constitute regulatory changes for purposes of computing the SGR. The commenters indicate that, because the statute provides the authority to adjust the SGR for statutory or regulatory changes, any new coverage initiative should be taken into account in determining the SGR. Commenters noted that CMS has previously stated that it is very difficult to estimate any costs or savings associated with specific coverage decisions. Additionally, CMS has stated that adjustments to the target for NCDs would likely be of such a small magnitude that it would have little effect on future projected updates. Commenters noted that CMS adjusts Medicare Advantage payments to account for NCDs, so clearly CMS has some means to estimate the costs of NCDs. Some commenters contracted with a private research firm to estimate the costs of several NCDs, to illustrate that it is possible to make such estimates and to provide a sense of their magnitude. These studies indicated that although certain individual NCDs do not significantly increase Medicare spending, some NCDs do have a significant impact. Furthermore, even if individually, the impacts of new NCDs are relatively minor, taken in the aggregate, even those NCDs with marginal impact contribute to rising utilization. *Response:*
                         The large majority of Medicare spending is for services that are covered at local carrier discretion. While we may establish national coverage (or noncoverage) for a new item or service with a defined statutory benefit category, the NCD does not necessarily increase Medicare spending to the extent that the service has or would have been covered at local carrier discretion in the absence of a NCD. Because Medicare would cover these services without an NCD, it is unclear whether there are any additional costs associated with the NCDs. We may also issue an NCD to clarify Medicare coverage for existing items or services. This decision may establish national policy that replaces differing local practices. In these cases, there may not have been consistency among Medicare carriers as to whether an item or service qualified for coverage based on existing statute or regulation. Thus, our NCD would replace differing local practices with a national determination which, based on existing law and regulations, clarifies Medicare coverage for an item or service. Spending may or may not increase or decrease depending upon the degree to which the particular item or service is currently being covered by Medicare carriers and whether the decision is to establish coverage or noncoverage of the item or service. As a result, at this time, we do not intend to make any adjustment to the SGR to account for new NCDs. We will examine this issue further, for example, to determine the impact of new NCDs on Medicare spending for physicians' services above and beyond what would happen with LCDs, though we expect that these NCDs would have, at most, a limited impact. *Comment:*
                         In response to the discussion in the proposed rule about substantial growth in Medicare spending in certain areas, commenters suggested that growth may be due to previously unmet needs that are only now being met. The commenters pointed out that nothing in the data presented suggested that the increased levels of service were inappropriate. Some commenters noted that since the introduction of the SGR methodology 
                        ( print page 70309)
                        many procedures have begun to move from settings, such as outpatient facilities, to physicians' offices. As a result, the full cost of these procedures is not reflected in either the SGR or allowed expenditures. Commenters believe CMS must recognize this shift in site of service and make appropriate adjustments to the target. *Response:*
                         We are taking collaborative steps to better understand these trends, including what changes in utilization are likely to be associated with important health improvements and which have limited or questionable health benefits. We have been reviewing the technical aspects of this situation in detail with health policy experts as well as the AMA and various specialty societies. Generally, our analysis indicates that while there are some identifiable factors that have contributed to higher spending, these factors do not account for a substantial part of the growth in spending on physicians' services. Major contributors to the rapid increase in spending are more frequent and more intensive following visits, more frequent and more complex imaging, more frequent and more intensive minor procedures such as physical therapy, more frequent and more complex laboratory tests, and increased use of drugs in physicians' offices. There is also a lot of evidence of much variation in the use of these services without much evidence of impact on health outcomes. This variation reinforces our commitment to continuing to develop better evidence on what additional spending is effective as well as to moving our payment system toward recognizing better quality care. Moreover, the statute does not provide a mechanism for us to recognize additional expenditures on physicians' services resulting from changes in medical practice that are not also changes in law and regulation. As a result, we do not see any legal basis to make adjustment to the SGR to reflect the additional expenditures associated with these factors. C. Preliminary Estimate of the SGR for 2006 Our preliminary estimate of the 2006 SGR is 1.7 percent. We first estimated the 2006 SGR in March and made the estimate available to the Medicare Payment Advisory Commission and on our web site. Table 36 shows that March 2005 and our current estimates of the factors included in the 2006 SGR. Table 36.—2006 SGR Calculation
Statutory factors
March estimate
Current estimateFees
2.8 percent (1.028)
2.7 percent (1.027).Enrollment
−2.5 percent (0.975)
−3.1 percent (0.969).Real Per Capita GDP
2.3 percent (1.023)
2.2 percent (1.022).Law and Regulation
0.0 percent (1.000)
0.0 percent (1.000).Total
2.5 percent (1.025)
1.7 percent (1.017)
 Note: Consistent with section 1848(f)(2) of the Act, the statutory factors are multiplied, not added, to produce the total (that is, 1.027 × 0.969 × 1.022 × 1.000 = 1.017). A more detailed explanation of each figure is provided in section VII.F.1 of this preamble. D. Revised Sustainable Growth Rate for 2005 Our current estimate of the 2005 SGR is 4.6 percent. Table 37 shows our preliminary estimate of the 2005 SGR that was published in the CY 2005 Final Rule (69 FR 66386) and our current estimate. Table 37.—2005 SGR Calculation
Statutory factors
Estimate from CY 2005 Final Rule
Current estimateFees
1.3 percent (1.013)
0.8 percent (1.008).Enrollment
−0.3 percent (0.997)
0.3 percent (1.003).Real Per Capita GDP
2.2 percent (1.022)
2.2 percent (1.022).Law and Regulation
1.0 percent (1.010)
1.2 percent (1.010).Total
4.3 percent (1.043)
4.6 percent (1.046).
 A more detailed explanation of each figure is provided in section VII.F.2 of this preamble. E. Final Sustainable Growth Rate for 2004 The SGR for 2004 is 6.6 percent. Table 38 shows our preliminary estimate of the 2004 SGR from the CY 2004 Final Rule (68 FR 63249), our revised estimate from the CY 2005 Final Rule (69 FR 66387) and the final figures determined using the latest available data. Table 38.—2004 SGR Calculation
Statutory factors
Estimate from CY 2004 Final Rule
Estimate from CY 2005 Final Rule
FinalFees
2.7 percent (1.027)
1.4 percent (1.014)
1.3 percent (1.013).Enrollment
1.7 percent (1.017)
1.7 percent (1.017)
1.3 percent (1.013).Real Per Capita GDP
2.8 percent (1.028)
2.2 percent (1.022)
2.1 percent (1.021).Law and Reg
0.0 percent (1.000)
1.5 percent (1.015)
1.7 percent (1.017).Total
7.4 percent (1.074)
7.0 percent (1.070)
6.6 percent (1.066).
 
 
 A more detailed explanation of each figure is provided in section VII.F.3. F. Calculation of 2006, 2005, and 2004 Sustainable Growth Rates 1. Detail on the 2006 SGR All of the figures used to determine the 2006 SGR are estimates that will be revised based on subsequent data. Any differences between these estimates and the actual measurement of these figures will be included in future revisions of the SGR and allowed expenditures and incorporated into subsequent PFS updates. • Factor 1—Changes in Fees for Physicians' Services (Before Applying Legislative Adjustments) for 2006 This factor is calculated as a weighted-average of the 2006 fee increases for the different types of services included in the definition of physicians' services for the SGR. Medical and other health services paid using the PFS are estimated to account for approximately 83.1 percent of total allowed charges included in the SGR in 2006 and are updated using the MEI. The MEI for 2006 is 2.8 percent. Diagnostic laboratory tests are estimated to represent approximately 7.2 percent of Medicare allowed charges included in the SGR for 2006. Medicare payments for these tests are updated by the Consumer Price Index for Urban Areas (CPI-U). However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from 2004 through 2008. Drugs are estimated to represent 9.7 percent of Medicare allowed charges included in the SGR in 2006. Sections 303 and 304 of the MMA require Medicare to pay for most drugs at 106 percent of ASP beginning January 1, 2005. We estimated a weighted-average change in fees for drugs included in the SGR (using the ASP plus 6 percent pricing methodology) of 4.1 percent for 2006. Table 39 shows the weighted-average of the MEI, laboratory and drug price changes for 2006. Table 39
Weight
UpdatePhysician
0.831
2.8Laboratory
0.072
0.0Drugs
0.097
4.1Weighted-average
1.000
2.7
 We estimate that the weighted-average increase in fees for physicians' services in 2006 under the SGR (before applying any legislative adjustments) will be 2.7 percent. • Factor 2—The Percentage Change in the Average Number of Part B Enrollees From 2005 to 2006 This factor is our estimate of the percent change in the average number of fee-for-service enrollees from 2005 to 2006. Services provided to Medicare Advantage (MA) plan enrollees are outside the scope of the SGR and are excluded from this estimate. OACT estimates that the average number of Medicare Part B fee-for-service enrollees will decrease by −3.1 percent from 2005 to 2006. Table 40 illustrates how this figure was determined. Table 40
2005
2006Overall
39.536 million
40.059 million.Medicare Advantage (MA)
5.070 million
6.654 million.Net
34.466 million
33.405 million.Percent Increase

−3.1 percent.
 An important factor affecting fee-for-service enrollment is beneficiary enrollment in MA plans. Because it is difficult to estimate the size of the MA enrollee population before the start of a calendar year, at this time we do not know how actual enrollment in MA plans will compare to current estimates. For this reason, the estimate may change substantially as actual Medicare fee-for-service enrollment for 2006 becomes known. • Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in 2006 We estimate that the growth in real GDP per capita from 2005 to 2006 will be 2.2 percent (based on the 10-year average GDP over the ten years of 1997-2006). Our past experience indicates that there have also been changes in estimates of real per capita GDP growth made before the year begins and the actual change in GDP computed after the year is complete. Thus, it is possible that this figure will change as actual information on economic performance becomes available to us in 2006. • Factor 4—Percentage Change in Expenditures for Physicians' Services Resulting From Changes in Statute or Regulations in 2006 Compared With 2005 The statutory and regulatory provisions that will affect expenditures in CY 2006 relative to CY 2005 are estimated to have an impact on expenditures of less than 0.05 percent. These provisions include the expiration of the temporary higher payments to physicians in Alaska, the new powered wheelchair code for physicians, and the impact of the new IVIG service discussed elsewhere in this final rule with comment. 2. Detail on the 2005 SGR A more detailed discussion of our revised estimates of the four elements of the 2005 SGR follows. • Factor 1—Changes in Fees for Physicians' Services (Before Applying Legislative Adjustments) for 2005 This factor was calculated as a weighted-average of the 2005 fee increases that apply for the different types of services included in the definition of physicians' services for the SGR. We estimate that services paid using the PFS account for approximately 84.3 percent of total allowed charges included in the SGR in 2005. These services were updated using the 2005 MEI of 3.1 percent. We estimate that diagnostic laboratory tests represent approximately 7.0 percent of total allowed charges included in the SGR in 2005. Medicare payments for these tests are updated by the CPI-U. However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from 2004 through 2008. We estimate that drugs represent 8.7 percent of Medicare allowed charges included in the SGR in 2005. Sections 303 and 304 of the MMA require 
                        ( print page 70311)
                        Medicare to pay for most drugs at 106 percent of ASP beginning January 1, 2005. We now estimate a weighted-average change in fees for drugs included in the SGR of −21.1 percent for 2005. The estimated weighted-average change in the CY 2005 Final Rule was −14.7 percent. The decline in the estimate is due to updated ASP data. Table 41 shows the weighted-average of the MEI, laboratory and drug price changes for 2005. Table 41
Weight
UpdatePhysician
0.843
3.1Laboratory
0.070
0.0Drugs
0.087
−21.1Weighted-average
1.000
0.8
 After taking into account the elements described in Table 41, we estimate that the weighted-average increase in fees for physicians' services in 2005 under the SGR (before applying any legislative adjustments) will be 0.8 percent. Our estimate of this factor in the CY 2005 Final Rule was 1.3 percent. The reduction from 1.3 percent to our current estimate of 0.8 percent is primarily due to application of the drug pricing changes required by sections 303 and 304 of the MMA. • Factor 2—The Percentage Change in the Average Number of Part B Enrollees From 2004 to 2005 OACT estimates that the average number of Medicare Part B fee-for-service enrollees (excluding beneficiaries enrolled in M+C plans) increased by 0.3 percent in 2005. Table 42 illustrates how we determined this figure. Table 42
2004
2005Overall
39.048 million
39.536 million.Medicare+Choice
4.683 million
5.070 million.Net
34.366 million
34.466 million.Percent Increase

0.3 percent.
 OACT's estimate of the 0.3 percent change in the number of fee-for-service enrollees, net of M+C enrollment for 2005 compared to 2004, is greater than our original estimate of −0.3 percent in the CY 2005 Final Rule (69 FR 66388). While our current projection based on data from 8 months of 2005 is greater than our original estimate of −0.3 percent when we had no data, it is still possible that our final estimate of this figure will be different once we have complete information on 2005 fee-for-service enrollment. • Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in 2005 We estimate that the growth in real GDP per capita will be 2.2 percent for 2005 (based on the 10-year average GDP over the ten years of 1996-2005). Our past experience indicates that there have also been differences between our estimates of real per capita GDP growth made prior to the year's end and the actual change in this factor. Thus, it is possible that this figure will change further as complete actual information on 2005 economic performance becomes available to us in 2006. • Factor 4—Percentage Change in Expenditures for Physicians' Services Resulting From Changes in Statute or Regulations in 2005 Compared With 2004 There are a number of statutory provisions that affect the 2005 SGR. As mentioned previously in the preamble, sections 303 and 304 of the MMA changed Medicare payment for drugs. These provisions also changed Medicare payments for the administration of drugs. Section 303(a)(1) of the MMA amended section 1848(c)(2) of the Act to require the Secretary to make a number of changes that increased Medicare payment for drug administration beginning January 1, 2004. These changes permanently increased Medicare payments for drug administration by a weighted-average of 110 percent. Section 303(a)(4) of the MMA required an additional transitional adjustment (temporary increase) to Medicare's payment for drug administration of 32 percent for 2004 and 3 percent for 2005. The change in the transitional adjustment of 32 percent for 2004 to 3 percent for 2005 would reduce Medicare payments for drug administration between 2004 and 2005. However, some of this reduction will be lessened because we also adopted changes to the codes and payment amounts for drug administration based on recommendations from the AMA's CPT Editorial Panel and Relative Value Update Committee (RUC), under the authority of section 1848(c)(2)(J) of the Act. We further increased PFS payments by paying separately for injections provided on the same day as another PFS service. We estimate that changes to our policy on injections and the changes to our drug administration payments taken together increased physician spending by 0.8 percent. There are several other statutory provisions that are estimated to increase Medicare spending for physicians' services under the SGR. Section 413(a) of the MMA establishes a 5 percent increase in the PFS payment for services provided in physician scarcity areas. Section 413(b) of the MMA improves the procedures for paying the 10 percent PFS bonus payment for services provided in health professional shortage areas. We estimate that the provisions of section 413 of the MMA will increase Medicare PFS payments by 0.1 percent. Sections 611 through 613 of the MMA provide Medicare coverage for an initial preventive physical examination, cardiovascular and diabetes screening tests. We estimate that new Medicare coverage for these preventive services will increase spending for physicians' services under the SGR by 0.3 percent. Taken together, we estimate that all of the statutory provisions for 2005 will increase Medicare spending for physicians' services by 1.2 percent. 3. Detail on the 2004 SGR A more detailed discussion of our final revised estimates of the four elements of the 2004 SGR follows. • Factor 1—Changes in Fees for Physicians' Services (Before Applying Legislative Adjustments) for 2004 This factor was calculated as a weighted-average of the 2004 fee increases that apply for the different types of services included in the definition of physicians' services for the SGR. Services paid using the PFS accounted for approximately 83.3 
                        ( print page 70312)
                        percent of total Medicare allowed charges included in the SGR for 2004 and are updated using the MEI. The MEI for 2004 was 2.9 percent. Diagnostic laboratory tests represented approximately 6.8 percent of total 2004 Medicare allowed charges included in the SGR and are updated by the CPI-U. However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from 2004 through 2008. Drugs represented approximately 9.9 percent of total Medicare allowed charges included in the SGR for 2004. Historically, Medicare paid for drugs under section 1842(o) of the Act at 95 percent of average wholesale price (AWP). However, with some exceptions, sections 303 and 304 of the MMA generally require Medicare to pay for drugs at 85 percent of the AWP determined as of April 1, 2003, or a specified percentage of AWP based on studies by the Government Accountability Office and the Office of the Inspector General in 2004. We implemented section 303 and 304 of the MMA in an interim final rule making changes to the PFS for 2004, which appeared in the 
                        **Federal Register**
                         on January 7, 2004 (see 69 FR 1086). Taking sections 303 and 304 of the MMA into account, we estimate a weighted-average change in fees for drugs included in the SGR of −11.5 percent for 2004. Table 43 shows the weighted-average of the MEI, laboratory, and drug price increases for 2004. Table 43
Weight
UpdatePhysician
0.833
2.9Laboratory
0.068
0.0Drugs
0.099
−11.5Weighted-average
1.000
1.3
 After taking into account the elements described in Table 43, we estimate that the weighted-average increase in fees for physicians' services in 2004 under the SGR (before applying any legislative adjustments) was 1.3 percent. • Factor 2—The Percentage Change in the Average Number of Part B Enrollees From 2003 to 2004 We estimate the increase in the number of fee-for-service enrollees (excluding beneficiaries enrolled in M+C plans) from 2003 to 2004 was 1.3 percent. Our calculation of this factor is based on complete data from 2004. Table 44 illustrates the calculation of this factor. Table 44
2003
2004Overall
38.465 million
39.048 million.Medicare+Choice
4.655 million
4.683 million.Net
33.810 million
34.366 million.Percent Increase

1.3 percent.
 • Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in 2004 We estimate that the growth in real per capita GDP was 2.1 percent in 2004 (based on the 10-year average GDP over the ten years of 1995-2004). This figure is a final one based on complete data for 2004. • Factor 4—Percentage Change in Expenditures for Physicians' Services Resulting From Changes in Statute or Regulations in 2004 Compared With 2003 There are four statutory provisions that increased 2004 Medicare spending relative to 2003. Section 412 of the MMA established a floor of 1.0 on adjustments to the physician work relative value unit for the GPCI for the years 2004 through 2006. Section 602 of the MMA increased the GPCIs for work, PE, and malpractice in Alaska to 1.67. We estimate that sections 412 and 602 of the MMA increased 2004 Medicare spending included in the SGR by 0.6 percent. Sections 303 and 304 of the MMA increased Medicare's payments for drug administration in 2004. It further exempted the increases in payment from the budget neutrality provisions of section 1848(c)(2) of the Act. We estimate the section 303 and 304 provisions increased spending for physicians' services by 1.0 percent in 2004. Taken together, we estimate that statutory provisions increased 2004 spending for physicians' services by 1.7 percent (after accounting for rounding). VIII. Anesthesia and Physician Fee Schedule Conversion Factors (CF) for CY 2006 The 2006 PFS CF will be $36.1770. The 2006 national average anesthesia CF is $16.9591. A. Physician Fee Schedule Conversion Factor Under section 1848(d)(1)(A) of the Act, the PFS CF is equal to the CF for the previous year multiplied by the update determined under section 1848(d)(4) of the Act. Under section 1848(c)(2) of the Act, adjustments to RVUs may not cause the amount of expenditures to differ by more than $20 million from the amount of expenditures that would have resulted without such adjustments. As described earlier, we are implementing several changes to the work RVUs that would result in a change in expenditures that would exceed $20 million if we made no offsetting adjustments to either the conversion factor or RVUs. With respect to the work RVUs, our policy has been to meet the budget-neutrality requirements in the statute by making an adjustment to the conversion factor. That is, we estimate the aggregate number of work RVUs that will be paid under current and revised policy in CY 2006. We apply a uniform adjustment factor to the conversion factor to make the aggregate payments under the revised work RVUs equal the aggregate payments under the current work RVUs. As a result of the 2006 work RVU changes described earlier, we will be making an adjustment of .9985 percent to the conversion factor to meet the budget neutrality requirements in the statute. Note that this adjustment is also being applied to the anesthesia fee schedule as shown in table 46. We illustrate the calculation for the 2006 PFS CF in Table 45. Table 45
2005 Conversion Factor
$37.8975.2006 Update
−4.4 percent.2006 Adjustment for Work RVU Changes
.9985.2006 Conversion Factor
$36.1770.
 
 
 B. Anesthesia Fee Schedule Conversion Factor Anesthesia services do not have RVUs like other PFS services. Therefore, we account for any necessary RVU adjustments through an adjustment to the anesthesia fee schedule CF to simulate changes to RVUs. We modeled the resource-based practice expense methodology using imputed anesthesia RVUs that were made comparable to other physician fee schedule services. As a result of modeling practice expense changes, we are incorporating a 1.00039 adjustment to the anesthesia fee schedule conversion factor. We used the following figures to determine the anesthesia fee schedule CF (see Table 46). Table 46
2005 Anesthesia Conversion Factor
$17.7594.2006 Update
−4.4 percent.2006 Adjustment for Work RVU Changes
.9985.2006 Adjustment for PE Changes
1.00039.2006 Anesthesia Conversion Factor
$16.9591.
 IX. Telehealth Originating Site Facility Fee Payment Amount Update Section 1834(m) of the Act establishes the payment amount for the Medicare telehealth originating site facility fee for telehealth services provided from October 1, 2001 through December 31 2002, at $20. For telehealth services provided on or after January 1 of each subsequent calendar year, the telehealth originating site facility fee is increased by the percentage increase in the MEI as defined in section 1842(i)(3) of the Act. The MEI increase for 2006 is 2.8 percent. Therefore, for CY 2006, the payment amount for HCPCS code “Q3014, telehealth originating site facility fee” is 80 percent of the lesser of the actual charge or $22.47. The Medicare telehealth originating site facility fee and MEI increase by the applicable time period is shown in Table 47. Table 47
Facility fee
MEI increase 
                                 (percent)
Period$20.00
N/A
10/01/2001-12/31/2002$20.60
3.0
01/01/2003-12/31/2003$21.20
2.9
01/01/2004-12/31/2004$21.86
3.1
01/01/2005-12/31/2005$22.47
2.8
01/01/2006-12/31/2006
 X. Provisions of the Final Rule With Comment The provisions of this final rule with comment restate the provisions of the August 2005 proposed rule, except as noted elsewhere in the preamble. XI. Waiver of Proposed Rulemaking We ordinarily publish a notice of proposed rulemaking in the 
                        **Federal Register**
                         and invite public comment on the proposed rule. The notice of proposed rulemaking includes a reference to the legal authority under which the rule is proposed, and the terms and substances of the proposed rule or a description of the subjects and issues involved. This procedure can be waived, however, if an agency finds good cause that a notice-and-comment procedure is impracticable, unnecessary, or contrary to the public interest and incorporates a statement of the finding and its reasons in the rule issued. As discussed in sections III. and V. of this final rule with comment, we utilize HCPCS codes for Medicare payment purposes. The HCPCS is a national drug coding system comprised of Level I (CPT) codes and Level II (HCPCS National Codes) that are intended to provide uniformity to coding procedures, services, and supplies across all types of medical providers and suppliers. Level I (CPT) codes are copyrighted by the AMA and consist of several categories, including Category I codes which are 5-digit numeric codes, and Category III codes which are temporary codes to track emerging technology, services and procedures. The AMA issues an annual update of the CPT code set each Fall, with January 1 as the effective date for implementing the updated CPT codes. The HCPCS, including both Level I and Level II codes, is similarly updated annually on a CY basis. Annual coding changes are not available to the public until the Fall immediately preceding the annual January update of the PFS. Because of the timing of the release of these new codes, it is impracticable for CMS to provide prior notice and solicit comment on these codes and the RVUs assigned to them in advance of publication of the final rule that implements the PFS. Yet, it is imperative that these coding changes be accounted for and recognized timely under the PFS for payment because services represented by these codes will be provided to Medicare beneficiaries by physicians during the CY in which they become effective. Moreover, regulations implementing HIPAA (42 CFR parts 160 and 162) reguire that the HCPCS be used to report health care services, including services paid under the PFS. We also assign interim RVUs to any new codes based on a review of the RUC recommendations for valuing these services. By reviewing these RUC recommendations for the new codes, we are able to assign RVUs to services based on input from the medical community and to establish payment for them, on an interim basis, that corresponds to the relative resources associated with providing the services. If we did not assign RVUs to new codes on an interim basis, the alternative would be to either not pay for these services during the initial CY or have each carrier establish a payment rate for these new codes. We believe both of these alternatives are contrary to the public interest, particularly since the RUC process allows for an assessment of the valuation of these services by the medical community prior to our establishing payment for these codes on an interim basis. Therefore, we believe it would be contrary to the public interest to delay establishment of fee schedule payment amounts for these codes. For the reasons outlined above, we find good cause to waive the notice of proposed rulemaking for the interim RVUs for selected procedure codes identified in Addendum C and to establish RVUs for these codes on an interim final basis. We are providing a 60-day public comment period. XII. Collection of Information Requirements Under the Paperwork Reduction Act of 1995, we are required to provide 60-
                        ( print page 70314)
                        day notice in the 
                        **Federal Register**
                         and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: The need for the information collection and its usefulness in carrying out the proper functions of our agency.
                    The accuracy of our estimate of the information collection burden.
                    The quality, utility, and clarity of the information to be collected.
                    Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. We are soliciting public comment on each of these issues for the following sections of this document that contain information collection requirements: Section 413.180 Procedures for Requesting Exceptions to Payment Rates Paragraph (b) specifies the criteria for a pediatric ESRD facility requesting an exception to payment rates. Paragraph (e) outlines the documentation that a pediatric ESRD facility must submit to CMS when requesting an exception to its payment rates. Paragraph (i) discusses the period of approval for payment exception requests. A prospective exception payment rate approved by CMS applies for the period from the date the complete exception request was filed with its intermediary until thirty days after the intermediary's receipt of the facility's letter notifying the intermediary of the facility's request to give up its exception rate. The burden associated with the requirements in paragraph (e) is the time and effort required by the facility to prepare and submit the exception request to CMS. The burden associated with the requirement in paragraph (i) is the time and effort required by the facility to draft and mail the letter that notifies the intermediary of the facilities request to give up its exception rate. The collection requirement in this section has not changed. While this requirement is subject to the PRA, this requirement is currently approved in OMB No. 0938-0296. Section 413.184 Payment Exception: Pediatric Patient Mix Paragraph (b) specifies the documentation requirements that a pediatric ESRD facility must meet in order to qualify for an exception to its prospective payment rate based on its pediatric patient mix. In addition to the other qualifications specified in this section, this section states that a facility must submit a listing of all outpatient dialysis patients (including all home patients) treated during the most recently completed and filed cost report. The burden associated with this requirement is the time and effort for the facility to submit a listing of all outpatient dialysis patients (including all home patients) treated during the most recently completed and filed cost report. The collection requirement in this section has not changed. While this requirement is subject to the PRA, this requirement is currently approved in OMB No. 0938-0296. Section 413.186 Payment Exception: Self-Dialysis Training Costs in Pediatric Facilities In summary, this section outlines the requirements a pediatric ESRD facility must meet to qualify for an exception to the prospective payment rate based on self-dialysis training costs. Paragraph (e) states that a facility must provide specific information to support its exception request. Paragraph (f) states that in addition to the other qualifications outlined in this section, pediatric ESRD facility must submit with its exception request a list of patients, by modality, trained during the most recent cost report period, in order to justify its accelerated training exception request. The burden associated with these requirements is the time and effort for the facility to prepare and submit the required information to support its exception request, and the time and effort for the pediatric ESRD facility to prepare and submit with its exception request a list of patients, by modality, trained during the most recent cost report period. The collection requirements in this section have not changed. While these requirements are subject to the PRA, they are currently approved in OMB No.0938-0296. Section 414.804 Basis of Payment In summary, this section requires manufacturers to report ASP data to CMS. This section details the process a manufacturer must follow to calculate the ASP. The ASP reporting requirements are discussed in further detail in the interim final rule with comment, Medicare Program; Manufacturer Submission of Manufacturer's Average Sales Price (ASP) Data for Medicare Part B Drugs and Biologicals, that published on April 2, 2004 in the 
                        **Federal Register**
                         (69FR17935-17941). The burden associated with these requirements is the time and effort required by manufacturers of Medicare Part B Drugs and biologicals to prepare and submit to the required ASP data to CMS. While these requirements are subject to the PRA, the requirements are currently approved in OMB No. 0938-0921, with a current expiration date of September 30, 2007. We intend to revise this information collection to include adequate instructions for manufacturers to report the ASP, the WAC, and other data elements. These revisions will be addressed in detail in a revised information collection request in accordance with the Paperwork Reduction Act of 1995. We have submitted a copy of this proposed rule to OMB for its review of the information collection requirements described above. These requirements are not effective until they have been approved by OMB. If you comment on these information collection and recordkeeping requirements, please mail copies directly to the following: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Regulations Development Group, Attn: Jim Wickliffe, [CMS-1502-P], Room C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850; and Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Attn: Brenda Aguilar, CMS Desk Officer, CMS-1502-P, 
                        *Brenda.Aguilar@omb.eop.gov.*
                         Fax (202) 395-6974. XIII. Response to Comments Because of the large number of public comments we normally receive on 
                        **Federal Register**
                         documents, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the 
                        **DATES**
                         section of this preamble, and, when we proceed with a subsequent document, we will respond to the comments in the preamble to that document. XIV. Regulatory Impact Analysis We have examined the impact of this rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 19, 1980 Pub. L. 96-354), section 1102(b) of the Social Security Act, the Unfunded 
                        ( print page 70315)
                        Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132. Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibilities of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, when regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis must be prepared for final rules with economically significant effects (that is, a final rule that would have an annual effect on the economy of $100 million or more in any one year, or would adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or tribal governments or communities). As indicated in more detail below, we estimate that the PFS provisions included in this final rule with comment will redistribute more than $100 million in one year. We are considering this final rule with comment to be economically significant because its provisions are estimated to result in an increase, decrease or aggregate redistribution of Medicare spending that will exceed $100 million. Therefore, this final rule with comment is a major rule and we have prepared a regulatory impact analysis. The RFA requires that we analyze regulatory options for small businesses and other entities. We prepare a regulatory flexibility analysis unless we certify that a rule would not have a significant economic impact on a substantial number of small entities. The analysis must include a justification concerning the reason action is being taken, the kinds and number of small entities the rule affects, and an explanation of any meaningful options that achieve the objectives with less significant adverse economic impact on the small entities. Section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any rule that may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside a Metropolitan Statistical Area and has fewer than 100 beds. We have determined that this final rule with comment would have minimal impact on small hospitals located in rural areas. Of 227 hospital-based ESRD facilities located in rural areas, only 40 are affiliated with hospitals with fewer than 100 beds. For purposes of the RFA, physicians, nonphysician practitioners, and suppliers are considered small businesses if they generate revenues of $6 million or less. Approximately 95 percent of physicians are considered to be small entities. There are about 875,000 physicians, other practitioners and medical suppliers that receive Medicare payment under the PFS. For purposes of the RFA, approximately 90 percent of suppliers of durable medical equipment (DME) and prosthetic devices are considered small businesses according to the Small Business Administration's (SBA) size standards. We estimate that 106,000 entities bill Medicare for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) each year. Total annual estimated Medicare revenues for DME suppliers exceed approximately $8.5 billion in 2004. Of this amount, approximately $1.4 billion were for nebulizer drugs in 2004. The vast majority, 95 percent, of retail pharmacy companies are small businesses as measured by the SBA size standard. Approximately, 16,000 pharmacies billed Medicare for immunosuppressive, oral anti-cancer, or oral anti-emetic drugs in 2004. Pharmacies received Medicare revenues for those drugs of approximately $350 million in 2004. In addition, most ESRD facilities are considered small entities, either based on nonprofit status or by having revenues of $29 million or less in any year. We consider a substantial number of entities to be affected if the final rule is estimated to impact more than 5 percent of the total number of small entities. Based on our analysis of the 957 nonprofit ESRD facilities considered small entities in accordance with the above definitions, we estimate that the combined impact of the changes to payment for renal dialysis services included in this final rule with comment would have a 1.5 percent decrease in payments relative to current payments. The impact of the CAP provisions included in this final rule with comment on an individual physician is dependent on whether the drugs they provide to Medicare beneficiaries are included in the list of CAP drugs and whether the physician chooses to obtain drugs administered to Medicare beneficiaries through the CAP. In addition, the CAP provisions in this rule will have a potential impact on entities, either existing or formed specifically for this purpose, that are involved in the dispensing or distribution of drugs. The impact is dependent on the ability of potential vendors to successfully compete on a national level and receive approval as a vendor under the CAP. The analysis and discussion provided in this section, as well as elsewhere in this final rule with comment, complies with the RFA requirements. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in expenditures in any year by State, local, or tribal governments, in the aggregate, or by the private sector, of $120 million. Medicare beneficiaries are considered to be part of the private sector for this purpose. We have examined this final rule with comment in accordance with Executive Order 13132 and have determined that this regulation would not have any significant impact on the rights, roles, or responsibilities of State, local, or tribal governments. A discussion concerning the impact of this rule on beneficiaries is found later in this section. We have prepared the following analysis, which, together with the information provided in the rest of this preamble, meets all assessment requirements. It explains the rationale for and purposes of the rule; details the costs and benefits of the rule; analyzes alternatives; and presents the measures we plan to use to minimize the burden on small entities. As indicated elsewhere in this final rule with comment, we are making a variety of changes to our regulations, payments, or payment policies to ensure that our payment systems reflect changes in medical practice and the relative value of services. We provide information for each of the policy changes in the relevant sections of this final rule with comment. We are unaware of any relevant Federal rules that duplicate, overlap or conflict with this rule. The relevant sections of this final rule with comment contain a description of significant alternatives if applicable. A. Resource-Based Work and PE RVUs Under section 1848(c)(2) of the Act, adjustments to RVUs may not cause the amount of expenditures to differ by more than $20 million from the amount of expenditures that would have resulted without such adjustments. We are implementing several changes that would result in a change in expenditures that would exceed $20 million if we made no offsetting adjustments to either the CF or RVUs. With respect to the work RVUs, our policy has been to meet the budget-neutrality requirements in the statute by 
                        ( print page 70316)
                        making an adjustment to the CF. That is, we estimate the aggregate number of work RVUs that will be paid under current and revised policy in CY 2006. We apply a uniform adjustment factor to the CF to make the aggregate payments under the revised work RVUs equal the aggregate payments under the current work RVUs. As a result of the 2006 work RVU changes described earlier, we will be making an adjustment of −0.6 percent to the CF to meet the budget neutrality requirements in the statute. For PE RVUs, our policy has been to meet the budget-neutrality requirements in the statute by incorporating a rescaling adjustment in the PE methodologies. That is, we estimate the aggregate number of PE RVUs that will be paid under current and revised policy in CY 2006. We apply a uniform adjustment factor to make the aggregate number of revised PE RVUs equal the number estimated that would be paid under current policy. While we are continuing to apply this policy for general changes in coding and RVUs, we are increasing aggregate PFS payments to account for the higher payments for drug administration services resulting from the incorporation of the survey data submitted by the AUA. These increases in payment are being made under the authority of section 1848(c)(2)(J) of the Act that exempts the changes in payments for drug administration from the budget neutrality requirements of section 1848(c)(2)(B)(iv) of the Act. As described earlier, we will base PE payments in 2006 on the current 2005 PE RVUs to the extent practicable after making changes required by law, such as the incorporation of the urology survey for the drug administration codes. In the situation where a code is new in 2006 and we do not have 2005 PE RVUs, we created new PE RVUs to use as the basis for 2006 payments. Table 49, Impact of CY 2006 RVU Changes, Multiple Imaging Discount, and Conversion Factor Update on Total Medicare Allowed Charges by Specialty, shows the percentage impact by specialty of the PE changes in combination with other changes being implemented. The −4 percent decrease in payment for clinical psychology shown in the PE refinements column in Table 49 is attributable to the deletion of several codes and creation of new codes for certain psychological testing services. The deleted codes had reflected the practitioner's work in the PE RVUs. As indicated in Table 29 of section III.D., we accepted the recommendation of the RUC's HCPAC for work RVUs for the new codes. Thus, there is a shift in payment from the PE RVUs to the work RVUs for these psychological testing codes. We note that the increase in the payment in the work RVUs exceeds the decrease in payment in the PE RVUs, causing an overall net increase in payments to clinical psychologists of 2 percent as a result of the shift from the PE RVUs to the work RVUs for these new codes. While not included in table 49, we estimate that temporary payment associated with IVIG described previously will result in approximately $10 million in additional CY 2006 allowed charges under the PFS. B. Malpractice RVUs As discussed in section II C. of this final rule with comment, we are making technical changes to the calculation of the malpractice RVUs. We are removing the malpractice data for specialties that occur less than 5 percent of the time in our data for a procedure code; adopting several changes to the crosswalks used to assign risk factors to specialties for which we did not otherwise have data; using the lowest risk factor of 1.00 for clinical psychology, licensed clinical social work, chiropractors, and physical therapists; and adding cardiology catheterization and angioplasty codes to the list of codes for which we apply surgical rather than nonsurgical risk adjustment factors. Table 49 shows the combined impact of these changes. The impact of these methodological changes in the calculation of resource-based malpractice expense RVUs is negligible as malpractice RVUs account for less than 4 percent of total payments. C. Multiple Imaging Procedures As discussed in section II.J of this final rule with comment, we are reducing payments for TCs of certain multiple imaging procedures performed in the same session within the same imaging families. In order to calculate the impact of this change, we examined 2004 PFS carrier claims processed through March 31, 2005. We extracted all claims that were billed on the same day, for the same beneficiary, at the same provider, for multiple diagnostic imaging procedures within the same family of codes. For each subset of claims, the procedures were arrayed based on the pricing of the TC of these services. In the proposed rule, we simulated the effect of the multiple procedure payment reduction by accounting for 100 percent of the highest priced TC, and 50 percent of all other TCs. In this final rule with comment, we simulated the effect of the multiple procedure payment reduction by accounting for 100 percent of the highest priced TC, and 25 percent of all other TCs. This change is the result of public comments described more fully in section II.J. of this rule. Note that if the procedure was billed globally, the professional component was always calculated at 100 percent of the professional component (modifier-26) value. The simulated total allowed charges for each family of codes includes all global, technical, and professional utilization for the family of codes (for example, the sum of claims where the multiple procedure payment reduction would have been in effect, in addition to claims that would not have been subject to the multiple procedure payment reduction). These simulated totals were then compared to the actual allowed charges for each family of codes within the same time period to calculate the impacts of the change. Table 48 shows the actual 2004 allowed charges by family of imaging procedures and lists the percentage impact by family if this policy had been in effect. Family 2 has the largest −9.5 percent impact, while Family 11 has the smallest −0.7 percent impact. Table 48.—Impact of Multiple Procedure Reduction for Diagnostic Imaging by Family of Imaging Services
Family
Description of family of imaging procedures
2004 Medicare allowed charges 
                                 ($ in millions)
Percentage impact01
Ultrasound (Chest/Abdomen/Pelvis—Non-Obstetrical)
$138
−3.402
CT and CTA (Chest/Thorax/Abd/Pelvis)
563
−9.503
CT and CTA (Head/Brain/Orbit/Maxillofacial/Neck)
97
−1.304
MRI and MRA (Chest/Abd/Pelvis)
105
−2.405
MRI and MRA (Head/Brain/Neck)
532
−3.1( print page 70317)06
MRI and MRA (spine)
540
−2.207
CT (spine)
24
−2.108
MRI and MRA (lower extremities)
166
−1.609
CT and CTA (lower extremities)
5
−1.010
MR and MRI (upper extremities and joints)
107
−1.411
CT and CTA (upper extremities)
2
−0.7Total for all procedures subject to multiple imaging reductions
2,276
−4.2
 Using the same data, we also summarized the dollar value of the reductions by specialty. Specialty-specific percentage impacts were calculated by comparing each specialty's 2004 allowed charges for all Medicare allowed services to the reduced allowed charges that would have occurred had this policy been in effect. As expected, the most significant impacts occur among radiologists, who would experience a −1 percent impact. Diagnostic testing facilities also experience a −1 percent impact. Most other specialties experience a very small (0.1 percent) payment increase as a result of the budget neutrality adjustment. (Because this multiple procedure reduction adjustment would otherwise reduce overall payments by 0.1 percent, it is necessary to include a budget neutrality adjustment to the PE RVUs, resulting in positive impacts for most specialties.) Table 49 shows the percentage impact by specialty in combination with other changes being implemented. D. Combined Impacts Our estimates of changes in Medicare revenues for PFS services compare payment rates for 2006 with payment rates for 2005 using 2004 Medicare utilization for both years. We are using 2004 Medicare claims processed and paid through June 30, 2005, that we estimate are 98.5 percent complete, and have adjusted the figures to reflect a full year of data. Thus, because we are using a single year of utilization, the estimated changes in revenues reflect payment changes only between 2005 and 2006. To the extent that there are year-to-year changes in the volume and mix of services provided by physicians, the actual impact on total Medicare revenues will be different than those shown here. The payment impacts reflect averages for each specialty based on Medicare utilization. The payment impact for an individual physician would be different from the average, based on the mix of services the physician provides. The average change in total revenues would be less than the impact displayed here because physicians furnish services to both Medicare and non-Medicare patients and specialties may receive substantial Medicare revenues for services that are not paid under the PFS. For instance, independent laboratories receive approximately 80 percent of their Medicare revenues from clinical laboratory services that are not paid under the PFS. Table 49 shows only the payment impact on PFS services. Table 49 shows the specialty level impact on payment of the work RVU changes, practice expense RVU changes, malpractice RVU changes, and multiple imaging payment changes being implemented for CY 2006. The column labeled “Final Rule Impacts” shows the combined effect of the changes in payment attributable to the work RVU changes, practice expense RVUs, malpractice RVUs, and the multiple imaging policy. The column labeled “Impact of Update and Drug Admin. Transition shows the impact of these changes, and reflects the expiration of the transitional adjustment required by section 303 of the MMA for drug administration services. This adjustment was set at 32 percent for 2004 and 3 percent for 2005. In addition, this column reflects a −4.4 percent payment update to the CF described in section VI. of this final rule with comment and the budget neutrality scaler required by the changes in the work RVUs. 
 
  
 
  
 
  Table 50 shows the impact on total payments for selected high-volume procedures of all of the changes previously discussed. We selected these procedures because they are the most commonly provided by a broad spectrum of physician specialties. There are separate columns that show the change in the facility rates and the nonfacility rates. For an explanation of facility and nonfacility PE refer to section II.A. in the preamble of this final rule with comment. 
 
  
 
  In the CY 2005 final rule, we showed the combined impact of PFS and drug payment changes on the total revenues for specialties that perform a significant volume of drug administration services. (69 FR 66406) Although we have not performed a similar combined impact analysis this year for all of the specialties considered last year, we have undertaken a similar analysis of hematology/oncology. In last year's final rule, we announced a 1 year demonstration to collect information about symptoms for cancer patients receiving chemotherapy (69 FR 66308). In this final rule with comment, we are announcing a new demonstration project again focused on improving the quality of care provided to beneficiaries stricken with cancer. Although both of these demonstrations are implemented through the Secretary's authority under sections 402(a)(1)(B) and 402(b) of the Social Security Act Amendments of 1967 (Pub. L. 90-248), we discussed the impacts of the additional payments from the 2005 demonstration in last year's final rule impact analysis. Therefore, we are also including an analysis of the 
                        ( print page 70323)
                        impact on payments to oncologists as the 2005 demonstration project ends and the new demonstration project begins. We have updated the analysis from the proposed rule using more recent data. As indicated in Table 51, PFS services account for approximately 25 percent of Medicare revenues for oncologists. The current demonstration accounts for approximately 3 percent of Medicare revenues for oncologists. If we assume no growth in the volume of PFS services, the combined 2006 impact of changes in Medicare payments for all PFS and demonstration services provided by oncologists is -10 percent. We estimate that approximately 70 percent of total Medicare revenues for oncologists are attributed to drugs. If we again assume no growth in the volume of PFS services and additionally assume no growth in Medicare Part B drug spending (price or volume), we project total Medicare revenues to oncologists would decline by -3 percent. If we assume historical growth for the volume of PFS services and continue to assume no growth in Medicare Part B drug spending, we estimate total Medicare revenues to oncologists would remain unchanged between 2005 and 2006. If we assure historical growth for the volume of PFS services and for the volume of Medicare Part B drugs, we estimate total Medicare revenues to oncologists would increase by 6 percent between 2005 and 2006. We estimate that the revised chemotherapy demonstration project discussed earlier will result in additional allowed charges to oncologists of approximately $150 million in CY 2006.  E. Medicare Telehealth Services In section II.D. of this final rule with comment, we are adding individual medical nutrition therapy, as represented by HCPCS codes G0270, 97802, and 97803, to the list of telehealth services. We believe that this change will have little effect on Medicare expenditures. F. Contractor Pricing of CPT Codes 97039 and 97139 As discussed earlier in the preamble of this final rule with comment (section II.E.), we will have the contractors value CPT codes 97039 and 97139. This will make the pricing methodology for these services consistent with our policy for other unlisted services and should not have a significant impact on Medicare expenditures. G. ESRD-MMA Related Provisions The ESRD related provisions in this final rule with comment are discussed in section II.G. To understand the impact of the changes affecting payments to different categories of ESRD facilities, it is necessary to compare estimated payments under the current payment system (current payments) to estimated payments under the revisions to the composite rate payment system as set forth in this final rule with comment (final payments). To estimate the impact among various classes of ESRD facilities, it is imperative that the estimates of current payments and final payments contain similar inputs. Therefore, we simulated payments only for those ESRD facilities for which we are able to calculate both current 2005 payments and final 2006 payments. Due to data limitations, we are unable to estimate current and final payments for 171 facilities that bill for ESRD dialysis treatments. ESRD providers were grouped into the categories based on characteristics provided in the Online Survey and Certification and Reporting (OSCAR) file and the most recent cost report data from the Healthcare Cost Report Information System (HCRIS). We also used the June 2005 update of CY 2004 Standard Analytical File (SAF) claims as a basis for Medicare dialysis treatments and separately billable drugs and biologicals. As we stated in the proposed rule, this is an updated version of the 2004 SAF file compared to the December 2004 version of the file we used in the proposed rule. 
 
  Table 52 shows the impact of CY 2006 changes to payments to hospital based and independent ESRD facilities. We have included both composite rate payments as well as payments for separately billable drugs and biologicals because both are affected by the CY 2006 changes. The first column of Table 52 identifies the type of ESRD provider, the second column indicates the number of ESRD facilities for each type, and the third column indicates the number of dialysis treatments. The fourth column shows the effect of changes to the ESRD wage index as it affects the composite rate payments to ESRD facilities. Composite rate 
                        ( print page 70325)
                        payments account for about 60 percent of revenues to ESRD facilities. The fourth column compares aggregate wage adjusted composite rate payments using the revised ESRD wage index compared to the current ESRD wage adjusted composite rate payments. Since CY 2006 is the first year of the 4-year transition to the revised ESRD wage index, ESRD facilities receive 25 percent of the revised CBSA-based wage adjusted composite rate and 75 percent of the current composite rate. The overall effect to all ESRD providers in aggregate is zero because the CY 2006 ESRD wage index has been multiplied by a BNF to comply with the statutory requirement that any wage index revisions be done in a manner that results in the same aggregate amount of expenditures as would have been made without any changes in the wage index. The percent changes shown in the fifth and sixth columns are the result of the increase to the drug add-on and the changes in drug prices which are explained in section XIV.G. of this final rule with comment. The fifth column shows the effect of the changes in drug payments to ESRD providers between CY 2006 and CY 2005. Drug payments account for about 40 percent of revenues to ESRD providers. Current payments for drugs represent 2005 Medicare reimbursement using AAP prices for the top ten drugs (as discussed earlier in this preamble). Current Medicare spending for the top ten drugs is estimated using 2005 AAP prices times actual drug utilization from 2004 claims. (EPO units are estimated using payments because the units field on bills represents the number of EPO administrations rather than the number of EPO units). Spending for CY 2006 is estimated by using the average of the four quarters of 2005 ASP +6 percent for the top ten drugs times actual drug utilization from 2004 claims. The prices for these top ten drugs are discussed earlier in this preamble and the average of the four quarters of 2005 are shown in Table 52. We did not have hospital-based facilities utilization data for top ten drugs other than EPO. Therefore, we needed a proxy to estimate CY 2006 payments to hospital-based facilities under ASP +6 pricing. We estimated these drugs by using the weighted spread of the difference between ASP +6 and AWP prices from independent facilities and applying it to payments to hospital-based facilities for top ten drugs other than EPO. Payment for drugs in 2006 also includes the 14.7 percent drug add-on to the composite rate. This amount is computed by multiplying the wage adjusted composite rate for each provider and the dialysis treatments from 2004 claims. Column 5 is computed by comparing spending under the CY 2006 payment for drugs (4 quarter average of 2005 ASP +6) including the 14.7 percent drug add-on amount to spending under current payments for drugs with the current drug add-on of 8.7 percent. We did not simulate any case mix in this impact table (Table 52) because 2004 claims data do not include the new data fields (height and weight) that are needed to calculate case mix. These data fields were not required to be reported by providers until January 1, 2005. However, we have not made any changes to case mix for CY 2006. Column 6 shows the overall effect of all changes in drug and composite rate payments to ESRD providers. The overall effect is measured as the difference between CY 2006 payment with all MMA changes in this final rule with comment and current payment. CY 2006 payment is computed by multiplying the composite rate for each provider (with both the CY 2006 ESRD wage index and the 14.7 percent drug add-on) times dialysis treatments from 2004. In addition, the CY 2006 payment includes payments for separately billable drugs under the ASP +6 drug pricing using a 4 quarter average of 2005 ASP +6. Current payment is the current wage adjusted composite rate for each provider times dialysis treatments from 2004 claims plus current AAP priced drug payments for separately billable drugs with the current 8.7 percent drug add-on. The overall impact on ESRD providers in the aggregate is 1.2 percent increase. At first it may not seem obvious how the growth rates in columns 4 and 5 combine to result in the overall growth effect in column 6. While the wage index changes are budget neutral in aggregate, the drug payments to all ESRD providers have increased by 2.9 percent. Since drug payments to ESRD providers account for about 40 percent of revenues and the composite payment rate payment account for the other 60 percent of revenues, the 2.9 percent growth in drugs combined with the budget neutral composite rate payments result in the overall 1.2 percent growth in payment to all ESRD providers. Some commenters expressed concern regarding the reduction in payment rates for dialysis facilities in certain States and requested that we provide a State-specific impact analysis. Table 53 lists the impact for each State. 
 
  
 
 H. Payment for Covered Outpatient Drugs and Biologicals, and CAP Provisions As discussed in section II.H of this final rule with comment, the changes to the supplying fee for immunosuppressive, oral anticancer, and oral anti-emetic drugs are estimated to reduce total Federal expenditures by $2 million in 2006, and $14 million over the 5-year period, CY 2006 to 2010. The changes to the inhalation drug dispensing fee are expected to reduce total Federal expenditures by $120 million in 2006, and $720 million over the 5-year period, CY 2006 to 2010. For the CAP provisions contained in this final rule with comment, the purpose of the CAP program is to provide choices to physicians and potentially achieve budgetary savings to Medicare and beneficiaries through a competitive bidding approach to determining Medicare payment rates for selected drugs. In addition the CAP will provide physicians with an alternative way to obtain these selected drugs that they use for treating their Medicare beneficiaries in their offices. As discussed in the July 6, 2005 interim final rule (70 FR 39091), we have estimated the impact of the costs of furnishing or administering drugs through the CAP on the Medicare program and expect it to be negligible, at the beginning until participating CAP physicians, approved CAP vendors and CMS gain more experience with the program. During the first year, we anticipate no significant additional cost savings or increases associated with the CAP, relative to the ASP payment system. The CAP program will provide alternatives to physicians who do not wish to purchase drugs directly or collect coinsurance. I. Private Contracts and Opt-Out Provision The changes discussed in section II.I. of this final rule with comment, with respect to private contracts and the opt-out provision, are estimated to have no significant impact on Medicare expenditures. However, we believe the changes will clarify that the consequences for the failure to maintain opt-out will apply regardless of whether the physician or practitioner was notified by the carrier. J. FQHC Supplemental Payment Provision Section 237 of the MMA amended section 1833(a)(3) of Act to provide supplemental payments to FQHCs that contract with Medicare Advantage (MA) organizations to cover the difference, if any, between the payment received by the health center for treating MA enrollees and the payment to which the FQHC would be entitled to receive under its cost-based all-inclusive payment rate. We estimate that this new MMA payment provision for FQHC services will not increase Medicare payments. In other words, this MMA provision will have no budgetary impact on the Medicare trust fund due to the fact that a supplemental payment will only be made when the MA payment to the health center is less than its original FQHC cost based rate. Consequently, no additional Medicare expenditures will be needed to pay the center up to what it would have received under original Medicare. K. National Coverage Decisions Timeframes The changes to § 426.340 discussed in section II.N. of this final rule with comment, are made in order to conform certain timeframes in the regulation to meet legislative changes made by the MMA of 2003. These changes to the regulation meet Congressional intent in the development of NCDs, and conform the regulation to the overall NCD process. There are no budget implications as a result of these changes. L. Coverage of Screening for Glaucoma As discussed in section II.O. of the preamble to this final rule with comment, we are expanding the definition of an eligible beneficiary under the glaucoma screening benefit to include Hispanic Americans age 65 and over, effective January 1, 2006, subject to certain frequency and other limitations on coverage. At present, § 410.23(a)(2) (Conditions for and limitations on coverage of screening for glaucoma) defines the term “eligible beneficiary” to include individuals in the following high risk categories: Individual with diabetes mellitus.
                    Individual with a family history of glaucoma.
                    African-Americans age 50 and over. Based on the projected utilization of these screening services and related medically necessary follow-up tests and treatment that may be required for the additional beneficiaries screened, we estimate that this expanded benefit will result in an increase in Medicare payments to ophthalmologists or optometrists who will provide these screening tests and related follow-up tests and treatment. However, as discussed in earlier in section II.O. this is not expected to have a significant cost impact on the Medicare program. M. Physician Referral for Nuclear Medicine Services As discussed earlier in section V., we are revising the regulations at 411.351 to include all diagnostic and therapeutic nuclear medicine services and supplies furnished or referred on or after January 1, 2007, in the definitions of “radiology and certain other imaging services” and “radiation therapy services and supplies,” respectively. As stated in the proposed rule, the inclusion of nuclear medicine as a designated health service (DHS) primarily would affect physicians and health care entities that furnish these types of items and services to Medicare beneficiaries. We are unable to quantify the number of physicians who have either an ownership or an investment interest in entities that furnish nuclear medicine services and/or supplies. Even if we assume that a substantial number of physicians have ownership or investment interests in these types of entities, we believe that, in general, the economic impact on these physicians would not necessarily be substantial, for the reasons stated below. Physician owners/investors of entities that furnish nuclear medicine services and supplies in a manner that satisfies the requirements of the in-office ancillary services exception would not be affected by this proposed rule. Similarly, a physician's ownership of, or investment in, a rural provider of nuclear medicine services and supplies would not be affected by this rule if the financial relationship complies with the rural provider exception at § 411.356(c)(1), which allows a physician to own and refer to an entity at least 75 percent of all DHS that it furnishes to residents of a rural area, as defined in the physician self-referral statute. We also do not know the extent to which equipment (such as a PET scanner) that was purchased by an entity in which a physician has an ownership or investment interest will be fully depreciated (or mostly so) or functionally obsolete by the time this rule is effective. Although the impact on an individual physician may be significant, we do not believe that physicians, in general, will be significantly affected if they are required to stop making referrals to an entity in which they have an ownership interest. We believe that the majority of physicians receive most of their income from the services they personally provide, and not from nuclear medicine services performed by entities that they own or invest in. In addition, we assume that, unless the physician established the entity to serve only his 
                        ( print page 70328)
                        or her patients, the entity receives referrals from other physicians. Thus, the physician may still receive a return on the ownership or investment. Likewise, we do not believe that a physician's divestiture of his or her ownership interest would necessarily have a significant economic effect. We assume, that, from an economic standpoint, most physicians invest in entities because they are income producing. If an investment is successful, a physician should have little difficulty finding new investors willing to acquire the physician's investment. We are unable to quantify the number of physicians who would wish to divest his or her ownership interest as a result of this rule, nor are we able to ascertain the degree to which these physicians would sell their ownership interests at a loss or profit. We believe the cost of divestiture will vary from situation to situation. Also, since the rule is not effective until January 1, 2007, this will give those physicians who wish to divest additional time to find a suitable buyer and will allow those physicians an additional year in which to depreciate their nuclear medicine equipment. We expect that this change may result in savings to both the Medicare and Medicaid programs by minimizing anti-competitive business arrangements as well as financial incentives that encourage over-utilization of costly nuclear medicine services. We cannot gauge with any certainty the extent of these savings to either program at this time. N. Alternatives Considered This final rule with comment contains a range of policies, including some which are related to specific MMA provisions. The preamble provides descriptions of the statutory provisions that are addressed, identifies those policies when discretion has been exercised, presents rationale for our decisions and, where relevant, alternatives that were considered. We considered making our proposal to include diagnostic and therapeutic nuclear medicine services and supplies as a DHS effective immediately; however, we are persuaded that delaying the effective date until January 1, 2007 would be less disruptive to physicians who may choose to divest their investment and to beneficiaries who may need to receive services and supplies at another location. O. Impact on Beneficiaries There are a number of changes made in this final rule with comment that would have an effect on beneficiaries. In general, we believe these changes will improve beneficiary access to services that are currently covered or will expand the Medicare benefit package to include new services. As explained in more detail below, the regulatory provisions may affect beneficiary liability in some cases. Any changes in aggregate beneficiary liability from a particular provision will be a function of the coinsurance (20 percent if applicable for the particular provision after the beneficiary has met the deductible) and the effect of the aggregate cost (savings) of the provision on the calculation of the Medicare Part B premium rate (generally 25 percent of the provision's cost or savings). To illustrate this point, under this final rule with comment the 2006 national payment amount in the nonfacility setting for CPT code 99203, as shown in Table 50, is $92.61 which means that, in 2006, the beneficiary coinsurance for this service would be $18.52. In addition, as with the 2005 chemotherapy demonstration project, the Medicare beneficiaries, or their supplemental insurers, who receive office-based cancer treatment, will be liable for the 20 percent Part B coinsurance on the G codes billed under the 2006 oncology demonstration. The service linking the payment of the demonstration fee has changed from a chemotherapy infusion or push service in 2005 to an established office visit of level 2, 3, 4, or 5 in 2006. The demonstration fee payment will be lower per unit of service for the Medicare beneficiary in 2006 than 2005 thus, we expect that the coinsurance liability for a Medicare beneficiary will be reduced. However, the total impact on a beneficiary will depend upon the specific services received during 2006. Very few of the changes we are making impact overall payments and therefore will affect Medicare beneficiaries' coinsurance liability. Changes discussed above that do affect overall spending would similarly impact beneficiaries' coinsurance. For example, we have tried to ensure that the rule concerning physician self-referral for nuclear medicine services would not adversely impact the medical care of Medicare or Medicaid patients. We recognize that our proposal may have an impact on current arrangements under which patients are receiving medical care, and that some financial arrangements may have to be restructured for patients to continue receiving medically necessary nuclear medicine services and supplies at the same location or from the same entity. Therefore, we are delaying the effective date of this provision until January 1, 2007. Implementation of this rule is consistent with the statutory intent of section 1877(h) of the Act. This final rule with comment may help minimize anti-competitive behavior that can affect where a beneficiary receives health care services. It may also reduce the potential for overutilization, and thus, decrease the number of unnecessary tests or procedures to which Medicare and Medicaid patients are subjected. With respect to the CAP provisions, we do not expect, during the first year of the program, that there will be an appreciable difference to the beneficiaries if their drugs were to be administered by a physician participating in the CAP or purchasing them and being reimbursed for them within the ASP payment system. At least initially, until approved CAP vendors, participating CAP physicians, and CMS gain more experience with this new program, we do not anticipate there would be any significant additional costs or savings to a beneficiary whose physician participates in the CAP. The CAP should be largely transparent to the beneficiary population. The only change should be the entity that bills the beneficiary for the coinsurance. We also do not believe that beneficiaries would experience drug access issues as a result of implementation of the CAP. However, we intend to monitor beneficiary access closely and may propose additional changes to our payment system in the future, if necessary. P. Accounting Statement As required by OMB Circular A-4 (available at 
                        *http://www.whitehouse.gov/​omb/​circulars/​a004/​a-4.pdf*), in Table 54 we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this final rule with comment. Table 54 includes the impact of the changes in this rule on providers and suppliers and encompasses the −4.4 percent negative update to the PFS based on the statutory SGR formula. Expenditures are classified as transfers to Medicare providers or suppliers (that is, ESRD facilities and physicians, other practitioners and medical suppliers, including CAP vendors, that receive payment under the PFS or Medicare Part B). 
                        ( print page 70329) Table 54.—Accounting Statement: Classification of Estimated Expenditures, From CY 2005 to the CY 2006
[In millions]
Category
TransfersAnnualized Monetized Transfers
Negative transfer—Estimated decrease in expenditures $2668.From Whom To Whom?
Federal Government To ESRD Medicare Providers; physicians, other practitioners and suppliers, including CAP vendors that receive payment under the Medicare Physician Fee Schedule; and Medicare Suppliers billing for Part B drugs.
 In accordance with the provisions of Executive Order 12866, this final rule with comment was reviewed by the Office of Management and Budget. List of Subjects 42 CFR Part 405 Administrative practice and procedure
Health facilities
Health professions
Kidney diseases
Medical devices
Medicare
Reporting and recordkeeping requirements
Rural areas
X-rays 42 CFR Part 410 Health facilities
Health professions
Kidney diseases
Laboratories
Medicare
Reporting and recordkeeping requirements
Rural areas
X-rays 42 CFR Part 411 Kidney diseases
Medicare
Physician Referral
Reporting and record keeping requirements 42 CFR Part 413 Health facilities
Kidney diseases
Medicare
Reporting and recordkeeping requirements 42 CFR Part 414 Administrative practice and procedure
Health facilities
Health professions
Kidney diseases
Medicare
Reporting and recordkeeping requirements 42 CFR Part 424 Emergency medical services
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements 42 CFR Part 426 Administrative practice and procedure
Medicare
Reporting and recordkeeping requirements
 For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR chapter IV as set forth below: PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
 1.The authority citation for part 405 continues to read as follows: Authority:
                            Secs. 1102, 1861, 1862(a), 1871, 1874, 1881, and 1886(k) of the Social Security Act (42 U.S.C. 1302, 1395x, 1395y(a), 1395hh, 1395kk, 1395rr, and 1395ww(k)), and sec. 353 of the Public Health Service Act (42 U.S.C. 263a). Subpart D—Private Contracts
 2.Section 405.435 is amended by— A. Revising paragraph (b) introductory text. B. Adding paragraph (d). The revision and addition read as follows: § 405.435
  
 (b) If a physician or practitioner fails to maintain opt-out in accordance with paragraph (a) of this section, then, for the remainder of the opt-out period, except as provided by paragraph (d) of this section— 
 (d) If a physician or practitioner demonstrates that he or she has taken good faith efforts to maintain opt-out (including by refunding amounts in excess of the charge limits to beneficiaries with whom he or she did not sign a private contract) within 45 days of a notice from the carrier of a violation of paragraph (a) of this section, then the requirements of paragraphs (b)(1) through (b)(8) of this section are not applicable. In situations where a violation of paragraph (a) of this section is not discovered by the carrier during the 2-year opt-out period when the violation actually occurred, then the requirements of paragraphs (b)(1) through (b)(8) of this section are applicable from the date that the first violation of paragraph (a) of this section occurred until the end of the opt-out period during which the violation occurred (unless the physician or practitioner takes good faith efforts, within 45 days of any notice from the carrier that the physician or practitioner failed to maintain opt-out, or within 45 days of the physician's or practitioner's discovery of the failure to maintain opt-out, whichever is earlier, to correct his or her violations of paragraph (a) of this section. Good faith efforts include, but are not limited to, refunding any amounts collected in excess of the charge limits to beneficiaries with whom he or she did not sign a private contract.
 Subpart X—Rural Health Clinic and Federally Qualified Health Center Services
 3.Add § 405.2469 to read as follows: § 405.2469
  Federally Qualified Health Centers under contract (directly or indirectly) with Medicare Advantage organizations are eligible for supplemental payments for covered Federally Qualified Health Center services furnished to enrollees in Medicare Advantage plans offered by the Medicare Advantage organization to cover the difference, if any, between their payments from the Medicare Advantage plan and what they would receive under the cost-based Federally Qualified Health Center payment system. (a) 
                                *Calculation of supplemental payment.*
                                 (1) The supplemental payment for Federally Qualified Health Center covered services provided to Medicare patients enrolled in Medicare Advantage plans is based on— (i) The difference between payments received by the center from the Medicare Advantage plan as determined on a per visit basis; (ii) The Federally Qualified Health Center's all-inclusive cost-based per visit rate as set forth in this subpart; (iii) Less any amount the FQHC may charge as described in section 1857(e)(3)(B) of the Act. (2) Any financial incentives provided to Federally Qualified Health Centers under their Medicare Advantage contracts, such as risk pool payments, bonuses, or withholds, are prohibited from being included in the calculation of supplemental payments due to the Federally Qualified Health Center. 
                                ( print page 70330) (b) 
                                *Per visit supplemental payment.*
                                 A supplemental payment required under this section is made to the Federally Qualified Health Center when a covered face-to-face encounter occurs between a Medicare Advantage enrollee and a practitioner as set forth in § 405.2463.
 PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
 4.The authority citation for part 410 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). Subpart B—Medical and Other Health Services
 5.Section 410.23 is amended by— A. Revising paragraphs (a)(2)(i) through (iii). B. Adding a new paragraph (a)(2)(iv). The revision and addition read as follows: § 410.23
  (a) * * * (2) * * * (i) Individual with diabetes mellitus. (ii) Individual with a family history of glaucoma. (iii) African-Americans age 50 and over. (iv) Hispanic-Americans age 65 and over.
 6.Section 410.78 is amended by— A. Revising paragraph (b) introductory text. B. Adding paragraph (b)(2)(viii). The revision and addition read as follows: § 410.78
  
 (b) 
                                *General rule.*
                                 Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management, end stage renal disease related services included in the monthly capitation payment (except for one visit per month to examine the access site), and individual medical nutrition therapy furnished by an interactive telecommunications system if the following conditions are met: 
 (2) * * * (viii) A registered dietitian or nutrition professional as described in § 410.134.
 PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT
 7.The authority citation for part 411 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). Subpart J—Financial Relationships Between Physicians and Entities Furnishing Designated Health Services
 8.Section 411.351 is amended by— A. Revising the definition of “Radiation therapy services and supplies”. B. Revising the definition of “Radiology and certain other imaging services”. C. Revising the introductory text of paragraph (2) of the definition of “Referral”. The revisions read as follows: § 411.351
  
 *Radiation therapy services and supplies*
                                 means those particular services and supplies, including (effective January 1, 2007) therapeutic nuclear medicine services and supplies, so identified on the List of CPT/HCPCS Codes. All services and supplies so identified on the List of CPT/HCPCS Codes are radiation therapy services and supplies for purposes of this subpart. Any service or supply not specifically identified as radiation therapy services or supplies on the List of CPT/HCPCS Codes is not a radiation therapy service or supply for purposes of this subpart. The list of codes identifying radiation therapy services and supplies is based on section 1861(s)(4) of the Act and § 410.35 of this chapter. *Radiology and certain other imaging services*
                                 means those particular services so identified on the List of CPT/HCPCS Codes. All services so identified on the List of CPT/HCPCS Codes are radiology and certain other imaging services for purposes of this subpart. Any service not specifically identified as radiology and certain other imaging services on the List of CPT/HCPCS Codes is not a radiology or certain other imaging service for purposes of this subpart. The list of codes identifying radiology and certain other imaging services includes the professional and technical components of any diagnostic test or procedure using x-rays, ultrasound, computerized axial tomography, magnetic resonance imaging, nuclear medicine (effective January 1, 2007), or other imaging services. All codes identified as radiology and certain other imaging services are covered under section 1861(s)(3) of the Act and § 410.32 and § 410.34 of this chapter, but do not include— (1) X-ray, fluoroscopy, or ultrasound procedures that require the insertion of a needle, catheter, tube, or probe through the skin or into a body orifice; and (2) Radiology procedures that are integral to the performance of a nonradiological medical procedure and performed— (i) During the nonradiological medical procedure; or (ii) Immediately following the nonradiological medical procedure when necessary to confirm placement of an item placed during the nonradiological medical procedure. Referral— 
 (2) Does not include a request by a pathologist for clinical diagnostic laboratory tests and pathological examination services, by a radiologist for diagnostic radiology services, and by a radiation oncologist for radiation therapy or ancillary services necessary for, and integral to, the provision of radiation therapy, if—
 PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES
 9.The authority citation for part 413 continues to read as follows: Authority:
                            Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and (n), 1871, 1881, 1883, and 1886 of the Social Security Act (42 U.S.C. 1302, 1395D(D), 1395f(b), 1395g, 13951(a), (i), and (n), 1395hh, 1395rr, 1395tt, and 1395ww). Subpart H—Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs
 10.Section 413.170 is amended by revising paragraph (b) to read as follows: § 413.170
  
 (b) Providing procedures and criteria under which a pediatric ESRD facility (an ESRD facility with at least a 50 percent pediatric patient mix as specified in § 413.184 of this subpart) may receive an exception to the prospective payment rates; and
 11.Section 413.174 is amended by— A. Revising paragraph (f). 
                            ( print page 70331) B. Removing paragraph (g). The revision reads as follows: § 413.174
  
 (f) 
                                *Additional payment for separately billable drugs.*
                                 CMS makes an additional payment for certain drugs furnished to ESRD patients by a Medicare-approved ESRD facility. CMS makes this payment directly to the ESRD facility. Payment for these drugs is made— (1) Only on an assignment basis, directly to the facility which must accept, as payment in full, the amount that CMS determines; (2) Subject to the Part B deductible and coinsurance; (3) Effective January 1, 2006, to hospital-based ESRD facilities in accordance with the methodology specified in § 414.904 of this subchapter. (4) To independent ESRD facilities in accordance with the methodology specified in § 405.517 of this subchapter.
 12.Section 413.180 is amended by— A. Revising paragraphs (b) and (d) B. Removing paragraphs (e) and (k). C. Redesignating paragraphs (f) through (j) as paragraphs (e) through (i). D. Revising newly redesignated paragraph (i). E. Redesignating paragraphs (l) and (m) as paragraphs (j) and (k). F. Revising newly redesignated paragraph (k). The revisions read as follows: § 413.180
  
 (b) 
                                *Criteria for requesting an exception.*
                                 If a pediatric ESRD facility projects on the basis of prior year costs and utilization trends that it has an allowable cost per treatment higher than its prospective rate set under § 413.174, and if these excess costs are attributable to one or more of the factors in § 413.182, the facility may request, in accordance with paragraph (e) of this section, that CMS approve an exception to that rate and set a higher prospective payment rate. 
 (d) 
                                *Payment rate exception request.*
                                 Effective October 1, 2002, CMS may approve exceptions to a pediatric ESRD facility's updated prospective payment rate, if the pediatric ESRD facility did not have an approved exception rate as of October 1, 2002. A pediatric ESRD facility may request an exception to its payment rate at any time after it is in operation for at least 12 consecutive months. 
 (i) 
                                *Period of approval: Payment exception request.*
                                 A prospective exception payment rate approved by CMS applies for the period from the date the complete exception request was filed with its intermediary until 30 days after the intermediary's receipt of the facility's letter notifying the intermediary of the facility's request to give up its exception rate and be subject to the basic case-mix adjusted composite payment rate methodology. ESRD facilities electing to retain their nonpediatric or pediatric exception rates (including self-dialysis training) do not need to notify their intermediaries. Once a facility notifies its fiscal intermediary in writing that it cannot retain its current exception rate, that decision cannot be subsequently reversed. 
 (k) 
                                *Criteria for refiling a denied exception request.*
                                 A pediatric ESRD facility that was denied an exception request may immediately file another exception request. Any subsequent exception request must address and document the issues cited in CMS' denial letter.
 13.Section 413.182 is revised to read as follows: § 413.182
  (a) CMS may approve exceptions to a pediatric ESRD facility's prospective payment rate if the pediatric ESRD facility did not have an approved exception rate as of October 1, 2002. (b) The pediatric ESRD facility must demonstrate, by convincing objective evidence, that its total per treatment costs are reasonable and allowable under the relevant cost reimbursement principles of part 413 and that its per treatment costs in excess of its payment rate are directly attributable to any of the following criteria: (1) Pediatric patient mix, as specified in § 413.184. (2) Self-dialysis training costs in pediatric facilities, as specified in § 413.186.
 14.Section 413.184 is amended by revising paragraphs (a) and (b)(1) to read as follows: § 413.184
  (a) 
                                *Qualifications.*
                                 To qualify for an exception to its prospective payment rate based on its pediatric patient mix a facility must demonstrate that— (1) At least 50 percent of its patients are individuals under 18 years of age; (2) Its nursing personnel costs are allocated properly between each mode of care; (3) The additional nursing hours per treatment are not the result of an excess number of employees; (4) Its pediatric patients require a significantly higher staff-to-patient ratio than typical adult patients; and (5) These services, procedures, or supplies and their per treatment costs are clearly prudent and reasonable when compared to those of pediatric facilities with a similar patient mix. (b) 
                                *Documentation.*
                                 (1) A pediatric ESRD facility must submit a listing of all outpatient dialysis patients (including all home patients) treated during the most recently completed and filed cost report (in accordance with cost reporting requirements under § 413.198) showing— (i) Age of patients and percentage of patients under the age of 18; (ii) Individual patient diagnosis; (iii) Home patients and ages; (iv) In-facility patients, staff-assisted, or self-dialysis; (v) Diabetic patients; and (vi) Patients isolated because of contagious disease.
 
 § 413.186
 15.Section 413.186 is removed. § 413.188
 16.Section 413.188 is removed. § 414.190
 17.Redesignate § 413.190 as § 413.186 and revise the newly designated § 413.186 to read as follows: § 413.186
  (a) 
                                *Qualification.*
                                 To qualify for an exception to the prospective payment rate based on self-dialysis training costs, the pediatric ESRD facility must establish that it incurs per treatment costs for furnishing self-dialysis and home dialysis training that exceed the facility's payment rate for the training sessions. (b) 
                                *Justification.*
                                 To justify its exception request, a facility must— (1) Separately identify those elements contributing to its costs in excess of the composite training rate; and (2) Demonstrate that its per treatment costs are reasonable and allowable. (c) 
                                *Criteria for determining proper cost reporting.*
                                 CMS considers the pediatric ESRD facility's total costs, cost finding and apportionment, including its allocation of costs, to determine if costs are properly reported by treatment modality. (d) 
                                *Limitation of exception requests.*
                                 Exception requests for a higher training rate are limited to those cost 
                                ( print page 70332)
                                components relating to training such as technical staff, medical supplies, and the special costs of education (manuals and education materials). These requests may include overhead and other indirect costs to the extent that these costs are directly attributable to the additional training costs. (e) 
                                *Documentation.*
                                 The pediatric ESRD facility must provide the following information to support its exception request: (1) A copy of the facility's training program. (2) Computation of the facility's cost per treatment for maintenance sessions and training sessions including an explanation of the cost difference between the two modalities. (3) Class size and patients' training schedules. (4) Number of training sessions required, by treatment modality, to train patients. (5) Number of patients trained for the current year and the prior 2 years on a monthly basis. (6) Projection for the next 12 months of future training candidates. (7) The number and qualifications of staff at training sessions. (f) 
                                *Accelerated training exception.*
                                 (1) A pediatric ESRD facility may bill Medicare for a dialysis training session only when a patient receives a dialysis treatment (normally 3 times a week for hemodialysis). Continuous cycling peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD) are daily treatment modalities; ESRD facilities are paid the equivalent of three hemodialysis treatments for each week that CCPD and CAPD treatments are provided. (2) If a pediatric ESRD facility elects to train all its patients using a particular treatment modality more often than during each dialysis treatment and, as a result, the number of billable training dialysis sessions is less than the number of actual training sessions, the facility may request a composite rate exception, limited to the lesser of the— (i) Facility's projected training cost per treatment; or (ii) Cost per treatment the facility receives in training a patient if it had trained patients only during a dialysis treatment, that is, three times per week. (3) An ESRD facility may bill a maximum of 25 training sessions per patient for hemodialysis training and 15 sessions for CCPD and CAPD training. (4) In computing the payment amount under an accelerated training exception, CMS uses a minimum number of training sessions per patient (15 for hemodialysis and 5 for CAPD and CCPD) when the facility actually provides fewer than the minimum number of training sessions. (5) To justify an accelerated training exception request, an ESRD facility must document that a significant number of training sessions for a particular modality are provided during a shorter but more condensed period. (6) The facility must submit with the exception request a list of patients, by modality, trained during the most recent cost report period. The list must include each beneficiary's— (i) Name; (ii) Age; and (iii) Training status (completed, not completed, being retrained, or in the process of being trained). (7) The total treatments from the patient list must be the same as the total treatments reported on the cost report filed with the request.
 § 413.192
 18.Section 413.192 is removed. PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
 19.The authority citation for part 414 continues to read as follows: Authority:
                            Secs. 1102, 1871, and 1881(b)(1) of the Social Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)). Subpart B—Physicians and Other Practitioners
 20.Section 414.65 is amended by revising paragraph (a)(1) to read as follows:. § 414.65
  (a) * * * (1) The Medicare payment amount for office or other outpatient visits, consultation, individual psychotherapy, psychiatric diagnostic interview examination, pharmacologic management, end stage renal disease related services included in the monthly capitation payment (except for one visit per month to examine the access site), and individual medical nutrition therapy furnished via an interactive telecommunications system is equal to the current fee schedule amount applicable for the service of the physician or practitioner.
 Subpart J—Submission of Manufacture's Average Sales Price Data
 21.Section 414.804(a) is amended by revising paragraph (a)(3)(iv) to read as follows: § 414.804
  (a) * * * (3) * * * (iv) 
                                *Example.*
                                 The total lagged price concessions (discounts, rebates, etc.) over the most recent 12-month period available associated with direct sales for National Drug Code 12345-6789-01 subject to the ASP reporting requirement equal $200,000. The total in dollars for the sales subject to the average sales price reporting requirement for the same period equals $600,000. The lagged price concessions percentage for this period equals 200,000/600,000 = .33333. The total in dollars for the direct sales subject to the average sales price reporting requirement for the quarter being reported equals $50,000 for 10,000 units sold. Assuming no non-lagged price concessions apply, the manufacturer's average sales price calculation for this National Drug Code for this quarter is: $50,000−(0.33333 × $50,000) = $33,334 (net total sales amount); $33,334/10,000 = $3.33 (average sales price).
 
 22.Section 414.904 is amended by— A. Revising paragraph (a) introductory text. B. Adding a new paragraph (d)(2)(iii). C. Revising paragraphs (d)(3) and (e)(2). The revisions and additions read as follows: § 414.904
  (a) 
                                *Method of payment.*
                                 Payment for a drug furnished on or after January 1, 2005 is based on the lesser of— 
 (d) * * * (2) * * * (iii) Effective for drugs and biologicals furnished in 2006, the payment for such drugs and biologicals furnished in connection with renal dialysis services and separately billed by freestanding and hospital-based renal dialysis facilities not paid on a cost basis is 106 percent of the average sales price. (3) 
                                *Widely available market price and average manufacturer price.*
                                 If the Inspector General finds that the average sales price exceeds the widely available market price or the average manufacturer price by 5 percent or more in calendar year 2006, the payment limit in the quarter following the transmittal of this information to the Secretary is the lesser of the widely available market price or 103 percent of the average manufacturer price. (e) * * * (2) 
                                *Infusion drugs furnished through a covered item of durable medical equipment.*
                                 The payment limit for an 
                                ( print page 70333)
                                infusion drug furnished through a covered item of durable medical equipment is calculated using 95 percent of the average wholesale price in effect on October 1, 2003 and is not updated in 2006.
 
 23.Section 414.906 is amended by revising paragraph (f) to read as follows: § 414.906
  
 (f) 
                                *Substitution or addition of drugs on an approved CAP vendor's CAP drug list.*
                                 (1) 
                                *Short-term substitution of a CAP drug.*
                                 On an occasional basis (for a period of time less than 2 weeks), an approved CAP vendor may agree to furnish a substitute NDC within a HCPCS code on the approved CAP vendor's CAP drug list if the approved CAP vendor— (i) Is willing to accept the payment amount that was established for the HCPCS code under this section; and (ii) Obtains the participating CAP physician's prior approval. (2) 
                                *Long-term substitution or addition of a CAP drug.*
                                 An approved CAP vendor may submit a request, as specified in paragraph (f)(3) of this section, for approval to substitute an NDC supplied by the approved CAP vendor for another NDC within the same HCPCS code or to add an NDC to the approved CAP vendor's drug list, if at least one of the following criteria is met: (i) Proposed substitution of an NDC for a period of 2 weeks or longer. (ii) Proposed addition of one or more NDCs within a HCPCS code included in the CAP drug category specified by CMS or on the approved CAP vendor's approved CAP drug list. (iii) Proposed addition of— (A) One or more newly issued HCPCS codes; or (B) One of the following single indication orphan drug J codes or their updates: J0205, J0256, J9300, J1785, J2355, J3240, J7513, J9010, J9015, J9017, J9160, J9216. (iv) Beginning January 1, 2007, the proposed addition of a drug(s) that has not yet been assigned a HCPCS code, but for which a HCPCS code must be established. (3) 
                                *Requesting the addition or substitution of CAP drug*. An approved CAP vendor that meets the one of the criteria specified in paragraph (f)(2) must submit a written request to CMS or its designee. The request must— (i) Specify the NDC(s) and the respective HCPCS code that is to be added or substituted. (ii) Address the rationale for the substitution or addition of the NDC(s) or the addition of the HCPCS code(s) as applicable; and (iii) Address the impact of the substitution of the NDC(s) or the addition of the NDC(s) or HCPCS code(s), or both on— (A) Patient and drug safety; (B) Drug waste; and (C) The potential for cost savings. (4) 
                                *Approval of a request(s)*. CMS or its designee notifies the approved CAP vendor of its decision. (i) Except as specified in paragraph (f)(4)(ii) of this section, an approved request is effective at the beginning of the next calendar quarter. (ii) Approved substitutions for request based on a drug shortage or other exigent circumstance may become effective immediately provided that— (A) CMS approves the immediate substitution; and (B) The approved CAP vendor's notifies its CAP participating physicians of the substitution immediately following CMS approval. (5) 
                                *Payment for an approved drug change(s)*. The payment for— (i) Substituted or added CAP drugs that are within a HCPCS code for which payment is computed under paragraph (c)(1) of this section is the single payment for that HCPCS code, as determined and updated in accordance with paragraph (c)(1) of this section; or (ii) Added CAP drugs that are not within a HCPCS code for which payment is computed under paragraph (c)(1) of this section is specified under paragraph (c)(2) of this section.
 24.Section 414.908 is amended by— A. Revising paragraphs (a)(3)(v)(M). B. Redesignating paragraphs (a)(3)(vi) through (a)(3) (xii) as (a)(3)(viii) through (a)(3)(xiv). C. Adding new paragraphs (a)(3)(vi) and (a)(3)(vii). D. Revising paragraph (a)(5). The revisions and additions read as follows: § 414.908
  (a) * * * (3) * * * (v) * * * (M) Additional patient information: date of birth, allergies, height/weight, ICD-9-CM (if necessary). (vi) Agrees to accept the particular National Drug Codes (NDCs) supplied by the approved CAP vendor for the duration of the participating CAP physician's enrollment with the approved CAP vendor, subject to paragraphs (a)(3)(vii) and (a)(3)(xiv) of this section. By electing to participate with an approved CAP vendor, the participating CAP physician also agrees to accept the changes to the approved CAP vendor's CAP drug list that have been approved in accordance with § 414.906(f). (vii) Agrees to place routine orders for CAP drugs at the HCPCs level, except when medical necessity requires a particular formulation on the approved CAP vendor's CAP drug list. Medical necessity must be documented. When the conditions of this paragraph are met, the participating CAP physician may submit a prescription order to the approved CAP vendor that specifies the NDC. 
 (5) 
                                *Additional opt out provision*. In addition to the circumstances listed in paragraph (a)(2) of this section, if the approved CAP vendor refuses to ship to the participating CAP physician because the conditions of § 414.914(h) were met, the physician can withdraw from the CAP category for the remainder of the year immediately upon notice to CMS and the approved CAP vendor.
 25.Section 414.914 is amended by— A. Redesignating paragraphs (f)(9) through (f)(11) as paragraphs (f)(14) through (f)(16). B. Redesignating (f)(5) through (f)(8) as paragraphs (f)(9) through (f)(12) and paragraphs. C. Adding new paragraphs (f)(5) through (f)(8) and (f)(13). D. Revising paragraph (g)(3). E. Revising paragraphs (h)(1) through (h)(3), (h)(5) and (h)(6), and (h)(8). The revisions and additions read as follows: § 414.914
  
 (f) * * * (5) Respond within 2 business days to any inquiry, or sooner if the inquiry is related to drug quality; (6) Staff a toll-free telephone line from 8:30 a.m. or earlier and until 5 p.m. or later for all time zones served in the continental United States by the CAP vendor on business days (Monday through Friday excluding Federal holidays) to provide customer assistance, and establish reasonable hours of operation for Hawaii, Alaska, Puerto Rico, and the other U.S. territories; (7) Staff an emergency toll-free telephone line for weekend and evening access when the call center is closed, and determine what hours on Saturday and Sunday the call center is staffed and which hours a toll-free emergency line is activated; and (8) Include assistance for the disabled, the hearing impaired, and Spanish-
                                ( print page 70334)
                                speaking inquirers in all customer service operations. 
 (13) Provide direct notification to participating CAP physicians enrolled with them of updates to the approved CAP vendor's CAP drug list on a quarterly basis. Changes must be disseminated at least 30 days before the approved changes are due to take effect, unless immediate notification as described in § 414.906(f)(4) is required. The approved CAP vendor's entire CAP drug list must be disseminated at least once yearly; and approved CAP vendors must make a complete list that incorporates the most recent updates available to physicians on an ongoing basis. CMS posts on its web site the updated CAP drug lists for each approved CAP vendor. 
 (g) * * * (3) A full or partial waiver of the cost-sharing amount after determining in good faith that the individual is in financial need or the failure of reasonable collection efforts, provided that the waiver meets all of the requirements of section 1128A(i)(6)(A) of the Act and the corresponding regulations at paragraph (1) of the definition of “Remuneration” in § 1003.101 of this title. The availability of waivers may not be advertised or be made as part of a solicitation. Approved CAP vendors must inform beneficiaries that they generally make available the categories of assistance described in paragraphs (g)(1), (g)(2), and (g)(3) of this section. In no event may the approved CAP vendor include or make any statements or representations that promise or guarantee that beneficiaries receive cost-sharing waivers. (h) * * * (1) Subsequent to receipt of final payment by Medicare, or the verification of drug administration by the participating CAP physician, the approved CAP vendor must bill any applicable supplemental insurance policies. (2) If a balance remains, after the supplemental insurer pays their share of the bill, or if there is no supplemental insurance, the approved CAP vendor may bill the beneficiary. (3) At the time of billing the beneficiary, or the participating CAP physician's presentation of the bill on behalf of the approved CAP vendor, the approved CAP vendor must inform the beneficiary of any types of cost-sharing assistance that may be available consistent with the requirements of section 1128A(a)(5) of the Act and § 414.914(g). (4) * * * (5) For purposes of paragraph (h) delivery means postmark date, or the date the coinsurance bill or notice was presented to the beneficiary by the participating CAP physician on behalf of the approved CAP vendor. (i) Except as specified in paragraph (h)(5)(ii), if after 45 days from delivery of the approved CAP vendor's bill to the beneficiary, the beneficiary's cost-sharing obligation remains unpaid, the approved CAP vendor may refuse further shipments to the participating CAP physician for that beneficiary. (ii) If the beneficiary has requested cost-sharing assistance within 45 days of receiving delivery of the approved CAP vendor's bill, provisions of paragraphs (h)(6), (h)(7), or (h)(8) of this section, apply. (6) If the approved CAP vendor implements a reasonable payment plan, as specified in § 414.914(g)(2), the approved CAP vendor must continue to ship CAP drugs for the beneficiary, as long as the beneficiary remains in compliance with the payment plan and makes an initial payment under the plan within 15 days after the delivery of the approved CAP vendor's written notice to the beneficiary offering the payment plan. (7) * * * (8) If the approved CAP vendor refers the beneficiary to a bona fide and independent charity in accordance with § 414.914(g)(1), the approved CAP vendor may refuse to ship drugs if the past due balance is not paid 15 days after the date of delivery of the approved CAP vendor's written notice to the beneficiary containing the referral for cost-sharing assistance.
 Subpart L—Supplying and Dispensing Fees
 26.Section 414.1001 is revised to read as follows: § 414.1001
  (a) 
                                *Supplying fees*. Beginning in CY 2006— (1) A supplying fee of $24 is paid to a pharmacy for the first prescription of drugs and biologicals described in sections 1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the Act, that the pharmacy provided to a beneficiary during a 30-day period. (2) A supplying fee of $16 is paid to a pharmacy for each prescription following the first prescription (as specified in paragraph (a)(1) of this section) of drugs and biologicals described in sections 1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the Act, that the pharmacy provided to a beneficiary during a 30-day period. (3) A separate supplying fee is paid to a pharmacy for each prescription of drugs and biologicals described in sections 1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the Act. (b) 
                                *Supplying fees following transplant*. Beginning CY 2006—(1) A supplying fee of $50 is paid to pharmacy for the initial supplied prescription of drugs and biologicals described in section 1861(s)(2)(J) of the Act, that the pharmacy provided to a patient during the first 30-day period following a transplant. (2) A supplying fee of $16 is paid to a pharmacy for each prescription following an initial prescription after a transplant (as specified in paragraph (b)(1) of this section) of drugs and biologicals describe in section 1861(s)(2)(J) of the Act, that the pharmacy provided to a beneficiary during a 30-day period. (c) 
                                *30-day dispensing fees*. Beginning CY 2006—(1) A dispensing fee of $57 is paid to a supplier to the extent that the prescription is for the initial dispensed 30-day supply of inhalation drugs furnished through durable medical equipment covered under section 1861(n) of the Act, regardless of the number of partial shipments of that 30-day supply. (2) Except for supplied inhalation drugs that meet criteria described in paragraph (c)(1) of this section, a dispensing fee of $33 is paid for each dispensed 30-day supply of inhalation drugs furnished through durable medical equipment covered under section 1861(n) of the Act, regardless of the number of partial shipments of that 30-day supply. (d) 
                                *90-day dispensing fee*. Beginning CY 2006, a dispensing fee of $66 is paid to a supplier for each dispensed 90-day supply of inhalation drugs furnished through durable medical equipment covered under section 1861(n) of the Act, regardless of the number of partial shipments of that 90-day supply.
 PART 424—CONDITIONS FOR MEDICARE PAYMENT
 27.The authority citation for part 424 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). § 424.22
 28.In § 424.22— A. The footnote for paragraph (a)(1)(iv), the term “hosptial” is removed and the term “hospital” is added in its place.
                            ( print page 70335) B. Paragraph (d), remove the reference to “§ 411.351” and add in its place the reference “§ 411.354”. PART 426—REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS
 29.The authority citation for part 426 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 30.The heading for Part 426 is revised to read as set forth above. Subpart C—General Provisions for the Review of LCDs and NCDs
 31.Section 426.340 is amended by revising paragraphs (e)(2) and (f)(2) to read as follows: § 426.340
  
 (e) * * * (2) Sets a reasonable timeframe— (i) For LCDs, of not more than 90 days, by which the contractor completes the reconsideration; or (ii) For NCDs, in compliance with the timeframes specified in section 1862(1) of the Act, by which CMS completes the reconsideration. (f) * * * (2) Does not meet— (i) For LCDs, the 90-day reconsideration timeframe; or (ii) For NCDs, the reconsideration timeframe specified by the Board, in compliance with section 1862(1) of the Act.
 (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: October 26, 2005. Mark B. McClellan, Administrator, Centers for Medicare & Medicaid Services. Approved: November 1, 2005. Michael O. Leavitt, Secretary.
 Note: These addenda will not appear in the Code of Federal Regulations. Addendum A: Explanation and Use of Addenda B The addenda on the following pages provides various data pertaining to the Medicare fee schedule for physicians' services furnished in 2006. Addendum B contains the RVUs for work, non-facility PE, facility PE, and malpractice expense, and other information for all services included in the PFS. In previous years, we have listed many services in Addendum B that are not paid under the PFS. To avoid publishing as many pages of codes for these services, we are not including clinical laboratory codes and most alpha-numeric codes (Healthcare Common Procedure Coding System (HCPCS) codes not included in CPT) in Addendum B. Addendum B—2006 Relative Value Units and Related Information Used in Determining Medicare Payments for 2006 This addendum contains the following information for each CPT code and alphanumeric HCPCS code, except for: alphanumeric codes beginning with B (enteral and parenteral therapy), E (durable medical equipment), K (temporary codes for nonphysicians' services or items), or L (orthotics); and codes for anesthesiology. Please also note the following: An “NA” in the “Non-facility PE RVUs” column of Addendum B means that CMS has not developed a PE RVU in the non-facility setting for the service because it is typically performed in the hospital (for example, an open heart surgery is generally performed in the hospital setting and not a physician's office).
                    Services that have an “NA” in the “Facility PE RVUs” column of Addendum B are typically not paid using the PFS when provided in a facility setting. These services (which include “incident to” services and the technical portion of diagnostic tests) are generally paid under either the outpatient hospital prospective payment system or bundled into the hospital inpatient prospective payment system payment. 1. 
                        *CPT/HCPCS code.*
                         This is the CPT or alphanumeric HCPCS number for the service. Alphanumeric HCPCS codes are included at the end of this addendum. 2. 
                        *Modifier.*
                         A modifier is shown if there is a technical component (modifier TC) and a professional component (PC) (modifier -26) for the service. If there is a PC and a TC for the service, Addendum B contains three entries for the code. A code for: the global values (both professional and technical); modifier -26 (PC); and, modifier TC. The global service is not designated by a modifier, and physicians must bill using the code without a modifier if the physician furnishes both the PC and the TC of the service. Modifier -53 is shown for a discontinued procedure. There will be RVUs for the code (CPT code 45378) with this modifier. 3. 
                        *Status indicator.*
                         This indicator shows whether the CPT/HCPCS code is in the PFS and whether it is separately payable if the service is covered. A = Active code. These codes are separately payable under the PFS if covered. There will be RVUs for codes with this status. The presence of an “A” indicator does not mean that Medicare has made a national coverage determination regarding the service. Carriers remain responsible for coverage decisions in the absence of a national Medicare policy. B = Bundled code. Payments for covered services are always bundled into payment for other services not specified. If RVUs are shown, they are not used for Medicare payment. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident (an example is a telephone call from a hospital nurse regarding care of a patient). C = Carrier-priced code. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation, such as an operative report. D = Deleted/discontinued code. These codes are deleted effective with the beginning of the CY and are always subject to a 90 day grace period. E = Excluded from the PFS by regulation. These codes are for items and services that CMS choses to exclude from the PFS payment by regulation. No RVUs are shown, and no payment may be made under the PFS for these codes. Payment for them, when covered, continues under reasonable charge procedures. F = Deleted/discontinued codes. (Code not subject to a 90-day grace period.) These codes are deleted effective with the beginning of the CY and are never subject to a grace period. This indicator is no longer effective with the 2006 PFS as of January 1, 2006. G = Code not valid for Medicare purposes. Medicare does not recognize codes assigned this status. Medicare uses another code for reporting of, and payment for, these services. (Code subject to a 90 day grace period.) This indicator is no longer effective with the 2006 PFS as of January 1, 2006. H = Deleted modifier. For 2000 and later years, either the TC or PC component shown for the code has been deleted and the deleted component is shown in the data base with the H status indicator. I = Not valid for Medicare purposes. Medicare uses another code for the 
                        ( print page 70336)
                        reporting of, and the payment for these services. (Code not subject to a 90-day grace period.) N = Noncovered service. These codes are noncovered services. Medicare payment may not be made for these codes. If RVUs are shown, they are not used for Medicare payment. P = Bundled or excluded code. There are no RVUs for these services. No separate payment is made for them under the PFS. —If the item or service is covered as incident to a physician's service and is furnished on the same day as a physician's service, payment for it is bundled into the payment for the physician's service to which it is incident (an example is an elastic bandage furnished by a physician incident to a physician's service). —If the item or service is covered as other than incident to a physician's service, it is excluded from the PFS (for example, colostomy supplies) and is paid under the other payment provisions of the Act. R = Restricted coverage. Special coverage instructions apply. If the service is covered and no RVUs are shown, it is carrier-priced. T = There are RVUs for these services, but they are only paid if there are no other services payable under the PFS billed on the same date by the same provider. If any other services payable under the PFS are billed on the same date by the same provider, these services are bundled into the service(s) for which payment is made. X = Exclusion by law. These codes represent an item or service that is not within the definition of “physicians' services” for PFS payment purposes. No RVUs are shown for these codes, and no payment may be made under the PFS. (Examples are ambulance services and clinical diagnostic laboratory services.) 4. 
                        *Description of code.*
                         This is an abbreviated version of the narrative description of the code. 5. 
                        *Physician work RVUs.*
                         These are the RVUs for the physician work for this service in 2006. Codes that are not used for Medicare payment are identified with a “+.” 6. 
                        *Non-facility practice expense RVUs.*
                         These are the resource-based PE RVUs for non-facility settings. 7. 
                        *Facility practice expense RVUs.*
                         These are the resource-based PE RVUs for facility settings. 8. 
                        *Malpractice expense RVUs.*
                         These are the RVUs for the malpractice expense for the service for 2006. 9. 
                        *Non-facility total.*
                         This is the sum of the work, non-facility practice expense, and malpractice expense RVUs. 10. 
                        *Facility total.*
                         This is the sum of the work, facility PE, and malpractice expense RVUs. 11. 
                        *Global period.*
                         This indicator shows the number of days in the global period for the code (0, 10, or 90 days). An explanation of the alpha codes follows: MMM = The code describes a service furnished in uncomplicated maternity cases including antepartum care, delivery, and postpartum care. The usual global surgical concept does not apply. See the 1999 Physicians' Current Procedural Terminology for specific definitions. XXX = The global concept does not apply. YYY = The global period is to be set by the carrier (for example, unlisted surgery codes). ZZZ = Code related to another service that is always included in the global period of the other service. (
                        **Note:**
                         Physician work and PE are associated with intra service time and in some instances the post service time.)    1 2 3 
 
 Addendum B.—Relative Value Units (RVUs) and Related Information
CPT 1
                                 
                                    HCPCS 2
Mod
Status
Description
Physician 
                                 work  
                                 
                                    RVUs 3
Non- 
                                 Facility  
                                 PE RVUs
Facility 
                                 PE RVUs
Mal- 
                                 practice  
                                 RVUs
Non- 
                                 Facility  
                                 Total
Facility 
                                 Total
Global0001F

I
Heart failure assessed
0.00
0.00
0.00
0.00
0.00
0.00
XXX0003T

C
Cervicography
0.00
0.00
0.00
0.00
0.00
0.00
XXX0005F

I
Osteoarthritis assessed
0.00
0.00
0.00
0.00
0.00
0.00
XXX0008T

C
Upper gi endoscopy w/suture
0.00
0.00
0.00
0.00
0.00
.00
XXX0016T

C
Thermotx choroid vasc lesion
0.00
0.00
0.00
0.00
0.00
0.00
XXX0017T

C
Photocoagulat macular drusen
0.00
0.00
0.00
0.00
0.00
0.00
XXX0018T

C
Transcranial magnetic stimul
0.00
0.00
0.00
0.00
0.00
0.00
XXX0019T

C
Extracorp shock wv tx,ms nos
0.00
0.00
0.00
0.00
0.00
0.00
XXX0021T

C
Fetal oximetry, trnsvag/cerv
0.00
0.00
0.00
0.00
0.00
0.00
XXX0024T

C
Transcath cardiac reduction
0.00
0.00
0.00
0.00
0.00
0.00
XXX0026T

C
Measure remnant lipoproteins
0.00
0.00
0.00
0.00
0.00
0.00
XXX0027T

C
Endoscopic epidural lysis
0.00
0.00
0.00
0.00
0.00
0.00
XXX0028T

C
Dexa body composition study
0.00
0.00
0.00
0.00
0.00
0.00
XXX0029T

C
Magnetic tx for incontinence
0.00
0.00
0.00
0.00
0.00
0.00
XXX0030T

C
Antiprothrombin antibody
0.00
0.00
0.00
0.00
0.00
0.00
XXX0031T

C
Speculoscopy
0.00
0.00
0.00
0.00
0.00
0.00
XXX0032T

C
Speculoscopy w/direct sample
0.00
0.00
0.00
0.00
0.00
0.00
XXX0041T

C
Detect ur infect agnt w/cpas
0.00
0.00
0.00
0.00
0.00
0.00
XXX0042T

C
Ct perfusion w/contrast, cbf
0.00
0.00
0.00
0.00
0.00
0.00
XXX0043T

C
Co expired gas analysis
0.00
0.00
0.00
0.00
0.00
0.00
XXX0044T

C
Whole body photography
0.00
0.00
0.00
0.00
0.00
0.00
XXX0045T

C
Whole body photography
0.00
0.00
0.00
0.00
0.00
0.00
XXX0046T

C
Cath lavage, mammary duct(s
0.00
0.00
0.00
0.00
0.00
0.00
XXX0047T

C
Cath lavage, mammary duct(s)
0.00
0.00
0.00
0.00
0.00
0.00
XXX0048T

C
Implant ventricular device
0.00
0.00
0.00
0.00
0.00
0.00
XXX0049T

C
External circulation assist
0.00
0.00
0.00
0.00
0.00
0.00
XXX0050T

C
Removal circulation assist
0.00
0.00
0.00
0.00
0.00
0.00
XXX0051T

C
Implant total heart system
0.00
0.00
0.00
0.00
0.00
0.00
XXX0052T

C
Replace component heart syst
0.00
0.00
0.00
0.00
0.00
0.00
XXX0053T

C
Replace component heart syst
0.00
0.00
0.00
0.00
0.00
0.00
XXX0054T

C
Bone surgery using computer
0.00
0.00
0.00
0.00
0.00
0.00
XXX0055T

C
Bone surgery using computer
0.00
0.00
0.00
0.00
0.00
0.00
XXX0056T

C
Bone surgery using computer
0.00
0.00
0.00
0.00
0.00
0.00
XXX0058T

C
Cryopreservation, ovary tiss
0.00
0.00
0.00
0.00
0.00
0.00
XXX0059T

C
Cryopreservation, oocyte
0.00
0.00
0.00
0.00
0.00
0.00
XXX0060T

C
Electrical impedance scan
0.00
0.00
0.00
0.00
0.00
0.00
XXX0061T

C
Destruction of tumor, breast
0.00
0.00
0.00
0.00
0.00
0.00
XXX0062T

C
Rep intradisc annulus;1 lev
0.00
0.00
0.00
0.00
0.00
0.00
XXX0063T

C
Rep intradisc annulus;>1lev
0.00
0.00
0.00
0.00
0.00
0.00
XXX0064T

C
Spectroscop eval expired gas
0.00
0.00
0.00
0.00
0.00
0.00
XXX0065T

C
Ocular photoscreen bilat
0.00
0.00
0.00
0.00
0.00
0.00
XXX0066T
26
N
Ct colonography;screen
0.00
0.00
0.00
0.00
0.00
0.00
XXX0066T
TC
N
Ct colonography;screen
0.00
0.00
0.00
0.00
0.00
0.00
XXX0066T

N
Ct colonography;screen
0.00
0.00
0.00
0.00
0.00
0.00
XXX0067T
26
C
Ct colonography;dx
0.00
0.00
0.00
0.00
0.00
0.00
XXX0067T
TC
C
Ct colonography;dx
0.00
0.00
0.00
0.00
0.00
0.00
XXX0067T

C
Ct colonography;dx
0.00
0.00
0.00
0.00
0.00
0.00
XXX0068T

C
Interp/rept heart sound
0.00
0.00
0.00
0.00
0.00
0.00
XXX0069T

C
Analysis only heart sound
0.00
0.00
0.00
0.00
0.00
0.00
XXX0070T

C
Interp only heart sound
0.00
0.00
0.00
0.00
0.00
0.00
XXX0071T

C
U/s leiomyomata ablate <200
0.00
0.00
0.00
0.00
0.00
0.00
XXX0072T

C
U/s leiomyomata ablate >200
0.00
0.00
0.00
0.00
0.00
0.00
XXX0073T

A
Delivery, comp imrt
0.00
18.07
NA
0.13
18.20
NA
XXX0074T

N
Online physician e/m
0.00
0.00
0.00
0.00
0.00
0.00
XXX0075T
26
C
Perq stent/chest vert art
0.00
0.00
0.00
0.00
0.00
0.00
XXX0075T
TC
C
Perq stent/chest vert art
0.00
0.00
0.00
0.00
0.00
0.00
XXX0075T

C
Perq stent/chest vert art
0.00
0.00
0.00
0.00
0.00
0.00
XXX0076T
26
C
S&i stent/chest vert art
0.00
0.00
0.00
0.00
0.00
0.00
XXX0076T
TC
C
S&i stent/chest vert art
0.00
0.00
0.00
0.00
0.00
0.00
XXX0076T

C
S&i stent/chest vert art
0.00
0.00
0.00
0.00
0.00
0.00
XXX0077T

C
Cereb therm perfusion probe
0.00
0.00
0.00
0.00
0.00
0.00
XXX0078T

C
Endovasc aort repr w/device
0.00
0.00
0.00
0.00
0.00
0.00
XXX0079T

C
Endovasc visc extnsn repr
0.00
0.00
0.00
0.00
0.00
0.00
XXX0080T

C
Endovasc aort repr rad s&i
0.00
0.00
0.00
0.00
0.00
0.00
XXX0081T

C
Endovasc visc extnsn s&i
0.00
0.00
0.00
0.00
0.00
0.00
XXX0082T

C
Stereotactic rad delivery
0.00
0.00
0.00
0.00
0.00
0.00
XXX0083T

C
Stereotactic rad tx mngmt
0.00
0.00
0.00
0.00
0.00
0.00
XXX0084T

C
Temp prostate urethral stent
0.00
0.00
0.00
0.00
0.00
0.00
XXX0085T

C
Breath test heart reject
0.00
0.00
0.00
0.00
0.00
0.00
XXX0086T

C
L ventricle fill pressure
0.00
0.00
0.00
0.00
0.00
0.00
XXX0087T

C
Sperm eval hyaluronan
0.00
0.00
0.00
0.00
0.00
0.00
XXX0088T

C
Rf tongue base vol reduxn
0.00
0.00
0.00
0.00
0.00
0.00
XXX0089T

C
Actigraphy testing, 3-day
0.00
0.00
0.00
0.00
0.00
0.00
XXX0090T

C
Cervical artific disc
0.00
0.00
0.00
0.00
0.00
0.00
XXX0091T

C
Lumbar artific disc
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70338)0092T

C
Artific disc addl
0.00
0.00
0.00
0.00
0.00
0.00
XXX0093T

C
Cervical artific diskectomy
0.00
0.00
0.00
0.00
0.00
0.00
XXX0094T

C
Lumbar artific diskectomy
0.00
0.00
0.00
0.00
0.00
0.00
XXX0095T

C
Artific diskectomy addl
0.00
0.00
0.00
0.00
0.00
0.00
XXX0096T

C
Rev cervical artific disc
0.00
0.00
0.00
0.00
0.00
0.00
XXX0097T

C
Rev lumbar artific disc
0.00
0.00
0.00
0.00
0.00
0.00
XXX0098T

C
Rev artific disc addl
0.00
0.00
0.00
0.00
0.00
0.00
XXX0099T

C
Implant corneal ring
0.00
0.00
0.00
0.00
0.00
0.00
XXX0100T

C
Prosth retina receive&gen
0.00
0.00
0.00
0.00
0.00
0.00
XXX0101T

C
Extracorp shockwv tx,hi enrg
0.00
0.00
0.00
0.00
0.00
0.00
XXX0102T

C
Extracorp shockwv tx,anesth
0.00
0.00
0.00
0.00
0.00
0.00
XXX0103T

C
Holotranscobalamin
0.00
0.00
0.00
0.00
0.00
0.00
XXX0104T

C
At rest cardio gas rebreathe
0.00
0.00
0.00
0.00
0.00
0.00
XXX0105T

C
Exerc cardio gas rebreathe
0.00
0.00
0.00
0.00
0.00
0.00
XXX0106T

C
Touch quant sensory test
0.00
0.00
0.00
0.00
0.00
0.00
XXX0107T

C
Vibrate quant sensory test
0.00
0.00
0.00
0.00
0.00
0.00
XXX0108T

C
Cool quant sensory test
0.00
0.00
0.00
0.00
0.00
0.00
XXX0109T

C
Heat quant sensory test
0.00
0.00
0.00
0.00
0.00
0.00
XXX0110T

C
Nos quant sensory test
0.00
0.00
0.00
0.00
0.00
0.00
XXX0111T

C
Rbc membranes fatty acids
0.00
0.00
0.00
0.00
0.00
0.00
XXX0115T

C
Med tx mngmt 15 min
0.00
0.00
0.00
0.00
0.00
0.00
XXX0116T

C
Med tx mngmt subsqt
0.00
0.00
0.00
0.00
0.00
0.00
XXX0117T

C
Med tx mngmt addl 15 min
0.00
0.00
0.00
0.00
0.00
0.00
XXX0120T

C
Fibroadenoma cryoablate, ea
0.00
0.00
0.00
0.00
0.00
0.00
XXX0123T

C
Scleral fistulization
0.00
0.00
0.00
0.00
0.00
0.00
XXX0124T

C
Conjunctival drug placement
0.00
0.00
0.00
0.00
0.00
0.00
XXX0126T

C
Chd risk imt study
0.00
0.00
0.00
0.00
0.00
0.00
XXX0130T

C
Chron care drug investigatn
0.00
0.00
0.00
0.00
0.00
0.00
XXX0133T

C
Esophageal implant injexn
0.00
0.00
0.00
0.00
0.00
0.00
XXX0135T

C
Perq cryoablate renal tumor
0.00
0.00
0.00
0.00
0.00
0.00
XXX0137T

C
Prostate saturation sampling
0.00
0.00
0.00
0.00
0.00
0.00
XXX0140T

C
Exhaled breath condensate ph
0.00
0.00
0.00
0.00
0.00
0.00
XXX0141T

C
Perq islet transplant
0.00
0.00
0.00
0.00
0.00
0.00
XXX0142T

C
Open islet transplant
0.00
0.00
0.00
0.00
0.00
0.00
XXX0143T

C
Laparoscopic islet transplnt
0.00
0.00
0.00
0.00
0.00
0.00
XXX0144T

C
CT heart wo dye; qual calc
0.00
0.00
0.00
0.00
0.00
0.00
XXX0145T

C
CT heart w/wo dye funct
0.00
0.00
0.00
0.00
0.00
0.00
XXX0146T

C
CCTA w/wo dye
0.00
0.00
0.00
0.00
0.00
0.00
XXX0147T

C
CCTA w/wo, quan calcium
0.00
0.00
0.00
0.00
0.00
0.00
XXX0148T

C
CCTA w/wo, strxr
0.00
0.00
0.00
0.00
0.00
0.00
XXX0149T

C
CCTA w/wo, strxr quan calc
0.00
0.00
0.00
0.00
0.00
0.00
XXX0150T

C
CCTA w/wo, disease strxr
0.00
0.00
0.00
0.00
0.00
0.00
XXX0151T

C
CT heart funct add-on
0.00
0.00
0.00
0.00
0.00
0.00
XXX0152T

C
Computer chest add-on
0.00
0.00
0.00
0.00
0.00
0.00
XXX0153T

C
Implant aneur sensor add-on
0.00
0.00
0.00
0.00
0.00
0.00
XXX0154T

C
Implant aneur sensor study
0.00
0.00
0.00
0.00
0.00
0.00
XXX0500F

I
Initial prenatal care visit
0.00
0.00
0.00
0.00
0.00
0.00
XXX0501F

I
Prenatal flow sheet
0.00
0.00
0.00
0.00
0.00
0.00
XXX0502F

I
Subsequent prenatal care
0.00
0.00
0.00
0.00
0.00
0.00
XXX0503F

I
Postpartum care visit
0.00
0.00
0.00
0.00
0.00
0.00
XXX1000F

I
Tobacco use, smoking, assess
0.00
0.00
0.00
0.00
0.00
0.00
XXX1001F

I
Tobacco use, non-smoking
0.00
0.00
0.00
0.00
0.00
0.00
XXX10021

A
Fna w/o image
1.27
2.16
0.54
0.10
3.53
1.91
XXX10022

A
Fna w/image
1.27
2.55
0.42
0.08
3.90
1.77
XXX1002F

I
Assess anginal symptom/level
0.00
0.00
0.00
0.00
0.00
0.00
XXX1003F

I
Level of activity assess
0.00
0.00
0.00
0.00
0.00
0.00
XXX10040

A
Acne surgery
1.18
1.01
0.79
0.05
2.24
2.02
0101004F

I
Clin symp vol ovrld assess
0.00
0.00
0.00
0.00
0.00
0.00
XXX1005F

I
Asthma symptoms evaluate
0.00
0.00
0.00
0.00
0.00
0.00
XXX10060

A
Drainage of skin abscess
1.17
1.21
0.93
0.12
2.50
2.22
01010061

A
Drainage of skin abscess
2.40
1.83
1.50
0.26
4.49
4.16
0101006F

I
Osteoarthritis assess
0.00
0.00
0.00
0.00
0.00
0.00
XXX1007F

I
Anti-inflm/anlgsc otc assess
0.00
0.00
0.00
0.00
0.00
0.00
XXX10080

A
Drainage of pilonidal cyst
1.17
3.11
1.11
0.11
4.39
2.39
01010081

A
Drainage of pilonidal cyst
2.45
4.08
1.50
0.24
6.77
4.19
0101008F

I
Gi/renal risk assess
0.00
0.00
0.00
0.00
0.00
0.00
XXX10120

A
Remove foreign body
1.22
2.18
0.97
0.12
3.52
2.31
01010121

A
Remove foreign body
2.69
3.52
1.79
0.33
6.54
4.81
01010140

A
Drainage of hematoma/fluid
1.53
1.78
1.29
0.19
3.50
3.01
01010160

A
Puncture drainage of lesion
1.20
1.60
1.08
0.14
2.94
2.42
01010180

A
Complex drainage, wound
2.25
2.99
1.99
0.35
5.59
4.59
01011000

A
Debride infected skin
0.60
0.58
0.22
0.07
1.25
0.89
00011001

A
Debride infected skin add-on
0.30
0.23
0.11
0.04
0.57
0.45
ZZZ11004

A
Debride genitalia & perineum
10.31
NA
3.91
0.67
NA
14.89
00011005

A
Debride abdom wall
13.75
NA
5.58
0.96
NA
20.29
000( print page 70339)11006

A
Debride genit/per/abdom wall
12.61
NA
4.86
1.28
NA
18.75
00011008

A
Remove mesh from abd wall
5.00
NA
2.03
0.61
NA
7.64
ZZZ11010

A
Debride skin, fx
4.19
6.89
2.63
0.66
11.74
7.48
01011011

A
Debride skin/muscle, fx
4.94
8.18
2.35
0.74
13.86
8.03
00011012

A
Debride skin/muscle/bone, fx
6.87
12.14
3.85
1.16
20.17
11.88
00011040

A
Debride skin, partial
0.50
0.52
0.21
0.06
1.08
0.77
00011041

A
Debride skin, full
0.82
0.66
0.33
0.10
1.58
1.25
00011042

A
Debride skin/tissue
1.12
0.97
0.44
0.13
2.22
1.69
00011043

A
Debride tissue/muscle
2.38
3.39
2.60
0.32
6.09
5.30
01011044

A
Debride tissue/muscle/bone
3.06
4.46
3.76
0.43
7.95
7.25
01011055

R
Trim skin lesion
0.43
0.56
0.17
0.05
1.04
0.65
00011056

R
Trim skin lesions, 2 to 4
0.61
0.64
0.23
0.07
1.32
0.91
00011057

R
Trim skin lesions, over 4
0.79
0.74
0.30
0.10
1.63
1.19
00011100

A
Biopsy, skin lesion
0.81
1.25
0.37
0.03
2.09
1.21
00011101

A
Biopsy, skin add-on
0.41
0.33
0.19
0.02
0.76
0.62
ZZZ11200

A
Removal of skin tags
0.77
1.04
0.76
0.04
1.85
1.57
01011201

A
Remove skin tags add-on
0.29
0.16
0.12
0.02
0.47
0.43
ZZZ11300

A
Shave skin lesion
0.51
0.99
0.21
0.03
1.53
0.75
00011301

A
Shave skin lesion
0.85
1.11
0.38
0.04
2.00
1.27
00011302

A
Shave skin lesion
1.05
1.30
0.46
0.05
2.40
1.56
00011303

A
Shave skin lesion
1.24
1.58
0.52
0.07
2.89
1.83
00011305

A
Shave skin lesion
0.67
0.85
0.27
0.07
1.59
1.01
00011306

A
Shave skin lesion
0.99
1.10
0.42
0.07
2.16
1.48
00011307

A
Shave skin lesion
1.14
1.29
0.49
0.07
2.50
1.70
00011308

A
Shave skin lesion
1.41
1.45
0.59
0.13
2.99
2.13
00011310

A
Shave skin lesion
0.73
1.11
0.32
0.04
1.88
1.09
00011311

A
Shave skin lesion
1.05
1.23
0.49
0.05
2.33
1.59
00011312

A
Shave skin lesion
1.20
1.42
0.55
0.06
2.68
1.81
00011313

A
Shave skin lesion
1.62
1.81
0.72
0.10
3.53
2.44
00011400

A
Exc tr-ext b9+marg 0.5 < cm
0.85
2.00
0.88
0.06
2.91
1.79
01011401

A
Exc tr-ext b9+marg 0.6-1 cm
1.23
2.06
1.02
0.10
3.39
2.35
01011402

A
Exc tr-ext b9+marg 1.1-2 cm
1.51
2.23
1.08
0.13
3.87
2.72
01011403

A
Exc tr-ext b9+marg 2.1-3 cm
1.79
2.40
1.32
0.17
4.36
3.28
01011404

A
Exc tr-ext b9+marg 3.1-4 cm
2.06
2.71
1.40
0.21
4.98
3.67
01011406

A
Exc tr-ext b9+marg > 4.0 cm
2.76
3.07
1.65
0.32
6.15
4.73
01011420

A
Exc h-f-nk-sp b9+marg 0.5 <
0.98
1.77
0.93
0.09
2.84
2.00
01011421

A
Exc h-f-nk-sp b9+marg 0.6-1
1.42
2.07
1.11
0.13
3.62
2.66
01011422

A
Exc h-f-nk-sp b9+marg 1.1-2
1.63
2.26
1.33
0.16
4.05
3.12
01011423

A
Exc h-f-nk-sp b9+marg 2.1-3
2.01
2.59
1.45
0.20
4.80
3.66
01011424

A
Exc h-f-nk-sp b9+marg 3.1-4
2.43
2.81
1.60
0.25
5.49
4.28
01011426

A
Exc h-f-nk-sp b9+marg > 4 cm
3.77
3.49
2.11
0.44
7.70
6.32
01011440

A
Exc face-mm b9+marg 0.5 < cm
1.06
2.21
1.31
0.08
3.35
2.45
01011441

A
Exc face-mm b9+marg 0.6-1 cm
1.48
2.34
1.49
0.13
3.95
3.10
01011442

A
Exc face-mm b9+marg 1.1-2 cm
1.72
2.55
1.57
0.16
4.43
3.45
01011443

A
Exc face-mm b9+marg 2.1-3 cm
2.29
2.92
1.82
0.22
5.43
4.33
01011444

A
Exc face-mm b9+marg 3.1-4 cm
3.14
3.48
2.19
0.30
6.92
5.63
01011446

A
Exc face-mm b9+marg > 4 cm
4.48
4.05
2.78
0.43
8.96
7.69
01011450

A
Removal, sweat gland lesion
2.73
5.04
2.03
0.34
8.11
5.10
09011451

A
Removal, sweat gland lesion
3.94
6.62
2.55
0.53
11.09
7.02
09011462

A
Removal, sweat gland lesion
2.51
5.12
2.02
0.32
7.95
4.85
09011463

A
Removal, sweat gland lesion
3.94
6.84
2.69
0.54
11.32
7.17
09011470

A
Removal, sweat gland lesion
3.25
5.07
2.27
0.40
8.72
5.92
09011471

A
Removal, sweat gland lesion
4.40
6.72
2.77
0.58
11.70
7.75
09011600

A
Exc tr-ext mlg+marg 0.5 < cm
1.31
2.64
0.97
0.10
4.05
2.38
01011601

A
Exc tr-ext mlg+marg 0.6-1 cm
1.80
2.71
1.22
0.12
4.63
3.14
01011602

A
Exc tr-ext mlg+marg 1.1-2 cm
1.95
2.83
1.26
0.12
4.90
3.33
01011603

A
Exc tr-ext mlg+marg 2.1-3 cm
2.19
3.08
1.33
0.16
5.43
3.68
01011604

A
Exc tr-ext mlg+marg 3.1-4 cm
2.40
3.38
1.39
0.20
5.98
3.99
01011606

A
Exc tr-ext mlg+marg > 4 cm
3.42
4.07
1.74
0.36
7.85
5.52
01011620

A
Exc h-f-nk-sp mlg+marg 0.5 <
1.19
2.60
0.95
0.09
3.88
2.23
01011621

A
Exc h-f-nk-sp mlg+marg 0.6-1
1.76
2.71
1.24
0.12
4.59
3.12
01011622

A
Exc h-f-nk-sp mlg+marg 1.1-2
2.09
2.97
1.39
0.14
5.20
3.62
01011623

A
Exc h-f-nk-sp mlg+marg 2.1-3
2.61
3.34
1.58
0.20
6.15
4.39
01011624

A
Exc h-f-nk-sp mlg+marg 3.1-4
3.06
3.75
1.78
0.27
7.08
5.11
01011626

A
Exc h-f-nk-sp mlg+mar > 4 cm
4.29
4.64
2.40
0.45
9.38
7.14
01011640

A
Exc face-mm malig+marg 0.5 <
1.35
2.66
1.11
0.11
4.12
2.57
01011641

A
Exc face-mm malig+marg 0.6-1
2.16
3.03
1.53
0.16
5.35
3.85
01011642

A
Exc face-mm malig+marg 1.1-2
2.59
3.41
1.71
0.19
6.19
4.49
01011643

A
Exc face-mm malig+marg 2.1-3
3.10
3.81
1.97
0.26
7.17
5.33
01011644

A
Exc face-mm malig+marg 3.1-4
4.02
4.69
2.46
0.37
9.08
6.85
01011646

A
Exc face-mm mlg+marg > 4 cm
5.94
5.77
3.48
0.61
12.32
10.03
01011719

R
Trim nail(s)
0.17
0.25
0.07
0.02
0.44
0.26
00011720

A
Debride nail, 1-5
0.32
0.34
0.12
0.04
0.70
0.48
00011721

A
Debride nail, 6 or more
0.54
0.44
0.21
0.07
1.05
0.82
00011730

A
Removal of nail plate
1.13
1.03
0.43
0.14
2.30
1.70
000( print page 70340)11732

A
Remove nail plate, add-on
0.57
0.44
0.22
0.07
1.08
0.86
ZZZ11740

A
Drain blood from under nail
0.37
0.55
0.35
0.04
0.96
0.76
00011750

A
Removal of nail bed
1.86
2.17
1.76
0.22
4.25
3.84
01011752

A
Remove nail bed/finger tip
2.67
3.00
3.00
0.35
6.02
6.02
01011755

A
Biopsy, nail unit
1.31
1.57
0.77
0.14
3.02
2.22
00011760

A
Repair of nail bed
1.58
2.63
1.79
0.21
4.42
3.58
01011762

A
Reconstruction of nail bed
2.89
2.89
2.35
0.36
6.14
5.60
01011765

A
Excision of nail fold, toe
0.69
1.79
0.76
0.08
2.56
1.53
01011770

A
Removal of pilonidal lesion
2.61
3.49
1.50
0.33
6.43
4.44
01011771

A
Removal of pilonidal lesion
5.73
5.66
3.32
0.74
12.13
9.79
09011772

A
Removal of pilonidal lesion
6.97
7.52
5.08
0.89
15.38
12.94
09011900

A
Injection into skin lesions
0.52
0.65
0.21
0.02
1.19
0.75
00011901

A
Added skin lesions injection
0.80
0.66
0.35
0.03
1.49
1.18
00011920

R
Correct skin color defects
1.61
3.71
1.09
0.24
5.56
2.94
00011921

R
Correct skin color defects
1.93
3.97
1.27
0.29
6.19
3.49
00011922

R
Correct skin color defects
0.49
1.14
0.25
0.07
1.70
0.81
ZZZ11950

R
Therapy for contour defects
0.84
1.14
0.39
0.06
2.04
1.29
00011951

R
Therapy for contour defects
1.19
1.49
0.51
0.11
2.79
1.81
00011952

R
Therapy for contour defects
1.69
1.86
0.68
0.16
3.71
2.53
00011954

R
Therapy for contour defects
1.85
2.45
0.90
0.25
4.55
3.00
00011960

A
Insert tissue expander(s)
9.07
NA
10.42
1.31
NA
20.80
09011970

A
Replace tissue expander
7.05
NA
6.15
1.05
NA
14.25
09011971

A
Remove tissue expander(s)
2.13
9.14
3.80
0.32
11.59
6.25
09011975

N
Insert contraceptive cap
+1.48
1.42
0.57
0.17
3.07
2.22
XXX11976

R
Removal of contraceptive cap
1.78
1.72
0.68
0.21
3.71
2.67
00011977

N
Removal/reinsert contra cap
+3.30
2.28
1.26
0.37
5.95
4.93
XXX11980

A
Implant hormone pellet(s)
1.48
1.08
0.54
0.13
2.69
2.15
00011981

A
Insert drug implant device
1.48
1.70
0.68
0.12
3.30
2.28
XXX11982

A
Remove drug implant device
1.78
1.95
0.83
0.17
3.90
2.78
XXX11983

A
Remove/insert drug implant
3.30
2.29
1.47
0.23
5.82
5.00
XXX12001

A
Repair superficial wound(s)
1.70
1.99
0.77
0.15
3.84
2.62
01012002

A
Repair superficial wound(s)
1.86
2.05
0.90
0.17
4.08
2.93
01012004

A
Repair superficial wound(s)
2.24
2.33
1.01
0.21
4.78
3.46
01012005

A
Repair superficial wound(s)
2.86
2.83
1.20
0.27
5.96
4.33
01012006

A
Repair superficial wound(s)
3.66
3.40
1.51
0.35
7.41
5.52
01012007

A
Repair superficial wound(s)
4.11
3.83
1.82
0.45
8.39
6.38
01012011

A
Repair superficial wound(s)
1.76
2.14
0.78
0.16
4.06
2.70
01012013

A
Repair superficial wound(s)
1.99
2.28
0.93
0.18
4.45
3.10
01012014

A
Repair superficial wound(s)
2.46
2.58
1.06
0.23
5.27
3.75
01012015

A
Repair superficial wound(s)
3.19
3.14
1.25
0.29
6.62
4.73
01012016

A
Repair superficial wound(s)
3.92
3.56
1.52
0.37
7.85
5.81
01012017

A
Repair superficial wound(s)
4.70
NA
1.90
0.47
NA
7.07
01012018

A
Repair superficial wound(s)
5.52
NA
2.26
0.64
NA
8.42
01012020

A
Closure of split wound
2.62
3.83
1.93
0.30
6.75
4.85
01012021

A
Closure of split wound
1.84
1.83
1.41
0.24
3.91
3.49
01012031

A
Layer closure of wound(s)
2.15
2.29
0.96
0.17
4.61
3.28
01012032

A
Layer closure of wound(s)
2.47
3.85
1.80
0.16
6.48
4.43
01012034

A
Layer closure of wound(s)
2.92
3.20
1.45
0.25
6.37
4.62
01012035

A
Layer closure of wound(s)
3.42
5.21
2.16
0.39
9.02
5.97
01012036

A
Layer closure of wound(s)
4.04
5.57
2.55
0.55
10.16
7.14
01012037

A
Layer closure of wound(s)
4.66
6.11
2.97
0.66
11.43
8.29
01012041

A
Layer closure of wound(s)
2.37
2.55
1.13
0.19
5.11
3.69
01012042

A
Layer closure of wound(s)
2.74
3.27
1.46
0.17
6.18
4.37
01012044

A
Layer closure of wound(s)
3.14
3.22
1.60
0.27
6.63
5.01
01012045

A
Layer closure of wound(s)
3.63
5.28
2.29
0.41
9.32
6.33
01012046

A
Layer closure of wound(s)
4.24
6.52
2.76
0.54
11.30
7.54
01012047

A
Layer closure of wound(s)
4.64
6.36
3.09
0.58
11.58
8.31
01012051

A
Layer closure of wound(s)
2.47
3.28
1.45
0.20
5.95
4.12
01012052

A
Layer closure of wound(s)
2.77
3.23
1.43
0.17
6.17
4.37
01012053

A
Layer closure of wound(s)
3.12
3.25
1.53
0.23
6.60
4.88
01012054

A
Layer closure of wound(s)
3.45
3.57
1.63
0.30
7.32
5.38
01012055

A
Layer closure of wound(s)
4.42
4.49
2.13
0.45
9.36
7.00
01012056

A
Layer closure of wound(s)
5.23
6.77
3.06
0.59
12.59
8.88
01012057

A
Layer closure of wound(s)
5.95
6.15
3.76
0.56
12.66
10.27
01013100

A
Repair of wound or lesion
3.12
4.06
2.31
0.26
7.44
5.69
01013101

A
Repair of wound or lesion
3.91
4.67
2.69
0.26
8.84
6.86
01013102

A
Repair wound/lesion add-on
1.24
1.17
0.57
0.13
2.54
1.94
ZZZ13120

A
Repair of wound or lesion
3.30
4.15
2.35
0.26
7.71
5.91
01013121

A
Repair of wound or lesion
4.32
4.86
2.80
0.25
9.43
7.37
01013122

A
Repair wound/lesion add-on
1.44
1.51
0.63
0.15
3.10
2.22
ZZZ13131

A
Repair of wound or lesion
3.78
4.37
2.69
0.26
8.41
6.73
01013132

A
Repair of wound or lesion
5.94
5.92
4.17
0.32
12.18
10.43
01013133

A
Repair wound/lesion add-on
2.19
1.66
1.03
0.18
4.03
3.40
ZZZ13150

A
Repair of wound or lesion
3.80
4.88
2.77
0.34
9.02
6.91
01013151

A
Repair of wound or lesion
4.44
4.81
3.15
0.31
9.56
7.90
010( print page 70341)13152

A
Repair of wound or lesion
6.32
6.05
4.05
0.40
12.77
10.77
01013153

A
Repair wound/lesion add-on
2.38
1.94
1.14
0.24
4.56
3.76
ZZZ13160

A
Late closure of wound
10.46
NA
7.18
1.54
NA
19.18
09014000

A
Skin tissue rearrangement
5.88
7.87
5.48
0.59
14.34
11.95
09014001

A
Skin tissue rearrangement
8.46
9.44
7.09
0.82
18.72
16.37
09014020

A
Skin tissue rearrangement
6.58
8.63
6.55
0.64
15.85
13.77
09014021

A
Skin tissue rearrangement
10.04
10.01
8.30
0.81
20.86
19.15
09014040

A
Skin tissue rearrangement
7.86
8.83
7.22
0.62
17.31
15.70
09014041

A
Skin tissue rearrangement
11.47
10.62
8.70
0.73
22.82
20.90
09014060

A
Skin tissue rearrangement
8.49
8.81
7.45
0.68
17.98
16.62
09014061

A
Skin tissue rearrangement
12.27
11.63
9.53
0.76
24.66
22.56
09014300

A
Skin tissue rearrangement
11.74
11.16
9.20
1.16
24.06
22.10
09014350

A
Skin tissue rearrangement
9.60
NA
7.16
1.34
NA
18.10
09015000

A
Wound prep, 1st 100 sq cm
3.99
3.80
2.19
0.54
8.33
6.72
00015001

A
Wound prep, addl 100 sq cm
1.00
1.35
0.41
0.14
2.49
1.55
ZZZ15040

A
Harvest cultured skin graft
2.00
4.57
1.13
0.24
6.81
3.37
00015050

A
Skin pinch graft
4.29
6.93
5.12
0.57
11.79
9.98
09015100

A
Skin splt grft, trnk/arm/leg
9.04
12.62
7.84
1.28
22.94
18.16
09015101

A
Skin splt grft t/a/l, add-on
1.72
3.74
1.17
0.24
5.70
3.13
ZZZ15110

A
Epidrm autogrft trnk/arm/leg
9.50
10.70
7.02
1.31
21.51
17.83
09015111

A
Epidrm autogrft t/a/l add-on
1.85
1.29
0.79
0.26
3.40
2.90
ZZZ15115

A
Epidrm a-grft face/nck/hf/g
9.81
9.25
7.37
1.15
20.21
18.33
09015116

A
Epidrm a-grft f/n/hf/g addl
2.50
1.58
1.12
0.33
4.41
3.95
ZZZ15120

A
Skn splt a-grft fac/nck/hf/g
9.82
10.75
7.80
1.16
21.73
18.78
09015121

A
Skn splt a-grft f/n/hf/g add
2.67
4.51
1.85
0.36
7.54
4.88
ZZZ15130

A
Derm autograft, trnk/arm/leg
7.00
9.89
6.36
0.97
17.86
14.33
09015131

A
Derm autograft t/a/l add-on
1.50
1.07
0.64
0.21
2.78
2.35
ZZZ15135

A
Derm autograft face/nck/hf/g
10.50
9.90
8.15
1.23
21.63
19.88
09015136

A
Derm autograft, f/n/hf/g add
1.50
0.89
0.67
0.20
2.59
2.37
ZZZ15150

A
Cult epiderm grft t/arm/leg
8.25
8.48
6.46
1.14
17.87
15.85
09015151

A
Cult epiderm grft t/a/l addl
2.00
1.31
0.85
0.28
3.59
3.13
ZZZ15152

A
Cult epiderm graft t/a/l +%
2.50
1.56
1.06
0.35
4.41
3.91
ZZZ15155

A
Cult epiderm graft, f/n/hf/g
9.00
7.84
6.98
1.05
17.89
17.03
09015156

A
Cult epidrm grft f/n/hfg add
2.75
1.56
1.24
0.36
4.67
4.35
ZZZ15157

A
Cult epiderm grft f/n/hfg +%
3.00
1.78
1.35
0.39
5.17
4.74
ZZZ15170

A
Acell graft trunk/arms/legs
5.00
3.84
2.37
0.55
9.39
7.92
09015171

A
Acell graft t/arm/leg add-on
1.55
0.68
0.62
0.19
2.42
2.36
ZZZ15175

A
Acellular graft, f/n/hf/g
7.00
5.44
4.01
0.82
13.26
11.83
09015176

A
Acell graft, f/n/hf/g add-on
2.45
1.11
0.99
0.29
3.85
3.73
ZZZ15200

A
Skin full graft, trunk
8.02
9.43
6.22
0.98
18.43
15.22
09015201

A
Skin full graft trunk add-on
1.32
2.57
0.62
0.19
4.08
2.13
ZZZ15220

A
Skin full graft sclp/arm/leg
7.86
9.21
6.70
0.84
17.91
15.40
09015221

A
Skin full graft add-on
1.19
2.33
0.56
0.16
3.68
1.91
ZZZ15240

A
Skin full grft face/genit/hf
9.03
10.23
7.97
0.92
20.18
17.92
09015241

A
Skin full graft add-on
1.86
2.45
0.91
0.23
4.54
3.00
ZZZ15260

A
Skin full graft een & lips
10.04
10.24
8.60
0.69
20.97
19.33
09015261

A
Skin full graft add-on
2.23
2.70
1.40
0.21
5.14
3.84
ZZZ15300

A
Apply skinallogrft, t/arm/lg
3.99
3.21
2.24
0.49
7.69
6.72
09015301

A
Apply sknallogrft t/a/l addl
1.00
0.47
0.40
0.14
1.61
1.54
ZZZ15320

A
Apply skin allogrft f/n/hf/g
4.70
3.63
2.54
0.58
8.91
7.82
09015321

A
Aply sknallogrft f/n/hfg add
1.50
0.69
0.59
0.21
2.40
2.30
ZZZ15330

A
Aply acell alogrft t/arm/leg
3.99
3.20
2.23
0.49
7.68
6.71
09015331

A
Aply acell grft t/a/l add-on
1.00
0.46
0.40
0.14
1.60
1.54
ZZZ15335

A
Apply acell graft, f/n/hf/g
4.50
3.48
2.45
0.55
8.53
7.50
09015336

A
Aply acell grft f/n/hf/g add
1.43
0.69
0.57
0.20
2.32
2.20
ZZZ15340

A
Apply cult skin substitute
3.72
4.01
2.76
0.41
8.14
6.89
01015341

A
Apply cult skin sub add-on
0.50
0.61
0.20
0.06
1.17
0.76
ZZZ15360

A
Apply cult derm sub, t/a/l
3.87
4.48
3.09
0.43
8.78
7.39
09015361

A
Aply cult derm sub t/a/l add
1.15
0.58
0.46
0.14
1.87
1.75
ZZZ15365

A
Apply cult derm sub f/n/hf/g
4.15
4.56
3.20
0.46
9.17
7.81
09015366

A
Apply cult derm f/hf/g add
1.45
0.70
0.58
0.17
2.32
2.20
ZZZ15400

A
Apply skin xenograft, t/a/l
3.99
4.02
4.02
0.47
8.48
8.48
09015401

A
Apply skn xenogrft t/a/l add
1.00
1.90
0.44
0.14
3.04
1.58
ZZZ15420

A
Apply skin xgraft, f/n/hf/g
4.50
4.79
3.80
0.52
9.81
8.82
09015421

A
Apply skn xgrft f/n/hf/g add
1.50
1.32
0.62
0.21
3.03
2.33
ZZZ15430

A
Apply acellular xenograft
5.75
6.92
6.63
0.66
13.33
13.04
09015431

C
Apply acellular xgraft add
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ15570

A
Form skin pedicle flap
9.20
11.33
6.78
1.34
21.87
17.32
09015572

A
Form skin pedicle flap
9.26
9.52
6.47
1.20
19.98
16.93
09015574

A
Form skin pedicle flap
9.87
10.71
7.81
1.20
21.78
18.88
09015576

A
Form skin pedicle flap
8.68
9.78
6.90
0.87
19.33
16.45
09015600

A
Skin graft
1.91
7.62
3.07
0.27
9.80
5.25
09015610

A
Skin graft
2.42
4.70
3.43
0.35
7.47
6.20
09015620

A
Skin graft
2.94
7.80
3.89
0.35
11.09
7.18
09015630

A
Skin graft
3.27
7.06
4.16
0.34
10.67
7.77
090( print page 70342)15650

A
Transfer skin pedicle flap
3.96
7.16
4.22
0.42
11.54
8.60
09015732

A
Muscle-skin graft, head/neck
17.81
18.09
12.25
1.99
37.89
32.05
09015734

A
Muscle-skin graft, trunk
17.76
18.16
12.41
2.61
38.53
32.78
09015736

A
Muscle-skin graft, arm
16.25
18.28
11.25
2.45
36.98
29.95
09015738

A
Muscle-skin graft, leg
17.89
18.02
11.75
2.65
38.56
32.29
09015740

A
Island pedicle flap graft
10.23
10.16
8.28
0.63
21.02
19.14
09015750

A
Neurovascular pedicle graft
11.39
NA
9.07
1.42
NA
21.88
09015756

A
Free myo/skin flap microvasc
35.18
NA
20.62
4.61
NA
60.41
09015757

A
Free skin flap, microvasc
35.18
NA
21.65
3.89
NA
60.72
09015758

A
Free fascial flap, microvasc
35.05
NA
21.63
4.23
NA
60.91
09015760

A
Composite skin graft
8.73
10.05
7.28
0.85
19.63
16.86
09015770

A
Derma-fat-fascia graft
7.51
NA
6.70
1.05
NA
15.26
09015775

R
Hair transplant punch grafts
3.95
4.24
1.30
0.52
8.71
5.77
00015776

R
Hair transplant punch grafts
5.53
5.37
2.81
0.72
11.62
9.06
00015780

A
Abrasion treatment of skin
7.28
11.55
8.27
0.67
19.50
16.22
09015781

A
Abrasion treatment of skin
4.84
6.93
5.38
0.34
12.11
10.56
09015782

A
Abrasion treatment of skin
4.31
9.88
6.57
0.34
14.53
11.22
09015783

A
Abrasion treatment of skin
4.28
6.89
4.19
0.28
11.45
8.75
09015786

A
Abrasion, lesion, single
2.03
3.36
1.32
0.11
5.50
3.46
01015787

A
Abrasion, lesions, add-on
0.33
1.09
0.16
0.04
1.46
0.53
ZZZ15788

R
Chemical peel, face, epiderm
2.09
6.73
3.09
0.11
8.93
5.29
09015789

R
Chemical peel, face, dermal
4.91
8.11
4.81
0.20
13.22
9.92
09015792

R
Chemical peel, nonfacial
1.86
7.11
4.46
0.13
9.10
6.45
09015793

A
Chemical peel, nonfacial
3.73
6.30
4.39
0.19
10.22
8.31
09015819

A
Plastic surgery, neck
9.37
NA
7.20
0.97
NA
17.54
09015820

A
Revision of lower eyelid
5.14
6.99
5.58
0.40
12.53
11.12
09015821

A
Revision of lower eyelid
5.71
7.37
5.73
0.45
13.53
11.89
09015822

A
Revision of upper eyelid
4.44
5.85
4.50
0.37
10.66
9.31
09015823

A
Revision of upper eyelid
7.04
7.87
6.45
0.50
15.41
13.99
09015824

R
Removal of forehead wrinkles
0.00
0.00
0.00
0.00
0.00
0.00
00015825

R
Removal of neck wrinkles
0.00
0.00
0.00
0.00
0.00
0.00
00015826

R
Removal of brow wrinkles
0.00
0.00
0.00
0.00
0.00
0.00
00015828

R
Removal of face wrinkles
0.00
0.00
0.00
0.00
0.00
0.00
00015829

R
Removal of skin wrinkles
0.00
0.00
0.00
0.00
0.00
0.00
00015831

A
Excise excessive skin tissue
12.38
NA
8.18
1.75
NA
22.31
09015832

A
Excise excessive skin tissue
11.57
NA
8.36
1.66
NA
21.59
09015833

A
Excise excessive skin tissue
10.62
NA
8.23
1.49
NA
20.34
09015834

A
Excise excessive skin tissue
10.83
NA
7.71
1.61
NA
20.15
09015835

A
Excise excessive skin tissue
11.65
NA
7.56
1.60
NA
20.81
09015836

A
Excise excessive skin tissue
9.33
NA
6.80
1.34
NA
17.47
09015837

A
Excise excessive skin tissue
8.42
8.57
7.39
1.18
18.17
16.99
09015838

A
Excise excessive skin tissue
7.12
NA
6.08
0.58
NA
13.78
09015839

A
Excise excessive skin tissue
9.37
8.85
6.41
1.22
19.44
17.00
09015840

A
Graft for face nerve palsy
13.24
NA
10.00
1.32
NA
24.56
09015841

A
Graft for face nerve palsy
23.23
NA
15.03
2.54
NA
40.80
09015842

A
Flap for face nerve palsy
37.90
NA
22.98
4.93
NA
65.81
09015845

A
Skin and muscle repair, face
12.55
NA
9.33
0.81
NA
22.69
09015850

B
Removal of sutures
+0.78
1.56
0.30
0.05
2.39
1.13
XXX15851

A
Removal of sutures
0.86
1.68
0.31
0.06
2.60
1.23
00015852

A
Dressing change not for burn
0.86
1.85
0.33
0.09
2.80
1.28
00015860

A
Test for blood flow in graft
1.95
0.83
0.78
0.27
3.05
3.00
00015876

R
Suction assisted lipectomy
0.00
0.00
0.00
0.00
0.00
0.00
00015877

R
Suction assisted lipectomy
0.00
0.00
0.00
0.00
0.00
0.00
00015878

R
Suction assisted lipectomy
0.00
0.00
0.00
0.00
0.00
0.00
00015879

R
Suction assisted lipectomy
0.00
0.00
0.00
0.00
0.00
0.00
00015920

A
Removal of tail bone ulcer
7.94
NA
5.57
1.04
NA
14.55
09015922

A
Removal of tail bone ulcer
9.89
NA
7.23
1.42
NA
18.54
09015931

A
Remove sacrum pressure sore
9.23
NA
5.70
1.25
NA
16.18
09015933

A
Remove sacrum pressure sore
10.83
NA
7.87
1.52
NA
20.22
09015934

A
Remove sacrum pressure sore
12.67
NA
8.06
1.78
NA
22.51
09015935

A
Remove sacrum pressure sore
14.55
NA
10.35
2.09
NA
26.99
09015936

A
Remove sacrum pressure sore
12.36
NA
8.24
1.76
NA
22.36
09015937

A
Remove sacrum pressure sore
14.19
NA
9.85
2.06
NA
26.10
09015940

A
Remove hip pressure sore
9.33
NA
6.19
1.31
NA
16.83
09015941

A
Remove hip pressure sore
11.41
NA
9.48
1.66
NA
22.55
09015944

A
Remove hip pressure sore
11.44
NA
8.62
1.65
NA
21.71
09015945

A
Remove hip pressure sore
12.67
NA
9.67
1.84
NA
24.18
09015946

A
Remove hip pressure sore
21.54
NA
14.41
3.16
NA
39.11
09015950

A
Remove thigh pressure sore
7.53
NA
5.43
1.04
NA
14.00
09015951

A
Remove thigh pressure sore
10.70
NA
7.88
1.49
NA
20.07
09015952

A
Remove thigh pressure sore
11.37
NA
7.77
1.60
NA
20.74
09015953

A
Remove thigh pressure sore
12.61
NA
9.02
1.79
NA
23.42
09015956

A
Remove thigh pressure sore
15.50
NA
10.80
2.21
NA
28.51
09015958

A
Remove thigh pressure sore
15.46
NA
11.07
2.25
NA
28.78
09015999

C
Removal of pressure sore
0.00
0.00
0.00
0.00
0.00
0.00
YYY( print page 70343)16000

A
Initial treatment of burn(s)
0.89
0.86
0.26
0.08
1.83
1.23
00016020

A
Dress/debrid p-thick burn, s
0.80
1.29
0.58
0.08
2.17
1.46
00016025

A
Dress/debrid p-thick burn, m
1.85
1.77
0.96
0.19
3.81
3.00
00016030

A
Dress/debrid p-thick burn, l
2.08
2.18
1.12
0.24
4.50
3.44
00016035

A
Incision of burn scab, initi
3.74
NA
1.58
0.46
NA
5.78
09016036

A
Escharotomy; add'l incision
1.50
NA
0.60
0.20
NA
2.30
ZZZ17000

A
Destroy benign/premlg lesion
0.60
0.97
0.54
0.03
1.60
1.17
01017003

A
Destroy lesions, 2-14
0.15
0.11
0.07
0.01
0.27
0.23
ZZZ17004

A
Destroy lesions, 15 or more
2.79
2.31
1.59
0.11
5.21
4.49
01017106

A
Destruction of skin lesions
4.58
4.61
3.34
0.35
9.54
8.27
09017107

A
Destruction of skin lesions
9.15
7.22
5.47
0.63
17.00
15.25
09017108

A
Destruction of skin lesions
13.18
9.29
7.68
0.54
23.01
21.40
09017110

A
Destruct lesion, 1-14
0.65
1.62
0.70
0.05
2.32
1.40
01017111

A
Destruct lesion, 15 or more
0.92
1.67
0.81
0.05
2.64
1.78
01017250

A
Chemical cautery, tissue
0.50
1.22
0.34
0.06
1.78
0.90
00017260

A
Destruction of skin lesions
0.91
1.28
0.67
0.04
2.23
1.62
01017261

A
Destruction of skin lesions
1.17
1.61
0.83
0.05
2.83
2.05
01017262

A
Destruction of skin lesions
1.58
1.89
1.02
0.06
3.53
2.66
01017263

A
Destruction of skin lesions
1.79
2.06
1.09
0.07
3.92
2.95
01017264

A
Destruction of skin lesions
1.94
2.23
1.12
0.08
4.25
3.14
01017266

A
Destruction of skin lesions
2.34
2.51
1.22
0.09
4.94
3.65
01017270

A
Destruction of skin lesions
1.32
1.70
0.87
0.05
3.07
2.24
01017271

A
Destruction of skin lesions
1.49
1.78
0.98
0.06
3.33
2.53
01017272

A
Destruction of skin lesions
1.77
2.00
1.11
0.07
3.84
2.95
01017273

A
Destruction of skin lesions
2.05
2.21
1.21
0.08
4.34
3.34
01017274

A
Destruction of skin lesions
2.59
2.57
1.44
0.10
5.26
4.13
01017276

A
Destruction of skin lesions
3.20
2.95
1.68
0.16
6.31
5.04
01017280

A
Destruction of skin lesions
1.17
1.61
0.81
0.05
2.83
2.03
01017281

A
Destruction of skin lesions
1.72
1.91
1.09
0.07
3.70
2.88
01017282

A
Destruction of skin lesions
2.04
2.16
1.24
0.08
4.28
3.36
01017283

A
Destruction of skin lesions
2.64
2.55
1.49
0.11
5.30
4.24
01017284

A
Destruction of skin lesions
3.21
2.93
1.76
0.13
6.27
5.10
01017286

A
Destruction of skin lesions
4.43
3.68
2.45
0.23
8.34
7.11
01017304

A
1 stage mohs, up to 5 spec
7.59
8.26
3.57
0.30
16.15
11.46
00017305

A
2 stage mohs, up to 5 spec
2.85
3.90
1.34
0.11
6.86
4.30
00017306

A
3 stage mohs, up to 5 spec
2.85
3.92
1.35
0.11
6.88
4.31
00017307

A
Mohs addl stage up to 5 spec
2.85
3.57
1.36
0.11
6.53
4.32
00017310

A
Mohs any stage > 5 spec each
0.95
1.62
0.46
0.03
2.60
1.44
ZZZ17340

A
Cryotherapy of skin
0.76
0.37
0.36
0.05
1.18
1.17
01017360

A
Skin peel therapy
1.43
1.44
0.87
0.06
2.93
2.36
01017380

R
Hair removal by electrolysis
0.00
0.00
0.00
0.00
0.00
0.00
00017999

C
Skin tissue procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY19000

A
Drainage of breast lesion
0.84
1.99
0.31
0.08
2.91
1.23
00019001

A
Drain breast lesion add-on
0.42
0.25
0.14
0.04
0.71
0.60
ZZZ19020

A
Incision of breast lesion
3.56
6.35
2.68
0.45
10.36
6.69
09019030

A
Injection for breast x-ray
1.53
2.87
0.50
0.09
4.49
2.12
00019100

A
Bx breast percut w/o image
1.27
2.09
0.42
0.16
3.52
1.85
00019101

A
Biopsy of breast, open
3.18
4.51
1.92
0.39
8.08
5.49
01019102

A
Bx breast percut w/image
2.00
3.84
0.66
0.14
5.98
2.80
00019103

A
Bx breast percut w/device
3.69
11.52
1.23
0.30
15.51
5.22
00019110

A
Nipple exploration
4.29
5.81
2.87
0.57
10.67
7.73
09019112

A
Excise breast duct fistula
3.66
6.08
2.69
0.48
10.22
6.83
09019120

A
Removal of breast lesion
5.55
4.55
3.07
0.73
10.83
9.35
09019125

A
Excision, breast lesion
6.05
4.79
3.29
0.80
11.64
10.14
09019126

A
Excision, addl breast lesion
2.93
NA
1.00
0.38
NA
4.31
ZZZ19140

A
Removal of breast tissue
5.13
7.16
3.40
0.69
12.98
9.22
09019160

A
Partial mastectomy
5.98
NA
3.43
0.79
NA
10.20
09019162

A
P-mastectomy w/ln removal
13.51
NA
6.35
1.79
NA
21.65
09019180

A
Removal of breast
8.79
NA
5.03
1.18
NA
15.00
09019182

A
Removal of breast
7.72
NA
4.76
1.04
NA
13.52
09019200

A
Removal of breast
15.47
NA
7.98
1.92
NA
25.37
09019220

A
Removal of breast
15.70
NA
8.25
2.07
NA
26.02
09019240

A
Removal of breast
15.98
NA
8.22
2.12
NA
26.32
09019260

A
Removal of chest wall lesion
15.42
NA
11.18
2.13
NA
28.73
09019271

A
Revision of chest wall
18.87
NA
18.00
2.62
NA
39.49
09019272

A
Extensive chest wall surgery
21.52
NA
18.98
2.99
NA
43.49
09019290

A
Place needle wire, breast
1.27
2.86
0.42
0.07
4.20
1.76
00019291

A
Place needle wire, breast
0.63
1.21
0.21
0.04
1.88
0.88
ZZZ19295

A
Place breast clip, percut
0.00
2.70
NA
0.01
2.71
NA
ZZZ19296

A
Place po breast cath for rad
3.63
125.75
1.53
0.36
129.74
5.52
00019297

A
Place breast cath for rad
1.72
NA
0.64
0.17
NA
2.53
ZZZ19298

A
Place breast rad tube/caths
6.00
42.28
2.42
0.43
48.71
8.85
00019316

A
Suspension of breast
10.67
NA
7.53
1.64
NA
19.84
09019318

A
Reduction of large breast
15.60
NA
11.20
2.92
NA
29.72
09019324

A
Enlarge breast
5.84
NA
4.90
0.84
NA
11.58
090( print page 70344)19325

A
Enlarge breast with implant
8.44
NA
6.54
1.33
NA
16.31
09019328

A
Removal of breast implant
5.67
NA
5.03
0.91
NA
11.61
09019330

A
Removal of implant material
7.58
NA
6.05
1.26
NA
14.89
09019340

A
Immediate breast prosthesis
6.32
NA
3.12
1.06
NA
10.50
ZZZ19342

A
Delayed breast prosthesis
11.18
NA
8.95
1.83
NA
21.96
09019350

A
Breast reconstruction
8.91
13.88
7.19
1.41
24.20
17.51
09019355

A
Correct inverted nipple(s)
7.56
10.28
4.71
0.92
18.76
13.19
09019357

A
Breast reconstruction
18.13
NA
15.66
2.93
NA
36.72
09019361

A
Breast reconstruction
19.23
NA
12.47
2.92
NA
34.62
09019364

A
Breast reconstruction
40.94
NA
23.61
6.22
NA
70.77
09019366

A
Breast reconstruction
21.25
NA
11.61
3.24
NA
36.10
09019367

A
Breast reconstruction
25.69
NA
16.74
4.03
NA
46.46
09019368

A
Breast reconstruction
32.37
NA
18.97
5.52
NA
56.86
09019369

A
Breast reconstruction
29.78
NA
18.45
4.50
NA
52.73
09019370

A
Surgery of breast capsule
8.04
NA
6.92
1.29
NA
16.25
09019371

A
Removal of breast capsule
9.34
NA
7.84
1.62
NA
18.80
09019380

A
Revise breast reconstruction
9.13
NA
7.72
1.44
NA
18.29
09019396

A
Design custom breast implant
2.17
1.08
0.99
0.30
3.55
3.46
00019499

C
Breast surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY20000

A
Incision of abscess
2.12
2.70
1.74
0.25
5.07
4.11
01020005

A
Incision of deep abscess
3.41
3.50
2.26
0.46
7.37
6.13
0102000F

I
Blood pressure measure
0.00
0.00
0.00
0.00
0.00
0.00
XXX2001F

I
Weight record
0.00
0.00
0.00
0.00
0.00
0.00
XXX2002F

I
Clin sign vol ovrld assess
0.00
0.00
0.00
0.00
0.00
0.00
XXX2003F

I
Auscultation heart perform
0.00
0.00
0.00
0.00
0.00
0.00
XXX2004F

I
Initial exam involved joints
0.00
0.00
0.00
0.00
0.00
0.00
XXX20100

A
Explore wound, neck
10.06
NA
4.47
1.21
NA
15.74
01020101

A
Explore wound, chest
3.22
5.94
1.62
0.44
9.60
5.28
01020102

A
Explore wound, abdomen
3.93
7.48
1.91
0.49
11.90
6.33
01020103

A
Explore wound, extremity
5.29
8.60
3.40
0.75
14.64
9.44
01020150

A
Excise epiphyseal bar
13.67
NA
7.05
2.03
NA
22.75
09020200

A
Muscle biopsy
1.46
3.04
0.75
0.23
4.73
2.44
00020205

A
Deep muscle biopsy
2.35
3.90
1.19
0.33
6.58
3.87
00020206

A
Needle biopsy, muscle
0.99
6.52
0.63
0.07
7.58
1.69
00020220

A
Bone biopsy, trocar/needle
1.27
4.57
0.79
0.08
5.92
2.14
00020225

A
Bone biopsy, trocar/needle
1.87
24.52
1.13
0.22
26.61
3.22
00020240

A
Bone biopsy, excisional
3.23
NA
2.56
0.44
NA
6.23
01020245

A
Bone biopsy, excisional
7.77
NA
6.59
1.31
NA
15.67
01020250

A
Open bone biopsy
5.02
NA
3.51
1.02
NA
9.55
01020251

A
Open bone biopsy
5.55
NA
4.17
1.15
NA
10.87
01020500

A
Injection of sinus tract
1.23
2.27
1.53
0.12
3.62
2.88
01020501

A
Inject sinus tract for x-ray
0.76
2.92
0.25
0.04
3.72
1.05
00020520

A
Removal of foreign body
1.85
2.92
1.77
0.21
4.98
3.83
01020525

A
Removal of foreign body
3.49
9.17
2.63
0.51
13.17
6.63
01020526

A
Ther injection, carp tunnel
0.94
0.97
0.52
0.13
2.04
1.59
00020550

A
Inj tendon sheath/ligament
0.75
0.71
0.23
0.09
1.55
1.07
00020551

A
Inj tendon origin/insertion
0.75
0.68
0.33
0.08
1.51
1.16
00020552

A
Inj trigger point, 1/2 muscl
0.66
0.72
0.20
0.05
1.43
0.91
00020553

A
Inject trigger points, =/> 3
0.75
0.82
0.22
0.04
1.61
1.01
00020600

A
Drain/inject, joint/bursa
0.66
0.65
0.35
0.08
1.39
1.09
00020605

A
Drain/inject, joint/bursa
0.68
0.76
0.36
0.08
1.52
1.12
00020610

A
Drain/inject, joint/bursa
0.79
0.95
0.42
0.11
1.85
1.32
00020612

A
Aspirate/inj ganglion cyst
0.70
0.71
0.36
0.10
1.51
1.16
00020615

A
Treatment of bone cyst
2.28
3.52
1.85
0.20
6.00
4.33
01020650

A
Insert and remove bone pin
2.23
2.37
1.55
0.31
4.91
4.09
01020660

A
Apply, rem fixation device
2.51
3.06
1.61
0.59
6.16
4.71
00020661

A
Application of head brace
4.88
NA
4.92
1.14
NA
10.94
09020662

A
Application of pelvis brace
6.06
NA
5.54
0.56
NA
12.16
09020663

A
Application of thigh brace
5.42
NA
4.84
0.94
NA
11.20
09020664

A
Halo brace application
8.05
NA
7.06
1.74
NA
16.85
09020665

A
Removal of fixation device
1.31
2.16
1.35
0.19
3.66
2.85
01020670

A
Removal of support implant
1.74
11.57
2.11
0.28
13.59
4.13
01020680

A
Removal of support implant
3.34
8.81
3.73
0.56
12.71
7.63
09020690

A
Apply bone fixation device
3.51
NA
2.52
0.59
NA
6.62
09020692

A
Apply bone fixation device
6.40
NA
3.78
1.05
NA
11.23
09020693

A
Adjust bone fixation device
5.85
NA
5.46
0.98
NA
12.29
09020694

A
Remove bone fixation device
4.15
7.16
4.05
0.71
12.02
8.91
09020802

A
Replantation, arm, complete
41.09
NA
21.01
3.81
NA
65.91
09020805

A
Replant forearm, complete
49.93
NA
34.41
4.84
NA
89.18
09020808

A
Replantation hand, complete
61.56
NA
42.34
6.86
NA
110.76
09020816

A
Replantation digit, complete
30.89
NA
37.90
4.52
NA
73.31
09020822

A
Replantation digit, complete
25.55
NA
34.69
4.18
NA
64.42
09020824

A
Replantation thumb, complete
30.89
NA
36.65
4.61
NA
72.15
09020827

A
Replantation thumb, complete
26.37
NA
36.58
3.66
NA
66.61
09020838

A
Replantation foot, complete
41.35
NA
22.34
1.12
NA
64.81
090( print page 70345)20900

A
Removal of bone for graft
5.57
8.45
5.69
0.94
14.96
12.20
09020902

A
Removal of bone for graft
7.54
NA
6.90
1.30
NA
15.74
09020910

A
Remove cartilage for graft
5.33
NA
5.20
0.71
NA
11.24
09020912

A
Remove cartilage for graft
6.34
NA
5.81
0.69
NA
12.84
09020920

A
Removal of fascia for graft
5.30
NA
4.23
0.66
NA
10.19
09020922

A
Removal of fascia for graft
6.60
7.56
4.88
0.70
14.86
12.18
09020924

A
Removal of tendon for graft
6.47
NA
5.90
1.04
NA
13.41
09020926

A
Removal of tissue for graft
5.52
NA
4.76
0.87
NA
11.15
09020930

B
Spinal bone allograft
0.00
0.00
0.00
0.00
0.00
0.00
XXX20931

A
Spinal bone allograft
1.81
NA
0.93
0.43
NA
3.17
ZZZ20936

B
Spinal bone autograft
0.00
0.00
0.00
0.00
0.00
0.00
XXX20937

A
Spinal bone autograft
2.79
NA
1.45
0.54
NA
4.78
ZZZ20938

A
Spinal bone autograft
3.02
NA
1.56
0.64
NA
5.22
ZZZ20950

A
Fluid pressure, muscle
1.26
6.86
0.99
0.20
8.32
2.45
00020955

A
Fibula bone graft, microvasc
39.15
NA
24.34
4.89
NA
68.38
09020956

A
Iliac bone graft, microvasc
39.21
NA
24.81
7.01
NA
71.03
09020957

A
Mt bone graft, microvasc
40.59
NA
18.99
7.05
NA
66.63
09020962

A
Other bone graft, microvasc
39.21
NA
26.60
6.55
NA
72.36
09020969

A
Bone/skin graft, microvasc
43.85
NA
26.71
4.79
NA
75.35
09020970

A
Bone/skin graft, iliac crest
43.00
NA
25.45
6.60
NA
75.05
09020972

A
Bone/skin graft, metatarsal
42.93
NA
20.64
5.30
NA
68.87
09020973

A
Bone/skin graft, great toe
45.69
NA
25.23
5.54
NA
76.46
09020974

A
Electrical bone stimulation
0.62
0.69
0.54
0.11
1.42
1.27
00020975

A
Electrical bone stimulation
2.60
NA
1.71
0.51
NA
4.82
00020979

A
Us bone stimulation
0.62
0.80
0.34
0.09
1.51
1.05
00020982

A
Ablate, bone tumor(s) perq
7.27
109.86
2.98
0.69
117.82
10.94
00020999

C
Musculoskeletal surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY21010

A
Incision of jaw joint
10.12
NA
7.11
1.11
NA
18.34
09021015

A
Resection of facial tumor
5.28
NA
5.02
0.70
NA
11.00
09021025

A
Excision of bone, lower jaw
10.04
12.28
9.38
1.32
23.64
20.74
09021026

A
Excision of facial bone(s)
4.84
7.88
6.34
0.60
13.32
11.78
09021029

A
Contour of face bone lesion
7.70
9.40
7.03
0.94
18.04
15.67
09021030

A
Excise max/zygoma b9 tumor
4.49
6.35
5.04
0.54
11.38
10.07
09021031

A
Remove exostosis, mandible
3.24
5.18
3.63
0.48
8.90
7.35
09021032

A
Remove exostosis, maxilla
3.24
5.36
3.52
0.47
9.07
7.23
09021034

A
Excise max/zygoma mlg tumor
16.15
15.97
12.70
1.71
33.83
30.56
09021040

A
Excise mandible lesion
4.49
6.41
4.73
0.54
11.44
9.76
09021044

A
Removal of jaw bone lesion
11.84
NA
9.40
1.12
NA
22.36
09021045

A
Extensive jaw surgery
16.15
NA
12.39
1.52
NA
30.06
09021046

A
Remove mandible cyst complex
12.98
NA
11.93
1.85
NA
26.76
09021047

A
Excise lwr jaw cyst w/repair
18.72
NA
13.48
2.12
NA
34.32
09021048

A
Remove maxilla cyst complex
13.48
NA
12.17
1.76
NA
27.41
09021049

A
Excis uppr jaw cyst w/repair
17.97
NA
13.06
1.59
NA
32.62
09021050

A
Removal of jaw joint
10.75
NA
9.47
1.47
NA
21.69
09021060

A
Remove jaw joint cartilage
10.21
NA
8.63
1.38
NA
20.22
09021070

A
Remove coronoid process
8.19
NA
7.12
1.27
NA
16.58
09021076

A
Prepare face/oral prosthesis
13.40
12.39
10.03
1.99
27.78
25.42
01021077

A
Prepare face/oral prosthesis
33.70
31.42
26.08
4.55
69.67
64.33
09021079

A
Prepare face/oral prosthesis
22.31
21.56
17.20
3.15
47.02
42.66
09021080

A
Prepare face/oral prosthesis
25.06
24.56
19.42
3.74
53.36
48.22
09021081

A
Prepare face/oral prosthesis
22.85
22.36
17.54
3.20
48.41
43.59
09021082

A
Prepare face/oral prosthesis
20.84
19.40
15.78
3.11
43.35
39.73
09021083

A
Prepare face/oral prosthesis
19.27
18.84
14.47
2.88
40.99
36.62
09021084

A
Prepare face/oral prosthesis
22.48
22.50
17.75
2.18
47.16
42.41
09021085

A
Prepare face/oral prosthesis
8.99
8.31
6.80
1.27
18.57
17.06
01021086

A
Prepare face/oral prosthesis
24.88
23.81
19.49
3.71
52.40
48.08
09021087

A
Prepare face/oral prosthesis
24.88
23.35
19.25
3.44
51.67
47.57
09021088

C
Prepare face/oral prosthesis
0.00
0.00
0.00
0.00
0.00
0.00
09021089

C
Prepare face/oral prosthesis
0.00
0.00
0.00
0.00
0.00
0.00
09021100

A
Maxillofacial fixation
4.21
11.56
4.75
0.34
16.11
9.30
09021110

A
Interdental fixation
5.20
9.59
8.38
0.72
15.51
14.30
09021116

A
Injection, jaw joint x-ray
0.81
4.34
0.33
0.06
5.21
1.20
00021120

A
Reconstruction of chin
4.92
10.61
7.51
0.60
16.13
13.03
09021121

A
Reconstruction of chin
7.63
9.76
7.84
0.90
18.29
16.37
09021122

A
Reconstruction of chin
8.51
NA
8.64
1.07
NA
18.22
09021123

A
Reconstruction of chin
11.14
NA
10.83
1.40
NA
23.37
09021125

A
Augmentation, lower jaw bone
10.60
55.38
8.34
0.79
66.77
19.73
09021127

A
Augmentation, lower jaw bone
11.10
42.92
9.48
1.52
55.54
22.10
09021137

A
Reduction of forehead
9.81
NA
7.75
1.32
NA
18.88
09021138

A
Reduction of forehead
12.17
NA
9.56
1.74
NA
23.47
09021139

A
Reduction of forehead
14.59
NA
11.09
1.18
NA
26.86
09021141

A
Reconstruct midface, lefort
18.07
NA
13.69
2.35
NA
34.11
09021142

A
Reconstruct midface, lefort
18.78
NA
12.86
2.38
NA
34.02
09021143

A
Reconstruct midface, lefort
19.55
NA
14.35
1.66
NA
35.56
09021145

A
Reconstruct midface, lefort
19.91
NA
13.94
2.84
NA
36.69
090( print page 70346)21146

A
Reconstruct midface, lefort
20.68
NA
15.37
3.09
NA
39.14
09021147

A
Reconstruct midface, lefort
21.74
NA
15.09
1.84
NA
38.67
09021150

A
Reconstruct midface, lefort
25.20
NA
16.81
2.55
NA
44.56
09021151

A
Reconstruct midface, lefort
28.26
NA
23.02
2.30
NA
53.58
09021154

A
Reconstruct midface, lefort
30.47
NA
23.19
2.48
NA
56.14
09021155

A
Reconstruct midface, lefort
34.40
NA
23.96
6.64
NA
65.00
09021159

A
Reconstruct midface, lefort
42.32
NA
29.16
8.18
NA
79.66
09021160

A
Reconstruct midface, lefort
46.37
NA
27.55
4.13
NA
78.05
09021172

A
Reconstruct orbit/forehead
27.76
NA
13.79
3.55
NA
45.10
09021175

A
Reconstruct orbit/forehead
33.12
NA
17.84
4.83
NA
55.79
09021179

A
Reconstruct entire forehead
22.22
NA
14.17
2.80
NA
39.19
09021180

A
Reconstruct entire forehead
25.15
NA
15.42
3.48
NA
44.05
09021181

A
Contour cranial bone lesion
9.89
NA
7.48
1.32
NA
18.69
09021182

A
Reconstruct cranial bone
32.14
NA
19.17
2.80
NA
54.11
09021183

A
Reconstruct cranial bone
35.26
NA
20.89
4.47
NA
60.62
09021184

A
Reconstruct cranial bone
38.18
NA
22.00
5.70
NA
65.88
09021188

A
Reconstruction of midface
22.43
NA
18.92
1.69
NA
43.04
09021193

A
Reconst lwr jaw w/o graft
17.12
NA
12.69
2.23
NA
32.04
09021194

A
Reconst lwr jaw w/graft
19.81
NA
13.79
2.02
NA
35.62
09021195

A
Reconst lwr jaw w/o fixation
17.21
NA
14.86
1.64
NA
33.71
09021196

A
Reconst lwr jaw w/fixation
18.88
NA
15.74
2.07
NA
36.69
09021198

A
Reconstr lwr jaw segment
14.14
NA
12.74
1.44
NA
28.32
09021199

A
Reconstr lwr jaw w/advance
15.98
NA
9.14
1.39
NA
26.51
09021206

A
Reconstruct upper jaw bone
14.08
NA
12.67
1.33
NA
28.08
09021208

A
Augmentation of facial bones
10.21
22.39
9.61
1.09
33.69
20.91
09021209

A
Reduction of facial bones
6.71
10.83
8.09
0.90
18.44
15.70
09021210

A
Face bone graft
10.21
24.94
9.38
1.30
36.45
20.89
09021215

A
Lower jaw bone graft
10.75
42.00
9.39
1.53
54.28
21.67
09021230

A
Rib cartilage graft
10.75
NA
8.06
1.29
NA
20.10
09021235

A
Ear cartilage graft
6.71
9.87
6.43
0.61
17.19
13.75
09021240

A
Reconstruction of jaw joint
14.03
NA
12.08
2.24
NA
28.35
09021242

A
Reconstruction of jaw joint
12.93
NA
11.54
1.78
NA
26.25
09021243

A
Reconstruction of jaw joint
20.76
NA
17.48
3.25
NA
41.49
09021244

A
Reconstruction of lower jaw
11.84
NA
12.13
1.25
NA
25.22
09021245

A
Reconstruction of jaw
11.84
14.44
9.88
1.19
27.47
22.91
09021246

A
Reconstruction of jaw
12.45
NA
9.07
1.35
NA
22.87
09021247

A
Reconstruct lower jaw bone
22.60
NA
17.40
2.83
NA
42.83
09021248

A
Reconstruction of jaw
11.46
12.17
9.43
1.55
25.18
22.44
09021249

A
Reconstruction of jaw
17.49
16.77
12.73
2.48
36.74
32.70
09021255

A
Reconstruct lower jaw bone
16.69
NA
16.18
2.38
NA
35.25
09021256

A
Reconstruction of orbit
16.17
NA
11.85
1.50
NA
29.52
09021260

A
Revise eye sockets
16.50
NA
12.80
0.97
NA
30.27
09021261

A
Revise eye sockets
31.44
NA
24.30
3.42
NA
59.16
09021263

A
Revise eye sockets
28.38
NA
19.13
2.62
NA
50.13
09021267

A
Revise eye sockets
18.87
NA
19.83
1.70
NA
40.40
09021268

A
Revise eye sockets
24.44
NA
20.27
3.65
NA
48.36
09021270

A
Augmentation, cheek bone
10.21
11.68
7.27
0.72
22.61
18.20
09021275

A
Revision, orbitofacial bones
11.22
NA
8.18
1.29
NA
20.69
09021280

A
Revision of eyelid
6.02
NA
5.94
0.42
NA
12.38
09021282

A
Revision of eyelid
3.48
NA
4.49
0.26
NA
8.23
09021295

A
Revision of jaw muscle/bone
1.53
NA
2.54
0.16
NA
4.23
09021296

A
Revision of jaw muscle/bone
4.24
NA
4.92
0.34
NA
9.50
09021299

C
Cranio/maxillofacial surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY21300

A
Treatment of skull fracture
0.72
2.37
0.26
0.13
3.22
1.11
00021310

A
Treatment of nose fracture
0.58
2.29
0.15
0.05
2.92
0.78
00021315

A
Treatment of nose fracture
1.51
4.24
1.89
0.14
5.89
3.54
01021320

A
Treatment of nose fracture
1.85
3.92
1.62
0.18
5.95
3.65
01021325

A
Treatment of nose fracture
3.76
NA
8.64
0.31
NA
12.71
09021330

A
Treatment of nose fracture
5.37
NA
9.73
0.56
NA
15.66
09021335

A
Treatment of nose fracture
8.60
NA
9.65
0.74
NA
18.99
09021336

A
Treat nasal septal fracture
5.71
NA
9.64
0.55
NA
15.90
09021337

A
Treat nasal septal fracture
2.70
6.14
3.58
0.28
9.12
6.56
09021338

A
Treat nasoethmoid fracture
6.45
NA
14.06
0.82
NA
21.33
09021339

A
Treat nasoethmoid fracture
8.08
NA
13.94
0.96
NA
22.98
09021340

A
Treatment of nose fracture
10.75
NA
8.42
1.15
NA
20.32
09021343

A
Treatment of sinus fracture
12.93
NA
15.51
1.47
NA
29.91
09021344

A
Treatment of sinus fracture
19.69
NA
16.55
2.43
NA
38.67
09021345

A
Treat nose/jaw fracture
8.15
9.87
7.19
0.92
18.94
16.26
09021346

A
Treat nose/jaw fracture
10.59
NA
12.24
1.21
NA
24.04
09021347

A
Treat nose/jaw fracture
12.67
NA
16.24
1.47
NA
30.38
09021348

A
Treat nose/jaw fracture
16.66
NA
11.14
2.48
NA
30.28
09021355

A
Treat cheek bone fracture
3.76
6.25
3.49
0.34
10.35
7.59
01021356

A
Treat cheek bone fracture
4.14
7.14
4.56
0.46
11.74
9.16
01021360

A
Treat cheek bone fracture
6.45
NA
5.95
0.74
NA
13.14
09021365

A
Treat cheek bone fracture
14.93
NA
10.86
1.69
NA
27.48
090( print page 70347)21366

A
Treat cheek bone fracture
17.74
NA
11.36
2.49
NA
31.59
09021385

A
Treat eye socket fracture
9.15
NA
8.30
0.97
NA
18.42
09021386

A
Treat eye socket fracture
9.15
NA
7.09
0.97
NA
17.21
09021387

A
Treat eye socket fracture
9.69
NA
8.98
1.08
NA
19.75
09021390

A
Treat eye socket fracture
10.11
NA
7.82
0.90
NA
18.83
09021395

A
Treat eye socket fracture
12.66
NA
9.05
1.44
NA
23.15
09021400

A
Treat eye socket fracture
1.40
2.62
1.88
0.15
4.17
3.43
09021401

A
Treat eye socket fracture
3.26
8.01
3.50
0.38
11.65
7.14
09021406

A
Treat eye socket fracture
7.00
NA
6.10
0.73
NA
13.83
09021407

A
Treat eye socket fracture
8.60
NA
6.88
0.94
NA
16.42
09021408

A
Treat eye socket fracture
12.36
NA
8.91
1.44
NA
22.71
09021421

A
Treat mouth roof fracture
5.13
9.36
8.33
0.73
15.22
14.19
09021422

A
Treat mouth roof fracture
8.31
NA
8.10
0.99
NA
17.40
09021423

A
Treat mouth roof fracture
10.38
NA
9.35
1.27
NA
21.00
09021431

A
Treat craniofacial fracture
7.04
NA
9.55
0.70
NA
17.29
09021432

A
Treat craniofacial fracture
8.60
NA
8.08
0.81
NA
17.49
09021433

A
Treat craniofacial fracture
25.31
NA
16.45
2.78
NA
44.54
09021435

A
Treat craniofacial fracture
17.22
NA
12.74
1.98
NA
31.94
09021436

A
Treat craniofacial fracture
28.00
NA
18.27
3.09
NA
49.36
09021440

A
Treat dental ridge fracture
2.70
7.12
6.18
0.38
10.20
9.26
09021445

A
Treat dental ridge fracture
5.37
9.78
8.39
0.78
15.93
14.54
09021450

A
Treat lower jaw fracture
2.97
7.40
6.89
0.33
10.70
10.19
09021451

A
Treat lower jaw fracture
4.86
9.38
8.42
0.63
14.87
13.91
09021452

A
Treat lower jaw fracture
1.98
13.06
4.62
0.27
15.31
6.87
09021453

A
Treat lower jaw fracture
5.53
10.77
10.76
0.74
17.04
17.03
09021454

A
Treat lower jaw fracture
6.45
NA
6.28
0.82
NA
13.55
09021461

A
Treat lower jaw fracture
8.08
24.53
12.70
0.98
33.59
21.76
09021462

A
Treat lower jaw fracture
9.78
27.69
12.75
1.27
38.74
23.80
09021465

A
Treat lower jaw fracture
11.89
NA
9.84
1.50
NA
23.23
09021470

A
Treat lower jaw fracture
15.32
NA
12.05
1.96
NA
29.33
09021480

A
Reset dislocated jaw
0.61
1.78
0.19
0.06
2.45
0.86
00021485

A
Reset dislocated jaw
3.98
8.24
7.68
0.51
12.73
12.17
09021490

A
Repair dislocated jaw
11.84
NA
9.72
1.96
NA
23.52
09021495

A
Treat hyoid bone fracture
5.68
NA
8.44
0.46
NA
14.58
09021497

A
Interdental wiring
3.85
8.47
7.66
0.50
12.82
12.01
09021499

C
Head surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY21501

A
Drain neck/chest lesion
3.80
6.44
3.83
0.43
10.67
8.06
09021502

A
Drain chest lesion
7.11
NA
5.65
0.97
NA
13.73
09021510

A
Drainage of bone lesion
5.73
NA
5.68
0.80
NA
12.21
09021550

A
Biopsy of neck/chest
2.06
3.59
1.72
0.16
5.81
3.94
01021555

A
Remove lesion, neck/chest
4.34
5.53
3.20
0.56
10.43
8.10
09021556

A
Remove lesion, neck/chest
5.56
NA
4.11
0.65
NA
10.32
09021557

A
Remove tumor, neck/chest
8.87
NA
5.37
1.08
NA
15.32
09021600

A
Partial removal of rib
6.88
NA
5.75
0.99
NA
13.62
09021610

A
Partial removal of rib
14.59
NA
8.89
3.07
NA
26.55
09021615

A
Removal of rib
9.86
NA
6.70
1.45
NA
18.01
09021616

A
Removal of rib and nerves
12.02
NA
8.04
1.86
NA
21.92
09021620

A
Partial removal of sternum
6.78
NA
5.99
0.98
NA
13.75
09021627

A
Sternal debridement
6.80
NA
6.32
1.02
NA
14.14
09021630

A
Extensive sternum surgery
17.35
NA
11.87
2.58
NA
31.80
09021632

A
Extensive sternum surgery
18.11
NA
11.14
2.65
NA
31.90
09021685

A
Hyoid myotomy & suspension
12.98
NA
10.00
1.06
NA
24.04
09021700

A
Revision of neck muscle
6.18
NA
4.45
0.32
NA
10.95
09021705

A
Revision of neck muscle/rib
9.59
NA
5.60
1.43
NA
16.62
09021720

A
Revision of neck muscle
5.67
2.47
2.47
0.91
9.05
9.05
09021725

A
Revision of neck muscle
6.98
NA
5.46
1.21
NA
13.65
09021740

A
Reconstruction of sternum
16.48
NA
8.54
2.36
NA
27.38
09021742

C
Repair stern/nuss w/o scope
0.00
0.00
0.00
0.00
0.00
0.00
09021743

C
Repair sternum/nuss w/scope
0.00
0.00
0.00
0.00
0.00
0.00
09021750

A
Repair of sternum separation
10.75
NA
6.13
1.63
NA
18.51
09021800

A
Treatment of rib fracture
0.96
NA
1.34
0.09
NA
2.39
09021805

A
Treatment of rib fracture
2.75
NA
3.21
0.38
NA
6.34
09021810

A
Treatment of rib fracture(s)
6.85
NA
4.98
0.94
NA
12.77
09021820

A
Treat sternum fracture
1.28
1.83
1.77
0.16
3.27
3.21
09021825

A
Treat sternum fracture
7.40
NA
6.41
1.11
NA
14.92
09021899

C
Neck/chest surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY21920

A
Biopsy soft tissue of back
2.06
3.29
1.47
0.14
5.49
3.67
01021925

A
Biopsy soft tissue of back
4.48
5.18
3.25
0.60
10.26
8.33
09021930

A
Remove lesion, back or flank
4.99
5.73
3.41
0.66
11.38
9.06
09021935

A
Remove tumor, back
17.93
NA
9.65
2.47
NA
30.05
09022010

A
I&d, p-spine, c/t/cerv-thor
11.05
NA
8.91
1.73
NA
21.69
09022015

A
I&d, p-spine, l/s/ls
10.94
NA
8.85
1.71
NA
21.50
09022100

A
Remove part of neck vertebra
9.72
NA
7.55
2.13
NA
19.40
09022101

A
Remove part, thorax vertebra
9.80
NA
7.77
1.90
NA
19.47
09022102

A
Remove part, lumbar vertebra
9.80
NA
8.13
1.87
NA
19.80
090( print page 70348)22103

A
Remove extra spine segment
2.34
NA
1.21
0.44
NA
3.99
ZZZ22110

A
Remove part of neck vertebra
12.72
NA
9.19
2.76
NA
24.67
09022112

A
Remove part, thorax vertebra
12.79
NA
9.30
2.52
NA
24.61
09022114

A
Remove part, lumbar vertebra
12.79
NA
9.28
2.63
NA
24.70
09022116

A
Remove extra spine segment
2.32
NA
1.17
0.50
NA
3.99
ZZZ22210

A
Revision of neck spine
23.78
NA
15.45
5.44
NA
44.67
09022212

A
Revision of thorax spine
19.39
NA
13.31
3.90
NA
36.60
09022214

A
Revision of lumbar spine
19.42
NA
13.85
3.91
NA
37.18
09022216

A
Revise, extra spine segment
6.03
NA
3.14
1.29
NA
10.46
ZZZ22220

A
Revision of neck spine
21.34
NA
13.66
5.06
NA
40.06
09022222

A
Revision of thorax spine
21.49
NA
11.16
4.12
NA
36.77
09022224

A
Revision of lumbar spine
21.49
NA
14.26
4.18
NA
39.93
09022226

A
Revise, extra spine segment
6.03
NA
3.10
1.29
NA
10.42
ZZZ22305

A
Treat spine process fracture
2.05
2.32
1.93
0.39
4.76
4.37
09022310

A
Treat spine fracture
2.61
2.81
2.36
0.50
5.92
5.47
09022315

A
Treat spine fracture
8.83
9.71
7.35
1.85
20.39
18.03
09022318

A
Treat odontoid fx w/o graft
21.47
NA
13.42
5.28
NA
40.17
09022319

A
Treat odontoid fx w/graft
23.96
NA
14.75
6.03
NA
44.74
09022325

A
Treat spine fracture
18.27
NA
12.11
3.87
NA
34.25
09022326

A
Treat neck spine fracture
19.56
NA
12.74
4.42
NA
36.72
09022327

A
Treat thorax spine fracture
19.17
NA
12.40
3.98
NA
35.55
09022328

A
Treat each add spine fx
4.60
NA
2.27
0.94
NA
7.81
ZZZ22505

A
Manipulation of spine
1.87
NA
0.94
0.36
NA
3.17
01022520

A
Percut vertebroplasty thor
8.90
61.84
5.11
1.71
72.45
15.72
01022521

A
Percut vertebroplasty lumb
8.33
56.13
4.96
1.60
66.06
14.89
01022522

A
Percut vertebroplasty add'l
4.30
NA
1.68
0.82
NA
6.80
ZZZ22523

A
Percut kyphoplasty, thor
8.94
NA
5.92
1.43
NA
16.29
01022524

A
Percut kyphoplasty, lumbar
8.54
NA
5.71
1.36
NA
15.61
01022525

A
Percut kyphoplasty, add-on
4.47
NA
2.28
0.72
NA
7.47
ZZZ22532

A
Lat thorax spine fusion
23.96
NA
14.86
4.34
NA
43.16
09022533

A
Lat lumbar spine fusion
23.09
NA
13.63
3.15
NA
39.87
09022534

A
Lat thor/lumb, add'l seg
5.99
NA
3.04
1.25
NA
10.28
ZZZ22548

A
Neck spine fusion
25.78
NA
15.85
5.59
NA
47.22
09022554

A
Neck spine fusion
18.59
NA
12.38
4.45
NA
35.42
09022556

A
Thorax spine fusion
23.42
NA
14.77
4.34
NA
42.53
09022558

A
Lumbar spine fusion
22.25
NA
13.33
3.15
NA
38.73
09022585

A
Additional spinal fusion
5.52
NA
2.80
1.25
NA
9.57
ZZZ22590

A
Spine & skull spinal fusion
20.48
NA
13.36
4.78
NA
38.62
09022595

A
Neck spinal fusion
19.36
NA
12.87
4.40
NA
36.63
09022600

A
Neck spine fusion
16.12
NA
11.22
3.72
NA
31.06
09022610

A
Thorax spine fusion
16.00
NA
11.44
3.52
NA
30.96
09022612

A
Lumbar spine fusion
20.97
NA
14.24
4.46
NA
39.67
09022614

A
Spine fusion, extra segment
6.43
NA
3.36
1.38
NA
11.17
ZZZ22630

A
Lumbar spine fusion
20.81
NA
13.64
4.72
NA
39.17
09022632

A
Spine fusion, extra segment
5.22
NA
2.67
1.16
NA
9.05
ZZZ22800

A
Fusion of spine
18.22
NA
12.81
3.75
NA
34.78
09022802

A
Fusion of spine
30.83
NA
19.65
6.15
NA
56.63
09022804

A
Fusion of spine
36.22
NA
22.76
6.98
NA
65.96
09022808

A
Fusion of spine
26.23
NA
16.35
4.92
NA
47.50
09022810

A
Fusion of spine
30.22
NA
18.41
5.13
NA
53.76
09022812

A
Fusion of spine
32.65
NA
20.12
5.28
NA
58.05
09022818

A
Kyphectomy, 1-2 segments
31.78
NA
18.92
6.45
NA
57.15
09022819

A
Kyphectomy, 3 or more
36.39
NA
20.11
7.65
NA
64.15
09022830

A
Exploration of spinal fusion
10.83
NA
7.98
2.29
NA
21.10
09022840

A
Insert spine fixation device
12.52
NA
6.51
2.78
NA
21.81
ZZZ22841

B
Insert spine fixation device
0.00
0.00
0.00
0.00
0.00
0.00
XXX22842

A
Insert spine fixation device
12.56
NA
6.52
2.74
NA
21.82
ZZZ22843

A
Insert spine fixation device
13.44
NA
6.62
2.85
NA
22.91
ZZZ22844

A
Insert spine fixation device
16.42
NA
8.78
3.18
NA
28.38
ZZZ22845

A
Insert spine fixation device
11.94
NA
6.09
2.85
NA
20.88
ZZZ22846

A
Insert spine fixation device
12.40
NA
6.35
2.95
NA
21.70
ZZZ22847

A
Insert spine fixation device
13.78
NA
7.04
2.99
NA
23.81
ZZZ22848

A
Insert pelv fixation device
5.99
NA
3.19
1.15
NA
10.33
ZZZ22849

A
Reinsert spinal fixation
18.48
NA
11.76
3.89
NA
34.13
09022850

A
Remove spine fixation device
9.51
NA
7.01
2.04
NA
18.56
09022851

A
Apply spine prosth device
6.70
NA
3.37
1.49
NA
11.56
ZZZ22852

A
Remove spine fixation device
9.00
NA
6.81
1.89
NA
17.70
09022855

A
Remove spine fixation device
15.11
NA
9.69
3.51
NA
28.31
09022899

C
Spine surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY22900

A
Remove abdominal wall lesion
5.79
NA
3.23
0.76
NA
9.78
09022999

C
Abdomen surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY23000

A
Removal of calcium deposits
4.35
8.55
4.43
0.68
13.58
9.46
09023020

A
Release shoulder joint
8.92
NA
7.58
1.54
NA
18.04
09023030

A
Drain shoulder lesion
3.42
7.41
2.91
0.57
11.40
6.90
01023031

A
Drain shoulder bursa
2.74
7.88
2.73
0.46
11.08
5.93
010( print page 70349)23035

A
Drain shoulder bone lesion
8.60
NA
8.29
1.47
NA
18.36
09023040

A
Exploratory shoulder surgery
9.19
NA
7.88
1.60
NA
18.67
09023044

A
Exploratory shoulder surgery
7.11
NA
6.45
1.24
NA
14.80
09023065

A
Biopsy shoulder tissues
2.27
2.49
1.62
0.20
4.96
4.09
01023066

A
Biopsy shoulder tissues
4.15
7.69
3.99
0.63
12.47
8.77
09023075

A
Removal of shoulder lesion
2.39
3.67
1.79
0.34
6.40
4.52
01023076

A
Removal of shoulder lesion
7.62
NA
5.57
1.13
NA
14.32
09023077

A
Remove tumor of shoulder
16.07
NA
10.24
2.33
NA
28.64
09023100

A
Biopsy of shoulder joint
6.02
NA
5.67
1.04
NA
12.73
09023101

A
Shoulder joint surgery
5.57
NA
5.35
0.96
NA
11.88
09023105

A
Remove shoulder joint lining
8.22
NA
7.14
1.42
NA
16.78
09023106

A
Incision of collarbone joint
5.95
NA
5.72
0.99
NA
12.66
09023107

A
Explore treat shoulder joint
8.61
NA
7.41
1.49
NA
17.51
09023120

A
Partial removal, collar bone
7.10
NA
6.48
1.23
NA
14.81
09023125

A
Removal of collar bone
9.38
NA
7.58
1.62
NA
18.58
09023130

A
Remove shoulder bone, part
7.54
NA
7.15
1.30
NA
15.99
09023140

A
Removal of bone lesion
6.88
NA
5.24
1.08
NA
13.20
09023145

A
Removal of bone lesion
9.08
NA
7.46
1.49
NA
18.03
09023146

A
Removal of bone lesion
7.82
NA
7.13
1.35
NA
16.30
09023150

A
Removal of humerus lesion
8.47
NA
6.94
1.32
NA
16.73
09023155

A
Removal of humerus lesion
10.33
NA
8.35
1.80
NA
20.48
09023156

A
Removal of humerus lesion
8.67
NA
7.40
1.50
NA
17.57
09023170

A
Remove collar bone lesion
6.85
NA
6.04
1.12
NA
14.01
09023172

A
Remove shoulder blade lesion
6.89
NA
6.30
1.01
NA
14.20
09023174

A
Remove humerus lesion
9.50
NA
8.38
1.65
NA
19.53
09023180

A
Remove collar bone lesion
8.52
NA
9.02
1.47
NA
19.01
09023182

A
Remove shoulder blade lesion
8.14
NA
8.57
1.37
NA
18.08
09023184

A
Remove humerus lesion
9.37
NA
9.34
1.63
NA
20.34
09023190

A
Partial removal of scapula
7.23
NA
6.19
1.17
NA
14.59
09023195

A
Removal of head of humerus
9.80
NA
7.75
1.70
NA
19.25
09023200

A
Removal of collar bone
12.06
NA
8.75
1.93
NA
22.74
09023210

A
Removal of shoulder blade
12.47
NA
9.02
2.02
NA
23.51
09023220

A
Partial removal of humerus
14.54
NA
10.85
2.48
NA
27.87
09023221

A
Partial removal of humerus
17.71
NA
11.75
3.05
NA
32.51
09023222

A
Partial removal of humerus
23.88
NA
15.83
3.94
NA
43.65
09023330

A
Remove shoulder foreign body
1.85
3.69
1.89
0.24
5.78
3.98
01023331

A
Remove shoulder foreign body
7.37
NA
6.81
1.27
NA
15.45
09023332

A
Remove shoulder foreign body
11.60
NA
9.35
2.02
NA
22.97
09023350

A
Injection for shoulder x-ray
1.00
3.47
0.33
0.06
4.53
1.39
00023395

A
Muscle transfer,shoulder/arm
16.82
NA
12.90
2.93
NA
32.65
09023397

A
Muscle transfers
16.11
NA
11.40
2.73
NA
30.24
09023400

A
Fixation of shoulder blade
13.52
NA
10.10
2.29
NA
25.91
09023405

A
Incision of tendon & muscle
8.36
NA
6.94
1.45
NA
16.75
09023406

A
Incise tendon(s) & muscle(s)
10.77
NA
8.36
1.87
NA
21.00
09023410

A
Repair rotator cuff, acute
12.43
NA
9.43
2.16
NA
24.02
09023412

A
Repair rotator cuff, chronic
13.29
NA
9.92
2.31
NA
25.52
09023415

A
Release of shoulder ligament
9.96
NA
8.01
1.73
NA
19.70
09023420

A
Repair of shoulder
13.28
NA
10.87
2.31
NA
26.46
09023430

A
Repair biceps tendon
9.97
NA
8.12
1.73
NA
19.82
09023440

A
Remove/transplant tendon
10.46
NA
8.28
1.82
NA
20.56
09023450

A
Repair shoulder capsule
13.38
NA
9.87
2.32
NA
25.57
09023455

A
Repair shoulder capsule
14.35
NA
10.47
2.49
NA
27.31
09023460

A
Repair shoulder capsule
15.35
NA
11.40
2.66
NA
29.41
09023462

A
Repair shoulder capsule
15.28
NA
10.78
2.59
NA
28.65
09023465

A
Repair shoulder capsule
15.83
NA
11.21
2.76
NA
29.80
09023466

A
Repair shoulder capsule
14.20
NA
11.40
2.46
NA
28.06
09023470

A
Reconstruct shoulder joint
17.12
NA
12.29
2.98
NA
32.39
09023472

A
Reconstruct shoulder joint
21.07
NA
14.45
3.66
NA
39.18
09023480

A
Revision of collar bone
11.16
NA
8.80
1.94
NA
21.90
09023485

A
Revision of collar bone
13.41
NA
9.92
2.33
NA
25.66
09023490

A
Reinforce clavicle
11.84
NA
8.72
1.47
NA
22.03
09023491

A
Reinforce shoulder bones
14.19
NA
10.74
2.46
NA
27.39
09023500

A
Treat clavicle fracture
2.08
2.88
2.53
0.30
5.26
4.91
09023505

A
Treat clavicle fracture
3.68
4.42
3.85
0.61
8.71
8.14
09023515

A
Treat clavicle fracture
7.40
NA
6.57
1.28
NA
15.25
09023520

A
Treat clavicle dislocation
2.16
2.86
2.75
0.34
5.36
5.25
09023525

A
Treat clavicle dislocation
3.59
4.55
3.95
0.46
8.60
8.00
09023530

A
Treat clavicle dislocation
7.30
NA
5.95
1.20
NA
14.45
09023532

A
Treat clavicle dislocation
8.00
NA
6.99
1.38
NA
16.37
09023540

A
Treat clavicle dislocation
2.23
2.87
2.37
0.29
5.39
4.89
09023545

A
Treat clavicle dislocation
3.25
4.20
3.37
0.35
7.80
6.97
09023550

A
Treat clavicle dislocation
7.23
NA
6.39
1.25
NA
14.87
09023552

A
Treat clavicle dislocation
8.44
NA
7.34
1.46
NA
17.24
09023570

A
Treat shoulder blade fx
2.23
3.02
2.90
0.36
5.61
5.49
09023575

A
Treat shoulder blade fx
4.05
4.89
4.32
0.59
9.53
8.96
090( print page 70350)23585

A
Treat scapula fracture
8.95
NA
7.66
1.54
NA
18.15
09023600

A
Treat humerus fracture
2.93
4.56
3.56
0.48
7.97
6.97
09023605

A
Treat humerus fracture
4.86
6.17
5.12
0.84
11.87
10.82
09023615

A
Treat humerus fracture
9.34
NA
8.86
1.62
NA
19.82
09023616

A
Treat humerus fracture
21.24
NA
14.18
3.69
NA
39.11
09023620

A
Treat humerus fracture
2.40
3.62
2.99
0.40
6.42
5.79
09023625

A
Treat humerus fracture
3.92
4.95
4.29
0.67
9.54
8.88
09023630

A
Treat humerus fracture
7.34
NA
6.65
1.27
NA
15.26
09023650

A
Treat shoulder dislocation
3.38
3.78
2.77
0.30
7.46
6.45
09023655

A
Treat shoulder dislocation
4.56
NA
4.18
0.69
NA
9.43
09023660

A
Treat shoulder dislocation
7.48
NA
6.40
1.29
NA
15.17
09023665

A
Treat dislocation/fracture
4.46
5.35
4.73
0.71
10.52
9.90
09023670

A
Treat dislocation/fracture
7.89
NA
6.85
1.36
NA
16.10
09023675

A
Treat dislocation/fracture
6.04
6.85
5.85
1.01
13.90
12.90
09023680

A
Treat dislocation/fracture
10.04
NA
8.13
1.75
NA
19.92
09023700

A
Fixation of shoulder
2.52
NA
2.18
0.44
NA
5.14
01023800

A
Fusion of shoulder joint
14.14
NA
10.44
2.35
NA
26.93
09023802

A
Fusion of shoulder joint
16.58
NA
10.20
2.70
NA
29.48
09023900

A
Amputation of arm & girdle
19.69
NA
11.74
3.18
NA
34.61
09023920

A
Amputation at shoulder joint
14.59
NA
9.95
2.46
NA
27.00
09023921

A
Amputation follow-up surgery
5.48
NA
5.09
0.78
NA
11.35
09023929

C
Shoulder surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY23930

A
Drainage of arm lesion
2.94
6.34
2.32
0.43
9.71
5.69
01023931

A
Drainage of arm bursa
1.79
5.93
2.18
0.28
8.00
4.25
01023935

A
Drain arm/elbow bone lesion
6.08
NA
5.93
1.05
NA
13.06
09024000

A
Exploratory elbow surgery
5.81
NA
5.43
0.97
NA
12.21
09024006

A
Release elbow joint
9.30
NA
7.77
1.50
NA
18.57
09024065

A
Biopsy arm/elbow soft tissue
2.08
3.22
1.75
0.17
5.47
4.00
01024066

A
Biopsy arm/elbow soft tissue
5.20
8.96
4.14
0.80
14.96
10.14
09024075

A
Remove arm/elbow lesion
3.91
7.37
3.41
0.56
11.84
7.88
09024076

A
Remove arm/elbow lesion
6.29
NA
4.87
0.95
NA
12.11
09024077

A
Remove tumor of arm/elbow
11.74
NA
7.76
1.72
NA
21.22
09024100

A
Biopsy elbow joint lining
4.92
NA
4.53
0.85
NA
10.30
09024101

A
Explore/treat elbow joint
6.12
NA
5.95
1.03
NA
13.10
09024102

A
Remove elbow joint lining
8.02
NA
6.88
1.33
NA
16.23
09024105

A
Removal of elbow bursa
3.60
NA
4.40
0.61
NA
8.61
09024110

A
Remove humerus lesion
7.38
NA
6.68
1.28
NA
15.34
09024115

A
Remove/graft bone lesion
9.62
NA
7.23
1.67
NA
18.52
09024116

A
Remove/graft bone lesion
11.79
NA
9.10
2.05
NA
22.94
09024120

A
Remove elbow lesion
6.64
NA
5.94
1.10
NA
13.68
09024125

A
Remove/graft bone lesion
7.88
NA
6.18
1.06
NA
15.12
09024126

A
Remove/graft bone lesion
8.30
NA
7.04
1.16
NA
16.50
09024130

A
Removal of head of radius
6.24
NA
6.04
1.04
NA
13.32
09024134

A
Removal of arm bone lesion
9.72
NA
8.88
1.64
NA
20.24
09024136

A
Remove radius bone lesion
7.98
NA
7.24
1.38
NA
16.60
09024138

A
Remove elbow bone lesion
8.04
NA
7.80
1.34
NA
17.18
09024140

A
Partial removal of arm bone
9.17
NA
9.13
1.51
NA
19.81
09024145

A
Partial removal of radius
7.57
NA
8.08
1.25
NA
16.90
09024147

A
Partial removal of elbow
7.53
NA
8.62
1.30
NA
17.45
09024149

A
Radical resection of elbow
14.18
NA
11.65
2.34
NA
28.17
09024150

A
Extensive humerus surgery
13.25
NA
10.02
2.32
NA
25.59
09024151

A
Extensive humerus surgery
15.56
NA
11.54
2.59
NA
29.69
09024152

A
Extensive radius surgery
10.04
NA
7.75
1.48
NA
19.27
09024153

A
Extensive radius surgery
11.52
NA
5.59
0.74
NA
17.85
09024155

A
Removal of elbow joint
11.71
NA
8.42
1.92
NA
22.05
09024160

A
Remove elbow joint implant
7.82
NA
6.91
1.30
NA
16.03
09024164

A
Remove radius head implant
6.22
NA
5.79
1.03
NA
13.04
09024200

A
Removal of arm foreign body
1.76
3.42
1.63
0.20
5.38
3.59
01024201

A
Removal of arm foreign body
4.55
9.84
4.24
0.72
15.11
9.51
09024220

A
Injection for elbow x-ray
1.31
3.64
0.44
0.08
5.03
1.83
00024300

A
Manipulate elbow w/anesth
3.74
NA
5.73
0.65
NA
10.12
09024301

A
Muscle/tendon transfer
10.18
NA
8.20
1.66
NA
20.04
09024305

A
Arm tendon lengthening
7.44
NA
6.73
1.15
NA
15.32
09024310

A
Revision of arm tendon
5.97
NA
5.60
0.96
NA
12.53
09024320

A
Repair of arm tendon
10.54
NA
7.55
1.73
NA
19.82
09024330

A
Revision of arm muscles
9.59
NA
7.90
1.60
NA
19.09
09024331

A
Revision of arm muscles
10.63
NA
8.70
1.77
NA
21.10
09024332

A
Tenolysis, triceps
7.44
NA
6.79
1.23
NA
15.46
09024340

A
Repair of biceps tendon
7.88
NA
7.00
1.36
NA
16.24
09024341

A
Repair arm tendon/muscle
7.89
NA
7.94
1.36
NA
17.19
09024342

A
Repair of ruptured tendon
10.60
NA
8.54
1.85
NA
20.99
09024343

A
Repr elbow lat ligmnt w/tiss
8.64
NA
8.17
1.43
NA
18.24
09024344

A
Reconstruct elbow lat ligmnt
13.98
NA
11.55
2.36
NA
27.89
09024345

A
Repr elbw med ligmnt w/tissu
8.64
NA
8.04
1.44
NA
18.12
09024346

A
Reconstruct elbow med ligmnt
13.98
NA
11.37
2.33
NA
27.68
090( print page 70351)24350

A
Repair of tennis elbow
5.24
NA
5.60
0.87
NA
11.71
09024351

A
Repair of tennis elbow
5.90
NA
5.94
1.02
NA
12.86
09024352

A
Repair of tennis elbow
6.42
NA
6.20
1.10
NA
13.72
09024354

A
Repair of tennis elbow
6.47
NA
6.17
1.07
NA
13.71
09024356

A
Revision of tennis elbow
6.67
NA
6.33
1.11
NA
14.11
09024360

A
Reconstruct elbow joint
12.32
NA
9.50
2.05
NA
23.87
09024361

A
Reconstruct elbow joint
14.06
NA
10.61
2.18
NA
26.85
09024362

A
Reconstruct elbow joint
14.97
NA
10.07
2.60
NA
27.64
09024363

A
Replace elbow joint
18.46
NA
13.75
3.01
NA
35.22
09024365

A
Reconstruct head of radius
8.38
NA
7.22
1.41
NA
17.01
09024366

A
Reconstruct head of radius
9.12
NA
7.56
1.52
NA
18.20
09024400

A
Revision of humerus
11.04
NA
8.88
1.92
NA
21.84
09024410

A
Revision of humerus
14.80
NA
10.34
2.57
NA
27.71
09024420

A
Revision of humerus
13.42
NA
10.57
2.17
NA
26.16
09024430

A
Repair of humerus
12.79
NA
9.77
2.21
NA
24.77
09024435

A
Repair humerus with graft
13.15
NA
10.91
2.27
NA
26.33
09024470

A
Revision of elbow joint
8.73
NA
7.74
1.48
NA
17.95
09024495

A
Decompression of forearm
8.11
NA
8.77
1.18
NA
18.06
09024498

A
Reinforce humerus
11.90
NA
9.29
2.06
NA
23.25
09024500

A
Treat humerus fracture
3.21
4.86
3.69
0.50
8.57
7.40
09024505

A
Treat humerus fracture
5.16
6.62
5.41
0.89
12.67
11.46
09024515

A
Treat humerus fracture
11.63
NA
9.41
2.02
NA
23.06
09024516

A
Treat humerus fracture
11.63
NA
9.14
2.02
NA
22.79
09024530

A
Treat humerus fracture
3.49
5.22
4.05
0.57
9.28
8.11
09024535

A
Treat humerus fracture
6.86
7.86
6.64
1.18
15.90
14.68
09024538

A
Treat humerus fracture
9.42
NA
8.73
1.64
NA
19.79
09024545

A
Treat humerus fracture
10.44
NA
8.47
1.82
NA
20.73
09024546

A
Treat humerus fracture
15.67
NA
11.35
2.73
NA
29.75
09024560

A
Treat humerus fracture
2.80
4.49
3.20
0.44
7.73
6.44
09024565

A
Treat humerus fracture
5.55
6.63
5.54
0.93
13.11
12.02
09024566

A
Treat humerus fracture
7.78
NA
8.18
1.30
NA
17.26
09024575

A
Treat humerus fracture
10.64
NA
8.42
1.86
NA
20.92
09024576

A
Treat humerus fracture
2.86
4.77
3.72
0.46
8.09
7.04
09024577

A
Treat humerus fracture
5.78
6.95
5.86
0.95
13.68
12.59
09024579

A
Treat humerus fracture
11.58
NA
8.86
2.02
NA
22.46
09024582

A
Treat humerus fracture
8.54
NA
9.14
1.48
NA
19.16
09024586

A
Treat elbow fracture
15.19
NA
11.26
2.64
NA
29.09
09024587

A
Treat elbow fracture
15.14
NA
11.05
2.52
NA
28.71
09024600

A
Treat elbow dislocation
4.22
4.87
3.51
0.50
9.59
8.23
09024605

A
Treat elbow dislocation
5.41
NA
5.38
0.89
NA
11.68
09024615

A
Treat elbow dislocation
9.41
NA
7.84
1.60
NA
18.85
09024620

A
Treat elbow fracture
6.97
NA
6.27
1.07
NA
14.31
09024635

A
Treat elbow fracture
13.17
NA
14.09
2.28
NA
29.54
09024640

A
Treat elbow dislocation
1.20
1.85
0.80
0.12
3.17
2.12
01024650

A
Treat radius fracture
2.16
3.79
2.76
0.35
6.30
5.27
09024655

A
Treat radius fracture
4.39
5.97
4.80
0.70
11.06
9.89
09024665

A
Treat radius fracture
8.13
NA
7.53
1.41
NA
17.07
09024666

A
Treat radius fracture
9.48
NA
8.09
1.62
NA
19.19
09024670

A
Treat ulnar fracture
2.54
4.12
3.08
0.41
7.07
6.03
09024675

A
Treat ulnar fracture
4.71
6.02
4.98
0.81
11.54
10.50
09024685

A
Treat ulnar fracture
8.79
NA
7.54
1.52
NA
17.85
09024800

A
Fusion of elbow joint
11.18
NA
8.77
1.63
NA
21.58
09024802

A
Fusion/graft of elbow joint
13.67
NA
10.41
2.37
NA
26.45
09024900

A
Amputation of upper arm
9.59
NA
7.08
1.53
NA
18.20
09024920

A
Amputation of upper arm
9.53
NA
6.96
1.61
NA
18.10
09024925

A
Amputation follow-up surgery
7.06
NA
6.10
1.14
NA
14.30
09024930

A
Amputation follow-up surgery
10.23
NA
7.26
1.67
NA
19.16
09024931

A
Amputate upper arm & implant
12.70
NA
5.74
1.89
NA
20.33
09024935

A
Revision of amputation
15.54
NA
8.04
2.13
NA
25.71
09024940

C
Revision of upper arm
0.00
0.00
0.00
0.00
0.00
0.00
09024999

C
Upper arm/elbow surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY25000

A
Incision of tendon sheath
3.37
NA
6.89
0.55
NA
10.81
09025001

A
Incise flexor carpi radialis
3.37
NA
4.24
0.55
NA
8.16
09025020

A
Decompress forearm 1 space
5.91
NA
9.59
0.93
NA
16.43
09025023

A
Decompress forearm 1 space
12.94
NA
14.98
2.03
NA
29.95
09025024

A
Decompress forearm 2 spaces
9.49
NA
7.49
1.36
NA
18.34
09025025

A
Decompress forearm 2 spaces
16.52
NA
10.00
1.82
NA
28.34
09025028

A
Drainage of forearm lesion
5.24
NA
8.18
0.81
NA
14.23
09025031

A
Drainage of forearm bursa
4.13
NA
7.94
0.63
NA
12.70
09025035

A
Treat forearm bone lesion
7.35
NA
13.63
1.24
NA
22.22
09025040

A
Explore/treat wrist joint
7.17
NA
7.32
1.15
NA
15.64
09025065

A
Biopsy forearm soft tissues
1.99
3.23
1.91
0.15
5.37
4.05
01025066

A
Biopsy forearm soft tissues
4.12
NA
7.08
0.64
NA
11.84
09025075

A
Removal forearm lesion subcu
3.73
NA
5.91
0.55
NA
10.19
09025076

A
Removal forearm lesion deep
4.91
NA
9.57
0.74
NA
15.22
090( print page 70352)25077

A
Remove tumor, forearm/wrist
9.75
NA
12.12
1.42
NA
23.29
09025085

A
Incision of wrist capsule
5.49
NA
7.14
0.85
NA
13.48
09025100

A
Biopsy of wrist joint
3.89
NA
5.29
0.59
NA
9.77
09025101

A
Explore/treat wrist joint
4.68
NA
5.91
0.75
NA
11.34
09025105

A
Remove wrist joint lining
5.84
NA
7.32
0.92
NA
14.08
09025107

A
Remove wrist joint cartilage
6.42
NA
8.36
0.99
NA
15.77
09025110

A
Remove wrist tendon lesion
3.91
NA
7.07
0.62
NA
11.60
09025111

A
Remove wrist tendon lesion
3.38
NA
4.71
0.53
NA
8.62
09025112

A
Reremove wrist tendon lesion
4.52
NA
5.27
0.70
NA
10.49
09025115

A
Remove wrist/forearm lesion
8.81
NA
14.07
1.31
NA
24.19
09025116

A
Remove wrist/forearm lesion
7.10
NA
13.18
1.11
NA
21.39
09025118

A
Excise wrist tendon sheath
4.36
NA
5.76
0.68
NA
10.80
09025119

A
Partial removal of ulna
6.03
NA
7.62
0.96
NA
14.61
09025120

A
Removal of forearm lesion
6.09
NA
12.12
1.00
NA
19.21
09025125

A
Remove/graft forearm lesion
7.47
NA
12.88
1.06
NA
21.41
09025126

A
Remove/graft forearm lesion
7.54
NA
13.05
1.27
NA
21.86
09025130

A
Removal of wrist lesion
5.25
NA
6.44
0.80
NA
12.49
09025135

A
Remove & graft wrist lesion
6.88
NA
7.53
1.02
NA
15.43
09025136

A
Remove & graft wrist lesion
5.96
NA
6.61
1.03
NA
13.60
09025145

A
Remove forearm bone lesion
6.36
NA
12.09
1.01
NA
19.46
09025150

A
Partial removal of ulna
7.08
NA
8.23
1.14
NA
16.45
09025151

A
Partial removal of radius
7.38
NA
12.76
1.18
NA
21.32
09025170

A
Extensive forearm surgery
11.07
NA
15.19
1.77
NA
28.03
09025210

A
Removal of wrist bone
5.94
NA
6.81
0.88
NA
13.63
09025215

A
Removal of wrist bones
7.88
NA
8.78
1.19
NA
17.85
09025230

A
Partial removal of radius
5.22
NA
6.16
0.79
NA
12.17
09025240

A
Partial removal of ulna
5.16
NA
6.97
0.81
NA
12.94
09025246

A
Injection for wrist x-ray
1.45
3.45
0.48
0.09
4.99
2.02
00025248

A
Remove forearm foreign body
5.13
NA
8.54
0.72
NA
14.39
09025250

A
Removal of wrist prosthesis
6.59
NA
6.12
1.01
NA
13.72
09025251

A
Removal of wrist prosthesis
9.56
NA
7.94
1.26
NA
18.76
09025259

A
Manipulate wrist w/anesthes
3.74
NA
5.74
0.62
NA
10.10
09025260

A
Repair forearm tendon/muscle
7.79
NA
13.35
1.19
NA
22.33
09025263

A
Repair forearm tendon/muscle
7.81
NA
13.30
1.18
NA
22.29
09025265

A
Repair forearm tendon/muscle
9.87
NA
14.35
1.47
NA
25.69
09025270

A
Repair forearm tendon/muscle
5.99
NA
12.06
0.95
NA
19.00
09025272

A
Repair forearm tendon/muscle
7.03
NA
12.83
1.11
NA
20.97
09025274

A
Repair forearm tendon/muscle
8.74
NA
13.66
1.36
NA
23.76
09025275

A
Repair forearm tendon sheath
8.49
NA
7.60
1.31
NA
17.40
09025280

A
Revise wrist/forearm tendon
7.21
NA
12.67
1.08
NA
20.96
09025290

A
Incise wrist/forearm tendon
5.28
NA
15.03
0.82
NA
21.13
09025295

A
Release wrist/forearm tendon
6.54
NA
12.19
1.00
NA
19.73
09025300

A
Fusion of tendons at wrist
8.79
NA
8.47
1.26
NA
18.52
09025301

A
Fusion of tendons at wrist
8.39
NA
8.08
1.29
NA
17.76
09025310

A
Transplant forearm tendon
8.13
NA
13.07
1.21
NA
22.41
09025312

A
Transplant forearm tendon
9.56
NA
13.98
1.41
NA
24.95
09025315

A
Revise palsy hand tendon(s)
10.18
NA
14.44
1.58
NA
26.20
09025316

A
Revise palsy hand tendon(s)
12.31
NA
16.27
1.74
NA
30.32
09025320

A
Repair/revise wrist joint
10.75
NA
11.42
1.61
NA
23.78
09025332

A
Revise wrist joint
11.39
NA
9.20
1.83
NA
22.42
09025335

A
Realignment of hand
12.86
NA
11.62
1.92
NA
26.40
09025337

A
Reconstruct ulna/radioulnar
10.15
NA
11.11
1.61
NA
22.87
09025350

A
Revision of radius
8.77
NA
14.01
1.46
NA
24.24
09025355

A
Revision of radius
10.15
NA
14.65
1.73
NA
26.53
09025360

A
Revision of ulna
8.42
NA
13.91
1.41
NA
23.74
09025365

A
Revise radius & ulna
12.38
NA
15.69
2.15
NA
30.22
09025370

A
Revise radius or ulna
13.34
NA
16.12
2.28
NA
31.74
09025375

A
Revise radius & ulna
13.02
NA
16.47
2.26
NA
31.75
09025390

A
Shorten radius or ulna
10.38
NA
14.62
1.65
NA
26.65
09025391

A
Lengthen radius or ulna
13.63
NA
16.60
2.21
NA
32.44
09025392

A
Shorten radius & ulna
13.93
NA
16.01
2.10
NA
32.04
09025393

A
Lengthen radius & ulna
15.85
NA
17.63
2.76
NA
36.24
09025394

A
Repair carpal bone, shorten
10.38
NA
8.08
1.59
NA
20.05
09025400

A
Repair radius or ulna
10.90
NA
15.23
1.82
NA
27.95
09025405

A
Repair/graft radius or ulna
14.36
NA
17.32
2.32
NA
34.00
09025415

A
Repair radius & ulna
13.33
NA
16.56
2.17
NA
32.06
09025420

A
Repair/graft radius & ulna
16.31
NA
18.32
2.61
NA
37.24
09025425

A
Repair/graft radius or ulna
13.19
NA
21.45
2.08
NA
36.72
09025426

A
Repair/graft radius & ulna
15.80
NA
16.60
2.54
NA
34.94
09025430

A
Vasc graft into carpal bone
9.24
NA
7.36
1.27
NA
17.87
09025431

A
Repair nonunion carpal bone
10.42
NA
8.42
1.90
NA
20.74
09025440

A
Repair/graft wrist bone
10.42
NA
9.43
1.63
NA
21.48
09025441

A
Reconstruct wrist joint
12.88
NA
10.03
2.07
NA
24.98
09025442

A
Reconstruct wrist joint
10.83
NA
8.91
1.53
NA
21.27
09025443

A
Reconstruct wrist joint
10.37
NA
8.80
1.37
NA
20.54
090( print page 70353)25444

A
Reconstruct wrist joint
11.13
NA
9.06
1.71
NA
21.90
09025445

A
Reconstruct wrist joint
9.68
NA
8.01
1.55
NA
19.24
09025446

A
Wrist replacement
16.53
NA
11.95
2.47
NA
30.95
09025447

A
Repair wrist joint(s)
10.35
NA
8.68
1.61
NA
20.64
09025449

A
Remove wrist joint implant
14.47
NA
10.70
2.21
NA
27.38
09025450

A
Revision of wrist joint
7.86
NA
10.22
1.36
NA
19.44
09025455

A
Revision of wrist joint
9.48
NA
10.89
0.96
NA
21.33
09025490

A
Reinforce radius
9.53
NA
13.77
1.43
NA
24.73
09025491

A
Reinforce ulna
9.95
NA
14.50
1.60
NA
26.05
09025492

A
Reinforce radius and ulna
12.31
NA
15.34
2.14
NA
29.79
09025500

A
Treat fracture of radius
2.45
3.58
2.72
0.35
6.38
5.52
09025505

A
Treat fracture of radius
5.20
6.56
5.44
0.90
12.66
11.54
09025515

A
Treat fracture of radius
9.17
NA
7.48
1.59
NA
18.24
09025520

A
Treat fracture of radius
6.25
6.88
6.08
1.08
14.21
13.41
09025525

A
Treat fracture of radius
12.22
NA
10.02
2.12
NA
24.36
09025526

A
Treat fracture of radius
12.96
NA
13.54
2.19
NA
28.69
09025530

A
Treat fracture of ulna
2.09
3.77
2.87
0.34
6.20
5.30
09025535

A
Treat fracture of ulna
5.13
6.03
5.31
0.89
12.05
11.33
09025545

A
Treat fracture of ulna
8.89
NA
7.68
1.53
NA
18.10
09025560

A
Treat fracture radius & ulna
2.44
3.70
2.61
0.35
6.49
5.40
09025565

A
Treat fracture radius & ulna
5.62
6.72
5.44
0.93
13.27
11.99
09025574

A
Treat fracture radius & ulna
7.00
NA
7.22
1.21
NA
15.43
09025575

A
Treat fracture radius/ulna
10.43
NA
9.54
1.81
NA
21.78
09025600

A
Treat fracture radius/ulna
2.63
4.10
2.98
0.42
7.15
6.03
09025605

A
Treat fracture radius/ulna
5.80
7.25
6.24
1.00
14.05
13.04
09025611

A
Treat fracture radius/ulna
7.76
NA
8.99
1.34
NA
18.09
09025620

A
Treat fracture radius/ulna
8.54
NA
7.28
1.42
NA
17.24
09025622

A
Treat wrist bone fracture
2.61
4.28
3.11
0.41
7.30
6.13
09025624

A
Treat wrist bone fracture
4.52
6.32
5.08
0.76
11.60
10.36
09025628

A
Treat wrist bone fracture
8.42
NA
7.84
1.37
NA
17.63
09025630

A
Treat wrist bone fracture
2.88
4.19
2.95
0.45
7.52
6.28
09025635

A
Treat wrist bone fracture
4.38
5.96
3.91
0.74
11.08
9.03
09025645

A
Treat wrist bone fracture
7.24
NA
6.65
1.20
NA
15.09
09025650

A
Treat wrist bone fracture
3.05
4.32
3.18
0.45
7.82
6.68
09025651

A
Pin ulnar styloid fracture
5.35
NA
5.50
0.86
NA
11.71
09025652

A
Treat fracture ulnar styloid
7.59
NA
7.02
1.21
NA
15.82
09025660

A
Treat wrist dislocation
4.75
NA
4.72
0.58
NA
10.05
09025670

A
Treat wrist dislocation
7.91
NA
7.01
1.28
NA
16.20
09025671

A
Pin radioulnar dislocation
5.99
NA
6.17
1.00
NA
13.16
09025675

A
Treat wrist dislocation
4.66
5.67
4.66
0.62
10.95
9.94
09025676

A
Treat wrist dislocation
8.03
NA
7.32
1.34
NA
16.69
09025680

A
Treat wrist fracture
5.98
NA
4.75
0.78
NA
11.51
09025685

A
Treat wrist fracture
9.77
NA
7.82
1.60
NA
19.19
09025690

A
Treat wrist dislocation
5.49
NA
5.52
0.88
NA
11.89
09025695

A
Treat wrist dislocation
8.33
NA
7.11
1.32
NA
16.76
09025800

A
Fusion of wrist joint
9.75
NA
9.12
1.57
NA
20.44
09025805

A
Fusion/graft of wrist joint
11.26
NA
10.28
1.80
NA
23.34
09025810

A
Fusion/graft of wrist joint
10.55
NA
9.93
1.67
NA
22.15
09025820

A
Fusion of hand bones
7.44
NA
7.87
1.22
NA
16.53
09025825

A
Fuse hand bones with graft
9.26
NA
9.26
1.41
NA
19.93
09025830

A
Fusion, radioulnar jnt/ulna
10.04
NA
14.45
1.55
NA
26.04
09025900

A
Amputation of forearm
9.00
NA
12.60
1.30
NA
22.90
09025905

A
Amputation of forearm
9.11
NA
12.33
1.40
NA
22.84
09025907

A
Amputation follow-up surgery
7.79
NA
11.79
1.10
NA
20.68
09025909

A
Amputation follow-up surgery
8.95
NA
12.31
1.44
NA
22.70
09025915

A
Amputation of forearm
17.05
NA
18.93
2.93
NA
38.91
09025920

A
Amputate hand at wrist
8.67
NA
7.87
1.35
NA
17.89
09025922

A
Amputate hand at wrist
7.41
NA
7.07
1.12
NA
15.60
09025924

A
Amputation follow-up surgery
8.45
NA
8.11
1.32
NA
17.88
09025927

A
Amputation of hand
8.79
NA
11.71
1.27
NA
21.77
09025929

A
Amputation follow-up surgery
7.58
NA
5.89
1.14
NA
14.61
09025931

A
Amputation follow-up surgery
7.80
NA
11.49
1.15
NA
20.44
09025999

C
Forearm or wrist surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY26010

A
Drainage of finger abscess
1.54
5.58
1.63
0.18
7.30
3.35
01026011

A
Drainage of finger abscess
2.19
8.84
2.33
0.33
11.36
4.85
01026020

A
Drain hand tendon sheath
4.66
NA
5.37
0.73
NA
10.76
09026025

A
Drainage of palm bursa
4.81
NA
5.13
0.76
NA
10.70
09026030

A
Drainage of palm bursa(s)
5.92
NA
5.74
0.92
NA
12.58
09026034

A
Treat hand bone lesion
6.22
NA
6.37
1.01
NA
13.60
09026035

A
Decompress fingers/hand
9.50
NA
7.89
1.47
NA
18.86
09026037

A
Decompress fingers/hand
7.24
NA
6.34
1.13
NA
14.71
09026040

A
Release palm contracture
3.33
NA
4.06
0.53
NA
7.92
09026045

A
Release palm contracture
5.55
NA
5.66
0.93
NA
12.14
09026055

A
Incise finger tendon sheath
2.69
14.39
3.95
0.43
17.51
7.07
09026060

A
Incision of finger tendon
2.81
NA
3.52
0.45
NA
6.78
090( print page 70354)26070

A
Explore/treat hand joint
3.68
NA
3.37
0.48
NA
7.53
09026075

A
Explore/treat finger joint
3.78
NA
3.79
0.53
NA
8.10
09026080

A
Explore/treat finger joint
4.23
NA
4.86
0.66
NA
9.75
09026100

A
Biopsy hand joint lining
3.66
NA
4.14
0.54
NA
8.34
09026105

A
Biopsy finger joint lining
3.70
NA
4.24
0.59
NA
8.53
09026110

A
Biopsy finger joint lining
3.52
NA
4.05
0.53
NA
8.10
09026115

A
Removal hand lesion subcut
3.85
13.13
4.78
0.59
17.57
9.22
09026116

A
Removal hand lesion, deep
5.52
NA
6.02
0.84
NA
12.38
09026117

A
Remove tumor, hand/finger
8.54
NA
7.08
1.26
NA
16.88
09026121

A
Release palm contracture
7.53
NA
6.98
1.17
NA
15.68
09026123

A
Release palm contracture
9.28
NA
8.88
1.43
NA
19.59
09026125

A
Release palm contracture
4.60
NA
2.45
0.70
NA
7.75
ZZZ26130

A
Remove wrist joint lining
5.41
NA
5.36
0.94
NA
11.71
09026135

A
Revise finger joint, each
6.95
NA
6.48
1.07
NA
14.50
09026140

A
Revise finger joint, each
6.16
NA
6.06
0.92
NA
13.14
09026145

A
Tendon excision, palm/finger
6.31
NA
6.07
0.97
NA
13.35
09026160

A
Remove tendon sheath lesion
3.15
12.41
4.13
0.49
16.05
7.77
09026170

A
Removal of palm tendon, each
4.76
NA
4.95
0.69
NA
10.40
09026180

A
Removal of finger tendon
5.17
NA
5.43
0.78
NA
11.38
09026185

A
Remove finger bone
5.24
NA
6.05
0.81
NA
12.10
09026200

A
Remove hand bone lesion
5.50
NA
5.37
0.88
NA
11.75
09026205

A
Remove/graft bone lesion
7.69
NA
6.91
1.20
NA
15.80
09026210

A
Removal of finger lesion
5.14
NA
5.44
0.79
NA
11.37
09026215

A
Remove/graft finger lesion
7.09
NA
6.33
0.98
NA
14.40
09026230

A
Partial removal of hand bone
6.32
NA
5.93
1.01
NA
13.26
09026235

A
Partial removal, finger bone
6.18
NA
5.83
0.95
NA
12.96
09026236

A
Partial removal, finger bone
5.31
NA
5.34
0.81
NA
11.46
09026250

A
Extensive hand surgery
7.54
NA
6.45
1.07
NA
15.06
09026255

A
Extensive hand surgery
12.41
NA
9.40
1.68
NA
23.49
09026260

A
Extensive finger surgery
7.02
NA
6.20
1.01
NA
14.23
09026261

A
Extensive finger surgery
9.08
NA
6.19
1.14
NA
16.41
09026262

A
Partial removal of finger
5.66
NA
5.35
0.88
NA
11.89
09026320

A
Removal of implant from hand
3.97
NA
4.32
0.59
NA
8.88
09026340

A
Manipulate finger w/anesth
2.50
NA
4.89
0.39
NA
7.78
09026350

A
Repair finger/hand tendon
5.98
NA
14.65
0.93
NA
21.56
09026352

A
Repair/graft hand tendon
7.67
NA
15.40
1.13
NA
24.20
09026356

A
Repair finger/hand tendon
8.06
NA
18.42
1.21
NA
27.69
09026357

A
Repair finger/hand tendon
8.57
NA
15.68
1.33
NA
25.58
09026358

A
Repair/graft hand tendon
9.13
NA
16.69
1.38
NA
27.20
09026370

A
Repair finger/hand tendon
7.10
NA
15.15
1.12
NA
23.37
09026372

A
Repair/graft hand tendon
8.75
NA
16.58
1.40
NA
26.73
09026373

A
Repair finger/hand tendon
8.15
NA
16.09
1.23
NA
25.47
09026390

A
Revise hand/finger tendon
9.18
NA
13.32
1.40
NA
23.90
09026392

A
Repair/graft hand tendon
10.24
NA
16.77
1.57
NA
28.58
09026410

A
Repair hand tendon
4.62
NA
11.97
0.73
NA
17.32
09026412

A
Repair/graft hand tendon
6.30
NA
13.31
0.97
NA
20.58
09026415

A
Excision, hand/finger tendon
8.33
NA
11.81
0.98
NA
21.12
09026416

A
Graft hand or finger tendon
9.36
NA
14.63
0.79
NA
24.78
09026418

A
Repair finger tendon
4.24
NA
12.36
0.67
NA
17.27
09026420

A
Repair/graft finger tendon
6.76
NA
13.67
1.07
NA
21.50
09026426

A
Repair finger/hand tendon
6.14
NA
13.20
0.95
NA
20.29
09026428

A
Repair/graft finger tendon
7.20
NA
13.90
1.09
NA
22.19
09026432

A
Repair finger tendon
4.01
NA
10.29
0.64
NA
14.94
09026433

A
Repair finger tendon
4.55
NA
10.82
0.72
NA
16.09
09026434

A
Repair/graft finger tendon
6.08
NA
11.57
0.93
NA
18.58
09026437

A
Realignment of tendons
5.81
NA
11.60
0.89
NA
18.30
09026440

A
Release palm/finger tendon
5.01
NA
13.47
0.75
NA
19.23
09026442

A
Release palm & finger tendon
8.15
NA
15.99
1.20
NA
25.34
09026445

A
Release hand/finger tendon
4.30
NA
13.18
0.65
NA
18.13
09026449

A
Release forearm/hand tendon
6.99
NA
15.82
1.06
NA
23.87
09026450

A
Incision of palm tendon
3.66
NA
7.35
0.59
NA
11.60
09026455

A
Incision of finger tendon
3.63
NA
7.30
0.58
NA
11.51
09026460

A
Incise hand/finger tendon
3.45
NA
7.16
0.55
NA
11.16
09026471

A
Fusion of finger tendons
5.72
NA
11.27
0.88
NA
17.87
09026474

A
Fusion of finger tendons
5.31
NA
11.42
0.76
NA
17.49
09026476

A
Tendon lengthening
5.17
NA
10.96
0.79
NA
16.92
09026477

A
Tendon shortening
5.14
NA
11.09
0.81
NA
17.04
09026478

A
Lengthening of hand tendon
5.79
NA
11.87
0.90
NA
18.56
09026479

A
Shortening of hand tendon
5.73
NA
11.59
0.92
NA
18.24
09026480

A
Transplant hand tendon
6.68
NA
15.08
1.02
NA
22.78
09026483

A
Transplant/graft hand tendon
8.28
NA
15.54
1.26
NA
25.08
09026485

A
Transplant palm tendon
7.69
NA
15.40
1.15
NA
24.24
09026489

A
Transplant/graft palm tendon
9.54
NA
12.09
1.26
NA
22.89
09026490

A
Revise thumb tendon
8.40
NA
12.86
1.21
NA
22.47
09026492

A
Tendon transfer with graft
9.61
NA
13.64
1.40
NA
24.65
090( print page 70355)26494

A
Hand tendon/muscle transfer
8.46
NA
13.01
1.28
NA
22.75
09026496

A
Revise thumb tendon
9.58
NA
13.27
1.45
NA
24.30
09026497

A
Finger tendon transfer
9.56
NA
13.61
1.41
NA
24.58
09026498

A
Finger tendon transfer
13.98
NA
16.21
2.10
NA
32.29
09026499

A
Revision of finger
8.97
NA
13.08
1.35
NA
23.40
09026500

A
Hand tendon reconstruction
5.95
NA
11.47
0.90
NA
18.32
09026502

A
Hand tendon reconstruction
7.13
NA
12.05
1.13
NA
20.31
09026504

A
Hand tendon reconstruction
7.46
NA
12.62
1.24
NA
21.32
09026508

A
Release thumb contracture
6.00
NA
11.71
0.98
NA
18.69
09026510

A
Thumb tendon transfer
5.42
NA
11.37
0.79
NA
17.58
09026516

A
Fusion of knuckle joint
7.14
NA
12.27
1.10
NA
20.51
09026517

A
Fusion of knuckle joints
8.82
NA
13.54
1.41
NA
23.77
09026518

A
Fusion of knuckle joints
9.01
NA
13.43
1.35
NA
23.79
09026520

A
Release knuckle contracture
5.29
NA
13.93
0.80
NA
20.02
09026525

A
Release finger contracture
5.32
NA
14.01
0.81
NA
20.14
09026530

A
Revise knuckle joint
6.68
NA
6.16
1.04
NA
13.88
09026531

A
Revise knuckle with implant
7.90
NA
7.14
1.17
NA
16.21
09026535

A
Revise finger joint
5.23
NA
3.75
0.71
NA
9.69
09026536

A
Revise/implant finger joint
6.36
NA
9.68
0.96
NA
17.00
09026540

A
Repair hand joint
6.42
NA
11.90
0.99
NA
19.31
09026541

A
Repair hand joint with graft
8.61
NA
13.43
1.28
NA
23.32
09026542

A
Repair hand joint with graft
6.77
NA
12.06
1.02
NA
19.85
09026545

A
Reconstruct finger joint
6.91
NA
12.17
1.05
NA
20.13
09026546

A
Repair nonunion hand
8.91
NA
15.07
1.44
NA
25.42
09026548

A
Reconstruct finger joint
8.02
NA
12.89
1.20
NA
22.11
09026550

A
Construct thumb replacement
21.21
NA
17.63
2.45
NA
41.29
09026551

A
Great toe-hand transfer
46.51
NA
32.53
7.96
NA
87.00
09026553

A
Single transfer, toe-hand
46.20
NA
22.75
2.41
NA
71.36
09026554

A
Double transfer, toe-hand
54.87
NA
37.64
9.41
NA
101.92
09026555

A
Positional change of finger
16.61
NA
18.23
2.48
NA
37.32
09026556

A
Toe joint transfer
47.19
NA
33.42
2.57
NA
83.18
09026560

A
Repair of web finger
5.37
NA
9.83
0.85
NA
16.05
09026561

A
Repair of web finger
10.90
NA
12.38
1.45
NA
24.73
09026562

A
Repair of web finger
14.98
NA
17.19
2.23
NA
34.40
09026565

A
Correct metacarpal flaw
6.73
NA
12.04
1.00
NA
19.77
09026567

A
Correct finger deformity
6.81
NA
11.98
1.04
NA
19.83
09026568

A
Lengthen metacarpal/finger
9.07
NA
15.47
1.49
NA
26.03
09026580

A
Repair hand deformity
18.15
NA
13.68
2.28
NA
34.11
09026587

A
Reconstruct extra finger
14.03
NA
9.24
1.53
NA
24.80
09026590

A
Repair finger deformity
17.93
NA
13.98
2.77
NA
34.68
09026591

A
Repair muscles of hand
3.25
NA
9.65
0.48
NA
13.38
09026593

A
Release muscles of hand
5.30
NA
11.16
0.78
NA
17.24
09026596

A
Excision constricting tissue
8.94
NA
8.85
1.43
NA
19.22
09026600

A
Treat metacarpal fracture
1.96
3.62
2.66
0.30
5.88
4.92
09026605

A
Treat metacarpal fracture
2.85
4.57
3.66
0.49
7.91
7.00
09026607

A
Treat metacarpal fracture
5.35
NA
6.29
0.87
NA
12.51
09026608

A
Treat metacarpal fracture
5.35
NA
6.27
0.88
NA
12.50
09026615

A
Treat metacarpal fracture
5.32
NA
5.32
0.86
NA
11.50
09026641

A
Treat thumb dislocation
3.93
4.58
3.54
0.39
8.90
7.86
09026645

A
Treat thumb fracture
4.40
5.18
4.20
0.67
10.25
9.27
09026650

A
Treat thumb fracture
5.71
NA
6.71
0.94
NA
13.36
09026665

A
Treat thumb fracture
7.59
NA
6.63
0.90
NA
15.12
09026670

A
Treat hand dislocation
3.68
4.27
2.95
0.39
8.34
7.02
09026675

A
Treat hand dislocation
4.63
5.49
4.48
0.77
10.89
9.88
09026676

A
Pin hand dislocation
5.51
NA
6.71
0.91
NA
13.13
09026685

A
Treat hand dislocation
6.97
NA
6.16
1.09
NA
14.22
09026686

A
Treat hand dislocation
7.93
NA
6.92
1.24
NA
16.09
09026700

A
Treat knuckle dislocation
3.68
3.77
2.87
0.35
7.80
6.90
09026705

A
Treat knuckle dislocation
4.18
5.35
4.31
0.66
10.19
9.15
09026706

A
Pin knuckle dislocation
5.11
NA
5.10
0.81
NA
11.02
09026715

A
Treat knuckle dislocation
5.73
NA
5.53
0.91
NA
12.17
09026720

A
Treat finger fracture, each
1.66
2.79
2.06
0.24
4.69
3.96
09026725

A
Treat finger fracture, each
3.33
4.78
3.51
0.53
8.64
7.37
09026727

A
Treat finger fracture, each
5.22
NA
6.25
0.84
NA
12.31
09026735

A
Treat finger fracture, each
5.97
NA
5.57
0.95
NA
12.49
09026740

A
Treat finger fracture, each
1.94
3.14
2.71
0.31
5.39
4.96
09026742

A
Treat finger fracture, each
3.84
5.00
3.89
0.58
9.42
8.31
09026746

A
Treat finger fracture, each
5.80
NA
5.58
0.91
NA
12.29
09026750

A
Treat finger fracture, each
1.70
2.49
2.02
0.22
4.41
3.94
09026755

A
Treat finger fracture, each
3.10
4.43
3.01
0.42
7.95
6.53
09026756

A
Pin finger fracture, each
4.38
NA
5.74
0.71
NA
10.83
09026765

A
Treat finger fracture, each
4.16
NA
4.40
0.66
NA
9.22
09026770

A
Treat finger dislocation
3.02
3.44
2.42
0.27
6.73
5.71
09026775

A
Treat finger dislocation
3.70
5.21
3.82
0.54
9.45
8.06
09026776

A
Pin finger dislocation
4.79
NA
6.02
0.77
NA
11.58
090( print page 70356)26785

A
Treat finger dislocation
4.20
NA
4.54
0.68
NA
9.42
09026820

A
Thumb fusion with graft
8.25
NA
13.29
1.30
NA
22.84
09026841

A
Fusion of thumb
7.12
NA
13.27
1.18
NA
21.57
09026842

A
Thumb fusion with graft
8.23
NA
13.41
1.32
NA
22.96
09026843

A
Fusion of hand joint
7.60
NA
12.39
1.15
NA
21.14
09026844

A
Fusion/graft of hand joint
8.72
NA
13.40
1.33
NA
23.45
09026850

A
Fusion of knuckle
6.96
NA
12.24
1.06
NA
20.26
09026852

A
Fusion of knuckle with graft
8.45
NA
12.93
1.22
NA
22.60
09026860

A
Fusion of finger joint
4.68
NA
11.22
0.73
NA
16.63
09026861

A
Fusion of finger jnt, add-on
1.74
NA
0.93
0.27
NA
2.94
ZZZ26862

A
Fusion/graft of finger joint
7.36
NA
12.38
1.10
NA
20.84
09026863

A
Fuse/graft added joint
3.89
NA
2.12
0.56
NA
6.57
ZZZ26910

A
Amputate metacarpal bone
7.59
NA
11.25
1.16
NA
20.00
09026951

A
Amputation of finger/thumb
4.58
NA
10.18
0.71
NA
15.47
09026952

A
Amputation of finger/thumb
6.30
NA
11.69
0.95
NA
18.94
09026989

C
Hand/finger surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY26990

A
Drainage of pelvis lesion
7.47
NA
7.23
1.22
NA
15.92
09026991

A
Drainage of pelvis bursa
6.67
11.19
5.45
1.11
18.97
13.23
09026992

A
Drainage of bone lesion
13.00
NA
10.41
2.16
NA
25.57
09027000

A
Incision of hip tendon
5.61
NA
5.30
0.98
NA
11.89
09027001

A
Incision of hip tendon
6.93
NA
6.11
1.24
NA
14.28
09027003

A
Incision of hip tendon
7.33
NA
6.50
1.12
NA
14.95
09027005

A
Incision of hip tendon
9.65
NA
7.84
1.72
NA
19.21
09027006

A
Incision of hip tendons
9.67
NA
8.00
1.69
NA
19.36
09027025

A
Incision of hip/thigh fascia
11.14
NA
8.57
1.84
NA
21.55
09027030

A
Drainage of hip joint
12.99
NA
9.67
2.26
NA
24.92
09027033

A
Exploration of hip joint
13.37
NA
9.95
2.32
NA
25.64
09027035

A
Denervation of hip joint
16.66
NA
11.26
2.15
NA
30.07
09027036

A
Excision of hip joint/muscle
12.86
NA
10.03
2.26
NA
25.15
09027040

A
Biopsy of soft tissues
2.87
5.25
2.02
0.27
8.39
5.16
01027041

A
Biopsy of soft tissues
9.88
NA
6.66
1.35
NA
17.89
09027047

A
Remove hip/pelvis lesion
7.44
7.13
4.78
1.03
15.60
13.25
09027048

A
Remove hip/pelvis lesion
6.24
NA
4.81
0.92
NA
11.97
09027049

A
Remove tumor, hip/pelvis
13.64
NA
8.42
2.06
NA
24.12
09027050

A
Biopsy of sacroiliac joint
4.35
NA
4.43
0.60
NA
9.38
09027052

A
Biopsy of hip joint
6.22
NA
5.90
1.08
NA
13.20
09027054

A
Removal of hip joint lining
8.53
NA
7.36
1.47
NA
17.36
09027060

A
Removal of ischial bursa
5.42
NA
4.38
0.80
NA
10.60
09027062

A
Remove femur lesion/bursa
5.36
NA
5.21
0.93
NA
11.50
09027065

A
Removal of hip bone lesion
5.89
NA
5.46
1.01
NA
12.36
09027066

A
Removal of hip bone lesion
10.31
NA
8.46
1.79
NA
20.56
09027067

A
Remove/graft hip bone lesion
13.81
NA
10.69
1.84
NA
26.34
09027070

A
Partial removal of hip bone
10.70
NA
9.16
1.74
NA
21.60
09027071

A
Partial removal of hip bone
11.44
NA
10.15
1.92
NA
23.51
09027075

A
Extensive hip surgery
34.95
NA
19.26
5.64
NA
59.85
09027076

A
Extensive hip surgery
22.09
NA
14.55
3.70
NA
40.34
09027077

A
Extensive hip surgery
39.94
NA
22.73
6.12
NA
68.79
09027078

A
Extensive hip surgery
13.42
NA
9.97
2.22
NA
25.61
09027079

A
Extensive hip surgery
13.73
NA
9.57
1.94
NA
25.24
09027080

A
Removal of tail bone
6.38
NA
4.84
0.93
NA
12.15
09027086

A
Remove hip foreign body
1.87
4.56
1.83
0.25
6.68
3.95
01027087

A
Remove hip foreign body
8.53
NA
6.68
1.35
NA
16.56
09027090

A
Removal of hip prosthesis
11.13
NA
8.81
1.94
NA
21.88
09027091

A
Removal of hip prosthesis
22.11
NA
14.03
3.84
NA
39.98
09027093

A
Injection for hip x-ray
1.30
4.47
0.48
0.13
5.90
1.91
00027095

A
Injection for hip x-ray
1.50
5.74
0.52
0.14
7.38
2.16
00027096

A
Inject sacroiliac joint
1.40
4.36
0.33
0.08
5.84
1.81
00027097

A
Revision of hip tendon
8.79
NA
6.43
1.57
NA
16.79
09027098

A
Transfer tendon to pelvis
8.82
NA
7.04
0.95
NA
16.81
09027100

A
Transfer of abdominal muscle
11.06
NA
8.69
1.85
NA
21.60
09027105

A
Transfer of spinal muscle
11.75
NA
9.19
1.72
NA
22.66
09027110

A
Transfer of iliopsoas muscle
13.24
NA
9.14
2.18
NA
24.56
09027111

A
Transfer of iliopsoas muscle
12.13
NA
9.16
1.94
NA
23.23
09027120

A
Reconstruction of hip socket
17.98
NA
11.87
3.08
NA
32.93
09027122

A
Reconstruction of hip socket
14.96
NA
11.07
2.61
NA
28.64
09027125

A
Partial hip replacement
14.67
NA
10.65
2.54
NA
27.86
09027130

A
Total hip arthroplasty
20.09
NA
13.34
3.50
NA
36.93
09027132

A
Total hip arthroplasty
23.27
NA
15.68
4.04
NA
42.99
09027134

A
Revise hip joint replacement
28.48
NA
17.84
4.94
NA
51.26
09027137

A
Revise hip joint replacement
21.14
NA
13.97
3.67
NA
38.78
09027138

A
Revise hip joint replacement
22.14
NA
14.43
3.84
NA
40.41
09027140

A
Transplant femur ridge
12.22
NA
9.44
2.11
NA
23.77
09027146

A
Incision of hip bone
17.40
NA
12.17
2.96
NA
32.53
09027147

A
Revision of hip bone
20.55
NA
13.29
3.57
NA
37.41
09027151

A
Incision of hip bones
22.48
NA
7.97
3.91
NA
34.36
090( print page 70357)27156

A
Revision of hip bones
24.59
NA
16.11
4.21
NA
44.91
09027158

A
Revision of pelvis
19.71
NA
11.00
3.16
NA
33.87
09027161

A
Incision of neck of femur
16.68
NA
12.14
2.94
NA
31.76
09027165

A
Incision/fixation of femur
17.88
NA
12.95
3.10
NA
33.93
09027170

A
Repair/graft femur head/neck
16.05
NA
11.33
2.81
NA
30.19
09027175

A
Treat slipped epiphysis
8.45
NA
6.69
1.46
NA
16.60
09027176

A
Treat slipped epiphysis
12.03
NA
9.04
2.22
NA
23.29
09027177

A
Treat slipped epiphysis
15.06
NA
10.92
2.61
NA
28.59
09027178

A
Treat slipped epiphysis
11.97
NA
8.44
2.08
NA
22.49
09027179

A
Revise head/neck of femur
12.96
NA
10.02
2.25
NA
25.23
09027181

A
Treat slipped epiphysis
14.66
NA
10.23
1.57
NA
26.46
09027185

A
Revision of femur epiphysis
9.17
NA
7.54
2.39
NA
19.10
09027187

A
Reinforce hip bones
13.52
NA
10.35
2.37
NA
26.24
09027193

A
Treat pelvic ring fracture
5.55
5.10
5.10
0.96
11.61
11.61
09027194

A
Treat pelvic ring fracture
9.64
NA
7.67
1.65
NA
18.96
09027200

A
Treat tail bone fracture
1.84
2.23
2.16
0.28
4.35
4.28
09027202

A
Treat tail bone fracture
7.03
NA
16.91
1.06
NA
25.00
09027215

A
Treat pelvic fracture(s)
10.03
NA
7.10
1.97
NA
19.10
09027216

A
Treat pelvic ring fracture
15.17
NA
9.62
2.63
NA
27.42
09027217

A
Treat pelvic ring fracture
14.09
NA
10.17
2.41
NA
26.67
09027218

A
Treat pelvic ring fracture
20.12
NA
11.43
3.48
NA
35.03
09027220

A
Treat hip socket fracture
6.17
5.74
5.65
1.07
12.98
12.89
09027222

A
Treat hip socket fracture
12.68
NA
10.00
2.19
NA
24.87
09027226

A
Treat hip wall fracture
14.89
NA
7.83
2.48
NA
25.20
09027227

A
Treat hip fracture(s)
23.41
NA
15.44
4.05
NA
42.90
09027228

A
Treat hip fracture(s)
27.12
NA
17.67
4.66
NA
49.45
09027230

A
Treat thigh fracture
5.49
5.53
5.11
0.95
11.97
11.55
09027232

A
Treat thigh fracture
10.66
NA
7.19
1.85
NA
19.70
09027235

A
Treat thigh fracture
12.14
NA
9.48
2.11
NA
23.73
09027236

A
Treat thigh fracture
15.58
NA
11.08
2.71
NA
29.37
09027238

A
Treat thigh fracture
5.51
NA
5.15
0.89
NA
11.55
09027240

A
Treat thigh fracture
12.48
NA
9.50
2.16
NA
24.14
09027244

A
Treat thigh fracture
15.92
NA
11.33
2.77
NA
30.02
09027245

A
Treat thigh fracture
20.28
NA
13.78
3.52
NA
37.58
09027246

A
Treat thigh fracture
4.70
4.47
4.43
0.81
9.98
9.94
09027248

A
Treat thigh fracture
10.43
NA
8.23
1.81
NA
20.47
09027250

A
Treat hip dislocation
6.94
NA
4.63
0.62
NA
12.19
09027252

A
Treat hip dislocation
10.37
NA
7.45
1.66
NA
19.48
09027253

A
Treat hip dislocation
12.90
NA
9.81
2.24
NA
24.95
09027254

A
Treat hip dislocation
18.23
NA
12.05
3.17
NA
33.45
09027256

A
Treat hip dislocation
4.11
3.53
2.09
0.46
8.10
6.66
01027257

A
Treat hip dislocation
5.21
NA
2.82
0.69
NA
8.72
01027258

A
Treat hip dislocation
15.41
NA
10.90
2.64
NA
28.95
09027259

A
Treat hip dislocation
21.52
NA
14.16
3.74
NA
39.42
09027265

A
Treat hip dislocation
5.04
NA
4.80
0.63
NA
10.47
09027266

A
Treat hip dislocation
7.48
NA
6.36
1.29
NA
15.13
09027275

A
Manipulation of hip joint
2.27
NA
2.11
0.39
NA
4.77
01027280

A
Fusion of sacroiliac joint
13.37
NA
10.29
2.53
NA
26.19
09027282

A
Fusion of pubic bones
11.32
NA
8.02
1.86
NA
21.20
09027284

A
Fusion of hip joint
23.41
NA
14.80
3.92
NA
42.13
09027286

A
Fusion of hip joint
23.41
NA
15.84
3.12
NA
42.37
09027290

A
Amputation of leg at hip
23.25
NA
14.10
3.43
NA
40.78
09027295

A
Amputation of leg at hip
18.62
NA
11.34
2.95
NA
32.91
09027299

C
Pelvis/hip joint surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY27301

A
Drain thigh/knee lesion
6.48
10.10
5.15
1.04
17.62
12.67
09027303

A
Drainage of bone lesion
8.27
NA
7.00
1.43
NA
16.70
09027305

A
Incise thigh tendon & fascia
5.91
NA
5.20
1.01
NA
12.12
09027306

A
Incision of thigh tendon
4.61
NA
4.73
0.85
NA
10.19
09027307

A
Incision of thigh tendons
5.79
NA
5.40
1.04
NA
12.23
09027310

A
Exploration of knee joint
9.26
NA
7.60
1.61
NA
18.47
09027315

A
Partial removal, thigh nerve
6.96
NA
4.96
1.09
NA
13.01
09027320

A
Partial removal, thigh nerve
6.29
NA
5.25
1.06
NA
12.60
09027323

A
Biopsy, thigh soft tissues
2.28
3.52
1.89
0.24
6.04
4.41
01027324

A
Biopsy, thigh soft tissues
4.89
NA
4.19
0.75
NA
9.83
09027327

A
Removal of thigh lesion
4.46
6.01
3.73
0.64
11.11
8.83
09027328

A
Removal of thigh lesion
5.56
NA
4.38
0.84
NA
10.78
09027329

A
Remove tumor, thigh/knee
14.12
NA
9.05
2.14
NA
25.31
09027330

A
Biopsy, knee joint lining
4.96
NA
4.58
0.86
NA
10.40
09027331

A
Explore/treat knee joint
5.87
NA
5.54
1.02
NA
12.43
09027332

A
Removal of knee cartilage
8.26
NA
7.14
1.43
NA
16.83
09027333

A
Removal of knee cartilage
7.29
NA
6.69
1.26
NA
15.24
09027334

A
Remove knee joint lining
8.69
NA
7.43
1.51
NA
17.63
09027335

A
Remove knee joint lining
9.99
NA
8.24
1.74
NA
19.97
09027340

A
Removal of kneecap bursa
4.17
NA
4.57
0.72
NA
9.46
09027345

A
Removal of knee cyst
5.91
NA
5.64
1.00
NA
12.55
090( print page 70358)27347

A
Remove knee cyst
5.77
NA
5.44
0.98
NA
12.19
09027350

A
Removal of kneecap
8.16
NA
7.26
1.41
NA
16.83
09027355

A
Remove femur lesion
7.64
NA
6.79
1.32
NA
15.75
09027356

A
Remove femur lesion/graft
9.47
NA
7.87
1.65
NA
18.99
09027357

A
Remove femur lesion/graft
10.51
NA
8.73
1.95
NA
21.19
09027358

A
Remove femur lesion/fixation
4.73
NA
2.53
0.82
NA
8.08
ZZZ27360

A
Partial removal, leg bone(s)
10.48
NA
9.58
1.83
NA
21.89
09027365

A
Extensive leg surgery
16.25
NA
11.71
2.79
NA
30.75
09027370

A
Injection for knee x-ray
0.96
3.73
0.32
0.08
4.77
1.36
00027372

A
Removal of foreign body
5.06
10.08
4.70
0.84
15.98
10.60
09027380

A
Repair of kneecap tendon
7.15
NA
7.30
1.24
NA
15.69
09027381

A
Repair/graft kneecap tendon
10.32
NA
9.12
1.79
NA
21.23
09027385

A
Repair of thigh muscle
7.75
NA
7.65
1.36
NA
16.76
09027386

A
Repair/graft of thigh muscle
10.54
NA
9.54
1.85
NA
21.93
09027390

A
Incision of thigh tendon
5.32
NA
5.12
0.92
NA
11.36
09027391

A
Incision of thigh tendons
7.19
NA
6.58
1.23
NA
15.00
09027392

A
Incision of thigh tendons
9.19
NA
7.61
1.57
NA
18.37
09027393

A
Lengthening of thigh tendon
6.38
NA
5.85
1.10
NA
13.33
09027394

A
Lengthening of thigh tendons
8.49
NA
7.24
1.47
NA
17.20
09027395

A
Lengthening of thigh tendons
11.71
NA
9.35
2.04
NA
23.10
09027396

A
Transplant of thigh tendon
7.85
NA
7.02
1.34
NA
16.21
09027397

A
Transplants of thigh tendons
11.26
NA
9.07
1.82
NA
22.15
09027400

A
Revise thigh muscles/tendons
9.01
NA
7.27
1.31
NA
17.59
09027403

A
Repair of knee cartilage
8.32
NA
7.20
1.44
NA
16.96
09027405

A
Repair of knee ligament
8.64
NA
7.51
1.51
NA
17.66
09027407

A
Repair of knee ligament
10.26
NA
8.34
1.78
NA
20.38
09027409

A
Repair of knee ligaments
12.88
NA
9.98
2.24
NA
25.10
09027412

A
Autochondrocyte implant knee
23.23
NA
14.84
4.35
NA
42.42
09027415

A
Osteochondral knee allograft
18.49
NA
12.59
4.35
NA
35.43
09027418

A
Repair degenerated kneecap
10.83
NA
8.93
1.88
NA
21.64
09027420

A
Revision of unstable kneecap
9.82
NA
8.13
1.71
NA
19.66
09027422

A
Revision of unstable kneecap
9.77
NA
8.14
1.70
NA
19.61
09027424

A
Revision/removal of kneecap
9.80
NA
8.11
1.70
NA
19.61
09027425

A
Lat retinacular release open
5.21
NA
5.54
0.90
NA
11.65
09027427

A
Reconstruction, knee
9.35
NA
7.82
1.63
NA
18.80
09027428

A
Reconstruction, knee
13.98
NA
11.27
2.42
NA
27.67
09027429

A
Reconstruction, knee
15.50
NA
12.45
2.70
NA
30.65
09027430

A
Revision of thigh muscles
9.66
NA
8.02
1.69
NA
19.37
09027435

A
Incision of knee joint
9.48
NA
8.50
1.69
NA
19.67
09027437

A
Revise kneecap
8.45
NA
7.26
1.49
NA
17.20
09027438

A
Revise kneecap with implant
11.21
NA
8.56
1.95
NA
21.72
09027440

A
Revision of knee joint
10.41
NA
6.01
1.81
NA
18.23
09027441

A
Revision of knee joint
10.80
NA
6.73
1.88
NA
19.41
09027442

A
Revision of knee joint
11.87
NA
8.94
2.09
NA
22.90
09027443

A
Revision of knee joint
10.91
NA
8.75
1.90
NA
21.56
09027445

A
Revision of knee joint
17.65
NA
12.39
3.08
NA
33.12
09027446

A
Revision of knee joint
15.82
NA
11.30
2.80
NA
29.92
09027447

A
Total knee arthroplasty
21.45
NA
14.64
3.79
NA
39.88
09027448

A
Incision of thigh
11.04
NA
8.62
1.94
NA
21.60
09027450

A
Incision of thigh
13.96
NA
10.61
2.42
NA
26.99
09027454

A
Realignment of thigh bone
17.53
NA
12.54
3.12
NA
33.19
09027455

A
Realignment of knee
12.80
NA
9.91
2.24
NA
24.95
09027457

A
Realignment of knee
13.43
NA
9.95
2.34
NA
25.72
09027465

A
Shortening of thigh bone
13.85
NA
10.25
2.47
NA
26.57
09027466

A
Lengthening of thigh bone
16.31
NA
11.86
2.77
NA
30.94
09027468

A
Shorten/lengthen thighs
18.94
NA
12.39
3.30
NA
34.63
09027470

A
Repair of thigh
16.05
NA
11.82
2.79
NA
30.66
09027472

A
Repair/graft of thigh
17.69
NA
12.72
3.07
NA
33.48
09027475

A
Surgery to stop leg growth
8.63
NA
7.23
1.36
NA
17.22
09027477

A
Surgery to stop leg growth
9.84
NA
7.75
1.73
NA
19.32
09027479

A
Surgery to stop leg growth
12.78
NA
9.67
2.78
NA
25.23
09027485

A
Surgery to stop leg growth
8.83
NA
7.42
1.53
NA
17.78
09027486

A
Revise/replace knee joint
19.24
NA
13.53
3.36
NA
36.13
09027487

A
Revise/replace knee joint
25.23
NA
16.60
4.39
NA
46.22
09027488

A
Removal of knee prosthesis
15.72
NA
11.73
2.74
NA
30.19
09027495

A
Reinforce thigh
15.53
NA
11.44
2.71
NA
29.68
09027496

A
Decompression of thigh/knee
6.10
NA
5.62
0.99
NA
12.71
09027497

A
Decompression of thigh/knee
7.16
NA
5.45
1.15
NA
13.76
09027498

A
Decompression of thigh/knee
7.98
NA
5.97
1.24
NA
15.19
09027499

A
Decompression of thigh/knee
8.99
NA
6.84
1.47
NA
17.30
09027500

A
Treatment of thigh fracture
5.91
6.14
5.00
1.02
13.07
11.93
09027501

A
Treatment of thigh fracture
5.91
5.81
5.40
1.03
12.75
12.34
09027502

A
Treatment of thigh fracture
10.56
NA
8.13
1.78
NA
20.47
09027503

A
Treatment of thigh fracture
10.56
NA
8.31
1.84
NA
20.71
09027506

A
Treatment of thigh fracture
17.42
NA
12.82
3.03
NA
33.27
090( print page 70359)27507

A
Treatment of thigh fracture
13.97
NA
9.87
2.42
NA
26.26
09027508

A
Treatment of thigh fracture
5.82
6.48
5.50
0.97
13.27
12.29
09027509

A
Treatment of thigh fracture
7.70
NA
7.98
1.34
NA
17.02
09027510

A
Treatment of thigh fracture
9.12
NA
7.35
1.53
NA
18.00
09027511

A
Treatment of thigh fracture
13.62
NA
11.23
2.37
NA
27.22
09027513

A
Treatment of thigh fracture
17.89
NA
13.92
3.12
NA
34.93
09027514

A
Treatment of thigh fracture
17.27
NA
13.39
3.00
NA
33.66
09027516

A
Treat thigh fx growth plate
5.36
6.37
5.53
0.81
12.54
11.70
09027517

A
Treat thigh fx growth plate
8.77
NA
7.47
1.22
NA
17.46
09027519

A
Treat thigh fx growth plate
15.00
NA
11.62
2.55
NA
29.17
09027520

A
Treat kneecap fracture
2.86
4.55
3.45
0.47
7.88
6.78
09027524

A
Treat kneecap fracture
9.99
NA
8.25
1.74
NA
19.98
09027530

A
Treat knee fracture
3.77
5.33
4.43
0.65
9.75
8.85
09027532

A
Treat knee fracture
7.29
7.38
6.47
1.26
15.93
15.02
09027535

A
Treat knee fracture
11.48
NA
10.14
2.00
NA
23.62
09027536

A
Treat knee fracture
15.63
NA
11.64
2.73
NA
30.00
09027538

A
Treat knee fracture(s)
4.86
6.15
5.21
0.84
11.85
10.91
09027540

A
Treat knee fracture
13.08
NA
9.54
2.27
NA
24.89
09027550

A
Treat knee dislocation
5.75
6.03
4.94
0.76
12.54
11.45
09027552

A
Treat knee dislocation
7.89
NA
6.97
1.36
NA
16.22
09027556

A
Treat knee dislocation
14.39
NA
11.68
2.50
NA
28.57
09027557

A
Treat knee dislocation
16.74
NA
13.16
2.97
NA
32.87
09027558

A
Treat knee dislocation
17.69
NA
13.08
3.08
NA
33.85
09027560

A
Treat kneecap dislocation
3.81
4.85
3.19
0.40
9.06
7.40
09027562

A
Treat kneecap dislocation
5.78
NA
4.78
0.94
NA
11.50
09027566

A
Treat kneecap dislocation
12.21
NA
9.35
2.12
NA
23.68
09027570

A
Fixation of knee joint
1.74
NA
1.78
0.30
NA
3.82
01027580

A
Fusion of knee
19.34
NA
14.84
3.37
NA
37.55
09027590

A
Amputate leg at thigh
12.01
NA
6.69
1.74
NA
20.44
09027591

A
Amputate leg at thigh
12.66
NA
8.67
2.02
NA
23.35
09027592

A
Amputate leg at thigh
10.00
NA
6.19
1.45
NA
17.64
09027594

A
Amputation follow-up surgery
6.91
NA
5.18
1.02
NA
13.11
09027596

A
Amputation follow-up surgery
10.58
NA
6.83
1.57
NA
18.98
09027598

A
Amputate lower leg at knee
10.51
NA
7.04
1.65
NA
19.20
09027599

C
Leg surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY27600

A
Decompression of lower leg
5.64
NA
4.54
0.86
NA
11.04
09027601

A
Decompression of lower leg
5.63
NA
4.86
0.80
NA
11.29
09027602

A
Decompression of lower leg
7.34
NA
5.14
1.10
NA
13.58
09027603

A
Drain lower leg lesion
4.93
7.51
4.17
0.74
13.18
9.84
09027604

A
Drain lower leg bursa
4.46
6.10
3.97
0.69
11.25
9.12
09027605

A
Incision of achilles tendon
2.87
7.70
2.33
0.41
10.98
5.61
01027606

A
Incision of achilles tendon
4.13
NA
3.37
0.69
NA
8.19
01027607

A
Treat lower leg bone lesion
7.96
NA
6.19
1.31
NA
15.46
09027610

A
Explore/treat ankle joint
8.33
NA
7.02
1.40
NA
16.75
09027612

A
Exploration of ankle joint
7.32
NA
6.11
1.13
NA
14.56
09027613

A
Biopsy lower leg soft tissue
2.17
3.24
1.81
0.20
5.61
4.18
01027614

A
Biopsy lower leg soft tissue
5.65
7.15
4.45
0.78
13.58
10.88
09027615

A
Remove tumor, lower leg
12.54
NA
9.42
1.83
NA
23.79
09027618

A
Remove lower leg lesion
5.08
6.03
4.00
0.72
11.83
9.80
09027619

A
Remove lower leg lesion
8.39
9.54
5.97
1.25
19.18
15.61
09027620

A
Explore/treat ankle joint
5.97
NA
5.48
0.97
NA
12.42
09027625

A
Remove ankle joint lining
8.29
NA
6.48
1.28
NA
16.05
09027626

A
Remove ankle joint lining
8.90
NA
6.94
1.48
NA
17.32
09027630

A
Removal of tendon lesion
4.79
7.58
4.39
0.74
13.11
9.92
09027635

A
Remove lower leg bone lesion
7.77
NA
6.76
1.31
NA
15.84
09027637

A
Remove/graft leg bone lesion
9.84
NA
8.31
1.66
NA
19.81
09027638

A
Remove/graft leg bone lesion
10.55
NA
8.31
1.84
NA
20.70
09027640

A
Partial removal of tibia
11.35
NA
10.34
1.88
NA
23.57
09027641

A
Partial removal of fibula
9.23
NA
8.36
1.46
NA
19.05
09027645

A
Extensive lower leg surgery
14.15
NA
12.08
2.41
NA
28.64
09027646

A
Extensive lower leg surgery
12.64
NA
11.06
2.05
NA
25.75
09027647

A
Extensive ankle/heel surgery
12.22
NA
7.63
1.75
NA
21.60
09027648

A
Injection for ankle x-ray
0.96
3.53
0.33
0.08
4.57
1.37
00027650

A
Repair achilles tendon
9.68
NA
7.53
1.59
NA
18.80
09027652

A
Repair/graft achilles tendon
10.31
NA
8.05
1.71
NA
20.07
09027654

A
Repair of achilles tendon
10.00
NA
7.16
1.58
NA
18.74
09027656

A
Repair leg fascia defect
4.56
8.55
3.78
0.69
13.80
9.03
09027658

A
Repair of leg tendon, each
4.97
NA
4.57
0.79
NA
10.33
09027659

A
Repair of leg tendon, each
6.80
NA
5.66
1.09
NA
13.55
09027664

A
Repair of leg tendon, each
4.58
NA
4.56
0.76
NA
9.90
09027665

A
Repair of leg tendon, each
5.39
NA
4.98
0.89
NA
11.26
09027675

A
Repair lower leg tendons
7.17
NA
5.75
1.11
NA
14.03
09027676

A
Repair lower leg tendons
8.41
NA
6.77
1.37
NA
16.55
09027680

A
Release of lower leg tendon
5.73
NA
5.12
0.93
NA
11.78
09027681

A
Release of lower leg tendons
6.81
NA
5.93
1.15
NA
13.89
090( print page 70360)27685

A
Revision of lower leg tendon
6.49
7.31
5.48
0.97
14.77
12.94
09027686

A
Revise lower leg tendons
7.45
NA
6.51
1.24
NA
15.20
09027687

A
Revision of calf tendon
6.23
NA
5.33
1.00
NA
12.56
09027690

A
Revise lower leg tendon
8.70
NA
6.37
1.33
NA
16.40
09027691

A
Revise lower leg tendon
9.95
NA
7.78
1.64
NA
19.37
09027692

A
Revise additional leg tendon
1.87
NA
0.93
0.32
NA
3.12
ZZZ27695

A
Repair of ankle ligament
6.50
NA
5.89
1.05
NA
13.44
09027696

A
Repair of ankle ligaments
8.26
NA
6.45
1.28
NA
15.99
09027698

A
Repair of ankle ligament
9.35
NA
6.96
1.47
NA
17.78
09027700

A
Revision of ankle joint
9.28
NA
5.70
1.30
NA
16.28
09027702

A
Reconstruct ankle joint
13.65
NA
10.49
2.37
NA
26.51
09027703

A
Reconstruction, ankle joint
15.85
NA
11.26
2.76
NA
29.87
09027704

A
Removal of ankle implant
7.61
NA
5.61
1.27
NA
14.49
09027705

A
Incision of tibia
10.36
NA
8.19
1.80
NA
20.35
09027707

A
Incision of fibula
4.36
NA
4.95
0.76
NA
10.07
09027709

A
Incision of tibia & fibula
9.94
NA
8.15
1.73
NA
19.82
09027712

A
Realignment of lower leg
14.23
NA
10.77
2.47
NA
27.47
09027715

A
Revision of lower leg
14.37
NA
10.80
2.49
NA
27.66
09027720

A
Repair of tibia
11.77
NA
9.43
2.04
NA
23.24
09027722

A
Repair/graft of tibia
11.80
NA
9.16
2.05
NA
23.01
09027724

A
Repair/graft of tibia
18.17
NA
12.40
3.16
NA
33.73
09027725

A
Repair of lower leg
15.57
NA
11.94
2.71
NA
30.22
09027727

A
Repair of lower leg
13.99
NA
10.37
2.43
NA
26.79
09027730

A
Repair of tibia epiphysis
7.40
NA
6.44
1.72
NA
15.56
09027732

A
Repair of fibula epiphysis
5.31
NA
4.94
0.77
NA
11.02
09027734

A
Repair lower leg epiphyses
8.47
NA
6.30
1.35
NA
16.12
09027740

A
Repair of leg epiphyses
9.29
NA
8.01
1.62
NA
18.92
09027742

A
Repair of leg epiphyses
10.28
5.58
5.58
1.79
17.65
17.65
09027745

A
Reinforce tibia
10.05
NA
8.19
1.75
NA
19.99
09027750

A
Treatment of tibia fracture
3.19
4.77
3.86
0.55
8.51
7.60
09027752

A
Treatment of tibia fracture
5.83
6.67
5.69
1.01
13.51
12.53
09027756

A
Treatment of tibia fracture
6.77
NA
6.48
1.17
NA
14.42
09027758

A
Treatment of tibia fracture
11.65
NA
9.21
2.03
NA
22.89
09027759

A
Treatment of tibia fracture
13.74
NA
10.34
2.38
NA
26.46
09027760

A
Treatment of ankle fracture
3.01
4.69
3.60
0.48
8.18
7.09
09027762

A
Treatment of ankle fracture
5.24
6.35
5.29
0.85
12.44
11.38
09027766

A
Treatment of ankle fracture
8.35
NA
7.24
1.44
NA
17.03
09027780

A
Treatment of fibula fracture
2.65
4.19
3.22
0.41
7.25
6.28
09027781

A
Treatment of fibula fracture
4.39
5.51
4.65
0.73
10.63
9.77
09027784

A
Treatment of fibula fracture
7.10
NA
6.49
1.23
NA
14.82
09027786

A
Treatment of ankle fracture
2.84
4.47
3.34
0.46
7.77
6.64
09027788

A
Treatment of ankle fracture
4.44
5.66
4.66
0.74
10.84
9.84
09027792

A
Treatment of ankle fracture
7.65
NA
6.98
1.32
NA
15.95
09027808

A
Treatment of ankle fracture
2.83
4.81
3.71
0.46
8.10
7.00
09027810

A
Treatment of ankle fracture
5.12
6.26
5.16
0.82
12.20
11.10
09027814

A
Treatment of ankle fracture
10.66
NA
8.58
1.85
NA
21.09
09027816

A
Treatment of ankle fracture
2.89
4.39
3.42
0.43
7.71
6.74
09027818

A
Treatment of ankle fracture
5.49
6.39
5.18
0.82
12.70
11.49
09027822

A
Treatment of ankle fracture
10.98
NA
10.68
1.91
NA
23.57
09027823

A
Treatment of ankle fracture
12.98
NA
11.50
2.25
NA
26.73
09027824

A
Treat lower leg fracture
2.89
4.07
3.57
0.45
7.41
6.91
09027825

A
Treat lower leg fracture
6.18
6.62
5.40
1.02
13.82
12.60
09027826

A
Treat lower leg fracture
8.53
NA
8.85
1.47
NA
18.85
09027827

A
Treat lower leg fracture
14.04
NA
12.80
2.43
NA
29.27
09027828

A
Treat lower leg fracture
16.21
NA
13.97
2.81
NA
32.99
09027829

A
Treat lower leg joint
5.48
NA
6.80
0.95
NA
13.23
09027830

A
Treat lower leg dislocation
3.78
4.40
3.86
0.54
8.72
8.18
09027831

A
Treat lower leg dislocation
4.55
NA
4.47
0.73
NA
9.75
09027832

A
Treat lower leg dislocation
6.48
NA
6.19
1.03
NA
13.70
09027840

A
Treat ankle dislocation
4.57
NA
3.77
0.46
NA
8.80
09027842

A
Treat ankle dislocation
6.20
NA
5.13
1.00
NA
12.33
09027846

A
Treat ankle dislocation
9.78
NA
7.95
1.70
NA
19.43
09027848

A
Treat ankle dislocation
11.18
NA
9.74
1.94
NA
22.86
09027860

A
Fixation of ankle joint
2.34
NA
1.99
0.39
NA
4.72
01027870

A
Fusion of ankle joint, open
13.89
NA
10.55
2.36
NA
26.80
09027871

A
Fusion of tibiofibular joint
9.16
NA
7.60
1.59
NA
18.35
09027880

A
Amputation of lower leg
11.83
NA
7.15
1.75
NA
20.73
09027881

A
Amputation of lower leg
12.32
NA
8.87
1.98
NA
23.17
09027882

A
Amputation of lower leg
8.93
NA
6.50
1.29
NA
16.72
09027884

A
Amputation follow-up surgery
8.20
NA
5.77
1.22
NA
15.19
09027886

A
Amputation follow-up surgery
9.31
NA
6.53
1.40
NA
17.24
09027888

A
Amputation of foot at ankle
9.66
NA
7.52
1.51
NA
18.69
09027889

A
Amputation of foot at ankle
9.97
NA
6.49
1.46
NA
17.92
09027892

A
Decompression of leg
7.38
NA
5.61
1.10
NA
14.09
09027893

A
Decompression of leg
7.34
NA
5.48
1.10
NA
13.92
090( print page 70361)27894

A
Decompression of leg
10.47
NA
7.79
1.65
NA
19.91
09027899

C
Leg/ankle surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY28001

A
Drainage of bursa of foot
2.73
2.99
1.96
0.33
6.05
5.02
01028002

A
Treatment of foot infection
4.61
5.00
3.78
0.61
10.22
9.00
01028003

A
Treatment of foot infection
8.40
6.25
5.24
1.12
15.77
14.76
09028005

A
Treat foot bone lesion
8.67
NA
6.06
1.16
NA
15.89
09028008

A
Incision of foot fascia
4.44
4.56
3.21
0.57
9.57
8.22
09028010

A
Incision of toe tendon
2.84
2.38
2.38
0.36
5.58
5.58
09028011

A
Incision of toe tendons
4.13
NA
3.31
0.59
NA
8.03
09028020

A
Exploration of foot joint
5.00
6.03
4.14
0.72
11.75
9.86
09028022

A
Exploration of foot joint
4.66
5.21
3.86
0.62
10.49
9.14
09028024

A
Exploration of toe joint
4.37
5.23
3.93
0.58
10.18
8.88
09028030

A
Removal of foot nerve
6.14
NA
3.66
0.74
NA
10.54
09028035

A
Decompression of tibia nerve
5.08
5.87
4.10
0.70
11.65
9.88
09028043

A
Excision of foot lesion
3.53
3.82
3.18
0.46
7.81
7.17
09028045

A
Excision of foot lesion
4.71
5.39
3.61
0.63
10.73
8.95
09028046

A
Resection of tumor, foot
10.16
8.79
6.49
1.36
20.31
18.01
09028050

A
Biopsy of foot joint lining
4.24
4.90
3.60
0.60
9.74
8.44
09028052

A
Biopsy of foot joint lining
3.93
4.92
3.44
0.53
9.38
7.90
09028054

A
Biopsy of toe joint lining
3.44
4.73
3.24
0.46
8.63
7.14
09028060

A
Partial removal, foot fascia
5.22
5.49
3.88
0.70
11.41
9.80
09028062

A
Removal of foot fascia
6.51
6.53
4.02
0.83
13.87
11.36
09028070

A
Removal of foot joint lining
5.09
5.23
3.82
0.73
11.05
9.64
09028072

A
Removal of foot joint lining
4.57
5.54
4.31
0.68
10.79
9.56
09028080

A
Removal of foot lesion
3.57
5.12
3.69
0.47
9.16
7.73
09028086

A
Excise foot tendon sheath
4.77
8.00
4.69
0.76
13.53
10.22
09028088

A
Excise foot tendon sheath
3.85
5.77
3.90
0.61
10.23
8.36
09028090

A
Removal of foot lesion
4.40
5.15
3.46
0.59
10.14
8.45
09028092

A
Removal of toe lesions
3.63
5.23
3.53
0.49
9.35
7.65
09028100

A
Removal of ankle/heel lesion
5.65
7.98
4.70
0.82
14.45
11.17
09028102

A
Remove/graft foot lesion
7.72
NA
5.96
1.14
NA
14.82
09028103

A
Remove/graft foot lesion
6.49
NA
4.62
0.91
NA
12.02
09028104

A
Removal of foot lesion
5.11
5.50
3.93
0.70
11.31
9.74
09028106

A
Remove/graft foot lesion
7.15
NA
4.44
0.97
NA
12.56
09028107

A
Remove/graft foot lesion
5.55
6.54
4.21
0.74
12.83
10.50
09028108

A
Removal of toe lesions
4.15
4.60
3.26
0.53
9.28
7.94
09028110

A
Part removal of metatarsal
4.07
5.23
3.23
0.54
9.84
7.84
09028111

A
Part removal of metatarsal
5.00
6.29
3.66
0.67
11.96
9.33
09028112

A
Part removal of metatarsal
4.48
5.82
3.58
0.61
10.91
8.67
09028113

A
Part removal of metatarsal
4.78
6.07
4.32
0.63
11.48
9.73
09028114

A
Removal of metatarsal heads
9.78
11.65
8.39
1.42
22.85
19.59
09028116

A
Revision of foot
7.74
6.81
5.18
1.03
15.58
13.95
09028118

A
Removal of heel bone
5.95
6.26
4.35
0.84
13.05
11.14
09028119

A
Removal of heel spur
5.38
5.44
3.73
0.70
11.52
9.81
09028120

A
Part removal of ankle/heel
5.39
7.30
4.42
0.77
13.46
10.58
09028122

A
Partial removal of foot bone
7.28
6.85
5.28
0.98
15.11
13.54
09028124

A
Partial removal of toe
4.80
5.00
3.66
0.60
10.40
9.06
09028126

A
Partial removal of toe
3.51
4.22
3.00
0.45
8.18
6.96
09028130

A
Removal of ankle bone
8.10
NA
6.73
1.26
NA
16.09
09028140

A
Removal of metatarsal
6.90
7.24
4.77
0.92
15.06
12.59
09028150

A
Removal of toe
4.08
4.84
3.29
0.53
9.45
7.90
09028153

A
Partial removal of toe
3.65
4.32
2.69
0.47
8.44
6.81
09028160

A
Partial removal of toe
3.73
4.57
3.34
0.49
8.79
7.56
09028171

A
Extensive foot surgery
9.59
NA
5.44
1.33
NA
16.36
09028173

A
Extensive foot surgery
8.79
7.61
5.21
1.12
17.52
15.12
09028175

A
Extensive foot surgery
6.04
5.72
3.71
0.73
12.49
10.48
09028190

A
Removal of foot foreign body
1.96
3.40
1.48
0.22
5.58
3.66
01028192

A
Removal of foot foreign body
4.63
5.49
3.65
0.61
10.73
8.89
09028193

A
Removal of foot foreign body
5.72
5.62
3.93
0.73
12.07
10.38
09028200

A
Repair of foot tendon
4.59
5.10
3.56
0.61
10.30
8.76
09028202

A
Repair/graft of foot tendon
6.83
7.23
4.50
0.91
14.97
12.24
09028208

A
Repair of foot tendon
4.36
4.82
3.31
0.58
9.76
8.25
09028210

A
Repair/graft of foot tendon
6.34
6.23
4.03
0.81
13.38
11.18
09028220

A
Release of foot tendon
4.52
4.68
3.43
0.57
9.77
8.52
09028222

A
Release of foot tendons
5.61
5.25
4.13
0.69
11.55
10.43
09028225

A
Release of foot tendon
3.65
4.29
2.91
0.46
8.40
7.02
09028226

A
Release of foot tendons
4.52
4.80
3.75
0.58
9.90
8.85
09028230

A
Incision of foot tendon(s)
4.23
4.68
3.68
0.55
9.46
8.46
09028232

A
Incision of toe tendon
3.38
4.53
3.32
0.44
8.35
7.14
09028234

A
Incision of foot tendon
3.36
4.68
3.36
0.44
8.48
7.16
09028238

A
Revision of foot tendon
7.72
7.26
4.94
1.06
16.04
13.72
09028240

A
Release of big toe
4.35
4.64
3.49
0.58
9.57
8.42
09028250

A
Revision of foot fascia
5.91
5.64
4.14
0.82
12.37
10.87
09028260

A
Release of midfoot joint
7.95
6.34
5.00
1.14
15.43
14.09
09028261

A
Revision of foot tendon
11.71
8.63
7.32
1.57
21.91
20.60
090( print page 70362)28262

A
Revision of foot and ankle
15.81
13.59
10.94
2.59
31.99
29.34
09028264

A
Release of midfoot joint
10.33
7.75
7.30
1.54
19.62
19.17
09028270

A
Release of foot contracture
4.75
4.90
3.74
0.62
10.27
9.11
09028272

A
Release of toe joint, each
3.79
4.19
2.86
0.46
8.44
7.11
09028280

A
Fusion of toes
5.18
6.26
4.49
0.73
12.17
10.40
09028285

A
Repair of hammertoe
4.58
4.87
3.43
0.59
10.04
8.60
09028286

A
Repair of hammertoe
4.55
4.80
3.26
0.57
9.92
8.38
09028288

A
Partial removal of foot bone
4.73
5.95
4.89
0.65
11.33
10.27
09028289

A
Repair hallux rigidus
7.03
8.00
5.78
1.02
16.05
13.83
09028290

A
Correction of bunion
5.65
6.27
4.73
0.82
12.74
11.20
09028292

A
Correction of bunion
7.03
7.48
5.55
0.91
15.42
13.49
09028293

A
Correction of bunion
9.14
10.77
6.12
1.13
21.04
16.39
09028294

A
Correction of bunion
8.55
7.45
4.72
1.09
17.09
14.36
09028296

A
Correction of bunion
9.17
8.17
5.43
1.19
18.53
15.79
09028297

A
Correction of bunion
9.17
8.97
6.27
1.32
19.46
16.76
09028298

A
Correction of bunion
7.93
7.23
5.01
1.05
16.21
13.99
09028299

A
Correction of bunion
10.56
8.79
6.08
1.37
20.72
18.01
09028300

A
Incision of heel bone
9.53
NA
7.05
1.54
NA
18.12
09028302

A
Incision of ankle bone
9.54
NA
6.90
1.42
NA
17.86
09028304

A
Incision of midfoot bones
9.15
7.96
5.75
1.27
18.38
16.17
09028305

A
Incise/graft midfoot bones
10.48
NA
6.74
1.27
NA
18.49
09028306

A
Incision of metatarsal
5.85
6.85
4.18
0.84
13.54
10.87
09028307

A
Incision of metatarsal
6.32
11.05
5.30
0.90
18.27
12.52
09028308

A
Incision of metatarsal
5.28
5.76
3.69
0.70
11.74
9.67
09028309

A
Incision of metatarsals
12.76
NA
7.97
2.04
NA
22.77
09028310

A
Revision of big toe
5.42
5.76
3.56
0.70
11.88
9.68
09028312

A
Revision of toe
4.54
5.45
3.64
0.63
10.62
8.81
09028313

A
Repair deformity of toe
5.00
5.29
4.84
0.73
11.02
10.57
09028315

A
Removal of sesamoid bone
4.85
4.90
3.34
0.63
10.38
8.82
09028320

A
Repair of foot bones
9.17
NA
6.73
1.43
NA
17.33
09028322

A
Repair of metatarsals
8.33
9.20
6.35
1.27
18.80
15.95
09028340

A
Resect enlarged toe tissue
6.97
6.46
4.25
0.84
14.27
12.06
09028341

A
Resect enlarged toe
8.40
6.95
4.82
1.01
16.36
14.23
09028344

A
Repair extra toe(s)
4.25
5.76
3.64
0.51
10.52
8.40
09028345

A
Repair webbed toe(s)
5.91
6.21
4.69
0.80
12.92
11.40
09028360

A
Reconstruct cleft foot
13.32
NA
10.52
2.28
NA
26.12
09028400

A
Treatment of heel fracture
2.16
3.64
3.06
0.35
6.15
5.57
09028405

A
Treatment of heel fracture
4.56
4.84
4.63
0.73
10.13
9.92
09028406

A
Treatment of heel fracture
6.30
NA
6.81
1.11
NA
14.22
09028415

A
Treat heel fracture
15.95
NA
13.32
2.66
NA
31.93
09028420

A
Treat/graft heel fracture
16.62
NA
12.95
2.80
NA
32.37
09028430

A
Treatment of ankle fracture
2.09
3.40
2.57
0.31
5.80
4.97
09028435

A
Treatment of ankle fracture
3.39
3.89
3.75
0.55
7.83
7.69
09028436

A
Treatment of ankle fracture
4.70
NA
5.93
0.81
NA
11.44
09028445

A
Treat ankle fracture
15.60
NA
11.06
2.58
NA
29.24
09028450

A
Treat midfoot fracture, each
1.90
3.12
2.48
0.28
5.30
4.66
09028455

A
Treat midfoot fracture, each
3.09
3.43
3.43
0.44
6.96
6.96
09028456

A
Treat midfoot fracture
2.68
NA
4.16
0.44
NA
7.28
09028465

A
Treat midfoot fracture, each
7.00
NA
6.33
1.10
NA
14.43
09028470

A
Treat metatarsal fracture
1.99
3.13
2.45
0.30
5.42
4.74
09028475

A
Treat metatarsal fracture
2.97
3.34
3.22
0.44
6.75
6.63
09028476

A
Treat metatarsal fracture
3.37
NA
4.99
0.54
NA
8.90
09028485

A
Treat metatarsal fracture
5.70
NA
5.46
0.83
NA
11.99
09028490

A
Treat big toe fracture
1.09
2.02
1.64
0.14
3.25
2.87
09028495

A
Treat big toe fracture
1.58
2.18
2.07
0.20
3.96
3.85
09028496

A
Treat big toe fracture
2.33
8.27
3.20
0.36
10.96
5.89
09028505

A
Treat big toe fracture
3.80
8.12
3.91
0.56
12.48
8.27
09028510

A
Treatment of toe fracture
1.09
1.53
1.53
0.14
2.76
2.76
09028515

A
Treatment of toe fracture
1.46
1.90
1.90
0.18
3.54
3.54
09028525

A
Treat toe fracture
3.32
7.53
3.44
0.49
11.34
7.25
09028530

A
Treat sesamoid bone fracture
1.06
1.44
1.44
0.14
2.64
2.64
09028531

A
Treat sesamoid bone fracture
2.35
7.28
2.07
0.34
9.97
4.76
09028540

A
Treat foot dislocation
2.04
2.41
2.41
0.26
4.71
4.71
09028545

A
Treat foot dislocation
2.45
2.35
2.35
0.37
5.17
5.17
09028546

A
Treat foot dislocation
3.20
6.93
4.39
0.52
10.65
8.11
09028555

A
Repair foot dislocation
6.29
9.93
5.69
1.04
17.26
13.02
09028570

A
Treat foot dislocation
1.66
2.43
2.34
0.23
4.32
4.23
09028575

A
Treat foot dislocation
3.31
3.73
3.73
0.56
7.60
7.60
09028576

A
Treat foot dislocation
4.16
NA
4.18
0.69
NA
9.03
09028585

A
Repair foot dislocation
7.98
7.34
5.85
1.25
16.57
15.08
09028600

A
Treat foot dislocation
1.89
2.82
2.69
0.27
4.98
4.85
09028605

A
Treat foot dislocation
2.71
3.13
3.13
0.40
6.24
6.24
09028606

A
Treat foot dislocation
4.89
NA
4.70
0.82
NA
10.41
09028615

A
Repair foot dislocation
7.76
NA
8.06
1.30
NA
17.12
09028630

A
Treat toe dislocation
1.70
1.57
1.00
0.20
3.47
2.90
010( print page 70363)28635

A
Treat toe dislocation
1.91
2.03
1.53
0.26
4.20
3.70
01028636

A
Treat toe dislocation
2.77
3.88
2.63
0.43
7.08
5.83
01028645

A
Repair toe dislocation
4.21
4.96
3.28
0.57
9.74
8.06
09028660

A
Treat toe dislocation
1.23
1.26
0.79
0.13
2.62
2.15
01028665

A
Treat toe dislocation
1.92
NA
1.43
0.26
NA
3.61
01028666

A
Treat toe dislocation
2.66
5.90
2.59
0.43
8.99
5.68
01028675

A
Repair of toe dislocation
2.92
7.16
3.36
0.45
10.53
6.73
09028705

A
Fusion of foot bones
18.77
NA
12.47
3.08
NA
34.32
09028715

A
Fusion of foot bones
13.08
NA
9.78
2.16
NA
25.02
09028725

A
Fusion of foot bones
11.59
NA
8.26
1.86
NA
21.71
09028730

A
Fusion of foot bones
10.74
NA
8.50
1.70
NA
20.94
09028735

A
Fusion of foot bones
10.83
NA
7.84
1.68
NA
20.35
09028737

A
Revision of foot bones
9.63
NA
6.82
1.47
NA
17.92
09028740

A
Fusion of foot bones
8.01
10.89
6.48
1.22
20.12
15.71
09028750

A
Fusion of big toe joint
7.29
11.94
6.68
1.13
20.36
15.10
09028755

A
Fusion of big toe joint
4.73
6.12
3.76
0.65
11.50
9.14
09028760

A
Fusion of big toe joint
7.74
7.99
5.53
1.05
16.78
14.32
09028800

A
Amputation of midfoot
8.20
NA
5.81
1.15
NA
15.16
09028805

A
Amputation thru metatarsal
8.38
NA
5.66
1.18
NA
15.22
09028810

A
Amputation toe & metatarsal
6.20
NA
4.48
0.86
NA
11.54
09028820

A
Amputation of toe
4.40
7.57
3.79
0.61
12.58
8.80
09028825

A
Partial amputation of toe
3.58
7.01
3.49
0.50
11.09
7.57
09028890

A
High energy eswt, plantar f
3.30
5.73
2.09
0.41
9.44
5.80
09028899

C
Foot/toes surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY29000

A
Application of body cast
2.25
2.97
1.74
0.41
5.63
4.40
00029010

A
Application of body cast
2.06
3.29
1.78
0.45
5.80
4.29
00029015

A
Application of body cast
2.41
2.98
1.60
0.28
5.67
4.29
00029020

A
Application of body cast
2.11
3.19
1.41
0.28
5.58
3.80
00029025

A
Application of body cast
2.40
3.15
1.86
0.44
5.99
4.70
00029035

A
Application of body cast
1.77
3.62
1.58
0.28
5.67
3.63
00029040

A
Application of body cast
2.22
2.47
1.51
0.36
5.05
4.09
00029044

A
Application of body cast
2.12
3.98
1.91
0.35
6.45
4.38
00029046

A
Application of body cast
2.41
3.24
2.10
0.42
6.07
4.93
00029049

A
Application of figure eight
0.89
1.30
0.53
0.13
2.32
1.55
00029055

A
Application of shoulder cast
1.78
2.99
1.47
0.30
5.07
3.55
00029058

A
Application of shoulder cast
1.31
1.56
0.72
0.17
3.04
2.20
00029065

A
Application of long arm cast
0.87
1.33
0.75
0.15
2.35
1.77
00029075

A
Application of forearm cast
0.77
1.26
0.68
0.13
2.16
1.58
00029085

A
Apply hand/wrist cast
0.87
1.28
0.63
0.14
2.29
1.64
00029086

A
Apply finger cast
0.62
0.96
0.49
0.07
1.65
1.18
00029105

A
Apply long arm splint
0.87
1.23
0.51
0.12
2.22
1.50
00029125

A
Apply forearm splint
0.59
1.02
0.39
0.07
1.68
1.05
00029126

A
Apply forearm splint
0.77
1.21
0.46
0.07
2.05
1.30
00029130

A
Application of finger splint
0.50
0.47
0.17
0.06
1.03
0.73
00029131

A
Application of finger splint
0.55
0.74
0.24
0.03
1.32
0.82
00029200

A
Strapping of chest
0.65
0.72
0.34
0.04
1.41
1.03
00029220

A
Strapping of low back
0.64
0.72
0.39
0.04
1.40
1.07
00029240

A
Strapping of shoulder
0.71
0.85
0.36
0.06
1.62
1.13
00029260

A
Strapping of elbow or wrist
0.55
0.74
0.32
0.05
1.34
0.92
00029280

A
Strapping of hand or finger
0.51
0.80
0.32
0.03
1.34
0.86
00029305

A
Application of hip cast
2.03
3.35
1.77
0.35
5.73
4.15
00029325

A
Application of hip casts
2.32
3.54
1.96
0.40
6.26
4.68
00029345

A
Application of long leg cast
1.40
1.77
1.06
0.24
3.41
2.70
00029355

A
Application of long leg cast
1.53
1.71
1.12
0.26
3.50
2.91
00029358

A
Apply long leg cast brace
1.43
2.07
1.09
0.25
3.75
2.77
00029365

A
Application of long leg cast
1.18
1.66
0.95
0.20
3.04
2.33
00029405

A
Apply short leg cast
0.86
1.22
0.71
0.14
2.22
1.71
00029425

A
Apply short leg cast
1.01
1.23
0.74
0.15
2.39
1.90
00029435

A
Apply short leg cast
1.18
1.56
0.93
0.20
2.94
2.31
00029440

A
Addition of walker to cast
0.57
0.69
0.27
0.08
1.34
0.92
00029445

A
Apply rigid leg cast
1.78
1.81
0.96
0.27
3.86
3.01
00029450

A
Application of leg cast
2.08
1.47
1.09
0.27
3.82
3.44
00029505

A
Application, long leg splint
0.69
1.18
0.45
0.08
1.95
1.22
00029515

A
Application lower leg splint
0.73
0.87
0.46
0.09
1.69
1.28
00029520

A
Strapping of hip
0.54
0.85
0.47
0.03
1.42
1.04
00029530

A
Strapping of knee
0.57
0.79
0.33
0.05
1.41
0.95
00029540

A
Strapping of ankle and/or ft
0.51
0.42
0.31
0.06
0.99
0.88
00029550

A
Strapping of toes
0.47
0.42
0.28
0.06
0.95
0.81
00029580

A
Application of paste boot
0.57
0.65
0.35
0.07
1.29
0.99
00029590

A
Application of foot splint
0.76
0.51
0.29
0.09
1.36
1.14
00029700

A
Removal/revision of cast
0.57
0.89
0.28
0.08
1.54
0.93
00029705

A
Removal/revision of cast
0.76
0.82
0.38
0.13
1.71
1.27
00029710

A
Removal/revision of cast
1.34
1.53
0.70
0.20
3.07
2.24
00029715

A
Removal/revision of cast
0.94
1.17
0.40
0.09
2.20
1.43
00029720

A
Repair of body cast
0.68
1.16
0.39
0.12
1.96
1.19
000( print page 70364)29730

A
Windowing of cast
0.75
0.81
0.35
0.12
1.68
1.22
00029740

A
Wedging of cast
1.12
1.15
0.49
0.18
2.45
1.79
00029750

A
Wedging of clubfoot cast
1.26
1.06
0.58
0.21
2.53
2.05
00029799

C
Casting/strapping procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY29800

A
Jaw arthroscopy/surgery
6.42
NA
6.99
0.99
NA
14.40
09029804

A
Jaw arthroscopy/surgery
8.13
NA
7.64
1.38
NA
17.15
09029805

A
Shoulder arthroscopy, dx
5.88
NA
5.69
1.02
NA
12.59
09029806

A
Shoulder arthroscopy/surgery
14.35
NA
11.19
2.49
NA
28.03
09029807

A
Shoulder arthroscopy/surgery
13.88
NA
11.02
2.41
NA
27.31
09029819

A
Shoulder arthroscopy/surgery
7.61
NA
6.81
1.32
NA
15.74
09029820

A
Shoulder arthroscopy/surgery
7.06
NA
6.24
1.22
NA
14.52
09029821

A
Shoulder arthroscopy/surgery
7.71
NA
6.82
1.33
NA
15.86
09029822

A
Shoulder arthroscopy/surgery
7.42
NA
6.71
1.28
NA
15.41
09029823

A
Shoulder arthroscopy/surgery
8.16
NA
7.24
1.41
NA
16.81
09029824

A
Shoulder arthroscopy/surgery
8.24
NA
7.55
1.42
NA
17.21
09029825

A
Shoulder arthroscopy/surgery
7.61
NA
6.78
1.32
NA
15.71
09029826

A
Shoulder arthroscopy/surgery
8.98
NA
7.55
1.55
NA
18.08
09029827

A
Arthroscop rotator cuff repr
15.34
NA
11.56
2.66
NA
29.56
09029830

A
Elbow arthroscopy
5.75
NA
5.36
0.99
NA
12.10
09029834

A
Elbow arthroscopy/surgery
6.27
NA
5.85
1.08
NA
13.20
09029835

A
Elbow arthroscopy/surgery
6.47
NA
5.90
1.13
NA
13.50
09029836

A
Elbow arthroscopy/surgery
7.54
NA
6.81
1.22
NA
15.57
09029837

A
Elbow arthroscopy/surgery
6.86
NA
6.15
1.19
NA
14.20
09029838

A
Elbow arthroscopy/surgery
7.70
NA
6.91
1.30
NA
15.91
09029840

A
Wrist arthroscopy
5.53
NA
5.34
0.84
NA
11.71
09029843

A
Wrist arthroscopy/surgery
6.00
NA
5.64
0.92
NA
12.56
09029844

A
Wrist arthroscopy/surgery
6.36
NA
5.84
1.04
NA
13.24
09029845

A
Wrist arthroscopy/surgery
7.51
NA
6.49
0.99
NA
14.99
09029846

A
Wrist arthroscopy/surgery
6.74
NA
6.07
1.07
NA
13.88
09029847

A
Wrist arthroscopy/surgery
7.07
NA
6.21
1.08
NA
14.36
09029848

A
Wrist endoscopy/surgery
5.43
NA
5.62
0.86
NA
11.91
09029850

A
Knee arthroscopy/surgery
8.18
NA
5.05
1.25
NA
14.48
09029851

A
Knee arthroscopy/surgery
13.08
NA
9.82
2.34
NA
25.24
09029855

A
Tibial arthroscopy/surgery
10.60
NA
8.79
1.84
NA
21.23
09029856

A
Tibial arthroscopy/surgery
14.12
NA
10.70
2.39
NA
27.21
09029860

A
Hip arthroscopy, dx
8.04
NA
6.97
1.36
NA
16.37
09029861

A
Hip arthroscopy/surgery
9.14
NA
7.36
1.59
NA
18.09
09029862

A
Hip arthroscopy/surgery
9.89
NA
8.58
1.62
NA
20.09
09029863

A
Hip arthroscopy/surgery
9.89
NA
8.53
1.42
NA
19.84
09029866

A
Autgrft implnt, knee w/scope
13.88
NA
11.38
2.39
NA
27.65
09029867

A
Allgrft implnt, knee w/scope
17.00
NA
13.26
2.78
NA
33.04
09029868

A
Meniscal trnspl, knee w/scpe
23.59
NA
16.84
4.35
NA
44.78
09029870

A
Knee arthroscopy, dx
5.06
NA
4.90
0.85
NA
10.81
09029871

A
Knee arthroscopy/drainage
6.54
NA
5.89
1.14
NA
13.57
09029873

A
Knee arthroscopy/surgery
5.99
NA
6.59
1.04
NA
13.62
09029874

A
Knee arthroscopy/surgery
7.04
NA
6.09
1.11
NA
14.24
09029875

A
Knee arthroscopy/surgery
6.30
NA
5.87
1.09
NA
13.26
09029876

A
Knee arthroscopy/surgery
7.91
NA
7.04
1.37
NA
16.32
09029877

A
Knee arthroscopy/surgery
7.34
NA
6.76
1.28
NA
15.38
09029879

A
Knee arthroscopy/surgery
8.03
NA
7.14
1.39
NA
16.56
09029880

A
Knee arthroscopy/surgery
8.49
NA
7.38
1.47
NA
17.34
09029881

A
Knee arthroscopy/surgery
7.75
NA
6.98
1.34
NA
16.07
09029882

A
Knee arthroscopy/surgery
8.64
NA
7.26
1.50
NA
17.40
09029883

A
Knee arthroscopy/surgery
11.03
NA
9.09
1.92
NA
22.04
09029884

A
Knee arthroscopy/surgery
7.32
NA
6.72
1.27
NA
15.31
09029885

A
Knee arthroscopy/surgery
9.08
NA
7.99
1.58
NA
18.65
09029886

A
Knee arthroscopy/surgery
7.53
NA
6.87
1.30
NA
15.70
09029887

A
Knee arthroscopy/surgery
9.03
NA
7.95
1.57
NA
18.55
09029888

A
Knee arthroscopy/surgery
13.88
NA
10.23
2.41
NA
26.52
09029889

A
Knee arthroscopy/surgery
15.98
NA
12.47
2.78
NA
31.23
09029891

A
Ankle arthroscopy/surgery
8.39
NA
7.53
1.39
NA
17.31
09029892

A
Ankle arthroscopy/surgery
8.99
NA
7.76
1.41
NA
18.16
09029893

A
Scope, plantar fasciotomy
5.21
6.30
4.00
0.63
12.14
9.84
09029894

A
Ankle arthroscopy/surgery
7.20
NA
5.49
1.15
NA
13.84
09029895

A
Ankle arthroscopy/surgery
6.98
NA
5.49
1.11
NA
13.58
09029897

A
Ankle arthroscopy/surgery
7.17
NA
5.90
1.17
NA
14.24
09029898

A
Ankle arthroscopy/surgery
8.31
NA
6.21
1.28
NA
15.80
09029899

A
Ankle arthroscopy/surgery
13.89
NA
10.57
2.40
NA
26.86
09029900

A
Mcp joint arthroscopy, dx
5.41
NA
5.88
0.94
NA
12.23
09029901

A
Mcp joint arthroscopy, surg
6.12
NA
6.28
1.06
NA
13.46
09029902

A
Mcp joint arthroscopy, surg
6.69
NA
6.56
1.12
NA
14.37
09029999

C
Arthroscopy of joint
0.00
0.00
0.00
0.00
0.00
0.00
YYY30000

A
Drainage of nose lesion
1.43
4.08
1.39
0.12
5.63
2.94
0103000F

I
Blood press </= 140/90 mmhg
0.00
0.00
0.00
0.00
0.00
0.00
XXX30020

A
Drainage of nose lesion
1.43
3.28
1.47
0.12
4.83
3.02
010( print page 70365)3002F

I
Blood pressure > 140/90 mmhg
0.00
0.00
0.00
0.00
0.00
0.00
XXX30100

A
Intranasal biopsy
0.94
1.98
0.82
0.07
2.99
1.83
00030110

A
Removal of nose polyp(s)
1.63
3.25
1.57
0.14
5.02
3.34
01030115

A
Removal of nose polyp(s)
4.34
NA
5.78
0.41
NA
10.53
09030117

A
Removal of intranasal lesion
3.16
13.18
4.64
0.26
16.60
8.06
09030118

A
Removal of intranasal lesion
9.68
NA
9.22
0.78
NA
19.68
09030120

A
Revision of nose
5.26
6.51
6.02
0.52
12.29
11.80
09030124

A
Removal of nose lesion
3.10
NA
3.62
0.25
NA
6.97
09030125

A
Removal of nose lesion
7.15
NA
8.34
0.63
NA
16.12
09030130

A
Excise inferior turbinate
3.37
NA
5.61
0.31
NA
9.29
09030140

A
Resect inferior turbinate
3.42
NA
6.21
0.35
NA
9.98
09030150

A
Partial removal of nose
9.13
NA
11.04
0.93
NA
21.10
09030160

A
Removal of nose
9.57
NA
10.24
0.88
NA
20.69
09030200

A
Injection treatment of nose
0.78
1.62
0.74
0.06
2.46
1.58
00030210

A
Nasal sinus therapy
1.08
2.11
1.31
0.09
3.28
2.48
01030220

A
Insert nasal septal button
1.54
4.24
1.53
0.12
5.90
3.19
01030300

A
Remove nasal foreign body
1.04
4.64
1.92
0.08
5.76
3.04
01030310

A
Remove nasal foreign body
1.96
NA
3.11
0.16
NA
5.23
01030320

A
Remove nasal foreign body
4.51
NA
7.06
0.39
NA
11.96
09030400

R
Reconstruction of nose
9.82
NA
15.53
1.04
NA
26.39
09030410

R
Reconstruction of nose
12.96
NA
18.42
1.42
NA
32.80
09030420

R
Reconstruction of nose
15.86
NA
17.96
1.46
NA
35.28
09030430

R
Revision of nose
7.20
NA
16.06
0.77
NA
24.03
09030435

R
Revision of nose
11.69
NA
19.41
1.22
NA
32.32
09030450

R
Revision of nose
18.62
NA
21.95
1.96
NA
42.53
09030460

A
Revision of nose
9.95
NA
9.97
1.03
NA
20.95
09030462

A
Revision of nose
19.54
NA
20.30
2.53
NA
42.37
09030465

A
Repair nasal stenosis
11.62
NA
12.00
1.06
NA
24.68
09030520

A
Repair of nasal septum
5.69
NA
6.68
0.46
NA
12.83
09030540

A
Repair nasal defect
7.74
NA
9.30
0.67
NA
17.71
09030545

A
Repair nasal defect
11.36
NA
11.93
1.70
NA
24.99
09030560

A
Release of nasal adhesions
1.26
4.78
2.14
0.10
6.14
3.50
01030580

A
Repair upper jaw fistula
6.68
7.79
5.81
0.89
15.36
13.38
09030600

A
Repair mouth/nose fistula
6.01
7.54
5.03
0.70
14.25
11.74
09030620

A
Intranasal reconstruction
5.96
NA
8.86
0.57
NA
15.39
09030630

A
Repair nasal septum defect
7.11
NA
7.97
0.61
NA
15.69
09030801

A
Ablate inf turbinate, superf
1.09
4.14
1.93
0.09
5.32
3.11
01030802

A
Cauterization, inner nose
2.03
4.62
2.37
0.16
6.81
4.56
01030901

A
Control of nosebleed
1.21
1.36
0.32
0.11
2.68
1.64
00030903

A
Control of nosebleed
1.54
2.72
0.50
0.13
4.39
2.17
00030905

A
Control of nosebleed
1.97
3.52
0.76
0.17
5.66
2.90
00030906

A
Repeat control of nosebleed
2.45
3.90
1.20
0.20
6.55
3.85
00030915

A
Ligation, nasal sinus artery
7.19
NA
6.71
0.58
NA
14.48
09030920

A
Ligation, upper jaw artery
9.82
NA
9.00
0.80
NA
19.62
09030930

A
Ther fx, nasal inf turbinate
1.26
NA
1.62
0.12
NA
3.00
01030999

C
Nasal surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY31000

A
Irrigation, maxillary sinus
1.15
2.85
1.40
0.09
4.09
2.64
01031002

A
Irrigation, sphenoid sinus
1.91
NA
3.25
0.15
NA
5.31
01031020

A
Exploration, maxillary sinus
2.94
8.55
5.20
0.29
11.78
8.43
09031030

A
Exploration, maxillary sinus
5.91
11.53
6.68
0.60
18.04
13.19
09031032

A
Explore sinus, remove polyps
6.56
NA
7.25
0.59
NA
14.40
09031040

A
Exploration behind upper jaw
9.41
NA
9.85
0.87
NA
20.13
09031050

A
Exploration, sphenoid sinus
5.27
NA
6.37
0.49
NA
12.13
09031051

A
Sphenoid sinus surgery
7.10
NA
8.26
0.62
NA
15.98
09031070

A
Exploration of frontal sinus
4.27
NA
5.95
0.38
NA
10.60
09031075

A
Exploration of frontal sinus
9.15
NA
9.76
0.75
NA
19.66
09031080

A
Removal of frontal sinus
11.40
NA
13.57
1.23
NA
26.20
09031081

A
Removal of frontal sinus
12.73
NA
14.04
2.46
NA
29.23
09031084

A
Removal of frontal sinus
13.49
NA
13.54
1.19
NA
28.22
09031085

A
Removal of frontal sinus
14.18
NA
14.00
1.72
NA
29.90
09031086

A
Removal of frontal sinus
12.84
NA
13.32
1.07
NA
27.23
09031087

A
Removal of frontal sinus
13.08
NA
12.57
1.44
NA
27.09
09031090

A
Exploration of sinuses
9.52
NA
12.59
0.94
NA
23.05
09031200

A
Removal of ethmoid sinus
4.96
NA
9.24
0.29
NA
14.49
09031201

A
Removal of ethmoid sinus
8.36
NA
9.20
0.82
NA
18.38
09031205

A
Removal of ethmoid sinus
10.22
NA
11.91
0.67
NA
22.80
09031225

A
Removal of upper jaw
19.20
NA
17.87
1.59
NA
38.66
09031230

A
Removal of upper jaw
21.91
NA
19.42
1.77
NA
43.10
09031231

A
Nasal endoscopy, dx
1.10
3.39
0.88
0.09
4.58
2.07
00031233

A
Nasal/sinus endoscopy, dx
2.18
4.31
1.48
0.20
6.69
3.86
00031235

A
Nasal/sinus endoscopy, dx
2.64
4.92
1.72
0.26
7.82
4.62
00031237

A
Nasal/sinus endoscopy, surg
2.98
5.21
1.89
0.28
8.47
5.15
00031238

A
Nasal/sinus endoscopy, surg
3.26
5.25
2.10
0.27
8.78
5.63
00031239

A
Nasal/sinus endoscopy, surg
8.69
NA
8.02
0.62
NA
17.33
01031240

A
Nasal/sinus endoscopy, surg
2.61
NA
1.74
0.24
NA
4.59
000( print page 70366)31254

A
Revision of ethmoid sinus
4.64
NA
2.86
0.45
NA
7.95
00031255

A
Removal of ethmoid sinus
6.95
NA
4.12
0.73
NA
11.80
00031256

A
Exploration maxillary sinus
3.29
NA
2.12
0.33
NA
5.74
00031267

A
Endoscopy, maxillary sinus
5.45
NA
3.30
0.55
NA
9.30
00031276

A
Sinus endoscopy, surgical
8.84
NA
5.13
0.92
NA
14.89
00031287

A
Nasal/sinus endoscopy, surg
3.91
NA
2.46
0.39
NA
6.76
00031288

A
Nasal/sinus endoscopy, surg
4.57
NA
2.82
0.46
NA
7.85
00031290

A
Nasal/sinus endoscopy, surg
17.21
NA
12.08
1.40
NA
30.69
01031291

A
Nasal/sinus endoscopy, surg
18.16
NA
12.51
1.68
NA
32.35
01031292

A
Nasal/sinus endoscopy, surg
14.74
NA
10.64
1.21
NA
26.59
01031293

A
Nasal/sinus endoscopy, surg
16.19
NA
11.41
1.28
NA
28.88
01031294

A
Nasal/sinus endoscopy, surg
19.03
NA
12.91
1.53
NA
33.47
01031299

C
Sinus surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY31300

A
Removal of larynx lesion
14.27
NA
15.02
1.17
NA
30.46
09031320

A
Diagnostic incision, larynx
5.25
NA
10.33
0.46
NA
16.04
09031360

A
Removal of larynx
17.05
NA
16.77
1.38
NA
35.20
09031365

A
Removal of larynx
24.12
NA
20.42
1.97
NA
46.51
09031367

A
Partial removal of larynx
21.83
NA
21.95
1.78
NA
45.56
09031368

A
Partial removal of larynx
27.05
NA
25.56
2.20
NA
54.81
09031370

A
Partial removal of larynx
21.35
NA
22.32
1.74
NA
45.41
09031375

A
Partial removal of larynx
20.18
NA
20.44
1.63
NA
42.25
09031380

A
Partial removal of larynx
20.18
NA
20.66
1.70
NA
42.54
09031382

A
Partial removal of larynx
20.49
NA
21.67
1.67
NA
43.83
09031390

A
Removal of larynx & pharynx
27.49
NA
24.45
2.23
NA
54.17
09031395

A
Reconstruct larynx & pharynx
31.04
NA
28.38
2.48
NA
61.90
09031400

A
Revision of larynx
10.29
NA
13.81
0.83
NA
24.93
09031420

A
Removal of epiglottis
10.20
NA
9.57
0.83
NA
20.60
09031500

A
Insert emergency airway
2.33
NA
0.55
0.17
NA
3.05
00031502

A
Change of windpipe airway
0.65
0.31
0.28
0.05
1.01
0.98
00031505

A
Diagnostic laryngoscopy
0.61
1.45
0.61
0.05
2.11
1.27
00031510

A
Laryngoscopy with biopsy
1.92
3.31
1.25
0.16
5.39
3.33
00031511

A
Remove foreign body, larynx
2.16
3.13
1.06
0.19
5.48
3.41
00031512

A
Removal of larynx lesion
2.07
3.21
1.36
0.18
5.46
3.61
00031513

A
Injection into vocal cord
2.10
NA
1.46
0.17
NA
3.73
00031515

A
Laryngoscopy for aspiration
1.80
3.55
1.06
0.14
5.49
3.00
00031520

A
Dx laryngoscopy, newborn
2.56
NA
1.56
0.20
NA
4.32
00031525

A
Dx laryngoscopy excl nb
2.63
3.65
1.66
0.21
6.49
4.50
00031526

A
Dx laryngoscopy w/oper scope
2.57
NA
1.72
0.21
NA
4.50
00031527

A
Laryngoscopy for treatment
3.27
NA
1.88
0.26
NA
5.41
00031528

A
Laryngoscopy and dilation
2.37
NA
1.46
0.19
NA
4.02
00031529

A
Laryngoscopy and dilation
2.68
NA
1.71
0.22
NA
4.61
00031530

A
Laryngoscopy w/fb removal
3.38
NA
1.96
0.29
NA
5.63
00031531

A
Laryngoscopy w/fb & op scope
3.58
NA
2.28
0.29
NA
6.15
00031535

A
Laryngoscopy w/biopsy
3.16
NA
2.00
0.26
NA
5.42
00031536

A
Laryngoscopy w/bx & op scope
3.55
NA
2.26
0.29
NA
6.10
00031540

A
Laryngoscopy w/exc of tumor
4.12
NA
2.55
0.33
NA
7.00
00031541

A
Larynscop w/tumr exc + scope
4.52
NA
2.79
0.37
NA
7.68
00031545

A
Remove vc lesion w/scope
6.30
NA
3.48
0.37
NA
10.15
00031546

A
Remove vc lesion scope/graft
9.73
NA
4.98
0.78
NA
15.49
00031560

A
Laryngoscop w/arytenoidectom
5.45
NA
3.16
0.43
NA
9.04
00031561

A
Larynscop, remve cart + scop
5.99
NA
3.38
0.49
NA
9.86
00031570

A
Laryngoscope w/vc inj
3.86
5.69
2.39
0.31
9.86
6.56
00031571

A
Laryngoscop w/vc inj + scope
4.26
NA
2.61
0.35
NA
7.22
00031575

A
Diagnostic laryngoscopy
1.10
1.91
0.89
0.09
3.10
2.08
00031576

A
Laryngoscopy with biopsy
1.97
3.67
1.29
0.14
5.78
3.40
00031577

A
Remove foreign body, larynx
2.47
3.77
1.53
0.21
6.45
4.21
00031578

A
Removal of larynx lesion
2.84
4.29
1.52
0.23
7.36
4.59
00031579

A
Diagnostic laryngoscopy
2.26
3.79
1.48
0.18
6.23
3.92
00031580

A
Revision of larynx
12.36
NA
15.96
1.00
NA
29.32
09031582

A
Revision of larynx
21.59
NA
25.87
1.75
NA
49.21
09031584

A
Treat larynx fracture
19.61
NA
18.20
1.71
NA
39.52
09031587

A
Revision of larynx
11.97
NA
9.29
0.97
NA
22.23
09031588

A
Revision of larynx
13.09
NA
13.65
1.06
NA
27.80
09031590

A
Reinnervate larynx
6.96
NA
15.58
0.84
NA
23.38
09031595

A
Larynx nerve surgery
8.33
NA
10.58
0.68
NA
19.59
09031599

C
Larynx surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY31600

A
Incision of windpipe
7.17
NA
3.20
0.80
NA
11.17
00031601

A
Incision of windpipe
4.44
NA
2.41
0.40
NA
7.25
00031603

A
Incision of windpipe
4.14
NA
1.71
0.44
NA
6.29
00031605

A
Incision of windpipe
3.57
NA
1.19
0.40
NA
5.16
00031610

A
Incision of windpipe
8.75
NA
8.28
0.79
NA
17.82
09031611

A
Surgery/speech prosthesis
5.63
NA
7.08
0.46
NA
13.17
09031612

A
Puncture/clear windpipe
0.91
1.10
0.35
0.08
2.09
1.34
00031613

A
Repair windpipe opening
4.58
NA
6.01
0.42
NA
11.01
09031614

A
Repair windpipe opening
7.11
NA
8.74
0.58
NA
16.43
090( print page 70367)31615

A
Visualization of windpipe
2.09
2.60
1.20
0.16
4.85
3.45
00031620

A
Endobronchial us add-on
1.40
5.66
0.55
0.11
7.17
2.06
ZZZ31622

A
Dx bronchoscope/wash
2.78
5.67
1.06
0.18
8.63
4.02
00031623

A
Dx bronchoscope/brush
2.88
6.44
1.05
0.13
9.45
4.06
00031624

A
Dx bronchoscope/lavage
2.88
5.79
1.05
0.13
8.80
4.06
00031625

A
Bronchoscopy w/biopsy(s)
3.36
5.83
1.21
0.18
9.37
4.75
00031628

A
Bronchoscopy/lung bx, each
3.80
7.04
1.30
0.18
11.02
5.28
00031629

A
Bronchoscopy/needle bx, each
4.09
14.29
1.40
0.16
18.54
5.65
00031630

A
Bronchoscopy dilate/fx repr
3.81
NA
1.72
0.32
NA
5.85
00031631

A
Bronchoscopy, dilate w/stent
4.36
NA
1.77
0.34
NA
6.47
00031632

A
Bronchoscopy/lung bx, add'l
1.03
0.81
0.31
0.18
2.02
1.52
ZZZ31633

A
Bronchoscopy/needle bx add'l
1.32
0.92
0.40
0.16
2.40
1.88
ZZZ31635

A
Bronchoscopy w/fb removal
3.67
6.13
1.43
0.24
10.04
5.34
00031636

A
Bronchoscopy, bronch stents
4.30
NA
1.77
0.31
NA
6.38
00031637

A
Bronchoscopy, stent add-on
1.58
NA
0.56
0.13
NA
2.27
ZZZ31638

A
Bronchoscopy, revise stent
4.88
NA
1.98
0.22
NA
7.08
00031640

A
Bronchoscopy w/tumor excise
4.93
NA
2.08
0.46
NA
7.47
00031641

A
Bronchoscopy, treat blockage
5.02
NA
1.89
0.35
NA
7.26
00031643

A
Diag bronchoscope/catheter
3.49
NA
1.23
0.20
NA
4.92
00031645

A
Bronchoscopy, clear airways
3.16
5.15
1.12
0.16
8.47
4.44
00031646

A
Bronchoscopy, reclear airway
2.72
4.87
1.00
0.14
7.73
3.86
00031656

A
Bronchoscopy, inj for x-ray
2.17
7.31
0.83
0.15
9.63
3.15
00031700

A
Insertion of airway catheter
1.34
2.16
0.68
0.08
3.58
2.10
00031708

A
Instill airway contrast dye
1.41
2.04
0.46
0.07
3.52
1.94
00031710

A
Insertion of airway catheter
1.30
NA
0.41
0.12
NA
1.83
00031715

A
Injection for bronchus x-ray
1.11
NA
0.34
0.07
NA
1.52
00031717

A
Bronchial brush biopsy
2.12
8.27
0.79
0.14
10.53
3.05
00031720

A
Clearance of airways
1.06
0.33
0.33
0.07
1.46
1.46
00031725

A
Clearance of airways
1.96
0.65
0.58
0.14
2.75
2.68
00031730

A
Intro, windpipe wire/tube
2.85
2.20
1.00
0.21
5.26
4.06
00031750

A
Repair of windpipe
13.00
NA
17.60
1.05
NA
31.65
09031755

A
Repair of windpipe
15.91
NA
24.59
1.29
NA
41.79
09031760

A
Repair of windpipe
22.32
NA
10.74
2.94
NA
36.00
09031766

A
Reconstruction of windpipe
30.38
NA
13.69
4.52
NA
48.59
09031770

A
Repair/graft of bronchus
22.48
NA
10.27
2.83
NA
35.58
09031775

A
Reconstruct bronchus
23.50
NA
11.82
3.01
NA
38.33
09031780

A
Reconstruct windpipe
17.69
NA
11.08
1.65
NA
30.42
09031781

A
Reconstruct windpipe
23.49
NA
12.16
2.24
NA
37.89
09031785

A
Remove windpipe lesion
17.20
NA
10.21
1.59
NA
29.00
09031786

A
Remove windpipe lesion
23.94
NA
13.13
3.29
NA
40.36
09031800

A
Repair of windpipe injury
7.42
NA
9.27
0.79
NA
17.48
09031805

A
Repair of windpipe injury
13.11
NA
7.23
1.82
NA
22.16
09031820

A
Closure of windpipe lesion
4.48
5.68
3.66
0.38
10.54
8.52
09031825

A
Repair of windpipe defect
6.80
7.68
5.39
0.53
15.01
12.72
09031830

A
Revise windpipe scar
4.49
5.78
3.99
0.44
10.71
8.92
09031899

C
Airways surgical procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY32000

A
Drainage of chest
1.54
3.06
0.48
0.08
4.68
2.10
00032002

A
Treatment of collapsed lung
2.19
3.22
1.06
0.12
5.53
3.37
00032005

A
Treat lung lining chemically
2.19
6.47
0.70
0.23
8.89
3.12
00032019

A
Insert pleural catheter
4.17
20.02
1.65
0.42
24.61
6.24
00032020

A
Insertion of chest tube
3.97
NA
1.35
0.43
NA
5.75
00032035

A
Exploration of chest
8.66
NA
5.87
1.26
NA
15.79
09032036

A
Exploration of chest
9.67
NA
6.45
1.43
NA
17.55
09032095

A
Biopsy through chest wall
8.35
NA
5.38
1.22
NA
14.95
09032100

A
Exploration/biopsy of chest
15.22
NA
7.84
2.23
NA
25.29
09032110

A
Explore/repair chest
22.97
NA
10.76
3.21
NA
36.94
09032120

A
Re-exploration of chest
11.52
NA
7.09
1.63
NA
20.24
09032124

A
Explore chest free adhesions
12.70
NA
7.23
1.89
NA
21.82
09032140

A
Removal of lung lesion(s)
13.91
NA
7.70
1.96
NA
23.57
09032141

A
Remove/treat lung lesions
13.98
NA
7.57
2.00
NA
23.55
09032150

A
Removal of lung lesion(s)
14.13
NA
7.62
2.00
NA
23.75
09032151

A
Remove lung foreign body
14.19
NA
8.02
2.03
NA
24.24
09032160

A
Open chest heart massage
9.29
NA
5.28
1.31
NA
15.88
09032200

A
Drain, open, lung lesion
15.27
NA
8.63
2.13
NA
26.03
09032201

A
Drain, percut, lung lesion
3.99
20.76
1.30
0.24
24.99
5.53
00032215

A
Treat chest lining
11.31
NA
6.92
1.68
NA
19.91
09032220

A
Release of lung
23.96
NA
12.99
3.56
NA
40.51
09032225

A
Partial release of lung
13.94
NA
7.67
2.06
NA
23.67
09032310

A
Removal of chest lining
13.42
NA
7.41
1.99
NA
22.82
09032320

A
Free/remove chest lining
23.96
NA
12.19
3.51
NA
39.66
09032400

A
Needle biopsy chest lining
1.76
2.13
0.55
0.10
3.99
2.41
00032402

A
Open biopsy chest lining
7.55
NA
5.12
1.07
NA
13.74
09032405

A
Biopsy, lung or mediastinum
1.93
0.67
0.63
0.11
2.71
2.67
00032420

A
Puncture/clear lung
2.18
NA
0.68
0.12
NA
2.98
00032440

A
Removal of lung
24.96
NA
12.93
3.68
NA
41.57
090( print page 70368)32442

A
Sleeve pneumonectomy
26.20
NA
14.80
3.84
NA
44.84
09032445

A
Removal of lung
25.05
NA
14.10
3.71
NA
42.86
09032480

A
Partial removal of lung
23.71
NA
12.09
3.49
NA
39.29
09032482

A
Bilobectomy
24.96
NA
12.95
3.66
NA
41.57
09032484

A
Segmentectomy
20.66
NA
11.41
3.03
NA
35.10
09032486

A
Sleeve lobectomy
23.88
NA
13.28
3.51
NA
40.67
09032488

A
Completion pneumonectomy
25.67
NA
13.82
3.80
NA
43.29
09032491

R
Lung volume reduction
21.22
NA
12.66
2.98
NA
36.86
09032500

A
Partial removal of lung
21.97
NA
12.39
3.25
NA
37.61
09032501

A
Repair bronchus add-on
4.68
NA
1.54
0.65
NA
6.87
ZZZ32503

A
Resect apical lung tumor
30.00
NA
15.11
4.37
NA
49.48
09032504

A
Resect apical lung tum/chest
34.80
NA
16.72
5.07
NA
56.59
09032540

A
Removal of lung lesion
14.62
NA
9.66
2.07
NA
26.35
09032601

A
Thoracoscopy, diagnostic
5.45
NA
2.36
0.80
NA
8.61
00032602

A
Thoracoscopy, diagnostic
5.95
NA
2.53
0.87
NA
9.35
00032603

A
Thoracoscopy, diagnostic
7.80
NA
3.04
1.14
NA
11.98
00032604

A
Thoracoscopy, diagnostic
8.77
NA
3.46
1.25
NA
13.48
00032605

A
Thoracoscopy, diagnostic
6.92
NA
2.91
1.00
NA
10.83
00032606

A
Thoracoscopy, diagnostic
8.39
NA
3.34
1.22
NA
12.95
00032650

A
Thoracoscopy, surgical
10.73
NA
6.78
1.58
NA
19.09
09032651

A
Thoracoscopy, surgical
12.89
NA
7.25
1.86
NA
22.00
09032652

A
Thoracoscopy, surgical
18.63
NA
10.17
2.72
NA
31.52
09032653

A
Thoracoscopy, surgical
12.85
NA
6.99
1.88
NA
21.72
09032654

A
Thoracoscopy, surgical
12.42
NA
7.55
1.63
NA
21.60
09032655

A
Thoracoscopy, surgical
13.08
NA
7.26
1.89
NA
22.23
09032656

A
Thoracoscopy, surgical
12.89
NA
7.96
1.89
NA
22.74
09032657

A
Thoracoscopy, surgical
13.63
NA
7.70
1.99
NA
23.32
09032658

A
Thoracoscopy, surgical
11.61
NA
7.37
1.69
NA
20.67
09032659

A
Thoracoscopy, surgical
11.57
NA
7.47
1.62
NA
20.66
09032660

A
Thoracoscopy, surgical
17.40
NA
9.51
2.08
NA
28.99
09032661

A
Thoracoscopy, surgical
13.23
NA
7.81
1.92
NA
22.96
09032662

A
Thoracoscopy, surgical
16.42
NA
8.85
2.17
NA
27.44
09032663

A
Thoracoscopy, surgical
18.44
NA
10.79
2.72
NA
31.95
09032664

A
Thoracoscopy, surgical
14.18
NA
7.65
2.32
NA
24.15
09032665

A
Thoracoscopy, surgical
15.52
NA
8.15
2.15
NA
25.82
09032800

A
Repair lung hernia
13.67
NA
7.43
1.98
NA
23.08
09032810

A
Close chest after drainage
13.03
NA
7.54
1.93
NA
22.50
09032815

A
Close bronchial fistula
23.12
NA
11.00
3.27
NA
37.39
09032820

A
Reconstruct injured chest
21.45
NA
12.20
2.52
NA
36.17
09032850

X
Donor pneumonectomy
0.00
0.00
0.00
0.00
0.00
0.00
XXX32851

A
Lung transplant, single
38.57
NA
27.74
5.56
NA
71.87
09032852

A
Lung transplant with bypass
41.74
NA
33.26
6.00
NA
81.00
09032853

A
Lung transplant, double
47.74
NA
31.84
7.05
NA
86.63
09032854

A
Lung transplant with bypass
50.90
NA
34.83
7.20
NA
92.93
09032855

C
Prepare donor lung, single
0.00
0.00
0.00
0.00
0.00
0.00
XXX32856

C
Prepare donor lung, double
0.00
0.00
0.00
0.00
0.00
0.00
XXX32900

A
Removal of rib(s)
20.24
NA
9.91
2.93
NA
33.08
09032905

A
Revise & repair chest wall
20.72
NA
10.16
3.15
NA
34.03
09032906

A
Revise & repair chest wall
26.73
NA
12.09
3.97
NA
42.79
09032940

A
Revision of lung
19.40
NA
9.50
2.88
NA
31.78
09032960

A
Therapeutic pneumothorax
1.84
1.74
0.56
0.16
3.74
2.56
00032997

A
Total lung lavage
5.99
NA
1.92
0.55
NA
8.46
00032999

C
Chest surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY33010

A
Drainage of heart sac
2.24
NA
0.78
0.14
NA
3.16
00033011

A
Repeat drainage of heart sac
2.24
NA
0.81
0.15
NA
3.20
00033015

A
Incision of heart sac
6.79
NA
4.96
0.65
NA
12.40
09033020

A
Incision of heart sac
12.59
NA
6.80
1.79
NA
21.18
09033025

A
Incision of heart sac
12.07
NA
6.37
1.80
NA
20.24
09033030

A
Partial removal of heart sac
18.68
NA
9.55
2.83
NA
31.06
09033031

A
Partial removal of heart sac
21.76
NA
10.06
3.13
NA
34.95
09033050

A
Removal of heart sac lesion
14.34
NA
7.86
2.14
NA
24.34
09033120

A
Removal of heart lesion
24.52
NA
11.61
3.69
NA
39.82
09033130

A
Removal of heart lesion
21.36
NA
10.14
3.00
NA
34.50
09033140

A
Heart revascularize (tmr)
19.97
NA
10.91
2.85
NA
33.73
09033141

A
Heart tmr w/other procedure
4.83
NA
1.58
0.69
NA
7.10
ZZZ33200

A
Insertion of heart pacemaker
12.46
NA
6.86
1.70
NA
21.02
09033201

A
Insertion of heart pacemaker
10.16
NA
6.60
1.36
NA
18.12
09033206

A
Insertion of heart pacemaker
6.66
NA
4.47
0.52
NA
11.65
09033207

A
Insertion of heart pacemaker
8.03
NA
4.67
0.59
NA
13.29
09033208

A
Insertion of heart pacemaker
8.12
NA
4.78
0.56
NA
13.46
09033210

A
Insertion of heart electrode
3.30
NA
1.25
0.18
NA
4.73
00033211

A
Insertion of heart electrode
3.39
NA
1.31
0.21
NA
4.91
00033212

A
Insertion of pulse generator
5.51
NA
3.37
0.43
NA
9.31
09033213

A
Insertion of pulse generator
6.36
NA
3.73
0.45
NA
10.54
09033214

A
Upgrade of pacemaker system
7.74
NA
4.90
0.58
NA
13.22
090( print page 70369)33215

A
Reposition pacing-defib lead
4.75
NA
3.19
0.37
NA
8.31
09033216

A
Insert lead pace-defib, one
5.77
NA
4.21
0.36
NA
10.34
09033217

A
Insert lead pace-defib, dual
5.74
NA
4.24
0.39
NA
10.37
09033218

A
Repair lead pace-defib, one
5.43
NA
4.31
0.37
NA
10.11
09033220

A
Repair lead pace-defib, dual
5.51
NA
4.28
0.37
NA
10.16
09033222

A
Revise pocket, pacemaker
4.95
NA
4.30
0.42
NA
9.67
09033223

A
Revise pocket, pacing-defib
6.45
NA
4.60
0.45
NA
11.50
09033224

A
Insert pacing lead & connect
9.04
NA
4.01
0.54
NA
13.59
00033225

A
L ventric pacing lead add-on
8.33
NA
3.26
0.45
NA
12.04
ZZZ33226

A
Reposition l ventric lead
8.68
NA
3.83
0.59
NA
13.10
00033233

A
Removal of pacemaker system
3.29
NA
3.28
0.22
NA
6.79
09033234

A
Removal of pacemaker system
7.81
NA
4.92
0.56
NA
13.29
09033235

A
Removal pacemaker electrode
9.39
NA
6.83
0.73
NA
16.95
09033236

A
Remove electrode/thoracotomy
12.58
NA
7.45
1.68
NA
21.71
09033237

A
Remove electrode/thoracotomy
13.69
NA
7.80
1.59
NA
23.08
09033238

A
Remove electrode/thoracotomy
15.20
NA
8.22
2.02
NA
25.44
09033240

A
Insert pulse generator
7.59
NA
4.59
0.41
NA
12.59
09033241

A
Remove pulse generator
3.24
NA
2.97
0.18
NA
6.39
09033243

A
Remove eltrd/thoracotomy
22.61
NA
11.49
2.09
NA
36.19
09033244

A
Remove eltrd, transven
13.74
NA
8.92
0.99
NA
23.65
09033245

A
Insert epic eltrd pace-defib
14.28
NA
7.92
2.01
NA
24.21
09033246

A
Insert epic eltrd/generator
20.68
NA
10.31
2.63
NA
33.62
09033249

A
Eltrd/insert pace-defib
14.21
NA
8.38
0.77
NA
23.36
09033250

A
Ablate heart dysrhythm focus
21.82
NA
11.05
3.18
NA
36.05
09033251

A
Ablate heart dysrhythm focus
24.84
NA
11.69
3.59
NA
40.12
09033253

A
Reconstruct atria
31.01
NA
13.86
4.52
NA
49.39
09033261

A
Ablate heart dysrhythm focus
24.84
NA
11.80
3.45
NA
40.09
09033282

A
Implant pat-active ht record
4.16
NA
4.03
0.23
NA
8.42
09033284

A
Remove pat-active ht record
2.50
NA
3.54
0.14
NA
6.18
09033300

A
Repair of heart wound
17.89
NA
9.26
2.65
NA
29.80
09033305

A
Repair of heart wound
21.41
NA
10.64
3.12
NA
35.17
09033310

A
Exploratory heart surgery
18.48
NA
9.61
2.58
NA
30.67
09033315

A
Exploratory heart surgery
22.34
NA
10.91
3.27
NA
36.52
09033320

A
Repair major blood vessel(s)
16.76
NA
8.24
2.07
NA
27.07
09033321

A
Repair major vessel
20.17
NA
9.81
2.90
NA
32.88
09033322

A
Repair major blood vessel(s)
20.59
NA
10.39
2.85
NA
33.83
09033330

A
Insert major vessel graft
21.40
NA
10.29
2.81
NA
34.50
09033332

A
Insert major vessel graft
23.92
NA
10.54
3.02
NA
37.48
09033335

A
Insert major vessel graft
29.96
NA
13.37
4.27
NA
47.60
09033400

A
Repair of aortic valve
28.46
NA
15.71
4.10
NA
48.27
09033401

A
Valvuloplasty, open
23.87
NA
13.54
3.56
NA
40.97
09033403

A
Valvuloplasty, w/cp bypass
24.85
NA
14.34
3.54
NA
42.73
09033404

A
Prepare heart-aorta conduit
28.50
NA
14.58
4.32
NA
47.40
09033405

A
Replacement of aortic valve
34.95
NA
18.34
5.31
NA
58.60
09033406

A
Replacement of aortic valve
37.44
NA
19.18
5.43
NA
62.05
09033410

A
Replacement of aortic valve
32.41
NA
16.63
4.68
NA
53.72
09033411

A
Replacement of aortic valve
36.20
NA
18.79
5.46
NA
60.45
09033412

A
Replacement of aortic valve
41.94
NA
20.46
6.37
NA
68.77
09033413

A
Replacement of aortic valve
43.43
NA
20.87
6.51
NA
70.81
09033414

A
Repair of aortic valve
30.30
NA
14.17
4.56
NA
49.03
09033415

A
Revision, subvalvular tissue
27.11
NA
12.05
4.13
NA
43.29
09033416

A
Revise ventricle muscle
30.30
NA
13.54
4.56
NA
48.40
09033417

A
Repair of aortic valve
28.49
NA
13.65
4.09
NA
46.23
09033420

A
Revision of mitral valve
22.67
NA
9.59
1.81
NA
34.07
09033422

A
Revision of mitral valve
25.90
NA
13.69
3.93
NA
43.52
09033425

A
Repair of mitral valve
26.96
NA
13.09
4.06
NA
44.11
09033426

A
Repair of mitral valve
32.95
NA
17.18
5.01
NA
55.14
09033427

A
Repair of mitral valve
39.94
NA
19.42
6.07
NA
65.43
09033430

A
Replacement of mitral valve
33.45
NA
17.34
5.08
NA
55.87
09033460

A
Revision of tricuspid valve
23.56
NA
11.33
3.44
NA
38.33
09033463

A
Valvuloplasty, tricuspid
25.58
NA
12.95
3.86
NA
42.39
09033464

A
Valvuloplasty, tricuspid
27.29
NA
13.56
4.14
NA
44.99
09033465

A
Replace tricuspid valve
28.75
NA
13.00
4.38
NA
46.13
09033468

A
Revision of tricuspid valve
30.07
NA
13.69
4.06
NA
47.82
09033470

A
Revision of pulmonary valve
20.78
NA
10.72
1.03
NA
32.53
09033471

A
Valvotomy, pulmonary valve
22.22
NA
9.78
3.38
NA
35.38
09033472

A
Revision of pulmonary valve
22.22
NA
11.89
3.54
NA
37.65
09033474

A
Revision of pulmonary valve
23.01
NA
10.91
3.21
NA
37.13
09033475

A
Replacement, pulmonary valve
32.95
NA
15.41
4.92
NA
53.28
09033476

A
Revision of heart chamber
25.73
NA
11.99
2.41
NA
40.13
09033478

A
Revision of heart chamber
26.70
NA
13.09
3.88
NA
43.67
09033496

A
Repair, prosth valve clot
27.21
NA
12.78
4.12
NA
44.11
09033500

A
Repair heart vessel fistula
25.51
NA
11.49
3.86
NA
40.86
09033501

A
Repair heart vessel fistula
17.75
NA
8.30
1.90
NA
27.95
09033502

A
Coronary artery correction
21.01
NA
11.10
2.99
NA
35.10
090( print page 70370)33503

A
Coronary artery graft
21.75
NA
9.76
1.77
NA
33.28
09033504

A
Coronary artery graft
24.62
NA
11.84
3.35
NA
39.81
09033505

A
Repair artery w/tunnel
26.80
NA
12.94
2.18
NA
41.92
09033506

A
Repair artery, translocation
35.45
NA
14.60
4.65
NA
54.70
09033507

A
Repair art, intramural
30.00
NA
13.68
4.05
NA
47.73
09033508

A
Endoscopic vein harvest
0.31
NA
0.10
0.04
NA
0.45
ZZZ33510

A
CABG, vein, single
28.96
NA
16.38
4.40
NA
49.74
09033511

A
CABG, vein, two
29.96
NA
17.12
4.55
NA
51.63
09033512

A
CABG, vein, three
31.75
NA
17.65
4.66
NA
54.06
09033513

A
CABG, vein, four
31.95
NA
17.83
4.87
NA
54.65
09033514

A
CABG, vein, five
32.70
NA
18.10
4.76
NA
55.56
09033516

A
Cabg, vein, six or more
34.95
NA
18.85
5.11
NA
58.91
09033517

A
CABG, artery-vein, single
2.57
NA
0.84
0.39
NA
3.80
ZZZ33518

A
CABG, artery-vein, two
4.84
NA
1.58
0.73
NA
7.15
ZZZ33519

A
CABG, artery-vein, three
7.11
NA
2.33
1.04
NA
10.48
ZZZ33521

A
CABG, artery-vein, four
9.39
NA
3.08
1.37
NA
13.84
ZZZ33522

A
CABG, artery-vein, five
11.65
NA
3.82
1.77
NA
17.24
ZZZ33523

A
Cabg, art-vein, six or more
13.93
NA
4.54
2.12
NA
20.59
ZZZ33530

A
Coronary artery, bypass/reop
5.85
NA
1.92
0.88
NA
8.65
ZZZ33533

A
CABG, arterial, single
29.96
NA
16.51
4.55
NA
51.02
09033534

A
CABG, arterial, two
32.15
NA
17.76
4.69
NA
54.60
09033535

A
CABG, arterial, three
34.45
NA
18.18
5.01
NA
57.64
09033536

A
Cabg, arterial, four or more
37.44
NA
18.34
5.42
NA
61.20
09033542

A
Removal of heart lesion
28.81
NA
13.03
4.37
NA
46.21
09033545

A
Repair of heart damage
36.72
NA
15.67
5.19
NA
57.58
09033548

A
Restore/remodel, ventricle
37.97
NA
19.35
5.51
NA
62.83
09033572

A
Open coronary endarterectomy
4.44
NA
1.45
0.65
NA
6.54
ZZZ33600

A
Closure of valve
29.47
NA
12.55
4.41
NA
46.43
09033602

A
Closure of valve
28.50
NA
12.48
3.81
NA
44.79
09033606

A
Anastomosis/artery-aorta
30.69
NA
13.71
4.40
NA
48.80
09033608

A
Repair anomaly w/conduit
31.04
NA
14.14
4.73
NA
49.91
09033610

A
Repair by enlargement
30.56
NA
13.64
4.55
NA
48.75
09033611

A
Repair double ventricle
33.95
NA
14.17
4.36
NA
52.48
09033612

A
Repair double ventricle
34.95
NA
15.19
5.28
NA
55.42
09033615

A
Repair, modified fontan
33.95
NA
13.18
4.31
NA
51.44
09033617

A
Repair single ventricle
36.94
NA
16.04
5.64
NA
58.62
09033619

A
Repair single ventricle
44.93
NA
20.86
6.44
NA
72.23
09033641

A
Repair heart septum defect
21.36
NA
9.60
3.22
NA
34.18
09033645

A
Revision of heart veins
24.78
NA
11.80
3.78
NA
40.36
09033647

A
Repair heart septum defects
28.69
NA
13.81
3.31
NA
45.81
09033660

A
Repair of heart defects
29.96
NA
13.52
4.48
NA
47.96
09033665

A
Repair of heart defects
28.56
NA
13.87
3.99
NA
46.42
09033670

A
Repair of heart chambers
34.95
NA
13.21
4.64
NA
52.80
09033681

A
Repair heart septum defect
30.56
NA
14.72
4.44
NA
49.72
09033684

A
Repair heart septum defect
29.61
NA
13.66
3.38
NA
46.65
09033688

A
Repair heart septum defect
30.57
NA
10.50
4.72
NA
45.79
09033690

A
Reinforce pulmonary artery
19.52
NA
10.19
1.96
NA
31.67
09033692

A
Repair of heart defects
30.70
NA
13.96
4.57
NA
49.23
09033694

A
Repair of heart defects
33.95
NA
14.26
5.26
NA
53.47
09033697

A
Repair of heart defects
35.95
NA
14.91
4.08
NA
54.94
09033702

A
Repair of heart defects
26.50
NA
12.60
3.67
NA
42.77
09033710

A
Repair of heart defects
29.67
NA
14.00
4.42
NA
48.09
09033720

A
Repair of heart defect
26.52
NA
12.32
3.83
NA
42.67
09033722

A
Repair of heart defect
28.37
NA
13.89
1.30
NA
43.56
09033730

A
Repair heart-vein defect(s)
34.20
NA
14.16
5.01
NA
53.37
09033732

A
Repair heart-vein defect
28.12
NA
13.42
3.67
NA
45.21
09033735

A
Revision of heart chamber
21.36
NA
8.98
1.91
NA
32.25
09033736

A
Revision of heart chamber
23.48
NA
11.88
3.08
NA
38.44
09033737

A
Revision of heart chamber
21.73
NA
10.96
3.24
NA
35.93
09033750

A
Major vessel shunt
21.38
NA
10.24
1.16
NA
32.78
09033755

A
Major vessel shunt
21.76
NA
8.83
3.25
NA
33.84
09033762

A
Major vessel shunt
21.76
NA
10.18
3.13
NA
35.07
09033764

A
Major vessel shunt & graft
21.76
NA
10.25
3.00
NA
35.01
09033766

A
Major vessel shunt
22.73
NA
11.70
3.69
NA
38.12
09033767

A
Major vessel shunt
24.46
NA
11.75
3.81
NA
40.02
09033768

A
Cavopulmonary shunting
8.00
NA
2.67
1.19
NA
11.86
ZZZ33770

A
Repair great vessels defect
36.94
NA
14.72
5.72
NA
57.38
09033771

A
Repair great vessels defect
34.60
NA
12.42
5.66
NA
52.68
09033774

A
Repair great vessels defect
30.93
NA
14.70
4.80
NA
50.43
09033775

A
Repair great vessels defect
32.15
NA
15.03
4.98
NA
52.16
09033776

A
Repair great vessels defect
33.99
NA
15.85
5.07
NA
54.91
09033777

A
Repair great vessels defect
33.41
NA
15.66
5.47
NA
54.54
09033778

A
Repair great vessels defect
39.94
NA
16.94
6.18
NA
63.06
09033779

A
Repair great vessels defect
36.16
NA
15.41
2.91
NA
54.48
09033780

A
Repair great vessels defect
41.69
NA
19.14
3.67
NA
64.50
090( print page 70371)33781

A
Repair great vessels defect
36.40
NA
13.37
5.95
NA
55.72
09033786

A
Repair arterial trunk
38.94
NA
16.76
5.69
NA
61.39
09033788

A
Revision of pulmonary artery
26.58
NA
11.98
4.02
NA
42.58
09033800

A
Aortic suspension
16.22
NA
8.13
2.45
NA
26.80
09033802

A
Repair vessel defect
17.63
NA
9.25
2.26
NA
29.14
09033803

A
Repair vessel defect
19.57
NA
9.79
3.19
NA
32.55
09033813

A
Repair septal defect
20.62
NA
10.94
3.12
NA
34.68
09033814

A
Repair septal defect
25.73
NA
12.68
3.84
NA
42.25
09033820

A
Revise major vessel
16.27
NA
8.38
2.34
NA
26.99
09033822

A
Revise major vessel
17.29
NA
8.98
2.67
NA
28.94
09033824

A
Revise major vessel
19.49
NA
10.01
2.88
NA
32.38
09033840

A
Remove aorta constriction
20.60
NA
10.32
2.15
NA
33.07
09033845

A
Remove aorta constriction
22.09
NA
11.38
3.21
NA
36.68
09033851

A
Remove aorta constriction
21.24
NA
10.71
3.17
NA
35.12
09033852

A
Repair septal defect
23.67
NA
11.39
2.15
NA
37.21
09033853

A
Repair septal defect
31.67
NA
14.86
4.47
NA
51.00
09033860

A
Ascending aortic graft
37.94
NA
16.50
5.74
NA
60.18
09033861

A
Ascending aortic graft
41.94
NA
17.76
6.35
NA
66.05
09033863

A
Ascending aortic graft
44.93
NA
18.74
6.57
NA
70.24
09033870

A
Transverse aortic arch graft
43.93
NA
18.43
6.60
NA
68.96
09033875

A
Thoracic aortic graft
33.01
NA
14.13
4.88
NA
52.02
09033877

A
Thoracoabdominal graft
42.54
NA
16.36
5.92
NA
64.82
09033880

A
Endovasc taa repr incl subcl
33.00
NA
13.51
2.74
NA
49.25
09033881

A
Endovasc taa repr w/o subcl
28.00
NA
11.99
2.32
NA
42.31
09033883

A
Insert endovasc prosth, taa
20.00
NA
9.21
2.10
NA
31.31
09033884

A
Endovasc prosth, taa, add-on
8.20
NA
2.58
0.86
NA
11.64
ZZZ33886

A
Endovasc prosth, delayed
17.00
NA
8.25
1.79
NA
27.04
09033889

A
Artery transpose/endovas taa
15.92
NA
5.19
2.17
NA
23.28
00033891

A
Car-car bp grft/endovas taa
20.00
NA
6.98
2.72
NA
29.70
00033910

A
Remove lung artery emboli
24.55
NA
11.46
3.69
NA
39.70
09033915

A
Remove lung artery emboli
20.99
NA
9.66
1.44
NA
32.09
09033916

A
Surgery of great vessel
25.79
NA
11.37
3.66
NA
40.82
09033917

A
Repair pulmonary artery
24.46
NA
12.22
3.69
NA
40.37
09033920

A
Repair pulmonary atresia
31.90
NA
13.86
4.37
NA
50.13
09033922

A
Transect pulmonary artery
23.48
NA
10.93
3.09
NA
37.50
09033924

A
Remove pulmonary shunt
5.49
NA
1.85
0.82
NA
8.16
ZZZ33925

A
Rpr pul art unifocal w/o cpb
29.50
NA
14.70
4.60
NA
48.80
09033926

A
Repr pul art, unifocal w/cpb
42.00
NA
17.73
6.20
NA
65.93
09033930

X
Removal of donor heart/lung
0.00
0.00
0.00
0.00
0.00
0.00
XXX33933

C
Prepare donor heart/lung
0.00
0.00
0.00
0.00
0.00
0.00
XXX33935

R
Transplantation, heart/lung
60.87
NA
28.85
9.03
NA
98.75
09033940

X
Removal of donor heart
0.00
0.00
0.00
0.00
0.00
0.00
XXX33944

C
Prepare donor heart
0.00
0.00
0.00
0.00
0.00
0.00
XXX33945

R
Transplantation of heart
42.04
NA
21.45
6.24
NA
69.73
09033960

A
External circulation assist
19.33
NA
4.92
2.66
NA
26.91
00033961

A
External circulation assist
10.91
NA
3.62
0.88
NA
15.41
ZZZ33967

A
Insert ia percut device
4.84
NA
1.85
0.35
NA
7.04
00033968

A
Remove aortic assist device
0.64
NA
0.23
0.07
NA
0.94
00033970

A
Aortic circulation assist
6.74
NA
2.29
0.82
NA
9.85
00033971

A
Aortic circulation assist
9.68
NA
6.02
1.25
NA
16.95
09033973

A
Insert balloon device
9.75
NA
3.32
1.26
NA
14.33
00033974

A
Remove intra-aortic balloon
14.39
NA
7.90
1.73
NA
24.02
09033975

A
Implant ventricular device
20.97
NA
6.30
3.06
NA
30.33
XXX33976

A
Implant ventricular device
22.97
NA
7.57
3.25
NA
33.79
XXX33977

A
Remove ventricular device
19.26
NA
11.10
2.80
NA
33.16
09033978

A
Remove ventricular device
21.70
NA
11.78
3.30
NA
36.78
09033979

A
Insert intracorporeal device
45.93
NA
14.96
6.95
NA
67.84
XXX33980

A
Remove intracorporeal device
56.17
NA
25.31
8.56
NA
90.04
09033999

C
Cardiac surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY34001

A
Removal of artery clot
12.89
NA
6.73
1.84
NA
21.46
09034051

A
Removal of artery clot
15.19
NA
7.80
2.20
NA
25.19
09034101

A
Removal of artery clot
9.99
NA
5.37
1.41
NA
16.77
09034111

A
Removal of arm artery clot
9.99
NA
5.37
1.40
NA
16.76
09034151

A
Removal of artery clot
24.96
NA
10.43
3.55
NA
38.94
09034201

A
Removal of artery clot
10.01
NA
5.43
1.45
NA
16.89
09034203

A
Removal of leg artery clot
16.48
NA
8.08
2.35
NA
26.91
09034401

A
Removal of vein clot
24.96
NA
10.69
3.09
NA
38.74
09034421

A
Removal of vein clot
11.98
NA
6.31
1.55
NA
19.84
09034451

A
Removal of vein clot
26.96
NA
11.47
3.83
NA
42.26
09034471

A
Removal of vein clot
10.16
NA
5.32
1.18
NA
16.66
09034490

A
Removal of vein clot
9.85
NA
5.44
1.41
NA
16.70
09034501

A
Repair valve, femoral vein
15.98
NA
8.51
2.34
NA
26.83
09034502

A
Reconstruct vena cava
26.91
NA
12.33
3.62
NA
42.86
09034510

A
Transposition of vein valve
18.92
NA
9.44
2.32
NA
30.68
09034520

A
Cross-over vein graft
17.92
NA
8.47
2.28
NA
28.67
090( print page 70372)34530

A
Leg vein fusion
16.62
NA
8.63
1.73
NA
26.98
09034800

A
Endovas aaa repr w/sm tube
20.72
NA
9.19
2.45
NA
32.36
09034802

A
Endovas aaa repr w/2-p part
22.97
NA
9.81
2.32
NA
35.10
09034803

A
Endovas aaa repr w/3-p part
24.00
NA
10.24
2.00
NA
36.24
09034804

A
Endovas aaa repr w/1-p part
22.97
NA
9.83
2.29
NA
35.09
09034805

A
Endovas aaa repr w/long tube
21.85
NA
9.67
2.00
NA
33.52
09034808

A
Endovas iliac a device addon
4.12
NA
1.37
0.59
NA
6.08
ZZZ34812

A
Xpose for endoprosth, femorl
6.74
NA
2.24
1.18
NA
10.16
00034813

A
Femoral endovas graft add-on
4.79
NA
1.57
0.67
NA
7.03
ZZZ34820

A
Xpose for endoprosth, iliac
9.74
NA
3.24
1.50
NA
14.48
00034825

A
Endovasc extend prosth, init
11.98
NA
6.16
1.28
NA
19.42
09034826

A
Endovasc exten prosth, add'l
4.12
NA
1.37
0.44
NA
5.93
ZZZ34830

A
Open aortic tube prosth repr
32.54
NA
13.73
4.54
NA
50.81
09034831

A
Open aortoiliac prosth repr
35.29
NA
11.76
4.88
NA
51.93
09034832

A
Open aortofemor prosth repr
35.29
NA
14.66
4.84
NA
54.79
09034833

A
Xpose for endoprosth, iliac
11.98
NA
4.44
1.69
NA
18.11
00034834

A
Xpose, endoprosth, brachial
5.34
NA
2.20
0.76
NA
8.30
00034900

A
Endovasc iliac repr w/graft
16.36
NA
7.60
1.99
NA
25.95
09035001

A
Repair defect of artery
19.61
NA
9.58
2.80
NA
31.99
09035002

A
Repair artery rupture, neck
20.97
NA
9.72
2.99
NA
33.68
09035005

A
Repair defect of artery
18.09
NA
8.87
1.76
NA
28.72
09035011

A
Repair defect of artery
17.97
NA
8.00
2.54
NA
28.51
09035013

A
Repair artery rupture, arm
21.97
NA
9.70
3.09
NA
34.76
09035021

A
Repair defect of artery
19.62
NA
9.44
2.86
NA
31.92
09035022

A
Repair artery rupture, chest
23.15
NA
9.88
3.16
NA
36.19
09035045

A
Repair defect of arm artery
17.54
NA
7.52
2.44
NA
27.50
09035081

A
Repair defect of artery
27.97
NA
11.49
4.00
NA
43.46
09035082

A
Repair artery rupture, aorta
38.44
NA
15.33
5.42
NA
59.19
09035091

A
Repair defect of artery
35.35
NA
13.60
5.12
NA
54.07
09035092

A
Repair artery rupture, aorta
44.93
NA
17.68
6.38
NA
68.99
09035102

A
Repair defect of artery
30.71
NA
12.39
4.47
NA
47.57
09035103

A
Repair artery rupture, groin
40.44
NA
15.89
5.74
NA
62.07
09035111

A
Repair defect of artery
24.96
NA
10.49
3.46
NA
38.91
09035112

A
Repair artery rupture,spleen
29.96
NA
11.99
4.07
NA
46.02
09035121

A
Repair defect of artery
29.96
NA
12.40
4.29
NA
46.65
09035122

A
Repair artery rupture, belly
34.95
NA
13.84
4.74
NA
53.53
09035131

A
Repair defect of artery
24.96
NA
10.77
3.79
NA
39.52
09035132

A
Repair artery rupture, groin
29.96
NA
12.41
4.29
NA
46.66
09035141

A
Repair defect of artery
19.97
NA
8.94
2.89
NA
31.80
09035142

A
Repair artery rupture, thigh
23.27
NA
10.39
3.35
NA
37.01
09035151

A
Repair defect of artery
22.61
NA
10.01
3.23
NA
35.85
09035152

A
Repair artery rupture, knee
25.58
NA
11.40
3.60
NA
40.58
09035180

A
Repair blood vessel lesion
13.60
NA
6.96
1.00
NA
21.56
09035182

A
Repair blood vessel lesion
29.96
NA
12.83
4.35
NA
47.14
09035184

A
Repair blood vessel lesion
17.97
NA
8.31
2.52
NA
28.80
09035188

A
Repair blood vessel lesion
14.26
NA
7.65
2.15
NA
24.06
09035189

A
Repair blood vessel lesion
27.96
NA
11.98
4.00
NA
43.94
09035190

A
Repair blood vessel lesion
12.73
NA
6.49
1.79
NA
21.01
09035201

A
Repair blood vessel lesion
16.12
NA
8.01
2.33
NA
26.46
09035206

A
Repair blood vessel lesion
13.23
NA
6.57
1.86
NA
21.66
09035207

A
Repair blood vessel lesion
10.13
NA
7.37
1.48
NA
18.98
09035211

A
Repair blood vessel lesion
22.09
NA
10.64
3.19
NA
35.92
09035216

A
Repair blood vessel lesion
18.72
NA
9.00
2.64
NA
30.36
09035221

A
Repair blood vessel lesion
24.35
NA
9.96
3.36
NA
37.67
09035226

A
Repair blood vessel lesion
14.48
NA
7.45
2.01
NA
23.94
09035231

A
Repair blood vessel lesion
19.97
NA
9.79
2.88
NA
32.64
09035236

A
Repair blood vessel lesion
17.08
NA
7.90
2.42
NA
27.40
09035241

A
Repair blood vessel lesion
23.09
NA
11.15
3.52
NA
37.76
09035246

A
Repair blood vessel lesion
26.41
NA
11.45
3.85
NA
41.71
09035251

A
Repair blood vessel lesion
30.15
NA
11.82
4.12
NA
46.09
09035256

A
Repair blood vessel lesion
18.33
NA
8.37
2.62
NA
29.32
09035261

A
Repair blood vessel lesion
17.77
NA
8.03
2.60
NA
28.40
09035266

A
Repair blood vessel lesion
14.89
NA
7.02
2.09
NA
24.00
09035271

A
Repair blood vessel lesion
22.09
NA
10.54
3.15
NA
35.78
09035276

A
Repair blood vessel lesion
24.21
NA
11.23
3.48
NA
38.92
09035281

A
Repair blood vessel lesion
27.96
NA
11.73
3.96
NA
43.65
09035286

A
Repair blood vessel lesion
16.14
NA
8.07
2.34
NA
26.55
09035301

A
Rechanneling of artery
18.67
NA
8.45
2.67
NA
29.79
09035311

A
Rechanneling of artery
26.96
NA
11.77
3.41
NA
42.14
09035321

A
Rechanneling of artery
15.98
NA
7.40
2.24
NA
25.62
09035331

A
Rechanneling of artery
26.16
NA
11.26
3.82
NA
41.24
09035341

A
Rechanneling of artery
25.07
NA
10.89
3.77
NA
39.73
09035351

A
Rechanneling of artery
22.97
NA
9.62
3.34
NA
35.93
09035355

A
Rechanneling of artery
18.47
NA
8.10
2.66
NA
29.23
09035361

A
Rechanneling of artery
28.16
NA
11.73
4.14
NA
44.03
090( print page 70373)35363

A
Rechanneling of artery
30.15
NA
12.62
4.32
NA
47.09
09035371

A
Rechanneling of artery
14.70
NA
6.97
2.13
NA
23.80
09035372

A
Rechanneling of artery
17.97
NA
8.06
2.62
NA
28.65
09035381

A
Rechanneling of artery
15.79
NA
7.83
2.25
NA
25.87
09035390

A
Reoperation, carotid add-on
3.19
NA
1.06
0.46
NA
4.71
ZZZ35400

A
Angioscopy
3.00
NA
1.11
0.43
NA
4.54
ZZZ35450

A
Repair arterial blockage
10.05
NA
3.57
1.25
NA
14.87
00035452

A
Repair arterial blockage
6.90
NA
2.61
0.94
NA
10.45
00035454

A
Repair arterial blockage
6.03
NA
2.32
0.87
NA
9.22
00035456

A
Repair arterial blockage
7.34
NA
2.77
1.04
NA
11.15
00035458

A
Repair arterial blockage
9.48
NA
3.48
1.26
NA
14.22
00035459

A
Repair arterial blockage
8.62
NA
3.18
1.21
NA
13.01
00035460

A
Repair venous blockage
6.03
NA
2.28
0.83
NA
9.14
00035470

A
Repair arterial blockage
8.62
89.12
3.36
0.69
98.43
12.67
00035471

A
Repair arterial blockage
10.05
100.55
3.96
0.67
111.27
14.68
00035472

A
Repair arterial blockage
6.90
64.54
2.75
0.58
72.02
10.23
00035473

A
Repair arterial blockage
6.03
60.01
2.43
0.51
66.55
8.97
00035474

A
Repair arterial blockage
7.35
87.98
2.90
0.57
95.90
10.82
00035475

R
Repair arterial blockage
9.48
56.26
3.57
0.62
66.36
13.67
00035476

A
Repair venous blockage
6.03
44.86
2.36
0.34
51.23
8.73
00035480

A
Atherectomy, open
11.06
NA
4.05
1.28
NA
16.39
00035481

A
Atherectomy, open
7.60
NA
2.88
1.13
NA
11.61
00035482

A
Atherectomy, open
6.64
NA
2.57
0.89
NA
10.10
00035483

A
Atherectomy, open
8.09
NA
3.03
1.15
NA
12.27
00035484

A
Atherectomy, open
10.42
NA
3.78
1.27
NA
15.47
00035485

A
Atherectomy, open
9.48
NA
3.54
1.35
NA
14.37
00035490

A
Atherectomy, percutaneous
11.06
NA
4.71
0.71
NA
16.48
00035491

A
Atherectomy, percutaneous
7.60
NA
3.30
0.74
NA
11.64
00035492

A
Atherectomy, percutaneous
6.64
NA
3.20
0.43
NA
10.27
00035493

A
Atherectomy, percutaneous
8.09
NA
3.81
0.56
NA
12.46
00035494

A
Atherectomy, percutaneous
10.42
NA
4.47
0.59
NA
15.48
00035495

A
Atherectomy, percutaneous
9.48
NA
4.40
0.69
NA
14.57
00035500

A
Harvest vein for bypass
6.44
NA
2.03
0.93
NA
9.40
ZZZ35501

A
Artery bypass graft
19.16
NA
8.48
2.80
NA
30.44
09035506

A
Artery bypass graft
19.64
NA
9.49
2.86
NA
31.99
09035507

A
Artery bypass graft
19.64
NA
9.45
2.84
NA
31.93
09035508

A
Artery bypass graft
18.62
NA
9.47
2.77
NA
30.86
09035509

A
Artery bypass graft
18.04
NA
8.79
2.61
NA
29.44
09035510

A
Artery bypass graft
22.97
NA
10.20
2.11
NA
35.28
09035511

A
Artery bypass graft
21.17
NA
9.38
2.90
NA
33.45
09035512

A
Artery bypass graft
22.47
NA
10.03
2.11
NA
34.61
09035515

A
Artery bypass graft
18.62
NA
9.31
2.77
NA
30.70
09035516

A
Artery bypass graft
16.30
NA
6.82
2.33
NA
25.45
09035518

A
Artery bypass graft
21.17
NA
9.00
3.02
NA
33.19
09035521

A
Artery bypass graft
22.17
NA
9.86
3.12
NA
35.15
09035522

A
Artery bypass graft
21.73
NA
9.78
2.11
NA
33.62
09035525

A
Artery bypass graft
20.60
NA
9.40
2.11
NA
32.11
09035526

A
Artery bypass graft
29.91
NA
12.54
3.62
NA
46.07
09035531

A
Artery bypass graft
36.15
NA
14.51
5.16
NA
55.82
09035533

A
Artery bypass graft
27.96
NA
11.75
3.84
NA
43.55
09035536

A
Artery bypass graft
31.65
NA
12.98
4.61
NA
49.24
09035541

A
Artery bypass graft
25.76
NA
11.23
3.70
NA
40.69
09035546

A
Artery bypass graft
25.50
NA
10.89
3.69
NA
40.08
09035548

A
Artery bypass graft
21.54
NA
9.45
2.97
NA
33.96
09035549

A
Artery bypass graft
23.31
NA
10.40
3.29
NA
37.00
09035551

A
Artery bypass graft
26.63
NA
11.52
3.74
NA
41.89
09035556

A
Artery bypass graft
21.73
NA
9.75
3.09
NA
34.57
09035558

A
Artery bypass graft
21.17
NA
9.57
2.99
NA
33.73
09035560

A
Artery bypass graft
31.95
NA
13.35
4.74
NA
50.04
09035563

A
Artery bypass graft
24.16
NA
10.55
3.51
NA
38.22
09035565

A
Artery bypass graft
23.17
NA
10.16
3.29
NA
36.62
09035566

A
Artery bypass graft
26.88
NA
11.41
3.82
NA
42.11
09035571

A
Artery bypass graft
24.02
NA
10.87
3.42
NA
38.31
09035572

A
Harvest femoropopliteal vein
6.81
NA
2.25
0.99
NA
10.05
ZZZ35583

A
Vein bypass graft
22.34
NA
10.18
3.16
NA
35.68
09035585

A
Vein bypass graft
28.35
NA
12.25
4.01
NA
44.61
09035587

A
Vein bypass graft
24.71
NA
11.48
3.51
NA
39.70
09035600

A
Harvest artery for cabg
4.94
NA
1.62
0.73
NA
7.29
ZZZ35601

A
Artery bypass graft
17.47
NA
8.64
2.49
NA
28.60
09035606

A
Artery bypass graft
18.68
NA
9.04
2.69
NA
30.41
09035612

A
Artery bypass graft
15.74
NA
7.90
2.08
NA
25.72
09035616

A
Artery bypass graft
15.68
NA
8.12
2.19
NA
25.99
09035621

A
Artery bypass graft
19.97
NA
8.70
2.91
NA
31.58
09035623

A
Bypass graft, not vein
23.96
NA
10.52
3.45
NA
37.93
09035626

A
Artery bypass graft
27.71
NA
12.00
4.07
NA
43.78
090( print page 70374)35631

A
Artery bypass graft
33.95
NA
13.87
4.95
NA
52.77
09035636

A
Artery bypass graft
29.46
NA
12.33
4.09
NA
45.88
09035641

A
Artery bypass graft
24.53
NA
11.09
3.53
NA
39.15
09035642

A
Artery bypass graft
17.95
NA
8.71
2.27
NA
28.93
09035645

A
Artery bypass graft
17.44
NA
8.29
2.49
NA
28.22
09035646

A
Artery bypass graft
30.95
NA
13.14
4.43
NA
48.52
09035647

A
Artery bypass graft
27.96
NA
11.80
3.98
NA
43.74
09035650

A
Artery bypass graft
18.97
NA
8.38
2.71
NA
30.06
09035651

A
Artery bypass graft
25.00
NA
10.75
3.35
NA
39.10
09035654

A
Artery bypass graft
24.96
NA
10.68
3.52
NA
39.16
09035656

A
Artery bypass graft
19.50
NA
8.62
2.79
NA
30.91
09035661

A
Artery bypass graft
18.97
NA
8.95
2.71
NA
30.63
09035663

A
Artery bypass graft
21.97
NA
10.00
3.10
NA
35.07
09035665

A
Artery bypass graft
20.97
NA
9.47
3.00
NA
33.44
09035666

A
Artery bypass graft
22.16
NA
10.67
3.15
NA
35.98
09035671

A
Artery bypass graft
19.30
NA
9.39
2.77
NA
31.46
09035681

A
Composite bypass graft
1.60
NA
0.53
0.23
NA
2.36
ZZZ35682

A
Composite bypass graft
7.19
NA
2.39
1.03
NA
10.61
ZZZ35683

A
Composite bypass graft
8.49
NA
2.83
1.20
NA
12.52
ZZZ35685

A
Bypass graft patency/patch
4.04
NA
1.35
0.58
NA
5.97
ZZZ35686

A
Bypass graft/av fist patency
3.34
NA
1.13
0.47
NA
4.94
ZZZ35691

A
Arterial transposition
18.02
NA
8.42
2.58
NA
29.02
09035693

A
Arterial transposition
15.34
NA
7.74
2.21
NA
25.29
09035694

A
Arterial transposition
19.13
NA
8.62
2.69
NA
30.44
09035695

A
Arterial transposition
19.13
NA
8.57
2.73
NA
30.43
09035697

A
Reimplant artery each
3.00
NA
1.02
0.41
NA
4.43
ZZZ35700

A
Reoperation, bypass graft
3.08
NA
1.02
0.44
NA
4.54
ZZZ35701

A
Exploration, carotid artery
8.49
NA
5.16
1.12
NA
14.77
09035721

A
Exploration, femoral artery
7.17
NA
4.44
1.03
NA
12.64
09035741

A
Exploration popliteal artery
7.99
NA
4.67
1.12
NA
13.78
09035761

A
Exploration of artery/vein
5.36
NA
4.02
0.75
NA
10.13
09035800

A
Explore neck vessels
7.01
NA
4.66
0.95
NA
12.62
09035820

A
Explore chest vessels
12.86
NA
7.22
1.94
NA
22.02
09035840

A
Explore abdominal vessels
9.76
NA
5.30
1.34
NA
16.40
09035860

A
Explore limb vessels
5.54
NA
4.04
0.78
NA
10.36
09035870

A
Repair vessel graft defect
22.14
NA
9.79
3.00
NA
34.93
09035875

A
Removal of clot in graft
10.11
NA
5.20
1.41
NA
16.72
09035876

A
Removal of clot in graft
16.97
NA
7.53
2.39
NA
26.89
09035879

A
Revise graft w/vein
15.98
NA
7.71
2.27
NA
25.96
09035881

A
Revise graft w/vein
17.97
NA
8.69
2.55
NA
29.21
09035901

A
Excision, graft, neck
8.18
NA
5.32
1.15
NA
14.65
09035903

A
Excision, graft, extremity
9.38
NA
6.17
1.30
NA
16.85
09035905

A
Excision, graft, thorax
31.20
NA
13.22
4.43
NA
48.85
09035907

A
Excision, graft, abdomen
34.95
NA
14.20
4.91
NA
54.06
09036000

A
Place needle in vein
0.18
0.57
0.05
0.01
0.76
0.24
XXX36002

A
Pseudoaneurysm injection trt
1.96
2.87
0.97
0.17
5.00
3.10
00036005

A
Injection ext venography
0.95
7.67
0.31
0.05
8.67
1.31
00036010

A
Place catheter in vein
2.43
19.36
0.79
0.20
21.99
3.42
XXX36011

A
Place catheter in vein
3.14
27.90
1.06
0.27
31.31
4.47
XXX36012

A
Place catheter in vein
3.51
19.00
1.19
0.23
22.74
4.93
XXX36013

A
Place catheter in artery
2.52
21.42
0.69
0.25
24.19
3.46
XXX36014

A
Place catheter in artery
3.02
20.18
1.03
0.19
23.39
4.24
XXX36015

A
Place catheter in artery
3.51
23.73
1.19
0.21
27.45
4.91
XXX36100

A
Establish access to artery
3.02
12.11
1.11
0.26
15.39
4.39
XXX36120

A
Establish access to artery
2.01
10.73
0.65
0.14
12.88
2.80
XXX36140

A
Establish access to artery
2.01
12.81
0.64
0.16
14.98
2.81
XXX36145

A
Artery to vein shunt
2.01
12.59
0.66
0.11
14.71
2.78
XXX36160

A
Establish access to aorta
2.52
13.52
0.84
0.26
16.30
3.62
XXX36200

A
Place catheter in aorta
3.02
16.56
1.01
0.24
19.82
4.27
XXX36215

A
Place catheter in artery
4.67
27.11
1.61
0.27
32.05
6.55
XXX36216

A
Place catheter in artery
5.27
29.16
1.80
0.31
34.74
7.38
XXX36217

A
Place catheter in artery
6.29
55.60
2.18
0.44
62.33
8.91
XXX36218

A
Place catheter in artery
1.01
5.10
0.34
0.07
6.18
1.42
ZZZ36245

A
Place catheter in artery
4.67
32.18
1.68
0.31
37.16
6.66
XXX36246

A
Place catheter in artery
5.27
30.05
1.83
0.38
35.70
7.48
XXX36247

A
Place catheter in artery
6.29
49.65
2.15
0.47
56.41
8.91
XXX36248

A
Place catheter in artery
1.01
4.05
0.34
0.07
5.13
1.42
ZZZ36260

A
Insertion of infusion pump
9.70
NA
4.89
1.29
NA
15.88
09036261

A
Revision of infusion pump
5.44
NA
3.67
0.70
NA
9.81
09036262

A
Removal of infusion pump
4.01
NA
2.76
0.54
NA
7.31
09036299

C
Vessel injection procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY36400

A
Bl draw < 3 yrs fem/jugular
0.38
0.28
0.09
0.03
0.69
0.50
XXX36405

A
Bl draw < 3 yrs scalp vein
0.31
0.26
0.08
0.03
0.60
0.42
XXX36406

A
Bl draw < 3 yrs other vein
0.18
0.28
0.05
0.01
0.47
0.24
XXX36410

A
Non-routine bl draw > 3 yrs
0.18
0.29
0.05
0.01
0.48
0.24
XXX( print page 70375)36415

X
Routine venipuncture
0.00
0.00
0.00
0.00
0.00
0.00
XXX36416

B
Capillary blood draw
0.00
0.00
0.00
0.00
0.00
0.00
XXX36420

A
Vein access cutdown < 1 yr
1.01
0.34
0.27
0.07
1.42
1.35
XXX36425

A
Vein access cutdown > 1 yr
0.76
NA
0.22
0.06
NA
1.04
XXX36430

A
Blood transfusion service
0.00
1.01
NA
0.06
1.07
NA
XXX36440

A
Bl push transfuse, 2 yr or <
1.03
NA
0.29
0.10
NA
1.42
XXX36450

A
Bl exchange/transfuse, nb
2.23
NA
0.71
0.21
NA
3.15
XXX36455

A
Bl exchange/transfuse non-nb
2.43
NA
1.01
0.15
NA
3.59
XXX36460

A
Transfusion service, fetal
6.58
NA
2.25
0.79
NA
9.62
XXX36468

R
Injection(s), spider veins
0.00
0.00
0.00
0.00
0.00
0.00
00036469

R
Injection(s), spider veins
0.00
0.00
0.00
0.00
0.00
0.00
00036470

A
Injection therapy of vein
1.09
2.69
0.73
0.12
3.90
1.94
01036471

A
Injection therapy of veins
1.57
3.08
0.96
0.19
4.84
2.72
01036475

A
Endovenous rf, 1st vein
6.72
51.54
2.54
0.37
58.63
9.63
00036476

A
Endovenous rf, vein add-on
3.38
7.90
1.14
0.18
11.46
4.70
ZZZ36478

A
Endovenous laser, 1st vein
6.72
46.91
2.54
0.37
54.00
9.63
00036479

A
Endovenous laser vein addon
3.38
8.01
1.14
0.18
11.57
4.70
ZZZ36481

A
Insertion of catheter, vein
6.98
5.75
2.60
0.55
13.28
10.13
00036500

A
Insertion of catheter, vein
3.51
NA
1.37
0.20
NA
5.08
00036510

A
Insertion of catheter, vein
1.09
3.90
0.61
0.10
5.09
1.80
00036511

A
Apheresis wbc
1.74
NA
0.73
0.08
NA
2.55
00036512

A
Apheresis rbc
1.74
NA
0.74
0.08
NA
2.56
00036513

A
Apheresis platelets
1.74
NA
0.73
0.17
NA
2.64
00036514

A
Apheresis plasma
1.74
17.02
0.71
0.08
18.84
2.53
00036515

A
Apheresis, adsorp/reinfuse
1.74
66.49
0.66
0.08
68.31
2.48
00036516

A
Apheresis, selective
1.22
84.29
0.48
0.08
85.59
1.78
00036522

A
Photopheresis
1.67
32.46
0.96
0.13
34.26
2.76
00036540

B
Collect blood venous device
0.00
0.00
0.00
0.00
0.00
0.00
XXX36550

A
Declot vascular device
0.00
0.39
NA
0.37
0.76
NA
XXX36555

A
Insert non-tunnel cv cath
2.68
5.77
0.80
0.11
8.56
3.59
00036556

A
Insert non-tunnel cv cath
2.50
5.64
0.74
0.19
8.33
3.43
00036557

A
Insert tunneled cv cath
5.09
21.20
2.66
0.57
26.86
8.32
01036558

A
Insert tunneled cv cath
4.79
21.10
2.56
0.57
26.46
7.92
01036560

A
Insert tunneled cv cath
6.24
29.76
3.04
0.57
36.57
9.85
01036561

A
Insert tunneled cv cath
5.99
29.67
2.96
0.57
36.23
9.52
01036563

A
Insert tunneled cv cath
6.19
26.82
2.99
0.84
33.85
10.02
01036565

A
Insert tunneled cv cath
5.99
24.77
2.96
0.57
31.33
9.52
01036566

A
Insert tunneled cv cath
6.49
25.57
3.12
0.57
32.63
10.18
01036568

A
Insert picc cath
1.92
7.55
0.58
0.11
9.58
2.61
00036569

A
Insert picc cath
1.82
7.36
0.57
0.19
9.37
2.58
00036570

A
Insert picvad cath
5.31
33.27
2.73
0.57
39.15
8.61
01036571

A
Insert picvad cath
5.29
33.34
2.72
0.57
39.20
8.58
01036575

A
Repair tunneled cv cath
0.67
4.06
0.26
0.20
4.93
1.13
00036576

A
Repair tunneled cv cath
3.19
6.96
1.85
0.19
10.34
5.23
01036578

A
Replace tunneled cv cath
3.49
11.16
2.31
0.19
14.84
5.99
01036580

A
Replace cvad cath
1.31
6.96
0.41
0.19
8.46
1.91
00036581

A
Replace tunneled cv cath
3.43
19.55
1.93
0.19
23.17
5.55
01036582

A
Replace tunneled cv cath
5.19
26.09
2.87
0.19
31.47
8.25
01036583

A
Replace tunneled cv cath
5.24
26.11
2.89
0.19
31.54
8.32
01036584

A
Replace picc cath
1.20
6.99
0.55
0.19
8.38
1.94
00036585

A
Replace picvad cath
4.79
27.90
2.74
0.19
32.88
7.72
01036589

A
Removal tunneled cv cath
2.27
2.25
1.39
0.24
4.76
3.90
01036590

A
Removal tunneled cv cath
3.30
3.38
1.72
0.44
7.12
5.46
01036595

A
Mech remov tunneled cv cath
3.59
17.30
1.45
0.21
21.10
5.25
00036596

A
Mech remov tunneled cv cath
0.75
3.70
0.50
0.05
4.50
1.30
00036597

A
Reposition venous catheter
1.21
2.41
0.44
0.07
3.69
1.72
00036598

T
Inj w/fluor, eval cv device
0.74
2.65
2.65
0.05
3.44
3.44
00036600

A
Withdrawal of arterial blood
0.32
0.49
0.09
0.02
0.83
0.43
XXX36620

A
Insertion catheter, artery
1.15
NA
0.23
0.07
NA
1.45
00036625

A
Insertion catheter, artery
2.11
NA
0.53
0.26
NA
2.90
00036640

A
Insertion catheter, artery
2.10
NA
1.04
0.21
NA
3.35
00036660

A
Insertion catheter, artery
1.40
NA
0.44
0.14
NA
1.98
00036680

A
Insert needle, bone cavity
1.20
NA
0.49
0.11
NA
1.80
00036800

A
Insertion of cannula
2.43
NA
1.81
0.25
NA
4.49
00036810

A
Insertion of cannula
3.96
NA
1.68
0.45
NA
6.09
00036815

A
Insertion of cannula
2.62
NA
1.17
0.35
NA
4.14
00036818

A
Av fuse, uppr arm, cephalic
11.52
NA
6.05
1.89
NA
19.46
09036819

A
Av fuse, uppr arm, basilic
13.98
NA
6.39
1.95
NA
22.32
09036820

A
Av fusion/forearm vein
13.98
NA
6.40
1.94
NA
22.32
09036821

A
Av fusion direct any site
8.92
NA
4.66
1.23
NA
14.81
09036822

A
Insertion of cannula(s)
5.41
NA
4.39
0.79
NA
10.59
09036823

A
Insertion of cannula(s)
20.97
NA
9.40
2.88
NA
33.25
09036825

A
Artery-vein autograft
9.83
NA
5.06
1.35
NA
16.24
09036830

A
Artery-vein nonautograft
11.98
NA
5.25
1.66
NA
18.89
09036831

A
Open thrombect av fistula
7.99
NA
3.95
1.09
NA
13.03
090( print page 70376)36832

A
Av fistula revision, open
10.48
NA
4.73
1.44
NA
16.65
09036833

A
Av fistula revision
11.93
NA
5.22
1.65
NA
18.80
09036834

A
Repair A-V aneurysm
9.92
NA
4.80
1.37
NA
16.09
09036835

A
Artery to vein shunt
7.14
NA
4.33
0.98
NA
12.45
09036838

A
Dist revas ligation, hemo
20.60
NA
9.41
3.01
NA
33.02
09036860

A
External cannula declotting
2.01
1.78
0.68
0.11
3.90
2.80
00036861

A
Cannula declotting
2.52
NA
1.49
0.27
NA
4.28
00036870

A
Percut thrombect av fistula
5.15
53.18
3.16
0.29
58.62
8.60
09037140

A
Revision of circulation
23.56
NA
10.51
2.01
NA
36.08
09037145

A
Revision of circulation
24.57
NA
10.89
3.25
NA
38.71
09037160

A
Revision of circulation
21.57
NA
9.28
2.81
NA
33.66
09037180

A
Revision of circulation
24.57
NA
10.32
3.34
NA
38.23
09037181

A
Splice spleen/kidney veins
26.64
NA
11.03
3.40
NA
41.07
09037182

A
Insert hepatic shunt (tips)
16.97
NA
6.08
1.00
NA
24.05
00037183

A
Remove hepatic shunt (tips)
7.99
NA
3.02
0.47
NA
11.48
00037184

A
Prim art mech thrombectomy
8.66
71.90
3.36
0.55
81.11
12.57
00037185

A
Prim art m-thrombect add-on
3.28
22.95
1.11
0.21
26.44
4.60
ZZZ37186

A
Sec art m-thrombect add-on
4.92
49.53
1.66
0.32
54.77
6.90
ZZZ37187

A
Venous mech thrombectomy
8.03
70.38
3.15
0.51
78.92
11.69
00037188

A
Venous m-thrombectomy add-on
5.71
62.15
2.37
0.37
68.23
8.45
00037195

C
Thrombolytic therapy, stroke
0.00
0.00
0.00
0.00
0.00
0.00
XXX37200

A
Transcatheter biopsy
4.55
NA
1.50
0.27
NA
6.32
00037201

A
Transcatheter therapy infuse
4.99
NA
2.55
0.33
NA
7.87
00037202

A
Transcatheter therapy infuse
5.67
NA
3.04
0.43
NA
9.14
00037203

A
Transcatheter retrieval
5.02
32.97
2.04
0.29
38.28
7.35
00037204

A
Transcatheter occlusion
18.11
NA
5.92
1.48
NA
25.51
00037205

A
Transcath iv stent, percut
8.27
NA
3.76
0.60
NA
12.63
00037206

A
Transcath iv stent/perc addl
4.12
NA
1.43
0.31
NA
5.86
ZZZ37207

A
Transcath iv stent, open
8.27
NA
3.17
1.17
NA
12.61
00037208

A
Transcath iv stent/open addl
4.12
NA
1.38
0.59
NA
6.09
ZZZ37209

A
Change iv cath at thromb tx
2.27
NA
0.74
0.15
NA
3.16
00037215

R
Transcath stent, cca w/eps
18.71
NA
9.12
1.09
NA
28.92
09037216

R
Transcath stent, cca w/o eps
17.98
NA
8.84
1.04
NA
27.86
09037250

A
Iv us first vessel add-on
2.10
NA
0.75
0.21
NA
3.06
ZZZ37251

A
Iv us each add vessel add-on
1.60
NA
0.55
0.19
NA
2.34
ZZZ37500

A
Endoscopy ligate perf veins
10.98
NA
6.87
1.54
NA
19.39
09037501

C
Vascular endoscopy procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY37565

A
Ligation of neck vein
10.86
NA
5.64
1.33
NA
17.83
09037600

A
Ligation of neck artery
11.23
NA
6.65
1.41
NA
19.29
09037605

A
Ligation of neck artery
13.09
NA
6.92
1.98
NA
21.99
09037606

A
Ligation of neck artery
6.27
NA
4.57
1.23
NA
12.07
09037607

A
Ligation of a-v fistula
6.15
NA
3.57
0.85
NA
10.57
09037609

A
Temporal artery procedure
3.00
4.51
1.97
0.36
7.87
5.33
01037615

A
Ligation of neck artery
5.72
NA
4.12
0.68
NA
10.52
09037616

A
Ligation of chest artery
16.47
NA
8.10
2.32
NA
26.89
09037617

A
Ligation of abdomen artery
22.03
NA
9.20
2.97
NA
34.20
09037618

A
Ligation of extremity artery
4.83
NA
3.62
0.67
NA
9.12
09037620

A
Revision of major vein
10.54
NA
5.73
0.91
NA
17.18
09037650

A
Revision of major vein
7.79
NA
4.69
1.01
NA
13.49
09037660

A
Revision of major vein
20.97
NA
9.08
2.48
NA
32.53
09037700

A
Revise leg vein
3.72
NA
2.80
0.53
NA
7.05
09037718

A
Ligate/strip short leg vein
6.76
NA
4.07
0.14
NA
10.97
09037722

A
Ligate/strip long leg vein
7.79
NA
4.42
0.86
NA
13.07
09037735

A
Removal of leg veins/lesion
10.51
NA
5.52
1.48
NA
17.51
09037760

A
Ligation, leg veins, open
10.45
NA
5.36
1.44
NA
17.25
09037765

A
Phleb veins - extrem - to 20
7.34
NA
4.63
0.48
NA
12.45
09037766

A
Phleb veins - extrem 20+
9.29
NA
5.34
0.48
NA
15.11
09037780

A
Revision of leg vein
3.83
NA
2.86
0.53
NA
7.22
09037785

A
Ligate/divide/excise vein
3.83
5.21
2.73
0.54
9.58
7.10
09037788

A
Revascularization, penis
21.98
NA
9.11
2.25
NA
33.34
09037790

A
Penile venous occlusion
8.33
NA
4.38
0.59
NA
13.30
09037799

C
Vascular surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY38100

A
Removal of spleen, total
14.48
NA
6.19
1.91
NA
22.58
09038101

A
Removal of spleen, partial
15.29
NA
6.54
2.04
NA
23.87
09038102

A
Removal of spleen, total
4.79
NA
1.64
0.63
NA
7.06
ZZZ38115

A
Repair of ruptured spleen
15.80
NA
6.66
2.08
NA
24.54
09038120

A
Laparoscopy, splenectomy
16.97
NA
7.40
2.24
NA
26.61
09038129

C
Laparoscope proc, spleen
0.00
0.00
0.00
0.00
0.00
0.00
YYY38200

A
Injection for spleen x-ray
2.64
NA
0.89
0.14
NA
3.67
00038204

B
Bl donor search management
0.00
0.00
0.00
0.00
0.00
0.00
XXX38205

R
Harvest allogenic stem cells
1.50
NA
0.67
0.07
NA
2.24
00038206

R
Harvest auto stem cells
1.50
NA
0.67
0.07
NA
2.24
00038207

I
Cryopreserve stem cells
0.00
0.00
0.00
0.00
0.00
0.00
XXX38208

I
Thaw preserved stem cells
0.00
0.00
0.00
0.00
0.00
0.00
XXX38209

I
Wash harvest stem cells
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70377)38210

I
T-cell depletion of harvest
0.00
0.00
0.00
0.00
0.00
0.00
XXX38211

I
Tumor cell deplete of harvst
0.00
0.00
0.00
0.00
0.00
0.00
XXX38212

I
Rbc depletion of harvest
0.00
0.00
0.00
0.00
0.00
0.00
XXX38213

I
Platelet deplete of harvest
0.00
0.00
0.00
0.00
0.00
0.00
XXX38214

I
Volume deplete of harvest
0.00
0.00
0.00
0.00
0.00
0.00
XXX38215

I
Harvest stem cell concentrte
0.00
0.00
0.00
0.00
0.00
0.00
XXX38220

A
Bone marrow aspiration
1.08
3.73
0.52
0.05
4.86
1.65
XXX38221

A
Bone marrow biopsy
1.37
3.94
0.65
0.07
5.38
2.09
XXX38230

R
Bone marrow collection
4.53
NA
3.23
0.48
NA
8.24
01038240

R
Bone marrow/stem transplant
2.24
NA
1.03
0.11
NA
3.38
XXX38241

R
Bone marrow/stem transplant
2.24
NA
1.04
0.11
NA
3.39
XXX38242

A
Lymphocyte infuse transplant
1.71
NA
0.78
0.08
NA
2.57
00038300

A
Drainage, lymph node lesion
1.99
4.31
2.06
0.25
6.55
4.30
01038305

A
Drainage, lymph node lesion
5.99
NA
4.45
0.88
NA
11.32
09038308

A
Incision of lymph channels
6.44
NA
3.75
0.85
NA
11.04
09038380

A
Thoracic duct procedure
7.45
NA
5.70
0.74
NA
13.89
09038381

A
Thoracic duct procedure
12.86
NA
6.90
1.84
NA
21.60
09038382

A
Thoracic duct procedure
10.06
NA
5.77
1.37
NA
17.20
09038500

A
Biopsy/removal, lymph nodes
3.74
3.70
2.09
0.49
7.93
6.32
01038505

A
Needle biopsy, lymph nodes
1.14
2.06
0.78
0.09
3.29
2.01
00038510

A
Biopsy/removal, lymph nodes
6.42
5.56
3.49
0.72
12.70
10.63
01038520

A
Biopsy/removal, lymph nodes
6.66
NA
4.06
0.84
NA
11.56
09038525

A
Biopsy/removal, lymph nodes
6.06
NA
3.30
0.80
NA
10.16
09038530

A
Biopsy/removal, lymph nodes
7.97
NA
4.40
1.12
NA
13.49
09038542

A
Explore deep node(s), neck
5.90
NA
4.49
0.60
NA
10.99
09038550

A
Removal, neck/armpit lesion
6.91
NA
3.92
0.88
NA
11.71
09038555

A
Removal, neck/armpit lesion
14.12
NA
8.55
1.75
NA
24.42
09038562

A
Removal, pelvic lymph nodes
10.47
NA
5.79
1.20
NA
17.46
09038564

A
Removal, abdomen lymph nodes
10.81
NA
5.26
1.32
NA
17.39
09038570

A
Laparoscopy, lymph node biop
9.24
NA
3.98
1.13
NA
14.35
01038571

A
Laparoscopy, lymphadenectomy
14.66
NA
5.66
1.15
NA
21.47
01038572

A
Laparoscopy, lymphadenectomy
16.57
NA
7.09
1.90
NA
25.56
01038589

C
Laparoscope proc, lymphatic
0.00
0.00
0.00
0.00
0.00
0.00
YYY38700

A
Removal of lymph nodes, neck
8.23
NA
6.25
0.72
NA
15.20
09038720

A
Removal of lymph nodes, neck
13.59
NA
9.38
1.20
NA
24.17
09038724

A
Removal of lymph nodes, neck
14.52
NA
9.86
1.28
NA
25.66
09038740

A
Remove armpit lymph nodes
10.01
NA
4.95
1.32
NA
16.28
09038745

A
Remove armpit lymph nodes
13.08
NA
6.09
1.73
NA
20.90
09038746

A
Remove thoracic lymph nodes
4.88
NA
1.61
0.72
NA
7.21
ZZZ38747

A
Remove abdominal lymph nodes
4.88
NA
1.67
0.64
NA
7.19
ZZZ38760

A
Remove groin lymph nodes
12.93
NA
6.14
1.71
NA
20.78
09038765

A
Remove groin lymph nodes
19.95
NA
8.83
2.47
NA
31.25
09038770

A
Remove pelvis lymph nodes
13.21
NA
5.76
1.40
NA
20.37
09038780

A
Remove abdomen lymph nodes
16.57
NA
8.22
1.88
NA
26.67
09038790

A
Inject for lymphatic x-ray
1.29
7.37
0.76
0.13
8.79
2.18
00038792

A
Identify sentinel node
0.52
NA
0.44
0.06
NA
1.02
00038794

A
Access thoracic lymph duct
4.44
NA
3.46
0.32
NA
8.22
09038999

C
Blood/lymph system procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY39000

A
Exploration of chest
6.09
NA
4.66
0.89
NA
11.64
09039010

A
Exploration of chest
11.77
NA
7.56
1.75
NA
21.08
09039200

A
Removal chest lesion
13.60
NA
7.55
2.02
NA
23.17
09039220

A
Removal chest lesion
17.39
NA
9.39
2.45
NA
29.23
09039400

A
Visualization of chest
5.60
NA
4.86
0.82
NA
11.28
01039499

C
Chest procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY39501

A
Repair diaphragm laceration
13.17
NA
6.47
1.77
NA
21.41
09039502

A
Repair paraesophageal hernia
16.31
NA
7.16
2.16
NA
25.63
09039503

A
Repair of diaphragm hernia
94.86
NA
33.47
10.95
NA
139.28
09039520

A
Repair of diaphragm hernia
16.08
NA
8.06
2.23
NA
26.37
09039530

A
Repair of diaphragm hernia
15.39
NA
7.15
2.10
NA
24.64
09039531

A
Repair of diaphragm hernia
16.40
NA
7.40
2.21
NA
26.01
09039540

A
Repair of diaphragm hernia
13.30
NA
6.24
1.79
NA
21.33
09039541

A
Repair of diaphragm hernia
14.39
NA
6.60
1.92
NA
22.91
09039545

A
Revision of diaphragm
13.35
NA
7.56
1.83
NA
22.74
09039560

A
Resect diaphragm, simple
11.98
NA
6.30
1.59
NA
19.87
09039561

A
Resect diaphragm, complex
17.47
NA
9.36
2.44
NA
29.27
09039599

C
Diaphragm surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY4000F

I
Tobacco use txmnt counseling
0.00
0.00
0.00
0.00
0.00
0.00
XXX4001F

I
Tobacco use txmnt, pharmacol
0.00
0.00
0.00
0.00
0.00
0.00
XXX4002F

I
Statin therapy, rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX4003F

I
Pt ed write/oral, pts w/ hf
0.00
0.00
0.00
0.00
0.00
0.00
XXX4006F

I
Beta-blocker therapy rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX4009F

I
Ace inhibitor therapy rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX4011F

I
Oral antiplatelet therapy rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX4012F

I
Warfarin therapy rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX4014F

I
Written discharge instr prvd
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70378)4015F

I
Persist asthma medicine ctrl
0.00
0.00
0.00
0.00
0.00
0.00
XXX4016F

I
Anti-inflm/anlgsc agent rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX4017F

I
Gi prophylaxis for nsaid rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX4018F

I
Therapy exercise joint rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX40490

A
Biopsy of lip
1.22
1.63
0.61
0.05
2.90
1.88
00040500

A
Partial excision of lip
4.27
6.91
4.34
0.38
11.56
8.99
09040510

A
Partial excision of lip
4.69
6.63
4.02
0.49
11.81
9.20
09040520

A
Partial excision of lip
4.66
7.56
4.12
0.52
12.74
9.30
09040525

A
Reconstruct lip with flap
7.54
NA
6.32
0.85
NA
14.71
09040527

A
Reconstruct lip with flap
9.12
NA
7.37
0.97
NA
17.46
09040530

A
Partial removal of lip
5.39
7.83
4.59
0.55
13.77
10.53
09040650

A
Repair lip
3.63
6.81
3.30
0.38
10.82
7.31
09040652

A
Repair lip
4.25
7.76
4.27
0.52
12.53
9.04
09040654

A
Repair lip
5.30
8.62
4.94
0.60
14.52
10.84
09040700

A
Repair cleft lip/nasal
12.77
NA
9.10
0.95
NA
22.82
09040701

A
Repair cleft lip/nasal
15.83
NA
11.36
1.65
NA
28.84
09040702

A
Repair cleft lip/nasal
13.02
NA
8.27
1.23
NA
22.52
09040720

A
Repair cleft lip/nasal
13.53
NA
9.92
1.79
NA
25.24
09040761

A
Repair cleft lip/nasal
14.70
NA
10.30
1.93
NA
26.93
09040799

C
Lip surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY40800

A
Drainage of mouth lesion
1.17
2.97
1.78
0.13
4.27
3.08
01040801

A
Drainage of mouth lesion
2.53
4.03
2.75
0.31
6.87
5.59
01040804

A
Removal, foreign body, mouth
1.24
3.40
1.86
0.11
4.75
3.21
01040805

A
Removal, foreign body, mouth
2.69
4.49
2.82
0.32
7.50
5.83
01040806

A
Incision of lip fold
0.31
1.84
0.50
0.04
2.19
0.85
00040808

A
Biopsy of mouth lesion
0.96
2.66
1.48
0.10
3.72
2.54
01040810

A
Excision of mouth lesion
1.31
2.89
1.66
0.13
4.33
3.10
01040812

A
Excise/repair mouth lesion
2.31
3.73
2.41
0.28
6.32
5.00
01040814

A
Excise/repair mouth lesion
3.41
4.95
3.90
0.41
8.77
7.72
09040816

A
Excision of mouth lesion
3.66
5.18
4.01
0.40
9.24
8.07
09040818

A
Excise oral mucosa for graft
2.41
5.18
3.98
0.21
7.80
6.60
09040819

A
Excise lip or cheek fold
2.41
4.09
3.10
0.29
6.79
5.80
09040820

A
Treatment of mouth lesion
1.28
3.94
2.45
0.11
5.33
3.84
01040830

A
Repair mouth laceration
1.76
3.73
2.10
0.19
5.68
4.05
01040831

A
Repair mouth laceration
2.46
4.67
3.06
0.30
7.43
5.82
01040840

R
Reconstruction of mouth
8.72
9.81
6.99
1.08
19.61
16.79
09040842

R
Reconstruction of mouth
8.72
10.09
6.80
1.08
19.89
16.60
09040843

R
Reconstruction of mouth
12.08
11.98
7.83
1.39
25.45
21.30
09040844

R
Reconstruction of mouth
15.99
15.81
11.59
1.99
33.79
29.57
09040845

R
Reconstruction of mouth
18.55
17.11
13.25
2.00
37.66
33.80
09040899

C
Mouth surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY41000

A
Drainage of mouth lesion
1.30
2.32
1.41
0.12
3.74
2.83
01041005

A
Drainage of mouth lesion
1.26
3.34
1.72
0.12
4.72
3.10
01041006

A
Drainage of mouth lesion
3.24
4.80
3.18
0.35
8.39
6.77
09041007

A
Drainage of mouth lesion
3.10
5.15
3.03
0.31
8.56
6.44
09041008

A
Drainage of mouth lesion
3.36
4.69
3.21
0.42
8.47
6.99
09041009

A
Drainage of mouth lesion
3.58
4.98
3.58
0.47
9.03
7.63
09041010

A
Incision of tongue fold
1.06
3.43
1.60
0.07
4.56
2.73
01041015

A
Drainage of mouth lesion
3.95
5.42
4.15
0.46
9.83
8.56
09041016

A
Drainage of mouth lesion
4.06
5.63
4.23
0.53
10.22
8.82
09041017

A
Drainage of mouth lesion
4.06
5.65
4.31
0.53
10.24
8.90
09041018

A
Drainage of mouth lesion
5.09
6.15
4.58
0.68
11.92
10.35
09041100

A
Biopsy of tongue
1.63
2.43
1.42
0.15
4.21
3.20
01041105

A
Biopsy of tongue
1.42
2.31
1.32
0.13
3.86
2.87
01041108

A
Biopsy of floor of mouth
1.05
2.08
1.13
0.10
3.23
2.28
01041110

A
Excision of tongue lesion
1.51
2.99
1.64
0.13
4.63
3.28
01041112

A
Excision of tongue lesion
2.73
4.48
3.23
0.28
7.49
6.24
09041113

A
Excision of tongue lesion
3.19
4.75
3.48
0.34
8.28
7.01
09041114

A
Excision of tongue lesion
8.46
NA
7.21
0.83
NA
16.50
09041115

A
Excision of tongue fold
1.74
3.30
1.86
0.18
5.22
3.78
01041116

A
Excision of mouth lesion
2.44
4.36
2.81
0.23
7.03
5.48
09041120

A
Partial removal of tongue
9.76
NA
15.35
0.79
NA
25.90
09041130

A
Partial removal of tongue
11.13
NA
16.24
0.93
NA
28.30
09041135

A
Tongue and neck surgery
23.06
NA
23.29
1.88
NA
48.23
09041140

A
Removal of tongue
25.46
NA
26.75
2.26
NA
54.47
09041145

A
Tongue removal, neck surgery
30.01
NA
30.63
2.54
NA
63.18
09041150

A
Tongue, mouth, jaw surgery
23.01
NA
24.78
1.94
NA
49.73
09041153

A
Tongue, mouth, neck surgery
23.73
NA
25.09
2.00
NA
50.82
09041155

A
Tongue, jaw, & neck surgery
27.68
NA
26.88
2.33
NA
56.89
09041250

A
Repair tongue laceration
1.91
2.75
1.18
0.18
4.84
3.27
01041251

A
Repair tongue laceration
2.27
3.28
1.55
0.22
5.77
4.04
01041252

A
Repair tongue laceration
2.97
3.90
2.26
0.29
7.16
5.52
01041500

A
Fixation of tongue
3.70
NA
7.47
0.30
NA
11.47
09041510

A
Tongue to lip surgery
3.41
NA
7.95
0.20
NA
11.56
09041520

A
Reconstruction, tongue fold
2.73
4.63
3.63
0.27
7.63
6.63
090( print page 70379)41599

C
Tongue and mouth surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY41800

A
Drainage of gum lesion
1.17
2.60
1.28
0.12
3.89
2.57
01041805

A
Removal foreign body, gum
1.24
2.68
2.22
0.13
4.05
3.59
01041806

A
Removal foreign body,jawbone
2.69
3.59
3.04
0.37
6.65
6.10
01041820

R
Excision, gum, each quadrant
0.00
0.00
0.00
0.00
0.00
0.00
00041821

R
Excision of gum flap
0.00
0.00
0.00
0.00
0.00
0.00
00041822

R
Excision of gum lesion
2.31
3.90
1.88
0.31
6.52
4.50
01041823

R
Excision of gum lesion
3.30
5.58
4.02
0.47
9.35
7.79
09041825

A
Excision of gum lesion
1.31
3.07
2.25
0.15
4.53
3.71
01041826

A
Excision of gum lesion
2.31
2.44
2.11
0.30
5.05
4.72
01041827

A
Excision of gum lesion
3.41
5.53
3.67
0.35
9.29
7.43
09041828

R
Excision of gum lesion
3.09
3.81
2.97
0.44
7.34
6.50
01041830

R
Removal of gum tissue
3.34
4.97
3.63
0.44
8.75
7.41
01041850

R
Treatment of gum lesion
0.00
0.00
0.00
0.00
0.00
0.00
00041870

R
Gum graft
0.00
0.00
0.00
0.00
0.00
0.00
00041872

R
Repair gum
2.59
5.03
3.47
0.30
7.92
6.36
09041874

R
Repair tooth socket
3.09
4.85
3.18
0.45
8.39
6.72
09041899

C
Dental surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY42000

A
Drainage mouth roof lesion
1.23
2.57
1.25
0.12
3.92
2.60
01042100

A
Biopsy roof of mouth
1.31
2.09
1.36
0.13
3.53
2.80
01042104

A
Excision lesion, mouth roof
1.64
2.55
1.55
0.16
4.35
3.35
01042106

A
Excision lesion, mouth roof
2.10
3.23
2.45
0.25
5.58
4.80
01042107

A
Excision lesion, mouth roof
4.43
5.73
3.96
0.44
10.60
8.83
09042120

A
Remove palate/lesion
6.16
NA
11.80
0.52
NA
18.48
09042140

A
Excision of uvula
1.62
3.73
2.10
0.13
5.48
3.85
09042145

A
Repair palate, pharynx/uvula
8.04
NA
7.51
0.65
NA
16.20
09042160

A
Treatment mouth roof lesion
1.80
4.26
2.30
0.17
6.23
4.27
01042180

A
Repair palate
2.50
3.08
2.11
0.21
5.79
4.82
01042182

A
Repair palate
3.82
3.88
3.04
0.40
8.10
7.26
01042200

A
Reconstruct cleft palate
11.98
NA
10.24
1.27
NA
23.49
09042205

A
Reconstruct cleft palate
13.27
NA
10.10
1.58
NA
24.95
09042210

A
Reconstruct cleft palate
14.48
NA
11.49
2.16
NA
28.13
09042215

A
Reconstruct cleft palate
8.81
NA
9.10
1.31
NA
19.22
09042220

A
Reconstruct cleft palate
7.01
NA
6.80
0.73
NA
14.54
09042225

A
Reconstruct cleft palate
9.53
NA
17.11
0.86
NA
27.50
09042226

A
Lengthening of palate
9.99
NA
14.74
1.01
NA
25.74
09042227

A
Lengthening of palate
9.51
NA
15.59
0.98
NA
26.08
09042235

A
Repair palate
7.86
NA
11.89
0.72
NA
20.47
09042260

A
Repair nose to lip fistula
9.79
10.22
7.08
1.26
21.27
18.13
09042280

A
Preparation, palate mold
1.54
1.97
1.14
0.19
3.70
2.87
01042281

A
Insertion, palate prosthesis
1.93
2.64
1.88
0.17
4.74
3.98
01042299

C
Palate/uvula surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY42300

A
Drainage of salivary gland
1.93
2.83
1.82
0.16
4.92
3.91
01042305

A
Drainage of salivary gland
6.06
NA
4.73
0.51
NA
11.30
09042310

A
Drainage of salivary gland
1.56
2.27
1.54
0.13
3.96
3.23
01042320

A
Drainage of salivary gland
2.35
3.28
2.10
0.21
5.84
4.66
01042330

A
Removal of salivary stone
2.21
3.15
1.85
0.19
5.55
4.25
01042335

A
Removal of salivary stone
3.31
4.91
3.15
0.29
8.51
6.75
09042340

A
Removal of salivary stone
4.59
6.06
3.94
0.42
11.07
8.95
09042400

A
Biopsy of salivary gland
0.78
1.65
0.72
0.06
2.49
1.56
00042405

A
Biopsy of salivary gland
3.29
4.01
2.46
0.28
7.58
6.03
01042408

A
Excision of salivary cyst
4.53
5.93
3.62
0.45
10.91
8.60
09042409

A
Drainage of salivary cyst
2.81
4.53
2.77
0.27
7.61
5.85
09042410

A
Excise parotid gland/lesion
9.33
NA
6.24
0.91
NA
16.48
09042415

A
Excise parotid gland/lesion
16.86
NA
10.89
1.43
NA
29.18
09042420

A
Excise parotid gland/lesion
19.56
NA
12.41
1.65
NA
33.62
09042425

A
Excise parotid gland/lesion
13.00
NA
8.63
1.05
NA
22.68
09042426

A
Excise parotid gland/lesion
21.23
NA
13.05
1.80
NA
36.08
09042440

A
Excise submaxillary gland
6.96
NA
4.80
0.59
NA
12.35
09042450

A
Excise sublingual gland
4.61
5.92
4.26
0.42
10.95
9.29
09042500

A
Repair salivary duct
4.29
5.70
4.19
0.41
10.40
8.89
09042505

A
Repair salivary duct
6.17
7.14
5.38
0.55
13.86
12.10
09042507

A
Parotid duct diversion
6.10
NA
6.55
0.49
NA
13.14
09042508

A
Parotid duct diversion
9.09
NA
8.36
1.04
NA
18.49
09042509

A
Parotid duct diversion
11.52
NA
10.22
0.93
NA
22.67
09042510

A
Parotid duct diversion
8.14
NA
7.81
0.66
NA
16.61
09042550

A
Injection for salivary x-ray
1.25
3.22
0.41
0.07
4.54
1.73
00042600

A
Closure of salivary fistula
4.81
6.60
4.13
0.43
11.84
9.37
09042650

A
Dilation of salivary duct
0.77
1.10
0.71
0.07
1.94
1.55
00042660

A
Dilation of salivary duct
1.13
1.35
0.85
0.09
2.57
2.07
00042665

A
Ligation of salivary duct
2.53
4.18
2.60
0.23
6.94
5.36
09042699

C
Salivary surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY42700

A
Drainage of tonsil abscess
1.62
2.66
1.70
0.13
4.41
3.45
01042720

A
Drainage of throat abscess
5.41
4.84
3.80
0.44
10.69
9.65
01042725

A
Drainage of throat abscess
10.70
NA
8.24
0.91
NA
19.85
090( print page 70380)42800

A
Biopsy of throat
1.39
2.19
1.40
0.11
3.69
2.90
01042802

A
Biopsy of throat
1.54
4.77
2.07
0.12
6.43
3.73
01042804

A
Biopsy of upper nose/throat
1.24
3.75
1.74
0.10
5.09
3.08
01042806

A
Biopsy of upper nose/throat
1.58
4.08
1.94
0.13
5.79
3.65
01042808

A
Excise pharynx lesion
2.30
3.10
1.94
0.19
5.59
4.43
01042809

A
Remove pharynx foreign body
1.81
2.34
1.33
0.16
4.31
3.30
01042810

A
Excision of neck cyst
3.25
5.73
3.55
0.29
9.27
7.09
09042815

A
Excision of neck cyst
7.06
NA
6.43
0.61
NA
14.10
09042820

A
Remove tonsils and adenoids
3.90
NA
3.30
0.31
NA
7.51
09042821

A
Remove tonsils and adenoids
4.28
NA
3.51
0.35
NA
8.14
09042825

A
Removal of tonsils
3.41
NA
3.18
0.25
NA
6.84
09042826

A
Removal of tonsils
3.37
NA
3.04
0.27
NA
6.68
09042830

A
Removal of adenoids
2.57
NA
2.57
0.20
NA
5.34
09042831

A
Removal of adenoids
2.71
NA
2.85
0.22
NA
5.78
09042835

A
Removal of adenoids
2.30
NA
2.47
0.21
NA
4.98
09042836

A
Removal of adenoids
3.18
NA
2.97
0.26
NA
6.41
09042842

A
Extensive surgery of throat
8.75
NA
11.02
0.71
NA
20.48
09042844

A
Extensive surgery of throat
14.29
NA
16.28
1.16
NA
31.73
09042845

A
Extensive surgery of throat
24.25
NA
23.25
1.98
NA
49.48
09042860

A
Excision of tonsil tags
2.22
NA
2.41
0.18
NA
4.81
09042870

A
Excision of lingual tonsil
5.39
NA
8.59
0.44
NA
14.42
09042890

A
Partial removal of pharynx
12.92
NA
14.19
1.05
NA
28.16
09042892

A
Revision of pharyngeal walls
15.81
NA
17.22
1.28
NA
34.31
09042894

A
Revision of pharyngeal walls
22.85
NA
22.08
1.86
NA
46.79
09042900

A
Repair throat wound
5.24
NA
3.67
0.50
NA
9.41
01042950

A
Reconstruction of throat
8.09
NA
11.90
0.72
NA
20.71
09042953

A
Repair throat, esophagus
8.95
NA
17.38
0.88
NA
27.21
09042955

A
Surgical opening of throat
7.38
NA
10.70
0.80
NA
18.88
09042960

A
Control throat bleeding
2.33
NA
1.97
0.19
NA
4.49
01042961

A
Control throat bleeding
5.58
NA
4.97
0.45
NA
11.00
09042962

A
Control throat bleeding
7.13
NA
5.93
0.58
NA
13.64
09042970

A
Control nose/throat bleeding
5.42
NA
4.19
0.39
NA
10.00
09042971

A
Control nose/throat bleeding
6.20
NA
5.13
0.51
NA
11.84
09042972

A
Control nose/throat bleeding
7.19
NA
5.72
0.62
NA
13.53
09042999

C
Throat surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY43020

A
Incision of esophagus
8.08
NA
5.43
0.87
NA
14.38
09043030

A
Throat muscle surgery
7.68
NA
5.51
0.70
NA
13.89
09043045

A
Incision of esophagus
20.09
NA
10.73
2.58
NA
33.40
09043100

A
Excision of esophagus lesion
9.18
NA
6.24
0.93
NA
16.35
09043101

A
Excision of esophagus lesion
16.22
NA
7.90
2.31
NA
26.43
09043107

A
Removal of esophagus
39.94
NA
18.31
5.22
NA
63.47
09043108

A
Removal of esophagus
34.14
NA
14.25
4.07
NA
52.46
09043112

A
Removal of esophagus
43.43
NA
19.42
5.79
NA
68.64
09043113

A
Removal of esophagus
35.22
NA
15.15
4.42
NA
54.79
09043116

A
Partial removal of esophagus
31.17
NA
16.74
3.05
NA
50.96
09043117

A
Partial removal of esophagus
39.94
NA
17.32
5.17
NA
62.43
09043118

A
Partial removal of esophagus
33.15
NA
13.82
4.10
NA
51.07
09043121

A
Partial removal of esophagus
29.15
NA
13.71
3.90
NA
46.76
09043122

A
Partial removal of esophagus
39.94
NA
17.44
5.40
NA
62.78
09043123

A
Partial removal of esophagus
33.15
NA
14.14
4.15
NA
51.44
09043124

A
Removal of esophagus
27.28
NA
13.12
3.73
NA
44.13
09043130

A
Removal of esophagus pouch
11.73
NA
7.58
1.16
NA
20.47
09043135

A
Removal of esophagus pouch
16.08
NA
8.11
2.33
NA
26.52
09043200

A
Esophagus endoscopy
1.59
4.14
1.07
0.13
5.86
2.79
00043201

A
Esoph scope w/submucous inj
2.09
4.64
1.10
0.15
6.88
3.34
00043202

A
Esophagus endoscopy, biopsy
1.89
5.56
0.94
0.15
7.60
2.98
00043204

A
Esoph scope w/sclerosis inj
3.76
NA
1.52
0.30
NA
5.58
00043205

A
Esophagus endoscopy/ligation
3.78
NA
1.52
0.28
NA
5.58
00043215

A
Esophagus endoscopy
2.60
NA
1.20
0.22
NA
4.02
00043216

A
Esophagus endoscopy/lesion
2.40
NA
1.06
0.20
NA
3.66
00043217

A
Esophagus endoscopy
2.90
6.97
1.19
0.26
10.13
4.35
00043219

A
Esophagus endoscopy
2.80
NA
1.35
0.24
NA
4.39
00043220

A
Esoph endoscopy, dilation
2.10
NA
0.97
0.17
NA
3.24
00043226

A
Esoph endoscopy, dilation
2.34
NA
1.03
0.19
NA
3.56
00043227

A
Esoph endoscopy, repair
3.59
NA
1.45
0.28
NA
5.32
00043228

A
Esoph endoscopy, ablation
3.76
NA
1.55
0.34
NA
5.65
00043231

A
Esoph endoscopy w/us exam
3.19
NA
1.31
0.23
NA
4.73
00043232

A
Esoph endoscopy w/us fn bx
4.47
NA
1.82
0.34
NA
6.63
00043234

A
Upper GI endoscopy, exam
2.01
5.34
0.87
0.17
7.52
3.05
00043235

A
Uppr gi endoscopy, diagnosis
2.39
5.18
1.02
0.19
7.76
3.60
00043236

A
Uppr gi scope w/submuc inj
2.92
6.42
1.22
0.21
9.55
4.35
00043237

A
Endoscopic us exam, esoph
3.98
NA
1.59
0.43
NA
6.00
00043238

A
Uppr gi endoscopy w/us fn bx
5.02
NA
1.97
0.43
NA
7.42
00043239

A
Upper GI endoscopy, biopsy
2.87
5.73
1.19
0.22
8.82
4.28
00043240

A
Esoph endoscope w/drain cyst
6.85
NA
2.61
0.56
NA
10.02
000( print page 70381)43241

A
Upper GI endoscopy with tube
2.59
NA
1.10
0.21
NA
3.90
00043242

A
Uppr gi endoscopy w/us fn bx
7.30
NA
2.74
0.53
NA
10.57
00043243

A
Upper gi endoscopy & inject
4.56
NA
1.80
0.33
NA
6.69
00043244

A
Upper GI endoscopy/ligation
5.04
NA
1.97
0.37
NA
7.38
00043245

A
Uppr gi scope dilate strictr
3.18
NA
1.30
0.26
NA
4.74
00043246

A
Place gastrostomy tube
4.32
NA
1.69
0.34
NA
6.35
00043247

A
Operative upper GI endoscopy
3.38
NA
1.37
0.27
NA
5.02
00043248

A
Uppr gi endoscopy/guide wire
3.15
NA
1.31
0.23
NA
4.69
00043249

A
Esoph endoscopy, dilation
2.90
NA
1.21
0.22
NA
4.33
00043250

A
Upper GI endoscopy/tumor
3.20
NA
1.31
0.26
NA
4.77
00043251

A
Operative upper GI endoscopy
3.69
NA
1.48
0.29
NA
5.46
00043255

A
Operative upper GI endoscopy
4.81
NA
1.89
0.35
NA
7.05
00043256

A
Uppr gi endoscopy w/stent
4.34
NA
1.71
0.32
NA
6.37
00043257

A
Uppr gi scope w/thrml txmnt
5.50
NA
2.21
0.36
NA
8.07
00043258

A
Operative upper GI endoscopy
4.54
NA
1.79
0.33
NA
6.66
00043259

A
Endoscopic ultrasound exam
5.19
NA
2.00
0.35
NA
7.54
00043260

A
Endo cholangiopancreatograph
5.95
NA
2.29
0.43
NA
8.67
00043261

A
Endo cholangiopancreatograph
6.26
NA
2.40
0.46
NA
9.12
00043262

A
Endo cholangiopancreatograph
7.38
NA
2.79
0.54
NA
10.71
00043263

A
Endo cholangiopancreatograph
7.28
NA
2.77
0.54
NA
10.59
00043264

A
Endo cholangiopancreatograph
8.89
NA
3.32
0.65
NA
12.86
00043265

A
Endo cholangiopancreatograph
10.00
NA
3.70
0.73
NA
14.43
00043267

A
Endo cholangiopancreatograph
7.38
NA
2.79
0.54
NA
10.71
00043268

A
Endo cholangiopancreatograph
7.38
NA
2.89
0.54
NA
10.81
00043269

A
Endo cholangiopancreatograph
8.20
NA
3.08
0.60
NA
11.88
00043271

A
Endo cholangiopancreatograph
7.38
NA
2.79
0.54
NA
10.71
00043272

A
Endo cholangiopancreatograph
7.38
NA
2.79
0.54
NA
10.71
00043280

A
Laparoscopy, fundoplasty
17.22
NA
7.29
2.27
NA
26.78
09043289

C
Laparoscope proc, esoph
0.00
0.00
0.00
0.00
0.00
0.00
YYY43300

A
Repair of esophagus
9.13
NA
6.39
1.12
NA
16.64
09043305

A
Repair esophagus and fistula
17.36
NA
10.72
1.54
NA
29.62
09043310

A
Repair of esophagus
25.35
NA
11.09
3.60
NA
40.04
09043312

A
Repair esophagus and fistula
28.38
NA
11.92
4.00
NA
44.30
09043313

A
Esophagoplasty congenital
45.21
NA
18.86
5.45
NA
69.52
09043314

A
Tracheo-esophagoplasty cong
50.19
NA
19.24
6.63
NA
76.06
09043320

A
Fuse esophagus & stomach
19.90
NA
9.23
2.73
NA
31.86
09043324

A
Revise esophagus & stomach
20.54
NA
8.79
2.75
NA
32.08
09043325

A
Revise esophagus & stomach
20.03
NA
8.81
2.59
NA
31.43
09043326

A
Revise esophagus & stomach
19.71
NA
9.32
2.84
NA
31.87
09043330

A
Repair of esophagus
19.74
NA
8.55
2.62
NA
30.91
09043331

A
Repair of esophagus
20.10
NA
9.81
2.93
NA
32.84
09043340

A
Fuse esophagus & intestine
19.58
NA
8.99
2.45
NA
31.02
09043341

A
Fuse esophagus & intestine
20.82
NA
10.04
2.91
NA
33.77
09043350

A
Surgical opening, esophagus
15.76
NA
8.46
1.42
NA
25.64
09043351

A
Surgical opening, esophagus
18.32
NA
9.82
2.46
NA
30.60
09043352

A
Surgical opening, esophagus
15.24
NA
8.40
2.05
NA
25.69
09043360

A
Gastrointestinal repair
35.65
NA
15.11
4.96
NA
55.72
09043361

A
Gastrointestinal repair
40.44
NA
16.93
4.49
NA
61.86
09043400

A
Ligate esophagus veins
21.17
NA
9.46
1.95
NA
32.58
09043401

A
Esophagus surgery for veins
22.06
NA
9.51
3.04
NA
34.61
09043405

A
Ligate/staple esophagus
19.98
NA
9.61
2.83
NA
32.42
09043410

A
Repair esophagus wound
13.45
NA
7.65
1.71
NA
22.81
09043415

A
Repair esophagus wound
24.96
NA
11.77
3.52
NA
40.25
09043420

A
Repair esophagus opening
14.33
NA
7.42
1.43
NA
23.18
09043425

A
Repair esophagus opening
21.00
NA
10.00
3.02
NA
34.02
09043450

A
Dilate esophagus
1.38
2.64
0.69
0.11
4.13
2.18
00043453

A
Dilate esophagus
1.51
6.08
0.73
0.11
7.70
2.35
00043456

A
Dilate esophagus
2.57
13.78
1.10
0.20
16.55
3.87
00043458

A
Dilate esophagus
3.06
6.67
1.28
0.24
9.97
4.58
00043460

A
Pressure treatment esophagus
3.79
NA
1.49
0.31
NA
5.59
00043496

C
Free jejunum flap, microvasc
0.00
0.00
0.00
0.00
0.00
0.00
09043499

C
Esophagus surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY43500

A
Surgical opening of stomach
11.03
NA
4.98
1.45
NA
17.46
09043501

A
Surgical repair of stomach
20.01
NA
8.32
2.64
NA
30.97
09043502

A
Surgical repair of stomach
23.10
NA
9.48
3.09
NA
35.67
09043510

A
Surgical opening of stomach
13.06
NA
6.60
1.48
NA
21.14
09043520

A
Incision of pyloric muscle
9.98
NA
5.27
1.36
NA
16.61
09043600

A
Biopsy of stomach
1.91
NA
0.66
0.14
NA
2.71
00043605

A
Biopsy of stomach
11.96
NA
5.30
1.58
NA
18.84
09043610

A
Excision of stomach lesion
14.58
NA
6.16
1.93
NA
22.67
09043611

A
Excision of stomach lesion
17.81
NA
7.58
2.35
NA
27.74
09043620

A
Removal of stomach
29.99
NA
11.82
3.95
NA
45.76
09043621

A
Removal of stomach
30.68
NA
12.00
4.03
NA
46.71
09043622

A
Removal of stomach
32.48
NA
12.62
4.29
NA
49.39
09043631

A
Removal of stomach, partial
22.56
NA
9.18
2.98
NA
34.72
090( print page 70382)43632

A
Removal of stomach, partial
22.56
NA
9.18
2.98
NA
34.72
09043633

A
Removal of stomach, partial
23.07
NA
9.35
3.05
NA
35.47
09043634

A
Removal of stomach, partial
25.08
NA
10.11
3.32
NA
38.51
09043635

A
Removal of stomach, partial
2.06
NA
0.70
0.27
NA
3.03
ZZZ43640

A
Vagotomy & pylorus repair
16.99
NA
7.27
2.25
NA
26.51
09043641

A
Vagotomy & pylorus repair
17.24
NA
7.38
2.24
NA
26.86
09043644

A
Lap gastric bypass/roux-en-y
27.83
NA
11.24
3.15
NA
42.22
09043645

A
Lap gastr bypass incl smll i
29.96
NA
12.04
3.53
NA
45.53
09043651

A
Laparoscopy, vagus nerve
10.13
NA
4.77
1.33
NA
16.23
09043652

A
Laparoscopy, vagus nerve
12.13
NA
5.77
1.55
NA
19.45
09043653

A
Laparoscopy, gastrostomy
7.72
NA
4.19
1.01
NA
12.92
09043659

C
Laparoscope proc, stom
0.00
0.00
0.00
0.00
0.00
0.00
YYY43750

A
Place gastrostomy tube
4.48
NA
2.20
0.43
NA
7.11
01043752

A
Nasal/orogastric w/stent
0.81
0.28
0.26
0.02
1.11
1.09
00043760

A
Change gastrostomy tube
1.10
2.09
0.45
0.09
3.28
1.64
00043761

A
Reposition gastrostomy tube
2.01
1.17
0.66
0.13
3.31
2.80
00043770

A
Lap, place gastr adjust band
16.71
NA
7.73
2.18
NA
26.62
09043771

A
Lap, revise adjust gast band
19.50
NA
8.61
2.54
NA
30.65
09043772

A
Lap, remove adjust gast band
15.00
NA
6.44
1.92
NA
23.36
09043773

A
Lap, change adjust gast band
19.50
NA
8.61
2.55
NA
30.66
09043774

A
Lap remov adj gast band/port
15.00
NA
6.58
1.84
NA
23.42
09043800

A
Reconstruction of pylorus
13.67
NA
5.91
1.81
NA
21.39
09043810

A
Fusion of stomach and bowel
14.63
NA
6.19
1.93
NA
22.75
09043820

A
Fusion of stomach and bowel
15.35
NA
6.42
2.03
NA
23.80
09043825

A
Fusion of stomach and bowel
19.19
NA
8.03
2.53
NA
29.75
09043830

A
Place gastrostomy tube
9.52
NA
4.85
1.25
NA
15.62
09043831

A
Place gastrostomy tube
7.83
NA
4.52
1.03
NA
13.38
09043832

A
Place gastrostomy tube
15.58
NA
6.86
1.97
NA
24.41
09043840

A
Repair of stomach lesion
15.54
NA
6.78
2.05
NA
24.37
09043842

A
V-band gastroplasty
18.44
NA
7.81
2.44
NA
28.69
09043843

A
Gastroplasty w/o v-band
18.62
NA
7.78
2.45
NA
28.85
09043845

A
Gastroplasty duodenal switch
31.00
10.80
10.80
4.05
45.85
45.85
09043846

A
Gastric bypass for obesity
24.01
NA
10.05
3.18
NA
37.24
09043847

A
Gastric bypass incl small i
26.88
NA
10.92
3.55
NA
41.35
09043848

A
Revision gastroplasty
29.35
NA
11.84
3.87
NA
45.06
09043850

A
Revise stomach-bowel fusion
24.68
NA
9.84
3.27
NA
37.79
09043855

A
Revise stomach-bowel fusion
26.12
NA
10.35
3.46
NA
39.93
09043860

A
Revise stomach-bowel fusion
24.96
NA
9.99
3.30
NA
38.25
09043865

A
Revise stomach-bowel fusion
26.48
NA
10.53
3.50
NA
40.51
09043870

A
Repair stomach opening
9.68
NA
4.52
1.27
NA
15.47
09043880

A
Repair stomach-bowel fistula
24.61
NA
9.92
3.26
NA
37.79
09043886

A
Revise gastric port, open
4.00
NA
3.14
0.25
NA
7.39
09043887

A
Remove gastric port, open
3.95
NA
2.78
0.51
NA
7.24
09043888

A
Change gastric port, open
5.80
NA
3.77
0.70
NA
10.27
09043999

C
Stomach surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY44005

A
Freeing of bowel adhesion
16.21
NA
6.73
2.14
NA
25.08
09044010

A
Incision of small bowel
12.50
NA
5.46
1.64
NA
19.60
09044015

A
Insert needle cath bowel
2.62
NA
0.88
0.35
NA
3.85
ZZZ44020

A
Explore small intestine
13.97
NA
5.95
1.85
NA
21.77
09044021

A
Decompress small bowel
14.06
NA
5.98
1.86
NA
21.90
09044025

A
Incision of large bowel
14.26
NA
6.04
1.89
NA
22.19
09044050

A
Reduce bowel obstruction
14.01
NA
5.97
1.85
NA
21.83
09044055

A
Correct malrotation of bowel
21.97
NA
8.75
2.90
NA
33.62
09044100

A
Biopsy of bowel
2.01
NA
0.71
0.17
NA
2.89
00044110

A
Excise intestine lesion(s)
11.79
NA
5.24
1.55
NA
18.58
09044111

A
Excision of bowel lesion(s)
14.27
NA
6.12
1.86
NA
22.25
09044120

A
Removal of small intestine
16.97
NA
7.09
2.24
NA
26.30
09044121

A
Removal of small intestine
4.44
NA
1.52
0.58
NA
6.54
ZZZ44125

A
Removal of small intestine
17.51
NA
7.27
2.26
NA
27.04
09044126

A
Enterectomy w/o taper, cong
35.45
NA
14.15
4.68
NA
54.28
09044127

A
Enterectomy w/taper, cong
40.94
NA
15.76
5.75
NA
62.45
09044128

A
Enterectomy cong, add-on
4.44
NA
1.53
0.61
NA
6.58
ZZZ44130

A
Bowel to bowel fusion
14.47
NA
6.23
1.87
NA
22.57
09044132

R
Enterectomy, cadaver donor
0.00
0.00
0.00
0.00
0.00
0.00
XXX44133

R
Enterectomy, live donor
0.00
0.00
0.00
0.00
0.00
0.00
XXX44135

R
Intestine transplnt, cadaver
0.00
0.00
0.00
0.00
0.00
0.00
XXX44136

R
Intestine transplant, live
0.00
0.00
0.00
0.00
0.00
0.00
XXX44137

C
Remove intestinal allograft
0.00
0.00
0.00
0.00
0.00
0.00
XXX44139

A
Mobilization of colon
2.23
NA
0.76
0.28
NA
3.27
ZZZ44140

A
Partial removal of colon
20.97
NA
8.67
2.70
NA
32.34
09044141

A
Partial removal of colon
19.48
NA
10.07
2.52
NA
32.07
09044143

A
Partial removal of colon
22.96
NA
10.71
3.04
NA
36.71
09044144

A
Partial removal of colon
21.50
NA
9.64
2.85
NA
33.99
09044145

A
Partial removal of colon
26.38
NA
10.83
3.28
NA
40.49
09044146

A
Partial removal of colon
27.50
NA
12.89
3.40
NA
43.79
090( print page 70383)44147

A
Partial removal of colon
20.68
NA
8.71
2.55
NA
31.94
09044150

A
Removal of colon
23.91
NA
12.05
3.03
NA
38.99
09044151

A
Removal of colon/ileostomy
26.84
NA
13.43
3.48
NA
43.75
09044152

A
Removal of colon/ileostomy
27.79
NA
11.62
3.51
NA
42.92
09044153

A
Removal of colon/ileostomy
30.54
NA
14.41
3.54
NA
48.49
09044155

A
Removal of colon/ileostomy
27.82
NA
13.34
3.27
NA
44.43
09044156

A
Removal of colon/ileostomy
30.74
NA
15.07
3.94
NA
49.75
09044160

A
Removal of colon
18.59
NA
7.76
2.36
NA
28.71
09044180

A
Lap, enterolysis
14.42
NA
6.25
1.85
NA
22.52
09044186

A
Lap, jejunostomy
9.77
NA
4.80
1.27
NA
15.84
09044187

A
Lap, ileo/jejuno-stomy
15.93
NA
8.29
1.95
NA
26.17
09044188

A
Lap, colostomy
17.61
NA
8.87
2.23
NA
28.71
09044202

A
Lap, enterectomy
22.01
NA
8.95
2.84
NA
33.80
09044203

A
Lap resect s/intestine, addl
4.44
NA
1.50
0.57
NA
6.51
ZZZ44204

A
Laparo partial colectomy
25.04
NA
9.98
3.10
NA
38.12
09044205

A
Lap colectomy part w/ileum
22.20
NA
8.87
2.74
NA
33.81
09044206

A
Lap part colectomy w/stoma
26.96
NA
11.28
3.45
NA
41.69
09044207

A
L colectomy/coloproctostomy
29.96
NA
11.51
3.66
NA
45.13
09044208

A
L colectomy/coloproctostomy
31.95
NA
13.17
3.87
NA
48.99
09044210

A
Laparo total proctocolectomy
27.96
NA
11.90
3.41
NA
43.27
09044211

A
Laparo total proctocolectomy
34.95
NA
14.71
4.16
NA
53.82
09044212

A
Laparo total proctocolectomy
32.45
NA
13.72
3.77
NA
49.94
09044213

A
Lap, mobil splenic fl add-on
3.50
NA
1.22
0.44
NA
5.16
ZZZ44227

A
Lap, close enterostomy
26.50
NA
10.65
3.37
NA
40.52
09044238

C
Laparoscope proc, intestine
0.00
0.00
0.00
0.00
0.00
0.00
YYY44300

A
Open bowel to skin
12.09
NA
5.50
1.60
NA
19.19
09044310

A
Ileostomy/jejunostomy
15.93
NA
6.71
1.98
NA
24.62
09044312

A
Revision of ileostomy
8.01
NA
4.00
0.92
NA
12.93
09044314

A
Revision of ileostomy
15.03
NA
6.57
1.74
NA
23.34
09044316

A
Devise bowel pouch
21.06
NA
8.56
2.37
NA
31.99
09044320

A
Colostomy
17.61
NA
7.67
2.25
NA
27.53
09044322

A
Colostomy with biopsies
11.96
NA
8.59
1.54
NA
22.09
09044340

A
Revision of colostomy
7.71
NA
4.27
0.99
NA
12.97
09044345

A
Revision of colostomy
15.41
NA
6.90
1.96
NA
24.27
09044346

A
Revision of colostomy
16.96
NA
7.40
2.12
NA
26.48
09044360

A
Small bowel endoscopy
2.59
NA
1.10
0.19
NA
3.88
00044361

A
Small bowel endoscopy/biopsy
2.87
NA
1.20
0.21
NA
4.28
00044363

A
Small bowel endoscopy
3.49
NA
1.38
0.27
NA
5.14
00044364

A
Small bowel endoscopy
3.73
NA
1.49
0.27
NA
5.49
00044365

A
Small bowel endoscopy
3.31
NA
1.36
0.24
NA
4.91
00044366

A
Small bowel endoscopy
4.40
NA
1.74
0.32
NA
6.46
00044369

A
Small bowel endoscopy
4.51
NA
1.74
0.33
NA
6.58
00044370

A
Small bowel endoscopy/stent
4.79
NA
1.98
0.37
NA
7.14
00044372

A
Small bowel endoscopy
4.40
NA
1.74
0.35
NA
6.49
00044373

A
Small bowel endoscopy
3.49
NA
1.42
0.27
NA
5.18
00044376

A
Small bowel endoscopy
5.25
NA
2.03
0.42
NA
7.70
00044377

A
Small bowel endoscopy/biopsy
5.52
NA
2.14
0.40
NA
8.06
00044378

A
Small bowel endoscopy
7.12
NA
2.70
0.52
NA
10.34
00044379

A
S bowel endoscope w/stent
7.46
NA
2.92
0.62
NA
11.00
00044380

A
Small bowel endoscopy
1.05
NA
0.55
0.08
NA
1.68
00044382

A
Small bowel endoscopy
1.27
NA
0.63
0.12
NA
2.02
00044383

A
Ileoscopy w/stent
2.94
NA
1.27
0.21
NA
4.42
00044385

A
Endoscopy of bowel pouch
1.82
3.36
0.75
0.15
5.33
2.72
00044386

A
Endoscopy, bowel pouch/biop
2.12
6.66
0.88
0.20
8.98
3.20
00044388

A
Colonoscopy
2.82
5.09
1.15
0.26
8.17
4.23
00044389

A
Colonoscopy with biopsy
3.13
6.64
1.27
0.27
10.04
4.67
00044390

A
Colonoscopy for foreign body
3.82
7.13
1.49
0.32
11.27
5.63
00044391

A
Colonoscopy for bleeding
4.31
8.75
1.69
0.34
13.40
6.34
00044392

A
Colonoscopy & polypectomy
3.81
6.60
1.49
0.34
10.75
5.64
00044393

A
Colonoscopy, lesion removal
4.83
6.92
1.87
0.42
12.17
7.12
00044394

A
Colonoscopy w/snare
4.42
7.83
1.72
0.38
12.63
6.52
00044397

A
Colonoscopy w/stent
4.70
NA
1.80
0.39
NA
6.89
00044500

A
Intro, gastrointestinal tube
0.49
NA
0.16
0.03
NA
0.68
00044602

A
Suture, small intestine
16.01
NA
6.41
2.11
NA
24.53
09044603

A
Suture, small intestine
18.63
NA
7.29
2.41
NA
28.33
09044604

A
Suture, large intestine
16.01
NA
6.47
2.11
NA
24.59
09044605

A
Repair of bowel lesion
19.50
NA
8.41
2.51
NA
30.42
09044615

A
Intestinal stricturoplasty
15.91
NA
6.69
2.06
NA
24.66
09044620

A
Repair bowel opening
12.18
NA
5.34
1.51
NA
19.03
09044625

A
Repair bowel opening
15.03
NA
6.32
1.85
NA
23.20
09044626

A
Repair bowel opening
25.32
NA
9.84
3.26
NA
38.42
09044640

A
Repair bowel-skin fistula
21.62
NA
8.59
2.77
NA
32.98
09044650

A
Repair bowel fistula
22.54
NA
8.91
2.92
NA
34.37
09044660

A
Repair bowel-bladder fistula
21.33
NA
8.36
2.13
NA
31.82
09044661

A
Repair bowel-bladder fistula
24.77
NA
9.58
2.80
NA
37.15
090( print page 70384)44680

A
Surgical revision, intestine
15.38
NA
6.46
1.99
NA
23.83
09044700

A
Suspend bowel w/prosthesis
16.09
NA
6.68
1.83
NA
24.60
09044701

A
Intraop colon lavage add-on
3.10
NA
1.06
0.37
NA
4.53
ZZZ44715

C
Prepare donor intestine
0.00
0.00
0.00
0.00
0.00
0.00
XXX44720

A
Prep donor intestine/venous
5.00
NA
1.71
0.37
NA
7.08
XXX44721

A
Prep donor intestine/artery
7.00
NA
2.40
0.97
NA
10.37
XXX44799

C
Unlisted procedure intestine
0.00
0.00
0.00
0.00
0.00
0.00
YYY44800

A
Excision of bowel pouch
11.21
NA
5.40
1.47
NA
18.08
09044820

A
Excision of mesentery lesion
12.07
NA
5.50
1.59
NA
19.16
09044850

A
Repair of mesentery
10.72
NA
5.01
1.39
NA
17.12
09044899

C
Bowel surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY44900

A
Drain app abscess, open
10.12
NA
4.70
1.33
NA
16.15
09044901

A
Drain app abscess, percut
3.37
27.97
1.11
0.22
31.56
4.70
00044950

A
Appendectomy
9.99
NA
4.32
1.31
NA
15.62
09044955

A
Appendectomy add-on
1.53
NA
0.54
0.20
NA
2.27
ZZZ44960

A
Appendectomy
12.32
NA
5.35
1.63
NA
19.30
09044970

A
Laparoscopy, appendectomy
8.69
NA
4.09
1.14
NA
13.92
09044979

C
Laparoscope proc, app
0.00
0.00
0.00
0.00
0.00
0.00
YYY45000

A
Drainage of pelvic abscess
4.51
NA
2.97
0.52
NA
8.00
09045005

A
Drainage of rectal abscess
1.99
4.06
1.58
0.25
6.30
3.82
01045020

A
Drainage of rectal abscess
4.71
NA
3.28
0.55
NA
8.54
09045100

A
Biopsy of rectum
3.67
NA
2.37
0.44
NA
6.48
09045108

A
Removal of anorectal lesion
4.75
NA
2.78
0.59
NA
8.12
09045110

A
Removal of rectum
27.96
NA
12.43
3.35
NA
43.74
09045111

A
Partial removal of rectum
16.46
NA
7.18
2.06
NA
25.70
09045112

A
Removal of rectum
30.49
NA
11.79
3.42
NA
45.70
09045113

A
Partial proctectomy
30.53
NA
12.63
3.48
NA
46.64
09045114

A
Partial removal of rectum
27.28
NA
10.90
3.35
NA
41.53
09045116

A
Partial removal of rectum
24.54
NA
10.05
2.87
NA
37.46
09045119

A
Remove rectum w/reservoir
30.79
NA
12.49
3.35
NA
46.63
09045120

A
Removal of rectum
24.56
NA
10.15
2.89
NA
37.60
09045121

A
Removal of rectum and colon
27.00
NA
11.13
3.24
NA
41.37
09045123

A
Partial proctectomy
16.68
NA
6.87
1.85
NA
25.40
09045126

A
Pelvic exenteration
45.09
NA
19.26
4.32
NA
68.67
09045130

A
Excision of rectal prolapse
16.42
NA
6.78
1.79
NA
24.99
09045135

A
Excision of rectal prolapse
19.25
NA
8.43
2.35
NA
30.03
09045136

A
Excise ileoanal reservior
27.26
NA
12.55
2.81
NA
42.62
09045150

A
Excision of rectal stricture
5.66
NA
2.97
0.61
NA
9.24
09045160

A
Excision of rectal lesion
15.30
NA
6.66
1.67
NA
23.63
09045170

A
Excision of rectal lesion
11.47
NA
5.25
1.35
NA
18.07
09045190

A
Destruction, rectal tumor
9.73
NA
4.63
1.13
NA
15.49
09045300

A
Proctosigmoidoscopy dx
0.38
1.53
0.28
0.04
1.95
0.70
00045303

A
Proctosigmoidoscopy dilate
0.44
18.73
0.33
0.05
19.22
0.82
00045305

A
Proctosigmoidoscopy w/bx
1.01
2.64
0.50
0.11
3.76
1.62
00045307

A
Proctosigmoidoscopy fb
0.94
3.04
0.48
0.11
4.09
1.53
00045308

A
Proctosigmoidoscopy removal
0.83
2.00
0.44
0.09
2.92
1.36
00045309

A
Proctosigmoidoscopy removal
2.01
2.82
0.84
0.22
5.05
3.07
00045315

A
Proctosigmoidoscopy removal
1.40
2.87
0.63
0.15
4.42
2.18
00045317

A
Proctosigmoidoscopy bleed
1.50
2.44
0.66
0.15
4.09
2.31
00045320

A
Proctosigmoidoscopy ablate
1.58
2.92
0.71
0.16
4.66
2.45
00045321

A
Proctosigmoidoscopy volvul
1.17
NA
0.56
0.13
NA
1.86
00045327

A
Proctosigmoidoscopy w/stent
1.65
NA
0.69
0.16
NA
2.50
00045330

A
Diagnostic sigmoidoscopy
0.96
2.28
0.50
0.08
3.32
1.54
00045331

A
Sigmoidoscopy and biopsy
1.15
3.08
0.59
0.09
4.32
1.83
00045332

A
Sigmoidoscopy w/fb removal
1.79
5.01
0.80
0.16
6.96
2.75
00045333

A
Sigmoidoscopy & polypectomy
1.79
4.88
0.80
0.15
6.82
2.74
00045334

A
Sigmoidoscopy for bleeding
2.73
NA
1.14
0.20
NA
4.07
00045335

A
Sigmoidoscopy w/submuc inj
1.46
3.22
0.69
0.11
4.79
2.26
00045337

A
Sigmoidoscopy & decompress
2.36
NA
1.00
0.21
NA
3.57
00045338

A
Sigmoidoscopy w/tumr remove
2.34
5.23
1.00
0.19
7.76
3.53
00045339

A
Sigmoidoscopy w/ablate tumr
3.14
3.47
1.28
0.26
6.87
4.68
00045340

A
Sig w/balloon dilation
1.89
6.19
0.83
0.15
8.23
2.87
00045341

A
Sigmoidoscopy w/ultrasound
2.60
NA
1.07
0.19
NA
3.86
00045342

A
Sigmoidoscopy w/us guide bx
4.05
NA
1.54
0.30
NA
5.89
00045345

A
Sigmoidoscopy w/stent
2.92
NA
1.16
0.23
NA
4.31
00045355

A
Surgical colonoscopy
3.51
NA
1.38
0.36
NA
5.25
00045378
53
A
Diagnostic colonoscopy
0.96
2.28
0.50
0.08
3.32
1.54
00045378

A
Diagnostic colonoscopy
3.69
6.16
1.47
0.30
10.15
5.46
00045379

A
Colonoscopy w/fb removal
4.68
7.68
1.82
0.39
12.75
6.89
00045380

A
Colonoscopy and biopsy
4.43
7.21
1.74
0.35
11.99
6.52
00045381

A
Colonoscopy, submucous inj
4.19
7.13
1.65
0.30
11.62
6.14
00045382

A
Colonoscopy/control bleeding
5.68
9.97
2.19
0.41
16.06
8.28
00045383

A
Lesion removal colonoscopy
5.86
7.94
2.23
0.48
14.28
8.57
00045384

A
Lesion remove colonoscopy
4.69
6.82
1.83
0.38
11.89
6.90
00045385

A
Lesion removal colonoscopy
5.30
7.82
2.04
0.42
13.54
7.76
000( print page 70385)45386

A
Colonoscopy dilate stricture
4.57
12.44
1.79
0.39
17.40
6.75
00045387

A
Colonoscopy w/stent
5.90
NA
2.34
0.48
NA
8.72
00045391

A
Colonoscopy w/endoscope us
5.09
NA
1.98
0.42
NA
7.49
00045392

A
Colonoscopy w/endoscopic fnb
6.54
NA
2.49
0.42
NA
9.45
00045395

A
Lap, removal of rectum
30.50
NA
13.71
3.62
NA
47.83
09045397

A
Lap, remove rectum w/pouch
34.00
NA
14.30
3.66
NA
51.96
09045400

A
Laparoscopic proctopexy
18.06
NA
7.85
2.02
NA
27.93
09045402

A
Lap proctopexy w/sig resect
25.04
NA
10.01
2.81
NA
37.86
09045499

C
Laparoscope proc, rectum
0.00
0.00
0.00
0.00
0.00
0.00
YYY45500

A
Repair of rectum
7.28
NA
3.54
0.75
NA
11.57
09045505

A
Repair of rectum
7.57
NA
3.86
0.86
NA
12.29
09045520

A
Treatment of rectal prolapse
0.55
1.64
0.37
0.05
2.24
0.97
00045540

A
Correct rectal prolapse
16.25
NA
6.81
1.84
NA
24.90
09045541

A
Correct rectal prolapse
13.38
NA
5.96
1.55
NA
20.89
09045550

A
Repair rectum/remove sigmoid
22.97
NA
9.24
2.61
NA
34.82
09045560

A
Repair of rectocele
10.56
NA
5.06
1.13
NA
16.75
09045562

A
Exploration/repair of rectum
15.36
NA
7.00
1.83
NA
24.19
09045563

A
Exploration/repair of rectum
23.43
NA
10.54
3.10
NA
37.07
09045800

A
Repair rect/bladder fistula
17.74
NA
7.44
1.85
NA
27.03
09045805

A
Repair fistula w/colostomy
20.75
NA
9.53
2.02
NA
32.30
09045820

A
Repair rectourethral fistula
18.45
NA
7.64
1.58
NA
27.67
09045825

A
Repair fistula w/colostomy
21.22
NA
9.84
2.31
NA
33.37
09045900

A
Reduction of rectal prolapse
2.61
NA
1.50
0.30
NA
4.41
01045905

A
Dilation of anal sphincter
2.30
NA
1.43
0.27
NA
4.00
01045910

A
Dilation of rectal narrowing
2.80
NA
1.66
0.30
NA
4.76
01045915

A
Remove rectal obstruction
3.14
4.33
2.10
0.30
7.77
5.54
01045990

A
Surg dx exam, anorectal
1.80
NA
0.79
0.17
NA
2.76
00045999

C
Rectum surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY46020

A
Placement of seton
2.90
2.34
1.86
0.31
5.55
5.07
01046030

A
Removal of rectal marker
1.23
1.35
0.71
0.14
2.72
2.08
01046040

A
Incision of rectal abscess
4.95
5.51
3.59
0.62
11.08
9.16
09046045

A
Incision of rectal abscess
4.31
NA
2.90
0.54
NA
7.75
09046050

A
Incision of anal abscess
1.19
2.55
0.84
0.14
3.88
2.17
01046060

A
Incision of rectal abscess
5.68
NA
3.25
0.67
NA
9.60
09046070

A
Incision of anal septum
2.71
NA
1.84
0.36
NA
4.91
09046080

A
Incision of anal sphincter
2.49
2.37
1.13
0.30
5.16
3.92
01046083

A
Incise external hemorrhoid
1.40
2.53
0.92
0.15
4.08
2.47
01046200

A
Removal of anal fissure
3.41
3.86
2.87
0.39
7.66
6.67
09046210

A
Removal of anal crypt
2.67
5.12
2.63
0.31
8.10
5.61
09046211

A
Removal of anal crypts
4.24
5.42
3.51
0.48
10.14
8.23
09046220

A
Removal of anal tag
1.56
2.30
0.95
0.17
4.03
2.68
01046221

A
Ligation of hemorrhoid(s)
2.04
2.65
1.75
0.23
4.92
4.02
01046230

A
Removal of anal tags
2.57
3.08
1.29
0.30
5.95
4.16
01046250

A
Hemorrhoidectomy
3.88
5.32
2.62
0.48
9.68
6.98
09046255

A
Hemorrhoidectomy
4.59
5.85
2.84
0.58
11.02
8.01
09046257

A
Remove hemorrhoids & fissure
5.39
NA
2.88
0.64
NA
8.91
09046258

A
Remove hemorrhoids & fistula
5.72
NA
3.28
0.68
NA
9.68
09046260

A
Hemorrhoidectomy
6.36
NA
3.19
0.76
NA
10.31
09046261

A
Remove hemorrhoids & fissure
7.07
NA
3.61
0.79
NA
11.47
09046262

A
Remove hemorrhoids & fistula
7.49
NA
3.74
0.83
NA
12.06
09046270

A
Removal of anal fistula
3.71
5.00
2.84
0.46
9.17
7.01
09046275

A
Removal of anal fistula
4.55
4.64
2.98
0.52
9.71
8.05
09046280

A
Removal of anal fistula
5.97
NA
3.26
0.66
NA
9.89
09046285

A
Removal of anal fistula
4.08
3.77
2.75
0.44
8.29
7.27
09046288

A
Repair anal fistula
7.12
NA
3.68
0.79
NA
11.59
09046320

A
Removal of hemorrhoid clot
1.61
2.13
0.85
0.18
3.92
2.64
01046500

A
Injection into hemorrhoid(s)
1.61
2.12
1.15
0.16
3.89
2.92
01046505

A
Chemodenervation anal musc
2.86
3.05
1.97
0.14
6.05
4.97
01046600

A
Diagnostic anoscopy
0.50
1.56
0.34
0.05
2.11
0.89
00046604

A
Anoscopy and dilation
1.31
9.15
0.62
0.12
10.58
2.05
00046606

A
Anoscopy and biopsy
0.81
3.79
0.43
0.09
4.69
1.33
00046608

A
Anoscopy, remove for body
1.51
4.41
0.65
0.16
6.08
2.32
00046610

A
Anoscopy, remove lesion
1.32
4.04
0.61
0.15
5.51
2.08
00046611

A
Anoscopy
1.81
3.34
0.78
0.19
5.34
2.78
00046612

A
Anoscopy, remove lesions
2.34
5.20
0.98
0.28
7.82
3.60
00046614

A
Anoscopy, control bleeding
2.01
2.33
0.84
0.20
4.54
3.05
00046615

A
Anoscopy
2.68
2.49
1.07
0.33
5.50
4.08
00046700

A
Repair of anal stricture
9.12
NA
4.21
0.94
NA
14.27
09046705

A
Repair of anal stricture
6.89
NA
3.69
0.91
NA
11.49
09046706

A
Repr of anal fistula w/glue
2.39
NA
1.25
0.28
NA
3.92
01046710

A
Repr per/vag pouch sngl proc
16.00
NA
7.77
1.38
NA
25.15
09046712

A
Repr per/vag pouch dbl proc
34.00
NA
15.08
3.66
NA
52.74
09046715

A
Rep perf anoper fistu
7.19
NA
3.58
0.92
NA
11.69
09046716

A
Rep perf anoper/vestib fistu
15.05
NA
7.99
1.58
NA
24.62
09046730

A
Construction of absent anus
26.71
NA
12.05
2.46
NA
41.22
090( print page 70386)46735

A
Construction of absent anus
32.12
NA
13.58
3.20
NA
48.90
09046740

A
Construction of absent anus
29.96
NA
13.26
2.41
NA
45.63
09046742

A
Repair of imperforated anus
35.75
NA
17.43
3.19
NA
56.37
09046744

A
Repair of cloacal anomaly
52.55
NA
21.17
6.38
NA
80.10
09046746

A
Repair of cloacal anomaly
58.13
NA
25.21
7.68
NA
91.02
09046748

A
Repair of cloacal anomaly
64.11
NA
23.70
3.36
NA
91.17
09046750

A
Repair of anal sphincter
10.23
NA
5.06
1.10
NA
16.39
09046751

A
Repair of anal sphincter
8.76
NA
5.43
0.94
NA
15.13
09046753

A
Reconstruction of anus
8.28
NA
3.85
0.94
NA
13.07
09046754

A
Removal of suture from anus
2.20
3.60
1.67
0.19
5.99
4.06
01046760

A
Repair of anal sphincter
14.41
NA
7.10
1.59
NA
23.10
09046761

A
Repair of anal sphincter
13.82
NA
6.02
1.43
NA
21.27
09046762

A
Implant artificial sphincter
12.69
NA
5.53
1.24
NA
19.46
09046900

A
Destruction, anal lesion(s)
1.91
2.59
1.27
0.17
4.67
3.35
01046910

A
Destruction, anal lesion(s)
1.86
2.91
1.06
0.19
4.96
3.11
01046916

A
Cryosurgery, anal lesion(s)
1.86
3.16
1.39
0.11
5.13
3.36
01046917

A
Laser surgery, anal lesions
1.86
9.15
1.12
0.21
11.22
3.19
01046922

A
Excision of anal lesion(s)
1.86
3.28
1.07
0.22
5.36
3.15
01046924

A
Destruction, anal lesion(s)
2.76
8.71
1.35
0.26
11.73
4.37
01046934

A
Destruction of hemorrhoids
3.50
5.08
2.96
0.32
8.90
6.78
09046935

A
Destruction of hemorrhoids
2.43
3.47
1.21
0.23
6.13
3.87
01046936

A
Destruction of hemorrhoids
3.68
4.88
2.50
0.34
8.90
6.52
09046937

A
Cryotherapy of rectal lesion
2.69
2.78
1.22
0.14
5.61
4.05
01046938

A
Cryotherapy of rectal lesion
4.65
4.00
3.06
0.58
9.23
8.29
09046940

A
Treatment of anal fissure
2.32
2.00
1.09
0.23
4.55
3.64
01046942

A
Treatment of anal fissure
2.04
1.84
1.02
0.19
4.07
3.25
01046945

A
Ligation of hemorrhoids
1.84
3.27
2.48
0.19
5.30
4.51
09046946

A
Ligation of hemorrhoids
2.58
3.73
2.40
0.27
6.58
5.25
09046947

A
Hemorrhoidopexy by stapling
5.20
NA
2.72
0.75
NA
8.67
09046999

C
Anus surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY47000

A
Needle biopsy of liver
1.90
3.08
0.63
0.12
5.10
2.65
00047001

A
Needle biopsy, liver add-on
1.90
NA
0.65
0.25
NA
2.80
ZZZ47010

A
Open drainage, liver lesion
15.99
NA
8.41
1.80
NA
26.20
09047011

A
Percut drain, liver lesion
3.69
NA
1.21
0.22
NA
5.12
00047015

A
Inject/aspirate liver cyst
15.09
NA
7.50
1.83
NA
24.42
09047100

A
Wedge biopsy of liver
11.65
NA
6.05
1.53
NA
19.23
09047120

A
Partial removal of liver
35.45
NA
15.18
4.65
NA
55.28
09047122

A
Extensive removal of liver
55.05
NA
21.50
7.19
NA
83.74
09047125

A
Partial removal of liver
49.12
NA
19.56
6.45
NA
75.13
09047130

A
Partial removal of liver
53.27
NA
21.02
6.94
NA
81.23
09047133

X
Removal of donor liver
0.00
0.00
0.00
0.00
0.00
0.00
XXX47135

R
Transplantation of liver
81.40
NA
31.59
9.93
NA
122.92
09047136

R
Transplantation of liver
68.50
NA
27.09
8.41
NA
104.00
09047140

A
Partial removal, donor liver
54.92
NA
22.33
5.17
NA
82.42
09047141

A
Partial removal, donor liver
67.40
NA
26.98
5.17
NA
99.55
09047142

A
Partial removal, donor liver
74.89
NA
29.55
5.17
NA
109.61
09047143

C
Prep donor liver, whole
0.00
0.00
0.00
0.00
0.00
0.00
XXX47144

C
Prep donor liver, 3-segment
0.00
0.00
0.00
0.00
0.00
0.00
09047145

C
Prep donor liver, lobe split
0.00
0.00
0.00
0.00
0.00
0.00
09047146

A
Prep donor liver/venous
6.00
NA
2.06
0.83
NA
8.89
XXX47147

A
Prep donor liver/arterial
7.00
NA
2.40
0.97
NA
10.37
XXX47300

A
Surgery for liver lesion
15.06
NA
7.24
1.98
NA
24.28
09047350

A
Repair liver wound
19.53
NA
8.89
2.58
NA
31.00
09047360

A
Repair liver wound
26.88
NA
11.60
3.37
NA
41.85
09047361

A
Repair liver wound
47.05
NA
18.56
5.85
NA
71.46
09047362

A
Repair liver wound
18.48
NA
8.74
2.50
NA
29.72
09047370

A
Laparo ablate liver tumor rf
19.66
NA
8.15
2.55
NA
30.36
09047371

A
Laparo ablate liver cryosurg
19.66
NA
8.16
2.60
NA
30.42
09047379

C
Laparoscope procedure, liver
0.00
0.00
0.00
0.00
0.00
0.00
YYY47380

A
Open ablate liver tumor rf
22.97
NA
9.38
2.86
NA
35.21
09047381

A
Open ablate liver tumor cryo
23.24
NA
9.61
2.84
NA
35.69
09047382

A
Percut ablate liver rf
15.17
NA
6.09
0.96
NA
22.22
01047399

C
Liver surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY47400

A
Incision of liver duct
32.44
NA
13.47
3.07
NA
48.98
09047420

A
Incision of bile duct
19.85
NA
8.78
2.62
NA
31.25
09047425

A
Incision of bile duct
19.80
NA
8.83
2.61
NA
31.24
09047460

A
Incise bile duct sphincter
18.01
NA
8.38
2.20
NA
28.59
09047480

A
Incision of gallbladder
10.80
NA
5.92
1.42
NA
18.14
09047490

A
Incision of gallbladder
7.22
NA
5.58
0.43
NA
13.23
09047500

A
Injection for liver x-rays
1.96
NA
0.64
0.12
NA
2.72
00047505

A
Injection for liver x-rays
0.76
NA
0.25
0.04
NA
1.05
00047510

A
Insert catheter, bile duct
7.82
NA
5.02
0.46
NA
13.30
09047511

A
Insert bile duct drain
10.48
NA
5.09
0.62
NA
16.19
09047525

A
Change bile duct catheter
5.54
15.13
2.81
0.33
21.00
8.68
01047530

A
Revise/reinsert bile tube
5.84
33.88
3.72
0.37
40.09
9.93
090( print page 70387)47550

A
Bile duct endoscopy add-on
3.02
NA
1.02
0.40
NA
4.44
ZZZ47552

A
Biliary endoscopy thru skin
6.03
NA
2.38
0.42
NA
8.83
00047553

A
Biliary endoscopy thru skin
6.34
NA
2.07
0.37
NA
8.78
00047554

A
Biliary endoscopy thru skin
9.05
NA
3.36
0.96
NA
13.37
00047555

A
Biliary endoscopy thru skin
7.55
NA
2.47
0.45
NA
10.47
00047556

A
Biliary endoscopy thru skin
8.55
NA
2.79
0.50
NA
11.84
00047560

A
Laparoscopy w/cholangio
4.88
NA
1.67
0.65
NA
7.20
00047561

A
Laparo w/cholangio/biopsy
5.17
NA
1.92
0.66
NA
7.75
00047562

A
Laparoscopic cholecystectomy
11.07
NA
4.99
1.46
NA
17.52
09047563

A
Laparo cholecystectomy/graph
11.92
NA
5.31
1.58
NA
18.81
09047564

A
Laparo cholecystectomy/explr
14.21
NA
5.96
1.88
NA
22.05
09047570

A
Laparo cholecystoenterostomy
12.56
NA
5.38
1.65
NA
19.59
09047579

C
Laparoscope proc, biliary
0.00
0.00
0.00
0.00
0.00
0.00
YYY47600

A
Removal of gallbladder
13.56
NA
6.14
1.79
NA
21.49
09047605

A
Removal of gallbladder
14.67
NA
6.51
1.94
NA
23.12
09047610

A
Removal of gallbladder
18.79
NA
7.94
2.48
NA
29.21
09047612

A
Removal of gallbladder
18.75
NA
7.89
2.47
NA
29.11
09047620

A
Removal of gallbladder
20.61
NA
8.53
2.73
NA
31.87
09047630

A
Remove bile duct stone
9.10
NA
4.89
0.65
NA
14.64
09047700

A
Exploration of bile ducts
15.60
NA
7.42
2.06
NA
25.08
09047701

A
Bile duct revision
27.77
NA
11.50
3.67
NA
42.94
09047711

A
Excision of bile duct tumor
23.00
NA
9.94
3.04
NA
35.98
09047712

A
Excision of bile duct tumor
30.19
NA
12.44
3.92
NA
46.55
09047715

A
Excision of bile duct cyst
18.77
NA
8.44
2.48
NA
29.69
09047716

A
Fusion of bile duct cyst
16.42
NA
7.83
2.14
NA
26.39
09047720

A
Fuse gallbladder & bowel
15.89
NA
7.48
2.10
NA
25.47
09047721

A
Fuse upper gi structures
19.09
NA
8.57
2.52
NA
30.18
09047740

A
Fuse gallbladder & bowel
18.45
NA
8.38
2.41
NA
29.24
09047741

A
Fuse gallbladder & bowel
21.31
NA
9.30
2.82
NA
33.43
09047760

A
Fuse bile ducts and bowel
25.81
NA
10.86
3.41
NA
40.08
09047765

A
Fuse liver ducts & bowel
24.84
NA
10.81
3.29
NA
38.94
09047780

A
Fuse bile ducts and bowel
26.46
NA
11.22
3.49
NA
41.17
09047785

A
Fuse bile ducts and bowel
31.13
NA
12.93
4.09
NA
48.15
09047800

A
Reconstruction of bile ducts
23.27
NA
10.07
3.07
NA
36.41
09047801

A
Placement, bile duct support
15.15
NA
8.16
1.16
NA
24.47
09047802

A
Fuse liver duct & intestine
21.52
NA
9.68
2.85
NA
34.05
09047900

A
Suture bile duct injury
19.87
NA
8.88
2.64
NA
31.39
09047999

C
Bile tract surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY48000

A
Drainage of abdomen
28.03
NA
11.52
3.47
NA
43.02
09048001

A
Placement of drain, pancreas
35.40
NA
13.90
4.68
NA
53.98
09048005

A
Resect/debride pancreas
42.11
NA
16.59
5.54
NA
64.24
09048020

A
Removal of pancreatic stone
15.68
NA
7.31
2.12
NA
25.11
09048100

A
Biopsy of pancreas, open
12.21
NA
5.60
1.62
NA
19.43
09048102

A
Needle biopsy, pancreas
4.67
7.97
1.95
0.28
12.92
6.90
01048120

A
Removal of pancreas lesion
15.83
NA
6.86
2.09
NA
24.78
09048140

A
Partial removal of pancreas
22.91
NA
9.55
3.02
NA
35.48
09048145

A
Partial removal of pancreas
23.98
NA
9.84
3.17
NA
36.99
09048146

A
Pancreatectomy
26.36
NA
12.00
3.49
NA
41.85
09048148

A
Removal of pancreatic duct
17.31
NA
7.61
2.29
NA
27.21
09048150

A
Partial removal of pancreas
47.93
NA
19.54
6.30
NA
73.77
09048152

A
Pancreatectomy
43.68
NA
18.23
5.78
NA
67.69
09048153

A
Pancreatectomy
47.82
NA
19.58
6.29
NA
73.69
09048154

A
Pancreatectomy
44.03
NA
18.26
5.82
NA
68.11
09048155

A
Removal of pancreas
24.60
NA
11.68
3.26
NA
39.54
09048160

N
Pancreas removal/transplant
0.00
0.00
0.00
0.00
0.00
0.00
XXX48180

A
Fuse pancreas and bowel
24.68
NA
10.17
3.27
NA
38.12
09048400

A
Injection, intraop add-on
1.95
NA
0.64
0.15
NA
2.74
ZZZ48500

A
Surgery of pancreatic cyst
15.26
NA
7.34
2.02
NA
24.62
09048510

A
Drain pancreatic pseudocyst
14.29
NA
7.45
1.82
NA
23.56
09048511

A
Drain pancreatic pseudocyst
3.99
20.95
1.31
0.24
25.18
5.54
00048520

A
Fuse pancreas cyst and bowel
15.57
NA
6.71
2.05
NA
24.33
09048540

A
Fuse pancreas cyst and bowel
19.69
NA
8.12
2.60
NA
30.41
09048545

A
Pancreatorrhaphy
18.15
NA
7.99
2.37
NA
28.51
09048547

A
Duodenal exclusion
25.79
NA
10.50
3.41
NA
39.70
09048550

X
Donor pancreatectomy
0.00
0.00
0.00
0.00
0.00
0.00
XXX48551

C
Prep donor pancreas
0.00
0.00
0.00
0.00
0.00
0.00
XXX48552

A
Prep donor pancreas/venous
4.30
NA
1.46
0.31
NA
6.07
XXX48554

R
Transpl allograft pancreas
34.12
NA
18.30
4.18
NA
56.60
09048556

A
Removal, allograft pancreas
15.69
NA
8.08
2.07
NA
25.84
09048999

C
Pancreas surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY49000

A
Exploration of abdomen
11.66
NA
5.39
1.52
NA
18.57
09049002

A
Reopening of abdomen
10.47
NA
5.02
1.37
NA
16.86
09049010

A
Exploration behind abdomen
12.26
NA
5.91
1.51
NA
19.68
09049020

A
Drain abdominal abscess
22.81
NA
10.21
2.84
NA
35.86
09049021

A
Drain abdominal abscess
3.37
21.11
1.11
0.20
24.68
4.68
000( print page 70388)49040

A
Drain, open, abdom abscess
13.50
NA
6.43
1.69
NA
21.62
09049041

A
Drain, percut, abdom abscess
3.99
19.57
1.31
0.24
23.80
5.54
00049060

A
Drain, open, retrop abscess
15.84
NA
7.44
1.74
NA
25.02
09049061

A
Drain, percut, retroper absc
3.69
19.68
1.21
0.22
23.59
5.12
00049062

A
Drain to peritoneal cavity
11.34
NA
5.44
1.39
NA
18.17
09049080

A
Puncture, peritoneal cavity
1.35
3.99
0.46
0.08
5.42
1.89
00049081

A
Removal of abdominal fluid
1.26
2.59
0.43
0.09
3.94
1.78
00049085

A
Remove abdomen foreign body
12.12
NA
5.51
1.62
NA
19.25
09049180

A
Biopsy, abdominal mass
1.73
3.11
0.57
0.10
4.94
2.40
00049200

A
Removal of abdominal lesion
10.23
NA
5.03
1.24
NA
16.50
09049201

A
Remove abdom lesion, complex
14.82
NA
7.04
1.87
NA
23.73
09049215

A
Excise sacral spine tumor
33.45
NA
14.08
4.37
NA
51.90
09049220

A
Multiple surgery, abdomen
14.86
NA
6.64
1.88
NA
23.38
09049250

A
Excision of umbilicus
8.34
NA
4.27
1.08
NA
13.69
09049255

A
Removal of omentum
11.12
NA
5.62
1.43
NA
18.17
09049320

A
Diag laparo separate proc
5.09
NA
2.64
0.65
NA
8.38
01049321

A
Laparoscopy, biopsy
5.39
NA
2.65
0.70
NA
8.74
01049322

A
Laparoscopy, aspiration
5.69
NA
3.00
0.71
NA
9.40
01049323

A
Laparo drain lymphocele
9.47
NA
4.50
1.20
NA
15.17
09049329

C
Laparo proc, abdm/per/oment
0.00
0.00
0.00
0.00
0.00
0.00
YYY49400

A
Air injection into abdomen
1.88
3.08
0.62
0.15
5.11
2.65
00049419

A
Insrt abdom cath for chemotx
6.64
NA
3.57
0.81
NA
11.02
09049420

A
Insert abdom drain, temp
2.22
NA
1.09
0.21
NA
3.52
00049421

A
Insert abdom drain, perm
5.53
NA
3.16
0.74
NA
9.43
09049422

A
Remove perm cannula/catheter
6.24
NA
2.90
0.83
NA
9.97
01049423

A
Exchange drainage catheter
1.46
14.11
0.52
0.09
15.66
2.07
00049424

A
Assess cyst, contrast inject
0.76
3.72
0.29
0.04
4.52
1.09
00049425

A
Insert abdomen-venous drain
11.35
NA
5.61
1.54
NA
18.50
09049426

A
Revise abdomen-venous shunt
9.62
NA
4.77
1.28
NA
15.67
09049427

A
Injection, abdominal shunt
0.89
NA
0.30
0.07
NA
1.26
00049428

A
Ligation of shunt
6.05
NA
3.93
0.80
NA
10.78
01049429

A
Removal of shunt
7.39
NA
3.43
1.02
NA
11.84
01049491

A
Rpr hern preemie reduc
11.11
NA
5.06
1.40
NA
17.57
09049492

A
Rpr ing hern premie, blocked
14.01
NA
6.12
1.80
NA
21.93
09049495

A
Rpr ing hernia baby, reduc
5.88
NA
2.96
0.74
NA
9.58
09049496

A
Rpr ing hernia baby, blocked
8.78
NA
4.28
1.07
NA
14.13
09049500

A
Rpr ing hernia, init, reduce
5.47
NA
3.12
0.71
NA
9.30
09049501

A
Rpr ing hernia, init blocked
8.87
NA
4.21
1.12
NA
14.20
09049505

A
Prp i/hern init reduc >5 yr
7.59
NA
3.75
1.03
NA
12.37
09049507

A
Prp i/hern init block >5 yr
9.56
NA
4.46
1.27
NA
15.29
09049520

A
Rerepair ing hernia, reduce
9.62
NA
4.44
1.28
NA
15.34
09049521

A
Rerepair ing hernia, blocked
11.95
NA
5.25
1.59
NA
18.79
09049525

A
Repair ing hernia, sliding
8.56
NA
4.08
1.13
NA
13.77
09049540

A
Repair lumbar hernia
10.37
NA
4.75
1.37
NA
16.49
09049550

A
Rpr rem hernia, init, reduce
8.62
NA
4.13
1.14
NA
13.89
09049553

A
Rpr fem hernia, init blocked
9.43
NA
4.42
1.24
NA
15.09
09049555

A
Rerepair fem hernia, reduce
9.02
NA
4.27
1.20
NA
14.49
09049557

A
Rerepair fem hernia, blocked
11.13
NA
4.99
1.47
NA
17.59
09049560

A
Rpr ventral hern init, reduc
11.55
NA
5.15
1.52
NA
18.22
09049561

A
Rpr ventral hern init, block
14.23
NA
6.07
1.88
NA
22.18
09049565

A
Rerepair ventrl hern, reduce
11.55
NA
5.23
1.52
NA
18.30
09049566

A
Rerepair ventrl hern, block
14.38
NA
6.14
1.90
NA
22.42
09049568

A
Hernia repair w/mesh
4.88
NA
1.67
0.64
NA
7.19
ZZZ49570

A
Rpr epigastric hern, reduce
5.68
NA
3.17
0.75
NA
9.60
09049572

A
Rpr epigastric hern, blocked
6.72
NA
3.47
0.88
NA
11.07
09049580

A
Rpr umbil hern, reduc < 5 yr
4.10
NA
2.60
0.54
NA
7.24
09049582

A
Rpr umbil hern, block < 5 yr
6.64
NA
3.47
0.88
NA
10.99
09049585

A
Rpr umbil hern, reduc > 5 yr
6.22
NA
3.30
0.82
NA
10.34
09049587

A
Rpr umbil hern, block > 5 yr
7.55
NA
3.74
0.99
NA
12.28
09049590

A
Repair spigelian hernia
8.53
NA
4.09
1.13
NA
13.75
09049600

A
Repair umbilical lesion
10.94
NA
5.34
1.32
NA
17.60
09049605

A
Repair umbilical lesion
75.89
NA
28.58
9.36
NA
113.83
09049606

A
Repair umbilical lesion
18.57
NA
7.70
2.45
NA
28.72
09049610

A
Repair umbilical lesion
10.48
NA
5.21
1.07
NA
16.76
09049611

A
Repair umbilical lesion
8.91
NA
6.99
0.78
NA
16.68
09049650

A
Laparo hernia repair initial
6.26
NA
3.20
0.93
NA
10.39
09049651

A
Laparo hernia repair recur
8.23
NA
4.05
1.14
NA
13.42
09049659

C
Laparo proc, hernia repair
0.00
0.00
0.00
0.00
0.00
0.00
YYY49900

A
Repair of abdominal wall
12.26
NA
6.24
1.62
NA
20.12
09049904

A
Omental flap, extra-abdom
19.97
NA
15.25
2.69
NA
37.91
09049905

A
Omental flap, intra-abdom
6.54
NA
2.30
0.75
NA
9.59
ZZZ49906

C
Free omental flap, microvasc
0.00
0.00
0.00
0.00
0.00
0.00
09049999

C
Abdomen surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY50010

A
Exploration of kidney
10.96
NA
5.23
0.93
NA
17.12
09050020

A
Renal abscess, open drain
14.64
NA
7.76
1.34
NA
23.74
090( print page 70389)50021

A
Renal abscess, percut drain
3.37
21.71
1.10
0.20
25.28
4.67
00050040

A
Drainage of kidney
14.92
NA
6.82
1.03
NA
22.77
09050045

A
Exploration of kidney
15.44
NA
6.61
1.24
NA
23.29
09050060

A
Removal of kidney stone
19.27
NA
7.84
1.36
NA
28.47
09050065

A
Incision of kidney
20.76
NA
6.09
1.59
NA
28.44
09050070

A
Incision of kidney
20.29
NA
8.23
1.44
NA
29.96
09050075

A
Removal of kidney stone
25.30
NA
9.92
1.80
NA
37.02
09050080

A
Removal of kidney stone
14.69
NA
6.29
1.04
NA
22.02
09050081

A
Removal of kidney stone
21.77
NA
8.78
1.54
NA
32.09
09050100

A
Revise kidney blood vessels
16.07
NA
7.80
2.06
NA
25.93
09050120

A
Exploration of kidney
15.89
NA
6.78
1.21
NA
23.88
09050125

A
Explore and drain kidney
16.50
NA
6.98
1.43
NA
24.91
09050130

A
Removal of kidney stone
17.26
NA
7.18
1.22
NA
25.66
09050135

A
Exploration of kidney
19.15
NA
7.79
1.33
NA
28.27
09050200

A
Biopsy of kidney
2.63
NA
1.29
0.16
NA
4.08
00050205

A
Biopsy of kidney
11.29
NA
5.02
1.30
NA
17.61
09050220

A
Remove kidney, open
17.12
NA
7.25
1.35
NA
25.72
09050225

A
Removal kidney open, complex
20.20
NA
8.16
1.50
NA
29.86
09050230

A
Removal kidney open, radical
22.04
NA
8.59
1.55
NA
32.18
09050234

A
Removal of kidney & ureter
22.37
NA
8.85
1.59
NA
32.81
09050236

A
Removal of kidney & ureter
24.82
NA
10.27
1.76
NA
36.85
09050240

A
Partial removal of kidney
21.97
NA
9.03
1.55
NA
32.55
09050250

A
Cryoablate renal mass open
19.97
NA
9.18
1.39
NA
30.54
09050280

A
Removal of kidney lesion
15.65
NA
6.70
1.19
NA
23.54
09050290

A
Removal of kidney lesion
14.71
NA
6.47
1.41
NA
22.59
09050300

X
Remove cadaver donor kidney
0.00
0.00
0.00
0.00
0.00
0.00
XXX50320

A
Remove kidney, living donor
22.18
NA
10.68
2.35
NA
35.21
09050323

C
Prep cadaver renal allograft
0.00
0.00
0.00
0.00
0.00
0.00
XXX50325

C
Prep donor renal graft
0.00
0.00
0.00
0.00
0.00
0.00
XXX50327

A
Prep renal graft/venous
4.00
NA
1.35
0.29
NA
5.64
XXX50328

A
Prep renal graft/arterial
3.50
NA
1.18
0.26
NA
4.94
XXX50329

A
Prep renal graft/ureteral
3.34
NA
1.13
0.25
NA
4.72
XXX50340

A
Removal of kidney
12.13
NA
6.51
1.65
NA
20.29
09050360

A
Transplantation of kidney
31.48
NA
15.51
3.81
NA
50.80
09050365

A
Transplantation of kidney
36.75
NA
18.24
4.42
NA
59.41
09050370

A
Remove transplanted kidney
13.70
NA
7.16
1.67
NA
22.53
09050380

A
Reimplantation of kidney
20.73
NA
12.05
2.50
NA
35.28
09050382

A
Change ureter stent, percut
5.50
36.22
1.87
0.34
42.06
7.71
00050384

A
Remove ureter stent, percut
5.00
35.32
1.71
0.31
40.63
7.02
00050387

A
Change ext/int ureter stent
2.00
18.26
0.67
0.12
20.38
2.79
00050389

A
Remove renal tube w/fluoro
1.10
12.78
0.37
0.07
13.95
1.54
00050390

A
Drainage of kidney lesion
1.96
NA
0.64
0.12
NA
2.72
00050391

A
Instll rx agnt into rnal tub
1.96
1.58
0.63
0.14
3.68
2.73
00050392

A
Insert kidney drain
3.37
NA
1.52
0.20
NA
5.09
00050393

A
Insert ureteral tube
4.15
NA
1.79
0.25
NA
6.19
00050394

A
Injection for kidney x-ray
0.76
2.69
0.66
0.05
3.50
1.47
00050395

A
Create passage to kidney
3.37
NA
1.50
0.21
NA
5.08
00050396

A
Measure kidney pressure
2.09
NA
1.08
0.13
NA
3.30
00050398

A
Change kidney tube
1.46
16.36
0.52
0.09
17.91
2.07
00050400

A
Revision of kidney/ureter
19.47
NA
7.89
1.38
NA
28.74
09050405

A
Revision of kidney/ureter
23.89
NA
9.05
1.78
NA
34.72
09050500

A
Repair of kidney wound
19.54
NA
8.40
2.01
NA
29.95
09050520

A
Close kidney-skin fistula
17.20
NA
7.44
1.49
NA
26.13
09050525

A
Repair renal-abdomen fistula
22.24
NA
9.02
1.83
NA
33.09
09050526

A
Repair renal-abdomen fistula
23.98
NA
9.88
1.96
NA
35.82
09050540

A
Revision of horseshoe kidney
19.90
NA
8.34
1.36
NA
29.60
09050541

A
Laparo ablate renal cyst
15.98
NA
6.50
1.13
NA
23.61
09050542

A
Laparo ablate renal mass
19.97
NA
8.15
1.39
NA
29.51
09050543

A
Laparo partial nephrectomy
25.46
NA
10.22
1.80
NA
37.48
09050544

A
Laparoscopy, pyeloplasty
22.37
NA
8.54
1.58
NA
32.49
09050545

A
Laparo radical nephrectomy
23.96
NA
9.21
1.70
NA
34.87
09050546

A
Laparoscopic nephrectomy
20.45
NA
8.38
1.57
NA
30.40
09050547

A
Laparo removal donor kidney
25.46
NA
11.13
2.76
NA
39.35
09050548

A
Laparo remove w/ureter
24.36
NA
9.20
1.72
NA
35.28
09050549

C
Laparoscope proc, renal
0.00
0.00
0.00
0.00
0.00
0.00
YYY50551

A
Kidney endoscopy
5.59
4.15
1.98
0.40
10.14
7.97
00050553

A
Kidney endoscopy
5.98
4.37
2.18
0.39
10.74
8.55
00050555

A
Kidney endoscopy & biopsy
6.52
4.82
2.34
0.45
11.79
9.31
00050557

A
Kidney endoscopy & treatment
6.61
4.59
2.30
0.47
11.67
9.38
00050561

A
Kidney endoscopy & treatment
7.58
5.09
2.65
0.54
13.21
10.77
00050562

A
Renal scope w/tumor resect
10.90
NA
4.32
0.73
NA
15.95
09050570

A
Kidney endoscopy
9.53
NA
3.22
0.68
NA
13.43
00050572

A
Kidney endoscopy
10.33
NA
3.51
0.85
NA
14.69
00050574

A
Kidney endoscopy & biopsy
11.00
NA
3.75
0.77
NA
15.52
00050575

A
Kidney endoscopy
13.96
NA
4.64
0.99
NA
19.59
000( print page 70390)50576

A
Kidney endoscopy & treatment
10.97
NA
3.67
0.78
NA
15.42
00050580

A
Kidney endoscopy & treatment
11.84
NA
3.97
0.83
NA
16.64
00050590

A
Fragmenting of kidney stone
9.08
12.43
4.12
0.65
22.16
13.85
09050592

A
Perc rf ablate renal tumor
6.75
149.45
2.99
0.43
156.63
10.17
01050600

A
Exploration of ureter
15.82
NA
6.68
1.13
NA
23.63
09050605

A
Insert ureteral support
15.44
NA
6.75
1.45
NA
23.64
09050610

A
Removal of ureter stone
15.90
NA
6.98
1.43
NA
24.31
09050620

A
Removal of ureter stone
15.14
NA
6.35
1.07
NA
22.56
09050630

A
Removal of ureter stone
14.92
NA
6.29
1.09
NA
22.30
09050650

A
Removal of ureter
17.38
NA
7.24
1.23
NA
25.85
09050660

A
Removal of ureter
19.52
NA
7.97
1.38
NA
28.87
09050684

A
Injection for ureter x-ray
0.76
4.98
0.47
0.05
5.79
1.28
00050686

A
Measure ureter pressure
1.51
3.45
0.82
0.11
5.07
2.44
00050688

A
Change of ureter tube/stent
1.17
NA
1.06
0.07
NA
2.30
01050690

A
Injection for ureter x-ray
1.16
1.83
0.72
0.07
3.06
1.95
00050700

A
Revision of ureter
15.19
NA
7.13
1.27
NA
23.59
09050715

A
Release of ureter
18.87
NA
8.76
2.13
NA
29.76
09050722

A
Release of ureter
16.33
NA
7.82
1.90
NA
26.05
09050725

A
Release/revise ureter
18.46
NA
8.06
1.52
NA
28.04
09050727

A
Revise ureter
8.17
NA
4.28
0.61
NA
13.06
09050728

A
Revise ureter
12.00
NA
5.57
1.00
NA
18.57
09050740

A
Fusion of ureter & kidney
18.39
NA
7.75
1.96
NA
28.10
09050750

A
Fusion of ureter & kidney
19.48
NA
8.00
1.38
NA
28.86
09050760

A
Fusion of ureters
18.39
NA
7.69
1.55
NA
27.63
09050770

A
Splicing of ureters
19.48
NA
7.99
1.45
NA
28.92
09050780

A
Reimplant ureter in bladder
18.33
NA
7.60
1.51
NA
27.44
09050782

A
Reimplant ureter in bladder
19.51
NA
8.79
1.61
NA
29.91
09050783

A
Reimplant ureter in bladder
20.52
NA
8.23
1.98
NA
30.73
09050785

A
Reimplant ureter in bladder
20.49
NA
8.31
1.45
NA
30.25
09050800

A
Implant ureter in bowel
14.50
NA
6.48
1.19
NA
22.17
09050810

A
Fusion of ureter & bowel
20.02
NA
9.11
2.31
NA
31.44
09050815

A
Urine shunt to intestine
19.90
NA
8.46
1.54
NA
29.90
09050820

A
Construct bowel bladder
21.86
NA
8.66
1.89
NA
32.41
09050825

A
Construct bowel bladder
28.14
NA
11.15
2.07
NA
41.36
09050830

A
Revise urine flow
31.23
NA
12.20
2.37
NA
45.80
09050840

A
Replace ureter by bowel
19.97
NA
8.44
1.47
NA
29.88
09050845

A
Appendico-vesicostomy
20.86
NA
8.92
1.57
NA
31.35
09050860

A
Transplant ureter to skin
15.34
NA
6.63
1.29
NA
23.26
09050900

A
Repair of ureter
13.60
NA
6.15
1.14
NA
20.89
09050920

A
Closure ureter/skin fistula
14.31
NA
6.58
1.01
NA
21.90
09050930

A
Closure ureter/bowel fistula
18.69
NA
7.98
1.28
NA
27.95
09050940

A
Release of ureter
14.49
NA
6.41
1.26
NA
22.16
09050945

A
Laparoscopy ureterolithotomy
16.97
NA
7.05
1.36
NA
25.38
09050947

A
Laparo new ureter/bladder
24.46
NA
9.71
2.16
NA
36.33
09050948

A
Laparo new ureter/bladder
22.47
NA
8.71
1.70
NA
32.88
09050949

C
Laparoscope proc, ureter
0.00
0.00
0.00
0.00
0.00
0.00
YYY50951

A
Endoscopy of ureter
5.83
4.30
2.06
0.41
10.54
8.30
00050953

A
Endoscopy of ureter
6.23
4.41
2.37
0.43
11.07
9.03
00050955

A
Ureter endoscopy & biopsy
6.74
6.43
2.69
0.48
13.65
9.91
00050957

A
Ureter endoscopy & treatment
6.78
4.57
2.38
0.48
11.83
9.64
00050961

A
Ureter endoscopy & treatment
6.04
4.37
2.19
0.41
10.82
8.64
00050970

A
Ureter endoscopy
7.13
NA
2.47
0.52
NA
10.12
00050972

A
Ureter endoscopy & catheter
6.88
NA
2.47
0.49
NA
9.84
00050974

A
Ureter endoscopy & biopsy
9.16
NA
3.11
0.64
NA
12.91
00050976

A
Ureter endoscopy & treatment
9.03
NA
3.07
0.66
NA
12.76
00050980

A
Ureter endoscopy & treatment
6.84
NA
2.38
0.48
NA
9.70
00051000

A
Drainage of bladder
0.78
1.95
0.24
0.05
2.78
1.07
00051005

A
Drainage of bladder
1.02
4.71
0.34
0.10
5.83
1.46
00051010

A
Drainage of bladder
3.52
5.62
1.88
0.28
9.42
5.68
01051020

A
Incise & treat bladder
6.70
NA
3.86
0.47
NA
11.03
09051030

A
Incise & treat bladder
6.76
NA
3.98
0.58
NA
11.32
09051040

A
Incise & drain bladder
4.39
NA
2.77
0.31
NA
7.47
09051045

A
Incise bladder/drain ureter
6.76
NA
3.93
0.52
NA
11.21
09051050

A
Removal of bladder stone
6.91
NA
3.65
0.49
NA
11.05
09051060

A
Removal of ureter stone
8.84
NA
4.51
0.62
NA
13.97
09051065

A
Remove ureter calculus
8.84
NA
4.36
0.63
NA
13.83
09051080

A
Drainage of bladder abscess
5.95
NA
3.55
0.43
NA
9.93
09051500

A
Removal of bladder cyst
10.12
NA
5.01
1.03
NA
16.16
09051520

A
Removal of bladder lesion
9.28
NA
4.68
0.69
NA
14.65
09051525

A
Removal of bladder lesion
13.95
NA
6.14
0.99
NA
21.08
09051530

A
Removal of bladder lesion
12.36
NA
5.76
1.05
NA
19.17
09051535

A
Repair of ureter lesion
12.55
NA
6.12
1.23
NA
19.90
09051550

A
Partial removal of bladder
15.64
NA
6.74
1.31
NA
23.69
09051555

A
Partial removal of bladder
21.20
NA
8.68
1.69
NA
31.57
09051565

A
Revise bladder & ureter(s)
21.59
NA
8.98
1.63
NA
32.20
090( print page 70391)51570

A
Removal of bladder
24.20
NA
9.76
1.71
NA
35.67
09051575

A
Removal of bladder & nodes
30.40
NA
12.05
2.16
NA
44.61
09051580

A
Remove bladder/revise tract
31.03
NA
12.52
2.24
NA
45.79
09051585

A
Removal of bladder & nodes
35.18
NA
13.73
2.48
NA
51.39
09051590

A
Remove bladder/revise tract
32.61
NA
12.64
2.27
NA
47.52
09051595

A
Remove bladder/revise tract
37.08
NA
14.16
2.59
NA
53.83
09051596

A
Remove bladder/create pouch
39.46
NA
15.26
2.77
NA
57.49
09051597

A
Removal of pelvic structures
38.29
NA
14.86
2.81
NA
55.96
09051600

A
Injection for bladder x-ray
0.88
5.06
0.29
0.06
6.00
1.23
00051605

A
Preparation for bladder xray
0.64
6.07
0.35
0.04
6.75
1.03
00051610

A
Injection for bladder x-ray
1.05
2.29
0.60
0.07
3.41
1.72
00051700

A
Irrigation of bladder
0.88
1.60
0.28
0.06
2.54
1.22
00051701

A
Insert bladder catheter
0.50
1.58
0.19
0.04
2.12
0.73
00051702

A
Insert temp bladder cath
0.50
2.09
0.24
0.04
2.63
0.78
00051703

A
Insert bladder cath, complex
1.47
2.74
0.56
0.10
4.31
2.13
00051705

A
Change of bladder tube
1.02
2.28
0.61
0.07
3.37
1.70
01051710

A
Change of bladder tube
1.49
3.34
0.77
0.11
4.94
2.37
01051715

A
Endoscopic injection/implant
3.73
3.91
1.35
0.29
7.93
5.37
00051720

A
Treatment of bladder lesion
1.96
1.75
0.69
0.14
3.85
2.79
00051725
26
A
Simple cystometrogram
1.51
0.49
0.49
0.12
2.12
2.12
00051725
TC
A
Simple cystometrogram
0.00
5.11
NA
0.04
5.15
NA
00051725

A
Simple cystometrogram
1.51
5.60
NA
0.16
7.27
NA
00051726
26
A
Complex cystometrogram
1.71
0.56
0.56
0.13
2.40
2.40
00051726
TC
A
Complex cystometrogram
0.00
6.96
NA
0.05
7.01
NA
00051726

A
Complex cystometrogram
1.71
7.52
NA
0.18
9.41
NA
00051736
26
A
Urine flow measurement
0.61
0.20
0.20
0.05
0.86
0.86
00051736
TC
A
Urine flow measurement
0.00
0.38
NA
0.01
0.39
NA
00051736

A
Urine flow measurement
0.61
0.58
NA
0.06
1.25
NA
00051741
26
A
Electro-uroflowmetry, first
1.14
0.37
0.37
0.09
1.60
1.60
00051741
TC
A
Electro-uroflowmetry, first
0.00
0.42
NA
0.02
0.44
NA
00051741

A
Electro-uroflowmetry, first
1.14
0.79
NA
0.11
2.04
NA
00051772
26
A
Urethra pressure profile
1.61
0.55
0.55
0.15
2.31
2.31
00051772
TC
A
Urethra pressure profile
0.00
5.04
NA
0.05
5.09
NA
00051772

A
Urethra pressure profile
1.61
5.59
NA
0.20
7.40
NA
00051784
26
A
Anal/urinary muscle study
1.53
0.50
0.50
0.12
2.15
2.15
00051784
TC
A
Anal/urinary muscle study
0.00
3.49
NA
0.04
3.53
NA
00051784

A
Anal/urinary muscle study
1.53
3.99
NA
0.16
5.68
NA
00051785
26
A
Anal/urinary muscle study
1.53
0.50
0.50
0.11
2.14
2.14
00051785
TC
A
Anal/urinary muscle study
0.00
3.95
NA
0.04
3.99
NA
00051785

A
Anal/urinary muscle study
1.53
4.45
NA
0.15
6.13
NA
00051792
26
A
Urinary reflex study
1.10
0.41
0.41
0.07
1.58
1.58
00051792
TC
A
Urinary reflex study
0.00
5.60
NA
0.13
5.73
NA
00051792

A
Urinary reflex study
1.10
6.01
NA
0.20
7.31
NA
00051795
26
A
Urine voiding pressure study
1.53
0.50
0.50
0.12
2.15
2.15
00051795
TC
A
Urine voiding pressure study
0.00
6.81
NA
0.10
6.91
NA
00051795

A
Urine voiding pressure study
1.53
7.31
NA
0.22
9.06
NA
00051797
26
A
Intraabdominal pressure test
1.60
0.53
0.53
0.12
2.25
2.25
00051797
TC
A
Intraabdominal pressure test
0.00
5.27
NA
0.05
5.32
NA
00051797

A
Intraabdominal pressure test
1.60
5.80
NA
0.17
7.57
NA
00051798

A
Us urine capacity measure
0.00
0.34
NA
0.08
0.42
NA
XXX51800

A
Revision of bladder/urethra
17.39
NA
7.58
1.32
NA
26.29
09051820

A
Revision of urinary tract
17.86
NA
8.30
1.74
NA
27.90
09051840

A
Attach bladder/urethra
10.69
NA
5.58
1.06
NA
17.33
09051841

A
Attach bladder/urethra
13.01
NA
6.39
1.24
NA
20.64
09051845

A
Repair bladder neck
9.72
NA
4.75
0.79
NA
15.26
09051860

A
Repair of bladder wound
12.00
NA
5.77
1.16
NA
18.93
09051865

A
Repair of bladder wound
15.02
NA
6.69
1.23
NA
22.94
09051880

A
Repair of bladder opening
7.65
NA
3.96
0.72
NA
12.33
09051900

A
Repair bladder/vagina lesion
12.95
NA
6.08
1.21
NA
20.24
09051920

A
Close bladder-uterus fistula
11.79
NA
5.65
1.18
NA
18.62
09051925

A
Hysterectomy/bladder repair
15.56
NA
8.63
2.03
NA
26.22
09051940

A
Correction of bladder defect
28.39
NA
12.11
2.14
NA
42.64
09051960

A
Revision of bladder & bowel
22.98
NA
9.66
1.63
NA
34.27
09051980

A
Construct bladder opening
11.34
NA
5.39
0.86
NA
17.59
09051990

A
Laparo urethral suspension
12.48
NA
6.16
1.39
NA
20.03
09051992

A
Laparo sling operation
13.99
NA
6.22
1.41
NA
21.62
09051999

C
Laparoscope proc, bladder
0.00
0.00
0.00
0.00
0.00
0.00
YYY52000

A
Cystoscopy
2.01
3.31
0.76
0.14
5.46
2.91
00052001

A
Cystoscopy, removal of clots
5.44
5.08
1.87
0.39
10.91
7.70
00052005

A
Cystoscopy & ureter catheter
2.37
5.58
0.89
0.17
8.12
3.43
00052007

A
Cystoscopy and biopsy
3.02
16.49
1.15
0.22
19.73
4.39
00052010

A
Cystoscopy & duct catheter
3.02
10.78
1.15
0.21
14.01
4.38
00052204

A
Cystoscopy
2.37
14.55
0.90
0.17
17.09
3.44
00052214

A
Cystoscopy and treatment
3.70
38.21
1.33
0.26
42.17
5.29
00052224

A
Cystoscopy and treatment
3.14
36.56
1.15
0.22
39.92
4.51
000( print page 70392)52234

A
Cystoscopy and treatment
4.62
NA
1.66
0.33
NA
6.61
00052235

A
Cystoscopy and treatment
5.44
NA
1.94
0.39
NA
7.77
00052240

A
Cystoscopy and treatment
9.71
NA
3.31
0.69
NA
13.71
00052250

A
Cystoscopy and radiotracer
4.49
NA
1.65
0.32
NA
6.46
00052260

A
Cystoscopy and treatment
3.91
NA
1.42
0.28
NA
5.61
00052265

A
Cystoscopy and treatment
2.94
13.38
1.11
0.22
16.54
4.27
00052270

A
Cystoscopy & revise urethra
3.36
11.06
1.24
0.24
14.66
4.84
00052275

A
Cystoscopy & revise urethra
4.69
15.60
1.66
0.33
20.62
6.68
00052276

A
Cystoscopy and treatment
4.99
NA
1.79
0.35
NA
7.13
00052277

A
Cystoscopy and treatment
6.16
NA
2.23
0.44
NA
8.83
00052281

A
Cystoscopy and treatment
2.80
7.11
1.08
0.20
10.11
4.08
00052282

A
Cystoscopy, implant stent
6.39
NA
2.24
0.45
NA
9.08
00052283

A
Cystoscopy and treatment
3.73
3.95
1.38
0.26
7.94
5.37
00052285

A
Cystoscopy and treatment
3.60
4.02
1.33
0.26
7.88
5.19
00052290

A
Cystoscopy and treatment
4.58
NA
1.65
0.32
NA
6.55
00052300

A
Cystoscopy and treatment
5.30
NA
1.91
0.38
NA
7.59
00052301

A
Cystoscopy and treatment
5.50
NA
1.99
0.46
NA
7.95
00052305

A
Cystoscopy and treatment
5.30
NA
1.86
0.38
NA
7.54
00052310

A
Cystoscopy and treatment
2.81
4.70
1.03
0.20
7.71
4.04
00052315

A
Cystoscopy and treatment
5.20
8.69
1.84
0.37
14.26
7.41
00052317

A
Remove bladder stone
6.71
29.02
2.29
0.48
36.21
9.48
00052318

A
Remove bladder stone
9.18
NA
3.10
0.65
NA
12.93
00052320

A
Cystoscopy and treatment
4.69
NA
1.63
0.33
NA
6.65
00052325

A
Cystoscopy, stone removal
6.15
NA
2.12
0.44
NA
8.71
00052327

A
Cystoscopy, inject material
5.18
31.90
1.82
0.37
37.45
7.37
00052330

A
Cystoscopy and treatment
5.03
38.93
1.76
0.36
44.32
7.15
00052332

A
Cystoscopy and treatment
2.83
5.76
1.05
0.21
8.80
4.09
00052334

A
Create passage to kidney
4.82
NA
1.74
0.35
NA
6.91
00052341

A
Cysto w/ureter stricture tx
5.99
NA
2.22
0.43
NA
8.64
00052342

A
Cysto w/up stricture tx
6.49
NA
2.35
0.46
NA
9.30
00052343

A
Cysto w/renal stricture tx
7.19
NA
2.59
0.51
NA
10.29
00052344

A
Cysto/uretero, stricture tx
7.69
NA
2.80
0.55
NA
11.04
00052345

A
Cysto/uretero w/up stricture
8.19
NA
2.96
0.58
NA
11.73
00052346

A
Cystouretero w/renal strict
9.22
NA
3.29
0.65
NA
13.16
00052351

A
Cystouretero & or pyeloscope
5.85
NA
2.15
0.41
NA
8.41
00052352

A
Cystouretero w/stone remove
6.87
NA
2.51
0.49
NA
9.87
00052353

A
Cystouretero w/lithotripsy
7.96
NA
2.86
0.57
NA
11.39
00052354

A
Cystouretero w/biopsy
7.33
NA
2.68
0.52
NA
10.53
00052355

A
Cystouretero w/excise tumor
8.81
NA
3.15
0.63
NA
12.59
00052400

A
Cystouretero w/congen repr
9.67
NA
3.74
0.68
NA
14.09
09052402

A
Cystourethro cut ejacul duct
5.27
NA
1.70
0.40
NA
7.37
00052450

A
Incision of prostate
7.63
NA
3.68
0.54
NA
11.85
09052500

A
Revision of bladder neck
8.46
NA
3.93
0.60
NA
12.99
09052510

A
Dilation prostatic urethra
6.71
NA
3.12
0.48
NA
10.31
09052601

A
Prostatectomy (TURP)
12.35
NA
5.11
0.87
NA
18.33
09052606

A
Control postop bleeding
8.12
NA
3.56
0.57
NA
12.25
09052612

A
Prostatectomy, first stage
7.97
NA
3.74
0.56
NA
12.27
09052614

A
Prostatectomy, second stage
6.83
NA
3.35
0.48
NA
10.66
09052620

A
Remove residual prostate
6.60
NA
2.99
0.47
NA
10.06
09052630

A
Remove prostate regrowth
7.25
NA
3.20
0.51
NA
10.96
09052640

A
Relieve bladder contracture
6.61
NA
2.97
0.47
NA
10.05
09052647

A
Laser surgery of prostate
10.34
74.15
4.54
0.73
85.22
15.61
09052648

A
Laser surgery of prostate
11.19
NA
4.80
0.79
NA
16.78
09052700

A
Drainage of prostate abscess
6.79
NA
3.19
0.48
NA
10.46
09053000

A
Incision of urethra
2.28
NA
1.54
0.16
NA
3.98
01053010

A
Incision of urethra
3.63
NA
2.92
0.24
NA
6.79
09053020

A
Incision of urethra
1.77
3.01
0.67
0.13
4.91
2.57
00053025

A
Incision of urethra
1.13
3.74
0.51
0.08
4.95
1.72
00053040

A
Drainage of urethra abscess
6.39
NA
3.44
0.45
NA
10.28
09053060

A
Drainage of urethra abscess
2.63
2.09
1.37
0.28
5.00
4.28
01053080

A
Drainage of urinary leakage
6.28
NA
5.97
0.52
NA
12.77
09053085

A
Drainage of urinary leakage
10.25
NA
7.42
0.92
NA
18.59
09053200

A
Biopsy of urethra
2.59
1.32
0.98
0.20
4.11
3.77
00053210

A
Removal of urethra
12.55
NA
5.85
0.89
NA
19.29
09053215

A
Removal of urethra
15.56
NA
6.64
1.10
NA
23.30
09053220

A
Treatment of urethra lesion
6.99
NA
3.72
0.49
NA
11.20
09053230

A
Removal of urethra lesion
9.57
NA
4.72
0.73
NA
15.02
09053235

A
Removal of urethra lesion
10.12
NA
4.91
0.72
NA
15.75
09053240

A
Surgery for urethra pouch
6.44
NA
3.53
0.52
NA
10.49
09053250

A
Removal of urethra gland
5.88
NA
3.30
0.49
NA
9.67
09053260

A
Treatment of urethra lesion
2.98
2.25
1.42
0.25
5.48
4.65
01053265

A
Treatment of urethra lesion
3.12
2.72
1.42
0.24
6.08
4.78
01053270

A
Removal of urethra gland
3.09
2.21
1.54
0.30
5.60
4.93
01053275

A
Repair of urethra defect
4.52
NA
2.26
0.32
NA
7.10
01053400

A
Revise urethra, stage 1
12.75
NA
6.04
0.98
NA
19.77
090( print page 70393)53405

A
Revise urethra, stage 2
14.46
NA
6.33
1.10
NA
21.89
09053410

A
Reconstruction of urethra
16.42
NA
7.07
1.16
NA
24.65
09053415

A
Reconstruction of urethra
19.38
NA
7.35
1.37
NA
28.10
09053420

A
Reconstruct urethra, stage 1
14.06
NA
6.30
0.96
NA
21.32
09053425

A
Reconstruct urethra, stage 2
15.96
NA
6.90
1.13
NA
23.99
09053430

A
Reconstruction of urethra
16.32
NA
7.01
1.15
NA
24.48
09053431

A
Reconstruct urethra/bladder
19.86
NA
8.07
1.41
NA
29.34
09053440

A
Male sling procedure
13.60
NA
5.99
0.96
NA
20.55
09053442

A
Remove/revise male sling
11.55
NA
5.45
0.82
NA
17.82
09053444

A
Insert tandem cuff
13.38
NA
5.89
0.94
NA
20.21
09053445

A
Insert uro/ves nck sphincter
14.04
NA
7.10
0.99
NA
22.13
09053446

A
Remove uro sphincter
10.21
NA
5.23
0.72
NA
16.16
09053447

A
Remove/replace ur sphincter
13.47
NA
6.44
0.95
NA
20.86
09053448

A
Remov/replc ur sphinctr comp
21.12
NA
9.07
1.50
NA
31.69
09053449

A
Repair uro sphincter
9.69
NA
4.73
0.68
NA
15.10
09053450

A
Revision of urethra
6.13
NA
3.30
0.43
NA
9.86
09053460

A
Revision of urethra
7.11
NA
3.70
0.50
NA
11.31
09053500

A
Urethrlys, transvag w/ scope
12.19
NA
6.22
0.90
NA
19.31
09053502

A
Repair of urethra injury
7.62
NA
3.99
0.62
NA
12.23
09053505

A
Repair of urethra injury
7.62
NA
3.87
0.54
NA
12.03
09053510

A
Repair of urethra injury
10.09
NA
5.17
0.74
NA
16.00
09053515

A
Repair of urethra injury
13.29
NA
5.94
1.05
NA
20.28
09053520

A
Repair of urethra defect
8.67
NA
4.48
0.61
NA
13.76
09053600

A
Dilate urethra stricture
1.21
1.14
0.43
0.09
2.44
1.73
00053601

A
Dilate urethra stricture
0.98
1.27
0.37
0.07
2.32
1.42
00053605

A
Dilate urethra stricture
1.28
NA
0.41
0.09
NA
1.78
00053620

A
Dilate urethra stricture
1.62
2.00
0.59
0.11
3.73
2.32
00053621

A
Dilate urethra stricture
1.35
2.08
0.49
0.10
3.53
1.94
00053660

A
Dilation of urethra
0.71
1.31
0.31
0.05
2.07
1.07
00053661

A
Dilation of urethra
0.72
1.30
0.29
0.05
2.07
1.06
00053665

A
Dilation of urethra
0.76
NA
0.25
0.06
NA
1.07
00053850

A
Prostatic microwave thermotx
9.44
94.33
3.95
0.67
104.44
14.06
09053852

A
Prostatic rf thermotx
9.87
89.03
4.38
0.70
99.60
14.95
09053853

A
Prostatic water thermother
5.23
55.50
2.86
0.37
61.10
8.46
09053899

C
Urology surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY54000

A
Slitting of prepuce
1.54
2.92
0.93
0.11
4.57
2.58
01054001

A
Slitting of prepuce
2.19
3.19
1.11
0.15
5.53
3.45
01054015

A
Drain penis lesion
5.31
NA
2.56
0.38
NA
8.25
01054050

A
Destruction, penis lesion(s)
1.24
1.66
1.03
0.08
2.98
2.35
01054055

A
Destruction, penis lesion(s)
1.22
1.57
0.80
0.08
2.87
2.10
01054056

A
Cryosurgery, penis lesion(s)
1.24
1.69
1.13
0.06
2.99
2.43
01054057

A
Laser surg, penis lesion(s)
1.24
2.22
0.83
0.09
3.55
2.16
01054060

A
Excision of penis lesion(s)
1.93
3.11
1.06
0.13
5.17
3.12
01054065

A
Destruction, penis lesion(s)
2.42
2.64
1.23
0.13
5.19
3.78
01054100

A
Biopsy of penis
1.90
2.81
0.82
0.10
4.81
2.82
00054105

A
Biopsy of penis
3.49
4.29
1.94
0.25
8.03
5.68
01054110

A
Treatment of penis lesion
10.11
NA
4.76
0.72
NA
15.59
09054111

A
Treat penis lesion, graft
13.55
NA
5.78
0.96
NA
20.29
09054112

A
Treat penis lesion, graft
15.84
NA
6.81
1.11
NA
23.76
09054115

A
Treatment of penis lesion
6.14
4.38
3.46
0.43
10.95
10.03
09054120

A
Partial removal of penis
9.96
NA
4.68
0.68
NA
15.32
09054125

A
Removal of penis
13.51
NA
5.84
0.95
NA
20.30
09054130

A
Remove penis & nodes
20.11
NA
8.19
1.52
NA
29.82
09054135

A
Remove penis & nodes
26.32
NA
10.19
1.87
NA
38.38
09054150

A
Circumcision
1.81
4.36
0.70
0.16
6.33
2.67
00054152

A
Circumcision
2.31
NA
1.20
0.19
NA
3.70
01054160

A
Circumcision
2.48
4.15
1.09
0.19
6.82
3.76
01054161

A
Circumcision
3.27
NA
1.56
0.23
NA
5.06
01054162

A
Lysis penil circumic lesion
3.00
4.66
1.44
0.21
7.87
4.65
01054163

A
Repair of circumcision
3.00
NA
2.01
0.21
NA
5.22
01054164

A
Frenulotomy of penis
2.50
NA
1.84
0.18
NA
4.52
01054200

A
Treatment of penis lesion
1.06
1.80
0.97
0.08
2.94
2.11
01054205

A
Treatment of penis lesion
7.92
NA
4.69
0.56
NA
13.17
09054220

A
Treatment of penis lesion
2.42
3.85
0.95
0.17
6.44
3.54
00054230

A
Prepare penis study
1.34
1.08
0.63
0.09
2.51
2.06
00054231

A
Dynamic cavernosometry
2.04
1.37
0.87
0.16
3.57
3.07
00054235

A
Penile injection
1.19
0.96
0.58
0.08
2.23
1.85
00054240
26
A
Penis study
1.31
0.43
0.43
0.11
1.85
1.85
00054240
TC
A
Penis study
0.00
0.60
NA
0.06
0.66
NA
00054240

A
Penis study
1.31
1.03
NA
0.17
2.51
NA
00054250
26
A
Penis study
2.22
0.71
0.71
0.16
3.09
3.09
00054250
TC
A
Penis study
0.00
0.20
NA
0.02
0.22
NA
00054250

A
Penis study
2.22
0.91
NA
0.18
3.31
NA
00054300

A
Revision of penis
10.39
NA
5.58
0.76
NA
16.73
09054304

A
Revision of penis
12.47
NA
6.34
0.88
NA
19.69
090( print page 70394)54308

A
Reconstruction of urethra
11.81
NA
5.97
0.84
NA
18.62
09054312

A
Reconstruction of urethra
13.55
NA
7.00
1.24
NA
1.79
09054316

A
Reconstruction of urethra
16.79
NA
7.96
1.21
NA
25.96
09054318

A
Reconstruction of urethra
11.23
NA
5.80
1.39
NA
18.42
09054322

A
Reconstruction of urethra
12.99
NA
6.47
0.92
NA
20.38
09054324

A
Reconstruction of urethra
16.29
NA
7.97
1.14
NA
25.40
09054326

A
Reconstruction of urethra
15.70
NA
7.79
1.11
NA
24.60
09054328

A
Revise penis/urethra
15.63
NA
7.26
0.98
NA
23.87
09054332

A
Revise penis/urethra
17.05
NA
7.74
1.21
NA
26.00
09054336

A
Revise penis/urethra
20.01
NA
10.31
2.20
NA
32.52
09054340

A
Secondary urethral surgery
8.90
NA
5.04
0.63
NA
14.57
09054344

A
Secondary urethral surgery
15.92
NA
7.76
1.54
NA
25.22
09054348

A
Secondary urethral surgery
17.12
NA
8.36
1.23
NA
26.71
09054352

A
Reconstruct urethra/penis
24.70
NA
11.20
2.24
NA
38.14
09054360

A
Penis plastic surgery
11.91
NA
6.04
0.84
NA
18.79
09054380

A
Repair penis
13.16
NA
6.62
0.93
NA
20.71
09054385

A
Repair penis
15.37
NA
8.27
0.86
NA
24.50
09054390

A
Repair penis and bladder
21.58
NA
9.43
1.54
NA
32.55
09054400

A
Insert semi-rigid prosthesis
8.98
NA
4.35
0.64
NA
13.97
09054401

A
Insert self-contd prosthesis
10.26
NA
5.74
0.73
NA
16.73
09054405

A
Insert multi-comp penis pros
13.41
NA
5.93
0.95
NA
20.29
09054406

A
Remove muti-comp penis pros
12.08
NA
5.43
0.86
NA
18.37
09054408

A
Repair multi-comp penis pros
12.73
NA
5.74
0.90
NA
19.37
09054410

A
Remove/replace penis prosth
15.48
NA
6.63
1.10
NA
23.21
09054411

A
Remov/replc penis pros, comp
15.98
NA
7.05
1.13
NA
24.16
09054415

A
Remove self-contd penis pros
8.19
NA
4.20
0.58
NA
12.97
09054416

A
Remv/repl penis contain pros
10.85
NA
5.38
0.77
NA
17.00
09054417

A
Remv/replc penis pros, compl
14.17
NA
6.18
1.00
NA
21.35
09054420

A
Revision of penis
11.40
NA
5.58
0.81
NA
17.79
09054430

A
Revision of penis
10.13
NA
5.11
0.72
NA
15.96
09054435

A
Revision of penis
6.11
NA
3.62
0.43
NA
10.16
09054440

C
Repair of penis
0.00
0.00
0.00
0.00
0.00
0.00
09054450

A
Preputial stretching
1.12
0.95
0.44
0.08
2.15
1.64
00054500

A
Biopsy of testis
1.31
0.61
0.56
0.10
2.02
1.97
00054505

A
Biopsy of testis
3.45
NA
1.92
0.27
NA
5.64
01054512

A
Excise lesion testis
8.57
NA
4.13
0.67
NA
13.37
09054520

A
Removal of testis
5.22
NA
2.79
0.50
NA
8.51
09054522

A
Orchiectomy, partial
9.49
NA
4.87
0.89
NA
15.25
09054530

A
Removal of testis
8.57
NA
4.24
0.66
NA
13.47
09054535

A
Extensive testis surgery
12.14
NA
5.55
0.95
NA
18.64
09054550

A
Exploration for testis
7.77
NA
3.81
0.59
NA
12.17
09054560

A
Exploration for testis
11.11
NA
5.16
0.90
NA
17.17
09054600

A
Reduce testis torsion
7.00
NA
3.55
0.51
NA
11.06
09054620

A
Suspension of testis
4.89
NA
2.44
0.37
NA
7.70
01054640

A
Suspension of testis
6.89
NA
3.74
0.62
NA
11.25
09054650

A
Orchiopexy (Fowler-Stephens)
11.43
NA
5.41
1.16
NA
18.00
09054660

A
Revision of testis
5.10
NA
3.00
0.44
NA
8.54
09054670

A
Repair testis injury
6.40
NA
3.54
0.47
NA
10.41
09054680

A
Relocation of testis(es)
12.63
NA
6.16
1.16
NA
19.95
09054690

A
Laparoscopy, orchiectomy
10.94
NA
4.94
1.02
NA
16.90
09054692

A
Laparoscopy, orchiopexy
12.86
NA
5.44
1.30
NA
19.60
09054699

C
Laparoscope proc, testis
0.00
0.00
0.00
0.00
0.00
0.00
YYY54700

A
Drainage of scrotum
3.42
NA
1.94
0.28
NA
5.64
01054800

A
Biopsy of epididymis
2.33
0.94
0.90
0.23
3.50
3.46
00054820

A
Exploration of epididymis
5.13
NA
2.94
0.40
NA
8.47
09054830

A
Remove epididymis lesion
5.37
NA
3.02
0.41
NA
8.80
09054840

A
Remove epididymis lesion
5.19
NA
2.78
0.37
NA
8.34
09054860

A
Removal of epididymis
6.31
NA
3.31
0.45
NA
10.07
09054861

A
Removal of epididymis
8.89
NA
4.31
0.63
NA
13.83
09054900

A
Fusion of spermatic ducts
13.18
NA
5.80
0.93
NA
19.91
09054901

A
Fusion of spermatic ducts
17.91
NA
7.53
1.82
NA
27.26
09055000

A
Drainage of hydrocele
1.43
2.07
0.65
0.11
3.61
2.19
00055040

A
Removal of hydrocele
5.35
NA
2.90
0.43
NA
8.68
09055041

A
Removal of hydroceles
7.73
NA
3.97
0.60
NA
12.30
09055060

A
Repair of hydrocele
5.51
NA
3.08
0.46
NA
9.05
09055100

A
Drainage of scrotum abscess
2.13
3.68
1.56
0.17
5.98
3.86
01055110

A
Explore scrotum
5.69
NA
3.13
0.43
NA
9.25
09055120

A
Removal of scrotum lesion
5.08
NA
2.95
0.39
NA
8.42
09055150

A
Removal of scrotum
7.21
NA
3.84
0.56
NA
11.61
09055175

A
Revision of scrotum
5.23
NA
3.01
0.37
NA
8.61
09055180

A
Revision of scrotum
10.70
NA
5.37
0.90
NA
16.97
09055200

A
Incision of sperm duct
4.23
12.35
2.38
0.33
16.91
6.94
09055250

A
Removal of sperm duct(s)
3.29
11.50
2.22
0.25
15.04
5.76
09055300

A
Prepare, sperm duct x-ray
3.50
NA
1.31
0.25
NA
5.06
00055400

A
Repair of sperm duct
8.48
NA
4.06
0.64
NA
13.18
090( print page 70395)55450

A
Ligation of sperm duct
4.11
7.01
1.87
0.29
11.41
6.27
01055500

A
Removal of hydrocele
5.58
NA
3.09
0.55
NA
9.22
09055520

A
Removal of sperm cord lesion
6.02
NA
3.25
0.75
NA
10.02
09055530

A
Revise spermatic cord veins
5.65
NA
3.01
0.45
NA
9.11
09055535

A
Revise spermatic cord veins
6.55
NA
3.40
0.47
NA
10.42
09055540

A
Revise hernia & sperm veins
7.66
NA
3.80
0.94
NA
12.40
09055550

A
Laparo ligate spermatic vein
6.56
NA
3.30
0.57
NA
10.43
09055559

C
Laparo proc, spermatic cord
0.00
0.00
0.00
0.00
0.00
0.00
YYY55600

A
Incise sperm duct pouch
6.37
NA
3.33
0.62
NA
10.32
09055605

A
Incise sperm duct pouch
7.95
NA
4.29
0.64
NA
12.88
09055650

A
Remove sperm duct pouch
11.78
NA
5.28
0.92
NA
17.98
09055680

A
Remove sperm pouch lesion
5.18
NA
2.97
0.47
NA
8.62
09055700

A
Biopsy of prostate
1.57
4.20
0.64
0.11
5.88
2.32
00055705

A
Biopsy of prostate
4.56
NA
2.30
0.32
NA
7.18
01055720

A
Drainage of prostate abscess
7.63
NA
3.82
0.95
NA
12.40
09055725

A
Drainage of prostate abscess
8.67
NA
4.49
0.70
NA
13.86
09055801

A
Removal of prostate
17.77
NA
7.62
1.34
NA
26.73
09055810

A
Extensive prostate surgery
22.55
NA
8.95
1.60
NA
33.10
09055812

A
Extensive prostate surgery
27.47
NA
10.99
2.04
NA
40.50
09055815

A
Extensive prostate surgery
30.41
NA
11.90
2.16
NA
44.47
09055821

A
Removal of prostate
14.23
NA
6.21
1.01
NA
21.45
09055831

A
Removal of prostate
15.60
NA
6.66
1.10
NA
23.36
09055840

A
Extensive prostate surgery
22.66
NA
9.29
1.61
NA
33.56
09055842

A
Extensive prostate surgery
24.34
NA
9.85
1.72
NA
35.91
09055845

A
Extensive prostate surgery
28.51
NA
10.94
2.02
NA
41.47
09055859

A
Percut/needle insert, pros
12.50
NA
5.85
0.89
NA
19.24
09055860

A
Surgical exposure, prostate
14.43
NA
6.41
1.02
NA
21.86
09055862

A
Extensive prostate surgery
18.36
NA
7.85
1.49
NA
27.70
09055865

A
Extensive prostate surgery
22.84
NA
9.27
1.63
NA
33.74
09055866

A
Laparo radical prostatectomy
30.69
NA
11.73
2.16
NA
44.58
09055870

A
Electroejaculation
2.58
1.53
1.08
0.16
4.27
3.82
00055873

A
Cryoablate prostate
19.44
NA
8.96
1.38
NA
29.78
09055899

C
Genital surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY55970

N
Sex transformation, M to F
0.00
0.00
0.00
0.00
0.00
0.00
XXX55980

N
Sex transformation, F to M
0.00
0.00
0.00
0.00
0.00
0.00
XXX56405

A
I & D of vulva/perineum
1.44
1.33
1.14
0.17
2.94
2.75
01056420

A
Drainage of gland abscess
1.39
2.28
1.04
0.16
3.83
2.59
01056440

A
Surgery for vulva lesion
2.84
NA
1.71
0.34
NA
4.89
01056441

A
Lysis of labial lesion(s)
1.97
1.82
1.41
0.20
3.99
3.58
01056501

A
Destroy, vulva lesions, sim
1.53
1.79
1.24
0.18
3.50
2.95
01056515

A
Destroy vulva lesion/s compl
2.76
2.55
1.82
0.33
5.64
4.91
01056605

A
Biopsy of vulva/perineum
1.10
1.07
0.46
0.13
2.30
1.69
00056606

A
Biopsy of vulva/perineum
0.55
0.49
0.22
0.07
1.11
0.84
ZZZ56620

A
Partial removal of vulva
7.46
NA
4.80
0.90
NA
13.16
09056625

A
Complete removal of vulva
8.39
NA
5.33
1.02
NA
14.74
09056630

A
Extensive vulva surgery
12.34
NA
6.85
1.49
NA
20.68
09056631

A
Extensive vulva surgery
16.18
NA
8.83
1.95
NA
26.96
09056632

A
Extensive vulva surgery
20.26
NA
9.54
2.38
NA
32.18
09056633

A
Extensive vulva surgery
16.45
NA
8.61
1.97
NA
27.03
09056634

A
Extensive vulva surgery
17.85
NA
9.45
2.16
NA
29.46
09056637

A
Extensive vulva surgery
21.94
NA
11.09
2.60
NA
35.63
09056640

A
Extensive vulva surgery
22.14
NA
10.64
2.88
NA
35.66
09056700

A
Partial removal of hymen
2.52
NA
1.84
0.30
NA
4.66
01056720

A
Incision of hymen
0.68
NA
0.51
0.08
NA
1.27
00056740

A
Remove vagina gland lesion
4.56
NA
2.57
0.56
NA
7.69
01056800

A
Repair of vagina
3.88
NA
2.20
0.44
NA
6.52
01056805

A
Repair clitoris
18.83
NA
9.44
2.14
NA
30.41
09056810

A
Repair of perineum
4.12
NA
2.30
0.49
NA
6.91
01056820

A
Exam of vulva w/scope
1.50
1.31
0.65
0.18
2.99
2.33
00056821

A
Exam/biopsy of vulva w/scope
2.05
1.76
0.91
0.25
4.06
3.21
00057000

A
Exploration of vagina
2.97
NA
1.72
0.31
NA
5.00
01057010

A
Drainage of pelvic abscess
6.02
NA
3.81
0.71
NA
10.54
09057020

A
Drainage of pelvic fluid
1.50
0.94
0.59
0.18
2.62
2.27
00057022

A
I & d vaginal hematoma, pp
2.56
NA
1.49
0.26
NA
4.31
01057023

A
I & d vag hematoma, non-ob
4.74
NA
2.58
0.58
NA
7.90
01057061

A
Destroy vag lesions, simple
1.25
1.65
1.12
0.15
3.05
2.52
01057065

A
Destroy vag lesions, complex
2.61
2.30
1.67
0.31
5.22
4.59
01057100

A
Biopsy of vagina
1.20
1.08
0.48
0.14
2.42
1.82
00057105

A
Biopsy of vagina
1.69
1.80
1.42
0.20
3.69
3.31
01057106

A
Remove vagina wall, partial
6.35
NA
4.19
0.73
NA
11.27
09057107

A
Remove vagina tissue, part
22.97
NA
10.49
2.71
NA
36.17
09057109

A
Vaginectomy partial w/nodes
26.96
NA
11.27
3.21
NA
41.44
09057110

A
Remove vagina wall, complete
14.27
NA
7.29
1.73
NA
23.29
09057111

A
Remove vagina tissue, compl
26.96
NA
12.65
3.17
NA
42.78
09057112

A
Vaginectomy w/nodes, compl
28.96
NA
12.13
3.07
NA
44.16
090( print page 70396)57120

A
Closure of vagina
7.40
NA
4.61
0.89
NA
12.90
09057130

A
Remove vagina lesion
2.43
2.16
1.54
0.29
4.88
4.26
01057135

A
Remove vagina lesion
2.67
2.27
1.65
0.31
5.25
4.63
01057150

A
Treat vagina infection
0.55
1.10
0.21
0.07
1.72
0.83
00057155

A
Insert uteri tandems/ovoids
6.26
NA
4.57
0.43
NA
11.26
09057160

A
Insert pessary/other device
0.89
1.01
0.34
0.10
2.00
1.33
00057170

A
Fitting of diaphragm/cap
0.91
1.48
0.33
0.11
2.50
1.35
00057180

A
Treat vaginal bleeding
1.58
2.17
1.26
0.19
3.94
3.03
01057200

A
Repair of vagina
3.93
NA
2.90
0.46
NA
7.29
09057210

A
Repair vagina/perineum
5.16
NA
3.44
0.62
NA
9.22
09057220

A
Revision of urethra
4.30
NA
3.11
0.51
NA
7.92
09057230

A
Repair of urethral lesion
5.63
NA
3.41
0.54
NA
9.58
09057240

A
Repair bladder & vagina
6.06
NA
3.82
0.62
NA
10.50
09057250

A
Repair rectum & vagina
5.52
NA
3.58
0.65
NA
9.75
09057260

A
Repair of vagina
8.26
NA
4.84
0.97
NA
14.07
09057265

A
Extensive repair of vagina
11.32
NA
6.05
1.32
NA
18.69
09057267

A
Insert mesh/pelvic flr addon
4.88
NA
1.98
0.64
NA
7.50
ZZZ57268

A
Repair of bowel bulge
6.75
NA
4.20
0.79
NA
11.74
09057270

A
Repair of bowel pouch
12.09
NA
6.26
1.42
NA
19.77
09057280

A
Suspension of vagina
15.02
NA
7.38
1.67
NA
24.07
09057282

A
Colpopexy, extraperitoneal
6.86
NA
4.51
1.02
NA
12.39
09057283

A
Colpopexy, intraperitoneal
10.84
NA
5.93
1.02
NA
17.79
09057284

A
Repair paravaginal defect
12.68
NA
7.16
1.41
NA
21.25
09057287

A
Revise/remove sling repair
10.69
NA
5.49
0.90
NA
17.08
09057288

A
Repair bladder defect
13.00
NA
5.92
1.12
NA
20.04
09057289

A
Repair bladder & vagina
11.56
NA
6.05
1.21
NA
18.82
09057291

A
Construction of vagina
7.94
NA
4.93
0.93
NA
13.80
09057292

A
Construct vagina with graft
13.07
NA
6.95
1.58
NA
21.60
09057295

A
Change vaginal graft
7.45
NA
4.44
0.91
NA
12.80
09057300

A
Repair rectum-vagina fistula
7.60
NA
4.29
0.87
NA
12.76
09057305

A
Repair rectum-vagina fistula
13.75
NA
6.28
1.72
NA
21.75
09057307

A
Fistula repair & colostomy
15.91
NA
7.01
2.01
NA
24.93
09057308

A
Fistula repair, transperine
9.93
NA
5.10
1.14
NA
16.17
09057310

A
Repair urethrovaginal lesion
6.77
NA
3.84
0.54
NA
11.15
09057311

A
Repair urethrovaginal lesion
7.97
NA
4.12
0.65
NA
12.74
09057320

A
Repair bladder-vagina lesion
8.00
NA
4.37
0.69
NA
13.06
09057330

A
Repair bladder-vagina lesion
12.33
NA
5.72
1.06
NA
19.11
09057335

A
Repair vagina
18.70
NA
9.05
1.91
NA
29.66
09057400

A
Dilation of vagina
2.27
NA
1.11
0.26
NA
3.64
00057410

A
Pelvic examination
1.75
2.02
0.89
0.18
3.95
2.82
00057415

A
Remove vaginal foreign body
2.17
NA
1.42
0.24
NA
3.83
01057420

A
Exam of vagina w/scope
1.60
1.35
0.67
0.19
3.14
2.46
00057421

A
Exam/biopsy of vag w/scope
2.20
1.85
0.96
0.27
4.32
3.43
00057425

A
Laparoscopy, surg, colpopexy
15.73
NA
6.65
1.75
NA
24.13
09057452

A
Exam of cervix w/scope
1.50
1.28
0.76
0.18
2.96
2.44
00057454

A
Bx/curett of cervix w/scope
2.33
1.64
1.15
0.28
4.25
3.76
00057455

A
Biopsy of cervix w/scope
1.99
1.72
0.87
0.24
3.95
3.10
00057456

A
Endocerv curettage w/scope
1.85
1.65
0.82
0.22
3.72
2.89
00057460

A
Bx of cervix w/scope, leep
2.83
5.86
1.38
0.34
9.03
4.55
00057461

A
Conz of cervix w/scope, leep
3.43
6.12
1.47
0.41
9.96
5.31
00057500

A
Biopsy of cervix
0.97
2.55
0.63
0.12
3.64
1.72
00057505

A
Endocervical curettage
1.14
1.46
1.10
0.14
2.74
2.38
01057510

A
Cauterization of cervix
1.90
1.56
1.04
0.23
3.69
3.17
01057511

A
Cryocautery of cervix
1.90
1.83
1.37
0.23
3.96
3.50
01057513

A
Laser surgery of cervix
1.90
1.72
1.40
0.23
3.85
3.53
01057520

A
Conization of cervix
4.03
3.94
2.88
0.49
8.46
7.40
09057522

A
Conization of cervix
3.35
3.16
2.46
0.41
6.92
6.22
09057530

A
Removal of cervix
4.78
NA
3.39
0.58
NA
8.75
09057531

A
Removal of cervix, radical
27.96
NA
13.20
3.34
NA
44.50
09057540

A
Removal of residual cervix
12.20
NA
6.25
1.49
NA
19.94
09057545

A
Remove cervix/repair pelvis
13.01
NA
6.69
1.52
NA
21.22
09057550

A
Removal of residual cervix
5.52
NA
3.83
0.67
NA
10.02
09057555

A
Remove cervix/repair vagina
8.94
NA
5.09
1.09
NA
15.12
09057556

A
Remove cervix, repair bowel
8.36
NA
4.86
0.92
NA
14.14
09057700

A
Revision of cervix
3.54
NA
3.11
0.41
NA
7.06
09057720

A
Revision of cervix
4.12
NA
3.11
0.49
NA
7.72
09057800

A
Dilation of cervical canal
0.77
0.76
0.47
0.09
1.62
1.33
00057820

A
D & c of residual cervix
1.67
1.47
1.14
0.20
3.34
3.01
01058100

A
Biopsy of uterus lining
1.53
1.32
0.72
0.18
3.03
2.43
00058110

A
Bx done w/colposcopy add-on
0.77
0.55
0.31
0.09
1.41
1.17
ZZZ58120

A
Dilation and curettage
3.27
2.31
1.88
0.39
5.97
5.54
01058140

A
Myomectomy abdom method
14.58
NA
7.12
1.81
NA
23.51
09058145

A
Myomectomy vag method
8.03
NA
4.80
0.97
NA
13.80
09058146

A
Myomectomy abdom complex
18.97
NA
9.03
2.32
NA
30.32
09058150

A
Total hysterectomy
15.22
NA
7.50
1.84
NA
24.56
090( print page 70397)58152

A
Total hysterectomy
20.57
NA
9.88
2.47
NA
32.92
09058180

A
Partial hysterectomy
15.27
NA
7.47
1.64
NA
24.38
09058200

A
Extensive hysterectomy
21.56
NA
10.02
2.54
NA
34.12
09058210

A
Extensive hysterectomy
28.81
NA
13.23
3.37
NA
45.41
09058240

A
Removal of pelvis contents
38.33
NA
17.66
4.22
NA
60.21
09058260

A
Vaginal hysterectomy
12.96
NA
6.71
1.57
NA
21.24
09058262

A
Vag hyst including t/o
14.75
NA
7.40
1.79
NA
23.94
09058263

A
Vag hyst w/t/o & vag repair
16.04
NA
7.90
1.94
NA
25.88
09058267

A
Vag hyst w/urinary repair
17.01
NA
8.39
2.06
NA
27.46
09058270

A
Vag hyst w/enterocele repair
14.24
NA
7.08
1.73
NA
23.05
09058275

A
Hysterectomy/revise vagina
15.74
NA
7.79
1.91
NA
25.44
09058280

A
Hysterectomy/revise vagina
16.98
NA
8.27
2.06
NA
27.31
09058285

A
Extensive hysterectomy
22.23
NA
9.97
2.70
NA
34.90
09058290

A
Vag hyst complex
18.97
NA
9.15
2.29
NA
30.41
09058291

A
Vag hyst incl t/o, complex
20.76
NA
9.90
2.52
NA
33.18
09058292

A
Vag hyst t/o & repair, compl
22.05
NA
10.39
2.67
NA
35.11
09058293

A
Vag hyst w/uro repair, compl
23.03
NA
10.68
2.78
NA
36.49
09058294

A
Vag hyst w/enterocele, compl
20.25
NA
9.58
2.39
NA
32.22
09058300

N
Insert intrauterine device
+1.01
1.42
0.38
0.12
2.55
1.51
XXX58301

A
Remove intrauterine device
1.27
1.32
0.48
0.15
2.74
1.90
00058321

A
Artificial insemination
0.92
1.15
0.37
0.10
2.17
1.39
00058322

A
Artificial insemination
1.10
1.20
0.42
0.13
2.43
1.65
00058323

A
Sperm washing
0.23
0.53
0.09
0.03
0.79
0.35
00058340

A
Catheter for hysterography
0.88
3.17
0.65
0.09
4.14
1.62
00058345

A
Reopen fallopian tube
4.65
NA
2.44
0.41
NA
7.50
01058346

A
Insert heyman uteri capsule
6.74
NA
3.93
0.56
NA
11.23
09058350

A
Reopen fallopian tube
1.01
1.49
0.92
0.12
2.62
2.05
01058353

A
Endometr ablate, thermal
3.55
35.76
2.06
0.43
39.74
6.04
01058356

A
Endometrial cryoablation
6.36
61.61
2.70
0.82
68.79
9.88
01058400

A
Suspension of uterus
6.35
NA
3.94
0.75
NA
11.04
09058410

A
Suspension of uterus
12.71
NA
6.45
1.45
NA
20.61
09058520

A
Repair of ruptured uterus
11.90
NA
6.05
1.47
NA
19.42
09058540

A
Revision of uterus
14.62
NA
6.97
1.78
NA
23.37
09058545

A
Laparoscopic myomectomy
14.58
NA
7.20
1.77
NA
23.55
09058546

A
Laparo-myomectomy, complex
18.97
NA
8.94
2.30
NA
30.21
09058550

A
Laparo-asst vag hysterectomy
14.17
NA
7.31
1.72
NA
23.20
09058552

A
Laparo-vag hyst incl t/o
15.98
NA
8.03
1.72
NA
25.73
09058553

A
Laparo-vag hyst, complex
18.97
NA
8.94
2.30
NA
30.21
09058554

A
Laparo-vag hyst w/t/o, compl
21.97
NA
10.42
2.27
NA
34.66
09058555

A
Hysteroscopy, dx, sep proc
3.33
2.20
1.55
0.40
5.93
5.28
00058558

A
Hysteroscopy, biopsy
4.74
NA
2.18
0.57
NA
7.49
00058559

A
Hysteroscopy, lysis
6.16
NA
2.74
0.74
NA
9.64
00058560

A
Hysteroscopy, resect septum
6.99
NA
3.09
0.84
NA
10.92
00058561

A
Hysteroscopy, remove myoma
9.99
NA
4.29
1.21
NA
15.49
00058562

A
Hysteroscopy, remove fb
5.20
NA
2.36
0.63
NA
8.19
00058563

A
Hysteroscopy, ablation
6.16
56.35
2.76
0.74
63.25
9.66
00058565

A
Hysteroscopy, sterilization
7.02
49.70
3.91
1.19
57.91
12.12
09058578

C
Laparo proc, uterus
0.00
0.00
0.00
0.00
0.00
0.00
YYY58579

C
Hysteroscope procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY58600

A
Division of fallopian tube
5.59
NA
3.34
0.66
NA
9.59
09058605

A
Division of fallopian tube
4.99
NA
3.12
0.59
NA
8.70
09058611

A
Ligate oviduct(s) add-on
1.45
NA
0.57
0.18
NA
2.20
ZZZ58615

A
Occlude fallopian tube(s)
3.89
NA
2.71
0.47
NA
7.07
01058660

A
Laparoscopy, lysis
11.27
NA
5.27
1.40
NA
17.94
09058661

A
Laparoscopy, remove adnexa
11.03
NA
5.13
1.34
NA
17.50
01058662

A
Laparoscopy, excise lesions
11.77
NA
5.80
1.43
NA
19.00
09058670

A
Laparoscopy, tubal cautery
5.59
NA
3.28
0.67
NA
9.54
09058671

A
Laparoscopy, tubal block
5.59
NA
3.28
0.68
NA
9.55
09058672

A
Laparoscopy, fimbrioplasty
12.86
NA
6.20
1.60
NA
20.66
09058673

A
Laparoscopy, salpingostomy
13.72
NA
6.59
1.69
NA
22.00
09058679

C
Laparo proc, oviduct-ovary
0.00
0.00
0.00
0.00
0.00
0.00
YYY58700

A
Removal of fallopian tube
12.03
NA
6.00
1.51
NA
19.54
09058720

A
Removal of ovary/tube(s)
11.34
NA
5.79
1.39
NA
18.52
09058740

A
Revise fallopian tube(s)
13.98
NA
7.15
1.71
NA
22.84
09058750

A
Repair oviduct
14.82
NA
7.38
1.84
NA
24.04
09058752

A
Revise ovarian tube(s)
14.82
NA
6.96
1.80
NA
23.58
09058760

A
Remove tubal obstruction
13.11
NA
6.73
1.79
NA
21.63
09058770

A
Create new tubal opening
13.95
NA
6.92
1.73
NA
22.60
09058800

A
Drainage of ovarian cyst(s)
4.13
3.65
2.91
0.43
8.21
7.47
09058805

A
Drainage of ovarian cyst(s)
5.87
NA
3.51
0.69
NA
10.07
09058820

A
Drain ovary abscess, open
4.21
NA
3.30
0.52
NA
8.03
09058822

A
Drain ovary abscess, percut
10.11
NA
5.23
1.16
NA
16.50
09058823

A
Drain pelvic abscess, percut
3.37
21.38
1.12
0.24
24.99
4.73
00058825

A
Transposition, ovary(s)
10.96
NA
5.81
1.32
NA
18.09
09058900

A
Biopsy of ovary(s)
5.98
NA
3.58
0.69
NA
10.25
090( print page 70398)58920

A
Partial removal of ovary(s)
11.34
NA
5.59
1.43
NA
18.36
09058925

A
Removal of ovarian cyst(s)
11.34
NA
5.70
1.41
NA
18.45
09058940

A
Removal of ovary(s)
7.28
NA
4.11
0.91
NA
12.30
09058943

A
Removal of ovary(s)
18.40
NA
8.67
2.22
NA
29.29
09058950

A
Resect ovarian malignancy
16.90
NA
8.42
2.04
NA
27.36
09058951

A
Resect ovarian malignancy
22.35
NA
10.47
2.63
NA
35.45
09058952

A
Resect ovarian malignancy
24.97
NA
11.78
3.02
NA
39.77
09058953

A
Tah, rad dissect for debulk
31.95
NA
14.58
3.83
NA
50.36
09058954

A
Tah rad debulk/lymph remove
34.95
NA
15.75
4.17
NA
54.87
09058956

A
Bso, omentectomy w/tah
20.78
NA
10.34
4.00
NA
35.12
09058960

A
Exploration of abdomen
14.63
NA
7.37
1.79
NA
23.79
09058970

A
Retrieval of oocyte
3.52
2.32
1.49
0.43
6.27
5.44
00058974

C
Transfer of embryo
0.00
0.00
0.00
0.00
0.00
0.00
00058976

A
Transfer of embryo
3.82
2.69
1.83
0.47
6.98
6.12
00058999

C
Genital surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY59000

A
Amniocentesis, diagnostic
1.30
2.08
0.67
0.31
3.69
2.28
00059001

A
Amniocentesis, therapeutic
3.00
NA
1.41
0.71
NA
5.12
00059012

A
Fetal cord puncture, prenatal
3.44
NA
1.54
0.82
NA
5.80
00059015

A
Chorion biopsy
2.20
1.55
1.04
0.52
4.27
3.76
00059020
26
A
Fetal contract stress test
0.66
0.26
0.26
0.16
1.08
1.08
00059020
TC
A
Fetal contract stress test
0.00
0.52
NA
0.10
0.62
NA
00059020

A
Fetal contract stress test
0.66
0.78
NA
0.26
1.70
NA
00059025
26
A
Fetal non-stress test
0.53
0.21
0.21
0.13
0.87
0.87
00059025
TC
A
Fetal non-stress test
0.00
0.23
NA
0.02
0.25
NA
00059025

A
Fetal non-stress test
0.53
0.44
NA
0.15
1.12
NA
00059030

A
Fetal scalp blood sample
1.99
NA
0.77
0.47
NA
3.23
00059050

A
Fetal monitor w/report
0.89
NA
0.35
0.21
NA
1.45
XXX59051

A
Fetal monitor/interpret only
0.74
NA
0.29
0.17
NA
1.20
XXX59070

A
Transabdom amnioinfus w/us
5.24
5.16
2.32
0.28
10.68
7.84
00059072

A
Umbilical cord occlud w/us
8.99
NA
3.13
0.16
NA
12.28
00059074

A
Fetal fluid drainage w/us
5.24
4.58
2.32
0.28
10.10
7.84
00059076

A
Fetal shunt placement, w/us
8.99
NA
3.13
0.16
NA
12.28
00059100

A
Remove uterus lesion
12.33
NA
6.47
2.94
NA
21.74
09059120

A
Treat ectopic pregnancy
11.47
NA
6.26
2.72
NA
20.45
09059121

A
Treat ectopic pregnancy
11.65
NA
6.34
2.78
NA
20.77
09059130

A
Treat ectopic pregnancy
14.20
NA
4.80
3.38
NA
22.38
09059135

A
Treat ectopic pregnancy
13.86
NA
7.24
3.30
NA
24.40
09059136

A
Treat ectopic pregnancy
13.16
NA
6.62
3.13
NA
22.91
09059140

A
Treat ectopic pregnancy
5.45
2.22
2.22
1.29
8.96
8.96
09059150

A
Treat ectopic pregnancy
11.65
NA
6.01
2.78
NA
20.44
09059151

A
Treat ectopic pregnancy
11.47
NA
6.07
2.73
NA
20.27
09059160

A
D & c after delivery
2.71
3.30
2.14
0.64
6.65
5.49
01059200

A
Insert cervical dilator
0.79
1.19
0.30
0.19
2.17
1.28
00059300

A
Episiotomy or vaginal repair
2.41
2.18
0.96
0.57
5.16
3.94
00059320

A
Revision of cervix
2.48
NA
1.24
0.59
NA
4.31
00059325

A
Revision of cervix
4.06
NA
1.90
0.88
NA
6.84
00059350

A
Repair of uterus
4.94
NA
1.88
1.17
NA
7.99
00059400

A
Obstetrical care
23.03
NA
15.36
5.48
NA
43.87
MMM59409

A
Obstetrical care
13.48
NA
5.32
3.21
NA
22.01
MMM59410

A
Obstetrical care
14.76
NA
6.32
3.51
NA
24.59
MMM59412

A
Antepartum manipulation
1.71
NA
0.81
0.40
NA
2.92
MMM59414

A
Deliver placenta
1.61
NA
0.64
0.38
NA
2.63
MMM59425

A
Antepartum care only
4.80
4.21
1.86
1.14
10.15
7.80
MMM59426

A
Antepartum care only
8.27
7.56
3.23
1.97
17.80
13.47
MMM59430

A
Care after delivery
2.13
1.23
0.94
0.50
3.86
3.57
MMM59510

A
Cesarean delivery
26.18
NA
17.31
6.23
NA
49.72
MMM59514

A
Cesarean delivery only
15.95
NA
6.23
3.79
NA
25.97
MMM59515

A
Cesarean delivery
17.34
NA
7.85
4.12
NA
29.31
MMM59525

A
Remove uterus after cesarean
8.53
NA
3.31
1.94
NA
13.78
ZZZ59610

A
Vbac delivery
24.58
NA
15.91
5.85
NA
46.34
MMM59612

A
Vbac delivery only
15.04
NA
6.07
3.58
NA
24.69
MMM59614

A
Vbac care after delivery
16.32
NA
6.95
3.88
NA
27.15
MMM59618

A
Attempted vbac delivery
27.74
NA
18.28
6.59
NA
52.61
MMM59620

A
Attempted vbac delivery only
17.50
NA
6.78
4.16
NA
28.44
MMM59622

A
Attempted vbac after care
18.90
NA
8.66
4.49
NA
32.05
MMM59812

A
Treatment of miscarriage
4.00
NA
2.55
0.95
NA
7.50
09059820

A
Care of miscarriage
4.00
4.43
3.57
0.95
9.38
8.52
09059821

A
Treatment of miscarriage
4.46
4.28
3.41
1.06
9.80
8.93
09059830

A
Treat uterus infection
6.10
NA
3.99
1.44
NA
11.53
09059840

R
Abortion
3.01
NA
2.13
0.71
NA
5.85
01059841

R
Abortion
5.23
3.50
2.98
1.24
9.97
9.45
01059850

R
Abortion
5.90
NA
3.26
1.28
NA
10.44
09059851

R
Abortion
5.92
NA
3.75
1.28
NA
10.95
09059852

R
Abortion
8.23
NA
5.05
1.80
NA
15.08
09059855

R
Abortion
6.11
NA
3.55
1.45
NA
11.11
090( print page 70399)59856

R
Abortion
7.47
NA
4.07
1.78
NA
13.32
09059857

R
Abortion
9.28
NA
4.72
2.01
NA
16.01
09059866

R
Abortion (mpr)
3.99
NA
1.90
0.87
NA
6.76
00059870

A
Evacuate mole of uterus
6.00
NA
4.49
1.42
NA
11.91
09059871

A
Remove cerclage suture
2.13
1.75
1.13
0.50
4.38
3.76
00059897

C
Fetal invas px w/us
0.00
0.00
0.00
0.00
0.00
0.00
YYY59898

C
Laparo proc, ob care/deliver
0.00
0.00
0.00
0.00
0.00
0.00
YYY59899

C
Maternity care procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY60000

A
Drain thyroid/tongue cyst
1.76
1.93
1.71
0.15
3.84
3.62
01060001

A
Aspirate/inject thyriod cyst
0.97
1.41
0.33
0.07
2.45
1.37
00060100

A
Biopsy of thyroid
1.56
1.40
0.53
0.10
3.06
2.19
00060200

A
Remove thyroid lesion
9.54
NA
6.00
1.01
NA
16.55
09060210

A
Partial thyroid excision
10.86
NA
5.65
1.23
NA
17.74
09060212

A
Partial thyroid excision
16.01
NA
7.69
1.94
NA
25.64
09060220

A
Partial removal of thyroid
11.88
NA
6.16
1.32
NA
19.36
09060225

A
Partial removal of thyroid
14.17
NA
7.42
1.64
NA
23.23
09060240

A
Removal of thyroid
16.04
NA
7.60
1.85
NA
25.49
09060252

A
Removal of thyroid
20.54
NA
10.12
2.29
NA
32.95
09060254

A
Extensive thyroid surgery
26.95
NA
14.18
2.60
NA
43.73
09060260

A
Repeat thyroid surgery
17.44
NA
8.67
1.93
NA
28.04
09060270

A
Removal of thyroid
20.24
NA
10.48
2.32
NA
33.04
09060271

A
Removal of thyroid
16.80
NA
8.60
1.74
NA
27.14
09060280

A
Remove thyroid duct lesion
5.86
NA
4.67
0.54
NA
11.07
09060281

A
Remove thyroid duct lesion
8.52
NA
5.85
0.73
NA
15.10
09060500

A
Explore parathyroid glands
16.21
NA
7.42
2.00
NA
25.63
09060502

A
Re-explore parathyroids
20.32
NA
9.38
2.53
NA
32.23
09060505

A
Explore parathyroid glands
21.46
NA
10.95
2.64
NA
35.05
09060512

A
Autotransplant parathyroid
4.44
NA
1.62
0.53
NA
6.59
ZZZ60520

A
Removal of thymus gland
16.78
NA
8.31
2.19
NA
27.28
09060521

A
Removal of thymus gland
18.84
NA
9.57
2.81
NA
31.22
09060522

A
Removal of thymus gland
23.06
NA
11.29
3.26
NA
37.61
09060540

A
Explore adrenal gland
17.00
NA
7.60
1.74
NA
26.34
09060545

A
Explore adrenal gland
19.85
NA
8.55
2.07
NA
30.47
09060600

A
Remove carotid body lesion
17.90
NA
10.99
2.19
NA
31.08
09060605

A
Remove carotid body lesion
20.21
NA
12.29
2.49
NA
34.99
09060650

A
Laparoscopy adrenalectomy
19.97
NA
8.00
2.28
NA
30.25
09060659

C
Laparo proc, endocrine
0.00
0.00
0.00
0.00
0.00
0.00
YYY60699

C
Endocrine surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY61000

A
Remove cranial cavity fluid
1.58
NA
0.95
0.13
NA
2.66
00061001

A
Remove cranial cavity fluid
1.49
NA
1.06
0.16
NA
2.71
00061020

A
Remove brain cavity fluid
1.51
NA
1.34
0.34
NA
3.19
00061026

A
Injection into brain canal
1.69
NA
1.39
0.33
NA
3.41
00061050

A
Remove brain canal fluid
1.51
NA
1.27
0.11
NA
2.89
00061055

A
Injection into brain canal
2.10
NA
1.42
0.17
NA
3.69
00061070

A
Brain canal shunt procedure
0.89
NA
1.01
0.17
NA
2.07
00061105

A
Twist drill hole
5.13
NA
3.94
1.32
NA
10.39
09061107

A
Drill skull for implantation
4.99
NA
2.54
1.29
NA
8.82
00061108

A
Drill skull for drainage
10.17
NA
7.16
2.63
NA
19.96
09061120

A
Burr hole for puncture
8.75
NA
6.01
2.09
NA
16.85
09061140

A
Pierce skull for biopsy
15.88
NA
9.91
4.11
NA
29.90
09061150

A
Pierce skull for drainage
17.54
NA
10.40
4.31
NA
32.25
09061151

A
Pierce skull for drainage
12.40
NA
7.83
3.00
NA
23.23
09061154

A
Pierce skull & remove clot
14.97
NA
9.51
4.20
NA
28.68
09061156

A
Pierce skull for drainage
16.30
NA
9.86
4.22
NA
30.38
09061210

A
Pierce skull, implant device
5.83
NA
2.92
1.50
NA
10.25
00061215

A
Insert brain-fluid device
4.88
NA
4.01
1.26
NA
10.15
09061250

A
Pierce skull & explore
10.40
NA
6.87
2.76
NA
20.03
09061253

A
Pierce skull & explore
12.34
NA
7.74
2.61
NA
22.69
09061304

A
Open skull for exploration
21.93
NA
12.87
5.61
NA
40.41
09061305

A
Open skull for exploration
26.57
NA
15.35
6.07
NA
47.99
09061312

A
Open skull for drainage
24.53
NA
15.08
6.34
NA
45.95
09061313

A
Open skull for drainage
24.89
NA
14.84
6.43
NA
46.16
09061314

A
Open skull for drainage
24.19
NA
13.07
6.26
NA
43.52
09061315

A
Open skull for drainage
27.64
NA
16.06
7.14
NA
50.84
09061316

A
Implt cran bone flap to abdo
1.39
NA
0.60
0.35
NA
2.34
ZZZ61320

A
Open skull for drainage
25.58
NA
14.79
6.60
NA
46.97
09061321

A
Open skull for drainage
28.46
NA
16.17
7.12
NA
51.75
09061322

A
Decompressive craniotomy
29.46
NA
15.71
7.61
NA
52.78
09061323

A
Decompressive lobectomy
30.95
NA
16.13
8.01
NA
55.09
09061330

A
Decompress eye socket
23.29
NA
13.76
2.31
NA
39.36
09061332

A
Explore/biopsy eye socket
27.24
NA
15.64
4.82
NA
47.70
09061333

A
Explore orbit/remove lesion
27.91
NA
15.62
3.91
NA
47.44
09061334

A
Explore orbit/remove object
18.24
NA
10.66
1.74
NA
30.64
09061340

A
Subtemporal decompression
18.63
NA
11.15
4.83
NA
34.61
09061343

A
Incise skull (press relief)
29.73
NA
16.85
7.62
NA
54.20
090( print page 70400)61345

A
Relieve cranial pressure
27.16
NA
15.43
7.02
NA
49.61
09061440

A
Incise skull for surgery
26.59
NA
14.24
6.88
NA
47.71
09061450

A
Incise skull for surgery
25.91
NA
14.32
5.77
NA
46.00
09061458

A
Incise skull for brain wound
27.25
NA
15.55
7.01
NA
49.81
09061460

A
Incise skull for surgery
28.35
NA
16.46
6.02
NA
50.83
09061470

A
Incise skull for surgery
26.02
NA
13.89
5.88
NA
45.79
09061480

A
Incise skull for surgery
26.45
NA
15.31
6.71
NA
48.47
09061490

A
Incise skull for surgery
25.62
NA
14.36
6.90
NA
46.88
09061500

A
Removal of skull lesion
17.89
NA
10.83
4.10
NA
32.82
09061501

A
Remove infected skull bone
14.82
NA
9.23
3.21
NA
27.26
09061510

A
Removal of brain lesion
28.41
NA
16.74
7.33
NA
52.48
09061512

A
Remove brain lining lesion
35.04
NA
19.73
9.05
NA
63.82
09061514

A
Removal of brain abscess
25.22
NA
14.47
6.52
NA
46.21
09061516

A
Removal of brain lesion
24.57
NA
14.30
6.33
NA
45.20
09061517

A
Implt brain chemotx add-on
1.38
NA
0.64
0.35
NA
2.37
ZZZ61518

A
Removal of brain lesion
37.26
NA
21.15
9.62
NA
68.03
09061519

A
Remove brain lining lesion
41.33
NA
22.71
10.60
NA
74.64
09061520

A
Removal of brain lesion
54.76
NA
30.41
11.18
NA
96.35
09061521

A
Removal of brain lesion
44.41
NA
24.28
11.36
NA
80.05
09061522

A
Removal of brain abscess
29.41
NA
16.46
7.60
NA
53.47
09061524

A
Removal of brain lesion
27.82
NA
15.71
7.14
NA
50.67
09061526

A
Removal of brain lesion
52.09
NA
29.57
7.05
NA
88.71
09061530

A
Removal of brain lesion
43.79
NA
25.12
6.13
NA
75.04
09061531

A
Implant brain electrodes
14.61
NA
9.15
3.78
NA
27.54
09061533

A
Implant brain electrodes
19.68
NA
11.56
5.10
NA
36.34
09061534

A
Removal of brain lesion
20.94
NA
12.12
5.42
NA
38.48
09061535

A
Remove brain electrodes
11.61
NA
7.44
3.01
NA
22.06
09061536

A
Removal of brain lesion
35.47
NA
19.84
9.18
NA
64.49
09061537

A
Removal of brain tissue
24.96
NA
14.78
6.92
NA
46.66
09061538

A
Removal of brain tissue
26.77
NA
15.35
6.92
NA
49.04
09061539

A
Removal of brain tissue
32.03
NA
17.81
8.30
NA
58.14
09061540

A
Removal of brain tissue
29.96
NA
17.29
8.30
NA
55.55
09061541

A
Incision of brain tissue
28.81
NA
16.25
6.58
NA
51.64
09061542

A
Removal of brain tissue
30.97
NA
17.87
8.01
NA
56.85
09061543

A
Removal of brain tissue
29.18
NA
16.43
7.54
NA
53.15
09061544

A
Remove & treat brain lesion
25.46
NA
13.86
5.95
NA
45.27
09061545

A
Excision of brain tumor
43.73
NA
24.28
10.60
NA
78.61
09061546

A
Removal of pituitary gland
31.25
NA
17.54
7.65
NA
56.44
09061548

A
Removal of pituitary gland
21.50
NA
12.82
3.42
NA
37.74
09061550

A
Release of skull seams
14.63
NA
6.95
0.98
NA
22.56
09061552

A
Release of skull seams
19.53
NA
9.14
1.06
NA
29.73
09061556

A
Incise skull/sutures
22.23
NA
11.39
4.64
NA
38.26
09061557

A
Incise skull/sutures
22.35
NA
13.66
5.78
NA
41.79
09061558

A
Excision of skull/sutures
25.54
NA
14.23
1.36
NA
41.13
09061559

A
Excision of skull/sutures
32.74
NA
19.37
8.48
NA
60.59
09061563

A
Excision of skull tumor
26.79
NA
15.28
5.15
NA
47.22
09061564

A
Excision of skull tumor
33.78
NA
18.33
8.75
NA
60.86
09061566

A
Removal of brain tissue
30.95
NA
17.82
6.92
NA
55.69
09061567

A
Incision of brain tissue
35.45
NA
20.73
6.52
NA
62.70
09061570

A
Remove foreign body, brain
24.56
NA
13.95
5.86
NA
44.37
09061571

A
Incise skull for brain wound
26.35
NA
15.18
6.77
NA
48.30
09061575

A
Skull base/brainstem surgery
34.31
NA
19.69
5.32
NA
59.32
09061576

A
Skull base/brainstem surgery
52.35
NA
34.83
5.56
NA
92.74
09061580

A
Craniofacial approach, skull
30.30
NA
25.65
3.36
NA
59.31
09061581

A
Craniofacial approach, skull
34.55
NA
23.51
3.91
NA
61.97
09061582

A
Craniofacial approach, skull
31.61
NA
27.38
7.19
NA
66.18
09061583

A
Craniofacial approach, skull
36.16
NA
25.18
9.18
NA
70.52
09061584

A
Orbitocranial approach/skull
34.60
NA
24.59
8.16
NA
67.35
09061585

A
Orbitocranial approach/skull
38.55
NA
26.57
7.01
NA
72.13
09061586

A
Resect nasopharynx, skull
25.06
NA
22.65
4.36
NA
52.07
09061590

A
Infratemporal approach/skull
41.72
NA
28.70
5.29
NA
75.71
09061591

A
Infratemporal approach/skull
43.61
NA
29.61
5.64
NA
78.86
09061592

A
Orbitocranial approach/skull
39.58
NA
26.58
10.04
NA
76.20
09061595

A
Transtemporal approach/skull
29.53
NA
22.41
3.97
NA
55.91
09061596

A
Transcochlear approach/skull
35.58
NA
24.51
3.39
NA
63.48
09061597

A
Transcondylar approach/skull
37.90
NA
23.06
8.81
NA
69.77
09061598

A
Transpetrosal approach/skull
33.36
NA
23.30
5.68
NA
62.34
09061600

A
Resect/excise cranial lesion
25.81
NA
19.83
3.78
NA
49.42
09061601

A
Resect/excise cranial lesion
27.85
NA
20.55
6.61
NA
55.01
09061605

A
Resect/excise cranial lesion
29.29
NA
22.02
2.85
NA
54.16
09061606

A
Resect/excise cranial lesion
38.77
NA
25.22
8.94
NA
72.93
09061607

A
Resect/excise cranial lesion
36.22
NA
23.85
6.88
NA
66.95
09061608

A
Resect/excise cranial lesion
42.04
NA
26.66
10.72
NA
79.42
09061609

A
Transect artery, sinus
9.88
NA
4.86
2.55
NA
17.29
ZZZ61610

A
Transect artery, sinus
29.63
NA
13.18
7.66
NA
50.47
ZZZ( print page 70401)61611

A
Transect artery, sinus
7.41
NA
3.83
1.88
NA
13.12
ZZZ61612

A
Transect artery, sinus
27.84
NA
13.35
4.30
NA
45.49
ZZZ61613

A
Remove aneurysm, sinus
40.80
NA
26.34
8.42
NA
75.56
09061615

A
Resect/excise lesion, skull
32.02
NA
22.79
4.72
NA
59.53
09061616

A
Resect/excise lesion, skull
43.27
NA
28.73
8.24
NA
80.24
09061618

A
Repair dura
16.96
NA
10.47
3.71
NA
31.14
09061619

A
Repair dura
20.68
NA
12.28
3.94
NA
36.90
09061623

A
Endovasc tempory vessel occl
9.95
NA
4.09
1.05
NA
15.09
00061624

A
Transcath occlusion, cns
20.12
NA
6.91
1.95
NA
28.98
00061626

A
Transcath occlusion, non-cns
16.60
NA
5.53
1.24
NA
23.37
00061630

N
Intracranial angioplasty
0.00
0.00
0.00
0.00
0.00
0.00
09061635

N
Intracran angioplsty w/stent
0.00
0.00
0.00
0.00
0.00
0.00
09061640

N
Dilate ic vasospasm, init
0.00
0.00
0.00
0.00
0.00
0.00
00061641

N
Dilate ic vasospasm add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ61642

N
Dilate ic vasospasm add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ61680

A
Intracranial vessel surgery
30.66
NA
17.48
7.93
NA
56.07
09061682

A
Intracranial vessel surgery
61.48
NA
32.30
15.85
NA
109.63
09061684

A
Intracranial vessel surgery
39.75
NA
22.06
10.28
NA
72.09
09061686

A
Intracranial vessel surgery
64.39
NA
34.82
16.66
NA
115.87
09061690

A
Intracranial vessel surgery
29.27
NA
16.77
6.92
NA
52.96
09061692

A
Intracranial vessel surgery
51.79
NA
27.55
13.39
NA
92.73
09061697

A
Brain aneurysm repr, complx
50.44
NA
28.09
12.81
NA
91.34
09061698

A
Brain aneurysm repr, complx
48.34
NA
26.77
12.50
NA
87.61
09061700

A
Brain aneurysm repr, simple
50.44
NA
27.88
12.98
NA
91.30
09061702

A
Inner skull vessel surgery
48.34
NA
26.11
10.76
NA
85.21
09061703

A
Clamp neck artery
17.44
NA
10.49
4.05
NA
31.98
09061705

A
Revise circulation to head
36.15
NA
19.31
8.84
NA
64.30
09061708

A
Revise circulation to head
35.25
NA
15.19
2.50
NA
52.94
09061710

A
Revise circulation to head
29.63
NA
13.68
4.51
NA
47.82
09061711

A
Fusion of skull arteries
36.28
NA
19.86
9.39
NA
65.53
09061720

A
Incise skull/brain surgery
16.74
NA
10.00
2.78
NA
29.52
09061735

A
Incise skull/brain surgery
20.40
NA
12.20
2.72
NA
35.32
09061750

A
Incise skull/brain biopsy
18.17
NA
10.64
4.71
NA
33.52
09061751

A
Brain biopsy w/ct/mr guide
17.59
NA
10.85
4.55
NA
32.99
09061760

A
Implant brain electrodes
22.24
NA
8.74
5.40
NA
36.38
09061770

A
Incise skull for treatment
21.41
NA
12.29
3.54
NA
37.24
09061790

A
Treat trigeminal nerve
10.84
NA
5.93
2.81
NA
19.58
09061791

A
Treat trigeminal tract
14.59
NA
8.94
3.39
NA
26.92
09061793

A
Focus radiation beam
17.21
NA
10.15
4.45
NA
31.81
09061795

A
Brain surgery using computer
4.03
NA
2.04
0.79
NA
6.86
ZZZ61850

A
Implant neuroelectrodes
12.37
NA
7.69
3.21
NA
23.27
09061860

A
Implant neuroelectrodes
20.84
NA
12.09
4.94
NA
37.87
09061863

A
Implant neuroelectrode
18.97
NA
11.80
5.41
NA
36.18
09061864

A
Implant neuroelectrde, addl
4.49
NA
2.29
5.41
NA
12.19
ZZZ61867

A
Implant neuroelectrode
31.29
NA
18.07
5.41
NA
54.77
09061868

A
Implant neuroelectrde, add'l
7.91
NA
4.02
5.41
NA
17.34
ZZZ61870

A
Implant neuroelectrodes
14.92
NA
9.73
3.86
NA
28.51
09061875

A
Implant neuroelectrodes
15.04
NA
8.59
2.94
NA
26.57
09061880

A
Revise/remove neuroelectrode
6.28
NA
4.58
1.66
NA
12.52
09061885

A
Insrt/redo neurostim 1 array
5.84
NA
5.32
1.59
NA
12.75
09061886

A
Implant neurostim arrays
7.99
NA
6.37
1.96
NA
16.32
09061888

A
Revise/remove neuroreceiver
5.06
NA
3.68
1.33
NA
10.07
01062000

A
Treat skull fracture
12.51
NA
5.53
1.06
NA
19.10
09062005

A
Treat skull fracture
16.15
NA
8.82
3.86
NA
28.83
09062010

A
Treatment of head injury
19.78
NA
11.74
5.12
NA
36.64
09062100

A
Repair brain fluid leakage
22.00
NA
12.82
4.83
NA
39.65
09062115

A
Reduction of skull defect
21.63
NA
11.67
5.49
NA
38.79
09062116

A
Reduction of skull defect
23.55
NA
13.40
6.09
NA
43.04
09062117

A
Reduction of skull defect
26.56
NA
15.41
4.52
NA
46.49
09062120

A
Repair skull cavity lesion
23.31
NA
18.53
2.99
NA
44.83
09062121

A
Incise skull repair
21.55
NA
15.49
4.16
NA
41.20
09062140

A
Repair of skull defect
13.49
NA
8.34
3.46
NA
25.29
09062141

A
Repair of skull defect
14.89
NA
9.07
3.75
NA
27.71
09062142

A
Remove skull plate/flap
10.77
NA
7.01
2.72
NA
20.50
09062143

A
Replace skull plate/flap
13.03
NA
8.06
3.36
NA
24.45
09062145

A
Repair of skull & brain
18.79
NA
10.92
4.49
NA
34.20
09062146

A
Repair of skull with graft
16.10
NA
9.66
3.61
NA
29.37
09062147

A
Repair of skull with graft
19.31
NA
11.33
4.31
NA
34.95
09062148

A
Retr bone flap to fix skull
2.00
NA
0.86
0.48
NA
3.34
ZZZ62160

A
Neuroendoscopy add-on
3.00
NA
1.53
0.77
NA
5.30
ZZZ62161

A
Dissect brain w/scope
19.97
NA
12.13
5.17
NA
37.27
09062162

A
Remove colloid cyst w/scope
25.21
NA
14.89
5.89
NA
45.99
09062163

A
Neuroendoscopy w/fb removal
15.48
NA
9.95
4.00
NA
29.43
09062164

A
Remove brain tumor w/scope
27.46
NA
14.99
5.36
NA
47.81
09062165

A
Remove pituit tumor w/scope
21.97
NA
13.42
3.00
NA
38.39
090( print page 70402)62180

A
Establish brain cavity shunt
21.03
NA
12.32
4.97
NA
38.32
09062190

A
Establish brain cavity shunt
11.05
NA
7.10
2.79
NA
20.94
09062192

A
Establish brain cavity shunt
12.23
NA
7.64
3.01
NA
22.88
09062194

A
Replace/irrigate catheter
5.02
NA
2.44
0.92
NA
8.38
01062200

A
Establish brain cavity shunt
18.29
NA
10.87
4.64
NA
33.80
09062201

A
Brain cavity shunt w/scope
14.84
NA
9.47
3.67
NA
27.98
09062220

A
Establish brain cavity shunt
12.98
NA
8.00
3.34
NA
24.32
09062223

A
Establish brain cavity shunt
12.85
NA
8.26
3.13
NA
24.24
09062225

A
Replace/irrigate catheter
5.40
NA
4.10
1.39
NA
10.89
09062230

A
Replace/revise brain shunt
10.52
NA
6.50
2.70
NA
19.72
09062252
26
A
Csf shunt reprogram
0.74
0.37
0.37
0.19
1.30
1.30
XXX62252
TC
A
Csf shunt reprogram
0.00
1.10
NA
0.02
1.12
NA
XXX62252

A
Csf shunt reprogram
0.74
1.47
NA
0.21
2.42
NA
XXX62256

A
Remove brain cavity shunt
6.59
NA
4.70
1.71
NA
13.00
09062258

A
Replace brain cavity shunt
14.52
NA
8.74
3.73
NA
26.99
09062263

A
Epidural lysis mult sessions
6.13
12.73
3.20
0.41
19.27
9.74
01062264

A
Epidural lysis on single day
4.42
7.75
1.42
0.27
12.44
6.11
01062268

A
Drain spinal cord cyst
4.73
11.56
2.15
0.43
16.72
7.31
00062269

A
Needle biopsy, spinal cord
5.01
14.72
1.98
0.37
20.10
7.36
00062270

A
Spinal fluid tap, diagnostic
1.13
3.00
0.56
0.08
4.21
1.77
00062272

A
Drain cerebro spinal fluid
1.35
3.62
0.71
0.18
5.15
2.24
00062273

A
Inject epidural patch
2.15
2.72
0.71
0.13
5.00
2.99
00062280

A
Treat spinal cord lesion
2.63
6.95
1.01
0.30
9.88
3.94
01062281

A
Treat spinal cord lesion
2.66
5.67
0.89
0.19
8.52
3.74
01062282

A
Treat spinal canal lesion
2.33
8.38
0.92
0.17
10.88
3.42
01062284

A
Injection for myelogram
1.54
4.97
0.68
0.13
6.64
2.35
00062287

A
Percutaneous diskectomy
8.07
NA
5.57
0.58
NA
14.22
09062290

A
Inject for spine disk x-ray
3.00
7.15
1.38
0.23
10.38
4.61
00062291

A
Inject for spine disk x-ray
2.91
5.95
1.23
0.26
9.12
4.40
00062292

A
Injection into disk lesion
7.85
NA
4.48
0.82
NA
13.15
09062294

A
Injection into spinal artery
11.81
NA
5.60
1.24
NA
18.65
09062310

A
Inject spine c/t
1.91
4.82
0.65
0.12
6.85
2.68
00062311

A
Inject spine l/s (cd)
1.54
4.93
0.59
0.09
6.56
2.22
00062318

A
Inject spine w/cath, c/t
2.04
5.74
0.65
0.12
7.90
2.81
00062319

A
Inject spine w/cath l/s (cd)
1.87
4.99
0.61
0.11
6.97
2.59
00062350

A
Implant spinal canal cath
6.86
NA
3.95
1.02
NA
11.83
09062351

A
Implant spinal canal cath
9.99
NA
7.14
2.24
NA
19.37
09062355

A
Remove spinal canal catheter
5.44
NA
3.17
0.71
NA
9.32
09062360

A
Insert spine infusion device
2.62
NA
2.69
0.34
NA
5.65
09062361

A
Implant spine infusion pump
5.41
NA
3.93
0.80
NA
10.14
09062362

A
Implant spine infusion pump
7.03
NA
4.37
1.18
NA
12.58
09062365

A
Remove spine infusion device
5.41
NA
3.59
0.86
NA
9.86
09062367

A
Analyze spine infusion pump
0.48
0.61
0.10
0.03
1.12
0.61
XXX62368

A
Analyze spine infusion pump
0.75
0.69
0.17
0.06
1.50
0.98
XXX63001

A
Removal of spinal lamina
15.80
NA
9.54
3.76
NA
29.10
09063003

A
Removal of spinal lamina
15.93
NA
9.89
3.72
NA
29.54
09063005

A
Removal of spinal lamina
14.90
NA
10.00
3.34
NA
28.24
09063011

A
Removal of spinal lamina
14.50
NA
8.29
3.37
NA
26.16
09063012

A
Removal of spinal lamina
15.38
NA
10.15
3.48
NA
29.01
09063015

A
Removal of spinal lamina
19.32
NA
11.90
4.75
NA
35.97
09063016

A
Removal of spinal lamina
19.17
NA
11.81
4.58
NA
35.56
09063017

A
Removal of spinal lamina
15.92
NA
10.42
3.63
NA
29.97
09063020

A
Neck spine disk surgery
14.79
NA
9.70
3.71
NA
28.20
09063030

A
Low back disk surgery
11.98
NA
8.44
3.00
NA
23.42
09063035

A
Spinal disk surgery add-on
3.15
NA
1.59
0.79
NA
5.53
ZZZ63040

A
Laminotomy, single cervical
18.78
NA
11.53
4.67
NA
34.98
09063042

A
Laminotomy, single lumbar
17.44
NA
11.37
4.25
NA
33.06
09063043

C
Laminotomy, add'l cervical
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ63044

C
Laminotomy, add'l lumbar
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ63045

A
Removal of spinal lamina
16.48
NA
10.38
3.98
NA
30.84
09063046

A
Removal of spinal lamina
15.78
NA
10.21
3.55
NA
29.54
09063047

A
Removal of spinal lamina
14.59
NA
9.92
3.23
NA
27.74
09063048

A
Remove spinal lamina add-on
3.26
NA
1.66
0.72
NA
5.64
ZZZ63050

A
Cervical laminoplasty
20.75
NA
11.87
4.66
NA
37.28
09063051

A
C-laminoplasty w/graft/plate
24.25
NA
13.51
4.66
NA
42.42
09063055

A
Decompress spinal cord
21.96
NA
13.17
5.27
NA
40.40
09063056

A
Decompress spinal cord
20.33
NA
12.60
4.75
NA
37.68
09063057

A
Decompress spine cord add-on
5.25
NA
2.64
1.22
NA
9.11
ZZZ63064

A
Decompress spinal cord
24.57
NA
14.46
5.69
NA
44.72
09063066

A
Decompress spine cord add-on
3.26
NA
1.66
0.69
NA
5.61
ZZZ63075

A
Neck spine disk surgery
19.38
NA
12.12
4.62
NA
36.12
09063076

A
Neck spine disk surgery
4.04
NA
2.06
0.96
NA
7.06
ZZZ63077

A
Spine disk surgery, thorax
21.41
NA
12.83
3.98
NA
38.22
09063078

A
Spine disk surgery, thorax
3.28
NA
1.64
0.66
NA
5.58
ZZZ63081

A
Removal of vertebral body
23.69
NA
14.36
5.54
NA
43.59
090( print page 70403)63082

A
Remove vertebral body add-on
4.36
NA
2.23
1.02
NA
7.61
ZZZ63085

A
Removal of vertebral body
26.88
NA
15.51
4.48
NA
46.87
09063086

A
Remove vertebral body add-on
3.19
NA
1.59
0.59
NA
5.37
ZZZ63087

A
Removal of vertebral body
35.52
NA
19.51
6.20
NA
61.23
09063088

A
Remove vertebral body add-on
4.32
NA
2.18
0.82
NA
7.32
ZZZ63090

A
Removal of vertebral body
28.12
NA
16.08
4.21
NA
48.41
09063091

A
Remove vertebral body add-on
3.03
NA
1.46
0.48
NA
4.97
ZZZ63101

A
Removal of vertebral body
31.95
NA
19.33
5.69
NA
56.97
09063102

A
Removal of vertebral body
31.95
NA
19.33
5.69
NA
56.97
09063103

A
Remove vertebral body add-on
4.82
NA
2.51
0.69
NA
8.02
ZZZ63170

A
Incise spinal cord tract(s)
19.80
NA
11.89
4.86
NA
36.55
09063172

A
Drainage of spinal cyst
17.63
NA
10.67
4.48
NA
32.78
09063173

A
Drainage of spinal cyst
21.96
NA
12.84
5.68
NA
40.48
09063180

A
Revise spinal cord ligaments
18.24
NA
11.01
3.95
NA
33.20
09063182

A
Revise spinal cord ligaments
20.47
NA
10.98
5.30
NA
36.75
09063185

A
Incise spinal column/nerves
15.02
NA
8.11
2.79
NA
25.92
09063190

A
Incise spinal column/nerves
17.42
NA
10.16
3.24
NA
30.82
09063191

A
Incise spinal column/nerves
17.51
NA
10.50
6.34
NA
34.35
09063194

A
Incise spinal column & cord
19.16
NA
11.74
3.26
NA
34.16
09063195

A
Incise spinal column & cord
18.81
NA
11.07
4.87
NA
34.75
09063196

A
Incise spinal column & cord
22.27
NA
13.42
5.76
NA
41.45
09063197

A
Incise spinal column & cord
21.08
NA
12.24
5.36
NA
38.68
09063198

A
Incise spinal column & cord
25.34
NA
8.45
6.43
NA
40.22
09063199

A
Incise spinal column & cord
26.85
NA
15.07
1.40
NA
43.32
09063200

A
Release of spinal cord
19.15
NA
11.32
4.96
NA
35.43
09063250

A
Revise spinal cord vessels
40.70
NA
19.98
9.01
NA
69.69
09063251

A
Revise spinal cord vessels
41.14
NA
22.65
10.41
NA
74.20
09063252

A
Revise spinal cord vessels
41.13
NA
22.29
10.64
NA
74.06
09063265

A
Excise intraspinal lesion
21.53
NA
12.80
5.43
NA
39.76
09063266

A
Excise intraspinal lesion
22.27
NA
13.21
5.54
NA
41.02
09063267

A
Excise intraspinal lesion
17.92
NA
11.10
4.37
NA
33.39
09063268

A
Excise intraspinal lesion
18.49
NA
10.39
3.69
NA
32.57
09063270

A
Excise intraspinal lesion
26.76
NA
15.50
6.82
NA
49.08
09063271

A
Excise intraspinal lesion
26.88
NA
15.61
6.90
NA
49.39
09063272

A
Excise intraspinal lesion
25.28
NA
14.72
6.18
NA
46.18
09063273

A
Excise intraspinal lesion
24.25
NA
14.37
5.74
NA
44.36
09063275

A
Biopsy/excise spinal tumor
23.64
NA
13.80
5.80
NA
43.24
09063276

A
Biopsy/excise spinal tumor
23.41
NA
13.71
5.83
NA
42.95
09063277

A
Biopsy/excise spinal tumor
20.80
NA
12.55
5.01
NA
38.36
09063278

A
Biopsy/excise spinal tumor
20.53
NA
12.42
4.55
NA
37.50
09063280

A
Biopsy/excise spinal tumor
28.31
NA
16.35
7.27
NA
51.93
09063281

A
Biopsy/excise spinal tumor
28.01
NA
16.21
7.17
NA
51.39
09063282

A
Biopsy/excise spinal tumor
26.35
NA
15.36
6.76
NA
48.47
09063283

A
Biopsy/excise spinal tumor
24.96
NA
14.69
6.26
NA
45.91
09063285

A
Biopsy/excise spinal tumor
35.95
NA
19.99
9.18
NA
65.12
09063286

A
Biopsy/excise spinal tumor
35.58
NA
19.95
9.21
NA
64.74
09063287

A
Biopsy/excise spinal tumor
36.64
NA
20.47
9.39
NA
66.50
09063290

A
Biopsy/excise spinal tumor
37.32
NA
20.64
9.02
NA
66.98
09063295

A
Repair of laminectomy defect
5.25
NA
2.15
1.03
NA
8.43
ZZZ63300

A
Removal of vertebral body
24.39
NA
14.33
5.97
NA
44.69
09063301

A
Removal of vertebral body
27.56
NA
15.59
5.39
NA
48.54
09063302

A
Removal of vertebral body
27.77
NA
15.89
5.53
NA
49.19
09063303

A
Removal of vertebral body
30.45
NA
16.95
4.68
NA
52.08
09063304

A
Removal of vertebral body
30.28
NA
17.31
6.41
NA
54.00
09063305

A
Removal of vertebral body
31.98
NA
18.09
5.71
NA
55.78
09063306

A
Removal of vertebral body
32.17
NA
17.84
8.33
NA
58.34
09063307

A
Removal of vertebral body
31.58
NA
16.85
4.46
NA
52.89
09063308

A
Remove vertebral body add-on
5.24
NA
2.61
1.29
NA
9.14
ZZZ63600

A
Remove spinal cord lesion
14.00
NA
5.41
1.52
NA
20.93
09063610

A
Stimulation of spinal cord
8.72
59.85
2.26
0.86
69.43
11.84
00063615

A
Remove lesion of spinal cord
16.26
NA
9.29
2.84
NA
28.39
09063650

A
Implant neuroelectrodes
6.73
NA
3.18
0.53
NA
10.44
09063655

A
Implant neuroelectrodes
10.27
NA
6.91
2.43
NA
19.61
09063660

A
Revise/remove neuroelectrode
6.15
NA
3.62
0.78
NA
10.55
09063685

A
Insrt/redo spine n generator
7.03
NA
4.15
1.05
NA
12.23
09063688

A
Revise/remove neuroreceiver
5.38
NA
3.56
0.89
NA
9.83
09063700

A
Repair of spinal herniation
16.51
NA
10.33
3.52
NA
30.36
09063702

A
Repair of spinal herniation
18.45
NA
11.06
4.12
NA
33.63
09063704

A
Repair of spinal herniation
21.15
NA
12.95
4.57
NA
38.67
09063706

A
Repair of spinal herniation
24.07
NA
13.61
6.23
NA
43.91
09063707

A
Repair spinal fluid leakage
11.24
NA
7.72
2.51
NA
21.47
09063709

A
Repair spinal fluid leakage
14.30
NA
9.42
3.09
NA
26.81
09063710

A
Graft repair of spine defect
14.05
NA
9.06
3.40
NA
26.51
09063740

A
Install spinal shunt
11.34
NA
7.36
2.93
NA
21.63
09063741

A
Install spinal shunt
8.24
NA
4.76
1.66
NA
14.66
090( print page 70404)63744

A
Revision of spinal shunt
8.09
NA
5.27
1.89
NA
15.25
09063746

A
Removal of spinal shunt
6.42
NA
3.78
1.53
NA
11.73
09064400

A
N block inj, trigeminal
1.11
1.90
0.43
0.07
3.08
1.61
00064402

A
N block inj, facial
1.25
1.61
0.60
0.09
2.95
1.94
00064405

A
N block inj, occipital
1.32
1.46
0.46
0.08
2.86
1.86
00064408

A
N block inj, vagus
1.41
1.58
0.85
0.10
3.09
2.36
00064410

A
N block inj, phrenic
1.43
2.51
0.46
0.09
4.03
1.98
00064412

A
N block inj, spinal accessor
1.18
2.66
0.43
0.08
3.92
1.69
00064413

A
N block inj, cervical plexus
1.40
1.85
0.50
0.08
3.33
1.98
00064415

A
N block inj, brachial plexus
1.48
2.81
0.46
0.09
4.38
2.03
00064416

A
N block cont infuse, b plex
3.49
NA
0.79
0.31
NA
4.59
01064417

A
N block inj, axillary
1.44
3.04
0.49
0.11
4.59
2.04
00064418

A
N block inj, suprascapular
1.32
2.63
0.44
0.07
4.02
1.83
00064420

A
N block inj, intercost, sng
1.18
3.89
0.42
0.08
5.15
1.68
00064421

A
N block inj, intercost, mlt
1.68
6.10
0.52
0.11
7.89
2.31
00064425

A
N block inj, ilio-ing/hypogi
1.75
1.65
0.54
0.13
3.53
2.42
00064430

A
N block inj, pudendal
1.46
2.52
0.55
0.10
4.08
2.11
00064435

A
N block inj, paracervical
1.45
2.53
0.69
0.16
4.14
2.30
00064445

A
N block inj, sciatic, sng
1.48
2.68
0.50
0.10
4.26
2.08
00064446

A
N blk inj, sciatic, cont inf
3.25
NA
1.00
0.20
NA
4.45
01064447

A
N block inj fem, single
1.50
NA
0.43
0.09
NA
2.02
00064448

A
N block inj fem, cont inf
3.00
NA
0.81
0.18
NA
3.99
01064449

A
N block inj, lumbar plexus
3.00
NA
0.96
0.15
NA
4.11
01064450

A
N block, other peripheral
1.27
1.24
0.48
0.13
2.64
1.88
00064470

A
Inj paravertebral c/t
1.85
7.25
0.71
0.11
9.21
2.67
00064472

A
Inj paravertebral c/t add-on
1.29
2.34
0.34
0.08
3.71
1.71
ZZZ64475

A
Inj paravertebral l/s
1.41
6.90
0.63
0.10
8.41
2.14
00064476

A
Inj paravertebral l/s add-on
0.98
2.13
0.24
0.07
3.18
1.29
ZZZ64479

A
Inj foramen epidural c/t
2.20
7.51
0.89
0.12
9.83
3.21
00064480

A
Inj foramen epidural add-on
1.54
2.85
0.47
0.10
4.49
2.11
ZZZ64483

A
Inj foramen epidural l/s
1.90
7.91
0.83
0.11
9.92
2.84
00064484

A
Inj foramen epidural add-on
1.33
3.29
0.37
0.08
4.70
1.78
ZZZ64505

A
N block, spenopalatine gangl
1.36
1.24
0.66
0.10
2.70
2.12
00064508

A
N block, carotid sinus s/p
1.12
3.33
0.74
0.07
4.52
1.93
00064510

A
N block, stellate ganglion
1.22
3.46
0.51
0.07
4.75
1.80
00064517

A
N block inj, hypogas plxs
2.20
2.73
0.87
0.11
5.04
3.18
00064520

A
N block, lumbar/thoracic
1.35
5.15
0.55
0.08
6.58
1.98
00064530

A
N block inj, celiac pelus
1.58
4.46
0.65
0.10
6.14
2.33
00064550

A
Apply neurostimulator
0.18
0.28
0.05
0.01
0.47
0.24
00064553

A
Implant neuroelectrodes
2.31
2.84
1.86
0.18
5.33
4.35
01064555

A
Implant neuroelectrodes
2.27
3.11
1.19
0.19
5.57
3.65
01064560

A
Implant neuroelectrodes
2.36
2.64
1.28
0.22
5.22
3.86
01064561

A
Implant neuroelectrodes
6.73
30.14
2.78
0.51
37.38
10.02
01064565

A
Implant neuroelectrodes
1.76
3.29
1.26
0.13
5.18
3.15
01064573

A
Implant neuroelectrodes
7.49
NA
5.26
1.60
NA
14.35
09064575

A
Implant neuroelectrodes
4.34
NA
2.68
0.61
NA
7.63
09064577

A
Implant neuroelectrodes
4.61
NA
3.29
1.04
NA
8.94
09064580

A
Implant neuroelectrodes
4.11
NA
3.56
0.36
NA
8.03
09064581

A
Implant neuroelectrodes
13.48
NA
5.39
1.05
NA
19.92
09064585

A
Revise/remove neuroelectrode
2.06
11.31
2.14
0.20
13.57
4.40
01064590

A
Insrt/redo perph n generator
2.40
7.16
2.29
0.19
9.75
4.88
01064595

A
Revise/remove neuroreceiver
1.73
10.42
1.93
0.19
12.34
3.85
01064600

A
Injection treatment of nerve
3.44
9.38
1.65
0.34
13.16
5.43
01064605

A
Injection treatment of nerve
5.60
9.58
2.19
0.79
15.97
8.58
01064610

A
Injection treatment of nerve
7.15
8.89
3.72
1.58
17.62
12.45
01064612

A
Destroy nerve, face muscle
1.96
2.49
1.32
0.11
4.56
3.39
01064613

A
Destroy nerve, neck muscle
1.96
2.94
1.22
0.11
5.01
3.29
01064614

A
Destroy nerve, extrem musc
2.20
3.23
1.31
0.10
5.53
3.61
01064620

A
Injection treatment of nerve
2.84
5.07
1.33
0.20
8.11
4.37
01064622

A
Destr paravertebrl nerve l/s
3.00
7.78
1.37
0.18
10.96
4.55
01064623

A
Destr paravertebral n add-on
0.99
2.97
0.22
0.06
4.02
1.27
ZZZ64626

A
Destr paravertebrl nerve c/t
3.28
7.80
1.97
0.20
11.28
5.45
01064627

A
Destr paravertebral n add-on
1.16
4.54
0.27
0.07
5.77
1.50
ZZZ64630

A
Injection treatment of nerve
3.00
2.74
1.41
0.22
5.96
4.63
01064640

A
Injection treatment of nerve
2.76
4.19
1.85
0.29
7.24
4.90
01064650

A
Chemodenerv eccrine glands
0.70
0.87
0.30
0.06
1.63
1.06
00064653

A
Chemodenerv eccrine glands
0.88
0.92
0.38
0.08
1.88
1.34
00064680

A
Injection treatment of nerve
2.62
6.73
1.43
0.18
9.53
4.23
01064681

A
Injection treatment of nerve
3.54
9.32
2.07
0.28
13.14
5.89
01064702

A
Revise finger/toe nerve
4.22
NA
3.87
0.61
NA
8.70
09064704

A
Revise hand/foot nerve
4.56
NA
3.32
0.61
NA
8.49
09064708

A
Revise arm/leg nerve
6.11
NA
4.87
0.96
NA
11.94
09064712

A
Revision of sciatic nerve
7.74
NA
4.97
0.95
NA
13.66
09064713

A
Revision of arm nerve(s)
10.98
NA
5.89
1.82
NA
18.69
09064714

A
Revise low back nerve(s)
10.31
NA
4.21
1.19
NA
15.71
090( print page 70405)64716

A
Revision of cranial nerve
6.30
NA
5.99
0.63
NA
12.92
09064718

A
Revise ulnar nerve at elbow
5.98
NA
6.01
1.05
NA
13.04
09064719

A
Revise ulnar nerve at wrist
4.84
NA
4.53
0.77
NA
10.14
09064721

A
Carpal tunnel surgery
4.28
NA
5.38
0.73
NA
10.39
09064722

A
Relieve pressure on nerve(s)
4.69
NA
3.05
0.48
NA
8.22
09064726

A
Release foot/toe nerve
4.17
NA
2.80
0.54
NA
7.51
09064727

A
Internal nerve revision
3.10
NA
1.50
0.48
NA
5.08
ZZZ64732

A
Incision of brow nerve
4.40
NA
3.51
0.98
NA
8.89
09064734

A
Incision of cheek nerve
4.91
NA
4.06
0.89
NA
9.86
09064736

A
Incision of chin nerve
4.59
NA
4.03
0.52
NA
9.14
09064738

A
Incision of jaw nerve
5.72
NA
4.62
1.08
NA
11.42
09064740

A
Incision of tongue nerve
5.58
NA
5.13
0.69
NA
11.40
09064742

A
Incision of facial nerve
6.21
NA
4.71
0.73
NA
11.65
09064744

A
Incise nerve, back of head
5.23
NA
3.78
1.16
NA
10.17
09064746

A
Incise diaphragm nerve
5.92
NA
4.51
0.82
NA
11.25
09064752

A
Incision of vagus nerve
7.05
NA
4.29
0.93
NA
12.27
09064755

A
Incision of stomach nerves
13.50
NA
5.65
1.83
NA
20.98
09064760

A
Incision of vagus nerve
6.95
NA
3.46
0.81
NA
11.22
09064761

A
Incision of pelvis nerve
6.40
NA
3.53
0.53
NA
10.46
09064763

A
Incise hip/thigh nerve
6.92
NA
5.21
0.94
NA
13.07
09064766

A
Incise hip/thigh nerve
8.66
NA
5.26
1.06
NA
14.98
09064771

A
Sever cranial nerve
7.34
NA
5.57
1.23
NA
14.14
09064772

A
Incision of spinal nerve
7.20
NA
4.93
1.40
NA
13.53
09064774

A
Remove skin nerve lesion
5.16
NA
3.84
0.74
NA
9.74
09064776

A
Remove digit nerve lesion
5.11
NA
3.69
0.76
NA
9.56
09064778

A
Digit nerve surgery add-on
3.11
NA
1.50
0.46
NA
5.07
ZZZ64782

A
Remove limb nerve lesion
6.22
NA
3.78
0.86
NA
10.86
09064783

A
Limb nerve surgery add-on
3.71
NA
1.84
0.51
NA
6.06
ZZZ64784

A
Remove nerve lesion
9.81
NA
6.61
1.38
NA
17.80
09064786

A
Remove sciatic nerve lesion
15.44
NA
9.86
2.60
NA
27.90
09064787

A
Implant nerve end
4.29
NA
2.13
0.58
NA
7.00
ZZZ64788

A
Remove skin nerve lesion
4.60
NA
3.47
0.73
NA
8.80
09064790

A
Removal of nerve lesion
11.29
NA
7.22
2.10
NA
20.61
09064792

A
Removal of nerve lesion
14.90
NA
8.85
2.48
NA
26.23
09064795

A
Biopsy of nerve
3.01
NA
1.56
0.52
NA
5.09
00064802

A
Remove sympathetic nerves
9.14
NA
5.14
1.29
NA
15.57
09064804

A
Remove sympathetic nerves
14.62
NA
7.18
2.14
NA
23.94
09064809

A
Remove sympathetic nerves
13.65
NA
5.78
1.50
NA
20.93
09064818

A
Remove sympathetic nerves
10.28
NA
5.30
1.33
NA
16.91
09064820

A
Remove sympathetic nerves
10.35
NA
7.14
1.49
NA
18.98
09064821

A
Remove sympathetic nerves
8.74
NA
7.36
1.24
NA
17.34
09064822

A
Remove sympathetic nerves
8.74
NA
7.25
1.30
NA
17.29
09064823

A
Remove sympathetic nerves
10.35
NA
8.15
1.57
NA
20.07
09064831

A
Repair of digit nerve
9.43
NA
7.09
1.41
NA
17.93
09064832

A
Repair nerve add-on
5.65
NA
2.94
0.85
NA
9.44
ZZZ64834

A
Repair of hand or foot nerve
10.17
NA
7.11
1.54
NA
18.82
09064835

A
Repair of hand or foot nerve
10.92
NA
7.71
1.73
NA
20.36
09064836

A
Repair of hand or foot nerve
10.92
NA
7.68
1.67
NA
20.27
09064837

A
Repair nerve add-on
6.25
NA
3.24
0.97
NA
10.46
ZZZ64840

A
Repair of leg nerve
13.00
NA
8.27
1.37
NA
22.64
09064856

A
Repair/transpose nerve
13.78
NA
9.21
2.12
NA
25.11
09064857

A
Repair arm/leg nerve
14.47
NA
9.66
2.21
NA
26.34
09064858

A
Repair sciatic nerve
16.47
NA
10.80
3.33
NA
30.60
09064859

A
Nerve surgery
4.25
NA
2.20
0.67
NA
7.12
ZZZ64861

A
Repair of arm nerves
19.21
NA
11.80
4.08
NA
35.09
09064862

A
Repair of low back nerves
19.41
NA
11.96
4.31
NA
35.68
09064864

A
Repair of facial nerve
12.53
NA
8.79
1.26
NA
22.58
09064865

A
Repair of facial nerve
15.22
NA
13.56
1.50
NA
30.28
09064866

A
Fusion of facial/other nerve
15.72
NA
13.20
2.04
NA
30.96
09064868

A
Fusion of facial/other nerve
14.02
NA
11.46
1.43
NA
26.91
09064870

A
Fusion of facial/other nerve
15.97
NA
8.75
1.30
NA
26.02
09064872

A
Subsequent repair of nerve
1.99
NA
1.08
0.29
NA
3.36
ZZZ64874

A
Repair & revise nerve add-on
2.98
NA
1.53
0.42
NA
4.93
ZZZ64876

A
Repair nerve/shorten bone
3.37
NA
1.75
0.47
NA
5.59
ZZZ64885

A
Nerve graft, head or neck
17.50
NA
11.63
1.63
NA
30.76
09064886

A
Nerve graft, head or neck
20.72
NA
13.58
2.08
NA
36.38
09064890

A
Nerve graft, hand or foot
15.13
NA
10.02
2.29
NA
27.44
09064891

A
Nerve graft, hand or foot
16.12
NA
7.60
1.63
NA
25.35
09064892

A
Nerve graft, arm or leg
14.63
NA
8.89
2.47
NA
25.99
09064893

A
Nerve graft, arm or leg
15.58
NA
9.89
2.61
NA
28.08
09064895

A
Nerve graft, hand or foot
19.22
NA
9.68
2.57
NA
31.47
09064896

A
Nerve graft, hand or foot
20.46
NA
11.01
3.16
NA
34.63
09064897

A
Nerve graft, arm or leg
18.21
NA
10.72
2.54
NA
31.47
09064898

A
Nerve graft, arm or leg
19.47
NA
11.82
2.77
NA
34.06
09064901

A
Nerve graft add-on
10.20
NA
5.28
1.37
NA
16.85
ZZZ( print page 70406)64902

A
Nerve graft add-on
11.81
NA
5.98
1.55
NA
19.34
ZZZ64905

A
Nerve pedicle transfer
14.00
NA
8.51
2.00
NA
24.51
09064907

A
Nerve pedicle transfer
18.80
NA
12.56
3.16
NA
34.52
09064999

C
Nervous system surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY65091

A
Revise eye
6.45
NA
8.37
0.32
NA
15.14
09065093

A
Revise eye with implant
6.86
NA
8.74
0.34
NA
15.94
09065101

A
Removal of eye
7.02
NA
9.55
0.35
NA
16.92
09065103

A
Remove eye/insert implant
7.56
NA
9.76
0.37
NA
17.69
09065105

A
Remove eye/attach implant
8.48
NA
10.49
0.42
NA
19.39
09065110

A
Removal of eye
13.93
NA
13.71
0.81
NA
28.45
09065112

A
Remove eye/revise socket
16.36
NA
16.18
1.30
NA
33.84
09065114

A
Remove eye/revise socket
17.50
NA
16.39
1.02
NA
34.91
09065125

A
Revise ocular implant
3.12
8.83
3.61
0.19
12.14
6.92
09065130

A
Insert ocular implant
7.14
NA
9.19
0.35
NA
16.68
09065135

A
Insert ocular implant
7.32
NA
9.34
0.36
NA
17.02
09065140

A
Attach ocular implant
8.01
NA
9.90
0.40
NA
18.31
09065150

A
Revise ocular implant
6.25
NA
7.99
0.31
NA
14.55
09065155

A
Reinsert ocular implant
8.65
NA
10.51
0.50
NA
19.66
09065175

A
Removal of ocular implant
6.27
NA
8.50
0.31
NA
15.08
09065205

A
Remove foreign body from eye
0.71
0.64
0.29
0.03
1.38
1.03
00065210

A
Remove foreign body from eye
0.84
0.81
0.38
0.04
1.69
1.26
00065220

A
Remove foreign body from eye
0.71
0.64
0.28
0.05
1.40
1.04
00065222

A
Remove foreign body from eye
0.93
0.89
0.38
0.04
1.86
1.35
00065235

A
Remove foreign body from eye
7.56
NA
6.76
0.37
NA
14.69
09065260

A
Remove foreign body from eye
10.94
NA
9.68
0.57
NA
21.19
09065265

A
Remove foreign body from eye
12.57
NA
10.65
0.62
NA
23.84
09065270

A
Repair of eye wound
1.90
5.24
1.39
0.09
7.23
3.38
01065272

A
Repair of eye wound
3.81
7.73
3.30
0.19
11.73
7.30
09065273

A
Repair of eye wound
4.35
NA
3.59
0.22
NA
8.16
09065275

A
Repair of eye wound
5.33
6.33
3.95
0.26
11.92
9.54
09065280

A
Repair of eye wound
7.65
NA
6.25
0.38
NA
14.28
09065285

A
Repair of eye wound
12.88
NA
9.24
0.64
NA
22.76
09065286

A
Repair of eye wound
5.50
11.17
4.63
0.27
16.94
10.40
09065290

A
Repair of eye socket wound
5.40
NA
4.75
0.31
NA
10.46
09065400

A
Removal of eye lesion
6.05
8.35
6.14
0.30
14.70
12.49
09065410

A
Biopsy of cornea
1.47
2.12
0.97
0.07
3.66
2.51
00065420

A
Removal of eye lesion
4.16
8.88
4.45
0.21
13.25
8.82
09065426

A
Removal of eye lesion
5.24
10.20
4.93
0.25
15.69
10.42
09065430

A
Corneal smear
1.47
1.29
0.98
0.07
2.83
2.52
00065435

A
Curette/treat cornea
0.92
1.00
0.71
0.04
1.96
1.67
00065436

A
Curette/treat cornea
4.18
4.10
3.68
0.21
8.49
8.07
09065450

A
Treatment of corneal lesion
3.27
4.08
3.95
0.16
7.51
7.38
09065600

A
Revision of cornea
3.39
5.02
3.36
0.17
8.58
6.92
09065710

A
Corneal transplant
12.33
NA
11.23
0.61
NA
24.17
09065730

A
Corneal transplant
14.23
NA
12.05
0.70
NA
26.98
09065750

A
Corneal transplant
14.98
NA
12.00
0.74
NA
27.72
09065755

A
Corneal transplant
14.87
NA
11.92
0.73
NA
27.52
09065760

N
Revision of cornea
0.00
0.00
0.00
0.00
0.00
0.00
XXX65765

N
Revision of cornea
0.00
0.00
0.00
0.00
0.00
0.00
XXX65767

N
Corneal tissue transplant
0.00
0.00
0.00
0.00
0.00
0.00
XXX65770

A
Revise cornea with implant
17.53
NA
13.24
0.87
NA
31.64
09065771

N
Radial keratotomy
0.00
0.00
0.00
0.00
0.00
0.00
XXX65772

A
Correction of astigmatism
4.28
5.55
4.14
0.21
10.04
8.63
09065775

A
Correction of astigmatism
5.78
NA
5.97
0.28
NA
12.03
09065780

A
Ocular reconst, transplant
10.23
NA
10.32
0.44
NA
20.99
09065781

A
Ocular reconst, transplant
17.64
NA
13.71
0.44
NA
31.79
09065782

A
Ocular reconst, transplant
14.98
NA
12.02
0.44
NA
27.44
09065800

A
Drainage of eye
1.91
1.80
1.18
0.09
3.80
3.18
00065805

A
Drainage of eye
1.91
2.18
1.19
0.09
4.18
3.19
00065810

A
Drainage of eye
4.86
NA
4.71
0.24
NA
9.81
09065815

A
Drainage of eye
5.04
10.03
4.82
0.25
15.32
10.11
09065820

A
Relieve inner eye pressure
8.12
NA
9.08
0.40
NA
17.60
09065850

A
Incision of eye
10.50
NA
8.46
0.52
NA
19.48
09065855

A
Laser surgery of eye
3.84
4.32
3.11
0.19
8.35
7.14
01065860

A
Incise inner eye adhesions
3.54
4.05
2.51
0.18
7.77
6.23
09065865

A
Incise inner eye adhesions
5.59
NA
5.64
0.28
NA
11.51
09065870

A
Incise inner eye adhesions
6.26
NA
6.43
0.31
NA
13.00
09065875

A
Incise inner eye adhesions
6.53
NA
6.81
0.32
NA
13.66
09065880

A
Incise inner eye adhesions
7.08
NA
7.05
0.35
NA
14.48
09065900

A
Remove eye lesion
10.91
NA
10.28
0.54
NA
21.73
09065920

A
Remove implant of eye
8.39
NA
8.19
0.41
NA
16.99
09065930

A
Remove blood clot from eye
7.43
NA
6.85
0.37
NA
14.65
09066020

A
Injection treatment of eye
1.59
3.13
1.44
0.08
4.80
3.11
01066030

A
Injection treatment of eye
1.25
2.97
1.28
0.06
4.28
2.59
01066130

A
Remove eye lesion
7.68
9.65
5.63
0.38
17.71
13.69
090( print page 70407)66150

A
Glaucoma surgery
8.29
NA
9.43
0.46
NA
18.18
09066155

A
Glaucoma surgery
8.28
NA
9.38
0.41
NA
18.07
09066160

A
Glaucoma surgery
10.15
NA
10.22
0.50
NA
20.87
09066165

A
Glaucoma surgery
8.00
NA
9.27
0.40
NA
17.67
09066170

A
Glaucoma surgery
12.14
NA
12.26
0.60
NA
25.00
09066172

A
Incision of eye
15.02
NA
15.24
0.74
NA
31.00
09066180

A
Implant eye shunt
14.53
NA
10.79
0.71
NA
26.03
09066185

A
Revise eye shunt
8.13
NA
7.40
0.40
NA
15.93
09066220

A
Repair eye lesion
7.76
NA
7.12
0.40
NA
15.28
09066225

A
Repair/graft eye lesion
11.03
NA
8.76
0.55
NA
20.34
09066250

A
Follow-up surgery of eye
5.97
11.72
5.50
0.30
17.99
11.77
09066500

A
Incision of iris
3.70
NA
4.65
0.18
NA
8.53
09066505

A
Incision of iris
4.07
NA
5.00
0.20
NA
9.27
09066600

A
Remove iris and lesion
8.67
NA
8.24
0.43
NA
17.34
09066605

A
Removal of iris
12.77
NA
10.05
0.77
NA
23.59
09066625

A
Removal of iris
5.12
NA
4.74
0.26
NA
10.12
09066630

A
Removal of iris
6.15
NA
5.73
0.31
NA
12.19
09066635

A
Removal of iris
6.24
NA
5.76
0.31
NA
12.31
09066680

A
Repair iris & ciliary body
5.43
NA
5.29
0.27
NA
10.99
09066682

A
Repair iris & ciliary body
6.20
NA
6.63
0.31
NA
13.14
09066700

A
Destruction, ciliary body
4.77
5.26
3.94
0.24
10.27
8.95
09066710

A
Ciliary transsleral therapy
4.77
5.18
3.85
0.23
10.18
8.85
09066711

A
Ciliary endoscopic ablation
6.60
NA
6.49
0.30
NA
13.39
09066720

A
Destruction, ciliary body
4.77
5.81
4.73
0.26
10.84
9.76
09066740

A
Destruction, ciliary body
4.77
5.10
3.98
0.23
10.10
8.98
09066761

A
Revision of iris
4.06
5.61
4.32
0.20
9.87
8.58
09066762

A
Revision of iris
4.57
5.67
4.30
0.23
10.47
9.10
09066770

A
Removal of inner eye lesion
5.17
6.10
4.81
0.26
11.53
10.24
09066820

A
Incision, secondary cataract
3.88
NA
5.83
0.19
NA
9.90
09066821

A
After cataract laser surgery
2.35
4.10
3.63
0.11
6.56
6.09
09066825

A
Reposition intraocular lens
8.22
NA
9.09
0.40
NA
17.71
09066830

A
Removal of lens lesion
8.19
NA
6.97
0.36
NA
15.52
09066840

A
Removal of lens material
7.90
NA
6.88
0.39
NA
15.17
09066850

A
Removal of lens material
9.10
NA
7.66
0.45
NA
17.21
09066852

A
Removal of lens material
9.96
NA
8.12
0.49
NA
18.57
09066920

A
Extraction of lens
8.85
NA
7.32
0.44
NA
16.61
09066930

A
Extraction of lens
10.16
NA
8.16
0.49
NA
18.81
09066940

A
Extraction of lens
8.92
NA
7.62
0.43
NA
16.97
09066982

A
Cataract surgery, complex
13.48
NA
9.89
0.63
NA
24.00
09066983

A
Cataract surg w/iol, 1 stage
8.98
NA
6.13
0.14
NA
15.25
09066984

A
Cataract surg w/iol, 1 stage
10.21
NA
7.44
0.39
NA
18.04
09066985

A
Insert lens prosthesis
8.38
NA
7.47
0.36
NA
16.21
09066986

A
Exchange lens prosthesis
12.26
NA
9.20
0.60
NA
22.06
09066990

A
Ophthalmic endoscope add-on
1.51
NA
0.69
0.07
NA
2.27
ZZZ66999

C
Eye surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY67005

A
Partial removal of eye fluid
5.69
NA
4.87
0.28
NA
10.84
09067010

A
Partial removal of eye fluid
6.86
NA
5.43
0.34
NA
12.63
09067015

A
Release of eye fluid
6.91
NA
6.47
0.34
NA
13.72
09067025

A
Replace eye fluid
6.83
9.25
6.24
0.34
16.42
13.41
09067027

A
Implant eye drug system
10.83
NA
8.02
0.54
NA
19.39
09067028

A
Injection eye drug
2.52
2.71
1.46
0.12
5.35
4.10
00067030

A
Incise inner eye strands
4.83
NA
5.87
0.24
NA
10.94
09067031

A
Laser surgery, eye strands
3.66
4.61
3.65
0.18
8.45
7.49
09067036

A
Removal of inner eye fluid
11.87
NA
9.15
0.58
NA
21.60
09067038

A
Strip retinal membrane
21.21
NA
15.53
1.04
NA
37.78
09067039

A
Laser treatment of retina
14.50
NA
12.22
0.71
NA
27.43
09067040

A
Laser treatment of retina
17.20
NA
13.72
0.85
NA
31.77
09067101

A
Repair detached retina
7.52
9.15
6.55
0.37
17.04
14.44
09067105

A
Repair detached retina
7.40
8.10
6.17
0.37
15.87
13.94
09067107

A
Repair detached retina
14.82
NA
11.33
0.73
NA
26.88
09067108

A
Repair detached retina
20.79
NA
14.46
1.02
NA
36.27
09067110

A
Repair detached retina
8.80
10.26
7.41
0.44
19.50
16.65
09067112

A
Rerepair detached retina
16.83
NA
11.84
0.83
NA
29.50
09067115

A
Release encircling material
4.98
NA
5.09
0.25
NA
10.32
09067120

A
Remove eye implant material
5.97
8.60
5.55
0.29
14.86
11.81
09067121

A
Remove eye implant material
10.65
NA
8.55
0.53
NA
19.73
09067141

A
Treatment of retina
5.19
5.87
4.87
0.26
11.32
10.32
09067145

A
Treatment of retina
5.36
5.74
4.94
0.27
11.37
10.57
09067208

A
Treatment of retinal lesion
6.69
6.14
5.53
0.33
13.16
12.55
09067210

A
Treatment of retinal lesion
8.81
6.59
5.90
0.44
15.84
15.15
09067218

A
Treatment of retinal lesion
18.50
NA
12.19
0.92
NA
31.61
09067220

A
Treatment of choroid lesion
13.11
10.45
9.04
0.65
24.21
22.80
09067221

R
Ocular photodynamic ther
4.00
4.34
1.81
0.20
8.54
6.01
00067225

A
Eye photodynamic ther add-on
0.47
0.25
0.21
0.02
0.74
0.70
ZZZ67227

A
Treatment of retinal lesion
6.57
6.60
5.54
0.33
13.50
12.44
090( print page 70408)67228

A
Treatment of retinal lesion
12.72
11.51
8.56
0.63
24.86
21.91
09067250

A
Reinforce eye wall
8.65
NA
9.20
0.47
NA
18.32
09067255

A
Reinforce/graft eye wall
8.89
NA
9.92
0.44
NA
19.25
09067299

C
Eye surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY67311

A
Revise eye muscle
6.64
NA
6.04
0.37
NA
13.05
09067312

A
Revise two eye muscles
8.53
NA
6.77
0.43
NA
15.73
09067314

A
Revise eye muscle
7.51
NA
6.57
0.39
NA
14.47
09067316

A
Revise two eye muscles
9.65
NA
7.52
0.49
NA
17.66
09067318

A
Revise eye muscle(s)
7.84
NA
6.95
0.41
NA
15.20
09067320

A
Revise eye muscle(s) add-on
4.32
NA
1.96
0.22
NA
6.50
ZZZ67331

A
Eye surgery follow-up add-on
4.05
NA
1.84
0.21
NA
6.10
ZZZ67332

A
Rerevise eye muscles add-on
4.48
NA
2.03
0.23
NA
6.74
ZZZ67334

A
Revise eye muscle w/suture
3.97
NA
1.80
0.20
NA
5.97
ZZZ67335

A
Eye suture during surgery
2.49
NA
1.12
0.13
NA
3.74
ZZZ67340

A
Revise eye muscle add-on
4.92
NA
2.21
0.25
NA
7.38
ZZZ67343

A
Release eye tissue
7.34
NA
6.53
0.37
NA
14.24
09067345

A
Destroy nerve of eye muscle
2.96
2.59
2.02
0.17
5.72
5.15
01067350

A
Biopsy eye muscle
2.87
NA
1.88
0.15
NA
4.90
00067399

C
Eye muscle surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY67400

A
Explore/biopsy eye socket
9.75
NA
11.29
0.56
NA
21.60
09067405

A
Explore/drain eye socket
7.92
NA
9.80
0.44
NA
18.16
09067412

A
Explore/treat eye socket
9.49
NA
10.96
0.48
NA
20.93
09067413

A
Explore/treat eye socket
9.99
NA
10.80
0.50
NA
21.29
09067414

A
Explr/decompress eye socket
11.11
NA
12.07
0.65
NA
23.83
09067415

A
Aspiration, orbital contents
1.76
NA
0.76
0.09
NA
2.61
00067420

A
Explore/treat eye socket
20.03
NA
17.44
1.15
NA
38.62
09067430

A
Explore/treat eye socket
13.37
NA
14.93
0.86
NA
29.16
09067440

A
Explore/drain eye socket
13.07
NA
14.30
0.70
NA
28.07
09067445

A
Explr/decompress eye socket
14.40
NA
13.95
0.90
NA
29.25
09067450

A
Explore/biopsy eye socket
13.49
NA
14.73
0.68
NA
28.90
09067500

A
Inject/treat eye socket
0.79
0.67
0.29
0.05
1.51
1.13
00067505

A
Inject/treat eye socket
0.82
0.69
0.31
0.05
1.56
1.18
00067515

A
Inject/treat eye socket
0.61
0.59
0.38
0.03
1.23
1.02
00067550

A
Insert eye socket implant
10.17
NA
11.33
0.72
NA
22.22
09067560

A
Revise eye socket implant
10.58
NA
11.40
0.60
NA
22.58
09067570

A
Decompress optic nerve
13.56
NA
13.62
0.68
NA
27.86
09067599

C
Orbit surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY67700

A
Drainage of eyelid abscess
1.35
6.04
1.27
0.07
7.46
2.69
01067710

A
Incision of eyelid
1.02
5.39
1.21
0.05
6.46
2.28
01067715

A
Incision of eyelid fold
1.22
5.39
1.29
0.06
6.67
2.57
01067800

A
Remove eyelid lesion
1.38
1.62
1.04
0.07
3.07
2.49
01067801

A
Remove eyelid lesions
1.88
1.97
1.26
0.09
3.94
3.23
01067805

A
Remove eyelid lesions
2.22
2.53
1.65
0.11
4.86
3.98
01067808

A
Remove eyelid lesion(s)
3.79
NA
3.78
0.19
NA
7.76
09067810

A
Biopsy of eyelid
1.48
3.34
0.68
0.06
4.88
2.22
00067820

A
Revise eyelashes
0.89
0.60
0.56
0.04
1.53
1.49
00067825

A
Revise eyelashes
1.38
1.74
1.41
0.07
3.19
2.86
01067830

A
Revise eyelashes
1.70
5.55
1.50
0.08
7.33
3.28
01067835

A
Revise eyelashes
5.55
NA
4.63
0.28
NA
10.46
09067840

A
Remove eyelid lesion
2.04
5.49
1.65
0.10
7.63
3.79
01067850

A
Treat eyelid lesion
1.69
3.38
1.47
0.07
5.14
3.23
01067875

A
Closure of eyelid by suture
1.35
3.31
0.94
0.07
4.73
2.36
00067880

A
Revision of eyelid
3.79
6.63
3.81
0.19
10.61
7.79
09067882

A
Revision of eyelid
5.06
7.65
4.82
0.25
12.96
10.13
09067900

A
Repair brow defect
6.13
9.09
5.27
0.38
15.60
11.78
09067901

A
Repair eyelid defect
7.39
NA
5.42
0.54
NA
13.35
09067902

A
Repair eyelid defect
9.35
NA
5.48
0.60
NA
15.43
09067903

A
Repair eyelid defect
6.36
9.59
5.53
0.47
16.42
12.36
09067904

A
Repair eyelid defect
6.25
9.66
5.25
0.41
16.32
11.91
09067906

A
Repair eyelid defect
6.78
5.39
5.04
0.46
12.63
12.28
09067908

A
Repair eyelid defect
5.12
6.65
5.36
0.28
12.05
10.76
09067909

A
Revise eyelid defect
5.39
8.05
4.96
0.31
13.75
10.66
09067911

A
Revise eyelid defect
5.26
NA
4.79
0.31
NA
10.36
09067912

A
Correction eyelid w/implant
5.67
18.98
5.55
0.28
24.93
11.50
09067914

A
Repair eyelid defect
3.67
6.36
3.06
0.19
10.22
6.92
09067915

A
Repair eyelid defect
3.18
6.00
2.81
0.16
9.34
6.15
09067916

A
Repair eyelid defect
5.30
8.07
4.77
0.28
13.65
10.35
09067917

A
Repair eyelid defect
6.01
8.48
5.08
0.36
14.85
11.45
09067921

A
Repair eyelid defect
3.39
6.21
2.90
0.17
9.77
6.46
09067922

A
Repair eyelid defect
3.06
5.93
2.76
0.15
9.14
5.97
09067923

A
Repair eyelid defect
5.87
8.14
4.98
0.30
14.31
11.15
09067924

A
Repair eyelid defect
5.78
8.95
4.69
0.30
15.03
10.77
09067930

A
Repair eyelid wound
3.60
5.73
2.18
0.19
9.52
5.97
01067935

A
Repair eyelid wound
6.21
8.54
4.42
0.39
15.14
11.02
09067938

A
Remove eyelid foreign body
1.33
5.40
1.26
0.06
6.79
2.65
010( print page 70409)67950

A
Revision of eyelid
5.81
8.66
5.23
0.36
14.83
11.40
09067961

A
Revision of eyelid
5.68
8.71
5.04
0.33
14.72
11.05
09067966

A
Revision of eyelid
6.56
9.16
5.58
0.37
16.09
12.51
09067971

A
Reconstruction of eyelid
9.78
NA
7.30
0.53
NA
17.61
09067973

A
Reconstruction of eyelid
12.85
NA
9.34
0.75
NA
22.94
09067974

A
Reconstruction of eyelid
12.82
NA
9.26
0.75
NA
22.83
09067975

A
Reconstruction of eyelid
9.12
NA
6.97
0.50
NA
16.59
09067999

C
Revision of eyelid
0.00
0.00
0.00
0.00
0.00
0.00
YYY68020

A
Incise/drain eyelid lining
1.37
1.41
1.21
0.06
2.84
2.64
01068040

A
Treatment of eyelid lesions
0.85
0.71
0.43
0.04
1.60
1.32
00068100

A
Biopsy of eyelid lining
1.35
3.26
0.95
0.07
4.68
2.37
00068110

A
Remove eyelid lining lesion
1.77
4.11
1.65
0.09
5.97
3.51
01068115

A
Remove eyelid lining lesion
2.36
5.98
1.92
0.12
8.46
4.40
01068130

A
Remove eyelid lining lesion
4.92
8.74
4.61
0.24
13.90
9.77
09068135

A
Remove eyelid lining lesion
1.84
1.82
1.65
0.09
3.75
3.58
01068200

A
Treat eyelid by injection
0.49
0.54
0.33
0.02
1.05
0.84
00068320

A
Revise/graft eyelid lining
5.36
11.31
5.54
0.27
16.94
11.17
09068325

A
Revise/graft eyelid lining
7.35
NA
6.56
0.44
NA
14.35
09068326

A
Revise/graft eyelid lining
7.14
NA
6.43
0.35
NA
13.92
09068328

A
Revise/graft eyelid lining
8.17
NA
7.31
0.54
NA
16.02
09068330

A
Revise eyelid lining
4.82
9.44
4.73
0.24
14.50
9.79
09068335

A
Revise/graft eyelid lining
7.18
NA
6.40
0.36
NA
13.94
09068340

A
Separate eyelid adhesions
4.16
8.90
4.11
0.21
13.27
8.48
09068360

A
Revise eyelid lining
4.36
8.06
4.19
0.22
12.64
8.77
09068362

A
Revise eyelid lining
7.33
NA
6.42
0.36
NA
14.11
09068371

A
Harvest eye tissue, alograft
4.89
NA
4.74
0.44
NA
10.07
01068399

C
Eyelid lining surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY68400

A
Incise/drain tear gland
1.69
5.92
1.83
0.08
7.69
3.60
01068420

A
Incise/drain tear sac
2.30
6.21
2.11
0.11
8.62
4.52
01068440

A
Incise tear duct opening
0.94
2.09
1.27
0.05
3.08
2.26
01068500

A
Removal of tear gland
11.00
NA
9.76
0.55
NA
21.31
09068505

A
Partial removal, tear gland
10.92
NA
10.68
0.55
NA
22.15
09068510

A
Biopsy of tear gland
4.60
7.35
2.10
0.23
12.18
6.93
00068520

A
Removal of tear sac
7.50
NA
7.44
0.37
NA
15.31
09068525

A
Biopsy of tear sac
4.42
NA
2.03
0.22
NA
6.67
00068530

A
Clearance of tear duct
3.65
8.19
2.65
0.18
12.02
6.48
01068540

A
Remove tear gland lesion
10.58
NA
9.42
0.52
NA
20.52
09068550

A
Remove tear gland lesion
13.24
NA
11.38
0.80
NA
25.42
09068700

A
Repair tear ducts
6.59
NA
6.00
0.32
NA
12.91
09068705

A
Revise tear duct opening
2.06
4.18
1.80
0.10
6.34
3.96
01068720

A
Create tear sac drain
8.95
NA
7.88
0.44
NA
17.27
09068745

A
Create tear duct drain
8.62
NA
7.88
0.52
NA
17.02
09068750

A
Create tear duct drain
8.65
NA
8.29
0.43
NA
17.37
09068760

A
Close tear duct opening
1.73
3.55
1.63
0.09
5.37
3.45
01068761

A
Close tear duct opening
1.36
2.28
1.32
0.06
3.70
2.74
01068770

A
Close tear system fistula
7.01
3.19
3.19
0.35
10.55
10.55
09068801

A
Dilate tear duct opening
0.94
1.95
1.48
0.05
2.94
2.47
01068810

A
Probe nasolacrimal duct
1.90
3.67
2.68
0.10
5.67
4.68
01068811

A
Probe nasolacrimal duct
2.35
NA
2.42
0.13
NA
4.90
01068815

A
Probe nasolacrimal duct
3.20
8.26
2.82
0.17
11.63
6.19
01068840

A
Explore/irrigate tear ducts
1.25
1.60
1.12
0.06
2.91
2.43
01068850

A
Injection for tear sac x-ray
0.80
0.88
0.68
0.04
1.72
1.52
00068899

C
Tear duct system surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY69000

A
Drain external ear lesion
1.45
2.89
1.36
0.12
4.46
2.93
01069005

A
Drain external ear lesion
2.11
2.94
1.84
0.17
5.22
4.12
01069020

A
Drain outer ear canal lesion
1.48
4.00
2.07
0.12
5.60
3.67
01069090

N
Pierce earlobes
0.00
0.00
0.00
0.00
0.00
0.00
XXX69100

A
Biopsy of external ear
0.81
1.71
0.39
0.03
2.55
1.23
00069105

A
Biopsy of external ear canal
0.85
2.35
0.77
0.07
3.27
1.69
00069110

A
Remove external ear, partial
3.43
6.76
4.48
0.30
10.49
8.21
09069120

A
Removal of external ear
4.04
NA
6.20
0.38
NA
10.62
09069140

A
Remove ear canal lesion(s)
7.96
NA
13.32
0.65
NA
21.93
09069145

A
Remove ear canal lesion(s)
2.62
5.80
3.31
0.21
8.63
6.14
09069150

A
Extensive ear canal surgery
13.41
NA
13.44
1.22
NA
28.07
09069155

A
Extensive ear/neck surgery
20.77
NA
19.60
1.92
NA
42.29
09069200

A
Clear outer ear canal
0.77
2.39
0.55
0.06
3.22
1.38
00069205

A
Clear outer ear canal
1.20
NA
1.36
0.10
NA
2.66
01069210

A
Remove impacted ear wax
0.61
0.63
0.23
0.05
1.29
0.89
00069220

A
Clean out mastoid cavity
0.83
2.37
0.73
0.07
3.27
1.63
00069222

A
Clean out mastoid cavity
1.40
3.86
2.07
0.12
5.38
3.59
01069300

R
Revise external ear
6.35
NA
4.23
0.72
NA
11.30
YYY69310

A
Rebuild outer ear canal
10.77
NA
16.33
0.85
NA
27.95
09069320

A
Rebuild outer ear canal
16.93
NA
21.90
1.37
NA
40.20
09069399

C
Outer ear surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY69400

A
Inflate middle ear canal
0.83
2.17
0.67
0.07
3.07
1.57
000( print page 70410)69401

A
Inflate middle ear canal
0.63
1.24
0.65
0.05
1.92
1.33
00069405

A
Catheterize middle ear canal
2.63
3.51
2.32
0.21
6.35
5.16
01069420

A
Incision of eardrum
1.33
3.16
1.59
0.11
4.60
3.03
01069421

A
Incision of eardrum
1.73
NA
2.17
0.15
NA
4.05
01069424

A
Remove ventilating tube
0.85
2.19
0.68
0.07
3.11
1.60
00069433

A
Create eardrum opening
1.52
3.10
1.64
0.13
4.75
3.29
01069436

A
Create eardrum opening
1.96
NA
2.30
0.19
NA
4.45
01069440

A
Exploration of middle ear
7.56
NA
8.80
0.61
NA
16.97
09069450

A
Eardrum revision
5.56
NA
7.05
0.45
NA
13.06
09069501

A
Mastoidectomy
9.06
NA
9.03
0.73
NA
18.82
09069502

A
Mastoidectomy
12.36
NA
11.62
1.00
NA
24.98
09069505

A
Remove mastoid structures
12.97
NA
17.24
1.05
NA
31.26
09069511

A
Extensive mastoid surgery
13.50
NA
17.52
1.09
NA
32.11
09069530

A
Extensive mastoid surgery
19.16
NA
21.69
1.54
NA
42.39
09069535

A
Remove part of temporal bone
36.09
NA
32.05
2.92
NA
71.06
09069540

A
Remove ear lesion
1.20
3.75
1.98
0.10
5.05
3.28
01069550

A
Remove ear lesion
10.97
NA
14.90
0.89
NA
26.76
09069552

A
Remove ear lesion
19.43
NA
20.73
1.59
NA
41.75
09069554

A
Remove ear lesion
33.11
NA
30.42
2.91
NA
66.44
09069601

A
Mastoid surgery revision
13.22
NA
12.71
1.07
NA
27.00
09069602

A
Mastoid surgery revision
13.56
NA
13.27
1.10
NA
27.93
09069603

A
Mastoid surgery revision
14.00
NA
18.41
1.14
NA
33.55
09069604

A
Mastoid surgery revision
14.00
NA
13.73
1.14
NA
28.87
09069605

A
Mastoid surgery revision
18.46
NA
21.01
1.50
NA
40.97
09069610

A
Repair of eardrum
4.42
5.57
3.28
0.36
10.35
8.06
01069620

A
Repair of eardrum
5.88
11.15
6.31
0.48
17.51
12.67
09069631

A
Repair eardrum structures
9.85
NA
11.23
0.80
NA
21.88
09069632

A
Rebuild eardrum structures
12.73
NA
13.51
1.03
NA
27.27
09069633

A
Rebuild eardrum structures
12.08
NA
13.09
0.98
NA
26.15
09069635

A
Repair eardrum structures
13.31
NA
16.79
1.08
NA
31.18
09069636

A
Rebuild eardrum structures
15.20
NA
19.36
1.23
NA
35.79
09069637

A
Rebuild eardrum structures
15.09
NA
19.28
1.22
NA
35.59
09069641

A
Revise middle ear & mastoid
12.69
NA
12.82
1.03
NA
26.54
09069642

A
Revise middle ear & mastoid
16.81
NA
16.33
1.36
NA
34.50
09069643

A
Revise middle ear & mastoid
15.30
NA
14.86
1.24
NA
31.40
09069644

A
Revise middle ear & mastoid
16.94
NA
20.46
1.37
NA
38.77
09069645

A
Revise middle ear & mastoid
16.36
NA
20.08
1.33
NA
37.77
09069646

A
Revise middle ear & mastoid
17.96
NA
20.82
1.46
NA
40.24
09069650

A
Release middle ear bone
9.65
NA
9.94
0.78
NA
20.37
09069660

A
Revise middle ear bone
11.88
NA
11.21
0.96
NA
24.05
09069661

A
Revise middle ear bone
15.72
NA
14.74
1.27
NA
31.73
09069662

A
Revise middle ear bone
15.42
NA
13.79
1.25
NA
30.46
09069666

A
Repair middle ear structures
9.74
NA
10.00
0.79
NA
20.53
09069667

A
Repair middle ear structures
9.75
NA
10.01
0.79
NA
20.55
09069670

A
Remove mastoid air cells
11.49
NA
11.74
0.93
NA
24.16
09069676

A
Remove middle ear nerve
9.51
NA
10.78
0.81
NA
21.10
09069700

A
Close mastoid fistula
8.22
NA
9.27
0.67
NA
18.16
09069710

N
Implant/replace hearing aid
0.00
0.00
0.00
0.00
0.00
0.00
XXX69711

A
Remove/repair hearing aid
10.42
NA
10.82
0.83
NA
22.07
09069714

A
Implant temple bone w/stimul
13.98
NA
12.70
1.13
NA
27.81
09069715

A
Temple bne implnt w/stimulat
18.22
NA
15.07
1.48
NA
34.77
09069717

A
Temple bone implant revision
14.96
NA
14.51
0.90
NA
30.37
09069718

A
Revise temple bone implant
18.47
NA
15.34
3.21
NA
37.02
09069720

A
Release facial nerve
14.36
NA
14.56
1.16
NA
30.08
09069725

A
Release facial nerve
25.34
NA
20.19
2.44
NA
47.97
09069740

A
Repair facial nerve
15.94
NA
13.45
1.27
NA
30.66
09069745

A
Repair facial nerve
16.66
NA
15.01
1.14
NA
32.81
09069799

C
Middle ear surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY69801

A
Incise inner ear
8.55
NA
9.49
0.69
NA
18.73
09069802

A
Incise inner ear
13.08
NA
12.36
1.06
NA
26.50
09069805

A
Explore inner ear
13.80
NA
11.91
1.12
NA
26.83
09069806

A
Explore inner ear
12.33
NA
11.07
1.00
NA
24.40
09069820

A
Establish inner ear window
10.32
NA
11.25
0.90
NA
22.47
09069840

A
Revise inner ear window
10.24
NA
13.21
0.79
NA
24.24
09069905

A
Remove inner ear
11.08
NA
11.38
0.90
NA
23.36
09069910

A
Remove inner ear & mastoid
13.61
NA
11.95
1.07
NA
26.63
09069915

A
Incise inner ear nerve
21.20
NA
16.51
1.69
NA
39.40
09069930

A
Implant cochlear device
16.78
NA
14.79
1.36
NA
32.93
09069949

C
Inner ear surgery procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYY69950

A
Incise inner ear nerve
25.60
NA
18.95
2.28
NA
46.83
09069955

A
Release facial nerve
27.00
NA
21.44
2.48
NA
50.92
09069960

A
Release inner ear canal
27.00
NA
20.11
2.17
NA
49.28
09069970

A
Remove inner ear lesion
29.99
NA
23.34
2.41
NA
55.74
09069979

C
Temporal bone surgery
0.00
0.00
0.00
0.00
0.00
0.00
YYY69990

R
Microsurgery add-on
3.46
NA
1.80
0.89
NA
6.15
ZZZ( print page 70411)70010
26
A
Contrast x-ray of brain
1.19
0.39
0.39
0.05
1.63
1.63
XXX70010
TC
A
Contrast x-ray of brain
0.00
4.34
NA
0.22
4.56
NA
XXX70010

A
Contrast x-ray of brain
1.19
4.73
NA
0.27
6.19
NA
XXX70015
26
A
Contrast x-ray of brain
1.19
0.39
0.39
0.08
1.66
1.66
XXX70015
TC
A
Contrast x-ray of brain
0.00
1.35
NA
0.08
1.43
NA
XXX70015

A
Contrast x-ray of brain
1.19
1.74
NA
0.16
3.09
NA
XXX70030
26
A
X-ray eye for foreign body
0.17
0.06
0.06
0.01
0.24
0.24
XXX70030
TC
A
X-ray eye for foreign body
0.00
0.42
NA
0.02
0.44
NA
XXX70030

A
X-ray eye for foreign body
0.17
0.48
NA
0.03
0.68
NA
XXX70100
26
A
X-ray exam of jaw
0.18
0.06
0.06
0.01
0.25
0.25
XXX70100
TC
A
X-ray exam of jaw
0.00
0.52
NA
0.02
0.54
NA
XXX70100

A
X-ray exam of jaw
0.18
0.58
NA
0.03
0.79
NA
XXX70110
26
A
X-ray exam of jaw
0.25
0.08
0.08
0.01
0.34
0.34
XXX70110
TC
A
X-ray exam of jaw
0.00
0.62
NA
0.04
0.66
NA
XXX70110

A
X-ray exam of jaw
0.25
0.70
NA
0.05
1.00
NA
XXX70120
26
A
X-ray exam of mastoids
0.18
0.06
0.06
0.01
0.25
0.25
XXX70120
TC
A
X-ray exam of mastoids
0.00
0.62
NA
0.04
0.66
NA
XXX70120

A
X-ray exam of mastoids
0.18
0.68
NA
0.05
0.91
NA
XXX70130
26
A
X-ray exam of mastoids
0.34
0.11
0.11
0.02
0.47
0.47
XXX70130
TC
A
X-ray exam of mastoids
0.00
0.78
NA
0.05
0.83
NA
XXX70130

A
X-ray exam of mastoids
0.34
0.89
NA
0.07
1.30
NA
XXX70134
26
A
X-ray exam of middle ear
0.34
0.11
0.11
0.02
0.47
0.47
XXX70134
TC
A
X-ray exam of middle ear
0.00
0.73
NA
0.05
0.78
NA
XXX70134

A
X-ray exam of middle ear
0.34
0.84
NA
0.07
1.25
NA
XXX70140
26
A
X-ray exam of facial bones
0.19
0.06
0.06
0.01
0.26
0.26
XXX70140
TC
A
X-ray exam of facial bones
0.00
0.62
NA
0.04
0.66
NA
XXX70140

A
X-ray exam of facial bones
0.19
0.68
NA
0.05
0.92
NA
XXX70150
26
A
X-ray exam of facial bones
0.26
0.08
0.08
0.01
0.35
0.35
XXX70150
TC
A
X-ray exam of facial bones
0.00
0.78
NA
0.05
0.83
NA
XXX70150

A
X-ray exam of facial bones
0.26
0.86
NA
0.06
1.18
NA
XXX70160
26
A
X-ray exam of nasal bones
0.17
0.06
0.06
0.01
0.24
0.24
XXX70160
TC
A
X-ray exam of nasal bones
0.00
0.52
NA
0.02
0.54
NA
XXX70160

A
X-ray exam of nasal bones
0.17
0.58
NA
0.03
0.78
NA
XXX70170
26
A
X-ray exam of tear duct
0.30
0.10
0.10
0.01
0.41
0.41
XXX70170
TC
A
X-ray exam of tear duct
0.00
0.95
NA
0.06
1.01
NA
XXX70170

A
X-ray exam of tear duct
0.30
1.05
NA
0.07
1.42
NA
XXX70190
26
A
X-ray exam of eye sockets
0.21
0.07
0.07
0.01
0.29
0.29
XXX70190
TC
A
X-ray exam of eye sockets
0.00
0.62
NA
0.04
0.66
NA
XXX70190

A
X-ray exam of eye sockets
0.21
0.69
NA
0.05
0.95
NA
XXX70200
26
A
X-ray exam of eye sockets
0.28
0.09
0.09
0.01
0.38
0.38
XXX70200
TC
A
X-ray exam of eye sockets
0.00
0.78
NA
0.05
0.83
NA
XXX70200

A
X-ray exam of eye sockets
0.28
0.87
NA
0.06
1.21
NA
XXX70210
26
A
X-ray exam of sinuses
0.17
0.06
0.06
0.01
0.24
0.24
XXX70210
TC
A
X-ray exam of sinuses
0.00
0.62
NA
0.04
0.66
NA
XXX70210

A
X-ray exam of sinuses
0.17
0.68
NA
0.05
0.90
NA
XXX70220
26
A
X-ray exam of sinuses
0.25
0.08
0.08
0.01
0.34
0.34
XXX70220
TC
A
X-ray exam of sinuses
0.00
0.78
NA
0.05
0.83
NA
XXX70220

A
X-ray exam of sinuses
0.25
0.86
NA
0.06
1.17
NA
XXX70240
26
A
X-ray exam, pituitary saddle
0.19
0.06
0.06
0.01
0.26
0.26
XXX70240
TC
A
X-ray exam, pituitary saddle
0.00
0.42
NA
0.02
0.44
NA
XXX70240

A
X-ray exam, pituitary saddle
0.19
0.48
NA
0.03
0.70
NA
XXX70250
26
A
X-ray exam of skull
0.24
0.08
0.08
0.01
0.33
0.33
XXX70250
TC
A
X-ray exam of skull
0.00
0.62
NA
0.04
0.66
NA
XXX70250

A
X-ray exam of skull
0.24
0.70
NA
0.05
0.99
NA
XXX70260
26
A
X-ray exam of skull
0.34
0.11
0.11
0.02
0.47
0.47
XXX70260
TC
A
X-ray exam of skull
0.00
0.89
NA
0.06
0.95
NA
XXX70260

A
X-ray exam of skull
0.34
1.00
NA
0.08
1.42
NA
XXX70300
26
A
X-ray exam of teeth
0.10
0.05
0.05
0.01
0.16
0.16
XXX70300
TC
A
X-ray exam of teeth
0.00
0.26
NA
0.02
0.28
NA
XXX70300

A
X-ray exam of teeth
0.10
0.31
NA
0.03
0.44
NA
XXX70310
26
A
X-ray exam of teeth
0.16
0.08
0.08
0.01
0.25
0.25
XXX70310
TC
A
X-ray exam of teeth
0.00
0.42
NA
0.02
0.44
NA
XXX70310

A
X-ray exam of teeth
0.16
0.50
NA
0.03
0.69
NA
XXX70320
26
A
Full mouth x-ray of teeth
0.22
0.08
0.08
0.01
0.31
0.31
XXX70320
TC
A
Full mouth x-ray of teeth
0.00
0.78
NA
0.05
0.83
NA
XXX70320

A
Full mouth x-ray of teeth
0.22
0.86
NA
0.06
1.14
NA
XXX70328
26
A
X-ray exam of jaw joint
0.18
0.06
0.06
0.01
0.25
0.25
XXX70328
TC
A
X-ray exam of jaw joint
0.00
0.49
NA
0.02
0.51
NA
XXX70328

A
X-ray exam of jaw joint
0.18
0.55
NA
0.03
0.76
NA
XXX70330
26
A
X-ray exam of jaw joints
0.24
0.08
0.08
0.01
0.33
0.33
XXX70330
TC
A
X-ray exam of jaw joints
0.00
0.84
NA
0.05
0.89
NA
XXX70330

A
X-ray exam of jaw joints
0.24
0.92
NA
0.06
1.22
NA
XXX70332
26
A
X-ray exam of jaw joint
0.54
0.20
0.20
0.02
0.76
0.76
XXX70332
TC
A
X-ray exam of jaw joint
0.00
2.11
NA
0.12
2.23
NA
XXX70332

A
X-ray exam of jaw joint
0.54
2.31
NA
0.14
2.99
NA
XXX( print page 70412)70336
26
A
Magnetic image, jaw joint
1.48
0.49
0.49
0.07
2.04
2.04
XXX70336
TC
A
Magnetic image, jaw joint
0.00
11.23
NA
0.59
11.82
NA
XXX70336

A
Magnetic image, jaw joint
1.48
11.72
NA
0.66
13.86
NA
XXX70350
26
A
X-ray head for orthodontia
0.17
0.07
0.07
0.01
0.25
0.25
XXX70350
TC
A
X-ray head for orthodontia
0.00
0.38
NA
0.02
0.40
NA
XXX70350

A
X-ray head for orthodontia
0.17
0.45
NA
0.03
0.65
NA
XXX70355
26
A
Panoramic x-ray of jaws
0.20
0.07
0.07
0.01
0.28
0.28
XXX70355
TC
A
Panoramic x-ray of jaws
0.00
0.57
NA
0.04
0.61
NA
XXX70355

A
Panoramic x-ray of jaws
0.20
0.64
NA
0.05
0.89
NA
XXX70360
26
A
X-ray exam of neck
0.17
0.06
0.06
0.01
0.24
0.24
XXX70360
TC
A
X-ray exam of neck
0.00
0.42
NA
0.02
0.44
NA
XXX70360

A
X-ray exam of neck
0.17
0.48
NA
0.03
0.68
NA
XXX70370
26
A
Throat x-ray & fluoroscopy
0.32
0.10
0.10
0.01
0.43
0.43
XXX70370
TC
A
Throat x-ray & fluoroscopy
0.00
1.31
NA
0.07
1.38
NA
XXX70370

A
Throat x-ray & fluoroscopy
0.32
1.41
NA
0.08
1.81
NA
XXX70371
26
A
Speech evaluation, complex
0.84
0.28
0.28
0.04
1.16
1.16
XXX70371
TC
A
Speech evaluation, complex
0.00
2.11
NA
0.12
2.23
NA
XXX70371

A
Speech evaluation, complex
0.84
2.39
NA
0.16
3.39
NA
XXX70373
26
A
Contrast x-ray of larynx
0.44
0.14
0.14
0.02
0.60
0.60
XXX70373
TC
A
Contrast x-ray of larynx
0.00
1.79
NA
0.11
1.90
NA
XXX70373

A
Contrast x-ray of larynx
0.44
1.93
NA
0.13
2.50
NA
XXX70380
26
A
X-ray exam of salivary gland
0.17
0.06
0.06
0.01
0.24
0.24
XXX70380
TC
A
X-ray exam of salivary gland
0.00
0.67
NA
0.04
0.71
NA
XXX70380

A
X-ray exam of salivary gland
0.17
0.73
NA
0.05
0.95
NA
XXX70390
26
A
X-ray exam of salivary duct
0.38
0.12
0.12
0.02
0.52
0.52
XXX70390
TC
A
X-ray exam of salivary duct
0.00
1.79
NA
0.11
1.90
NA
XXX70390

A
X-ray exam of salivary duct
0.38
1.91
NA
0.13
2.42
NA
XXX70450
26
A
Ct head/brain w/o dye
0.85
0.28
0.28
0.04
1.17
1.17
XXX70450
TC
A
Ct head/brain w/o dye
0.00
4.73
NA
0.25
4.98
NA
XXX70450

A
Ct head/brain w/o dye
0.85
5.01
NA
0.29
6.15
NA
XXX70460
26
A
Ct head/brain w/dye
1.13
0.37
0.37
0.05
1.55
1.55
XXX70460
TC
A
Ct head/brain w/dye
0.00
5.68
NA
0.30
5.98
NA
XXX70460

A
Ct head/brain w/dye
1.13
6.05
NA
0.35
7.53
NA
XXX70470
26
A
Ct head/brain w/o & w/dye
1.27
0.42
0.42
0.06
1.75
1.75
XXX70470
TC
A
Ct head/brain w/o & w/dye
0.00
7.09
NA
0.37
7.46
NA
XXX70470

A
Ct head/brain w/o & w/dye
1.27
7.51
NA
0.43
9.21
NA
XXX70480
26
A
Ct orbit/ear/fossa w/o dye
1.28
0.42
0.42
0.06
1.76
1.76
XXX70480
TC
A
Ct orbit/ear/fossa w/o dye
0.00
4.73
NA
0.25
4.98
NA
XXX70480

A
Ct orbit/ear/fossa w/o dye
1.28
5.15
NA
0.31
6.74
NA
XXX70481
26
A
Ct orbit/ear/fossa w/dye
1.38
0.45
0.45
0.06
1.89
1.89
XXX70481
TC
A
Ct orbit/ear/fossa w/dye
0.00
5.68
NA
0.30
5.98
NA
XXX70481

A
Ct orbit/ear/fossa w/dye
1.38
6.13
NA
0.36
7.87
NA
XXX70482
26
A
Ct orbit/ear/fossa w/o&w/dye
1.45
0.48
0.48
0.06
1.99
1.99
XXX70482
TC
A
Ct orbit/ear/fossa w/o&w/dye
0.00
7.09
NA
0.37
7.46
NA
XXX70482

A
Ct orbit/ear/fossa w/o&w/dye
1.45
7.57
NA
0.43
9.45
NA
XXX70486
26
A
Ct maxillofacial w/o dye
1.14
0.37
0.37
0.05
1.56
1.56
XXX70486
TC
A
Ct maxillofacial w/o dye
0.00
4.73
NA
0.25
4.98
NA
XXX70486

A
Ct maxillofacial w/o dye
1.14
5.10
NA
0.30
6.54
NA
XXX70487
26
A
Ct maxillofacial w/dye
1.30
0.43
0.43
0.06
1.79
1.79
XXX70487
TC
A
Ct maxillofacial w/dye
0.00
5.68
NA
0.30
5.98
NA
XXX70487

A
Ct maxillofacial w/dye
1.30
6.11
NA
0.36
7.77
NA
XXX70488
26
A
Ct maxillofacial w/o & w/dye
1.42
0.46
0.46
0.06
1.94
1.94
XXX70488
TC
A
Ct maxillofacial w/o & w/dye
0.00
7.09
NA
0.37
7.46
NA
XXX70488

A
Ct maxillofacial w/o & w/dye
1.42
7.55
NA
0.43
9.40
NA
XXX70490
26
A
Ct soft tissue neck w/o dye
1.28
0.42
0.42
0.06
1.76
1.76
XXX70490
TC
A
Ct soft tissue neck w/o dye
0.00
4.73
NA
0.25
4.98
NA
XXX70490

A
Ct soft tissue neck w/o dye
1.28
5.15
NA
0.31
6.74
NA
XXX70491
26
A
Ct soft tissue neck w/dye
1.38
0.45
0.45
0.06
1.89
1.89
XXX70491
TC
A
Ct soft tissue neck w/dye
0.00
5.68
NA
0.30
5.98
NA
XXX70491

A
Ct soft tissue neck w/dye
1.38
6.13
NA
0.36
7.87
NA
XXX70492
26
A
Ct sft tsue nck w/o & w/dye
1.45
0.47
0.47
0.06
1.98
1.98
XXX70492
TC
A
Ct sft tsue nck w/o & w/dye
0.00
7.09
NA
0.37
7.46
NA
XXX70492

A
Ct sft tsue nck w/o & w/dye
1.45
7.56
NA
0.43
9.44
NA
XXX70496
26
A
Ct angiography, head
1.75
0.57
0.57
0.08
2.40
2.40
XXX70496
TC
A
Ct angiography, head
0.00
10.63
NA
0.58
11.21
NA
XXX70496

A
Ct angiography, head
1.75
11.20
NA
0.66
13.61
NA
XXX70498
26
A
Ct angiography, neck
1.75
0.57
0.57
0.08
2.40
2.40
XXX70498
TC
A
Ct angiography, neck
0.00
10.63
NA
0.58
11.21
NA
XXX70498

A
Ct angiography, neck
1.75
11.20
NA
0.66
13.61
NA
XXX70540
26
A
Mri orbit/face/neck w/o dye
1.35
0.44
0.44
0.06
1.85
1.85
XXX70540
TC
A
Mri orbit/face/neck w/o dye
0.00
11.23
NA
0.39
11.62
NA
XXX70540

A
Mri orbit/face/neck w/o dye
1.35
11.67
NA
0.45
13.47
NA
XXX70542
26
A
Mri orbit/face/neck w/dye
1.62
0.53
0.53
0.07
2.22
2.22
XXX70542
TC
A
Mri orbit/face/neck w/dye
0.00
13.48
NA
0.47
13.95
NA
XXX70542

A
Mri orbit/face/neck w/dye
1.62
14.01
NA
0.54
16.17
NA
XXX( print page 70413)70543
26
A
Mri orbt/fac/nck w/o & w/dye
2.15
0.71
0.71
0.10
2.96
2.96
XXX70543
TC
A
Mri orbt/fac/nck w/o & w/dye
0.00
24.95
NA
0.84
25.79
NA
XXX70543

A
Mri orbt/fac/nck w/o & w/dye
2.15
25.66
NA
0.94
28.75
NA
XXX70544
26
A
Mr angiography head w/o dye
1.20
0.40
0.40
0.05
1.65
1.65
XXX70544
TC
A
Mr angiography head w/o dye
0.00
11.23
NA
0.59
11.82
NA
XXX70544

A
Mr angiography head w/o dye
1.20
11.63
NA
0.64
13.47
NA
XXX70545
26
A
Mr angiography head w/dye
1.20
0.39
0.39
0.05
1.64
1.64
XXX70545
TC
A
Mr angiography head w/dye
0.00
11.23
NA
0.59
11.82
NA
XXX70545

A
Mr angiography head w/dye
1.20
11.62
NA
0.64
13.46
NA
XXX70546
26
A
Mr angiograph head w/o&w/dye
1.80
0.59
0.59
0.08
2.47
2.47
XXX70546
TC
A
Mr angiograph head w/o&w/dye
0.00
22.47
NA
0.59
23.06
NA
XXX70546

A
Mr angiograph head w/o&w/dye
1.80
23.06
NA
0.67
25.53
NA
XXX70547
26
A
Mr angiography neck w/o dye
1.20
0.39
0.39
0.05
1.64
1.64
XXX70547
TC
A
Mr angiography neck w/o dye
0.00
11.23
NA
0.59
11.82
NA
XXX70547

A
Mr angiography neck w/o dye
1.20
11.62
NA
0.64
13.46
NA
XXX70548
26
A
Mr angiography neck w/dye
1.20
0.39
0.39
0.05
1.64
1.64
XXX70548
TC
A
Mr angiography neck w/dye
0.00
11.23
NA
0.59
11.82
NA
XXX70548

A
Mr angiography neck w/dye
1.20
11.62
NA
0.64
13.46
NA
XXX70549
26
A
Mr angiograph neck w/o&w/dye
1.80
0.59
0.59
0.08
2.47
2.47
XXX70549
TC
A
Mr angiograph neck w/o&w/dye
0.00
22.47
NA
0.59
23.06
NA
XXX70549

A
Mr angiograph neck w/o&w/dye
1.80
23.06
NA
0.67
25.53
NA
XXX70551
26
A
Mri brain w/o dye
1.48
0.49
0.49
0.07
2.04
2.04
XXX70551
TC
A
Mri brain w/o dye
0.00
11.23
NA
0.59
11.82
NA
XXX70551

A
Mri brain w/o dye
1.48
11.72
NA
0.66
13.86
NA
XXX70552
26
A
Mri brain w/dye
1.78
0.59
0.59
0.08
2.45
2.45
XXX70552
TC
A
Mri brain w/dye
0.00
13.48
NA
0.70
14.18
NA
XXX70552

A
Mri brain w/dye
1.78
14.07
NA
0.78
16.63
NA
XXX70553
26
A
Mri brain w/o & w/dye
2.36
0.78
0.78
0.10
3.24
3.24
XXX70553
TC
A
Mri brain w/o & w/dye
0.00
24.95
NA
1.31
26.26
NA
XXX70553

A
Mri brain w/o & w/dye
2.36
25.73
NA
1.41
29.50
NA
XXX70557
26
A
Mri brain w/o dye
2.90
1.13
1.13
0.08
4.11
4.11
XXX70557
TC
C
Mri brain w/o dye
0.00
0.00
0.00
0.00
0.00
0.00
XXX70557

C
Mri brain w/o dye
0.00
0.00
0.00
0.00
0.00
0.00
XXX70558
26
A
Mri brain w/dye
3.20
1.24
1.24
0.10
4.54
4.54
XXX70558
TC
C
Mri brain w/dye
0.00
0.00
0.00
0.00
0.00
0.00
XXX70558

C
Mri brain w/dye
0.00
0.00
0.00
0.00
0.00
0.00
XXX70559
26
A
Mri brain w/o & w/dye
3.20
1.24
1.24
0.12
4.56
4.56
XXX70559
TC
C
Mri brain w/o & w/dye
0.00
0.00
0.00
0.00
0.00
0.00
XXX70559

C
Mri brain w/o & w/dye
0.00
0.00
0.00
0.00
0.00
0.00
XXX71010
26
A
Chest x-ray
0.18
0.06
0.06
0.01
0.25
0.25
XXX71010
TC
A
Chest x-ray
0.00
0.47
NA
0.02
0.49
NA
XXX71010

A
Chest x-ray
0.18
0.53
NA
0.03
0.74
NA
XXX71015
26
A
Chest x-ray
0.21
0.07
0.07
0.01
0.29
0.29
XXX71015
TC
A
Chest x-ray
0.00
0.52
NA
0.02
0.54
NA
XXX71015

A
Chest x-ray
0.21
0.59
NA
0.03
0.83
NA
XXX71020
26
A
Chest x-ray
0.22
0.07
0.07
0.01
0.30
0.30
XXX71020
TC
A
Chest x-ray
0.00
0.62
NA
0.04
0.66
NA
XXX71020

A
Chest x-ray
0.22
0.69
NA
0.05
0.96
NA
XXX71021
26
A
Chest x-ray
0.27
0.09
0.09
0.01
0.37
0.37
XXX71021
TC
A
Chest x-ray
0.00
0.73
NA
0.05
0.78
NA
XXX71021

A
Chest x-ray
0.27
0.82
NA
0.06
1.15
NA
XXX71022
26
A
Chest x-ray
0.31
0.10
0.10
0.01
0.42
0.42
XXX71022
TC
A
Chest x-ray
0.00
0.73
NA
0.05
0.78
NA
XXX71022

A
Chest x-ray
0.31
0.83
NA
0.06
1.20
NA
XXX71023
26
A
Chest x-ray and fluoroscopy
0.38
0.13
0.13
0.01
0.52
0.52
XXX71023
TC
A
Chest x-ray and fluoroscopy
0.00
0.78
NA
0.05
0.83
NA
XXX71023

A
Chest x-ray and fluoroscopy
0.38
0.91
NA
0.06
1.35
NA
XXX71030
26
A
Chest x-ray
0.31
0.10
0.10
0.01
0.42
0.42
XXX71030
TC
A
Chest x-ray
0.00
0.78
NA
0.05
0.83
NA
XXX71030

A
Chest x-ray
0.31
0.88
NA
0.06
1.25
NA
XXX71034
26
A
Chest x-ray and fluoroscopy
0.46
0.16
0.16
0.02
0.64
0.64
XXX71034
TC
A
Chest x-ray and fluoroscopy
0.00
1.44
NA
0.08
1.52
NA
XXX71034

A
Chest x-ray and fluoroscopy
0.46
1.60
NA
0.10
2.16
NA
XXX71035
26
A
Chest x-ray
0.18
0.06
0.06
0.01
0.25
0.25
XXX71035
TC
A
Chest x-ray
0.00
0.52
NA
0.02
0.54
NA
XXX71035

A
Chest x-ray
0.18
0.58
NA
0.03
0.79
NA
XXX71040
26
A
Contrast x-ray of bronchi
0.58
0.19
0.19
0.03
0.80
0.80
XXX71040
TC
A
Contrast x-ray of bronchi
0.00
1.46
NA
0.08
1.54
NA
XXX71040

A
Contrast x-ray of bronchi
0.58
1.65
NA
0.11
2.34
NA
XXX71060
26
A
Contrast x-ray of bronchi
0.74
0.24
0.24
0.03
1.01
1.01
XXX71060
TC
A
Contrast x-ray of bronchi
0.00
2.21
NA
0.13
2.34
NA
XXX71060

A
Contrast x-ray of bronchi
0.74
2.45
NA
0.16
3.35
NA
XXX71090
26
A
X-ray & pacemaker insertion
0.54
0.21
0.21
0.02
0.77
0.77
XXX71090
TC
A
X-ray & pacemaker insertion
0.00
1.68
NA
0.11
1.79
NA
XXX71090

A
X-ray & pacemaker insertion
0.54
1.89
NA
0.13
2.56
NA
XXX( print page 70414)71100
26
A
X-ray exam of ribs
0.22
0.07
0.07
0.01
0.30
0.30
XXX71100
TC
A
X-ray exam of ribs
0.00
0.57
NA
0.04
0.61
NA
XXX71100

A
X-ray exam of ribs
0.22
0.64
NA
0.05
0.91
NA
XXX71101
26
A
X-ray exam of ribs/chest
0.27
0.09
0.09
0.01
0.37
0.37
XXX71101
TC
A
X-ray exam of ribs/chest
0.00
0.67
NA
0.04
0.71
NA
XXX71101

A
X-ray exam of ribs/chest
0.27
0.76
NA
0.05
1.08
NA
XXX71110
26
A
X-ray exam of ribs
0.27
0.09
0.09
0.01
0.37
0.37
XXX71110
TC
A
X-ray exam of ribs
0.00
0.78
NA
0.05
0.83
NA
XXX71110

A
X-ray exam of ribs
0.27
0.87
NA
0.06
1.20
NA
XXX71111
26
A
X-ray exam of ribs/chest
0.32
0.10
0.10
0.01
0.43
0.43
XXX71111
TC
A
X-ray exam of ribs/chest
0.00
0.89
NA
0.06
0.95
NA
XXX71111

A
X-ray exam of ribs/chest
0.32
0.99
NA
0.07
1.38
NA
XXX71120
26
A
X-ray exam of breastbone
0.20
0.07
0.07
0.01
0.28
0.28
XXX71120
TC
A
X-ray exam of breastbone
0.00
0.65
NA
0.04
0.69
NA
XXX71120

A
X-ray exam of breastbone
0.20
0.72
NA
0.05
0.97
NA
XXX71130
26
A
X-ray exam of breastbone
0.22
0.07
0.07
0.01
0.30
0.30
XXX71130
TC
A
X-ray exam of breastbone
0.00
0.71
NA
0.04
0.75
NA
XXX71130

A
X-ray exam of breastbone
0.22
0.78
NA
0.05
1.05
NA
XXX71250
26
A
Ct thorax w/o dye
1.16
0.38
0.38
0.05
1.59
1.59
XXX71250
TC
A
Ct thorax w/o dye
0.00
5.93
NA
0.31
6.24
NA
XXX71250

A
Ct thorax w/o dye
1.16
6.31
NA
0.36
7.83
NA
XXX71260
26
A
Ct thorax w/dye
1.24
0.41
0.41
0.05
1.70
1.70
XXX71260
TC
A
Ct thorax w/dye
0.00
7.09
NA
0.37
7.46
NA
XXX71260

A
Ct thorax w/dye
1.24
7.50
NA
0.42
9.16
NA
XXX71270
26
A
Ct thorax w/o & w/dye
1.38
0.45
0.45
0.06
1.89
1.89
XXX71270
TC
A
Ct thorax w/o & w/dye
0.00
8.88
NA
0.46
9.34
NA
XXX71270

A
Ct thorax w/o & w/dye
1.38
9.33
NA
0.52
11.23
NA
XXX71275
26
A
Ct angiography, chest
1.92
0.63
0.63
0.09
2.64
2.64
XXX71275
TC
A
Ct angiography, chest
0.00
12.42
NA
0.39
12.81
NA
XXX71275

A
Ct angiography, chest
1.92
13.05
NA
0.48
15.45
NA
XXX71550
26
A
Mri chest w/o dye
1.46
0.48
0.48
0.06
2.00
2.00
XXX71550
TC
A
Mri chest w/o dye
0.00
11.23
NA
0.45
11.68
NA
XXX71550

A
Mri chest w/o dye
1.46
11.71
NA
0.51
13.68
NA
XXX71551
26
A
Mri chest w/dye
1.73
0.57
0.57
0.08
2.38
2.38
XXX71551
TC
A
Mri chest w/dye
0.00
13.48
NA
0.52
14.00
NA
XXX71551

A
Mri chest w/dye
1.73
14.05
NA
0.60
16.38
NA
XXX71552
26
A
Mri chest w/o & w/dye
2.26
0.74
0.74
0.10
3.10
3.10
XXX71552
TC
A
Mri chest w/o & w/dye
0.00
24.95
NA
0.68
25.63
NA
XXX71552

A
Mri chest w/o & w/dye
2.26
25.69
NA
0.78
28.73
NA
XXX71555
26
R
Mri angio chest w or w/o dye
1.81
0.60
0.60
0.08
2.49
2.49
XXX71555
TC
R
Mri angio chest w or w/o dye
0.00
11.23
NA
0.59
11.82
NA
XXX71555

R
Mri angio chest w or w/o dye
1.81
11.83
NA
0.67
14.31
NA
XXX72010
26
A
X-ray exam of spine
0.45
0.15
0.15
0.02
0.62
0.62
XXX72010
TC
A
X-ray exam of spine
0.00
1.02
NA
0.06
1.08
NA
XXX72010

A
X-ray exam of spine
0.45
1.17
NA
0.08
1.70
NA
XXX72020
26
A
X-ray exam of spine
0.15
0.05
0.05
0.01
0.21
0.21
XXX72020
TC
A
X-ray exam of spine
0.00
0.42
NA
0.02
0.44
NA
XXX72020

A
X-ray exam of spine
0.15
0.47
NA
0.03
0.65
NA
XXX72040
26
A
X-ray exam of neck spine
0.22
0.07
0.07
0.01
0.30
0.30
XXX72040
TC
A
X-ray exam of neck spine
0.00
0.60
NA
0.04
0.64
NA
XXX72040

A
X-ray exam of neck spine
0.22
0.67
NA
0.05
0.94
NA
XXX72050
26
A
X-ray exam of neck spine
0.31
0.10
0.10
0.01
0.42
0.42
XXX72050
TC
A
X-ray exam of neck spine
0.00
0.89
NA
0.06
0.95
NA
XXX72050

A
X-ray exam of neck spine
0.31
0.99
NA
0.07
1.37
NA
XXX72052
26
A
X-ray exam of neck spine
0.36
0.12
0.12
0.02
0.50
0.50
XXX72052
TC
A
X-ray exam of neck spine
0.00
1.13
NA
0.06
1.19
NA
XXX72052

A
X-ray exam of neck spine
0.36
1.25
NA
0.08
1.69
NA
XXX72069
26
A
X-ray exam of trunk spine
0.22
0.08
0.08
0.01
0.31
0.31
XXX72069
TC
A
X-ray exam of trunk spine
0.00
0.49
NA
0.02
0.51
NA
XXX72069

A
X-ray exam of trunk spine
0.22
0.57
NA
0.03
0.82
NA
XXX72070
26
A
X-ray exam of thoracic spine
0.22
0.07
0.07
0.01
0.30
0.30
XXX72070
TC
A
X-ray exam of thoracic spine
0.00
0.65
NA
0.04
0.69
NA
XXX72070

A
X-ray exam of thoracic spine
0.22
0.72
NA
0.05
0.99
NA
XXX72072
26
A
X-ray exam of thoracic spine
0.22
0.07
0.07
0.01
0.30
0.30
XXX72072
TC
A
X-ray exam of thoracic spine
0.00
0.73
NA
0.05
0.78
NA
XXX72072

A
X-ray exam of thoracic spine
0.22
0.80
NA
0.06
1.08
NA
XXX72074
26
A
X-ray exam of thoracic spine
0.22
0.07
0.07
0.01
0.30
0.30
XXX72074
TC
A
X-ray exam of thoracic spine
0.00
0.91
NA
0.06
0.97
NA
XXX72074

A
X-ray exam of thoracic spine
0.22
0.98
NA
0.07
1.27
NA
XXX72080
26
A
X-ray exam of trunk spine
0.22
0.07
0.07
0.01
0.30
0.30
XXX72080
TC
A
X-ray exam of trunk spine
0.00
0.67
NA
0.04
0.71
NA
XXX72080

A
X-ray exam of trunk spine
0.22
0.74
NA
0.05
1.01
NA
XXX72090
26
A
X-ray exam of trunk spine
0.28
0.09
0.09
0.01
0.38
0.38
XXX72090
TC
A
X-ray exam of trunk spine
0.00
0.67
NA
0.04
0.71
NA
XXX72090

A
X-ray exam of trunk spine
0.28
0.76
NA
0.05
1.09
NA
XXX( print page 70415)72100
26
A
X-ray exam of lower spine
0.22
0.07
0.07
0.01
0.30
0.30
XXX72100
TC
A
X-ray exam of lower spine
0.00
0.67
NA
0.04
0.71
NA
XXX72100

A
X-ray exam of lower spine
0.22
0.74
NA
0.05
1.01
NA
XXX72110
26
A
X-ray exam of lower spine
0.31
0.10
0.10
0.01
0.42
0.42
XXX72110
TC
A
X-ray exam of lower spine
0.00
0.91
NA
0.06
0.97
NA
XXX72110

A
X-ray exam of lower spine
0.31
1.01
NA
0.07
1.39
NA
XXX72114
26
A
X-ray exam of lower spine
0.36
0.12
0.12
0.02
0.50
0.50
XXX72114
TC
A
X-ray exam of lower spine
0.00
1.19
NA
0.06
1.25
NA
XXX72114

A
X-ray exam of lower spine
0.36
1.31
NA
0.08
1.75
NA
XXX72120
26
A
X-ray exam of lower spine
0.22
0.07
0.07
0.01
0.30
0.30
XXX72120
TC
A
X-ray exam of lower spine
0.00
0.89
NA
0.06
0.95
NA
XXX72120

A
X-ray exam of lower spine
0.22
0.96
NA
0.07
1.25
NA
XXX72125
26
A
Ct neck spine w/o dye
1.16
0.38
0.38
0.05
1.59
1.59
XXX72125
TC
A
Ct neck spine w/o dye
0.00
5.93
NA
0.31
6.24
NA
XXX72125

A
Ct neck spine w/o dye
1.16
6.31
NA
0.36
7.83
NA
XXX72126
26
A
Ct neck spine w/dye
1.22
0.40
0.40
0.05
1.67
1.67
XXX72126
TC
A
Ct neck spine w/dye
0.00
7.09
NA
0.37
7.46
NA
XXX72126

A
Ct neck spine w/dye
1.22
7.49
NA
0.42
9.13
NA
XXX72127
26
A
Ct neck spine w/o & w/dye
1.27
0.42
0.42
0.06
1.75
1.75
XXX72127
TC
A
Ct neck spine w/o & w/dye
0.00
8.88
NA
0.46
9.34
NA
XXX72127

A
Ct neck spine w/o & w/dye
1.27
9.30
NA
0.52
11.09
NA
XXX72128
26
A
Ct chest spine w/o dye
1.16
0.38
0.38
0.05
1.59
1.59
XXX72128
TC
A
Ct chest spine w/o dye
0.00
5.93
NA
0.31
6.24
NA
XXX72128

A
Ct chest spine w/o dye
1.16
6.31
NA
0.36
7.83
NA
XXX72129
26
A
Ct chest spine w/dye
1.22
0.40
0.40
0.05
1.67
1.67
XXX72129
TC
A
Ct chest spine w/dye
0.00
7.09
NA
0.37
7.46
NA
XXX72129

A
Ct chest spine w/dye
1.22
7.49
NA
0.42
9.13
NA
XXX72130
26
A
Ct chest spine w/o & w/dye
1.27
0.42
0.42
0.06
1.75
1.75
XXX72130
TC
A
Ct chest spine w/o & w/dye
0.00
8.88
NA
0.46
9.34
NA
XXX72130

A
Ct chest spine w/o & w/dye
1.27
9.30
NA
0.52
11.09
NA
XXX72131
26
A
Ct lumbar spine w/o dye
1.16
0.38
0.38
0.05
1.59
1.59
XXX72131
TC
A
Ct lumbar spine w/o dye
0.00
5.93
NA
0.31
6.24
NA
XXX72131

A
Ct lumbar spine w/o dye
1.16
6.31
NA
0.36
7.83
NA
XXX72132
26
A
Ct lumbar spine w/dye
1.22
0.40
0.40
0.05
1.67
1.67
XXX72132
TC
A
Ct lumbar spine w/dye
0.00
7.09
NA
0.37
7.46
NA
XXX72132

A
Ct lumbar spine w/dye
1.22
7.49
NA
0.42
9.13
NA
XXX72133
26
A
Ct lumbar spine w/o & w/dye
1.27
0.42
0.42
0.06
1.75
1.75
XXX72133
TC
A
Ct lumbar spine w/o & w/dye
0.00
8.88
NA
0.46
9.34
NA
XXX72133

A
Ct lumbar spine w/o & w/dye
1.27
9.30
NA
0.52
11.09
NA
XXX72141
26
A
Mri neck spine w/o dye
1.60
0.53
0.53
0.07
2.20
2.20
XXX72141
TC
A
Mri neck spine w/o dye
0.00
11.23
NA
0.59
11.82
NA
XXX72141

A
Mri neck spine w/o dye
1.60
11.76
NA
0.66
14.02
NA
XXX72142
26
A
Mri neck spine w/dye
1.92
0.64
0.64
0.09
2.65
2.65
XXX72142
TC
A
Mri neck spine w/dye
0.00
13.48
NA
0.70
14.18
NA
XXX72142

A
Mri neck spine w/dye
1.92
14.12
NA
0.79
16.83
NA
XXX72146
26
A
Mri chest spine w/o dye
1.60
0.53
0.53
0.07
2.20
2.20
XXX72146
TC
A
Mri chest spine w/o dye
0.00
12.48
NA
0.64
13.12
NA
XXX72146

A
Mri chest spine w/o dye
1.60
13.01
NA
0.71
15.32
NA
XXX72147
26
A
Mri chest spine w/dye
1.92
0.63
0.63
0.09
2.64
2.64
XXX72147
TC
A
Mri chest spine w/dye
0.00
13.48
NA
0.70
14.18
NA
XXX72147

A
Mri chest spine w/dye
1.92
14.11
NA
0.79
16.82
NA
XXX72148
26
A
Mri lumbar spine w/o dye
1.48
0.49
0.49
0.07
2.04
2.04
XXX72148
TC
A
Mri lumbar spine w/o dye
0.00
12.48
NA
0.64
13.12
NA
XXX72148

A
Mri lumbar spine w/o dye
1.48
12.97
NA
0.71
15.16
NA
XXX72149
26
A
Mri lumbar spine w/dye
1.78
0.60
0.60
0.08
2.46
2.46
XXX72149
TC
A
Mri lumbar spine w/dye
0.00
13.48
NA
0.70
14.18
NA
XXX72149

A
Mri lumbar spine w/dye
1.78
14.08
NA
0.78
16.64
NA
XXX72156
26
A
Mri neck spine w/o & w/dye
2.57
0.85
0.85
0.11
3.53
3.53
XXX72156
TC
A
Mri neck spine w/o & w/dye
0.00
24.95
NA
1.31
26.26
NA
XXX72156

A
Mri neck spine w/o & w/dye
2.57
25.80
NA
1.42
29.79
NA
XXX72157
26
A
Mri chest spine w/o & w/dye
2.57
0.84
0.84
0.11
3.52
3.52
XXX72157
TC
A
Mri chest spine w/o & w/dye
0.00
24.95
NA
1.31
26.26
NA
XXX72157

A
Mri chest spine w/o & w/dye
2.57
25.79
NA
1.42
29.78
NA
XXX72158
26
A
Mri lumbar spine w/o & w/dye
2.36
0.78
0.78
0.10
3.24
3.24
XXX72158
TC
A
Mri lumbar spine w/o & w/dye
0.00
24.95
NA
1.31
26.26
NA
XXX72158

A
Mri lumbar spine w/o & w/dye
2.36
25.73
NA
1.41
29.50
NA
XXX72159
26
N
Mr angio spine w/o&w/dye
+1.80
0.69
0.69
0.10
2.59
2.59
XXX72159
TC
N
Mr angio spine w/o&w/dye
+0.00
12.27
12.27
0.64
12.91
12.91
XXX72159

N
Mr angio spine w/o&w/dye
+1.80
12.96
12.96
0.74
15.50
15.50
XXX72170
26
A
X-ray exam of pelvis
0.17
0.06
0.06
0.01
0.24
0.24
XXX72170
TC
A
X-ray exam of pelvis
0.00
0.52
NA
0.02
0.54
NA
XXX72170

A
X-ray exam of pelvis
0.17
0.58
NA
0.03
0.78
NA
XXX72190
26
A
X-ray exam of pelvis
0.21
0.07
0.07
0.01
0.29
0.29
XXX72190
TC
A
X-ray exam of pelvis
0.00
0.67
NA
0.04
0.71
NA
XXX72190

A
X-ray exam of pelvis
0.21
0.74
NA
0.05
1.00
NA
XXX( print page 70416)72191
26
A
Ct angiograph pelv w/o&w/dye
1.81
0.60
0.60
0.08
2.49
2.49
XXX72191
TC
A
Ct angiograph pelv w/o&w/dye
0.00
12.06
NA
0.39
12.45
NA
XXX72191

A
Ct angiograph pelv w/o&w/dye
1.81
12.66
NA
0.47
14.94
NA
XXX72192
26
A
Ct pelvis w/o dye
1.09
0.36
0.36
0.05
1.50
1.50
XXX72192
TC
A
Ct pelvis w/o dye
0.00
5.93
NA
0.31
6.24
NA
XXX72192

A
Ct pelvis w/o dye
1.09
6.29
NA
0.36
7.74
NA
XXX72193
26
A
Ct pelvis w/dye
1.16
0.38
0.38
0.05
1.59
1.59
XXX72193
TC
A
Ct pelvis w/dye
0.00
6.86
NA
0.36
7.22
NA
XXX72193

A
Ct pelvis w/dye
1.16
7.24
NA
0.41
8.81
NA
XXX72194
26
A
Ct pelvis w/o & w/dye
1.22
0.40
0.40
0.05
1.67
1.67
XXX72194
TC
A
Ct pelvis w/o & w/dye
0.00
8.51
NA
0.43
8.94
NA
XXX72194

A
Ct pelvis w/o & w/dye
1.22
8.91
NA
0.48
10.61
NA
XXX72195
26
A
Mri pelvis w/o dye
1.46
0.48
0.48
0.06
2.00
2.00
XXX72195
TC
A
Mri pelvis w/o dye
0.00
11.23
NA
0.45
11.68
NA
XXX72195

A
Mri pelvis w/o dye
1.46
11.71
NA
0.51
13.68
NA
XXX72196
26
A
Mri pelvis w/dye
1.73
0.57
0.57
0.08
2.38
2.38
XXX72196
TC
A
Mri pelvis w/dye
0.00
13.48
NA
0.52
14.00
NA
XXX72196

A
Mri pelvis w/dye
1.73
14.05
NA
0.60
16.38
NA
XXX72197
26
A
Mri pelvis w/o & w/dye
2.26
0.74
0.74
0.10
3.10
3.10
XXX72197
TC
A
Mri pelvis w/o & w/dye
0.00
24.95
NA
0.92
25.87
NA
XXX72197

A
Mri pelvis w/o & w/dye
2.26
25.69
NA
1.02
28.97
NA
XXX72198
26
A
Mr angio pelvis w/o & w/dye
1.80
0.59
0.59
0.08
2.47
2.47
XXX72198
TC
A
Mr angio pelvis w/o & w/dye
0.00
11.23
NA
0.59
11.82
NA
XXX72198

A
Mr angio pelvis w/o & w/dye
1.80
11.82
NA
0.67
14.29
NA
XXX72200
26
A
X-ray exam sacroiliac joints
0.17
0.06
0.06
0.01
0.24
0.24
XXX72200
TC
A
X-ray exam sacroiliac joints
0.00
0.52
NA
0.02
0.54
NA
XXX72200

A
X-ray exam sacroiliac joints
0.17
0.58
NA
0.03
0.78
NA
XXX72202
26
A
X-ray exam sacroiliac joints
0.19
0.06
0.06
0.01
0.26
0.26
XXX72202
TC
A
X-ray exam sacroiliac joints
0.00
0.62
NA
0.04
0.66
NA
XXX72202

A
X-ray exam sacroiliac joints
0.19
0.68
NA
0.05
0.92
NA
XXX72220
26
A
X-ray exam of tailbone
0.17
0.06
0.06
0.01
0.24
0.24
XXX72220
TC
A
X-ray exam of tailbone
0.00
0.57
NA
0.04
0.61
NA
XXX72220

A
X-ray exam of tailbone
0.17
0.63
NA
0.05
0.85
NA
XXX72240
26
A
Contrast x-ray of neck spine
0.91
0.29
0.29
0.04
1.24
1.24
XXX72240
TC
A
Contrast x-ray of neck spine
0.00
4.76
NA
0.25
5.01
NA
XXX72240

A
Contrast x-ray of neck spine
0.91
5.05
NA
0.29
6.25
NA
XXX72255
26
A
Contrast x-ray, thorax spine
0.91
0.27
0.27
0.04
1.22
1.22
XXX72255
TC
A
Contrast x-ray, thorax spine
0.00
4.34
NA
0.22
4.56
NA
XXX72255

A
Contrast x-ray, thorax spine
0.91
4.61
NA
0.26
5.78
NA
XXX72265
26
A
Contrast x-ray, lower spine
0.83
0.25
0.25
0.04
1.12
1.12
XXX72265
C
A
Contrast x-ray, lower spine
0.00
4.08
NA
0.22
4.30
NA
XXX72265

A
Contrast x-ray, lower spine
0.83
4.33
NA
0.26
5.42
NA
XXX72270
26
A
Contrast x-ray, spine
1.33
0.42
0.42
0.06
1.81
1.81
XXX72270
TC
A
Contrast x-ray, spine
0.00
6.12
NA
0.33
6.45
NA
XXX72270

A
Contrast x-ray, spine
1.33
6.54
NA
0.39
8.26
NA
XXX72275
26
A
Epidurography
0.76
0.20
0.20
0.04
1.00
1.00
XXX72275
TC
A
Epidurography
0.00
2.11
NA
0.22
2.33
NA
XXX72275

A
Epidurography
0.76
2.31
NA
0.26
3.33
NA
XXX72285
26
A
X-ray c/t spine disk
1.16
0.36
0.36
0.07
1.59
1.59
XXX72285
TC
A
X-ray c/t spine disk
0.00
8.40
NA
0.43
8.83
NA
XXX72285

A
X-ray c/t spine disk
1.16
8.76
NA
0.50
10.42
NA
XXX72295
26
A
X-ray of lower spine disk
0.83
0.27
0.27
0.06
1.16
1.16
XXX72295
TC
A
X-ray of lower spine disk
0.00
7.88
NA
0.40
8.28
NA
XXX72295

A
X-ray of lower spine disk
0.83
8.15
NA
0.46
9.44
NA
XXX73000
26
A
X-ray exam of collar bone
0.16
0.05
0.05
0.01
0.22
0.22
XXX73000
TC
A
X-ray exam of collar bone
0.00
0.52
NA
0.02
0.54
NA
XXX73000

A
X-ray exam of collar bone
0.16
0.57
NA
0.03
0.76
NA
XXX73010
26
A
X-ray exam of shoulder blade
0.17
0.06
0.06
0.01
0.24
0.24
XXX73010
TC
A
X-ray exam of shoulder blade
0.00
0.52
NA
0.02
0.54
NA
XXX73010

A
X-ray exam of shoulder blade
0.17
0.58
NA
0.03
0.78
NA
XXX73020
26
A
X-ray exam of shoulder
0.15
0.05
0.05
0.01
0.21
0.21
XXX73020
TC
A
X-ray exam of shoulder
0.00
0.47
NA
0.02
0.49
NA
XXX73020

A
X-ray exam of shoulder
0.15
0.52
NA
0.03
0.70
NA
XXX73030
26
A
X-ray exam of shoulder
0.18
0.06
0.06
0.01
0.25
0.25
XXX73030
TC
A
X-ray exam of shoulder
0.00
0.57
NA
0.04
0.61
NA
XXX73030

A
X-ray exam of shoulder
0.18
0.63
NA
0.05
0.86
NA
XXX73040
26
A
Contrast x-ray of shoulder
0.54
0.18
0.18
0.02
0.74
0.74
XXX73040
TC
A
Contrast x-ray of shoulder
0.00
2.11
NA
0.12
2.23
NA
XXX73040

A
Contrast x-ray of shoulder
0.54
2.29
NA
0.14
2.97
NA
XXX73050
26
A
X-ray exam of shoulders
0.20
0.07
0.07
0.01
0.28
0.28
XXX73050
TC
A
X-ray exam of shoulders
0.00
0.67
NA
0.04
0.71
NA
XXX73050

A
X-ray exam of shoulders
0.20
0.74
NA
0.05
0.99
NA
XXX73060
26
A
X-ray exam of humerus
0.17
0.06
0.06
0.01
0.24
0.24
XXX73060
TC
A
X-ray exam of humerus
0.00
0.57
NA
0.04
0.61
NA
XXX73060

A
X-ray exam of humerus
0.17
0.63
NA
0.05
0.85
NA
XXX( print page 70417)73070
26
A
X-ray exam of elbow
0.15
0.05
0.05
0.01
0.21
0.21
XXX73070
TC
A
X-ray exam of elbow
0.00
0.52
NA
0.02
0.54
NA
XXX73070

A
X-ray exam of elbow
0.15
0.57
NA
0.03
0.75
NA
XXX73080
26
A
X-ray exam of elbow
0.17
0.06
0.06
0.01
0.24
0.24
XXX73080
TC
A
X-ray exam of elbow
0.00
0.57
NA
0.04
0.61
NA
XXX73080

A
X-ray exam of elbow
0.17
0.63
NA
0.05
0.85
NA
XXX73085
26
A
Contrast x-ray of elbow
0.54
0.19
0.19
0.02
0.75
0.75
XXX73085
TC
A
Contrast x-ray of elbow
0.00
2.11
NA
0.12
2.23
NA
XXX73085

A
Contrast x-ray of elbow
0.54
2.30
NA
0.14
2.98
NA
XXX73090
26
A
X-ray exam of forearm
0.16
0.05
0.05
0.01
0.22
0.22
XXX73090
TC
A
X-ray exam of forearm
0.00
0.52
NA
0.02
0.54
NA
XXX73090

A
X-ray exam of forearm
0.16
0.57
NA
0.03
0.76
NA
XXX73092
26
A
X-ray exam of arm, infant
0.16
0.05
0.05
0.01
0.22
0.22
XXX73092
TC
A
X-ray exam of arm, infant
0.00
0.49
NA
0.02
0.51
NA
XXX73092

A
X-ray exam of arm, infant
0.16
0.54
NA
0.03
0.73
NA
XXX73100
26
A
X-ray exam of wrist
0.16
0.05
0.05
0.01
0.22
0.22
XXX73100
TC
A
X-ray exam of wrist
0.00
0.49
NA
0.02
0.51
NA
XXX73100

A
X-ray exam of wrist
0.16
0.54
NA
0.03
0.73
NA
XXX73110
26
A
X-ray exam of wrist
0.17
0.06
0.06
0.01
0.24
0.24
XXX73110
TC
A
X-ray exam of wrist
0.00
0.53
NA
0.02
0.55
NA
XXX73110

A
X-ray exam of wrist
0.17
0.59
NA
0.03
0.79
NA
XXX73115
26
A
Contrast x-ray of wrist
0.54
0.18
0.18
0.02
0.74
0.74
XXX73115
TC
A
Contrast x-ray of wrist
0.00
1.58
NA
0.10
1.68
NA
XXX73115

A
Contrast x-ray of wrist
0.54
1.76
NA
0.12
2.42
NA
XXX73120
26
A
X-ray exam of hand
0.16
0.05
0.05
0.01
0.22
0.22
XXX73120
TC
A
X-ray exam of hand
0.00
0.49
NA
0.02
0.51
NA
XXX73120

A
X-ray exam of hand
0.16
0.54
NA
0.03
0.73
NA
XXX73130
26
A
X-ray exam of hand
0.17
0.06
0.06
0.01
0.24
0.24
XXX73130
TC
A
X-ray exam of hand
0.00
0.53
NA
0.02
0.55
NA
XXX73130

A
X-ray exam of hand
0.17
0.59
NA
0.03
0.79
NA
XXX73140
26
A
X-ray exam of finger(s)
0.13
0.04
0.04
0.01
0.18
0.18
XXX73140
TC
A
X-ray exam of finger(s)
0.00
0.42
NA
0.02
0.44
NA
XXX73140

A
X-ray exam of finger(s)
0.13
0.46
NA
0.03
0.62
NA
XXX73200
26
A
Ct upper extremity w/o dye
1.09
0.36
0.36
0.05
1.50
1.50
XXX73200
TC
A
Ct upper extremity w/o dye
0.00
4.97
NA
0.25
5.22
NA
XXX73200

A
Ct upper extremity w/o dye
1.09
5.33
NA
0.30
6.72
NA
XXX73201
26
A
Ct upper extremity w/dye
1.16
0.38
0.38
0.05
1.59
1.59
XXX73201
TC
A
Ct upper extremity w/dye
0.00
5.93
NA
0.31
6.24
NA
XXX73201

A
Ct upper extremity w/dye
1.16
6.31
NA
0.36
7.83
NA
XXX73202
26
A
Ct uppr extremity w/o&w/dye
1.22
0.40
0.40
0.05
1.67
1.67
XXX73202
TC
A
Ct uppr extremity w/o&w/dye
0.00
7.44
NA
0.39
7.83
NA
XXX73202

A
Ct uppr extremity w/o&w/dye
1.22
7.84
NA
0.44
9.50
NA
XXX73206
26
A
Ct angio upr extrm w/o&w/dye
1.81
0.59
0.59
0.08
2.48
2.48
XXX73206
TC
A
Ct angio upr extrm w/o&w/dye
0.00
10.99
NA
0.39
11.38
NA
XXX73206

A
Ct angio upr extrm w/o&w/dye
1.81
11.58
NA
0.47
13.86
NA
XXX73218
26
A
Mri upper extremity w/o dye
1.35
0.44
0.44
0.06
1.85
1.85
XXX73218
TC
A
Mri upper extremity w/o dye
0.00
11.23
NA
0.39
11.62
NA
XXX73218

A
Mri upper extremity w/o dye
1.35
11.67
NA
0.45
13.47
NA
XXX73219
26
A
Mri upper extremity w/dye
1.62
0.54
0.54
0.07
2.23
2.23
XXX73219
TC
A
Mri upper extremity w/dye
0.00
13.48
NA
0.47
13.95
NA
XXX73219

A
Mri upper extremity w/dye
1.62
14.02
NA
0.54
16.18
NA
XXX73220
26
A
Mri uppr extremity w/o&w/dye
2.15
0.71
0.71
0.10
2.96
2.96
XXX73220
TC
A
Mri uppr extremity w/o&w/dye
0.00
24.95
NA
0.84
25.79
NA
XXX73220

A
Mri uppr extremity w/o&w/dye
2.15
25.66
NA
0.94
28.75
NA
XXX73221
26
A
Mri joint upr extrem w/o dye
1.35
0.44
0.44
0.06
1.85
1.85
XXX73221
TC
A
Mri joint upr extrem w/o dye
0.00
11.23
NA
0.39
11.62
NA
XXX73221

A
Mri joint upr extrem w/o dye
1.35
11.67
NA
0.45
13.47
NA
XXX73222
26
A
Mri joint upr extrem w/dye
1.62
0.53
0.53
0.07
2.22
2.22
XXX73222
TC
A
Mri joint upr extrem w/dye
0.00
13.48
NA
0.47
13.95
NA
XXX73222

A
Mri joint upr extrem w/dye
1.62
14.01
NA
0.54
16.17
NA
XXX73223
26
A
Mri joint upr extr w/o&w/dye
2.15
0.71
0.71
0.10
2.96
2.96
XXX73223
TC
A
Mri joint upr extr w/o&w/dye
0.00
24.95
NA
0.84
25.79
NA
XXX73223

A
Mri joint upr extr w/o&w/dye
2.15
25.66
NA
0.94
28.75
NA
XXX73225
26
N
Mr angio upr extr w/o&w/dye
+1.73
0.67
0.67
0.10
2.50
2.50
XXX73225
TC
N
Mr angio upr extr w/o&w/dye
+0.00
11.04
11.04
0.59
11.63
11.63
XXX73225

N
Mr angio upr extr w/o&w/dye
+1.73
11.71
11.71
0.69
14.13
14.13
XXX73500
26
A
X-ray exam of hip
0.17
0.06
0.06
0.01
0.24
0.24
XXX73500
TC
A
X-ray exam of hip
0.00
0.47
NA
0.02
0.49
NA
XXX73500

A
X-ray exam of hip
0.17
0.53
NA
0.03
0.73
NA
XXX73510
26
A
X-ray exam of hip
0.21
0.07
0.07
0.01
0.29
0.29
XXX73510
TC
A
X-ray exam of hip
0.00
0.57
NA
0.04
0.61
NA
XXX73510

A
X-ray exam of hip
0.21
0.64
NA
0.05
0.90
NA
XXX73520
26
A
X-ray exam of hips
0.26
0.09
0.09
0.01
0.36
0.36
XXX73520
TC
A
X-ray exam of hips
0.00
0.67
NA
0.04
0.71
NA
XXX73520

A
X-ray exam of hips
0.26
0.76
NA
0.05
1.07
NA
XXX( print page 70418)73525
26
A
Contrast x-ray of hip
0.54
0.18
0.18
0.03
0.75
0.75
XXX73525
TC
A
Contrast x-ray of hip
0.00
2.11
NA
0.12
2.23
NA
XXX73525

A
Contrast x-ray of hip
0.54
2.29
NA
0.15
2.98
NA
XXX73530
26
A
X-ray exam of hip
0.29
0.10
0.10
0.01
0.40
0.40
XXX73530
TC
A
X-ray exam of hip
0.00
0.52
NA
0.02
0.54
NA
XXX73530

A
X-ray exam of hip
0.29
0.62
NA
0.03
0.94
NA
XXX73540
26
A
X-ray exam of pelvis & hips
0.20
0.07
0.07
0.01
0.28
0.28
XXX73540
TC
A
X-ray exam of pelvis & hips
0.00
0.57
NA
0.04
0.61
NA
XXX73540

A
X-ray exam of pelvis & hips
0.20
0.64
NA
0.05
0.89
NA
XXX73542
26
A
X-ray exam, sacroiliac joint
0.59
0.16
0.16
0.03
0.78
0.78
XXX73542
TC
A
X-ray exam, sacroiliac joint
0.00
2.11
NA
0.12
2.23
NA
XXX73542

A
X-ray exam, sacroiliac joint
0.59
2.27
NA
0.15
3.01
NA
XXX73550
26
A
X-ray exam of thigh
0.17
0.06
0.06
0.01
0.24
0.24
XXX73550
TC
A
X-ray exam of thigh
0.00
0.57
NA
0.04
0.61
NA
XXX73550

A
X-ray exam of thigh
0.17
0.63
NA
0.05
0.85
NA
XXX73560
26
A
X-ray exam of knee, 1 or 2
0.17
0.06
0.06
0.01
0.24
0.24
XXX73560
TC
A
X-ray exam of knee, 1 or 2
0.00
0.52
NA
0.02
0.54
NA
XXX73560

A
X-ray exam of knee, 1 or 2
0.17
0.58
NA
0.03
0.78
NA
XXX73562
26
A
X-ray exam of knee, 3
0.18
0.06
0.06
0.01
0.25
0.25
XXX73562
TC
A
X-ray exam of knee, 3
0.00
0.57
NA
0.04
0.61
NA
XXX73562

A
X-ray exam of knee, 3
0.18
0.63
NA
0.05
0.86
NA
XXX73564
26
A
X-ray exam, knee, 4 or more
0.22
0.07
0.07
0.01
0.30
0.30
XXX73564
TC
A
X-ray exam, knee, 4 or more
0.00
0.62
NA
0.04
0.66
NA
XXX73564

A
X-ray exam, knee, 4 or more
0.22
0.69
NA
0.05
0.96
NA
XXX73565
26
A
X-ray exam of knees
0.17
0.06
0.06
0.01
0.24
0.24
XXX73565
TC
A
X-ray exam of knees
0.00
0.49
NA
0.02
0.51
NA
XXX73565

A
X-ray exam of knees
0.17
0.55
NA
0.03
0.75
NA
XXX73580
26
A
Contrast x-ray of knee joint
0.54
0.17
0.17
0.03
0.74
0.74
XXX73580
TC
A
Contrast x-ray of knee joint
0.00
2.63
NA
0.14
2.77
NA
XXX73580

A
Contrast x-ray of knee joint
0.54
2.80
NA
0.17
3.51
NA
XXX73590
26
A
X-ray exam of lower leg
0.17
0.06
0.06
0.01
0.24
0.24
XXX73590
TC
A
X-ray exam of lower leg
0.00
0.52
NA
0.02
0.54
NA
XXX73590

A
X-ray exam of lower leg
0.17
0.58
NA
0.03
0.78
NA
XXX73592
26
A
X-ray exam of leg, infant
0.16
0.05
0.05
0.01
0.22
0.22
XXX73592
TC
A
X-ray exam of leg, infant
0.00
0.49
NA
0.02
0.51
NA
XXX73592

A
X-ray exam of leg, infant
0.16
0.54
NA
0.03
0.73
NA
XXX73600
26
A
X-ray exam of ankle
0.16
0.05
0.05
0.01
0.22
0.22
XXX73600
TC
A
X-ray exam of ankle
0.00
0.49
NA
0.02
0.51
NA
XXX73600

A
X-ray exam of ankle
0.16
0.54
NA
0.03
0.73
NA
XXX73610
26
A
X-ray exam of ankle
0.17
0.06
0.06
0.01
0.24
0.24
XXX73610
TC
A
X-ray exam of ankle
0.00
0.53
NA
0.02
0.55
NA
XXX73610

A
X-ray exam of ankle
0.17
0.59
NA
0.03
0.79
NA
XXX73615
26
A
Contrast x-ray of ankle
0.54
0.18
0.18
0.03
0.75
0.75
XXX73615
TC
A
Contrast x-ray of ankle
0.00
2.11
NA
0.12
2.23
NA
XXX73615

A
Contrast x-ray of ankle
0.54
2.29
NA
0.15
2.98
NA
XXX73620
26
A
X-ray exam of foot
0.16
0.05
0.05
0.01
0.22
0.22
XXX73620
TC
A
X-ray exam of foot
0.00
0.49
NA
0.02
0.51
NA
XXX73620

A
X-ray exam of foot
0.16
0.54
NA
0.03
0.73
NA
XXX73630
26
A
X-ray exam of foot
0.17
0.06
0.06
0.01
0.24
0.24
XXX73630
TC
A
X-ray exam of foot
0.00
0.53
NA
0.02
0.55
NA
XXX73630

A
X-ray exam of foot
0.17
0.59
NA
0.03
0.79
NA
XXX73650
26
A
X-ray exam of heel
0.16
0.05
0.05
0.01
0.22
0.22
XXX73650
TC
A
X-ray exam of heel
0.00
0.47
NA
0.02
0.49
NA
XXX73650

A
X-ray exam of heel
0.16
0.52
NA
0.03
0.71
NA
XXX73660
26
A
X-ray exam of toe(s)
0.13
0.04
0.04
0.01
0.18
0.18
XXX73660
TC
A
X-ray exam of toe(s)
0.00
0.42
NA
0.02
0.44
NA
XXX73660

A
X-ray exam of toe(s)
0.13
0.46
NA
0.03
0.62
NA
XXX73700
26
A
Ct lower extremity w/o dye
1.09
0.36
0.36
0.05
1.50
1.50
XXX73700
TC
A
Ct lower extremity w/o dye
0.00
4.97
NA
0.25
5.22
NA
XXX73700

A
Ct lower extremity w/o dye
1.09
5.33
NA
0.30
6.72
NA
XXX73701
26
A
Ct lower extremity w/dye
1.16
0.38
0.38
0.05
1.59
1.59
XXX73701
TC
A
Ct lower extremity w/dye
0.00
5.93
NA
0.31
6.24
NA
XXX73701

A
Ct lower extremity w/dye
1.16
6.31
NA
0.36
7.83
NA
XXX73702
26
A
Ct lwr extremity w/o&w/dye
1.22
0.40
0.40
0.05
1.67
1.67
XXX73702
TC
A
Ct lwr extremity w/o&w/dye
0.00
7.44
NA
0.39
7.83
NA
XXX73702

A
Ct lwr extremity w/o&w/dye
1.22
7.84
NA
0.44
9.50
NA
XXX73706
26
A
Ct angio lwr extr w/o&w/dye
1.90
0.62
0.62
0.08
2.60
2.60
XXX73706
TC
A
Ct angio lwr extr w/o&w/dye
0.00
10.99
NA
0.39
11.38
NA
XXX73706

A
Ct angio lwr extr w/o&w/dye
1.90
11.61
NA
0.47
13.98
NA
XXX73718
26
A
Mri lower extremity w/o dye
1.35
0.44
0.44
0.06
1.85
1.85
XXX73718
TC
A
Mri lower extremity w/o dye
0.00
11.23
NA
0.39
11.62
NA
XXX73718

A
Mri lower extremity w/o dye
1.35
11.67
NA
0.45
13.47
NA
XXX73719
26
A
Mri lower extremity w/dye
1.62
0.53
0.53
0.07
2.22
2.22
XXX73719
TC
A
Mri lower extremity w/dye
0.00
13.48
NA
0.47
13.95
NA
XXX73719

A
Mri lower extremity w/dye
1.62
14.01
NA
0.54
16.17
NA
XXX( print page 70419)73720
26
A
Mri lwr extremity w/o&w/dye
2.15
0.70
0.70
0.10
2.95
2.95
XXX73720
TC
A
Mri lwr extremity w/o&w/dye
0.00
24.95
NA
0.84
25.79
NA
XXX73720

A
Mri lwr extremity w/o&w/dye
2.15
25.65
NA
0.94
28.74
NA
XXX73721
26
A
Mri jnt of lwr extre w/o dye
1.35
0.44
0.44
0.06
1.85
1.85
XXX73721
TC
A
Mri jnt of lwr extre w/o dye
0.00
11.23
NA
0.39
11.62
NA
XXX73721

A
Mri jnt of lwr extre w/o dye
1.35
11.67
NA
0.45
13.47
NA
XXX73722
26
A
Mri joint of lwr extr w/dye
1.62
0.53
0.53
0.07
2.22
2.22
XXX73722
TC
A
Mri joint of lwr extr w/dye
0.00
13.48
NA
0.47
13.95
NA
XXX73722

A
Mri joint of lwr extr w/dye
1.62
14.01
NA
0.54
16.17
NA
XXX73723
26
A
Mri joint lwr extr w/o&w/dye
2.15
0.71
0.71
0.10
2.96
2.96
XXX73723
TC
A
Mri joint lwr extr w/o&w/dye
0.00
24.95
NA
0.84
25.79
NA
XXX73723

A
Mri joint lwr extr w/o&w/dye
2.15
25.66
NA
0.94
28.75
NA
XXX73725
26
R
Mr ang lwr ext w or w/o dye
1.82
0.60
0.60
0.08
2.50
2.50
XXX73725
TC
R
Mr ang lwr ext w or w/o dye
0.00
11.23
NA
0.59
11.82
NA
XXX73725

R
Mr ang lwr ext w or w/o dye
1.82
11.83
NA
0.67
14.32
NA
XXX74000
26
A
X-ray exam of abdomen
0.18
0.06
0.06
0.01
0.25
0.25
XXX74000
TC
A
X-ray exam of abdomen
0.00
0.52
NA
0.02
0.54
NA
XXX74000

A
X-ray exam of abdomen
0.18
0.58
NA
0.03
0.79
NA
XXX74010
26
A
X-ray exam of abdomen
0.23
0.08
0.08
0.01
0.32
0.32
XXX74010
TC
A
X-ray exam of abdomen
0.00
0.57
NA
0.04
0.61
NA
XXX74010

A
X-ray exam of abdomen
0.23
0.65
NA
0.05
0.93
NA
XXX74020
26
A
X-ray exam of abdomen
0.27
0.09
0.09
0.01
0.37
0.37
XXX74020
TC
A
X-ray exam of abdomen
0.00
0.62
NA
0.04
0.66
NA
XXX74020

A
X-ray exam of abdomen
0.27
0.71
NA
0.05
1.03
NA
XXX74022
26
A
X-ray exam series, abdomen
0.32
0.10
0.10
0.01
0.43
0.43
XXX74022
TC
A
X-ray exam series, abdomen
0.00
0.73
NA
0.05
0.78
NA
XXX74022

A
X-ray exam series, abdomen
0.32
0.83
NA
0.06
1.21
NA
XXX74150
26
A
Ct abdomen w/o dye
1.19
0.39
0.39
0.05
1.63
1.63
XXX74150
TC
A
Ct abdomen w/o dye
0.00
5.68
NA
0.30
5.98
NA
XXX74150

A
Ct abdomen w/o dye
1.19
6.07
NA
0.35
7.61
NA
XXX74160
26
A
Ct abdomen w/dye
1.27
0.42
0.42
0.06
1.75
1.75
XXX74160
TC
A
Ct abdomen w/dye
0.00
6.86
NA
0.36
7.22
NA
XXX74160

A
Ct abdomen w/dye
1.27
7.28
NA
0.42
8.97
NA
XXX74170
26
A
Ct abdomen w/o & w/dye
1.40
0.46
0.46
0.06
1.92
1.92
XXX74170
TC
A
Ct abdomen w/o & w/dye
0.00
8.51
NA
0.43
8.94
NA
XXX74170

A
Ct abdomen w/o & w/dye
1.40
8.97
NA
0.49
10.86
NA
XXX74175
26
A
Ct angio abdom w/o & w/dye
1.90
0.62
0.62
0.08
2.60
2.60
XXX74175
TC
A
Ct angio abdom w/o & w/dye
0.00
12.06
NA
0.39
12.45
NA
XXX74175

A
Ct angio abdom w/o & w/dye
1.90
12.68
NA
0.47
15.05
NA
XXX74181
26
A
Mri abdomen w/o dye
1.46
0.48
0.48
0.06
2.00
2.00
XXX74181
TC
A
Mri abdomen w/o dye
0.00
11.23
NA
0.45
11.68
NA
XXX74181

A
Mri abdomen w/o dye
1.46
11.71
NA
0.51
13.68
NA
XXX74182
26
A
Mri abdomen w/dye
1.73
0.57
0.57
0.08
2.38
2.38
XXX74182
TC
A
Mri abdomen w/dye
0.00
13.48
NA
0.52
14.00
NA
XXX74182

A
Mri abdomen w/dye
1.73
14.05
NA
0.60
16.38
NA
XXX74183
26
A
Mri abdomen w/o & w/dye
2.26
0.74
0.74
0.10
3.10
3.10
XXX74183
TC
A
Mri abdomen w/o & w/dye
0.00
24.95
NA
0.92
25.87
NA
XXX74183

A
Mri abdomen w/o & w/dye
2.26
25.69
NA
1.02
28.97
NA
XXX74185
26
R
Mri angio, abdom w orw/o dye
1.80
0.59
0.59
0.08
2.47
2.47
XXX74185
TC
R
Mri angio, abdom w orw/o dye
0.00
11.23
NA
0.59
11.82
NA
XXX74185

R
Mri angio, abdom w orw/o dye
1.80
11.82
NA
0.67
14.29
NA
XXX74190
26
A
X-ray exam of peritoneum
0.48
0.16
0.16
0.02
0.66
0.66
XXX74190
TC
A
X-ray exam of peritoneum
0.00
1.31
NA
0.07
1.38
NA
XXX74190

A
X-ray exam of peritoneum
0.48
1.47
NA
0.09
2.04
NA
XXX74210
26
A
Contrst x-ray exam of throat
0.36
0.12
0.12
0.02
0.50
0.50
XXX74210
TC
A
Contrst x-ray exam of throat
0.00
1.19
NA
0.06
1.25
NA
XXX74210

A
Contrst x-ray exam of throat
0.36
1.31
NA
0.08
1.75
NA
XXX74220
26
A
Contrast x-ray, esophagus
0.46
0.15
0.15
0.02
0.63
0.63
XXX74220
TC
A
Contrast x-ray, esophagus
0.00
1.19
NA
0.06
1.25
NA
XXX74220

A
Contrast x-ray, esophagus
0.46
1.34
NA
0.08
1.88
NA
XXX74230
26
A
Cine/vid x-ray, throat/esoph
0.53
0.17
0.17
0.02
0.72
0.72
XXX74230
TC
A
Cine/vid x-ray, throat/esoph
0.00
1.31
NA
0.07
1.38
NA
XXX74230

A
Cine/vid x-ray, throat/esoph
0.53
1.48
NA
0.09
2.10
NA
XXX74235
26
A
Remove esophagus obstruction
1.19
0.39
0.39
0.05
1.63
1.63
XXX74235
TC
C
Remove esophagus obstruction
0.00
0.00
0.00
0.00
0.00
0.00
XXX74235

C
Remove esophagus obstruction
0.00
0.00
0.00
0.00
0.00
0.00
XXX74240
26
A
X-ray exam, upper gi tract
0.69
0.23
0.23
0.03
0.95
0.95
XXX74240
TC
A
X-ray exam, upper gi tract
0.00
1.46
NA
0.08
1.54
NA
XXX74240

A
X-ray exam, upper gi tract
0.69
1.69
NA
0.11
2.49
NA
XXX74241
26
A
X-ray exam, upper gi tract
0.69
0.23
0.23
0.03
0.95
0.95
XXX74241
TC
A
X-ray exam, upper gi tract
0.00
1.49
NA
0.08
1.57
NA
XXX74241

A
X-ray exam, upper gi tract
0.69
1.72
NA
0.11
2.52
NA
XXX74245
26
A
X-ray exam, upper gi tract
0.91
0.30
0.30
0.04
1.25
1.25
XXX74245
TC
A
X-ray exam, upper gi tract
0.00
2.39
NA
0.13
2.52
NA
XXX74245

A
X-ray exam, upper gi tract
0.91
2.69
NA
0.17
3.77
NA
XXX( print page 70420)74246
26
A
Contrst x-ray uppr gi tract
0.69
0.23
0.23
0.03
0.95
0.95
XXX74246
TC
A
Contrst x-ray uppr gi tract
0.00
1.64
NA
0.10
1.74
NA
XXX74246

A
Contrst x-ray uppr gi tract
0.69
1.87
NA
0.13
2.69
NA
XXX74247
26
A
Contrst x-ray uppr gi tract
0.69
0.23
0.23
0.03
0.95
0.95
XXX74247
TC
A
Contrst x-ray uppr gi tract
0.00
1.68
NA
0.11
1.79
NA
XXX74247

A
Contrst x-ray uppr gi tract
0.69
1.91
NA
0.14
2.74
NA
XXX74249
26
A
Contrst x-ray uppr gi tract
0.91
0.30
0.30
0.04
1.25
1.25
XXX74249
TC
A
Contrst x-ray uppr gi tract
0.00
2.58
NA
0.14
2.72
NA
XXX74249

A
Contrst x-ray uppr gi tract
0.91
2.88
NA
0.18
3.97
NA
XXX74250
26
A
X-ray exam of small bowel
0.47
0.15
0.15
0.02
0.64
0.64
XXX74250
TC
A
X-ray exam of small bowel
0.00
1.31
NA
0.07
1.38
NA
XXX74250

A
X-ray exam of small bowel
0.47
1.46
NA
0.09
2.02
NA
XXX74251
26
A
X-ray exam of small bowel
0.69
0.23
0.23
0.03
0.95
0.95
XXX74251
TC
A
X-ray exam of small bowel
0.00
1.31
NA
0.07
1.38
NA
XXX74251

A
X-ray exam of small bowel
0.69
1.54
NA
0.10
2.33
NA
XXX74260
26
A
X-ray exam of small bowel
0.50
0.16
0.16
0.02
0.68
0.68
XXX74260
TC
A
X-ray exam of small bowel
0.00
1.49
NA
0.08
1.57
NA
XXX74260

A
X-ray exam of small bowel
0.50
1.65
NA
0.10
2.25
NA
XXX74270
26
A
Contrast x-ray exam of colon
0.69
0.23
0.23
0.03
0.95
0.95
XXX74270
TC
A
Contrast x-ray exam of colon
0.00
1.70
NA
0.11
1.81
NA
XXX74270

A
Contrast x-ray exam of colon
0.69
1.93
NA
0.14
2.76
NA
XXX74280
26
A
Contrast x-ray exam of colon
0.99
0.32
0.32
0.04
1.35
1.35
XXX74280
TC
A
Contrast x-ray exam of colon
0.00
2.24
NA
0.13
2.37
NA
XXX74280

A
Contrast x-ray exam of colon
0.99
2.56
NA
0.17
3.72
NA
XXX74283
26
A
Contrast x-ray exam of colon
2.02
0.66
0.66
0.09
2.77
2.77
XXX74283
TC
A
Contrast x-ray exam of colon
0.00
2.57
NA
0.14
2.71
NA
XXX74283

A
Contrast x-ray exam of colon
2.02
3.23
NA
0.23
5.48
NA
XXX74290
26
A
Contrast x-ray, gallbladder
0.32
0.10
0.10
0.01
0.43
0.43
XXX74290
TC
A
Contrast x-ray, gallbladder
0.00
0.73
NA
0.05
0.78
NA
XXX74290

A
Contrast x-ray, gallbladder
0.32
0.83
NA
0.06
1.21
NA
XXX74291
26
A
Contrast x-rays, gallbladder
0.20
0.07
0.07
0.01
0.28
0.28
XXX74291
TC
A
Contrast x-rays, gallbladder
0.00
0.42
NA
0.02
0.44
NA
XXX74291

A
Contrast x-rays, gallbladder
0.20
0.49
NA
0.03
0.72
NA
XXX74300
26
A
X-ray bile ducts/pancreas
0.36
0.12
0.12
0.02
0.50
0.50
XXX74300
TC
C
X-ray bile ducts/pancreas
0.00
0.00
0.00
0.00
0.00
0.00
XXX74300

C
X-ray bile ducts/pancreas
0.00
0.00
0.00
0.00
0.00
0.00
XXX74301
26
A
X-rays at surgery add-on
0.21
0.07
0.07
0.01
0.29
0.29
ZZZ74301
TC
C
X-rays at surgery add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ74301

C
X-rays at surgery add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ74305
26
A
X-ray bile ducts/pancreas
0.42
0.14
0.14
0.02
0.58
0.58
XXX74305
TC
A
X-ray bile ducts/pancreas
0.00
0.78
NA
0.05
0.83
NA
XXX74305

A
X-ray bile ducts/pancreas
0.42
0.92
NA
0.07
1.41
NA
XXX74320
26
A
Contrast x-ray of bile ducts
0.54
0.18
0.18
0.02
0.74
0.74
XXX74320
TC
A
Contrast x-ray of bile ducts
0.00
3.16
NA
0.17
3.33
NA
XXX74320

A
Contrast x-ray of bile ducts
0.54
3.34
NA
0.19
4.07
NA
XXX74327
26
A
X-ray bile stone removal
0.70
0.23
0.23
0.03
0.96
0.96
XXX74327
TC
A
X-ray bile stone removal
0.00
1.77
NA
0.11
1.88
NA
XXX74327

A
X-ray bile stone removal
0.70
2.00
NA
0.14
2.84
NA
XXX74328
26
A
X-ray bile duct endoscopy
0.70
0.23
0.23
0.03
0.96
0.96
XXX74328
TC
A
X-ray bile duct endoscopy
0.00
3.16
NA
0.17
3.33
NA
XXX74328

A
X-ray bile duct endoscopy
0.70
3.39
NA
0.20
4.29
NA
XXX74329
26
A
X-ray for pancreas endoscopy
0.70
0.23
0.23
0.03
0.96
0.96
XXX74329
TC
C
X-ray for pancreas endoscopy
0.00
0.00
0.00
0.00
0.00
0.00
XXX74329

C
X-ray for pancreas endoscopy
0.00
0.00
0.00
0.00
0.00
0.00
XXX74330
26
A
X-ray bile/panc endoscopy
0.90
0.29
0.29
0.04
1.23
1.23
XXX74330
TC
A
X-ray bile/panc endoscopy
0.00
3.16
NA
0.17
3.33
NA
XXX74330

A
X-ray bile/panc endoscopy
0.90
3.45
NA
0.21
4.56
NA
XXX74340
26
A
X-ray guide for GI tube
0.54
0.18
0.18
0.02
0.74
0.74
XXX74340
TC
A
X-ray guide for GI tube
0.00
2.63
NA
0.14
2.77
NA
XXX74340

A
X-ray guide for GI tube
0.54
2.81
NA
0.16
3.51
NA
XXX74350
26
A
X-ray guide, stomach tube
0.76
0.25
0.25
0.03
1.04
1.04
XXX74350
TC
A
X-ray guide, stomach tube
0.00
3.16
NA
0.17
3.33
NA
XXX74350

A
X-ray guide, stomach tube
0.76
3.41
NA
0.20
4.37
NA
XXX74355
26
A
X-ray guide, intestinal tube
0.76
0.25
0.25
0.03
1.04
1.04
XXX74355
TC
A
X-ray guide, intestinal tube
0.00
2.63
NA
0.14
2.77
NA
XXX74355

A
X-ray guide, intestinal tube
0.76
2.88
NA
0.17
3.81
NA
XXX74360
26
A
X-ray guide, GI dilation
0.54
0.19
0.19
0.02
0.75
0.75
XXX74360
TC
A
X-ray guide, GI dilation
0.00
3.16
NA
0.17
3.33
NA
XXX74360

A
X-ray guide, GI dilation
0.54
3.35
NA
0.19
4.08
NA
XXX74363
26
A
X-ray, bile duct dilation
0.88
0.29
0.29
0.04
1.21
1.21
XXX74363
TC
C
X-ray, bile duct dilation
0.00
0.00
0.00
0.00
0.00
0.00
XXX74363

C
X-ray, bile duct dilation
0.00
0.00
0.00
0.00
0.00
0.00
XXX74400
26
A
Contrst x-ray, urinary tract
0.49
0.16
0.16
0.02
0.67
0.67
XXX74400
TC
A
Contrst x-ray, urinary tract
0.00
1.68
NA
0.11
1.79
NA
XXX74400

A
Contrst x-ray, urinary tract
0.49
1.84
NA
0.13
2.46
NA
XXX( print page 70421)74410
26
A
Contrst x-ray, urinary tract
0.49
0.16
0.16
0.02
0.67
0.67
XXX74410
TC
A
Contrst x-ray, urinary tract
0.00
1.96
NA
0.11
2.07
NA
XXX74410

A
Contrst x-ray, urinary tract
0.49
2.12
NA
0.13
2.74
NA
XXX74415
26
A
Contrst x-ray, urinary tract
0.49
0.16
0.16
0.02
0.67
0.67
XXX74415
TC
A
Contrst x-ray, urinary tract
0.00
2.13
NA
0.12
2.25
NA
XXX74415

A
Contrst x-ray, urinary tract
0.49
2.29
NA
0.14
2.92
NA
XXX74420
26
A
Contrst x-ray, urinary tract
0.36
0.12
0.12
0.02
0.50
0.50
XXX74420
TC
A
Contrst x-ray, urinary tract
0.00
2.63
NA
0.14
2.77
NA
XXX74420

A
Contrst x-ray, urinary tract
0.36
2.75
NA
0.16
3.27
NA
XXX74425
26
A
Contrst x-ray, urinary tract
0.36
0.12
0.12
0.02
0.50
0.50
XXX74425
TC
A
Contrst x-ray, urinary tract
0.00
1.31
NA
0.07
1.38
NA
XXX74425

A
Contrst x-ray, urinary tract
0.36
1.43
NA
0.09
1.88
NA
XXX74430
26
A
Contrast x-ray, bladder
0.32
0.10
0.10
0.02
0.44
0.44
XXX74430
TC
A
Contrast x-ray, bladder
0.00
1.05
NA
0.06
1.11
NA
XXX74430

A
Contrast x-ray, bladder
0.32
1.15
NA
0.08
1.55
NA
XXX74440
26
A
X-ray, male genital tract
0.38
0.12
0.12
0.02
0.52
0.52
XXX74440
TC
A
X-ray, male genital tract
0.00
1.13
NA
0.06
1.19
NA
XXX74440

A
X-ray, male genital tract
0.38
1.25
NA
0.08
1.71
NA
XXX74445
26
A
X-ray exam of penis
1.14
0.37
0.37
0.07
1.58
1.58
XXX74445
TC
A
X-ray exam of penis
0.00
1.13
NA
0.06
1.19
NA
XXX74445

A
X-ray exam of penis
1.14
1.50
NA
0.13
2.77
NA
XXX74450
26
A
X-ray, urethra/bladder
0.33
0.11
0.11
0.02
0.46
0.46
XXX74450
TC
A
X-ray, urethra/bladder
0.00
1.46
NA
0.08
1.54
NA
XXX74450

A
X-ray, urethra/bladder
0.33
1.57
NA
0.10
2.00
NA
XXX74455
26
A
X-ray, urethra/bladder
0.33
0.11
0.11
0.02
0.46
0.46
XXX74455
TC
A
X-ray, urethra/bladder
0.00
1.58
NA
0.10
1.68
NA
XXX74455

A
X-ray, urethra/bladder
0.33
1.69
NA
0.12
2.14
NA
XXX74470
26
A
X-ray exam of kidney lesion
0.54
0.18
0.18
0.02
0.74
0.74
XXX74470
TC
A
X-ray exam of kidney lesion
0.00
1.25
NA
0.07
1.32
NA
XXX74470

A
X-ray exam of kidney lesion
0.54
1.43
NA
0.09
2.06
NA
XXX74475
26
A
X-ray control, cath insert
0.54
0.18
0.18
0.02
0.74
0.74
XXX74475
TC
A
X-ray control, cath insert
0.00
4.08
NA
0.22
4.30
NA
XXX74475

A
X-ray control, cath insert
0.54
4.26
NA
0.24
5.04
NA
XXX74480
26
A
X-ray control, cath insert
0.54
0.18
0.18
0.02
0.74
0.74
XXX74480
TC
A
X-ray control, cath insert
0.00
4.08
NA
0.22
4.30
NA
XXX74480

A
X-ray control, cath insert
0.54
4.26
NA
0.24
5.04
NA
XXX74485
26
A
X-ray guide, GU dilation
0.54
0.17
0.17
0.03
0.74
0.74
XXX74485
TC
A
X-ray guide, GU dilation
0.00
3.16
NA
0.17
3.33
NA
XXX74485

A
X-ray guide, GU dilation
0.54
3.33
NA
0.20
4.07
NA
XXX74710
26
A
X-ray measurement of pelvis
0.34
0.11
0.11
0.02
0.47
0.47
XXX74710
TC
A
X-ray measurement of pelvis
0.00
1.05
NA
0.06
1.11
NA
XXX74710

A
X-ray measurement of pelvis
0.34
1.16
NA
0.08
1.58
NA
XXX74740
26
A
X-ray, female genital tract
0.38
0.13
0.13
0.02
0.53
0.53
XXX74740
TC
A
X-ray, female genital tract
0.00
1.31
NA
0.07
1.38
NA
XXX74740

A
X-ray, female genital tract
0.38
1.44
NA
0.09
1.91
NA
XXX74742
26
A
X-ray, fallopian tube
0.61
0.20
0.20
0.03
0.84
0.84
XXX74742
TC
C
X-ray, fallopian tube
0.00
0.00
0.00
0.00
0.00
0.00
XXX74742

C
X-ray, fallopian tube
0.00
0.00
0.00
0.00
0.00
0.00
XXX74775
26
A
X-ray exam of perineum
0.62
0.21
0.21
0.03
0.86
0.86
XXX74775
TC
A
X-ray exam of perineum
0.00
1.46
NA
0.08
1.54
NA
XXX74775

A
X-ray exam of perineum
0.62
1.67
NA
0.11
2.40
NA
XXX75552
26
A
Heart mri for morph w/o dye
1.60
0.53
0.53
0.07
2.20
2.20
XXX75552
TC
A
Heart mri for morph w/o dye
0.00
11.23
NA
0.59
11.82
NA
XXX75552

A
Heart mri for morph w/o dye
1.60
11.76
NA
0.66
14.02
NA
XXX75553
26
A
Heart mri for morph w/dye
2.00
0.65
0.65
0.07
2.72
2.72
XXX75553
TC
A
Heart mri for morph w/dye
0.00
11.23
NA
0.59
11.82
NA
XXX75553

A
Heart mri for morph w/dye
2.00
11.88
NA
0.66
14.54
NA
XXX75554
26
A
Cardiac MRI/function
1.83
0.64
0.64
0.07
2.54
2.54
XXX75554
TC
A
Cardiac MRI/function
0.00
11.23
NA
0.59
11.82
NA
XXX75554

A
Cardiac MRI/function
1.83
11.87
NA
0.66
14.36
NA
XXX75555
26
A
Cardiac MRI/limited study
1.74
0.64
0.64
0.07
2.45
2.45
XXX75555
TC
A
Cardiac MRI/limited study
0.00
11.23
NA
0.59
11.82
NA
XXX75555

A
Cardiac MRI/limited study
1.74
11.87
NA
0.66
14.27
NA
XXX75556

N
Cardiac MRI/flow mapping
0.00
0.00
0.00
0.00
0.00
0.00
XXX75600
26
A
Contrast x-ray exam of aorta
0.49
0.19
0.19
0.02
0.70
0.70
XXX75600
TC
A
Contrast x-ray exam of aorta
0.00
12.64
NA
0.65
13.29
NA
XXX75600

A
Contrast x-ray exam of aorta
0.49
12.83
NA
0.67
13.99
NA
XXX75605
26
A
Contrast x-ray exam of aorta
1.14
0.40
0.40
0.05
1.59
1.59
XXX75605
TC
A
Contrast x-ray exam of aorta
0.00
12.64
NA
0.65
13.29
NA
XXX75605

A
Contrast x-ray exam of aorta
1.14
13.04
NA
0.70
14.88
NA
XXX75625
26
A
Contrast x-ray exam of aorta
1.14
0.38
0.38
0.06
1.58
1.58
XXX75625
TC
A
Contrast x-ray exam of aorta
0.00
12.64
NA
0.65
13.29
NA
XXX75625

A
Contrast x-ray exam of aorta
1.14
13.02
NA
0.71
14.87
NA
XXX75630
26
A
X-ray aorta, leg arteries
1.79
0.61
0.61
0.11
2.51
2.51
XXX75630
TC
A
X-ray aorta, leg arteries
0.00
13.17
NA
0.69
13.86
NA
XXX( print page 70422)75630

A
X-ray aorta, leg arteries
1.79
13.78
NA
0.80
16.37
NA
XXX75635
26
A
Ct angio abdominal arteries
2.40
0.79
0.79
0.11
3.30
3.30
XXX75635
TC
A
Ct angio abdominal arteries
0.00
15.96
NA
0.39
16.35
NA
XXX75635

A
Ct angio abdominal arteries
2.40
16.75
NA
0.50
19.65
NA
XXX75650
26
A
Artery x-rays, head & neck
1.49
0.49
0.49
0.07
2.05
2.05
XXX75650
TC
A
Artery x-rays, head & neck
0.00
12.64
NA
0.65
13.29
NA
XXX75650

A
Artery x-rays, head & neck
1.49
13.13
NA
0.72
15.34
NA
XXX75658
26
A
Artery x-rays, arm
1.31
0.47
0.47
0.07
1.85
1.85
XXX75658
TC
A
Artery x-rays, arm
0.00
12.64
NA
0.65
13.29
NA
XXX75658

A
Artery x-rays, arm
1.31
13.11
NA
0.72
15.14
NA
XXX75660
26
A
Artery x-rays, head & neck
1.31
0.44
0.44
0.06
1.81
1.81
XXX75660
TC
A
Artery x-rays, head & neck
0.00
12.64
NA
0.65
13.29
NA
XXX75660

A
Artery x-rays, head & neck
1.31
13.08
NA
0.71
15.10
NA
XXX75662
26
A
Artery x-rays, head & neck
1.66
0.59
0.59
0.06
2.31
2.31
XXX75662
TC
A
Artery x-rays, head & neck
0.00
12.64
NA
0.65
13.29
NA
XXX75662

A
Artery x-rays, head & neck
1.66
13.23
NA
0.71
15.60
NA
XXX75665
26
A
Artery x-rays, head & neck
1.31
0.44
0.44
0.09
1.84
1.84
XXX75665
TC
A
Artery x-rays, head & neck
0.00
12.64
NA
0.65
13.29
NA
XXX75665

A
Artery x-rays, head & neck
1.31
13.08
NA
0.74
15.13
NA
XXX75671
26
A
Artery x-rays, head & neck
1.66
0.55
0.55
0.07
2.28
2.28
XXX75671
TC
A
Artery x-rays, head & neck
0.00
12.64
NA
0.65
13.29
NA
XXX75671

A
Artery x-rays, head & neck
1.66
13.19
NA
0.72
15.57
NA
XXX75676
26
A
Artery x-rays, neck
1.31
0.44
0.44
0.07
1.82
1.82
XXX75676
TC
A
Artery x-rays, neck
0.00
12.64
NA
0.65
13.29
NA
XXX75676

A
Artery x-rays, neck
1.31
13.08
NA
0.72
15.11
NA
XXX75680
26
A
Artery x-rays, neck
1.66
0.55
0.55
0.07
2.28
2.28
XXX75680
TC
A
Artery x-rays, neck
0.00
12.64
NA
0.65
13.29
NA
XXX75680

A
Artery x-rays, neck
1.66
13.19
NA
0.72
15.57
NA
XXX75685
26
A
Artery x-rays, spine
1.31
0.43
0.43
0.06
1.80
1.80
XXX75685
TC
A
Artery x-rays, spine
0.00
12.64
NA
0.65
13.29
NA
XXX75685

A
Artery x-rays, spine
1.31
13.07
NA
0.71
15.09
NA
XXX75705
26
A
Artery x-rays, spine
2.18
0.73
0.73
0.13
3.04
3.04
XXX75705
TC
A
Artery x-rays, spine
0.00
12.64
NA
0.65
13.29
NA
XXX75705

A
Artery x-rays, spine
2.18
13.37
NA
0.78
16.33
NA
XXX75710
26
A
Artery x-rays, arm/leg
1.14
0.39
0.39
0.07
1.60
1.60
XXX75710
TC
A
Artery x-rays, arm/leg
0.00
12.64
NA
0.65
13.29
NA
XXX75710

A
Artery x-rays, arm/leg
1.14
13.03
NA
0.72
14.89
NA
XXX75716
26
A
Artery x-rays, arms/legs
1.31
0.43
0.43
0.07
1.81
1.81
XXX75716
TC
A
Artery x-rays, arms/legs
0.00
12.64
NA
0.65
13.29
NA
XXX75716

A
Artery x-rays, arms/legs
1.31
13.07
NA
0.72
15.10
NA
XXX75722
26
A
Artery x-rays, kidney
1.14
0.40
0.40
0.05
1.59
1.59
XXX75722
TC
A
Artery x-rays, kidney
0.00
12.64
NA
0.65
13.29
NA
XXX75722

A
Artery x-rays, kidney
1.14
13.04
NA
0.70
14.88
NA
XXX75724
26
A
Artery x-rays, kidneys
1.49
0.56
0.56
0.05
2.10
2.10
XXX75724
TC
A
Artery x-rays, kidneys
0.00
12.64
NA
0.65
13.29
NA
XXX75724

A
Artery x-rays, kidneys
1.49
13.20
NA
0.70
15.39
NA
XXX75726
26
A
Artery x-rays, abdomen
1.14
0.37
0.37
0.05
1.56
1.56
XXX75726
TC
A
Artery x-rays, abdomen
0.00
12.64
NA
0.65
13.29
NA
XXX75726

A
Artery x-rays, abdomen
1.14
13.01
NA
0.70
14.85
NA
XXX75731
26
A
Artery x-rays, adrenal gland
1.14
0.37
0.37
0.06
1.57
1.57
XXX75731
TC
A
Artery x-rays, adrenal gland
0.00
12.64
NA
0.65
13.29
NA
XXX75731

A
Artery x-rays, adrenal gland
1.14
13.01
NA
0.71
14.86
NA
XXX75733
26
A
Artery x-rays, adrenals
1.31
0.44
0.44
0.06
1.81
1.81
XXX75733
TC
A
Artery x-rays, adrenals
0.00
12.64
NA
0.65
13.29
NA
XXX75733

A
Artery x-rays, adrenals
1.31
13.08
NA
0.71
15.10
NA
XXX75736
26
A
Artery x-rays, pelvis
1.14
0.38
0.38
0.06
1.58
1.58
XXX75736
TC
A
Artery x-rays, pelvis
0.00
12.64
NA
0.65
13.29
NA
XXX75736

A
Artery x-rays, pelvis
1.14
13.02
NA
0.71
14.87
NA
XXX75741
26
A
Artery x-rays, lung
1.31
0.43
0.43
0.06
1.80
1.80
XXX75741
TC
A
Artery x-rays, lung
0.00
12.64
NA
0.65
13.29
NA
XXX75741

A
Artery x-rays, lung
1.31
13.07
NA
0.71
15.09
NA
XXX75743
26
A
Artery x-rays, lungs
1.66
0.54
0.54
0.07
2.27
2.27
XXX75743
TC
A
Artery x-rays, lungs
0.00
12.64
NA
0.65
13.29
NA
XXX75743

A
Artery x-rays, lungs
1.66
13.18
NA
0.72
15.56
NA
XXX75746
26
A
Artery x-rays, lung
1.14
0.38
0.38
0.05
1.57
1.57
XXX75746
TC
A
Artery x-rays, lung
0.00
12.64
NA
0.65
13.29
NA
XXX75746

A
Artery x-rays, lung
1.14
13.02
NA
0.70
14.86
NA
XXX75756
26
A
Artery x-rays, chest
1.14
0.45
0.45
0.04
1.63
1.63
XXX75756
TC
A
Artery x-rays, chest
0.00
12.64
NA
0.65
13.29
NA
XXX75756

A
Artery x-rays, chest
1.14
13.09
NA
0.69
14.92
NA
XXX75774
26
A
Artery x-ray, each vessel
0.36
0.12
0.12
0.02
0.50
0.50
ZZZ75774
TC
A
Artery x-ray, each vessel
0.00
12.64
NA
0.65
13.29
NA
ZZZ75774

A
Artery x-ray, each vessel
0.36
12.76
NA
0.67
13.79
NA
ZZZ75790
26
A
Visualize A-V shunt
1.84
0.60
0.60
0.09
2.53
2.53
XXX75790
TC
A
Visualize A-V shunt
0.00
1.35
NA
0.08
1.43
NA
XXX( print page 70423)75790

A
Visualize A-V shunt
1.84
1.95
NA
0.17
3.96
NA
XXX75801
26
A
Lymph vessel x-ray, arm/leg
0.81
0.27
0.27
0.08
1.16
1.16
XXX75801
TC
A
Lymph vessel x-ray, arm/leg
0.00
5.43
NA
0.29
5.72
NA
XXX75801

A
Lymph vessel x-ray, arm/leg
0.81
5.70
NA
0.37
6.88
NA
XXX75803
26
A
Lymph vessel x-ray,arms/legs
1.17
0.38
0.38
0.05
1.60
1.60
XXX75803
TC
A
Lymph vessel x-ray,arms/legs
0.00
5.43
NA
0.29
5.72
NA
XXX75803

A
Lymph vessel x-ray,arms/legs
1.17
5.81
NA
0.34
7.32
NA
XXX75805
26
A
Lymph vessel x-ray, trunk
0.81
0.27
0.27
0.05
1.13
1.13
XXX75805
TC
A
Lymph vessel x-ray, trunk
0.00
6.12
NA
0.33
6.45
NA
XXX75805

A
Lymph vessel x-ray, trunk
0.81
6.39
NA
0.38
7.58
NA
XXX75807
26
A
Lymph vessel x-ray, trunk
1.17
0.38
0.38
0.05
1.60
1.60
XXX75807
TC
C
Lymph vessel x-ray, trunk
0.00
0.00
0.00
0.00
0.00
0.00
XXX75807

C
Lymph vessel x-ray, trunk
0.00
0.00
0.00
0.00
0.00
0.00
XXX75809
26
A
Nonvascular shunt, x-ray
0.47
0.15
0.15
0.02
0.64
0.64
XXX75809
TC
A
Nonvascular shunt, x-ray
0.00
0.78
NA
0.05
0.83
NA
XXX75809

A
Nonvascular shunt, x-ray
0.47
0.93
NA
0.07
1.47
NA
XXX75810
26
A
Vein x-ray, spleen/liver
1.14
0.37
0.37
0.05
1.56
1.56
XXX75810
TC
A
Vein x-ray, spleen/liver
0.00
12.64
NA
0.65
13.29
NA
XXX75810

A
Vein x-ray, spleen/liver
1.14
13.01
NA
0.70
14.85
NA
XXX75820
26
A
Vein x-ray, arm/leg
0.70
0.23
0.23
0.03
0.96
0.96
XXX75820
TC
A
Vein x-ray, arm/leg
0.00
0.95
NA
0.06
1.01
NA
XXX75820

A
Vein x-ray, arm/leg
0.70
1.18
NA
0.09
1.97
NA
XXX75822
26
A
Vein x-ray, arms/legs
1.06
0.35
0.35
0.05
1.46
1.46
XXX75822
TC
A
Vein x-ray, arms/legs
0.00
1.48
NA
0.08
1.56
NA
XXX75822

A
Vein x-ray, arms/legs
1.06
1.83
NA
0.13
3.02
NA
XXX75825
26
A
Vein x-ray, trunk
1.14
0.37
0.37
0.07
1.58
1.58
XXX75825
TC
A
Vein x-ray, trunk
0.00
12.64
NA
0.65
13.29
NA
XXX75825

A
Vein x-ray, trunk
1.14
13.01
NA
0.72
14.87
NA
XXX75827
26
A
Vein x-ray, chest
1.14
0.37
0.37
0.05
1.56
1.56
XXX75827
TC
A
Vein x-ray, chest
0.00
12.64
NA
0.65
13.29
NA
XXX75827

A
Vein x-ray, chest
1.14
13.01
NA
0.70
14.85
NA
XXX75831
26
A
Vein x-ray, kidney
1.14
0.37
0.37
0.06
1.57
1.57
XXX75831
TC
A
Vein x-ray, kidney
0.00
12.64
NA
0.65
13.29
NA
XXX75831

A
Vein x-ray, kidney
1.14
13.01
NA
0.71
14.86
NA
XXX75833
26
A
Vein x-ray, kidneys
1.49
0.49
0.49
0.09
2.07
2.07
XXX75833
TC
A
Vein x-ray, kidneys
0.00
12.64
NA
0.65
13.29
NA
XXX75833

A
Vein x-ray, kidneys
1.49
13.13
NA
0.74
15.36
NA
XXX75840
26
A
Vein x-ray, adrenal gland
1.14
0.38
0.38
0.07
1.59
1.59
XXX75840
TC
A
Vein x-ray, adrenal gland
0.00
12.64
NA
0.65
13.29
NA
XXX75840

A
Vein x-ray, adrenal gland
1.14
13.02
NA
0.72
14.88
NA
XXX75842
26
A
Vein x-ray, adrenal glands
1.49
0.48
0.48
0.07
2.04
2.04
XXX75842
TC
A
Vein x-ray, adrenal glands
0.00
12.64
NA
0.65
13.29
NA
XXX75842

A
Vein x-ray, adrenal glands
1.49
13.12
NA
0.72
15.33
NA
XXX75860
26
A
Vein x-ray, neck
1.14
0.39
0.39
0.04
1.57
1.57
XXX75860
TC
A
Vein x-ray, neck
0.00
12.64
NA
0.65
13.29
NA
XXX75860

A
Vein x-ray, neck
1.14
13.03
NA
0.69
14.86
NA
XXX75870
26
A
Vein x-ray, skull
1.14
0.39
0.39
0.05
1.58
1.58
XXX75870
TC
A
Vein x-ray, skull
0.00
12.64
NA
0.65
13.29
NA
XXX75870

A
Vein x-ray, skull
1.14
13.03
NA
0.70
14.87
NA
XXX75872
26
A
Vein x-ray, skull
1.14
0.37
0.37
0.14
1.65
1.65
XXX75872
TC
A
Vein x-ray, skull
0.00
12.64
NA
0.65
13.29
NA
XXX75872

A
Vein x-ray, skull
1.14
13.01
NA
0.79
14.94
NA
XXX75880
26
A
Vein x-ray, eye socket
0.70
0.23
0.23
0.03
0.96
0.96
XXX75880
TC
A
Vein x-ray, eye socket
0.00
0.95
NA
0.06
1.01
NA
XXX75880

A
Vein x-ray, eye socket
0.70
1.18
NA
0.09
1.97
NA
XXX75885
26
A
Vein x-ray, liver
1.44
0.47
0.47
0.06
1.97
1.97
XXX75885
TC
A
Vein x-ray, liver
0.00
12.64
NA
0.65
13.29
NA
XXX75885

A
Vein x-ray, liver
1.44
13.11
NA
0.71
15.26
NA
XXX75887
26
A
Vein x-ray, liver
1.44
0.47
0.47
0.06
1.97
1.97
XXX75887
TC
A
Vein x-ray, liver
0.00
12.64
NA
0.65
13.29
NA
XXX75887

A
Vein x-ray, liver
1.44
13.11
NA
0.71
15.26
NA
XXX75889
26
A
Vein x-ray, liver
1.14
0.37
0.37
0.05
1.56
1.56
XXX75889
TC
A
Vein x-ray, liver
0.00
12.64
NA
0.65
13.29
NA
XXX75889

A
Vein x-ray, liver
1.14
13.01
NA
0.70
14.85
NA
XXX75891
26
A
Vein x-ray, liver
1.14
0.37
0.37
0.05
1.56
1.56
XXX75891
TC
A
Vein x-ray, liver
0.00
12.64
NA
0.65
13.29
NA
XXX75891

A
Vein x-ray, liver
1.14
13.01
NA
0.70
14.85
NA
XXX75893
26
A
Venous sampling by catheter
0.54
0.18
0.18
0.02
0.74
0.74
XXX75893
TC
A
Venous sampling by catheter
0.00
12.64
NA
0.65
13.29
NA
XXX75893

A
Venous sampling by catheter
0.54
12.82
NA
0.67
14.03
NA
XXX75894
26
A
X-rays, transcath therapy
1.31
0.43
0.43
0.08
1.82
1.82
XXX75894
TC
A
X-rays, transcath therapy
0.00
24.20
NA
1.27
25.47
NA
XXX75894

A
X-rays, transcath therapy
1.31
24.63
NA
1.35
27.29
NA
XXX75896
26
A
X-rays, transcath therapy
1.31
0.45
0.45
0.05
1.81
1.81
XXX75896
TC
A
X-rays, transcath therapy
0.00
21.05
NA
1.10
22.15
NA
XXX( print page 70424)75896

A
X-rays, transcath therapy
1.31
21.50
NA
1.15
23.96
NA
XXX75898
26
A
Follow-up angiography
1.65
0.55
0.55
0.07
2.27
2.27
XXX75898
TC
A
Follow-up angiography
0.00
1.05
NA
0.06
1.11
NA
XXX75898

A
Follow-up angiography
1.65
1.60
NA
0.13
3.38
NA
XXX75900
26
A
Intravascular cath exchange
0.49
0.16
0.16
0.03
0.68
0.68
XXX75900
TC
C
Intravascular cath exchange
0.00
0.00
0.00
0.00
0.00
0.00
XXX75900

C
Intravascular cath exchange
0.00
0.00
0.00
0.00
0.00
0.00
XXX75901
26
A
Remove cva device obstruct
0.49
0.16
0.16
0.02
0.67
0.67
XXX75901
TC
A
Remove cva device obstruct
0.00
1.31
NA
0.83
2.14
NA
XXX75901

A
Remove cva device obstruct
0.49
1.47
NA
0.85
2.81
NA
XXX75902
26
A
Remove cva lumen obstruct
0.39
0.13
0.13
0.02
0.54
0.54
XXX75902
TC
A
Remove cva lumen obstruct
0.00
1.31
NA
0.83
2.14
NA
XXX75902

A
Remove cva lumen obstruct
0.39
1.44
NA
0.85
2.68
NA
XXX75940
26
A
X-ray placement, vein filter
0.54
0.18
0.18
0.04
0.76
0.76
XXX75940
TC
A
X-ray placement, vein filter
0.00
12.64
NA
0.65
13.29
NA
XXX75940

A
X-ray placement, vein filter
0.54
12.82
NA
0.69
14.05
NA
XXX75945
26
A
Intravascular us
0.40
0.14
0.14
0.04
0.58
0.58
XXX75945
TC
A
Intravascular us
0.00
4.57
NA
0.24
4.81
NA
XXX75945

A
Intravascular us
0.40
4.71
NA
0.28
5.39
NA
XXX75946
26
A
Intravascular us add-on
0.40
0.14
0.14
0.05
0.59
0.59
ZZZ75946
TC
C
Intravascular us add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ75946

C
Intravascular us add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ75952
26
A
Endovasc repair abdom aorta
4.49
1.49
1.49
0.43
6.41
6.41
XXX75952
TC
C
Endovasc repair abdom aorta
0.00
0.00
0.00
0.00
0.00
0.00
XXX75952

C
Endovasc repair abdom aorta
0.00
0.00
0.00
0.00
0.00
0.00
XXX75953
26
A
Abdom aneurysm endovas rpr
1.36
0.45
0.45
0.13
1.94
1.94
XXX75953
TC
C
Abdom aneurysm endovas rpr
0.00
0.00
0.00
0.00
0.00
0.00
XXX75953

C
Abdom aneurysm endovas rpr
0.00
0.00
0.00
0.00
0.00
0.00
XXX75954
26
A
Iliac aneurysm endovas rpr
2.25
0.78
0.78
0.15
3.18
3.18
XXX75954
TC
C
Iliac aneurysm endovas rpr
0.00
0.00
0.00
0.00
0.00
0.00
XXX75954

C
Iliac aneurysm endovas rpr
0.00
0.00
0.00
0.00
0.00
0.00
XXX75956
26
A
Xray, endovasc thor ao repr
7.00
2.71
2.71
0.69
10.40
10.40
XXX75956
TC
C
Xray, endovasc thor ao repr
0.00
0.00
0.00
0.00
0.00
0.00
XXX75956

C
Xray, endovasc thor ao repr
0.00
0.00
0.00
0.00
0.00
0.00
XXX75957
26
A
Xray, endovasc thor ao repr
6.00
2.32
2.32
0.59
8.91
8.91
XXX75957
TC
C
Xray, endovasc thor ao repr
0.00
0.00
0.00
0.00
0.00
0.00
XXX75957

C
Xray, endovasc thor ao repr
0.00
0.00
0.00
0.00
0.00
0.00
XXX75958
26
A
Xray, place prox ext thor ao
4.00
1.55
1.55
0.39
5.94
5.94
XXX75958
TC
C
Xray, place prox ext thor ao
0.00
0.00
0.00
0.00
0.00
0.00
XXX75958

C
Xray, place prox ext thor ao
0.00
0.00
0.00
0.00
0.00
0.00
XXX75959
26
A
Xray, place dist ext thor ao
3.50
1.36
1.36
0.34
5.20
5.20
XXX75959
TC
C
Xray, place dist ext thor ao
0.00
0.00
0.00
0.00
0.00
0.00
XXX75959

C
Xray, place dist ext thor ao
0.00
0.00
0.00
0.00
0.00
0.00
XXX75960
26
A
Transcath iv stent rs&i
0.82
0.28
0.28
0.05
1.15
1.15
XXX75960
TC
A
Transcath iv stent rs&i
0.00
14.94
NA
0.77
15.71
NA
XXX75960

A
Transcath iv stent rs&i
0.82
15.22
NA
0.82
16.86
NA
XXX75961
26
A
Retrieval, broken catheter
4.24
1.39
1.39
0.18
5.81
5.81
XXX75961
TC
A
Retrieval, broken catheter
0.00
10.53
NA
0.55
11.08
NA
XXX75961

A
Retrieval, broken catheter
4.24
11.92
NA
0.73
16.89
NA
XXX75962
26
A
Repair arterial blockage
0.54
0.18
0.18
0.03
0.75
0.75
XXX75962
TC
A
Repair arterial blockage
0.00
15.79
NA
0.83
16.62
NA
XXX75962

A
Repair arterial blockage
0.54
15.97
NA
0.86
17.37
NA
XXX75964
26
A
Repair artery blockage, each
0.36
0.12
0.12
0.03
0.51
0.51
ZZZ75964
TC
A
Repair artery blockage, each
0.00
8.41
NA
0.43
8.84
NA
ZZZ75964

A
Repair artery blockage, each
0.36
8.53
NA
0.46
9.35
NA
ZZZ75966
26
A
Repair arterial blockage
1.31
0.46
0.46
0.06
1.83
1.83
XXX75966
TC
A
Repair arterial blockage
0.00
15.79
NA
0.83
16.62
NA
XXX75966

A
Repair arterial blockage
1.31
16.25
NA
0.89
18.45
NA
XXX75968
26
A
Repair artery blockage, each
0.36
0.13
0.13
0.02
0.51
0.51
ZZZ75968
TC
A
Repair artery blockage, each
0.00
8.41
NA
0.43
8.84
NA
ZZZ75968

A
Repair artery blockage, each
0.36
8.54
NA
0.45
9.35
NA
ZZZ75970
26
A
Vascular biopsy
0.83
0.28
0.28
0.04
1.15
1.15
XXX75970
TC
A
Vascular biopsy
0.00
11.57
NA
0.60
12.17
NA
XXX75970

A
Vascular biopsy
0.83
11.85
NA
0.64
13.32
NA
XXX75978
26
A
Repair venous blockage
0.54
0.18
0.18
0.02
0.74
0.74
XXX75978
TC
A
Repair venous blockage
0.00
15.79
NA
0.83
16.62
NA
XXX75978

A
Repair venous blockage
0.54
15.97
NA
0.85
17.36
NA
XXX75980
26
A
Contrast xray exam bile duct
1.44
0.47
0.47
0.06
1.97
1.97
XXX75980
TC
A
Contrast xray exam bile duct
0.00
5.43
NA
0.29
5.72
NA
XXX75980

A
Contrast xray exam bile duct
1.44
5.90
NA
0.35
7.69
NA
XXX75982
26
A
Contrast xray exam bile duct
1.44
0.47
0.47
0.06
1.97
1.97
XXX75982
TC
C
Contrast xray exam bile duct
0.00
0.00
0.00
0.00
0.00
0.00
XXX75982

C
Contrast xray exam bile duct
0.00
0.00
0.00
0.00
0.00
0.00
XXX75984
26
A
Xray control catheter change
0.72
0.23
0.23
0.03
0.98
0.98
XXX75984
TC
A
Xray control catheter change
0.00
1.96
NA
0.11
2.07
NA
XXX( print page 70425)75984

A
Xray control catheter change
0.72
2.19
NA
0.14
3.05
NA
XXX75989
26
A
Abscess drainage under x-ray
1.19
0.39
0.39
0.05
1.63
1.63
XXX75989
TC
A
Abscess drainage under x-ray
0.00
3.16
NA
0.17
3.33
NA
XXX75989

A
Abscess drainage under x-ray
1.19
3.55
NA
0.22
4.96
NA
XXX75992
26
A
Atherectomy, x-ray exam
0.54
0.19
0.19
0.03
0.76
0.76
XXX75992
TC
A
Atherectomy, x-ray exam
0.00
15.79
NA
0.83
16.62
NA
XXX75992

A
Atherectomy, x-ray exam
0.54
15.98
NA
0.86
17.38
NA
XXX75993
26
A
Atherectomy, x-ray exam
0.36
0.13
0.13
0.02
0.51
0.51
ZZZ75993
TC
C
Atherectomy, x-ray exam
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ75993

C
Atherectomy, x-ray exam
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ75994
26
A
Atherectomy, x-ray exam
1.31
0.46
0.46
0.07
1.84
1.84
XXX75994
TC
C
Atherectomy, x-ray exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX75994

C
Atherectomy, x-ray exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX75995
26
A
Atherectomy, x-ray exam
1.31
0.47
0.47
0.05
1.83
1.83
XXX75995
TC
C
Atherectomy, x-ray exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX75995

C
Atherectomy, x-ray exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX75996
26
A
Atherectomy, x-ray exam
0.36
0.12
0.12
0.02
0.50
0.50
ZZZ75996
TC
C
Atherectomy, x-ray exam
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ75996

C
Atherectomy, x-ray exam
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ75998
26
A
Fluoroguide for vein device
0.38
0.13
0.13
0.01
0.52
0.52
ZZZ75998
TC
A
Fluoroguide for vein device
0.00
1.31
NA
0.10
1.41
NA
ZZZ75998

A
Fluoroguide for vein device
0.38
1.44
NA
0.11
1.93
NA
ZZZ76000
26
A
Fluoroscope examination
0.17
0.05
0.05
0.01
0.23
0.23
XXX76000
TC
A
Fluoroscope examination
0.00
1.31
NA
0.07
1.38
NA
XXX76000

A
Fluoroscope examination
0.17
1.36
NA
0.08
1.61
NA
XXX76001
26
A
Fluoroscope exam, extensive
0.67
0.22
0.22
0.05
0.94
0.94
XXX76001
TC
A
Fluoroscope exam, extensive
0.00
2.63
NA
0.14
2.77
NA
XXX76001

A
Fluoroscope exam, extensive
0.67
2.85
NA
0.19
3.71
NA
XXX76003
26
A
Needle localization by x-ray
0.54
0.17
0.17
0.02
0.73
0.73
XXX76003
TC
A
Needle localization by x-ray
0.00
1.31
NA
0.07
1.38
NA
XXX76003

A
Needle localization by x-ray
0.54
1.48
NA
0.09
2.11
NA
XXX76005
26
A
Fluoroguide for spine inject
0.60
0.15
0.15
0.03
0.78
0.78
XXX76005
TC
A
Fluoroguide for spine inject
0.00
1.31
NA
0.07
1.38
NA
XXX76005

A
Fluoroguide for spine inject
0.60
1.46
NA
0.10
2.16
NA
XXX76006

A
X-ray stress view
0.41
0.18
0.18
0.06
0.65
0.65
XXX76010
26
A
X-ray, nose to rectum
0.18
0.06
0.06
0.01
0.25
0.25
XXX76010
TC
A
X-ray, nose to rectum
0.00
0.52
NA
0.02
0.54
NA
XXX76010

A
X-ray, nose to rectum
0.18
0.58
NA
0.03
0.79
NA
XXX76012
26
A
Percut vertebroplasty fluor
1.31
0.47
0.47
0.10
1.88
1.88
XXX76012
TC
C
Percut vertebroplasty fluor
0.00
0.00
0.00
0.00
0.00
0.00
XXX76012

C
Percut vertebroplasty fluor
0.00
0.00
0.00
0.00
0.00
0.00
XXX76013
26
A
Percut vertebroplasty, ct
1.38
0.48
0.48
0.07
1.93
1.93
XXX76013
TC
C
Percut vertebroplasty, ct
0.00
0.00
0.00
0.00
0.00
0.00
XXX76013

C
Percut vertebroplasty, ct
0.00
0.00
0.00
0.00
0.00
0.00
XXX76020
26
A
X-rays for bone age
0.19
0.06
0.06
0.01
0.26
0.26
XXX76020
TC
A
X-rays for bone age
0.00
0.52
NA
0.02
0.54
NA
XXX76020

A
X-rays for bone age
0.19
0.58
NA
0.03
0.80
NA
XXX76040
26
A
X-rays, bone evaluation
0.27
0.09
0.09
0.01
0.37
0.37
XXX76040
TC
A
X-rays, bone evaluation
0.00
0.78
NA
0.05
0.83
NA
XXX76040

A
X-rays, bone evaluation
0.27
0.87
NA
0.06
1.20
NA
XXX76061
26
A
X-rays, bone survey
0.45
0.15
0.15
0.02
0.62
0.62
XXX76061
TC
A
X-rays, bone survey
0.00
1.00
NA
0.06
1.06
NA
XXX76061

A
X-rays, bone survey
0.45
1.15
NA
0.08
1.68
NA
XXX76062
26
A
X-rays, bone survey
0.54
0.18
0.18
0.02
0.74
0.74
XXX76062
TC
A
X-rays, bone survey
0.00
1.44
NA
0.08
1.52
NA
XXX76062

A
X-rays, bone survey
0.54
1.62
NA
0.10
2.26
NA
XXX76065
26
A
X-rays, bone evaluation
0.70
0.23
0.23
0.03
0.96
0.96
XXX76065
TC
A
X-rays, bone evaluation
0.00
0.73
NA
0.05
0.78
NA
XXX76065

A
X-rays, bone evaluation
0.70
0.96
NA
0.08
1.74
NA
XXX76066
26
A
Joint survey, single view
0.31
0.10
0.10
0.02
0.43
0.43
XXX76066
TC
A
Joint survey, single view
0.00
1.11
NA
0.06
1.17
NA
XXX76066

A
Joint survey, single view
0.31
1.21
NA
0.08
1.60
NA
XXX76070
26
A
Ct bone density, axial
0.25
0.08
0.08
0.01
0.34
0.34
XXX76070
TC
A
Ct bone density, axial
0.00
2.96
NA
0.16
3.12
NA
XXX76070

A
Ct bone density, axial
0.25
3.04
NA
0.17
3.46
NA
XXX76071
26
A
Ct bone density, peripheral
0.22
0.07
0.07
0.01
0.30
0.30
XXX76071
TC
A
Ct bone density, peripheral
0.00
2.96
NA
0.05
3.01
NA
XXX76071

A
Ct bone density, peripheral
0.22
3.03
NA
0.06
3.31
NA
XXX76075
26
A
Dxa bone density, axial
0.30
0.10
0.10
0.01
0.41
0.41
XXX76075
TC
A
Dxa bone density, axial
0.00
3.10
NA
0.17
3.27
NA
XXX76075

A
Dxa bone density, axial
0.30
3.20
NA
0.18
3.68
NA
XXX76076
26
A
Dxa bone density/peripheral
0.22
0.08
0.08
0.01
0.31
0.31
XXX76076
TC
A
Dxa bone density/peripheral
0.00
0.75
NA
0.05
0.80
NA
XXX76076

A
Dxa bone density/peripheral
0.22
0.83
NA
0.06
1.11
NA
XXX76077
26
A
Dxa bone density/v-fracture
0.17
0.06
0.06
0.01
0.24
0.24
XXX( print page 70426)76077
TC
A
Dxa bone density/v-fracture
0.00
0.75
NA
0.05
0.80
NA
XXX76077

A
Dxa bone density/v-fracture
0.17
0.81
NA
0.06
1.04
NA
XXX76078
26
A
Radiographic absorptiometry
0.20
0.07
0.07
0.01
0.28
0.28
XXX76078
TC
A
Radiographic absorptiometry
0.00
0.75
NA
0.05
0.80
NA
XXX76078

A
Radiographic absorptiometry
0.20
0.82
NA
0.06
1.08
NA
XXX76080
26
A
X-ray exam of fistula
0.54
0.18
0.18
0.02
0.74
0.74
XXX76080
TC
A
X-ray exam of fistula
0.00
1.05
NA
0.06
1.11
NA
XXX76080

A
X-ray exam of fistula
0.54
1.23
NA
0.08
1.85
NA
XXX76082
26
A
Computer mammogram add-on
0.06
0.02
0.02
0.01
0.09
0.09
ZZZ76082
TC
A
Computer mammogram add-on
0.00
0.42
NA
0.01
0.43
NA
ZZZ76082

A
Computer mammogram add-on
0.06
0.44
NA
0.02
0.52
NA
ZZZ76083
26
A
Computer mammogram add-on
0.06
0.02
0.02
0.01
0.09
0.09
ZZZ76083
TC
A
Computer mammogram add-on
0.00
0.42
NA
0.01
0.43
NA
ZZZ76083

A
Computer mammogram add-on
0.06
0.44
NA
0.02
0.52
NA
ZZZ76086
26
A
X-ray of mammary duct
0.36
0.12
0.12
0.02
0.50
0.50
XXX76086
TC
A
X-ray of mammary duct
0.00
2.63
NA
0.14
2.77
NA
XXX76086

A
X-ray of mammary duct
0.36
2.75
NA
0.16
3.27
NA
XXX76088
26
A
X-ray of mammary ducts
0.45
0.15
0.15
0.02
0.62
0.62
XXX76088
TC
A
X-ray of mammary ducts
0.00
3.67
NA
0.19
3.86
NA
XXX76088

A
X-ray of mammary ducts
0.45
3.82
NA
0.21
4.48
NA
XXX76090
26
A
Mammogram, one breast
0.70
0.23
0.23
0.03
0.96
0.96
XXX76090
TC
A
Mammogram, one breast
0.00
1.05
NA
0.06
1.11
NA
XXX76090

A
Mammogram, one breast
0.70
1.28
NA
0.09
2.07
NA
XXX76091
26
A
Mammogram, both breasts
0.87
0.28
0.28
0.04
1.19
1.19
XXX76091
TC
A
Mammogram, both breasts
0.00
1.31
NA
0.07
1.38
NA
XXX76091

A
Mammogram, both breasts
0.87
1.59
NA
0.11
2.57
NA
XXX76092
26
A
Mammogram, screening
0.70
0.23
0.23
0.03
0.96
0.96
XXX76092
TC
A
Mammogram, screening
0.00
1.23
NA
0.07
1.30
NA
XXX76092

A
Mammogram, screening
0.70
1.46
NA
0.10
2.26
NA
XXX76093
26
A
Magnetic image, breast
1.63
0.53
0.53
0.07
2.23
2.23
XXX76093
TC
A
Magnetic image, breast
0.00
17.67
NA
0.92
18.59
NA
XXX76093

A
Magnetic image, breast
1.63
18.20
NA
0.99
20.82
NA
XXX76094
26
A
Magnetic image, both breasts
1.63
0.53
0.53
0.07
2.23
2.23
XXX76094
TC
A
Magnetic image, both breasts
0.00
23.98
NA
1.24
25.22
NA
XXX76094

A
Magnetic image, both breasts
1.63
24.51
NA
1.31
27.45
NA
XXX76095
26
A
Stereotactic breast biopsy
1.59
0.52
0.52
0.09
2.20
2.20
XXX76095
TC
A
Stereotactic breast biopsy
0.00
7.18
NA
0.37
7.55
NA
XXX76095

A
Stereotactic breast biopsy
1.59
7.70
NA
0.46
9.75
NA
XXX76096
26
A
X-ray of needle wire, breast
0.56
0.18
0.18
0.02
0.76
0.76
XXX76096
TC
A
X-ray of needle wire, breast
0.00
1.31
NA
0.07
1.38
NA
XXX76096

A
X-ray of needle wire, breast
0.56
1.49
NA
0.09
2.14
NA
XXX76098
26
A
X-ray exam, breast specimen
0.16
0.05
0.05
0.01
0.22
0.22
XXX76098
TC
A
X-ray exam, breast specimen
0.00
0.42
NA
0.02
0.44
NA
XXX76098

A
X-ray exam, breast specimen
0.16
0.47
NA
0.03
0.66
NA
XXX76100
26
A
X-ray exam of body section
0.58
0.19
0.19
0.03
0.80
0.80
XXX76100
TC
A
X-ray exam of body section
0.00
1.25
NA
0.07
1.32
NA
XXX76100

A
X-ray exam of body section
0.58
1.44
NA
0.10
2.12
NA
XXX76101
26
A
Complex body section x-ray
0.58
0.19
0.19
0.03
0.80
0.80
XXX76101
TC
A
Complex body section x-ray
0.00
1.42
NA
0.08
1.50
NA
XXX76101

A
Complex body section x-ray
0.58
1.61
NA
0.11
2.30
NA
XXX76102
26
A
Complex body section x-rays
0.58
0.19
0.19
0.03
0.80
0.80
XXX76102
TC
A
Complex body section x-rays
0.00
1.74
NA
0.11
1.85
NA
XXX76102

A
Complex body section x-rays
0.58
1.93
NA
0.14
2.65
NA
XXX76120
26
A
Cine/video x-rays
0.38
0.13
0.13
0.02
0.53
0.53
XXX76120
TC
A
Cine/video x-rays
0.00
1.05
NA
0.06
1.11
NA
XXX76120

A
Cine/video x-rays
0.38
1.18
NA
0.08
1.64
NA
XXX76125
26
A
Cine/video x-rays add-on
0.27
0.09
0.09
0.01
0.37
0.37
ZZZ76125
TC
A
Cine/video x-rays add-on
0.00
0.78
NA
0.05
0.83
NA
ZZZ76125

A
Cine/video x-rays add-on
0.27
0.87
NA
0.06
1.20
NA
ZZZ76140

I
X-ray consultation
0.00
0.00
0.00
0.00
0.00
0.00
XXX76150

A
X-ray exam, dry process
0.00
0.42
NA
0.02
0.44
NA
XXX76350

C
Special x-ray contrast study
0.00
0.00
0.00
0.00
0.00
0.00
XXX76355
26
A
Ct scan for localization
1.21
0.40
0.40
0.05
1.66
1.66
XXX76355
TC
A
Ct scan for localization
0.00
8.28
NA
0.42
8.70
NA
XXX76355

A
Ct scan for localization
1.21
8.68
NA
0.47
10.36
NA
XXX76360
26
A
Ct scan for needle biopsy
1.16
0.38
0.38
0.05
1.59
1.59
XXX76360
TC
A
Ct scan for needle biopsy
0.00
8.28
NA
0.42
8.70
NA
XXX76360

A
Ct scan for needle biopsy
1.16
8.66
NA
0.47
10.29
NA
XXX76362
26
A
Ct guide for tissue ablation
3.99
1.30
1.30
0.18
5.47
5.47
XXX76362
TC
A
Ct guide for tissue ablation
0.00
8.28
NA
1.46
9.74
NA
XXX76362

A
Ct guide for tissue ablation
3.99
9.58
NA
1.64
15.21
NA
XXX76370
26
A
Ct scan for therapy guide
0.85
0.28
0.28
0.04
1.17
1.17
XXX76370
TC
A
Ct scan for therapy guide
0.00
2.96
NA
0.16
3.12
NA
XXX76370

A
Ct scan for therapy guide
0.85
3.24
NA
0.20
4.29
NA
XXX76376
26
A
3d render w/o postprocess
0.20
0.07
0.07
0.02
0.29
0.29
XXX( print page 70427)76376
TC
A
3d render w/o postprocess
0.00
3.43
NA
0.08
3.51
NA
XXX76376

A
3d render w/o postprocess
0.20
3.50
NA
0.10
3.80
NA
XXX76377
26
A
3d rendering w/postprocess
0.79
0.27
0.27
0.08
1.14
1.14
XXX76377
TC
A
3d rendering w/postprocess
0.00
3.43
NA
0.31
3.74
NA
XXX76377

A
3d rendering w/postprocess
0.79
3.70
NA
0.39
4.88
NA
XXX76380
26
A
CAT scan follow-up study
0.98
0.32
0.32
0.04
1.34
1.34
XXX76380
TC
A
CAT scan follow-up study
0.00
3.51
NA
0.18
3.69
NA
XXX76380

A
CAT scan follow-up study
0.98
3.83
NA
0.22
5.03
NA
XXX76390
26
N
Mr spectroscopy
+1.40
0.47
0.47
0.07
1.94
1.94
XXX76390
TC
N
Mr spectroscopy
+0.00
11.04
11.04
0.59
11.63
11.63
XXX76390

N
Mr spectroscopy
+1.40
11.51
11.51
0.66
13.57
13.57
XXX76393
26
A
Mr guidance for needle place
1.50
0.50
0.50
0.09
2.09
2.09
XXX76393
TC
A
Mr guidance for needle place
0.00
11.23
NA
0.55
11.78
NA
XXX76393

A
Mr guidance for needle place
1.50
11.73
NA
0.64
13.87
NA
XXX76394
26
A
Mri for tissue ablation
4.24
1.38
1.38
0.24
5.86
5.86
XXX76394
TC
A
Mri for tissue ablation
0.00
11.23
NA
1.57
12.80
NA
XXX76394

A
Mri for tissue ablation
4.24
12.61
NA
1.81
18.66
NA
XXX76400
26
A
Magnetic image, bone marrow
1.60
0.52
0.52
0.07
2.19
2.19
XXX76400
TC
A
Magnetic image, bone marrow
0.00
11.23
NA
0.59
11.82
NA
XXX76400

A
Magnetic image, bone marrow
1.60
11.75
NA
0.66
14.01
NA
XXX76496
26
C
Fluoroscopic procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76496
TC
C
Fluoroscopic procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76496

C
Fluoroscopic procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76497
26
C
Ct procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76497
TC
C
Ct procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76497

C
Ct procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76498
26
C
Mri procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76498
TC
C
Mri procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76498

C
Mri procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76499
26
C
Radiographic procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76499
TC
C
Radiographic procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76499

C
Radiographic procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76506
26
A
Echo exam of head
0.63
0.24
0.24
0.06
0.93
0.93
XXX76506
TC
A
Echo exam of head
0.00
1.42
NA
0.08
1.50
NA
XXX76506

A
Echo exam of head
0.63
1.66
NA
0.14
2.43
NA
XXX76510
26
A
Ophth us, b & quant a
1.55
0.68
0.68
0.03
2.26
2.26
XXX76510
TC
A
Ophth us, b & quant a
0.00
2.19
NA
0.07
2.26
NA
XXX76510

A
Ophth us, b & quant a
1.55
2.87
NA
0.10
4.52
NA
XXX76511
26
A
Ophth us, quant a only
0.94
0.40
0.40
0.03
1.37
1.37
XXX76511
TC
A
Ophth us, quant a only
0.00
2.04
NA
0.07
2.11
NA
XXX76511

A
Ophth us, quant a only
0.94
2.44
NA
0.10
3.48
NA
XXX76512
26
A
Ophth us, b w/non-quant a
0.94
0.42
0.42
0.02
1.38
1.38
XXX76512
TC
A
Ophth us, b w/non-quant a
0.00
1.82
NA
0.10
1.92
NA
XXX76512

A
Ophth us, b w/non-quant a
0.94
2.24
NA
0.12
3.30
NA
XXX76513
26
A
Echo exam of eye, water bath
0.66
0.29
0.29
0.02
0.97
0.97
XXX76513
TC
A
Echo exam of eye, water bath
0.00
1.52
NA
0.10
1.62
NA
XXX76513

A
Echo exam of eye, water bath
0.66
1.81
NA
0.12
2.59
NA
XXX76514
26
A
Echo exam of eye, thickness
0.17
0.08
0.08
0.01
0.26
0.26
XXX76514
TC
A
Echo exam of eye, thickness
0.00
0.05
NA
0.01
0.06
NA
XXX76514

A
Echo exam of eye, thickness
0.17
0.13
NA
0.02
0.32
NA
XXX76516
26
A
Echo exam of eye
0.54
0.24
0.24
0.01
0.79
0.79
XXX76516
TC
A
Echo exam of eye
0.00
1.22
NA
0.07
1.29
NA
XXX76516

A
Echo exam of eye
0.54
1.46
NA
0.08
2.08
NA
XXX76519
26
A
Echo exam of eye
0.54
0.24
0.24
0.01
0.79
0.79
XXX76519
TC
A
Echo exam of eye
0.00
1.31
NA
0.07
1.38
NA
XXX76519

A
Echo exam of eye
0.54
1.55
NA
0.08
2.17
NA
XXX76529
26
A
Echo exam of eye
0.57
0.24
0.24
0.02
0.83
0.83
XXX76529
TC
A
Echo exam of eye
0.00
1.13
NA
0.08
1.21
NA
XXX76529

A
Echo exam of eye
0.57
1.37
NA
0.10
2.04
NA
XXX76536
26
A
Us exam of head and neck
0.56
0.18
0.18
0.02
0.76
0.76
XXX76536
TC
A
Us exam of head and neck
0.00
1.42
NA
0.08
1.50
NA
XXX76536

A
Us exam of head and neck
0.56
1.60
NA
0.10
2.26
NA
XXX76604
26
A
Us exam, chest, b-scan
0.55
0.18
0.18
0.02
0.75
0.75
XXX76604
TC
A
Us exam, chest, b-scan
0.00
1.31
NA
0.07
1.38
NA
XXX76604

A
Us exam, chest, b-scan
0.55
1.49
NA
0.09
2.13
NA
XXX76645
26
A
Us exam, breast(s)
0.54
0.18
0.18
0.02
0.74
0.74
XXX76645
TC
A
Us exam, breast(s)
0.00
1.05
NA
0.06
1.11
NA
XXX76645

A
Us exam, breast(s)
0.54
1.23
NA
0.08
1.85
NA
XXX76700
26
A
Us exam, abdom, complete
0.81
0.27
0.27
0.04
1.12
1.12
XXX76700
TC
A
Us exam, abdom, complete
0.00
1.98
NA
0.11
2.09
NA
XXX76700

A
Us exam, abdom, complete
0.81
2.25
NA
0.15
3.21
NA
XXX76705
26
A
Echo exam of abdomen
0.59
0.19
0.19
0.03
0.81
0.81
XXX76705
TC
A
Echo exam of abdomen
0.00
1.42
NA
0.08
1.50
NA
XXX76705

A
Echo exam of abdomen
0.59
1.61
NA
0.11
2.31
NA
XXX76770
26
A
Us exam abdo back wall, comp
0.74
0.24
0.24
0.03
1.01
1.01
XXX( print page 70428)76770
TC
A
Us exam abdo back wall, comp
0.00
1.98
NA
0.11
2.09
NA
XXX76770

A
Us exam abdo back wall, comp
0.74
2.22
NA
0.14
3.10
NA
XXX76775
26
A
Us exam abdo back wall, lim
0.58
0.19
0.19
0.03
0.80
0.80
XXX76775
TC
A
Us exam abdo back wall, lim
0.00
1.42
NA
0.08
1.50
NA
XXX76775

A
Us exam abdo back wall, lim
0.58
1.61
NA
0.11
2.30
NA
XXX76778
26
A
Us exam kidney transplant
0.74
0.24
0.24
0.03
1.01
1.01
XXX76778
TC
A
Us exam kidney transplant
0.00
1.98
NA
0.11
2.09
NA
XXX76778

A
Us exam kidney transplant
0.74
2.22
NA
0.14
3.10
NA
XXX76800
26
A
Us exam, spinal canal
1.13
0.34
0.34
0.05
1.52
1.52
XXX76800
TC
A
Us exam, spinal canal
0.00
1.42
NA
0.08
1.50
NA
XXX76800

A
Us exam, spinal canal
1.13
1.76
NA
0.13
3.02
NA
XXX76801
26
A
Ob us < 14 wks, single fetus
0.99
0.34
0.34
0.04
1.37
1.37
XXX76801
TC
A
Ob us < 14 wks, single fetus
0.00
2.11
NA
0.12
2.23
NA
XXX76801

A
Ob us < 14 wks, single fetus
0.99
2.45
NA
0.16
3.60
NA
XXX76802
26
A
Ob us < 14 wks, add'l fetus
0.83
0.29
0.29
0.04
1.16
1.16
ZZZ76802
TC
A
Ob us < 14 wks, add'l fetus
0.00
1.05
NA
0.12
1.17
NA
ZZZ76802

A
Ob us < 14 wks, add'l fetus
0.83
1.34
NA
0.16
2.33
NA
ZZZ76805
26
A
Ob us >/= 14 wks, sngl fetus
0.99
0.34
0.34
0.04
1.37
1.37
XXX76805
TC
A
Ob us >/= 14 wks, sngl fetus
0.00
2.11
NA
0.12
2.23
NA
XXX76805

A
Ob us >/= 14 wks, sngl fetus
0.99
2.45
NA
0.16
3.60
NA
XXX76810
26
A
Ob us >/= 14 wks, addl fetus
0.98
0.34
0.34
0.04
1.36
1.36
ZZZ76810
TC
A
Ob us >/= 14 wks, addl fetus
0.00
1.05
NA
0.22
1.27
NA
ZZZ76810

A
Ob us >/= 14 wks, addl fetus
0.98
1.39
NA
0.26
2.63
NA
ZZZ76811
26
A
Ob us, detailed, sngl fetus
1.90
0.71
0.71
0.09
2.70
2.70
XXX76811
TC
A
Ob us, detailed, sngl fetus
0.00
3.54
NA
0.43
3.97
NA
XXX76811

A
Ob us, detailed, sngl fetus
1.90
4.25
NA
0.52
6.67
NA
XXX76812
26
A
Ob us, detailed, addl fetus
1.78
0.66
0.66
0.08
2.52
2.52
ZZZ76812
TC
A
Ob us, detailed, addl fetus
0.00
1.05
NA
0.41
1.46
NA
ZZZ76812

A
Ob us, detailed, addl fetus
1.78
1.71
NA
0.49
3.98
NA
ZZZ76815
26
A
Ob us, limited, fetus(s)
0.65
0.23
0.23
0.03
0.91
0.91
XXX76815
TC
A
Ob us, limited, fetus(s)
0.00
1.42
NA
0.08
1.50
NA
XXX76815

A
Ob us, limited, fetus(s)
0.65
1.65
NA
0.11
2.41
NA
XXX76816
26
A
Ob us, follow-up, per fetus
0.85
0.32
0.32
0.04
1.21
1.21
XXX76816
TC
A
Ob us, follow-up, per fetus
0.00
1.11
NA
0.06
1.17
NA
XXX76816

A
Ob us, follow-up, per fetus
0.85
1.43
NA
0.10
2.38
NA
XXX76817
26
A
Transvaginal us, obstetric
0.75
0.26
0.26
0.03
1.04
1.04
XXX76817
TC
A
Transvaginal us, obstetric
0.00
1.52
NA
0.06
1.58
NA
XXX76817

A
Transvaginal us, obstetric
0.75
1.78
NA
0.09
2.62
NA
XXX76818
26
A
Fetal biophys profile w/nst
1.05
0.39
0.39
0.05
1.49
1.49
XXX76818
TC
A
Fetal biophys profile w/nst
0.00
1.61
NA
0.10
1.71
NA
XXX76818

A
Fetal biophys profile w/nst
1.05
2.00
NA
0.15
3.20
NA
XXX76819
26
A
Fetal biophys profil w/o nst
0.77
0.28
0.28
0.03
1.08
1.08
XXX76819
TC
A
Fetal biophys profil w/o nst
0.00
1.61
NA
0.10
1.71
NA
XXX76819

A
Fetal biophys profil w/o nst
0.77
1.89
NA
0.13
2.79
NA
XXX76820
26
A
Umbilical artery echo
0.50
0.19
0.19
0.03
0.72
0.72
XXX76820
TC
A
Umbilical artery echo
0.00
1.61
NA
0.12
1.73
NA
XXX76820

A
Umbilical artery echo
0.50
1.80
NA
0.15
2.45
NA
XXX76821
26
A
Middle cerebral artery echo
0.70
0.27
0.27
0.03
1.00
1.00
XXX76821
TC
A
Middle cerebral artery echo
0.00
1.61
NA
0.12
1.73
NA
XXX76821

A
Middle cerebral artery echo
0.70
1.88
NA
0.15
2.73
NA
XXX76825
26
A
Echo exam of fetal heart
1.67
0.60
0.60
0.07
2.34
2.34
XXX76825
TC
A
Echo exam of fetal heart
0.00
1.98
NA
0.11
2.09
NA
XXX76825

A
Echo exam of fetal heart
1.67
2.58
NA
0.18
4.43
NA
XXX76826
26
A
Echo exam of fetal heart
0.83
0.29
0.29
0.03
1.15
1.15
XXX76826
TC
A
Echo exam of fetal heart
0.00
0.71
NA
0.05
0.76
NA
XXX76826

A
Echo exam of fetal heart
0.83
1.00
NA
0.08
1.91
NA
XXX76827
26
A
Echo exam of fetal heart
0.58
0.21
0.21
0.02
0.81
0.81
XXX76827
TC
A
Echo exam of fetal heart
0.00
1.72
NA
0.12
1.84
NA
XXX76827

A
Echo exam of fetal heart
0.58
1.93
NA
0.14
2.65
NA
XXX76828
26
A
Echo exam of fetal heart
0.56
0.22
0.22
0.03
0.81
0.81
XXX76828
TC
A
Echo exam of fetal heart
0.00
1.11
NA
0.08
1.19
NA
XXX76828

A
Echo exam of fetal heart
0.56
1.33
NA
0.11
2.00
NA
XXX76830
26
A
Transvaginal us, non-ob
0.69
0.23
0.23
0.03
0.95
0.95
XXX76830
TC
A
Transvaginal us, non-ob
0.00
1.52
NA
0.10
1.62
NA
XXX76830

A
Transvaginal us, non-ob
0.69
1.75
NA
0.13
2.57
NA
XXX76831
26
A
Echo exam, uterus
0.72
0.25
0.25
0.03
1.00
1.00
XXX76831
TC
A
Echo exam, uterus
0.00
1.52
NA
0.10
1.62
NA
XXX76831

A
Echo exam, uterus
0.72
1.77
NA
0.13
2.62
NA
XXX76856
26
A
Us exam, pelvic, complete
0.69
0.23
0.23
0.03
0.95
0.95
XXX76856
TC
A
Us exam, pelvic, complete
0.00
1.52
NA
0.10
1.62
NA
XXX76856

A
Us exam, pelvic, complete
0.69
1.75
NA
0.13
2.57
NA
XXX76857
26
A
Us exam, pelvic, limited
0.38
0.12
0.12
0.02
0.52
0.52
XXX76857
TC
A
Us exam, pelvic, limited
0.00
1.71
NA
0.06
1.77
NA
XXX76857

A
Us exam, pelvic, limited
0.38
1.83
NA
0.08
2.29
NA
XXX76870
26
A
Us exam, scrotum
0.64
0.21
0.21
0.03
0.88
0.88
XXX( print page 70429)76870
TC
A
Us exam, scrotum
0.00
1.52
NA
0.10
1.62
NA
XXX76870

A
Us exam, scrotum
0.64
1.73
NA
0.13
2.50
NA
XXX76872
26
A
Us, transrectal
0.69
0.22
0.22
0.04
0.95
0.95
XXX76872
TC
A
Us, transrectal
0.00
2.03
NA
0.10
2.13
NA
XXX76872

A
Us, transrectal
0.69
2.25
NA
0.14
3.08
NA
XXX76873
26
A
Echograp trans r, pros study
1.55
0.50
0.50
0.09
2.14
2.14
XXX76873
TC
A
Echograp trans r, pros study
0.00
2.11
NA
0.16
2.27
NA
XXX76873

A
Echograp trans r, pros study
1.55
2.61
NA
0.25
4.41
NA
XXX76880
26
A
Us exam, extremity
0.59
0.19
0.19
0.03
0.81
0.81
XXX76880
TC
A
Us exam, extremity
0.00
1.42
NA
0.08
1.50
NA
XXX76880

A
Us exam, extremity
0.59
1.61
NA
0.11
2.31
NA
XXX76885
26
A
Us exam infant hips, dynamic
0.74
0.24
0.24
0.03
1.01
1.01
XXX76885
TC
A
Us exam infant hips, dynamic
0.00
1.52
NA
0.10
1.62
NA
XXX76885

A
Us exam infant hips, dynamic
0.74
1.76
NA
0.13
2.63
NA
XXX76886
26
A
Us exam infant hips, static
0.62
0.20
0.20
0.03
0.85
0.85
XXX76886
TC
A
Us exam infant hips, static
0.00
1.42
NA
0.08
1.50
NA
XXX76886

A
Us exam infant hips, static
0.62
1.62
NA
0.11
2.35
NA
XXX76930
26
A
Echo guide, cardiocentesis
0.67
0.25
0.25
0.02
0.94
0.94
XXX76930
TC
A
Echo guide, cardiocentesis
0.00
1.52
NA
0.10
1.62
NA
XXX76930

A
Echo guide, cardiocentesis
0.67
1.77
NA
0.12
2.56
NA
XXX76932
26
A
Echo guide for heart biopsy
0.67
0.25
0.25
0.02
0.94
0.94
XXX76932
TC
A
Echo guide for heart biopsy
0.00
1.52
NA
0.10
1.62
NA
XXX76932

A
Echo guide for heart biopsy
0.67
1.77
NA
0.12
2.56
NA
XXX76936
26
A
Echo guide for artery repair
1.99
0.66
0.66
0.13
2.78
2.78
XXX76936
TC
A
Echo guide for artery repair
0.00
6.31
NA
0.34
6.65
NA
XXX76936

A
Echo guide for artery repair
1.99
6.97
NA
0.47
9.43
NA
XXX76937
26
A
Us guide, vascular access
0.30
0.10
0.10
0.03
0.43
0.43
ZZZ76937
TC
A
Us guide, vascular access
0.00
0.38
NA
0.10
0.48
NA
ZZZ76937

A
Us guide, vascular access
0.30
0.48
NA
0.13
0.91
NA
ZZZ76940
26
A
Us guide, tissue ablation
2.00
0.65
0.65
0.31
2.96
2.96
XXX76940
TC
A
Us guide, tissue ablation
0.00
1.52
NA
0.29
1.81
NA
XXX76940

A
Us guide, tissue ablation
2.00
2.17
NA
0.60
4.77
NA
XXX76941
26
A
Echo guide for transfusion
1.34
0.47
0.47
0.07
1.88
1.88
XXX76941
TC
A
Echo guide for transfusion
0.00
1.53
NA
0.08
1.61
NA
XXX76941

A
Echo guide for transfusion
1.34
2.00
NA
0.15
3.49
NA
XXX76942
26
A
Echo guide for biopsy
0.67
0.22
0.22
0.03
0.92
0.92
XXX76942
TC
A
Echo guide for biopsy
0.00
2.82
NA
0.10
2.92
NA
XXX76942

A
Echo guide for biopsy
0.67
3.04
NA
0.13
3.84
NA
XXX76945
26
A
Echo guide, villus sampling
0.67
0.22
0.22
0.03
0.92
0.92
XXX76945
TC
A
Echo guide, villus sampling
0.00
1.53
NA
0.08
1.61
NA
XXX76945

A
Echo guide, villus sampling
0.67
1.75
NA
0.11
2.53
NA
XXX76946
26
A
Echo guide for amniocentesis
0.38
0.14
0.14
0.02
0.54
0.54
XXX76946
TC
A
Echo guide for amniocentesis
0.00
1.52
NA
0.10
1.62
NA
XXX76946

A
Echo guide for amniocentesis
0.38
1.66
NA
0.12
2.16
NA
XXX76948
26
A
Echo guide, ova aspiration
0.38
0.13
0.13
0.02
0.53
0.53
XXX76948
TC
A
Echo guide, ova aspiration
0.00
1.52
NA
0.10
1.62
NA
XXX76948

A
Echo guide, ova aspiration
0.38
1.65
NA
0.12
2.15
NA
XXX76950
26
A
Echo guidance radiotherapy
0.58
0.19
0.19
0.03
0.80
0.80
XXX76950
TC
A
Echo guidance radiotherapy
0.00
1.31
NA
0.07
1.38
NA
XXX76950

A
Echo guidance radiotherapy
0.58
1.50
NA
0.10
2.18
NA
XXX76965
26
A
Echo guidance radiotherapy
1.34
0.43
0.43
0.08
1.85
1.85
XXX76965
TC
A
Echo guidance radiotherapy
0.00
5.59
NA
0.29
5.88
NA
XXX76965

A
Echo guidance radiotherapy
1.34
6.02
NA
0.37
7.73
NA
XXX76970
26
A
Ultrasound exam follow-up
0.40
0.13
0.13
0.02
0.55
0.55
XXX76970
TC
A
Ultrasound exam follow-up
0.00
1.05
NA
0.06
1.11
NA
XXX76970

A
Ultrasound exam follow-up
0.40
1.18
NA
0.08
1.66
NA
XXX76975
26
A
GI endoscopic ultrasound
0.81
0.28
0.28
0.04
1.13
1.13
XXX76975
TC
A
GI endoscopic ultrasound
0.00
1.52
NA
0.10
1.62
NA
XXX76975

A
GI endoscopic ultrasound
0.81
1.80
NA
0.14
2.75
NA
XXX76977
26
A
Us bone density measure
0.05
0.02
0.02
0.01
0.08
0.08
XXX76977
TC
A
Us bone density measure
0.00
0.82
NA
0.05
0.87
NA
XXX76977

A
Us bone density measure
0.05
0.84
NA
0.06
0.95
NA
XXX76986
26
A
Ultrasound guide intraoper
1.20
0.40
0.40
0.13
1.73
1.73
XXX76986
TC
A
Ultrasound guide intraoper
0.00
2.63
NA
0.14
2.77
NA
XXX76986

A
Ultrasound guide intraoper
1.20
3.03
NA
0.27
4.50
NA
XXX76999
26
C
Echo examination procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76999
TC
C
Echo examination procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX76999

C
Echo examination procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX77261

A
Radiation therapy planning
1.39
0.51
0.51
0.07
1.97
1.97
XXX77262

A
Radiation therapy planning
2.11
0.75
0.75
0.11
2.97
2.97
XXX77263

A
Radiation therapy planning
3.14
1.11
1.11
0.16
4.41
4.41
XXX77280
26
A
Set radiation therapy field
0.70
0.22
0.22
0.04
0.96
0.96
XXX77280
TC
A
Set radiation therapy field
0.00
3.48
NA
0.18
3.66
NA
XXX77280

A
Set radiation therapy field
0.70
3.70
NA
0.22
4.62
NA
XXX77285
26
A
Set radiation therapy field
1.05
0.34
0.34
0.05
1.44
1.44
XXX( print page 70430)77285
TC
A
Set radiation therapy field
0.00
5.59
NA
0.30
5.89
NA
XXX77285

A
Set radiation therapy field
1.05
5.93
NA
0.35
7.33
NA
XXX77290
26
A
Set radiation therapy field
1.56
0.50
0.50
0.08
2.14
2.14
XXX77290
TC
A
Set radiation therapy field
0.00
6.53
NA
0.35
6.88
NA
XXX77290

A
Set radiation therapy field
1.56
7.03
NA
0.43
9.02
NA
XXX77295
26
A
Set radiation therapy field
4.56
1.46
1.46
0.23
6.25
6.25
XXX77295
TC
A
Set radiation therapy field
0.00
28.01
NA
1.48
29.49
NA
XXX77295

A
Set radiation therapy field
4.56
29.47
NA
1.71
35.74
NA
XXX77299
26
C
Radiation therapy planning
0.00
0.00
0.00
0.00
0.00
0.00
XXX77299
TC
C
Radiation therapy planning
0.00
0.00
0.00
0.00
0.00
0.00
XXX77299

C
Radiation therapy planning
0.00
0.00
0.00
0.00
0.00
0.00
XXX77300
26
A
Radiation therapy dose plan
0.62
0.20
0.20
0.03
0.85
0.85
XXX77300
TC
A
Radiation therapy dose plan
0.00
1.34
NA
0.07
1.41
NA
XXX77300

A
Radiation therapy dose plan
0.62
1.54
NA
0.10
2.26
NA
XXX77301
26
A
Radiotherapy dose plan, imrt
7.99
2.57
2.57
0.40
10.96
10.96
XXX77301
TC
A
Radiotherapy dose plan, imrt
0.00
28.01
NA
1.48
29.49
NA
XXX77301

A
Radiotherapy dose plan, imrt
7.99
30.58
NA
1.88
40.45
NA
XXX77305
26
A
Teletx isodose plan simple
0.70
0.23
0.23
0.04
0.97
0.97
XXX77305
TC
A
Teletx isodose plan simple
0.00
1.87
NA
0.11
1.98
NA
XXX77305

A
Teletx isodose plan simple
0.70
2.10
NA
0.15
2.95
NA
XXX77310
26
A
Teletx isodose plan intermed
1.05
0.34
0.34
0.05
1.44
1.44
XXX77310
TC
A
Teletx isodose plan intermed
0.00
2.34
NA
0.13
2.47
NA
XXX77310

A
Teletx isodose plan intermed
1.05
2.68
NA
0.18
3.91
NA
XXX77315
26
A
Teletx isodose plan complex
1.56
0.50
0.50
0.08
2.14
2.14
XXX77315
TC
A
Teletx isodose plan complex
0.00
2.67
NA
0.14
2.81
NA
XXX77315

A
Teletx isodose plan complex
1.56
3.17
NA
0.22
4.95
NA
XXX77321
26
A
Special teletx port plan
0.95
0.30
0.30
0.05
1.30
1.30
XXX77321
TC
A
Special teletx port plan
0.00
4.05
NA
0.21
4.26
NA
XXX77321

A
Special teletx port plan
0.95
4.35
NA
0.26
5.56
NA
XXX77326
26
A
Brachytx isodose calc simp
0.93
0.30
0.30
0.05
1.28
1.28
XXX77326
TC
A
Brachytx isodose calc simp
0.00
2.37
NA
0.13
2.50
NA
XXX77326

A
Brachytx isodose calc simp
0.93
2.67
NA
0.18
3.78
NA
XXX77327
26
A
Brachytx isodose calc interm
1.39
0.44
0.44
0.07
1.90
1.90
XXX77327
TC
A
Brachytx isodose calc interm
0.00
3.48
NA
0.18
3.66
NA
XXX77327

A
Brachytx isodose calc interm
1.39
3.92
NA
0.25
5.56
NA
XXX77328
26
A
Brachytx isodose plan compl
2.09
0.67
0.67
0.11
2.87
2.87
XXX77328
TC
A
Brachytx isodose plan compl
0.00
4.97
NA
0.25
5.22
NA
XXX77328

A
Brachytx isodose plan compl
2.09
5.64
NA
0.36
8.09
NA
XXX77331
26
A
Special radiation dosimetry
0.87
0.28
0.28
0.04
1.19
1.19
XXX77331
TC
A
Special radiation dosimetry
0.00
0.50
NA
0.02
0.52
NA
XXX77331

A
Special radiation dosimetry
0.87
0.78
NA
0.06
1.71
NA
XXX77332
26
A
Radiation treatment aid(s)
0.54
0.17
0.17
0.03
0.74
0.74
XXX77332
TC
A
Radiation treatment aid(s)
0.00
1.34
NA
0.07
1.41
NA
XXX77332

A
Radiation treatment aid(s)
0.54
1.51
NA
0.10
2.15
NA
XXX77333
26
A
Radiation treatment aid(s)
0.84
0.27
0.27
0.04
1.15
1.15
XXX77333
TC
A
Radiation treatment aid(s)
0.00
1.90
NA
0.11
2.01
NA
XXX77333

A
Radiation treatment aid(s)
0.84
2.17
NA
0.15
3.16
NA
XXX77334
26
A
Radiation treatment aid(s)
1.24
0.40
0.40
0.06
1.70
1.70
XXX77334
TC
A
Radiation treatment aid(s)
0.00
3.26
NA
0.17
3.43
NA
XXX77334

A
Radiation treatment aid(s)
1.24
3.66
NA
0.23
5.13
NA
XXX77336

A
Radiation physics consult
0.00
2.99
NA
0.16
3.15
NA
XXX77370

A
Radiation physics consult
0.00
3.50
NA
0.18
3.68
NA
XXX77399
26
C
External radiation dosimetry
0.00
0.00
0.00
0.00
0.00
0.00
XXX77399
TC
C
External radiation dosimetry
0.00
0.00
0.00
0.00
0.00
0.00
XXX77399

C
External radiation dosimetry
0.00
0.00
0.00
0.00
0.00
0.00
XXX77401

A
Radiation treatment delivery
0.00
1.78
NA
0.11
1.89
NA
XXX77402

A
Radiation treatment delivery
0.00
1.78
NA
0.11
1.89
NA
XXX77403

A
Radiation treatment delivery
0.00
1.78
NA
0.11
1.89
NA
XXX77404

A
Radiation treatment delivery
0.00
1.78
NA
0.11
1.89
NA
XXX77406

A
Radiation treatment delivery
0.00
1.78
NA
0.11
1.89
NA
XXX77407

A
Radiation treatment delivery
0.00
2.10
NA
0.12
2.22
NA
XXX77408

A
Radiation treatment delivery
0.00
2.10
NA
0.12
2.22
NA
XXX77409

A
Radiation treatment delivery
0.00
2.10
NA
0.12
2.22
NA
XXX77411

A
Radiation treatment delivery
0.00
2.10
NA
0.12
2.22
NA
XXX77412

A
Radiation treatment delivery
0.00
2.34
NA
0.13
2.47
NA
XXX77413

A
Radiation treatment delivery
0.00
2.34
NA
0.13
2.47
NA
XXX77414

A
Radiation treatment delivery
0.00
2.34
NA
0.13
2.47
NA
XXX77416

A
Radiation treatment delivery
0.00
2.34
NA
0.13
2.47
NA
XXX77417

A
Radiology port film(s)
0.00
0.59
NA
0.04
0.63
NA
XXX77418

A
Radiation tx delivery, imrt
0.00
18.07
NA
0.13
18.20
NA
XXX77421
26
A
Stereoscopic x-ray guidance
0.39
0.13
0.13
0.02
0.54
0.54
XXX77421
TC
A
Stereoscopic x-ray guidance
0.00
3.36
NA
0.10
3.46
NA
XXX77421

A
Stereoscopic x-ray guidance
0.39
3.49
NA
0.12
4.00
NA
XXX77422

A
Neutron beam tx, simple
0.00
1.71
NA
0.13
1.84
NA
XXX77423

A
Neutron beam tx, complex
0.00
2.26
NA
0.13
2.39
NA
XXX( print page 70431)77427

A
Radiation tx management, x5
3.31
1.06
1.06
0.17
4.54
4.54
XXX77431

A
Radiation therapy management
1.81
0.68
0.68
0.09
2.58
2.58
XXX77432

A
Stereotactic radiation trmt
7.92
2.91
2.91
0.41
11.24
11.24
XXX77470
26
A
Special radiation treatment
2.09
0.67
0.67
0.11
2.87
2.87
XXX77470
TC
A
Special radiation treatment
0.00
11.18
NA
0.59
11.77
NA
XXX77470

A
Special radiation treatment
2.09
11.85
NA
0.70
14.64
NA
XXX77499
26
C
Radiation therapy management
0.00
0.00
0.00
0.00
0.00
0.00
XXX77499
TC
C
Radiation therapy management
0.00
0.00
0.00
0.00
0.00
0.00
XXX77499

C
Radiation therapy management
0.00
0.00
0.00
0.00
0.00
0.00
XXX77520

C
Proton trmt, simple w/o comp
0.00
0.00
0.00
0.00
0.00
0.00
XXX77522

C
Proton trmt, simple w/comp
0.00
0.00
0.00
0.00
0.00
0.00
XXX77523

C
Proton trmt, intermediate
0.00
0.00
0.00
0.00
0.00
0.00
XXX77525

C
Proton treatment, complex
0.00
0.00
0.00
0.00
0.00
0.00
XXX77600
26
R
Hyperthermia treatment
1.56
0.50
0.50
0.08
2.14
2.14
XXX77600
TC
R
Hyperthermia treatment
0.00
3.06
NA
0.16
3.22
NA
XXX77600

R
Hyperthermia treatment
1.56
3.56
NA
0.24
5.36
NA
XXX77605
26
R
Hyperthermia treatment
2.09
0.66
0.66
0.16
2.91
2.91
XXX77605
TC
R
Hyperthermia treatment
0.00
4.07
NA
0.22
4.29
NA
XXX77605

R
Hyperthermia treatment
2.09
4.73
NA
0.38
7.20
NA
XXX77610
26
R
Hyperthermia treatment
1.56
0.51
0.51
0.08
2.15
2.15
XXX77610
TC
R
Hyperthermia treatment
0.00
3.06
NA
0.16
3.22
NA
XXX77610

R
Hyperthermia treatment
1.56
3.57
NA
0.24
5.37
NA
XXX77615
26
R
Hyperthermia treatment
2.09
0.66
0.66
0.11
2.86
2.86
XXX77615
TC
R
Hyperthermia treatment
0.00
4.07
NA
0.22
4.29
NA
XXX77615

R
Hyperthermia treatment
2.09
4.73
NA
0.33
7.15
NA
XXX77620
26
R
Hyperthermia treatment
1.56
0.52
0.52
0.20
2.28
2.28
XXX77620
TC
R
Hyperthermia treatment
0.00
3.06
NA
0.16
3.22
NA
XXX77620

R
Hyperthermia treatment
1.56
3.58
NA
0.36
5.50
NA
XXX77750
26
A
Infuse radioactive materials
4.90
1.58
1.58
0.25
6.73
6.73
09077750
TC
A
Infuse radioactive materials
0.00
1.33
NA
0.07
1.40
NA
09077750

A
Infuse radioactive materials
4.90
2.91
NA
0.32
8.13
NA
09077761
26
A
Apply intrcav radiat simple
3.80
1.09
1.09
0.19
5.08
5.08
09077761
TC
A
Apply intrcav radiat simple
0.00
2.51
NA
0.14
2.65
NA
09077761

A
Apply intrcav radiat simple
3.80
3.60
NA
0.33
7.73
NA
09077762
26
A
Apply intrcav radiat interm
5.71
1.84
1.84
0.29
7.84
7.84
09077762
TC
A
Apply intrcav radiat interm
0.00
3.62
NA
0.19
3.81
NA
09077762

A
Apply intrcav radiat interm
5.71
5.46
NA
0.48
11.65
NA
09077763
26
A
Apply intrcav radiat compl
8.56
2.75
2.75
0.43
11.74
11.74
09077763
TC
A
Apply intrcav radiat compl
0.00
4.50
NA
0.23
4.73
NA
09077763

A
Apply intrcav radiat compl
8.56
7.25
NA
0.66
16.47
NA
09077776
26
A
Apply interstit radiat simpl
4.65
0.95
0.95
0.44
6.04
6.04
09077776
TC
A
Apply interstit radiat simpl
0.00
2.19
NA
0.13
2.32
NA
09077776

A
Apply interstit radiat simpl
4.65
3.14
NA
0.57
8.36
NA
09077777
26
A
Apply interstit radiat inter
7.47
2.38
2.38
0.39
10.24
10.24
09077777
TC
A
Apply interstit radiat inter
0.00
4.24
NA
0.22
4.46
NA
09077777

A
Apply interstit radiat inter
7.47
6.62
NA
0.61
14.70
NA
09077778
26
A
Apply interstit radiat compl
11.17
3.58
3.58
0.57
15.32
15.32
09077778
TC
A
Apply interstit radiat compl
0.00
5.14
NA
0.27
5.41
NA
09077778

A
Apply interstit radiat compl
11.17
8.72
NA
0.84
20.73
NA
09077781
26
A
High intensity brachytherapy
1.66
0.53
0.53
0.08
2.27
2.27
09077781
TC
A
High intensity brachytherapy
0.00
20.36
NA
1.06
21.42
NA
09077781

A
High intensity brachytherapy
1.66
20.89
NA
1.14
23.69
NA
09077782
26
A
High intensity brachytherapy
2.49
0.80
0.80
0.13
3.42
3.42
09077782
TC
A
High intensity brachytherapy
0.00
20.36
NA
1.06
21.42
NA
09077782

A
High intensity brachytherapy
2.49
21.16
NA
1.19
24.84
NA
09077783
26
A
High intensity brachytherapy
3.72
1.19
1.19
0.19
5.10
5.10
09077783
TC
A
High intensity brachytherapy
0.00
20.36
NA
1.06
21.42
NA
09077783

A
High intensity brachytherapy
3.72
21.55
NA
1.25
26.52
NA
09077784
26
A
High intensity brachytherapy
5.60
1.80
1.80
0.29
7.69
7.69
09077784
TC
A
High intensity brachytherapy
0.00
20.36
NA
1.06
21.42
NA
09077784

A
High intensity brachytherapy
5.60
22.16
NA
1.35
29.11
NA
09077789
26
A
Apply surface radiation
1.12
0.37
0.37
0.06
1.55
1.55
00077789
TC
A
Apply surface radiation
0.00
0.45
NA
0.02
0.47
NA
00077789

A
Apply surface radiation
1.12
0.82
NA
0.08
2.02
NA
00077790
26
A
Radiation handling
1.05
0.34
0.34
0.05
1.44
1.44
XXX77790
TC
A
Radiation handling
0.00
0.50
NA
0.02
0.52
NA
XXX77790

A
Radiation handling
1.05
0.84
NA
0.07
1.96
NA
XXX77799
26
C
Radium/radioisotope therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXX77799
TC
C
Radium/radioisotope therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXX77799

C
Radium/radioisotope therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXX78000
26
A
Thyroid, single uptake
0.19
0.06
0.06
0.01
0.26
0.26
XXX78000
TC
A
Thyroid, single uptake
0.00
0.97
NA
0.06
1.03
NA
XXX78000

A
Thyroid, single uptake
0.19
1.03
NA
0.07
1.29
NA
XXX78001
26
A
Thyroid, multiple uptakes
0.26
0.09
0.09
0.01
0.36
0.36
XXX78001
TC
A
Thyroid, multiple uptakes
0.00
1.31
NA
0.07
1.38
NA
XXX( print page 70432)78001

A
Thyroid, multiple uptakes
0.26
1.40
NA
0.08
1.74
NA
XXX78003
26
A
Thyroid suppress/stimul
0.33
0.11
0.11
0.01
0.45
0.45
XXX78003
TC
A
Thyroid suppress/stimul
0.00
0.97
NA
0.06
1.03
NA
XXX78003

A
Thyroid suppress/stimul
0.33
1.08
NA
0.07
1.48
NA
XXX78006
26
A
Thyroid imaging with uptake
0.49
0.16
0.16
0.02
0.67
0.67
XXX78006
TC
A
Thyroid imaging with uptake
0.00
2.39
NA
0.13
2.52
NA
XXX78006

A
Thyroid imaging with uptake
0.49
2.55
NA
0.15
3.19
NA
XXX78007
26
A
Thyroid image, mult uptakes
0.50
0.17
0.17
0.02
0.69
0.69
XXX78007
TC
A
Thyroid image, mult uptakes
0.00
2.58
NA
0.14
2.72
NA
XXX78007

A
Thyroid image, mult uptakes
0.50
2.75
NA
0.16
3.41
NA
XXX78010
26
A
Thyroid imaging
0.39
0.13
0.13
0.02
0.54
0.54
XXX78010
TC
A
Thyroid imaging
0.00
1.83
NA
0.11
1.94
NA
XXX78010

A
Thyroid imaging
0.39
1.96
NA
0.13
2.48
NA
XXX78011
26
A
Thyroid imaging with flow
0.45
0.15
0.15
0.02
0.62
0.62
XXX78011
TC
A
Thyroid imaging with flow
0.00
2.42
NA
0.13
2.55
NA
XXX78011

A
Thyroid imaging with flow
0.45
2.57
NA
0.15
3.17
NA
XXX78015
26
A
Thyroid met imaging
0.67
0.23
0.23
0.03
0.93
0.93
XXX78015
TC
A
Thyroid met imaging
0.00
2.58
NA
0.14
2.72
NA
XXX78015

A
Thyroid met imaging
0.67
2.81
NA
0.17
3.65
NA
XXX78016
26
A
Thyroid met imaging/studies
0.82
0.28
0.28
0.03
1.13
1.13
XXX78016
TC
A
Thyroid met imaging/studies
0.00
3.49
NA
0.18
3.67
NA
XXX78016

A
Thyroid met imaging/studies
0.82
3.77
NA
0.21
4.80
NA
XXX78018
26
A
Thyroid met imaging, body
0.86
0.30
0.30
0.04
1.20
1.20
XXX78018
TC
A
Thyroid met imaging, body
0.00
5.44
NA
0.29
5.73
NA
XXX78018

A
Thyroid met imaging, body
0.86
5.74
NA
0.33
6.93
NA
XXX78020
26
A
Thyroid met uptake
0.60
0.21
0.21
0.02
0.83
0.83
ZZZ78020
TC
A
Thyroid met uptake
0.00
1.31
NA
0.14
1.45
NA
ZZZ78020

A
Thyroid met uptake
0.60
1.52
NA
0.16
2.28
NA
ZZZ78070
26
A
Parathyroid nuclear imaging
0.82
0.28
0.28
0.04
1.14
1.14
XXX78070
TC
A
Parathyroid nuclear imaging
0.00
4.28
NA
0.11
4.39
NA
XXX78070

A
Parathyroid nuclear imaging
0.82
4.56
NA
0.15
5.53
NA
XXX78075
26
A
Adrenal nuclear imaging
0.74
0.26
0.26
0.03
1.03
1.03
XXX78075
TC
A
Adrenal nuclear imaging
0.00
5.44
NA
0.29
5.73
NA
XXX78075

A
Adrenal nuclear imaging
0.74
5.70
NA
0.32
6.76
NA
XXX78099
26
C
Endocrine nuclear procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX78099
TC
C
Endocrine nuclear procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX78099

C
Endocrine nuclear procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX78102
26
A
Bone marrow imaging, ltd
0.55
0.19
0.19
0.02
0.76
0.76
XXX78102
TC
A
Bone marrow imaging, ltd
0.00
2.05
NA
0.12
2.17
NA
XXX78102

A
Bone marrow imaging, ltd
0.55
2.24
NA
0.14
2.93
NA
XXX78103
26
A
Bone marrow imaging, mult
0.75
0.26
0.26
0.03
1.04
1.04
XXX78103
TC
A
Bone marrow imaging, mult
0.00
3.18
NA
0.17
3.35
NA
XXX78103

A
Bone marrow imaging, mult
0.75
3.44
NA
0.20
4.39
NA
XXX78104
26
A
Bone marrow imaging, body
0.80
0.27
0.27
0.03
1.10
1.10
XXX78104
TC
A
Bone marrow imaging, body
0.00
4.08
NA
0.22
4.30
NA
XXX78104

A
Bone marrow imaging, body
0.80
4.35
NA
0.25
5.40
NA
XXX78110
26
A
Plasma volume, single
0.19
0.07
0.07
0.01
0.27
0.27
XXX78110
TC
A
Plasma volume, single
0.00
0.95
NA
0.06
1.01
NA
XXX78110

A
Plasma volume, single
0.19
1.02
NA
0.07
1.28
NA
XXX78111
26
A
Plasma volume, multiple
0.22
0.08
0.08
0.01
0.31
0.31
XXX78111
TC
A
Plasma volume, multiple
0.00
2.58
NA
0.14
2.72
NA
XXX78111

A
Plasma volume, multiple
0.22
2.66
NA
0.15
3.03
NA
XXX78120
26
A
Red cell mass, single
0.23
0.08
0.08
0.01
0.32
0.32
XXX78120
TC
A
Red cell mass, single
0.00
1.74
NA
0.11
1.85
NA
XXX78120

A
Red cell mass, single
0.23
1.82
NA
0.12
2.17
NA
XXX78121
26
A
Red cell mass, multiple
0.32
0.11
0.11
0.01
0.44
0.44
XXX78121
TC
A
Red cell mass, multiple
0.00
2.92
NA
0.14
3.06
NA
XXX78121

A
Red cell mass, multiple
0.32
3.03
NA
0.15
3.50
NA
XXX78122
26
A
Blood volume
0.45
0.16
0.16
0.02
0.63
0.63
XXX78122
TC
A
Blood volume
0.00
4.61
NA
0.24
4.85
NA
XXX78122

A
Blood volume
0.45
4.77
NA
0.26
5.48
NA
XXX78130
26
A
Red cell survival study
0.61
0.21
0.21
0.03
0.85
0.85
XXX78130
TC
A
Red cell survival study
0.00
2.86
NA
0.14
3.00
NA
XXX78130

A
Red cell survival study
0.61
3.07
NA
0.17
3.85
NA
XXX78135
26
A
Red cell survival kinetics
0.64
0.22
0.22
0.03
0.89
0.89
XXX78135
TC
A
Red cell survival kinetics
0.00
4.88
NA
0.25
5.13
NA
XXX78135

A
Red cell survival kinetics
0.64
5.10
NA
0.28
6.02
NA
XXX78140
26
A
Red cell sequestration
0.61
0.20
0.20
0.03
0.84
0.84
XXX78140
TC
A
Red cell sequestration
0.00
3.94
NA
0.21
4.15
NA
XXX78140

A
Red cell sequestration
0.61
4.14
NA
0.24
4.99
NA
XXX78185
26
A
Spleen imaging
0.40
0.14
0.14
0.02
0.56
0.56
XXX78185
TC
A
Spleen imaging
0.00
2.37
NA
0.13
2.50
NA
XXX78185

A
Spleen imaging
0.40
2.51
NA
0.15
3.06
NA
XXX78190
26
A
Platelet survival, kinetics
1.09
0.39
0.39
0.08
1.56
1.56
XXX78190
TC
A
Platelet survival, kinetics
0.00
5.73
NA
0.30
6.03
NA
XXX( print page 70433)78190

A
Platelet survival, kinetics
1.09
6.12
NA
0.38
7.59
NA
XXX78191
26
A
Platelet survival
0.61
0.20
0.20
0.03
0.84
0.84
XXX78191
TC
A
Platelet survival
0.00
7.36
NA
0.37
7.73
NA
XXX78191

A
Platelet survival
0.61
7.56
NA
0.40
8.57
NA
XXX78195
26
A
Lymph system imaging
1.20
0.41
0.41
0.06
1.67
1.67
XXX78195
TC
A
Lymph system imaging
0.00
4.08
NA
0.22
4.30
NA
XXX78195

A
Lymph system imaging
1.20
4.49
NA
0.28
5.97
NA
XXX78199
26
C
Blood/lymph nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78199
TC
C
Blood/lymph nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78199

C
Blood/lymph nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78201
26
A
Liver imaging
0.44
0.15
0.15
0.02
0.61
0.61
XXX78201
TC
A
Liver imaging
0.00
2.37
NA
0.13
2.50
NA
XXX78201

A
Liver imaging
0.44
2.52
NA
0.15
3.11
NA
XXX78202
26
A
Liver imaging with flow
0.51
0.17
0.17
0.02
0.70
0.70
XXX78202
TC
A
Liver imaging with flow
0.00
2.89
NA
0.14
3.03
NA
XXX78202

A
Liver imaging with flow
0.51
3.06
NA
0.16
3.73
NA
XXX78205
26
A
Liver imaging (3D)
0.71
0.24
0.24
0.03
0.98
0.98
XXX78205
TC
A
Liver imaging (3D)
0.00
5.93
NA
0.31
6.24
NA
XXX78205

A
Liver imaging (3D)
0.71
6.17
NA
0.34
7.22
NA
XXX78206
26
A
Liver image (3d) with flow
0.96
0.33
0.33
0.04
1.33
1.33
XXX78206
TC
A
Liver image (3d) with flow
0.00
5.93
NA
0.11
6.04
NA
XXX78206

A
Liver image (3d) with flow
0.96
6.26
NA
0.15
7.37
NA
XXX78215
26
A
Liver and spleen imaging
0.49
0.16
0.16
0.02
0.67
0.67
XXX78215
TC
A
Liver and spleen imaging
0.00
2.95
NA
0.14
3.09
NA
XXX78215

A
Liver and spleen imaging
0.49
3.11
NA
0.16
3.76
NA
XXX78216
26
A
Liver & spleen image/flow
0.57
0.19
0.19
0.02
0.78
0.78
XXX78216
TC
A
Liver & spleen image/flow
0.00
3.49
NA
0.18
3.67
NA
XXX78216

A
Liver & spleen image/flow
0.57
3.68
NA
0.20
4.45
NA
XXX78220
26
A
Liver function study
0.49
0.16
0.16
0.02
0.67
0.67
XXX78220
TC
A
Liver function study
0.00
3.73
NA
0.19
3.92
NA
XXX78220

A
Liver function study
0.49
3.89
NA
0.21
4.59
NA
XXX78223
26
A
Hepatobiliary imaging
0.84
0.28
0.28
0.04
1.16
1.16
XXX78223
TC
A
Hepatobiliary imaging
0.00
3.67
NA
0.19
3.86
NA
XXX78223

A
Hepatobiliary imaging
0.84
3.95
NA
0.23
5.02
NA
XXX78230
26
A
Salivary gland imaging
0.45
0.15
0.15
0.02
0.62
0.62
XXX78230
TC
A
Salivary gland imaging
0.00
2.19
NA
0.13
2.32
NA
XXX78230

A
Salivary gland imaging
0.45
2.34
NA
0.15
2.94
NA
XXX78231
26
A
Serial salivary imaging
0.52
0.18
0.18
0.02
0.72
0.72
XXX78231
TC
A
Serial salivary imaging
0.00
3.18
NA
0.17
3.35
NA
XXX78231

A
Serial salivary imaging
0.52
3.36
NA
0.19
4.07
NA
XXX78232
26
A
Salivary gland function exam
0.47
0.16
0.16
0.02
0.65
0.65
XXX78232
TC
A
Salivary gland function exam
0.00
3.55
NA
0.18
3.73
NA
XXX78232

A
Salivary gland function exam
0.47
3.71
NA
0.20
4.38
NA
XXX78258
26
A
Esophageal motility study
0.74
0.25
0.25
0.03
1.02
1.02
XXX78258
TC
A
Esophageal motility study
0.00
2.89
NA
0.14
3.03
NA
XXX78258

A
Esophageal motility study
0.74
3.14
NA
0.17
4.05
NA
XXX78261
26
A
Gastric mucosa imaging
0.69
0.24
0.24
0.03
0.96
0.96
XXX78261
TC
A
Gastric mucosa imaging
0.00
4.11
NA
0.22
4.33
NA
XXX78261

A
Gastric mucosa imaging
0.69
4.35
NA
0.25
5.29
NA
XXX78262
26
A
Gastroesophageal reflux exam
0.68
0.23
0.23
0.03
0.94
0.94
XXX78262
TC
A
Gastroesophageal reflux exam
0.00
4.26
NA
0.22
4.48
NA
XXX78262

A
Gastroesophageal reflux exam
0.68
4.49
NA
0.25
5.42
NA
XXX78264
26
A
Gastric emptying study
0.78
0.26
0.26
0.03
1.07
1.07
XXX78264
TC
A
Gastric emptying study
0.00
4.14
NA
0.22
4.36
NA
XXX78264

A
Gastric emptying study
0.78
4.40
NA
0.25
5.43
NA
XXX78267

X
Breath tst attain/anal c-14
0.00
0.00
0.00
0.00
0.00
0.00
XXX78268

X
Breath test analysis, c-14
0.00
0.00
0.00
0.00
0.00
0.00
XXX78270
26
A
Vit B-12 absorption exam
0.20
0.07
0.07
0.01
0.28
0.28
XXX78270
TC
A
Vit B-12 absorption exam
0.00
1.55
NA
0.10
1.65
NA
XXX78270

A
Vit B-12 absorption exam
0.20
1.62
NA
0.11
1.93
NA
XXX78271
26
A
Vit b-12 absrp exam, int fac
0.20
0.07
0.07
0.01
0.28
0.28
XXX78271
TC
A
Vit b-12 absrp exam, int fac
0.00
1.64
NA
0.10
1.74
NA
XXX78271

A
Vit b-12 absrp exam, int fac
0.20
1.71
NA
0.11
2.02
NA
XXX78272
26
A
Vit B-12 absorp, combined
0.27
0.09
0.09
0.01
0.37
0.37
XXX78272
TC
A
Vit B-12 absorp, combined
0.00
2.33
NA
0.13
2.46
NA
XXX78272

A
Vit B-12 absorp, combined
0.27
2.42
NA
0.14
2.83
NA
XXX78278
26
A
Acute GI blood loss imaging
0.99
0.33
0.33
0.04
1.36
1.36
XXX78278
TC
A
Acute GI blood loss imaging
0.00
4.88
NA
0.25
5.13
NA
XXX78278

A
Acute GI blood loss imaging
0.99
5.21
NA
0.29
6.49
NA
XXX78282
26
A
GI protein loss exam
0.38
0.13
0.13
0.02
0.53
0.53
XXX78282
TC
C
GI protein loss exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78282

C
GI protein loss exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78290
26
A
Meckel's divert exam
0.68
0.23
0.23
0.03
0.94
0.94
XXX78290
TC
A
Meckel's divert exam
0.00
3.06
NA
0.16
3.22
NA
XXX78290

A
Meckel's divert exam
0.68
3.29
NA
0.19
4.16
NA
XXX( print page 70434)78291
26
A
Leveen/shunt patency exam
0.88
0.30
0.30
0.04
1.22
1.22
XXX78291
TC
A
Leveen/shunt patency exam
0.00
3.07
NA
0.16
3.23
NA
XXX78291

A
Leveen/shunt patency exam
0.88
3.37
NA
0.20
4.45
NA
XXX78299
26
C
GI nuclear procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX78299
TC
C
GI nuclear procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX78299

C
GI nuclear procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX78300
26
A
Bone imaging, limited area
0.62
0.21
0.21
0.03
0.86
0.86
XXX78300
TC
A
Bone imaging, limited area
0.00
2.49
NA
0.14
2.63
NA
XXX78300

A
Bone imaging, limited area
0.62
2.70
NA
0.17
3.49
NA
XXX78305
26
A
Bone imaging, multiple areas
0.83
0.28
0.28
0.04
1.15
1.15
XXX78305
TC
A
Bone imaging, multiple areas
0.00
3.67
NA
0.19
3.86
NA
XXX78305

A
Bone imaging, multiple areas
0.83
3.95
NA
0.23
5.01
NA
XXX78306
26
A
Bone imaging, whole body
0.86
0.29
0.29
0.04
1.19
1.19
XXX78306
TC
A
Bone imaging, whole body
0.00
4.28
NA
0.22
4.50
NA
XXX78306

A
Bone imaging, whole body
0.86
4.57
NA
0.26
5.69
NA
XXX78315
26
A
Bone imaging, 3 phase
1.02
0.34
0.34
0.04
1.40
1.40
XXX78315
TC
A
Bone imaging, 3 phase
0.00
4.79
NA
0.25
5.04
NA
XXX78315

A
Bone imaging, 3 phase
1.02
5.13
NA
0.29
6.44
NA
XXX78320
26
A
Bone imaging (3D)
1.04
0.36
0.36
0.04
1.44
1.44
XXX78320
TC
A
Bone imaging (3D)
0.00
5.93
NA
0.31
6.24
NA
XXX78320

A
Bone imaging (3D)
1.04
6.29
NA
0.35
7.68
NA
XXX78350
26
A
Bone mineral, single photon
0.22
0.07
0.07
0.01
0.30
0.30
XXX78350
TC
A
Bone mineral, single photon
0.00
0.75
NA
0.05
0.80
NA
XXX78350

A
Bone mineral, single photon
0.22
0.82
NA
0.06
1.10
NA
XXX78351

N
Bone mineral, dual photon
+0.30
1.72
0.12
0.01
2.03
0.43
XXX78399
26
C
Musculoskeletal nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78399
TC
C
Musculoskeletal nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78399

C
Musculoskeletal nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78414
26
A
Non-imaging heart function
0.45
0.16
0.16
0.02
0.63
0.63
XXX78414
TC
C
Non-imaging heart function
0.00
0.00
0.00
0.00
0.00
0.00
XXX78414

C
Non-imaging heart function
0.00
0.00
0.00
0.00
0.00
0.00
XXX78428
26
A
Cardiac shunt imaging
0.78
0.29
0.29
0.03
1.10
1.10
XXX78428
TC
A
Cardiac shunt imaging
0.00
2.26
NA
0.13
2.39
NA
XXX78428

A
Cardiac shunt imaging
0.78
2.55
NA
0.16
3.49
NA
XXX78445
26
A
Vascular flow imaging
0.49
0.17
0.17
0.02
0.68
0.68
XXX78445
TC
A
Vascular flow imaging
0.00
1.87
NA
0.11
1.98
NA
XXX78445

A
Vascular flow imaging
0.49
2.04
NA
0.13
2.66
NA
XXX78456
26
A
Acute venous thrombus image
1.00
0.34
0.34
0.04
1.38
1.38
XXX78456
TC
A
Acute venous thrombus image
0.00
3.99
NA
0.29
4.28
NA
XXX78456

A
Acute venous thrombus image
1.00
4.33
NA
0.33
5.66
NA
XXX78457
26
A
Venous thrombosis imaging
0.77
0.26
0.26
0.03
1.06
1.06
XXX78457
TC
A
Venous thrombosis imaging
0.00
2.67
NA
0.14
2.81
NA
XXX78457

A
Venous thrombosis imaging
0.77
2.93
NA
0.17
3.87
NA
XXX78458
26
A
Ven thrombosis images, bilat
0.90
0.32
0.32
0.04
1.26
1.26
XXX78458
TC
A
Ven thrombosis images, bilat
0.00
4.03
NA
0.21
4.24
NA
XXX78458

A
Ven thrombosis images, bilat
0.90
4.35
NA
0.25
5.50
NA
XXX78459
26
A
Heart muscle imaging (PET)
1.50
0.57
0.57
0.05
2.12
2.12
XXX78459
TC
C
Heart muscle imaging (PET)
0.00
0.00
0.00
0.00
0.00
0.00
XXX78459

C
Heart muscle imaging (PET)
0.00
0.00
0.00
0.00
0.00
0.00
XXX78460
26
A
Heart muscle blood, single
0.86
0.29
0.29
0.04
1.19
1.19
XXX78460
TC
A
Heart muscle blood, single
0.00
2.37
NA
0.13
2.50
NA
XXX78460

A
Heart muscle blood, single
0.86
2.66
NA
0.17
3.69
NA
XXX78461
26
A
Heart muscle blood, multiple
1.23
0.43
0.43
0.05
1.71
1.71
XXX78461
TC
A
Heart muscle blood, multiple
0.00
4.73
NA
0.25
4.98
NA
XXX78461

A
Heart muscle blood, multiple
1.23
5.16
NA
0.30
6.69
NA
XXX78464
26
A
Heart image (3d), single
1.09
0.38
0.38
0.04
1.51
1.51
XXX78464
TC
A
Heart image (3d), single
0.00
7.09
NA
0.37
7.46
NA
XXX78464

A
Heart image (3d), single
1.09
7.47
NA
0.41
8.97
NA
XXX78465
26
A
Heart image (3d), multiple
1.46
0.52
0.52
0.05
2.03
2.03
XXX78465
TC
A
Heart image (3d), multiple
0.00
11.82
NA
0.62
12.44
NA
XXX78465

A
Heart image (3d), multiple
1.46
12.34
NA
0.67
14.47
NA
XXX78466
26
A
Heart infarct image
0.69
0.24
0.24
0.03
0.96
0.96
XXX78466
TC
A
Heart infarct image
0.00
2.63
NA
0.14
2.77
NA
XXX78466

A
Heart infarct image
0.69
2.87
NA
0.17
3.73
NA
XXX78468
26
A
Heart infarct image (ef)
0.80
0.27
0.27
0.03
1.10
1.10
XXX78468
TC
A
Heart infarct image (ef)
0.00
3.67
NA
0.19
3.86
NA
XXX78468

A
Heart infarct image (ef)
0.80
3.94
NA
0.22
4.96
NA
XXX78469
26
A
Heart infarct image (3D)
0.92
0.31
0.31
0.03
1.26
1.26
XXX78469
TC
A
Heart infarct image (3D)
0.00
5.24
NA
0.28
5.52
NA
XXX78469

A
Heart infarct image (3D)
0.92
5.55
NA
0.31
6.78
NA
XXX78472
26
A
Gated heart, planar, single
0.98
0.34
0.34
0.04
1.36
1.36
XXX78472
TC
A
Gated heart, planar, single
0.00
5.53
NA
0.30
5.83
NA
XXX78472

A
Gated heart, planar, single
0.98
5.87
NA
0.34
7.19
NA
XXX78473
26
A
Gated heart, multiple
1.47
0.51
0.51
0.06
2.04
2.04
XXX78473
TC
A
Gated heart, multiple
0.00
8.28
NA
0.42
8.70
NA
XXX( print page 70435)78473

A
Gated heart, multiple
1.47
8.79
NA
0.48
10.74
NA
XXX78478
26
A
Heart wall motion add-on
0.62
0.23
0.23
0.02
0.87
0.87
XXX78478
TC
A
Heart wall motion add-on
0.00
1.56
NA
0.10
1.66
NA
XXX78478

A
Heart wall motion add-on
0.62
1.79
NA
0.12
2.53
NA
XXX78480
26
A
Heart function add-on
0.62
0.22
0.22
0.02
0.86
0.86
XXX78480
TC
A
Heart function add-on
0.00
1.56
NA
0.10
1.66
NA
XXX78480

A
Heart function add-on
0.62
1.78
NA
0.12
2.52
NA
XXX78481
26
A
Heart first pass, single
0.98
0.36
0.36
0.03
1.37
1.37
XXX78481
TC
A
Heart first pass, single
0.00
5.24
NA
0.28
5.52
NA
XXX78481

A
Heart first pass, single
0.98
5.60
NA
0.31
6.89
NA
XXX78483
26
A
Heart first pass, multiple
1.47
0.54
0.54
0.05
2.06
2.06
XXX78483
TC
A
Heart first pass, multiple
0.00
7.89
NA
0.41
8.30
NA
XXX78483

A
Heart first pass, multiple
1.47
8.43
NA
0.46
10.36
NA
XXX78491
26
A
Heart image (pet), single
1.50
0.59
0.59
0.06
2.15
2.15
XXX78491
TC
C
Heart image (pet), single
0.00
0.00
0.00
0.00
0.00
0.00
XXX78491

C
Heart image (pet), single
0.00
0.00
0.00
0.00
0.00
0.00
XXX78492
26
A
Heart image (pet), multiple
1.87
0.74
0.74
0.07
2.68
2.68
XXX78492
TC
C
Heart image (pet), multiple
0.00
0.00
0.00
0.00
0.00
0.00
XXX78492

C
Heart image (pet), multiple
0.00
0.00
0.00
0.00
0.00
0.00
XXX78494
26
A
Heart image, spect
1.19
0.42
0.42
0.05
1.66
1.66
XXX78494
TC
A
Heart image, spect
0.00
7.09
NA
0.30
7.39
NA
XXX78494

A
Heart image, spect
1.19
7.51
NA
0.35
9.05
NA
XXX78496
26
A
Heart first pass add-on
0.50
0.18
0.18
0.02
0.70
0.70
ZZZ78496
TC
A
Heart first pass add-on
0.00
7.09
NA
0.30
7.39
NA
ZZZ78496

A
Heart first pass add-on
0.50
7.27
NA
0.32
8.09
NA
ZZZ78499
26
C
Cardiovascular nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78499
TC
C
Cardiovascular nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78499

C
Cardiovascular nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78580
26
A
Lung perfusion imaging
0.74
0.25
0.25
0.03
1.02
1.02
XXX78580
TC
A
Lung perfusion imaging
0.00
3.44
NA
0.18
3.62
NA
XXX78580

A
Lung perfusion imaging
0.74
3.69
NA
0.21
4.64
NA
XXX78584
26
A
Lung V/Q image single breath
0.99
0.33
0.33
0.04
1.36
1.36
XXX78584
TC
A
Lung V/Q image single breath
0.00
3.21
NA
0.17
3.38
NA
XXX78584

A
Lung V/Q image single breath
0.99
3.54
NA
0.21
4.74
NA
XXX78585
26
A
Lung V/Q imaging
1.09
0.36
0.36
0.05
1.50
1.50
XXX78585
TC
A
Lung V/Q imaging
0.00
5.66
NA
0.30
5.96
NA
XXX78585

A
Lung V/Q imaging
1.09
6.02
NA
0.35
7.46
NA
XXX78586
26
A
Aerosol lung image, single
0.40
0.13
0.13
0.02
0.55
0.55
XXX78586
TC
A
Aerosol lung image, single
0.00
2.60
NA
0.14
2.74
NA
XXX78586

A
Aerosol lung image, single
0.40
2.73
NA
0.16
3.29
NA
XXX78587
26
A
Aerosol lung image, multiple
0.49
0.17
0.17
0.02
0.68
0.68
XXX78587
TC
A
Aerosol lung image, multiple
0.00
2.81
NA
0.14
2.95
NA
XXX78587

A
Aerosol lung image, multiple
0.49
2.98
NA
0.16
3.63
NA
XXX78588
26
A
Perfusion lung image
1.09
0.36
0.36
0.05
1.50
1.50
XXX78588
TC
A
Perfusion lung image
0.00
3.21
NA
0.18
3.39
NA
XXX78588

A
Perfusion lung image
1.09
3.57
NA
0.23
4.89
NA
XXX78591
26
A
Vent image, 1 breath, 1 proj
0.40
0.13
0.13
0.02
0.55
0.55
XXX78591
TC
A
Vent image, 1 breath, 1 proj
0.00
2.86
NA
0.14
3.00
NA
XXX78591

A
Vent image, 1 breath, 1 proj
0.40
2.99
NA
0.16
3.55
NA
XXX78593
26
A
Vent image, 1 proj, gas
0.49
0.16
0.16
0.02
0.67
0.67
XXX78593
TC
A
Vent image, 1 proj, gas
0.00
3.46
NA
0.18
3.64
NA
XXX78593

A
Vent image, 1 proj, gas
0.49
3.62
NA
0.20
4.31
NA
XXX78594
26
A
Vent image, mult proj, gas
0.53
0.18
0.18
0.02
0.73
0.73
XXX78594
TC
A
Vent image, mult proj, gas
0.00
4.99
NA
0.25
5.24
NA
XXX78594

A
Vent image, mult proj, gas
0.53
5.17
NA
0.27
5.97
NA
XXX78596
26
A
Lung differential function
1.27
0.42
0.42
0.05
1.74
1.74
XXX78596
TC
A
Lung differential function
0.00
7.09
NA
0.37
7.46
NA
XXX78596

A
Lung differential function
1.27
7.51
NA
0.42
9.20
NA
XXX78599
26
C
Respiratory nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78599
TC
C
Respiratory nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78599

C
Respiratory nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78600
26
A
Brain imaging, ltd static
0.44
0.15
0.15
0.02
0.61
0.61
XXX78600
TC
A
Brain imaging, ltd static
0.00
2.89
NA
0.14
3.03
NA
XXX78600

A
Brain imaging, ltd static
0.44
3.04
NA
0.16
3.64
NA
XXX78601
26
A
Brain imaging, ltd w/flow
0.51
0.17
0.17
0.02
0.70
0.70
XXX78601
TC
A
Brain imaging, ltd w/flow
0.00
3.41
NA
0.18
3.59
NA
XXX78601

A
Brain imaging, ltd w/flow
0.51
3.58
NA
0.20
4.29
NA
XXX78605
26
A
Brain imaging, complete
0.53
0.18
0.18
0.02
0.73
0.73
XXX78605
TC
A
Brain imaging, complete
0.00
3.41
NA
0.18
3.59
NA
XXX78605

A
Brain imaging, complete
0.53
3.59
NA
0.20
4.32
NA
XXX78606
26
A
Brain imaging, compl w/flow
0.64
0.21
0.21
0.03
0.88
0.88
XXX78606
TC
A
Brain imaging, compl w/flow
0.00
3.88
NA
0.21
4.09
NA
XXX78606

A
Brain imaging, compl w/flow
0.64
4.09
NA
0.24
4.97
NA
XXX78607
26
A
Brain imaging (3D)
1.23
0.43
0.43
0.05
1.71
1.71
XXX78607
TC
A
Brain imaging (3D)
0.00
6.57
NA
0.35
6.92
NA
XXX( print page 70436)78607

A
Brain imaging (3D)
1.23
7.00
NA
0.40
8.63
NA
XXX78608
26
A
Brain imaging (PET)
1.50
0.51
0.51
0.06
2.07
2.07
XXX78608
TC
C
Brain imaging (PET)
0.00
0.00
0.00
0.00
0.00
0.00
XXX78608

C
Brain imaging (PET)
0.00
0.00
0.00
0.00
0.00
0.00
XXX78609
26
A
Brain imaging (PET)
1.50
0.51
0.51
0.06
2.07
2.07
XXX78609
TC
C
Brain imaging (PET)
0.00
0.00
0.00
0.00
0.00
0.00
XXX78609

C
Brain imaging (PET)
0.00
0.00
0.00
0.00
0.00
0.00
XXX78610
26
A
Brain flow imaging only
0.30
0.11
0.11
0.01
0.42
0.42
XXX78610
TC
A
Brain flow imaging only
0.00
1.58
NA
0.10
1.68
NA
XXX78610

A
Brain flow imaging only
0.30
1.69
NA
0.11
2.10
NA
XXX78615
26
A
Cerebral vascular flow image
0.42
0.15
0.15
0.02
0.59
0.59
XXX78615
TC
A
Cerebral vascular flow image
0.00
3.86
NA
0.21
4.07
NA
XXX78615

A
Cerebral vascular flow image
0.42
4.01
NA
0.23
4.66
NA
XXX78630
26
A
Cerebrospinal fluid scan
0.68
0.23
0.23
0.03
0.94
0.94
XXX78630
TC
A
Cerebrospinal fluid scan
0.00
5.05
NA
0.27
5.32
NA
XXX78630

A
Cerebrospinal fluid scan
0.68
5.28
NA
0.30
6.26
NA
XXX78635
26
A
CSF ventriculography
0.61
0.23
0.23
0.02
0.86
0.86
XXX78635
TC
A
CSF ventriculography
0.00
2.55
NA
0.14
2.69
NA
XXX78635

A
CSF ventriculography
0.61
2.78
NA
0.16
3.55
NA
XXX78645
26
A
CSF shunt evaluation
0.57
0.19
0.19
0.02
0.78
0.78
XXX78645
TC
A
CSF shunt evaluation
0.00
3.44
NA
0.18
3.62
NA
XXX78645

A
CSF shunt evaluation
0.57
3.63
NA
0.20
4.40
NA
XXX78647
26
A
Cerebrospinal fluid scan
0.90
0.31
0.31
0.04
1.25
1.25
XXX78647
TC
A
Cerebrospinal fluid scan
0.00
5.93
NA
0.31
6.24
NA
XXX78647

A
Cerebrospinal fluid scan
0.90
6.24
NA
0.35
7.49
NA
XXX78650
26
A
CSF leakage imaging
0.61
0.21
0.21
0.03
0.85
0.85
XXX78650
TC
A
CSF leakage imaging
0.00
4.65
NA
0.24
4.89
NA
XXX78650

A
CSF leakage imaging
0.61
4.86
NA
0.27
5.74
NA
XXX78660
26
A
Nuclear exam of tear flow
0.53
0.18
0.18
0.02
0.73
0.73
XXX78660
TC
A
Nuclear exam of tear flow
0.00
2.13
NA
0.12
2.25
NA
XXX78660

A
Nuclear exam of tear flow
0.53
2.31
NA
0.14
2.98
NA
XXX78699
26
C
Nervous system nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78699
TC
C
Nervous system nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78699

C
Nervous system nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78700
26
A
Kidney imaging, static
0.45
0.15
0.15
0.02
0.62
0.62
XXX78700
TC
A
Kidney imaging, static
0.00
3.06
NA
0.16
3.22
NA
XXX78700

A
Kidney imaging, static
0.45
3.21
NA
0.18
3.84
NA
XXX78701
26
A
Kidney imaging with flow
0.49
0.16
0.16
0.02
0.67
0.67
XXX78701
TC
A
Kidney imaging with flow
0.00
3.57
NA
0.18
3.75
NA
XXX78701

A
Kidney imaging with flow
0.49
3.73
NA
0.20
4.42
NA
XXX78704
26
A
Imaging renogram
0.74
0.25
0.25
0.03
1.02
1.02
XXX78704
TC
A
Imaging renogram
0.00
3.96
NA
0.21
4.17
NA
XXX78704

A
Imaging renogram
0.74
4.21
NA
0.24
5.19
NA
XXX78707
26
A
Kidney flow/function image
0.96
0.32
0.32
0.04
1.32
1.32
XXX78707
TC
A
Kidney flow/function image
0.00
4.48
NA
0.23
4.71
NA
XXX78707

A
Kidney flow/function image
0.96
4.80
NA
0.27
6.03
NA
XXX78708
26
A
Kidney flow/function image
1.21
0.41
0.41
0.05
1.67
1.67
XXX78708
TC
A
Kidney flow/function image
0.00
4.48
NA
0.23
4.71
NA
XXX78708

A
Kidney flow/function image
1.21
4.89
NA
0.28
6.38
NA
XXX78709
26
A
Kidney flow/function image
1.41
0.47
0.47
0.06
1.94
1.94
XXX78709
TC
A
Kidney flow/function image
0.00
4.48
NA
0.23
4.71
NA
XXX78709

A
Kidney flow/function image
1.41
4.95
NA
0.29
6.65
NA
XXX78710
26
A
Kidney imaging (3D)
0.66
0.22
0.22
0.03
0.91
0.91
XXX78710
TC
A
Kidney imaging (3D)
0.00
5.93
NA
0.31
6.24
NA
XXX78710

A
Kidney imaging (3D)
0.66
6.15
NA
0.34
7.15
NA
XXX78715
26
A
Renal vascular flow exam
0.30
0.11
0.11
0.01
0.42
0.42
XXX78715
TC
A
Renal vascular flow exam
0.00
1.58
NA
0.10
1.68
NA
XXX78715

A
Renal vascular flow exam
0.30
1.69
NA
0.11
2.10
NA
XXX78725
26
A
Kidney function study
0.38
0.13
0.13
0.02
0.53
0.53
XXX78725
TC
A
Kidney function study
0.00
1.79
NA
0.11
1.90
NA
XXX78725

A
Kidney function study
0.38
1.92
NA
0.13
2.43
NA
XXX78730
26
A
Urinary bladder retention
0.36
0.12
0.12
0.02
0.50
0.50
XXX78730
TC
A
Urinary bladder retention
0.00
1.46
NA
0.08
1.54
NA
XXX78730

A
Urinary bladder retention
0.36
1.58
NA
0.10
2.04
NA
XXX78740
26
A
Ureteral reflux study
0.57
0.19
0.19
0.03
0.79
0.79
XXX78740
TC
A
Ureteral reflux study
0.00
2.13
NA
0.12
2.25
NA
XXX78740

A
Ureteral reflux study
0.57
2.32
NA
0.15
3.04
NA
XXX78760
26
A
Testicular imaging
0.66
0.22
0.22
0.03
0.91
0.91
XXX78760
TC
A
Testicular imaging
0.00
2.69
NA
0.14
2.83
NA
XXX78760

A
Testicular imaging
0.66
2.91
NA
0.17
3.74
NA
XXX78761
26
A
Testicular imaging/flow
0.71
0.24
0.24
0.03
0.98
0.98
XXX78761
TC
A
Testicular imaging/flow
0.00
3.21
NA
0.17
3.38
NA
XXX78761

A
Testicular imaging/flow
0.71
3.45
NA
0.20
4.36
NA
XXX78799
26
C
Genitourinary nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78799
TC
C
Genitourinary nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70437)78799

C
Genitourinary nuclear exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78800
26
A
Tumor imaging, limited area
0.66
0.22
0.22
0.04
0.92
0.92
XXX78800
TC
A
Tumor imaging, limited area
0.00
3.41
NA
0.18
3.59
NA
XXX78800

A
Tumor imaging, limited area
0.66
3.63
NA
0.22
4.51
NA
XXX78801
26
A
Tumor imaging, mult areas
0.79
0.27
0.27
0.05
1.11
1.11
XXX78801
TC
A
Tumor imaging, mult areas
0.00
4.23
NA
0.22
4.45
NA
XXX78801

A
Tumor imaging, mult areas
0.79
4.50
NA
0.27
5.56
NA
XXX78802
26
A
Tumor imaging, whole body
0.86
0.29
0.29
0.04
1.19
1.19
XXX78802
TC
A
Tumor imaging, whole body
0.00
5.55
NA
0.30
5.85
NA
XXX78802

A
Tumor imaging, whole body
0.86
5.84
NA
0.34
7.04
NA
XXX78803
26
A
Tumor imaging (3D)
1.09
0.38
0.38
0.05
1.52
1.52
XXX78803
TC
A
Tumor imaging (3D)
0.00
6.57
NA
0.35
6.92
NA
XXX78803

A
Tumor imaging (3D)
1.09
6.95
NA
0.40
8.44
NA
XXX78804
26
A
Tumor imaging, whole body
1.07
0.37
0.37
0.04
1.48
1.48
XXX78804
TC
A
Tumor imaging, whole body
0.00
11.09
NA
0.30
11.39
NA
XXX78804

A
Tumor imaging, whole body
1.07
11.46
NA
0.34
12.87
NA
XXX78805
26
A
Abscess imaging, ltd area
0.73
0.25
0.25
0.03
1.01
1.01
XXX78805
TC
A
Abscess imaging, ltd area
0.00
3.41
NA
0.18
3.59
NA
XXX78805

A
Abscess imaging, ltd area
0.73
3.66
NA
0.21
4.60
NA
XXX78806
26
A
Abscess imaging, whole body
0.86
0.29
0.29
0.04
1.19
1.19
XXX78806
TC
A
Abscess imaging, whole body
0.00
6.45
NA
0.35
6.80
NA
XXX78806

A
Abscess imaging, whole body
0.86
6.74
NA
0.39
7.99
NA
XXX78807
26
A
Nuclear localization/abscess
1.09
0.39
0.39
0.04
1.52
1.52
XXX78807
TC
A
Nuclear localization/abscess
0.00
6.57
NA
0.35
6.92
NA
XXX78807

A
Nuclear localization/abscess
1.09
6.96
NA
0.39
8.44
NA
XXX78811
26
A
Tumor imaging (pet), limited
1.54
0.53
0.53
0.11
2.18
2.18
XXX78811
TC
C
Tumor imaging (pet), limited
0.00
0.00
0.00
0.00
0.00
0.00
XXX78811

C
Tumor imaging (pet), limited
0.00
0.00
0.00
0.00
0.00
0.00
XXX78812
26
A
Tumor image (pet)/skul-thigh
1.93
0.66
0.66
0.11
2.70
2.70
XXX78812
TC
C
Tumor image (pet)/skul-thigh
0.00
0.00
0.00
0.00
0.00
0.00
XXX78812

C
Tumor image (pet)/skul-thigh
0.00
0.00
0.00
0.00
0.00
0.00
XXX78813
26
A
Tumor image (pet) full body
2.00
0.69
0.69
0.11
2.80
2.80
XXX78813
TC
C
Tumor image (pet) full body
0.00
0.00
0.00
0.00
0.00
0.00
XXX78813

C
Tumor image (pet) full body
0.00
0.00
0.00
0.00
0.00
0.00
XXX78814
26
A
Tumor image pet/ct, limited
2.20
0.76
0.76
0.11
3.07
3.07
XXX78814
TC
C
Tumor image pet/ct, limited
0.00
0.00
0.00
0.00
0.00
0.00
XXX78814

C
Tumor image pet/ct, limited
0.00
0.00
0.00
0.00
0.00
0.00
XXX78815
26
A
Tumorimage pet/ct skul-thigh
2.44
0.84
0.84
0.11
3.39
3.39
XXX78815
TC
C
Tumorimage pet/ct skul-thigh
0.00
0.00
0.00
0.00
0.00
0.00
XXX78815

C
Tumorimage pet/ct skul-thigh
0.00
0.00
0.00
0.00
0.00
0.00
XXX78816
26
A
Tumor image pet/ct full body
2.50
0.86
0.86
0.11
3.47
3.47
XXX78816
TC
C
Tumor image pet/ct full body
0.00
0.00
0.00
0.00
0.00
0.00
XXX78816

C
Tumor image pet/ct full body
0.00
0.00
0.00
0.00
0.00
0.00
XXX78890
26
B
Nuclear medicine data proc
+0.05
0.02
0.02
0.01
0.08
0.08
XXX78890
TC
B
Nuclear medicine data proc
+0.00
1.31
NA
0.06
1.37
NA
XXX78890

B
Nuclear medicine data proc
+0.05
1.33
NA
0.07
1.45
NA
XXX78891
26
B
Nuclear med data proc
+0.10
0.04
0.04
0.01
0.15
0.15
XXX78891
TC
B
Nuclear med data proc
+0.00
2.63
NA
0.13
2.76
NA
XXX78891

B
Nuclear med data proc
+0.10
2.67
NA
0.14
2.91
NA
XXX78999
26
C
Nuclear diagnostic exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78999
TC
C
Nuclear diagnostic exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX78999

C
Nuclear diagnostic exam
0.00
0.00
0.00
0.00
0.00
0.00
XXX79005
26
A
Nuclear rx, oral admin
1.80
0.60
0.60
0.08
2.48
2.48
XXX79005
TC
A
Nuclear rx, oral admin
0.00
2.63
NA
0.14
2.77
NA
XXX79005

A
Nuclear rx, oral admin
1.80
3.23
NA
0.22
5.25
NA
XXX79101
26
A
Nuclear rx, iv admin
1.96
0.67
0.67
0.08
2.71
2.71
XXX79101
TC
A
Nuclear rx, iv admin
0.00
2.63
NA
0.14
2.77
NA
XXX79101

A
Nuclear rx, iv admin
1.96
3.30
NA
0.22
5.48
NA
XXX79200
26
A
Nuclear rx, intracav admin
1.99
0.69
0.69
0.09
2.77
2.77
XXX79200
TC
A
Nuclear rx, intracav admin
0.00
2.63
NA
0.14
2.77
NA
XXX79200

A
Nuclear rx, intracav admin
1.99
3.32
NA
0.23
5.54
NA
XXX79300
26
A
Nuclr rx, interstit colloid
1.60
0.56
0.56
0.13
2.29
2.29
XXX79300
TC
C
Nuclr rx, interstit colloid
0.00
0.00
0.00
0.00
0.00
0.00
XXX79300

C
Nuclr rx, interstit colloid
0.00
0.00
0.00
0.00
0.00
0.00
XXX79403
26
A
Hematopoietic nuclear tx
2.25
0.89
0.89
0.10
3.24
3.24
XXX79403
TC
A
Hematopoietic nuclear tx
0.00
4.28
NA
0.14
4.42
NA
XXX79403

A
Hematopoietic nuclear tx
2.25
5.17
NA
0.24
7.66
NA
XXX79440
26
A
Nuclear rx, intra-articular
1.99
0.72
0.72
0.08
2.79
2.79
XXX79440
TC
A
Nuclear rx, intra-articular
0.00
2.63
NA
0.14
2.77
NA
XXX79440

A
Nuclear rx, intra-articular
1.99
3.35
NA
0.22
5.56
NA
XXX79445
26
A
Nuclear rx, intra-arterial
2.40
0.82
0.82
0.12
3.34
3.34
XXX79445
TC
C
Nuclear rx, intra-arterial
0.00
0.00
0.00
0.00
0.00
0.00
XXX79445

C
Nuclear rx, intra-arterial
0.00
0.00
0.00
0.00
0.00
0.00
XXX79999
26
C
Nuclear medicine therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXX79999
TC
C
Nuclear medicine therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70438)79999

C
Nuclear medicine therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXX80500

A
Lab pathology consultation
0.37
0.21
0.16
0.01
0.59
0.54
XXX80502

A
Lab pathology consultation
1.33
0.54
0.54
0.04
1.91
1.91
XXX83020
26
A
Hemoglobin electrophoresis
0.37
0.15
0.15
0.01
0.53
0.53
XXX83912
26
A
Genetic examination
0.37
0.12
0.12
0.01
0.50
0.50
XXX84165
26
A
Protein e-phoresis, serum
0.37
0.14
0.14
0.01
0.52
0.52
XXX84166
26
A
Protein e-phoresis/urine/csf
0.37
0.14
0.14
0.01
0.52
0.52
XXX84181
26
A
Western blot test
0.37
0.14
0.14
0.01
0.52
0.52
XXX84182
26
A
Protein, western blot test
0.37
0.16
0.16
0.02
0.55
0.55
XXX85060

A
Blood smear interpretation
0.45
0.18
0.18
0.02
0.65
0.65
XXX85097

A
Bone marrow interpretation
0.94
1.92
0.41
0.04
2.90
1.39
XXX85390
26
A
Fibrinolysins screen
0.37
0.13
0.13
0.01
0.51
0.51
XXX85396

A
Clotting assay, whole blood
0.37
NA
0.16
0.04
NA
0.57
XXX85576
26
A
Blood platelet aggregation
0.37
0.16
0.16
0.01
0.54
0.54
XXX86077

A
Physician blood bank service
0.94
0.39
0.39
0.03
1.36
1.36
XXX86078

A
Physician blood bank service
0.94
0.46
0.40
0.03
1.43
1.37
XXX86079

A
Physician blood bank service
0.94
0.45
0.41
0.03
1.42
1.38
XXX86255
26
A
Fluorescent antibody, screen
0.37
0.15
0.15
0.01
0.53
0.53
XXX86256
26
A
Fluorescent antibody, titer
0.37
0.15
0.15
0.01
0.53
0.53
XXX86320
26
A
Serum immunoelectrophoresis
0.37
0.15
0.15
0.01
0.53
0.53
XXX86325
26
A
Other immunoelectrophoresis
0.37
0.13
0.13
0.01
0.51
0.51
XXX86327
26
A
Immunoelectrophoresis assay
0.42
0.18
0.18
0.02
0.62
0.62
XXX86334
26
A
Immunofix e-phoresis, serum
0.37
0.15
0.15
0.01
0.53
0.53
XXX86335
26
A
Immunfix e-phorsis/urine/csf
0.37
0.14
0.14
0.01
0.52
0.52
XXX86485

C
Skin test, candida
0.00
0.00
0.00
0.00
0.00
0.00
XXX86490

A
Coccidioidomycosis skin test
0.00
0.29
NA
0.02
0.31
NA
XXX86510

A
Histoplasmosis skin test
0.00
0.32
NA
0.02
0.34
NA
XXX86580

A
TB intradermal test
0.00
0.25
NA
0.02
0.27
NA
XXX87164
26
A
Dark field examination
0.37
0.12
0.12
0.01
0.50
0.50
XXX87207
26
A
Smear, special stain
0.37
0.16
0.16
0.01
0.54
0.54
XXX88104
26
A
Cytopathology, fluids
0.56
0.24
0.24
0.02
0.82
0.82
XXX88104
TC
A
Cytopathology, fluids
0.00
0.61
NA
0.02
0.63
NA
XXX88104

A
Cytopathology, fluids
0.56
0.85
NA
0.04
1.45
NA
XXX88106
26
A
Cytopathology, fluids
0.56
0.24
0.24
0.02
0.82
0.82
XXX88106
TC
A
Cytopathology, fluids
0.00
1.11
NA
0.02
1.13
NA
XXX88106

A
Cytopathology, fluids
0.56
1.35
NA
0.04
1.95
NA
XXX88107
26
A
Cytopathology, fluids
0.76
0.33
0.33
0.03
1.12
1.12
XXX88107
TC
A
Cytopathology, fluids
0.00
1.21
NA
0.02
1.23
NA
XXX88107

A
Cytopathology, fluids
0.76
1.54
NA
0.05
2.35
NA
XXX88108
26
A
Cytopath, concentrate tech
0.56
0.24
0.24
0.02
0.82
0.82
XXX88108
TC
A
Cytopath, concentrate tech
0.00
0.97
NA
0.02
0.99
NA
XXX88108

A
Cytopath, concentrate tech
0.56
1.21
NA
0.04
1.81
NA
XXX88112
26
A
Cytopath, cell enhance tech
1.18
0.51
0.51
0.02
1.71
1.71
XXX88112
TC
A
Cytopath, cell enhance tech
0.00
1.46
NA
0.02
1.48
NA
XXX88112

A
Cytopath, cell enhance tech
1.18
1.97
NA
0.04
3.19
NA
XXX88125
26
A
Forensic cytopathology
0.26
0.11
0.11
0.01
0.38
0.38
XXX88125
TC
A
Forensic cytopathology
0.00
0.16
NA
0.01
0.17
NA
XXX88125

A
Forensic cytopathology
0.26
0.27
NA
0.02
0.55
NA
XXX88141

A
Cytopath, c/v, interpret
0.42
0.15
0.15
0.02
0.59
0.59
XXX88160
26
A
Cytopath smear, other source
0.50
0.21
0.21
0.02
0.73
0.73
XXX88160
TC
A
Cytopath smear, other source
0.00
0.62
NA
0.02
0.64
NA
XXX88160

A
Cytopath smear, other source
0.50
0.83
NA
0.04
1.37
NA
XXX88161
26
A
Cytopath smear, other source
0.50
0.21
0.21
0.02
0.73
0.73
XXX88161
TC
A
Cytopath smear, other source
0.00
0.73
NA
0.02
0.75
NA
XXX88161

A
Cytopath smear, other source
0.50
0.94
NA
0.04
1.48
NA
XXX88162
26
A
Cytopath smear, other source
0.76
0.33
0.33
0.03
1.12
1.12
XXX88162
TC
A
Cytopath smear, other source
0.00
0.69
NA
0.02
0.71
NA
XXX88162

A
Cytopath smear, other source
0.76
1.02
NA
0.05
1.83
NA
XXX88172
26
A
Cytopathology eval of fna
0.60
0.26
0.26
0.02
0.88
0.88
XXX88172
TC
A
Cytopathology eval of fna
0.00
0.47
NA
0.02
0.49
NA
XXX88172

A
Cytopathology eval of fna
0.60
0.73
NA
0.04
1.37
NA
XXX88173
26
A
Cytopath eval, fna, report
1.39
0.59
0.59
0.05
2.03
2.03
XXX88173
TC
A
Cytopath eval, fna, report
0.00
1.55
NA
0.02
1.57
NA
XXX88173

A
Cytopath eval, fna, report
1.39
2.14
NA
0.07
3.60
NA
XXX88182
26
A
Cell marker study
0.77
0.33
0.33
0.03
1.13
1.13
XXX88182
TC
A
Cell marker study
0.00
1.65
NA
0.04
1.69
NA
XXX88182

A
Cell marker study
0.77
1.98
NA
0.07
2.82
NA
XXX88184

A
Flowcytometry/ tc, 1 marker
0.00
1.32
NA
0.02
1.34
NA
XXX88185

A
Flowcytometry/tc, add-on
0.00
0.64
NA
0.02
0.66
NA
ZZZ88187

A
Flowcytometry/read, 2-8
1.36
0.45
0.45
0.01
1.82
1.82
XXX88188

A
Flowcytometry/read, 9-15
1.69
0.57
0.57
0.01
2.27
2.27
XXX88189

A
Flowcytometry/read, 16 & >
2.23
0.75
0.75
0.01
2.99
2.99
XXX88199
26
C
Cytopathology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX88199
TC
C
Cytopathology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX88199

C
Cytopathology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70439)88291

A
Cyto/molecular report
0.52
0.17
0.17
0.02
0.71
0.71
XXX88299

C
Cytogenetic study
0.00
0.00
0.00
0.00
0.00
0.00
XXX88300
26
A
Surgical path, gross
0.08
0.03
0.03
0.01
0.12
0.12
XXX88300
TC
A
Surgical path, gross
0.00
0.42
NA
0.01
0.43
NA
XXX88300

A
Surgical path, gross
0.08
0.45
NA
0.02
0.55
NA
XXX88302
26
A
Tissue exam by pathologist
0.13
0.06
0.06
0.01
0.20
0.20
XXX88302
TC
A
Tissue exam by pathologist
0.00
0.97
NA
0.02
0.99
NA
XXX88302

A
Tissue exam by pathologist
0.13
1.03
NA
0.03
1.19
NA
XXX88304
26
A
Tissue exam by pathologist
0.22
0.09
0.09
0.01
0.32
0.32
XXX88304
TC
A
Tissue exam by pathologist
0.00
1.23
NA
0.02
1.25
NA
XXX88304

A
Tissue exam by pathologist
0.22
1.32
NA
0.03
1.57
NA
XXX88305
26
A
Tissue exam by pathologist
0.75
0.33
0.33
0.03
1.11
1.11
XXX88305
TC
A
Tissue exam by pathologist
0.00
1.58
NA
0.04
1.62
NA
XXX88305

A
Tissue exam by pathologist
0.75
1.91
NA
0.07
2.73
NA
XXX88307
26
A
Tissue exam by pathologist
1.59
0.68
0.68
0.06
2.33
2.33
XXX88307
TC
A
Tissue exam by pathologist
0.00
2.48
NA
0.06
2.54
NA
XXX88307

A
Tissue exam by pathologist
1.59
3.16
NA
0.12
4.87
NA
XXX88309
26
A
Tissue exam by pathologist
2.28
0.97
0.97
0.08
3.33
3.33
XXX88309
TC
A
Tissue exam by pathologist
0.00
3.43
NA
0.06
3.49
NA
XXX88309

A
Tissue exam by pathologist
2.28
4.40
NA
0.14
6.82
NA
XXX88311
26
A
Decalcify tissue
0.24
0.10
0.10
0.01
0.35
0.35
XXX88311
TC
A
Decalcify tissue
0.00
0.13
NA
0.01
0.14
NA
XXX88311

A
Decalcify tissue
0.24
0.23
NA
0.02
0.49
NA
XXX88312
26
A
Special stains
0.54
0.23
0.23
0.02
0.79
0.79
XXX88312
TC
A
Special stains
0.00
1.29
NA
0.01
1.30
NA
XXX88312

A
Special stains
0.54
1.52
NA
0.03
2.09
NA
XXX88313
26
A
Special stains
0.24
0.10
0.10
0.01
0.35
0.35
XXX88313
TC
A
Special stains
0.00
1.15
NA
0.01
1.16
NA
XXX88313

A
Special stains
0.24
1.25
NA
0.02
1.51
NA
XXX88314
26
A
Histochemical stain
0.45
0.19
0.19
0.02
0.66
0.66
XXX88314
TC
A
Histochemical stain
0.00
1.88
NA
0.02
1.90
NA
XXX88314

A
Histochemical stain
0.45
2.07
NA
0.04
2.56
NA
XXX88318
26
A
Chemical histochemistry
0.42
0.18
0.18
0.02
0.62
0.62
XXX88318
TC
A
Chemical histochemistry
0.00
1.47
NA
0.01
1.48
NA
XXX88318

A
Chemical histochemistry
0.42
1.65
NA
0.03
2.10
NA
XXX88319
26
A
Enzyme histochemistry
0.53
0.22
0.22
0.02
0.77
0.77
XXX88319
TC
A
Enzyme histochemistry
0.00
3.20
NA
0.02
3.22
NA
XXX88319

A
Enzyme histochemistry
0.53
3.42
NA
0.04
3.99
NA
XXX88321

A
Microslide consultation
1.30
0.79
0.56
0.05
2.14
1.91
XXX88323
26
A
Microslide consultation
1.35
0.57
0.57
0.05
1.97
1.97
XXX88323
TC
A
Microslide consultation
0.00
1.21
NA
0.02
1.23
NA
XXX88323

A
Microslide consultation
1.35
1.78
NA
0.07
3.20
NA
XXX88325

A
Comprehensive review of data
2.22
2.94
0.95
0.07
5.23
3.24
XXX88329

A
Path consult introp
0.67
0.65
0.29
0.02
1.34
0.98
XXX88331
26
A
Path consult intraop, 1 bloc
1.19
0.51
0.51
0.04
1.74
1.74
XXX88331
TC
A
Path consult intraop, 1 bloc
0.00
0.59
NA
0.04
0.63
NA
XXX88331

A
Path consult intraop, 1 bloc
1.19
1.10
NA
0.08
2.37
NA
XXX88332
26
A
Path consult intraop, add'l
0.59
0.25
0.25
0.02
0.86
0.86
XXX88332
TC
A
Path consult intraop, add'l
0.00
0.21
NA
0.02
0.23
NA
XXX88332

A
Path consult intraop, add'l
0.59
0.46
NA
0.04
1.09
NA
XXX88333
26
A
Intraop cyto path consult, 1
1.20
0.53
0.53
0.04
1.77
1.77
XXX88333
TC
A
Intraop cyto path consult, 1
0.00
0.55
NA
0.04
0.59
NA
XXX88333

A
Intraop cyto path consult, 1
1.20
1.08
NA
0.08
2.36
NA
XXX88334
26
A
Intraop cyto path consult, 2
0.59
0.26
0.26
0.02
0.87
0.87
XXX88334
TC
A
Intraop cyto path consult, 2
0.00
0.34
NA
0.02
0.36
NA
XXX88334

A
Intraop cyto path consult, 2
0.59
0.60
NA
0.04
1.23
NA
XXX88342
26
A
Immunohistochemistry
0.85
0.36
0.36
0.03
1.24
1.24
XXX88342
TC
A
Immunohistochemistry
0.00
1.10
NA
0.02
1.12
NA
XXX88342

A
Immunohistochemistry
0.85
1.46
NA
0.05
2.36
NA
XXX88346
26
A
Immunofluorescent study
0.86
0.36
0.36
0.03
1.25
1.25
XXX88346
TC
A
Immunofluorescent study
0.00
1.21
NA
0.02
1.23
NA
XXX88346

A
Immunofluorescent study
0.86
1.57
NA
0.05
2.48
NA
XXX88347
26
A
Immunofluorescent study
0.86
0.35
0.35
0.03
1.24
1.24
XXX88347
TC
A
Immunofluorescent study
0.00
0.91
NA
0.02
0.93
NA
XXX88347

A
Immunofluorescent study
0.86
1.26
NA
0.05
2.17
NA
XXX88348
26
A
Electron microscopy
1.51
0.64
0.64
0.06
2.21
2.21
XXX88348
TC
A
Electron microscopy
0.00
8.74
NA
0.07
8.81
NA
XXX88348

A
Electron microscopy
1.51
9.38
NA
0.13
11.02
NA
XXX88349
26
A
Scanning electron microscopy
0.76
0.33
0.33
0.03
1.12
1.12
XXX88349
TC
A
Scanning electron microscopy
0.00
3.24
NA
0.06
3.30
NA
XXX88349

A
Scanning electron microscopy
0.76
3.57
NA
0.09
4.42
NA
XXX88355
26
A
Analysis, skeletal muscle
1.85
0.79
0.79
0.07
2.71
2.71
XXX88355
TC
A
Analysis, skeletal muscle
0.00
8.00
NA
0.06
8.06
NA
XXX88355

A
Analysis, skeletal muscle
1.85
8.79
NA
0.13
10.77
NA
XXX88356
26
A
Analysis, nerve
3.02
1.26
1.26
0.12
4.40
4.40
XXX( print page 70440)88356
TC
A
Analysis, nerve
0.00
2.93
NA
0.07
3.00
NA
XXX88356

A
Analysis, nerve
3.02
4.19
NA
0.19
7.40
NA
XXX88358
26
A
Analysis, tumor
0.95
0.40
0.40
0.10
1.45
1.45
XXX88358
TC
A
Analysis, tumor
0.00
0.44
NA
0.07
0.51
NA
XXX88358

A
Analysis, tumor
0.95
0.84
NA
0.17
1.96
NA
XXX88360
26
A
Tumor immunohistochem/manual
1.10
0.47
0.47
0.06
1.63
1.63
XXX88360
TC
A
Tumor immunohistochem/manual
0.00
1.26
NA
0.02
1.28
NA
XXX88360

A
Tumor immunohistochem/manual
1.10
1.73
NA
0.08
2.91
NA
XXX88361
26
A
Tumor immunohistochem/comput
1.18
0.49
0.49
0.10
1.77
1.77
XXX88361
TC
A
Tumor immunohistochem/comput
0.00
2.54
NA
0.07
2.61
NA
XXX88361

A
Tumor immunohistochem/comput
1.18
3.03
NA
0.17
4.38
NA
XXX88362
26
A
Nerve teasing preparations
2.17
0.92
0.92
0.09
3.18
3.18
XXX88362
TC
A
Nerve teasing preparations
0.00
3.78
NA
0.06
3.84
NA
XXX88362

A
Nerve teasing preparations
2.17
4.70
NA
0.15
7.02
NA
XXX88365
26
A
Insitu hybridization (fish)
1.20
0.51
0.51
0.03
1.74
1.74
XXX88365
TC
A
Insitu hybridization (fish)
0.00
1.62
NA
0.02
1.64
NA
XXX88365

A
Insitu hybridization (fish)
1.20
2.13
NA
0.05
3.38
NA
XXX88367
26
A
Insitu hybridization, auto
1.30
0.54
0.54
0.06
1.90
1.90
XXX88367
TC
A
Insitu hybridization, auto
0.00
3.50
NA
0.06
3.56
NA
XXX88367

A
Insitu hybridization, auto
1.30
4.04
NA
0.12
5.46
NA
XXX88368
26
A
Insitu hybridization, manual
1.40
0.60
0.60
0.06
2.06
2.06
XXX88368
TC
A
Insitu hybridization, manual
0.00
1.80
NA
0.06
1.86
NA
XXX88368

A
Insitu hybridization, manual
1.40
2.40
NA
0.12
3.92
NA
XXX88371
26
A
Protein, western blot tissue
0.37
0.13
0.13
0.01
0.51
0.51
XXX88372
26
A
Protein analysis w/probe
0.37
0.16
0.16
0.01
0.54
0.54
XXX88380
26
C
Microdissection
0.00
0.00
0.00
0.00
0.00
0.00
XXX88380
TC
C
Microdissection
0.00
0.00
0.00
0.00
0.00
0.00
XXX88380

C
Microdissection
0.00
0.00
0.00
0.00
0.00
0.00
XXX88384
26
C
Eval molecular probes, 11-50
0.00
0.00
0.00
0.00
0.00
0.00
XXX88384
TC
C
Eval molecular probes, 11-50
0.00
0.00
0.00
0.00
0.00
0.00
XXX88384

C
Eval molecular probes, 11-50
0.00
0.00
0.00
0.00
0.00
0.00
XXX88385
26
A
Eval molecul probes, 51-250
1.50
0.65
0.65
0.06
2.21
2.21
XXX88385
TC
C
Eval molecul probes, 51-250
0.00
0.00
0.00
0.00
0.00
0.00
XXX88385

C
Eval molecul probes, 51-250
0.00
0.00
0.00
0.00
0.00
0.00
XXX88386
26
A
Eval molecul probes, 251-500
1.88
0.82
0.82
0.08
2.78
2.78
XXX88386
TC
C
Eval molecul probes, 251-500
0.00
0.00
0.00
0.00
0.00
0.00
XXX88386

C
Eval molecul probes, 251-500
0.00
0.00
0.00
0.00
0.00
0.00
XXX88399
26
C
Surgical pathology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX88399
TC
C
Surgical pathology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX88399

C
Surgical pathology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX89049

A
Chct for mal hyperthermia
1.40
3.56
0.27
0.06
5.02
1.73
XXX89060
26
A
Exam,synovial fluid crystals
0.37
0.16
0.16
0.01
0.54
0.54
XXX89100

A
Sample intestinal contents
0.60
1.84
0.21
0.03
2.47
0.84
XXX89105

A
Sample intestinal contents
0.50
2.23
0.17
0.02
2.75
0.69
XXX89130

A
Sample stomach contents
0.45
1.75
0.13
0.02
2.22
0.60
XXX89132

A
Sample stomach contents
0.19
1.55
0.06
0.01
1.75
0.26
XXX89135

A
Sample stomach contents
0.79
1.90
0.25
0.04
2.73
1.08
XXX89136

A
Sample stomach contents
0.21
1.74
0.09
0.01
1.96
0.31
XXX89140

A
Sample stomach contents
0.94
2.09
0.27
0.04
3.07
1.25
XXX89141

A
Sample stomach contents
0.85
2.80
0.33
0.03
3.68
1.21
XXX89220

A
Sputum specimen collection
0.00
0.43
NA
0.02
0.45
NA
XXX89230

A
Collect sweat for test
0.00
0.11
NA
0.02
0.13
NA
XXX89240

C
Pathology lab procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX90281

I
Human ig, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90283

I
Human ig, iv
0.00
0.00
0.00
0.00
0.00
0.00
XXX90287

I
Botulinum antitoxin
0.00
0.00
0.00
0.00
0.00
0.00
XXX90288

I
Botulism ig, iv
0.00
0.00
0.00
0.00
0.00
0.00
XXX90291

I
Cmv ig, iv
0.00
0.00
0.00
0.00
0.00
0.00
XXX90296

E
Diphtheria antitoxin
0.00
0.00
0.00
0.00
0.00
0.00
XXX90371

E
Hep b ig, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90375

E
Rabies ig, im/sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90376

E
Rabies ig, heat treated
0.00
0.00
0.00
0.00
0.00
0.00
XXX90378

X
Rsv ig, im, 50mg
0.00
0.00
0.00
0.00
0.00
0.00
XXX90379

I
Rsv ig, iv
0.00
0.00
0.00
0.00
0.00
0.00
XXX90384

I
Rh ig, full-dose, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90385

E
Rh ig, minidose, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90386

I
Rh ig, iv
0.00
0.00
0.00
0.00
0.00
0.00
XXX90389

I
Tetanus ig, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90393

E
Vaccina ig, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90396

E
Varicella-zoster ig, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90399

I
Immune globulin
0.00
0.00
0.00
0.00
0.00
0.00
XXX90465

A
Immune admin 1 inj, < 8 yrs
0.17
0.31
NA
0.01
0.49
NA
XXX90466

A
Immune admin addl inj, < 8 y
0.15
0.13
NA
0.01
0.29
NA
ZZZ90467

R
Immune admin o or n, < 8 yrs
0.17
0.17
0.09
0.01
0.35
0.27
XXX90468

R
Immune admin o/n, addl < 8 y
0.15
0.11
0.06
0.01
0.27
0.22
ZZZ( print page 70441)90471

A
Immunization admin
0.17
0.31
NA
0.01
0.49
NA
XXX90472

A
Immunization admin, each add
0.15
0.13
NA
0.01
0.29
NA
ZZZ90473

R
Immune admin oral/nasal
0.17
0.19
0.07
0.01
0.37
0.25
XXX90474

R
Immune admin oral/nasal addl
0.15
0.10
0.06
0.01
0.26
0.22
ZZZ90476

E
Adenovirus vaccine, type 4
0.00
0.00
0.00
0.00
0.00
0.00
XXX90477

E
Adenovirus vaccine, type 7
0.00
0.00
0.00
0.00
0.00
0.00
XXX90581

E
Anthrax vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90585

E
Bcg vaccine, percut
0.00
0.00
0.00
0.00
0.00
0.00
XXX90586

E
Bcg vaccine, intravesical
0.00
0.00
0.00
0.00
0.00
0.00
XXX90632

E
Hep a vaccine, adult im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90633

E
Hep a vacc, ped/adol, 2 dose
0.00
0.00
0.00
0.00
0.00
0.00
XXX90634

E
Hep a vacc, ped/adol, 3 dose
0.00
0.00
0.00
0.00
0.00
0.00
XXX90636

E
Hep a/hep b vacc, adult im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90645

E
Hib vaccine, hboc, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90646

E
Hib vaccine, prp-d, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90647

E
Hib vaccine, prp-omp, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90648

E
Hib vaccine, prp-t, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90649

E
H papilloma vacc 3 dose im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90655

X
Flu vaccine no preserv 6-35m
0.00
0.00
0.00
0.00
0.00
0.00
XXX90656

X
Flu vaccine no preserv 3 & >
0.00
0.00
0.00
0.00
0.00
0.00
XXX90657

X
Flu vaccine, 6-35 mo, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90658

X
Flu vaccine age 3 & over, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90660

X
Flu vaccine, nasal
0.00
0.00
0.00
0.00
0.00
0.00
XXX90665

E
Lyme disease vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90669

N
Pneumococcal vacc, ped <5
0.00
0.00
0.00
0.00
0.00
0.00
XXX90675

E
Rabies vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90676

E
Rabies vaccine, id
0.00
0.00
0.00
0.00
0.00
0.00
XXX90680

E
Rotovirus vacc 3 dose, oral
0.00
0.00
0.00
0.00
0.00
0.00
XXX90690

E
Typhoid vaccine, oral
0.00
0.00
0.00
0.00
0.00
0.00
XXX90691

E
Typhoid vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90692

E
Typhoid vaccine, h-p, sc/id
0.00
0.00
0.00
0.00
0.00
0.00
XXX90693

E
Typhoid vaccine, akd, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90698

E
Dtap-hib-ip vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90700

E
Dtap vaccine, < 7 yrs, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90701

E
Dtp vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90702

E
Dt vaccine < 7, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90703

E
Tetanus vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90704

E
Mumps vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90705

E
Measles vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90706

E
Rubella vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90707

E
Mmr vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90708

E
Measles-rubella vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90710

E
Mmrv vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90712

E
Oral poliovirus vaccine
0.00
0.00
0.00
0.00
0.00
0.00
XXX90713

E
Poliovirus, ipv, sc/im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90714

E
Td vaccine no prsrv >/= 7 im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90715

E
Tdap vaccine >7 im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90716

E
Chicken pox vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90717

E
Yellow fever vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90718

E
Td vaccine > 7, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90719

E
Diphtheria vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90720

E
Dtp/hib vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90721

E
Dtap/hib vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90723

I
Dtap-hep b-ipv vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90725

E
Cholera vaccine, injectable
0.00
0.00
0.00
0.00
0.00
0.00
XXX90727

E
Plague vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90732

X
Pneumococcal vaccine
0.00
0.00
0.00
0.00
0.00
0.00
XXX90733

E
Meningococcal vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90734

E
Meningococcal vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90735

E
Encephalitis vaccine, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90736

E
Zoster vacc, sc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90740

X
Hepb vacc, ill pat 3 dose im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90743

X
Hep b vacc, adol, 2 dose, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90744

X
Hepb vacc ped/adol 3 dose im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90746

X
Hep b vaccine, adult, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90747

X
Hepb vacc, ill pat 4 dose im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90748

I
Hep b/hib vaccine, im
0.00
0.00
0.00
0.00
0.00
0.00
XXX90749

E
Vaccine toxoid
0.00
0.00
0.00
0.00
0.00
0.00
XXX90760

A
Hydration iv infusion, init
0.17
1.43
1.43
0.07
1.67
1.67
XXX90761

A
Hydrate iv infusion, add-on
0.09
0.40
0.40
0.04
0.53
0.53
ZZZ90765

A
Ther/proph/diag iv inf, init
0.21
1.76
1.76
0.07
2.04
2.04
XXX90766

A
Ther/proph/dg iv inf, add-on
0.18
0.46
0.46
0.04
0.68
0.68
ZZZ90767

A
Tx/proph/dg addl seq iv inf
0.19
0.89
0.89
0.04
1.12
1.12
ZZZ90768

A
Ther/diag concurrent inf
0.17
0.44
0.44
0.04
0.65
0.65
ZZZ90772

A
Ther/proph/diag inj, sc/im
0.17
0.31
0.31
0.01
0.49
0.49
XXX( print page 70442)90773

A
Ther/proph/diag inj, ia
0.17
0.32
0.32
0.02
0.51
0.51
XXX90774

A
Ther/proph/diag inj, iv push
0.18
1.30
1.30
0.04
1.52
1.52
XXX90775

A
Ther/proph/diag inj add-on
0.10
0.57
0.57
0.04
0.71
0.71
ZZZ90779

C
Ther/prop/diag inj/inf proc
0.00
0.00
0.00
0.00
0.00
0.00
XXX90801

A
Psy dx interview
2.80
1.17
0.93
0.06
4.03
3.79
XXX90802

A
Intac psy dx interview
3.01
1.20
0.98
0.07
4.28
4.06
XXX90804

A
Psytx, office, 20-30 min
1.21
0.49
0.38
0.03
1.73
1.62
XXX90805

A
Psytx, off, 20-30 min w/e&m
1.37
0.50
0.42
0.03
1.90
1.82
XXX90806

A
Psytx, off, 45-50 min
1.86
0.70
0.60
0.04
2.60
2.50
XXX90807

A
Psytx, off, 45-50 min w/e&m
2.02
0.70
0.63
0.05
2.77
2.70
XXX90808

A
Psytx, office, 75-80 min
2.79
1.03
0.90
0.06
3.88
3.75
XXX90809

A
Psytx, off, 75-80, w/e&m
2.95
1.00
0.92
0.07
4.02
3.94
XXX90810

A
Intac psytx, off, 20-30 min
1.32
0.51
0.42
0.04
1.87
1.78
XXX90811

A
Intac psytx, 20-30, w/e&m
1.48
0.57
0.46
0.04
2.09
1.98
XXX90812

A
Intac psytx, off, 45-50 min
1.97
0.79
0.64
0.04
2.80
2.65
XXX90813

A
Intac psytx, 45-50 min w/e&m
2.13
0.77
0.67
0.05
2.95
2.85
XXX90814

A
Intac psytx, off, 75-80 min
2.90
1.10
0.98
0.06
4.06
3.94
XXX90815

A
Intac psytx, 75-80 w/e&m
3.06
1.05
0.95
0.07
4.18
4.08
XXX90816

A
Psytx, hosp, 20-30 min
1.25
NA
0.46
0.03
NA
1.74
XXX90817

A
Psytx, hosp, 20-30 min w/e&m
1.41
NA
0.46
0.03
NA
1.90
XXX90818

A
Psytx, hosp, 45-50 min
1.89
NA
0.69
0.04
NA
2.62
XXX90819

A
Psytx, hosp, 45-50 min w/e&m
2.05
NA
0.65
0.05
NA
2.75
XXX90821

A
Psytx, hosp, 75-80 min
2.83
NA
1.01
0.06
NA
3.90
XXX90822

A
Psytx, hosp, 75-80 min w/e&m
2.99
NA
0.95
0.08
NA
4.02
XXX90823

A
Intac psytx, hosp, 20-30 min
1.36
NA
0.48
0.03
NA
1.87
XXX90824

A
Intac psytx, hsp 20-30 w/e&m
1.52
NA
0.49
0.04
NA
2.05
XXX90826

A
Intac psytx, hosp, 45-50 min
2.01
NA
0.72
0.05
NA
2.78
XXX90827

A
Intac psytx, hsp 45-50 w/e&m
2.16
NA
0.68
0.05
NA
2.89
XXX90828

A
Intac psytx, hosp, 75-80 min
2.94
NA
1.06
0.06
NA
4.06
XXX90829

A
Intac psytx, hsp 75-80 w/e&m
3.10
NA
0.98
0.07
NA
4.15
XXX90845

A
Psychoanalysis
1.79
0.58
0.55
0.04
2.41
2.38
XXX90846

R
Family psytx w/o patient
1.83
0.65
0.65
0.04
2.52
2.52
XXX90847

R
Family psytx w/patient
2.21
0.82
0.76
0.05
3.08
3.02
XXX90849

R
Multiple family group psytx
0.59
0.27
0.24
0.02
0.88
0.85
XXX90853

A
Group psychotherapy
0.59
0.25
0.23
0.01
0.85
0.83
XXX90857

A
Intac group psytx
0.63
0.29
0.25
0.01
0.93
0.89
XXX90862

A
Medication management
0.95
0.40
0.32
0.02
1.37
1.29
XXX90865

A
Narcosynthesis
2.84
1.36
0.91
0.12
4.32
3.87
XXX90870

A
Electroconvulsive therapy
1.88
1.94
0.59
0.04
3.86
2.51
00090875

N
Psychophysiological therapy
+1.20
0.90
0.46
0.04
2.14
1.70
XXX90876

N
Psychophysiological therapy
+1.90
1.16
0.73
0.05
3.11
2.68
XXX90880

A
Hypnotherapy
2.19
1.04
0.69
0.05
3.28
2.93
XXX90882

N
Environmental manipulation
0.00
0.00
0.00
0.00
0.00
0.00
XXX90885

B
Psy evaluation of records
+0.97
0.37
0.37
0.02
1.36
1.36
XXX90887

B
Consultation with family
+1.48
0.82
0.56
0.04
2.34
2.08
XXX90889

B
Preparation of report
0.00
0.00
0.00
0.00
0.00
0.00
XXX90899

C
Psychiatric service/therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXX90901

A
Biofeedback train, any meth
0.41
0.65
0.14
0.02
1.08
0.57
00090911

A
Biofeedback peri/uro/rectal
0.89
1.56
0.31
0.06
2.51
1.26
00090918

I
ESRD related services, month
+11.16
6.13
6.13
0.36
17.65
17.65
XXX90919

I
ESRD related services, month
+8.53
4.01
4.01
0.29
12.83
12.83
XXX90920

I
ESRD related services, month
+7.26
3.76
3.76
0.23
11.25
11.25
XXX90921

I
ESRD related services, month
+4.46
2.45
2.45
0.14
7.05
7.05
XXX90922

I
ESRD related services, day
+0.37
0.21
0.21
0.01
0.59
0.59
XXX90923

I
Esrd related services, day
+0.28
0.13
0.13
0.01
0.42
0.42
XXX90924

I
Esrd related services, day
+0.24
0.12
0.12
0.01
0.37
0.37
XXX90925

I
Esrd related services, day
+0.15
0.08
0.08
0.01
0.24
0.24
XXX90935

A
Hemodialysis, one evaluation
1.22
NA
0.67
0.04
NA
1.93
00090937

A
Hemodialysis, repeated eval
2.11
NA
0.97
0.07
NA
3.15
00090940

X
Hemodialysis access study
0.00
0.00
0.00
0.00
0.00
0.00
XXX90945

A
Dialysis, one evaluation
1.28
NA
0.69
0.04
NA
2.01
00090947

A
Dialysis, repeated eval
2.16
NA
0.99
0.07
NA
3.22
00090989

X
Dialysis training, complete
0.00
0.00
0.00
0.00
0.00
0.00
XXX90993

X
Dialysis training, incompl
0.00
0.00
0.00
0.00
0.00
0.00
XXX90997

A
Hemoperfusion
1.84
NA
0.66
0.06
NA
2.56
00090999

C
Dialysis procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX91000
26
A
Esophageal intubation
0.73
0.25
0.25
0.03
1.01
1.01
00091000
TC
A
Esophageal intubation
0.00
0.08
NA
0.01
0.09
NA
00091000

A
Esophageal intubation
0.73
0.33
NA
0.04
1.10
NA
00091010
26
A
Esophagus motility study
1.25
0.44
0.44
0.06
1.75
1.75
00091010
TC
A
Esophagus motility study
0.00
3.98
NA
0.06
4.04
NA
00091010

A
Esophagus motility study
1.25
4.42
NA
0.12
5.79
NA
00091011
26
A
Esophagus motility study
1.50
0.53
0.53
0.07
2.10
2.10
00091011
TC
A
Esophagus motility study
0.00
4.71
NA
0.06
4.77
NA
00091011

A
Esophagus motility study
1.50
5.24
NA
0.13
6.87
NA
000( print page 70443)91012
26
A
Esophagus motility study
1.46
0.51
0.51
0.06
2.03
2.03
00091012
TC
A
Esophagus motility study
0.00
5.26
NA
0.07
5.33
NA
00091012

A
Esophagus motility study
1.46
5.77
NA
0.13
7.36
NA
00091020
26
A
Gastric motility studies
1.44
0.49
0.49
0.07
2.00
2.00
00091020
TC
A
Gastric motility studies
0.00
4.04
NA
0.06
4.10
NA
00091020

A
Gastric motility studies
1.44
4.53
NA
0.13
6.10
NA
00091022
26
A
Duodenal motility study
1.44
0.51
0.51
0.07
2.02
2.02
00091022
TC
A
Duodenal motility study
0.00
3.90
NA
0.06
3.96
NA
00091022

A
Duodenal motility study
1.44
4.41
NA
0.13
5.98
NA
00091030
26
A
Acid perfusion of esophagus
0.91
0.32
0.32
0.04
1.27
1.27
00091030
TC
A
Acid perfusion of esophagus
0.00
2.12
NA
0.02
2.14
NA
00091030

A
Acid perfusion of esophagus
0.91
2.44
NA
0.06
3.41
NA
00091034
26
A
Gastroesophageal reflux test
0.97
0.34
0.34
0.06
1.37
1.37
00091034
TC
A
Gastroesophageal reflux test
0.00
4.91
NA
0.06
4.97
NA
00091034

A
Gastroesophageal reflux test
0.97
5.25
NA
0.12
6.34
NA
00091035
26
A
G-esoph reflx tst w/electrod
1.59
0.56
0.56
0.06
2.21
2.21
00091035
TC
A
G-esoph reflx tst w/electrod
0.00
10.27
NA
0.06
10.33
NA
00091035

A
G-esoph reflx tst w/electrod
1.59
10.83
NA
0.12
12.54
NA
00091037
26
A
Esoph imped function test
0.97
0.34
0.34
0.06
1.37
1.37
00091037
TC
A
Esoph imped function test
0.00
2.60
NA
0.06
2.66
NA
00091037

A
Esoph imped function test
0.97
2.94
NA
0.12
4.03
NA
00091038
26
A
Esoph imped funct test > 1h
1.10
0.39
0.39
0.06
1.55
1.55
00091038
TC
A
Esoph imped funct test > 1h
0.00
1.84
NA
0.06
1.90
NA
00091038

A
Esoph imped funct test > 1h
1.10
2.23
NA
0.12
3.45
NA
00091040
26
A
Esoph balloon distension tst
0.97
0.34
0.34
0.06
1.37
1.37
00091040
TC
A
Esoph balloon distension tst
0.00
10.82
NA
0.06
10.88
NA
00091040

A
Esoph balloon distension tst
0.97
11.16
NA
0.12
12.25
NA
00091052
26
A
Gastric analysis test
0.79
0.28
0.28
0.03
1.10
1.10
00091052
TC
A
Gastric analysis test
0.00
2.18
NA
0.02
2.20
NA
00091052

A
Gastric analysis test
0.79
2.46
NA
0.05
3.30
NA
00091055
26
A
Gastric intubation for smear
0.94
0.27
0.27
0.05
1.26
1.26
00091055
TC
A
Gastric intubation for smear
0.00
2.68
NA
0.02
2.70
NA
00091055

A
Gastric intubation for smear
0.94
2.95
NA
0.07
3.96
NA
00091060
26
A
Gastric saline load test
0.45
0.14
0.14
0.03
0.62
0.62
00091060
TC
A
Gastric saline load test
0.00
1.83
NA
0.02
1.85
NA
00091060

A
Gastric saline load test
0.45
1.97
NA
0.05
2.47
NA
00091065
26
A
Breath hydrogen test
0.20
0.07
0.07
0.01
0.28
0.28
00091065
TC
A
Breath hydrogen test
0.00
1.39
NA
0.02
1.41
NA
00091065

A
Breath hydrogen test
0.20
1.46
NA
0.03
1.69
NA
00091100

A
Pass intestine bleeding tube
1.08
2.80
0.28
0.07
3.95
1.43
00091105

A
Gastric intubation treatment
0.37
2.11
0.09
0.03
2.51
0.49
00091110
26
A
Gi tract capsule endoscopy
3.64
1.28
1.28
0.09
5.01
5.01
XXX91110
TC
A
Gi tract capsule endoscopy
0.00
20.96
NA
0.07
21.03
NA
XXX91110

A
Gi tract capsule endoscopy
3.64
22.24
NA
0.16
26.04
NA
XXX91120
26
A
Rectal sensation test
0.97
0.34
0.34
0.07
1.38
1.38
XXX91120
TC
A
Rectal sensation test
0.00
10.67
NA
0.04
10.71
NA
XXX91120

A
Rectal sensation test
0.97
11.01
NA
0.11
12.09
NA
XXX91122
26
A
Anal pressure record
1.77
0.60
0.60
0.13
2.50
2.50
00091122
TC
A
Anal pressure record
0.00
4.51
NA
0.08
4.59
NA
00091122

A
Anal pressure record
1.77
5.11
NA
0.21
7.09
NA
00091123

B
Irrigate fecal impaction
0.00
0.00
0.00
0.00
0.00
0.00
XXX91132
26
A
Electrogastrography
0.52
0.18
0.18
0.02
0.72
0.72
XXX91132
TC
C
Electrogastrography
0.00
0.00
0.00
0.00
0.00
0.00
XXX91132

C
Electrogastrography
0.00
0.00
0.00
0.00
0.00
0.00
XXX91133
26
A
Electrogastrography w/test
0.66
0.23
0.23
0.03
0.92
0.92
XXX91133
TC
C
Electrogastrography w/test
0.00
0.00
0.00
0.00
0.00
0.00
XXX91133

C
Electrogastrography w/test
0.00
0.00
0.00
0.00
0.00
0.00
XXX91299
26
C
Gastroenterology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX91299
TC
C
Gastroenterology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX91299

C
Gastroenterology procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX92002

A
Eye exam, new patient
0.88
0.97
0.34
0.02
1.87
1.24
XXX92004

A
Eye exam, new patient
1.67
1.70
0.68
0.04
3.41
2.39
XXX92012

A
Eye exam established pat
0.67
1.03
0.29
0.02
1.72
0.98
XXX92014

A
Eye exam & treatment
1.10
1.41
0.47
0.03
2.54
1.60
XXX92015

N
Refraction
+0.38
1.49
0.15
0.01
1.88
0.54
XXX92018

A
New eye exam & treatment
2.50
NA
1.07
0.07
NA
3.64
XXX92019

A
Eye exam & treatment
1.31
NA
0.56
0.03
NA
1.90
XXX92020

A
Special eye evaluation
0.37
0.34
0.16
0.01
0.72
0.54
XXX92060
26
A
Special eye evaluation
0.69
0.29
0.29
0.02
1.00
1.00
XXX92060
TC
A
Special eye evaluation
0.00
0.44
NA
0.01
0.45
NA
XXX92060

A
Special eye evaluation
0.69
0.73
NA
0.03
1.45
NA
XXX92065
26
A
Orthoptic/pleoptic training
0.37
0.15
0.15
0.01
0.53
0.53
XXX92065
TC
A
Orthoptic/pleoptic training
0.00
0.38
NA
0.01
0.39
NA
XXX92065

A
Orthoptic/pleoptic training
0.37
0.53
NA
0.02
0.92
NA
XXX92070

A
Fitting of contact lens
0.70
1.07
0.32
0.02
1.79
1.04
XXX( print page 70444)92081
26
A
Visual field examination(s)
0.36
0.15
0.15
0.01
0.52
0.52
XXX92081
TC
A
Visual field examination(s)
0.00
0.79
NA
0.01
0.80
NA
XXX92081

A
Visual field examination(s)
0.36
0.94
NA
0.02
1.32
NA
XXX92082
26
A
Visual field examination(s)
0.44
0.19
0.19
0.01
0.64
0.64
XXX92082
TC
A
Visual field examination(s)
0.00
1.04
NA
0.01
1.05
NA
XXX92082

A
Visual field examination(s)
0.44
1.23
NA
0.02
1.69
NA
XXX92083
26
A
Visual field examination(s)
0.50
0.22
0.22
0.01
0.73
0.73
XXX92083
TC
A
Visual field examination(s)
0.00
1.21
NA
0.01
1.22
NA
XXX92083

A
Visual field examination(s)
0.50
1.43
NA
0.02
1.95
NA
XXX92100
A

Serial tonometry exam(s)
0.92
1.35
0.36
0.02
2.29
1.30
XXX92120

A
Tonography & eye evaluation
0.81
1.07
0.32
0.02
1.90
1.15
XXX92130

A
Water provocation tonography
0.81
1.28
0.37
0.02
2.11
1.20
XXX92135
26
A
Opthalmic dx imaging
0.35
0.15
0.15
0.01
0.51
0.51
XXX92135
TC
A
Opthalmic dx imaging
0.00
0.64
NA
0.01
0.65
NA
XXX92135

A
Opthalmic dx imaging
0.35
0.79
NA
0.02
1.16
NA
XXX92136
26
A
Ophthalmic biometry
0.54
0.24
0.24
0.01
0.79
0.79
XXX92136
TC
A
Ophthalmic biometry
0.00
1.41
NA
0.07
1.48
NA
XXX92136

A
Ophthalmic biometry
0.54
1.65
NA
0.08
2.27
NA
XXX92140

A
Glaucoma provocative tests
0.50
0.99
0.21
0.01
1.50
0.72
XXX92225

A
Special eye exam, initial
0.38
0.22
0.16
0.01
0.61
0.55
XXX92226

A
Special eye exam, subsequent
0.33
0.21
0.14
0.01
0.55
0.48
XXX92230

A
Eye exam with photos
0.60
1.53
0.20
0.02
2.15
0.82
XXX92235
26
A
Eye exam with photos
0.81
0.37
0.37
0.02
1.20
1.20
XXX92235
TC
A
Eye exam with photos
0.00
2.25
NA
0.06
2.31
NA
XXX92235

A
Eye exam with photos
0.81
2.62
NA
0.08
3.51
NA
XXX92240
26
A
Icg angiography
1.10
0.50
0.50
0.03
1.63
1.63
XXX92240
TC
A
Icg angiography
0.00
5.62
NA
0.06
5.68
NA
XXX92240

A
Icg angiography
1.10
6.12
NA
0.09
7.31
NA
XXX92250
26
A
Eye exam with photos
0.44
0.19
0.19
0.01
0.64
0.64
XXX92250
TC
A
Eye exam with photos
0.00
1.34
NA
0.01
1.35
NA
XXX92250

A
Eye exam with photos
0.44
1.53
NA
0.02
1.99
NA
XXX92260

A
Ophthalmoscopy/dynamometry
0.20
0.26
0.09
0.01
0.47
0.30
XXX92265
26
A
Eye muscle evaluation
0.81
0.28
0.28
0.04
1.13
1.13
XXX92265
TC
A
Eye muscle evaluation
0.00
1.21
NA
0.02
1.23
NA
XXX92265

A
Eye muscle evaluation
0.81
1.49
NA
0.06
2.36
NA
XXX92270
26
A
Electro-oculography
0.81
0.33
0.33
0.03
1.17
1.17
XXX92270
TC
A
Electro-oculography
0.00
1.20
NA
0.02
1.22
NA
XXX92270

A
Electro-oculography
0.81
1.53
NA
0.05
2.39
NA
XXX92275
26
A
Electroretinography
1.01
0.43
0.43
0.03
1.47
1.47
XXX92275
TC
A
Electroretinography
0.00
1.51
NA
0.02
1.53
NA
XXX92275

A
Electroretinography
1.01
1.94
NA
0.05
3.00
NA
XXX92283
26
A
Color vision examination
0.17
0.07
0.07
0.01
0.25
0.25
XXX92283
TC
A
Color vision examination
0.00
0.77
NA
0.01
0.78
NA
XXX92283

A
Color vision examination
0.17
0.84
NA
0.02
1.03
NA
XXX92284
26
A
Dark adaptation eye exam
0.24
0.08
0.08
0.01
0.33
0.33
XXX92284
TC
A
Dark adaptation eye exam
0.00
1.81
NA
0.01
1.82
NA
XXX92284

A
Dark adaptation eye exam
0.24
1.89
NA
0.02
2.15
NA
XXX92285
26
A
Eye photography
0.20
0.09
0.09
0.01
0.30
0.30
XXX92285
TC
A
Eye photography
0.00
0.90
NA
0.01
0.91
NA
XXX92285

A
Eye photography
0.20
0.99
NA
0.02
1.21
NA
XXX92286
26
A
Internal eye photography
0.66
0.29
0.29
0.02
0.97
0.97
XXX92286
TC
A
Internal eye photography
0.00
2.77
NA
0.02
2.79
NA
XXX92286

A
Internal eye photography
0.66
3.06
NA
0.04
3.76
NA
XXX92287

A
Internal eye photography
0.81
2.39
0.31
0.02
3.22
1.14
XXX92310

N
Contact lens fitting
+1.17
1.12
0.45
0.04
2.33
1.66
XXX92311

A
Contact lens fitting
1.08
1.09
0.35
0.03
2.20
1.46
XXX92312

A
Contact lens fitting
1.26
1.08
0.50
0.03
2.37
1.79
XXX92313

A
Contact lens fitting
0.92
1.06
0.29
0.02
2.00
1.23
XXX92314

N
Prescription of contact lens
+0.69
0.94
0.27
0.01
1.64
0.97
XXX92315

A
Prescription of contact lens
0.45
0.85
0.16
0.01
1.31
0.62
XXX92316

A
Prescription of contact lens
0.68
0.91
0.29
0.02
1.61
0.99
XXX92317

A
Prescription of contact lens
0.45
0.94
0.15
0.01
1.40
0.61
XXX92325

A
Modification of contact lens
0.00
0.40
NA
0.01
0.41
NA
XXX92326

A
Replacement of contact lens
0.00
1.63
NA
0.06
1.69
NA
XXX92340

N
Fitting of spectacles
+0.37
0.70
0.14
0.01
1.08
0.52
XXX92341

N
Fitting of spectacles
+0.47
0.74
0.18
0.01
1.22
0.66
XXX92342

N
Fitting of spectacles
+0.53
0.76
0.21
0.01
1.30
0.75
XXX92352

B
Special spectacles fitting
+0.37
0.68
0.14
0.01
1.06
0.52
XXX92353

B
Special spectacles fitting
+0.50
0.73
0.19
0.02
1.25
0.71
XXX92354

B
Special spectacles fitting
+0.00
8.89
NA
0.10
8.99
NA
XXX92355

B
Special spectacles fitting
+0.00
4.34
NA
0.01
4.35
NA
XXX92358

B
Eye prosthesis service
+0.00
0.97
NA
0.05
1.02
NA
XXX92370

N
Repair & adjust spectacles
+0.32
0.55
0.13
0.02
0.89
0.47
XXX92371

B
Repair & adjust spectacles
+0.00
0.62
NA
0.02
0.64
NA
XXX92499
26
C
Eye service or procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70445)92499
TC
C
Eye service or procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX92499

C
Eye service or procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX92502

A
Ear and throat examination
1.51
NA
1.11
0.05
NA
2.67
00092504

A
Ear microscopy examination
0.18
0.50
0.09
0.01
0.69
0.28
XXX92506

A
Speech/hearing evaluation
0.86
2.60
0.40
0.03
3.49
1.29
XXX92507

A
Speech/hearing therapy
0.52
1.11
0.23
0.02
1.65
0.77
XXX92508

A
Speech/hearing therapy
0.26
0.51
0.12
0.01
0.78
0.39
XXX92511

A
Nasopharyngoscopy
0.84
3.32
0.78
0.03
4.19
1.65
00092512

A
Nasal function studies
0.55
1.14
0.18
0.02
1.71
0.75
XXX92516

A
Facial nerve function test
0.43
1.20
0.22
0.01
1.64
0.66
XXX92520

A
Laryngeal function studies
0.75
0.51
0.39
0.03
1.29
1.17
XXX92526

A
Oral function therapy
0.55
1.64
0.20
0.02
2.21
0.77
XXX92531

B
Spontaneous nystagmus study
0.00
0.00
0.00
0.00
0.00
0.00
XXX92532

B
Positional nystagmus test
0.00
0.00
0.00
0.00
0.00
0.00
XXX92533

B
Caloric vestibular test
0.00
0.00
0.00
0.00
0.00
0.00
XXX92534

B
Optokinetic nystagmus test
0.00
0.00
0.00
0.00
0.00
0.00
XXX92541
26
A
Spontaneous nystagmus test
0.40
0.19
0.19
0.02
0.61
0.61
XXX92541
TC
A
Spontaneous nystagmus test
0.00
0.84
NA
0.02
0.86
NA
XXX92541

A
Spontaneous nystagmus test
0.40
1.03
NA
0.04
1.47
NA
XXX92542
26
A
Positional nystagmus test
0.33
0.16
0.16
0.01
0.50
0.50
XXX92542
TC
A
Positional nystagmus test
0.00
0.98
NA
0.02
1.00
NA
XXX92542

A
Positional nystagmus test
0.33
1.14
NA
0.03
1.50
NA
XXX92543
26
A
Caloric vestibular test
0.10
0.05
0.05
0.01
0.16
0.16
XXX92543
TC
A
Caloric vestibular test
0.00
0.52
NA
0.01
0.53
NA
XXX92543

A
Caloric vestibular test
0.10
0.57
NA
0.02
0.69
NA
XXX92544
26
A
Optokinetic nystagmus test
0.26
0.12
0.12
0.01
0.39
0.39
XXX92544
TC
A
Optokinetic nystagmus test
0.00
0.78
NA
0.02
0.80
NA
XXX92544

A
Optokinetic nystagmus test
0.26
0.90
NA
0.03
1.19
NA
XXX92545
26
A
Oscillating tracking test
0.23
0.11
0.11
0.01
0.35
0.35
XXX92545
TC
A
Oscillating tracking test
0.00
0.69
NA
0.02
0.71
NA
XXX92545

A
Oscillating tracking test
0.23
0.80
NA
0.03
1.06
NA
XXX92546
26
A
Sinusoidal rotational test
0.29
0.13
0.13
0.01
0.43
0.43
XXX92546
TC
A
Sinusoidal rotational test
0.00
1.86
NA
0.02
1.88
NA
XXX92546

A
Sinusoidal rotational test
0.29
1.99
NA
0.03
2.31
NA
XXX92547

A
Supplemental electrical test
0.00
0.08
NA
0.06
0.14
NA
ZZZ92548
26
A
Posturography
0.50
0.26
0.26
0.02
0.78
0.78
XXX92548
TC
A
Posturography
0.00
2.00
NA
0.13
2.13
NA
XXX92548

A
Posturography
0.50
2.26
NA
0.15
2.91
NA
XXX92551

N
Pure tone hearing test, air
0.00
0.00
0.00
0.00
0.00
0.00
XXX92552

A
Pure tone audiometry, air
0.00
0.44
NA
0.04
0.48
NA
XXX92553

A
Audiometry, air & bone
0.00
0.66
NA
0.06
0.72
NA
XXX92555

A
Speech threshold audiometry
0.00
0.38
NA
0.04
0.42
NA
XXX92556

A
Speech audiometry, complete
0.00
0.57
NA
0.06
0.63
NA
XXX92557

A
Comprehensive hearing test
0.00
1.19
NA
0.12
1.31
NA
XXX92559

N
Group audiometric testing
0.00
0.00
0.00
0.00
0.00
0.00
XXX92560

N
Bekesy audiometry, screen
0.00
0.00
0.00
0.00
0.00
0.00
XXX92561

A
Bekesy audiometry, diagnosis
0.00
0.72
NA
0.06
0.78
NA
XXX92562

A
Loudness balance test
0.00
0.41
NA
0.04
0.45
NA
XXX92563

A
Tone decay hearing test
0.00
0.38
NA
0.04
0.42
NA
XXX92564

A
Sisi hearing test
0.00
0.47
NA
0.05
0.52
NA
XXX92565

A
Stenger test, pure tone
0.00
0.40
NA
0.04
0.44
NA
XXX92567

A
Tympanometry
0.00
0.52
NA
0.06
0.58
NA
XXX92568

A
Acoustic refl threshold tst
0.00
0.38
NA
0.04
0.42
NA
XXX92569

A
Acoustic reflex decay test
0.00
0.41
NA
0.04
0.45
NA
XXX92571

A
Filtered speech hearing test
0.00
0.39
NA
0.04
0.43
NA
XXX92572

A
Staggered spondaic word test
0.00
0.09
NA
0.01
0.10
NA
XXX92573

A
Lombard test
0.00
0.35
NA
0.04
0.39
NA
XXX92575

A
Sensorineural acuity test
0.00
0.30
NA
0.02
0.32
NA
XXX92576

A
Synthetic sentence test
0.00
0.44
NA
0.05
0.49
NA
XXX92577

A
Stenger test, speech
0.00
0.72
NA
0.07
0.79
NA
XXX92579

A
Visual audiometry (vra)
0.00
0.73
NA
0.06
0.79
NA
XXX92582

A
Conditioning play audiometry
0.00
0.73
NA
0.06
0.79
NA
XXX92583

A
Select picture audiometry
0.00
0.89
NA
0.08
0.97
NA
XXX92584

A
Electrocochleography
0.00
2.48
NA
0.21
2.69
NA
XXX92585
26
A
Auditor evoke potent, compre
0.50
0.21
0.21
0.03
0.74
0.74
XXX92585
TC
A
Auditor evoke potent, compre
0.00
1.86
NA
0.14
2.00
NA
XXX92585

A
Auditor evoke potent, compre
0.50
2.07
NA
0.17
2.74
NA
XXX92586

A
Auditor evoke potent, limit
0.00
1.86
NA
0.14
2.00
NA
XXX92587
26
A
Evoked auditory test
0.13
0.06
0.06
0.01
0.20
0.20
XXX92587
TC
A
Evoked auditory test
0.00
1.31
NA
0.11
1.42
NA
XXX92587

A
Evoked auditory test
0.13
1.37
NA
0.12
1.62
NA
XXX92588
26
A
Evoked auditory test
0.36
0.16
0.16
0.01
0.53
0.53
XXX92588
TC
A
Evoked auditory test
0.00
1.47
NA
0.13
1.60
NA
XXX92588

A
Evoked auditory test
0.36
1.63
NA
0.14
2.13
NA
XXX92590

N
Hearing aid exam, one ear
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70446)92591

N
Hearing aid exam, both ears
0.00
0.00
0.00
0.00
0.00
0.00
XXX92592

N
Hearing aid check, one ear
0.00
0.00
0.00
0.00
0.00
0.00
XXX92593

N
Hearing aid check, both ears
0.00
0.00
0.00
0.00
0.00
0.00
XXX92594

N
Electro hearng aid test, one
0.00
0.00
0.00
0.00
0.00
0.00
XXX92595

N
Electro hearng aid tst, both
0.00
0.00
0.00
0.00
0.00
0.00
XXX92596

A
Ear protector evaluation
0.00
0.59
NA
0.06
0.65
NA
XXX92597

A
Oral speech device eval
0.86
1.69
0.45
0.03
2.58
1.34
XXX92601

A
Cochlear implt f/up exam < 7
0.00
3.51
NA
0.07
3.58
NA
XXX92602

A
Reprogram cochlear implt < 7
0.00
2.39
NA
0.07
2.46
NA
XXX92603

A
Cochlear implt f/up exam 7 >
0.00
2.15
NA
0.07
2.22
NA
XXX92604

A
Reprogram cochlear implt 7 >
0.00
1.35
NA
0.07
1.42
NA
XXX92605

B
Eval for nonspeech device rx
0.00
0.00
0.00
0.00
0.00
0.00
XXX92606

B
Non-speech device service
0.00
0.00
0.00
0.00
0.00
0.00
XXX92607

A
Ex for speech device rx, 1hr
0.00
3.09
NA
0.05
3.14
NA
XXX92608

A
Ex for speech device rx addl
0.00
0.55
NA
0.05
0.60
NA
XXX92609

A
Use of speech device service
0.00
1.59
NA
0.04
1.63
NA
XXX92610

A
Evaluate swallowing function
0.00
3.44
NA
0.08
3.52
NA
XXX92611

A
Motion fluoroscopy/swallow
0.00
3.44
NA
0.08
3.52
NA
XXX92612

A
Endoscopy swallow tst (fees)
1.27
2.75
0.66
0.04
4.06
1.97
XXX92613

A
Endoscopy swallow tst (fees)
0.71
0.40
0.39
0.05
1.16
1.15
XXX92614

A
Laryngoscopic sensory test
1.27
2.51
0.66
0.04
3.82
1.97
XXX92615

A
Eval laryngoscopy sense tst
0.63
0.35
0.35
0.05
1.03
1.03
XXX92616

A
Fees w/laryngeal sense test
1.88
3.40
0.99
0.06
5.34
2.93
XXX92617

A
Interprt fees/laryngeal test
0.79
0.44
0.44
0.05
1.28
1.28
XXX92620

A
Auditory function, 60 min
0.00
1.14
NA
0.06
1.20
NA
XXX92621

A
Auditory function, + 15 min
0.00
0.25
NA
0.06
0.31
NA
ZZZ92625

A
Tinnitus assessment
0.00
1.12
NA
0.06
1.18
NA
XXX92626

A
Eval aud rehab status
0.00
0.55
NA
0.06
0.61
NA
XXX92627

A
Eval aud status rehab add-on
0.00
0.55
NA
0.06
0.61
NA
XXX92630

I
Aud rehab pre-ling hear loss
0.00
0.00
0.00
0.00
0.00
0.00
XXX92633

I
Aud rehab postling hear loss
0.00
0.00
0.00
0.00
0.00
0.00
XXX92700

C
Ent procedure/service
0.00
0.00
0.00
0.00
0.00
0.00
XXX92950

A
Heart/lung resuscitation cpr
3.79
4.21
0.97
0.28
8.28
5.04
00092953

A
Temporary external pacing
0.23
NA
0.07
0.02
NA
0.32
00092960

A
Cardioversion electric, ext
2.25
6.33
1.17
0.07
8.65
3.49
00092961

A
Cardioversion, electric, int
4.59
NA
2.09
0.29
NA
6.97
00092970

A
Cardioassist, internal
3.51
NA
1.06
0.16
NA
4.73
00092971

A
Cardioassist, external
1.77
NA
0.85
0.06
NA
2.68
00092973

A
Percut coronary thrombectomy
3.28
NA
1.29
0.23
NA
4.80
ZZZ92974

A
Cath place, cardio brachytx
3.00
NA
1.18
0.21
NA
4.39
ZZZ92975

A
Dissolve clot, heart vessel
7.24
NA
2.82
0.50
NA
10.56
00092977

A
Dissolve clot, heart vessel
0.00
8.07
NA
0.46
8.53
NA
XXX92978
26
A
Intravasc us, heart add-on
1.80
0.71
0.71
0.06
2.57
2.57
ZZZ92978
TC
A
Intravasc us, heart add-on
0.00
4.57
NA
0.24
4.81
NA
ZZZ92978

A
Intravasc us, heart add-on
1.80
5.28
NA
0.30
7.38
NA
ZZZ92979
26
A
Intravasc us, heart add-on
1.44
0.56
0.56
0.06
2.06
2.06
ZZZ92979
TC
A
Intravasc us, heart add-on
0.00
2.30
NA
0.13
2.43
NA
ZZZ92979

A
Intravasc us, heart add-on
1.44
2.86
NA
0.19
4.49
NA
ZZZ92980

A
Insert intracoronary stent
14.82
NA
6.07
1.03
NA
21.92
00092981

A
Insert intracoronary stent
4.16
NA
1.63
0.29
NA
6.08
ZZZ92982

A
Coronary artery dilation
10.96
NA
4.54
0.76
NA
16.26
00092984

A
Coronary artery dilation
2.97
NA
1.16
0.21
NA
4.34
ZZZ92986

A
Revision of aortic valve
21.77
NA
11.86
1.51
NA
35.14
09092987

A
Revision of mitral valve
22.67
NA
12.25
1.59
NA
36.51
09092990

A
Revision of pulmonary valve
17.31
NA
9.82
1.20
NA
28.33
09092992

C
Revision of heart chamber
0.00
0.00
0.00
0.00
0.00
0.00
09092993

C
Revision of heart chamber
0.00
0.00
0.00
0.00
0.00
0.00
09092995

A
Coronary atherectomy
12.07
NA
4.97
0.84
NA
17.88
00092996

A
Coronary atherectomy add-on
3.26
NA
1.27
0.10
NA
4.63
ZZZ92997

A
Pul art balloon repr, percut
11.98
NA
4.83
0.40
NA
17.21
00092998

A
Pul art balloon repr, percut
5.99
NA
2.21
0.28
NA
8.48
ZZZ93000

A
Electrocardiogram, complete
0.17
0.51
NA
0.03
0.71
NA
XXX93005

A
Electrocardiogram, tracing
0.00
0.45
NA
0.02
0.47
NA
XXX93010

A
Electrocardiogram report
0.17
0.06
0.06
0.01
0.24
0.24
XXX93012

A
Transmission of ecg
0.00
6.03
NA
0.18
6.21
NA
XXX93014

A
Report on transmitted ecg
0.52
0.19
0.19
0.02
0.73
0.73
XXX93015

A
Cardiovascular stress test
0.75
1.96
NA
0.14
2.85
NA
XXX93016

A
Cardiovascular stress test
0.45
0.17
0.17
0.02
0.64
0.64
XXX93017

A
Cardiovascular stress test
0.00
1.68
NA
0.11
1.79
NA
XXX93018

A
Cardiovascular stress test
0.30
0.11
0.11
0.01
0.42
0.42
XXX93024
26
A
Cardiac drug stress test
1.17
0.45
0.45
0.04
1.66
1.66
XXX93024
TC
A
Cardiac drug stress test
0.00
1.12
NA
0.08
1.20
NA
XXX93024

A
Cardiac drug stress test
1.17
1.57
NA
0.12
2.86
NA
XXX93025
26
A
Microvolt t-wave assess
0.75
0.29
0.29
0.03
1.07
1.07
XXX93025
TC
A
Microvolt t-wave assess
0.00
7.32
NA
0.11
7.43
NA
XXX( print page 70447)93025

A
Microvolt t-wave assess
0.75
7.61
NA
0.14
8.50
NA
XXX93040

A
Rhythm ECG with report
0.16
0.20
NA
0.02
0.38
NA
XXX93041

A
Rhythm ECG, tracing
0.00
0.15
NA
0.01
0.16
NA
XXX93042

A
Rhythm ECG, report
0.16
0.05
0.05
0.01
0.22
0.22
XXX93224

A
ECG monitor/report, 24 hrs
0.52
3.62
NA
0.24
4.38
NA
XXX93225

A
ECG monitor/record, 24 hrs
0.00
1.24
NA
0.08
1.32
NA
XXX93226

A
ECG monitor/report, 24 hrs
0.00
2.19
NA
0.14
2.33
NA
XXX93227

A
ECG monitor/review, 24 hrs
0.52
0.19
0.19
0.02
0.73
0.73
XXX93230

A
ECG monitor/report, 24 hrs
0.52
3.90
NA
0.26
4.68
NA
XXX93231

A
Ecg monitor/record, 24 hrs
0.00
1.52
NA
0.11
1.63
NA
XXX93232

A
ECG monitor/report, 24 hrs
0.00
2.19
NA
0.13
2.32
NA
XXX93233

A
ECG monitor/review, 24 hrs
0.52
0.19
0.19
0.02
0.73
0.73
XXX93235

A
ECG monitor/report, 24 hrs
0.45
2.79
NA
0.16
3.40
NA
XXX93236

A
ECG monitor/report, 24 hrs
0.00
2.63
NA
0.14
2.77
NA
XXX93237

A
ECG monitor/review, 24 hrs
0.45
0.16
0.16
0.02
0.63
0.63
XXX93268

A
ECG record/review
0.52
7.46
NA
0.28
8.26
NA
XXX93270

A
ECG recording
0.00
1.24
NA
0.08
1.32
NA
XXX93271

A
Ecg/monitoring and analysis
0.00
6.03
NA
0.18
6.21
NA
XXX93272

A
Ecg/review, interpret only
0.52
0.19
0.19
0.02
0.73
0.73
XXX93278
26
A
ECG/signal-averaged
0.25
0.10
0.10
0.01
0.36
0.36
XXX93278
TC
A
ECG/signal-averaged
0.00
1.15
NA
0.11
1.26
NA
XXX93278

A
ECG/signal-averaged
0.25
1.25
NA
0.12
1.62
NA
XXX93303
26
A
Echo transthoracic
1.30
0.48
0.48
0.04
1.82
1.82
XXX93303
TC
A
Echo transthoracic
0.00
3.87
NA
0.23
4.10
NA
XXX93303

A
Echo transthoracic
1.30
4.35
NA
0.27
5.92
NA
XXX93304
26
A
Echo transthoracic
0.75
0.28
0.28
0.02
1.05
1.05
XXX93304
TC
A
Echo transthoracic
0.00
1.95
NA
0.13
2.08
NA
XXX93304

A
Echo transthoracic
0.75
2.23
NA
0.15
3.13
NA
XXX93307
26
A
Echo exam of heart
0.92
0.35
0.35
0.03
1.30
1.30
XXX93307
TC
A
Echo exam of heart
0.00
3.87
NA
0.23
4.10
NA
XXX93307

A
Echo exam of heart
0.92
4.22
NA
0.26
5.40
NA
XXX93308
26
A
Echo exam of heart
0.53
0.20
0.20
0.02
0.75
0.75
XXX93308
TC
A
Echo exam of heart
0.00
1.95
NA
0.13
2.08
NA
XXX93308

A
Echo exam of heart
0.53
2.15
NA
0.15
2.83
NA
XXX93312
26
A
Echo transesophageal
2.20
0.79
0.79
0.08
3.07
3.07
XXX93312
TC
A
Echo transesophageal
0.00
3.79
NA
0.29
4.08
NA
XXX93312

A
Echo transesophageal
2.20
4.58
NA
0.37
7.15
NA
XXX93313

A
Echo transesophageal
0.95
NA
0.21
0.06
NA
1.22
XXX93314
26
A
Echo transesophageal
1.25
0.47
0.47
0.04
1.76
1.76
XXX93314
TC
A
Echo transesophageal
0.00
3.79
NA
0.29
4.08
NA
XXX93314

A
Echo transesophageal
1.25
4.26
NA
0.33
5.84
NA
XXX93315
26
A
Echo transesophageal
2.78
1.01
1.01
0.09
3.88
3.88
XXX93315
TC
C
Echo transesophageal
0.00
0.00
0.00
0.00
0.00
0.00
XXX93315

C
Echo transesophageal
0.00
0.00
0.00
0.00
0.00
0.00
XXX93316

A
Echo transesophageal
0.95
NA
0.24
0.05
NA
1.24
XXX93317
26
A
Echo transesophageal
1.83
0.67
0.67
0.08
2.58
2.58
XXX93317
TC
C
Echo transesophageal
0.00
0.00
0.00
0.00
0.00
0.00
XXX93317

C
Echo transesophageal
0.00
0.00
0.00
0.00
0.00
0.00
XXX93318
26
A
Echo transesophageal intraop
2.20
0.48
0.48
0.14
2.82
2.82
XXX93318
TC
C
Echo transesophageal intraop
0.00
0.00
0.00
0.00
0.00
0.00
XXX93318

C
Echo transesophageal intraop
0.00
0.00
0.00
0.00
0.00
0.00
XXX93320
26
A
Doppler echo exam, heart
0.38
0.15
0.15
0.01
0.54
0.54
ZZZ93320
TC
A
Doppler echo exam, heart
0.00
1.71
NA
0.12
1.83
NA
ZZZ93320

A
Doppler echo exam, heart
0.38
1.86
NA
0.13
2.37
NA
ZZZ93321
26
A
Doppler echo exam, heart
0.15
0.06
0.06
0.01
0.22
0.22
ZZZ93321
TC
A
Doppler echo exam, heart
0.00
1.11
NA
0.08
1.19
NA
ZZZ93321

A
Doppler echo exam, heart
0.15
1.17
NA
0.09
1.41
NA
ZZZ93325
26
A
Doppler color flow add-on
0.07
0.03
0.03
0.01
0.11
0.11
ZZZ93325
TC
A
Doppler color flow add-on
0.00
2.91
NA
0.21
3.12
NA
ZZZ93325

A
Doppler color flow add-on
0.07
2.94
NA
0.22
3.23
NA
ZZZ93350
26
A
Echo transthoracic
1.48
0.57
0.57
0.05
2.10
2.10
XXX93350
TC
A
Echo transthoracic
0.00
1.77
NA
0.13
1.90
NA
XXX93350

A
Echo transthoracic
1.48
2.34
NA
0.18
4.00
NA
XXX93501
26
A
Right heart catheterization
3.02
1.15
1.15
0.21
4.38
4.38
00093501
TC
A
Right heart catheterization
0.00
16.95
NA
1.05
18.00
NA
00093501

A
Right heart catheterization
3.02
18.10
NA
1.26
22.38
NA
00093503

A
Insert/place heart catheter
2.91
NA
0.68
0.20
NA
3.79
00093505
26
A
Biopsy of heart lining
4.37
1.68
1.68
0.30
6.35
6.35
00093505
TC
A
Biopsy of heart lining
0.00
1.99
NA
0.16
2.15
NA
00093505

A
Biopsy of heart lining
4.37
3.67
NA
0.46
8.50
NA
00093508
26
A
Cath placement, angiography
4.09
2.09
2.09
0.28
6.46
6.46
00093508
TC
A
Cath placement, angiography
0.00
12.64
NA
0.65
13.29
NA
00093508

A
Cath placement, angiography
4.09
14.73
NA
0.93
19.75
NA
00093510
26
A
Left heart catheterization
4.32
2.18
2.18
0.30
6.80
6.80
00093510
TC
A
Left heart catheterization
0.00
37.06
NA
2.31
39.37
NA
000( print page 70448)93510

A
Left heart catheterization
4.32
39.24
NA
2.61
46.17
NA
00093511
26
A
Left heart catheterization
5.02
2.45
2.45
0.35
7.82
7.82
00093511
TC
A
Left heart catheterization
0.00
36.07
NA
2.24
38.31
NA
00093511

A
Left heart catheterization
5.02
38.52
NA
2.59
46.13
NA
00093514
26
A
Left heart catheterization
7.04
3.13
3.13
0.49
10.66
10.66
00093514
TC
C
Left heart catheterization
0.00
0.00
0.00
0.00
0.00
0.00
00093514

R
Left heart catheterization
7.04
39.09
39.09
2.74
48.87
48.87
00093524
26
A
Left heart catheterization
6.94
3.18
3.18
0.48
10.60
10.60
00093524
TC
A
Left heart catheterization
0.00
47.14
NA
2.95
50.09
NA
00093524

A
Left heart catheterization
6.94
50.32
NA
3.43
60.69
NA
00093526
26
A
Rt & Lt heart catheters
5.98
2.82
2.82
0.42
9.22
9.22
00093526
TC
A
Rt & Lt heart catheters
0.00
48.43
NA
3.04
51.47
NA
00093526

A
Rt & Lt heart catheters
5.98
51.25
NA
3.46
60.69
NA
00093527
26
A
Rt & Lt heart catheters
7.27
3.32
3.32
0.51
11.10
11.10
00093527
TC
A
Rt & Lt heart catheters
0.00
47.14
NA
2.95
50.09
NA
00093527

A
Rt & Lt heart catheters
7.27
50.46
NA
3.46
61.19
NA
00093528
26
A
Rt & Lt heart catheters
8.99
4.04
4.04
0.62
13.65
13.65
00093528
TC
A
Rt & Lt heart catheters
0.00
47.14
NA
2.95
50.09
NA
00093528

A
Rt & Lt heart catheters
8.99
51.18
NA
3.57
63.74
NA
00093529
26
A
Rt, lt heart catheterization
4.79
2.28
2.28
0.33
7.40
7.40
00093529
TC
A
Rt, lt heart catheterization
0.00
47.14
NA
2.95
50.09
NA
00093529

A
Rt, lt heart catheterization
4.79
49.42
NA
3.28
57.49
NA
00093530
26
A
Rt heart cath, congenital
4.22
1.94
1.94
0.29
6.45
6.45
00093530
TC
A
Rt heart cath, congenital
0.00
16.95
NA
1.05
18.00
NA
00093530

A
Rt heart cath, congenital
4.22
18.89
NA
1.34
24.45
NA
00093531
26
A
R & l heart cath, congenital
8.34
3.59
3.59
0.58
12.51
12.51
00093531
TC
A
R & l heart cath, congenital
0.00
48.43
NA
3.04
51.47
NA
00093531

A
R & l heart cath, congenital
8.34
52.02
NA
3.62
63.98
NA
00093532
26
A
R & l heart cath, congenital
9.99
4.26
4.26
0.69
14.94
14.94
00093532
TC
C
R & l heart cath, congenital
0.00
0.00
0.00
0.00
0.00
0.00
00093532

C
R & l heart cath, congenital
0.00
0.00
0.00
0.00
0.00
0.00
00093533
26
A
R & l heart cath, congenital
6.69
2.80
2.80
0.47
9.96
9.96
00093533
TC
C
R & l heart cath, congenital
0.00
0.00
0.00
0.00
0.00
0.00
00093533

C
R & l heart cath, congenital
0.00
0.00
0.00
0.00
0.00
0.00
00093539

A
Injection, cardiac cath
0.40
NA
0.16
0.01
NA
0.57
00093540

A
Injection, cardiac cath
0.43
NA
0.17
0.01
NA
0.61
00093541

A
Injection for lung angiogram
0.29
NA
0.11
0.01
NA
0.41
00093542

A
Injection for heart x-rays
0.29
NA
0.11
0.01
NA
0.41
00093543

A
Injection for heart x-rays
0.29
NA
0.11
0.01
NA
0.41
00093544

A
Injection for aortography
0.25
NA
0.10
0.01
NA
0.36
00093545

A
Inject for coronary x-rays
0.40
NA
0.16
0.01
NA
0.57
00093555
26
A
Imaging, cardiac cath
0.81
0.32
0.32
0.03
1.16
1.16
XXX93555
TC
A
Imaging, cardiac cath
0.00
6.29
NA
0.34
6.63
NA
XXX93555

A
Imaging, cardiac cath
0.81
6.61
NA
0.37
7.79
NA
XXX93556
26
A
Imaging, cardiac cath
0.83
0.32
0.32
0.03
1.18
1.18
XXX93556
TC
A
Imaging, cardiac cath
0.00
9.92
NA
0.51
10.43
NA
XXX93556

A
Imaging, cardiac cath
0.83
10.24
NA
0.54
11.61
NA
XXX93561
26
A
Cardiac output measurement
0.50
0.16
0.16
0.02
0.68
0.68
00093561
TC
A
Cardiac output measurement
0.00
0.52
NA
0.06
0.58
NA
00093561

A
Cardiac output measurement
0.50
0.68
NA
0.08
1.26
NA
00093562
26
A
Cardiac output measurement
0.16
0.05
0.05
0.01
0.22
0.22
00093562
TC
A
Cardiac output measurement
0.00
0.32
NA
0.04
0.36
NA
00093562

A
Cardiac output measurement
0.16
0.37
NA
0.05
0.58
NA
00093571
26
A
Heart flow reserve measure
1.80
0.68
0.68
0.06
2.54
2.54
ZZZ93571
TC
A
Heart flow reserve measure
0.00
4.57
NA
0.24
4.81
NA
ZZZ93571

A
Heart flow reserve measure
1.80
5.25
NA
0.30
7.35
NA
ZZZ93572
26
A
Heart flow reserve measure
1.44
0.50
0.50
0.04
1.98
1.98
ZZZ93572
TC
C
Heart flow reserve measure
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93572

C
Heart flow reserve measure
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93580

A
Transcath closure of asd
17.97
NA
7.40
1.25
NA
26.62
00093581

A
Transcath closure of vsd
24.39
NA
9.42
1.71
NA
35.52
00093600
26
A
Bundle of His recording
2.12
0.83
0.83
0.16
3.11
3.11
00093600
TC
A
Bundle of His recording
0.00
1.96
NA
0.13
2.09
NA
00093600

A
Bundle of His recording
2.12
2.79
NA
0.29
5.20
NA
00093602
26
A
Intra-atrial recording
2.12
0.82
0.82
0.17
3.11
3.11
00093602
TC
A
Intra-atrial recording
0.00
1.11
NA
0.07
1.18
NA
00093602

A
Intra-atrial recording
2.12
1.93
NA
0.24
4.29
NA
00093603
26
A
Right ventricular recording
2.12
0.81
0.81
0.18
3.11
3.11
00093603
TC
A
Right ventricular recording
0.00
1.68
NA
0.11
1.79
NA
00093603

A
Right ventricular recording
2.12
2.49
NA
0.29
4.90
NA
00093609
26
A
Map tachycardia, add-on
4.99
1.96
1.96
0.35
7.30
7.30
ZZZ93609
TC
A
Map tachycardia, add-on
0.00
2.73
NA
0.17
2.90
NA
ZZZ93609

A
Map tachycardia, add-on
4.99
4.69
NA
0.52
10.20
NA
ZZZ93610
26
A
Intra-atrial pacing
3.02
1.16
1.16
0.24
4.42
4.42
00093610
TC
A
Intra-atrial pacing
0.00
1.35
NA
0.10
1.45
NA
000( print page 70449)93610

A
Intra-atrial pacing
3.02
2.51
NA
0.34
5.87
NA
00093612
26
A
Intraventricular pacing
3.02
1.16
1.16
0.25
4.43
4.43
00093612
TC
A
Intraventricular pacing
0.00
1.61
NA
0.11
1.72
NA
00093612

A
Intraventricular pacing
3.02
2.77
NA
0.36
6.15
NA
00093613

A
Electrophys map 3d, add-on
6.99
NA
2.77
0.49
NA
10.25
ZZZ93615
26
A
Esophageal recording
0.99
0.27
0.27
0.03
1.29
1.29
00093615
TC
A
Esophageal recording
0.00
0.32
NA
0.02
0.34
NA
00093615

A
Esophageal recording
0.99
0.59
NA
0.05
1.63
NA
00093616
26
A
Esophageal recording
1.49
0.43
0.43
0.09
2.01
2.01
00093616
TC
C
Esophageal recording
0.00
0.00
0.00
0.00
0.00
0.00
00093616

C
Esophageal recording
0.00
0.00
0.00
0.00
0.00
0.00
00093618
26
A
Heart rhythm pacing
4.25
1.67
1.67
0.30
6.22
6.22
00093618
TC
A
Heart rhythm pacing
0.00
3.97
NA
0.24
4.21
NA
00093618

A
Heart rhythm pacing
4.25
5.64
NA
0.54
10.43
NA
00093619
26
A
Electrophysiology evaluation
7.31
3.19
3.19
0.51
11.01
11.01
00093619
TC
A
Electrophysiology evaluation
0.00
7.72
NA
0.47
8.19
NA
00093619

A
Electrophysiology evaluation
7.31
10.91
NA
0.98
19.20
NA
00093620
26
A
Electrophysiology evaluation
11.57
4.85
4.85
0.80
17.22
17.22
00093620
TC
C
Electrophysiology evaluation
0.00
0.00
0.00
0.00
0.00
0.00
00093620

C
Electrophysiology evaluation
0.00
0.00
0.00
0.00
0.00
0.00
00093621
26
A
Electrophysiology evaluation
2.10
0.82
0.82
0.15
3.07
3.07
ZZZ93621
TC
C
Electrophysiology evaluation
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93621

C
Electrophysiology evaluation
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93622
26
A
Electrophysiology evaluation
3.10
1.21
1.21
0.22
4.53
4.53
ZZZ93622
TC
C
Electrophysiology evaluation
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93622

C
Electrophysiology evaluation
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93623
26
A
Stimulation, pacing heart
2.85
1.11
1.11
0.20
4.16
4.16
ZZZ93623
TC
C
Stimulation, pacing heart
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93623

C
Stimulation, pacing heart
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93624
26
A
Electrophysiologic study
4.80
2.20
2.20
0.33
7.33
7.33
00093624
TC
A
Electrophysiologic study
0.00
1.99
NA
0.13
2.12
NA
00093624

A
Electrophysiologic study
4.80
4.19
NA
0.46
9.45
NA
00093631
26
A
Heart pacing, mapping
7.59
2.78
2.78
0.97
11.34
11.34
00093631
TC
C
Heart pacing, mapping
0.00
0.00
0.00
0.00
0.00
0.00
00093631

C
Heart pacing, mapping
0.00
0.00
0.00
0.00
0.00
0.00
00093640
26
A
Evaluation heart device
3.51
1.36
1.36
0.24
5.11
5.11
00093640
TC
A
Evaluation heart device
0.00
7.19
NA
0.42
7.61
NA
00093640

A
Evaluation heart device
3.51
8.55
NA
0.66
12.72
NA
00093641
26
A
Electrophysiology evaluation
5.92
2.32
2.32
0.41
8.65
8.65
00093641
TC
A
Electrophysiology evaluation
0.00
7.19
NA
0.42
7.61
NA
00093641

A
Electrophysiology evaluation
5.92
9.51
NA
0.83
16.26
NA
00093642
26
A
Electrophysiology evaluation
4.88
2.22
2.22
0.15
7.25
7.25
00093642
TC
A
Electrophysiology evaluation
0.00
7.19
NA
0.42
7.61
NA
00093642

A
Electrophysiology evaluation
4.88
9.41
NA
0.57
14.86
NA
00093650

A
Ablate heart dysrhythm focus
10.49
NA
4.44
0.73
NA
15.66
00093651

A
Ablate heart dysrhythm focus
16.23
NA
6.34
1.13
NA
23.70
00093652

A
Ablate heart dysrhythm focus
17.65
NA
6.90
1.23
NA
25.78
00093660
26
A
Tilt table evaluation
1.89
0.74
0.74
0.06
2.69
2.69
00093660
TC
A
Tilt table evaluation
0.00
1.68
NA
0.02
1.70
NA
00093660

A
Tilt table evaluation
1.89
2.42
NA
0.08
4.39
NA
00093662
26
A
Intracardiac ecg (ice)
2.80
1.11
1.11
0.09
4.00
4.00
ZZZ93662
TC
C
Intracardiac ecg (ice)
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93662

C
Intracardiac ecg (ice)
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ93668

N
Peripheral vascular rehab
0.00
0.00
0.00
0.00
0.00
0.00
XXX93701
26
A
Bioimpedance, thoracic
0.17
0.07
0.07
0.01
0.25
0.25
XXX93701
TC
A
Bioimpedance, thoracic
0.00
0.91
NA
0.01
0.92
NA
XXX93701

A
Bioimpedance, thoracic
0.17
0.98
NA
0.02
1.17
NA
XXX93720

A
Total body plethysmography
0.17
0.76
NA
0.07
1.00
NA
XXX93721

A
Plethysmography tracing
0.00
0.71
NA
0.06
0.77
NA
XXX93722

A
Plethysmography report
0.17
0.05
0.05
0.01
0.23
0.23
XXX93724
26
A
Analyze pacemaker system
4.88
1.92
1.92
0.15
6.95
6.95
00093724
TC
A
Analyze pacemaker system
0.00
3.97
NA
0.24
4.21
NA
00093724

A
Analyze pacemaker system
4.88
5.89
NA
0.39
11.16
NA
00093727

A
Analyze ilr system
0.52
0.20
0.20
0.02
0.74
0.74
XXX93731
26
A
Analyze pacemaker system
0.45
0.17
0.17
0.01
0.63
0.63
XXX93731
TC
A
Analyze pacemaker system
0.00
0.49
NA
0.04
0.53
NA
XXX93731

A
Analyze pacemaker system
0.45
0.66
NA
0.05
1.16
NA
XXX93732
26
A
Analyze pacemaker system
0.92
0.35
0.35
0.03
1.30
1.30
XXX93732
TC
A
Analyze pacemaker system
0.00
0.51
NA
0.04
0.55
NA
XXX93732

A
Analyze pacemaker system
0.92
0.86
NA
0.07
1.85
NA
XXX93733
26
A
Telephone analy, pacemaker
0.17
0.07
0.07
0.01
0.25
0.25
XXX93733
TC
A
Telephone analy, pacemaker
0.00
0.73
NA
0.06
0.79
NA
XXX93733

A
Telephone analy, pacemaker
0.17
0.80
NA
0.07
1.04
NA
XXX93734
26
A
Analyze pacemaker system
0.38
0.15
0.15
0.01
0.54
0.54
XXX93734
TC
A
Analyze pacemaker system
0.00
0.35
NA
0.02
0.37
NA
XXX( print page 70450)93734

A
Analyze pacemaker system
0.38
0.50
NA
0.03
0.91
NA
XXX93735
26
A
Analyze pacemaker system
0.74
0.28
0.28
0.02
1.04
1.04
XXX93735
TC
A
Analyze pacemaker system
0.00
0.44
NA
0.04
0.48
NA
XXX93735

A
Analyze pacemaker system
0.74
0.72
NA
0.06
1.52
NA
XXX93736
26
A
Telephonic analy, pacemaker
0.15
0.06
0.06
0.01
0.22
0.22
XXX93736
TC
A
Telephonic analy, pacemaker
0.00
0.63
NA
0.06
0.69
NA
XXX93736

A
Telephonic analy, pacemaker
0.15
0.69
NA
0.07
0.91
NA
XXX93740
26
B
Temperature gradient studies
+0.16
0.04
0.04
0.01
0.21
0.21
XXX93740
TC
B
Temperature gradient studies
+0.00
0.15
NA
0.01
0.16
NA
XXX93740

B
Temperature gradient studies
+0.16
0.19
NA
0.02
0.37
NA
XXX93741
26
A
Analyze ht pace device sngl
0.80
0.31
0.31
0.03
1.14
1.14
XXX93741
TC
A
Analyze ht pace device sngl
0.00
0.67
NA
0.04
0.71
NA
XXX93741

A
Analyze ht pace device sngl
0.80
0.98
NA
0.07
1.85
NA
XXX93742
26
A
Analyze ht pace device sngl
0.91
0.36
0.36
0.03
1.30
1.30
XXX93742
TC
A
Analyze ht pace device sngl
0.00
0.67
NA
0.04
0.71
NA
XXX93742

A
Analyze ht pace device sngl
0.91
1.03
NA
0.07
2.01
NA
XXX93743
26
A
Analyze ht pace device dual
1.03
0.40
0.40
0.03
1.46
1.46
XXX93743
TC
A
Analyze ht pace device dual
0.00
0.73
NA
0.04
0.77
NA
XXX93743

A
Analyze ht pace device dual
1.03
1.13
NA
0.07
2.23
NA
XXX93744
26
A
Analyze ht pace device dual
1.18
0.46
0.46
0.04
1.68
1.68
XXX93744
TC
A
Analyze ht pace device dual
0.00
0.67
NA
0.04
0.71
NA
XXX93744

A
Analyze ht pace device dual
1.18
1.13
NA
0.08
2.39
NA
XXX93745
26
C
Set-up cardiovert-defibrill
0.00
0.00
0.00
0.00
0.00
0.00
XXX93745
TC
C
Set-up cardiovert-defibrill
0.00
0.00
0.00
0.00
0.00
0.00
XXX93745

C
Set-up cardiovert-defibrill
0.00
0.00
0.00
0.00
0.00
0.00
XXX93760

N
Cephalic thermogram
0.00
0.00
0.00
0.00
0.00
0.00
XXX93762

N
Peripheral thermogram
0.00
0.00
0.00
0.00
0.00
0.00
XXX93770
26
B
Measure venous pressure
+0.16
0.05
0.05
0.01
0.22
0.22
XXX93770
TC
B
Measure venous pressure
+0.00
0.03
NA
0.01
0.04
NA
XXX93770

B
Measure venous pressure
+0.16
0.08
NA
0.02
0.26
NA
XXX93784

A
Ambulatory BP monitoring
0.38
1.55
NA
0.03
1.96
NA
XXX93786

A
Ambulatory BP recording
0.00
0.91
NA
0.01
0.92
NA
XXX93788

A
Ambulatory BP analysis
0.00
0.51
NA
0.01
0.52
NA
XXX93790

A
Review/report BP recording
0.38
0.13
0.13
0.01
0.52
0.52
XXX93797

A
Cardiac rehab
0.18
0.30
0.07
0.01
0.49
0.26
00093798

A
Cardiac rehab/monitor
0.28
0.46
0.11
0.01
0.75
0.40
00093799
26
C
Cardiovascular procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX93799
TC
C
Cardiovascular procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX93799

C
Cardiovascular procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX93875
26
A
Extracranial study
0.22
0.08
0.08
0.01
0.31
0.31
XXX93875
TC
A
Extracranial study
0.00
2.26
NA
0.11
2.37
NA
XXX93875

A
Extracranial study
0.22
2.34
NA
0.12
2.68
NA
XXX93880
26
A
Extracranial study
0.60
0.20
0.20
0.04
0.84
0.84
XXX93880
TC
A
Extracranial study
0.00
5.37
NA
0.35
5.72
NA
XXX93880

A
Extracranial study
0.60
5.57
NA
0.39
6.56
NA
XXX93882
26
A
Extracranial study
0.40
0.14
0.14
0.04
0.58
0.58
XXX93882
TC
A
Extracranial study
0.00
3.37
NA
0.22
3.59
NA
XXX93882

A
Extracranial study
0.40
3.51
NA
0.26
4.17
NA
XXX93886
26
A
Intracranial study
0.94
0.37
0.37
0.06
1.37
1.37
XXX93886
TC
A
Intracranial study
0.00
6.39
NA
0.39
6.78
NA
XXX93886

A
Intracranial study
0.94
6.76
NA
0.45
8.15
NA
XXX93888
26
A
Intracranial study
0.62
0.23
0.23
0.05
0.90
0.90
XXX93888
TC
A
Intracranial study
0.00
4.02
NA
0.27
4.29
NA
XXX93888

A
Intracranial study
0.62
4.25
NA
0.32
5.19
NA
XXX93890
26
A
Tcd, vasoreactivity study
1.00
0.40
0.40
0.06
1.46
1.46
XXX93890
TC
A
Tcd, vasoreactivity study
0.00
4.51
NA
0.39
4.90
NA
XXX93890

A
Tcd, vasoreactivity study
1.00
4.91
NA
0.45
6.36
NA
XXX93892
26
A
Tcd, emboli detect w/o inj
1.15
0.46
0.46
0.06
1.67
1.67
XXX93892
TC
A
Tcd, emboli detect w/o inj
0.00
4.71
NA
0.39
5.10
NA
XXX93892

A
Tcd, emboli detect w/o inj
1.15
5.17
NA
0.45
6.77
NA
XXX93893
26
A
Tcd, emboli detect w/inj
1.15
0.46
0.46
0.06
1.67
1.67
XXX93893
TC
A
Tcd, emboli detect w/inj
0.00
4.58
NA
0.39
4.97
NA
XXX93893

A
Tcd, emboli detect w/inj
1.15
5.04
NA
0.45
6.64
NA
XXX93922
26
A
Extremity study
0.25
0.08
0.08
0.02
0.35
0.35
XXX93922
TC
A
Extremity study
0.00
2.61
NA
0.13
2.74
NA
XXX93922

A
Extremity study
0.25
2.69
NA
0.15
3.09
NA
XXX93923
26
A
Extremity study
0.45
0.15
0.15
0.04
0.64
0.64
XXX93923
TC
A
Extremity study
0.00
3.89
NA
0.22
4.11
NA
XXX93923

A
Extremity study
0.45
4.04
NA
0.26
4.75
NA
XXX93924
26
A
Extremity study
0.50
0.17
0.17
0.05
0.72
0.72
XXX93924
TC
A
Extremity study
0.00
4.63
NA
0.25
4.88
NA
XXX93924

A
Extremity study
0.50
4.80
NA
0.30
5.60
NA
XXX93925
26
A
Lower extremity study
0.58
0.20
0.20
0.04
0.82
0.82
XXX93925
TC
A
Lower extremity study
0.00
6.60
NA
0.35
6.95
NA
XXX93925

A
Lower extremity study
0.58
6.80
NA
0.39
7.77
NA
XXX( print page 70451)93926
26
A
Lower extremity study
0.39
0.13
0.13
0.04
0.56
0.56
XXX93926
TC
A
Lower extremity study
0.00
3.93
NA
0.23
4.16
NA
XXX93926

A
Lower extremity study
0.39
4.06
NA
0.27
4.72
NA
XXX93930
26
A
Upper extremity study
0.46
0.16
0.16
0.04
0.66
0.66
XXX93930
TC
A
Upper extremity study
0.00
5.21
NA
0.37
5.58
NA
XXX93930

A
Upper extremity study
0.46
5.37
NA
0.41
6.24
NA
XXX93931
26
A
Upper extremity study
0.31
0.10
0.10
0.03
0.44
0.44
XXX93931
TC
A
Upper extremity study
0.00
3.39
NA
0.24
3.63
NA
XXX93931

A
Upper extremity study
0.31
3.49
NA
0.27
4.07
NA
XXX93965
26
A
Extremity study
0.35
0.12
0.12
0.02
0.49
0.49
XXX93965
TC
A
Extremity study
0.00
2.68
NA
0.12
2.80
NA
XXX93965

A
Extremity study
0.35
2.80
NA
0.14
3.29
NA
XXX93970
26
A
Extremity study
0.68
0.23
0.23
0.06
0.97
0.97
XXX93970
TC
A
Extremity study
0.00
5.03
NA
0.40
5.43
NA
XXX93970

A
Extremity study
0.68
5.26
NA
0.46
6.40
NA
XXX93971
26
A
Extremity study
0.45
0.15
0.15
0.03
0.63
0.63
XXX93971
TC
A
Extremity study
0.00
3.45
NA
0.27
3.72
NA
XXX93971

A
Extremity study
0.45
3.60
NA
0.30
4.35
NA
XXX93975
26
A
Vascular study
1.80
0.60
0.60
0.13
2.53
2.53
XXX93975
TC
A
Vascular study
0.00
7.05
NA
0.43
7.48
NA
XXX93975

A
Vascular study
1.80
7.65
NA
0.56
10.01
NA
XXX93976
26
A
Vascular study
1.21
0.40
0.40
0.05
1.66
1.66
XXX93976
TC
A
Vascular study
0.00
3.94
NA
0.30
4.24
NA
XXX93976

A
Vascular study
1.21
4.34
NA
0.35
5.90
NA
XXX93978
26
A
Vascular study
0.65
0.22
0.22
0.06
0.93
0.93
XXX93978
TC
A
Vascular study
0.00
4.30
NA
0.37
4.67
NA
XXX93978

A
Vascular study
0.65
4.52
NA
0.43
5.60
NA
XXX93979
26
A
Vascular study
0.44
0.15
0.15
0.03
0.62
0.62
XXX93979
TC
A
Vascular study
0.00
3.07
NA
0.24
3.31
NA
XXX93979

A
Vascular study
0.44
3.22
NA
0.27
3.93
NA
XXX93980
26
A
Penile vascular study
1.25
0.41
0.41
0.08
1.74
1.74
XXX93980
TC
A
Penile vascular study
0.00
2.45
NA
0.34
2.79
NA
XXX93980

A
Penile vascular study
1.25
2.86
NA
0.42
4.53
NA
XXX93981
26
A
Penile vascular study
0.44
0.14
0.14
0.02
0.60
0.60
XXX93981
TC
A
Penile vascular study
0.00
2.74
NA
0.31
3.05
NA
XXX93981

A
Penile vascular study
0.44
2.88
NA
0.33
3.65
NA
XXX93990
26
A
Doppler flow testing
0.25
0.09
0.09
0.03
0.37
0.37
XXX93990
TC
A
Doppler flow testing
0.00
3.91
NA
0.23
4.14
NA
XXX93990

A
Doppler flow testing
0.25
4.00
NA
0.26
4.51
NA
XXX94010
26
A
Breathing capacity test
0.17
0.05
0.05
0.01
0.23
0.23
XXX94010
TC
A
Breathing capacity test
0.00
0.62
NA
0.02
0.64
NA
XXX94010

A
Breathing capacity test
0.17
0.67
NA
0.03
0.87
NA
XXX94014

A
Patient recorded spirometry
0.52
0.76
NA
0.03
1.31
NA
XXX94015

A
Patient recorded spirometry
0.00
0.59
NA
0.01
0.60
NA
XXX94016

A
Review patient spirometry
0.52
0.17
0.17
0.02
0.71
0.71
XXX94060
26
A
Evaluation of wheezing
0.31
0.09
0.09
0.01
0.41
0.41
XXX94060
TC
A
Evaluation of wheezing
0.00
0.98
NA
0.06
1.04
NA
XXX94060

A
Evaluation of wheezing
0.31
1.07
NA
0.07
1.45
NA
XXX94070
26
A
Evaluation of wheezing
0.60
0.18
0.18
0.03
0.81
0.81
XXX94070
TC
A
Evaluation of wheezing
0.00
0.64
NA
0.10
0.74
NA
XXX94070

A
Evaluation of wheezing
0.60
0.82
NA
0.13
1.55
NA
XXX94150
26
B
Vital capacity test
+0.07
0.03
0.03
0.01
0.11
0.11
XXX94150
TC
B
Vital capacity test
+0.00
0.44
NA
0.01
0.45
NA
XXX94150

B
Vital capacity test
+0.07
0.47
NA
0.02
0.56
NA
XXX94200
26
A
Lung function test (MBC/MVV)
0.11
0.03
0.03
0.01
0.15
0.15
XXX94200
TC
A
Lung function test (MBC/MVV)
0.00
0.41
NA
0.02
0.43
NA
XXX94200

A
Lung function test (MBC/MVV)
0.11
0.44
NA
0.03
0.58
NA
XXX94240
26
A
Residual lung capacity
0.26
0.08
0.08
0.01
0.35
0.35
XXX94240
TC
A
Residual lung capacity
0.00
0.58
NA
0.05
0.63
NA
XXX94240

A
Residual lung capacity
0.26
0.66
NA
0.06
0.98
NA
XXX94250
26
A
Expired gas collection
0.11
0.03
0.03
0.01
0.15
0.15
XXX94250
TC
A
Expired gas collection
0.00
0.61
NA
0.01
0.62
NA
XXX94250

A
Expired gas collection
0.11
0.64
NA
0.02
0.77
NA
XXX94260
26
A
Thoracic gas volume
0.13
0.04
0.04
0.01
0.18
0.18
XXX94260
TC
A
Thoracic gas volume
0.00
0.54
NA
0.04
0.58
NA
XXX94260

A
Thoracic gas volume
0.13
0.58
NA
0.05
0.76
NA
XXX94350
26
A
Lung nitrogen washout curve
0.26
0.08
0.08
0.01
0.35
0.35
XXX94350
TC
A
Lung nitrogen washout curve
0.00
0.68
NA
0.04
0.72
NA
XXX94350

A
Lung nitrogen washout curve
0.26
0.76
NA
0.05
1.07
NA
XXX94360
26
A
Measure airflow resistance
0.26
0.08
0.08
0.01
0.35
0.35
XXX94360
TC
A
Measure airflow resistance
0.00
0.62
NA
0.06
0.68
NA
XXX94360

A
Measure airflow resistance
0.26
0.70
NA
0.07
1.03
NA
XXX94370
26
A
Breath airway closing volume
0.26
0.08
0.08
0.01
0.35
0.35
XXX94370
TC
A
Breath airway closing volume
0.00
0.64
NA
0.02
0.66
NA
XXX94370

A
Breath airway closing volume
0.26
0.72
NA
0.03
1.01
NA
XXX( print page 70452)94375
26
A
Respiratory flow volume loop
0.31
0.09
0.09
0.01
0.41
0.41
XXX94375
TC
A
Respiratory flow volume loop
0.00
0.51
NA
0.02
0.53
NA
XXX94375

A
Respiratory flow volume loop
0.31
0.60
NA
0.03
0.94
NA
XXX94400
26
A
CO2 breathing response curve
0.40
0.12
0.12
0.03
0.55
0.55
XXX94400
TC
A
CO2 breathing response curve
0.00
0.72
NA
0.06
0.78
NA
XXX94400

A
CO2 breathing response curve
0.40
0.84
NA
0.09
1.33
NA
XXX94450
26
A
Hypoxia response curve
0.40
0.12
0.12
0.02
0.54
0.54
XXX94450
TC
A
Hypoxia response curve
0.00
0.73
NA
0.02
0.75
NA
XXX94450

A
Hypoxia response curve
0.40
0.85
NA
0.04
1.29
NA
XXX94452
26
A
Hast w/report
0.31
0.09
0.09
0.02
0.42
0.42
XXX94452
TC
A
Hast w/report
0.00
0.93
NA
0.02
0.95
NA
XXX94452

A
Hast w/report
0.31
1.02
NA
0.04
1.37
NA
XXX94453
26
A
Hast w/oxygen titrate
0.40
0.12
0.12
0.02
0.54
0.54
XXX94453
TC
A
Hast w/oxygen titrate
0.00
1.39
NA
0.02
1.41
NA
XXX94453

A
Hast w/oxygen titrate
0.40
1.51
NA
0.04
1.95
NA
XXX94620
26
A
Pulmonary stress test/simple
0.64
0.20
0.20
0.03
0.87
0.87
XXX94620
TC
A
Pulmonary stress test/simple
0.00
2.30
NA
0.10
2.40
NA
XXX94620

A
Pulmonary stress test/simple
0.64
2.50
NA
0.13
3.27
NA
XXX94621
26
A
Pulm stress test/complex
1.42
0.44
0.44
0.06
1.92
1.92
XXX94621
TC
A
Pulm stress test/complex
0.00
1.77
NA
0.10
1.87
NA
XXX94621

A
Pulm stress test/complex
1.42
2.21
NA
0.16
3.79
NA
XXX94640

A
Airway inhalation treatment
0.00
0.30
NA
0.02
0.32
NA
XXX94642

C
Aerosol inhalation treatment
0.00
0.00
0.00
0.00
0.00
0.00
XXX94656

A
Initial ventilator mgmt
1.22
1.16
0.32
0.06
2.44
1.60
XXX94657

A
Continued ventilator mgmt
0.83
0.98
0.25
0.04
1.85
1.12
XXX94660

A
Pos airway pressure, CPAP
0.76
0.65
0.23
0.04
1.45
1.03
XXX94662

A
Neg press ventilation, cnp
0.76
NA
0.23
0.03
NA
1.02
XXX94664

A
Evaluate pt use of inhaler
0.00
0.31
NA
0.04
0.35
NA
XXX94667

A
Chest wall manipulation
0.00
0.52
NA
0.05
0.57
NA
XXX94668

A
Chest wall manipulation
0.00
0.45
NA
0.02
0.47
NA
XXX94680
26
A
Exhaled air analysis, o2
0.26
0.08
0.08
0.01
0.35
0.35
XXX94680
TC
A
Exhaled air analysis, o2
0.00
1.79
NA
0.06
1.85
NA
XXX94680

A
Exhaled air analysis, o2
0.26
1.87
NA
0.07
2.20
NA
XXX94681
26
A
Exhaled air analysis, o2/co2
0.20
0.06
0.06
0.01
0.27
0.27
XXX94681
TC
A
Exhaled air analysis, o2/co2
0.00
2.47
NA
0.12
2.59
NA
XXX94681

A
Exhaled air analysis, o2/co2
0.20
2.53
NA
0.13
2.86
NA
XXX94690
26
A
Exhaled air analysis
0.07
0.02
0.02
0.01
0.10
0.10
XXX94690
TC
A
Exhaled air analysis
0.00
1.98
NA
0.04
2.02
NA
XXX94690

A
Exhaled air analysis
0.07
2.00
NA
0.05
2.12
NA
XXX94720
26
A
Monoxide diffusing capacity
0.26
0.08
0.08
0.01
0.35
0.35
XXX94720
TC
A
Monoxide diffusing capacity
0.00
0.92
NA
0.06
0.98
NA
XXX94720

A
Monoxide diffusing capacity
0.26
1.00
NA
0.07
1.33
NA
XXX94725
26
A
Membrane diffusion capacity
0.26
0.08
0.08
0.01
0.35
0.35
XXX94725
TC
A
Membrane diffusion capacity
0.00
2.84
NA
0.12
2.96
NA
XXX94725

A
Membrane diffusion capacity
0.26
2.92
NA
0.13
3.31
NA
XXX94750
26
A
Pulmonary compliance study
0.23
0.07
0.07
0.01
0.31
0.31
XXX94750
TC
A
Pulmonary compliance study
0.00
1.27
NA
0.04
1.31
NA
XXX94750

A
Pulmonary compliance study
0.23
1.34
NA
0.05
1.62
NA
XXX94760

T
Measure blood oxygen level
0.00
0.04
NA
0.02
0.06
NA
XXX94761

T
Measure blood oxygen level
0.00
0.07
NA
0.06
0.13
NA
XXX94762

A
Measure blood oxygen level
0.00
0.47
NA
0.10
0.57
NA
XXX94770
26
A
Exhaled carbon dioxide test
0.15
0.04
0.04
0.01
0.20
0.20
XXX94770
TC
A
Exhaled carbon dioxide test
0.00
0.71
NA
0.07
0.78
NA
XXX94770

A
Exhaled carbon dioxide test
0.15
0.75
NA
0.08
0.98
NA
XXX94772
26
C
Breath recording, infant
0.00
0.00
0.00
0.00
0.00
0.00
XXX94772
TC
C
Breath recording, infant
0.00
0.00
0.00
0.00
0.00
0.00
XXX94772

C
Breath recording, infant
0.00
0.00
0.00
0.00
0.00
0.00
XXX94799
26
C
Pulmonary service/procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX94799
TC
C
Pulmonary service/procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX94799

C
Pulmonary service/procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX95004

A
Percut allergy skin tests
0.00
0.10
NA
0.01
0.11
NA
XXX95010

A
Percut allergy titrate test
0.15
0.32
0.06
0.01
0.48
0.22
XXX95015

A
Id allergy titrate-drug/bug
0.15
0.14
0.06
0.01
0.30
0.22
XXX95024

A
Id allergy test, drug/bug
0.00
0.15
NA
0.01
0.16
NA
XXX95027

A
Id allergy titrate-airborne
0.00
0.15
NA
0.01
0.16
NA
XXX95028

A
Id allergy test-delayed type
0.00
0.23
NA
0.01
0.24
NA
XXX95044

A
Allergy patch tests
0.00
0.20
NA
0.01
0.21
NA
XXX95052

A
Photo patch test
0.00
0.25
NA
0.01
0.26
NA
XXX95056

A
Photosensitivity tests
0.00
0.17
NA
0.01
0.18
NA
XXX95060

A
Eye allergy tests
0.00
0.35
NA
0.02
0.37
NA
XXX95065

A
Nose allergy test
0.00
0.20
NA
0.01
0.21
NA
XXX95070

A
Bronchial allergy tests
0.00
2.29
NA
0.02
2.31
NA
XXX95071

A
Bronchial allergy tests
0.00
2.93
NA
0.02
2.95
NA
XXX95075

A
Ingestion challenge test
0.95
0.82
0.38
0.03
1.80
1.36
XXX95078

A
Provocative testing
0.00
0.25
NA
0.02
0.27
NA
XXX( print page 70453)95115

A
Immunotherapy, one injection
0.00
0.39
NA
0.02
0.41
NA
XXX95117

A
Immunotherapy injections
0.00
0.50
NA
0.02
0.52
NA
XXX95120

I
Immunotherapy, one injection
0.00
0.00
0.00
0.00
0.00
0.00
XXX95125

I
Immunotherapy, many antigens
0.00
0.00
0.00
0.00
0.00
0.00
XXX95130

I
Immunotherapy, insect venom
0.00
0.00
0.00
0.00
0.00
0.00
XXX95131

I
Immunotherapy, insect venoms
0.00
0.00
0.00
0.00
0.00
0.00
XXX95132

I
Immunotherapy, insect venoms
0.00
0.00
0.00
0.00
0.00
0.00
XXX95133

I
Immunotherapy, insect venoms
0.00
0.00
0.00
0.00
0.00
0.00
XXX95134

I
Immunotherapy, insect venoms
0.00
0.00
0.00
0.00
0.00
0.00
XXX95144

A
Antigen therapy services
0.06
0.19
0.02
0.01
0.26
0.09
XXX95145

A
Antigen therapy services
0.06
0.32
0.02
0.01
0.39
0.09
XXX95146

A
Antigen therapy services
0.06
0.44
0.03
0.01
0.51
0.10
XXX95147

A
Antigen therapy services
0.06
0.42
0.02
0.01
0.49
0.09
XXX95148

A
Antigen therapy services
0.06
0.58
0.03
0.01
0.65
0.10
XXX95149

A
Antigen therapy services
0.06
0.80
0.03
0.01
0.87
0.10
XXX95165

A
Antigen therapy services
0.06
0.19
0.02
0.01
0.26
0.09
XXX95170

A
Antigen therapy services
0.06
0.13
0.03
0.01
0.20
0.10
XXX95180

A
Rapid desensitization
2.01
2.04
0.93
0.04
4.09
2.98
XXX95199

C
Allergy immunology services
0.00
0.00
0.00
0.00
0.00
0.00
XXX95250

A
Glucose monitoring, cont
0.00
4.11
NA
0.01
4.12
NA
XXX95251

A
Gluc monitor, cont, phys i&r
0.52
0.19
0.19
0.02
0.73
0.73
XXX95805
26
A
Multiple sleep latency test
1.88
0.66
0.66
0.09
2.63
2.63
XXX95805
TC
A
Multiple sleep latency test
0.00
16.65
NA
0.34
16.99
NA
XXX95805

A
Multiple sleep latency test
1.88
17.31
NA
0.43
19.62
NA
XXX95806
26
A
Sleep study, unattended
1.66
0.54
0.54
0.08
2.28
2.28
XXX95806
TC
A
Sleep study, unattended
0.00
2.80
NA
0.31
3.11
NA
XXX95806

A
Sleep study, unattended
1.66
3.34
NA
0.39
5.39
NA
XXX95807
26
A
Sleep study, attended
1.66
0.53
0.53
0.08
2.27
2.27
XXX95807
TC
A
Sleep study, attended
0.00
11.35
NA
0.42
11.77
NA
XXX95807

A
Sleep study, attended
1.66
11.88
NA
0.50
14.04
NA
XXX95808
26
A
Polysomnography, 1-3
2.65
0.92
0.92
0.13
3.70
3.70
XXX95808
TC
A
Polysomnography, 1-3
0.00
12.31
NA
0.42
12.73
NA
XXX95808

A
Polysomnography, 1-3
2.65
13.23
NA
0.55
16.43
NA
XXX95810
26
A
Polysomnography, 4 or more
3.52
1.18
1.18
0.17
4.87
4.87
XXX95810
TC
A
Polysomnography, 4 or more
0.00
16.36
NA
0.42
16.78
NA
XXX95810

A
Polysomnography, 4 or more
3.52
17.54
NA
0.59
21.65
NA
XXX95811
26
A
Polysomnography w/cpap
3.79
1.27
1.27
0.18
5.24
5.24
XXX95811
TC
A
Polysomnography w/cpap
0.00
17.97
NA
0.43
18.40
NA
XXX95811

A
Polysomnography w/cpap
3.79
19.24
NA
0.61
23.64
NA
XXX95812
26
A
Eeg, 41-60 minutes
1.08
0.45
0.45
0.06
1.59
1.59
XXX95812
TC
A
Eeg, 41-60 minutes
0.00
3.59
NA
0.11
3.70
NA
XXX95812

A
Eeg, 41-60 minutes
1.08
4.04
NA
0.17
5.29
NA
XXX95813
26
A
Eeg, over 1 hour
1.73
0.70
0.70
0.09
2.52
2.52
XXX95813
TC
A
Eeg, over 1 hour
0.00
4.33
NA
0.11
4.44
NA
XXX95813

A
Eeg, over 1 hour
1.73
5.03
NA
0.20
6.96
NA
XXX95816
26
A
Eeg, awake and drowsy
1.08
0.46
0.46
0.06
1.60
1.60
XXX95816
TC
A
Eeg, awake and drowsy
0.00
3.26
NA
0.10
3.36
NA
XXX95816

A
Eeg, awake and drowsy
1.08
3.72
NA
0.16
4.96
NA
XXX95819
26
A
Eeg, awake and asleep
1.08
0.46
0.46
0.06
1.60
1.60
XXX95819
TC
A
Eeg, awake and asleep
0.00
2.53
NA
0.10
2.63
NA
XXX95819

A
Eeg, awake and asleep
1.08
2.99
NA
0.16
4.23
NA
XXX95822
26
A
Eeg, coma or sleep only
1.08
0.46
0.46
0.06
1.60
1.60
XXX95822
TC
A
Eeg, coma or sleep only
0.00
4.15
NA
0.13
4.28
NA
XXX95822

A
Eeg, coma or sleep only
1.08
4.61
NA
0.19
5.88
NA
XXX95824
26
A
Eeg, cerebral death only
0.74
0.31
0.31
0.04
1.09
1.09
XXX95824
TC
C
Eeg, cerebral death only
0.00
0.00
0.00
0.00
0.00
0.00
XXX95824

C
Eeg, cerebral death only
0.00
0.00
0.00
0.00
0.00
0.00
XXX95827
26
A
Eeg, all night recording
1.08
0.41
0.41
0.05
1.54
1.54
XXX95827
TC
A
Eeg, all night recording
0.00
2.30
NA
0.14
2.44
NA
XXX95827

A
Eeg, all night recording
1.08
2.71
NA
0.19
3.98
NA
XXX95829
26
A
Surgery electrocorticogram
6.20
2.32
2.32
0.48
9.00
9.00
XXX95829
TC
A
Surgery electrocorticogram
0.00
28.77
NA
0.02
28.79
NA
XXX95829

A
Surgery electrocorticogram
6.20
31.09
NA
0.50
37.79
NA
XXX95830

A
Insert electrodes for EEG
1.70
3.30
0.73
0.11
5.11
2.54
XXX95831

A
Limb muscle testing, manual
0.28
0.46
0.13
0.01
0.75
0.42
XXX95832

A
Hand muscle testing, manual
0.29
0.33
0.12
0.02
0.64
0.43
XXX95833

A
Body muscle testing, manual
0.47
0.58
0.23
0.02
1.07
0.72
XXX95834

A
Body muscle testing, manual
0.60
0.63
0.28
0.03
1.26
0.91
XXX95851

A
Range of motion measurements
0.16
0.36
0.08
0.01
0.53
0.25
XXX95852

A
Range of motion measurements
0.11
0.26
0.05
0.01
0.38
0.17
XXX95857

A
Tensilon test
0.53
0.60
0.23
0.02
1.15
0.78
XXX95860
26
A
Muscle test, one limb
0.96
0.42
0.42
0.05
1.43
1.43
XXX95860
TC
A
Muscle test, one limb
0.00
1.00
NA
0.02
1.02
NA
XXX95860

A
Muscle test, one limb
0.96
1.42
NA
0.07
2.45
NA
XXX95861
26
A
Muscle test, 2 limbs
1.54
0.68
0.68
0.07
2.29
2.29
XXX( print page 70454)95861
TC
A
Muscle test, 2 limbs
0.00
0.73
NA
0.06
0.79
NA
XXX95861

A
Muscle test, 2 limbs
1.54
1.41
NA
0.13
3.08
NA
XXX95863
26
A
Muscle test, 3 limbs
1.87
0.80
0.80
0.09
2.76
2.76
XXX95863
TC
A
Muscle test, 3 limbs
0.00
0.94
NA
0.06
1.00
NA
XXX95863

A
Muscle test, 3 limbs
1.87
1.74
NA
0.15
3.76
NA
XXX95864
26
A
Muscle test, 4 limbs
1.99
0.87
0.87
0.09
2.95
2.95
XXX95864
TC
A
Muscle test, 4 limbs
0.00
1.79
NA
0.12
1.91
NA
XXX95864

A
Muscle test, 4 limbs
1.99
2.66
NA
0.21
4.86
NA
XXX95865
26
A
Muscle test, larynx
1.57
0.77
0.77
0.08
2.42
2.42
XXX95865
TC
A
Muscle test, larynx
0.00
0.68
NA
0.03
0.71
NA
XXX95865

A
Muscle test, larynx
1.57
1.45
NA
0.11
3.13
NA
XXX95866
26
A
Muscle test, hemidiaphragm
1.25
0.56
0.56
0.07
1.88
1.88
XXX95866
TC
A
Muscle test, hemidiaphragm
0.00
0.20
NA
0.03
0.23
NA
XXX95866

A
Muscle test, hemidiaphragm
1.25
0.76
NA
0.10
2.11
NA
XXX95867
26
A
Muscle test cran nerv unilat
0.79
0.35
0.35
0.03
1.17
1.17
XXX95867
TC
A
Muscle test cran nerv unilat
0.00
0.58
NA
0.04
0.62
NA
XXX95867

A
Muscle test cran nerv unilat
0.79
0.93
NA
0.07
1.79
NA
XXX95868
26
A
Muscle test cran nerve bilat
1.18
0.51
0.51
0.05
1.74
1.74
XXX95868
TC
A
Muscle test cran nerve bilat
0.00
0.70
NA
0.05
0.75
NA
XXX95868

A
Muscle test cran nerve bilat
1.18
1.21
NA
0.10
2.49
NA
XXX95869
26
A
Muscle test, thor paraspinal
0.37
0.16
0.16
0.02
0.55
0.55
XXX95869
TC
A
Muscle test, thor paraspinal
0.00
0.21
NA
0.02
0.23
NA
XXX95869

A
Muscle test, thor paraspinal
0.37
0.37
NA
0.04
0.78
NA
XXX95870
26
A
Muscle test, nonparaspinal
0.37
0.16
0.16
0.02
0.55
0.55
XXX95870
TC
A
Muscle test, nonparaspinal
0.00
0.21
NA
0.02
0.23
NA
XXX95870

A
Muscle test, nonparaspinal
0.37
0.37
NA
0.04
0.78
NA
XXX95872
26
A
Muscle test, one fiber
1.50
0.63
0.63
0.08
2.21
2.21
XXX95872
TC
A
Muscle test, one fiber
0.00
0.60
NA
0.05
0.65
NA
XXX95872

A
Muscle test, one fiber
1.50
1.23
NA
0.13
2.86
NA
XXX95873
26
A
Guide nerv destr, elec stim
0.37
0.16
0.16
0.02
0.55
0.55
ZZZ95873
TC
A
Guide nerv destr, elec stim
0.00
0.20
NA
0.02
0.22
NA
ZZZ95873

A
Guide nerv destr, elec stim
0.37
0.36
NA
0.04
0.77
NA
ZZZ95874
26
A
Guide nerv destr, needle emg
0.37
0.17
0.17
0.02
0.56
0.56
ZZZ95874
TC
A
Guide nerv destr, needle emg
0.00
0.20
NA
0.02
0.22
NA
ZZZ95874

A
Guide nerv destr, needle emg
0.37
0.37
NA
0.04
0.78
NA
ZZZ95875
26
A
Limb exercise test
1.10
0.47
0.47
0.05
1.62
1.62
XXX95875
TC
A
Limb exercise test
0.00
0.98
NA
0.06
1.04
NA
XXX95875

A
Limb exercise test
1.10
1.45
NA
0.11
2.66
NA
XXX95900
26
A
Motor nerve conduction test
0.42
0.18
0.18
0.02
0.62
0.62
XXX95900
TC
A
Motor nerve conduction test
0.00
1.08
NA
0.02
1.10
NA
XXX95900

A
Motor nerve conduction test
0.42
1.26
NA
0.04
1.72
NA
XXX95903
26
A
Motor nerve conduction test
0.60
0.26
0.26
0.03
0.89
0.89
XXX95903
TC
A
Motor nerve conduction test
0.00
0.93
NA
0.02
0.95
NA
XXX95903

A
Motor nerve conduction test
0.60
1.19
NA
0.05
1.84
NA
XXX95904
26
A
Sense nerve conduction test
0.34
0.15
0.15
0.02
0.51
0.51
XXX95904
TC
A
Sense nerve conduction test
0.00
0.94
NA
0.02
0.96
NA
XXX95904

A
Sense nerve conduction test
0.34
1.09
NA
0.04
1.47
NA
XXX95920
26
A
Intraop nerve test add-on
2.11
0.93
0.93
0.16
3.20
3.20
ZZZ95920
TC
A
Intraop nerve test add-on
0.00
1.31
NA
0.07
1.38
NA
ZZZ95920

A
Intraop nerve test add-on
2.11
2.24
NA
0.23
4.58
NA
ZZZ95921
26
A
Autonomic nerv function test
0.90
0.33
0.33
0.04
1.27
1.27
XXX95921
TC
A
Autonomic nerv function test
0.00
0.38
NA
0.02
0.40
NA
XXX95921

A
Autonomic nerv function test
0.90
0.71
NA
0.06
1.67
NA
XXX95922
26
A
Autonomic nerv function test
0.96
0.40
0.40
0.05
1.41
1.41
XXX95922
TC
A
Autonomic nerv function test
0.00
0.38
NA
0.02
0.40
NA
XXX95922

A
Autonomic nerv function test
0.96
0.78
NA
0.07
1.81
NA
XXX95923
26
A
Autonomic nerv function test
0.90
0.38
0.38
0.05
1.33
1.33
XXX95923
TC
A
Autonomic nerv function test
0.00
1.56
NA
0.02
1.58
NA
XXX95923

A
Autonomic nerv function test
0.90
1.94
NA
0.07
2.91
NA
XXX95925
26
A
Somatosensory testing
0.54
0.22
0.22
0.04
0.80
0.80
XXX95925
TC
A
Somatosensory testing
0.00
0.91
NA
0.06
0.97
NA
XXX95925

A
Somatosensory testing
0.54
1.13
NA
0.10
1.77
NA
XXX95926
26
A
Somatosensory testing
0.54
0.23
0.23
0.03
0.80
0.80
XXX95926
TC
A
Somatosensory testing
0.00
0.91
NA
0.06
0.97
NA
XXX95926

A
Somatosensory testing
0.54
1.14
NA
0.09
1.77
NA
XXX95927
26
A
Somatosensory testing
0.54
0.25
0.25
0.04
0.83
0.83
XXX95927
TC
A
Somatosensory testing
0.00
0.91
NA
0.06
0.97
NA
XXX95927

A
Somatosensory testing
0.54
1.16
NA
0.10
1.80
NA
XXX95928
26
A
C motor evoked, uppr limbs
1.50
0.65
0.65
0.06
2.21
2.21
XXX95928
TC
A
C motor evoked, uppr limbs
0.00
2.38
NA
0.03
2.41
NA
XXX95928

A
C motor evoked, uppr limbs
1.50
3.03
NA
0.09
4.62
NA
XXX95929
26
A
C motor evoked, lwr limbs
1.50
0.65
0.65
0.06
2.21
2.21
XXX95929
TC
A
C motor evoked, lwr limbs
0.00
2.57
NA
0.03
2.60
NA
XXX95929

A
C motor evoked, lwr limbs
1.50
3.22
NA
0.09
4.81
NA
XXX95930
26
A
Visual evoked potential test
0.35
0.15
0.15
0.02
0.52
0.52
XXX( print page 70455)95930
TC
A
Visual evoked potential test
0.00
2.10
NA
0.01
2.11
NA
XXX95930

A
Visual evoked potential test
0.35
2.25
NA
0.03
2.63
NA
XXX95933
26
A
Blink reflex test
0.59
0.24
0.24
0.04
0.87
0.87
XXX95933
TC
A
Blink reflex test
0.00
0.78
NA
0.06
0.84
NA
XXX95933

A
Blink reflex test
0.59
1.02
NA
0.10
1.71
NA
XXX95934
26
A
H-reflex test
0.51
0.22
0.22
0.02
0.75
0.75
XXX95934
TC
A
H-reflex test
0.00
0.21
NA
0.02
0.23
NA
XXX95934

A
H-reflex test
0.51
0.43
NA
0.04
0.98
NA
XXX95936
26
A
H-reflex test
0.55
0.24
0.24
0.03
0.82
0.82
XXX95936
TC
A
H-reflex test
0.00
0.21
NA
0.02
0.23
NA
XXX95936

A
H-reflex test
0.55
0.45
NA
0.05
1.05
NA
XXX95937
26
A
Neuromuscular junction test
0.65
0.27
0.27
0.08
1.00
1.00
XXX95937
TC
A
Neuromuscular junction test
0.00
0.34
NA
0.02
0.36
NA
XXX95937

A
Neuromuscular junction test
0.65
0.61
NA
0.10
1.36
NA
XXX95950
26
A
Ambulatory eeg monitoring
1.51
0.64
0.64
0.08
2.23
2.23
XXX95950
TC
A
Ambulatory eeg monitoring
0.00
3.30
NA
0.43
3.73
NA
XXX95950

A
Ambulatory eeg monitoring
1.51
3.94
NA
0.51
5.96
NA
XXX95951
26
A
EEG monitoring/videorecord
5.99
2.56
2.56
0.32
8.87
8.87
XXX95951
TC
C
EEG monitoring/videorecord
0.00
0.00
0.00
0.00
0.00
0.00
XXX95951

C
EEG monitoring/videorecord
0.00
0.00
0.00
0.00
0.00
0.00
XXX95953
26
A
EEG monitoring/computer
3.08
1.29
1.29
0.17
4.54
4.54
XXX95953
TC
A
EEG monitoring/computer
0.00
6.35
NA
0.43
6.78
NA
XXX95953

A
EEG monitoring/computer
3.08
7.64
NA
0.60
11.32
NA
XXX95954
26
A
EEG monitoring/giving drugs
2.45
1.04
1.04
0.13
3.62
3.62
XXX95954
TC
A
EEG monitoring/giving drugs
0.00
3.19
NA
0.06
3.25
NA
XXX95954

A
EEG monitoring/giving drugs
2.45
4.23
NA
0.19
6.87
NA
XXX95955
26
A
EEG during surgery
1.01
0.36
0.36
0.05
1.42
1.42
XXX95955
TC
A
EEG during surgery
0.00
1.97
NA
0.17
2.14
NA
XXX95955

A
EEG during surgery
1.01
2.33
NA
0.22
3.56
NA
XXX95956
26
A
Eeg monitoring, cable/radio
3.08
1.30
1.30
0.16
4.54
4.54
XXX95956
TC
A
Eeg monitoring, cable/radio
0.00
14.15
NA
0.43
14.58
NA
XXX95956

A
Eeg monitoring, cable/radio
3.08
15.45
NA
0.59
19.12
NA
XXX95957
26
A
EEG digital analysis
1.98
0.85
0.85
0.11
2.94
2.94
XXX95957
TC
A
EEG digital analysis
0.00
1.70
NA
0.12
1.82
NA
XXX95957

A
EEG digital analysis
1.98
2.55
NA
0.23
4.76
NA
XXX95958
26
A
EEG monitoring/function test
4.24
1.75
1.75
0.21
6.20
6.20
XXX95958
TC
A
EEG monitoring/function test
0.00
1.75
NA
0.13
1.88
NA
XXX95958

A
EEG monitoring/function test
4.24
3.50
NA
0.34
8.08
NA
XXX95961
26
A
Electrode stimulation, brain
2.97
1.32
1.32
0.48
4.77
4.77
XXX95961
TC
A
Electrode stimulation, brain
0.00
1.31
NA
0.07
1.38
NA
XXX95961

A
Electrode stimulation, brain
2.97
2.63
NA
0.55
6.15
NA
XXX95962
26
A
Electrode stim, brain add-on
3.21
1.39
1.39
0.32
4.92
4.92
ZZZ95962
TC
A
Electrode stim, brain add-on
0.00
1.31
NA
0.07
1.38
NA
ZZZ95962

A
Electrode stim, brain add-on
3.21
2.70
NA
0.39
6.30
NA
ZZZ95965
26
A
Meg, spontaneous
7.99
3.43
3.43
0.46
11.88
11.88
XXX95965
TC
C
Meg, spontaneous
0.00
0.00
0.00
0.00
0.00
0.00
XXX95965

C
Meg, spontaneous
0.00
0.00
0.00
0.00
0.00
0.00
XXX95966
26
A
Meg, evoked, single
3.99
1.71
1.71
0.19
5.89
5.89
XXX95966
TC
C
Meg, evoked, single
0.00
0.00
0.00
0.00
0.00
0.00
XXX95966

C
Meg, evoked, single
0.00
0.00
0.00
0.00
0.00
0.00
XXX95967
26
A
Meg, evoked, each add'l
3.49
1.18
1.18
0.16
4.83
4.83
ZZZ95967
TC
C
Meg, evoked, each add'l
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ95967

C
Meg, evoked, each add'l
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ95970

A
Analyze neurostim, no prog
0.45
0.85
0.14
0.03
1.33
0.62
XXX95971

A
Analyze neurostim, simple
0.78
0.68
0.22
0.07
1.53
1.07
XXX95972

A
Analyze neurostim, complex
1.50
1.21
0.49
0.14
2.85
2.13
XXX95973

A
Analyze neurostim, complex
0.92
0.62
0.34
0.07
1.61
1.33
ZZZ95974

A
Cranial neurostim, complex
3.00
1.70
1.30
0.16
4.86
4.46
XXX95975

A
Cranial neurostim, complex
1.70
0.89
0.73
0.12
2.71
2.55
ZZZ95978

A
Analyze neurostim brain/1h
3.50
1.94
1.30
0.18
5.62
4.98
XXX95979

A
Analyz neurostim brain addon
1.64
0.87
0.69
0.08
2.59
2.41
ZZZ95990

A
Spin/brain pump refil & main
0.00
1.50
NA
0.06
1.56
NA
XXX95991

A
Spin/brain pump refil & main
0.77
1.46
0.17
0.06
2.29
1.00
XXX95999

C
Neurological procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX96000

A
Motion analysis, video/3d
1.80
NA
0.53
0.11
NA
2.44
XXX96001

A
Motion test w/ft press meas
2.15
NA
0.66
0.10
NA
2.91
XXX96002

A
Dynamic surface emg
0.41
NA
0.15
0.02
NA
0.58
XXX96003

A
Dynamic fine wire emg
0.37
NA
0.12
0.02
NA
0.51
XXX96004

A
Phys review of motion tests
2.14
0.94
0.94
0.11
3.19
3.19
XXX96101

A
Psycho testing by psych/phys
1.86
0.65
0.63
0.05
2.56
2.54
XXX96102

A
Psycho testing by technician
0.50
0.66
0.17
0.01
1.17
0.68
XXX96103

A
Psycho testing admin by comp
0.51
0.21
0.17
0.02
0.74
0.70
XXX96105

A
Assessment of aphasia
0.00
1.77
NA
0.18
1.95
NA
XXX96110

A
Developmental test, lim
0.00
0.18
NA
0.18
0.36
NA
XXX96111

A
Developmental test, extend
2.60
1.05
NA
0.18
3.83
NA
XXX( print page 70456)96116

A
Neurobehavioral status exam
1.86
0.83
0.64
0.18
2.87
2.68
XXX96118

A
Neuropsych tst by psych/phys
1.86
1.39
0.63
0.18
3.43
2.67
XXX96119

A
Neuropsych testing by tech
0.55
1.02
0.19
0.18
1.75
0.92
XXX96120

A
Neuropsych tst admin w/comp
0.51
0.74
0.17
0.02
1.27
0.70
XXX96150

A
Assess hlth/behave, init
0.50
0.18
0.18
0.01
0.69
0.69
XXX96151

A
Assess hlth/behave, subseq
0.48
0.18
0.17
0.01
0.67
0.66
XXX96152

A
Intervene hlth/behave, indiv
0.46
0.17
0.16
0.01
0.64
0.63
XXX96153

A
Intervene hlth/behave, group
0.10
0.04
0.03
0.01
0.15
0.14
XXX96154

A
Interv hlth/behav, fam w/pt
0.45
0.17
0.16
0.01
0.63
0.62
XXX96155

N
Interv hlth/behav fam no pt
+0.44
0.18
0.17
0.02
0.64
0.63
XXX96401

A
Chemo, anti-neopl, sq/im
0.21
1.53
1.53
0.01
1.75
1.75
XXX96402

A
Chemo hormon antineopl sq/im
0.19
0.74
0.74
0.01
0.94
0.94
XXX96405

A
Chemo intralesional, up to 7
0.52
2.78
0.24
0.03
3.33
0.79
00096406

A
Chemo intralesional over 7
0.80
3.08
0.29
0.03
3.91
1.12
00096409

A
Chemo, iv push, sngl drug
0.24
2.93
2.93
0.06
3.23
3.23
XXX96411

A
Chemo, iv push, addl drug
0.20
1.61
1.61
0.06
1.87
1.87
ZZZ96413

A
Chemo, iv infusion, 1 hr
0.28
4.20
4.20
0.08
4.56
4.56
XXX96415

A
Chemo, iv infusion, addl hr
0.19
0.77
0.77
0.07
1.03
1.03
ZZZ96416

A
Chemo prolong infuse w/pump
0.21
4.61
4.61
0.08
4.90
4.90
XXX96417

A
Chemo iv infus each addl seq
0.21
1.95
1.95
0.07
2.23
2.23
ZZZ96420

A
Chemo, ia, push tecnique
0.17
2.66
NA
0.08
2.91
NA
XXX96422

A
Chemo ia infusion up to 1 hr
0.17
4.84
NA
0.08
5.09
NA
XXX96423

A
Chemo ia infuse each addl hr
0.17
1.89
NA
0.02
2.08
NA
ZZZ96425

A
Chemotherapy,infusion method
0.17
4.48
NA
0.08
4.73
NA
XXX96440

A
Chemotherapy, intracavitary
2.37
8.04
1.23
0.17
10.58
3.77
00096445

A
Chemotherapy, intracavitary
2.20
8.05
1.18
0.14
10.39
3.52
00096450

A
Chemotherapy, into CNS
1.53
6.96
1.29
0.09
8.58
2.91
00096521

A
Refill/maint, portable pump
0.21
3.77
3.77
0.06
4.04
4.04
XXX96522

A
Refill/maint pump/resvr syst
0.21
2.65
2.65
0.06
2.92
2.92
XXX96523

T
Irrig drug delivery device
0.04
0.69
0.69
0.01
0.74
0.74
XXX96542

A
Chemotherapy injection
0.75
4.24
0.66
0.07
5.06
1.48
XXX96549

C
Chemotherapy, unspecified
0.00
0.00
0.00
0.00
0.00
0.00
XXX96567

A
Photodynamic tx, skin
0.00
1.96
NA
0.04
2.00
NA
XXX96570

A
Photodynamic tx, 30 min
1.10
NA
0.37
0.11
NA
1.58
ZZZ96571

A
Photodynamic tx, addl 15 min
0.55
NA
0.19
0.03
NA
0.77
ZZZ96900

A
Ultraviolet light therapy
0.00
0.44
NA
0.02
0.46
NA
XXX96902

B
Trichogram
+0.41
0.18
0.16
0.01
0.60
0.58
XXX96910

A
Photochemotherapy with UV-B
0.00
0.99
NA
0.04
1.03
NA
XXX96912

A
Photochemotherapy with UV-A
0.00
1.26
NA
0.05
1.31
NA
XXX96913

A
Photochemotherapy, UV-A or B
0.00
1.68
NA
0.10
1.78
NA
XXX96920

A
Laser tx, skin < 250 sq cm
1.15
2.54
0.56
0.02
3.71
1.73
00096921

A
Laser tx, skin 250-500 sq cm
1.17
2.61
0.57
0.03
3.81
1.77
00096922

A
Laser tx, skin > 500 sq cm
2.10
3.49
0.62
0.04
5.63
2.76
00096999

C
Dermatological procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX97001

A
Pt evaluation
1.20
0.75
0.45
0.05
2.00
1.70
XXX97002

A
Pt re-evaluation
0.60
0.44
0.23
0.02
1.06
0.85
XXX97003

A
Ot evaluation
1.20
0.88
0.40
0.06
2.14
1.66
XXX97004

A
Ot re-evaluation
0.60
0.67
0.19
0.02
1.29
0.81
XXX97005

I
Athletic train eval
0.00
0.00
0.00
0.00
0.00
0.00
XXX97006

I
Athletic train reeval
0.00
0.00
0.00
0.00
0.00
0.00
XXX97010

B
Hot or cold packs therapy
+0.06
0.05
NA
0.01
0.12
NA
XXX97012

A
Mechanical traction therapy
0.25
0.13
NA
0.01
0.39
NA
XXX97014

I
Electric stimulation therapy
+0.18
0.19
0.19
0.01
0.38
0.38
XXX97016

A
Vasopneumatic device therapy
0.18
0.18
NA
0.01
0.37
NA
XXX97018

A
Paraffin bath therapy
0.06
0.10
NA
0.01
0.17
NA
XXX97022

A
Whirlpool therapy
0.17
0.21
NA
0.01
0.39
NA
XXX97024

A
Diathermy eg, microwave
0.06
0.07
NA
0.01
0.14
NA
XXX97026

A
Infrared therapy
0.06
0.06
NA
0.01
0.13
NA
XXX97028

A
Ultraviolet therapy
0.08
0.07
NA
0.01
0.16
NA
XXX97032

A
Electrical stimulation
0.25
0.16
NA
0.01
0.42
NA
XXX97033

A
Electric current therapy
0.26
0.27
NA
0.01
0.54
NA
XXX97034

A
Contrast bath therapy
0.21
0.15
NA
0.01
0.37
NA
XXX97035

A
Ultrasound therapy
0.21
0.10
NA
0.01
0.32
NA
XXX97036

A
Hydrotherapy
0.28
0.32
NA
0.01
0.61
NA
XXX97039

C
Physical therapy treatment
0.00
0.00
0.00
0.00
0.00
0.00
XXX97110

A
Therapeutic exercises
0.45
0.27
NA
0.02
0.74
NA
XXX97112

A
Neuromuscular reeducation
0.45
0.31
NA
0.01
0.77
NA
XXX97113

A
Aquatic therapy/exercises
0.44
0.39
NA
0.01
0.84
NA
XXX97116

A
Gait training therapy
0.40
0.24
NA
0.01
0.65
NA
XXX97124

A
Massage therapy
0.35
0.23
NA
0.01
0.59
NA
XXX97139

C
Physical medicine procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX97140

A
Manual therapy
0.43
0.25
NA
0.01
0.69
NA
XXX97150

A
Group therapeutic procedures
0.27
0.18
NA
0.01
0.46
NA
XXX97530

A
Therapeutic activities
0.44
0.32
NA
0.01
0.77
NA
XXX97532

A
Cognitive skills development
0.44
0.20
NA
0.01
0.65
NA
XXX( print page 70457)97533

A
Sensory integration
0.44
0.24
NA
0.01
0.69
NA
XXX97535

A
Self care mngment training
0.45
0.33
NA
0.01
0.79
NA
XXX97537

A
Community/work reintegration
0.45
0.26
NA
0.01
0.72
NA
XXX97542

A
Wheelchair mngment training
0.45
0.28
NA
0.01
0.74
NA
XXX97545

R
Work hardening
0.00
0.00
0.00
0.00
0.00
0.00
XXX97546

R
Work hardening add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ97597

A
Active wound care/20 cm or <
0.58
0.66
NA
0.05
1.29
NA
XXX97598

A
Active wound care > 20 cm
0.80
0.79
NA
0.05
1.64
NA
XXX97602

B
Wound(s) care non-selective
0.00
0.00
0.00
0.00
0.00
0.00
XXX97605

A
Neg press wound tx, < 50 cm
0.55
0.34
0.22
0.02
0.91
0.79
XXX97606

A
Neg press wound tx, > 50 cm
0.60
0.90
0.41
0.03
1.53
1.04
XXX97750

A
Physical performance test
0.45
0.32
NA
0.02
0.79
NA
XXX97755

A
Assistive technology assess
0.62
0.28
NA
0.02
0.92
NA
XXX97760

A
Orthotic mgmt and training
0.45
0.34
0.20
0.03
0.82
0.68
XXX97761

A
Prosthetic training
0.45
0.28
0.19
0.02
0.75
0.66
XXX97762

A
C/o for orthotic/prosth use
0.25
0.42
0.19
0.02
0.69
0.46
XXX97799

C
Physical medicine procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXX97802

A
Medical nutrition, indiv, in
0.00
0.47
NA
0.01
0.48
NA
XXX97803

A
Med nutrition, indiv, subseq
0.00
0.47
NA
0.01
0.48
NA
XXX97804

A
Medical nutrition, group
0.00
0.18
NA
0.01
0.19
NA
XXX97810

N
Acupunct w/o stimul 15 min
+0.60
0.38
0.23
0.03
1.01
0.86
XXX97811

N
Acupunct w/o stimul addl 15m
+0.50
0.25
0.19
0.03
0.78
0.72
ZZZ97813

N
Acupunct w/stimul 15 min
+0.65
0.40
0.25
0.03
1.08
0.93
XXX97814

N
Acupunct w/stimul addl 15m
+0.55
0.30
0.21
0.03
0.88
0.79
ZZZ98925

A
Osteopathic manipulation
0.45
0.32
0.14
0.02
0.79
0.61
00098926

A
Osteopathic manipulation
0.65
0.41
0.25
0.03
1.09
0.93
00098927

A
Osteopathic manipulation
0.87
0.50
0.29
0.03
1.40
1.19
00098928

A
Osteopathic manipulation
1.03
0.59
0.34
0.04
1.66
1.41
00098929

A
Osteopathic manipulation
1.19
0.67
0.37
0.05
1.91
1.61
00098940

A
Chiropractic manipulation
0.45
0.23
0.12
0.01
0.69
0.58
00098941

A
Chiropractic manipulation
0.65
0.30
0.17
0.01
0.96
0.83
00098942

A
Chiropractic manipulation
0.87
0.36
0.23
0.02
1.25
1.12
00098943

N
Chiropractic manipulation
+0.40
0.24
0.16
0.01
0.65
0.57
XXX98960

N
Self-mgmt educ & train, 1 pt
0.00
0.00
0.00
0.00
0.00
0.00
XXX98961

N
Self-mgmt educ/train, 2-4 pt
0.00
0.00
0.00
0.00
0.00
0.00
XXX98962

N
Self-mgmt educ/train, 5-8 pt
0.00
0.00
0.00
0.00
0.00
0.00
XXX99000

B
Specimen handling
0.00
0.00
0.00
0.00
0.00
0.00
XXX99001

B
Specimen handling
0.00
0.00
0.00
0.00
0.00
0.00
XXX99002

B
Device handling
0.00
0.00
0.00
0.00
0.00
0.00
XXX99024

B
Postop follow-up visit
0.00
0.00
0.00
0.00
0.00
0.00
XXX99026

N
In-hospital on call service
0.00
0.00
0.00
0.00
0.00
0.00
XXX99027

N
Out-of-hosp on call service
0.00
0.00
0.00
0.00
0.00
0.00
XXX99050

B
Medical services after hrs
0.00
0.00
0.00
0.00
0.00
0.00
XXX99051

B
Med serv, eve/wkend/holiday
0.00
0.00
0.00
0.00
0.00
0.00
XXX99053

B
Med serv 10pm-8am, 24 hr fac
0.00
0.00
0.00
0.00
0.00
0.00
XXX99056

B
Med service out of office
0.00
0.00
0.00
0.00
0.00
0.00
XXX99058

B
Office emergency care
0.00
0.00
0.00
0.00
0.00
0.00
XXX99060

B
Out of office emerg med serv
0.00
0.00
0.00
0.00
0.00
0.00
XXX99070

B
Special supplies
0.00
0.00
0.00
0.00
0.00
0.00
XXX99071

B
Patient education materials
0.00
0.00
0.00
0.00
0.00
0.00
XXX99075

N
Medical testimony
0.00
0.00
0.00
0.00
0.00
0.00
XXX99078

B
Group health education
0.00
0.00
0.00
0.00
0.00
0.00
XXX99080

B
Special reports or forms
0.00
0.00
0.00
0.00
0.00
0.00
XXX99082

C
Unusual physician travel
0.00
0.00
0.00
0.00
0.00
0.00
XXX99090

B
Computer data analysis
0.00
0.00
0.00
0.00
0.00
0.00
XXX99091

B
Collect/review data from pt
0.00
0.00
0.00
0.00
0.00
0.00
XXX99100

B
Special anesthesia service
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99116

B
Anesthesia with hypothermia
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99135

B
Special anesthesia procedure
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99140

B
Emergency anesthesia
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99143

C
Mod cs by same phys, < 5 yrs
0.00
0.00
0.00
0.00
0.00
0.00
XXX99144

C
Mod cs by same phys, 5 yrs +
0.00
0.00
0.00
0.00
0.00
0.00
XXX99145

C
Mod cs by same phys add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99148

C
Mod cs diff phys < 5 yrs
0.00
0.00
0.00
0.00
0.00
0.00
XXX99149

C
Mod cs diff phys 5 yrs +
0.00
0.00
0.00
0.00
0.00
0.00
XXX99150

C
Mod cs diff phys add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99170

A
Anogenital exam, child
1.75
1.77
0.55
0.08
3.60
2.38
00099172

N
Ocular function screen
0.00
0.00
0.00
0.00
0.00
0.00
XXX99173

N
Visual acuity screen
0.00
0.00
0.00
0.00
0.00
0.00
XXX99175

A
Induction of vomiting
0.00
1.39
NA
0.10
1.49
NA
XXX99183

A
Hyperbaric oxygen therapy
2.34
3.25
0.72
0.16
5.75
3.22
XXX99185

A
Regional hypothermia
0.00
0.64
NA
0.04
0.68
NA
XXX99186

A
Total body hypothermia
0.00
1.79
NA
0.45
2.24
NA
XXX99190

X
Special pump services
0.00
0.00
0.00
0.00
0.00
0.00
XXX99191

X
Special pump services
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70458)99192

X
Special pump services
0.00
0.00
0.00
0.00
0.00
0.00
XXX99195

A
Phlebotomy
0.00
0.44
NA
0.02
0.46
NA
XXX99199

C
Special service/proc/report
0.00
0.00
0.00
0.00
0.00
0.00
XXX99201

A
Office/outpatient visit, new
0.45
0.49
0.15
0.03
0.97
0.63
XXX99202

A
Office/outpatient visit, new
0.88
0.79
0.31
0.05
1.72
1.24
XXX99203

A
Office/outpatient visit, new
1.34
1.13
0.48
0.09
2.56
1.91
XXX99204

A
Office/outpatient visit, new
2.00
1.50
0.71
0.12
3.62
2.83
XXX99205

A
Office/outpatient visit, new
2.67
1.78
0.95
0.15
4.60
3.77
XXX99211

A
Office/outpatient visit, est
0.17
0.39
0.06
0.01
0.57
0.24
XXX99212

A
Office/outpatient visit, est
0.45
0.54
0.16
0.03
1.02
0.64
XXX99213

A
Office/outpatient visit, est
0.67
0.69
0.24
0.03
1.39
0.94
XXX99214

A
Office/outpatient visit, est
1.10
1.03
0.41
0.05
2.18
1.56
XXX99215

A
Office/outpatient visit, est
1.77
1.32
0.65
0.08
3.17
2.50
XXX99217

A
Observation care discharge
1.28
NA
0.53
0.06
NA
1.87
XXX99218

A
Observation care
1.28
NA
0.44
0.06
NA
1.78
XXX99219

A
Observation care
2.14
NA
0.72
0.10
NA
2.96
XXX99220

A
Observation care
2.99
NA
1.03
0.14
NA
4.16
XXX99221

A
Initial hospital care
1.28
NA
0.45
0.07
NA
1.80
XXX99222

A
Initial hospital care
2.14
NA
0.74
0.10
NA
2.98
XXX99223

A
Initial hospital care
2.99
NA
1.03
0.13
NA
4.15
XXX99231

A
Subsequent hospital care
0.64
NA
0.23
0.03
NA
0.90
XXX99232

A
Subsequent hospital care
1.06
NA
0.37
0.04
NA
1.47
XXX99233

A
Subsequent hospital care
1.51
NA
0.52
0.06
NA
2.09
XXX99234

A
Observ/hosp same date
2.56
NA
0.89
0.13
NA
3.58
XXX99235

A
Observ/hosp same date
3.41
NA
1.15
0.16
NA
4.72
XXX99236

A
Observ/hosp same date
4.26
NA
1.44
0.19
NA
5.89
XXX99238

A
Hospital discharge day
1.28
NA
0.54
0.05
NA
1.87
XXX99239

A
Hospital discharge day
1.75
NA
0.73
0.07
NA
2.55
XXX99241

A
Office consultation
0.64
0.64
0.22
0.05
1.33
0.91
XXX99242

A
Office consultation
1.29
1.04
0.46
0.10
2.43
1.85
XXX99243

A
Office consultation
1.72
1.39
0.63
0.13
3.24
2.48
XXX99244

A
Office consultation
2.58
1.83
0.92
0.16
4.57
3.66
XXX99245

A
Office consultation
3.42
2.28
1.24
0.21
5.91
4.87
XXX99251

A
Initial inpatient consult
0.66
NA
0.24
0.05
NA
0.95
XXX99252

A
Initial inpatient consult
1.32
NA
0.50
0.09
NA
1.91
XXX99253

A
Initial inpatient consult
1.82
NA
0.68
0.11
NA
2.61
XXX99254

A
Initial inpatient consult
2.64
NA
0.98
0.13
NA
3.75
XXX99255

A
Initial inpatient consult
3.64
NA
1.35
0.18
NA
5.17
XXX99281

A
Emergency dept visit
0.33
NA
0.09
0.02
NA
0.44
XXX99282

A
Emergency dept visit
0.55
NA
0.14
0.04
NA
0.73
XXX99283

A
Emergency dept visit
1.24
NA
0.31
0.09
NA
1.64
XXX99284

A
Emergency dept visit
1.95
NA
0.47
0.14
NA
2.56
XXX99285

A
Emergency dept visit
3.06
NA
0.72
0.23
NA
4.01
XXX99288

B
Direct advanced life support
0.00
0.00
0.00
0.00
0.00
0.00
XXX99289

A
Ped crit care transport
4.79
NA
1.45
0.24
NA
6.48
XXX99290

A
Ped crit care transport addl
2.40
NA
0.81
0.12
NA
3.33
ZZZ99291

A
Critical care, first hour
3.99
2.58
1.28
0.21
6.78
5.48
XXX99292

A
Critical care, add'l 30 min
2.00
0.90
0.64
0.11
3.01
2.75
ZZZ99293

A
Ped critical care, initial
15.98
NA
4.76
1.12
NA
21.86
XXX99294

A
Ped critical care, subseq
7.99
NA
2.41
0.45
NA
10.85
XXX99295

A
Neonate crit care, initial
18.46
NA
5.39
1.16
NA
25.01
XXX99296

A
Neonate critical care subseq
7.99
NA
2.55
0.32
NA
10.86
XXX99298

A
Ic for lbw infant < 1500 gm
2.75
NA
0.93
0.17
NA
3.85
XXX99299

A
Ic, lbw infant 1500-2500 gm
2.50
NA
0.86
0.16
NA
3.52
XXX99300

A
Ic, infant pbw 2501-5000 gm
2.40
NA
0.84
2.40
NA
5.64
XXX99304

A
Nursing facility care, init
1.20
0.49
0.49
0.05
1.74
1.74
XXX99305

A
Nursing facility care, init
1.61
0.63
0.63
0.07
2.31
2.31
XXX99306

A
Nursing facility care, init
2.01
0.75
0.75
0.09
2.85
2.85
XXX99307

A
Nursing fac care, subseq
0.60
0.27
0.27
0.03
0.90
0.90
XXX99308

A
Nursing fac care, subseq
1.00
0.45
0.45
0.04
1.49
1.49
XXX99309

A
Nursing fac care, subseq
1.42
0.62
0.62
0.06
2.10
2.10
XXX99310

A
Nursing fac care, subseq
1.77
0.78
0.78
0.08
2.63
2.63
XXX99315

A
Nursing fac discharge day
1.13
0.45
0.45
0.05
1.63
1.63
XXX99316

A
Nursing fac discharge day
1.50
0.59
0.59
0.06
2.15
2.15
XXX99318

A
Annual nursing fac assessmnt
1.20
0.49
0.49
0.05
1.74
1.74
XXX99324

A
Domicil/r-home visit new pat
1.01
0.49
0.38
0.05
1.55
1.44
XXX99325

A
Domicil/r-home visit new pat
1.52
0.68
0.55
0.07
2.27
2.14
XXX99326

A
Domicil/r-home visit new pat
2.27
0.92
0.78
0.10
3.29
3.15
XXX99327

A
Domicil/r-home visit new pat
3.03
1.17
1.05
0.13
4.33
4.21
XXX99328

A
Domicil/r-home visit new pat
3.78
1.42
1.31
0.16
5.36
5.25
XXX99334

A
Domicil/r-home visit est pat
0.76
0.40
0.26
0.04
1.20
1.06
XXX99335

A
Domicil/r-home visit est pat
1.26
0.58
0.43
0.06
1.90
1.75
XXX99336

A
Domicil/r-home visit est pat
2.02
0.82
0.66
0.09
2.93
2.77
XXX99337

A
Domicil/r-home visit est pat
3.03
1.15
0.98
0.13
4.31
4.14
XXX99339

B
Domicil/r-home care supervis
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70459)99340

I
Domicil/r-home care supervis
0.00
0.00
0.00
0.00
0.00
0.00
XXX99341

A
Home visit, new patient
1.01
0.48
NA
0.05
1.54
NA
XXX99342

A
Home visit, new patient
1.52
0.68
NA
0.07
2.27
NA
XXX99343

A
Home visit, new patient
2.27
0.94
NA
0.10
3.31
NA
XXX99344

A
Home visit, new patient
3.03
1.18
NA
0.13
4.34
NA
XXX99345

A
Home visit, new patient
3.78
1.43
NA
0.16
5.37
NA
XXX99347

A
Home visit, est patient
0.76
0.40
NA
0.04
1.20
NA
XXX99348

A
Home visit, est patient
1.26
0.58
NA
0.06
1.90
NA
XXX99349

A
Home visit, est patient
2.02
0.83
NA
0.09
2.94
NA
XXX99350

A
Home visit, est patient
3.03
1.18
NA
0.13
4.34
NA
XXX99354

A
Prolonged service, office
1.77
0.77
0.66
0.08
2.62
2.51
ZZZ99355

A
Prolonged service, office
1.77
0.75
0.62
0.07
2.59
2.46
ZZZ99356

A
Prolonged service, inpatient
1.71
NA
0.62
0.07
NA
2.40
ZZZ99357

A
Prolonged service, inpatient
1.71
NA
0.63
0.08
NA
2.42
ZZZ99358

B
Prolonged serv, w/o contact
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99359

B
Prolonged serv, w/o contact
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99360

X
Physician standby services
0.00
0.00
0.00
0.00
0.00
0.00
XXX99361

B
Physician/team conference
0.00
0.00
0.00
0.00
0.00
0.00
XXX99362

B
Physician/team conference
0.00
0.00
0.00
0.00
0.00
0.00
XXX99371

B
Physician phone consultation
0.00
0.00
0.00
0.00
0.00
0.00
XXX99372

B
Physician phone consultation
0.00
0.00
0.00
0.00
0.00
0.00
XXX99373

B
Physician phone consultation
0.00
0.00
0.00
0.00
0.00
0.00
XXX99374

B
Home health care supervision
+1.10
0.70
0.42
0.05
1.85
1.57
XXX99375

I
Home health care supervision
+1.73
1.55
1.55
0.07
3.35
3.35
XXX99377

B
Hospice care supervision
+1.10
0.70
0.42
0.05
1.85
1.57
XXX99378

I
Hospice care supervision
+1.73
1.95
1.95
0.07
3.75
3.75
XXX99379

B
Nursing fac care supervision
+1.10
0.70
0.42
0.04
1.84
1.56
XXX99380

B
Nursing fac care supervision
+1.73
0.99
0.66
0.06
2.78
2.45
XXX99381

N
Prev visit, new, infant
+1.19
1.50
0.45
0.05
2.74
1.69
XXX99382

N
Prev visit, new, age 1-4
+1.36
1.54
0.52
0.05
2.95
1.93
XXX99383

N
Prev visit, new, age 5-11
+1.36
1.48
0.52
0.05
2.89
1.93
XXX99384

N
Prev visit, new, age 12-17
+1.53
1.55
0.59
0.06
3.14
2.18
XXX99385

N
Prev visit, new, age 18-39
+1.53
1.55
0.59
0.06
3.14
2.18
XXX99386

N
Prev visit, new, age 40-64
+1.88
1.75
0.72
0.07
3.70
2.67
XXX99387

N
Prev visit, new, 65 & over
+2.06
1.88
0.79
0.07
4.01
2.92
XXX99391

N
Prev visit, est, infant
+1.02
1.02
0.39
0.04
2.08
1.45
XXX99392

N
Prev visit, est, age 1-4
+1.19
1.09
0.45
0.05
2.33
1.69
XXX99393

N
Prev visit, est, age 5-11
+1.19
1.06
0.45
0.05
2.30
1.69
XXX99394

N
Prev visit, est, age 12-17
+1.36
1.13
0.52
0.05
2.54
1.93
XXX99395

N
Prev visit, est, age 18-39
+1.36
1.16
0.52
0.05
2.57
1.93
XXX99396

N
Prev visit, est, age 40-64
+1.53
1.25
0.59
0.06
2.84
2.18
XXX99397

N
Prev visit, est, 65 & over
+1.71
1.36
0.66
0.06
3.13
2.43
XXX99401

N
Preventive counseling, indiv
+0.48
0.62
0.19
0.01
1.11
0.68
XXX99402

N
Preventive counseling, indiv
+0.98
0.87
0.37
0.02
1.87
1.37
XXX99403

N
Preventive counseling, indiv
+1.46
1.09
0.56
0.04
2.59
2.06
XXX99404

N
Preventive counseling, indiv
+1.95
1.32
0.75
0.05
3.32
2.75
XXX99411

N
Preventive counseling, group
+0.15
0.18
0.06
0.01
0.34
0.22
XXX99412

N
Preventive counseling, group
+0.25
0.25
0.10
0.01
0.51
0.36
XXX99420

N
Health risk assessment test
0.00
0.00
0.00
0.00
0.00
0.00
XXX99429

N
Unlisted preventive service
0.00
0.00
0.00
0.00
0.00
0.00
XXX99431

A
Initial care, normal newborn
1.17
NA
0.38
0.05
NA
1.60
XXX99432

A
Newborn care, not in hosp
1.26
0.93
0.40
0.07
2.26
1.73
XXX99433

A
Normal newborn care/hospital
0.62
NA
0.20
0.02
NA
0.84
XXX99435

A
Newborn discharge day hosp
1.50
NA
0.59
0.06
NA
2.15
XXX99436

A
Attendance, birth
1.50
NA
0.47
0.06
NA
2.03
XXX99440

A
Newborn resuscitation
2.93
NA
0.93
0.12
NA
3.98
XXX99450

N
Life/disability evaluation
0.00
0.00
0.00
0.00
0.00
0.00
XXX99455

R
Disability examination
0.00
0.00
0.00
0.00
0.00
0.00
XXX99456

R
Disability examination
0.00
0.00
0.00
0.00
0.00
0.00
XXX99499

C
Unlisted e&m service
0.00
0.00
0.00
0.00
0.00
0.00
XXX99500

I
Home visit, prenatal
0.00
0.00
0.00
0.00
0.00
0.00
XXX99501

I
Home visit, postnatal
0.00
0.00
0.00
0.00
0.00
0.00
XXX99502

I
Home visit, nb care
0.00
0.00
0.00
0.00
0.00
0.00
XXX99503

I
Home visit, resp therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXX99504

I
Home visit mech ventilator
0.00
0.00
0.00
0.00
0.00
0.00
XXX99505

I
Home visit, stoma care
0.00
0.00
0.00
0.00
0.00
0.00
XXX99506

I
Home visit, im injection
0.00
0.00
0.00
0.00
0.00
0.00
XXX99507

I
Home visit, cath maintain
0.00
0.00
0.00
0.00
0.00
0.00
XXX99509

I
Home visit day life activity
0.00
0.00
0.00
0.00
0.00
0.00
XXX99510

I
Home visit, sing/m/fam couns
0.00
0.00
0.00
0.00
0.00
0.00
XXX99511

I
Home visit, fecal/enema mgmt
0.00
0.00
0.00
0.00
0.00
0.00
XXX99512

I
Home visit for hemodialysis
0.00
0.00
0.00
0.00
0.00
0.00
XXX99600

I
Home visit nos
0.00
0.00
0.00
0.00
0.00
0.00
XXX99601

I
Home infusion/visit, 2 hrs
0.00
0.00
0.00
0.00
0.00
0.00
XXX99602

I
Home infusion, each add'l hr
0.00
0.00
0.00
0.00
0.00
0.00
XXX( print page 70460)A4890

R
Repair/maint cont hemo equip
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0150

R
Comprehensve oral evaluation
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0240

R
Intraoral occlusal film
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0250

R
Extraoral first film
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0260

R
Extraoral ea additional film
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0270

R
Dental bitewing single film
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0272

R
Dental bitewings two films
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0274

R
Dental bitewings four films
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0277

R
Vert bitewings-sev to eight
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0416

R
Viral culture
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0421

R
Gen tst suscept oral disease
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0431

R
Diag tst detect mucos abnorm
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0460

R
Pulp vitality test
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0472

R
Gross exam, prep & report
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0473

R
Micro exam, prep & report
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0474

R
Micro w exam of surg margins
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0475

R
Decalcification procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0476

R
Spec stains for microorganis
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0477

R
Spec stains not for microorg
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0478

R
Immunohistochemical stains
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0479

R
Tissue in-situ hybridization
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0480

R
Cytopath smear prep & report
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0481

R
Electron microscopy diagnost
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0482

R
Direct immunofluorescence
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0483

R
Indirect immunofluorescence
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0484

R
Consult slides prep elsewher
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0485

R
Consult inc prep of slides
0.00
0.00
0.00
0.00
0.00
0.00
XXXD0502

R
Other oral pathology procedu
0.00
0.00
0.00
0.00
0.00
0.00
YYYD0999

R
Unspecified diagnostic proce
0.00
0.00
0.00
0.00
0.00
0.00
YYYD1510

R
Space maintainer fxd unilat
0.00
0.00
0.00
0.00
0.00
0.00
YYYD1515

R
Fixed bilat space maintainer
0.00
0.00
0.00
0.00
0.00
0.00
YYYD1520

R
Remove unilat space maintain
0.00
0.00
0.00
0.00
0.00
0.00
YYYD1525

R
Remove bilat space maintain
0.00
0.00
0.00
0.00
0.00
0.00
YYYD1550

R
Recement space maintainer
0.00
0.00
0.00
0.00
0.00
0.00
YYYD2999

R
Dental unspec restorative pr
0.00
0.00
0.00
0.00
0.00
0.00
YYYD3460

R
Endodontic endosseous implan
0.00
0.00
0.00
0.00
0.00
0.00
YYYD3999

R
Endodontic procedure
0.00
0.00
0.00
0.00
0.00
0.00
YYYD4260

R
Osseous surgery per quadrant
0.00
0.00
0.00
0.00
0.00
0.00
YYYD4263

R
Bone replce graft first site
0.00
0.00
0.00
0.00
0.00
0.00
YYYD4264

R
Bone replce graft each add
0.00
0.00
0.00
0.00
0.00
0.00
YYYD4268

R
Surgical revision procedure
0.00
0.00
0.00
0.00
0.00
0.00
XXXD4270

R
Pedicle soft tissue graft pr
0.00
0.00
0.00
0.00
0.00
0.00
YYYD4271

R
Free soft tissue graft proc
0.00
0.00
0.00
0.00
0.00
0.00
YYYD4273

R
Subepithelial tissue graft
0.00
0.00
0.00
0.00
0.00
0.00
YYYD4355

R
Full mouth debridement
0.00
0.00
0.00
0.00
0.00
0.00
YYYD4381

R
Localized delivery antimicro
0.00
0.00
0.00
0.00
0.00
0.00
YYYD5911

R
Facial moulage sectional
0.00
0.00
0.00
0.00
0.00
0.00
YYYD5912

R
Facial moulage complete
0.00
0.00
0.00
0.00
0.00
0.00
YYYD5951

R
Feeding aid
0.00
0.00
0.00
0.00
0.00
0.00
YYYD5983

R
Radiation applicator
0.00
0.00
0.00
0.00
0.00
0.00
YYYD5984

R
Radiation shield
0.00
0.00
0.00
0.00
0.00
0.00
YYYD5985

R
Radiation cone locator
0.00
0.00
0.00
0.00
0.00
0.00
YYYD5987

R
Commissure splint
0.00
0.00
0.00
0.00
0.00
0.00
YYYD6920

R
Dental connector bar
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7111

R
Extraction coronal remnants
0.00
0.00
0.00
0.00
0.00
0.00
XXXD7140

R
Extraction erupted tooth/exr
0.00
0.00
0.00
0.00
0.00
0.00
XXXD7210

R
Rem imp tooth w mucoper flp
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7220

R
Impact tooth remov soft tiss
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7230

R
Impact tooth remov part bony
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7240

R
Impact tooth remov comp bony
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7241

R
Impact tooth rem bony w/comp
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7250

R
Tooth root removal
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7260

R
Oral antral fistula closure
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7261

R
Primary closure sinus perf
0.00
0.00
0.00
0.00
0.00
0.00
XXXD7283

R
Place device impacted tooth
0.00
0.00
0.00
0.00
0.00
0.00
XXXD7288

R
Brush biopsy
0.00
0.00
0.00
0.00
0.00
0.00
XXXD7291

R
Transseptal fiberotomy
0.00
0.00
0.00
0.00
0.00
0.00
YYYD7321

R
Alveoloplasty not w/extracts
0.00
0.00
0.00
0.00
0.00
0.00
XXXD7511

R
Incision/drain abscess intra
0.00
0.00
0.00
0.00
0.00
0.00
XXXD7521

R
Incision/drain abscess extra
0.00
0.00
0.00
0.00
0.00
0.00
XXXD7940

R
Reshaping bone orthognathic
0.00
0.00
0.00
0.00
0.00
0.00
YYYD9110

R
Tx dental pain minor proc
0.00
0.00
0.00
0.00
0.00
0.00
YYYD9230

R
Analgesia
0.00
0.00
0.00
0.00
0.00
0.00
YYYD9248

R
Sedation (non-iv)
0.00
0.00
0.00
0.00
0.00
0.00
XXXD9630

R
Other drugs/medicaments
0.00
0.00
0.00
0.00
0.00
0.00
YYY( print page 70461)D9930

R
Treatment of complications
0.00
0.00
0.00
0.00
0.00
0.00
YYYD9940

R
Dental occlusal guard
0.00
0.00
0.00
0.00
0.00
0.00
YYYD9950

R
Occlusion analysis
0.00
0.00
0.00
0.00
0.00
0.00
YYYD9951

R
Limited occlusal adjustment
0.00
0.00
0.00
0.00
0.00
0.00
YYYD9952

R
Complete occlusal adjustment
0.00
0.00
0.00
0.00
0.00
0.00
YYYG0008

X
Admin influenza virus vac
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0009

X
Admin pneumococcal vaccine
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0010

X
Admin hepatitis b vaccine
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0027

X
Semen analysis
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0101

A
CA screen;pelvic/breast exam
0.45
0.52
0.17
0.02
0.99
0.64
XXXG0102

A
Prostate ca screening; dre
0.17
0.39
0.06
0.01
0.57
0.24
XXXG0103

X
Psa, total screening
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0104

A
CA screen;flexi sigmoidscope
0.96
2.28
0.50
0.08
3.32
1.54
000G0105
53
A
Colorectal scrn; hi risk ind
0.96
2.28
0.50
0.08
3.32
1.54
000G0105

A
Colorectal scrn; hi risk ind
3.69
6.16
1.47
0.30
10.15
5.46
000G0106
26
A
Colon CA screen;barium enema
0.99
0.32
0.32
0.04
1.35
1.35
XXXG0106
TC
A
Colon CA screen;barium enema
0.00
2.24
NA
0.13
2.37
NA
XXXG0106

A
Colon CA screen;barium enema
0.99
2.56
NA
0.17
3.72
NA
XXXG0107

X
CA screen; fecal blood test
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0108

A
Diab manage trn per indiv
0.00
0.83
NA
0.01
0.84
NA
XXXG0109

A
Diab manage trn ind/group
0.00
0.48
NA
0.01
0.49
NA
XXXG0117

T
Glaucoma scrn hgh risk direc
0.45
0.72
0.19
0.01
1.18
0.65
XXXG0118

T
Glaucoma scrn hgh risk direc
0.17
0.53
0.06
0.01
0.71
0.24
XXXG0120
26
A
Colon ca scrn; barium enema
0.99
0.32
0.32
0.04
1.35
1.35
XXXG0120
TC
A
Colon ca scrn; barium enema
0.00
2.24
NA
0.13
2.37
NA
XXXG0120

A
Colon ca scrn; barium enema
0.99
2.56
NA
0.17
3.72
NA
XXXG0121
53
A
Colon ca scrn not hi rsk ind
0.96
2.28
0.50
0.08
3.32
1.54
000G0121

A
Colon ca scrn not hi rsk ind
3.69
6.16
1.47
0.30
10.15
5.46
000G0122
26
N
Colon ca scrn; barium enema
+0.99
0.38
0.38
0.05
1.42
1.42
XXXG0122
TC
N
Colon ca scrn; barium enema
+0.00
2.20
2.20
0.13
2.33
2.33
XXXG0122

N
Colon ca scrn; barium enema
+0.99
2.58
2.58
0.18
3.75
3.75
XXXG0123

X
Screen cerv/vag thin layer
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0124

A
Screen c/v thin layer by MD
0.42
0.15
0.15
0.02
0.59
0.59
XXXG0127

R
Trim nail(s)
0.17
0.25
0.07
0.01
0.43
0.25
000G0128

R
CORF skilled nursing service
0.08
0.03
0.03
0.01
0.12
0.12
XXXG0130
26
A
Single energy x-ray study
0.22
0.07
0.07
0.01
0.30
0.30
XXXG0130
TC
A
Single energy x-ray study
0.00
0.80
NA
0.05
0.85
NA
XXXG0130

A
Single energy x-ray study
0.22
0.87
NA
0.06
1.15
NA
XXXG0141

A
Scr c/v cyto,autosys and md
0.42
0.15
0.15
0.02
0.59
0.59
XXXG0143

X
Scr c/v cyto,thinlayer,rescr
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0144

X
Scr c/v cyto,thinlayer,rescr
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0145

X
Scr c/v cyto,thinlayer,rescr
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0147

X
Scr c/v cyto, automated sys
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0148

X
Scr c/v cyto, autosys, rescr
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0166

A
Extrnl counterpulse, per tx
0.07
3.58
0.03
0.01
3.66
0.11
XXXG0168

A
Wound closure by adhesive
0.45
1.94
0.22
0.03
2.42
0.70
000G0173

X
Linear acc stereo radsur com
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0175

X
OPPS Service,sched team conf
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0176

X
OPPS/PHP;activity therapy
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0177

X
OPPS/PHP; train & educ serv
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0179

A
MD recertification HHA PT
0.45
1.03
NA
0.02
1.50
NA
XXXG0180

A
MD certification HHA patient
0.67
1.26
NA
0.03
1.96
NA
XXXG0181

A
Home health care supervision
1.73
1.48
NA
0.07
3.28
NA
XXXG0182

A
Hospice care supervision
1.73
1.66
NA
0.07
3.46
NA
XXXG0186

C
Dstry eye lesn,fdr vssl tech
0.00
0.00
0.00
0.00
0.00
0.00
YYYG0202
26
A
Screeningmammographydigital
0.70
0.23
0.23
0.03
0.96
0.96
XXXG0202
TC
A
Screeningmammographydigital
0.00
2.55
NA
0.07
2.62
NA
XXXG0202

A
Screeningmammographydigital
0.70
2.78
NA
0.10
3.58
NA
XXXG0204
26
A
Diagnosticmammographydigital
0.87
0.28
0.28
0.04
1.19
1.19
XXXG0204
TC
A
Diagnosticmammographydigital
0.00
2.51
NA
0.07
2.58
NA
XXXG0204

A
Diagnosticmammographydigital
0.87
2.79
NA
0.11
3.77
NA
XXXG0206
26
A
Diagnosticmammographydigital
0.70
0.23
0.23
0.03
0.96
0.96
XXXG0206
TC
A
Diagnosticmammographydigital
0.00
2.03
NA
0.06
2.09
NA
XXXG0206

A
Diagnosticmammographydigital
0.70
2.26
NA
0.09
3.05
NA
XXXG0219
26
N
PET img wholbod melano nonco
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0219
TC
N
PET img wholbod melano nonco
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0219

N
PET img wholbod melano nonco
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0235
26
N
PET not otherwise specified
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0235
TC
N
PET not otherwise specified
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0235

N
PET not otherwise specified
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0237

A
Therapeutic procd strg endur
0.00
0.47
NA
0.02
0.49
NA
XXXG0238

A
Oth resp proc, indiv
0.00
0.49
NA
0.02
0.51
NA
XXXG0239

A
Oth resp proc, group
0.00
0.33
NA
0.02
0.35
NA
XXXG0243

X
Multisour photon stero treat
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0245

R
Initial foot exam pt lops
0.88
0.79
0.31
0.04
1.71
1.23
XXX( print page 70462)G0246

R
Followup eval of foot pt lop
0.45
0.54
0.16
0.02
1.01
0.63
XXXG0247

R
Routine footcare pt w lops
0.50
0.52
0.21
0.02
1.04
0.73
ZZZG0248

R
Demonstrate use home inr mon
0.00
6.63
NA
0.01
6.64
NA
XXXG0249

R
Provide test material,equipm
0.00
3.97
NA
0.01
3.98
NA
XXXG0250

R
MD review interpret of test
0.18
0.06
0.06
0.01
0.25
0.25
XXXG0251

E
Linear acc based stero radio
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0255
26
N
Current percep threshold tst
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0255
TC
N
Current percep threshold tst
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0255

N
Current percep threshold tst
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0257

E
Unsched dialysis ESRD pt hos
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0259

E
Inject for sacroiliac joint
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0260

E
Inj for sacroiliac jt anesth
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0265

X
Cryopresevation Freeze+stora
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0266

X
Thawing + expansion froz cel
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0267

X
Bone marrow or psc harvest
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0268

A
Removal of impacted wax md
0.61
0.63
0.24
0.02
1.26
0.87
000G0269

B
Occlusive device in vein art
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0270

A
MNT subs tx for change dx
0.00
0.47
NA
0.01
0.48
NA
XXXG0271

A
Group MNT 2 or more 30 mins
0.00
0.18
NA
0.01
0.19
NA
XXXG0275

A
Renal angio, cardiac cath
0.25
NA
0.10
0.01
NA
0.36
ZZZG0278

A
Iliac art angio,cardiac cath
0.25
NA
0.10
0.01
NA
0.36
ZZZG0281

A
Elec stim unattend for press
0.18
0.11
NA
0.01
0.30
NA
XXXG0282

N
Elect stim wound care not pd
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0283

A
Elec stim other than wound
0.18
0.11
NA
0.01
0.30
NA
XXXG0288

A
Recon, CTA for surg plan
0.00
10.64
NA
0.18
10.82
NA
XXXG0289

A
Arthro, loose body + chondro
1.48
NA
0.80
0.26
NA
2.54
ZZZG0290

E
Drug-eluting stents, single
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0291

E
Drug-eluting stents,each add
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0293

E
Non-cov surg proc,clin trial
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0294

E
Non-cov proc, clinical trial
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0295

N
Electromagnetic therapy onc
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0297

X
Insert single chamber/cd
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0298

X
Insert dual chamber/cd
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0299

X
Inser/repos single icd+leads
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0300

X
Insert reposit lead dual+gen
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0302

X
Pre-op service LVRS complete
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0303

X
Pre-op service LVRS 10-15dos
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0304

X
Pre-op service LVRS 1-9 dos
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0305

X
Post op service LVRS min 6
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0306

X
CBC/diffwbc w/o platelet
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0307

X
CBC without platelet
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0308

A
ESRD related svc 4+mo < 2yrs
12.74
8.56
8.56
0.42
21.72
21.72
XXXG0309

A
ESRD related svc 2-3mo <2yrs
10.61
7.12
7.12
0.36
18.09
18.09
XXXG0310

A
ESRD related svc 1 vst <2yrs
8.49
5.70
5.70
0.28
14.47
14.47
XXXG0311

A
ESRD related svs 4+mo 2-11yr
9.73
4.73
4.73
0.34
14.80
14.80
XXXG0312

A
ESRD relate svs 2-3 mo 2-11y
8.11
3.93
3.93
0.29
12.33
12.33
XXXG0313

A
ESRD related svs 1 mon 2-11y
6.49
3.15
3.15
0.22
9.86
9.86
XXXG0314

A
ESRD related svs 4+ mo 12-19
8.28
4.43
4.43
0.27
12.98
12.98
XXXG0315

A
ESRD related svs 2-3mo/12-19
6.90
3.68
3.68
0.23
10.81
10.81
XXXG0316

A
ESRD related svs 1vis/12-19y
5.52
2.95
2.95
0.17
8.64
8.64
XXXG0317

A
ESRD related svs 4+mo 20+yrs
5.09
2.87
2.87
0.17
8.13
8.13
XXXG0318

A
ESRD related svs 2-3 mo 20+y
4.24
2.39
2.39
0.14
6.77
6.77
XXXG0319

A
ESRD related svs 1visit 20+y
3.39
1.91
1.91
0.11
5.41
5.41
XXXG0320

A
ESD related svs home undr 2
10.61
7.12
7.12
0.36
18.09
18.09
XXXG0321

A
ESRDrelatedsvs home mo 2-11y
8.11
3.93
3.93
0.29
12.33
12.33
XXXG0322

A
ESRD related svs hom mo12-19
6.90
3.68
3.68
0.23
10.81
10.81
XXXG0323

A
ESRD related svs home mo 20+
4.24
2.39
2.39
0.14
6.77
6.77
XXXG0324

A
ESRD relate svs home/dy <2yr
0.35
0.24
0.24
0.01
0.60
0.60
XXXG0325

A
ESRD relate home/day/ 2-11yr
0.23
0.12
0.12
0.01
0.36
0.36
XXXG0326

A
ESRD relate home/dy 12-19yr
0.27
0.13
0.13
0.01
0.41
0.41
XXXG0327

A
ESRD relate home/dy 20+yrs
0.14
0.08
0.08
0.01
0.23
0.23
XXXG0328

X
Fecal blood scrn immunoassay
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0329

A
Electromagntic tx for ulcers
0.06
0.14
0.02
0.01
0.21
0.09
XXXG0337

X
Hospice evaluation preelecti
+1.34
0.51
0.51
0.09
1.94
1.94
XXXG0339

C
Robot lin-radsurg com, first
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0340

C
Robt lin-radsurg fractx 2-5
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0341

A
Percutaneous islet celltrans
6.98
5.75
2.60
0.48
13.21
10.06
000G0342

A
Laparoscopy islet cell trans
11.92
NA
5.31
1.46
NA
18.69
090G0343

A
Laparotomy islet cell transp
19.85
NA
8.78
2.06
NA
30.69
090G0344

A
Initial preventive exam
1.34
1.13
0.48
0.10
2.57
1.92
XXXG0364

A
Bone marrow aspirate &biopsy
0.16
0.14
0.06
0.04
0.34
0.26
ZZZG0365
26
A
Vessel mapping hemo access
0.25
0.09
0.09
0.02
0.36
0.36
XXXG0365
TC
A
Vessel mapping hemo access
0.00
3.91
NA
0.23
4.14
NA
XXXG0365

A
Vessel mapping hemo access
0.25
4.00
NA
0.25
4.50
NA
XXXG0366

A
EKG for initial prevent exam
0.17
0.51
NA
0.03
0.71
NA
XXX( print page 70463)G0367

A
EKG tracing for initial prev
0.00
0.45
NA
0.02
0.47
NA
XXXG0368

A
EKG interpret & report preve
0.17
0.06
0.06
0.01
0.24
0.24
XXXG0372

A
MD service required for PMD
0.17
0.39
0.06
0.01
0.57
0.24
XXXG0375

A
Smoke/tobacco counselng 3-10
0.24
0.09
0.09
0.01
0.34
0.34
XXXG0376

A
Smoke/tobacco counseling >10
0.48
0.18
0.17
0.01
0.67
0.66
XXXG0378

X
Hospital observation per hr
0.00
0.00
0.00
0.00
0.00
0.00
XXXG0379

X
Direct admit hospital observ
0.00
0.00
0.00
0.00
0.00
0.00
XXXG3001

X
Admin + supply, tositumomab
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9001

X
MCCD, initial rate
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9002

X
MCCD,maintenance rate
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9003

X
MCCD, risk adj hi, initial
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9004

X
MCCD, risk adj lo, initial
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9005

X
MCCD, risk adj, maintenance
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9006

X
MCCD, Home monitoring
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9007

X
MCCD, sch team conf
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9008

X
Mccd,phys coor-care ovrsght
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9009

X
MCCD, risk adj, level 3
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9010

X
MCCD, risk adj, level 4
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9011

X
MCCD, risk adj, level 5
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9012

X
Other Specified Case Mgmt
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9013

N
ESRD demo bundle level I
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9014

N
ESRD demo bundle-level II
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9016

N
Demo-smoking cessation coun
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9017

X
Amantadine HCL 100mg oral
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9018

X
Zanamivir,inhalation pwd 10m
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9019

X
Oseltamivir phosphate 75mg
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9020

X
Rimantadine HCL 100mg oral
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9021

X
Chemo assess nausea vomit L1
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9022

X
Chemo assess nausea vomit L2
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9023

X
Chemo assess nausea vomit L3
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9024

X
Chemo assess nausea vomit L4
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9025

X
Chemo assessment pain level1
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9026

X
Chemo assessment pain level2
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9027

X
Chemo assessment pain level3
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9028

X
Chemo assessment pain level4
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9029

X
Chemo assess for fatigue L1
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9030

X
Chemo assess for fatigue L2
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9031

X
Chemo assess for fatigue L3
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9032

X
Chemo assess for fatigue L4
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9033

X
Amantadine HCL oral brand
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9034

X
Zanamivir, inh pwdr, brand
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9035

X
Oseltamivir phosp, brand
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9036

X
Rimantadine HCL, brand
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9041

X
Low vision rehab occupationa
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9042

X
Low vision rehab orient/mobi
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9043

X
Low vision lowvision therapi
0.00
0.00
0.00
0.00
0.00
0.00
XXXG9044

X
Low vision rehabilate teache
0.00
0.00
0.00
0.00
0.00
0.00
XXXM0064

A
Visit for drug monitoring
0.37
0.34
0.12
0.01
0.72
0.50
XXXP3001

A
Screening pap smear by phys
0.42
0.15
0.15
0.02
0.59
0.59
XXXQ0035
26
A
Cardiokymography
0.17
0.06
0.06
0.01
0.24
0.24
XXXQ0035
TC
A
Cardiokymography
0.00
0.39
NA
0.02
0.41
NA
XXXQ0035

A
Cardiokymography
0.17
0.45
NA
0.03
0.65
NA
XXXQ0091

A
Obtaining screen pap smear
0.37
0.67
0.14
0.02
1.06
0.53
XXXQ0092

A
Set up port xray equipment
0.00
0.32
NA
0.01
0.33
NA
XXXQ3001

C
Brachytherapy Radioelements
0.00
0.00
0.00
0.00
0.00
0.00
XXXQ3014

X
Telehealth facility fee
0.00
0.00
0.00
0.00
0.00
0.00
XXXR0070

C
Transport portable x-ray
0.00
0.00
0.00
0.00
0.00
0.00
XXXR0075

C
Transport port x-ray multipl
0.00
0.00
0.00
0.00
0.00
0.00
XXXR0076

B
Transport portable EKG
0.00
0.00
0.00
0.00
0.00
0.00
XXXV5299

R
Hearing service
0.00
0.00
0.00
0.00
0.00
0.00
XXX1
                             CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved.2
                             Copyright 2005 American Dental Association. All rights reserved.3
                             +Indicates RVUs are not used for Medicare payment.
  1 2 3 Addendum C.—Codes With Interim RVUs
CPT 1
                                 
                                    HCPCS 2
Mod
Status
Description
Physician 
                                 work  
                                 
                                    RVUs 3
Non- 
                                 Facility  
                                 PE RVUs
Facility 
                                 PE RVUs
Mal- 
                                 practice  
                                 RVUs
Non- 
                                 Facility  
                                 Total
Facility 
                                 Total
Global15040

A
Harvest cultured skin graft
2.00
4.57
1.13
0.24
6.81
3.37
00015110

A
Epidrm autogrft trnk/arm/leg
9.50
10.70
7.02
1.31
21.51
17.83
09015111

A
Epidrm autogrft t/a/l add-on
1.85
1.29
0.79
0.26
3.40
2.90
ZZZ( print page 70464)15115

A
Epidrm a-grft face/nck/hf/g
9.81
9.25
7.37
1.15
20.21
18.33
09015116

A
Epidrm a-grft f/n/hf/g addl
2.50
1.58
1.12
0.33
4.41
3.95
ZZZ15130

A
Derm autograft, trnk/arm/leg
7.00
9.89
6.36
0.97
17.86
14.33
09015131

A
Derm autograft t/a/l add-on
1.50
1.07
0.64
0.21
2.78
2.35
ZZZ15135

A
Derm autograft face/nck/hf/g
10.50
9.90
8.15
1.23
21.63
19.88
09015136

A
Derm autograft, f/n/hf/g add
1.50
0.89
0.67
0.20
2.59
2.37
ZZZ15150

A
Cult epiderm grft t/arm/leg
8.25
8.48
6.46
1.14
17.87
15.85
09015151

A
Cult epiderm grft t/a/l addl
2.00
1.31
0.85
0.28
3.59
3.13
ZZZ15152

A
Cult epiderm graft t/a/l +%
2.50
1.56
1.06
0.35
4.41
3.91
ZZZ15155

A
Cult epiderm graft, f/n/hf/g
9.00
7.84
6.98
1.05
17.89
17.03
09015156

A
Cult epidrm grft f/n/hfg add
2.75
1.56
1.24
0.36
4.67
4.35
ZZZ15157

A
Cult epiderm grft f/n/hfg +%
3.00
1.78
1.35
0.39
5.17
4.74
ZZZ15170

A
Acell graft trunk/arms/legs
5.00
3.84
2.37
0.55
9.39
7.92
09015171

A
Acell graft t/arm/leg add-on
1.55
0.68
0.62
0.19
2.42
2.36
ZZZ15175

A
Acellular graft, f/n/hf/g
7.00
5.44
4.01
0.82
13.26
11.83
09015176

A
Acell graft, f/n/hf/g add-on
2.45
1.11
0.99
0.29
3.85
3.73
ZZZ15300

A
Apply skinallogrft, t/arm/lg
3.99
3.21
2.24
0.49
7.69
6.72
09015301

A
Apply sknallogrft t/a/l addl
1.00
0.47
0.40
0.14
1.61
1.54
ZZZ15320

A
Apply skin allogrft f/n/hf/g
4.70
3.63
2.54
0.58
8.91
7.82
09015321

A
Aply sknallogrft f/n/hfg add
1.50
0.69
0.59
0.21
2.40
2.30
ZZZ15330

A
Aply acell alogrft t/arm/leg
3.99
3.20
2.23
0.49
7.68
6.71
09015331

A
Aply acell grft t/a/l add-on
1.00
0.46
0.40
0.14
1.60
1.54
ZZZ15335

A
Apply acell graft, f/n/hf/g
4.50
3.48
2.45
0.55
8.53
7.50
09015336

A
Aply acell grft f/n/hf/g add
1.43
0.69
0.57
0.20
2.32
2.20
ZZZ15340

A
Apply cult skin substitute
3.72
4.01
2.76
0.41
8.14
6.89
01015341

A
Apply cult skin sub add-on
0.50
0.61
0.20
0.06
1.17
0.76
ZZZ15360

A
Apply cult derm sub, t/a/l
3.87
4.48
3.09
0.43
8.78
7.39
09015361

A
Aply cult derm sub t/a/l add
1.15
0.58
0.46
0.14
1.87
1.75
ZZZ15365

A
Apply cult derm sub f/n/hf/g
4.15
4.56
3.20
0.46
9.17
7.81
09015366

A
Apply cult derm f/hf/g add
1.45
0.70
0.58
0.17
2.32
2.20
ZZZ15420

A
Apply skin xgraft, f/n/hf/g
4.50
4.79
3.80
0.52
9.81
8.82
09015421

A
Apply skn xgrft f/n/hf/g add
1.50
1.32
0.62
0.21
3.03
2.33
ZZZ15430

A
Apply acellular xenograft
5.75
6.92
6.63
0.66
13.33
13.04
09015431

C
Apply acellular xgraft add
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ22010

A
I&d, p-spine, c/t/cerv-thor
11.05
NA
8.91
1.73
NA
21.69
09022015

A
I&d, p-spine, l/s/ls
10.94
NA
8.85
1.71
NA
21.50
09022523

A
Percut kyphoplasty, thor
8.94
NA
5.92
1.43
NA
16.29
01022524

A
Percut kyphoplasty, lumbar
8.54
NA
5.71
1.36
NA
15.61
01022525

A
Percut kyphoplasty, add-on
4.47
NA
2.28
0.72
NA
7.47
ZZZ28890

A
High energy eswt, plantar f
3.30
5.73
2.09
0.41
9.44
5.80
09032503

A
Resect apical lung tumor
30.00
NA
15.11
4.37
NA
49.48
09032504

A
Resect apical lung tum/chest
34.80
NA
16.72
5.07
NA
56.59
09033507

A
Repair art, intramural
30.00
NA
13.68
4.05
NA
47.73
09033548

A
Restore/remodel, ventricle
37.97
NA
19.35
5.51
NA
62.83
09033768

A
Cavopulmonary shunting
8.00
NA
2.67
1.19
NA
11.86
ZZZ33880

A
Endovasc taa repr incl subcl
33.00
NA
13.51
2.74
NA
49.25
09033881

A
Endovasc taa repr w/o subcl
28.00
NA
11.99
2.32
NA
42.31
09033883

A
Insert endovasc prosth, taa
20.00
NA
9.21
2.10
NA
31.31
09033884

A
Endovasc prosth, taa, add-on
8.20
NA
2.58
0.86
NA
11.64
ZZZ33886

A
Endovasc prosth, delayed
17.00
NA
8.25
1.79
NA
27.04
09033889

A
Artery transpose/endovas taa
15.92
NA
5.19
2.17
NA
23.28
00033891

A
Car-car bp grft/endovas taa
20.00
NA
6.98
2.72
NA
29.70
00033925

A
Rpr pul art unifocal w/o cpb
29.50
NA
14.70
4.60
NA
48.80
09033926

A
Repr pul art, unifocal w/cpb
42.00
NA
17.73
6.20
NA
65.93
09036598

T
Inj w/fluor, eval cv device
0.74
2.65
2.65
0.05
3.44
3.44
00037184

A
Prim art mech thrombectomy
8.66
71.90
3.36
0.55
81.11
12.57
00037185

A
Prim art m-thrombect add-on
3.28
22.95
1.11
0.21
26.44
4.60
ZZZ37186

A
Sec art m-thrombect add-on
4.92
49.53
1.66
0.32
54.77
6.90
ZZZ37187

A
Venous mech thrombectomy
8.03
70.38
3.15
0.51
78.92
11.69
00037188

A
Venous m-thrombectomy add-on
5.71
62.15
2.37
0.37
68.23
8.45
00037718

A
Ligate/strip short leg vein
6.76
NA
4.07
0.14
NA
10.97
09037722

A
Ligate/strip long leg vein
7.79
NA
4.42
0.86
NA
13.07
09043770

A
Lap, place gastr adjust band
16.71
NA
7.73
2.18
NA
26.62
09043771

A
Lap, revise adjust gast band
19.50
NA
8.61
2.54
NA
30.65
09043772

A
Lap, remove adjust gast band
15.00
NA
6.44
1.92
NA
23.36
09043773

A
Lap, change adjust gast band
19.50
NA
8.61
2.55
NA
30.66
09043774

A
Lap remov adj gast band/port
15.00
NA
6.58
1.84
NA
23.42
09043845

A
Gastroplasty duodenal switch
31.00
10.80
10.80
4.05
45.85
45.85
09043886

A
Revise gastric port, open
4.00
NA
3.14
0.25
NA
7.39
09043887

A
Remove gastric port, open
3.95
NA
2.78
0.51
NA
7.24
09043888

A
Change gastric port, open
5.80
NA
3.77
0.70
NA
10.27
09044180

A
Lap, enterolysis
14.42
NA
6.25
1.85
NA
22.52
09044186

A
Lap, jejunostomy
9.77
NA
4.80
1.27
NA
15.84
09044187

A
Lap, ileo/jejuno-stomy
15.93
NA
8.29
1.95
NA
26.17
09044188

A
Lap, colostomy
17.61
NA
8.87
2.23
NA
28.71
090( print page 70465)44213

A
Lap, mobil splenic fl add-on
3.50
NA
1.22
0.44
NA
5.16
ZZZ44227

A
Lap, close enterostomy
26.50
NA
10.65
3.37
NA
40.52
09045395

A
Lap, removal of rectum
30.50
NA
13.71
3.62
NA
47.83
09045397

A
Lap, remove rectum w/pouch
34.00
NA
14.30
3.66
NA
51.96
09045400

A
Laparoscopic proctopexy
18.06
NA
7.85
2.02
NA
27.93
09045402

A
Lap proctopexy w/sig resect
25.04
NA
10.01
2.81
NA
37.86
09045499

C
Laparoscope proc, rectum
0.00
0.00
0.00
0.00
0.00
0.00
YYY45990

A
Surg dx exam, anorectal
1.80
NA
0.79
0.17
NA
2.76
00046505

A
Chemodenervation anal musc
2.86
3.05
1.97
0.14
6.05
4.97
01046710

A
Repr per/vag pouch sngl proc
16.00
NA
7.77
1.38
NA
25.15
09046712

A
Repr per/vag pouch dbl proc
34.00
NA
15.08
3.66
NA
52.74
09050250

A
Cryoablate renal mass open
19.97
NA
9.18
1.39
NA
30.54
09050382

A
Change ureter stent, percut
5.50
36.22
1.87
0.34
42.06
7.71
00050384

A
Remove ureter stent, percut
5.00
35.32
1.71
0.31
40.63
7.02
00050387

A
Change ext/int ureter stent
2.00
18.26
0.67
0.12
20.38
2.79
00050389

A
Remove renal tube w/fluoro
1.10
12.78
0.37
0.07
13.95
1.54
00050592

A
Perc rf ablate renal tumor
6.75
149.45
2.99
0.43
156.63
10.17
01051999

C
Laparoscope proc, bladder
0.00
0.00
0.00
0.00
0.00
0.00
YYY57295

A
Change vaginal graft
7.45
NA
4.44
0.91
NA
12.80
09058110

A
Bx done w/colposcopy add-on
0.77
0.55
0.31
0.09
1.41
1.17
ZZZ61630

N
Intracranial angioplasty
0.00
0.00
0.00
0.00
0.00
0.00
09061635

N
Intracran angioplsty w/stent
0.00
0.00
0.00
0.00
0.00
0.00
09061640

N
Dilate ic vasospasm, init
0.00
0.00
0.00
0.00
0.00
0.00
00061641

N
Dilate ic vasospasm add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ61642

N
Dilate ic vasospasm add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ64650

A
Chemodenerv eccrine glands
0.70
0.87
0.30
0.06
1.63
1.06
00064653

A
Chemodenerv eccrine glands
0.88
0.92
0.38
0.08
1.88
1.34
00067901

A
Repair eyelid defect
7.39
NA
5.42
0.54
NA
13.35
09067902

A
Repair eyelid defect
9.35
NA
5.48
0.60
NA
15.43
09075956
26
A
Xray, endovasc thor ao repr
7.00
2.71
2.71
0.69
10.40
10.40
XXX75957
26
A
Xray, endovasc thor ao repr
6.00
2.32
2.32
0.59
8.91
8.91
XXX75958
26
A
Xray, place prox ext thor ao
4.00
1.55
1.55
0.39
5.94
5.94
XXX75959
26
A
Xray, place dist ext thor ao
3.50
1.36
1.36
0.34
5.20
5.20
XXX76376
26
A
3d render w/o postprocess
0.20
0.07
0.07
0.02
0.29
0.29
XXX76377
26
A
3d rendering w/postprocess
0.79
0.27
0.27
0.08
1.14
1.14
XXX77421
26
A
Stereoscopic x-ray guidance
0.39
0.13
0.13
0.02
0.54
0.54
XXX77422

A
Neutron beam tx, simple
0.00
1.71
NA
0.13
1.84
NA
XXX77423

A
Neutron beam tx, complex
0.00
2.26
NA
0.13
2.39
NA
XXX88333
26
A
Intraop cyto path consult, 1
1.20
0.53
0.53
0.04
1.77
1.77
XXX88334
26
A
Intraop cyto path consult, 2
0.59
0.26
0.26
0.02
0.87
0.87
XXX88384
26
C
Eval molecular probes, 11-50
0.00
0.00
0.00
0.00
0.00
0.00
XXX88385
26
A
Eval molecul probes, 51-250
1.50
0.65
0.65
0.06
2.21
2.21
XXX88386
26
A
Eval molecul probes, 251-500
1.88
0.82
0.82
0.08
2.78
2.78
XXX89049

A
Chct for mal hyperthermia
1.40
3.56
0.27
0.06
5.02
1.73
XXX90760

A
Hydration iv infusion, init
0.17
1.43
1.43
0.07
1.67
1.67
XXX90761

A
Hydrate iv infusion, add-on
0.09
0.40
0.40
0.04
0.53
0.53
ZZZ90765

A
Ther/proph/diag iv inf, init
0.21
1.76
1.76
0.07
2.04
2.04
XXX90766

A
Ther/proph/dg iv inf, add-on
0.18
0.46
0.46
0.04
0.68
0.68
ZZZ90767

A
Tx/proph/dg addl seq iv inf
0.19
0.89
0.89
0.04
1.12
1.12
ZZZ90768

A
Ther/diag concurrent inf
0.17
0.44
0.44
0.04
0.65
0.65
ZZZ90772

A
Ther/proph/diag inj, sc/im
0.17
0.31
0.31
0.01
0.49
0.49
XXX90773

A
Ther/proph/diag inj, ia
0.17
0.32
0.32
0.02
0.51
0.51
XXX90774

A
Ther/proph/diag inj, iv push
0.18
1.30
1.30
0.04
1.52
1.52
XXX90775

A
Ther/proph/diag inj add-on
0.10
0.57
0.57
0.04
0.71
0.71
ZZZ90779

C
Ther/prop/diag inj/inf proc
0.00
0.00
0.00
0.00
0.00
0.00
XXX91022
26
A
Duodenal motility study
1.44
0.51
0.51
0.07
2.02
2.02
00092520

A
Laryngeal function studies
0.75
0.51
0.39
0.03
1.29
1.17
XXX92626

A
Eval aud rehab status
0.00
0.55
NA
0.06
0.61
NA
XXX92627

A
Eval aud status rehab add-on
0.00
0.55
NA
0.06
0.61
NA
XXX92630

I
Aud rehab pre-ling hear loss
0.00
0.00
0.00
0.00
0.00
0.00
XXX92633

I
Aud rehab postling hear loss
0.00
0.00
0.00
0.00
0.00
0.00
XXX95251

A
Gluc monitor, cont, phys i&r
0.52
0.19
0.19
0.02
0.73
0.73
XXX95865
26
A
Muscle test, larynx
1.57
0.77
0.77
0.08
2.42
2.42
XXX95866
26
A
Muscle test, hemidiaphragm
1.25
0.56
0.56
0.07
1.88
1.88
XXX95873
26
A
Guide nerv destr, elec stim
0.37
0.16
0.16
0.02
0.55
0.55
ZZZ95874
26
A
Guide nerv destr, needle emg
0.37
0.17
0.17
0.02
0.56
0.56
ZZZ96101

A
Psycho testing by psych/phys
1.86
0.65
0.63
0.05
2.56
2.54
XXX96102

A
Psycho testing by technician
0.50
0.66
0.17
0.01
1.17
0.68
XXX96103

A
Psycho testing admin by comp
0.51
0.21
0.17
0.02
0.74
0.70
XXX96116

A
Neurobehavioral status exam
1.86
0.83
0.64
0.18
2.87
2.68
XXX96118

A
Neuropsych tst by psych/phys
1.86
1.39
0.63
0.18
3.43
2.67
XXX96119

A
Neuropsych testing by tech
0.55
1.02
0.19
0.18
1.75
0.92
XXX96120

A
Neuropsych tst admin w/comp
0.51
0.74
0.17
0.02
1.27
0.70
XXX96401

A
Chemo, anti-neopl, sq/im
0.21
1.53
1.53
0.01
1.75
1.75
XXX96402

A
Chemo hormon antineopl sq/im
0.19
0.74
0.74
0.01
0.94
0.94
XXX( print page 70466)96409

A
Chemo, iv push, sngl drug
0.24
2.93
2.93
0.06
3.23
3.23
XXX96411

A
Chemo, iv push, addl drug
0.20
1.61
1.61
0.06
1.87
1.87
ZZZ96413

A
Chemo, iv infusion, 1 hr
0.28
4.20
4.20
0.08
4.56
4.56
XXX96415

A
Chemo, iv infusion, addl hr
0.19
0.77
0.77
0.07
1.03
1.03
ZZZ96416

A
Chemo prolong infuse w/pump
0.21
4.61
4.61
0.08
4.90
4.90
XXX96417

A
Chemo iv infus each addl seq
0.21
1.95
1.95
0.07
2.23
2.23
ZZZ96450

A
Chemotherapy, into CNS
1.53
6.96
1.29
0.09
8.58
2.91
00096521

A
Refill/maint, portable pump
0.21
3.77
3.77
0.06
4.04
4.04
XXX96522

A
Refill/maint pump/resvr syst
0.21
2.65
2.65
0.06
2.92
2.92
XXX96523

T
Irrig drug delivery device
0.04
0.69
0.69
0.01
0.74
0.74
XXX96542

A
Chemotherapy injection
0.75
4.24
0.66
0.07
5.06
1.48
XXX97760

A
Orthotic mgmt and training
0.45
0.34
0.20
0.03
0.82
0.68
XXX97761

A
Prosthetic training
0.45
0.28
0.19
0.02
0.75
0.66
XXX97762

A
C/o for orthotic/prosth use
0.25
0.42
0.19
0.02
0.69
0.46
XXX98960

N
Self-mgmt educ & train, 1 pt
0.00
0.00
0.00
0.00
0.00
0.00
XXX98961

N
Self-mgmt educ/train, 2-4 pt
0.00
0.00
0.00
0.00
0.00
0.00
XXX98962

N
Self-mgmt educ/train, 5-8 pt
0.00
0.00
0.00
0.00
0.00
0.00
XXX99143

C
Mod cs by same phys, < 5 yrs
0.00
0.00
0.00
0.00
0.00
0.00
XXX99144

C
Mod cs by same phys, 5 yrs +
0.00
0.00
0.00
0.00
0.00
0.00
XXX99145

C
Mod cs by same phys add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99148

C
Mod cs diff phys < 5 yrs
0.00
0.00
0.00
0.00
0.00
0.00
XXX99149

C
Mod cs diff phys 5 yrs +
0.00
0.00
0.00
0.00
0.00
0.00
XXX99150

C
Mod cs diff phys add-on
0.00
0.00
0.00
0.00
0.00
0.00
ZZZ99300

A
Ic, infant pbw 2501-5000 gm
2.40
NA
0.84
2.40
NA
5.64
XXX99304

A
Nursing facility care, init
1.20
0.49
0.49
0.05
1.74
1.74
XXX99305

A
Nursing facility care, init
1.61
0.63
0.63
0.07
2.31
2.31
XXX99306

A
Nursing facility care, init
2.01
0.75
0.75
0.09
2.85
2.85
XXX99307

A
Nursing fac care, subseq
0.60
0.27
0.27
0.03
0.90
0.90
XXX99308

A
Nursing fac care, subseq
1.00
0.45
0.45
0.04
1.49
1.49
XXX99309

A
Nursing fac care, subseq
1.42
0.62
0.62
0.06
2.10
2.10
XXX99310

A
Nursing fac care, subseq
1.77
0.78
0.78
0.08
2.63
2.63
XXX99318

A
Annual nursing fac assessmnt
1.20
0.49
0.49
0.05
1.74
1.74
XXX99324

A
Domicil/r-home visit new pat
1.01
0.49
0.38
0.05
1.55
1.44
XXX99325

A
Domicil/r-home visit new pat
1.52
0.68
0.55
0.07
2.27
2.14
XXX99326

A
Domicil/r-home visit new pat
2.27
0.92
0.78
0.10
3.29
3.15
XXX99327

A
Domicil/r-home visit new pat
3.03
1.17
1.05
0.13
4.33
4.21
XXX99328

A
Domicil/r-home visit new pat
3.78
1.42
1.31
0.16
5.36
5.25
XXX99334

A
Domicil/r-home visit est pat
0.76
0.40
0.26
0.04
1.20
1.06
XXX99335

A
Domicil/r-home visit est pat
1.26
0.58
0.43
0.06
1.90
1.75
XXX99336

A
Domicil/r-home visit est pat
2.02
0.82
0.66
0.09
2.93
2.77
XXX99337

A
Domicil/r-home visit est pat
3.03
1.15
0.98
0.13
4.31
4.14
XXX99339

B
Domicil/r-home care supervis
0.00
0.00
0.00
0.00
0.00
0.00
XXX99340

I
Domicil/r-home care supervis
0.00
0.00
0.00
0.00
0.00
0.00
XXX1
                             CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.2
                             Copyright 2005 American Dental Association. All rights reserved.3
                             +Indicates RVUs are not used for Medicare payment.
  Addendum D.—2006 Geographic Practice Cost Indices by Medicare Carrier and Locality
Carrier
Locality
Locality Name
Work 
                                 GPCI
PE 
                                 GPCI
MP 
                                 GPCI00510
00
Alabama
1.000
0.846
0.75200831
01
Alaska
1.017
1.103
1.02900832
00
Arizona
1.000
0.992
1.06900520
13
Arkansas
1.000
0.831
0.43831140
03
Marin/Napa/Solano, CA
1.035
1.340
0.65131140
05
San Francisco, CA
1.060
1.543
0.65131140
06
San Mateo, CA
1.073
1.536
0.63931140
07
Oakland/Berkley, CA
1.054
1.371
0.65131140
09
Santa Clara, CA
1.083
1.540
0.60431146
17
Ventura, CA
1.028
1.179
0.74431146
18
Los Angeles, CA
1.041
1.156
0.95431146
26
Anaheim/Santa Ana, CA
1.034
1.236
0.95431140
99
Rest of California*
1.007
1.053
0.73331146
99
Rest of California*
1.007
1.053
0.73300824
01
Colorado
1.000
1.014
0.80300591
00
Connecticut
1.038
1.170
0.90000903
01
DC + MD/VA Suburbs
1.048
1.250
0.92600902
01
Delaware
1.012
1.018
0.89200590
03
Fort Lauderdale, FL
1.000
0.988
1.70300590
04
Miami, FL
1.000
1.046
2.26900590
99
Rest of Florida
1.000
0.934
1.272( print page 70467)00511
01
Atlanta, GA
1.010
1.089
0.96600511
99
Rest of Georgia
1.000
0.872
0.96600833
01
Hawaii/Guam
1.005
1.111
0.80005130
00
Idaho
1.000
0.868
0.45900952
12
East St. Louis, IL
1.000
0.939
1.75000952
15
Suburban Chicago, IL
1.018
1.115
1.65200952
16
Chicago, IL
1.025
1.126
1.86700952
99
Rest of Illinois
1.000
0.872
1.19300630
00
Indiana
1.000
0.906
0.43600826
00
Iowa
1.000
0.868
0.58900650
00
Kansas*
1.000
0.878
0.72100660
00
Kentucky
1.000
0.854
0.87300528
01
New Orleans, LA
1.000
0.946
1.19700528
99
Rest of Louisiana
1.000
0.847
1.05831142
03
Southern Maine
1.000
1.013
0.63731142
99
Rest of Maine
1.000
0.886
0.63700901
01
Baltimore/Surr. Cntys, MD
1.012
1.078
0.94700901
99
Rest of Maryland
1.000
0.980
0.76031143
01
Metropolitan Boston
1.030
1.329
0.82331143
99
Rest of Massachusetts
1.007
1.103
0.82300953
01
Detroit, MI
1.037
1.054
2.74400953
99
Rest of Michigan
1.000
0.921
1.51800954
00
Minnesota
1.000
1.005
0.41000512
00
Mississippi
1.000
0.839
0.72200740
02
Metropolitan Kansas City, MO
1.000
0.975
0.94600523
01
Metropolitan St. Louis, MO
1.000
0.955
0.94100523
99
Rest of Missouri*
1.000
0.802
0.89200740
99
Rest of Missouri*
1.000
0.802
0.89200751
01
Montana
1.000
0.844
0.90400655
00
Nebraska
1.000
0.875
0.45400834
00
Nevada
1.003
1.043
1.06831144
40
New Hampshire
1.000
1.027
0.94200805
01
Northern NJ
1.058
1.220
0.97300805
99
Rest of New Jersey
1.043
1.119
0.97300521
05
New Mexico
1.000
0.887
0.89500801
99
Rest of New York
1.000
0.917
0.67700803
01
Manhattan, NY
1.065
1.298
1.50400803
02
NYC Suburbs/Long I., NY
1.052
1.280
1.78500803
03
Poughkpsie/N NYC Suburbs, NY
1.014
1.074
1.16714330
04
Queens, NY
1.032
1.228
1.71005535
00
North Carolina
1.000
0.920
0.64000820
01
North Dakota
1.000
0.860
0.60200883
00
Ohio
1.000
0.933
0.97600522
00
Oklahoma
1.000
0.854
0.38200835
01
Portland, OR
1.002
1.057
0.44100835
99
Rest of Oregon
1.000
0.925
0.44100865
01
Metropolitan Philadelphia, PA
1.016
1.104
1.38600865
99
Rest of Pennsylvania
1.000
0.902
0.80600973
20
Puerto Rico
1.000
0.698
0.26100524
01
Rhode Island
1.045
0.989
0.90900880
01
South Carolina
1.000
0.893
0.39400820
02
South Dakota
1.000
0.876
0.36505440
35
Tennessee
1.000
0.879
0.63100900
09
Brazoria, TX
1.020
0.961
1.29800900
11
Dallas, TX
1.009
1.062
1.06100900
15
Galveston, TX
1.000
0.952
1.29800900
18
Houston, TX
1.016
1.014
1.29700900
20
Beaumont, TX
1.000
0.860
1.29800900
28
Fort Worth, TX
1.000
0.989
1.06100900
31
Austin, TX
1.000
1.046
0.98600900
99
Rest of Texas
1.000
0.865
1.13800823
09
Utah
1.000
0.937
0.66231145
50
Vermont
1.000
0.968
0.51400973
50
Virgin Islands
1.000
1.014
1.00300904
00
Virginia
1.000
0.940
0.57900836
02
Seattle (King Cnty), WA
1.014
1.131
0.81900836
99
Rest of Washington
1.000
0.978
0.81900884
16
West Virginia
1.000
0.819
1.54700951
00
Wisconsin
1.000
0.918
0.79000825
21
Wyoming
1.000
0.853
0.935For 2005 & 2006, if the work GPCI falls below a 1.0 index, the work GPCI equals 1.0. 
                            ( print page 70468)* States are served by more than one carrier.
 Addendum E.—2006 GAFs
Carrier
Locality
Locality name
2006 GAF31140
09
Santa Clara, CA
1.26531140
06
San Mateo, CA
1.25931140
05
San Francisco, CA
1.25600803
01
Manhattan, NY
1.18400803
02
NYC Suburbs/Long I., NY
1.18031140
07
Oakland/Berkley, CA
1.17731140
03
Marin/Napa/Solano, CA
1.15431143
01
Metropolitan Boston
1.15314330
04
Queens, NY
1.14400903
01
DC + MD/VA Suburbs
1.13200805
01
Northern NJ
1.12631146
26
Anaheim/Santa Ana, CA
1.11900953
01
Detroit, MI
1.11100952
16
Chicago, IL
1.10200591
00
Connecticut
1.09131146
18
Los Angeles, CA
1.08800952
15
Suburban Chicago, IL
1.08531146
17
Ventura, CA
1.08300805
99
Rest of New Jersey
1.07400865
01
Metropolitan Philadelphia, PA
1.06900590
04
Miami, FL
1.06900836
02
Seattle (King Cnty), WA
1.05800831
01
Alaska
1.05500803
03
Poughkpsie/N NYC Suburbs, NY
1.04600833
01
Hawaii/Guam
1.04400511
01
Atlanta, GA
1.04331143
99
Rest of Massachusetts
1.04200901
01
Baltimore/Surr. Cntys, MD
1.03900900
11
Dallas, TX
1.03400900
18
Houston, TX
1.02600834
00
Nevada
1.02300590
03
Fort Lauderdale, FL
1.02200900
31
Austin, TX
1.02031146
99
Rest of California*
1.01731140
99
Rest of California*
1.01731144
40
New Hampshire
1.01000902
01
Delaware
1.01000973
50
Virgin Islands
1.00700900
09
Brazoria, TX
1.00500835
01
Portland, OR
1.00500952
12
East St. Louis, IL
1.00300832
00
Arizona
0.99900824
01
Colorado
0.99900900
28
Fort Worth, TX
0.99831142
03
Southern Maine
0.99200900
15
Galveston, TX
0.99100740
02
Metropolitan Kansas City, MO
0.98700953
99
Rest of Michigan
0.98600836
99
Rest of Washington
0.98400528
01
New Orleans, LA
0.98400901
99
Rest of Maryland
0.98200590
99
Rest of Florida
0.98200954
00
Minnesota
0.98000523
01
Metropolitan St. Louis, MO
0.97800883
00
Ohio
0.97031145
50
Vermont
0.96800823
09
Utah
0.96000904
00
Virginia
0.95800951
00
Wisconsin
0.95600952
99
Rest of Illinois
0.95200801
99
Rest of New York
0.95205535
00
North Carolina
0.95100900
20
Beaumont, TX
0.95100865
99
Rest of Pennsylvania
0.95000900
99
Rest of Texas
0.94700521
05
New Mexico
0.94700835
99
Rest of Oregon
0.94600511
99
Rest of Georgia
0.94300740
99
Rest of Missouri*
0.910( print page 70469)00884
16
West Virginia
0.94200630
00
Indiana
0.93731142
99
Rest of Maine
0.93600650
00
Kansas*
0.93600528
99
Rest of Louisiana
0.93600825
21
Wyoming
0.93405440
35
Tennessee
0.93300660
00
Kentucky
0.93200880
01
South Carolina
0.93000870
01
Rhode Island
0.93000751
01
Montana
0.92800826
00
Iowa
0.92700655
00
Nebraska
0.92500820
01
North Dakota
0.92400510
00
Alabama
0.92305130
00
Idaho
0.92200820
02
South Dakota
0.92200512
00
Mississippi
0.91900522
00
Oklahoma
0.91300740
99
Rest of Missouri*
0.91000523
99
Rest of Missouri*
0.91000520
13
Arkansas
0.90500973
20
Puerto Rico
0.840* States are served by more than one carrier.
 Addendum F.—Revised Single Drug Category List
HCPCS
Long description
Recalculated 
                                 weightsJ0150
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG
0.00069828J0152
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG
0.00458348J0170
INJECTION, ADRENALIN, EPINEPHRINE, 1 ML AMPULE
0.00007878J0207
INJECTION, AMIFOSTINE, 500 MG
0.00016059J0215
INJECTION, ALEFACEPT, 0.5 MG
0.00083178J0280
INJECTION, AMINOPHYLLIN, 250 MG
0.00081886J0290
INJECTION, AMPICILLIN SODIUM, 500 MG
0.00012626J0475
INJECTION, BACLOFEN, 10 MG
0.00024582J0540
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 1,200,000 UNITS
0.00007191J0550
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 2,400,000 UNITS
0.00001826J0570
INJECTION, PENICILLIN G BENZATHINE, 1,200,000 UNITS
0.00004593J0585
BOTULINUM TOXIN TYPE A, PER UNIT
0.03734001J0587
BOTULINUM TOXIN TYPE B, PER 100 UNITS
0.00150333J0600
INJECTION, EDETATE CALCIUM DISODIUM, 1000 MG
0.00004448J0637
INJECTION, CASPOFUNGIN ACETATE, 5 MG
0.00008462J0640
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
0.01061886J0670
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
0.00038303J0690
INJECTION, CEFAZOLIN SODIUM, 500 MG
0.00042306J0692
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
0.00024785J0696
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
0.00667188J0698
INJECTION, CEFOTAXIME SODIUM, PER GM
0.00014842J0702
INJECTION, BETAMETHASONE ACETATE & BETAMETHASONE SODIUM PHOSPHATE, PER 3 MG
0.00287002J0704
INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG
0.00056918J0735
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
0.00034065J0800
INJECTION, CORTICOTROPIN, 40 UNITS
0.00363050J0895
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
0.00024388J1000
INJECTION, DEPO-ESTRADIOL CYPIONATE, 5 MG
0.00020962J1020
INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
0.00127016J1030
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
0.00591680J1040
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
0.00526505J1051
INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG
0.00006510J1094
INJECTION, DEXAMETHASONE ACETATE, 1 MG
0.00350405J1100
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
0.05478551J1190
INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
0.00002438J1200
INJECTION, DIPHENHYDRAMINE HCL, 50 MG
0.00215958J1212
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
0.00008455J1245
INJECTION, DIPYRIDAMOLE, PER 10 MG
0.00382235J1250
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
0.00053051J1260
INJECTION, DOLASETRON MESYLATE, 10 MG
0.01732829J1335
INJECTION, ERTAPENEM SODIUM, 500 MG
0.00013230( print page 70470)J1440
INJECTION, FILGRASTIM (G-CSF), 300 MCG
0.00193096J1441
INJECTION, FILGRASTIM (G-CSF), 480 MCG
0.00406386J1450
INJECTION FLUCONAZOLE, 200 MG
0.00001605J1580
INJECTION, GARAMYCIN, GENTAMICIN, 80 MG
0.00039839J1600
INJECTION, GOLD SODIUM THIOMALATE, 50 MG
0.00005600J1626
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
0.01480082J1631
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
0.00020651J1642
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS
0.06406943J1644
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
0.00353690J1645
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
0.00011497J1650
INJECTION, ENOXAPARIN SODIUM, 10 MG
0.00135285J1655
INJECTION, TINZAPARIN SODIUM, 1000 IU
0.00047054J1720
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, 100 MG
0.00013295J1745
INJECTION INFLIXIMAB, 10 MG
0.02755927J1750
INJECTION, IRON DEXTRAN, 50 MG
0.00245914J1756
INJECTION, IRON SUCROSE, 1 MG
0.01024469J1885
INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
0.00329270J1940
INJECTION, FUROSEMIDE, 20 MG
0.00065208J1956
INJECTION, LEVOFLOXACIN, 250 MG
0.00008608J2001
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
0.00077337J2010
INJECTION, LINCOMYCIN HCL, 300 MG
0.00062307J2150
INJECTION, MANNITOL, 25% IN 50 ML
0.00029139J2260
INJECTION, MILRINONE LACTATE, 5 MG
0.00004947J2300
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
0.00026276J2325
INJECTION, NESIRITIDE, 0.1 MG
0.00027338J2353
INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG
0.00194628J2354
INJECTION, OCTREOTIDE, NON-DEPOT SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG
0.00008391J2405
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
0.01369661J2430
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
0.00156404J2505
INJECTION, PEGFILGRASTIM, 6 MG
0.00064954J2550
INJECTION, PROMETHAZINE HCL, 50 MG
0.00068512J2680
INJECTION, FLUPHENAZINE DECANOATE, 25 MG
0.00015076J2765
INJECTION, METOCLOPRAMIDE HCL, 10 MG
0.00011107J2780
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
0.00088333J2820
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
0.00217374J2912
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
0.00678337J2916
INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG
0.00060984J2920
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 40 MG
0.00031153J2930
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 125 MG
0.00077009J2997
INJECTION, ALTEPLASE RECOMBINANT, 1 MG
0.00012209J3260
INJECTION, TOBRAMYCIN SULFATE, 80 MG
0.00018247J3301
INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG
0.02161210J3302
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
0.00172788J3303
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
0.00094370J3315
INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
0.00000712J3370
INJECTION, VANCOMYCIN HCL, 500 MG
0.00083980J3396
INJECTION, VERTEPORFIN, 0.1 MG
0.05425250J3410
INJECTION, HYDROXYZINE HCL, 25 MG
0.00040904J3420
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
0.01200091J3475
INJECTION, MAGNESIUM SULFATE, PER 500 MG
0.00108238J3480
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
0.00215178J3487
INJECTION, ZOLEDRONIC ACID, 1 MG
0.00335651J7030
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
0.00102582J7040
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
0.00242568J7042
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
0.00049750J7050
INFUSION, NORMAL SALINE SOLUTION , 250 CC
0.00990901J7060
5% DEXTROSE/WATER (500 ML = 1 UNIT)
0.00102607J7070
INFUSION, D5W, 1000 CC
0.00015855J7120
RINGERS LACTATE INFUSION, 1000 CC
0.00016938J7318
HYALURONAN (SODIUM HYALURONATE) OR DERIVATIVE, INTRA-ARTICULAR INJECTION, 1 MG
0.00340613J9000
DOXORUBICIN HCL, 10 MG
0.00235266J9001
DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG
0.00032456J9031
BCG (INTRAVESICAL) PER INSTILLATION
0.00049146J9040
BLEOMYCIN SULFATE, 15 UNITS
0.00003718J9045
CARBOPLATIN, 50 MG
0.00568694J9050
CARMUSTINE, 100 MG
0.00000887J9060
CISPLATIN, POWDER OR S0LUTION, PER 10 MG
0.00095159J9062
CISPLATIN, 50 MG
0.00025368J9065
INJECTION, CLADRIBINE, PER 1 MG
0.00008122J9070
CYCLOPHOSPHAMIDE, 100 MG
0.00062537J9080
CYCLOPHOSPHAMIDE, 200 MG
0.00004956( print page 70471)J9090
CYCLOPHOSPHAMIDE, 500 MG
0.00008105J9091
CYCLOPHOSPHAMIDE, 1.0 GRAM
0.00005036J9092
CYCLOPHOSPHAMIDE, 2.0 GRAM
0.00000528J9093
CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG
0.00092452J9094
CYCLOPHOSPHAMIDE, LYOPHILIZED, 200 MG
0.00009167J9095
CYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG
0.00017653J9096
CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM
0.00013943J9097
CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM
0.00001356J9098
CYTARABINE LIPOSOME, 10 MG
0.00000815J9100
CYTARABINE, 100 MG
0.00012978J9110
CYTARABINE, 500 MG
0.00002071J9130
DACARBAZINE, 100 MG
0.00009406J9140
DACARBAZINE, 200 MG
0.00007007J9150
DAUNORUBICIN, 10 MG
0.00000488J9170
DOCETAXEL, 20 MG
0.00256588J9178
INJECTION, EPIRUBICIN HCL, 2 MG
0.00121617J9181
ETOPOSIDE, 10 MG
0.00230896J9182
ETOPOSIDE, 100 MG
0.00052981J9185
FLUDARABINE PHOSPHATE, 50 MG
0.00030572J9190
FLUOROURACIL, 500 MG
0.00395219J9200
FLOXURIDINE, 500 MG
0.00000408J9201
GEMCITABINE HCL, 200 MG
0.00494962J9202
GOSERELIN ACETATE IMPLANT, PER 3.6 MG
0.00287887J9206
IRINOTECAN, 20 MG
0.00318310J9208
IFOSFAMIDE, 1 GM
0.00007873J9209
MESNA, 200 MG
0.00036778J9211
IDARUBICIN HYDROCHLORIDE, 5 MG
0.00000318J9213
INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
0.00008062J9214
INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
0.00673538J9219
LEUPROLIDE ACETATE IMPLANT, 65 MG
0.00006510J9245
INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG
0.00000158J9250
METHOTREXATE SODIUM, 5 MG
0.00186241J9260
METHOTREXATE SODIUM, 50 MG
0.00051323J9263
INJECTION, OXALIPLATIN, 0.5 MG
0.07300568J9265
PACLITAXEL, 30 MG
0.00555323J9268
PENTOSTATIN, PER 10 MG
0.00000643J9280
MITOMYCIN, 5 MG
0.00004067J9290
MITOMYCIN, 20 MG
0.00003473J9291
MITOMYCIN, 40 MG
0.00006128J9293
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
0.00025058J9310
RITUXIMAB, 100 MG
0.00408558J9320
STREPTOZOCIN, 1 GM
0.00000671J9340
THIOTEPA, 15 MG
0.00002446J9350
TOPOTECAN, 4 MG
0.00018223J9355
TRASTUZUMAB, 10 MG
0.00542012J9360
VINBLASTINE SULFATE, 1 MG
0.00035725J9370
VINCRISTINE SULFATE, 1 MG
0.00019702J9375
VINCRISTINE SULFATE, 2 MG
0.00011487J9390
VINORELBINE TARTRATE, PER 10 MG
0.00110762J9395
INJECTION, FULVESTRANT, 25 MG
0.00126358J9600
PORFIMER SODIUM, 75 MG
0.00000030J0885
INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS
0.25074794J0881
INJECTION, DARBEPOETIN ALFA, 1 MCG (NON-ESRD USE)
0.15914222Q3025
INJECTION, INTERFERON BETA-1A, 11 MCG FOR INTRAMUSCULAR USE
0.00078070
 Addendum G.—Revised New Drugs for CAP Bidding for 2006
[Effective January 1, 2006]
HCPCS
Long descriptionJ0128
Abarelix injection.J0180
Agalsidase beta injection.J0278
Amikacin.J0878
Daptomycin injection.J1751
Iron Dextran 165.J1752
Iron Dextran 267.J1931
Laronidase injection.J2357
Omalizumab injection.J2469
Palonosetron HCl.J2503
Pegaptanib.J2794
Risperidone, long acting.J9035
Bevacizumab injection.J9041
Bortezomib injection.J9055
Cetuximab injection.J9225
Histrelin implant.J9264
Paclitaxel protein bound particles.J9305
Pemetrexed injection.
 
 
 Addendum H.—List of CPT 1
                            /HCPCS Codes Used to Describe Certain Designated Health Service Categories 2
                             Under Section 1877 of the Social Security Act
[Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.]
**CLINICAL LABORATORY SERVICES**Include CPT codes for all clinical laboratory services in the 80000 series, except EXCLUDE CPT codes for the following blood component collection services:86890
Autologous blood process86891
Autologous blood, op salvage86927
Plasma, fresh frozen86930
Frozen blood prep86931
Frozen blood thaw86932
Frozen blood freeze/thaw86945
Blood product/irradiation86950
Leukacyte transfusion86965
Pooling blood platelets86985
Split blood or productsInclude the following CPT and HCPCS level 2 codes for other clinical laboratory services:0026T
Measure remnant lipoproteins0030T
Antiprothrombin antibody0041T
Detect ur infect agnt w/cpas0043T
Co expired gas analysis0058T
Cryopreservation, ovary tiss0059T
Cryopreservation, oocyte0064T
Spectroscop eval expired gas0085T
Breath test heart reject0087T
Sperm eval hyaluronan0103T
Holotranscobalamin0104T
At rest cardio gas rebreathe0111T
RBC membranes fatty acids0140T
Exhaled breath condensate ph36415
Routine venipuncture78267
Breath test attain/anal c-1478268
Breath test analysis c-14G0027
Semen analysisG0103
Psa, total screeningG0107
CA screen; fecal blood testG0123
Screen cerv/vag thin layerG0124
Screen c/v thin layer by MDG0141
Scr c/v cyto,autosys and mdG0143
Scr c/v cyto,thinlayer,rescrG0144
Scr c/v cyto,thinlayer,rescrG0145
Scr c/v cyto,thinlayer,rescrG0147
Scr c/v cyto, automated sysG0148
Scr c/v cyto, autosys, rescrG0306
CBC/diffwbc w/o plateletG0307
CBC without plateletG0328
Fecal blood scrn immunoassayP2028
Cephalin floculation testP2029
Congo red blood testP2033
Blood thymol turbidityP2038
Blood mucoproteinP3000
Screen pap by tech w md supvP3001
Screening pap smear by physP9612
Catheterize for urine specP9615
Urine specimen collect multQ0111
Wet mounts/ w preparationsQ0112
Potassium hydroxide prepsQ0113
Pinworm examinationsQ0114
Fern testQ0115
Post-coital mucous exam**PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY**Include the following CPT and HCPCS codes for the physical therapy/occupational therapy/speech-language pathology services:0019T
Extracorp shock wv tx,ms nos0029T
Magnetic tx for incontinence64550
Apply neurostimulator90901
Biofeedback train, any meth90911
Biofeedback peri/uro/rectal92506
Speech/hearing evaluation92507
Speech/hearing therapy92508
Speech/hearing therapy92526
Oral function therapy92597
Oral speech device eval92607
Ex for speech device rx, 1hr92608
Ex for speech device rx addl92609
Use of speech device service92610
Evaluate swallowing function92611
Motion fluoroscopy/swallow92612
Endoscopy swallow tst (fees)92614
Laryngoscopic sensory test92616
Fees w/laryngeal sense test93797
Cardiac rehab93798
Cardiac rehab/monitor94667
Chest wall manipulation94668
Chest wall manipulation95831
Limb muscle testing, manual95832
Hand muscle testing, manual95833
Body muscle testing, manual95834
Body muscle testing, manual95851
Range of motion measurements95852
Range of motion measurements96000
Motion analysis, video/3d96001
Motion test w/ft press meas96002
Dynamic surface emg96003
Dynamic fine wire emg96105
Assessment of aphasia96110
Developmental test, lim96111
Developmental test, extend97001
Pt evaluation97002
Pt re-evaluation97003
Ot evaluation97004
Ot re-evaluation97010
Hot or cold packs therapy97012
Mechanical traction therapy97016
Vasopneumatic device therapy97018
Paraffin bath therapy97022
Whirlpool therapy97024
Diathermy eg, microwave97026
Infrared therapy97028
Ultraviolet therapy97032
Electrical stimulation97033
Electric current therapy97034
Contrast bath therapy97035
Ultrasound therapy97036
Hydrotherapy97039
Physical therapy treatment97110
Therapeutic exercises97112
Neuromuscular reeducation97113
Aquatic therapy/exercises97116
Gait training therapy97124
Massage therapy97139
Physical medicine procedure97140
Manual therapy97150
Group therapeutic procedures97530
Therapeutic activities97532
Cognitive skills development97533
Sensory integration97535
Self care mngment training97537
Community/work reintegration97542
Wheelchair mngment training97545
Work hardening97546
Work hardening add-on97597
Active wound care/20cm or <97598
Active wound care > 20cm97602
Wound(s) care nonselective97605
Neg press wound tx, < 50 cm97606
Neg press wound tx, > 50 cm97750
Physical performance test97755
Assistive technology assess97760
Orthotic mgmt and training97761
Prosthetic training97762
C/O for orthotic/prosth use97799
Physical medicine procedureG0281
Elec stim unattend for pressG0283
Elec stim other than woundG0329
Electromagntic tx for ulcers**RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES**Include the following CPT and HCPCS codes:0028T
Dexa body composition study0042T
Ct perfusion w/contrast, cbf0067T
Ct colonography;dx51798
Us urine capacity measure70100
X-ray exam of jaw70110
X-ray exam of jaw70120
X-ray exam of mastoids70130
X-ray exam of mastoids70134
X-ray exam of middle ear70140
X-ray exam of facial bones70150
X-ray exam of facial bones70160
X-ray exam of nasal bones70190
X-ray exam of eye sockets70200
X-ray exam of eye sockets70210
X-ray exam of sinuses70220
X-ray exam of sinuses70240
X-ray exam, pituitary saddle70250
X-ray exam of skull70260
X-ray exam of skull70300
X-ray exam of teeth70310
X-ray exam of teeth70320
Full mouth x-ray of teeth70328
X-ray exam of jaw joint70330
X-ray exam of jaw joints70336
Magnetic image, jaw joint70350
X-ray head for orthodontia70355
Panoramic x-ray of jaws70360
X-ray exam of neck70370
Throat x-ray & fluoroscopy70371
Speech evaluation, complex70380
X-ray exam of salivary gland70450
Ct head/brain w/o dye70460
Ct head/brain w/dye70470
Ct head/brain w/o & w/dye70480
Ct orbit/ear/fossa w/o dye70481
Ct orbit/ear/fossa w/dye70482
Ct orbit/ear/fossa w/o&w/dye70486
Ct maxillofacial w/o dye70487
Ct maxillofacial w/dye70488
Ct maxillofacial w/o & w/dye70490
Ct soft tissue neck w/o dye70491
Ct soft tissue neck w/dye70492
Ct sft tsue nck w/o & w/dye70496
Ct angiography, head70498
Ct angiography, neck70540
Mri orbit/face/neck w/o dye70542
Mri orbit/face/neck w/dye70543
Mri orbt/fac/nck w/o & w/dye70544
Mr angiography head w/o dye70545
Mr angiography head w/dye70546
Mr angiograph head w/o&w/dye70547
Mr angiography neck w/o dye70548
Mr angiography neck w/dye70549
Mr angiograph neck w/o&w/dye70551
Mri brain w/o dye70552
Mri brain w/dye70553
Mri brain w/o & w/dye71010
Chest x-ray71015
Chest x-ray71020
Chest x-ray71021
Chest x-ray71022
Chest x-ray( print page 70473)71023
Chest x-ray and fluoroscopy71030
Chest x-ray71034
Chest x-ray and fluoroscopy71035
Chest x-ray71100
X-ray exam of ribs71101
X-ray exam of ribs/chest71110
X-ray exam of ribs71111
X-ray exam of ribs/chest71120
X-ray exam of breastbone71130
X-ray exam of breastbone71250
Ct thorax w/o dye71260
Ct thorax w/dye71270
Ct thorax w/o & w/dye71275
Ct angiography, chest71550
Mri chest w/o dye71551
Mri chest w/dye71552
Mri chest w/o & w/dye71555
Mri angio chest w or w/o dye72010
X-ray exam of spine72020
X-ray exam of spine72040
X-ray exam of neck spine72050
X-ray exam of neck spine72052
X-ray exam of neck spine72069
X-ray exam of trunk spine72070
X-ray exam of thoracic spine72072
X-ray exam of thoracic spine72074
X-ray exam of thoracic spine72080
X-ray exam of trunk spine72090
X-ray exam of trunk spine72100
X-ray exam of lower spine72110
X-ray exam of lower spine72114
X-ray exam of lower spine72120
X-ray exam of lower spine72125
Ct neck spine w/o dye72126
Ct neck spine w/dye72127
Ct neck spine w/o & w/dye72128
Ct chest spine w/o dye72129
Ct chest spine w/dye72130
Ct chest spine w/o & w/dye72131
Ct lumbar spine w/o dye72132
Ct lumbar spine w/dye72133
Ct lumbar spine w/o & w/dye72141
Mri neck spine w/o dye72142
Mri neck spine w/dye72146
Mri chest spine w/o dye72147
Mri chest spine w/dye72148
Mri lumbar spine w/o dye72149
Mri lumbar spine w/dye72156
Mri neck spine w/o & w/dye72157
Mri chest spine w/o & w/dye72158
Mri lumbar spine w/o & w/dye72170
X-ray exam of pelvis72190
X-ray exam of pelvis72191
Ct angiograph pelv w/o&w/dye72192
Ct pelvis w/o dye72193
Ct pelvis w/dye72194
Ct pelvis w/o & w/dye72195
Mri pelvis w/o dye72196
Mri pelvis w/dye72197
Mri pelvis w/o & w/dye72198
Mr angio pelvis w/o & w/dye72200
X-ray exam sacroiliac joints72202
X-ray exam sacroiliac joints72220
X-ray exam of tailbone73000
X-ray exam of collar bone73010
X-ray exam of shoulder blade73020
X-ray exam of shoulder73030
X-ray exam of shoulder73050
X-ray exam of shoulders73060
X-ray exam of humerus73070
X-ray exam of elbow73080
X-ray exam of elbow73090
X-ray exam of forearm73092
X-ray exam of arm, infant73100
X-ray exam of wrist73110
X-ray exam of wrist73120
X-ray exam of hand73130
X-ray exam of hand73140
X-ray exam of finger(s)73200
Ct upper extremity w/o dye73201
Ct upper extremity w/dye73202
Ct uppr extremity w/o&w/dye73206
Ct angio upr extrm w/o&w/dye73218
Mri upper extremity w/o dye73219
Mri upper extremity w/dye73220
Mri uppr extremity w/o&w/dye73221
Mri joint upr extrem w/o dye73222
Mri joint upr extrem w/dye73223
Mri joint upr extr w/o&w/dye73500
X-ray exam of hip73510
X-ray exam of hip73520
X-ray exam of hips73540
X-ray exam of pelvis & hips73550
X-ray exam of thigh73560
X-ray exam of knee, 1 or 273562
X-ray exam of knee, 373564
X-ray exam, knee, 4 or more73565
X-ray exam of knees73590
X-ray exam of lower leg73592
X-ray exam of leg, infant73600
X-ray exam of ankle73610
X-ray exam of ankle73620
X-ray exam of foot73630
X-ray exam of foot73650
X-ray exam of heel73660
X-ray exam of toe(s)73700
Ct lower extremity w/o dye73701
Ct lower extremity w/dye73702
Ct lwr extremity w/o&w/dye73706
Ct angio lwr extr w/o&w/dye73718
Mri lower extremity w/o dye73719
Mri lower extremity w/dye73720
Mri lwr extremity w/o&w/dye73721
Mri jnt of lwr extre w/o dye73722
Mri joint of lwr extr w/dye73723
Mri joint lwr extr w/o&w/dye73725
Mr ang lwr ext w or w/o dye74000
X-ray exam of abdomen74010
X-ray exam of abdomen74020
X-ray exam of abdomen74022
X-ray exam series, abdomen74150
Ct abdomen w/o dye74160
Ct abdomen w/dye74170
Ct abdomen w/o & w/dye74175
Ct angio abdom w/o & w/dye74181
Mri abdomen w/o dye74182
Mri abdomen w/dye74183
Mri abdomen w/o & w/dye74185
Mri angio, abdom w orw/o dye74210
Contrst x-ray exam of throat74220
Contrast x-ray, esophagus74230
Cine/vid x-ray, throat/esoph74240
X-ray exam, upper gi tract74241
X-ray exam, upper gi tract74245
X-ray exam, upper gi tract74246
Contrst x-ray uppr gi tract74247
Contrst x-ray uppr gi tract74249
Contrst x-ray uppr gi tract74250
X-ray exam of small bowel74290
Contrast x-ray, gallbladder74291
Contrast x-rays, gallbladder74710
X-ray measurement of pelvis75552
Heart mri for morph w/o dye75553
Heart mri for morph w/dye75554
Cardiac MRI/function75555
Cardiac MRI/limited study75635
Ct angio abdominal arteries76000
Fluoroscope examination76006
X-ray stress view76010
X-ray, nose to rectum76020
X-rays for bone age76040
X-rays, bone evaluation76061
X-rays, bone survey76062
X-rays, bone survey76065
X-rays, bone evaluation76066
Joint survey, single view76070
Ct bone density, axial76071
Ct bone density, peripheral76075
Dxa bone density, axial76076
Dxa bone density/peripheral76077
Dxa bone density/v-fracture76078
Radiographic absorptiometry76082
Computer mammogram add-on76083
Computer mammogram add-on76090
Mammogram, one breast76091
Mammogram, both breasts76092
Mammogram, screening76093
Magnetic image, breast76094
Magnetic image, both breasts76100
X-ray exam of body section76101
Complex body section x-ray76102
Complex body section x-rays76120
Cine/video x-rays76125
Cine/video x-rays add-on76150
X-ray exam, dry process76370
Ct scan for therapy guide76376
3d render w/o postprocess76377
3d rendering w/postprocess76380
CAT scan follow-up study76400
Magnetic image, bone marrow76499
Radiographic procedure76506
Echo exam of head76510
Ophth us, b & quant a76511
Ophth us, quant a only76512
Ophth us, b w/non-quant a76513
Echo exam of eye, water bath76514
Echo exam of eye, thickness76516
Echo exam of eye76519
Echo exam of eye76536
Us exam of head and neck76604
Us exam, chest, b-scan76645
Us exam, breast(s)76700
Us exam, abdom, complete76705
Echo exam of abdomen76770
Us exam abdo back wall, comp76775
Us exam abdo back wall, lim76778
Us exam kidney transplant76800
Us exam, spinal canal76801
Ob us < 14 wks, single fetus76802
Ob us < 14 wks, add'l fetus76805
Ob us >/= 14 wks, sngl fetus76810
Ob us >/= 14 wks, addl fetus76811
Ob us, detailed, sngl fetus76812
Ob us, detailed, addl fetus76815
Ob us, limited, fetus(s)76816
Ob us, follow-up, per fetus76818
Fetal biophys profile w/nst76819
Fetal biophys profil w/o nst76820
Umbilical artery echo76821
Middle cerebral artery echo76825
Echo exam of fetal heart76826
Echo exam of fetal heart76827
Echo exam of fetal heart76828
Echo exam of fetal heart76856
Us exam, pelvic, complete76857
Us exam, pelvic, limited( print page 70474)76870
Us exam, scrotum76880
Us exam, extremity76885
Us exam infant hips, dynamic76886
Us exam infant hips, static76970
Ultrasound exam follow-up76977
Us bone density measure76999
Echo examination procedure78000*
Thyroid, single uptake78001*
Thyroid, multiple uptakes78003*
Thyroid suppress/stimul78006*
Thyroid imaging with uptake78007*
Thyroid image, mult uptakes78010*
Thyroid imaging78011*
Thyroid imaging with flow78015*
Thyroid met imaging78016*
Thyroid met imaging/studies78018*
Thyroid met imaging, body78020*
Thyroid met uptake78070*
Parathyroid nuclear imaging78075*
Adrenal nuclear imaging78099*
Endocrine nuclear procedure78102*
Bone marrow imaging, ltd78103*
Bone marrow imaging, mult78104*
Bone marrow imaging, body78110*
Plasma volume, single78111*
Plasma volume, multiple78120*
Red cell mass, single78121*
Red cell mass, multiple78122*
Blood volume78130*
Red cell survival study78135*
Red cell survival kinetics78140*
Red cell sequestration78185*
Spleen imaging78190*
Platelet survival, kinetics78191*
Platelet survival78195*
Lymph system imaging78199*
Blood/lymph nuclear exam78201*
Liver imaging78202*
Liver imaging with flow78205*
Liver imaging (3D)78206*
Liver image (3d) with flow78215*
Liver and spleen imaging78216*
Liver & spleen image/flow78220*
Liver function study78223*
Hepatobiliary imaging78230*
Salivary gland imaging78231*
Serial salivary imaging78232*
Salivary gland function exam78258*
Esophageal motility study78261*
Gastric mucosa imaging78262*
Gastroesophageal reflux exam78264*
Gastric emptying study78270*
Vit B-12 absorption exam78271*
Vit B-12 absrp exam, int fac78272*
Vit B-12 absorp, combined78278*
Acute GI blood loss imaging78282*
GI protein loss exam78290*
Meckel's divert exam78291*
Leveen/shunt patency exam78299*
GI nuclear procedure78300*
Bone imaging, limited area78305*
Bone imaging, multiple areas78306*
Bone imaging, whole body78315*
Bone imaging, 3 phase78320*
Bone imaging (3D)78350
Bone mineral, single photon78399*
Musculoskeletal nuclear exam78414*
Non-imaging heart function78428*
Cardiac shunt imaging78445*
Vascular flow imaging78456*
Acute venous thrombus image78457*
Venous thrombosis imaging78458*
Ven thrombosis images, bilat78459*
Heart muscle imaging (PET)78460*
Heart muscle blood, single78461*
Heart muscle blood, multiple78464*
Heart image (3d), single78465*
Heart image (3d), multiple78466*
Heart infarct image78468*
Heart infarct image (ef)78469*
Heart infarct image (3D)78472*
Gated heart, planar, single78473*
Gated heart, multiple78478*
Heart wall motion add-on78480*
Heart function add-on78481*
Heart first pass, single78483*
Heart first pass, multiple78491*
Heart image (pet), single78492*
Heart image (pet), multiple78494*
Heart image, spect78496*
Heart first pass add-on78499*
Cardiovascular nuclear exam78580*
Lung perfusion imaging78584*
Lung V/Q image single breath78585*
Lung V/Q imaging78586*
Aerosol lung image, single78587*
Aerosol lung image, multiple78588*
Perfusion lung image78591*
Vent image, 1 breath, 1 proj78593*
Vent image, 1 proj, gas78594*
Vent image, mult proj, gas78596*
Lung differential function78599*
Respiratory nuclear exam78600*
Brain imaging, ltd static78601*
Brain imaging, ltd w/flow78605*
Brain imaging, complete78606*
Brain imaging, compl w/flow78607*
Brain imaging (3D)78608*
Brain imaging (PET)78609*
Brain imaging (PET)78610*
Brain flow imaging only78615*
Cerebral vascular flow image78630*
Cerebrospinal fluid scan78635*
CSF ventriculography78645*
CSF shunt evaluation78647*
Cerebrospinal fluid scan78650*
CSF leakage imaging78660*
Nuclear exam of tear flow78699*
Nervous system nuclear exam78700*
Kidney imaging, static78701*
Kidney imaging with flow78704*
Imaging renogram78707*
Kidney flow/function image78708*
Kidney flow/function image78709*
Kidney flow/function image78710*
Kidney imaging (3D)78715*
Renal vascular flow exam78725*
Kidney function study78730*
Urinary bladder retention78740*
Ureteral reflux study78760*
Testicular imaging78761*
Testicular imaging/flow78799*
Genitourinary nuclear exam78800*
Tumor imaging, limited area78801*
Tumor imaging, mult areas78802*
Tumor imaging, whole body78803*
Tumor imaging (3D)78804*
Tumor imaging, whole body78805*
Abscess imaging, ltd area78806*
Abscess imaging, whole body78807*
Nuclear localization/abscess78811*
Tumor imaging (pet), limited78812*
Tumor image (pet)/skul-thigh78813*
Tumor image (pet) full body78814*
Tumor image pet/ct, limited78815*
Tumor image pet/ct skul-thigh78816*
Tumor image pet/ct full body78890*
Nuclear medicine data proc78891*
Nuclear med data proc78999*
Nuclear diagnostic exam91110
Gi tract capsule endoscopy93303
Echo transthoracic93304
Echo transthoracic93307
Echo exam of heart93308
Echo exam of heart93320
Doppler echo exam, heart [if used in conjunction with 93303-93308]93321
Doppler echo exam, heart [if used in conjunction with 93303-93308]93325
Doppler color flow add-on [if used in conjunction with 93303-93308]93875
Extracranial study93880
Extracranial study93882
Extracranial study93886
Intracranial study93888
Intracranial study93890
Tcd, vasoreactivity study93892
Tcd, emboli detect w/o inj93922
Extremity study93923
Extremity study93924
Extremity study93925
Lower extremity study93926
Lower extremity study93930
Upper extremity study93931
Upper extremity study93965
Extremity study93970
Extremity study93971
Extremity study93975
Vascular study93976
Vascular study93978
Vascular study93979
Vascular study93980
Penile vascular study93981
Penile vascular study93990
Doppler flow testingA4641*
Diagnostic imaging agentA4642*
Satumomab pendetide per doseA9500*
Technetium TC 99m sestamibiA9502*
Technetium TC99M tetrofosminA9503*
Technetium TC 99m medronateA9504*
Technetium tc 99m apcitideA9505*
Thallous chloride TL 201/mciA9507*
Indium/111 capromab pendetidA9508*
Iobenguane sulfate I-131A9510*
Technetium TC99m DisofeninA9511*
Technetium TC 99m depreotideA9512*
Technetiumtc99mpertechnetateA9513*
Technetium tc-99m mebrofeninA9514*
Technetiumtc99m pyrophosphateA9515*
Technetium tc-99m pentetateA9516*
I-123 sodium iodide capsuleA9519*
Technetiumtc-99mmacroag albuA9520*
Technetiumtc-99m sulfur clldA9521*
Technetiumtc-99m exametazineA9522*
Indium111ibritumomabtiuxetanA9524*
Iodinated I-131 serumalbuminA9526*
Ammonia N-13, per doseA9528*
Dx I131 so iodide cap millicA9529*
Dx I131 so iodide sol millicA9531*
Dx I131 so iodide microcurie( print page 70475)A9533*
I-131 tositumomab diagnosticA9700*
Echocardiography contrastG0130
Single energy x-ray studyG0202
ScreeningmammographydigitalG0204
DiagnosticmammographydigitalG0206
DiagnosticmammographydigitalG0288
Recon, CTA for surg planQ0092
Set up port xray equipmentQ3000*
Rubidium RB-82Q3002*
Gallium ga 67Q3003*
Technetium tc99m bicisateQ3004*
Xenon xe 133Q3005*
Technetium tc99m mertiatideQ3006*
Technetium tc99m glucepatateQ3007*
Sodium phosphate p32Q3008*
Indium 111-in pentetreotideQ3009*
Technetium tc99m oxidronateQ3010*
Technetium tc99mlabeledrbcsQ3011*
Chromic phosphate p32Q3012*
Cyanocobalamin cobalt co57Q9945*
LOCM<=149mg/ml iodine, 1 mlQ9946*
LOCM 150-199mg/ml iodine,1mlQ9947*
LOCM 200-249mg/ml iodine,1mlQ9948*
LOCM 250-299mg/ml/iodine,1mlQ9949*
LOCM 300-349mg/ml iodine,1mlQ9950*
LOCM 350-399mg/ml iodine,1mlQ9951*
LOCM>=400 mg/ml iodine,1mlQ9952*
Inj Gad-base MR contrast, mlQ9953*
Inj Fe-base MR contrast, mlQ9954*
Oral MR contrast, 100mlQ9955*
Inj perflexane lip micros, mlQ9956*
Inj octafluoropropane mic,mlQ9957*
Inj perflutren lip micros, mlR0070
Transport portable x-rayR0075
Transport port x-ray multipl**RADIATION THERAPY SERVICES AND SUPPLIES**Include the following CPT and HCPCS codes:0073T
Delivery, comp imrt0082T
Stereotactic rad delivery0083T
Stereotactic rad tx mngmt19296
Place po breast cath for rad19297
Place breast cath for rad19298
Place breast rad tube/caths31643
Diag bronchoscope/catheter55859
Percut/needle insert, pros57155
Insert uteri tandems/ovoids58346
Insert heyman uteri capsule61770
Incise skull for treatment61793
Focus radiation beam77261
Radiation therapy planning77262
Radiation therapy planning77263
Radiation therapy planning77280
Set radiation therapy field77285
Set radiation therapy field77290
Set radiation therapy field77295
Set radiation therapy field77299
Radiation therapy planning77300
Radiation therapy dose plan77301
Radiotherapy dose plan, imrt77305
Teletx isodose plan simple77310
Teletx isodose plan intermed77315
Teletx isodose plan complex77321
Special teletx port plan77326
Brachytx isodose calc simp77327
Brachytx isodose calc interm77328
Brachytx isodose plan compl77331
Special radiation dosimetry77332
Radiation treatment aid(s)77333
Radiation treatment aid(s)77334
Radiation treatment aid(s)77336
Radiation physics consult77370
Radiation physics consult77399
External radiation dosimetry77401
Radiation treatment delivery77402
Radiation treatment delivery77403
Radiation treatment delivery77404
Radiation treatment delivery77406
Radiation treatment delivery77407
Radiation treatment delivery77408
Radiation treatment delivery77409
Radiation treatment delivery77411
Radiation treatment delivery77412
Radiation treatment delivery77413
Radiation treatment delivery77414
Radiation treatment delivery77416
Radiation treatment delivery77417
Radiology port film(s)77418
Radiation tx delivery, imrt77421
Stereoscopic x-ray guidance77422
Neutron beam tx, single77423
Neutron beam tx, complex77427
Radiation tx management, x577431
Radiation therapy management77432
Stereotactic radiation trmt77470
Special radiation treatment77499
Radiation therapy management77520
Proton trmt, simple w/o comp77522
Proton trmt, simple w/comp77523
Proton trmt, intermediate77525
Proton treatment, complex77600
Hyperthermia treatment77605
Hyperthermia treatment77610
Hyperthermia treatment77615
Hyperthermia treatment77620
Hyperthermia treatment77750
Infuse radioactive materials77761
Apply intrcav radiat simple77762
Apply intrcav radiat interm77763
Apply intrcav radiat compl77776
Apply interstit radiat simpl77777
Apply interstit radiat inter77778
Apply interstit radiat compl77781
High intensity brachytherapy77782
High intensity brachytherapy77783
High intensity brachytherapy77784
High intensity brachytherapy77789
Apply surface radiation77790
Radiation handling77799
Radium/radioisotope therapy79005*
Nuclear rx, oral admin79101*
Nuclear rx, iv admin79200*
Nuclear rx, intracav admin79300*
Nuclr rx, interstit colloid79403*
Hematopoietic nuclear tx79440*
Nuclear rx, intra-articular79445*
Nuclear rx, intra-arterial79999*
Nuclear medicine therapy92974
Cath place, cardio brachytxA9517*
Th I131 so iodide cap millicA9523*
Yttrium90ibritumomabtiuxetanA9530*
Th I131 so iodide sol millicA9532*
I-125 serum albumin microA9534*
I-131 tositumomab therapeutA9600*
Strontium-89 chlorideA9605*
Samarium sm153 lexidronammA9699*
Noc therapeutic radiopharmG0173
Stereo radiosurgery,completeG0243
Multisour photon stero treatG0251
Linear acc based stero radioG0339
Robot lin-radsurg com, firstG0340
Robt lin-radsurg fractx 2-5Q3001*
Brachytherapy radioelementsQ3007*
Sodium phosphate p32Q3011*
Chromic phosphate p32**EPO AND OTHER DIALYSIS-RELATED DRUGS**The physician self-referral prohibition does not apply to the following codes for EPO and other dialysis-related drugs furnished in or by an ESRD facility if the conditions in § 411.355(g) are satisfied:J0630
Calcitonin salmon injectionJ0636
Inj calcitriol per 0.1 mcgJ0882
Darbepoetin alfa, esrd useJ0886
Epoetin alfa, esrdJ0895
Deferoxamine mesylate injJ1270
Injection, doxercalciferolJ1751
Iron dextran 165 injectionJ1752
Iron dextran 267 injectionJ1756
Iron sucrose injectionJ1955
Inj levocarnitine per 1 gmJ2501
ParicalcitolJ2916
Na ferric gluconate complexJ2993
Reteplase injectionJ2995
Inj streptokinase /250000 IUJ2997
Alteplase recombinantJ3364
Urokinase 5000 IU injectionP9041
Albumin (human),5%, 50mlP9045
Albumin (human), 5%, 250mlP9046
Albumin (human), 25%, 20mlP9047
Albumin (human), 25%, 50ml**PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES**The physician self-referral prohibition does not apply to the following tests if they are performed for screening purposes and satisfy the conditions in § 411.355(h):76083
Computer mammogram add-on76092
Mammogram, screening80061
Lipid panel [only when billed with one of the following ICD-9-CM codes: V81.0, V81.1, or V.81.2]82465
Assay, bld/serum cholesterol [only when billed with one of the following ICD-9-CM codes: V81.0, V81.1, or V.81.2]82947
Assay, glucose, blood quant [only when billed with ICD-9-CM code V77.1]82950
Glucose test [only when billed with ICD-9-CM code V77.1]82951
Glucose tolerance test (GTT) [only when billed with ICD-9-CM code V77.1]83718
Assay of lipoprotein [only when billed with one of the following ICD-9-CM codes: V81.0, V81.1, or V.81.2]84478
Assay of triglycerides [only when billed with one of the following ICD-9-CM codes: V81.0, V81.1, or V.81.2]G0103
Psa, total screeningG0107
CA screen; fecal blood testG0123
Screen cerv/vag thin layerG0124
Screen c/v thin layer by MDG0141
Scr c/v cyto,autosys and mdG0143
Scr c/v cyto,thinlayer,rescrG0144
Scr c/v cyto,thinlayer,rescrG0145
Scr c/v cyto,thinlayer,rescr( print page 70476)G0147
Scr c/v cyto, automated sysG0148
Scr c/v cyto, autosys, rescrG0202
Screening mammographydigitalG0328
Fecal blood scrn immunoassayP3000
Screen pap by tech w md supvP3001
Screening pap smear by physThe physician self-referral prohibition does not apply to the following immunization and vaccine codes if they satisfy the conditions in § 411.355(h):90655
Flu vaccine no preserv 6-35m90656
Flu vaccine no preserv 3 & >90657
Flu vaccine, 6-35 mo, im90658
Flu vaccine age 3 & over, im90732
Pneumococcal vaccine90740
Hepb vacc, ill pat 3 dose im90743
Hep b vacc, adol, 2 dose, im90744
Hepb vacc ped/adol 3 dose im90746
Hep b vaccine, adult, im90747
Hepb vacc, ill pat 4 dose im1
                             CPT codes and descriptions only are copyright 2005 American Medical Association. All rights are reserved and applicable FARS/DFARS clauses apply.2
                             This list does not include codes for the following designated health service (DHS) categories: durable medical equipment and supplies; parenteral and enteral nutrients, equipment and supplies; prosthetics, orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services. For the definitions of these DHS categories, refer to 42 CFR 411.351. For more information, refer to http://cms.hhs.gov/​medlearn/​refphys.asp.* Nuclear medicine services and supplies assigned an asterisk will be subject to the physician self-referral prohibition effective January 1, 2007.


# Footnotes

1.
    
                             GAO, “Medicare Payment for Covered Outpatient Drugs Exceed Providers' Costs,” September 2001. OIG, “Excessive Medicare Reimbursement for Albuterol,” March 2002. Back to Citation
 2.
    
                             Muse & Associates Report for the American Assoication for Homecare, “The Cost of Delivering Inhalation Drug Services to Medicare Beneficiaries,” August 2004. Back to Citation
 3.
    
                             GAO, “Appropriate Dispensing Fee Needed for Suppliers of Inhalation Therapy Drugs,” GAO-050-72, October 2004. Back to Citation
 4.
    
                             Muse Associates Report Prepared for the American Association for Homecare, “Examination of Inhalation Drug Services to Medicare Beneficiaries Under the Average Sales Price Reimbursement Methodology In Response to the CMS Notice of Proposed Rule Making (CMS-1502-P),” September 2005. Back to Citation
 5.
    
                             Office of the Inspector General, “Review of Services Provided by Inhalation Drug Suppliers,” September 2005, OEI-01-05-00090. Back to Citation
 6.
    
                             Fisher, Elliott S., MD, MPH; David E. Wennberg, MD, MPH; Therese A. Stukel, Ph.D.; Daniel J. Gottlieb, MS; F.L. Lucas, Ph.D.; and Etoile L. Pinder, MS, “The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care,” in The Annals of Internal Medicine, February 18, 2003, Vol 138, Issue 4. Back to Citation


BILLING CODE 4121-01-U BILLING CODE 4120-01-C BILLING CODE 4120-01-U BILLING CODE 4120-01-U
                        ( print page 70250) BILLING CODE 4120-01-C
                        ( print page 70251) BILLING CODE 4120-01-P [FR Doc. 05-22160 Filed 11-2-05; 5:07 pm]